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Multifocal motor neuropathy (MMN) is an immune-mediated and acquired demyelinating motor polyneuropathy. Several cases of polyneuropathy associated with severe acquired respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination have been reported. However, MMN has not been reported as a complication of SARS-CoV-2 vaccination. In this study, we report a case of MMN with progressive muscle weakness following the second dose of the Pfizer-BioNTech mRNA vaccine. It was diagnosed by clinical evaluation and electroneuromyography. SARS-CoV-2 vaccination is increasing rapidly all over the world. Some cases of polyneuropathy, especially Guillain–Barré syndrome, have been reported after vaccination. This is the first case report of MMN after SARS-CoV-2 vaccination.

Introduction and AimStroke is a disease with high mortality and morbidity. Although studies are generally performed on all patients with stroke, it is known that gender has an effect on etiology and prognosis. This study aimed to determine the importance of clinical stroke scales and laboratory markers in determining the short-term prognosis of female patients with ischemic stroke of anterior circulation.Materials and MethodsThe study was planned as a retrospective and cross-sectional study. SEDAN score, the National Institutes of Health stroke scale (NIHSS), the Modified Rankin Scale (mRS), the Glasgow Coma Scale (GCS), and THRIVE score applied to the patients at the time of admission were recorded. Admission blood glucose, hemoglobin, leukocyte, urea, albumin, and blood lipid levels were evaluated. The relationship of all these parameters with in-hospital prognosis, mortality, and disability at discharge was examined. The relationship between groups and data was analyzed using the SPSS package program after the normality analysis.ResultsIn this study, there were 733 female patients with stroke with a mean age of 69.53 ± 14.51 years and 858 male patients with stroke with a mean age of 64.27 ± 13.29 years. Hospitalization time, length of stay in the intensive care unit, ventilation need rate, mortality, and dependency rate were higher in female patients (p = 0.001). The NIHSS, SEDAN, and THRIVE scores were higher in female patients who had in-hospital mortality, had a poor prognosis, and who were discharged as dependent (p = 0.001). GCS was lower in this patient group (p = 0.001). Blood glucose, creatinine, leukocytes, urea, and CRP levels were higher; the albumin and hemoglobin levels was lower in female patients who had fatal outcomes (p = 0.009, 0.001, 0.001, 0.001, 0.001, and 0.020; respectively). In female patients who were dependent at discharge, blood urea, glucose, and CRP levels were higher and the albumin levels were lower than those in female patients who achieved functional independence (p = 0.001, 0.016, 0.002, and 0.001, respectively).ConclusionOur study showed that the short-term prognosis is worse in female patients who had an ischemic stroke of anterior circulation. It also revealed some clinical and laboratory parameters that could predict this situation. More intensive monitoring may be needed to improve prognosis in female patients.

Background Antiplatelet therapy increases the risk of hematoma expansion in intracerebral hemorrhage (ICH) while the effect on functional outcome is uncertain. Methods and Results This is an exploratory analysis of the TICH‐2 (Tranexamic Acid in Intracerebral Hemorrhage‐2) double‐blind, randomized, placebo‐controlled trial, which studied the efficacy of tranexamic acid in patients with spontaneous ICH within 8 hours of onset. Multivariable logistic regression and ordinal regression were performed to explore the relationship between pre‐ICH antiplatelet therapy, and 24‐hour hematoma expansion and day 90 modified Rankin Scale score, as well as the effect of tranexamic acid. Of 2325 patients, 611 (26.3%) had pre‐ICH antiplatelet therapy. They were older (mean age, 75.7 versus 66.5 years), more likely to have ischemic heart disease (25.4% versus 2.7%), ischemic stroke (36.2% versus 6.3%), intraventricular hemorrhage (40.2% versus 27.5%), and larger baseline hematoma volume (mean, 28.1 versus 22.6 mL) than the no‐antiplatelet group. Pre‐ICH antiplatelet therapy was associated with a significantly increased risk of hematoma expansion (adjusted odds ratio [OR], 1.28; 95% CI, 1.01–1.63), a shift toward unfavorable outcome in modified Rankin Scale (adjusted common OR, 1.58; 95% CI, 1.32–1.91) and a higher risk of death at day 90 (adjusted OR, 1.63; 95% CI, 1.25–2.11). Tranexamic acid reduced the risk of hematoma expansion in the overall patients with ICH (adjusted OR, 0.76; 95% CI, 0.62–0.93) and antiplatelet subgroup (adjusted OR, 0.61; 95% CI, 0.41–0.91) with no significant interaction between pre‐ICH antiplatelet therapy and tranexamic acid (P interaction=0.248). Conclusions Antiplatelet therapy is independently associated with hematoma expansion and unfavorable functional outcome. Tranexamic acid reduced hematoma expansion regardless of prior antiplatelet therapy use. Registration URL: https://www.isrctn.com; Unique identifier: ISRCTN93732214.

Background. Early diagnosis of cerebral venous sinus thrombosis (CVST) associated with reproductive health-related risk factors (RHRF) including pregnancy, puerperium, and oral contraceptive (OC) use can prevent severe neurological sequelae; thus, the symptoms must be documented in detail for each group. Methods. Out of 1144 patients with CVST, a total of 777 women were enrolled from a multicenter for the study of cerebral venous sinus thrombosis (VENOST). Demographic, biochemical, clinical, and radiological aspects were compared for 324 cases with RHRF and 453 cases without RHRF. Results. The mean age of the RHRF (-) group (43.2 ± 13 years) was significantly higher than of the RHRF (+) group (34±9 years). A previous history of deep venous thrombosis (3%), isolated cavernous sinus involvement (1%), cranial neuropathy (13%), comorbid malignancy (7%), and its disability scores after 12 months (9%) were significantly higher in the RHRF (-) group. The RHRF (+) group consisted of 44% cases of puerperium, 33% cases of OC users and 23% of pregnant women. The mean age was found to be higher in OC users (38±9 years). A previous history of deep venous thrombosis was slightly higher in the pregnancy subgroup (4%). Epileptic seizures were more common in the puerperium group (44%). Conclusion. The results of our study indicate that the risk of CSVT increases parallel to age, OC use, and puerperium period. In addition, when considering the frequency of findings and symptoms, epileptic seizures in the puerperium subgroup of the RHRF (+) group and malignancies in the RHRF (-) group may accompany the CSVT. In daily practice, predicting these risks for the CSVT and early recognition of the symptoms will provide significant benefits to patients.

