Does extracorporeal shock wave therapy decrease spasticity of ankle plantar flexor muscles in patients with stroke: A randomized controlled trial.

OBJECTIVE: To evaluate the effectiveness of radial extracorporeal shock wave therapy on ankle flexor spasticity in stroke survivors and to reveal changes in the fibroelastic components of muscle. DESIGN: Randomized controlled trial. SETTING: Inpatient neuro-rehabilitation clinic of a university hospital. PARTICIPANTS: Stroke patients with ankle flexor spasticity. INTERVENTIONS: Patients were randomized to three groups; radial extracorporeal shock wave therapy, sham, or control. Active and sham therapy were administered two sessions/week for two weeks. All patients received conventional rehabilitation. MAIN MEASURES: The primary outcome was Modified Ashworth Scale. Secondary outcomes were the Tardieu Scale and elastic properties of plantar flexor muscles assessed by elastography (strain index). All assessments were performed before, immediately after the treatment, and four weeks later at follow-up. RESULTS: Fifty-one participants were enrolled (active therapy n = 17, sham n = 17, control n = 17). Modified Ashworth scores showed a significant decrease in the active therapy group (from 2.47 ± 0.72 to 1.41 ± 0.62) compared to sham (from 2.19 ± 1.05 to 2.06 ± 1.12) and control (from 2.06 ± 0.85 to 2.00 ± 0.73) groups immediately after the treatment (P < 0.001). Tardieu results were also in concordance (P < 0.001), however this effect was not preserved at follow-up. Elastic properties of the ankle flexors were improved in all groups at both assessments after the therapy showing significant decreases in strain index (P < 0.001). However, there was no difference among the groups in terms of improvement in elastography. CONCLUSION: Radial extracorporeal shock wave therapy has short-term anti-spastic effects on ankle flexor muscles when used as an adjunct to conventional rehabilitation.

Assessment of voiding dysfunction in Parkinson's disease: Reliability and validity of the Turkish version of the Danish Prostate Symptom Score.

AIMS: To investigate the reliability and validity of the Turkish version of the Danish Prostate Symptom Score (Dan-PSS) questionnaire in patients with Parkinson's disease (PD) and to compare the burden of LUTS (Lower urinary tract symptoms) in men and women. METHODS: For analysis of test-retest reliability, the Turkish version of the Dan-PSS scale was developed using the back translation method, and it was administered on the day of admission and repeated 1 week after in 60 patients with PD. The OAB-q (Overactive Bladder Questionnaire) and PDQ-39 (Parkinson's Disease Questionnaire-39) were administered to 73 patients for validity analysis. RESULTS: Both the internal consistency (Cronbach's alpha coefficient: 0.99-1.00) and the test-retest reliability (intraclass correlation coefficient: 0.99-1.00) of the Dan-PSS were found to be high in patients with PD. Although weak to moderate correlations were found between the subscales of the Dan-PSS and PDQ-39 (r: 0.20-0.42; P < 0.05), a strong correlation was found with the OAB-q (r: 0.60-0.79; P < 0.05). Nocturnal urination was the most frequent (93.2%), and bothersome (54.8%) symptom. The majority of the symptom and bother responses were similar in men and women. CONCLUSIONS: Current study shows that the Turkish version of the Dan-PSS questionnaire is an internally consistent, reliable, and valid scale for patients with PD. Therefore, it can be used to evaluate frequency and severity of LUTS in PD. LUTS are commonly seen in patients with PD in both sexes. It is suggested that all patients with PD should be referred for urological assessment.

An evaluation of bladder emptying methods and the effect of demographic and clinical factors on spontaneous voiding frequency in stroke patients.

