Is impairment of facial emotion recognition independent of cognitive dysfunction in multiple sclerosis?

BACKGROUND: Emotions expressed on the face play a key role in social cognition and communication by providing inner emotional experiences. This study aimed to evaluate facial emotion identification and discrimination and empathy abilities in patients with MS and whether it is related to cognitive dysfunction. METHODS: One hundred twenty patients with relapsing-remitting MS and age- and sex-matched 120 healthy controls were enrolled in the study. All the subjects were evaluated with the Facial Emotion Identification Test (FEIT), Facial Emotion Discrimination Test (FEIDT), and Empathy Quotient (EQ). We used the Beck Depression Inventory (BDI) for depression and detailed cognitive tests, including the Montreal Cognitive Assessment (MoCA), the Symbol Digit Modalities Test (SDMT), and the Paced Auditory Serial Addition Test (PASAT). The quality of life was assessed with Multiple Sclerosis Quality of Life-54 (MSQL-54). RESULTS: Patients with MS were 37.6 ± 9.5 years old, had a mean disease duration of 8.8 ± 6.6 (8-28) years, and a mean EDSS score of 1.6 ± 1.3 (0-4.5). We found significant differences in the identification of facial emotions, discrimination of facial emotions, and empathy in MS patients compared to controls (p < 0.05). Especially the recognition of feelings of sadness, fear, and shame was significantly lower in MS patients. The multivariate logistic regression analysis showed low SDMT and FEIDT scores which showed an independent association with MS. CONCLUSIONS: Our findings indicate that facial emotion recognition and identification deficits are remarkable among patients with MS and emotion recognition is impaired together with and independently of cognitive dysfunction in MS patients.

Retrospective Evaluation of the Results of Low-Dose Intravenous Thrombolytic Therapy in Acute Ischemic Stroke.

Objectives: This study aimed to investigate the clinical data of patients with acute ischemic stroke who received low-dose intravenous (IV) thrombolytic therapy (0.9 mg/kg; maximum 50 mg) for various reasons, compare the obtained results with those of patients who received standard-dose thrombolytic therapy, and discuss them in light of the literature. Methods: Patients who received IV thrombolytic therapy within 4.5 h of symptom onset between January 2015 and June 2018 were retrospectively reviewed. Patients were divided into the low-dose group (0.9 mg/kg; max. 50 mg) and the standard-dose group (0.9 mg/kg; max 90 mg) according to the thrombolytic therapy dose, after which demographic data and clinical results were analyzed. Results: A total of 109 patients receiving thrombolytic therapy (19 patients in the low-dose group and 90 patients in the standard-dose group) were included in the study. There was no significant difference between the two groups in terms of good outcome rates (47.4% vs. 52.2%). There was no statistically significant difference in terms of symptomatic and asymptomatic intracerebral hemorrhage rates. Conclusion: Our study showed similar efficacy and safety for low-dose IV thrombolytic therapy compared with standard-dose IV thrombolytic therapy administered within 4.5 h of symptom onset in patients with acute ischemic stroke.

Correlation of brain segmental volume changes with clinical parameters: a longitudinal study in multiple sclerosis patients.

