Esra Okuyucu

Ultrasound-guided vs. blind steroid injections in carpal tunnel syndrome: A single-blind randomized prospective study.

ObjectiveThe aim of this study was to compare the efficacy and the safety of ultrasound (US)–guided vs. blind steroid injections in patients with carpal tunnel syndrome (CTS). DesignThis prospective randomized single-blind clinical trial included 46 patients with CTS (46 affected median nerves). The subjects were randomized—to either the US-guided or the blind injection group—before they received 40 mg of methylprednisolone. They were evaluated using the Boston Carpal Tunnel Questionnaire symptom/function at baseline and at 6 wks and 12 wks after injection, and the side effects were noted. ResultsThe symptom severity and functional status scores improved significantly in both groups at 6 wks after treatment, and these improvements persisted at 12 wks after treatment (all P < 0.05). The improvement in symptom severity scores in the US-guided group at 12 wks was higher than in the palpation-guided group (P < 0.05). Average time to symptom relief was shorter in the US-guided group (P < 0.05). There was no significant difference between the two groups in terms of side effects (P > 0.05). ConclusionsAlthough both US-guided and blind steroid injections were effective in reducing the symptoms of CTS and improving the function, an earlier onset/better improvement of symptom relief suggests that US-guided steroid injection may be more effective than are blind injections in CTS.

Peripheral nervous system involvement in patients with sickle cell disease

Background and purpose:  Peripheral nervous system involvement is rare in sickle cell disease (SCD). The aim of this study is to determine the peripheral nerve involvement electrophysiologically in SCD patients without clinically evident neurological signs, symptoms and to determine the relationship between the frequency of sickle cell crisis and peripheral neuropathy.

EEG abnormalities during treatment with tadalafil, a phosphodiesterase type 5 inhibitor

Abstract Objective: Tadalafil is a selective phosphodiesterase type 5 (PDE-5) inhibitor approved for the treatment of erectile dysfunction. Less is known about the electroencephalography (EEG) effects of PDE-5 inhibitors, and the present study, therefore, examined the risk of EEG abnormalities associated with tadalafil. Method: EEG recordings from 35 erectile dysfunction patients taking tadalafil (20 mg) were graded for severity of EEG abnormalities (at admission, 2 and 48 hours after tadalafil administration). Results: At admission, there were no EEG abnormalities. At second EEG, abnormalities occurred in 12 (34.3%) of the 35 patients. Eight (22.9%) patients had mild and four (11.4%) patients had moderate EEG abnormalities. At third EEG, one (2.9%) patient had mild and one (2.9%) patient had moderate EEG abnormalities. Conclusion: PDE-5 inhibitors may produce EEG abnormalities. Although the exact role of PDE in altering susceptibility to seizure remains unclear, epileptic seizures may occur during treatment with PDE inhibitors.

Sickle cell disease with regional silent cerebral infarction detected by SPECT.

An 18-year-old boy was admitted to the hospital for a right leg ulcer, which appeared 1 year ago. After physical and hematologic examinations, he was referred for neurologic and cardiologic examination because his hemoglobin analysis and hematologic findings were interpreted as being consistent with sickle cell anemia. Although he had no neurologic symptoms, MRI and Tc-99m ethyl cysteinate dimer cerebral perfusion single photon emission computer tomography were performed to rule out a silent cerebral infarction. Changes secondary to an infarct were seen in the region of the caudate nucleus.

Atypical Herpes Simplex Encephalitis With Extratemporal Involvement

Herpes simplex virus (HSV) is recognized as the most common cause of sporadic encephalitis among adults. The combination of magnetic resonance imaging, electroencephalography, and cerebrospinal fluid tests is usually diagnostic. In this article, we describe a case of atypical HSV encephalitis presenting a syndrome of febrile encephalopathy in the absence of focal neurological features, including mental and sensory disturbance, pyramidal signs, ataxia, and cranial nerve deficits, and in which magnetic resonance imaging demonstrated lesions restricted to the parietal and occipital lobes without typical localization of HSV encephalitis in the insula and inferior frontal lobe.

Neurologic soft signs in Behcet disease.

Background Patients with Behcet disease have an excess of minor neurologic abnormalities (neurologic soft signs). Objective (a) To investigate the neurologic soft signs (NSS) in Behcet disease (BD) patients who had no neurologic symptoms, by using the neurologic evaluation scale (NES). (b) To evaluate the effect of silent infarction on NES scores in BD patients. Methods Thirty six BD patients without neurologic symptoms and 36 healthy controls were included in the study. NSS were assessed with the NES. Cranial magnetic resonance imaging was conducted to determine the presence of silent cerebral infarcts. Results Patients with BD had significantly higher scores overall and on each subscale (except for subscale “others”) of the NES than the control groups. Tandem walk, adventitious overflow, tremor, graphesthesia, fist edge palm test, Ozeretski test, finger thumb opposition, mirror movements, extinction, synkinesis, convergence, finger nose test, glabellar reflex, grasp reflex, and suck reflex were also significantly higher in patients with BD than in the healthy control group. There were no significant differences in the total NES scores, total subscale scores and each of the NES items between BD patients with silent infarction and those without infarction. Conclusion Early diagnosis of neurologic involvement in BD is important and the NES is a useful instrument for detecting subclinical neurologic involvement in BD patients.