In this study, the bladder emptying methods at different stages of the post-stroke period along with the effects of demographic and clinical parameters on spontaneous voiding frequency were investigated. The frequencies of bladder emptying methods at admission to the rehabilitation clinic, after neurourological and urodynamic assessment and at home after discharge were spontaneous voiding (SV) 51/99 (51.5 %), 62/99 (62.6 %), 73/99 (73.7 %), emptying without a urinary catheter + an external collector system (EWUC + ECS) 24/99 (24.2 %), 18/99 (18.2 %), 17/99 (17.2 %), intermittent catheterization (IC) 1/99 (1.0 %), 15/99 (15.2 %), 6/99 (6.1 %), indwelling urethral catheter (IUC) 23/99 (23.2 %), 4/99 (4.0 %) and 3/99 (3.0 %), respectively. Lower spontaneous voiding frequencies were observed in single-divorced and geriatric individuals (p < 0.05). The number of patients who modified the method at home was 2/62 for SV, 5/18 for EWUC + ECS, 9/15 for IC, and 2/4 for IUC. The majority of stroke patients were able to void spontaneously and the spontaneous voiding frequency increased at follow-up. The spontaneous voiding frequency was low in geriatric and single-divorced subgroups. The method in which the most changes occurred was IC.

The relationship between inadequate response to physical therapy and central sensitization in patients with knee osteoarthritis: A prospective cohort study.

Objectives: This study aims to investigate the relationship between physical therapy response and the presence of central sensitization (CS) in patients with painful knee osteoarthritis (OA). Patients and methods: Between May 2019 and March 2020, a total of 84 patients with knee OA (12 males, 72 females; mean age: 60.7±7.7 years; range 50 to 74 years) and 30 age and sex-matched controls (6 males, 24 females; mean age: 59.2±8.9 years; range 50 to 75 years) were included in this study. Knee pain and functional status were evaluated by Visual Analog Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Structural damage was assessed by knee radiography. The Central Sensitization Inventory (CSI), Beck Depression Inventory (BDI), Insomnia Severity Index (ISI), Pain Catastrophizing Scale (PCS), and PainDETECT Questionnaire (PDQ) were applied at baseline. Pain pressure thresholds (PPTs) of the patients were measured and compared with the control group. All patients underwent a total of 15 sessions of physical therapy program for five sessions/weekly. After treatment, the patients were divided into two groups as responders and non-responders according to the Osteoarthritis Research Society International (OARSI) criteria. Results: The CSI score of the patients in non-responder group was significantly higher compared to the responder group (p=0.004). Using a cut-off value of ≥40, the proportion of patients with CSI scores of ≥40 was significantly lower in the responder group compared to non-responder group (p=0.021). The PPT measurement values were significantly lower in the non-responder group compared to the responder and control groups (p <0.01). There was a significant difference in the frequency of hyperalgesia between the groups (p=0.021). Central sensitization and depression were the most significant predictors of non-response to physical therapy (p=0.045 and p=0.024, respectively). Conclusion: Our study results suggest the presence of CS and depression may result in an inadequate response to physical therapy in patients with knee OA. Clinicians should consider the findings of CS and depression in treatment planning.

Silent Pulmonary Thromboembolism in Patients Undergoing Craniotomy for Brain Tumor.

AIM: To detect the silent pulmonary thromboembolism (SPTE) frequency in patients who underwent craniotomy for a brain tumor, and to examine the correlation based on the data obtained from patients. MATERIAL AND METHODS: Overall, 100 patients with brain tumors were included in the study. The mean age was 54.29 years (±12.5 years), with the youngest patient being 19 years old and the oldest 73 years. All patients underwent craniotomy, and a pulmonary ventilation-perfusion scintigraphy was performed 48 h after surgery to detect SPTE. The frequency of SPTE and the conditions related to it were investigated. RESULTS: The incidence of SPTE was 26% in patients with a brain tumor who underwent craniotomy. Statistically, no correlation was observed between SPTE and data obtained from patients (tumor histopathology, tumor localization, perilesional edema, midline shift, bleeding time, surgical positioning, smoking history, age, duration of surgery, etc.). CONCLUSION: Our study revealed a high rate of SPTE in patients with a brain tumor who underwent craniotomy. Although most articles suggest using anticoagulant therapy in these patients, the literature lacks definite evidence for the same.

