Zeynep Özözen Ayas

Alteration of mean platelet volume in the pathogenesis of acute ischemic stroke: cause or consequence?

Background and purpose Platelets have a crucial role on vascular disease which are involved in pathogenesis of ischemic stroke. Platelet size is measured as mean platelet volume (MPV) and is a marker of platelet activity. Platelets contain more dense granules as the size increases and produce more serotonin and tromboglobulin (b-TG) than small platelets. In this study, the alteration of MPV values were investigated in patients with acute stroke, who had MPV values before stroke, during acute ischemic stroke and 7 days after the stroke. The relationship between this alteration and risk factors, etiology and localization of ischemic stroke were also investigated. Methods Sixty-seven patients with clinically and radiologically established diagnoses of ischemic stroke were enrolled into the study and stroke etiology was classified by modified Trial of Org 10 172 in Acute Stroke Treatment (TOAST) classification and, modified Bamford classification was used for localization and stroke risk factors were also evaluated. The platelet counts and MPV values from patient files in patients who had values before stroke (at examination for another diseases), within 24 hours of symptom onset and after 7 further days were analysed. Results MPV values increased after stroke (10.59±2.26) compared with acute stroke values (9.84±1.64) and the values before stroke (9.59±1.72) (p<0.0001); this alteration of MPV values occured 7 days after stroke (p<0.016). There was a positive correlation between age and MPV values during acute stroke (r=0.270; p<0.05). Patients with atrial fibrillation had higher alteration in the time of MPV compared with patients without atrial fibrillation (p>0.006). We assessed for gender, men (n=38) had a higher alteration in the time of MPV compared with women (n=29) (p=0.013). Conclusion Although there was no alteration of platelet counts, MPV values were increased 7 days after stroke in patients with acute ischemic stroke.Background and purpose There is a lack of research on the association between body image perception (BIP) and multiple sclerosis (MS). The aim of this study was to evaluate BIP in MS patients and its correlation with depression, anxiety, duration of the disease, and sociodemographic characteristics of the patients. Methods Fifty patients with MS who applied to our outpatient clinic were examined. Forty-five healthy control were recruited for the study. All patients were diagnosed with MS according to 2010 revisions of McDonald criteria. Expanded Disability Status Scale (EDSS) was performed by the same neurologist for all patients. The participants were asked to complete a sociodemographic form, Body Cathexis Scale (BCS), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). Results The mean BCS score was 86.54 ± 32.24 in MS patients and 155.00 ± 20.90 in the healthy subjects (p<0.001). While MS patients had significantly higher anxiety levels, depression scores were similar in both groups. The mean BAI score was 18.50 ± 14.03 for MS patients and 10.06 ± 7.96 in the control group (p=0.001). The BDI score of the patients was 13.77 ± 11.61 and 11.91 ± 8.65 for the controls (p=0.34). Early age of the disease onset, increased number of attacks, increased depressive symptoms, and higher anxiety levels were significantly correlated with higher BCS scores. Age and being single/ divorced/ widowed were also correlated with BCS scores. Conclusion It is important to preserve the mental well-being of patients. Even in apparently healthy patients, the body perception may be severely impaired.

Autoimmune neurological syndromes associated limbic encephalitis and paraneoplastic cerebellar degeneration

INTRODUCTION Autoimmune neurological syndrome is a group of disorders caused by cancer affecting nervous system by different immunological mechanisms. In this study, we aim to study the clinical symptoms, cerebrospinal fluid (CSF) findings, autoantibody tests, computed tomography (CT), magnetic resonance imaging (MRI) signs and treatment outcome of patients with autoimmune syndromes. METHODS In this study, 7 patients (4 male, 3 female) diagnosed with autoimmune neurological syndrome were retrospectively examined. RESULTS Five of patients were diagnosed with limbic encephalitis, two of them were paraneoplastic cerebellar degeneration. Confusion and seizure were the most seen symptoms. Two patients had psychiatric disturbances (28,5%) followed by seizure. Headache was seen in 2 patients (% 28,5), disartria in 1 patient (% 14,2), and gait disorder in 2 patients (28,5%). The duration of symptoms was 46 (3-150) days on average. CSF abnormalities were detected in 2 patients. CT and MRI of the brain was available in all patients. Five patients had involvement of mesiotemporal region, two patients had diffuse cerebellar atrophy. One of patients had anti-GABAR B1 positivity. Tumors were detected in 2 patients while investigation for paraneoplasia screening. CONCLUSION Remission is only possible with the detection and treatment of the malignancy. Early diagnosis and treatment are of paramount importance.

