Yildiz Degirmenci

Habituation and dishabituation of P300.

ObjectiveWe aimed to see the consequences of habituation and posthabituation by means of repeatedly measuring the effects over a longer period. MethodThe study was performed on 27 healthy volunteers. The event-related potentials were recorded from the Fz, the Cz, and the Pz electrode sites. The rare tone-frequent tone probability ratio was 20%. All subjects were asked to press a button when they heard a rare tone. The test was continued until 20 artifact-free rare tones were averaged, which was accepted as 1 trial block. After 10 trial blocks were obtained in a sequential manner, the test was completed. ResultThis study has indicated that P300 amplitudes decrease with repeated stimulations, that is, there is a habituation period. As the test continues, the speed of amplitude decrease slows down and after a while it even starts to increase: that is, a dishabituation occurs. ConclusionsIt is very likely that this habituation relates to a period of learning and dishabituation relates to a period of mental fatigue. In these processes, changes of amplitude and latency values reflect changes in amount of neuronal activation.

Quantitative EEG and cognitive evoked potentials in anemia

OBJECTIVE The anemic status may alter brain functions and electrogenesis, as reflected by EEG and cognitive EPs (CEPs). This study aims to evaluate CEPs and EEG power spectra in adult patients with iron-deficiency anemia and to determine the effects of appropriate iron therapy on electrodiagnostic findings. METHODS Fifty-one patients with iron-deficiency anemia underwent CEP and EEG recording. All patients were re-assessed after three months of oral-iron therapy. RESULTS All patients had recovered from their anemia through the three-month iron therapy. Central N1 amplitude and parietal P2 amplitude was increased. N2 latencies were shortened in frontal and central regions. P3 latencies were shortened in frontal, central and parietal areas and P3 amplitude was increased in the parietal region. Except in the gamma-band, all pretreatment and post-treatment mean-power values were significantly lower at the temporal, parietal and occipital regions. CONCLUSIONS This study indicates that in iron-deficiency anemia, appropriate iron therapy can improve brain electrogenesis, as reflected by P300 and EEG power spectra.

Perceptions of epilepsy of three different groups in Turkey

OBJECTIVE Our aim was to investigate epilepsy-related knowledge, behavior, perceptions, and attitudes of people with epilepsy, their relatives, and a control group (390 participants in total) at the State Hospital Neurology Clinic, Yuksekova City, Turkey. METHODS The Survey of Epileptic Patient Relatives on the Knowledge, Attitudes, and Behavior Regarding the Disorder was used and included questions about descriptive characteristics, familiarity with epilepsy, attitudes toward epilepsy, and understanding of epilepsy. Data on SPSS 15.0 software were analyzed with the χ(2) test. RESULTS Patients (95.3%), their relatives (89.2%), and controls (63.3%) felt primarily fear when they heard the diagnosis of epilepsy. Most participants would not let their child marry a person with epilepsy, with no statistically significant difference between groups (P>0.05). Patients (66.7%) and relatives (70%) saw no problem in people with epilepsy having children; there was a statistically significant difference between groups on this point because of the control groups response (31.5%) (P<0.05). CONCLUSION Patients and relatives showed similar attitudes and behaviors, perhaps because they had common information and experience regarding the disorder.

Susac's syndrome: A case of simultaneous development of all three components of the triad

Susacs syndrome is characterized by the clinical triad of encephalopathy, branch retinal artery occlusions and sensorineural hearing loss. We here report a case of 46 year old woman with a sudden diminution in visual acuity at the left eye, headache and decreased hearing at the right ear with mild confusion considered as Susacs syndrome with complete triad. Although its a relatively rare entity, it should be kept in mind in differential diagnosis of the neurological disorders, especially in women in 20- to 40-year of age presenting with acute hearing loss.

A case of ischemic stroke after bonzai: syntetic cannabinoid from Turkey.