OBJECTIVE: To measure the cranial volume differences from 15 different parts in the follow-up of relapsing-remitting multiple sclerosis (RRMS) patients and correlate them with clinical parameters. METHODS: Forty-seven patients with RRMS were included in the study. Patients were grouped into two categories; low Expanded Disability Status Scale (EDSS) (< 3; group 1), and moderate-high EDSS (≥ 3; group 2). Patients were evaluated with Beck Depression Inventory (BDI), Montreal Cognitive Assessment (MOCA), Symbol Digit Modalities Test (SDMT), Fatigue Severity Scale (FSS), and calculated Annualized Relapse Rate (ARR) scores. Magnetic resonance imaging (MRI) was performed with a 1.5T MRI device (Magnetom AERA, Siemens, Erlangen, Germany) twice in a 1-year period. Volumetric analysis was performed by a free, automated, online MRI brain volumetry software. The differences in volumetric values between the two MRI scans were calculated and correlated with the demographic and clinical parameters of the patients. RESULTS: The number of attacks, disease duration, BDI, and FSS scores were higher in group 2; SDMT was higher in group 1. As expected, volumetric analyses have shown volume loss in total cerebral white matter in follow-up patients (p < 0.001). In addition, putaminal volume loss was related to a higher number of attacks. Besides, a negative relation between FSS with total amygdala volumes, a link between atrophy of globus pallidus and ARR, and BDI scores was found with the aid of network analysis. CONCLUSIONS: Apart from a visual demonstration of volume loss, cranial MRI with volumetric analysis has a great potential for revealing covert links between segmental volume changes and clinical parameters.

OBJETIVO: Medir as diferenças de dominância craniana de 15 regiões diferentes no seguimento de pacientes com esclerose múltipla recorrente-remitente (EMRR) e correlacioná-las com parâmetros clínicos. MéTODOS: Quarenta e sete pacientes com EMRR foram incluídos no estudo. Os pacientes foram agrupados em duas categorias; EDSS baixo (< 3; grupo 1) e EDSS médio-alto (≥ 3; grupo 2). Os pacientes foram avaliados com o Inventário de Depressão de Beck (BDI, na sigla em inglês), Montreal Cognitive Assessment (MOCA, na sigla em inglês), Symbol Digit Modality Tests (SDMT, na sigla em inglês), Fatigue Severity Scale (FSS, na sigla em inglês) e taxa de ataque anual (ARR, na sigla em inglês). Duas ressonâncias magnéticas (RMs) foram feitas em um ano com um aparelho de imagem de 1,5 T MR (Magnetom AERA, Siemens, Erlangen, Alemanha). A análise de volume foi realizada com um software de medição mestre cerebral de RM gratuito e automatizado. As diferenças volumétricas entre os dois exames de RM foram calculadas e correlacionadas com os parâmetros demográficos e clínicos dos pacientes. RESULTADOS: Número de crises, duração da doença, escores BDI e FSS foram mais elevados no grupo 2; as pontuações do SDMT foram maiores no grupo 1. Como esperado, as análises volumétricas mostraram perda total de volume de substância branca no seguimento (p < 0,001). Além disso, a perda da dominância putaminal foi associada ao maior número de ataques. Além disso, uma relação negativa entre FSS e volume total da amígdala, e uma correlação entre ARR e BDI e atrofia do globo pálido foi determinada com a ajuda da análise de rede. CONCLUSõES: Além da demonstração visual da perda de volume, a RM com análise volumétrica tem grande potencial para revelar alterações segmentares dominantes e conexões ocultas entre parâmetros clínicos.

Effect of Adiponectin on Acute Experimental Cerebral Ischemia/Reperfusion Injury.

AIM: To examine the effect of adiponectin administration on acute brain injury in an experimental model of cerebral ischemia/ reperfusion (I/R) in rats. MATERIAL AND METHODS: The study animals were divided into the following four groups: group I, sham (did not undergo surgical intervention and did not receive drugs); group II, the I/R model (received the intervention, but did not receive drugs); group III (I/Radiponectin) (the I/R model was used, and the animals were treated with 5 mg/kg adiponectin peritoneally 30 minutes after the ischemia); and group IV (I/R-tirofiban)( the I/R model was used, and the animals were treated with 0.5 mg/kg tirofiban peritoneally 30 minutes after the ischemia). RESULTS: Tumor necrosis factor-? (TNF-?) and interleukin (IL)-1? levels were statistically higher in the I/R group (group II) than in other groups. In the post-hoc (Tukey) test analysis, groups I, III, and IV had significantly lower TNF-? and IL-1? levels after treatment with both tirofiban and adiponectin than group II. No statistically significant difference was found between groups III and IV in terms of TNF-? levels. However, the decreased IL-1? level was more pronounced in group IV (tirofiban) than in other groups. The mean neurologic deficit scores were statistically significantly different among the groups. In the post-hoc (Tukey) test analysis, neurologic deficit scores were statistically significantly lower in groups III and IV than in group II. CONCLUSION: Adiponectin has anti-inflammatory and cerebral protective effects in experimental cerebral I/R injury.

