Time­dependent changes in blood cells, NIHSS and mRS according to reperfusion treatment type in stroke patients who developed hemorrhagic complication.

Hemorrhagic complications may be seen following reperfusion therapy with rtPA and/or thrombectomy after acute ischemic stroke (AIS). Neutrophils, lymphocytes, and platelets have important roles in the inflammatory and immune responses that develop in these patients. We investigated time­dependent changes in blood cells, NIHSS and mRS values according to type of reperfusion therapy in AIS patients who developed cerebral hemorrhage. In AIS patients who underwent rtPA and/or thrombectomy and developed cerebral hemorrhage within the first 24 hours after treatment, leukocyte, neutrophil, lymphocyte, platelet counts and their ratios were recorded on admission, 1st, 3rd, and 7th days. NIHSS values on admission, 3rd days and mRS values on admission, discharge, and the 3rd month were recorded. These values were compared according to the type of reperfusion therapy. Out of 436 AIS patients, rtPA was applied in 50.5%, thrombectomy in 28.2%, and rtPA+thrombectomy in 21.3%. Hemorrhage developed in 25.5% of the patients. Patients treated with thrombectomy had a greater rate of cerebral hemorrhage. Pre­stroke mRS values were lower in all therapy types than mRS scores at discharge and the 3rd month. The NIHSS scores did not differ significantly in 3 days. Depending on the type of reperfusion treatment, there are a few time­dependent significant changes observed in the blood cell counts and ratios. In conclusion, there is a relation between the type of reperfusion therapy and the time­dependent changes in blood cells and ratios as well as mRS scores among AIS patients who have undergone rtPA and/or thrombectomy and developed cerebral hemorrhage.

Electrodiagnostic methods to verify Guillain-Barré syndrome subtypes in Istanbul: A prospective multicenter study.

BACKGROUND AND AIMS: This study aimed to identify the clinical characteristics and electrodiagnostic subtypes of Guillain-Barré syndrome (GBS) in Istanbul. METHODS: Patients with GBS were prospectively recruited between April 2019 and March 2022 and two electrodiagnostic examinations were performed on each patient. The criteria of Ho et al., Hadden et al., Rajabally et al., and Uncini et al. were compared for the differentiation of demyelinating and axonal subtypes, and their relations with anti-ganglioside antibodies were analyzed. RESULTS: One hundred seventy-seven patients were included, 69 before the coronavirus disease 2019 pandemic (April 2019-February 2020) and 108 during the pandemic (March 2020-March 2022), without substantial changes in monthly frequencies. As compared with the criteria of Uncini et al., demyelinating GBS subtype diagnosis was more frequent according to the Ho et al. and Hadden et al. criteria (95/162, 58.6% vs. 110/174, 63.2% and 121/174, 69.5%, respectively), and less frequent according to Rajabally et al.'s criteria (76/174, 43.7%). Fourteen patients' diagnoses made using Rajabally et al.'s criteria were shifted to the other subtype with the second electrodiagnostic examination. Of the 106 analyzed patients, 22 had immunoglobulin G anti-ganglioside antibodies (14 with the axonal subtype). They had less frequent sensory symptoms (54.5% vs. 83.1%, p = 0.009), a more frequent history of previous gastroenteritis (54.5% vs. 22.9%, p = 0.007), and a more severe disease as compared with those without antibodies. INTERPRETATION: Serial electrodiagnostic examinations are more helpful for accurate subtype diagnosis of GBS because of the dynamic pathophysiology of the disease. We observed no significant increase in GBS frequency during the pandemic in this metropolis.

Symptomatic and asymptomatic pontine hyperintensities: are they central pontine myelinolysis? Case series.

