Turkish Journal of Neurology

Turkish Journal of Neurology

Basic info

  • Publisher: Galenos Publishing House
  • Country of publisher: turkey
  • Date added to EuroPub: 2019/Aug/13

Subject and more

  • LCC Subject Category: Medicine, Neurology, Neuroscience
  • Publisher's keywords: Neurology, Medicine
  • Language of fulltext: english, turkish

Publication charges

  • Article Processing Charges (APCs): No
  • Submission charges: No
  • Waiver policy for charges? No

Editorial information

Open access & licensing

  • Type of License: CC BY-NC-ND
  • License terms
  • Open Access Statement: Yes
  • Year open access content began: 2004
  • Does the author retain unrestricted copyright? False
  • Does the author retain publishing rights? False

Best practice polices

  • Permanent article identifier: DOI
  • Content digitally archived in: Other
  • Deposit policy registered in: None

This journal has '43' articles

Blind Versus Ultrasound Guidance Injections: Lateral Femoral Cutaneous Nerve Blockage Revisited

Blind Versus Ultrasound Guidance Injections: Lateral Femoral Cutaneous Nerve Blockage Revisited

Authors: Berke Aras, Emre Adıgüzel, Fatih Tok
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Abstract

Meralgia paresthetica is a nerve entrapment that may cause pain, numbness, hypersensivity, and paresthesias within the anterolateral region of the thigh, which is the area of distribution of the lateral femoral cutaneous nerve (LCFN). According to the literature, there is a large variability in the nerve course as the nerve pierces the inguinal ligament. Blockade of the LFCN has been classically described using anatomic landmarks, but the anatomic variability of the nerve may be responsible for failure rates being as high as 60%. Ultrasound (US) guidance for peripheral nerve blocks has become popular among physicians because of its several advantages when compared with traditional nerve localization techniques. US-guided LCFN blocks can be performed with better success.

Keywords: Meralgia paresthetica, ultrasound-guided injection, lateral femoral cutaneus nerve
The Contribution of Neuroimaging to Diagnosis in Idiopathic Intracranial Hypertension

The Contribution of Neuroimaging to Diagnosis in Idiopathic Intracranial Hypertension

Authors: Bedia Samancı, Erdi Şahin, Yavuz Samancı, Esme Ekizoğlu, Nilüfer Yeşilot, Oğuzhan Çoban, Betül Baykan
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Abstract

Objective: Due to difficulties in diagnosis, the presence of patients with idiopathic intracranial hypertension (IIH) without papilledema has led to the addition of neuro-radiologic features, which are indicative of increased intracranial pressure, to new diagnostic criteria. In this study, it was aimed to investigate the inter-rater agreement regarding the evaluation of neuroimaging findings of patients diagnosed as having definite IIH and to detect their possible contribution to diagnosis. Materials and Methods: Forty-one consecutive patients with definite IIH who had both brain magnetic resonance imaging (MRI) and MR-venography (MRV) examinations were included in the study. Images were evaluated by two experienced neurologists, who were blinded to the clinical presentation of the cases, in terms of empty sella, flattened posterior globe/sclera, tortuosity of optic nerve, transverse sinus stenosis/hypoplasia, and additionally non-specific white matter lesions using a standardized form. The results were evaluated using kappa (κ) analysis in terms of inter-rater agreement. Results: The mean body mass index and cerebral spinal fluid opening pressure of the patients (38 female, 3 male) were 29.2±5.48 kg and 371±149.4 mmH2O, respectively. Six patients did not have papilledema. When MRI and MRV examinations were evaluated in terms of the presence of additional evidence supporting diagnosis, there was fair agreement for MRI (κ=0.333, p=0.021), and substantial agreement for MRV (κ=0.735, p<0.0001). Regarding subheadings, there was moderate agreement for empty sella, tortuosity of the optic nerve, and non-specific white matter lesions (κ=0.417, p=0.001; κ=0.523, p=0.001; κ=0.443, p=0.002, respectively), fair agreement for flattened posterior globe/sclera and transvers venous sinus stenosis (κ=0.291, p=0.06; κ=0.389, p=0.006, respectively), and substantial agreement for transverse venous sinus hypoplasia (κ=0.801, p<0.001). Conclusion: In our study, it was found that additional neuroradiologic findings, especially those described in the new Friedman diagnostic criteria for patients without papilledema, showed fair-to-moderate agreement, even between two experienced neurologists. We believe that it is appropriate to examine the neuroradiologic images carefully for new criteria without evaluating only mass lesions, and to take clinical findings into account while evaluating patients with IIH.

