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Especially in recent years, temporal muscle thickness has been used as an important parameter for sarcopenia in neurological disorders. In addition, triglyceride glucose index was evaluated separately in studies conducted in terms of coronary diseases, diabetes, high blood pressure, body mass index and acute stroke. In this clinical study, unlike the others, both temporal muscle thickness and triglyceride glucose index were evaluated together in acute stroke patients in terms of sarcopenia. We aimed to investigate the relationship between temporal muscle thickness and triglyceride glucose index, which is atherosclerotic index, with mortality and 3rd month functional outcomes in acute stroke patients. In this retrospective study, 147 patients admitted to Ankara City Hospital with the diagnosis of acute ischemic stroke between January 2021 and September 2022 were evaluated. Fasting triglyceride glucose indexes of the patients were calculated. The temporal muscle thickness measurement of the patients was performed by the radiologist using computed tomography images. Those who scored 3 or higher on the modified Rankin Scale (mRS) at the third month were considered to have poor functional outcome. A significant cutoff point was found for estimating mortality for the temporal muscle thickness parameter [area under the curve for a receiver operating characteristic curve (AUC)â =â 0.636; Pâ =â .012]. The cutoff point was obtained asâ ≤â 5.2. Sensitivity value was 65%, specificity value was 65%, the positive predictive value (PPV) value was 42.62% and the negative predictive value (NPV) value was 82.28%. Similarly, for the triglyceride glucose index parameter, there was a significant cutoff point in estimating mortality (AUCâ =â 0.673; Pâ =â .003). The cutoff point was obtained asâ ≥â 8.23. Sensitivity value was 91.18%, specificity value was 13%, PPV value was 26.96% and NPV value was 81%. Temporal muscle thickness and triglyceride glucose index parameters were found to be statistically important parameters of sarcopenia. It was concluded that the evaluation of these 2 parameters in terms of both mortality and sarcopenia in acute stroke patients is important in the evaluation of neurological and cardiac disorders.
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Accidente Cerebrovascular Isquémico , Sarcopenia , Accidente Cerebrovascular , Humanos , Estudios Retrospectivos , Glucosa , Músculo Temporal , Accidente Cerebrovascular/diagnósticoRESUMEN
BACKGROUND: The development of candidemia is a highly fatal condition in severe COVID-19 infection. OBJECTIVES: This study aimed to develop a candidemia prediction score in COVID-19 patient based on the patient's clinical characteristics, and healthcare-related factors during intensive care units (ICU) follow-up. PATIENTS/METHODS: Severe COVID-19 patients hospitalised in ICU in Ankara City Hospital during the one-year period (August 15, 2020, and August 15, 2021) were included. After univariate analysis, multivariate analysis was applied using variable selection approach to investigate the effects of variables together and to create a score model for candidemia. Statistically significant factors were included in the development process of candida prediction score. RESULTS: Of 1305 COVID-19 ICU patients, 139 had a candidemia episode. According to the final model, four variables, presence of central venous catheter (CVC) (OR 19.07, CI 8.12-44.8, p < .0001), multifocal colonisation (OR 2.28, CI 1.39-3.72, p 0.001), length of ICU stays ≥14 days (OR 3.62, CI 2.42-5.44, p < .0001) and corticosteroids (OR 0.51, CI 0.34-0.76, p 0.0011) were the only statistically significant independent risk factors for candidemia. Score model was demonstrated by a nomogram, and the risk for candidemia was calculated to be high in patients who scored ≥56 points by using the criteria [CVC = 51, multifocal colonisation = 14, prolonged hospitalisation = 23, no steroid use = 12 points]. The AUC of the score is 0.84 (CI 0.81-0.87). CONCLUSION: We developed and validated an easy-to-use clinical prediction score for candidemia in severe COVID-19 infection. In COVID-19 ICU patients, the risk of candidemia is high if one of the other risk factors is present together with CVC.