Giant Ependymoma Removal via a Skipped Myelotomy Technique.

Intramedullary ependymomas should be treated with surgical resection. Different surgical techniques are described for these tumors, such as skipped and long-segment myelotomies. A 31-year-old male patient with a giant thoracic spinal cord ependymoma extending from the level of T5 to T10 was operated on with a skipped myelotomy technique. Although the patient had urinary incontinence and muscle weakness in both legs, the patient's complaints were nearly completely resolved in the fourth postoperative month. Operating with the smallest possible myelotomy has given us preferable results; however, more studies are needed to hypothesize the superiority of this technique over conventional myelotomy.

High-Frequency Bipolar Coagulation Limits Epidural Fibrosis in Lumbar Microdiscectomy.

BACKGROUND AND AIM: We propose a vast study to examine the effect of high-frequency bipolar coagulation used in the operating room to prevent the development of epidural fibrosis after lumbar microdiscectomy. MATERIALS AND METHODS: A total of 1004 participants were divided into two groups: no high-frequency bipolar coagulation (NC group) and high-frequency bipolar coagulation (C group). Postoperative epidural fibrosis, infection rates, reoperation status, and dural injury complications during the operation were recorded. RESULTS: Considering the epidural fibrosis rates of the two groups, epidural fibrosis was seen in 10.6% of the patients in the NC group. In contrast, it was seen in only 6.2% of the patients in the C group. CONCLUSION: The complication of epidural fibrosis that develops after lumbar microsurgery operations both impairs patient comfort and brings with it the complications of reoperation. After performing hemostasis with bipolar, coagulating the annulus may effectively reduce epidural fibrosis and prevent reoperation.

Management of Epidural Hematomas in Pediatric and Adult Population: A Hospital-Based Retrospective Study.

OBJECTIVE: We retrospectively reviewed and evaluated our treatment protocols in epidural hematoma (EDH) cases to compare surgical versus nonsurgical treatment subsections with their trauma mechanism, injury type, clinical pattern, radiological details, functional outcome, and mortality rates. METHODS: This study included 350 patients (142 females and 208 males) treated for EDH between 2010 and 2018. Two hundred seven operated and 143 observed patients for EDH were compared for demography, injury type, treatment, and outcome scores retrospectively. Glasgow Coma Scale and Glasgow Outcome Scale were used to standardize the clinical findings. Marshall and Rotterdam classifications classified radiological abnormalities. The Infinity PACS system measured hematoma volume, and volume parameters were evaluated differently in pediatric and adult groups. RESULTS: Radiological parameters showed that the observation was more favorable when the EDH volume was <30 ml in the adult and <20 ml in the pediatric group. However, close clinical follow-up with repeated computerized tomography scans suggested that when the hematoma increases in volume in the first 24 hours, it should be treated surgically. Headache, vomiting, and paresis were significant clinical symptoms in this period. Only 11% of conservatively followed cases required delayed surgical intervention. When we analyzed the findings of the 2 groups of the patient, pediatric and adult, we noticed that rebleeding after the first surgery was more common in the adult group than the pediatric group, whereas surgery due to a growing hematoma was less common in the pediatric group. CONCLUSIONS: Age, trauma severity, initial neurological statuses, and accompanying comorbidities can affect the functional outcome in acute EDH. We found that urgent surgical intervention and conservative treatment may lead to excellent results in most cases. Thus, EDH can be managed both conservatively and surgically in certain conditions. We made a comparison between pediatric and adult age groups according to treatment modalities. Both rebleeding and mortality rates are relatively lower in the pediatric operated group than in the adult operated group. In the adult observation group, rates of delayed surgery because of growing hematoma seem relatively higher than in the pediatric observation group. During radiological follow-up, we found that the progression rate of EDH in the adult observed group according to time is faster than in the pediatric observed group (P < 0.05).