Keywords: Idiopathic intracranial hypertension, MRI, MRV, neuroimaging, neuroradiology
The Adverse Effects of High-dose Corticosteroids with Early and Late Severe Morbidity in the Treatment of Patients with Multiple Sclerosis: Long-term Observation Results

The Adverse Effects of High-dose Corticosteroids with Early and Late Severe Morbidity in the Treatment of Patients with Multiple Sclerosis: Long-term Observation Results

Authors: Sami Ömerhoca, Sinem Yazıcı Akkaş, Zerrin Yıldırım Haşimoğlu, Sebatiye Erdoğan, Nilüfer Kale
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Abstract

Objective: Intravenous methylprednisolone (IVMP) is the most commonly used emergency treatment for multiple sclerosis (MS) attacks and the risk of adverse effects is high due to frequent use. The aim of our study was to investigate the relationship between adverse effects that can lead to severe morbidity and possible pharmaceutic and/or physiologic causes. Materials and Methods: This study included patients with clinically definite MS who underwent IVMP treatment between 2010-2018. The corticosteroid treatment dose and duration, demographic characteristics, laboratory findings and adverse effect profiles of the patients were examined. Results: The medical records of 390 patients (F/M=294/96) with follow-up were evaluated retrospectively. Eleven (F/M=8/3) patients who developed severe complications after IVMP were detected. The drug infusion was ceased in two patients due to severe allergic reactions or tachyarrhythmia. One patient with severe tachycardia and two patients with corticosteroid-induced allergy received IVMP therapy along with alternative treatment and observation methods. In nine patients, avascular bone necrosis (AVN) developed after the treatment. AVN was multifocal in six patients and monofocal in three patients. The most frequently affected localization was the femoral head (six patients), followed by the tibia and talus. Only one patient had a high and repeated-dose (42 g total) drug use. Two patients received single-dose IVMP treatment. Conclusion: In our study, the treatment-related complications of patients diagnosed as having clinical definite MS and receiving IVMP were defined and it was thought that they might not be related to drug dose and duration.

Keywords: Avascular bone necrosis, corticosteroids, multiple sclerosis, adverse effect
Assessment of Serum Uric Acid Levels According to Sex and Stage for Patients with Alzheimer-type Dementia

Assessment of Serum Uric Acid Levels According to Sex and Stage for Patients with Alzheimer-type Dementia

Authors: Tamer Yazar1, Hülya Olgun Yazar
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Abstract

Objective: The aim of this study was to identify serum uric acid (UA) concentrations according to disease stage in patients with Alzheimer-type dementia (AD), and to collect data related to the hypothesis that oxidative stress is effective on the etiopathogenesis and progression of disease stage. Materials and Methods: The study was conducted with 180 patients who were categorized into disease stages in accordance with the Clinical Dementia Rating Scale (CDR) and 150 healthy individuals of the same age group. In our retrospective study, patients who showed more than one cognitive deficit and diagnosed with possible AD according to the diagnostic criteria of National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer’s Disease and Related Disorders Association were administered the CDR, Mini-Mental Test (MMSE), Geriatric Depression Rating Scale (GDRS), and individuals in the control group were administered the MMSE and GDRS. Venous blood samples for biochemical studies were collected after 12-14 hours of fasting in the patient and control groups. Results: In patients diagnosed as having AD, it was found that there was a statistically significant increase in age and duration of disease parallel with the progression of disease stages, and a decrease in UA and albumin concentrations in both males and females (p<0.05). Conclusion: Our study supports the hypothesis that the decrease detected in serum UA concentrations in parallel with the progression of disease stages is directly related to the pathogenesis of AD. For the identification of chronic progressive diseases such as AD and to take precautions, the identification of variations in easily accessible and low-cost parameters such as serum albumin and UA concentrations in the early stages becomes important. In future years, when neuroprotective and neuro-restorative treatment options are available, identification of serum UA values as a marker of disease progression and knowledge of the association between serum UA concentrations and disease stage in our data will guide and support research into disease etiology.

