Betul Tekin - Academia.edu (original) (raw)
Papers by Betul Tekin
Türk Beyin Damar Hastalıkları Dergisi, 2016
Thalamus is a mass of gray matter, which plays a role in the transmission of sensory and motor in... more Thalamus is a mass of gray matter, which plays a role in the transmission of sensory and motor information to the primary sensory and motor centers of the cerebral cortex, cerebellum and basal ganglia. Vascular lesions of thalamus may occur in different syndromes depending on the affected nuclei. In this report, a case with acute evolving personality and behavior changes and detected bilateral thalamic infarction will be presented. A 40-year-old male patient was brought to the psychiatric ER with complaints of acute excessive sleep and behavioral changing. His neurological examination was normal except for limited cooperation and dysarthria. There was hyperintensity in bilateral paramedian thalamic regions in diffusion MRI and hypointensity in the right side in the ADC. During clinical observation the patient occasionally had visual hallucinations and attempted suicide. The psychiatrist diagnosed the patient with psychotic disorder due to his general medical condition and olanzapine 10 mg / day was prescribed. Etiological tests were normal. The patient was discharged after clinical improvement on the tenth day of hospitalization. Bilateral thalamic infarcts are very rare in all ischemic cerebrovascular diseases and typically result in changing of consciousness, gaze palsy and memory. The most common etiological cause of bilateral thalamic infarct is cardioembolism and the prognosis is generally good. Thalamic infarcts have a clinical spectrum varying according to the location of the lesion and may even just be present with psychiatric symptoms. In acute or subacute personality and behavior changes in a patient with no history of psychiatric disorders, thalamic lesions should be considered.
Turkish Neurosurgery, 2021
AIM: To discuss seizure outcomes of patients with invasive electroencephalography (EEG) monitoriz... more AIM: To discuss seizure outcomes of patients with invasive electroencephalography (EEG) monitorization (IEM) following their epilepsy surgery at our centre. MATERIAL and METHODS: Forty-seven patients suffering from refractory epilepsy and who were evaluated by invasive EEG were included in this retrospective study at Istanbul Faculty of Medicine from 2003 to 2017. We examined the Video EEG and invasive EEG monitorization, cranial MRI, SPECT, PET and neuropsychological tests of all patients. Postoperative seizure outcome results were evaluated according to Engel classification. The factors affecting seizure outcomes were discussed. RESULTS: Twenty-six of the patients were female (55.3%), 21 were male (44.7). The average age was 32.0 (± 12.4). Forty-three patients had surgery and the average age of these patients was 26,6 (±11.15). 38.3% of the patients had hippocampal sclerosis (HS), 23.4% had focal cortical dysplasia (FCD), 8.5% had a tumor, 14.9% had sequela lesion and 14.9% had unknown etiology. Postoperative seizure status according to the Engel classification showed that 81.6% of the patients were class I, 10.5% were class II, 2.6% were class III and 5.3% were class IV. CONCLUSION: A significant relation was statistically determined between structural MRI lesion and favorable seizure outcome (p<0.05). The most frequent etiology was HS in our patients. Of the patients with Engel I, the averages of their ages, ages at onset of epilepsy and ages at surgery were lower than other groups, but the difference was not statistically significant (p>0.05). We argue that IEM is an essential examination for favorable outcomes for determining the epileptogenic zone and/or the proximity of the functional structures.
Multiple sclerosis and related disorders, Apr 1, 2018
Multiple sclerosis (MS) is a common chronic neurological disease that causes disability. MS can h... more Multiple sclerosis (MS) is a common chronic neurological disease that causes disability. MS can have various clinical manifestations, one of which is olfactory dysfunction. In clinical practice, olfactory disturbances are usually underdiagnosed. The aim of our study is to assess olfactory function and its relationship with MS disease duration, disability and cognition. We assessed 31 MS patients and 24 healthy controls matched in sex and age at our MS outpatient clinic of the Istanbul Education and Research Hospital Neurology Department. Each subject was interviewed to obtain demographic data. The Connecticut Chemosensory Clinical Research Center (CCCRC) olfactory test and Montreal Cognitive Assessment (MOCA) were applied to each participant. The CCCRC test scores of the MS patients were lower than those in the control group (p < 0.05). Patients with a longer disease duration and more frequent attacks had lower CCCRC scores (p < 0.05). The Expanded Disability Status Scale scores had no correlation with the CCCRC test scores. The MOCA score was positively correlated with all domains of the olfactory test scores. This study supports the presence of olfactory dysfunction in early stages of MS and the correlation of cognitive impairment with olfactory dysfunction, even in the early stages of the disease in young and less physically- disabled patients. The assessment of olfaction may be helpful as a surrogate method for tracking disease progression in patients over time.
Turkish Journal Of Neurology, Jun 15, 2018
Kluver-Bucy syndrome (KBS) is characterized by visual agnosia, hypersexuality, emotional behavior... more Kluver-Bucy syndrome (KBS) is characterized by visual agnosia, hypersexuality, emotional behavior changes, hyperorality, hypermetamorphosis, and cognitive dysfunction. The syndrome is often seen in pathologic states that destroy the anterior and medial temporal lobes, often bilaterally. Herpes simplex encephalitis (HSE) is the leading infectious cause of KBS owing to its frequent involvement of the temporal lobes. HSE is also the most common cause of KBS in general. In this paper, we present a rare case of KBS after HSE.