Is there a relationship between fall status, cognition and cerebellar lobule volume in patients with multiple sclerosis?

In this prospective case control study, relationship of detailed cerebellar volumetric data and cognition in patients with multiple sclerosis considering falling status using 3 D MRI and network analysis were evaluated. Participants consist of 106 adults with relapsing-remitting multiple sclerosis. Scores of Montreal cognitive assessment test, symbol digit modality Test, nine-hole peg test, berg balance scale test, timed up and go test, timed 25-foot walk test were worse in faller group than non faller group (p < 0.05 for all tests). There was no significant difference in terms of cerebellar lobule volumes between groups. But using artificial intelligence (AI) based network analysis, we brought a new perspective to interpreting the relationship between the cerebellum, cognition, gait, and balance. Overall, data from the study suggest a possible relationship between cerebellar volume changes and cognitive dysfunction through connectivity analysis in patients with multiple sclerosis. Further studies are needed to examine this issue by using connectivity analysis.

Initial Cervical Spinal Cord Demyelinating Lesions are not Associated with Restless Legs Syndrome in Patients with Multiple Sclerosis.

Purpose: This study aims to determine the prevalence and severity of restless legs syndrome (RLS) in patients with multiple sclerosis (MS) and its association with spinal cord lesions, fatigue, quality of life, and sleep disturbance. Methods: We recruited 222 consecutive MS patients admitted to MS outpatient clinic. Beck's Depression Inventory (BDI), Fatigue Severity Scale (FSS), Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and MS Quality of Life-54 (MSQoL-54) questionnaire scores of all patients were measured. Initial cervical spinal cord magnetic resonance imaging (MRI) of the patients at first clinical evaluation for diagnosis was reviewed for accompanying demyelinating lesions. Results: RLS was diagnosed in 53 (23.87%) patients. RLS was associated with poor sleep, worse quality of life, increased fatigue, and depressive mood. The sleep quality index, FSS, and MSQoL-54 physical composite scores significantly correlated with RLS severity (P < 0.001, P = 0.001, P < 0.001, respectively). Of the 200 patients, 127 (63.5%) had spinal cord lesions. 22.83% of the patients with cervical spinal cord lesions had RLS comorbidity. We found no significant difference regarding spinal cord demyelinating lesions between RLS positives and negatives. (P = 0.77). In addition, having multiple spinal cord demyelinating lesions did not differ between the two groups (P = 0.84). Besides, the severity of RLS symptoms did not differ in patients who had a single cervical spinal lesion and those who had multiple lesions (P = 0.35). Conclusion: We have demonstrated the negative impact of comorbid RLS on fatigue, sleep quality, mood, and quality of life in MS patients. However, initial spinal cord lesions did not correlate with RLS comorbidity. The severity of RLS symptoms is associated with poor sleep and physical health.

Correlation of brain segmental volume changes with clinical parameters: a longitudinal study in multiple sclerosis patients / Correlação das alterações do volume segmentar cerebral com parâmetros clínicos: um estudo longitudinal em pacientes com esclerose múltipla