Objective: Some comorbid diseases are recognized as specific risk factors for stroke. Rheumatological diseases constitute an important group of these diseases. In our study, we evaluated patients who were followed up for stroke in our clinic. We included patients with additional rheumatological diagnoses in a separate group and attempted to determine their differences from patients without a diagnosis. In this way, we aim to investigate the effect of rheumatological comorbidity on prognosis in stroke patients. Material and methods: We included patients diagnosed with ischemic stroke, hemorrhagic stroke, transient ischemic attack, and hemorrhagic infarction, who were admitted to our hospital between 2016-2020 and were hospitalized, in the study. Age, gender, stroke subtype, need for intensive care, and exitus status of these patients was recorded. We compared patients with a rheumatological diagnosis to patients with other stroke diagnoses using appropriate statistical methods.Results: 2053 patients with an average age of 66.22±14.33 participated in the study. A total of 37 patients were diagnosed with at least 1 rheumatological disease. We calculated the average age of these patients as 51.62±15.88. Compared to patients without a diagnosis of rheumatological disease, the age was significantly lower(p

Objective: To reveal the profile and practice in patients with acute stroke who received intravenous tissue plasminogen activator (IV tPA) and/or neuro-interventional therapy in Türkiye. Materials and Methods: On World Stroke Awareness Day, May 10, 2018, 1,790 patients hospitalized in 87 neurology units spread over 30 health regions were evaluated retrospectively and prospectively. Results: Intravenous tPA was administered to 12% of 859 cases of acute ischemic stroke in 45 units participating in the study. In the same period, 8.3% of the cases received neurointerventional treatment. The rate of good prognosis [modified Rankin score (mRS) 0–2] at discharge was 46% in 83 patients who received only IV tPA [age: 67 +- 12 years; National Institutes of Health Stroke Scale (NIHSS): 12 +- 6; hospital stay, 24 +- 29 days]; 35% in 51 patients who underwent thrombectomy (MT) alone (age: 64 +- 13 years; NIHSS: 14.1 +- 6.5; length of hospital stay, 33 +- 31 days), 19% in those who received combined treatment (age: 66 +- 14 years; NIHSS: 15.6 +- 5.4; length of hospital stay, 26 +- 35 days), and 56% of 695 patients who did not receive treatment for revascularization (age: 70 +- 13 years; NIHSS: 7.6 +- 7.2; length of hospital stay, 21 +- 28 days). The symptom-to-door time was 87 +- 53 minutes in the IV treatment group and 200 +- 26 minutes in the neurointerventional group. The average door-to-needle time was 66 +- 49 minutes in the IV tPA group. In the neurothrombectomy group, the door-to-groin time was 103 +- 90 minutes, and the TICI 2b-3 rate was 70.3%. In 103 patients who received IV tPA, the discharge mRS 0–2 was 41%, while the rate of mRS 0–1 was 28%. In 71 patients who underwent neurothrombectomy, the mRS 0–2 was 31% and mRS 0–1 was 18%. The door-to-groin time was approximately 30 minutes longer if IV tPA was received (125 +- 107 and 95 +- 83 minutes, respectively). Symptomatic bleeding rates were 4.8% in IV recipients, 17.6% among those who received only MT, and 15% in combined therapy. Globally, the hemorrhage rate was 6.8% in patients receiving IV tPA and 16.9% in MT. Conclusion: IV thrombolytic and neurointerventional treatment applications in acute ischemic stroke in Türkiye can provide the anticipated results. Heterogeneity has begun to be reduced in our country with the dissemination of the system indicated by the 'Directive on Health Services to be Provided to Patients with Acute Stroke.'

Objective: Atrial fibrillation (AF) is the most common directly preventable cause of ischemic stroke. There is no dependable neurology-based data on the spectrum of stroke caused by AF in our country. Within the scope of NeuroTek-Turkey, hospital-based data on acute stroke patients with AF were collected to contribute to the creation of acute stroke algorithms. Materials and Methods: Atrial fibrillation (AF) is the most common directly preventable cause of ischemic stroke. There is no dependable neurology-based data on the spectrum of stroke caused by AF in Türkiye. Within the scope of NöroTek-Türkiye (TR), hospital-based data on acute stroke patients with AF were collected to contribute to the creation of acute-stroke algorithms. Results: The rate of AF in patients hospitalized for ischemic stroke/TIA was 29.8%, of which 65% were known before stroke, 5% were paroxysmal, and 30% were diagnosed after hospital admission. The proportion of patients with AF who received 'effective' treatment [international normalization ratio ≥2.0 warfarin or non-vitamin K antagonist oral anticoagulants (NOACs) at a guideline dose] was 25.3%, and, either no medication or only antiplatelet was used in 42.5% of the cases. The low dose rate was 50% in 42 patients who had a stroke while taking NOACs. Anticoagulant was prescribed to the patient at discharge at a rate of 94.6%; low molecular weight or unfractionated heparin was prescribed in 28.1%, warfarin in 32.5%, and NOACs in 31%. The dose was in the low category in 22% of the cases discharged with NOACs, and half of the cases, who received NOACs at admission, were discharged with the same drug. Conclusion: NöroTekTR revealed the high but expected frequency of AF in acute stroke in Türkiye, as well as the aspects that could be improved in the management of secondary prophylaxis. AF is found in approximately one-third of hospitalized acute stroke cases in Türkiye. Effective anticoagulant therapy was not used in three-quarters of acute stroke cases with known AF. In AF, heparin, warfarin, and NOACs are planned at a similar frequency (one-third) within the scope of stroke secondary prophylaxis, and the prescribed NOAC dose is subtherapeutic in a quarter of the cases. Non-medical and medical education appears necessary to prevent stroke caused by AF.

