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Objectives: Hyperhomocysteinemia is a risk factor for ischemic stroke. Hypothyroidism may cause hyperhomocysteinemia. To date, no works have examined the association between hypothyroidism and hyperhomocysteinemia in ischemic stroke. We aimed to investigate the roles of hypothyroidism and hyperhomocysteinemia in ischemic stroke, and whether any relationship exists between hypothyroidism and hyperhomocysteinemia in ischemic stroke patients. Methods: The study included 249 ischemic stroke patients and 102 patients with no history of stroke. Patients were evaluated for conventional risk factors and levels of homocysteine, thyroid-stimulating hormone, vitamin B12 and folic acid. Results: Ten (4%) patients in the ischemic stroke group had subclinical hypothyroidism. We did not find any overt or subclinical hypothyroidism in the control group. Hypothyroidism was higher to a statistically significant degree in the ischemic stroke group (p<0.05). Both hyperhomocysteinemia and hypothyroidism were associated with ischemic stroke patients. However, no association was found between hyperhomocysteinemia and hypothyroidism. Ischemic stroke patients with hypothyroidism had lower levels of HDL cholesterol and levels of total cholesterol/HDL-C and LDL-C/HDL-C were higher than those of ischemic stroke patients without hypothyroidism. Discussion: Hypothyroidism is associated with ischemic stroke. Low HDL cholesterol, high total cholesterol/HDL-C and high LDL-C/HDL-C were associated in ischemic stroke patients with hypothyroidism. Hyperhomocysteinemia was not found to be associated with ischemic stroke patients with hypothyroidism. [ABSTRACT FROM AUTHOR]

We sought to examine the changes in the strength-duration time constant (SDTC) of the median nerve in diabetic polyneuropathy. The SDTC is a measure of axonal excitability and depends on the biophysical properties of the axonal membrane. It may provide some information about Na(+) channel functioning. Forty-nine diabetic patients (30 men, 19 women; mean age, 54.6+/-9.4 years) and 15 age-matched healthy subjects (11 men, 4 women; mean age, 53.1+/-7.6 years) participated in the study. SDTC and rheobase values were 384.5+/-97.9mus and 4.6+/-2.4mA in patients and 313.8+/-46.7mus and 6.0+/-2.6mA in controls. The SDTC was found to be significantly different between the two groups (P=.009 for SDTC and P=.066 for rheobase). Fasting glucose and HbA1c levels of patients were 206.6+/-88.7mg/dL and 8.8+/-2.4%, and these were not correlated with SDTC or rheobase (P<.05). We suggest that longer SDTC, indicating increased axonal excitability may develop in patients with polyneuropathy associated with uncontrolled diabetes. [ABSTRACT FROM AUTHOR]

Background The incidence of bariatric surgery (BS) is on the rise, and the prevalence of complications associated with this procedure has also increased. The most common neurologic complications of BS are peripheral neuropathy and encephalopathy. In this study, we presented the clinical and electrophysiological courses of five patients with acute-subacute axonal polyneuropathy after BS. Method We evaluated neurological examinations, micronutrient deficiencies (B12, folic acid, thiamine, and vitamin D), nerve conduction studies (NCS), and Guillain-Barré syndrome (GBS) disability scores. Cases All patients were female; the average weight loss was 35.2 ± 7.52 kg, and the CSF protein level was 40.98 ± 6.99 mg/d. All patients underwent vitamin supplementation and physical therapies. The presence of more pronounced axonal involvement in NCS and the higher likelihood of normal CSF protein levels in BS-related acute polyneuropathy patients suggest that the underlying pathogenesis may differ from classical GBS. In the presented studies in the literature, inflammation is frequently observed in nerve biopsies of BS patients, suggesting that both micronutrient deficiencies and immune mechanisms play a role in the pathogenesis. Intravenous immunoglobulin (IVIG) treatment may improve neurologic deficits in patients with GBS-like clinical presentations. In the presented study, three patients were treated with IVIG, while two patients were treated with plasma exchange therapy followed by IVIG. Three cases improved significantly and were able to walk without assistance at one year visit. Conclusıon In patients with bariatric surgery (BS)-associated polyneuropathy, immunotherapy, and intensive pre- and post-operative nutritional management may improve patients' morbidity. Therefore, we suggest close monitoring by a multidisciplinary team for PBS patients.