Abstract Objective To measure the cranial volume differences from 15 different parts in the follow-up of relapsing-remitting multiple sclerosis (RRMS) patients and correlate them with clinical parameters. Methods Forty-seven patients with RRMS were included in the study. Patients were grouped into two categories; low Expanded Disability Status Scale (EDSS) (< 3; group 1), and moderate-high EDSS (≥ 3; group 2). Patients were evaluated with Beck Depression Inventory (BDI), Montreal Cognitive Assessment (MOCA), Symbol Digit Modalities Test(SDMT), Fatigue Severity Scale (FSS), and calculated Annualized Relapse Rate (ARR) scores. Magnetic resonance imaging (MRI) was performed with a 1.5T MRI device (Magnetom AERA, Siemens, Erlangen, Germany) twice in a 1-year period. Volumetric analysis was performed by a free, automated, online MRI brain volumetry software. The differences in volumetric values between the two MRI scans were calculated and correlated with the demographic and clinical parameters of the patients. Results The number of attacks, disease duration, BDI, and FSS scores were higher in group 2; SDMT was higher in group 1. As expected, volumetric analyses have shown volume loss in total cerebral white matter in follow-up patients (p < 0.001). In addition, putaminal volume loss was related to a higher number of attacks. Besides, a negative relation between FSS with total amygdala volumes, a link between atrophy of globus pallidus and ARR, and BDI scores was found with the aid of network analysis. Conclusions Apart from a visual demonstration of volume loss, cranial MRI with volumetric analysis has a great potential for revealing covert links between segmental volume changes and clinical parameters.

Resumo Objetivo Medir as diferenças de dominância craniana de 15 regiões diferentes no seguimento de pacientes com esclerose múltipla recorrente-remitente (EMRR) e correlacioná-las com parâmetros clínicos. Métodos Quarenta e sete pacientes com EMRR foram incluídos no estudo. Os pacientes foram agrupados em duas categorias; EDSS baixo (< 3; grupo 1) e EDSS médio-alto (≥ 3; grupo 2). Os pacientes foram avaliados com o Inventário de Depressão de Beck (BDI, na sigla em inglês), Montreal Cognitive Assessment (MOCA, na sigla em inglês), Symbol Digit Modality Tests (SDMT, na sigla em inglês), Fatigue Severity Scale (FSS, na sigla em inglês) e taxa de ataque anual (ARR, na sigla em inglês). Duas ressonâncias magnéticas (RMs) foram feitas em um ano com um aparelho de imagem de 1,5 T MR (Magnetom AERA, Siemens, Erlangen, Alemanha). A análise de volume foi realizada com um software de medição mestre cerebral de RM gratuito e automatizado. As diferenças volumétricas entre os dois exames de RM foram calculadas e correlacionadas com os parâmetros demográficos e clínicos dos pacientes. Resultados Número de crises, duração da doença, escores BDI e FSS foram mais elevados no grupo 2; as pontuações do SDMT foram maiores no grupo 1. Como esperado, as análises volumétricas mostraram perda total de volume de substância branca no seguimento (p < 0,001). Além disso, a perda da dominância putaminal foi associada ao maior número de ataques. Além disso, uma relação negativa entre FSS e volume total da amígdala, e uma correlação entre ARR e BDI e atrofia do globo pálido foi determinada com a ajuda da análise de rede. Conclusões Além da demonstração visual da perda de volume, a RM com análise volumétrica tem grande potencial para revelar alterações segmentares dominantes e conexões ocultas entre parâmetros clínicos.

Restless legs syndrome in multiple sclerosis is related to retinal thinning.

BACKGROUND: Restless legs syndrome (RLS) is one of the most frequent comorbidities accompanying multiple sclerosis. Patients with multiple sclerosis (MS) show thinning in the retinal layers throughout the disease. The thinning is related to acute attacks and progression and atrophy of the brain. Optical coherence tomography (OCT) provides relevant information on the pathophysiology of MS. We aimed to evaluate OCT parameters in patients with MS to investigate any changes related to the coexistence of RLS. METHODS: We consecutively enrolled 75 adults with relapsing-remitting MS. Participants were assessed by using demographic and clinical parameters along with the excessive sleepiness in the daytime (ESS), fatigue severity scale (FSS), and RLS severity scale (IRLSSG). The thickness of the peripapillary retinal nerve fiber layer (pRNFL), macular thickness (MT), and macular ganglion cell - inner plexiform layer (MGCIPL) complex was measured with spectral-domain OCT. RESULTS: Of the 75 participants, 20 were found to have RLS, and 55 did not. Scores of ESS, FSS, and MS disability (EDSS) were worse in patients with RLS. There was no significant difference in retinal nerve fiber layer thickness except for the inferior quadrant(p = 0.029). The mean inferior pRNFL thickness was 104.5 ± 22.6 µm in the RLS (+) group and 114.2 ± 21.6 µm in the RLS (-) group. CONCLUSION: Patients with RLS had excessive daytime sleepiness, were more fatigued, had higher EDSS scores, and had a thinner retinal layer in the inferior quadrant. Overall, data from the study suggest a possible relationship between retinal volume changes in MS patients with RLS.

