Özlem Kayım Yıldız

Serum 25-hydroxyvitamin D levels in restless legs syndrome patients

OBJECTIVE Restless legs syndrome is characterised by discomfort during rest and an urge to move the limbs that is accompanied by abnormal sensations. Studies on disease pathophysiology have focused on dopaminergic dysfunction. Vitamin D may play an important role in dopamine function, but the role of vitamin D in restless legs syndrome has not been examined. We compared the serum vitamin D levels of RLS patients and matched controls and explored the correlation of plasma vitamin D levels with disease severity. PATIENTS/METHODS We measured serum 25-hydroxyvitamin D levels in 36 patients with restless legs syndrome and compared them to 38 healthy control subjects. RESULTS The mean serum 25-hydroxyvitamin D levels were 7.31±4.63 ng/mL in female patients with restless legs syndrome and 12.31±5.27 ng/mL in female control subjects (p=0.001). We found a significant inverse correlation between vitamin D levels and disease severity in females (p=0.01, r=-0.47). CONCLUSION The mean serum vitamin D levels were lower in female patients with restless legs syndrome. Low vitamin D levels may cause dopaminergic dysfunction in restless legs syndrome patients. Further studies are required to confirm these results.

Previous Antiplatelet Use is Associated with Hematoma Expansion in Patients with Spontaneous Intracerebral Hemorrhage

BACKGROUND Patients with intracerebral hemorrhage (ICH) often report the use of antiplatelet medications, even more commonly than the use of anticoagulants. The effect of antiplatelet drugs on the course of ICH is controversial. In this study, our aim was to determine the effects of previous antiplatelet therapy on admission hematoma volume and hematoma expansion in patients with spontaneous ICH. METHODS A consecutive series of patients with a diagnosis of ICH who underwent brain computed tomographic (CT) scans within 12 hours of symptom onset and a follow-up CT scan within 72 hours were included in the study. Hematoma volume was calculated by using the ABC/2 method on admission and follow-up images. Univariate and multivariate analyses were performed to determine the independent role of antiplatelet use on baseline hematoma volume and hematoma expansion (defined as an increase in hematoma volume >12.5 mL or 33% of the baseline ICH volume). RESULTS A total of 153 patients were included in the study. Fifty-two (34%) patients were using antiplatelet drugs at the time of symptom onset. Antiplatelet users tend to have a larger baseline hematoma volume; however, this difference failed to reach statistical significance (P = .17). Antiplatelet therapy was found to be a significant determinant of substantial hematoma expansion, both in univariate and multivariate analyses (P < .01). CONCLUSIONS Previous antiplatelet use significantly contributes to hematoma expansion in patients with ICH.

Isolated Cortical Vein Thrombosis After Epidural Anesthesia: Report of Three Cases

ABSTRACT Cerebral venous thrombosis rarely develops after lumbar puncture and spinal anesthesia with accidental dural puncture, however, occurrence of isolated cortical vein thrombosis after epidural anesthesia is extremely rare. We report three cases who developed postural headache and isolated cortical vein thrombosis after epidural anesthesia. We postulate that intracranial hypotension is the cause of compensatory venous dilatation and resultant thrombosis.

Acute lumbosacral polyradiculoneuropathy heralding transformation to systemic lupus erythematosus in a patient with discoid lupus

Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disease with which a variety of neuropathic disorders have been associated. Among these, the acute inflammatory demyelinating polyradiculoneuropathy variant of Guillain–Barré syndrome has been well established. However, acute axonal lumbosacral polyradiculoneuropathy accompanied by albuminocytological dissociation in the cerebrospinal fluid has been extremely rarely reported in SLE. We report on a 47-year-old woman with discoid lupus presenting with acute onset of flaccid paraplegia. Extensive investigations suggested the diagnoses of axonal lumbosacral polyradiculoneuropathy and SLE. Treatment with intravenous methylprednisolone and cyclophosphamide resulted in clinical recovery. Development of immune-mediated polyneuropathy in a patient with discoid lupus should forewarn the clinician regarding transformation into the systemic form of the disease.

