The functional role of the pulvinar in discriminating between objective and subjective cognitive impairment in major depressive disorder.

INTRODUCTION: Emotionally driven cognitive complaints represent a major diagnostic challenge for clinicians and indicate the importance of objective confirmation of the accuracy of depressive patients' descriptions of their cognitive symptoms. METHODS: We compared cognitive status and structural and functional brain connectivity changes in the pulvinar and hippocampus between patients with total depression and healthy controls. The depressive group was also classified as "amnestic" or "nonamnestic," based on the members' subjective reports concerning their forgetfulness. We then sought to determine whether these patients would differ in terms of objective neuroimaging and cognitive findings. RESULTS: The right pulvinar exhibited altered connectivity in individuals with depression with objective cognitive impairment, a finding which was not apparent in depressive patients with subjective cognitive impairment. DISCUSSION: The pulvinar may play a role in depression-related cognitive impairments. Connectivity network changes may differ between objective and subjective cognitive impairment in depression and may play a role in the increased risk of dementia in patients with depression.

Prognostic Factors For Functional Outcome in Patients with Mesencephalic Hemorrhage.

Introduction: Mesencephalic hemorrhage (MH) is a rare presentation of spontaneous intraparenchymal hemorrhage. This study aims to evaluate prognostic parameters of the MH outcome. Methods: We conducted an extensive search in the literature for cases with spontaneous, isolated mesencephalic hemorrhage. The study was conducted according to the statement of Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Sixty-two eligible cases have been reported in the literature as proven by CT or MRI, and to these, we added six cases confirmed by MRI. The modified Rankin Scale (mRS) was dichotomized into two groups as the favorable outcome (FO; score, 0-2) and unfavorable outcome (UO; score, 3-6). Results: Of the 68 patients studied, 26 (38%) presented with normal consciousness, 22 (32%) with lethargy , and 20 (29%) with stupor or coma. There was no cause of hemorrhage in 26 (65%) patients with FO and 12 (43%) with UO (p=0.059). In univariate analyses, neither arteriovenous malformations (p=0.33) nor cavernomas (p=0.19) were associated with outcome. Multiple logistic regression analysis revealed that hypertension (OR, 51.22; CI95%, 1.92-1370.24; P=0.019), consciousness (OR, 133.54; CI95%, 1.61-1113.3; P=0.03), NIHSS at admission (OR, 57.23; CI95%, 2.87-1141.2; p=0.008), and ventrodorsal hemorrhage size (≥1 cm) (OR, 61.83; CI95%, 2.15-1779.2; p=0.016) were significantly associated with UO. Three months after stroke, 40 patients (59%) had FO, 28 (41%) had UO, and 8 (12%) died. Conclusion: These results suggest that ventrodorsal size of hemorrhage and clinical severity at stroke onset are possible predictors of functional outcome after mesencephalic hemorrhage.

Evaluation of Temperament and Character Traits and Their Subscale Dimensions Associated with Major Depressive Disorder.

Objectives: The relationship between major depressive disorder (MDD) and, especially harm avoidance, self-directedness, and cooperativeness has been determined based on Cloninger's psychobiological personality model; there are not enough studies in the literature on the role of the subdimensions. Therefore, the aim of this study was to compare the patients with MDD and healthy controls in terms of temperament and character traits and especially subdimensions and thus to determine the role and predictive value of temperament and character subdimensions in major depression patients. Methods: The sample of this cross-sectional study consisted of 105 participants, 65 of whom were MDD patients, and 40 healthy controls, who voluntarily agreed to participate in the study. Sociodemographic data form, temperament and character inventory, and Hamilton depression rating scale were administered to the participants. Results: Compared with healthy controls, patients with MDD had lower self-directedness (p<0.001), cooperativeness (p=0.017), persistence (p<0.001), self-transcendence (p=0.001), and higher harm avoidance (p<0.001) scores. While there was no significant difference in novelty seeking (p=0.774); it was determined that MDD patients got higher scores in "Impulsiveness" (p=0.013) and lower scores in "Exploratory excitability" (p=0.001) subscales. Reward dependence has been identified as the only personality trait that there was no significant difference between major depression patients and healthy controls (p=0.511). As a result of the logistic regression analysis performed to determine the predictors of temperament and character subdimensions in major depression patients, only three temperament and character traits "Fatigability, Purposefulness, and Spiritual Acceptance" were determined as significant predictors (p<0.001). Fatigability was determined to be a serious risk factor, increasing the probability of MDD 3.6 times (p<0.001); purposefulness and spiritual acceptance were found to be protective personality traits that together reduced the probability of MDD by 0.8 times (p<0.001). Conclusion: This study shows that the risk of developing MDD is increased in individuals with low self-directedness, cooperativeness, persistence, and self-transcendence profiles, and whereas with prominent Harm avoidance personality traits. Therapeutic interventions, especially considering the temperament and character traits of "Fatigability, Purposefulness, and Spiritual Acceptance" determined in our study, may contribute positively to MDD treatment.

Evaluation of the effect of unilateral late blindness on the retina, optic nerve and choroid parameters in the sighted eye.