Is the left/right judgment task performance altered in unilateral carpal tunnel syndrome: And associated with symptom severity?

BACKGROUND: Left/right judgment task performance (LRJT) is impaired in severe neuropathic pain conditions. However, comparison of LRJT performance in patients with carpal tunnel syndrome (CTS) with a control group with similar cognitive functions has not been investigated. OBJECTIVE: The aim of the study was to compare the LRJT performance of CTS patients with healthy controls and the unaffected side. METHODS: Seventy-five CTS patients with dominant, right-hand involvement and 75 control subjects were included in the study. The Recognize® tablet application was used for LRJT performance. Tactile acuity (Two-point discrimination) and handgrip strength; pain severity (Visual Analog Scale) and neuropathic component of pain (Pain Detect Questionnaire); symptom severity and functional impact of CTS (Boston CTS Assessment Test) were evaluated. Mixed-design ANOVAs and correlation analyses were used for data analysis. DESIGN: Cross-sectional study. RESULTS: Analysis of variance showed that there was no significant effect of side (affected versus unaffected) or group (CTS versus control group) on recognition accuracy or time. Significant group*site interactions were found for the two-point discrimination F (1,148) = 6.388, p = 0.013; and for handgrip strength F (1,148) = 17.552, p < 0.01. A statistically significant negative correlation was found between recognition accuracy and symptom duration and a significant positive correlation was found between recognition accuracy and handgrip strength in CTS patients (r = -0.267, p = 0.020; r = 0.290, p = 0.012). CONCLUSION: CTS patients recognize the affected side as accurately and quickly as the unaffected side and control group. Further research is needed to clarify the relationship between LRJT performance in the severely affected CTS group. GOV REGISTRATION NUMBER: NCT04967144 CLINICALTRIALS. GOV REGISTRATION DATE: 19 July 2021.

Visual evoked potential and nerve conduction study findings in patients recovered from COVID-19.

OBJECTIVE: COVID-19 infection is associated with peripheral neuropathy. However, subclinical neurological involvement may occur anytime, and diagnostic methods that reveal this subclinical involvement are not well established. We aimed to assess the subclinical neurological involvement by visual evoked potential (VEP) measurements and nerve conduction studies (NCS) and explore the relationship between neurological electrophysiological findings and the severity of COVID-19 infection. METHODS: Seventy-six patients recovered from COVID-19 infection, and 44 healthy controls were enrolled in the study. Patients were assessed for clinical and demographic parameters. NCS and VEP analyses were performed to detect any peripheral neuropathy or optic neuropathy in both groups. RESULTS: None of the COVID-19 patients had electrophysiological evidence of peripheral neuropathy. However, patients with COVID-19 pneumonia had significant abnormalities in several peripheral nerve measurements compared to patients without pneumonia. Although P100 parameters did not differ significantly between patients and controls, 12 patients with COVID-19 had prolonged P100 latencies. CONCLUSIONS: We detected subclinical afferent visual pathway abnormality evaluated by VEP analysis. In addition, we found subtle electrophysiological features in the NCS of the patients presented with COVID-19 pneumonia. However, our findings did not fortify the diagnosis of peripheral neuropathy or optic neuropathy. Further studies are needed to determine the characteristics of COVID-19-related peripheral neuropathy/optic neuropathy whether it has distinct clinical features and disease course.