Posterior reversible encephalopathy and alexia without agraphia in a patient with Hashimoto's encephalopathy

Dear Editor, Hashimoto’s encephalopathy (HE) is a rare neurological disorder characterized by encephalopathy and high-serum antithyroid antibody concentrations [1]. Cases of HE presented with posterior reversible encephalopathy syndrome (PRES) have been reported before [2, 3]. PRES is characterized by headache, seizures, mental status change, aphasia, motor deficits and visual disturbances accompanied by predominantly posterior cerebral edema [4]. We report a case of HE presenting with PRES and alexia without agraphia that is a rare disconnection syndrome characterized by the loss of reading ability with the retention of writing and verbal comprehension [5]. A 55-year-old right-handed woman presented with headache, impairment of cognitive abilities, inability to read and visual hallucinations lasting for 2 months. Her past medical history was unremarkable except smoking for 31 years. On admission, physical examination showed no abnormal findings. There was no palpable goiter. A right homonymous hemianopia was detected on confrontation testing. Neuropsychiatric examination revealed lack of initiative, disorientation for time and place, impaired shortterm memory and dysarthria. Speech comprehension, repetition, right–left orientation, and finger naming were normal. She could identify and name visually presented objects, however, color naming was impaired. Although writing ability was normal, the patient was unable to visually recognize typed or written letters. There were no abnormal findings in laboratory data, including blood cell count, C-reactive protein, erythrocyte sedimentation rate, urine analysis, serum glucose, electrolytes, liver enzymes, calcium, magnesium, urea, creatinine and protein levels, syphilis serology, HIV antibody, tests for collagen vascular disorders, and tumor markers. The patient was euthyroid (thyroid-stimulating hormone 3.75 lIU/ml, reference range 0.35–4.99 lIU/ml; thyroxine 1.02 ng/dl, reference range 0.70–1.48 ng/dl; triiodothyronine 1.51 pg/ml, reference range 1.71–3.71 pg/ml). However, antimicrosomal antibodies were extremely elevated at a titer of 933.02 IU/ml (normal \5.61 U/ml), antithyroglobulin antibodies at 53.14 IU/ml (normal \4.11 IU/ml). Thyroid ultrasonography revealed heterogeneous echo imaging with diffuse hypoechogenicity suggestive of chronic thyroiditis. An electroencephalograph (EEG) showed diffuse slowing of background rhythms (5–7 s). Computerized perimetry documented a right homonymous hemianopia. Cerebrospinal fluid (CSF) analysis revealed an increased protein content (175 mg/dl, reference range 15–45 mg/dl) with normal glucose level and cell count, negative cytology and bacterial culture. T2-weighted and fluid-attenuated inversion recovery (FLAIR) magnetic resonance (MR) images of the brain showed cerebral atrophy and bilateral occipital increased signal within the cortex and the subcortical white matter which is more prominent on left, representing edema (Fig. 1a, b). The edema also extended to the left parietal and temporal lobes and the splenium of the corpus callosum. Apparent diffusion coefficient (ADC) maps showed increased signal intensity consistent with vasogenic edema. O. K. Yildiz (&) H. Segmen E. Bolayir S. Topaktas Department of Neurology, Cumhuriyet University School of Medicine, 58140 Sivas, Turkey e-mail: ozlemkayim@yahoo.com

Cerebral Venous Sinus Thrombosis Presenting as Transient Ischemic Attacks in a Case With Homozygous Mutations of MTHFR A1298C and CG677T

We report a case with recurrent, transient attacks of slurred speech, weakness, and numbness of the right half of the face and the right arm without seizure activity, accompanied by headache and double vision. Neurologic examination revealed bilateral papilledema and right abducens palsy. Brain magnetic resonance imaging revealed thrombosis of the dural venous sinuses and the cortical veins, with no evidence of parenchymal lesion. Homozygous mutations were found for methylenetetrahydrofolate reductase (MTHFR) A1298C and MTHFR CG677T. Anticoagulation with heparin and warfarin resulted in prompt cessation of the transient attacks, as well as the signs and symptoms of increased intracranial pressure. This report documents that, although rare, transient ischemic attacks can result from cerebral venous thrombosis.

The role of event-related potentials in subclinical cognitive dysfunction in essential tremor.