The diagnosis of central pontine hyperintensities on cranial magnetic resonance imaging has wide-spectrum clinical entities, and the pro-type diagnosis of these is central pontine myelinolysis. The rapid changes in extracellular environment due to an imbalance of electrolytes or metabolic or toxic stress to the myelin sheath can cause demyelination of white matter tracts in pons, which is why this situation could have different etiologies than just rapid sodium changes. Central pontine myelinolysis can be presented with different clinical scenarios from asymptomatic to death. Here, we present eight patients who had central pontine hyperintensities on radiological imaging but showed various clinical symptoms and different etiologies. The etiologies of these cases are hypertriglyceridemia, alcohol consumption, antidepressant usage, immunocompromised situations, uncontrolled diabetes mellitus, liver and kidney failure, electrolyte changes, and adrenal insufficiency. We aimed to take attention with this case series to the fact that not only fast correction of hyponatremia is the cause of central pontine myelinolysis, but also different etiologies could play a role in this situation, and making the central pontine myelinolysis diagnosis considering different diagnosis is very important.

HaNDL Syndrome: The Innocent Lymphocytic Pleocytosis.

INTRODUCTION: HaNDL syndrome is a transient and rare condition that presents with neurological deficit and headache accompanied by lymphocytosis on cerebrospinal fluid (CSF) analysis. It is usually characterized by spontaneous recovery without neurological sequelae. This is a benign condition, which has not yet been adequately defined and includes many diseases in the differential diagnosis. We indicated 2 different cases that applied with acute neurological findings. CASE REPORT: Two patients who were admitted to our hospital with transient neurological deficits and headaches were evaluated. There was no significant pathology in cranial imaging and EEG reports. Lymphocytic pleocytosis was observed in CSF. Patients were followed up with attacks but were discharged without deficits. We diagnosed the patients with HaNDL syndrome with clinical features, imaging, and laboratory findings. CONCLUSION: HaNDL is an underdiagnosed syndrome and it should be considered especially for young patients with headaches is prominent without a risk factor for ischemia, recurrent episodes with neurological symptoms, CSF pleocytosis, and normal imaging findings.Therefore, we wanted to raise awareness for the existence of this rare disease which is a waste of time by performing unnecessary tests and therapies during the diagnosis period.

Warfarin vs doac: Comparative outcomes of mechanical thrombectomy for acute ischemic stroke in atrial fibrillation patients.

PURPOSE: To compare outcomes of mechanical thrombectomy (MT) for acute ischemic stroke (AIS) in patients with atrial fibrillation (AF) taking warfarin or direct oral anticoagulants (DOACs). METHODS: A total of 71 consecutive patients with AF who underwent MT due to AIS between January 2018 and December 2021 were retrospectively analyzed. Patients were grouped as warfarin versus DOAC group. CHA2DS2-VASc, HAS-BLED, The National Institutes of Health Stroke Scale (NIHSS) at the time of admission and at 24 h, successful recanalization, post- MT complications and technical properties of MT were evaluated. Patients were divided into a good prognosis group, and a mortality group according to the 90th day mRS. RESULTS: HAS-BLED score was significantly higher in DOAC group (p = 0.006) There were no significant differences in stroke severity, successful recanalization rates, post-procedural complications and mRS 90th day scores between patients with warfarin and DOACs. CHA2DS2-VASc, NIHSS at admission and NIHSS on the 24th hour scores were significantly lower in the good mRS group (p = 0.012, p = 0.002, p < 0.001, respectively). CONCLUSION: MT is safe and effective in patients receiving warfarin or DOACs. HASBLED and CHA2DS2-VASc scores can help to predict functional outcome after MT.

Delayed radiation-induced motor neuron syndrome: A case report.

