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Background The purpose of this study is to assess the incidence and clinical characteristics of adolescent tibial tubercle fractures (TTFs) during the COVID-19 pandemic by sharing our experiences. Methods Pediatric patients aged between 0 and 18 years old with confirmed diagnosis of TTFs who were treated at our center between April 2020 and May 2020 were included in the study. In addition to demographics, mechanism injury, treatment modalities, complications were also noted. Results Sixteen patients were included in the study. The mean age was 14.8 ± 0.9 years (range: 13–16 years). The mean BMI of patients was 26.3 ± 2.3 kg/m2 (range: 23.2–30.4 kg/m2). According to the BMI-for-age percentiles growth chart, eight patients (50%) were overweight, and eight patients (50%) were at a risk of being categorized as overweight. The most common cause for the injury was jumping due to basketball (50%). Twelve of 16 patients were treated operatively by open reduction and internal fixation. The remaining 4 patients were treated non-operatively with long leg cast. Conclusion The incidence of TTFs was 16 cases over about two months during the pandemic isolation period. Our results demonstrated that all adolescent TTFs occurred during periods when outdoor activities were permitted. This finding may be explained by sudden athletic activity after prolonged immobilization. We observed that all of our patients were male and either overweight or at risk of being overweight.

Objectives This study aims to present our experience in the management of fractured femoral stems after primary and revision hip replacements by evaluating the clinical and radiographic characteristics and determining the effectiveness of the extraction methods. Patients and methods A total of 15 patients (5 males, 10 females; mean age 65.9 years; range, 49 to 87 years) who underwent revision hip replacement due to a fractured femoral stem between January 2005 and December 2019 were included in this retrospective study. The mechanisms and risk factors for failure as well as methods applied to extract fractured stem were analyzed through clinical and radiographic data. Results Nine patients had fractured cemented femoral stems, while six patients had fractured fully porous coated cementless revision stems. Lack of proximal buttress in distally fixed femoral stems was detected in 11 patients and identified as the predominant mechanism resulting in fracture. The proximal extraction method with conventional revision instrumentation, the cortical window technique, and extended trochanteric osteotomy (ETO) were used in three, seven, and five cases, respectively. Conclusion Our results demonstrated that the lack of proximal buttress is the most common reason for femoral stem fracture. Moreover, the proximal extraction method was mostly ineffective in fully porous femoral stems. A step-by-step approach should be considered for the extraction of a broken stem. The cortical window method can be considered as the second step if proximal extraction methods fail, and ETO should be considered at the last step if all techniques fail.

Minimally invasive percutaneous plate osteosynthesis (MIPO) and intramedullary nailing (IMN) are the two most commonly used methods for distal tibial extra-articular fractures; however, the ideal treatment is still on debate. The aim of this study was to compare MIPO and IMN in the treatment of distal tibial extra-articular fractures in terms of cost analysis according to health insurance records in Turkey.The data of patients who underwent either MIPO or IMN for the treatment of distal tibial extra-articular fractures between 2013 and 2018 were analyzed in this retrospective study. Patients' clinical data, as well as the overall expenses from the first admission until return to work including hospitalization, and all outpatient controls had been reviewed from the hospital's billing department. The total amount of money paid per month by Turkish National Social Security Institution to the patient until the patient's returns to work were also recorded.118 consecutive patients (35 female-83 male) with the mean age of 37.2±13.4 were participated to the study. IMN group consisted of 57 patients with a mean age of 36.7±12.8 years, and MIPO group consisted of 61 patients with a mean age of 37.8±13.6 years. No significant differences were observed between study groups in terms patients' age, gender, fracture classification (AO/OTA: Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association), soft-tissue injury (Tscherne classification), presence of type 1 open fracture, and presence of accompanying fibula fracture. There was no statistical difference between two groups in terms of pre-operative hospital stay (p=0.713). However, the mean length of hospital stay was significantly higher in the MIPO group (p=0.001). The means of number of total outpatient controls, time to union, and return to work were also significantly higher in the MIPO group (p=0.005, p0.001 and p0.001, respectively). The mean hospital cost until discharge and the mean total cost until return to work were significantly higher in the MIPO group (p=0.001 and 0.001, respectively). The mean total costs of hospital stay and outpatient controls were also significantly higher in the MIPO group (p=0.001 and 0.004, respectively). The mean implant costs did not significantly differ between groups (p=0.179).According to the results acquired from the present study, IMN is a better option compared to MIPO for the treatment of extra-articular distal tibial fractures in terms of costs paid by the national health insurance in Turkey.

