Sibel Benli

Personality, depression, and anxiety as risk factors for chronic migraine.

This article evaluated risk factors such as personality, depression, and anxiety in relation to migraine transformation in Turkish patients. Thirty-seven patients with chronic migraine and 50 patients with episodic migraine were investigated. The scores for hysteria, hypochondriasis, psychasthenia, depression, and social introversion were all significantly higher in the chronic-migraine group than the episodic-migraine group. Seventy-four percent of the chronic-migraine group and 26% of the episodic-migraine group had depression. Eighty percent of the chronic-migraine group and 36% of the episodic-migraine group had anxiety. The results suggest that depression, anxiety, and personality characteristics such as hysteria, hypochondriasis, psychasthenia, depression, and social introversion may be associated with chronic migraine in Turkish patients.

Akinetic mutism after fourth ventricle choroid plexus papilloma: treatment with a dopamine agonist

BACKGROUND Akinetic mutism is a behavioral state wherein a patient seems to be awake but does not move or speak. Several patients are reported to have developed mutism after posterior fossa surgery. We present a patient who developed akinetic mutism after total excision of a choroid plexus papilloma of the fourth ventricle, and who was treated with bromocriptine. CASE DESCRIPTION An 18-year-old woman was admitted with akinetic mutism, which had developed 6 days after posterior fossa surgery. She had had no neurologic deficit in the first 5 days after surgery and could communicate with her family. Despite antioedematous therapy and daily lumbar punctures to drain cerebrospinal fluid, there was no clinical improvement after she entered the akinetic mute state. Brain magnetic resonance revealed ventriculomegaly; brain single photon emission computed tomography revealed bilateral reduction of perfusion in the frontal region. Because daily lumbar drainage did not result in clinical improvement, shunt placement was not considered. Bromocriptine therapy was begun at a dose of 2x2.5 mg; 24 hours later, the patient started to speak and move her upper extremities. Further improvement occurred over the following week when the dose was increased to 3x2.5 mg. Bromocriptine was replaced with a placebo to determine whether the neurologic improvement was caused by the medicine. The patients neurologic status deteriorated progressively; therefore, bromocriptine was restarted and she was discharged from the hospital. During the 6 months of follow-up, the patient has remained in good health. CONCLUSIONS The etiology of akinetic mutism is not clear. Monoaminergic pathways, particularly dopaminergic cell groups, are most probably involved in this syndrome, because bromocriptine has a dramatic effect on these patients, as demonstrated in our case.

Is low blood magnesium level associated with hemodialysis headache

Objective.—The aim of this study was to evaluate the prevalence, demographic, clinical features, and possible risk factors for hemodialysis headache (HDH).

MRI of neurologic complications in end-stage renal failure patients on hemodialysis: pictorial review

Abstract End-stage renal disease patients who have been on long-term hemodialysis tend to develop central nervous system complications. The most common neurologic complications in this patient group include white matter changes, cerebral atrophy, osmotic demyelination syndrome, dialysis encephalopathy, hypertensive encephalopathy, intracranial hemorrhage, infarct, sinus thrombosis, and infection. Clinical evaluation of these patients is somehow complicated and MRI is important before establishment of the therapy. The purpose of this article is to illustrate the range of MRI findings of neurologic complications in end-stage renal failure patients on hemodialysis with etiologic factors.

Bilateral facial nerve enhancement demonstrated by magnetic resonance imaging in Guillain–Barre Syndrome

Guillain–Barré syndrome (GBS) is an acute inflammatory demyelinating peripheral nerve disorder. It is known that gadolinium enhancement on magnetic resonance imaging (MRI) reflects alteration of the blood–nerve barrier secondary to inflammation. Enhancement of the cauda equina roots with gadolinium on lumbosacral magnetic resonance imaging have been demonstrated in several reports. Although about 50% of GBS patients clinically exhibit facial nerve involvement, it has never been demonstrated on MRI. We aimed to observe facial nerve involvement in a GBS patient who has prominent facial diplegia. With the guidance of the literature, we predict that MRI in selected GBS patients may be an adjunct tool for the clinician in both diagnosis and monitoring the treatment response.

Angiotensin I‐Converting Enzyme Gene (I/D) Polymorphism in Patients With Migraine

In addition to the wide expression in many tissues including vascular endothelial cells, production of angiotensin II and degradation of bradykinin may indicate that angiotensin‐converting enzyme could be involved in vascular tension and blood pressure. It has been reported that the deletion allele of the angiotensin‐converting enzyme gene is associated with increased serum angiotensin‐converting enzyme levels and linked to cerebrovascular diseases. In this study, the possible association of migraine with aura with the angiotensin‐converting enzyme deletion–deletion (DD) and the angiotensin–converting enzyme insertion–deletion (ID) genotype was investigated in Turkish patients. To investigate the role of the angiotensin‐converting enzyme I/D polymorphism in Turkish patients with migraine with aura, we analyzed the I/D genotype of 53 patients with that disorder. Twenty‐two control subjects, who are volunteer Turkish patients without migraine, were included in the study. The frequency of the angiotensin‐converting enzyme D/D genotype was statistically significant more frequent in patients with migraine with aura (81.1%) than in controls (59.1%) (P < .05). No differences were found regarding the I/I genotype and the I/D genotype between the 2 groups (P > .05). The results of our study revealed that the angiotensin‐converting enzyme D/D genotype was more frequent in patients with migraine with aura than in controls. This might suggest that the angiotensin‐converting enzyme D/D genotype may be a genetic risk factor for migraine with aura in Turkish patients.