BACKGROUND: Delayed radiation-induced motor neuron syndrome (DRIMNS) is an atypical motor neuron disorder that develops months or years after radiation therapy. In this study we present a case of DRIMNS that developed forty years after radiotherapy and to discuss differential diagnoses. CASE PRESENTATION: A 56-year-old male patient was admitted to our clinic with complaints of increasing difficulty in walking for the past year. He had a history of operation and radiotherapy due to testicular tumor. Electroneuromyography (ENMG) and thoracic, lumbosacral, plexus and pelvic magnetic resonance imaging (MRI) were performed considering radiculopathy, plexopathy and motor neuron disease in the differential diagnosis. MRIs revealed no abnormality. Needle EMG of lower extremity and lumbar paraspinal muscles revealed fibrillation and positive sharp waves concomitant with fasciculations and reduced recruitment suggesting anterior horn cell/root involvement. DRIMNS was considered rather than motor neuron disease based on the long duration of symptoms with slow progressive course and history of radiotherapy to the pelvic region. CONCLUSION: DRIMNS is a rare entity that should be considered in the differential diagnosis of lower extremity muscle weakness in a patient with a history of malignancy and radiotherapy. EMG findings are very valuable in making the diagnosis together with the clinical picture.

Thrombectomy with or without Bridging Thrombolysis for Anterior Circulation Stroke.

Background: Currently, there is still no clear consensus on bridging thrombolysis (BT) before mechanical thrombectomy (MT). In this study, we aimed to compare clinical and procedural outcomes and complication rates of BT versus direct mechanical thrombectomy (d-MT) in anterior circulation stroke. Methods: A total of 359 consecutive anterior circulation stroke patients who received d-MT or BT in our tertiary stroke center between January 2018 and December 2020 were retrospectively analyzed. The patients were divided into two groups as Group d-MT (n = 210) and Group BT (n = 149). The primary outcome was the impact of BT on clinical and procedural outcomes, whereas the secondary outcome was the safety of BT. Results: The incidence of atrial fibrillation was higher in the d-MT group (p = 0.010). The median duration of the procedure was significantly higher in Group d-MT than in Group BT (35 vs 27 min, respectively; P = 0.044). The number of patients achieving good and excellent outcomes was significantly higher in Group BT (p = 0.006 and P = 0.03). The edema/malign infarction rate was higher in the d-MT group (p = 0.003). Successful reperfusion, first-pass effects, symptomatic intra-cranial hemorrhage, and mortality rates were similar between the groups (p > 0.05). Conclusions: In this study, BT seems to yield better clinical and procedural outcomes with lower complication rates than d-MT. These findings may support the additional value of intravenous alteplase in anterior system strokes. Further large-scale, prospective, randomized-controlled studies will clarify the gray lines in this consensus, but this paper is important for reflecting the real-world data in developing countries.

Prediction of Bleeding by the PRECISE-DAPT Score in Patients with Carotid Artery Stenting.

PURPOSE: The predicting bleeding complications in patients undergoing stent implantation and the subsequent dual antiplatelet therapy (PRECISE-DAPT) score predicts the risk of bleeding in patients with dual antiplatelet therapy (DAPT) after percutaneous coronary interventions (PCIs). Patients with carotid artery stenting (CAS) are also treated with DAPT. In this study, we aimed to investigate the performance of the PRECISE-DAPT score in predicting bleeding in patients with CAS. METHODS: Patients who had CAS between January 2018 and December 2020 were retrospectively enrolled. The PRECISE-DAPT score was calculated for each patient. The patients were divided into two groups based on their PRECISE-DAPT score: low < 25 and high ≥ 25. Bleeding and ischemia complications and laboratory data among the two groups were compared. RESULTS: A total of 120 patients with a mean age of 67.3 ± 9.7 years were included. Forty-three patients had high PRECISE-DAPT scores, and 77 patients had low PRECISE-DAPT scores. Six patients developed bleeding events during the six-month follow-up, and five of them were in the PRECISE DAPT score ≥ 25 group. The difference between the two groups regarding bleeding events at six months was significant (P = 0.022). CONCLUSION: The PRECISE-DAPT score might be used for predicting the bleeding risk in patients with CAS, and the bleeding rate was significantly higher in patients with a PRECISE-DAPT score ≥ 25.

Reversal of Oral Vitamin K Antagonists Using Prothrombin Complex Concentration Prior to IV tPA Administration.

