Sebnem Bicakci

Recurrent headache and MRI findings in systemic lupus erythematosus.

BACKGROUND Headache in patients with systemic lupus eryhtematosus (SLE) is considered a common neurological finding, although the relationship is unclear. Another obscure point is the relationship between headache and neuroradiologic findings in these patients. AIM In this study, we aimed to evaluate the correlation between headache characteristics and intracranial lesions in SLE patients. METHODS AND RESULTS Forty-eight SLE patients were chosen from those referred to our clinic depending on the American Collage of Rheumatology (ACR) criteria at the same time or after the diagnosis of SLE. Headache classification was done regarding the ICD-II criteria in the patients. Headache severity was assessed by visual analog scale (VAS), and subjects with VAS > or = 4 were included in the study. Patients were divided into two groups according to magnetic resonance imaging (MRI) findings: abnormal MRI (lesion positive) and normal MRI (lesion negative). On MRI, intracranial lesions were detected in 37.5% (n = 18) of the patients, and no lesion was found in 62.5% (n = 30). Headache characteristics were as tension type in 54.1% (n = 26) and migraine like in 39.6% (n = 19) of all patients. Imaging findings were mostly as periventricular and subcortical focal lesions, ranging from 3-22 mm in diameter. A significant correlation was found between abnormal MRI findings with advanced age and prolonged disease duration (p = 0.018, p = 0.016). CONCLUSIONS As a conclusion, a detailed neurologic evaluation and radiologic investigation, if necessary, should be performed in SLE patients with prolonged disease and advanced age, regardless of headache characteristics.

Transient parkinsonism: Induced by progesterone or pregnancy?

We report on the development of transient parkinsonism after progesterone injection in a pregnant patient with a risk of abortion. Etiological possibilities are discussed, including pregnancy itself, possible toxic effects of the dead fetus, and progesterone injection. Progesterone‐induced parkinsonism seems the most likely diagnosis in this case.

The Incidence and the Risk Factors of Silent Embolic Cerebral Infarction After Coronary Angiography and Percutaneous Coronary Interventions

Silent embolic cerebral infarction (SECI) is a major complication of coronary angiography (CAG) and percutaneous coronary intervention (PCI). Patients with stable coronary artery disease (CAD) who underwent CAG with or without PCI were recruited. Cerebral diffusion-weighted magnetic resonance imaging was performed for SECI within 24 hours. Clinical and angiographic characteristics were compared between patients with and without SECI. Silent embolic cerebral infarction occurred in 12 (12%) of the 101 patients. Age, total cholesterol, SYNTAX score (SS), and coronary artery bypass history were greater in the SECI(+) group (65 ± 10 vs 58 ± 11 years, P = .037; 223 ± 85 vs 173 ± 80 mg/dL, P = .048; 30.1 ± 2 vs 15 ± 3, P < .001; 4 [33.3%] vs 3 [3.3%], P = .005). The SECI was more common in the PCI group (8/24 vs 4/77, P = .01). On subanalysis, the SS was significantly higher in the SECI(+) patients in both the CAG and the PCI groups (29.3 ± 1.9 vs 15 ± 3, P < .01; 30.5 ± 1.9 vs 15.1 ± 3.2, P < .001, respectively). The risk of SECI after CAG and PCI increases with the complexity of CAD (represented by the SS). The SS is a predictor of the risk of SECI, a complication that should be considered more often after CAG.

Green urine appearance in a patient with refractory status epilepticus due to Propofol infusion

DOI: 10.4328/JCAM.5327 Received: 14.10.2017 Accepted: 16.10.2017 Publihed Online: 16.11.2017 Printed: 01.03.2018 J Clin Anal Med 2018;9(2): 150-2 Corresponding Author: Turgay Demir, Department of Neurology, Cukurova University, Faculty of Medicine, Adana, 01330, Turkey. GSM: +905064004722 E-Mail: tdemir@cu.edu.tr Abstract The color change in urine may result from various factors such as drugs, stains, foods, infections, metabolic diseases and structural abnormalities. When Status Epilepticus can not be controlled with the benzodiazepine and at least one antiepileptic drug treatments, it is defined as refractory status epilepticus. Propofol, which is a drug that may be used for the treatment of refractory status epilepticus. We present a 28-year-old male with refractory status epilepticus who experienced a color change in urine to green due to propofol infusion. Green urine discoloration is a benign and very rare side effect of propofol.

A Very Rare Type of Neuralgia: Nervus Intermedius Neuralgia

The nervus intermedius, which is the peripheral part of the facial nerve, has visceral motor and special sensory fibers. First described in 1563, the nerve was referred to as “portio media inter comunicantem faciei et nervum auditorium” by Heinrich August Wrisberg in 1777 (1). The word “intermedius” is used because of the intermediate position of the nerve between the superior part of the vestibular nerve and the facial nerve (2). The nervus intermedius enters the internal auditory meatus immediately after leaving the brainstem and travels with the facial nerve through the facial canal (Figure 1). According to the diagnostic criteria of the International Classification of Headache Disorders, 3rd edition (beta version), nervus intermedius (facial nerve) neuralgia (NIN) is a rare disorder characterized by brief paroxysms of pain felt deep in the auditory canal that sometimes radiates to the parieto-occipital region (3).

Diagnostic value of neuroimaging in patients with primary headaches

AbstractEmergencies in headache, requiring prompt diagnosis and treatment, are frequently important issues for the physician. Neuroimaging with computed tomography and magnetic resonance in the differential diagnosis of headache emergencies is the major diagnostic tool. To determine the differential diagnostic contribution of the imaging techniques, 275 consecutive patients with migraine with or without aura, tension type headache and other types of headaches were included in this study. The diagnoses were based on the International Headache Societys (IHS-2004) criteria. Regardless of the clinical diagnosis, CT and/or MRI images were performed in all cases.Abnormal images were encountered in 9.9% (27 of 275) of patients with headache. These findings were serious in 14 cases and led to the diagnosis of lacunar infarct, vascular malformation, mass lesion, calcification, subarachnoidal hemorrhage and leptomeningitis, while they were nonspesific in the other 13 patients (cortical or cerebral artophy and smal...

Worsening of SUNCT syndrome after frontal head trauma

SUNCT syndrome is a rare condition characterized by a short-lasting periorbital pain associated with autonomic symptoms. In this paper, a 50-year-old man with SUNCT syndrome is presented. Preexisting SUNCT syndrome in this patient worsened following mild frontal head trauma. Despite various medication regimes and trigeminal nerve block, complete recovery was not achieved at the end of one year follow-up period.