Environment psychologically affects individuals. According to the base of cognitive psychology, there is a direct relationship between human behavior, environment, and emotional process. Assuming that pleasantness and unpleasantness are associated with peripheral nervous system activation, the current study aims to explore if the pleasant or unpleasant architectural places can stimulate the brain regions engaged in emotions or not. As the main contribution, we used functional magnetic resonance imaging (fMRI) measuring blood oxygenation level-dependent (BOLD) changes to effectively detect the brain's region that mainly responds to the emotional-perceptual processes. Based on the results of examining the emotional assessment model of “Pleasure-Arousal” applied to 140 students, 30 most-rated images representing 15 pleasant and 15 unpleasant places were shown to 32 participants in a 1.5-T MRI scanner. After applying standard preprocessing steps (re-alignment, slice-timing, co-registration, segmentation, normalization, and smoothing) to functional MR images, first-level analysis was applied to each subject. The results were evaluated using statistical corrections at different levels for female and male participants with the second-level analysis. In conclusion, it has been shown that there is a significant linkage between environmental experience and brain activation so that the architectural qualities can change blood flow in specific brain regions.

Objective: Nutritional status assessment, dysphagia evaluation and enteral feeding decision are important determinants of prognosis in acute neurovascular diseases. Materials and Methods: NöroTek is a point prevalence study conducted with the participation of 87 hospitals spread across all health sub regions of Turkey conducted on 10-May-2018 (World Stroke Awareness Day). A total of 972 hospitalized neurovascular patients [female: 53%, age: 69+-14; acute ischemic stroke in 845; intracerebral hematoma (ICH) in 119 and post-resuscitation encephalopathy (PRE) in 8] with complete data were included in this sub-study. Results: Gastrostomy was inserted in 10.7% of the patients with ischemic stroke, 10.1% of the patients with ICH and in 50% of the patients with PRE. Independent predictors of percutaneous endoscopic gastrostomy (PEG) administration were The National Institutes of Health Stroke Scale score at admission [exp (β): 1.09 95% confidence interval (CI): 1.05-1.14, per point] in ischemic stroke; and mechanical ventilation in ischemic [exp (β): 6.18 (95% CI: 3.16-12.09)] and hemorrhagic strokes [exp (β): 26.48 (95% CI: 1.36-515.8)]. PEG was found to be a significant negative indicator of favorable (modified Rankin's scale score 0-2) functional outcome [exp (β): 0.032 (95% CI: 0.004-0.251)] but not of in-hospital mortality [exp (β): 1.731 (95% CI: 0.785-3.829)]. Nutritional and swallowing assessments were performed in approximately two-thirds of patients. Of the nutritional assessments 69% and 76% of dysphagia assessments were completed within the first 2 days. Tube feeding was performed in 39% of the patients. In 83.5% of them, tube was inserted in the first 2 days; 28% of the patients with feeding tube had PEG later. Conclusion: The NöroTek study provided the first reliable and large-scale data on key quality metrics of nutrition practice in acute stroke in Turkey. In terms of being economical and accurate it makes sense to use the point prevalence method.

Dünya Sağlık Örgütü tarafından 11 Mart 2019’da pandemi olarak kabul edilen COVID-19 hastalığının pandeminin ilk döneminde öncelikle solunum yollarını etkileyen ve ciddi akut solunum yetmezliğine (SARS) neden olan bir viral enfeksiyon olduğu kabul edilmiştir. Zaman içinde vasküler sistemler başta olmak üzere diğer organ sistemlerini ve en önemlisi de diğer sistemlerle beraber nörolojik sistemleri ve hatta bazen sadece nörolojik sistemleri etkilediği ortaya konmuştur. Ciddi semptomu olmayan hastalarda bile koku alma kaybı sık olarak görülmekte olup bazı hastalarda ilk veya tek belirti olabilmektedir. Viral enfeksiyonun iyileşmesine rağmen koku alma fonksiyonunun aynı hızla kazanılamaması yaşam kalitesini etkileyen önemli bir nörolojik tutulumdur. Dünyada pandemi sürecinde vaka bildirimleri ve klinik verilerin analizleri ile hızlı bilgi akışı devam etmektedir. Bu yazıda literatür incelemesi ile dünyada bildirilen nörolojik tutulumlar ışığında kranial sinir tutulumları, serebrovasküler hastalıklar ve inme, ansefalit, epilepsi, Guillain Barré sendromu, psikiyatrik bozukluklar ile ilgili güncel bilgilerin paylaşılması amaçlanmıştır.

Amaç: Gerilim tipi baş ağrısı (GTB) etiyolojisinde uyku bozukluğu önemlidir. Ağrı, uykunun birçok safhasına etki ederek uyku kalitesini bozmaktadır. Ayrıca, psikojenik etmenler de uyku kalitesini etkilemektedir. Bu nedenle GTB de uyku kalitesi, depresyon ve gündüz uykululuk durumu incelenmiştir. Gereç ve Yöntem: Çalışmaya 50 GTB hastası ve 40 kontrol alındı. Ağrı sıklığı, süresi, şiddeti, analjezik miktarı ve tedaviye cevap sorgulandı. Ağrı şiddeti için Görsel Ağrı Skalası (VAS) kullanıldı. Hastalarda yaş, cinsiyet, medeni durum, yaşam ortamı, sigara ve alkol kullanımı, eğitim, maddi durum, kilo ve boy değerlendirildi. Pittsburgh Uyku Kalitesi İndeksi (PUKİ), Beck Depresyon Ölçeği (BDÖ) ve Epworth Uykululuk Ölçeği (EUÖ) uygulandı. PUKİ 0-5, 6-10 ve 10 üzeri olarak 3 gruba ayrıldı. Veriler SPSS Windows 16 sürümü ile değerlendirildi. Bulgular: Çalışmada 50 (42 kadın, 8 erkek) hasta vardı. Ortalama±SD sonuçlar: yaş 37,92±14,18; boy 162,2±7,91; kilo 69,96±15,2; PUKİ 12,26±6,05; BDÖ 31,12±15,43 ve EUÖ 9,34±4,80 idi. Uyku süresi, latansı ve bozukluğu, ilaç sayısı ve PUKİ hastalarda daha yüksekti (p0,05). Hastaların sosyodemografik özellikleri, ağrı şiddeti, analjezik kullanımı ile uyku bozukluğu arasında ilişki yoktu (p>0,05). BDÖ ile uyku bozukluğu ve gündüz uykululuk durumu arasında pozitif korelasyon vardı (p