Ideggyogyaszati Szemle-clinical Neuroscience, 2015
Anti-N-methyl-D-aspartate receptor NMDA-R encephalitis is caused by antibodies against the NMDA-R... more Anti-N-methyl-D-aspartate receptor NMDA-R encephalitis is caused by antibodies against the NMDA-R and characterized by a severe encephalopathy with psychosis, epileptic seizures and autonomic disturbances. This disorder is often accompanied with malignancies, especially ovarian teratoma. Some patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; EEGs show a different pattern similar to the waveforms of premature infants and this pattern is specifically named as extreme delta brush (EDB). We report a 24-year-old female having anti-NMDA receptor encephalitis and EDB patern.
Türk Nöroloji Dergisi, 2017
Turkish Journal Of Neurology, Sep 15, 2017
Creutzfeldt Jakob disease (CJD) is the most common prion disease. The Heidenhain variant of CJD&#... more Creutzfeldt Jakob disease (CJD) is the most common prion disease. The Heidenhain variant of CJD's clinical feature is the association with visual symptoms such as progressive visual decline, cortical blindness, visual agnosia and visual hallucinations. Case: Sixty-year old man presented to us with progressive dementia, gait disturbances, audio-visual hallucinations and behavioral changes. On his neurological examination, the patient was confused, his attention span was decreased and accompanied by disorientation to time and place. There was tetraparesis and deep tendon reflexes were absent. The Babinski's sign was bilaterally negative. The myoclonic jerks are induced tactile or auditory stimulus. His cranial magnetic resonance imaging (cMRI) and diffusion-weighted imaging (DWI) showed cerebral and cerebellar atrophy, T2 and FLAIR-weighted sequences of basal ganglia, thalamus and occipital cortex showed increased signal intensity and diffusion limitation. His electroencephalography (EEG) findings showed low-amplitude slow wave activity in both hemispheres and periodic sharply contoured slow-wave in the occipital regions. The cerebrospinal fluid's (CSF) protein was high level and the result of CSF protein 14-3-3 was negative. The patient died in 6th month of clinical follow-up. Conclusion: The Heidenhain variant of CJD should be considered in all patients who present with dementia, ataxia and visual phenomena. Close follow-up as well as serial EEG can help clarify the underlying disease process. And DWI and FLAIR sequences should be included in the cMRI protocol.
Neurological Sciences, Mar 29, 2016
Cryptococcal meningoencephalitis (CM) is a serious central nervous system infection caused by Cry... more Cryptococcal meningoencephalitis (CM) is a serious central nervous system infection caused by Cryptococcus neoformans, seen mostly in immunocompromised hosts and less in immunocompetent patients. The vast majority of cryptococcosis cases are seen as human immunodeficiency virus infections with advanced immunosuppression. Meningitis and meningoencephalitis are the most common clinical manifestations. Nevertheless, immunocompetent patients with CM are rarely reported. Cerebral venous sinus thrombosis is a rare complication of CM. Here, we report an immunocompetent patient with CM from a nonendemic area, who presented with an acute onset and atypical symptoms associated with cerebral venous thrombosis.
Neurological Sciences, Jan 11, 2018
The comorbidity of headache and epilepsy is often seen in neurological practice. The objective of... more The comorbidity of headache and epilepsy is often seen in neurological practice. The objective of this study was to assess the prevalence, types of, and risk factors for headache in juvenile myoclonic epilepsy (JME). We assessed a total of 200 patients and 100 healthy controls in our study. Headache was classified in participants using a self-administered questionnaire. Demographical, clinical features and headache characteristics were recorded. Seizure and headache temporal profiles were noted. Headache was present in 111 (56%) patients and 50 (50%) healthy participants. From these patients, 47 (42.3%) JME patients had migraine [30 (27%) migraine without aura (MO), 17 (15.3%) migraine with aura (MA)], 52 (46.8%) had tension type headache (TTH), 4 (3.6%) had both migraine and TTH, and 8 (7.2%) had other non-primary headaches. In the healthy control group, migraine was detected in 16 (32%) subjects, TTH in 33 (66%), both migraine and TTH in 1 (2%) subject. A positive migraine family history and symptom relief with sleep were more frequent in JME patients (p = 0.01). Headache was classified as inter-ictal in 82 (79.6%) patients and peri-ictal in 21 (20.4%) patients. In conclusion, the present study revealed that headache frequency was not significantly different between JME patients and healthy controls (p &amp;gt; 0.05). However, migraine frequency was higher in JME patients than healthy controls. Some migraine and TTH characteristics were different in between groups. We suggest that our results support both genetic relationship and shared underlying hypothetical pathopysiological mechanisms between JME and headache, especially migraine.