Herein, we report two acute ischemic stroke cases that we used prothrombin complex to reverse the effects of warfarin in order to apply intravenous thrombolytic treatment. To the best of our knowledge, there are only limited amount of cases that prothrombin complex concentrates were applied prior to intravenous thrombolytic treatment administration. As one of the biggest acute stroke clinics in our country, we aim to open a discussion for this treatment to be fully researched and understood.

MEFV mutation frequencies in a Turkish cohort with low prevalence of familial Mediterranean fever

Background/aim: Familial Mediterranean fever (FMF) is a genetically recessive autoinflammatory disease caused by mutations in the Mediterranean fever (MEFV) gene. The aim of this study was to investigate the frequencies of the most common MEFV mutations among a sample of healthy individuals from the Havsa population of European Turkey, where FMF is less prevalent compared to Asian Turkey. Materials and methods: The study group consisted of 263 unrelated healthy adults. All of the participants were analyzed for the M694V, V726A, M680I, and E148Q mutations in the MEFV gene. Results: In total, 25 of the 263 individuals carried MEFV mutations (9.5%). The observed allele frequencies were 1.5% for M694V (95% confidence interval [CI] 0.5-2.5), 2.6% for E148Q (95% CI 1.6-3.9), 0.5% for M680I (95% CI 0.0-1.1), and 0.0% for V726A. The frequencies of the M694V, M680I, and E148Q mutations were not significantly different from allele frequencies (approximately 20%) determined for other regions of Turkey where FMF is more prevalent. Conclusion: These data suggest that the positivity of the MEFV gene mutation tests have lower predictive value in a population with low FMF prevalence.

Changes in neutrophil, lymphocyte, platelet ratios and their relationship with NIHSS after rtPA and/or thrombectomy in ischemic stroke.

BACKGROUND AND AIMS: Various reactive oxygen radicals and inflammatory mediators emerge in ischemic stroke, and changes occur in the number of leukocytes and platelets. Variations in the counts and ratios of these cells may be related to the early and late course and prognosis of stroke. In this study, the relationship between changes in counts or ratios of neutrophil, lymphocyte, platelet, and National Health Institute Stroke Scale (NIHSS) scores was investigated in patients who presented with an ischemic stroke and treated with recombinant tissue plasminogen activator (rtPA) and/or thrombectomy. METHODS: Changes in neutrophil, lymphocyte, platelet counts; neutrophil-to-leukocyte ratio (NLR), neutrophil-to-lymphocyte ratio, platelet-to-leukocyte ratio (PLR), and platelet-to- lymphocyte ratio between day of admission (day 0), and 1st, 3rd, and 7th days after application of treatment modalities in 296 patients presented with acute ischemic stroke who underwent rtPA within the first 4,5 hours and / or thrombectomy within 6 hours after stroke and the relationship between these changes and the NIHSS (National Health Institute Stroke Scale) scores were evaluated retrospectively. RESULTS: In our study, leukocyte and neutrophil counts were higher on the first day after acute ischemic stroke. Platelet counts decreased on the 1st and 3rd days relative to baseline values. Lymphocyte values decreased on day 1, 3 and 7 compared to day 0. There was a significant increase in neutrophil-to-lymphocyte ratios at day 1 and 3 compared to day 0. On the 7th day, neutrophil-to-lymphocyte ratios were significantly lower. There was an increase in platelet-to-lymphocyte ratios at day 1 compared to day 0. The increase in NLR values was more evident on day 1. The increase in PLR on the 7th day was also significant. The patients who underwent rtPA and/or thrombectomy had significantly lower NIHSS scores at the 72th hour of the stroke compared to the NIHSS values at hospital admissions. A positive correlation was found between NIHSS difference values and neutrophil-to-lymphocyte and platelet-to-lymphocyte percent changes. CONCLUSIONS: There are dynamic changes in platelet, neutrophil, lymphocyte counts and ratios in early period after treatment with rtPA and/or thrombectomy in acute ischemic stroke. Variations in the counts and ratios of these cells may be related to NIHSS, which determines the degree of neurological damage of stroke.

