Tahir Kurtuluş Yoldaş

Serum glutathione peroxidase, xanthine oxidase, and superoxide dismutase activities and malondialdehyde levels in patients with Parkinson's disease.

Parkinson’s disease (PD) is a progressive neurodegenerative disorder characterized by loss of dopaminergic (DA) neurons in the substantia nigra pars compacta (SNpc). Oxidative stress has been hypothesized to play a major role in the development of PD in various studies. This study assessed to investigate oxidative and anti-oxidative status in PD patients. We evaluated oxidant/antioxidant status by measuring serum malondialdehyde (MDA) levels, xanthine oxidase (XO) activities, and activities of antioxidant enzymes, namely, glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD). The study included 29 patients with PD and 32 healthy subjects as controls. Comparison of oxidative parameters in the patient and control groups revealed significantly higher GSH-Px and XO activities in the patient group. Serum MDA and SOD activities in PD patients were not significantly different from the controls. MDA was negatively correlated with duration of the PD and positively with age of onset. There was a negative correlation between SOD and Hoehn and Yahr (H&Y) stage. According to these results, we suggest that oxidative stress may contribute to the development of PD.

Decreased antioxidant status in migraine patients with brain white matter hyperintensities.

Migraine patients have an increased risk to develop deep white matter hyperintensities (WMH) than the general population. Oxidative stress is believed to play a role in the pathogenesis of migraine. The present study was undertaken to assess oxidant/antioxidant balance of migraineurs with and without WMH. We hypothesized that increased oxidative stress and decreased antioxidant response may play a role in the pathophysiology of WMH in migraineurs. The study included 32 patients in the migraine group and 17 age- and sex-matched healthy subjects without headache in the control group. The migraine group comprised 18 with WMH and 14 without WMH. We evaluated oxidative status with malondialdehyde (MDA) and to determine the activities of antioxidant enzymes: superoxide dismutase, glutathione peroxidase and catalase (CAT) in serum of migraineurs and controls. Comparison of the patient and control groups for oxidative parameters revealed significantly lower level of CAT and higher level of MDA in the patient group. Two-way comparison for CAT and MDA of the migraine with and without WMH and the controls revealed that CAT serum level significantly decreased in migraine patients with WMH than migraine patients without WMH and controls. In this preliminary study, we demonstrated that the levels of CAT were decreased in migraine patients with WMH compared to patients without WMH and controls. These findings suggest that decreased antioxidant response may play a role in the pathophysiology of WMH in migraineurs. Besides, our results encourage the new treatment and follow-up options based on antioxidant systems.

Serum oxidant and antioxidant status of patients with chronic tension-type headache: possible effects of medical treatment

Tension-type headache (TTH) is one of the most common and costly primary types of headache in clinical practice, with an unknown etiology. This study assessed to investigate oxidative and antioxidative status in patients with chronic tension-type headache (CTTH), and to evaluate possible effect of medical treatment. The study included 41 CTTH patients and 19 age- and sex-matched healthy subjects without headache as controls. The CTTH group comprised 20 patients receiving treatment and 21 untreated patients. We evaluated oxidant/antioxidant status by measuring serum malondialdehyde (MDA) levels and activities of antioxidant enzymes, namely glutathione peroxidase (GSH-Px) and catalase (CAT). Comparison of oxidative parameters in the patient and control groups revealed significantly lower CAT activities and higher MDA level and GSH-Px activities in the patient group. In the CTTH group, serum CAT activities were found to be significantly decreased in patient groups, while serum MDA levels and GSH-Px activities were found to be higher in the untreated CTTH patients. These findings suggest that oxidative stress is increased in the patients with CTTH, and medical treatment abolishes the stress in part. It has been concluded that antioxidant support might be helpful for the patients with CTTH to prevent oxidant stress and peroxidation damages further.