Coronavirus disease-2019 (COVID-19) can be associated with wide-range neurologic symptoms and complications. Parainfectious manifestations that are seen during the active infection period include stroke, olfactory and taste disturbance, encephalopathy, encephalitis, neuropathies, and myopathies. The main postinfectious complications are acute disseminated encephalomyelitis, transverse myelitis, Guillain-Barré syndrome, cognitive disorders, and sleep disorders. COVID-19 commonly causes neurological mid-to-long-term disability. The disease prognosis can be improved with sufficient knowledge, prompt recognition, and effective management of neurological complications.

Objectives:Corpus callosum (CC) is the largest commissural pathway that connects cerebral hemispheres. Structural changes have been reported in epilepsy. Therefore, in this study, the relationship between CC structure and blood parameters was evaluated in patients with epilepsy treated with monotherapy.Methods:In this study, 50 primary epilepsy patients treated with monotherapy and 40 healthy controls were included. Age, sex, antiepileptic drugs, duration of disease, type and frequency of seizures were questioned. Genu, truncus, splenium and anterior-posterior diameter of CC were measured in the TSE/T1 sagittal sequence of brain magnetic resonance imaging. The relationship between blood parameters, antiepileptic treatment and disease characteristics were evaluated.Results:Fifty patients (26 females, 24 males) were included in this study. The mean age was 34.46±13.02 years. Morphometric measurements of CC were genu was 11.12±1.69, truncus was 6.09±1.17, splenium was 10.39±1.93 and anterior-posterior was 69.08±5.19 millimeter (mm). Anterior-posterior diameter was smaller in patients with epilepsy (p=0.04). Female patients with epilepsy had smaller genu diameter (p=0.01). Splenium diameter was smaller in patients with longer disease duration (p=0.04). There was no difference between antiepileptic drug use and morphometric measurements (p>0.05). Urea and creatinine levels were higher in patients with epilepsy (p=0.00, 0.00). Vitamin D and ferritin levels were lower (p=0.01, 0.01). There was no correlation between blood values and morphometric measurements (p>0.05, r

Objective: Restless legs syndrome (RLS) presents with sensory symptoms such as burning in the legs, patients want to move their legs. Symptoms become apparent at rest and at night. The aim of this study was to investigate the relationship between sensory nerve conduction and hematologic parameters in RLS. Materials and Methods: Forty-five patients with RLS and 45 healthy controls were included in the study. Age, sex, and chronic diseases of the patients were questioned. Hemoglobin, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and ferritin values were recorded. Ulnar, median, and sural sensory nerve amplitude, latency and conduction velocity were evaluated in a electroneuromyography laboratory. Data were analyzed using descriptive, parametric and nonparametric tests with the SPSS 21 software. Results: There were 22 (49%) female and 23 (51%) male patients with RLS in the study. The mean age was 57.31±14.47 years. Mean blood values were as follows: Hemoglobin (g/dl) 14.06±1.88; MCV (fl) 85.70 (55.7-96.5); MCH (pg) 28.45 (17.6-32.5), and ferritin (ng/ml) 31.30 (4-848). There was no difference in terms of blood values between RLS and control group (p>0.05). Sural nerve conduction velocity was slower in patients with RLS (p=0.01). Sural nerve latency was longer (p=0.01). Other nerve conduction parameters were equal in the study and control groups (p>0.05) Conclusion: Central nervous system dopaminergic mechanisms, genetic transmission, and low ferritin levels are the main factors in the pathogenesis of RLS. There is less focus on the peripheral nervous system. In this study, sural nerve conduction velocity and latency were associated with RLS. However, there was no correlation between ferritin levels and nerve conduction.

Amaç: İnme tedavisinde asıl amaç, oklüde vasküler yapının belirli süre içerisinde rekanalizasyonudur. Medikal tedavide rekombinant doku plazminojen aktivatörü tPA kullanılmaktadır. Bu çalışmada, tPA tedavisi verilen iskemik inme hastaları değerlendirilmiştir.Gereç ve Yöntem: Temmuz 2015-Ağustos 2017 arasında tPA tedavisi uygulanan 97 akut iskemik inme hastası retrospektif incelendi. Demografik veriler, başvuru semptomları ve tedavi saatleri kaydedildi. Klinik durum ve prognoz ‘National Institutes of Health Stroke Skalası’ NIHSS ve fonksiyonel durum ölçeği ile değerlendirildi. Hemorajik dönüşüm bilgisayarlı tomografi ile değerlendirildi.Bulgular: Çalışmaya 61 %62,8 erkek ve 36 %37,2 kadın hasta alındı. Yaş ortalamaları 60,29±12,62 idi. 7 %7,2 hastaya 1. saate, 5 %25,8 hastaya 1-2 saat arasında, 31 %32 hastaya 2-3 saat arasında, 34 %35,1 hastaya 3-4,5 saat arasında tPAbaşlandı. Başvuruda en sık semptom hemi/monoparezi idi %92,8 .%69,1 oranında parsiyel anterior, %16,5 total anterior, %15,8 posterior vasküler oklüzyon saptandı. NIHSS sonuçları 10,39±4,36 tedavi öncesi ve 6,63±3,76 taburculuk idi. Hastalartam bağımsız %20,6 , kısmi bağımlı %43,3 ve tam bağımlı %21,6 olarak taburcu edildi.Hastaların %12’sinde hemorajik dönüşüm izlendi.Platelet değeri düşük olan hastalarda hemorajik transformasyon daha fazlaydı P

Intravenous tissue plasminogen activator (tPA) increases survival rates without sequelae in acute ischemic stroke. Complications and management of this treatment have become more important with the increasing use of tPA. An 80-year-old male patient was admitted with a sudden-onset speech disorder and loss of strength in his right arm, which started 3 hours ago. Magnetic resonance imaging revealed acute ischemia localized in the left insular cortex. Lip and tongue swelling, difficulty in speaking, and deepening in voice were observed in the 30th minute of infusion. There was mild respiratory distress. Orolingual angioedema was diagnosed. He completely recovered after treatment. Angioedema is a rare but potentially life-threatening complication of tPA. When this clinical symptom occurs, it should be recognized and treated quickly. This report aims to reveal the relationship of this rare complication with the localization of the ischemia.