Turkish Journal of Cerebrovascular Diseases
INTRODUCTION: In this study, we aimed to evaluate the relationship between cranial computed tomog... more INTRODUCTION: In this study, we aimed to evaluate the relationship between cranial computed tomography (CT) black hole sign (BHS) and cerebral microbleeds (CMB) detected on cranial magnetic resonance imaging (MRI), and the relationship between BHS and poor prognosis in patients with spontaneous intracerebral hemorrhage (ICH). METHODS: Our study is designed as a prospective observational study. Patients admitted to our hospital between September 2018 and October 2019 were evaluated. Patients older than 18 years old and whose cranial CT were performed within 6 hours of onset were included. The patients divided into two groups according to BHS presence. After exclusion of the patients who underwent surgery, demographic, clinical, laboratory, and imaging characteristics were compared between the two groups. The effect of BHS on poor prognosis were evaluated using multivariable logistic regression analysis. RESULTS: Sixty six of 88 patients admitted to our hospital were included. 47 of the patients (71.2%) were male, and mean age was 63.08 ± 14.33 years. BHS was found in 16 patients (24.2%). Anticoagulant use, hemorrhage volume on initial CT scan, presence of midline shift, and presence of pineal gland shift were significantly higher in BHS positive patients (p<0.05). While CMB presence was comparable between groups, CMB number was significantly lower in patients with BHS (p=0.023). In-hospital and 90-day mortality were significantly higher in BHS positive patients, but 90-day mRS scores were similar between two groups. BHS was not an independent predictor of poor prognosis in multivariable logistic regression (p>0.05). DISCUSSION AND CONCLUSION: BHS was shown to be associated with in-hospital and 90-day mortality. Negative relationship between BHS and CMB number may support the microbleeding-macrobleeding concept in ICH patients.
Neurological Sciences
This study aims to compare the styles of coping with stress between patients with epilepsy and he... more This study aims to compare the styles of coping with stress between patients with epilepsy and healthy individuals and to examine the effects of clinical features on methods of coping with stress. The study enrolled 120 patients diagnosed with epilepsy. Forty healthy individuals were included as control group. Sociodemographic and clinical characteristics of the patients were recorded. The patients and controls completed the Coping Strategies with Stress Inventory (COPE), which comprises 60 items distributed into 15 scales. The COPE scores of the patients and controls were compared. Comparing the COPE scores of the patients and controls, the substance use score was higher in the controls. In terms of gender, seeking instrumental social support, active coping, seeking emotional social support, acceptance, and emotion-focused total coping scores were higher in women among patients. In terms of marital status, the positive reinterpretation and growth score of single patients was significantly higher than that of married patients. In patients with a history of febrile convulsions, the active coping, seeking emotional social support, and denial scores were higher. In terms of treatment, for the patients receiving polytherapy, the suppression of competing activities, focus on and venting of emotions, and dysfunctional total coping scores were higher than in patients receiving monotherapy. Epilepsy and stress are intertwined conditions. Epilepsy patients, confronted with stress, avoided using alcohol and substances compared to healthy individuals. There were differences among epilepsy patients according to gender, marital status, febrile convulsion history, number of medications, and approaches to coping with stress.
Journal of Neurological Sciences-turkish, 2012
Neurological Sciences, 2021
Introduction This study aims to evaluate the effect of metabolic syndrome (MetS) and anthropometr... more Introduction This study aims to evaluate the effect of metabolic syndrome (MetS) and anthropometric indices on carpal tunnel syndrome (CTS). Methods Forty-three healthy controls and 41 CTS patients were enrolled. Complaints of patients were assessed by Boston Questionnaire (BQ). MetS components were investigated. Wrist circumference, wrist depth, wrist width, palm width, and palm length were measured. Routine nerve conduction studies of median and ulnar nerves as well as the “sensitive” comparison tests were performed. Cutaneous silent period (CuSP) was studied by stimulating both second and fifth digital nerves while recording over thenar muscles. Results The vast majority of the participants were female and right-handed. CTS was bilateral in 61% of patients. Data of 109 hands were analyzed. MetS was more frequent in CTS patients. BQ scores were not related to MetS. Waist circumference, serum TG, and fasting glucose levels were higher in CTS patients. CTS hands with MetS had lower median CMAP amplitudes and increased sensory thresholds. Sensory thresholds were increased with both median and ulnar nerve stimulations suggesting a wider spread of peripheral nerve excitability changes in MetS presence. CuSPs were recorded from all 109 hands. CuSP latencies and durations were similar between controls and CTS patients. Wrist ratio was the only anthropometric index that was a statistically significant predictor for CTS development. Conclusion MetS was more prevalent in CTS patients. Some clinical and electrophysiological features (mainly sensory thresholds) may worsen in presence of MetS, but not the wrist ratio.