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COVID-19 , Candidemia , Humanos , Candidemia/diagnóstico , Candidemia/epidemiología , Candida , Factores de Riesgo , Unidades de Cuidados Intensivos , Estudios RetrospectivosRESUMEN
BACKGROUND: Coronavirus disease 2019 (COVID-19) infection causes a wide variety of neurological disorders by affecting both central and peripheral nervous systems. The cytokine storm (CS) has been blamed for the development of severe neurological disorders in COVID-19. However, the relationship between COVID-19 CS and neurological manifestations has not been adequately studied. Thus, we aimed to investigate the neurological presentations in patients with COVID-19 CS. METHODS: The study population consisted of hospitalized moderate-to-severe COVID-19 patients. It was divided into two groups CS (36 patients, 29.3%) and non-CS (87 patients, 70.7%) based on significant clinical symptoms, elevated inflammatory marker levels, radiological findings, and interleukin-6 levels (IL-6). RESULTS: The three most common neurological symptoms in the CS group were altered level of consciousness, headache, and unsteadiness. Altered level of consciousness was higher in the CS group (69.4%) than the non-CS group (25.3%) (p:0.001). The frequency of headache was comparable in both groups (p:0.186). The number of patients requiring intensive care unit and intubation was higher in the CS group (p:0.005 and p:0.001). The mortality rate in the CS group (38.9%) was higher than the non-CS group (8.0%) (p:0.001). IL-6, CRP, ferritin, neutrophil-lymphocyte ratio, procalcitonin, and D-dimer levels were higher in the CS group (for all p:0.001) while lymphocyte count was lower (p:0.003). CONCLUSION: The most common neurological presentation in patients with CS was altered level of consciousness. The presence of CS was an independent risk factor for high mortality.
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COVID-19 , Enfermedades del Sistema Nervioso , Humanos , COVID-19/complicaciones , SARS-CoV-2 , Síndrome de Liberación de Citoquinas/complicaciones , Interleucina-6 , Trastornos de la Conciencia/complicaciones , Cefalea/etiologíaRESUMEN
We read Shafeeq Ahmed's letter about our recent article with interest. Stress is one of the most well-known migraine triggers. Early studies have already revealed that stress significantly affects migraine clinical course during the COVID-19 pandemic. Therefore, we also took into account the stress factor in our study. We tried to assess the influence of the COVID-19 pandemic on the psychological state of our patients using the Beck Depression Inventory and the Beck Anxiety Inventory. Due to the COVID-19 pandemic, personal protective equipment and disinfectants have been used so widely and intensively for the first time. Thus, we thought that evaluating the effect of the COVID-19 pandemic on migraine only through stress would be an inadequate approach. Our study demonstrated that in addition to stress, mask types, number of masks, duration of mask use, and disinfectant exposure might affect migraine attacks. Taking these factors into account, treatment and preventative methods may improve migraine sufferers' quality of life.
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COVID-19 , Trastornos Migrañosos , Humanos , Pandemias , Calidad de Vida/psicología , Trastornos Migrañosos/tratamiento farmacológico , Equipo de Protección PersonalRESUMEN
BACKGROUND: Critically ill COVID-19 patients have a high risk for the development of candidemia due to being exposed to both well-defined classical risk factors and COVID-19-specific risk factors in ICU. OBJECTIVES: In this study, we investigated the incidence of candidemia in critically COVID-19 patients, and the independent risk factors for candidemia. PATIENTS/METHODS: COVID-19 patients hospitalised in ICU during 1-year period (August 2020 to August 2021) were included. Clinical and laboratory characteristics of all COVID-19 patients, applied treatments, and invasive procedures that may predispose to candidemia were recorded. RESULTS: Of 1229 COVID-19 patients, 63 developed candidemia. Candidemia incidence rate was 4.4 episodes per 1000 ICU days. The most common species was Candida albicans (52.3%). Only 37 patients (58.7%) received antifungal therapy. The presence of central venous catheter (OR 4.7, 95% CI 1.8-12.2, p < .005), multifocal candida colonisation (OR 2.7, 95% CI 1.4-5.2, p < .005), a prolonged ICU stay (≥14 days) (OR 1.9, 95% CI 1.08-3-37, p < .05), the absence of chronic lung disease (OR 0.4, 95% CI 0.1-0.9, p < .05) and the absence of corticosteroid use (OR 0.3, 95% CI 0.14-0.52, p < .0001) were significantly associated with candidemia. CONCLUSIONS: Our study filled the knowledge gap in the literature about the impact of COVID-19-associated risk factors for the development of candidemia. The classical risk factors for candidemia had a significant effect on candidemia, and contrary to expectations, corticosteroids had a protective effect against the development of candidemia. The results of these studies showing interesting effects of corticosteroids in critically ill COVID-19 patients should be confirmed by further studies.