Neurological diseases are the most common and important health burden over the world. Coronavirus disease-19 (COVID-19) pandemic is a new and important burden for the neurological area. Information related to the neurological involvement of Severe Acute Respiratory syndrome-Coronavirus-2 infection has been increased during the last several months. Frequency and mechanisms of neurological involvement of the disease may be explained more efficiently by neurologists who are included within the multidisciplinary COVID-19 teams. Other very important point is possibility of failure of follow up and treatment of chronic neurological disorders which needed frequent and regular control and also quick action for the acute treatment. The regulations are extremely important for the neurologists to perform their responsibilities with considering all these requirements.

Objective: Thirty percent of all acute ischemic strokes cause is the internal carotid artery stenosis or occlusion. The carotid artery stenting (CAS) was rarely performed in early time, was used more frequently with the development of angiographic method and materials. In this study, we aimed to evaluate the success rates, clinical outcomes and complications of carotid stenting due to carotid stenosis in the Neurology Department of Selçuk University. Materials and Methods: The patients who underwent conventional angiography between November 2017 and August 2018 were evaluated retrospectively in the Neurology Department of Selçuk University. Ninety four patients who underwent conventional angiography due to carotid artery stenosis were included in the study. Fifty four of 94 patients underwent CAS. Control carotid doppler and/or carotid CT angiography was performed at 1 month after discharge. Neurological examinations of the patients were also repeated. Results: The operation success rate was 96.3% (two patients developed minor stroke at the 2 hours after the procedure). No deaths or major stroke occurred in any of these patients with CAS. No ischemic cerebrovascular event or transient ischemic attack occurred in any of the patients at 1 months follow-up. No restenosis was observed in any of the carotid doppler follow-ups or CT anjiyography. Conclusion: In conclusion, we have shown that CAS performed by neurology clinics is effective and reliable. We have also shown that a protective device is not necessary for the risk of distal embolism in these patients.

Objectives:The social stigma associated with epilepsy can be a major cause of concealment of illness. This behavior is associated with many neuropsychiatric disorders. Sleep is an important factor affecting epilepsy and seizures. The aim of this study was to evaluate concealment of illness, sleep disorders, and related factors in epilepsy.Methods:A total of 95 primary epilepsy patients who were referred to the neurology outpatient clinic were included in the study. The demographic and clinical characteristics of the patients were recorded. Concealment of illness was measured using a scale consisting of 17 questions, and the Pittsburgh Sleep Quality Index (PSQI), consisting of 24 questions, was also administered to assess sleep disorders.Results:There were 44 (46.3%) female and 51 (53.7%) male epilepsy patients in the study. The mean concealment score was 57.09±8.96 and the mean PSQI score was 8.12±3.09. Sleep latency was significantly prolonged, and sleep efficiency and daytime functions were impaired. Indications of a sleep disorder were greater in young people (p

Listeria monocytogenes is a gram positive microorganism that can cause multiorgan involvement. If brainstem involvement due to this microorganism occurs, it is called rhombencephalitis. There are nonspecific prodromal symptoms at the begining. Progressive brainstem symptoms and seizures can be added. 27 year old male patient presented with dizziness and ataxia for 15 days. It was learned that he had traveled to Saudi Arabia 2 months ago. Restricted abduction of left eye, left facial hemihypoesthesia, ataxia, dysmetria and bilateral Babinski sign positive were detected. In brain imaging, hyperintensity was detected at T2, DWI and FLAIR sequences in mesencephalon, pons and bulbus localization. Listeria monocytogenes in blood culture was detected. Immune deficit was not detected. Intravenous 150 mg/kg/day ampicillin was started. On the 12th day of admission, the patient died associated with respiratory deficit. Listeria monocytogenes should be considered in patients with resistant of classical antibiotic treatment cases who present with atypical brainstem symptoms. Typical brainstem involvement on brain imaging can be useful for diagnosis. Early recognition and treatment is the most important prognostic factor.

INTRODUCTION: About fifty million people have epilepsy in the world. This disease leads to concerns about occupational, social and marital in patients and their relatives. In addition, sleep disorders are more common in epileptic patients than normal. Disease-related concern and sleep disoder can affect negative the prognosis of disease. So, it is important to evaluate concern and sleep disorder. METHODS: Primary epilepsy patients were included between the ages of 18 and 85 who applied to the neurology clinic in 2016-2017. Demographic and clinical characteristics of the patients were evaluated. Epilepsy knowledge questionnaire and consisting of 16 questions, epilepsy concern scale consisting of 20 questions and Pittsburgh sleep quality tests were made. The results were evaluated with SPSS Windows 16 version. RESULTS: 49 (%48) female and 53 (%52) male patients included. The mean age was 31,86+-11,04. There were epileptic disease for 12,11+-12 years. 1,82+-1,02 different epilepsy medications were used. There were 2,06+-1,04 seizures in the last month. Epilepsy knowledge questionnaire was 10,56+-3,24; concern scale was 61,28+-6,82 and sleep quality test was 8,22+-3,27. Not relationship was found between disease-related concern and sleep quality (r: 0,12; p: 0,04). A low relation was found between the knowledge about the disease and concern (r: 0,35; p: 0,09). There was stronger relationship between seizure frequency and sleep disorder (r: 0,47; p: 0,04). DISCUSSION AND CONCLUSION: Patients had moderate knowledge but high level concern about epilepsy. Most of them had sleep disorder. So, disease-related concern and sleep disorder should also be evaluated during follow-up and treatment of patients.

