Lütfi Özel

Red cell distribution width identifies cerebral venous sinus thrombosis in patients with headache.

Background: Diagnosing cerebral venous sinus thrombosis (CVST) in patients referring to emergency service or neurology outpatient unit with complaints of headache is a challenging task. Magnetic resonance (MR) venography is the gold standard, but there are limitations regarding its use. Aim: To evaluate the validity of red cell distribution width (RDW) in CVST diagnosis in patients presenting with headache. Methods: A total of 138 patients comprising 37 patients with CVST and 101 control primer headache cases were included in this retrospective cross-sectional study. Control group consists of hospitalized patients with primary headache. Venous blood hemoglobin (Hb), platelet, mean corpuscular volume (MCV), RDW, fibrinogen, and vitamin B12 levels of the patients were recorded at the first referral. Diagnosis of CVST was established by MR venography. Results: The RDW ratio of patients with a diagnosis of CVST was significantly higher than that in patients with primary headache (15.3 ± 1.4 vs 13.3 ± 0.5; P <.0001). Fibrinogen and vitamin B12 levels were not significantly different between the 2 groups. In a total of 11 patients, there was more than 1 thrombosis. In 21 of the patients with CVST, gene mutation was detected. There was no significant difference between the patients with and without mutations regarding RDW values. Diagnostic validity of RDW was found to be excellent in differentiating patients with CVST and primary headache (area under the curve = 0.996; 95% CI: 0.990-1.000). Optimum RDW cutoff value was determined as 14.1% (sensitivity: 91.9%, specificity: 99%, positive predictive value: 92.8, negative predictive value: 0.082). Conclusion: We suppose that among patients presenting with the complaint of headache, RDW value may lead to diagnose CVST.

Karpal tünel sendromunda Novel metoduyla yapılan steroid enjeksiyonunun ağrı şiddeti ve elektrofizyolojik bulgular üzerine etkisi

Objective: The aim of the present study is to investigate the effects of local steroid injection therapy with the Novel method on subjective patient complaints and electrophysiological investigations at the end of 3 months. Methods: 101 hands of 59 subjects (5 men and 54 women) with mild carpal tunnel syndrome received steroid injection with the Novel technique. Visual Analogue Scale (VAS) was used to determine the severity of pain. Nerve conduction findings obtained prior to and 3 months after the injection were compared using the VAS. Results: According to the VAS, mean pain severity for the right hand (n:56) was 7.79±1.4 before the injection, and 3.29±1.9 at 3 months. Mean pain severity for the left hand (n=45) was 7.71±1.2 before the injection, and 3.16±2.0 at 3 months. Median motor nerve distal latency was statistically significant for both hands after the injec tion (p<0.001). Median motor velocity was statistically non-significant in both hands after the injection. After the injection, median sensory distal latency, amplitude and velocity were statistically significant for both hands. Conclusion: The present study showed the efficacy of local steroid injection therapy on subjective complaints and electrophysiological findings in mild carpal tunnel syndrome. Because the improvement is greater in the non-dominant hand compared to the other, splints should be used to keep the hand in neutral position and hand rest should be employed in addition to the local injection.

Correlation with Platelet Parameters and Genetic Markers of Thrombophilia Panel (Factor II g.20210G>A, Factor V Leiden, MTHFR (C677T, A1298C), PAI-1, β-Fibrinogen, Factor XIIIA (V34L), Glycoprotein IIIa (L33P)) in Ischemic Strokes

An important type of arterial thrombosis, ischemic stroke is associated with increased mortality risk, severe disability and life quality impairment. In this study, we analyzed mean platelet volume, platelet count values and genetic thrombophilia markers of patients who have ischemic stroke history and searched the relationship with genetic predisposition of ischemic strokes and platelet parameters. A retrospective, clinical trial was performed by reviewing the ischemic stroke history (except cryptogenic events) of 599 patients and 100 controls. The results of the genetic thrombophilia panel were used to classify the study group and control group into low and high risk for thrombophilia groups. The high-risk group included patients homozygous/heterozygous for Factor II g.20210G>A or Factor V Leiden mutations with/without any other polymorphism. The low-risk group included patients heterozygous or homozygous for MTHFR (C677T, A1298C), PAI-1, β-fibrinogen, Factor XIIIA (V34L) and glycoprotein IIIa (L33P) polymorphisms or negative in terms of both mutations and polymorphisms. The results of study showed us that high-risk group mutations are important risk factors for ischemic stroke but low-risk group polymorphisms are not significant. According to platelet parameters, although there was a significant difference between MPV and PLT values of ischemic stroke and control group, thrombophilia mutations and polymorphisms have not a significant effect on MPV and PLT values in ischemic stroke patients.

