Contralateral Facial Innervation in Healthy Subjects and in Patients with Peripheral Facial Palsy.

Background: We aimed to investigate the extent of the response of the orbicularis oris muscle to stimulation of the contralateral facial nerve both in patients with peripheral facial palsy (PFP) and in healthy subjects. Methods: EMG was performed at 2-6 weeks after the onset of PFP in the patient group and at any time in the healthy control group. We performed nerve conduction testing, electroneurography, and surface and needle EMG. Results: A total of 276 participants (patients/healthy controls: 218/58) were analyzed. The extent of the response of the contralateral orbicularis oris muscles to facial nerve stimulation was higher in healthy controls compared to that in the affected group. The response of the contralateral orbicularis oris muscles to stimulation of the paralyzed facial nerve was more extensive in those patients to whom glucocorticoid or physical therapy had been given. Cross-facial innervation in the orbicularis oris muscle extended up to 1.5 cm in one-third of healthy controls and was higher than that in those with PFP. Glucocorticoid or physical therapy seemed to improve cross-innervation in facial palsy. Conclusions: Our findings suggest that the stimulus leading to the contralateral muscular response is mediated through crossing axons rather than muscular fibers.

The Relationship between CT Angiography Collateral Score and Biochemical Parameters during Acute Ischemic Stroke Caused by Middle Cerebral Artery Infarct.

Background/Objectives: Collateral development after AIS is important for prognosis and treatment. In this study, we aimed to investigate the relationship and correlation between biochemical parameters and CT angiography collateral score within the first 9 h and its effect on the neurological outcomes of patients with AIS due to MCA infarction. Methods: A total of 98 patients with MCA infarction were hospitalized for diagnosis and treatment after undergoing CT angiography within 9 h of suffering a stroke. Demographic data, admission biochemical parameters, hospitalization data, and discharge NIHSS scores were recorded. Souza's scoring system for collateral distribution was used to evaluate collaterals. Souza CS system and clinical disability comparison outcomes identified. Results: According to the Souza CS system, 13 patients were in the malignant profile category, and 85 patients were in the good profile category. The NIHSS value of patients with a malignant profile was 27, while the mean NIHSS value of patients with a good profile was 9. There was a statistically significant difference in uric acid, total cholesterol, triglyceride, HDL cholesterol, CRP, hsCRP, D-Dimer, troponin I, vitamin B12, fibrinogen, NSE, homocysteine, aPTT, and INR levels according to collateral distribution. Conclusions: This study demonstrates that biochemical parameters can influence the distribution of malignant and benign collaterals in AIS independent of age and gender.

Ocular Flutter-Myoclonus-Ataxia Syndrome After mRNA BNT162b2 COVID-19 Vaccine: A Case Report.

Ocular flutter (OF) is a rare oculomotor syndrome. The most common etiologies are paraneoplastic, postinfectious and toxic-metabolic. However post-vaccinal etiology was rarely reported in OF. Here, we reported a post-vaccinal clinical syndrome characterized by OF-myoclonus and ataxia associated with oligoclonal bands (OCBs). A 60-year-old male who presented with dizziness, unsteady gait, involuntary movements, involuntary conjugate eye oscillations and extremity jerks that started 3 days after the second dose of mRNA BNT162b2 Covid-19 vaccine. Routine biochemical and serological analysis were within normal limits. No pathological finding was detected in brain MRI. Paraneoplastic and autoimmune encephalitis tests were unremarkable in cerebrospinal fluid (CSF). Oligoclonal bands were positive in CSF. This is the first description of the relationship between vaccines against SARS-CoV-2 and the clinical syndrome of OF, Myoclonus and Ataxia (OFMAS). Humoral immune mechanisms seem to play an important role in OFMAS. Presence of OCBs in CSF may also be associated with this condition.

Serum Levels of Melatonin and Sleep Evaluation Scales in the Diagnosis of Sleep Disorders in Patients with Idiopathic Parkinson's Disease.

INTRODUCTION: Sleep disturbances, such as difficulty in initiation of sleep, decrease in total sleep duration and efficacy, frequent awakenings, and increased daytime sleepiness are among the most common non-motor symptoms in patients with idiopathic Parkinson's disease (PD). However, patients usually do not consider these symptoms as important as their motor symptoms, and do not complain. We aimed to investigate PD patients for subtle sleep disturbances using sleep evaluation scales, and to evaluate the relationship between these tests and the serum levels of melatonin during night-sleep. METHODS: A total of 40 PD patients (19, female), older than 50 years, registered in our "Movement Disorders Out-patient Clinic", and 40 healthy, age and sex-matched control subjects (20, female) were included in the study. All subjects were assessed using Pittsburg Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). Serum melatonin levels during night-sleep were measured in blood samples taken at 00:00 and 05:00 hours in every subject. Both groups were compared for demographical data, sleep evaluation scales and serum levels of melatonin. RESULTS: Patients with PD had significantly higher scores in PSQI and ESS than the healthy controls (p<0.001). Although the serum melatonin levels at two different time points during night sleep were lower in PD patients than the controls, these differences did not reach statistical significance (p=0.104 at 00:00 am, p=0.528 at 05:00 am). There was no significant correlation between the PSQI scores and serum melatonin levels in patient group (p>0.05). However, there was a significant but weak correlation (r=-0.353, p=0.025) between ESS scores and the serum melatonin levels measured at 05:00 hours in patients, but not between the melatonin levels measured at 00:00 hours. CONCLUSION: Sleep evaluation questionnaires such as, PSQI and ESS, can provide useful information in PD patients with mild sleep disturbances. However, serum melatonin levels alone were not helpful in diagnosing the sleep disorders.