Mean Platelet Volume in Patients with Acute Ischemic Stroke with Nonvalvular Atrial Fibrillation.

Background: Platelets play an important role in the pathogenesis of vascular disease, and the size of the platelets can determine their reactivity. Large platelets secrete more prothrombotic factors and aggregate more quickly. In this study, we aimed to investigate mean platelet volume (MPV) levels, which are considered to be an indication of the increase in platelet function in previous studies, in cases of acute ischemic stroke (AIS) with nonvalvular atrial fibrillation (NVAF). Methods: At Fatih Sultan Mehmet Training and Research Hospital, 297 patients diagnosed with acute ischemic stroke were included in the study and two groups were assigned as patients with and without NVAF. In the study, the relationship between MPV and platelet counts in the first 24 hours after the onset of the symptom between the two groups was examined. In addition, the relationship between MPV and hypertension, diabetes, coronary artery disease, smoking and alcohol use, infarct location, and use of antiplatelet or anticoagulant was assessed. Results: MPV levels were significantly higher in acute ischemic stroke patients with NVAF (p = 0.001; p < 0.01). The mean MPV level in patients with NVAF and non-smokers was significantly higher than smokers (p = 0.012; p < 0.05), but there was no significant relationship between MPV and other parameters. Conclusions: In this study, it was shown that MPV levels were significantly higher in patients with acute ischemic stroke and NVAF than those without NVAF. This finding suggested that MPV which shows platelet reactivity can be assumed as a risk factor of AIS in patients with NVAF.

New treatment alternatives in the ulnar neuropathy at the elbow: ultrasound and low-level laser therapy.

Ulnar nerve entrapment at the elbow (UNE) is the second most common entrapment neuropathy of the arm. Conservative treatment is the treatment of choice in mild to moderate cases. Elbow splints and avoiding flexion of the involved elbow constitute majority of the conservative treatment; indeed, there is no other non-invasive treatment modality. The aim of this study was to investigate the efficacy of ultrasound (US) and low-level laser therapy (LLLT) in the treatment of UNE to provide an alternative conservative treatment method. A randomized single-blind study was carried out in 32 patients diagnosed with UNE. Short-segment conduction study (SSCS) was performed for the localization of the entrapment site. Patients were randomized into US treatment (frequency of 1 MHz, intensity of 1.5 W/cm(2), continuous mode) and LLLT (0.8 J/cm(2) with 905 nm wavelength), both applied five times a week for 2 weeks. Assessments were performed at baseline, at the end of the treatment, and at the first and third months by visual analog scale, hand grip strength, semmes weinstein monofilament test, latency change at SSCS, and patient satisfaction scale. Both treatment groups had significant improvements on clinical and electrophysiological parameters (p < 0.05) at first month with no statistically significant difference between them. Improvements in all parameters were sustained at the third month for the US group, while only changes in grip strength and latency were significant for the LLLT group at third month. The present study demonstrated that both US and LLLT provided improvements in clinical and electrophysiological parameters and have a satisfying short-term effectiveness in the treatment of UNE.

Confocal scanning laser tomography of the optic nerve head on the patients with Alzheimer's disease compared to glaucoma and control.

The purpose of this study was to evaluate optic nerve head (ONH) differences of the patients with Alzheimer's disease (AD) measured by confocal scanning laser tomography [Heidelberg Retina Tomograph (HRT) III] and compare with glaucoma and control subjects. Eighty-four patients were enrolled into the study: 44 eyes of 24 patients with mild to moderate AD (Group 1), 68 eyes of 35 patients with glaucoma (Group 2), and 49 eyes of 25 heathy volunteers as a control (Group 3). A complete ophthalmologic examination as well as a confocal scanning laser ophthalmoscopic assessment with HRT III were performed on all patients. Mean values of the ONH topographic parameters such as rim area (RA), rim volume (RV), height variation contour, linear cup/disc ratio, cup shape measure, and retinal nerve fiber layer (RNFL) were recorded. Mean values of RNFL thickness was 0.23 ± 0.07 in AD, 0.22 ± 0.09 in glaucoma and 0.24 ± 0.07 in the control group (p = 0.323). RA and RV were significantly lower, and linear C/D ratio was significantly higher in the glaucoma group when compared to AD and control (p < 0.05). There was no statistically significant difference between AD and control for the optic disc parameters tested (p > 0.05). We observed a negative correlation of the age with RNFL in all of the groups (p < 0.005). Age was the most important parameter affecting RNFL. Our results suggest that HRT does not demonstrate ONH differences between AD and control group, while it successfully differentiates glaucoma from AD and control cases of older age.