Adverse events report of inactivated COVID-19 vaccine from 4040 healthcare workers.

OBJECTIVES: Numerous vaccination studies are conducted to protect against COVID-19 infection, and preclinical and clinical studies are still ongoing worldwide. During this extraordinary period, the necessity to perform COVID-19 vaccine studies and immunization programs together has emerged. Vaccine Adverse Effects (VAEs) need to be documented quickly. We aimed to determine the VAEs and to compare the frequency of VAEs between groups according to sociodemographic characteristics after the inactivated vaccine (CoronaVac) was administered to healthcare workers (HCWs) in Turkey. METHODS: An online questionnaire was delivered to 4040 volunteer HCWs across the whole country who were vaccinated with CoronaVac. Sociodemographic characteristics, medical history, history of COVID-19 infection, and VAEs occurring after the first and second doses of the inactivated vaccine were evaluated. RESULTS: The most common local and systemic VAEs after first and second doses of the COVID-19 vaccine were reported as, pain at the injection site (37.9%; 37.6%), headache (21.5%; 16.8%), fatigue (18%; 15%), drowsiness (9.6%; 8.2%), back pain (8.8%; 8.2%), nausea (6.3%; 4.8%), and joint pain (4.7%; 4.7%). Individuals with a history of allergies (generalized or vaccine-related) and females had a higher rate of VAE. Participants aged 60 and over reported less frequent VAEs. CONCLUSION: It is extremely important to identify and document the VAEs occurring in the early postvaccination period in different groups of the community. These initial findings may provide reassurance to healthcare providers and vaccine recipients and promote confidence in the safety of this inactive COVID-19 vaccine, however longitudinal follow-up studies are recommended.

Horner's Syndrome and Vertebral Artery Occlusion Concomitant With Brachial Plexus Injury in a Patient With Anterior Approach Cervical Disc Herniation Surgery.

Horner's syndrome is one of the rare complications after anterior approach intervertebral disc herniation surgery. Here, we described a 35-year-old male patient with Horner's syndrome accompanied by brachial plexus injury at the upper trunk level and vertebral artery occlusion after anterior ipsilateral approach cervical discectomy and cervical disc prosthesis operation. We are not aware of a similar case of these complications after this operation in the literature. After the six-month follow-up period the patient's Horner's syndrome slightly improved and he partially gained right upper extremity muscle strength.

Clarifying the relationship between sarcopenia and depression in geriatric outpatients.

OBJECTIVE: We investigate the relationship between sarcopenia components and depression in geriatric outpatients, considering the effects of potential confounding factors. METHODS: Adults ≥60 years of age were selected from outpatient clinics. Muscle strength was assessed using handgrip strength (HGS) measured using a hydraulic hand dynamometer and chair stand test (CSST). Physical performance was evaluated by usual gait speed (UGS), nutritional status, and frailty were screened by mini-nutritional assessment (MNA) questionnaire and FRAIL scale. Depression was diagnosed through a psychiatric interview and the administration of the Geriatric Depression Scale (GDS). RESULTS: Participants with depression were similar to participants without depression regarding age (p = .055), education (p = .095), frailty (p = .857), and HGS scores (p = .053). The group with depression had longer CSST duration (p = .023), slower UGS (p = .027), and more malnutrition (p = .001). Multivariate regression analysis revealed that only the malnutrition was independently associated factor with depression after adjusting for confounding factors. CONCLUSIONS: Depression is associated with malnutrition and some components of sarcopenia in geriatric outpatients. Our results revealed that sarcopenia might be associated with depression through malnutrition. If malnutrition lasts for a long time, sarcopenia may become evident in the later stages of depression.

Impact of chemerin, lipid profile, and insulin resistance on disease parameters in patients with multiple sclerosis.

