Orhan Deniz

Comparison of Double Inversion Recovery and Conventional Magnetic Resonance Brain Imaging in Patients with Multiple Sclerosis and Relations with Disease Disability

Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system, predominantly affecting the white matter, but also the grey matter. Aim of this study was to detect MS lesions with double inversion recovery (DIR), fluid-attenuated inversion recovery (FLAIR) and T2-weighted magnetic resonance (MR) techniques and determine the sensitivity of these techniques, and the correlation between the number of lesions and expanded disability state scale (EDSS) scores. Thirty-four patients with MS (20 females and 14 males) were included in this study. DIR and conventional MR (T2-A, FLAIR) sequences were obtained. Lesions were counted and classified as belonging to one of seven anatomical regions: cortical, juxtacortical, deep grey matter, deep white matter, mixed white matter-grey matter, periventricular white matter and infratentorial. The correlation between lesion number and EDSS scores was investigated. DIR images showed more intracortical and mixed white matter-grey matter lesions in comparison with both FLAIR and T2 sequences (p=0, p=0 respectively). There was a significant difference between mean lesion numbers at the juxtacortical region, obtained with DIR and T2-weighted images (p = 0.002). The total number of lesions obtained with all methods was similar. DIR brain imaging had the highest sensitivity in the detection of cortical and mixed white matter - grey matter lesions, compared with FLAIR and T2 sequences. In addition, the lesions obtained with DIR images were more easily visualized.

A case study of neuro-psycho-Behçet's syndrome presenting with psychotic attack.

Behçets disease is a multisystem inflammatory disorder that presents with a classic triad of recurrent oral and genital ulcerations and uveitis with hypopyon. The initial symptom of Behçets disease is neurological in only 3% of cases. Although Neuro-Behçets Syndrome commonly presents with focal neurological symptoms, it is possible that psychiatric symptoms could be the first manifestation of the disease. To our knowledge, this is the first case report of Neuro-Behçets Syndrome that presents with an acute psychotic attack.

A novel oxidative stress marker in patients with Alzheimer’s disease: dynamic thiol–disulphide homeostasis

Objective The aim of this study was to evaluate the dynamic thiol–disulphide homeostasis as an oxidative stress parameter, using a newly proposed method, in patients with Alzheimer’s disease. Methods In total, 97 participants were included in the study. Among them, 51 had been diagnosed with Alzheimer’s disease, and the remaining 46 were healthy individuals. Total thiol (–SH+–S–S–) levels and native thiol (–SH) levels in serum of each participant were measured. The amount of dynamic disulphide bonds (–S–S–) and (–S–S–) ×100/(–SH), (–S–S–) ×100/(–SH+–S–S–), and –SH×100/(–SH+–S–S–) ratios were calculated from these values. The obtained data were used to compare Alzheimer’s disease patients with healthy individuals. Results The average total thiol and native thiol levels of patient with Alzheimer’s disease in the study were found to be significantly lower than those levels of healthy individuals. In addition, in the patient group, the –S–S–×100/–S–S+–SH ratio was found to be significantly higher, whereas the –SH×100/–S–S+–SH ratio was found to be significantly lower compared with healthy individuals. Total thiol and native thiol levels, dynamic disulphide bond amount, and –S–S–×100/–SH, –S–S–×100/–S–S+–SH, and –SH×100/–S–S+–SH ratios were not found to be correlated with mini mental state examination score or duration of disease. Conclusion Recent studies have shown that oxidative stress is the one of the molecular changes underlying the pathogenesis of Alzheimer’s disease. In this study, we have investigated the dynamic thiol–disulphide homeostasis in patients with Alzheimer’s disease, using a novel method.

Diffusion tensor magnetic resonance imaging in patients with multiple sclerosis and its relationship with disability.

Multiple sclerosis is a chronic inflammatory demyelinating disease of the central nervous system. Diffusion tensor magnetic resonance imaging (DTI) can yield important information on the in vivo pathological processes affecting water diffusion. The aim of this study was to quantitatively define water diffusion in normal-appearing white matter (NAWM) distant from the plaque, in the plaque, and around the plaque, and to investigate the correlation of these changes with clinical disability. Conventional MRI and DTI scans were conducted in 30 patients with MS and 15 healthy individuals. Fractional anisotropy maps and visible diffusion coefficients were created and integrated with T2-weighted images. Regions of interest (ROIs) were placed on the plaques on the same side, white matter around the plaques and NAWM on the opposite side. Only the white matter of healthy individuals in the control group, and FA and ADC values were obtained for comparison. The highest FA and lowest ADC were detected in the control group at the periventricular region, cerebellar peduncle and at all ROIs irrespective of location. There was a significant difference in comparison to the control group at all ROIs in patients with MS (p < 0.001 for all comparisons). No significant correlation between diffusion parameters and expanded disability state scale (EDSS) scores was found in patients with MS. DTI may provide more accurate information on the damage due to the illness, compared to T2A sequences, but this damage may not be correlated with the clinical disability measured by EDSS score.

The Prevalence of Dry Eye and Sjögren Syndrome in Patients with Migraine.

