Dilcan Kotan

Effects of insulin-like growth factor-I and platelet-rich plasma on sciatic nerve crush injury in a rat model.

OBJECT Local administration of insulin-like growth factor-I (IGF-I) has been shown to increase the rate of axon regeneration in crush-injured and freeze-injured rat sciatic nerves. Local administration of platelet-rich plasma (PRP) has been also shown to have a measurable effect on facial nerve regeneration after transection in a rat model. The objective of the study was to compare the effects of locally administered IGF-I and PRP on the parameters of the Sciatic Function Index (SFI), sensory function (SF), axon count, and myelin thickness/axon diameter ratio (G-ratio) in a rat model of crush-injured sciatic nerves. METHODS The right sciatic nerve of Wistar albino rats (24 animals) was crushed using a Yasargil-Phynox aneurysm clip for 45 minutes. All animals were randomly divided into 3 groups: Group 1 (control group) was treated with saline, Group 2 was treated with IGF-I, and Group 3 was treated with PRP. Injections were performed using the tissue expanders injection port with a connecting tube directed at the crush-injured site. Functional recovery was assessed with improvement in the SFI. Recovery of sensory function was using the pinch test. Histopathological examination was performed 3 months after the injury. RESULTS The SFI showed an improved functional recovery in the IGF-I-treated animals (Group 2) compared with the saline-treated animals (Group 1) 30 days after the injury. In IGF-I-treated rats, sensory function returned to the baseline level significantly faster than in saline-treated and PRP-treated rats as shown in values between SF-2 and SF-7. The G-ratios were found to be significantly higher in both experimental groups than in the control group. CONCLUSIONS This study suggests that the application of IGF-I to the crush-injured site may expedite the functional recovery of paralyzed muscle by increasing the rate of axon regeneration.

The distinct genetic pattern of ALS in Turkey and novel mutations

The frequency of amyotrophic lateral sclerosis (ALS) mutations has been extensively investigated in several populations; however, a systematic analysis in Turkish cases has not been reported so far. In this study, we screened 477 ALS patients for mutations, including 116 familial ALS patients from 82 families and 361 sporadic ALS (sALS) cases. Patients were genotyped for C9orf72 (18.3%), SOD1 (12.2%), FUS (5%), TARDBP (3.7%), and UBQLN2 (2.4%) gene mutations, which together account for approximately 40% of familial ALS in Turkey. No SOD1 mutations were detected in sALS patients; however, C9orf72 (3.1%) and UBQLN2 (0.6%) explained 3.7% of sALS in the population. Exome sequencing revealed mutations in OPTN, SPG11, DJ1, PLEKHG5, SYNE1, TRPM7, and SQSTM1 genes, many of them novel. The spectrum of mutations reflect both the distinct genetic background and the heterogeneous nature of the Turkish ALS population.

Acute median nerve palsy due to hemorrhaged schwannoma: case report

Schwannomas are common, benign nerve tumors originating from the sheath of peripheral nerves. In this article, a 54 year old woman suffered from sudden onset motor and sensory deficit at her first radial three fingers on her right hand. Radiological investigations were normal. Electromyography diagnosed a median nerve entrapment neuropathy and urgent surgery was performed. Interestingly, a hemorrhaged mass was detected in the median nevre at the proximal end of the carpal ligament and was resected totally. Histopathological diagnosis was Schwannoma. The patient maintained a healthy status for five years.

Acute cerebral ischaemia: Relationship between serum and cerebrospinal fluid orexin-A concentration and infarct volume

Objective Orexins are hypothalamic neuropeptides that are involved in feeding, neuroendocrine regulation, sleep-wakefulness and sleep disorders (such as narcolepsy). This study investigated the relationship between serum and cerebrospinal fluid (CSF) orexin-A concentrations and infarct volume, in patients with ischaemic stroke. Methods Serum and CSF concentrations of orexin-A were determined 48–72 h after the onset of ischaemic stroke in patients, then compared with those of healthy control subjects of comparable age. Infarct volumes were measured using computerized tomography, 48–72 h after hospitalization. Results Mean serum and CSF orexin-A concentrations were significantly lower among ischaemic stroke patients (n = 29) compared with control subjects (n = 13). There was a significant inverse correlation between infarct volumes and CSF orexin-A concentrations in patients with ischaemic stroke. Conclusion These data show that serum and CSF orexin-A concentrations decrease after cerebral ischaemia and may play a role in the development of brain injury. The orexin-A concentration in the CSF might be a useful biomarker for the assessment of progression of brain tissue damage during the early stages of ischaemic stroke.

