Sezer Sener Komsuoglu

Doppler evaluation of left ventricular diastolic filling in Behçet's disease

Although cardiac involvement such as pericarditis, myocarditis, coronary arteritis and valvular disease in Behçets disease occurs, few studies have assessed left ventricular diastolic function. This study assesses the prevalence of both systolic and diastolic left ventricular dysfunction in patients with Behçets disease who have no clinical cardiac manifestations. Twenty-two patients (12 women and 10 men, mean age 34 +/- 2.4 years) underwent full clinical examination, electrocardiography, M-mode, two-dimensional, and Doppler echocardiography. The mean disease duration was 5 +/- 4.7 years (range, 1 month-16 years). As age and sex-matched control group of 20 healthy subjects was also studied. Prolonged isovolumic relaxation time, prolonged deceleration time, reversal of the early and late peak transmitral diastolic flow velocities, late peak transmitral diastolic flow velocities (E/A ratio) and increased atrial filling fraction were noted in five patients. It is concluded that left ventricular dysfunction occurs frequently in patients with Behçets disease and Doppler echocardiography may be valuable in detecting diastolic filling abnormalities as an early sign of cardiac involvement.

Silent cerebral infarction in chronic heart failure: Ischemic and nonischemic dilated cardiomyopathy

Objectives Patients with dilated cardiomyopathy (DCM) may have a high incidence of clinically asymptomatic silent cerebral infarction (SCI). Prevalence of SCI and its risk factors may differ between ischemic and nonischemic DCM. The purpose of this study was to evaluate prevalence and related parameters of silent cerebral infarction in patients with ischemic and nonischemic DCM. Methods Patients with ischemic and nonischemic DCM (53 male, 19 female, aged 62 ± 12 years) were included in the study. Etiology of DCM was ischemic in 46 and nonischemic in 26 patients. Fifty-six age- and gender-matched healthy volunteers served as a control group for comparison of SCI prevalence. Results Prevalence of SCI was 39%, 27%, and 3.6% in ischemic, nonischemic DCM, and control group, respectively (ischemic DCM vs control group, p < 0.001, nonischemic DCM vs control group, p = 002). In patients with nonischemic DCM, the mean age of the subjects with SCI was significantly higher than that of subjects without lesions (67 ± 5 years vs 53 ± 13, p < 0.001), whereas in ischemic DCM NHYA Functional Class was statistically higher in patients with SCI than without SCI (p = 0.03). In both groups, patients with SCI had lower systolic functions than patients with normal MRI findings. In multivariable logistic regression analysis, restrictive type of diastolic filling pattern was found as an independent factor for SCI occurrence on the whole patient population (OR: 16.5, 95% CI: 4.4–61.8, p < 0.001). Conclusion SCI is common in patients with both ischemic and nonischemic DCM. In univariate analysis, both groups have similar systolic and diastolic characteristics in the occurrence of SCI. Logistic regression analysis revealed that restrictive diastolic filling pattern is an independent risk factor in the occurrence of SCI for the whole patient population.

Jervell and Lange-Nielsen Syndrome: Neurologic and Cardiologic Evaluation

Recurrent syncope, malignant ventricular arrhythmias, and sudden death are complications of the long QT syndrome (LQTS). Two well-known syndromes with long QT intervals are known. The Jervell and Lange-Nielsen syndrome (JLNS) is characterized by prolongation of the QT interval, deafness, and autosomal-recessive inheritance, and the Romano-Ward syndrome is characterized by a prolonged QT interval, autosomal-dominant inheritance, and no deafness. In the present study assessment was performed of the diagnostic importance of the ventricular derepolarization parameters, clinical features, and prevalence of JLNS among 132 children with congenital hearing loss (CHL). In the CHL group the mean QT, QTc, JT, and JTc intervals and the dispersion values (QT-d, JT-d, QTc-d, and JTc-d) were significantly longer than those of control subjects (n = 96) (P < 0.05). Patients with CHL and JLNS (n = 5) had significantly longer mean values of QT, QTc, JT, and JTc intervals and dispersion values than those of CHL without JLNS (n = 127) and control subjects (P < 0.05). The results suggest that assessment of ventricular derepolarization parameters in children with CHL will be helpful in the early detection of JLNS because infants with CHL cannot accurately describe the symptoms of syncope.

Inverse Relationship Between Nonverbal Intelligence and the Parameters of Pattern Reversal Visual Evoked Potentials in Left-Handed Male Subjects: Importance of Right Brain and Testosterone

The relationships between latencies of visual evoked potentials (VEPs) and nonverbal intelligence test scores (IQs from Cattells Culture Fair Intelligence Test) and correlations between serum testosterone level and VEP latencies were studied to examine the neural speed hypothesis of intelligence and its hormonal mechanisms in left-handed male subjects (Geschwind Scores). In accordance with the speed theory of intelligence, N1 and P1 latencies (and amplitudes) were found to be inversely related to IQ. However, this was true only for the right brain; the left brain did not contribute to this relationship. There was an inverse relationship between serum testosterone level and P1 latency; left minus right N1 latency, depending on N1 latency from right brain, linearly increased with testosterone. It was concluded that nonverbal intelligence largely depends on speed of information processing only by the right brain, not by the left brain in left-handed male subjects. This may have been created by testosterone in these subjects. Inconsistencies in the IQ literature concerning the speed hypothesis of intelligence may be explained by differences in cerebral lateralization.

