Hande Türker

Ultrasonography in patients with ulnar neuropathy at the elbow: Comparison of cross‐sectional area and swelling ratio with electrophysiological severity

The aim of this study was to determine the diagnostic value of ultrasonographic measurements in ulnar neuropathy at the elbow (UNE) and to assess the relationship between the measurements and the electrophysiological severity. The largest anteroposterior diameter (LAPD) and cross‐sectional area (CSA) measurements of the ulnar nerve were noted at multiple levels along the arm, and the distal‐to‐proximal ratios were calculated. Almost all of the measurements and swelling ratios between patients and controls showed statistically significant differences. The largest CSA, distal/largest CSA ratio, CSA at the epicondyle, and proximal LAPD had larger areas under the curve than other measurements. The sensitivity and specificity in diagnosing UNE were 95% and 71% for the largest CSA, 83% and 85% for the distal/largest CSA ratio, 83% and 81% for the CSA at the epicondyle, and 93% and 43% for the proximal LAPD, respectively. There was a statistically significant correlation between the electrophysiological severity scale score (ESSS) and the largest CSA, the CSA at the epicondyle and 2 cm proximal to the epicondyle, and the LAPD at the level of the epicondyle (P < 0.05). None of the swelling ratios showed a significant correlation with the ESSS. The largest CSA measurement is the most valuable ultrasonographic measurement both for diagnosis and determining the severity of UNE. Muscle Nerve, 2010

Bifid Median Nerve in Patients With Carpal Tunnel Syndrome

Objective. The aim of this study was to investigate the frequency of the anatomic variation of a bifid median nerve in patients with carpal tunnel syndrome (CTS) and to determine the size criteria for sonography. Methods. On axial sonograms of 320 hands of 170 patients with CTS and 240 hands of 120 unaffected individuals, the median nerve was evaluated morphologically for a bifid median nerve, and the cross‐sectional area was measured at 3 levels (radial‐ulnar junction, pisiform, and hook of the hamate). Electrophysiologic studies were performed in addition to clinical and sonographic evaluations in all patients, controls with a bifid median nerve, and controls with a cross‐sectional area of greater than 0.09 cm2. Results. A bifid median nerve was seen in 32 (19%) of 170 patients and 11 (9%) of 120 controls. It occurred relatively frequently in patients with CTS (P < .01). The cross‐sectional area of the bifid median nerve was relatively higher than that of the nonbifid median nerve in controls at 2 of the 3 levels (P < .001; P = .226; P < .01). The cutoff values for the cross‐sectional area at the level of the pisiform were 0.11 cm2 (sensitivity, 90%; specificity, 99%; P < .001) for patients with a bifid median nerve and 0.10 cm2 (sensitivity, 98%; specificity, 81%; P < .001) for patients with a nonbifid median nerve. Conclusions. A bifid median nerve occurs relatively frequently in patients with CTS. It may facilitate compression of the median nerve in the carpal tunnel because of its relatively higher cross‐sectional area compared with a nonbifid median nerve. The size criterion for CTS in patients with a bifid median nerve is slightly higher than in those with a nonbifid median nerve.

Pyridoxine and pyridostigmine treatment in vincristine-induced neuropathy.

Vincristine is a commonly used antineoplastic drug and frequently causes neurotoxicity. Here the authors report a 4-year-old boy with acute lymphoblastic leukemia in whom vincristine-induced peripheral and cranial neuropathy developed during remission induction therapy. The patient seemed to benefit from pyridoxine and pyridostigmine therapy greatly and this therapy is recommended in patients with severe vincristine-induced neuropathy.

Hereditary neuropathy with liability to pressure palsy (HNPP) in childhood: A case study emphasizing the relevance of detailed electrophysiological examination for suspected HNPP in the first decade

Hereditary neuropathy with liability to pressure palsy (HNPP) is an autosomal dominant disorder characterized by recurrent mono-neuropathies secondary to minor trauma or compression. Whilst typical episodes of palsy generally become apparent during the second and the third decades, HNPP is rarely diagnosed in the first decade. We present the case of a 6-year-old patient to draw attention to the possibility of HNPP attacks in the first decade and the importance of detailed electrophysiological examination.

