Turgut Zileli

Cerebral fat embolism studied with MRI and SPECT

SummaryIn a patient with fat embolism to the brain CT showed no abnormality. MRI performed after recovery from coma, when the patient had aphasia and quadriparesis, demonstrated multiple high signal abnormalities in the white matter on both T1- and T2-weighted images. HMPAO-SPECT showed left-sided hypoperfusion which resolved in parallel with clinical improvement 1 month later.

The prognosis of subacute sclerosing panencephalitis in adults. Report of 8 cases and review of the literature.

In this article, 8 cases of subacute sclerosing panencephalitis (SSPE) are presented with a review of the literature. The symptoms developed during pregnancy in 2 cases. All of the patients died within 1 year duration except one. According to the reviewed literature, the prognosis in the adult cases is worse than in children; the two sexes are equally affected in adult SSPE.

Neuro-Ophthalmologic Manifestations of Behcet's Disease

Three patients with retinal vasculitis are reported who were found to be seroreactive for Lyme borreliosis. Careful investigation revealed no other apparent etiology for the angiitis, and improvement of the retinal vasculitis on tetracycline therapy was documented by fluorescein angiography in one of them. Two cases of retinal vasculitis were presented at the International Conference on Lyme Borreliosis in Stockholm 18-21 June 1990, and two cases of cerebral vasculitis due to Borrelia burgdorferi have been published. To our knowledge, this is the first published report of retinal vasculitis occurring in patients seroreactive for Lyme borreliosis. Although further investigation will be necessary to prove a cause-and-effect relationship, ophthalmologists encountering patients with otherwise unexplained cases of retinal vasculitis, or Eales disease, are encouraged to study these patients carefully for the possibility of Borrelia burgdorferi infection.

Whistling Epilepsy: A Case Report

Whistling, as an ictal symptom, has been previously reported in frontal lobe epilepsy. For the first time in the literature, we present a patient with complex partial seizures of the temporal region associated with this peculiar symptom.

Hot Water Epilepsy

The clinical and EEG features of 10 patients with hot water epilepsy were presented. Eight of the 10 cases were male. The mean age of onset was 4.7 years. In four patients partial and in six cases generalized seizures were seen. Three patients also had non-hot water precipitated seizures. Interictal EEGs showed generalized abnormalities in eight and focal abnormalities in two cases. CT was performed and found normal in two patients. Anticonvulsant therapy was instituted for all patients. In six cases with adequate follow-up, complete remission was obtained in four and the frequency of the seizures was decreased in two, with anticonvulsant therapy.

ELECTROPHYSIOLOGICAL EVIDENCE FOR ACTIVATION OF NMDA RECEPTORS AND ITS ANTAGONISM BY MK-801 IN CEREBRAL ISCHEMIA

We studied the effects of iontophoretically administered MK-801 (50-150 nA) on ischemic changes on the CA1 hippocampal field potential. Twenty rats under urethane anesthesia, of which the hippocampal field response was depressed or lost upon ligation of the carotid arteries, were used. MK-801 applications starting before carotid ligation, decreased the depression of the field response in 8 of 11 trials. MK-801 was applied after the appearance of ischemic changes and partly restored the deteriorated hippocampal field potential in 16 of 34 penetrations. MK-801 was ineffective in preventing or restoring the severely depressed or lost evoked activity. During ischemia a DC potential shift of -32.6 +/- 3.7 mV (n = 10) was recorded. MK-801 reduced the amplitude of the DC potential shift by 50% when applied before (n = 6) or after (n = 4) the initiation of ischemia. Activation of N-methyl-D-aspartate (NMDA) receptors by glutamate or N-methyl-DL-aspartate (NMDLA) induces a slow negative wave on the field response. During ischemia a similar negative wave spontaneously appeared in 9 trials and was also induced with low currents (5-10 nA) of NMDLA which were insufficient to evoke the NMDA-mediated wave before ischemia. These data provide electrophysiological evidence that NMDA receptors are activated during ischemia and MK-801 reduces ischemia neuronal dysfunction.

High dose anticholinergic therapy (biperiden) in dystonia

We studied the effect of biperiden in the treatment of dystonia in six patients aged 15-30 years. Five patients had generalized and one patient had segmental dystonia. Biperiden was started at a dose of 2 mg/day and was gradually increased to 40 mg/day in a few weeks. All patients had clinically significant response in varying degrees after a mean follow up of 1.9 years. Three patients showed considerable or dramatic benefit. The 40 mg/day was generally well tolerated. High dose anticholinergic therapy is effective in the management of torsion dystonia.

Fibromuscular Dysplasia of the Basilar Artery: A Case with Brain Stem Stroke:

Fibromuscular dysplasia of the basilar artery is a rare and usually asymptomatic vascular disease with only 5 cases reported in the literature. A thirty-eight-year-old man who developed ischemic neurologic symptoms of the brain stem due to dysplasia of the basilar artery is presented, and the clinical features, radiology, treatment, and prognosis of this disease are discussed in correlation with the current data.

Intravenously and iontophoretically administered naloxone reverses ischemic changes in rat hippocampus.

Forty rats under urethane anesthesia were subjected to cerebral ischemia by ligation of the right carotid, the right plus the left carotid, or the right carotid plus two vertebral arteries. Ischemia caused three types of changes in the field potential of the right hippocampal CA1 region evoked by fimbrial stimulation: 1) completely reversible deterioration (57% and 16% of the rats with unilateral and bilateral carotid artery ligation, respectively), 2) moderate deterioration (37% and 24% of the rats with unilateral and bilateral carotid artery ligation) and 3) irreversible loss of the evoked activity (6% and 60% of the rats with unilateral and bilateral carotid artery ligation and all the rats subjected to three-vessel occlusion). Naloxone improved the moderate deterioration in 10 of 11 rats (1-3 mg/kg i.v.) and in 15 of 16 (50-150 nA) iontophoretic applications, but naloxone did not restore the lost evoked activity. Intravenous morphine (10 mg/kg) aggravated the ischemic changes, and this effect was reversed by naloxone, while iontophoretic administration of morphine caused only excitation. These findings suggest that naloxone has a favorable effect on cerebral ischemia not severe enough to cause transmission failure. The reversal of ischemic changes by iontophoretic naloxone indicates that its site of action is at the neuronal or microcirculatory level.

Severe ptosis without ophthalmoplegia due to porphyric neuropathy

In this case report, we present a patient with severe ptosis without ophthalmoplegia due to porphyric neuropathy. This could be explained only by selective involvement of oculomotor nuclei.