Summary Several studies have reported that patients with essential tremor (ET) may also have mild cognitive impairment. Event-related potentials (ERPs) involve cognitive processes in the brain. No detailed investigation has been conducted into auditory ERPs (AERPs) to detect the subclinical cognitive dysfunction in patients with ET. Therefore, this study aimed to clarify the usefulness of AERPs in ET-related cognitive impairment. The AERPs were obtained by using an oddball paradigm in 27 patients with ET and 27 age-matched control subjects. The mean latency and amplitude of the ERPs were compared between the two groups. The correlation between disease duration and the mean values of all components of the potentials was assessed. The association between tremor severity and potentials was also evaluated. The patients with ET showed significant prolongation of all components of the ERP latencies at each electrode site. The N200 and P300 amplitudes were reduced in the ET group. Interestingly, the significant prolongation of N100 and N200 latencies correlated with disease duration, and N200 latencies appeared significantly longer in patients with severe tremor. Significant differences were found between the components of the AERPs and tremor severity and disease duration. This finding implies that ERPs may be useful in evaluating the cognitive functions in ET and that those AERP abnormalities may appear before clinical presentation.

Monocyte/high-density lipoprotein ratio predicts the mortality in ischemic stroke patients

OBJECTIVE The inflammatory process is a very important stage in the development and prognosis of acute ischemic stroke (AIS). The monocyte to high-density lipoprotein (HDL) ratio (MHR) is accepted as a novel marker for demonstrating inflammation. However, the role of MHR as a predictor of mortality in patients with AIS remains unclear. METHODS We retrospectively enrolled 466 patients who were referred to our clinic within the first 24hours of symptom presentation and who were diagnosed with AIS between January 2008 and June 2016. Four hundred and eight controls of similar age and gender were also included. The patient group was classified into two groups according to 30-day mortality. The groups were compared in terms of monocyte counts, HDL, and MHR values. RESULTS The patient group had significantly higher monocyte counts and lower HDL levels; therefore, this group had higher values of MHR compared to controls. Additionally, the monocyte count and MHR value were higher, and the HDL level was lower in non-surviving patients (p<0.001). The MHR value was also observed as a significant independent variable of 30-day mortality in patients with AIS (p<0.001). The optimum cut-off value of MHR in predicting the 30-day mortality for patients with AIS was 17.52 (95% CI 0.95-0.98). CONCLUSION Our study demonstrated that a high MHR value is an independent predictor of 30-day mortality in patients with AIS.

Sydenham chorea and Hashimoto thyroiditis: an unusual association.

Sydenham chorea is an immune-mediated neuropsychiatric disorder associated with group A β-hemolytic streptococci infection. The authors present a 12-year-old female patient with Sydenham chorea and Hashimoto thyroiditis. Although Hashimoto thyroiditis has been associated with other autoimmune disorders, the association of Sydenham chorea and Hashimoto thyroiditis has not been previously reported. Immunological processes are suggested to be implicated in the pathogenesis of this association; however, the exact mechanism remains unclear.

The Effect of Eosinopenia on Mortality in Patients with Intracerebral Hemorrhage

INTRODUCTION Inflammation may determine the prognosis of intracerebral hemorrhage (ICH), which has high mortality and morbidity rates. Recent studies have increasingly demonstrated eosinopenia as a prognostic factor, particularly in bacteremia, chronic obstructive pulmonary disease, and myocardial and cerebral infarction. Nonetheless, its significance regarding the determination of prognosis in patients with ICH has not yet been clarified. MATERIALS AND METHODS Our study included 296 patients who presented to our clinic within 24 hours of the onset of symptoms and who were diagnosed with ICH between January 2008 and June 2016, along with 180 age- and sex-matched controls. During their hospitalization, 120 of these 296 patients died. Patients and controls were compared in terms of neutrophil count/percentage and eosinophil count/percentage; these were also compared between nonsurviving and surviving patients. The significance of eosinopenia in predicting mortality was also evaluated. RESULTS Patients had a significantly higher neutrophil count/percentage and a significantly lower eosinophil count/percentage than controls; these results were similar between nonsurviving and surviving patients (P < .001). Consequently, the patient group was divided into 4 subgroups depending on the presence of eosinopenia and/or neutrophilia. The mortality rate was highest (62%) in the group that had both eosinopenia and neutrophilia. Univariate and multivariate logistic regression analyses indicated that neutrophilia and eosinopenia were independent predictors of mortality in ICH (P = .002; P = .004) DISCUSSION: These results indicate that eosinopenia can occur in patients with ICH and that although the mechanism is unclear, eosinopenia is closely associated with mortality in these patients, particularly when accompanied by neutrophilia.