Aims: We aimed to explore axonal excitability parameters in patients with diabetes mellitus (DM) and polyneuropathy (PNP) as well as those without PNP., Methods: We used the short TROND protocol by QTRAC to measure axonal excitability parameters (strength-duration time constant (SDTC), rheobase, etc.) in 12 healthy subjects and 14 DM patients with PNP and 10 DM patients without PNP. The short TROND protocol was performed before and after 20min of deep hyperventilation in healthy subjects and patients with DM. Also, venous blood pH and partial pressure of O2 and CO2 were recorded before hyperventilation (HPV) and after 20min of HPV. A "hyperventilation score" was evaluated before and after HPV., Results: When the values of DM with PNP group and control group before HPV were compared, SDTC and latency were statistically significant. Comparing the values of the excitability parameters after HPV showed statistically significant changes in the SDTC, rheobase, and refractoriness at 2.5ms in controls and DM patients without PNP. HPV resulted in no changes in SDTC in DM patients with PNP., Conclusion: The results of this study suggest that patients with DM and healthy subjects have different responses to HPV, and pH changes have different effects on diabetic PNP compared with healthy controls and DM patients without PNP., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Objective: To determine the health related quality of life (HRQOL) in patients with epilepsy or psychogenic non-epileptic seizures (PNES)., Methods: This cross-sectional study was carried out between December 2010 and December 2014 in the Department of Neurology and Psychiatry, Faculty of Medicine, Baskent University, Adana, Turkey. Patients who were admitted for video-electroencephalography monitoring and diagnosed of epileptic seizures or PNES were asked to complete a questionnaire from the World Health Organization Quality of Life, and psychiatric comorbidities were diagnosed using the structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders Fourth Edition., Results: Patients with epilepsy and PNES were found to have similar HRQOL in physical, psychological, social, and environmental domains. However, the percentage of comorbid psychiatric disorders were higher in patients with PNES than patients with epilepsy., Conclusion: Patients with epilepsy and PNES have similar HRQOL, and PNES are resistant to the standard medical therapies used for the treatment of epileptic seizures. The direct lifetime cost of undiagnosed PNES may be of equal with intractable epilepsy. A better understanding of the impact of PNES manifestations and epilepsy would help to provide appropriate clinical, psychological and social care.

Ischemic stroke associated movement disorders can be seen as the first sign of a stroke or as a delayed onset development. Tremor after a stroke is a rare finding among movement disorders. In addition to reports of tremor caused by cerebral infarction of varied locations, data on the disappearance of existing tremor following infarction is also available. In this report, we present a case with acute tremor in the contralateral hand following frontal cortical infarction, and disappearance of the tremor after the second infarction comprising large areas in the same hemisphere.

Objective: To study strength-duration properties of motor and sensory axons to evaluate whether there is a change in current through the persistent sodium (Na+) channels of sensory and motor axons in peripheral nerves of epileptic patients before and after valproic acid (VPA) and carbamazepine (CBZ) treatment due to the presence of similar channels in the CNS and peripheral nervous system (PNS)., Methods: This study, conducted in Baskent University Faculty of Medicine, Adana, Turkey from January 2011 to February 2012, involved 10 patients with partial epilepsy, 10 patients with primary generalized epilepsy who were not currently prescribed anticonvulsant therapy, and 10 control subjects. Using an electromyography machine, stimulus intensity was performed to produce the target (40% of maximum) compound muscle action potentials and compound sensory action potentials. The currents required for different stimulus durations, 0.05, 0.1, 0.2, 0.3, 0.5, and 1 ms, were produced. Stimulus-response curves were then constructed, and the strength-duration time constants were estimated using Weiss`s formula., Results: The rheobase of motor and sensory fibres was lower in the control group than the values of patients before and after CBZ and VPA therapy., Conclusions: In the PNS of epileptic patients, CBZ and VPA therapy results in decreased axonal excitability. This method may be used in investigating the underlying pathology of peripheral nerve diseases in vivo.