Evaluation and management of neurogenic bladder after spinal cord injury: Current practice among physical medicine and rehabilitation specialists in Turkey.

OBJECTIVES: This study aims to determine the current trends in evaluation and management of neurogenic bladder secondary to spinal cord injury (SCI) among Physical Medicine and Rehabilitation (PMR) specialists in Turkey. MATERIALS AND METHODS: Between September 2013 and November 2013, a total of 100 PMR specialists from 18 different provinces of Turkey were included in the study. A 23-item questionnaire was developed to evaluate the current practice on assessment and follow-up of upper and lower urinary tract dysfunction. The questionnaire was delivered via e-mail to the participants routinely providing care for patients with SCI and all responses were obtained electronically. RESULTS: For surveillance of the upper urinary tract dysfunction, 93% of the participants preferred ultrasonography. A total of 59% of the participants favored an annual assessment and 36% preferred six-month intervals. Multichannel urodynamics, voiding cystourethrography combined with urodynamics, and video-urodynamics were preferred by 62%, 25%, and 10% of the participants, respectively for surveillance of the lower urinary tract. Urodynamic evaluation was performed annually by 51% of the participants. In patients with detrusor overactivity unresponsive to the combination of intermittent catheterization (IC) and anticholinergic agents, 66% preferred to increase the dose and 22% preferred to switch to another medication. For treatment of areflexic bladder, 78% preferred IC and 12% preferred the Credé' or Valsalva maneuvers. Treatment of asymptomatic bacteriuria was not favored in patients on IC and indwelling urethral catheter by 33% and 44% of the participants respectively. Totally, 84% participants preferred to administer antibiotics for 10 to 14 days for the treatment of symptomatic urinary tract infection. CONCLUSION: Our study results indicate that there are some differences in the current practice of PMR specialists for surveillance and management of SCI patients with neurogenic bladder. These results also emphasize the need for development of guidelines and implementation of continuous medical education activities in this field.

Foraminal Stenosis as a Cause of Postdiscectomy Syndrome.

AIM: To reveal the relation between postdiscectomy syndrome and foraminal stenosis due to height loss of disc level in patients operated for one-sided L5-S1 disc herniation. MATERIAL AND METHODS: 100 operated patients due to L5-S1 one-sided disc herniation were included. Mean age was 46.60 years (±10.52 years). Foraminal height, width, and intervertebral disc height were measured via CT. The diameters were compared preoperatively and postoperatively. The relation between the measurements and clinic findings was investigated. RESULTS: Six months after discectomy, for the operated side, the mean foraminal height decreased from 16.78 ± 1.75 mm to 14.43 ± 1.62 mm (p 0.05) and the mean foraminal width decreased from 6.30 ± 1.43 mm to 5.34 ± 1.56 mm (p 0.05). According to the correlation test, for the operated side, a statistically significant relationship was observed between the decrease in foramen height and leg pain visual analog scale (VAS) score. Moreover, a statistically significant relationship was observed between the decrease in the posterior side height of the disc level and the leg pain VAS score. CONCLUSION: Overall, after microdiscectomy, as the height of the foramen decreased, leg pain also increased. Moreover, the decrease in the posterior side height of the disc level was associated with an increase in leg pain. Therefore, over time, the collapse of the disc distance decreases the foramen height, which causes leg pain. After microdiscectomy, in patients whose leg pain was relieved at first but started again after a time, the foramen and disc level diameters should be checked.

Assessment of nocturnal polyuria in patients with spinal cord injury at three different mobilization phases: A multicenter cross-sectional study.