Inverse relationship between the size of pattern reversal visual evoked potentials from the left brain and the degree of left-hand preference in left-handed normal subjects: importance of the left brain.

The relation of the degree of left-hand preference to pattern reversal visual evoked potentials (VEPs) from right and left brain was studied in male left-handers. The degree of the left-hand preference was assessed by the Waterloo Handedness Questionnaire. Visual stimuli consisted of black and white checkerboard patterns generated on a TV screen. VEPs were simultaneously recorded from occipital leads of the right and left hemispheres. The degree of left-hand preference was found to be inversely and significantly related to size of VEPs only from left brain, not from right brain. That is, the conduction time, amplitude, duration, and area of N1-P1 waves linearly decreased as the degree of left-hand preference increased. These results were in accord with the testosterone hypothesis of cerebral lateralization, but not compatible with the right shift theory of handedness. It was concluded that visuomotor control by the left brain would be the main biological correlate of left-hand preference with regard to sensorimotor and cognitive functions.

Evaluation of Normal Appearing White Matter in Multiple Sclerosis

PurposeThe aim of this study was to determine diffusion magnetic resonance imaging (MRI), magnetization transfer (MT) imaging and multivoxel MR spectroscopy findings in plaques, periplaque white matter and normal appearing white matter (NAWM) regions in multiple sclerosis (MS) and to correlate the findings with the expanded disability status scale (EDSS).MethodsA total of 30 patients with MS and 30 healthy control subjects were studied and apparent diffusion coefficient (ADC) values, MT ratio (MTR), N-acetyl-aspartate/creatine (NAA/Cr) and choline/creatine (Cho/Cr) ratios were measured in plaques, periplaques and NAWM regions and compared with the control subjects.ResultsThe MTR and NAA/Cr ratio were decreased more in plaques than periplaques and NAWM, in contrast ADC values and Cho/Cr ratios were highest in plaques and higher in periplaques than in NAWM. Decreased MTR and NAA/Cr in NAWM demonstrated moderate inverse correlations (r = − 0.604, p < 0.001 and r = − 0.494, p < 0.001, respectively) while Cho/Cr ratios and ADC of NAWM demonstrated weak linear correlations (r = 0.370, p = 0.004, r = 0.297, p = 0.021 respectively) with EDSS.ConclusionsThe MS, MTR and MR spectroscopy findings were found to be useful for detecting subtle abnormalities in NAWM. Although ADC values were significantly altered in plaque and periplaque regions a significance difference was not found in NAWM.

Does metoprolol inhibit the cortical spreading depression? Acute effects of systematic metropol on CSD in rats

Cortical spreading depression (CSD) is supposed to be the underlying biological basis of the migraine aura. Metoprolol was proven to be effective in migraine prophylaxis in clinical trials, but its mechanism of action has not been clarified yet. We studied direct effects of metoprolol on a continuous CSD induction model in rats. Six adult Wistar rats were anaesthetized with intraperitoneal thiopental (50 mg/kg). CSD was induced with application of 1 M KCL through a burr hole into the left frontal dura-mater, and recorded by an Ag/AgCl DC electrode on the left parietal dura-mater. After a basal recording of CSD induction during the first 40-min period, metoprolol (5 mg/kg) was infused within 4 min. Then DC recordings were maintained for a further 120 min. Any significant differences in total number and duration of CSDs before and after metoprolol administration were not detected. This study suggests that the mode of action of metoprolol in prophylaxis is not via direct CSD inhibition.

Extracephalic Stabbing Pain Temporally Related to Cephalic Ones

A 23‐year‐old woman consulted with the complaint of short‐lasting, severe stabbing headaches and mild‐to‐moderate degree near‐daily migrainous headaches. Further questioning revealed that she also had stabbing pain on both ipsilateral hand and calf. Stabs on the hand were time‐locked to cephalic ones and stabs in the calf were alternating with the ones in the hand. Dizziness and scotomas were accompanying symptoms to cephalic ones and paresthesia was the accompanying symptom in the hand. Patients cephalic and extracephalic stabbing pains responded to indomethacine and daily headaches responded to prophylactic sodium valproate therapy. The stabs were felt in the head; hand and calf are considered as the parts of a whole. Along with its accompanying symptoms, stabbing pain may be the result of complex interactions in central nervous system.

A case of acute encephalopathy after iohexol lumbar myelography

A case of acute encephalopathy after lumbar myelography is reported in a female aged 26 years. Fourteen hours after the procedure, the patient developed coma (GCS 6) and had generalized slowing of EEG activity. This state lasted about 12 h, followed by gradual and full recovery.

Epilepsia partialis continua following pertussis infection.

Clinical, electrophysiological and CT findings of a patient with epilepsia partialis continua following pertussis infection are presented. The EEG showed lateralized abnormal slow waves and CT revealed global atrophy around the Sylvian fissure. The findings favor the primary role of the cerebral cortex in EPC.