Hypothyroid Myopathy with Manifestations of Hoffman's Syndrome and Myasthenia Gravis

Although hypothyroid myopathy is seen frequently and the relationship with autoimmune hypothyroidism and myasthenia gravis is well known, specific forms of hypothyroid myopathy such as Hoffmans syndrome (HS) are rarely described. Here we describe a 40-year-old patient with Hashimoto thyroiditis showing symptoms and signs of two discrete forms of hypothyroid myopathy (HS and myasthenic syndrome) together. To our knowledge this is the first reported case with features of both of these syndromes. We discuss the diagnosis, speculate whether this patient may represent a unique form of hypothyroid myopathy, and report the 6-month follow-up of the patient both clinically and electrophysiologically.

Diagnosing carpal tunnel syndrome with Doppler ultrasonography: a comparison of ultrasonographic measurements and electrophysiological severity

Abstract Introduction: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. Diagnosis is based on clinical history, physical examination, and electrophysiological studies. Imaging techniques are performed for difficult-to-diagnose cases because they provide information about the morphology of the median nerve. More recently, it has been shown that Doppler ultrasonography can detect increased intraneural blood flow in CTS. The aim of our study is to evaluate the relationship between the severity of CTS, hypervascularization, and cross-sectional area (CSA) to determine the diagnostic value of Doppler ultrasonography. Patients and methods: The study group comprised 125 wrists of 75 patients who had been diagnosed with CTS, both clinically and electrophysiologically. The control group comprised 100 wrists of 50 healthy volunteers. Wrists were classified into five stages of CTS severity based on electrophysiologic studies. A radiologist examined the wrists blindly with grayscale images and Doppler ultrasonography to assess CSA and hypervascularization. Results: A total of 121 wrists were included. There were 28 wrists with minimal CTS severity stage, 36 with mild, 36 with moderate, and 21 with severe. The sensitivity and specificity of CSA and hypervascularization in detecting CTS was 90.9, 94.0, 93.4, and 90.0%, respectively. There was a significant correlation between CTS severity and hypervascularization (p < 0.005) for all stages. Conclusion: Our study shows that Doppler ultrasonography results strongly correlate with CTS severity. Hence, this is a useful method for diagnosing CTS and estimating its severity.

Propriospinal Myoclonus in a Child

A 6-year-old girl was experiencing repetitive involuntary and massive jerks immediately involving limbs and trunk. The first motor events appeared approximately at 1 year old and only 5 months after a back trauma. Myoclonus became progressively more frequent and more violent, causing episodes of falls. Neurological examination showed jerks characterized by upper limb abduction, lower limb abduction, and head—body hyperextension. Apart from these motor events, the neurological examination was normal. The results of vitamin B12 and folate, antinuclear antibody, anti-DNA, anti-Tiroglobulin, anti-thyroid peroxidase antibody, lupus anticoagulant, anti-cardiolipin antibody, rheumatoid factor, and C3 and C4 were unexceptional. Electroencephalography and brain and spinal magnetic resonance imaging were unremarkable. Electromyographic records with surface electrodes showed that duration of myoclonic jerks was ranging from 100 to 300 ms. We thought she had propriospinal myoclonus because of presence of the spreading through the shoulder, upper limbs, and lower limbs in addition to thoracolumbar paraspinal muscles.