Gamma-glutamyl transferase levels in patients with acute ischemic stroke.

Objective. The aim of this study was to investigate the relationship between gamma-glutamyl transferase (GGT) levels, cerebrovascular risk factors, and distribution of cerebral infarct areas in patients with acute ischemic stroke (AIS). Patients and Methods. Sixty patients with AIS and 44 controls who had not cerebrovascular disease were included in the study. The patients were divided into four groups according to the location of the infarct area and evaluated as for GGT levels and the presence of diabetes mellitus (DM), hypertension (HT), and hyperlipidemia (HL). Results. The frequency of DM, HT, and HL and gender distributions were similar. The mean GGT levels were significantly higher in patients with AIS and those with relatively larger areas of infarction (P < 0.05). Increased mean GGT levels were found in the subgroup with hypertension, higher LDL-cholesterol, and triglyceride levels among cases with AIS (P < 0.05). Conclusion. Higher GGT levels in AIS patients reinforce the relationship of GGT with inflammation and oxidative stress. The observation of higher GGT levels in patients with relatively larger areas of infarction is indicative of a positive correlation between increases in infarct areas and elevated GGT levels.

An Observational Study on the Association between Migraines and Tension Type Headaches in Patients Diagnosed with Metabolic Syndrome.

Background. Our aim was to investigate the association between migraine, tension type headache, and metabolic syndrome. Methods. Presence of tension type headache and migraine was investigated in 120 patients diagnosed as metabolic syndrome. The severity of the headache was recorded according to the visual analog scale. Results. Mean age of the patients was 54.41 ± 11.60 years (range, 29-84 yrs). Diagnoses of tension type headache and migraine without aura were made for 39 (32.5%) and 18 (15%) patients, respectively. Mean age of migraine patients was significantly lower relative to the patients with tension type headache and no headache. Incidence of hypertriglyceridemia was significantly higher in migraine patients when compared with cases tension type headache and without headache. In the tension type headache group, requirement for analgesics decreased as HDL cholesterol levels increased, while need for analgesic drugs increased in line with higher diastolic blood pressures. In the migraine group duration of headache was found to be prolonged with decreasing HDL cholesterol levels. Conclusion. In patients presenting with headache, its association with metabolic syndrome should be considered, and the patients should be especially observed with respect to response to analgesic and the presence of hypertension and hyperlipidemia.

Postcoital internal carotid artery dissection presenting as isolated painful horner syndrome: a case report.

Postcoital artery dissection is a rare condition. Here we report a 40-year-old male patient with painful Horner syndrome related to postcoital internal carotid artery (ICA) dissection. In neurologic examination of the patient, semiptosis, enophthalmus, and myosis were observed on the left side. There were no carotid bruits. On T1-weighted and fat-suppressed cranial MRI, hyperintensity consistent with intramural hematoma was observed within cervical and temporal petrous segments of left ICA. On cervical and cranial MRA, marked decrease in the calibration of C1 and C2 segments of the left ICA was remarkable. The patient was diagnosed as left ICA dissection and anticoagulant therapy was initiated. A prominent improvement was noted in clinical findings during two months of followup period.

Ocular vestibular evoked myogenic potentials in patients with migraine.