Turkish Neurosurgery, 2021
AIM: To discuss seizure outcomes of patients with invasive electroencephalography (EEG) monitoriz... more AIM: To discuss seizure outcomes of patients with invasive electroencephalography (EEG) monitorization (IEM) following their epilepsy surgery at our centre. MATERIAL and METHODS: Forty-seven patients suffering from refractory epilepsy and who were evaluated by invasive EEG were included in this retrospective study at Istanbul Faculty of Medicine from 2003 to 2017. We examined the Video EEG and invasive EEG monitorization, cranial MRI, SPECT, PET and neuropsychological tests of all patients. Postoperative seizure outcome results were evaluated according to Engel classification. The factors affecting seizure outcomes were discussed. RESULTS: Twenty-six of the patients were female (55.3%), 21 were male (44.7). The average age was 32.0 (± 12.4). Forty-three patients had surgery and the average age of these patients was 26,6 (±11.15). 38.3% of the patients had hippocampal sclerosis (HS), 23.4% had focal cortical dysplasia (FCD), 8.5% had a tumor, 14.9% had sequela lesion and 14.9% had unknown etiology. Postoperative seizure status according to the Engel classification showed that 81.6% of the patients were class I, 10.5% were class II, 2.6% were class III and 5.3% were class IV. CONCLUSION: A significant relation was statistically determined between structural MRI lesion and favorable seizure outcome (p<0.05). The most frequent etiology was HS in our patients. Of the patients with Engel I, the averages of their ages, ages at onset of epilepsy and ages at surgery were lower than other groups, but the difference was not statistically significant (p>0.05). We argue that IEM is an essential examination for favorable outcomes for determining the epileptogenic zone and/or the proximity of the functional structures.
Neurological Sciences, 2020
Objective Cervicocephalic artery dissection (CeAD) is the most common cause of ischemic stroke in... more Objective Cervicocephalic artery dissection (CeAD) is the most common cause of ischemic stroke in young adults. Although the exact cause is unknown, inflammation is thought to have a role. Here, we investigated the relationship between CeAD and inflammation. Methods Patients diagnosed with CeAD in our stroke center were evaluated retrospectively, and their demographic and clinical features were recorded. The C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell, neutrophil and lymphocyte counts, platelet/lymphocyte ratio (PLR), and neutrophil/lymphocyte ratio (NLR) were recorded on admission. Modified Rankin scores (mRS) were noted on admission and at 6 months to evaluate the dependency status and functional outcome of each patient. Results Of the 95 patients in the study, 70 (73.7%) were male, and the mean age was 44.4 ± 9.8 years. Patients with high WBC count, ESR, PLR, and NLR frequently had mRS scores of 3-6 at admission; these differences were significant (p = 0.04, p = 0.02, p = 0.04, and p = 0.02, respectively). At 6 months, patients with high CRP and ESR at admission also had significantly poorer prognoses (p < 0.001, p = 0.002, respectively). PLR and NLR values were higher in patients with mRS of 3-6. But there were no significant differences between the good and poor prognosis groups regarding PLR and NLR (p = 0.22, p = 0.05, respectively). Conclusion Inflammation may have a role in the prognosis of CeAD, and inflammatory markers can be evaluated as auxiliary tests for determining prognosis.
Epilepsy & Behavior, 2018
The study aimed to examine the relationship between frontal lobe functions and interictal electro... more The study aimed to examine the relationship between frontal lobe functions and interictal electroencephalography (EEG) discharge characteristics of patients with juvenile myoclonic epilepsy (JME). Method: Thirty patients with JME who had EEG with asymmetrical generalized discharge (aEEG), 15 patients with JME who had EEG with symmetrical generalized discharge (sEEG), and 15 healthy controls were included in the study. To evaluate attention, the digit span and Corsi block tests were used; to evaluate memory, we applied verbal and visual memory tests; to evaluate frontal lobe functions, we used clock drawing, verbal fluency, the Stroop test, trail making, mental control, and antisaccadic eye movement tests as well as the continuous performance (CPT) tests. Ethical Considerations: The research was approved by the Research Ethics Committee of the Bakirkoy Research and Training Hospital for Psychiatry, Neurology, Neurosurgery, with protocol number: 41340010/4891-262, date: 05.02.2013. Results: The mean age of the 45 patients with JME was 22.89 ± 6.77 years, and 34 (75.6%) were female. The age at onset of seizures and disease duration of the patients with JME was 15.56 ± 4.06 years (range, 9-26 years) and 7.20 ± 5.59 years (range, 1-25 years), respectively. All patients were under valproate (VPA) treatment, and the mean VPA dosage was 783.33 ± 379.14 mg/day. Patients with JME scored worse than the control group in attention, memory, and frontal lobe functions. In patients with aEEG, scores of attention, memory, and frontal lobe function tests were lower than in patients with sEEG; however, with the exception of CPT, they were not statistically significant. Conclusion: Cognitive functions in JME have been shown to be impaired. Furthermore, we concluded that the frontal lobe cognitive functions may be worse in patients with aEEG than in patients with sEEG. Further studies in patients with JME with aEEG abnormalities may lead to a better understanding of the pathophysiology of JME.
Journal of the Turkish Epilepsi Society, 2018
Pregnancy follow-up is different in epilepsy patients in comparison with healthy individuals. The... more Pregnancy follow-up is different in epilepsy patients in comparison with healthy individuals. The rate of maternal and infant mortality, as well as pregnancy and delivery complications, is greater than in the normal population. The use of antiepileptic drugs during pregnancy increases the rate of congenital malformation 2 to 5-fold. Polytherapy patients are more at risk than monotherapy patients. In studies conducted in recent years, valproate, phenobarbital, and topiramate have been reported as the riskiest drugs to use during pregnancy, while levetiracetam, oxcarbazepine, and lamotrigine have been reported as the least risky. In order to reduce the teratogenic effects of antiepileptic drugs, additional folic acid is recommended.