Aims The aim of our study is to investigate alterations in visual evoked potentials (VEP) and brainstem auditory evoked potentials (BAEP) in children with obesity. Methods A total of 96 children, with a mean age of 12.1 ± 2.0 years (range 9–17 years, 63 obese and 33 age and sex-matched control subjects) were included in the study. Laboratory tests were performed to detect insulin resistance (IR) and dyslipidemia. The latencies and amplitudes of VEP and BAEP were measured in healthy and obese subjects. Results The VEP P100, BAEP interpeak latency (IPL) I–III and IPL I–V averages of obese children were significantly longer than the control subjects. When the obese group was divided into two subgroups, those with IR and without IR, BAEP wave I, wave III and P100 wave latencies were found to be longer in the group with IR. A statistically significant correlation was observed between BAEP wave I latency, IPL I–V, IPL I–III and the homeostatic model assessment insulin resistance (HOMA IR) index and fasting insulin level. Conclusions Our findings suggest that VEP and BAEP can be used to determine early subclinical on auditory and visual functions of obese children with insulin resistance.

Objective Primary aim is to compare the diagnostic value of contrast-enhanced 3D GRE T1-weighted sequences with unenhanced MR venography and conventional magnetic resonance imaging (MRI), in detection of dural venous sinus (DVS) and cortical venous thrombosis; secondary aim is to determine the relationship between DVS thrombosis/site and gender, age, infarction or hemorrhage. Methods We retrospectively reviewed conventional MR images, unenhanced MR venography and immediate post-contrast 3D GRE T1-weighted MR images in 30 patients (17 male and 13 female, 21–70 years old, mean age 40.1) with clinically suspected DVS thrombosis. MR examinations had been performed with 1.5T or 3T MR Scanners. DVSs were evaluated in 10 sub-segments, including cortical veins. Each set of MR images were examined separately, blinded to the final diagnosis. Associated findings were also noted and sensitivity, specificity and accuracy of each MRI technique were calculated. Results Final diagnosis of cortical venous and/or dural sinus thrombosis was established in 24 (80%) of 30 cases and 67 (22.3%) out of 300 segments. For detection of the thrombotic segment, sensitivity, specificity, and accuracy were 83.6%, 95.3%, and 92.7% by conventional MR sequences, 89.6%, 91.8%, and 91.3% by unenhanced MR venography, and 92.5%, 100%, and 98.3% by contrast-enhanced 3D GRE T1-weighted sequence, respectively. Infarction and hemorrhage were more frequent in cases with cortical venous thrombosis, while gender and age had no significant relation with DVS thrombosis or its site. Conventional MR sequences and unenhanced MR venography were helpful due to additional information they provided in some cases with isolated cortical venous thrombosis, with hyperintense thrombus material and with associated hemorrhage or infarction. Conclusion Contrast-enhanced 3D GRE T1-weighted MRI is the most accurate imaging method for the detection of DVS and/or cortical venous thrombosis. Infarction and hemorrhage were more frequent in cases with cortical venous thrombosis.

Migraine is a neurovascular disorder characterized by autonomic nervous system dysfunction and severe headache attacks. Studies have shown that changes in the intracranial vessels during migraine have an important role in the pathophysiology. Many studies have been conducted on the increased risk of stroke in patients with migraine, but insufficient data are available on the mechanism underlying the increase. This study aimed to evaluate basal cerebral blood flow velocity and vasomotor reactivity in patients with chronic migraine. We evaluated 38 patients with chronic migraine. Three of them were excluded because they had auras and four of them were excluded because of their use of medication that can affect cerebral blood flow velocity and breath holding index (beta or calcium channel blockers). Our study population consisted of 31 patients with chronic migraine without aura and 29 age- and gender-matched healthy individuals who were not taking any medication. The mean blood flow velocity and breath holding index were measured on both sides from the middle cerebral artery and posterior cerebral artery, with temporal window insonation. The breath holding index for middle cerebral artery and posterior cerebral artery was significantly lower in the migraine group compared to that of the control group (p < 0.05).The vasomotor reactivity indicates the dilatation potential of a vessel, and it is closely related to autoregulation. According to our results, the vasodilator response of cerebral arterioles to hypercapnia was lower in patients with chronic migraine. These findings showed the existence of impairments in the harmonic cerebral hemodynamic mechanisms in patients with chronic migraine. This finding also supports the existing idea of an increased risk of stroke in patients with chronic migraine due to impaired vasomotor reactivity.