BACKGROUND: Subclinical cerebello-vestibular impairment has been described in migraine patients. OBJECTIVES: Our aim was to investigate the presence of subclinical vestibulopathy in migraine patients using ocular vestibular evoked myogenic potentials (oVEMP). PATIENTS AND METHODS: Forty-three patients suffering from migraine without aura who had no vestibular complaints and 29 healthy controls were included in the study. The responses were recorded from contralateral lower eyelid just above of the inferior oblique muscle during 120 dB click stimulation. RESULTS: Eight migraine patients (18.6%) disclosed no response. Bilateral or unilateral response rates in the migraine group were 46.5% (n = 20) and 34.9% (n = 15) respectively. In controls, bilateral or unilateral responses could be obtained from 25 (86.7%), and 4 (13.2%) cases, respectively. In migraineurs group mean latencies of N1 and P1 were significantly longer, while N1-P1 amplitudes were found meaningfully lower. CONCLUSION: These data demonstrate that using oVEMP subclinical vestibular dysfunction can be elicited in migraine patients without vestibular complaints.

Creutzfeldt-Jacob Disease: a case report.

INTRODUCTION: Creutzfeldt-Jacob Disease is the most frequently seen type of prion diseases. Its clinical findings consist of predominantly progressive dementia with a rapid onset, myoclonus, and also cerebellar, pyramidal, extrapyramidal and visual signs. Definitive diagnosis is established with histological examination of brain biopsy or autopsy materials. Occurrence of periodical spikes in EEG, observation of cortical signal alterations during diffusion weighted (DW) MRI studies, and detection of protein 14-3-3 in cerebrospinal fluid (CSF) substantiate the diagnosis. CASE PRESENTATION: Seventy year-old male patient referred with complaints of weakness and involuntary movements in left arm, changes in behavior, and forgetfulness. He also developed akinetic mutism after nearly three months. In EEG periodic triphasic waves were seen. Despite the absence of any apparent pathological finding in T2 and FLAIR MRI, excluding signs of atrophy, on DW MRI hyperintense signal changes in cortical regions (cortical ribboning) were observed. Protein 14-3-3 in CSF was detected. CONCLUSION: Patients who have progressive dementia and associated atypical features should be investigated especially with DW MRI. Cortical ribboning is a very useful diagnostic sign for CJD.

The evaluation of the tensor veli palatini muscle function with electromyography in chronic middle ear diseases.

UNLABELLED: Although there are several factors affecting the pathogenesis of chronic otitis, the pathological process has not been entirely defined yet. One of the theories suggested for the development of middle ear diseases is tubal dysfunction. The aim of the study is to analyze the function of the tensor veli palatini (TVP) muscle electromyographically in chronic middle ear pathologies and to evaluate the role of this muscle in eustachian tube dysfunction and pathogenesis of associated middle ear diseases by comparing with the results of healthy individuals. STUDY DESIGN: A prospective, controlled, clinical trial. We enrolled 24 patients with chronic middle ear pathologies into our study and 18 controls without any previous ear problem. Electromyographic (EMG) needle was inserted into the TVP muscles in all patients transnasally. Functions of the TVP muscle were analyzed by using the amplitudes of the motor unit potential (MUP) and MUP durations detected on EMG. MUP amplitudes and MUP durations were compared statistically in all groups. When the mean MUP amplitudes and durations obtained from TVP muscles of all ears from the patient group were compared to the mean MUP amplitudes and durations obtained from healthy individuals, no statistically significant difference was observed between sick ears and control ears. Values obtained from the sick ears needed to be compared with mean values obtained from the control group separately, since absence of statistically significant difference cannot mean that we should ignore individual muscle dysfunction. The results we obtained from our study support that in the formation of different middle ear pathologies, myogenic defects in the eustachian tube have limited effects, except for existence of a predisposing factor like palate pathology. In all patients with chronic middle ear disease it is not appropriate to expect functional muscle dysfunction, however evaluation of TVP muscle function correctly may be helpful for bringing up the underlying possible muscle and nerve pathologies not in all patients.