Topiramate-Induced Changes in Anterior Chamber Angle and Choroidal Thickness.

PURPOSE: To investigate the acute effects of topiramate on the anterior chamber angle (ACA) and choroidal thickness in patients with migraine. METHODS: This prospective study included 15 eyes of 15 patients with migraine who have been scheduled to start topiramate therapy. All patients underwent complete ophthalmic examination including measurement of the ACA and choroidal thickness using a spectral domain optical coherence tomography device (Optovue Inc.) and refractive status evaluation with an autorefractokeratometer (KR-8100; Topcon) at the baseline and 1 week after starting therapy. The patients were asked to report any pain or discomfort in their eyes during therapy at the follow-up visit. RESULTS: None of the patients experienced pain or discomfort in their eyes. The mean ACA significantly decreased at the first week of the therapy compared with the baseline levels (40.34±7.06° and 36.89±6.87°, respectively) (P=0.001). However, the mean choroidal thickness increased from 277.33±95.60 µm at the baseline to 323.40±84.50 µm at the first week (P=0.01). There was a nonsignificant increase in the mean refractive error (from -0.25±0.54 diopter [D] at the baseline to -0.38±0.49 D after 1 week) (P=0.06). CONCLUSIONS: Topiramate can acutely decrease the ACA and increase the choroidal thickness. Because these effects may be asymptomatic, patients with migraine who start this therapy should be warned to be closely followed up by an ophthalmologist.

Predicting 10-day mortality in patients with strokes using neural networks and multivariate statistical methods.

BACKGROUND: The aim of the present study was to evaluate the performance of 2 different multivariate statistical methods and artificial neural networks (ANNs) in predicting the mortality of hemorrhagic and ischemic patients within the first 10 days after stroke. METHODS: The multilayer perceptron (MLP) ANN model and multivariate statistical methods (multivariate discriminant analysis [MDA] and logistic regression analysis [LRA]) have been used to predict acute stroke mortality. The data of total 570 patients (230 hemorrhagic and 340 ischemic stroke), who were admitted to the hospital within the first 24 hours after stroke onset, have been used to develop prediction models. The factors affecting the prognosis were used as inputs for prediction models. Survival or death status of the patients was taken as output of the models. RESULTS: For the MLP method, the accuracies were 99.9% in a training data set and 80.9% in a testing data set for the hemorrhagic group, whereas 97.8% and 75.9% for the ischemic group, respectively. For the MDA method, the training and testing performances were 89.8%, 87.8% and 80.6%, 79.7% for hemorrhagic and ischemic groups, respectively. For the LRA method, the training and testing performances for the hemorrhagic group were 89.7% and 86.1%, and for the ischemic group were 81.7% and 80.9%, respectively. CONCLUSIONS: Training and test performances yielded different results for ischemic and hemorrhagic groups. MLP method was most successful for the training phase, whereas LRA and MDA methods were successful for the test phase. In the hemorrhagic group, higher prediction performances were achieved for both training and testing phases.

Diffuse thrombosis secondary to Behçet's disease: a case report.

Behçet's disease is a multisystemic, potentially life-threatening condition with vascular involvement and thrombotic tendency. The disease course is characterized by exacerbations and remissions. Lower extremity vein thrombosis is the most frequent manifestation of vascular involvement, followed by vena cava thrombosis, pulmonary artery aneurysms, peripheral artery aneurysms, dural sinus thrombosis and abdominal aorta aneurysms. The case in this report was considered worth reporting due to vena cava thrombosis extending from brachiocephalic to jugular vein, accompanying thrombosis of the contralateral brachiocephalic vein and jugular veins as well as simultaneous dural sinus thrombosis, and also benefit from thrombolytic therapy.

The effect of high-dose steroid treatment used for the treatment of acute demyelinating diseases on endothelial and cardiac functions.