Syphilis is a spirochete disease that occurs due to Treponema pallidum infection. It can be sexually transmitted and can be transmitted from mother to baby vertically. Neurological involvement is more common in the late period. The use of common antibiotics may alter the natural course of the disease. Because of this, syphilis may present with different neurological findings. A 49-year-old male patient was admitted to our clinic with complaints of fluctuating double vision and droopy left eyelid for two months. In the neurological examination, pupils were mid-dilated, direct and indirect pupillary light reflexes were bilaterally absent, movements of the left eye in all directions and rightward movement of the right eye were restricted. Also, bilateral ptosis was detected. Brain magnetic resonance imaging and electrophysiological studies including repetitive stimulation were normal. Syphilis was diagnosed with blood and cerebrospinal fluid (CSF) tests. He was treated with long-term high-dose intravenous penicillin. Ocular findings are an important indicator of neurosyphilis. Ocular involvement due to primary disease process is rare. If meningitis-related CSF absorption defect develops, eye movement disorders and pupil abnormalities may occur. The diagnosis of neurosyphilis may be delayed due to different clinical manifestations. Neurosyphilis should be considered in case of ocular findings.

Creutzfeldt-Jakob disease (CJD) is a prion disease manifesting with signs of impaired conscious and mental state, cerebellar ataxia, myoclonus, and loss of vision. Since the disease progresses rapidly to death, it is important to distinguish it from other diseases. The exact diagnosis is made by postmortem histopathological analysis of the brain. The diagnosis of CJD is difficult because the clinical presentation varies between cases. In this paper, we present two cases of CJD. The first case was a 50-year-old male who was admitted with agitation, impaired consciousness and involuntary movements for three months. The second case was a 70-year-old male presented with forgetfulness, total loss of vision in the form of conversion disorder and ataxia. Diagnostic support was provided by magnetic resonance imaging (MRI) and electroencephalography (EEG). Increased cerebrospinal fluid concentration of 14.3.3 protein was determined. As a result, prion disease was considered in these cases due to rapid progression of the neuropsychiatric symptoms. Repeated EEG and MRI are useful for diagnosis in these patients. Although there is not effective treatment, diagnosis of the condition is very important in terms of preventive measures.

Multipl skleroz MS tanısında ve ayırıcı tanısında bazı olgularda çeşitli güçlükler yaşanmaktadır. Klinik belirti ve bulgular yanında, manyetik rezonans görüntüleme MRG , beyin omurilik sıvısı BOS incelemesi ve uyarılmış potansiyeller tanıyı kesinleştirmek için önemlidir. Tüm bunlara rağmen bu testlerin tanısal duyarlılık ve özgüllüğü sınırlıdır. Elli yedi yaşında tavuk çiftliği işletmecisi olan erkek hasta, 35 gün önce başlayan sağ yüz yarısında uyuşma ve denge bozukluğu yakınması ile başvurdu. Sağ yüz yarısında objektif hipoestezi ve sağda Babinski bulgusu saptandı. Beyin MRG incelemesindeki; 2 cm çapında, halkasal kontrast tutulumu olan homojen lezyon öncelikle kistik bir oluşumu düşündürdü. BOS ve görsel uyarılmış potansiyel neticesinde hastanın MS olduğu anlaşıldı. Bu hastaların klinik ve nörogörüntüleme ile takibi ayırıcı tanıda değerli bilgiler sağlayabilmektedir

One of the most important reasons why the use of the intravenous (IV) tissue plasminogen activator (tPA), which is one of the key elements of acute ischemic stroke treatment, is not sufficiently widespread is the fact that many common questions have not been adequately answered. In this review, questions about systemic nonneurologic conditions, problems related with IV tPA treatment and complications of treatment, which were collected from our colleagues practicing in Turkey and which are more important in clinical practice, were answered on the basis of the current literature and clear recommendations are made

Subarachnoid hemorrhage (SAH) is a clinical condition with acute-onset, sudden, and severe headache. In addition to headache, severe nausea, vomiting, dizziness, confusion, agitation, focal neurologic deficits, and hypertension can be detected. Findings of meningeal irritation may accompany to these clinical features, 6-24 hours after the hemorrhage. Digital subtraction angiography (DSA) is used for surgical or endovascular treatment planning in order to identify vascular abnormalities, in addition to other imaging studies. After DSA, the frequency of all neurologic complications is between 0.2% and 4.5%. Headache may occur after DSA in an average 50% of patients. This rate is especially higher in female patients. Headache types are usually classified as migraine, tension or postoperative atypical headaches The incidence of severe headache after DSA is low. Vascular wall rupture should be considered first in severe headache after the procedure. It should also be kept in mind that after all other secondary causes are excluded; SAH-like headaches after DSA can be detected

Varicella zoster virus (VZV) is a virus belonging to the family of herpes virus that can remain latent in trigeminal nerve and dorsal root ganglia. Some neurological complications; encephalitis, myelitis, meningitis and central nervous system angiitis may occur with virus reactivation. These complications are very rare in people with normal immune response. A 70-year-old male patient presented with complaints of lower extremity weakness and incontinence for 2 days. Vesiculobullous lesions were observed in the area of the left lower extremity L5 dermatome and sacrum. Magnetic resonance imaging showed involvement of between T9 and T12 as transverse myelitis. Lymphocytic pleocytosis and protein elevation was detected in sample of the cerebrospinal fluid. VZV-DNA positivity determined in polymerase chain reaction (PCR). Patients with dermatomal lesions and myelitis findings should be considered transverse myelitis associated with VZV even if they have not immunodeficient. Rapid recognition and treatment are important for the prognosis.