Familial Fahr disease in a Turkish family.

Fahr syndrome refers to a rare syndrome characterized by symmetrical and bilateral intracranial calcification. We present a 42-year-old woman with Fahr disease, but lacking extrapyramidal symptoms or a metabolic disorder. Her neurological examination was normal. Computed tomographic scans demonstrated symmetrical calcification over the basal ganglia, thalamus and cerebellum. No underlying cause for the bilateral calcification was found. When screening other family members, we detected Fahr syndrome in her two daughters and three brothers, revealing that the disease was an autosomal dominant trait. Fahr disease may be clinically asymptomatic, but have pronounced positive brain imaging findings. Computed tomographic scanning remains the most effective screening tool for adult relatives.

Serum levels of pentraxin-3 and other inflammatory biomarkers in migraine: Association with migraine characteristics.

Background Several studies have been conducted on the inflammatory aspects of migraine. Pentraxins are a novel and important part of innate immunity as a superfamily of acute phase proteins. In our study, we aimed to demonstrate the relationship between migraine and the serum levels of pentraxin-3 (PTX-3), C-reactive protein (CRP), fibrinogen and D-dimer. Methods We recruited 30 migraine patients (in both the attack and interictal period) and 30 healthy controls. Serum samples were obtained from all participants, and a brain MRI performed in the last six months was assessed regarding the presence of deep white matter lesions. Comparisons between the attack, interictal and control groups regarding the serum levels of PTX-3, CRP, fibrinogen and D-dimer were performed. The association between serum PTX-3 levels and migraine characteristics (disease duration, headache frequency, MRI findings, aura, family history, attack duration, and MIDAS score) was also assessed. Results We found higher serum levels of fibrinogen and PTX-3 in migraine attack patients compared with the interictal and control groups (p = 0.03 and p < 0.001, respectively). Subgroup analysis also showed that patients with a disease duration of more than five years and with an attack duration of more than 12 hours have lower serum levels of PTX-3 than patients who have a relatively new diagnosis and have relatively short-lasting migraine attacks (p = 0.042 and p = 0.038, respectively). Conclusions PTX-3 and fibrinogen exhibit different serum levels in patients undergoing a migraine attack compared with the interictal group and the controls. Participants with longer attacks and disease durations have lower serum levels of PTX-3, suggesting that inflammatory processes change along with disease progression.

The relationship of median nerve F-wave parameters with severity and subtypes of carpal tunnel syndrome1

PURPOSE F-wave analysis may help affirm or disprove a compression neuropathy. In this study we have analysed the effects of focal median nerve injury on F wave in Carpal Tunnel Syndrome (CTS). METHOD We studied 57 patients (100 hands) with clinical and electrophysiological CTS and 31 (62 hands) healthy subjects. Median nerve F-waves were evaluated following 10 supramaximal stimuli and recording from abductor pollicis brevis muscles. Minimum, maximum, and mean F-wave latencies, frequency of the F wave (Fp), chronodispersion (F_{CD}), mean F/M amplitude ratios (mF/M-amp) and F-wave conduction velocity (FwCV) were evaluated. RESULTS The CTS patients showed prolonged F-wave latencies, decreased Fp, and an increase of the F_{CD} as compared with normative values. Absent F wave was presented in 8 of 34 hands (23.5%) with severe CTS patients. In the severe group, the FwCV was significantly slower (p< 0.001) and the mF/M-amp was significantly higher (p< 0.001) than that of mild and moderate groups, respectively. Also, the mF/M-amp was significantly greater and Fp was lower in the axonal type than in the demyelinating type. The F_{CD} was not different among groups. A strong positive correlations between mMDL with Fmin (r=0.81, p< 0.000), Fmean (r=0.80, p< 0.000) and Fmax (r=0.71, p< 0.000) were revealed. CONCLUSION Results support the differing effects of demyelinating and axonal injury on F-waves and suggest that the mF/M-amp ratio and FwCV, which is influenced by neuronal damages in the distal segment of the median nerve, is useful in the discrimination of CTS severity.

