Serkan Ozben

ULTRASOUND ELASTOGRAPHIC EVALUATION IN THE DIAGNOSIS OF CARPAL TUNNEL SYNDROME: INITIAL FINDINGS

The purpose of this study was to investigate ultrasound (US)- and US elastography-detected changes in the median nerve of patients with carpal tunnel syndrome (CTS). Seventy-four wrists of 41 female patients with CTS (mean age, 47.73 ± 11.45 y) and 45 wrists of 24 asymptomatic female controls (mean age, 42.83 ± 10.66 y) were examined with US and US elastography. Electromyography results confirmed the diagnosis of CTS in the patients. The mean median nerve perimeter (MN-P = 15.26 ± 2.18 mm) and median nerve cross-sectional area (MN-CSA = 11.81 ± 4.05 mm²) of patients with CTS were higher than those of controls (12.08 ± 1.54 mm and 7.76 ± 1.40 mm², respectively) (p < 0.05). Mean tissue strain was lower in the patients with CTS (0.094 ± 0.045 than in the controls (0.145 ± 0.068) (p < 0.05). The most sensitive cut-off value for tissue strain was 0.0635, and the most specific was 0.19. US and US elastography, in addition to electromyography, proved to be beneficial in the diagnosis of CTS. US elastography is a new technique that may well find a place in the diagnosis of nerve entrapment syndromes.

Relationship between visual hallucinations and REM sleep behavior disorder in patients with Parkinson's disease

OBJECTIVES REM sleep behavior disorder (RBD) has been documented to precede or to co-occur with Parkinsons disease (PD). Parkinsons disease is one of the most common neurological conditions associated with visual hallucinations. Cognitive dysfunction is present in PD, even at the early stages of these diseases. In this study we aimed to investigate the relationship between visual hallucinations and RBD in patients with idiopathic Parkinsons disease (IPD). Additionally, we evaluated the association of the cognition and the pattern of cognitive impairment with VHs and RBD, effects of factors like duration and severity of the disease and duration of levodopa usage. PATIENTS AND METHODS Seventy-nine patients, diagnosed as PD, were included the study and then, patients were divided into four groups; with RBD and VHs (group 1), with RBD but no VHs (group 2), with VHs but no RBD (group 3), without RBD and VHs (group 4). We compared each group with the others according to demographic characteristics and neuropsychological test scores. RESULTS Of all patients, in 46% (n=36) RBD and in 48% (n=38) VHs were observed. Our study established VHs in 58% of patients with RBD, and RBD in 55% of patients with VHs. However, due to a 40% incidence of VHs in patients without RBD, RBD and VHs were not found to be correlated. All of the neuropsychometric test scores did not reveal significant difference between groups. CONCLUSION Although it seems like there is a small association between RBD and VHs in our patients, it was not significant. Group 1 presented with significantly worse scores in UPDRS total scores and I, II subscores.

Optic disc and retinal nerve fiber layer parameters as indicators of neurodegenerative brain changes in patients with obstructive sleep apnea syndrome

PurposeRetina is a unique part of the central nervous system (CNS) for visualizing the processes of axonal and neuronal degeneration. Optical coherence tomography (OCT) allows direct visualization and measurement of retinal nerve fiber layer (RNFL) thickness, macular volume, and optic disc (OD) parameters. One of the disorders associated with atrophy in different brain regions is obstructive sleep apnea syndrome (OSAS). In the present study, we aimed to determine OD and RNFL changes measured by OCT for investigating the progress of neurodegeneration development in OSAS, excluding all the other conditions that can directly affect RNFL thickness and optic nerve parameters.MethodsBoth eyes of 101 patients with OSAS and 20 controls were investigated by OCT. Full-night polysomnography (PSG) and ophthalmologic examination including automated visual field (VF) examination and OCT were performed in all of the patients.ResultsAccording to the OSAS grading, patients were grouped as mild (n = 15), moderate (n = 27), and severe (n = 59). We found significant decrease in RNFL thickness only in the patients with severe OSAS compared with the other groups and decreased macular ganglion cell thickness in the severe OSAS group compared with the control group. VF parameters were significantly worsened in all the OSAS subgroups compared to the control group. We found different data such as normal or increased optic nerve parameters as result of subtle OD edema, which may mask possible peripapillar axonal loss.ConclusionsWe think that evaluation of neurodegeneration in OSAS is not always possible by examining OD and RNFL because there are difficulties due to the confounding issues of cerebral atrophy and OD edema.

Prevalence and risk factors of epilepsy among school children in eastern Turkey.

Epilepsy is a serious chronic brain disorder of childhood. We performed a cross-sectional prevalence study, determined the prevalence of childhood epilepsy, and identified the significance of certain risk factors for epilepsy among 1625 primary-school students aged 6-14 years, living in the center of Kars province. A questionnaire was prepared according to the definitions and principles of the Commission on Epidemiology and Prognosis, International League Against Epilepsy. Twenty-two children were diagnosed as epileptic. The point prevalence of active epilepsy in males was 4.9/1000, and in females 12.4/1000, representing a total of 8.6/1000. The cumulative prevalence in males was 11.0/1000, and 16.1/1000 in females, representing a total of 13.5/1000. Febrile convulsions, family history of epilepsy, serious maternal illness during pregnancy, a history of head trauma, antenatal/postnatal problems, and a history of neonatal jaundice were statistically significantly related to the development of epilepsy.

Chorea as the presentating feature of neurosyphilis

Syphilis is still a significant public health problem in developing countries. Although chorea is a very rare manifestation of neurosyphilis, it might be on occasions the initial symptom. This report presents a patients with neurosyphilis who had chorea as the initial presenting symptom.