Türk Beyin Damar Hastalıkları Dergisi, 2016
Thalamus is a mass of gray matter, which plays a role in the transmission of sensory and motor in... more Thalamus is a mass of gray matter, which plays a role in the transmission of sensory and motor information to the primary sensory and motor centers of the cerebral cortex, cerebellum and basal ganglia. Vascular lesions of thalamus may occur in different syndromes depending on the affected nuclei. In this report, a case with acute evolving personality and behavior changes and detected bilateral thalamic infarction will be presented. A 40-year-old male patient was brought to the psychiatric ER with complaints of acute excessive sleep and behavioral changing. His neurological examination was normal except for limited cooperation and dysarthria. There was hyperintensity in bilateral paramedian thalamic regions in diffusion MRI and hypointensity in the right side in the ADC. During clinical observation the patient occasionally had visual hallucinations and attempted suicide. The psychiatrist diagnosed the patient with psychotic disorder due to his general medical condition and olanzapine 10 mg / day was prescribed. Etiological tests were normal. The patient was discharged after clinical improvement on the tenth day of hospitalization. Bilateral thalamic infarcts are very rare in all ischemic cerebrovascular diseases and typically result in changing of consciousness, gaze palsy and memory. The most common etiological cause of bilateral thalamic infarct is cardioembolism and the prognosis is generally good. Thalamic infarcts have a clinical spectrum varying according to the location of the lesion and may even just be present with psychiatric symptoms. In acute or subacute personality and behavior changes in a patient with no history of psychiatric disorders, thalamic lesions should be considered.
Turkish Neurosurgery, 2021
AIM: To discuss seizure outcomes of patients with invasive electroencephalography (EEG) monitoriz... more AIM: To discuss seizure outcomes of patients with invasive electroencephalography (EEG) monitorization (IEM) following their epilepsy surgery at our centre. MATERIAL and METHODS: Forty-seven patients suffering from refractory epilepsy and who were evaluated by invasive EEG were included in this retrospective study at Istanbul Faculty of Medicine from 2003 to 2017. We examined the Video EEG and invasive EEG monitorization, cranial MRI, SPECT, PET and neuropsychological tests of all patients. Postoperative seizure outcome results were evaluated according to Engel classification. The factors affecting seizure outcomes were discussed. RESULTS: Twenty-six of the patients were female (55.3%), 21 were male (44.7). The average age was 32.0 (± 12.4). Forty-three patients had surgery and the average age of these patients was 26,6 (±11.15). 38.3% of the patients had hippocampal sclerosis (HS), 23.4% had focal cortical dysplasia (FCD), 8.5% had a tumor, 14.9% had sequela lesion and 14.9% had unknown etiology. Postoperative seizure status according to the Engel classification showed that 81.6% of the patients were class I, 10.5% were class II, 2.6% were class III and 5.3% were class IV. CONCLUSION: A significant relation was statistically determined between structural MRI lesion and favorable seizure outcome (p<0.05). The most frequent etiology was HS in our patients. Of the patients with Engel I, the averages of their ages, ages at onset of epilepsy and ages at surgery were lower than other groups, but the difference was not statistically significant (p>0.05). We argue that IEM is an essential examination for favorable outcomes for determining the epileptogenic zone and/or the proximity of the functional structures.
Multiple sclerosis and related disorders, Apr 1, 2018
Multiple sclerosis (MS) is a common chronic neurological disease that causes disability. MS can h... more Multiple sclerosis (MS) is a common chronic neurological disease that causes disability. MS can have various clinical manifestations, one of which is olfactory dysfunction. In clinical practice, olfactory disturbances are usually underdiagnosed. The aim of our study is to assess olfactory function and its relationship with MS disease duration, disability and cognition. We assessed 31 MS patients and 24 healthy controls matched in sex and age at our MS outpatient clinic of the Istanbul Education and Research Hospital Neurology Department. Each subject was interviewed to obtain demographic data. The Connecticut Chemosensory Clinical Research Center (CCCRC) olfactory test and Montreal Cognitive Assessment (MOCA) were applied to each participant. The CCCRC test scores of the MS patients were lower than those in the control group (p < 0.05). Patients with a longer disease duration and more frequent attacks had lower CCCRC scores (p < 0.05). The Expanded Disability Status Scale scores had no correlation with the CCCRC test scores. The MOCA score was positively correlated with all domains of the olfactory test scores. This study supports the presence of olfactory dysfunction in early stages of MS and the correlation of cognitive impairment with olfactory dysfunction, even in the early stages of the disease in young and less physically- disabled patients. The assessment of olfaction may be helpful as a surrogate method for tracking disease progression in patients over time.
Turkish Journal Of Neurology, Jun 15, 2018
Kluver-Bucy syndrome (KBS) is characterized by visual agnosia, hypersexuality, emotional behavior... more Kluver-Bucy syndrome (KBS) is characterized by visual agnosia, hypersexuality, emotional behavior changes, hyperorality, hypermetamorphosis, and cognitive dysfunction. The syndrome is often seen in pathologic states that destroy the anterior and medial temporal lobes, often bilaterally. Herpes simplex encephalitis (HSE) is the leading infectious cause of KBS owing to its frequent involvement of the temporal lobes. HSE is also the most common cause of KBS in general. In this paper, we present a rare case of KBS after HSE.