Use of intravenous tissue plasminogen activator (tPA) is one of the key elements of acute ischemic stroke management. Its use has not become widespread, and has faced significant problems in our country for more than a quarter of a century most probably due to many unanswered questions about issues related with daily practice. However, recent developments, which adequately focused and found solutions for most of these problems and questions, have led to a major change of point of view and understanding of the hyperacute management of stroke. This article, in the light of the relevant literature, discusses and provides clear recommendations for questions directed by neurologists practicing in Turkey mainly about typical neurologic issues faced in the setting of tPA use for acute stroke

Objective: Nosocomial infections (NI) are serious threats for patients, especially those treated in intensive care units (ICU), which have high risk. Therefore, determining the infectious agents in this area and treating the infections are crucial for both the prognosis of primary disease and the time of stay in hospital. In this study, we aimed to perform an active infection surveillance in the neurological ICU (NICU). Materials and Methods: Two hundred ninety-one patients who stayed in NICU over a twelve-month period were included in the study. Data obtained by infection control committee of our faculty according to “Centres for Disease Control and Prevention” diagnostic criteria were used for the diagnosis of NI. Isolated microorganisms and their systemic involvement were examined. Results: The infections in NICU constituted 6.39% of all NI in the hospital. These were skin and soft tissue infections (3.13%), bloodstream infections (9.38%), pneumonia not associated with mechanical ventilator (9.38%), pneumonia associated with mechanical ventilator (6.25%), and urinary tract infections (UTI) (71.88%). Fourteen different microorganisms were determined in the unit over the twelve months. Conclusion: Caution is advised regarding urinary catheter insertion and care because catheters are the most common cause of infection, UTI, in the ICU. Also, diagnosis of NI and determining the antibiotic sensitivity of the causal microorganisms are very important for the determination of empiric treatment and reducing mortality and morbidity

Arı sokmaları, tüm böcek sokmaları içerisinde en sık olanıdır. Nörolojik etkilenme nadirdir. Ancak ensefalit, akut dissemine ensefalomiyelit, polinöropati ve ekstrapiramidal tutulum ortaya çıkabilmektedir. 79 yaşında erkek hasta sol hemiparezi ve dizartri yakınması ile başvurdu. 1 gün önce 10 tane bal arısı tarafından sokulduğu öğrenildi. Sol kol ve bacakta 4/5 kas gücü, ataksik yürüme ve dizartri bulunmaktaydı. Difüzyon ağırlıklı manyetik rezonans görüntülemede sağ ponsta akut iskemi ile uyumlu lezyon belirlendi. Asetilsalisilik asit 300 mg/gün vemetformin 1000 mg/gün başlandı. Arı sokması sonrası salgılanan kimyasal moleküller ile tromboza eğilim artmaktadır. Bu nedenle iskemik inme riski olan hastalar yakın takip edilmelidir. Gerekirse hastalar bu moleküllerin inaktivasyonunu sağlayan ilaçlar ile tedavi edilmelidir. Ancak hipotansiyon ve vazokonstriksiyon oluşturabilen antialerjik ilaçlar başlanmamalıdır

INTRODUCTION: Hyperemesis gravidarum (HG) is a disease characterized by excessive vomiting and nausea during pregnancy. It differs from normal pregnancy where simple nausea and vomiting are seen frequently with unknown cause. The place and role of the brain in HG is unknown. METHODS: Thirty-three healthy pregnant women and 30 patients diagnosed with HG admitted to Selçuk University Faculty of Medicine, Obstetrics and Gynecology Department were included and electroencephalograph (EEG) signals of all patients obtained at Neurology Department were examined. These signals were evaluated with high math and examined with developed engineering methods. The sampling frequency of the EEG was 200 Hz. Data were obtained in the frequency-power axis using 0.1 Hz frequency resolution, Hamming windowing, and 0.5 overlap ratio with signals on the time axis on all channels. All sub-bands have formed with unearthed power spectral density as delta, theta, alpha, and beta and after being created was calculated spectral densities. RESULTS: As a result, while showing significant changes as delta band for Fp1F3, theta band for C3P3, F3C3, Fp1F3, P3O1, T5O1, for other channels and subbands has not seen any significant changes with regard to average power spectral density. DISCUSSION AND CONCLUSION: HG and normal pregnancies, when examined in terms of power spectral density, abnormalities were observed in the EEG signals in the left hemisphere frontal area of the delta band, fronto-centro-parietal, and parietal-occipital areas of the theta band. In light of the literature, neither cerebral abnormalities in HG could be displayed nor the place of abnormality could be shown. However, this study is the first to clearly show abnormalities of theta-delta band activity and differences of locations in the left cerebral hemisphere.

Saf duyusal inme, derin ya da yüzeyel duyuların ayrı ayrı veya beraber tutulduğu, duysal veya irritatif bozukluklar ile kendini gösteren klinik sendromdur. Bu sendromda en sık talamusun ventro-posterior nükleusu etkilenir. Talamik etkilenmeleri olan hastalarda yukarı bakış felci, hemiparezi, hemihipoestezi, konfüzyon, uykuya meyil, duygusal labilite olabilmektedir. Talamus tüm duyu modalitelerinin koku hariç ortak kesişim noktası olduğundan tat, işitme, dokunma ve ağrı gibi duyusal modaliteler saf duyusal inmelerde etkilenebilmektedir. 56 yaşında erkek hasta sol kol, bacak, yüz ve gövde yarısında uyuşma yakınması ile başvurdu. Manyetik rezonans görüntülemede sağ talamusta iskemi ile uyumlu lezyon belirlendi. Sonrasında santral nörojenik ağrı sendromu gelişti. Nadir görülmesi, ek belirti olmadan hemihipoestezi ile başvurabilmesi ve hızla tanınıp tedavi başlanması gerektiğinden sunulmaya değerli görülmüştür

Since the last 20 years, entry of neurointensive care units (NICU) has provided a significant increase of survival rate and quality of post-ICU life of the patients with life-threatening neurological and neurosurgical catastrophies. Therefore, NICU has become a fundamental part of contemporary third-level hospitals or reference centers. Because extensiveness of specific examination, monitoring and treatment techniques and methods unique to neurology makes impossible to manage critical neurological patients in “General” ICUs instead of NICUs, the number of proponent stating that national health authorities “should” not only establish more and improve NICUs in all reference hospitals, but also (re)organize a transport and referral system to get the patients in need of NICU care to these hospitals is progressively increasing. As mandated by modern critical care paradigm, the proposed plan and strategy can be suggested as a “sine aqua non” for avoiding ethicolegal problems.