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COVID-19 , Candidemia , Corticoesteroides/efectos adversos , Antifúngicos/uso terapéutico , COVID-19/complicaciones , COVID-19/epidemiología , Candidemia/complicaciones , Candidemia/tratamiento farmacológico , Candidemia/epidemiología , Enfermedad Crítica , Humanos , Incidencia , Unidades de Cuidados Intensivos , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Since the onset of the COVID-19 pandemic, the use of personal protective equipment (PPE) and disinfectants has become necessary to prevent transmission of the virus. However, the effects of such pandemic obligations on chronic diseases such as migraine have not been fully elucidated. We aimed to investigate the effects of the COVID-19 pandemic, as well as the use of masks and disinfectants, on migraine patients. A total of 310 migraine patients were included. Demographic data, migraine characteristics, and mask and disinfectant use were obtained through a face-to-face survey. Patients were grouped as worsening, stable, or improving according to pre-pandemic and pandemic migraine characteristics. Migraine worsening was found in 177 (57.1%) patients, stable course in 96 (31%) patients, and improvement in 37 (11.9%) patients. The use of scalp contact masks and double masks and daily mask duration were higher in the worsening group (p:0.005, p:0.005 and p:0.001). In addition, the frequency of personal disinfectant use was higher in this group (p:0.011). In regression analysis, mask type, daily mask duration, presence of allodynia, being a health worker, depression score, and odor were determined as independent risk factors for migraine worsening. We found a worsening of migraines in more than half of patients during the COVID-19 pandemic. We also demonstrated a relationship between migraine worsening and mask type, number of masks, and intensive disinfectant use. Migraine patients should be advised of optimal prevention methods based on individual social and working conditions rather than exaggerated preventative measures.
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COVID-19 , Desinfectantes , Trastornos Migrañosos , COVID-19/prevención & control , Humanos , Máscaras/efectos adversos , Trastornos Migrañosos/epidemiología , Trastornos Migrañosos/etiología , Trastornos Migrañosos/prevención & control , Pandemias/prevención & control , SARS-CoV-2RESUMEN
BACKGROUND: Acute ischemic stroke (AIS) is characterized as a neurological deficit owing to an acute focal damage to the brain by cerebral infarction. A collateral score is the most significant factor evaluating the prognosis of AIS, its relationship with demographic data, serum biochemical parameters, and clinical disability in this field. METHODS: We conducted a single-center retrospective study with 100 patients with AIS within the first 6 h of ischemic stroke. Data for consecutive AIS patients were collected from February 2019 to May 2020. The collateral score was assessed by using developed scoring systems defined by Maas et al. The correlations between collateral score and demographic data, biochemical parameters, NIHSS scores (National Institutes of Health Stroke Scale), mRS (modified Rankin scale) scores were recorded. RESULTS: The research was performed in 100 patients (median age, 71.55 ± 11.46 years), and there was a statistically significant difference between elevated erythrocyte distribution width (RDW) and Maas collateral score (insular cortex) (p = 0.024) and lymphocyte/ monocyte ratio (LMO) and Maas collateral (leptomeningeal) score (p = 0.025).
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Isquemia Encefálica , Accidente Cerebrovascular Isquémico , Accidente Cerebrovascular , Humanos , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Infarto de la Arteria Cerebral Media , Circulación Colateral , Estudios Retrospectivos , Pronóstico , Resultado del TratamientoRESUMEN
OBJECTIVES: Headache is the most common complaint in cerebral venous sinus thrombosis (CVST) and it may sometimes be the only symptom in these patients. This retrospective and prospective study was an investigation of any differences in terms of clinical risk factors, radiological findings, or prognosis in patients with CVST who presented with isolated headache (IH) and cases with other concomitant findings (non-isolated headache [NIH]). METHODS: A total of 1144 patients from a multicenter study of cerebral venous sinus thrombosis (VENOST study) were enrolled in this research. The demographic, biochemical, clinical, and radiological aspects of 287 IH cases and 857 NIH cases were compared. RESULTS: There were twice as many women as men in the study group. In the IH group, when gender distribution was evaluated by age group, no statistically significant difference was found. The onset of headache was frequently subacute and chronic in the IH group, but an acute onset was more common in the NIH group. Other neurological findings were observed in 29% of the IH group during follow-up. A previous history of deep, cerebral, or other venous thromboembolism was less common in the IH group than in the NIH group. Transverse sinus involvement was greater in the IH group, whereas sagittal sinus involvement was greater in the NIH group. The presence of a plasminogen activator inhibitor (PAI) mutation was significantly greater in the IH group. CONCLUSION: IH and CVST should be kept in mind if a patient has subacute or chronic headache. PAI, which has an important role in thrombolytic events, may be a risk factor in CVST. Detailed hematological investigations should be considered. Additional studies are needed.