OBJECTIVE: The cardiovascular effects of short-term high-dose steroid treatment (pulse steroid treatment) have not yet been clarified. We examined the short- and long-term effects of pulse steroid treatment in demyelinating diseases on endothelial and cardiac functions. METHODS: In this prospective study, we included 35 patients (20 females and 15 males; mean age, 32.8±9.3 years) who were not treated with steroids and who were previously diagnosed with multiple sclerosis or neuromyelitis optica. Patients were evaluated before, 1 week after, and 3 months after the steroid treatment. Brachial artery flow-mediated relaxation and cardiac systolic/diastolic function were evaluated using echocardiography to assess physical examination results, carotid intima-media thickness, and endothelial function. RESULTS: There was no difference between biochemical values, systolic function, left ventricular dimensions, and carotid intima-media thicknesses in the three evaluation periods. There were significant increases in the body mass index, body weight, and systolic/diastolic blood pressure measurements at 1 week and 3 months after treatment (p<0.001). There was a significant decrease in brachial artery flow-mediated relaxation at 1 week and 3 months (1 versus 2, p=0.042; 1 versus 3, p=0.003). In Doppler measurements at 1 week and 3 months, there was an increase in mitral A velocity, IVRT, and EDT values and a decrease in the E/A ratio in line with diastolic dysfunction. CONCLUSION: Pulse steroid therapy used for demyelinating diseases deteriorated endothelial and left ventricular diastolic functions in the early and late periods. Future studies are needed to evaluate the development of cardiovascular mortality and morbidity in patients receiving this type of treatment.

Parathyroid Hormone Levels in the Prediction of Ischemic Stroke Risk.

Objective. It was examined whether PTH and 25-dihydroxyvitamin D (25(OH)D) levels, together or separately, are indicators of the risk of stroke. Materials and Methods. This prospective study was performed at two centers. In the study, 100 patients diagnosed with acute ischemic stroke and 100 control individuals in the same age range were examined. In addition to neurological examination, cranial imaging, extensive routine blood chemistry, PTH, and 25(OH)D levels were evaluated in all cases. Stroke risk factors were determined. Logistic regression was used for statistical analysis. Results. A total of 60 patients and 79 control individuals were included in the study. Different estimation models were designed in order to examine the relationship between PTH and 25(OH)D levels with stroke. According to modeling results, it was determined that the most effective predictor for risk of stroke was 25(OH)D levels, followed by hypertension and PTH levels, respectively. Conclusion. PTH and 25(OH)D levels together can make important contributions to determination of stroke risk, and further investigations are needed to understand this relationship more fully.

Epileptic Seizures Induced by a Spontaneous Carotid Cavernous Fistula.

A 79-year-old woman was admitted to our emergency department with complaints of fainting and loss of consciousness three times during the past month. She was diagnosed with epilepsy and started to be treated with antiepileptic drug. Physical examination showed, in the left eye, chemosis, limited eye movements in all directions, and minimal exophthalmos as unexisting symptoms on admission developed on the sixth day. Orbital magnetic resonance imaging (MRI) and digital subtraction angiography (DSA) imaging revealed a carotid cavernous fistula (CCF). Epileptic attacks and ophthalmic findings previously present but diagnosed during our examinations were determined to ameliorate completely after performing the coil embolization. Based on literature, we present the first case with nontraumatic CCF manifesting with epileptic seizures and intermittent eye symptoms in the present report.

Effects of Two Different Treatment Techniques on the Recovery Parameters of Moderate Carpal Tunnel Syndrome: A Six-Month Follow-up Study.