Ideggyogyaszati Szemle-clinical Neuroscience, 2015
Anti-N-methyl-D-aspartate receptor NMDA-R encephalitis is caused by antibodies against the NMDA-R... more Anti-N-methyl-D-aspartate receptor NMDA-R encephalitis is caused by antibodies against the NMDA-R and characterized by a severe encephalopathy with psychosis, epileptic seizures and autonomic disturbances. This disorder is often accompanied with malignancies, especially ovarian teratoma. Some patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; EEGs show a different pattern similar to the waveforms of premature infants and this pattern is specifically named as extreme delta brush (EDB). We report a 24-year-old female having anti-NMDA receptor encephalitis and EDB patern.
Türk Nöroloji Dergisi, 2017
Turkish Journal Of Neurology, Sep 15, 2017
Creutzfeldt Jakob disease (CJD) is the most common prion disease. The Heidenhain variant of CJD&#... more Creutzfeldt Jakob disease (CJD) is the most common prion disease. The Heidenhain variant of CJD's clinical feature is the association with visual symptoms such as progressive visual decline, cortical blindness, visual agnosia and visual hallucinations. Case: Sixty-year old man presented to us with progressive dementia, gait disturbances, audio-visual hallucinations and behavioral changes. On his neurological examination, the patient was confused, his attention span was decreased and accompanied by disorientation to time and place. There was tetraparesis and deep tendon reflexes were absent. The Babinski's sign was bilaterally negative. The myoclonic jerks are induced tactile or auditory stimulus. His cranial magnetic resonance imaging (cMRI) and diffusion-weighted imaging (DWI) showed cerebral and cerebellar atrophy, T2 and FLAIR-weighted sequences of basal ganglia, thalamus and occipital cortex showed increased signal intensity and diffusion limitation. His electroencephalography (EEG) findings showed low-amplitude slow wave activity in both hemispheres and periodic sharply contoured slow-wave in the occipital regions. The cerebrospinal fluid's (CSF) protein was high level and the result of CSF protein 14-3-3 was negative. The patient died in 6th month of clinical follow-up. Conclusion: The Heidenhain variant of CJD should be considered in all patients who present with dementia, ataxia and visual phenomena. Close follow-up as well as serial EEG can help clarify the underlying disease process. And DWI and FLAIR sequences should be included in the cMRI protocol.
Neurological Sciences, Mar 29, 2016
Cryptococcal meningoencephalitis (CM) is a serious central nervous system infection caused by Cry... more Cryptococcal meningoencephalitis (CM) is a serious central nervous system infection caused by Cryptococcus neoformans, seen mostly in immunocompromised hosts and less in immunocompetent patients. The vast majority of cryptococcosis cases are seen as human immunodeficiency virus infections with advanced immunosuppression. Meningitis and meningoencephalitis are the most common clinical manifestations. Nevertheless, immunocompetent patients with CM are rarely reported. Cerebral venous sinus thrombosis is a rare complication of CM. Here, we report an immunocompetent patient with CM from a nonendemic area, who presented with an acute onset and atypical symptoms associated with cerebral venous thrombosis.
Neurological Sciences, Jan 11, 2018
The comorbidity of headache and epilepsy is often seen in neurological practice. The objective of... more The comorbidity of headache and epilepsy is often seen in neurological practice. The objective of this study was to assess the prevalence, types of, and risk factors for headache in juvenile myoclonic epilepsy (JME). We assessed a total of 200 patients and 100 healthy controls in our study. Headache was classified in participants using a self-administered questionnaire. Demographical, clinical features and headache characteristics were recorded. Seizure and headache temporal profiles were noted. Headache was present in 111 (56%) patients and 50 (50%) healthy participants. From these patients, 47 (42.3%) JME patients had migraine [30 (27%) migraine without aura (MO), 17 (15.3%) migraine with aura (MA)], 52 (46.8%) had tension type headache (TTH), 4 (3.6%) had both migraine and TTH, and 8 (7.2%) had other non-primary headaches. In the healthy control group, migraine was detected in 16 (32%) subjects, TTH in 33 (66%), both migraine and TTH in 1 (2%) subject. A positive migraine family history and symptom relief with sleep were more frequent in JME patients (p = 0.01). Headache was classified as inter-ictal in 82 (79.6%) patients and peri-ictal in 21 (20.4%) patients. In conclusion, the present study revealed that headache frequency was not significantly different between JME patients and healthy controls (p &amp;gt; 0.05). However, migraine frequency was higher in JME patients than healthy controls. Some migraine and TTH characteristics were different in between groups. We suggest that our results support both genetic relationship and shared underlying hypothetical pathopysiological mechanisms between JME and headache, especially migraine.