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Trombosis de los Senos Intracraneales , Trombosis , Femenino , Cefalea/etiología , Humanos , Masculino , Estudios Prospectivos , Estudios Retrospectivos , Trombosis de los Senos Intracraneales/complicaciones , Trombosis de los Senos Intracraneales/diagnóstico por imagenRESUMEN
During the early phase of the COVID-19 pandemic, it was thought that virus affects only the respiratory system. However, now it is clear that it can affect other systems too, particularly the nervous system. We aimed to identify the most common neurological symptoms and findings of COVID-19 in hospitalized patients and investigate the relationship between these symptoms and clinical, radiological, and laboratory findings. A total of 307 patients, including 125 women and 182 men, were included in the study. They were classified as "confirmed cases" or "probable cases" based on confirmatory tests, including polymerase chain reaction testing of a nasopharyngeal sample or validated antibody test. All medical records, including medical history, clinical course, laboratory data, and radiographic studies, were evaluated by two expert neurologists. Altered mental status (AMS) is the most common neurological finding in both confirmed (68.1%) and probable cases (71.8%). Pre-existing neurological diseases were detected as an independent risk factor for AMS. The mortality rate of patients with AMS was dramatically higher than normal mental status in both confirmed (43.9% vs. 6.2%) and probable cases (47.3% vs. 6.9%) (for both p:0.001). The frequency of seizure attacks was 13.2% in confirmed and 17.5% in probable cases (p:0.321). The mortality rate was higher in patients with a seizure attack in both groups. We conclude that AMS was one of the most common neurological manifestations in this cohort of COVID-19 patients. The development of mental deterioration increases mortality dramatically. Also, the existence of seizure attacks was associated with a high mortality rate.
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COVID-19/complicaciones , Enfermedades del Sistema Nervioso/virología , Anciano , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades del Sistema Nervioso/epidemiología , SARS-CoV-2 , Centros de Atención Terciaria , Turquía/epidemiologíaRESUMEN
INTRODUCTION: Cerebral venous and sinus thrombosis (CVST) may lead to cerebral edema and increased intracranial pressure; besides, ischemic or hemorrhagic lesions may develop. Intracerebral hemorrhages occur in approximately one-third of CVST patients. We assessed and compared the findings of the cerebral hemorrhage (CH) group and the CVST group. MATERIALS AND METHODS: In the VENOST study, medical records of 1,193 patients with CVST, aged over 18 years, were obtained from 35 national stroke centers. Demographic characteristics, clinical symptoms, signs at the admission, radiological findings, etiologic factors, acute and maintenance treatment, and outcome results were reported. The number of involved sinuses or veins, localizations of thrombus, and lesions on CT and MRI scans were recorded. RESULTS: CH was detected in the brain imaging of 241 (21.1%) patients, as hemorrhagic infarction in 198 patients and intracerebral hemorrhage in 43 patients. Gynecologic causes comprised the largest percentage (41.7%) of etiology and risk factors in the CVST group. In the CH group, headache associated with other neurological symptoms was more frequent. These neurological symptoms were epileptic seizures (46.9%), nausea and/or vomiting (36.5%), altered consciousness (36.5%), and focal neurological deficits (33.6%). mRS was ≥3 in 23.1% of the patients in the CH group. DISCUSSION AND CONCLUSION: CVST, an important cause of stroke in the young, should be monitored closely if the patients have additional symptoms of headache, multiple sinus involvement, and CH. Older age and parenchymal lesion, either hemorrhagic infarction or intracerebral hemorrhage, imply poor outcome.