Introduction Creating vascularized nerve conduits for treatment of nerve gaps have been researched, however, these methods need microsurgical anastomosis thereby complicating the nerve repair process. Thus, the concept of vascularized nerve conduits has not popularized up till now. The aim of this study is to evaluate the effects of vascularized and non-vascularized biological conduits on peripheral nerve regeneration. Material and methods Following ethical board approval, 15 Sprague-Dawley rats were used in the study. The rats were equally divided into three groups. In group I, a silicon rod was inserted next to the sciatic nerve of the rat and connective tissue generated around this rod was used as a vascularized biological conduit. In group II, a silicon rod was inserted into the dorsum of the rat and connective tissue generated around this rod was used as a non-vascularized biological conduit. In group III, autogenic nerve graft was used to repair the nerve gap. The contralateral sciatic nerve is used as a control in all rats. Macroscopic, electrophysiological and histomorphometric evaluations were performed to determine the nerve regeneration. Results There was no statistically significant difference between groups, in terms of latency. However, the mean amplitude of group I was found to be higher than other groups. The difference between group I and II was statistically significant. Myelinated axonal counts in group I was significantly higher than groups II and III. Conclusion Our results showed that vascularized biological conduits provided better nerve regeneration when compared to autografts and non-vascularized biological conduits. Creation and application of vascularized conduits by using the technique described here is easy. Although this method is not an alternative to autogenic nerve grafts, our results are promising and encouraging for further studies.

A 43-year-old female was referred to our clinic for an electromyographic (EMG) examination due to weakness in both the lower extremities. Conduction blocks were indicated through nerve conduction studies (NCS). Because of demyelinating polyneuropathy findings and elevated protein levels in the cerebrospinal fluid (CSF), the patient was diagnosed with acute inflammatory demyelinating polyneuropathy (AIDP) and was treated with intravenous immunoglobulin. In the follow-up examination, a distal quadriparesis was found that was markedly pronounced in the lower left extremity, and a second EMG examination showed asymmetrical worsening. These findings combined with the lack of demyelination suggested axonal degeneration, and the partial conduction blocks observed during the first NCS were determined to be pseudo-blocks. Vasculitic syndromes were considered and the associated laboratory tests were performed. Following a sural nerve biopsy, non-infectious necrotizing arteritis was found and the patient was diagnosed with polyarteritis nodosa (PAN). Therefore, clinicians should be aware that conduction blocks observed in nerve conduction studies may potentially be pseudo-blocks and an indication of vasculitic neuropathy.

The present study was designed to describe the socio-demographic, clinical, and polysomnographic features of patients diagnosed with narcolepsy in our sleep center. This retrospective cross-sectional study was conducted on 181 patients diagnosed with narcolepsy based on the results of clinical evaluation, polysomnography (PSG), and multiple sleep latency test (MSLT) between 1993 and 2009. Approximately 70% of the patients had cataplexy, whereas 42% had hallucinations and 55.8% had sleep paralysis. Although sleep efficiency was higher (91.28 ± 5.89%) in patients with narcolepsy, they woke frequently during the night, and their percentages of deep sleep were low (stage 3, 5.12 ± 3.08%, stage 4, 9.60 ± 7.10%). Our study group was divided into two based on age: individuals aged30 years (n = 152) and30 years (n = 29). REM latency on PSG was shorter (t = 2.96, p = 0.004) and sleep onset REM (SOREM) on MSLT was higher (t = 2.56, p = 0.011) in the older group than in the younger group. Cataplexy is seen in most patients with narcolepsy. In older patients, REM latency on PSG is shorter and the number of SOREM on MSLT is higher.