OBJECTIVE: To determine the prevalence of nocturnal polyuria (NP) in patients with spinal cord injury (SCI) during three different particular phases, and investigate the impact of injury level and injury type on the prevalence of NP. DESIGN: A cross-sectional study. SETTING: Neurogenic Bladder Study Group from six different rehabilitation centers across the country. PARTICIPANTS: 40 patients with SCI. OUTCOME MEASURES: Patients were divided into three groups according to mobilization phase; 1st group included patients confined to bed (n = 14), 2nd group included patients sitting on a wheelchair (n = 19) and 3rd group included patients standing with an assistive ambulation device (n = 7). NP was assessed by nocturnal polyuria index (NPi) and nocturnal urine production (NUP) indexes. RESULTS: No significant difference was found between the groups (P = 0.312 for NPi and P = 0.763 for NUP) in terms of the presence of NP according to their mobilization phase. The night and 24-hour urine volumes showed no significant difference between the groups (P = 0.907 and P = 0.395 respectively). The NPi and NUP values did not show a significant difference between male and female patients (P = 0.826, P = 0.364 respectively), patients with the injury level of ≥T6 and

Comparison of ambulatory versus conventional urodynamics in females with urinary incontinence.

AIMS: We planned to compare the diagnostic accuracy of conventional urodynamics (UD) and ambulatory UD for the detection of detrusor over activity (DOA) and/or urodynamic stress incontinence (USI) in women presenting with urinary incontinence. METHODS: We prospectively enrolled 44 women with urinary incontinence and performed both urodynamic (UD) studies after they completed the UDI-6 questionnaire. During ambulatory UD one micturition cycle was recorded. According to responses for individual items on the UDI-6, patients were divided into three groups to define incontinence type irrespective of scoring. RESULTS: Mean age was 52.2 and mean duration of the symptoms was 4.94 years. The ambulatory UD detected an underlying pathophysiology of urinary incontinence (77.3%) in significantly more women than the conventional UD (6.8%) (P = 0.001). Among women with stress incontinence, 56% had USI on the ambulatory UD and none had abnormalities on the conventional UD (P = 0.002). Seventy-two percent of women with mixed symptoms had abnormal findings (USI and/or DOA) on the ambulatory UD and 9% had abnormal findings on the conventional UD (P = 0.001). CONCLUSIONS: Our findings suggest that ambulatory UD done in a clinical setting during one micturition cycle with unstandardized provocative activities detects an underlying pathophysiology (urge incontinence, stress incontinence, mixed incontinence) more often than conventional UD in supine position Conventional UD has a higher false-negative rate in diagnosis of DOA and/or USI compared to ambulatory UD.

Effectiveness of pulsed electromagnetic field therapy on pain, functional status, and quality of life in patients with chronic non-specific neck pain: A prospective, randomized-controlled study.

OBJECTIVES: The aim of this study was to evaluate whether pulsed electromagnetic field (PEMF) therapy when applied in addition to a conventional physical therapy program would provide any further benefits in reducing pain and functional limitation in patients with chronic non-specific neck pain. PATIENTS AND METHODS: This double-blind, prospective, randomized, placebo-controlled study included a total of 63 patients (15 males, 48 females; mean age 45.1; range, 25 to 59 years) with a complaint of mechanical neck pain between January 2016 and September 2016. The patients were divided into two groups as PEMF therapy group (n=33) and control group (n=30). A total of 15 sessions of conventional physical therapy program were applied to both groups for a total of three weeks. In addition, the active group received 20-min PEMF and the control group received 20-min sham PEMF. The patients were evaluated at baseline and after treatment. The therapeutic effect was evaluated using the visual analog scale (VAS), Neck Pain Disability Scale (NPDS), Short Form-36 (SF-36), and Physician Global Assessment (PGA). RESULTS: At baseline, two groups were similar in terms of the demographic and clinical characteristics (p>0.05). There were significant improvements in the VAS, NPDS, SF-36, and physician global assessment after treatment in both groups. However, the PEMF group was not found to be superior to the sham group in terms of improvements in the outcome parameters. CONCLUSION: Our study findings indicate that PEMF therapy is safe in patients with chronic non-specific neck pain. However, it does not provide further improvement in pain and functionality when applied in addition to a conventional physical therapy.