Oxidative and nitrosative stress in serum of patients with Parkinson’s disease

Parkinson’s disease (PD) is one of the common neurodegenerative disorders. Oxidative stress is considered as a contributing factor to the development of PD. The present study aims to investigate serum oxidative stress status in patients with PD. Oxidative stress was assessed by measuring serum nitric oxide levels, lipid hydroperoxide concentrations, and nitric oxide synthase activity. In addition, total serum antioxidant capacity (TAC) was evaluated using the serum 2,2-Diphenyl-1-picryl-hydrazyl (DPPH) free-radical scavenging method in 32 patient with Parkinson’s disease and 32 control subjects. Our results indicated that serum nitric oxide and lipid hydroperoxide levels were significantly lower in patients with PD than controls. Moreover, nitric oxide levels were found to be negatively correlated with Unified Parkinson’s Disease Rating Scale (UPDRS). However, no statistical difference was observed in total serum antioxidant capacities and nitric oxide synthase activities between patients and controls. The present study indicates that although antioxidant capacity was not changed, lipid hydroperoxide (LPO) level was found decreased. This might show pre-oxidative process in these patients. In addition, decreased nitric oxide (NO) level and negative correlation observed between NO level and disease rating scale implicated a role for NO in the disease process.

Whole thoracal spinal cord involvement in case of neuro-Behçet's disease.

Behçet’s disease is a chronic inflammatory, multisystem vasculitis. Neurological involvement is one of the most serious manifestations of Behçet’s disease. Although brain stem and diencephelon are the most affected areas in neuro-Behçet’s disease, spinal cord involvement are rarely seen. We report a case of paraplegia caused by completely thoracic cord involvement of Behçet’s disease in a 20-year-old woman.

Tuberculous ventriculitis as a relapse following central nervous system tuberculoma

A 74-year-old female patient was admitted with complaints of memory loss, nausea, loss of balance, and urinary incontinence, all of which started approximately 2 months earlier and increased gradually. These symptoms were so severe that she could no longer take care of herself, and her children had begun to assist her. Her medical history included a diagnosis of central nervous system (CNS) tuberculoma and tuberculous lymphadenitis 3 years prior, which were diagnosed upon complaints of severe headache and treated with isoniazid (300 mg/day), rifampicin (600 mg/day), ethambutol (1,500 mg/day) and pyrazinamide (2,000 mg/day) for 1 year. Cranial MR imaging (MRI) at diagnosis of CNS tuberculoma revealed an intense gadolinium-enhanced mass lesion with lobulated contour in the left basal ganglia (Fig 1), and thoracic computed tomography (TCT) identified paratracheal and subcarinal lymphadenopathies. The diagnosis of tuberculosis was confirmed by biopsy of the mediastinum. Following anti-tuberculosis treatment applied during that period, the patient’s ability to walk and her cognitive capacities recovered, and MRI revealed complete elimination of the tuberculoma. Due to the complaints mentioned above, the patient was hospitalized in the neurology service, where her vital signs and systemic physical examination remained normal. Neurological examination revealed an increased tendency to sleep and limited cooperation, even though she could comply with verbal directions, and her visual orientation was intact. No signs of motor deficit, cranial nerve palsy, or meningeal irritation were observed. DTRs and fundus examination were normal. Laboratory analysis indicated normal complete blood counts, biochemical parameters, thyroid function, and vitamin B12 levels, and an erythrocyte sedimentation rate of 25 mm/h. MRI identified a large ependymal contrast enhancement on the ventricular walls of the third, fourth, and lateral ventricles (Fig 2a–c). Lumbar puncture led to the following findings: protein 2,165 mg/L (150–450), glucose 43 mg/dL (simultaneous blood glucose level was 110 mg/dL), cell count 70 leukocyte/mm (all lymphocytes) and a positive Pandy’s test. A cerebrospinal fluid (CSF) smear showed large numbers of lymphocytes, few plasmocytes, degenerated cells and giant cells similar to Langhans type 1–2, and areas resembling eosinophilic small necroses, which led to a diagnosis of tuberculous meningitis (TBM). The CSF culture was negative. We evaluated albumin and IgG in serum and CSF, and found the patient’s IgG index to be 0.70, indicative of intrathecal IgG synthesis. TCT showed no evidence of tuberculous infection. After initiation of fourdrug antituberculosis treatment (isoniazid 300 mg/day, rifampicin 600 mg/day, ethambutol 1,500 mg/day, and pyrazinamide 2,000 mg/day and dexamethasone 2 mg/ day), she was referred to the Infectious Diseases Clinic where she was treated for 2 months. Upon discharge, the patient had full cognitive function; she could easily follow directions and was well-oriented to her surroundings. Control cranial MRI revealed a decrease in ependymal contrast uptake (Fig 2d–f). S. K. Guler (&) N. Gunes B. G. Cokal T. Yoldas Department of Neurology, Ankara Training and Research Hospital, Şukriye district, Ulucanlar Avenue, No: 89, 06340 Ankara, Altindag, Turkey e-mail: keskinselda@gmail.com