Relationship of olfactory function with olfactory bulbus volume, disease duration and Unified Parkinson’s disease rating scale scores in patients with early stage of idiopathic Parkinson’s disease

We aimed to investigate the relationship between olfactory function and olfactory bulbus (OB) volume, disease duration and Unified Parkinsons disease rating scale (UPDRS) scores in early stage idiopathic Parkinsons disease patients. The University of Pennsylvania Smell Identification Test (UPSIT) was used for the evaluation of olfactory function. UPSIT scores for patients with Parkinsons disease were significantly lower than controls. There was no significant difference between stage 1 and stage 2 patients. OB volumes were higher in stage 1 and 2 patients than controls, but there was no statistical difference between the three groups. No significant correlation was found between UPSIT and UPDRS total scores, nor between UPSIT scores and disease duration in stage 1 and 2 patients. According to our results, we propose UPSIT be used as a screening test to diagnose presymptomatic patients, but not OB volumes.

Advanced oxidation protein products and ischaemia-modified albumin in obstructive sleep apnea

Several studies have shown that obstructive sleep apnea increases incidence of cardiovascular morbidity and mortality. The high systemic oxidative stress in obstructive sleep apnea has been considered as a major pathogenic mechanism leading to cardiovascular disease. Oxidative stress‐related lipid and DNA oxidation in obstructive sleep apnea have been reported in the previous studies. In contrast, there is limited and contradictory information regarding protein oxidation in obstructive sleep apnea patients such as ischaemia‐modified albumin and advanced oxidation protein products. Therefore, we aimed to investigate plasma ischaemia‐modified albumin and advanced oxidation protein products and their correlation with total oxidative status and total antioxidative capacity in the obstructive sleep apnea patients.

The Second Lumbrical–interosseous Latency Comparison in Carpal Tunnel Syndrome

Summary: Carpal tunnel syndrome (CTS) is the most common nerve entrapment syndrome. Electromyogram (EMG) is beneficial in supporting the diagnosis of CTS. We compared standard nerve conduction studies of EMG with median and ulnar motor nerve conduction studies from recordings of second lumbrical and interosseal muscles in supporting the diagnosis of CTS. In this study, a total of 242 patients were included, and a total of 375 hands were involved. Electrophysiologic CTSs were diagnosed in 283 hands of 161 patients. A significant association between second lumbrical–interosseal distal motor latency difference (2LI-MDLD) and CTS was found in this study. Statistically, every 0.1 increment in the 2LI-MDLD value was observed to increase the risk of disease by 1.74. When a cut-off of ≥0.5 for 2LI-MDLD is taken for predicting CTS, the sensitivity of the test is found to be 89.4% and specificity 84.4%. When the cut-off value for motor distal latency of second lumbrical of the median nerve (2L-MDL) was taken as ≥3.15 milliseconds in the diagnosis of CTS, the sensitivity of the test was 87.3%, and specificity 70.7%. Previous reports and our findings suggest that in CTS diagnosis, not only 2LI-MDLD value but also 2L-MDL value are easy and rapidly obtainable and offer additional information in very severe cases where compound muscle action potentials (CMAP) cannot be recorded from the abductor pollicis brevis (APB) muscle.

Cerebral Venous Sinus Thrombosis: Gender Differences in Ten Years Experience

Cerebral venous sinus thrombosis: gender differences in ten years experience Objective: Cerebral venous sinus thrombosis (CVST) is an uncommon subtype of stroke. CVST is much more common in women than men with a ratio of three to one. This women preponderance is attributed to gender-specific risk factors (GSRF). In many patients, symptoms develop over days or weeks. In some patients, clinical presentations are nonspesific. Patients and Methods: We reviewed the records of patients with CVST treated at Neurology department of Haseki Training and Research Hospital between 2001-2011, which diagnoses were confirmed with cranial magnetic resonance imaging (MRI) and magnetic resonance venography (MRV). Thirty- four patients were included the study. Women/men ratio was 3.25/1. We analyzed the demographic features, comorbid conditions, clinical presentation, neuroradiological findings. Results: Thirty- four patients were included the study. Headache was present in all patients and it was present as isolated in 47.1% (n=16) of the patients. In 52.9% (n=18) of the patients onset of the symptoms were subacute, 29.4% (n=10) chronic, 17.6 (n=6) acute. Of all patients, 76.5% (n=26) were women. Transverse sinus was the mostly affected sinus as either isolated or with the other CSVT in both groups (in 20 women and 8 men). The most common presentation symptom (43.78%) in women was headache whereas; it was intracranial hypertension (34.78%) in men. Half of our women patients with GRSF; 7 (26.92%) women were oral contraceptives user and 5 (15.38%) women were in pregnancy or puerperium period. Conclusion: We have found differences between women and men in the presentation and risk factors.

Valvular heart disease in patients with Parkinson’s disease treated with pergolide, levodopa or both

Cardiac valvulopathy has been reported in patients with Parkinsons disease treated with pergolide. The aim of this study was to clarify the frequency and severity of valvular heart disease (VHD) in patients treated with pergolide, levodopa or both. We evaluated VHD by transthoracic echocardiography in 25 patients who were taking pergolide, 29 patients taking levodopa and 20 patients taking both levodopa and pergolide. All groups were compared with two separate age-matched control groups. There was no increase in the frequency of any type of echocardiographically-significant valvulopathy in the pergolide groups. Echocardiographically significant aortic regurgitation was found in 8% of the patients in the pergolide group and in 37.9% of the patients in the levodopa group. There was no correlation between VHD and pergolide dose, cumulative dose or duration of therapy. The mean pergolide dose was 2.6+/-1.4 mg/day in the pergolide monotherapy group. We did not find any unequivocal evidence that pergolide causes significant valvular regurgitation. However, the mean pergolide dosage in our study was lower than in previous studies.