Prognostic Value of Craniovertebral Junction Diffusion Tensor Imaging in Patients with Chiari Type 1 Malformation.

AIM: To examine the spinal cord status by using diffusion tensor imagıng (DTI) and tractography preoperatively and postoperatively in patients with Chiari malformation type 1 (CM1) and compare the results with the data obtained from healthy people. MATERIAL AND METHODS: Overall, 48 patients (33 patients with CM1, and 15 in the control group for DTI and tractography measurements) were included in the study. Mean age was 37.7 ± 11.8 years (minimum and maximum: 12 and 57 years). The DTI and tractography data were obtained from the craniocervical region in patients with CM1 and control group. Patients with CM1 were operated using the suboccipital decompression technique without opening the dura. Surgical results were evaluated using Chicago Chiari Outcome Scale (CCOS) and Asgari scale. RESULTS: Based on the CCOS and Asgari scale results, the surgical technique was determined to be clinically beneficial. The DTI and tractography values from the pontobulbar, cervicomedullary, and spinal cord C3â€"4 levels in patients with CM1 were compared to those of the control group. These values were observed to be near normal after surgery in patients with CM1. CONCLUSION: Based on the improvement in DTI-tractography data observed in our study, DTI and tractography can serve as a guiding measurement method for assessing the prognosis of patients with CM1.

Spontaneous Spinal Epidural Hematoma During Simultaneous Tocilizumab and Warfarin Use in a Patient With Rheumatoid Arthritis: Is There a Drug Interaction Between Tocilizumab and Oral Anticoagulants?

Interleukin 6 (IL-6) plays a main role in the immunopathogenesis of rheumatoid arthritis (RA). Tocilizumab (TCZ) is a humanized immunoglobulin G1 monoclonal antibody against the human IL-6. Warfarin sodium is an oral anticoagulant that is primarily metabolized by cytochrome P450 2C9 (CYP2C9). Impaired metabolism of this low therapeutic index drug is important as it may result in serious bleeding. In this article, we present a 56-year-old female patient with RA, treated with TCZ and warfarin sodium and presented spontaneous spinal epidural hematoma (SSEH) of thoracic spine although international normalized ratio levels were in normal ranges. One week after decompressive surgery for hematoma, a cervical spine abscess developed which resulted in her death. To the best of our knowledge, this is the first case of RA developing SSEH while taking TCZ and warfarin sodium together. Although it is difficult to attribute the severe bleeding to TCZ treatment, clinicians should be aware that concomitant use of oral anticoagulants and TCZ might result in potentially fatal complications in patients with RA.

Effects of spasticity and hemiplegic posture on median nerve and carpal tunnel in stroke patients: Electrophysiological and ultrasonographic evaluation.

This study aims to evaluate whether the upper extremity spasticity and hemiplegic posture have any effect on the morphology of the carpal tunnel and median nerve in stroke patients. Nerve conduction studies (NCS) were performed in 46 stroke patients and compared to those of 30 healthy controls. The cross-sectional area (CSA) of the carpal tunnel (CT) and median nerve (wrist/mid-forearm levels) was assessed by ultrasonography. The mean ages of the stroke and control group were 55.6 ± 13.5 and 56 ± 12.1 years, respectively. The median spasticity score of the forearm pronators and wrist flexor muscles was 2 (0-4) according to the Modified Ashworth Scale (MAS). The compound muscle action potential (CMAP) of the median nerve was reduced (10,093 ± 4,451 mV) when compared to non-paretic side (11,615 ± 4,397 mV) (p:0.02) and the CSA of the CT was thinner on the paretic side (1.9 ± 0.3 cm2 vs 2.08 ± 0.2 cm2) (p:0.03). Pronator spasticity had no significant effect on the CSA of the median nerve and NCS at the forearm level. The CSA of the median nerve at the wrist was significantly thicker in patients with the wrist flexor spasticity graded II (MAS) and above compared to those with spasticity graded I and below (9.5 ± 1.7 mm2 and 8.7 ± 1.7 mm2 respectively) (p:0.03). However, the thickening of the median nerve didn't cause significant abnormalities in NCS. This study shows that in stroke patients, wrist flexor spasticity and hemiplegic wrist posture can cause explicit morphological changes in the CT and median nerve albeit normal findings on NCS.