BACKGROUND: To investigate whether unilateral late blindness alters the peripapillary retinal nerve fiber layer (RNFL), ganglion cell complex (GCC), central macular thickness (CMT) and choroidal thickness (CT). METHODS: The 17 healthy eyes of 17 monocular patients with late blindness due to isolated eye trauma in one eye and the 19 eyes of 19 healthy individuals were evaluated in this retrospective study. Patients with at least 10 years of monocular blindness, a refractive error between + 1.5 and -1.5 D in the sighted eye, a best-corrected visual acuity of at least 20/20 and an axial length (AL) < 25 mm were included in the study. Following ophthalmologic examination, the RNFL, GCC, CMT and CT values were measured with spectral domain optic tomography (SD-OCT). Those with ocular, systemic or neurological disease that could influence the measured parameters were excluded from the study. RESULTS: A total of 17 (14 males, 3 females) monocular patients [mean age 41.00 ± 11.95 (24-64)] and 19 (16 males, 3 females) healthy individuals [mean age 39.79 ± 6.74 (30-56)], similar in age and gender (p = 0.949 and p = 0.881), were included in the study. The mean duration of being monocular was 22.76 ± 11.76 (10-49) years. No difference was present between the RNFL, GCC, CMT and CT measurements of the monocular patients and the healthy individuals (p = 0.692, p = 0.294, p = 0.113, p = 0.623, respectively). No significant correlation was found between the duration of monocularity and the retinal and optic nerve parameters. CONCLUSION: The results of our study indicate no difference in the optic nerve, retina and choroid OCT findings in the sighted eyes of subjects with long-term monocular blindness compared to subjects with bilateral normal eyes. Although functional and volumetric neuroimaging studies suggest the possibility of compensation in these patients, our findings indicate that this is not at the ocular level.

Topological network mechanisms of clinical response to antidepressant treatment in drug-naive major depressive disorder.

AIM: There is rapidly increasing evidence that remission of MDD is associated with substantial changes in functional brain connectivity. These New data have provided a holistic view on the mechanism of antidepressants on multiple levels that goes beyond their conventional effects on neurotransmitters. METHOD: The study was approved by the Local Ethics Committee of Istanbul Medipol University (10840098-604.01.01-E.65129) and followed the Helsinki Declaration principles. In our study, we have evaluated the effect of six weeks of treatment with antidepressants (escitalopram and duloxetine), and tested the underlying brain functional connectivity through a Graph analysis approach in a well-defined first-episode, drug-naive, and non-comorbid population with MDD. RESULTS: Beyond indicating that there was a significant correlation between the antidepressant response and topological characteristics of the brain, our results suggested that global rather than regional network alterations may be implicated in the antidepressant effect. CONCLUSION: Despite the small-sample size and non-controlled study design, our study provides important and relevant clinical data regarding the underlying mechanisms of the antidepressants on topological dynamics in the human brain.

A rare entity of acquired idiopathic generalised anhidrosis which has been successfully treated with pulse steroid therapy: Does the histopathology predict the treatment response?

Acquired idiopathic generalised anhidrosis is an uncommon sweating disorder characterized by loss of sweating in the absence of any neurologic, metabolic or sweat gland abnormalities. Although some possible immunological and structural mechanisms have been proposed for this rare entity, the definitive pathophysiology is still un-clear. Despite some successfully treated cases with systemic corticosteroid application, the dose and route of steroid application are controversial. Here, we present a 41-year-old man with lack of genera-lised sweating who has been successfully treated with high dose pulse intravenous prednisolone. We have discussed his clinical and histopathological findings as well as the treatment options in view of the current literature.

Paracetamol alters empathy scores in healthy and headache subjects: Functional MRI correlates.

INTRODUCTION: Although previous evidence suggest that paracetamol decreases psychological reactivity in healthy subjects, there is still no confirmed correlation between the empathy scores and brain activity in healthy and headache patients after paracetamol treatment. MATERIAL AND METHODS: The study group included 16 patients with tension-type headache, and 12 healthy age-and sex-matched controls. After a detailed neurological examination Positive and Negative Affect Schedule (PANAS) and Empathy for Pain Scale (EPS) were applied to all subjects. Next, 1000 mg paracetamol tablet was administered orally, after administration of paracetamol, EPS were repeated, and fMRI was performed to all subjects. RESULTS: We have revealed increased empathy scores in the headache group after the paracetamol treatment which were associated with significant alterations in brain regions which play a critical role in the processing of empathy. DISCUSSION: The observed neuroimaging and clinical difference between healthy and headache subjects could be related to the fact that pain perception in healthy subjects might differ in some aspects from the mechanisms of empathy in headache-experienced patients. CONCLUSION: To the best of our knowledge, this is the first study that evaluated the paracetamol treatment and neural networks' correlation with pain empathy in healthy and headache individuals.

The relationship between the degree of cognitive impairment and retinal nerve fiber layer thickness.

The goal of the present study is to investigate the relationship between the degree of cognitive impairment and retinal nerve fiber layer (RNFL) thickness which is measured by the optical coherence tomography (OCT). Thirty-five patients with Alzheimer's disease (AD), 35 patients with mild cognitive impairment (MCI), and 35 healthy volunteers, between the ages of 60-87, who were examined in the neurology outpatient clinic among 2012-2013 were prospectively involved in our study. Mini mental state examination (MMSE) test, montreal cognitive assessment (MOCA), and also neuropsychological test batteries were used for the neurocognitive evaluation. RNFL thickness was measured by the OCT technique and the differences among groups were studied. The relationship between RNFL thickness and MMSE scores with demographic characteristics was investigated. RNFL thickness was significantly lower in AD and MCI groups compared with the control group (p < 0.01). No significant differences of RNFL were found between the MCI and the AD groups (p > 0.05). Significant correlation was found between MMSE scores and the RNFL values (p < 0.05). Significant thinning in RNFL along with age was detected (p < 0.05). In our study, it is thought that retinal nerve fiber degeneration and central nervous system degeneration may be concurrent according to the thinning of RNFL measured by OCT in AD and MCI groups. RNFL measurement may also be useful for early diagnosis and evaluation of the disease progression. Further studies are needed to optimize the utility of this method as an ocular biomarker in AD.