Özcan Kocatürk

Posterior reversible encephalopathy during an attack of familial Mediterranean fever

Reported here is a 19-year-old female patient with familial Mediterranean fever who was seen for altered mental status and seizures. She was eventually diagnosed to have posterior reversible leukoencephalopathy syndrome. Although a variety of conditions have been reported in association with this syndrome, to our best notice, this is the second case in whom familial Mediterranean fever and posterior reversible leukoencephalopathy coexists.

Does stroke etiology play a role in predicting outcome of acute stroke patients who underwent endovascular treatment with stent retrievers

AIMS The goal of the study was to identify whether the stroke etiology play a role in the recanalization and outcome of patients who underwent mechanical thrombectomy with stent retrievers. METHODS AND RESULTS A retrospective analysis of a prospectively collected database included consecutive patients treated with stent retrievers. We included patients with cardioembolic stroke and large vessel atherosclerotic disease and compared risk factors for stroke, baseline NIHSS and Alberta Stroke Program Early CT scores (ASPECTS), stroke outcome, recanalization rate, onset-to-recanalization, onset-to-groin puncture time and the procedural time between two groups. Male sex was statistically more common in patients with large vessel atherosclerotic disease. Mean time from symptom onset- to the achievement of recanalization in patients with LVAD was 242±72.4 compared with cardioembolic stroke patients (301±70.7; p=0.014). Time for groin puncture to recanalization was longer in patients with cardioembolic stroke compared to LVAD group (97.5±44.3 vs 58.2±21.8; p=0.002). Time for microcatheter to successful recanalization or procedural termination was longer in patients with cardioembolic stroke compared to LVAD group (63.6±30.2 vs 34.2±19.4; p<0.001) with cardioembolic stroke had significantly worse long-term outcome (mRS 3-6) compared to those with LVAD (60.6% vs 26.3%; p=0.036). CONCLUSION Stroke etiology may play a role in the outcome of acute stroke patients who underwent endovascular stroke therapy. Cardioembolic strokes may be more resistant to endovascular acute stroke treatment.

An evaluation of serum paraoxonase together with arylesterase activities and oxidative stress in children with intractable epilepsy: A cross-sectional study

Epilepsy is the most common chronic neurological illness in childhood and adolescence. The aim of this study was to investigate paraoxonase and arylesterase activities along with oxidative status parameters in children with intractable epilepsy. The study comprised 42 subjects with intractable epilepsy and a control group of 35 healthy subjects. Serum paraoxonase and arylesterase activities, and lipid hydroperoxide levels were determined. All paraoxonase and arylesterase activities were significantly lower in the intractable epilepsy subjects than in the controls (P<0.001), whereas lipid hydroperoxide levels were significantly higher (P<0.05). In conclusion, paraoxonase and arylesterase activities were decreased and the lipid hydroperoxide level was increased in patients with intractable epilepsy. These results showed that intractable epilepsy subjects may be more prone to the development of atherosclerosis.

The relationship of carpal tunnel syndrome and mean platelet volume in geriatric patients

The aim of this study was to examine the relationship between idiopathic carpal tunnel syndrome (CTS) and mean platelet volume (MPV) in patients older than 65 years old. The study included 48 patients, 92 hands (45 right/47 left) from 8225 patients who were consulted to electroneuromyography (ENMG) laboratory in January 2010 to December 2013. ENMG data, whole blood cell, erythrocyte sedimentation rate, C-reactive protein (CRP) levels of all patients were noted. In patient group MPV levels were significantly high (P=0.014). Although CRP levels were significantly elevated in patients, all CRP levels were in normal range. As a result, in patients older than 65 years increased MPV levels may be associated with CTS etiology and increased risk of cardiovascular disease.