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Hemorragia Cerebral/epidemiología , Hemorragia Cerebral/etiología , Trombosis de los Senos Intracraneales/complicaciones , Trombosis de los Senos Intracraneales/diagnóstico , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Adulto JovenRESUMEN
BACKGROUND: Early diagnosis of cerebral venous sinus thrombosis (CVST) associated with reproductive health-related risk factors (RHRF) including pregnancy, puerperium, and oral contraceptive (OC) use can prevent severe neurological sequelae; thus, the symptoms must be documented in detail for each group. METHODS: Out of 1144 patients with CVST, a total of 777 women were enrolled from a multicenter for the study of cerebral venous sinus thrombosis (VENOST). Demographic, biochemical, clinical, and radiological aspects were compared for 324 cases with RHRF and 453 cases without RHRF. RESULTS: The mean age of the RHRF (-) group (43.2 ± 13 years) was significantly higher than of the RHRF (+) group (34 ± 9 years). A previous history of deep venous thrombosis (3%), isolated cavernous sinus involvement (1%), cranial neuropathy (13%), comorbid malignancy (7%), and its disability scores after 12 months (9%) were significantly higher in the RHRF (-) group. The RHRF (+) group consisted of 44% cases of puerperium, 33% cases of OC users and 23% of pregnant women. The mean age was found to be higher in OC users (38 ± 9 years). A previous history of deep venous thrombosis was slightly higher in the pregnancy subgroup (4%). Epileptic seizures were more common in the puerperium group (44%). CONCLUSION: The results of our study indicate that the risk of CSVT increases parallel to age, OC use, and puerperium period. In addition, when considering the frequency of findings and symptoms, epileptic seizures in the puerperium subgroup of the RHRF (+) group and malignancies in the RHRF (-) group may accompany the CSVT. In daily practice, predicting these risks for the CSVT and early recognition of the symptoms will provide significant benefits to patients.
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PURPOSE: The aim of this study is to evaluate the presence and prognostic impact of early seizures in cerebral venous sinus thrombosis patients (CVST). METHOD: VENOST is a retrospective and prospective national multicenter observational study. CVST patients with or without epileptic seizures (ES) were analyzed and compared in terms of demographic and imaging data, causative factors, clinical variables, and prognosis in a total of 1126 patients. RESULTS: The mean age of the patients in the ES group was 39.73 ± 12.64 and 40.17 ± 14.02 years in the non-ES group (p > 0.05). Epileptic seizures were more common (76.6 %) in females (p < 0.001). Early ES occurred in 269 of 1126 patients (23.9 %). Epileptic seizures mainly presented in the acute phase (71.4 %) of the disease (p < 0.001). Majority of these (60.5 %) were in the first 24 h of the CVST. The most common neurological signs were focal neurologic deficits (29.9 %) and altered consciousness (31.4 %) in the ES group. Superior sagittal sinus (SSS) and cortical veins (CV) involvement were the most common sites of thrombosis and the mostly related etiology were found puerperium in seizure group (30.3 % vs 13.9 %). Patients with seizures had worse outcome in the first month of the disease (p < 0.001) but these did not have any influence thereafter. CONCLUSIONS: In this largest CVST cohort (VENOST) reported female sex, presence of focal neurological deficits and altered consciousness, thrombosis of the SSS and CVs, hemorrhagic infarction were risk factors for ES occurrence in patients with CVST.
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Hemorragia Cerebral/fisiopatología , Infarto Cerebral/fisiopatología , Trastornos de la Conciencia/fisiopatología , Epilepsia/fisiopatología , Convulsiones/fisiopatología , Trombosis de los Senos Intracraneales/fisiopatología , Adulto , Hemorragia Cerebral/etiología , Infarto Cerebral/etiología , Trastornos de la Conciencia/etiología , Epilepsia/etiología , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Estudios Retrospectivos , Convulsiones/etiología , Trombosis de los Senos Intracraneales/complicacionesRESUMEN
BACKGROUND: Parkinson's disease is associated with impaired ability to recognize emotional facial expressions. In addition to a visual processing disorder, a visual recognition disorder may be involved in these patients. Pareidolia is a type of complex visual illusion that permits the interpretation of a vague stimulus as something known to the observer. Parkinson's patients experience pareidolic illusions. N170 and N250 waveforms are two event-related potentials (ERPs) involved in emotional facial expression recognition. OBJECTIVE: In this study, we investigated how Parkinson's patients process face and face-pareidolia stimuli at the neural level using N170, vertex positive potential (VPP), and N250 components of event-related potentials. METHODS: To examine the response of face and face-pareidolia processing in Parkinson's patients, we measured the N170, VPP, and N250 components of the event-related brain potentials in a group of 21 participants with Parkinson's disease and 26 control participants. RESULTS: We found that the latencies of N170 and VPP responses to both face and face-pareidolia stimuli were increased along with their amplitudes, and the amplitude of N250 responses decreased in Parkinson's patients compared to the control group. In both control and Parkinson's patients, face stimuli generated greater ERP amplitude and shorter latency in responses than did face-pareidolia stimuli. CONCLUSION: The results of our study showed that ERPs associated with face and also face-pareidolia stimuli processing are changed in early-stage neurophysiological activity in the temporoparietal cortex of Parkinson's patients.