We present a case of breast cancer whose initiating symptom was painful ophthalmoplegia and had pachymeningitis. A 70-year-old female admitted because of left ocular pain and ptosis. Magnetic resonance imaging revealed pachymeningitis and contrast enhancement and thickening of left cavernous sinus. Bone marrow pathology was associated with metastatic carcinoma. Bone scintigraphy indicated diffuse metastatic activity in skeleton particularly in cranium. Painful ophthalmoplegia and pachymeningitis are thought to be associated with metastatic carcinomatosis. Primary tumor indicated infiltrating ductal cancer of breast. Clinicians should consider that metastatic breast cancer may first be presented by painful ophthalmoplegia.

Neurological symptoms can be seen in 5%-8% of lymphoma patients. The most frequent causes of neurological symptoms are herpes virus infection, neurotoxicity due to vincristine, Guillain–Barre syndrome, and the nerve involvement of the tumor [1]. Paraneoplastic polyneuropathy is a rare neurological complication of lymphoma [2]. Here we report a case of relapsed follicular lymphoma presenting with paraneoplastic sensory neuropathy (ganglioneuropathy). A 45-year-old woman was admitted to the hospital 2 years ago with the complaints of numbness in the hands and feet, unsteadiness, weight loss, fever, and swellings in the neck, axilla, and inguinal region. She was diagnosed with follicular lymphoma through the excisional biopsy of the cervical lymph node. She was diagnosed with stage 3B disease based on the presence of lymphadenopathies in the paratracheal, precarinal, axillary, and inguinal regions and no infiltration by bone marrow examination. The treatment started with rituximab (500 mg/day), cyclophosphamide (1125 mg/day), adriablastine (80 mg/day), vincristine (2 mg/day), and prednisolone (80 mg/day). Therapy was completed in 8 courses with 21-day intervals. After the therapy, all of the symptoms had regressed and the case was evaluated as in remission with a follow-up PET scan (Figure 1). Gradually increasing unsteadiness, numbness, and pain and burning sensation in the hands and feet developed 1 month following that PET study. She applied to the neurology service and it was found that she had normal muscle strength but mild ataxia, positive Romberg test, and prominent hypoesthesia in the distal regions of the extremities and bilateral impairment of the deep tendon reflexes and indifferent plantar responses. Informed consent was obtained. An electromyography revealed sensorial gangliopathy. On physical examination the positioning and the vibration sensations of the patient were found to be diminished. Intravenous pulse steroid therapy (1000 mg/day) was administered for 5 days. Two days after this therapy, a severe and generalized pain developed in all of the extremities and joints. In neurological examination, distinct quadriparesis, ataxia, dysmetria, dysdiadochokinesia, hypoesthesia of the 4 extremities, and bilateral abolished deep tendon reflex with indifferent plantar responses were determined. There was Letter to the Editor DOI: 10.4274/TJH-2013.0125

The aim of this study was to investigate cutaneous-silent-period (CSP) parameters in patients with restless legs syndrome (RLS) and examine the effects of treatment on CSP which, to our knowledge, have not been investigated till date.A total of 25 patients with RLS and 25 healthy volunteers were studied. CSP latency and duration in the upper and lower extremities were examined in the two groups. In RLS patients, the variables were examined before and after pramipexole treatment.Lower-extremity CSP latency was longer (106.22±11.69 ms vs. 91.67±8.53 ms; p0.001) and CSP duration was shorter (35.50±10.91 ms vs. 49.47±6.43 ms; p0.001) in patients, compared with controls. In the patient group, CSP durations in the upper (40.88±7.95 ms vs. 46.84±10.22 ms; p=0.006) and lower extremities (35.50±10.91 ms vs. 44.91±6.43 ms; p=0.005) were prolonged after treatment, compared with pre-treatment values.Small-fibre neuropathy may exist in RLS. In addition, we suggest that pramipexole may regulate cortical and spinal inhibitory mechanisms.The use of CSP may aid in the diagnosis of RLS and may be used as a measure of treatment effectiveness.