Turkish Journal of Cerebrovascular Diseases
INTRODUCTION: In this study, we aimed to evaluate the relationship between cranial computed tomog... more INTRODUCTION: In this study, we aimed to evaluate the relationship between cranial computed tomography (CT) black hole sign (BHS) and cerebral microbleeds (CMB) detected on cranial magnetic resonance imaging (MRI), and the relationship between BHS and poor prognosis in patients with spontaneous intracerebral hemorrhage (ICH). METHODS: Our study is designed as a prospective observational study. Patients admitted to our hospital between September 2018 and October 2019 were evaluated. Patients older than 18 years old and whose cranial CT were performed within 6 hours of onset were included. The patients divided into two groups according to BHS presence. After exclusion of the patients who underwent surgery, demographic, clinical, laboratory, and imaging characteristics were compared between the two groups. The effect of BHS on poor prognosis were evaluated using multivariable logistic regression analysis. RESULTS: Sixty six of 88 patients admitted to our hospital were included. 47 of the patients (71.2%) were male, and mean age was 63.08 ± 14.33 years. BHS was found in 16 patients (24.2%). Anticoagulant use, hemorrhage volume on initial CT scan, presence of midline shift, and presence of pineal gland shift were significantly higher in BHS positive patients (p<0.05). While CMB presence was comparable between groups, CMB number was significantly lower in patients with BHS (p=0.023). In-hospital and 90-day mortality were significantly higher in BHS positive patients, but 90-day mRS scores were similar between two groups. BHS was not an independent predictor of poor prognosis in multivariable logistic regression (p>0.05). DISCUSSION AND CONCLUSION: BHS was shown to be associated with in-hospital and 90-day mortality. Negative relationship between BHS and CMB number may support the microbleeding-macrobleeding concept in ICH patients.
Neurological Sciences
This study aims to compare the styles of coping with stress between patients with epilepsy and he... more This study aims to compare the styles of coping with stress between patients with epilepsy and healthy individuals and to examine the effects of clinical features on methods of coping with stress. The study enrolled 120 patients diagnosed with epilepsy. Forty healthy individuals were included as control group. Sociodemographic and clinical characteristics of the patients were recorded. The patients and controls completed the Coping Strategies with Stress Inventory (COPE), which comprises 60 items distributed into 15 scales. The COPE scores of the patients and controls were compared. Comparing the COPE scores of the patients and controls, the substance use score was higher in the controls. In terms of gender, seeking instrumental social support, active coping, seeking emotional social support, acceptance, and emotion-focused total coping scores were higher in women among patients. In terms of marital status, the positive reinterpretation and growth score of single patients was significantly higher than that of married patients. In patients with a history of febrile convulsions, the active coping, seeking emotional social support, and denial scores were higher. In terms of treatment, for the patients receiving polytherapy, the suppression of competing activities, focus on and venting of emotions, and dysfunctional total coping scores were higher than in patients receiving monotherapy. Epilepsy and stress are intertwined conditions. Epilepsy patients, confronted with stress, avoided using alcohol and substances compared to healthy individuals. There were differences among epilepsy patients according to gender, marital status, febrile convulsion history, number of medications, and approaches to coping with stress.
Journal of Neurological Sciences-turkish, 2012
Neurological Sciences, 2021
Introduction This study aims to evaluate the effect of metabolic syndrome (MetS) and anthropometr... more Introduction This study aims to evaluate the effect of metabolic syndrome (MetS) and anthropometric indices on carpal tunnel syndrome (CTS). Methods Forty-three healthy controls and 41 CTS patients were enrolled. Complaints of patients were assessed by Boston Questionnaire (BQ). MetS components were investigated. Wrist circumference, wrist depth, wrist width, palm width, and palm length were measured. Routine nerve conduction studies of median and ulnar nerves as well as the “sensitive” comparison tests were performed. Cutaneous silent period (CuSP) was studied by stimulating both second and fifth digital nerves while recording over thenar muscles. Results The vast majority of the participants were female and right-handed. CTS was bilateral in 61% of patients. Data of 109 hands were analyzed. MetS was more frequent in CTS patients. BQ scores were not related to MetS. Waist circumference, serum TG, and fasting glucose levels were higher in CTS patients. CTS hands with MetS had lower median CMAP amplitudes and increased sensory thresholds. Sensory thresholds were increased with both median and ulnar nerve stimulations suggesting a wider spread of peripheral nerve excitability changes in MetS presence. CuSPs were recorded from all 109 hands. CuSP latencies and durations were similar between controls and CTS patients. Wrist ratio was the only anthropometric index that was a statistically significant predictor for CTS development. Conclusion MetS was more prevalent in CTS patients. Some clinical and electrophysiological features (mainly sensory thresholds) may worsen in presence of MetS, but not the wrist ratio.