PURPOSE: The optimal therapy for moderately severe carpal tunnel syndrome (CTS) remains unclear. In this study, the authors aimed at comparing the clinical and electrophysiologic recovery of CTS after local steroid injection and operation. METHODS: This is a clinical prospective study consisting of 100 patients with moderate CTS. The patients were diagnosed electrophysiologically with isolated median nerve neuropathy and had CTS symptoms for at least 3 months. While the patients undergoing local steroid injection were defined as injection group (42 women, 8 men and n = 50), other participants undergoing surgery were defined as operation group (47 women, 3 men and n = 50). The severity of the symptoms and electrophysiologic findings were evaluated before and at the first, third, and sixth months after the treatment. RESULTS: The authors found that all parameters were improved at the end of the first month in both groups. However, the recovery of all parameters increased at the third month and was statistically higher in operation group, compared with injection group. Furthermore, the recovery rate of distal sensory latencies and the visual analog scale scores was decreased in injection group at the third month. The authors observed that the recovery continued in both groups in the sixth month, and the rates of recovery were markedly lower in injection group than in operation group, compared with those obtained at the first month. CONCLUSIONS: The clinical recovery was more pronounced than the electrophysiologic recovery. And surgery is more effective technique than steroid injection for the treatment of the moderate CTS in the long term.

Evaluation of choroidal thickness using spectral-domain optical coherence tomography in patients with migraine: a comparative study.

PURPOSE: To assess choroidal thickness in patients with migraine and compare them with healthy controls, using spectral-domain optical coherence tomography (OCT). METHODS: In this prospective case-control study, choroidal thicknesses of 20 newly diagnosed migraine patients and 20 age- and sex-matched healthy subjects were measured using a high-speed, high-resolution frequency domain (FD) OCT device (λ = 840 nm, 26.000 A-scans/s, 5 µm axial resolution). All patients underwent a complete ophthalmic examination before the measurements. OCT measurements were taken at the same time of day (9:00 AM), in order to minimize the effects of diurnal variation. RESULTS: There was a statistically significant difference in median choroidal thickness between the migraine patients (277.00 [interquartile range (IQR) 85.75] µm) and controls (301.00 [IQR 90.50] µm) (p = 0.012). There were significant differences at all measurement points (p<0.05 for all). CONCLUSIONS: The decreased choroidal thickness of patients with migraine might be related to the vascular pathology of the disease. Further studies are needed to evaluate the etiopathologic relationship between choroidal thickness and migraine.

Dry eyes and migraines: is there really a correlation?

PURPOSE: The purpose of this study was to evaluate the tear film functions and clinical symptoms of patients with migraines. METHODS: This observational comparative study consisted of 33 migraine (26 women and 7 men) patients referred from neurology clinics and 33 (22 women and 11 men) control subjects referred from ophthalmology outpatient clinics. The control subjects had neither systemic nor ocular disease nor any type of headache. All 66 patients underwent a complete ophthalmic examination and diagnostic tests for dry eye, including tear break-up time, Schirmer test with topical anesthesia, lissamine green staining, and an ocular surface disease score. Patients with migraine were classified as migraine with an aura, migraine without an aura, and basilar migraine; a pain score from 1 to 4 was determined for each patient, based on the American Headache Society's Migraine Disability Assessment Test. RESULTS: Of the 33 patients who participated in the migraine group, 17 (51%) suffered from migraine with aura, 11 (33%) suffered from migraine without aura, and 5 (15%) suffered from basilar migraine. Significant differences in dry eye scores were found between the patients with migraine and the control subjects. In the migraine group, the mean tear break-up time was 7.75±2.37 seconds, whereas in the control group it was 9.15±1.93 seconds. For the Schirmer test, the migraine group had a mean value of 12.09±4.95 mm/5 minutes, whereas the control group had a mean value of 14.90±4.26 mm/5 minutes. Testing with lissamine green staining resulted in a mean value of 1.00±0.16 in the migraine group and 0.30±0.46 in the control group. In the migraine group, the mean for the ocular surface disease index scoring was 36.27±17.54. In the control group, it was 28.42±9.0. A significant difference (P<0.05) was found in the dry eye syndrome testing results between the 2 groups in this study. CONCLUSIONS: An increased frequency of dry eye disease was found to occur in patients with migraine, which might suggest that migraine headaches are related to dry eye disease. Some migraine attacks may be aggravated in the presence of dry eye syndrome.