Keywords: Alzheimer disease, dementia, oxidative stress, uric acid, sex
The Effects of Repetitive Greater Occipital Nerve Blocks on Cervicogenic Headache

The Effects of Repetitive Greater Occipital Nerve Blocks on Cervicogenic Headache

Authors: Devrimsel Harika Ertem, İlhan Yılmaz
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Abstract

Objective: The clinical features of cervicogenic headache (CH) are characterized by unilateral, dull headache; precipitated by neck movements or external pressure over the great occipital nerve (GON). No conservative therapies have been proved to be effective for the management of CH. The purpose of this study was to assess the effects of interventional pain management, including repetitive anesthetic block using lidocaine and methylprednisolone GON injections for local pain and associated headache. Materials and Methods: This retrospective cohort study was undertaken between January 2016 and December 2017. Twenty-one patients with CH were evaluated in our headache clinic during the study period. The diagnosis of CH was made according to International Classification of Headache Disorders 3rd edition beta version. The socio-demographic and clinical characteristics were recorded for all patients who underwent at least 3 GON blocks and attended at least 4 follow-up appointments. Change in the Numeric Pain Rating Scale (NPRS) was used to assess the response to GON blocks. SPSS 23.0 was used as the statistical analysis program. Results: The mean age of patients was 61.51±13.88 years; 42.85% were female. The duration of headache was 30.81±21.95 years. Eighty-five percent of patients had unilateral headache. Ten patients had myofascial spasm (trigger points) located in neck, occipitalis, and temporalis muscles. Sixty-six percent of patients reported headache following head trauma. From 3-months post treatment, a significant decrease in NPRS (p<0.001) was identified. The number of headaches was reduced significantly at three months (p<0.001) No serious complications were noted. The coexistence of myofascial spasms, history of trauma and additional headache had no significant effect on NPRS score improvements (p>0.05). Conclusion: The results of this study demonstrated that repetitive greater occipital blocks may be an effective option for the management of CH and contribute to significant reductions in pain severity scores at 3 months following injection.

Keywords: Headache, cervicogenic headache, chronic pain, greater occipital nerve, nerve block
The Relationship Between 25 (OH) Vitamin D Level and the Severity of Disease and Sleep Quality in Restless Legs Syndrome

The Relationship Between 25 (OH) Vitamin D Level and the Severity of Disease and Sleep Quality in Restless Legs Syndrome

Authors: Arife Çimen Atalar
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Abstract

Objective: Restless legs syndrome (RLS) is a common chronic sensory-motor neurologic disease with serious disabling effects on affected individuals’ physical and emotional health and quality of life. The underlying pathophysiology of the disease is not clear but iron metabolism disorders and dopaminergic dysfunction along with a genetic predisposition are blamed, and recently vitamin D deficiency was considered to play an important role in RLS. In this study, we aimed to investigate the relationship of concentrations of a vitamin D metabolite, 25 (OH) vitamin D, with RLS severity and quality of sleep. Materials and Methods: We enrolled 152 patients aged between 18 and 75 years who were referred to our general neurology outpatient clinic in Istanbul Training and Research Hospital, and diagnosed with RLS according to the International Restless Legs Syndrome Study Group diagnostic criteria, between September 2016 and September 2018. The patients were classified as the vitamin D deficiency group (<20 ng/mL, group 1) and normal vitamin D group (>20 ng/mL, group 2). Both groups were evaluated for their RLS severity index and Pittsburgh Sleep Quality Index (PQI). Both groups are compared statistically. Results: Of the 152 patients, 89 patients had low vitamin D concentrations (<20 ng/mL) (group 1) and 63 had normal vitamin D concentrations (>20 ng/mL) (group 2). There was no significant difference in terms of age, sex, body mass index, and cigarette consumption (p>0.05). There were significant differences between the two groups in terms of upper extremity involvement, ferritin concentrations, PQI, and RLS severity scores (p<0.05). Conclusion: The present study demonstrated that patients who are vitamin D deficient might have more severe RLS symptoms and an impaired quality of sleep compared with other patients with RLS.