Turkish Neurosurgery, 2021
AIM: To discuss seizure outcomes of patients with invasive electroencephalography (EEG) monitoriz... more AIM: To discuss seizure outcomes of patients with invasive electroencephalography (EEG) monitorization (IEM) following their epilepsy surgery at our centre. MATERIAL and METHODS: Forty-seven patients suffering from refractory epilepsy and who were evaluated by invasive EEG were included in this retrospective study at Istanbul Faculty of Medicine from 2003 to 2017. We examined the Video EEG and invasive EEG monitorization, cranial MRI, SPECT, PET and neuropsychological tests of all patients. Postoperative seizure outcome results were evaluated according to Engel classification. The factors affecting seizure outcomes were discussed. RESULTS: Twenty-six of the patients were female (55.3%), 21 were male (44.7). The average age was 32.0 (± 12.4). Forty-three patients had surgery and the average age of these patients was 26,6 (±11.15). 38.3% of the patients had hippocampal sclerosis (HS), 23.4% had focal cortical dysplasia (FCD), 8.5% had a tumor, 14.9% had sequela lesion and 14.9% had unknown etiology. Postoperative seizure status according to the Engel classification showed that 81.6% of the patients were class I, 10.5% were class II, 2.6% were class III and 5.3% were class IV. CONCLUSION: A significant relation was statistically determined between structural MRI lesion and favorable seizure outcome (p<0.05). The most frequent etiology was HS in our patients. Of the patients with Engel I, the averages of their ages, ages at onset of epilepsy and ages at surgery were lower than other groups, but the difference was not statistically significant (p>0.05). We argue that IEM is an essential examination for favorable outcomes for determining the epileptogenic zone and/or the proximity of the functional structures.
Neurological Sciences, 2020
Objective Cervicocephalic artery dissection (CeAD) is the most common cause of ischemic stroke in... more Objective Cervicocephalic artery dissection (CeAD) is the most common cause of ischemic stroke in young adults. Although the exact cause is unknown, inflammation is thought to have a role. Here, we investigated the relationship between CeAD and inflammation. Methods Patients diagnosed with CeAD in our stroke center were evaluated retrospectively, and their demographic and clinical features were recorded. The C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell, neutrophil and lymphocyte counts, platelet/lymphocyte ratio (PLR), and neutrophil/lymphocyte ratio (NLR) were recorded on admission. Modified Rankin scores (mRS) were noted on admission and at 6 months to evaluate the dependency status and functional outcome of each patient. Results Of the 95 patients in the study, 70 (73.7%) were male, and the mean age was 44.4 ± 9.8 years. Patients with high WBC count, ESR, PLR, and NLR frequently had mRS scores of 3-6 at admission; these differences were significant (p = 0.04, p = 0.02, p = 0.04, and p = 0.02, respectively). At 6 months, patients with high CRP and ESR at admission also had significantly poorer prognoses (p < 0.001, p = 0.002, respectively). PLR and NLR values were higher in patients with mRS of 3-6. But there were no significant differences between the good and poor prognosis groups regarding PLR and NLR (p = 0.22, p = 0.05, respectively). Conclusion Inflammation may have a role in the prognosis of CeAD, and inflammatory markers can be evaluated as auxiliary tests for determining prognosis.
Epilepsy & Behavior, 2018
The study aimed to examine the relationship between frontal lobe functions and interictal electro... more The study aimed to examine the relationship between frontal lobe functions and interictal electroencephalography (EEG) discharge characteristics of patients with juvenile myoclonic epilepsy (JME). Method: Thirty patients with JME who had EEG with asymmetrical generalized discharge (aEEG), 15 patients with JME who had EEG with symmetrical generalized discharge (sEEG), and 15 healthy controls were included in the study. To evaluate attention, the digit span and Corsi block tests were used; to evaluate memory, we applied verbal and visual memory tests; to evaluate frontal lobe functions, we used clock drawing, verbal fluency, the Stroop test, trail making, mental control, and antisaccadic eye movement tests as well as the continuous performance (CPT) tests. Ethical Considerations: The research was approved by the Research Ethics Committee of the Bakirkoy Research and Training Hospital for Psychiatry, Neurology, Neurosurgery, with protocol number: 41340010/4891-262, date: 05.02.2013. Results: The mean age of the 45 patients with JME was 22.89 ± 6.77 years, and 34 (75.6%) were female. The age at onset of seizures and disease duration of the patients with JME was 15.56 ± 4.06 years (range, 9-26 years) and 7.20 ± 5.59 years (range, 1-25 years), respectively. All patients were under valproate (VPA) treatment, and the mean VPA dosage was 783.33 ± 379.14 mg/day. Patients with JME scored worse than the control group in attention, memory, and frontal lobe functions. In patients with aEEG, scores of attention, memory, and frontal lobe function tests were lower than in patients with sEEG; however, with the exception of CPT, they were not statistically significant. Conclusion: Cognitive functions in JME have been shown to be impaired. Furthermore, we concluded that the frontal lobe cognitive functions may be worse in patients with aEEG than in patients with sEEG. Further studies in patients with JME with aEEG abnormalities may lead to a better understanding of the pathophysiology of JME.
Journal of the Turkish Epilepsi Society, 2018
Pregnancy follow-up is different in epilepsy patients in comparison with healthy individuals. The... more Pregnancy follow-up is different in epilepsy patients in comparison with healthy individuals. The rate of maternal and infant mortality, as well as pregnancy and delivery complications, is greater than in the normal population. The use of antiepileptic drugs during pregnancy increases the rate of congenital malformation 2 to 5-fold. Polytherapy patients are more at risk than monotherapy patients. In studies conducted in recent years, valproate, phenobarbital, and topiramate have been reported as the riskiest drugs to use during pregnancy, while levetiracetam, oxcarbazepine, and lamotrigine have been reported as the least risky. In order to reduce the teratogenic effects of antiepileptic drugs, additional folic acid is recommended.