ABSTRACT Purpose: To evaluate the presence of dry eye and primary Sjögren syndrome (SS) in patients with migraine. Methods: In total, 46 eyes of 46 patients with migraine (group 1) and 50 eyes of 50 healthy subjects (group 2) were included in this study. Detailed ophthalmologic, neurologic and rheumatologic examination were performed on all participants. Ocular surface disease index questionnaire, tear function tests, visual analog scale for pain, serologic analysis were also performed. Results: Dry eye symptoms and findings were significantly higher and more severe in group 1 when compared with group 2. Primary SS was not found in any of the participants. The migraine lifetime duration was negatively correlated with the tear function tests while it was positively correlated with the ocular surface disease index scores. Conclusions: Dry eye symptoms and findings are higher in migraine patients when compared with the healthy subjects without the presence of Sjögren syndrome.

Impairment of dynamic thiol–disulphide homeostasis in patients with idiopathic Parkinson’s disease and its relationship with clinical stage of disease

OBJECTIVE The aim of this study was to investigate dynamic thiol-disulphide homeostasis in patients with idiopathic Parkinsons disease and to determine its relationship with the clinical stage as assessed by the modified Hoehn and Yahr scale. DESIGN AND METHODS Fifty-two patients with Parkinsons disease (PD), diagnosed according to the United Kingdom Brain Bank Criteria for idiopathic PD, and 41 healthy individuals were included in the study. Clinical staging of patients was performed according to the Hoehn and Yahr scale. Peripheral blood samples were taken from all participants, and their native thiol and total thiol concentrations were measured using the newly developed automated method. In addition, their amount of disulphide bonds, disulphide/native thiol, disulphide/total thiol and native thiol/total thiol ratios were calculated. RESULTS Considering the data obtained from Parkinsons patients and the control group, both native thiol (-SH) and total thiol (-SH+-S-S) levels were found significantly lower in patients with Parkinsons disease. A negative and statistically significant relationship was found between both disease duration and disease stage and native thiol (-SH), total thiol (-SH+-S-S) levels and -SH/(-SH+-S-S-) ratio. A positive and statistically significant relationship was found between both disease duration and stage and -S-S-/-SH and -S-S-/(-SH+-S-S-) ratios. CONCLUSION In patients with Parkinsons disease, dynamic thiol-disulphide homeostasis is disrupted, according to disease stage and duration. This balance, easily measured by using the newly developed automated method, can be used in monitoring disease progression. To our knowledge, our study will be the first report in the literature.

Impaired thiol-disulphide homeostasis in patients with axonal polyneuropathy

Abstract Objective: The objective of this study is to examine thiol-disulphide homeostasis in patients with polyneuropathy dominated by diabetic or non-diabetic axonal degeneration. Materials-methods: Fifty-four patients diagnosed with polyneuropathy dominated by axonal damage and 41 healthy subjects were included in the study. The patients were grouped into two groups according to whether or not they had diabetes. The native thiol and total thiol concentrations were measured with the newly developed automated method. Results: While there was no significant difference between the patients with diabetic and non-diabetic polyneuropathy in terms of native thiol and total thiol levels (p > 0.05), the native thiol and total thiol levels of the groups with both diabetic polyneuropathy and non-diabetic polyneuropathy were significantly low compared to the control group (p < 0.01). The level of disulphides in the patients with diabetic polyneuropathy was significantly higher than that of the patients with non-diabetic polyneuropathy and the healthy individuals (p < 0.05). The loss in the sural nerve sensory neural action potential amplitude was positively correlated with the decrease in the levels of both native thiol and total thiol (p < 0.05). Discussion: In our study, we observed that the thiol-disulphide balance was also impaired in patients with non-diabetic polyneuropathy similar to patients with diabetic polyneuropathy, and we therefore considered that impaired the thiol-disulphide homeostasis could be the last common path in patients with polyneuropathy with axonal damage, regardless of the aetiology. Therefore, fortification of thiol deficiency with N-acetyl cysteine or alpha-lipoic acid can fix the thiol-disulphide balance and help decelerate the axonal damage.

Rhabdomyolysis Related to Dyskinesia in Parkinson’s Disease

Rhabdomyolysis is a life threatening syndrome. It accounts for an estimated 8% to 15% of cases of acute renal failure and is associated with a mortality rate of 5%. In movement disorders, various causes of rhabdomyolysis have been reported including status dystonicus, myoclonus, generalized chorea and parkinsonism-hyperprexia syndrome in Parkinson’s disease (PD). Levodopa-induced dyskinesia leading to rhabdomyolysis is a very rare phenomenon in PD. We report a case of 76 years old PD patient with dyskinesia and rhabdomyolysis.

Acute “upside-down” visual inversion in a patient with multiple sclerosis

Visual and oculomotor signs and symptoms are common and well defined in patients with multiple sclerosis. On the other hand, the phenomenon of “upside-down” reversal of vision is very rare and thus not well known. The physiopathology of this phenomenon also has not been well understood. Herein, we present a female patient with multiple sclerosis, who developed acute “upside-down” visual inversion, and discuss possible mechanisms of this rare phenomenon.