INTRODUCTION: Plasma chemerin, which has chemotactic and adipogenic functions, is increased in several inflammatory diseases. However, its relationship with multiple sclerosis (MS) has not been explored yet. In this study, we aimed to determine chemerin levels and their possible role in MS. METHODS: Chemerin serum concentrations were evaluated by using ELISA kit in 91 clinically definite MS patients and 52 healthy controls. The mean serum chemerin, insulin, and cholesterol levels were compared. Patients were divided into two groups according to the body mass index (BMI), and the relationships between clinical and metabolic parameters were evaluated. RESULTS: Serum chemerin levels were 10.46 ± 1.65 ng/mL in MS patients and 10.26 ± 2.14 ng/mL in the control group. No significant difference was found between patients and controls (p = 0.55). We found no difference regarding age, gender, and BMI between two groups (p = 0.053, p = 0.54, p = 0.41). However, female patients with MS had higher chemerin levels than male patients. There were no associations between serum chemerin levels and EDSS score, annualized relapse rate, BMI, insulin resistance, and serum cholesterol levels in MS patients. CONCLUSION: In this study, we aimed to determine serum chemerin levels in patients with MS. However, in our study, there was no significant difference between serum chemerin levels of MS patients and healthy controls'. Additionally, chemerin levels were not associated with other metabolic parameters, as well as cognitive dysfunction. Further studies are needed to evaluate the role of chemerin in MS patients.

Atypical posterior reversible encephalopathy syndrome with albuminocytological dissociation and late emerging neuroradiological findings: A case report.

Posterior reversible encephalopathy syndrome (PRES) is a central nervous system disorder accompanied by vasogenic edema in white matter that is usually located in temporo-parieto-occipital area. Typically, PRES is presented with headaches, seizures, and change of consciousness. The most common etiologic factor is fluctuations in blood pressure. An eighty-eight-year-old female patient was evaluated because of her acute confused state. Medical history revealed hypertension. Blood pressure was 190/100 mmHg. The initial examination showed impaired consciousness. Radiological investigations of brain showed chronic ischemic lesions. Albuminocytological dissociation was detected in CSF examination. On the 6th day of admission, cranial MRI was repeated. Radiological findings were typical for PRES. The cranial MRI is a valuable diagnostic tool for the diagnosis of the PRES but, as in our case, despite the subtle clinical and radiological findings presented during admission, repeated MRI and CSF examination may contribute to a definite diagnosis. This case is remarkable for severe protein elevation in CSF, irreversible fatal course and radiographic evidence of vasogenic edema occurred subsequently.

Acute fluconazole toxicity: a case presenting with protean manifestations including systemic and neurologic symptoms.

Neurologic adverse effects of triazole antifungal compounds used for the treatment of systemic and deep mycoses are relatively rare. The most common presentation is the involvement of peripheral nervous system, usually presenting with subjective symptoms such as paresthesia, dysesthesia, or numbness. Among these compounds, fluconazole has relatively more frequent neurological adverse reactions.A 54-year-old man was admitted with numbness and weakness in his both feet, which gradually worsened and resulted in difficulty in ambulation over time. He had no morbidity other than hypertension. He developed polyneuropathy (PNP), lower gastrointestinal system bleeding, acute renal insufficiency, thrombotic thrombocytopenic purpura, and confusional state. Severely disabling axonal and demyelinating sensorimotor PNP which led to immobilization of the patient for a few weeks but was recovered. When a more detailed past medical history was taken, he admitted to ingestion of 200 mg/day fluconazole for 1 month for onychomycosis without any prescription. This unusual combination of these rare adverse reactions of fluconazole may be explained by activation of an immune mechanism triggered by the drugs and genetic factors, or some other unknown individual factors.This case is reported due to the presence of rare systemic and neurologic adverse events of fluconazole, leading to this unusual clinical picture. We would like to emphasize fluconazole-related systemic and neurologic adverse reactions with life-threatening potential should be kept in mind.