Cyclic Alternating Pattern in Obstructive Sleep Apnea Patients with versus without Excessive Sleepiness

Background One of the main hypotheses on the development of daytime sleepiness (ES) is increased arousal in obstructive sleep apnea (OSA). Cyclic alternating pattern (CAP) is considered to be the main expression of sleep microstructure rather than arousal. Therefore, we aimed to investigate whether there is any difference between OSA patients with versus without ES in terms of the parameters of sleep macro- and microstructure and which variables are associated with Epworth Sleepiness Scale (ESS) score. Methods Thirty-eight male patients with moderate to severe OSA were divided into two subgroups by having been used to ESS as ES or non-ES. Results There was no difference between two groups in clinical characteristics and macrostructure parameters of sleep. However, ES group had significantly higher CAP rate, CAP duration, number of CAP cycles, and duration and rate of the subtypes A2 (p = 0.033, 0.019, 0.013, and 0.019, respectively) and lower mean phase B duration (p = 0.028) compared with non-ES group. In correlation analysis, ESS score was not correlated with any CAP measure. Conclusions OSA patients with ES have increased CAP measures rather than those without ES.

Asymmetric sensory nerve action potential amplitudes as an early hint for diagnosing Lewis–Sumner syndrome

Lewis–Sumner syndrome (LSS) is an immune-mediated peripheral nerve disorder characterized by multifocal conduction blocks. LSS is typically associated with distal, asymmetric weakness and sensory impairment, affecting primarily upper limbs [1]. It is still an open question whether LSS and multifocal motor neuropathy (MMN) are a variant of CIDP or whether these conditions represent different entities [2].

POEMS syndrome with peripheral and central nervous system demyelination: case report.

Introduction:POEMS syndrome is a rare, atypical plasma cell proliferative disorder. Predominantly motor chronic demyelinating polyneuropathy and monoclonal plasma cell disease are the major clinical features of POEMS syndrome. Demyelinating lesions of the central nervous system have been reported only in 2 patients with POEMS syndrome up to now. Case Report:A 71-year-old man was investigated for numbness, burning sensation, and weakness of the lower extremities. He was found to have hypertrichosis, white nails, and multiple hemangiomas in the lower extremities. Neurological examination revealed decreased strength of the proximal and distal muscles of the lower extremities and absence of deep tendon reflexes. There was a marked impairment of temperature, position, and vibration senses in the lower extremities. Romberg test was positive. Nerve conduction was markedly reduced in all extremities and needle electromyography showed denervation pattern. Cerebrospinal fluid was clear, colorless, and had no oligoclonal band. IgM kappa monoclonal gammopathy was identified in serum immunofixation electrophoresis. In bone marrow aspirate plasma cells were counted as being <2%, with normal morphology. Brain magnetic resonance imaging revealed hyperintense lesions in the regions of periventricular and subcortical white matter and thalamus. Normal TSH, T4, and T3 levels and elevated levels of antitiroglobulin antibody and antithyroid peroxydase antibody were found in the laboratory tests. Our patient was diagnosed with POEMS syndrome and treated with intermittent courses of melphalan and prednisone. Conclusions:POEMS syndrome should also be considered in differential diagnosis of patients with demyelinating brain lesions, accompanied by peripheral neuropathy. Diagnostic evaluation of patients with demyelinating polyneuropathy should include brain magnetic resonance imaging.

Mortal Seyreden Bir Amitriptilin İntoksikasyonu Olgusu

Ozet Trisiklik antidepresanlarin (TCA) asiri alimi, ciddi ilac zehirlenmelerinin en sik sebeplerinden biridir. Gorece dusuk (10 mg / kg) bir dozda amitriptilinin intihar etmek amaciyla icimi sonrasi TCA zehirlenmesine bagli cok siddetli norolojik ve kardiyovaskuler belirtiler gosteren 20 yasinda bir kadin hastayi sunuyoruz. Gastrik lavaj, aktif komur, sistemik alkalinizasyon (pH 7.50 olacak sekilde), destek tedavi ve plazma degisim tedavileri hasta icin yeterli olmadi. Hastanin derin koma durumu ve sok tablosu devam etti ve herhangi bir onlem hastayi hayatta tutmaya yetmedi. Bu vaka, TCA zehirlenmesinin onemini ve bu zehirlenmenin dusuk dozlarda dahi olumcul olabilecegini vurgulamaktadir.