Yılmaz İnanç

An assessment of vertigo patients presenting to the otorhinolaryngology and neurology outpatient clinics

Objective: Vertigo is a general term used for disorientation and is a frequent cause of admission to emergency services, otorhinolaryngology and neurology outpatient clinics. This study aims to evaluate the clinical findings, diagnostic laboratory tests, brain magnetic resonance imaging, and Doppler ultrasonography results of patients with complaints of vertigo. Methods: Patients aged >18 years who admitted to the Otorhinolaryngology and Neurology Outpatient clinics of Kahramanmaras Sutcu Imam University Training and Research Hospital with the main complaint of vertigo between January 2017 and August 2017 were retrospectively reviewed. The patients were evaluated in respect of anamnesis, examination findings, and diagnostic tests (pure tone audiometry, video nystagmography, brain magnetic resonance imaging, and carotid and vertebral artery Doppler ultrasonography). Results: The study included a total of 101 patients with a mean age of 46.36 ± 16.1 years who presented with the complaint of vertigo. Of the patients, 16 had an ischemic gliotic region, 4 had a lacunar infarct, 2 had an arachnoid cyst, 2 had a cerebellar infarct, 1 had a meningioma, and 1 had a pineal gland cyst on the brain magnetic resonance imaging. Of the patients evaluated in the Otorhinolaryngology outpatient clinic, 87 (86.13%) were diagnosed with peripheral vertigo and 14 (13.6%) with central vertigo. A diagnosis of central vertigo was made in 23 (22.77%) patients evaluated in the Neurology outpatient clinic. Conclusions: For patients presenting with the complaint of vertigo to the otorhinolaryngology and neurology outpatient clinics, a detailed anamnesis and a physical examination precede specific vestibular tests in the diagnosis. A coordinated communication of both clinics is important for a rapid diagnosis and prevention of unnecessary examinations.

The effects of Maras powder use on patients with migraine

Background It is accepted that smoking often triggers migraine. However, studies evaluating the relationship between the use of smokeless tobacco and migraine are limited, and there is no clear consensus on the subject. In this study, it was aimed to evaluate the relationship between migraine and Maras powder, which is the most common smokeless tobacco in Turkey. Subjects and methods The study included a total of 600 subjects, consisting of 300 patients (aged >18 years) diagnosed with a migraine according to the International Headache Society (IHS-ICHD-3 Beta) criteria after presenting at Sütçü Imam University Medical Faculty Neurology Policlinic with the complaint of headache between July 2016 and December 2016 and a control group of 300 individuals with similar features of age, gender, and educational level. A questionnaire was administered to each patient to record the status of smoking or using Maras powder. Results In the migraine patient group, 16.4% smoked and 9.7% used Maras powder. In the control group, the rate of smoking was 8.5% and the rate of Maras powder use was 11.86%. In males diagnosed with a migraine, the use of Maras powder was found to be at a higher rate than smoking (p<0.001). The Visual Pain Score and the headache frequency values were higher in those who smoked or used Maras powder than in non-users (p<0.001). The Fagerström Test for Nicotine Dependence Smokeless Tobacco results of the patients diagnosed with migraine and who used Maras powder were found to be higher than of those who smoked (Fagerström Test for Nicotine Dependence; p<0.001). When patients were evaluated according to the Migraine Disability Assessment Scale, the majority of migraine patients were seen to be at stages 1 and 2, and one in every three patients who used Maras powder cigarette and one in every two patients who smoked had headaches of a severity which affected their daily activities (p<0.001). Conclusion Smoking or the use of Maras powder increases the frequency and severity of migraines in a similar way. Therefore, Maras powder must be included in the scope of the fight against tobacco and people should be warned about this issue.

Sexual dysfunction and distress in premenopausal women with migraine: association with depression, anxiety and migraine-related disability

Migraine is a chronic disorder associated with impaired quality of life as well as sexual function. However, data about the sexual distress in women with migraine were lacked.This study aimed to determine the incidence and associated risk factors of both sexual function and distress in premenopausal women with migraine. Sixty-nine women diagnosed with migraine were included. Sexual function and distress were assessed by Female sexual function index (FSFI) and Female sexual distress scale-revised (FSDS-R), respectively. Depression and anxiety were investigated by Hospital depression and anxiety scale (HADS). Migraine related disability was evaluated by Migraine disability assessment scale (MIDAS) and average severity of pain was determied by Visual analog scale (VAS). Fifty-five women reported to have sexual dysfunction. Any headache-related feature including MIDAS and VAS scores, depression or anxiety was found to be related with sexual dysfunction. Sexual distress was noted in 37 cases, and depression, VAS and MIDAS scores were significantly higher in women with sexual distress. This study showed that women with migraine should be screened both for sexual dysfunction and distress to help clinicians dealing with sexual medicine to improve the standart of patient care in their regular practice. Special attention should be given to the ones whose MIDAS and VAS scores were high and who had depression.

The effect of demographic features on aortic arch anatomy and its role in the etiology of cerebrovascular disease

Purpose The aim of this study was to retrospectively evaluate the distribution of aortic arches, the relationship with demographic characteristics, and the results of carotid and vertebral artery stenting procedures in patients diagnosed with cerebrovascular disease through the intra-arterial digital subtraction angiography (DSA) technique. Methods A retrospective examination was performed on 288 patients diagnosed with cerebrovascular disease, who underwent DSA in the Department of Neurology of Gaziantep University Medical Faculty and Kahramanmaraş¸ Sütçü Imam University Medical Faculty. The patients were examined in respect of demographic features and aortic arch anatomic structure characteristics. All demographic characteristics, DSA, carotid, and vertebral artery stent results were recorded. Results The patients comprised 60.1% males and 39.9% females with a mean age of 58.25 years. Type 2 aortic arch was found in 175 (60.7%) patients, Type 2 aortic arch in 99 (34.3%) patients, and Type 3 aortic arch in 14 (4.8%) patients. The right carotid artery stenosis rate was found to be higher in patients with Type 2 aortic arch (P=0.013). When the patients were evaluated according to the presence of a bovine arch, there was no significant difference in terms of age, carotid, and vertebral artery lesions (P>0.05). Conclusion The aortic arch and its branching properties were not found to have a direct effect on increased risk of cerebrovascular disease or stenting rates. This study can be considered to raise awareness for new studies to demonstrate the effect of aortic arch anatomic differences on cerebrovascular diseases.

Creutzfeldt-Jakob disease presented with dizziness, weakness and neuropsychiatric symptoms: 2 Case Reports -

Creutzfeldt-Jakob disease (CJD) is among very rare, progressive, untreatable, neurodegenerative prion diseases. While the incidence is reported as 1/1000000 years in European countries, sporadic cases are rarely presented in Turkey. Clinical findings are in the form of rapid progressive dementia, myoclonus, cerebellar, pyramidal and extra pyramidal symptoms. Definitive diagnosis is established by histopathological examination. Our case is a 64-year-old male and 70-year-old female patients admitted with dizziness emerged as sub-acute weakness, nausea, vomiting, insomnia, imbalance and additional neuropsychiatric complaints. Focal activity slowness and common periodic sharp wave activities were observed in EEG. CJD was considered because bilateral symmetrical diffusion limitation was observed at both sides in the basal ganglia level in cranial diffusion MRI’s and 14-3-3 protein was resulted as positive in CSF examinations. CJD, which is a very rare disease in patients presenting with progressive neuropsychiatric symptoms and seizure, is one of the diagnosis to be considered and we wanted to emphasize that there is no treatment for it and preventive measures should be taken.