Purpose: The effects of epilepsy and seizures on cardiac functions have been documented, and this association has drawn attention in recent years. The aim of this study was to investigate left ventricle (LV) diastolic function by tissue Doppler imaging (TDI) in patients with newly diagnosed and untreated primary generalized epilepsy (PGE)., Method: Thirty newly diagnosed and untreated PGE patients (14 females, mean age 27.60±9.64 years) and 30 healthy age- and gender-matched control subjects (14 females, mean age 29.47±6.89 years) were included in the study. The LV functions of the study cohort were evaluated using conventional echocardiography and TDI., Results: There were no significant differences found between the two groups regarding the left atrium diameter, left atrium volume index, interventricular septum and posterior wall thickness, LV end diastolic diameter, and LV end diastolic volume (p>0.05 for each parameter). PGE patients exhibited a higher LV end systolic diameter and LV end systolic volume compared to the controls (p<0.001 for each parameter). Thus, the fractional shortening and ejection fraction were lower in the PGE patients (p<0.001 for each parameter). The E to average e' ratio, the most important noninvasive indicator of LV filling pressure, was significantly higher in patients with PGE (8.31±2.78 vs. 6.95±1.26, p=0.018)., Conclusion: The present study reports the systolic and diastolic dysfunction of LV in newly diagnosed PGE patients compared to control subjects. Taken together, the screening of epileptic patients using conventional echocardiography and TDI may be useful to evaluate the effects of epilepsy on cardiac functions., (Copyright © 2013 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.)

Autonomic manifestations regarding cardiac function in epilepsy are not rare and are being recognized with increasing frequency. The aim of this study was to assess autonomic function by measuring heart rate recovery (HRR), an index of vagal activity, in patients with epilepsy who were not taking any medication. Fourteen patients (eight with primary generalized epilepsy, four with secondary generalized epilepsy, and two with complex partial epilepsy) and 14 control subjects underwent exercise tolerance tests according to the modified Bruce protocol. HRR at 1 and 3 min (HRR1 and HRR3) were calculated. HRR1 and HRR3 were increased in patients with epilepsy. These results suggest increased parasympathetic function in epilepsy and support results of previous studies indicating autonomic dysfunction in epilepsy.

Neurofibromatosis type 1 (NF1) is a common, autosomal dominant neurocutaneous disorder in which any organ system, including the skin, skeleton and nervous system can be affected. In this study, we compared the electrophysiological and magnetic resonance imaging (MRI) findings in patients with NF1. Thirty-nine adolescent and adult patients (23 women and 16 men) diagnosed with NF1 with a mean age of 25.8±10 years (10-56) were included in this study. We collected data in the form of the results of neurological examinations, multimodal evoked potentials (EPs; brainstem auditory evoked potentials, BAEPs; somatosensory evoked potentials, SEPs; and visual evoked potentials, VEPs), cerebral/orbital/spinal MRIs, and electroneuromyography (ENMG). Twenty (51.3%) patients showed abnormal VEPs, 14 (35.9%) showed abnormal SEPs, and six (15.4%) showed abnormal BAEPs. All evoked potentials were abnormal in four (10.3%) cases. These electrophysiological findings occurred primarily in the absence of any clinical sign related to the affected system. MRI revealed pathologic findings in 26 of 39 patients, and these were not always correlated with visual, auditory, or somatosensory pathway abnormalities. ENMG showed polyneuropathy in two of 33 patients who underwent ENMG. Our study showed that MRI and electrophysiological abnormalities may be found in most patients with NF1, even in the absence of associated clinical symptoms or signs. Electrophysiological testing is helpful for monitoring the subclinical involvement of the central and peripheral nervous systems in patients with NF1., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Different subtypes producing the clinical picture of Guillain-Barré syndrome (GBS) and overlapping forms of GBS subtypes have been described. GBS as a complication in pregnancy has been reported rarely. The present report describes the clinical, electrophysiological and prognostic features of a pregnant woman with overlapping forms of GBS subtypes, acute motor axonal neuropathy and ophthalmoplegia., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Aim: Some neurological diseases associated with pregnancy may develop initially during gestation, pregnancy may predispose the patient to some of these diseases or some may occur only with pregnancy. The aim of this study is to draw attention to the rare neurological diseases--other than eclampsia--that develop during pregnancy or the diseases initially described as associated with pregnancy., Methods: Our sample comprised of 16 pregnant women who developed neurological disorders that are rarely encountered or initially reported during this phase, eclampsia excluded., Results: The proportion of cerebrovascular diseases was 56%. The others included intracranial hypotension accompanied by seizures, cerebral primitive neuroectodermal tumor, ophthalmoplegic migraine, hemiplegic migraine, spinal segmental myoclonus, acute motor axonal neuropathy and acute motor axonal neuropathy associated with ophthalmoplegia., Conclusion: Our results suggest that by adopting a careful and correct approach and accurate neurological diagnosis, most of these patients could be treated successfully with good prognosis of the newborns., (© 2010 The Authors. Journal of Obstetrics and Gynaecology Research © 2010 Japan Society of Obstetrics and Gynecology.)