Synthetic cannabinoids (SCs) are the substances created in the laboratories, mimicking the effects of natural, endogenous cannabinoids. In recent years, SCs have been frequently observed in seized materials all over the world. As SCs are easily available and cheap, they have also an increasing use in Turkey, as marijuana substitutes. Due to the effects and complications of cannabinoids, cannabinoid receptors CB1 and CB2 produce a wide range of responses throughout the body. Previous studies suggest that cannabis might produce stroke through direct effects on the cerebral circulation, orthostatic hypotension, central nervous system vasculitis, vasospasm, and atrial fibrillation [1–4]. SCs have many of these effects, since they interact with the same CB1 and CB2 receptors as natural cannabinoids. However, they act faster and are more potent leading to severe complications, due to the changes in their structures. Despite the well-known relationship between the stroke and cannabinoids [4, 5], there are limited reports about SCs and stroke in the last few years [6, 7]. Since SC use is gradually increasing among young people in today’s world, it is important to remember them in the differential diagnosis of stroke, especially in young patients who present to emergency services with aphasia and/or unconsciousness. Thus, we presented a 48-year-old man who presented to our emergency clinic with loss of consciousness. History taken from his siblings revealed that he was found lying unconsciousness at home, with second-degree burns on his hands. In his initial neurological examination, he was lethargic, cranial nerves were intact, had no neck stiffness, meningeal irritation signs. He had no motor deficit and had increased tendon reflexes with no plantar responses. Magnetic resonance imaging of the patient demonstrated an increased signal in diffusion-weighed sequences and an apparent diffusion coefficient reduction in the left cerebellar hemisphere, bilateral occipital and frontal lobes with millimetric, multifocal lesions (Fig. 1). Regarding these findings, we hospitalized the patient to our neurology clinic. Routine blood tests, complete blood count, thyroid function tests with toxicology analyses including ethanol, markers of vasculitis (serum C-ANCA, anti-nuclear antibody, antidsDNA antibody, anti-SM antibody, anti-Jo1 antibody, anti-SCL70 antibody and anti-gliadin antibodies were negative), coagulopathy (homocystein = 15.8 lmol/l, antithrombin III activity = 76, protein C = 77 %, protein S = 103 %, anticardiolipin and antiphospolipid antibodies were negative) panel were normal. Biochemical screening revealed abnormal kidney and liver functions. Cranial magnetic resonance angiography imaging of the patient was normal. There were no abnormalities in the cardiac examination of the patient including normal cardiac enzymes, electrocardiography and echocardiography findings. Intravenous hydration was ordered after the evaluation of the patient by gastroenterology and nephrology clinics. Anti-edematous and antiplatelet treatments were registered for the treatment of acute ischemic stroke. On the second day of his hospitalization, liver and kidney function tests turned to normal, he gained his consciousness, and declared the usage of substance called ‘‘Bonzai’’ via smoking hours before cerebrovascular accident. He had a history of ‘‘Bonzai’’ use since 1 month. Since the psychiatric assessment of the patient revealed an anxious emotional state with decreased attention, concentration, & Yildiz Degirmenci ydegir@gmail.com

Two foreign language automatisms in complex partial seizures

Ictal speech manifestations with or without loss of consciousness can frequently occur in TLE in which sometimes the patient may remain responsive, even in conjunction with automatisms. Foreign language ictal speech automatism (FLISA) is a rare ictal sign in temporal lobe epilepsy arising from the non-dominant hemisphere. While our literature review revealed no report of CPSs with two foreign language ictal speech automatisms, we here represented a rare case of a Turkish woman with TLE experiencing two foreign language ictal speech automatisms.

Long-term depression is a stroke risk factor.

Kocer E, Kocer A, Degirmenci Y, Eryılmaz M. Long-term depression is a stroke risk factor. Background and Aim: Only a few studies have evaluated depression prevalence in pre-stroke period in comparison to controls. We investigated this association based on a hospitalised stroke population. Methods: One hundred and forty-eight stroke patients were evaluated. The presence of depression was compared with those of 100 healthy controls without stroke, from the same region. Depression was accepted as present or not present after history and clinical evaluation according to Diagnostic and Statistical Manual of Mental Disorders-IV. Socio-demographic variables, other stroke risk factors and the time of diagnosis of depression (how many year or month they got depression) were recorded. Results: Gender and mean age of patients and controls were similar in comparison. Depression was diagnosed in 27 patients and 24 controls (p > 0.05). The time period passed after diagnosis of depression was longer in stroke patients in comparison to controls (p < 0.001). Conclusions: The risk of stroke should be considered in elderly with long-term depression. This indicates that treatment of depression is another factor which should be considered in prevention of brain stroke.

Evaluation of sleep in women with menopause: results of the Pittsburg Sleep Quality Index and polysomnography.