Patent Foramen Ovale in Young Patients with Ischemic Stroke

INTRODUCTION: The foramen ovale is a hole in the interatrial septum in prenatal period, which is closed after birth with the increase of left atrium pressure. If it does not close, stroke due to parodoxically embolism, local thrombosis, arrhythmia and hypercoagulability can be seen. In this article, the frequency of patent foramen ovale (PFO) and atrial septal aneurysm (ASA), treatment approaches and follow-up results have been reported in young stroke patients. MATERIAL and METHODS: The files of 163 young stroke patients between 18 and 45 years of age who were followed up at our clinic were reviewed retrospectively. Transthoracic echocardiography (TTE) revealed PFO in 2 patients, ASA in 2 patients. Transeosophageal echocardiography (TEE) reported PFO in 5 patients. Age, gender, premorbid disease and antiaggregant-anticoagulant medical theraphy, routine tests, imaging, TTE and TEE findings, treatment protocols, stroke recurrence were recorded. RESULTS: PFO was detected in 5 of 163 young stroke patients (3.06%) (3K, 2E). The average age was 30.2 (18-42). One patient had transient ischemic attack and 4 patients had stroke. There was a 1 patient has a previous stroke and 2 patients were smokers. Carotis stenosis was not detected in patients. ANA was positive in recurrent stroke patient, another patient had recurrent abortion, heterozygote mutation of FVL, MTHFR C677T and A1298C and hyperhomocysteinemia. One patient had PFO and no other pathological result for etiological investigation. Endovascular closure was performed in 2 _____________________________________________________________________________________________________________________________ Yazışma Adresi: Uzm. Dr. Zeynep Özözen Ayas Yunus Emre Devlet Hastanesi, Nöroloji Kliniği, Eskişehir. E-mail: zozozen@hotmail.com Telefon: 02222219595 Geliş Tarihi: 11.01. 2018 Kabul Tarihi: 25.05.2018 Received: 11.01.2018 Accepted: 25.05.2018 Bu makale şu şekilde atıf edilmelidir: Özözen Ayas Z, Aksoy Gündoğdu A, Üreyen Ç. M. Genç iskemik inmeli hastalarda patent foramen ovale. Türk Beyin Damar Hastalıkları Dergisi 2018; 24 (2): 46-51. doi: 10.5505/tbdhd.2018.21548

Serum prolidase enzyme activity level: Not a predictive biomarker for epilepsy

Objective Oxidative stress (OS) and inflammation are considered responsible for the pathogenesis of epilepsy. Prolidase has an extremely important role in proline recycling for collagen synthesis. Higher than normal proline levels have been shown to increase OS. Furthermore, prolidase activity is associated with inflammation during fibrotic process. No study has yet investigated the relationship between epilepsy and prolidase enzyme activity (PEA). In this study, we aimed to contribute to the existing literature by assessing postictal PEA levels, which are correlated with inflammation and OS, to determine whether PEA levels may be used as a biomarker for epilepsy. Materials and Methods This study included patients with epilepsy who presented to the emergency department within first 6 h of a seizure. Results The epileptic group included 27 patients (16 males, 11 females) and the control group included 31 healthy individuals (11 males, 20 females). The mean age of the epilepsy (n=27) and healthy control group (n=31) was 43.1±20.2 and 51.9±21 years, respectively. Serum PEA levels were 1171.90±343.3 in the epileptic group and 1137.1±295.6 in the control group. There were no significant differences between two groups (p>0.05). Conclusion Our study results suggest that although PEA is an enzyme associated with OS and inflammation, it is still not an ideal biomarker for epileptic patients. This study is important because it investigated PEA in patients with idiopathic epilepsy for the first time.

Atypical type of hirayama disease: onset of proximal upper extremity

Hirayama disease is a rare, benign motor neuron disease. It has been proposed that the dura maters posterior wall lacks sufficient elasticity in the lower cervical region and this causes the tense dura part to displace anteriorly upon flexion. The disease is described as involving unilateral upper extremity with a distal-onset. We reported weakness and atrophy of the proximal part of an extremity in a 45-year-old man who is diagnosed with Hirayama disease. Proximal onset is a rare type of Hirayama Disease. Clinicians must be alert of proximal involvement and the diagnosis should be confirmed with electrophysiological and flexion MRI studies.