A rare case report: Cervical subcutaneous and mediastinal emphysema due to mastoid fracture.

Subcutaneous emphysema occurs when air enters the soft tissue, which usually appears in the soft tissues of the chest wall or neck. It may also arise from pneumothorax or skin lacerations after trauma or other reasons. Mediastinal emphysema may be either associated with subcutaneous emphysema or seen alone. The air in the mastoid cells may spread from the retropharyngeal region or various neck compartments into the mediastinum. Usually, no severe neurological or clinical findings are observed except crepitation on palpation. We present a case report of a mastoid fracture as a rare cause of cervical subcutaneous and mediastinal emphysema.

Giant Primary Intracranial Hydatid Cyst in Child with Hemiparesis.

Hydatid cyst is the larval form of the parasite Echinococcus. Echinococcus granulosus and less commonly Echinococcus multilocularis species cause the disease. Intracranial hydatid disease is relatively rare; the incidence is approximately 1%-2%. Intracranial hydatid cyst can be classified as primary and secondary. A primary cyst, the most common type, is always solitary. The treatment of hydatid cyst is surgical, and the aim of surgery is to remove the cyst without rupture to prevent recurrence or anaphylactic reaction. The Dowling technique (improved by Arana-Iniguez and San Julian) has been widely used for the excision. Albendazole and praziquantel are the medical treatment of choice. In recurrent cases or cases with rupture during surgery, medical therapy has been reported to be effective. Preoperative and postoperative albendazole may be considered to sterilize the cyst, decrease the chance of anaphylaxis, lower the tension in the cyst wall, and reduce the recurrence.

Malignant Transformation of Vestibular Schwannoma After Stereotactic Radiosurgery.

Malignant transformation of vestibular schwannoma after stereotactic radiosurgery (SRS) is a fatal complication with a relatively less uncommon frequency over the past 5 years. Although SRS has been shown to be an alternative to microsurgical resection of vestibular schwannoma, this complication is disregarded most of the time. In this paper, we present a patient with left cerebellopontine angle vestibular schwannoma that was transformed into a malignant peripheral nerve sheath tumor after receiving SRS following microsurgical resection.

Does kinesiotaping affect standing balance in healthy individuals? A pilot, double-blind, randomized-controlled study.

OBJECTIVES: This study aims to investigate the immediate and short-term effects of kinesiotaping (KT) on balance, when applied to the ankles of healthy individuals. PATIENTS AND METHODS: In this pilot, double-blind, randomized, sham-controlled study, a total of 24 healthy male individuals (mean age 31.8 years; range, 22 to 40 years) were randomized into two groups as KT and sham between January 2014 to March 2014. The KT group had a therapeutic KT application which could provide the ankle stability. The control group had a prespecified sham application. Balance testing was done before, immediately after and 24 hours after the application of KT. Anteroposterior, mediolateral, and overall stability indexes (APSI, MLSI, and OSI, respectively) were measured and given in relative treatment effect (RTE). RESULTS: There was no statistically significant interaction between the intervention and time for all stability indexes. The main effects were evaluated. The main effect of time showed a significant difference in terms of RTE and mean ranks at all time points for the MLSI and OSI (p=0.034 and p=0.009, respectively). The KT of ankle had an immediate positive effect on standing balance of healthy individuals which did not sustain after 24 hours. The main effect of group showed that there was a significant difference in the RTE levels between the intervention groups for all indexes. Based on the rank means, the KT group had a better stability than the sham group for all indexes. CONCLUSION: Our study results suggest that KT of ankle has an immediate positive effect on standing balance of healthy individuals by increasing mediolateral stability of the ankle.