OBJECTIVE To investigate subjective sleep quality among women in the menopausal period and to confirm and diagnose the possible sleep disturbances with polysomnographic (PSG) evaluation objectively. MATERIAL AND METHODS Sixty-seven women with menopause were enrolled in the study. Sociodemographic characteristics and the features of menopause were recorded. We assessed subjective sleep quality with Pittsburg Sleep Quality Index (PSQI). To confirm sleep disturbances and further diagnose the underlying cause, PSG evaluation was performed to women with PSQI scores of >5 who gave their approval. RESULTS Mean PSQI score of women with normal PSG evaluation was 12.00±3.16, while it was 11.00±2.32 in women with abnormal PSG evaluation (p=0.466); 59.7% (n=40) of women had poor sleep quality. Among these, 11 (64.7%) had abnormal results in the PSG evaluation and were diagnosed with obstructive sleep apnea syndrome (OSAS); 54.5% had mild OSAS, 27.3% had moderate, and 18.2% had severe OSAS. CONCLUSION PSQI and PSG evaluations would give a chance to demonstrate sleep problems and shed a light on treatment options according to the underlying causes of sleep disturbances in menopause.

Lightning strike: a first case of unilateral diaphragmatic paralysis

Lightning injury is the second most common cause of weather-related deaths in the United States. Despite the several neurological complications such as polyneuropathy, myelopathy, spinal cord injury, motor neuron disease due to the lightning-induced injury, there is no documented case of unilateral diaphragmatic paralysis. We describe the case of a patient with a history of lightning strike at childhood period, prior the onset of isolated, diaphragmatic paralysis, unilaterally. Clinical and electrophysiological findings suggest an injury restricted to the phrenic nerve, unilaterally.

Can paroxysmal hemicrania be bilateral? A case report.

Paroxysmal hemicrania (PH) is a rare primary headache disorder classified in the trigeminal autonomic cephalgias. It can be described as headaches localized in the orbital, supraorbital, temporal or in any combination of these sites, lasting 2–30 min and occurring several or many times a day, associated with ipsilateral autonomic symptoms and respond absolutely to indomethacin. The frequently reported autonomic symptoms during the attacks are lacrimation, conjunctival injection, nasal congestion, rhinorrhea, while eyelid edema, ptosis, miosis and facial sweating are less common [1]. Since PH is a strictly unilateral headache in the majority of patients, and side shift or bilateral headache with bilateral autonomic symptoms been rarely reported [2, 3], we reported a case of shortlasting, bilateral, indomethacin-responsive headache with cranial autonomic features including eyelid edema, lacrimation, conjunctival injection, nasal congestion fulfilling the diagnostic criteria of episodic PH according to the IHS criteria (Beta version) [1]. A 48-year old woman presented to our neurology outpatient clinic with a 30-year history of headache. Her headaches began when she was 17, and she had several treatments with the diagnosis of migraine without any relief. She had no family history of headache. She was suffering from daily attacks of short, severe headache episodes occurring on an almost hourly basis, and lasting 2 or 3 days, two times a year. However, the frequency of headache cycles, as well as the duration of headaches gradually increased after the age of 25. While she had two episodes, lasting 2 or 3 days a year, she began to experience 3 or 4 episodes lasting 1 week in a year. After her pregnancy at the age of 30, the headache episodes recurred in typical manner. During the episodes, she was suffering from bouts of throbbing or stabbing headache localized around the orbital region bilaterally, with a sidedominance of left periorbital region. She had headache attacks lasting about 30 min to 1 h, with a frequency of 10–15 attacks/day. She had bilateral conjunctival injection, eye tearing and eyelid edema, as accompanying symptoms. Pain intensity and frequency of the single episodes increase slowly over the first few days of an episode until they reach a plateau, when attacks occur hourly and visual analogue scale (VAS; 0 = no pain, 10 = worst pain ever experienced) of the single attack is reported to be between 8 and 9. She describes pain-free periods more than 1 month, suggesting the term ‘‘episodic’’, and the features of headache with accompanying autonomic features were diagnosed as PH, according to the IHS criteria of beta-version [1]. To evaluate the symptomatic causes of PH, the performed routine blood tests including complete blood count, erythrocyte sedimentation test, vasculitis markers including anti-nuclear antibody, anti-cardiolipin and anti-phospholipid antibody evaluations were normal. Cranial magnetic resonance imaging of the patient was normal. We started her 25 mg of indomethacin three times a day in combination with a proton pump inhibitor (PPI, lansoprazole 30 mg). The morning following the first dose she was completely headache free and stayed so. At the follow-up visit after 2 weeks, she was pain free still. Presented as poster presentation in the 51st Turkish National Neurology Congress, Antalya, 2015.