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Migraine is a multifactorial brain disorder characterized by recurrent disabling headache attacks. One of the possible mechanisms in the pathogenesis of migraine may be a decrease in inhibitory cortical stimuli in the primary visual cortex attributable to cortical hyperexcitability. The aim of this study was to investigate the neural correlates underlying face and face pareidolia processing in terms of the event-related potential (ERP) components, N170, vertex positive potential (VPP), and N250, in patients with migraine. In total, 40 patients with migraine without aura, 23 patients with migraine and aura, and 30 healthy controls were enrolled. We recorded ERPs during the presentation of face and face pareidolia images. N170, VPP, and N250 mean amplitudes and latencies were examined. N170 was significantly greater in patients with migraine with aura than in healthy controls. VPP amplitude was significantly greater in patients with migraine without aura than in healthy controls. The face stimuli evoked significantly earlier VPP responses to faces (168.7 ms, SE = 1.46) than pareidolias (173.4 ms, SE = 1.41) in patients with migraine with aura. We did not find a significant difference between N250 amplitude for face and face pareidolia processing. A significant difference was observed between the groups for pareidolia in terms of N170 [F(2,86) = 14,75, P < 0.001] and VPP [F(2,86) = 16.43, P < 0.001] amplitudes. Early ERPs are a valuable tool to study the neural processing of face processing in patients with migraine to demonstrate visual cortical hyperexcitability.NEW & NOTEWORTHY Event-related potentials (ERPs) are important for understanding face and face pareidolia processing in patients with migraine. N170, vertex positive potential (VPP), and N250 ERPs were investigated. N170 was revealed as a potential component of cortical excitability for face and face pareidolia processing in patients with migraine.
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Potenciales Evocados/fisiología , Trastornos Migrañosos/fisiopatología , Reconocimiento Visual de Modelos/fisiología , Adulto , Electroencefalografía , Reconocimiento Facial/fisiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
AIM: Systemic lupus erythematosus (SLE) is an unusual risk factor for cerebral venous sinus thrombosis (CVST). As few CVST patients with SLE have been reported, little is known regarding its frequency as an underlying etiology, clinical characteristics, or long-term outcome. We evaluated a large cohort of CVST patients with SLE in a multicenter study of cerebral venous thrombosis, the VENOST study, and their clinical characteristics. MATERIAL AND METHOD: Among the 1144 CVST patients in the VENOST cohort, patients diagnosed with SLE were studied. Their demographic and clinical characteristics, etiological risk factors, venous involvement status, and outcomes were recorded. RESULTS: In total, 15 (1.31%) of 1144 CVST patients had SLE. The mean age of these patients was 39.9 ± 12.1 years and 13 (86.7%) were female. Presenting symptoms included headache (73.3%), visual field defects (40.0%), and altered consciousness (26.7%). The main sinuses involved were the transverse (60.0%), sagittal (40.0%), and sigmoid (20.0%) sinuses. Parenchymal involvement was not seen in 73.3% of the patients. On the modified Rankin scale, 92.9% of the patients scored 0-1 at the 1-month follow-up and 90.9% scored 0-1 at the 1-year follow-up. CONCLUSIONS: SLE was found in 1.31% of the CVST patients, most frequently in young women. Headache was the most common symptom and the CVST onset was chronic in the majority of cases. The patient outcomes were favorable. CVST should be suspected in SLE patients, even in those with isolated chronic headache symptoms with or without other neurological findings.