Can we distinguish stroke and stroke mimics via red cell distribution width in young patients

Introduction Discrimination of stroke and stroke mimics is problematic in young patients. The aim of the study was to determine whether arterial ischemic stroke and stroke mimics can be differentiated via the red cell distribution width (RDW) value in young patients. Material and methods In this retrospective cross-sectional study, a total of 236 patients hospitalized at the neurology ward were investigated. The patients were divided into 3 groups: the 1st group included young stroke patients, the 2nd group included patients with epilepsy, and the 3rd group included patients with multiple sclerosis (MS). Complete blood count and computed tomographic brain imaging tests were performed in all patients, and magnetic resonance imaging was done when necessary. Results A total of 236 patients were included in this study. Ninety-five (40%) patients were young stroke patients, 71 (30%) had epilepsy and 70 (30%) had MS. The mean RDW values of young patients with stroke were significantly higher than patients with epilepsy or MS (14.9 ±1.2, 13.3 ±1.2, 13.4 ±0.6, p < 0.0001, respectively). The diagnostic power of RDW in the differentiation of patients with stroke is good (area under the curve (AUC) = 0.89). When an RDW cut-off value of 14.05% is accepted for differentiating young patients with stroke from other disorders, the sensitivity, specificity, positive predictive and negative predictive values were 73.7%, 87.9%, 6.1 and 0.043, respectively. Conclusions Red cell distribution width is a promising, rapid, easy and inexpensive parameter to distinguish young stroke from stroke mimics (such as epilepsy and MS) in young patients.

Massive leptomeningeal dissemination of a low-grade thalamic astrocytoma in an adult patient

A 24-year-old male was referred to our department with complaints of intermittent diplopia, decreased vision, dizziness, and gait disturbance of 3 months duration. The patient had an unremarkable medical history. On the neurologic examination, there were weakness and paresthesia in both legs. He had a limitation of the right lateral gaze and a facial paralysis. Cerebral magnetic resonance imaging (MRI) revealed a non-enhancing mass without significant edema in right thalamus and invasion of the left thalamus via the massa intermedia (Fig. 1a, b). Brain imaging also revealed leptomeningeal dissemination of the basal cisterns (Fig. 2a, b). On the diffusion-weighted imaging, the mass has relatively homogeneous increased signal intensity (Fig. 3a). The apparent diffusion coefficient (ADC) map reveals increased ADC with a region of interest placed in the focal area of low ADC within the mass (Fig. 3b). Magnetic resonance (MR) spectroscopy showed a markedly increased choline/creatinine ratio (3.22) and prominent lactate peak (Fig. 4a, b). It also revealed a slightly increased myo-inositol/N-acetyl aspartate ratio (Fig. 4c). A spinal MRI revealed leptomeningeal dissemination of the entire spine (Fig. 5a, b and 6a, c). A stereotactic biopsy was performed from highest location of the Cho peak in MR spectroscopy. Histopathologic examination of the surgical specimen revealed a grade 2 astrocytoma (World Health Organization) (Fig. 7a, b). Immunohistochemical study showed that neoplastic cells were negative for glial fibrillary acidic protein and Ki-67 proliferation index was very low (Fig. 7c, d). Radiation therapy was started in the spinal seeding area. Subsequently, chemotherapy was administered, and the patient was discharged with recommendations. Low-grade gliomas of the brain are characterized by slow progression and a median survival between 5 and 10 years [1, 2]. Leptomeningeal dissemination is relatively rare and a factor associated with poor prognosis [2, 3]. Conventional MRI is helpful in characterizing cerebral tumor aggressiveness. However, the grading of gliomas with conventional MRI is not always possible [4]. Advanced MRI techniques such as diffusion-weighted MRI and proton MR spectroscopy have been used in the evaluation of glial tumors with increasing frequency [5]. MR spectroscopy is also a powerful tool in grading of glial tumors. Many authors advocate that the increase in Cho/ NAA ratios and the presence of lactate peak were the most significant spectral parameters in the differentiation of H. Ogul (&) G. Polat M. Kantarci Department of Radiology, Medical Faculty, Ataturk University, 25240 Erzurum, Turkey e-mail: drhogul@gmail.com