Differences in improvement between patients with idiopathic versus neurovascular hemifacial spasm after botulinum toxin treatment

This study was performed to investigate the differences in response to botulinum toxin treatment between patients with idiopathic versus neurovascular hemifacial spasm. A total of 69 patients with hemifacial spasm were investigated prospectively with cranial magnetic resonance imaging and magnetic resonance angiography. Neurovascular contact was found in 23 patients. All patients were assessed with a severity scale and a disease awareness scale. After treatment, the patients with idiopathic hemifacial spasm improved significantly in terms of both severity and awareness scores, but the patients with neurovascular hemifacial spasm improved only in the awareness scores. In conclusion, patients with idiopathic hemifacial spasm experienced a greater improvement after treatment with botulinum toxin than did patients with neurovascular hemifacial spasm.

Does transcutaneous nerve stimulation have effect on sympathetic skin response

OBJECTIVE This study examined the effects of transcutaneous electrical nerve stimulation (TENS) on the sympathetic nerve system by sympathetic skin response test. METHODS Fifty-five healthy volunteers received either: (i) 30minutes TENS (25 participants) (ii) 30minutes sham TENS (30 participants) and SSR test was performed pre- and post-TENS. The mean values of latency and peak-to-peak amplitude of five consecutive SSRs were calculated. RESULTS A significant amplitude difference was found between TENS and sham TENS group both in right and left hand (p=0.04, p=0.01, respectively). However there was no significant latancy difference between two groups (p>0.05 ). CONCLUSION TENS has an inhibitory effect on elicited SNS responses when compared with sham TENS control group.

Sleep changes during prophylactic treatment of migraine

Aims: To assess sleep quality in patients with primary headaches before and after prophylactic treatment using a validated sleep-screening instrument. Materials and Methods: A total of 147 patients, including 63 tension type headache (TTH) and 84 migraine patients were included. Patients were examined in terms of frequency and severity of headaches and sleep quality before and 12 weeks after prophylactic treatment with either propranolol or amitriptyline. Results: Baseline Visual Analogue Score (VAS) in migraine patients was 7.99 ± 1.39 compared with 6.86 ± 1.50 in TTH group (P < 0.001). VAS score after the first month of treatment was 6.08 ± 1.88 in migraine patients and 5.40 ± 1.61 in TTH (P = 0.023). VAS scores decreased after the third month of treatment to 4.32 ± 2.29 in migraine patients and 4.11 ± 1.66 in TTH patients (P = 0.344). The decrease was significant for patients treated with amitriptyline but not for those with propranolol. Baseline Pittsburgh Sleep Quality (PSQI) scores were 5.93 ± 2.43 in migraine patients and 6.71 ± 2.39 in TTH patients. Poor quality of sleep (PSQI ≥ 6) prior to prophylactic treatment was observed in 61.4% of migraine patients and in 77.7% of TTH patients. Comparison of PSQI scores before and 3 months following treatment showed significantly improved quality of sleep in all treatment groups; the greatest significance was detected in migraine patients with initial PSQI scores of ≥6 and treated with amitriptyline (P < 0.001). Conclusions: Increased understanding of routine objective sleep measures in migraine patients is needed to clarify the nature of sleep disturbances associated with primary headaches. This may in turn lead to improvements in headache treatments.

GEBELİKTE İZLENEN PRİMER BAŞ AĞRILARI VE BU NEDENLE REÇETE DIŞI İLAÇ KULLANIMI

Aim: The aim of this study is to demonstrate the characteristics of primary headaches during pregnancy, and the frequency of over the counter drug use by pregnant woman due to headache. Material and Methods: Third hundred and fifty women in the first three months of postpartum period were interviewed by a neurologist related to the headaches they have experienced during pregnancy, and their headache characteristics and their preferences in terms of prescription or over the counter drug use were examined. Results: Forty four of the 350 mothers were excluded from the study for various reasons. One hundred and twenty nine (42.2%) of the study participants expressed that they had not experienced any headaches. One hundred and seventy seven (57.8%) of them complained from primary headaches during their pregnancy. Forty four (24.8%) of headache sufferers sought medical advice from a medical doctor. While 83 (46.6%) of whom used drugs, only 36 (43.4%) of them consulted a physician to do so. Conclusion: The results of this study suggest that headaches experienced during pregnancy should be taken seriously, since it leads to uncontrolled drug use