Diabetic polyneuropathy can be easily diagnosed when the nerve conduction studies are affected. Strength Duration Time (SDTc) reflects nerve excitability properties and was previously used several times to demonstrate the excitability properties of the nerves in the existence of electrophysiologically developed diabetic polyneuropathy. But as we all know, diabetic patients may experience neuropathic symptoms even though their routine nerve conduction studies are normal. SDTc may be useful in this early stages of developing neuropathy. In this study we aimed to evaluate the SDTc properties of diabetic patients in this early preclinic stage. Recently SDTc was commonly studied in the upper extremities but most of the diabetic neuropathies are predominant in the lower extremities. So here we also studied both upper and lower extremities to demonstrate a possible difference. (C) 2011 Elsevier Ireland Ltd. All rights reserved.

diffusion MRI was undergone and acute lacuner infarct near the anterior horn of the right lateral ventricles was detected. The laboratory and cardiac tests were normal. So acetylsalicylicacid was given. Conclusion: Lacunar infarcts tend to cause restricted neurological signs due to their small sizes. Fisher CM stated that monoparesis does not ocur secondary to a lacunar infarct ,but some cases have been described despite the lack of clinical details or pathological confirmation. Clinicians should consider lacunar infarcts in patients presentingwithmonoparesis, so larger infarcts can be prevented.

Ulnar nerve usually gets entrapped at cubital sulcus, but it may rarely occur at the wrist region and the most frequent reason is chronic pressure. Entrapment of the ulnar nerve at the arm region is very rare and only a few case reports have been published. Arcade of Struthers, which is found in the middle region of the arm, is an entrapment area for ulnar nerve. We aimed to underline the importance and presence of arcade of Struthers by presenting a 20 year old male patient with a clinical presentation of ulnar entrapment neuropathy and having electrophysiological findings of ulnar entrapment at the middle region of his arm.

Objective: Cerebral venous sinus thrombosis (CVT) is a disease that is difficult to diagnose because of large variability of clinical symptoms and signs. Poor prognosis may occur due to late diagnosis. Methods: The demographic characteristics, initial symptoms and signs, clinical features, etiologies, imaging findings and treatments were retrospectively reviewed in the 17-patients accepted to our hospital between May-2003 and January-2011 with Cerebral Venous Thrombosis diagnosed by cranial magnetic resonance imaging and magnetic resonance venography. Results: The patients followed in our clinic with a diagnosis of cerebral venous thrombosis were 9-female and 8-men. All of the patients complained from headache, eight of the patients had epileptic seizures, six of patients had weakness and/or a complaint of numbness. Evaluation of etiologic factors revealed that CVT developed after pregnancy in three patient, after oral contraceptives in three patient. As the most common neurological examination findings during the first applicant were papillae edemas in 13 patients, 6 patients had motor deficits, sixth cranial nerve involvement was detected in 3 patients. All the patients were diagnosed with cerebral venous thrombosis were managed by anticoagulation therapy. One of our patients died. Conclusion: Although SVT is a rare disease, patient admitted with severe headaches and papilledema, epileptic seizure, and with prone to thrombosis, it should be considered. Early diagnosis is very important for CVT and anticoagulant, thrombolytic, antiepileptic and etiologic treatments should be done. Anticoagulant therapy is the first-line treatment for cerebral venous sinus thrombosis because of its efficacy and safety.