Tıp eğitimi öğrenciler, eğiticiler, eğitim programı ve eğitim altyapısını barındıran, çok ayaklı temeli olan bir sistem içinde gerçekleş- tirilir. Öğrenciler bu sistemin en önemli ayaklarından biridir. Selçuk Üniversitesi Tıp Fakültesi Dekanlığı tarafından 22 Mart 2014’de Selçuk Üniversitesi Tıp Fakültesinde gerçekleştirilen “Tıp Fakülteleri Öğrenci Temsilcileri Çalıştayı” tıp eğitimi konusunda öğrenci katılımını en yüksek düzeye çıkarmayı hedefledi. Türkiye’nin değişik bölgelerine ait tıp fakültelerinden gelen olan öğrenci temsilcileri, mensubu oldukları tıp fakültelerinin örnek alınması gereken ve geliştirilmesi gereken özelliklerini diğer tıp fakülteleri temsilcileri ile paylaştılar. Tıp fakültelerinin misyon ve vizyonunda önemli yer tutan, tıp fakültesi eğitim ve işleyişinde öğrenci temsiliyet ve katılı- mının sağlanmasının, daha iyiye yönelmede ileri bir adım olarak büyük katkısı olacağı belirtildi. Her fakülteye ait olumlu ve geliş- tirilecek yönler temsilci öğrenci tarafından ayrıntılı olarak sunuldu ve katılımcı öğrenciler tarafından keypad ile oylandı. Çalıştayın sonunda tıp fakültelerinde olması gereken ve ortak olarak belirlenen olumlu özellikler ile geliştirilmesi gereken özelliklerin öncelik ve önem sırasına göre bir rapor içinde hazırlanmasına ve “İlk Tıp Fakülteleri Öğrenci Temsilcileri Bildirgesi” olarak sunulmasına karar verildi. Tıp eğitimi alanında önemli paylaşımların yaşandığı çalıştay aynı zamanda, ülkemizin değişik bölgelerinden gelen tıp fakül- tesi öğrencilerine birbirlerini tanıma ve kaynaşma ortamı yaratarak, öğrenci temsilcilerinin sosyal ve kültürel paylaşımına önemli katkı sağlarken, geleceğin hekimlerinin vizyonlarının gelişimine de önemli katkı sağlamıştır. Önemli diğer bir sonuç ise, bu çalıştayın gelecek dönemlerde de aynı motivasyon ve enerji ile devam ettirilmesine yönelik karar olmuştur

This study aims to describe planning, application and the results of Turkish Neurology Board Examinations. Data was collected from five Board Examination process and with feedback questionnaires of the examinee between 2004 and 2008. Results were presented with descriptive tables and charts. KR 20 coefficients demonstrated that tests were reliable

OBJECTIVE: Hypoxemia is an important factor that increases cerebral damage in acute stroke patients. In conjunction with the growing importance of stroke intensive care units, there has been an increase in studies reporting on the correlation between oxygenation and the body position in acute stroke patients with hemiparesis. This study was planned to evaluate the relationship between oxygen saturation (SaO2) and position in acute stroke patients. METHODS: : Acute stroke patients followed in the Neurology Department of Ankara Numune Hospital between July 2000 and June 2001 were included in this study. The SaO2, pulse and blood pressure values were recorded initially, and at the 15th, 30th and 60th minutes in patients lying on either their paretic or healthy side in the lateral decubitus position on the 1st, 3rd and 7th days. Characteristics of the lesions were determined on computerized tomography (CT). Clinical parameters (consciousness, degree of paresis, functional disability, coma scores, and prognosis) were also recorded. RESULTS: The 50 patients (19 male, 31 female) included in this study with the diagnosis of acute stroke had a mean age of 68.32±12.02. CT imaging revealed hematoma in 19 of the patients, infarct in 30 and hemorrhagic infarct in 1. Arterial oxygen saturation (SaO2) values of the subjects recorded initially and at the 15th, 30th and 60th min from the healthy side in the lateral decubitus position in the first day of stroke were found to be higher than the paretic side (p

Scientific background: The Turkish Neurological Society Executive Committee began efforts to establish the Turkish Neurology Proficiency Board in 2001, and this was achieved in 2004. The Examination Committee, which is one of the key committees of this board, realized the first Turkish Neurological Society written examination for proficiency with the cooperation of Ege Medical Training Department in 2004 during the 40th National Neurology Congress. The preparation, application, and evaluation stages of this examination have been prepared for publication, to serve as a guide for the other neurology boards involved in this process, and to reflect the view of the Turkish Neurological Society

Abstract Stroke triggers a systemic inflammatory response over the ensuing days after the cerebral insult. The age and comorbidities of the stroke population make them a vulnerable population for low muscle mass and sarcopenia, the latter being another clinical condition that is closely associated with inflammation, as shown by increased levels of pro-inflammatory biomarkers, including neutrophil-to-lymphocyte ratio (NLR). In this study, we evaluated the relationship between post-stroke NLR changes and muscle mass in a prospective cohort of acute ischemic stroke patients (n = 102) enrolled in the Muscle Assessment in Stroke Study Turkey (MASS-TR). Admission lumbar computed tomography images were used to determine the cross-sectional muscle area of skeletal muscles at L3 vertebra level and calculate the skeletal muscle index (SMI). The median (IQR) SMI was 44.7 (39.1–52.5) cm2/m2, and the NLR at admission and follow-up were 4.2 (3.0–10.5) and 9.4 (5.7–16.2), respectively. While there was no relationship between SMI and admission NLR, a significant inverse correlation was observed between SMI and follow-up NLR (r = − 0.26; P = 0.007). Lower SMI remained significantly associated (P = 0.036) with higher follow-up NLR levels in multivariate analysis. Our findings highlight the importance of muscle mass as a novel factor related to the level of post-stroke stress response.