The neutrophil-to-lymphocyte ratio as a marker of peripheral inflammation in progressive supranuclear palsy: a retrospective study.

BACKGROUND AND PURPOSE: To evaluate the neutrophil-to-lymphocyte ratio (NLR) levels in the peripheral blood of patients with progressive supranuclear palsy (PSP), and to compare them with levels in patients with idiopathic Parkinson's disease (PD) and healthy controls. METHODS: Twenty-one patients with probable PSP, 42 with PD, and 40 age-matched healthy volunteers were enrolled in the study. Demographic data and duration of disease, comorbid systemic disease, and smoking status were recorded. NLR was calculated by dividing neutrophil count by the lymphocyte count. RESULTS: The mean age of patients with PSP was 68.28 ± 8.7 years and the mean duration of disease was 5.09 ± 2.52 years. The mean age in PD group was 66.59 ± 9.54 years and 65.05 ± 6.52 years in the healthy volunteer group. There were no significant differences in ages between the PSP group and the other two groups (p = 0.498; p = 0.107, respectively). The PSP group consisted of four female and 17 male patients. The PD group comprised 19 female and 23 male patients. There were 18 female and 2 male in the healthy volunteer group. The mean NLR value in the PSP group was significantly higher than in the PD group and healthy controls (p = 0.023; p = 0.001, respectively). The mean NLR value in the PD group was not significantly different from the healthy controls (p = 0.593). CONCLUSION: NLR values were found higher in the PSP group. The result of this study revealed the existence of peripheral inflammation in patients with PSP.

Coexistence of Papillitis and Posterior Placoid Chorioretinopathy as the Presenting Symptoms of Syphilis-Human Immunodeficiency Virus Coinfection.

A 27-year-old male was presented with a decrease in vision in the left eye. Best-corrected visual acuity was 10/10 in the right eye and counting fingers at 2 m in the left eye. On fundus examination, the left optic disc was oedematous and there was a wide yellowish, well-defined placoid lesion between the temporal vascular arcades with mild vitreous inflammation. However, a small yellowish well-defined placoid lesion was detected in the inferior temporal region of the macula in the right eye. He was diagnosed with posterior placoid chorioretinopathy (PPC), papillitis, and neurosyphilis after performing fundus fluorescein angiography, fundus autofluorescence imaging, optical coherence tomography, serology for human immunodeficiency virus (HIV) and syphilis, and cerebrospinal fluid examination. Intravenous penicillin treatment was commenced as soon as the diagnosis was established. Seven days after treatment initiation, lesions were partially regressed. PPC and papillitis are rare manifestations of ocular syphilis. In addition, neurosyphilis may also accompany these manifestations. Therefore, syphilis should be considered in the differential diagnosis of patients who have PPC or papillitis and all patients should be tested for HIV coinfection and neurosyphilis.

False-negative diffusion-weighted imaging in acute stroke and its frequency in anterior and posterior circulation ischemia.

OBJECTIVE: We aimed to investigate the location and size of ischemic stroke lesions that were frequently overlooked by diffusion-weighted imaging (DWI). MATERIALS AND METHODS: We retrospectively reviewed the medical records of 162 patients who had symptoms suggesting ischemic stroke. National Institutes of Health Stroke Scale and Modified Rankin Scale scores, lesion size, magnetic resonance imaging (MRI) findings, delay between onset of symptoms and initial MRI (MRI latency), and vascular distribution of the stroke lesions were analyzed in patients with false-negative DWI findings. RESULTS: Of the 116 patients with a final diagnosis of acute ischemic stroke, 11 patients (9.48%) had false-negative DWI findings in the initial period. The mean (SD) MRI latency was 4.3 (1.2) hours. There was no statistically significant difference in point of lesion size, the National Institutes of Health Stroke Scale, and the Modified Rankin Scales scores. CONCLUSIONS: False-negative DWI findings in acute stroke can be observed both in association with the posterior circulation/small lesions and the anterior circulation/large lesions.