Drug abuse, a rare cause of stroke: Case report

At the present time the incidence of illicit drug use increases worldwide among young adults. Abuse of these substances is a rare cause of stroke in young adults. Cocaine, heroin, cannabis, and amphetamines use increase the risk of stroke. Cannabis sativa induce main effects by delta-9-hydrocannabinol. The main mechanism of marijuana-related stroke in young patients is vasospazm. The other possible mechanisms are systemic hypotension, impaired cerebral autoregulation, alteration of cerebral blood flow, cardioembolism due to atrial fibrillation. In this article a 25-year-old young male patient with paresia and paresthesia of right side who had chronic abuse of marijuana is reported. Clinicians must be alert about marijuana can be seriously harmful to cerebrovascular system in chronic use.

A Case of First Epileptic Seizure Diagnosed with Top of the Basilar Syndrome

Submit Manuscript | http://medcraveonline.com irritation was noted. Her hemoglobin level was low (10.6 g/ dL (normal range 12-14 g/dL)). Her electrocardiogram showed normal sinus rhythm. Her brain CT and diffusion MRI were both normal. She was monitored at postictal period at the emergency service. Phenytoin infusion was started at a loading dose of 20 mg/ kg to suppress seizure activity. As she continued to have persistent alteration of consciousness, anisocoria, and delayed motor response to painful stimuli without any sign of improvement, neuroimaging tests were repeated at the same day. Control brain diffusion MRI B1000 sections showed hyperintense areas, and corresponding hypointense areas on ADC, consistent with acute infarction in bilateral cerebellar, bilateral mesencephalon, pons, and right thalamic area (Figure 1). Having been diagnosed with TOB-S, the patient was admitted to intensive care unit. She was administered acetylsalicylic acid, low molecular weight heparin, and levatirecetam 2x1000 mg as a maintenance dose. She had no recurrent seizure episodes. Her electroencephalogram did not show any active epileptiform pattern. On 21st day of admission she was intubated and connected to mechanical ventilation due to respiratory failure. However, owing to impaired creatinine clearance, no CT angiography, MR angiography, or carotidvertebral DSA study could be done. The patient died from cardiac arrest on 31st day of admission.

Reverzibilis posterior encephalopathia szindróma mint a szisztémás lupus erythematosus kezdeti megjelenése

Posterior reversible encephalopathy syndrome (PRES) is a disorder which is diagnosed with its characteristic clinical and radiological findings, typically resolves with treatment. The prevalence of PRES in systemic lupus erythematosus (SLE) patients is not exactly known. A systemic disorder frequently appears as a presenting symptom in SLE. However, in rare cases, the disease starts with a neurological manifestation. Here we report a 35-year-old woman presenting with a headache and blurred vision. She had neurologic symptoms and cerebral lesions on magnetic resonance imaging (MRI) suggesting PRES. The patient was diagnosed with SLE during the etiological investigation of PRES. In this article, we aimed to emphasize that PRES as an initial presentation of SLE.

A rare case, diagnosed as calcified callosal lipoma, when the patient presented with acute stroke

Corresponding author: Dilcan Kotan Department of Neurology Medical Faculty Sakarya University 25050 Sakarya, Turkey Phone: 4882143030 E-mail: dilcankotan@ yahoo.com 1 Department of Neurology, Sakarya University Training and Research Hospital, Sakarya, Turkey 2 Department of Neurology, Medical Faculty, Sakarya University, Sakarya, Turkey 3Department of Radiology, Koşuyolu Medipol Hospital, İstanbul, Turkey

Cerebral fat embolism diagnosed by cognitive disorder.

Fat embolism syndrome is a rarely seen complication of skeletal trauma, and it is seen at a rate of 2-5% after fractures of the long bones of the lower extremities. Its classic triad-+consists of hypoxemia, petechial bleedings on the skin and neurological findings. These neurological findings are highly variable and non-specific, and they can present with lethargy, irritability, delirium, stupor, convulsion or coma. In this report, a male case is presented who was diagnosed with cerebral embolism due to acute cognitive disorder after a segmental tibial fracture.