Prevalence of Tension-Type Headache in Individuals Aged between 18-65 Years in the Eastern Parts of Turkey

OBJECTIVE Although tension-type headache (TTHA) is one of the most frequently encountered diseases in the general population, relatively few studies have been conducted on this health condition. The published data are limited on the frequency of TTHA in Turkey, and no studies to date have been initiated on the prevalence of TTHA in the city of Erzurum or the Eastern Anatolian Region. MATERIALS AND METHODS The study was conducted using in-depth interviews from 1972 individuals from city of Erzurum. TTHA was queried in patients with a history of headache, according to the International Classification of Headache Disorders diagnostic criteria, and the frequency of TTHA was investigated. RESULTS A total of 1972 patients were enrolled in this study. The frequency reached a peak between the ages of 40-49 years (35%), and it significantly declined after the age of 49. During an examination (palpation), cranial muscle sensitivity was detected in 33% of the patients. CONCLUSION The frequency of TTHA has been identified as 22.3% in patients between the ages of 18-65. The frequency of tension type headache in the city of Erzurum was lower than that in the general population of Turkey.

Nonconvulsive Status Epilepticus

SUMMARY Status epilepticus (SE) can be divided into two subgroups, convul- sive status epilepticus (CSE) and nonconvulsive status epilepticus (NCSE). NCSE is clinically characterized by recurrence or persistence of absence or complex partial seizures which unconsciousness per- sists. Seizures are lasted more than 30 minutes, and accompanied by mental and behavioral changes. Although the main feature is the change of level of consciousness, affective, memory, cognitive, speech, motor systems, behavioral and psychiatric disorders can be also seen. Electroencephalography (EEG) is the single diagnos- tic method in this situation. NCSE constitutes approximately 25% of all SE, however it is thought that sometimes it is misdiagnosed and the incidence of NCSE may be higher. The causes are disorders of central nervous system (stroke, infection, trauma, tumor), and metabolic factors (hypoxia, renal diseases, drugs, failure to use an- tiepileptic drug). The treatment contains the standard therapy of SE. Short-acting benzodiazepines are preferred in initial treatment. For more resistant cases, loading of phenytoin is applied. If there is no response to treatment, midazolam and propofol additionally to barbiturates can be used. We aimed to present a case admitted to our ED with altered mental status and diagnosed as NCSE that is under-diagnosed.

P105 The effect of local corticosteroid injection on F-wave conduction velocity in carpal tunnel syndrome

Results: The sensitivity of the median sensory nerve latency (mSDL) and median motor distal latency (mMDL) were 75.8% and 68.5%, respectively. The most sensitive parameters of sensory and motor NCSs were the difference between median and ulnar sensory distal latencies to the fourth digit [(D4M-D4U), (77%)] and the median motor terminal latency index [(mTLI), (70.3%)], while the median-to-ulnar sensory action potential amplitude ratio (27%) and the median–thenar to ulnar–hypothenar motor action potential amplitude ratio (15%) were least sensitive tests. Sensory tests were more sensitive than motor NCSs. Combining mSDL with D4M-D4U and mMDL with mTLI allowed for the detection of abnormalities in 150 (91%) and 132 (80%) hands, respectively. Conclusion: The newer nerve conduction techniques and combining of different NCSs tests are more sensitive than single conventional NCSs tests for the diagnosis of suspected CTS.