WCN 2013 No: 2532 Topic: 2 — Movement Disorders The missing tau mutation: +15 exon 10/intron 10 boundary of MAPT stem loop structure in an Irish family with FTDP-17 R. Lonergan, A. McCarthy, S. O'Dowd, B. Magennis, E. Fallon, M. Spillantini, M. Hutton, T. Lynch. Neurology, Mater Misericordiae Hospital, Dublin, Ireland; Molecular Neurology, Addenbrooke's Hospital, Cambridge, UK; Eli Lilly and Company, London, UK Background: Up to 40% of families with autosomal dominant frontotemporal dementia with parkinsonism (AD FTDP-17) carry pathogenic 5′ splice site mutations in the Microtubule-Associated Protein Tau (MAPT) gene. Several stem-loop mutations of tau exon 10 were identified, but the +15 mutation remained elusive. Aim: We present a family with the ‘missing’ +15 mutation. Case: A 44 year old man developed progressive disinhibition, apathy and simultaneous amnestic syndrome. Neurological examination normal (primitive reflexes/disinhibition). Pedigree: autosomal dominant young-onset dementia. Investigations: MRI brain — moderate bitemporal atrophy; PET CT — low anterior temporal activity. CSF — raised protein: phosphorylated tau/beta-amyloid normal. Fluorescent sequencing analysis for familial tau variant: sequence variant c.915 + 15A N C, at exon 10/intron 10 boundary of MAPT gene. Identical variant in first cousin. Discussion: In 1998, Hutton described 5′ splice site mutations in tau, associated with FTDP-17, destabilising a stem-loop structure, causing alternate splicing of exon 10. The predicted +15 A N C mutation at intron 10 was ‘missing’ until now. In this unique family, the proband had profound short-term amnesia and behavioral change, suggesting atypical familial Alzheimer disease or atypical FTDP-17. Detection of novel +15 mutation clarified diagnosis of FTDP-17 and informed genetic counselling. Finding this mutation 14 years after prediction highlights value of pursuing complete family history to guide appropriate molecular genetic testing. doi:10.1016/j.jns.2013.07.549 Abstract — WCN 2013 No: 2483 Topic: 2 — Movement Disorders Orthostatic tremor responding to Rasagiline WCN 2013 No: 2483 Topic: 2 — Movement Disorders Orthostatic tremor responding to Rasagiline M. Yucel, H. Akgun, S. Tasdemir, S. Alay, O. Oz, E. Eroglu, S. Demirkaya. Department of Neurology, Kasimpasa Military Hospital, Istanbul, Turkey; Department of Neurology, Etimesgut Military Hospital, Ankara, Turkey; Department of Neurology, Gulhane Military Medical Academy, Ankara, Turkey Background: Orthostatic tremor is known as a lower extremity tremor occurring when standing. When a person stands, typical high frequency (13–18 Hz) tremor develops, and disappears with walking, sitting or continuous volatile leg movement. Objective: In this report we presented a patient with tremor on the lower limbs diagnosed with Parkinson's disease. Patients and methods: A 58-year-old female patient presented to our outpatient clinic with complaints of trembling in the body when standing, lasting for 1 year. The neurological examination revealed bradykinesia of the lower and upper right limbs, rigidity and rest tremor of the right hand and trembling of the lower limbs when standing. Results: The brain MRI and the routine nerve conduction studies were normal. The superficial electrode recordings of femoris, anterior tibialis, biceps femoris muscles documented a tremor of 13 Hz. The patient was diagnosed with Parkinson's disease accompanied by orthostatic tremor and was started 2 mg of Rasagiline. Significant improvement was noted. Conclusion: We found this case worth reporting because of the rare presentation of Parkinson's disease in the literature with orthostatic symptoms as a first sign. doi:10.1016/j.jns.2013.07.550 Abstract — WCN 2013 No: 2514 Topic: 2 — Movement Disorders Extrapontine myelinolysis presented with sudden-onset generalised chorea WCN 2013 No: 2514 Topic: 2 — Movement Disorders Extrapontine myelinolysis presented with sudden-onset generalised chorea D. Petrlenicova, M. Kucharik, M. Saling. 2nd Dept. of Neurology, Faculty of Medicine, Comenius University, University Hospital Bratislava, Bratislava

Objective: The aim of this study was to investigate cutaneous-silent-period (CSP) parameters in patients with type 2 diabetes mellitus (DM) and examine the effects of Alpha-lipoic acid (ALA) treatment on CSP which, to our knowledge, have not been investigated till date in the literature. Background Small myelinated (A-d) and unmyelinated (C) somatic sensory fibers are initially affected and may be the earliest exhibited sign of neuropathy in glucose dysmetabolism. Cutaneous silent period (CSP) is an inhibitory spinal reflex and its afferents consist of A-d nerve fibers. Design/Methods: A total of 17 patients with DM and 25 healthy volunteers were studied. CSP latency and duration in the upper and lower extremities were examined in the two groups. In DM patients, the variables were examined before and after ALA treatment. Results: Upper-extremity CSP latency {79,50 (59,50-89,50) ms} was longer in patients, compared with controls {73,75 (56,00-85,25) ms} (p=0,007). Lower-extremity CSP latency was longer {112,75 (78,25-152,75) ms} in patients, compared with controls {96,25 (80,00-113,00) ms} (p Conclusions: The results suggest that ALA treatment may improve small-fibre neuropathy (SFN) in DM patients. CSP may be used as a measure of ALA treatment effectiveness. Disclosure: Dr. Yucel has nothing to disclose. Dr. Oz has nothing to disclose. Dr. Akgun has nothing to disclose. Dr. Taslipinar has nothing to disclose. Dr. Erdogan has nothing to disclose. Dr. Yasar has nothing to disclose. Dr. Ulas has nothing to disclose. Dr. Odabasi has nothing to disclose.

