Turgay Demir

Evaluation of Choroidal Vascular Changes in Patients with Multiple Sclerosis Using Enhanced Depth Imaging Optical Coherence Tomography

Objective: To evaluate the choroidal thickness in patients with multiple sclerosis (MS) using enhanced depth imaging optical coherence tomography (EDI-OCT). Methods: In this observational comparative study, 68 eyes of 34 MS patients and 60 eyes of 30 healthy subjects were evaluated. All participants underwent complete ophthalmologic examination and OCT scanning. Choroidal thickness measurements were performed at seven points. Results: The mean subfoveal choroidal thickness was reduced significantly in MS patients (310.71 ± 61.85 μm) versus healthy controls (364.85 ± 41.81 μm) (p < 0.001). The difference was also significant at all six measurement points (p < 0.001 for all). Choroidal thickness measurements revealed no significant difference between MS eyes with a prior optic neuritis (ON) history (MS ON) and those without ON history (MS non-ON). Subfoveal choroidal thickness did not correlate with retinal nerve fiber layer and Expanded Disability Status Scale score, but reduced choroidal thickness was associated with longer disease duration (r = -0.28, p = 0.019) in MS patients. Conclusion: In MS patients, choroidal structural changes occur both in MS ON and MS non-ON eyes. The decreased choroidal thickness might provide evidence to support a potential role of vascular dysregulation in the pathophysiology of MS.

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.

Epileptic Seizure and Non epileptic Psychogenic Seizure Differential Diagnosis in Primary Health Care

Epileptic seizure (ES) and non-epileptic psychogenic seizure (NEPS) are one of the clinical situations where diagnostic confusions are experienced most frequently in neurology practice. Diagnostic errors lead to wrong treatment regimes that may take many years, drug side effects, additional financial burdens and negative effects in social life. ES and NEPS differential diagnosis are also the most common problems encountered at family health centers as well as at neurology clinics. Careful history taken from patient and his relatives, detailed neurologic examination are very important in reaching a correct diagnosis and treatment. In this study, it was aimed to review symptoms and results that may be used in EN and NEPS differential diagnosis at family health centers in the light of current literature.

Adaptation to Turkish and Reliability Study of the Revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R)

INTRODUCTION Amyotrophic lateral sclerosis (ALS) is a fatal disease characterized by progressive degeneration of the motor neurons. It is difficult to define the severity of the clinical findings of this destructive disease owing to its rapid progression, which presents serious alterations in a short time even in the same patient. The present study was designed to evaulate the validity of the Turkish version of the Revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R), which has been used in various countries for measuring the functional status of ALS patients. METHODS The ALSFRS-R scores of 41 ALS patients (24 male), in any stages of illness, were simultaneously assessed by two physicians. The functional status of the patients (motor system, bulbar, and pulmonary functions) was evaluated under 12 titles. In every subtitle, the functional status was evaluated as 0 for the worst functional status and 4 for the best functional status. The mean differentials for both subtitles and global scores and the 95% confidence bounds of these means were detected. The coherence was defined as the states in which the coefficient is above 0.80 and is statistically significant. RESULTS From the data obtained, the correlation between the two physicians was found to be statistically significant (p=0.000) in terms of the means of both subtitles and total scores. CONCLUSION It was shown in the present study that in the clinical follow-up of the disease, the Turkish version of ALSFRS-R is a simple, reliable, and easily applicable.

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).

Reply to the Comment by Yolcu et al. on Our Paper Entitled "Evaluation of Choroidal Vascular Changes in Patients with Multiple Sclerosis Using Enhanced Depth Imaging Optical Coherence Tomography".

have been reported in the text. The authors have wondered whether there is a significant difference between the three groups (control, MS ON and MS non-ON). As we have mentioned in detail in the article, both MS ON and MS non-ON eyes had significantly reduced average-RNFL thickness measurements when compared with healthy controls, and the average-RNFL thickness measurements in MS ON eyes were significantly thinner than those in MS non-ON eyes. We believe that the measurement of RNFL thicknesses might be a useful parameter for the assessment of the axonal loss and for monitoring the effects of demyelination on visual pathway integrity as complementary tools to other functional markers in MS patients. Dear Editor We thank Yolcu and Ilhan [1] for their valuable contributions to our article entitled Evaluation of choroidal vascular changes in patients with multiple sclerosis using enhanced depth imaging optical coherence tomography [2] . In our study, we evaluated the choroidal thickness in multiple sclerosis (MS) patients with enhanced depth imaging optical coherence tomography to provide insight into the potential effects of the disease on vessel structure. We also evaluated the average retinal nerve fiber layer (RNFL) thickness and compared the measurements of MS eyes with optic neuritis (ON; MS ON), MS eyes without ON (MS non-ON) and controls. The average values and the statistical significance of differences between these three groups Received: November 20, 2015 Accepted: November 26, 2015 Published online: January 5, 2016

POEMS Sendromu: İki Olgu Sunumu

Polinoropati, organomegali, endokrinopati, M proteini ve deri degisiklikleri ile karakterize olan POEMS sendromu nadir gorulen bir paraneoplastik sendromdur. Genellikle klinik tablo polinoropati ile baslar. Burada polinoropati klinigi ile basvuran ve POEMS tanisi alan iki olgu tartisilmistir. Polinoropatisi tanisi alan tum olgularda ayirici tanida POEMS sendromu da dikkate alinmalidir.

Clinical features of postroke epilepsy and relationship with prognosis/Inme sonrasi epilepside klinik ozellikler ve prognoz ile iliski

Objectives: This study was performed to determine the clinical features and types of treatment that affect the onset of seizures and prognosis in 188 patients with post-stroke seizures who were followed in Department of Neurology of Cukurova University Faculty of Medicine. Methods: In this retrospective study, archive files of 1789 patients diagnosed with acute cerebrovascular disease admitted to Department of Neurology of Cukurova University Faculty of Medicine between 1.1.2000 31.12.2010 were scanned and 188 patients who had seizures after stroke were included in the study. Patient history, demographic characteristics, neurological findings, etiology of stroke, stroke localization according MRI or CTI, age at stroke, stroke type, seizure onset date, type of anti-epileptic treatment and prognostic features were re-examined and evaluated. Results: 91 (48.4%) patients had early-onset seizures (first 15 days after stroke) , 97 (51.6%) had late-onset seizures (16th day and after). 172 (91.4%) patients had cortical involvement. 166 (88.2%) patients were treated with monotherapy, 22 (11.8%) patients had politherapy; seizures were full or partial controlled with monotherapy. Conclusion: Late-onset seizures after stroke arise more frequently than early-onset seizures and patients with poststroke epilepsy patients are often treated with monotherapy.