Assessment of nasal parameters in determination of olfactory dysfunction in Parkinson’s disease

Objectives To assess nasal cycle, nasal mucosal pH and mucociliary clearance time in patients with Parkinson’s disease and healthy control subjects. Methods Patients with idiopathic Parkinson’s disease and healthy control subjects were recruited. Presence of the nasal cycle, nasal mucosa pH and mucociliary clearance time were investigated in all participants. Results The study included 27 patients and 24 control subjects. The nasal cycle was present in significantly fewer patients than controls. Nasal pH and mucociliary clearance time were significantly higher in patients than in controls. Conclusions Parkinson’s disease is associated with alterations in nasal cycle, nasal mucosa pH and mucociliary clearance time. Measurements of these nasal parameters may be useful for the early diagnosis of autonomic and olfactory dysfunction in Parkinson’s disease.

Mechanism of cerebral fat embolism in subarachnoid hemorrhage: An experimental study

Subarachnoid hemorrhage (SAH) may cause neurogenic pulmonary edema (NPE), and chylomicron metabolism may be destroyed in injured lungs. We aimed to investigate the effect of neurogenic pulmonary edema (NPE), if present, on the development of cerebral fat embolism. This study has been conducted on 20 rabbits. Experimental SAH has been applied to half of the animals by injecting homologous blood into the cisterna magna, and the remaining half was applied only isotonic saline solution in the same manner under general anesthesia. After 20 days, all animals were killed. Their lungs and brains were examined histopathologically. Six animals died of SAH between 16 and 20 days, and foamy hemorrhagic parenchymal lesions and intra‐alveolar hemorrhage were observed in their lungs. Fat globules were abundantly found in cerebral arteries of six of all the non‐surviving animals. But, minimal histopathological changes were found in the lungs and brains of the surviving animals. Cerebral fat embolism was detected in only one animal that was given isotonic solution. SAH may cause NPE and result in lung tissue destruction. Chylomicron metabolism may be disordered in the destructed lungs and leakage of chylomicrons into systemic circulation may be facilitated via destroyed lung barrier. These pathologic processes may lead to cerebral fat embolism.

The Frequency of Fabry Disease among Young Cryptogenic Stroke Patients in the City of Sakarya

BACKGROUND Fabry disease (FD) is known as a rare cause of stroke. Recent studies suggested that FD is an underdiagnosed entity among young stroke patients. We aimed to investigate the frequency of FD in young cryptogenic stroke patients who lived in the City of Sakarya and to define the clinical features that help in recognizing patients with FD. METHODS Acute ischemic stroke patients aged 18-55 years who were admitted to our hospital between October 2013 and September 2016 were evaluated for inclusion. Patients with other recognized causes of stroke were excluded. The screening was performed for alpha-galactosidase A (α-Gal A) activity on dried blood spot, and DNA was sequenced for GLA mutation in patients with low plasma α-Gal A activity. RESULTS Among the 484 acute ischemic stroke patients, 54 (24 male, 44.4%) young cryptogenic stroke patients were enrolled. The α-Gal A activity was detected as low in 3 patients. c.[680G > A] p.[R227Q] missense mutation was identified in 2 male patients. The frequency of FD was calculated as 3.7%. CONCLUSIONS Our research is the first FD screening study in Turkish stroke patients. Our results underlined the importance of considering FD during the etiologic evaluation of young cryptogenic stroke patients as it is a rare but potentially treatable entity.