Neurological Complications of Hypothyroidism

Impaired memory, slowed mental processing, depression, nerve entrapment syndromes, ataxia, muscle weakness and muscle cramps are the most common neurological symptoms which may be caused by hypothyroidism (Roberts et al, 2004). Disorders of the thyroid gland are among the most common endocrine maladies. Hypothyroidism is the most prevalent form of thyroid disease and symptoms may include memory and learning impairment, depression, psychotic behaviour, retarded locomotor ability, somnolence, progressive intellectual deterioration and, in extreme cases, coma (Anderson, 2001; Smith et al., 2002). Since the thyroid hormones dramatically affect the maturation of specific neuronal populations, the absence of these hormones during the period of active neurogenesis leads to irreversible mental retardation and is accompanied by multiple morphological alterations in the brain (Smith et al., 2002).

Neurological Complications after Renal Transplantation: A Retrospective Clinical Study

INTRODUCTION The aim of this study was to evaluate the incidence and types of neurological complications (NCs) and associated factors in renal transplantation (RT) patients. METHODS Three hundred and forty-four patients who had RT performed at our institution between January 2005 and July 2014 were retrospectively evaluated. RESULTS File records of the patients revealed 19 who experienced a total of 22 episodes of NCs, of whom three had more than one episode. The mean age of 19 patients included in the study, of whom eight were female, was 37.52±13.08 (range, 18-65) years. NCs were classified into central or peripheral depending on the location of involvement of the central nervous system (CNS). CNS involvement was found in 16 (84.2%) of the 19 patients. Tremor (36.8%) was the most common CNS complication in these patients. Encephalopathy, generalized tonic-clonic seizures, and status epilepticus were observed in two patients (10.5%). Delirium and dementia were observed in one patient (5.2%). Headache was experienced by one patient, and agitated depression was observed in one patient. Six patients (26.3%) had the peripheral nervous system involvement. One patient had the numbness of hands with normal electromyography findings, and four patients had polyneuropathy. In one patient, lumbar plexopathy was observed. Seventeen of the 22 NCs were considered to be caused by immunosuppressive agents. Each incidence of amyloidosis, infection, septic emboli, and hypoglycemia caused a neurological episode. The etiology of one episode was unknown. CONCLUSION Different neurological disorders can be seen after RT, and most of them are caused by immunosuppressive drugs. NCs seen after RT can be treated by decreasing the dose or changing the immunosuppressive drug.

Middle and Long Latency Auditory Evoked Potentials and Their Usage in Fibromyalgia and Schizophrenia

1.1 Middle and long latency auditory evoked potentials and their usage in fibromyalgia FM is a chronic syndrome that occurs predominantly in women and is marked by generalized pain, multiple defined tender points, fatigue, disturbed sleep, cognitive difficulty, and numerous other somatic complaints. The etiology and pathophysiology of FM remain unclear. Despite extensive research, no structural pathology has been identified in muscles or other tissues. The general and widespread nature of pain in FM strongly suggests the involvement of central mechanisms (Williams et al., 2006). Although psychological factors associated with chronic distress appear to be important for the development of FM in many patients, abundant evidence now indicates that pain in FM reflects abnormal pain processing in the central nervous system (ie. central sensitivity) (Herrero JF et al., 2000, Staud R. et al, 2001). Recent research suggested that FM patients might have deficiencies in central inhibitory mechanisms, such as diffuse noxious inhibitory control or the endogenous pain inhibitory system. Nevertheless, little is yet known about the brain mechanisms involved in the processing of nonpainful somatosensory information in FM (Monyoto P et al., 2006, Julien N. Et al., 2005). Central mechanisms related to pathophysiology and hypervigilance have long been discussed for fibromyalgia. Nevertheless, research into this issue has been inconclusive so far. Our aim to design this study (Turker et al., 2008) was to determine whether central mechanisms played an important role in fibromyalgia via examining brain activity elicited by auditory evoked potentials in patients with FM and to assess relationship with clinical variables. Middle latency evoked potentials (Middle Latency Auditory Evoked Potentials) are composed of several components that can be recorded from 10 to 50 msec after stimulus onset. The most stable components are Na and Pa, with latencies between 16-30 msec and 30-45 msec, respectively. Most of the MLAEP complex is thought to originate near the auditory cortex, although No, Po and Na may be generated by subcortical structures.