Assessment of both serum S-100B protein and neuropeptide-Y levels in childhood breath-holding spells

OBJECTIVE Breath-holding spells are common paroxysmal events in children. Although the spells have a benign prognosis in the long term, they may be complicated by loss of consciousness, tonic-clonic movements, and occasionally seizures. Hence, this study aimed to measure the levels of serum S-100B proteins and neuropeptide-Y in the blood of children who experience breath-holding spells. METHODS The study groups consisted of 45 patients (13 females, 32 males) with breath-holding spells and a control group of 32 healthy individuals (12 females, 20 males). The serum S-100B levels were measured using commercially available ELISA kits. The neuropeptide-Y levels in the serum were measured with RayBio® Human/Mouse/Rat Neuropeptide Y ELISA kits. RESULTS The mean serum S-100B protein level of the breath-holding spells group was 56.38 ± 13.26 pg/mL, and of the control group, 48.53 ± 16.77 pg/mL. The mean neuropeptide-Y level was 62.29 ± 13.89 pg/mL in the breath-holding spells group and 58.24 ± 12.30 pg/mL in the control group. There were significant differences between the groups with respect to serum S-100B protein levels (p = 0.025), while there was no statistically significant difference in neuropeptide-Y levels between the breath-holding spells group and the control group (p = 0.192). CONCLUSIONS The findings of this study suggest that frequent and lengthy breath-holding may lead to the development of neuronal metabolic dysfunction or neuronal damage which is most likely related to hypoxia. In light of these findings, future studies should be conducted using biochemical and radiological imaging techniques to support these results.

An unusual cause of generalised seizure following cardiac surgery: with bolus cefazolin administration

Although some of the aetiological factors of seizure, such as cerebral microemboli, cerebral oedema, hypoperfusion, cerebral hypoxia and metabolic encephalopathy cannot be completely controlled during cardiac surgery, cautious management of all steps in the procedure may prevent the administrative causes of seizure. Cefazolin, which is known to be a proconvulsant agent, may be a suspected agent of seizure complications in patients with renal insufficiency. Surprisingly, intravenous bolus administration of cefazolin may also trigger seizure in patients with normal renal function. In this case report, a complication of generalised seizure after cardiac surgery with intravenous bolus administration of cefazolin is described, along with a brief review of the literature.

Hyperdense Middle Cerebral Artery Sign Together with Pulmonary Thromboembolism

Summary Background Hyperdense middle cerebral artery sign is an appearance of the middle cerebral artery on non-contrast-enhanced computed tomography. Embolic occlusion of the pulmonary arterial system is referred to as pulmonary embolism. When pulmonary embolism coexists with a patent foramen ovale, increased pressure in the right atrium may result in widening of the foramen and consequently, cause serious conditions due to paradoxical embolus. Coexistence of hyperdense middle cerebral artery sign and pulmonary thromboembolism is very rare in the literature. Case Report We presented a 60-year-old female patient who had both hyperdense middle cerebral artery sign and pulmonary thromboembolism. Conclusions To our knowledge, togetherness of hyperdense MCA sign and pulmonary thromboembolism is extremely rare in the literature. In our case, we found both pulmonary embolism due to DVT and paradoxical embolism due to existing patent foramen ovale.

Creutzfeldt-Jakob disease presented with dizziness, weakness and neuropsychiatric symptoms: 2 Case Reports -

Creutzfeldt-Jakob disease (CJD) is among very rare, progressive, untreatable, neurodegenerative prion diseases. While the incidence is reported as 1/1000000 years in European countries, sporadic cases are rarely presented in Turkey. Clinical findings are in the form of rapid progressive dementia, myoclonus, cerebellar, pyramidal and extra pyramidal symptoms. Definitive diagnosis is established by histopathological examination. Our case is a 64-year-old male and 70-year-old female patients admitted with dizziness emerged as sub-acute weakness, nausea, vomiting, insomnia, imbalance and additional neuropsychiatric complaints. Focal activity slowness and common periodic sharp wave activities were observed in EEG. CJD was considered because bilateral symmetrical diffusion limitation was observed at both sides in the basal ganglia level in cranial diffusion MRI’s and 14-3-3 protein was resulted as positive in CSF examinations. CJD, which is a very rare disease in patients presenting with progressive neuropsychiatric symptoms and seizure, is one of the diagnosis to be considered and we wanted to emphasize that there is no treatment for it and preventive measures should be taken.