Abducens Nerve Palsy in a Patient with COVID-19: A Case Report.

Numerous neurological manifestations associated with COVID-19 have been reported. However, abducens nerve palsy (ANP) associated with COVID-19 is very rare and mostly related to accompanying respiratory symptoms. Here we present a 29-year-old woman with unilateral ANP manifesting with diplopia and positive SARS-CoV-2 S antibodies, which were checked later. On admission, she had signs of viral pneumonia in thorax CT without any respiratory symptoms. Her cranial neuroimaging revealed no abnormality. Following treatment with favipiravir 2x1600 mg loading dose and then 2x600mg daily maintenance, dexamethasone 8 mg/day and enoxaparin 6000 IU/day, her CT findings recovered completely whereas her ANP only partially resolved. One week after the end of COVID-19 treatment, she also developed Herpes simplex keratitis which was successfully treated with valacyclovir. It should be kept in mind that isolated abducens nerve palsy may be the only finding of COVID-19 cases without any respiratory symptoms.

Idiopathic intracranial hypertension: Are there predictors for visual outcome or recurrences?

OBJECTIVE: To find out the predictors of final visual outcome and recurrences in idiopathic intracranial hypertension (IIH). PATIENTS AND METHODS: Medical records of 75 patients with IIH were analyzed retrospectively. Gender, age of disease onset (AODO), body mass index (BMI), lumbar puncture opening pressure (LP-OP), visual acuity (VA) in logMAR, optical disc appearance (ODA), visual field (VF) mean deviation (MD), treatment results and recurrence rates were considered. RESULTS: Mean age at onset age was 32.4 years, BMI was 311 kg/m² and median LP-OP was 380 mm H2O. All patients were treated with acetazolamide with a median dose of 1500 mg. The mean follow-up period was 44.8 months. AODO, BMI, LP-OP were not correlated with any of the examination parameters (VA, ODA, VF) at the first or last visit. The correlation between the VA and VF both at the first and last visit was not very powerful. VA of the last visit was fairly correlated with the VA of the first visit. However, the correlation between the last and first visit VF was very good. A very significant improvement in both VA and VF was recorded after treatment. Recurrences were noted in 23%. Demographic and clinical features of the recurring and non-recurring patients were not significantly different in terms of AODO, BMI, LP-OP, VA, VF or ODA. CONCLUSIONS: The patients with IIH respond to treatment with acetazolamide. First visit VF is the main determinant of the final visual outcome. Recurrences cannot be predicted by the demographic or clinical features at presentation.

Panayiotopoulos syndrome and symptomatic occipital lobe epilepsy of childhood: a clinical and EEG study.

AIM: Panayiotopoulos syndrome (PS) is an age-related seizure susceptibility syndrome that affects the central autonomic system. Although the majority of the few ictal recordings obtained so far suggest an occipital origin, semiological and interictal EEG data appear to favour more extensive involvement. In this study, the characteristics (including those based on semiology and EEG) of children with Panayiotopoulos syndrome (n=24) and those with lesion-related, symptomatic occipital lobe epilepsy (SOLE) (n=23) were compared. METHODS: Detailed semiological information and EEG parameters including the localisation, distribution, density (n/sec), reactivity, and morphological characteristics of spike-wave foci and their relationship with different states of vigilance were compared between the two groups. RESULTS: The age at seizure onset was significantly younger in patients with symptomatic occipital lobe epilepsy than in those with PS (mean age at onset: 3.4 versus 5.6 years, respectively; p=0.044). Autonomic seizures (p=0.001) and ictal syncope (p=0.055) were more frequent in PS than in symptomatic occipital lobe epilepsy (87.5% and 37.5% versus 43.5% and 13%, respectively). The interictal spike-wave activity increased significantly during non-rapid eye movement (non-REM) sleep in both groups. The spike waves in non-REM seen in PS tended to spread mainly to central and centro-temporal regions. CONCLUSIONS: The results indicate that although common features do exist, Panayiotopoulos syndrome differs from symptomatic occipital lobe epilepsy and has a unique low epileptogenic threshold related to particular brain circuits.

Hormone replacement therapy: relation to homocysteine and prooxidant-antioxidant status in healthy postmenopausal women.

OBJECTIVES: Studies have consistently shown a lower cardiovascular risk in women who received postmenopausal hormone replacement therapy (HRT). DESIGN AND METHODS: In this study, the effects of HRT were investigated on plasma total homocysteine (tHcy) and the oxidant-antioxidant status in postmenopausal women. 35 of postmenopausal receiving (2 mg estrodiol valerate + 1 mg cyproterone acetate) HRT group, the remaining 25 received orally placebo (NHRT group). RESULTS: There was no significant change in plasma tHcy levels between HRT and NHRT groups. Malondialdehyde (MDA) and total thiol (t-SH) correlated significantly with tHcy (0.388 and 0.478, respectively) content, and there was a significant negative correlation between E2 level and glutathione transferase (GST) activity (-0.425) in HRT group. Superoxide dismutase (SOD) and HDL-C correlated significantly with t-SH level (0.339 and 0.336, respectively) in plasma after HRT. CONCLUSION: Our results show that HRT is beneficial in the protection against oxidative damage, and prevents atherosclerotic complications.

The benefits of hormone replacement therapy on plasma and platelet antioxidant status and fatty acid composition in healthy postmenopausal women.

Oxidative stress is suggested to play an important role in the pathogenesis of cardiovascular disease (CVD). Various hormone replacement therapy (HRT) protocols are used to reduce the CVD risk in postmenopausal women. Recent studies found that HRT lowers lipid levels and improves vascular endothelial function in postmenopausal women. In this study the effects of HRT on plasma and platelet membrane fatty acid composition and the oxidant-antioxidant system in postmenopausal women are investigated. Blood samples were obtained from 50 postmenopausal women. Before starting treatment, all participants underwent clinical, biochemical and hormonal screening procedures including gynecologic and physical breast examination. Then oral HRT (2 mg estrodiol valerate + 1 mg cyproterone acetate) were given to all subjects for 1 year. Levels of malondialdehyde (MDA), total thiol (t-SH) and fatty acid contents, activities of glutathione-Stransferase (GST) and superoxide dismutase (SOD) were measured before and after treatment. Platelet membrane palmitic, stearic and oleic acid contents decreased (6.5%, 22.5% and 21.9% respectively) and linoleic and arachidonic acid contents increased (21.2% and 25.4% respectively) after HRT. Platelet MDA, GST and SOD levels were lower and t-SH content was higher than pre-treatment levels. These results indicate that hormone replacement therapy may affect platelet membrane fatty acid content and oxidant-antioxidant balance in postmenopausal women.