Keywords: Restless legs syndrome, sleep quality, vitamin D
Seizures with Autonomic Symptoms and Sudden Unexpected Death in Epilepsy (SUDEP)

Seizures with Autonomic Symptoms and Sudden Unexpected Death in Epilepsy (SUDEP)

Authors: Rabia Gökçen Gözübatık Çeli, Çiğdem Özkara
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Abstract

The autonomic nervous system, formerly the vegetative nervous system, is a division of the peripheral nervous system that supplies smooth muscle and glands, and thus influences the function of internal organs. The hypothalamus is the main center responsible for the autonomic functions in the central nervous system. Other anatomical structures can be listed as cingulate gyrus, amygdala, paraventricular nucleus. The central autonomic network involved in the pathophysiology of autonomous epilepsy is represented in the non-dominant hemisphere. Autonomic seizures are shown in temporal and insular lobe epilepsies commonly. Blood pressure changes, heart rhythm disturbances (tachycardia, bradycardia, arrhythmia, asystole), respiratory changes (apnea, hypopnea, bradypnea), salivation increase, vomiting/retching, pilo-erection, sweating increase, mydriasis/miosis, spitting, water drinking, genital automatism, intestinal motility disorders are clinical signs in autonomic epilepsy. SUDEP (sudden unexpected death in epilepsy) is defined as sudden, unexpected, nontraumatic, non-drowning death in an individual with epilepsy, witnessed or unwitnessed, in which post-mortem examination does not reveal an anatomical or toxicological cause of death. The vast majority of SUDEPs occur in the aftermath of a generalised tonic-clonic seizure. It’s responsible for 17% of deaths in epileptic patients. Witnessed recorded SUDEP cases involve postictal cardiorespiratory dysfunction with failure of arousal. It is reported that the threshold value of SpO2 is 80-86% for the risk of sudden death. While patients who have had seizures remotely and have had successful epilepsy surgeries also carry the SUDEP risk, the most important risk factor is a history of generalised tonic-clonic seizures.

Keywords: Autonomic seizures, epilepsy, SUDEP
Objective and Subjective Assessment of Physical Activity in Adults with Muscle Diseases

Objective and Subjective Assessment of Physical Activity in Adults with Muscle Diseases

Authors: Fatma Ayvat, Ender Ayvat, Özge Onursal Kılınç, Muhammed Kılınç, Sibel Aksu Yıldırım, Ersin Tan
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Abstract

Objective: The aim of this study was to investigate the physical activity of adults with muscle diseases relative to healthy controls. Materials and Methods: Individuals participated in this cross-sectional study by completing the International Physical Activity Questionnaire-Long Form and using SenseWear Armband Activity Monitor over a 5-day period to assess physical activity levels subjectively and objectively. Results: Forty healthy controls (16 males, 24 females) (aged 30.40±4.55 years) and 40 adults with muscle diseases (21 males, 19 females) (aged 32.67±6.57 years) participated in this study. We found that SenseWear Armband (step counts, duration of moderate and vigorous physical activity) and International Physical Activity Questionnaire (walking physical activity, vigorous physical activity, working physical activity, and total physical activity) parameters were significantly lower in the adults with muscle disease group than the healthy controls (p<0.05), whereas the total amount of energy expenditure was similar between the groups (p>0.05). Conclusion: Adults with muscle diseases expend the same amount of energy as healthy controls, but over fewer steps. This difference between energy expenditure and number of steps could be due to the higher energy requirements for walking in adults with muscle diseases. These findings will help healthcare professionals plan treatment strategies for adults with muscle diseases.

Keywords: Physical activity, chronic disease, energy expenditure

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