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Lupus Eritematoso Sistémico/epidemiología , Trombosis de los Senos Intracraneales/epidemiología , Adulto , Distribución por Edad , Trastornos de la Conciencia/diagnóstico , Trastornos de la Conciencia/epidemiología , Femenino , Trastornos de Cefalalgia/diagnóstico , Trastornos de Cefalalgia/epidemiología , Humanos , Lupus Eritematoso Sistémico/diagnóstico , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Estudios Retrospectivos , Factores de Riesgo , Distribución por Sexo , Trombosis de los Senos Intracraneales/diagnóstico , Factores de Tiempo , Turquía/epidemiología , Trastornos de la Visión/diagnóstico , Trastornos de la Visión/epidemiologíaRESUMEN
The presence of brachial diplegia despite the normal muscular strength of the lower extremities is called the man-in-the-barrel syndrome (MIBS). Although this rare syndrome often occurs due to the bilateral supratentorial brain lesions, it may also rarely occur as a result of infratentorial causes. In this report, we describe a case presenting with MIBS of which etiological underlying cause was bilateral brachial plexopathy developed secondarily to recurrent microtrauma. A 51-year-old male patient presented to our clinic with complaints of pain and weakness on both arms. After electrodiagnostic examination, bilateral brachial plexopathy was identified. The findings of the patient improved following methylprednisolone therapy. It is very important to determine the treatable causes of this syndrome at an early stage.
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Neuropatías del Plexo Braquial/etiología , Plexo Braquial/lesiones , Microtraumatismos Físicos/complicaciones , Traumatismos Ocupacionales/complicaciones , Potenciales de Acción , Antiinflamatorios/uso terapéutico , Neuropatías del Plexo Braquial/diagnóstico , Neuropatías del Plexo Braquial/tratamiento farmacológico , Electromiografía , Humanos , Masculino , Metilprednisolona/uso terapéutico , Persona de Mediana Edad , Conducción Nerviosa , SíndromeRESUMEN
OBJECTIVE: This study was performed to determine the rate of cerebral venous sinus thrombosis (CVST) among cases of Behçet's disease (BD) included in a multicentre study of cerebral venous sinus thrombosis (VENOST). METHODS: VENOST was a retrospective and prospective national multicentre observational study that included 1144 patients with CVST. The patients were classified according to aetiologic factors, time of CVST symptom onset, sinus involvement, treatment approach and prognosis. RESULTS: BD was shown to be a causative factor of CVST in 108 (9.4%) of 1144 patients. The mean age of patients in the BD group was 35.27 years and 68.5% were men, whereas in the non-BD CVST group, the mean age was 40.57 years and 28.3% were men (P < 0.001). Among the aetiologic factors for patients aged 18-36 years, BD was predominant for men, and puerperium was predominant for women. The onset of symptoms in the BD group was consistent with the subacute form. The transverse sinuses were the most common sites of thrombosis, followed by the superior sagittal sinuses. The most common symptom was headache (96.2%), followed by visual field defects (38%). CONCLUSIONS: BD was found in 9.4% of patients in our VENOST series. Patients with BD were younger and showed a male predominance. The functional outcome of CVST in patients with BD was good; only 12% of patients presenting with cranial nerve involvement and altered consciousness at the beginning had a poor outcome (modified Rankin Score ⩾2).
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Síndrome de Behçet/complicaciones , Trombosis de los Senos Intracraneales/etiología , Adulto , Factores de Edad , Síndrome de Behçet/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Trombosis de los Senos Intracraneales/patologíaRESUMEN
OBJECTIVE: The objective of this study is to examine thiol-disulphide homeostasis in patients with polyneuropathy dominated by diabetic or non-diabetic axonal degeneration. MATERIALS-METHODS: Fifty-four patients diagnosed with polyneuropathy dominated by axonal damage and 41 healthy subjects were included in the study. The patients were grouped into two groups according to whether or not they had diabetes. The native thiol and total thiol concentrations were measured with the newly developed automated method. RESULTS: While there was no significant difference between the patients with diabetic and non-diabetic polyneuropathy in terms of native thiol and total thiol levels (p > 0.05), the native thiol and total thiol levels of the groups with both diabetic polyneuropathy and non-diabetic polyneuropathy were significantly low compared to the control group (p < 0.01). The level of disulphides in the patients with diabetic polyneuropathy was significantly higher than that of the patients with non-diabetic polyneuropathy and the healthy individuals (p < 0.05). The loss in the sural nerve sensory neural action potential amplitude was positively correlated with the decrease in the levels of both native thiol and total thiol (p < 0.05). DISCUSSION: In our study, we observed that the thiol-disulphide balance was also impaired in patients with non-diabetic polyneuropathy similar to patients with diabetic polyneuropathy, and we therefore considered that impaired the thiol-disulphide homeostasis could be the last common path in patients with polyneuropathy with axonal damage, regardless of the aetiology. Therefore, fortification of thiol deficiency with N-acetyl cysteine or alpha-lipoic acid can fix the thiol-disulphide balance and help decelerate the axonal damage.