A diagnostic challenge of Parkinson's disease: Intractable hiccups

Parkinsons disease is a common neurodegenerative disorder and the diagnosis depends mostly on clinical assessment so it is important to be aware of less common symptoms of the disease for correct diagnosis and therapy. We describe a patient with intractable hiccups as a very unusual presentation of Parkinsons disease.

Abnormal diffusion-weighted imaging findings in an adult patient with acute cerebellitis presenting with a normal magnetic resonance imaging.

Acute cerebellitis is an unusual central nervous system complication of infectious disease often due to viral etiology. Diagnosis is aided by neuroimaging studies, actually by magnetic resonance imaging in the first place, which shows increased signal intensity on T2-weighted images. However, conventional magnetic resonance imaging may be unrevealing in some of the cases, and additional workup such as single photon emission computed tomography and diffusion-weighted imaging may be required. We present a case of acute cerebellitis in a 35-year-old woman diagnosed by diffusion-weighted imaging.

Spontaneous intra‑cerebral hemorrhage: A retrospective study of risk factors and outcome in a Turkish population

Background and Purpose: Stroke, which remains the third leading cause of death after heart disease and cancer in developed countries, is a disorder causing permanent neurologic disability. Even though, hemorrhagic strokes are seen less than the ischemic type, they are more fatal. We studied the risk factors for spontaneous intra-cerebral hemorrhage (ICH) to direct the proper preventive treatment modalities and the effects of these factors on mortality as well as applied therapeutic strategies on survival. Materials and Methods: The archive records of 106 patients (60 male, 46 female) who were diagnosed with spontaneous ICH in Baskent University Hospital, Ankara, between January 2003 and September 2008, were assessed retrospectively. Results: The mean age was found as 62.5. The most frequent risk factor was hypertension (73.5%); 69.2% of these hypertensive patients had uncontrolled blood pressure levels. The mortality rate was detected as 34.9% and patients were found to die approximately within 9 days after ICH. Older age, increased hemorrhage volume, ventricular extension of hemorrhage, and the presence of midline shift were found to significantly correlate with increased mortality (P < 0.05). Patients who underwent surgical therapy showed a longer survival rate (P = 0.016); however, no association was found between medical and surgical therapy in terms of mortality (P = 0.555). Conclusion: The results of this study suggest that effective control of blood pressure is important in the prevention of spontaneous ICH; clinical and radiological findings with treatment modalities influencing mortality should be carefully managed.

Subclinical hypothyroidism, hyperhomocysteinemia and dyslipidemia: investigating links with ischemic stroke in Turkish patients

Abstract Objectives: Hyperhomocysteinemia is a risk factor for ischemic stroke. Hypothyroidism may cause hyperhomocysteinemia. To date, no works have examined the association between hypothyroidism and hyperhomocysteinemia in ischemic stroke. We aimed to investigate the roles of hypothyroidism and hyperhomocysteinemia in ischemic stroke, and whether any relationship exists between hypothyroidism and hyperhomocysteinemia in ischemic stroke patients. Methods: The study included 249 ischemic stroke patients and 102 patients with no history of stroke. Patients were evaluated for conventional risk factors and levels of homocysteine, thyroid-stimulating hormone, vitamin B12 and folic acid. Results: Ten (4%) patients in the ischemic stroke group had subclinical hypothyroidism. We did not find any overt or subclinical hypothyroidism in the control group. Hypothyroidism was higher to a statistically significant degree in the ischemic stroke group (p<0.05). Both hyperhomocysteinemia and hypothyroidism were associated with ischemic stroke patients. However, no association was found between hyperhomocysteinemia and hypothyroidism. Ischemic stroke patients with hypothyroidism had lower levels of HDL cholesterol and levels of total cholesterol/HDL-C and LDL-C/HDL-C were higher than those of ischemic stroke patients without hypothyroidism. Discussion: Hypothyroidism is associated with ischemic stroke. Low HDL cholesterol, high total cholesterol/HDL-C and high LDL-C/HDL-C were associated in ischemic stroke patients with hypothyroidism. Hyperhomocysteinemia was not found to be associated with ischemic stroke patients with hypothyroidism.