Axonal injury and/or demyelination commonly result in peripheral mononeuropathy, polyneuropathy or entrapment neuropathies in hypothyroidism. In this study, we aimed to measure the strength-duration time constants (SDTC) of motor and sensory fibres in patients with primary hypothyroidism before and after hormone replacement treatment. The motor and sensory SDTC and rheobase of 14 patients with overt hypothyroidism (TSH>10mg/ml, free T4

Background: Autonomic dysfunction is a common and important complication in Guillain-Barre syndrome (GBS) and may be the cause of significant morbidity or death. Objectives : To show the possible autonomic involvement in patients with GBS., Materials and Methods: The sympathetic skin response (SSR) and the parameters of heart rate variability gathered from a 24-h electrocardiogram recording were studied in 14 patients with GBS [13 with acute inflammatory demyelinating polyneuropathy (AIDP) and one with acute motor axonal neuropathy (AMAN)]., Results: In two of the patients, SSR couldn't be elicited. In the rest of the patients, amplitude of SSR was found to be decreased when compared with the control subjects. In the time domain analysis of the 24-h electrocardiogram, SDNN (the standard deviation of all R-R intervals), SDANN (the standard deviation of the averages of R-R intervals during all 5-min periods that constitute the 24-h day), SDNN index (mean of the standard deviations of all R-R intervals for all 5-min segments of the 24-h recording); in the frequency domain analysis HF(high frequency), LF(low frequency), VLF (very low frequency) and total power were found decreased in patients when compared with the control subjects. When the mean values with standard deviations of controls were compared with the patients' values one by one, the pregnant patient with AMAN had increased heart rate variability parameters. The remaining 13 patients had decreased values., Conclusions: These findings reflect an involvement of both the parasympathetic and sympathetic systems in GBS. Our results suggest that SSR and heart rate variability parameters may be used for early detection of any autonomic dysfunction in patients with GBS.

The prevalence of abnormalities on brain magnetic resonance imaging (MRI) varies in primary Sjögren's syndrome (pSS) patients and they are generally multiple hyperintense areas in the subcortical and periventricular white matter on T2-weighted and fluid-attenuated inversion recovery sequences. Here, we report brainstem involvement in a patient with pSS that was extensive on MRI, but reversible. The patient's outcome was positive. To our knowledge, a similar case has not previously been described.

Aim: Primary intraventricular hemorrhage (PIVH), bleeding in the ventricular system without a recognizable parenchymal component, is a rare neurological disorder. The purpose of this study was to identify clinical features, risk factors, etiology and outcome of patients with PIVH., Material and Methods: We retrospectively reviewed the clinical data, complementary examinations, outcome and computed tomography (CT) IVH score of 24 patients in our hospital from 2004 to 2008. We identified 24 patients with the inclusion criteria of non-traumatic PIVH. Their mean age was 60.6+/-17.4 years (range 38-79). Fourteen patients were male and 10 were female., Results: The major symptoms included headache (n=24), loss of consciousness (n=6), confusion and disorientation (n=14), nausea/vomiting (n=10). Angiography revealed vascular malformations in five patients (21%). Other possible causative factors were hypertension in 12 patients (50%) and clotting disorder in one. The aetiology remained unknown in six patients. Most PIVH patients had associated hydrocephalus (58%) and 37% of the patients required ventricular drainage. In-hospital mortality was high (41%) and a FOUR score

Reversible posterior leukoencephalopathy syndrome associated with hypertension rarely presents with predominant involvement of the brainstem and sparing of the supratentorial regions. In this study, the clinical and neuroimaging features of a 39-year-old woman with hypertensive encephalopathy and magnetic resonance imaging (MRI) findings localized to pons and bilateral middle cerebellar peduncles were described. Reversible posterior leukoencephalopathy syndrome associated with hypertension rarely shows isolated brainstem and cerebellum involvement, and it is important to be familiar with the lack of correlation between the severity of the radiological abnormality and the clinical status.

Myasthenia gravis is a rare autoimmune disorder in which antibodies form against acetylcholine nicotinic postsynaptic receptors at the myoneural junction. Psoriasis vulgaris is a chronic, recurring, and an inflammatory skin disease. Myasthenia gravis and psoriasis are both autoimmune diseases and correlated with specific human histocompatibility antigens. In this report, a 53-year-old woman who has myasthenia gravis accompanied with psoriasis vulgaris is presented. To conclude, this association is extremely rare and the pathogenetic etiology was thought to depend on a generalized immunological disturbance.