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Disulfuros/metabolismo , Homeostasis/fisiología , Polineuropatías/metabolismo , Polineuropatías/fisiopatología , Compuestos de Sulfhidrilo/metabolismo , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Conducción Nerviosa/fisiología , Estudios Prospectivos , Estadísticas no ParamétricasRESUMEN
BACKGROUND: Platelet to lymphocyte ratio (PLR) and neutrophil to lymphocyte ratio (NLR) as recently emerging thrombo-inflammatory indicators were significantly associated with both major cerebrovascular/cardiovascular adverse events (MACE) and mortality. Therefore, we aimed to assess the effects of combinations of PLR and NLR in predicting the presence of CVST and in-hospital MACE. METHODS: A total of 277 participants comprising 80 patients with evidence of CVST and 197 controls with similar baseline characteristics were included in this retrospective study. Patients were classified into 3 groups based on the optimal cut-off values of PLR and NLR calculated with receiver operating characteristic (ROC) curve for in-hospital MACE rates. RESULTS: PLR (148±61 vs 101±50, p<0.001) and NLR (3.12±1.4 vs 1.94±1.1, p<0.001) were significantly higher in the CVST group. Furthermore, patients in the high risk group (a PLR of ≥115.0 and an NLR of ≥2.1) had the highest in-hospital MACE rates including seizure (p=0.012), papilledema (p=0.025) and diplopia or blurry vision (p=0.028). After multivariate logistic regression analysis MPV, PLR (1.052 [1.045-1.059], p=0.001) and NLR (1.442 [1.086-1.916], p=0.012) were found as independent predictors of CVST. CONCLUSION: These results suggest that PLR and NLR are easily available and cheap thrombo-inflammatory indicators, so that PLR and NLR could be used in prediction of CVST and in-hospital MACE.
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Plaquetas/patología , Linfocitos/patología , Neutrófilos/patología , Trombosis de los Senos Intracraneales/diagnóstico , Trombosis de los Senos Intracraneales/patología , Adulto , Anciano , Femenino , Humanos , Recuento de Leucocitos , Recuento de Linfocitos , Masculino , Persona de Mediana Edad , Recuento de Plaquetas , Valor Predictivo de las Pruebas , Curva ROC , Estudios RetrospectivosRESUMEN
BACKGROUND: Based on a number of small observational studies, cerebral venous sinus thrombosis has diverse clinical and imaging features, risk factors, and variable outcome. In a large, multicenter cerebral venous thrombosis (VENOST) study, we sought to more precisely characterize the clinical characteristics of Caucasian patients. METHODS: All data for the VENOST study were collected between the years 2000 and 2015 from the clinical follow-up files. Clinical and radiological characteristics, risk factors, and outcomes were compared in terms of age and sex distribution. RESULTS: Among 1144 patients 68% were women, and in older age group (>50 years) male patients were more prevalent (16.6% versus 27.8%). The most frequent symptoms were headache (89.4%) and visual field defects (28.9%) in men, and headache (86.1%) and epileptic seizures (26.8%) in women. Gynecological factors comprised the largest group in women, in particular puerperium (18.3%). Prothrombotic conditions (26.4%), mainly methylenetetrahydrofolate reductase mutation (6.3%) and Factor V Leiden mutation (5.1%), were the most common etiologies in both genders. 8.1% of patients had infection-associated and 5.2% had malignancy-related etiology that was significantly higher in men and older age group. Parenchymal involvement constitutively hemorrhagic infarcts, malignancy, and older age was associated with higher Rankin score. Epileptic seizures had no effect on prognosis. CONCLUSIONS: Clinical and radiological findings were consistent with previous larger studies but predisposing factors were different with a higher incidence of puerperium. Oral contraceptive use was not a prevalent risk factor in our cohort. Malignancy, older age, and hemorrhagic infarcts had worse outcome.