Progressive supranuclear palsy (PSP) is a form of neurodegenerative disease which affects the brainstem and basal ganglia. Patients present supranuclear ophthalmoplegia, postural instability and mild dementia. We analyzed five cases of PSP from 1 January 2005 to 31 December 2009. All patients underwent a memory test, autonomic examination, brain magnetic resonance imaging (MRI) and they evaluated by formal neurologic examination. All were taking L-dopa or dopamine agonists. At the onset of PSP the initial diagnosis was Parkinson’s disease in all patients. The brain MRI findings were revealed severe midbrain atrophy, while mini-mental state examination disclosed cognitive impairment, with predominant subcorticalfrontal involvement. Autonomic tests were failure in three of the patients. We emphasize the still obvious current difficulty in diagnosing PSP at an early stage in clinical practice. Therefore it is essential to formulate better clinical diagnostic criteria, to permit correct management of the disease.

INTRODUÇÃO: O período de silêncio cutâneo (PSC) é um reflexo protetor inibitório da coluna vertebral e seus aferentes consistem em fibras nervosas A-delta. Nosso objetivo foi avaliar pacientes com fibromialgia (FM) e controles saudáveis para determinar as diferenças entre os grupos em relação à duração e latência do PSC, e quando presente, determinar se há alguma relação com as características da doença, distúrbios psicológicos e qualidade de vida. MATERIAIS E MÉTODOS: Trinta e dois pacientes com FM e 32 voluntários saudáveis foram incluídos no estudo. Os dois grupos foram comparados em relação à latência e duração do PSC em ambos os membros superiores e inferiores. Características da doença, distúrbios psicológicos e qualidade de vida dos pacientes foram avaliados utilizando o Fibromyalgia Impact Questionnaire (FIQ), e o Short Form-36 (SF-36). Os pacientes com medida de PSC igual ou inferior às do grupo controle foram comparados com aqueles com valores mais elevados do que os controles em termos de características da doença, estado psicológicos e qualidade de vida. RESULTADOS: Latências significativamente prolongadas de PSC nos membros superiores e inferiores foram determinadas em pacientes comparados com os controles. Observou-se que a prolongamento da latência do PSC no membro inferior estava associado com a gravidade da doença e incapacidade funcional. CONCLUSÕES: Latências do PCS nos membros superiores e inferiores em pacientes com FM são mais longas do que em voluntários saudáveis. Além disso, o prolongamento da latência do PSC no membro inferior está associado com a gravidade da doença e incapacidade funcional física. INTRODUCTION: Cutaneous silent period (CSP) is an inhibitory spinal protective reflex and its afferents consist of A-delta nerve fibers. We aimed to evaluate patients with fibromyalgia (FM) and healthy controls to determine any differences between the groups in terms of CSP duration and latency, and if present, to determine whether there is any relationship with disease characteristics, psychological disorders and quality of life. MATERIALS AND METHODS: Thirty-two patients with FM and 32 healthy volunteers were included in the study. The patient and control groups were compared in terms of CSP latency and duration in both upper and lower extremities. Disease characteristics, psychological disorders and quality of life of patients were assessed using the Fibromyalgia Impact Questionnaire (FIQ) and Short Form-36 (SF-36). Patients with CSP measurements equal to or lower than those of the control group were compared with those with higher values than controls in terms of disease characteristics, psychological status and quality of life. RESULTS: Significantly prolonged CSP latencies in both upper and lower extremities were determined in patients compared to controls. We found that prolongation of CSP latency in the lower extremity is associated with disease severity and functional disability. CONCLUSIONS: CSP latencies in both upper and lower extremities in patients with FM are longer than in healthy volunteers. Moreover, prolongation of CSP latency in the lower extremity is associated with disease severity and physical functional disability.