Evaluation of cognitive dysfunction by the clock drawing test in multiple sclerosis and clinically isolated syndrome patients: Correlation with other neuropsychological tests.

OBJECTIVES: To evaluate the cognitive status with a simple practical test, clock drawing test (CDT), in a larger multiple sclerosis (MS) patient group and in comparison, with controls. METHODS: We included 171 patients (17-65 years) with MS and clinically isolated syndrome (CIS) and 98 healthy controls who applied between date 2018-2020 years in Neurology Department of Pamukkale University. The CDTs were applied to all subjects. In addition, the cognitive functions of the patient group were evaluated with the neuropsychological test battery. RESULTS: The CDT scores were significantly lower in relapsing-remitting MS (RRMS) group than the control group (p<0.005). Progressive MS patients' CDT scores were significantly lower than RRMS and CIS (p<0.0001). According to our results, the CDT showed progressive deterioration in MS better than another practical and free tests. Additionally, the CDT scores were statistically better in patients whose disease began with sensory symptoms than whose disease started with motor and brainstem symptoms (p<0.0001). CONCLUSION: The CDT cognitive impairment prediction performance is 60%, CDT is a useful, easy-to-administer, practical test that can be used in cognitive assessment in MS and CIS.

Altered Expression of Long Non-coding RNAs in Peripheral Blood Mononuclear Cells of Patients with Alzheimer's Disease.

Long non-coding RNAs (lncRNAs) are involved in many neurological conditions, and neurodegenerative disorders including Alzheimer's disease (AD) regulate gene expression at transcriptional, post-transcriptional, and epigenetic levels. However, the roles of lncRNAs in the pathogenesis of AD remain unclear. In this study, we aimed to determine the expression of lncRNAs and also mRNAs in AD which may alter expression and contribute to the pathogenesis of the disease. Peripheral blood samples were obtained from patients admitted to the Neurology Department of Pamukkale University Medical Faculty (23 patients with AD, 33 control groups). Total RNA obtained from peripheral blood mononuclear cells (PBMC) of subjects with probable AD (n = 4) and healthy control groups (n = 4) was examined to determine the altered expression of lncRNAs and mRNAs in AD were evaluated by microarray analysis. Five lncRNAs with the highest end-to-end fold change (fc ≥ 2.0, p < 0.05) were identified and confirmed by quantitative real-time polymerase chain reaction (qRT-PCR). In our study, the profiles of lncRNAs and mRNAs that may be associated with Alzheimer's disease were determined. A total of 14 lncRNAs and 35 mRNAs were determined as upregulated, and 20 lncRNAs and 73 mRNAs determined as downregulated as a result of microarray analysis in patients with AD compared with control groups (fold change ≥ 2.0, p < 0.05). From lncRNAs, expression of lncRNA TTC39C-AS1, lnc-AL445989.1-2, LINC01420, lnc-CSTB-1, and LOC401557 was confirmed by qRT-PCR. When assessed by KEGG analysis of AD PBMC lncRNA and mRNA profiles, TNF signaling pathway, PI3K/AKT, Ras, and MAPK pathways; glutamatergic, dopaminergic, and cholinergic synapses; GABA, and neurotrophin signaling pathways are found to be significant. This is the first known study to investigate lncRNA profiles in AD PBMCs. We think that these results may open a door to the understanding of AD pathogenesis targeted by lncRNAs.

Cerebral hemodynamics in patients with cirrhosis.

BACKGROUND/AIMS: Cirrhosis causes a decrease in cerebral blood flow because of a hyperdynamic circulatory state. We aimed to study the cerebral hemodynamic parameters in patients with decompensated cirrhosis and their relationship to the Child-Pugh and Model for End-Stage Liver Disease (MELD) scores. MATERIALS AND METHODS: We used transcranial Doppler to investigate the cerebral hemodynamic parameters, namely the mean flow velocity of the middle cerebral artery, pulsatility index (PI), and resistive index (RI), in 50 patients who had decompensated cirrhosis and in a control group of 50 healthy people. We also investigated their relationship to the Child-Pugh and MELD scores. RESULTS: Patients with cirrhosis had a lower mean flow velocity than those in the control group. Further, patients with cirrhosis had higher PI and RI values. There was a positive correlation between PI and the Child-Pugh score. In addition, there was a positive correlation among PI, RI, and the MELD score. The RI values of patients with ascites were higher than those of patients without ascites. CONCLUSION: Cerebral autoregulation might be impaired in patients with cirrhosis. Cerebral resistance proportionally increases to disease severity. There was a positive correlation among PI, RI, and MELD scores, which means that transcranial Doppler might be useful not only in the follow-up of the severity of the disease but also in determining the survival of these patients.

Giovanni Battista Morgagni (1682-1771).

Giovanni Battista Morgagni (1682-1771) is considered the father of neuropathology and one of the most important innovators in the history of medicine. In his "opus magnum" De sedibus et causis morborum per anatomen indagatis (The Seats and causes of diseases investigated by anatomy), he established pathological anatomy as a science by correlating clinical histories with autopsy findings.

Prevalence of cerebrovascular disease: a door-to-door survey in West Anatolia.

The aim of this study was to demonstrate the prevalence of cerebrovascular disease (CVD), and its relation to age, education, gender, and other risk factors in the city of Denizli, Turkey. The study was performed between 2010 and 2011 in the city center, where 138,000 inhabitants >45 years were included in the research. 2,441 inhabitants were selected by cluster sampling method. A specific questionnaire about CVD was employed during the interview. We inquired about patient's age, gender, and educational history. If there was suspicion of CVD, cranial imaging was performed, and recent medical records were re-evaluated. The mean age was 58 ± 10.1 (45-100) among 2,441 in this study. Of those, 1,257 (51.5 %) participants were female and 1,184 (48.5 %) were male. We found the prevalence of CVD to be 0.9 % with 0.68 % among males and 1.21 % among females (p = 0.023). The mean age of subjects with CVD was 72.4 ± 8.1 (56-86) years. CVD was found to increase with age (p = 0.001), but was lower than reported rates in other European countries; however, it was similar to that of Mediterranean countries. CVD was detected more frequently in women than men. This finding differed from other studies, but was first to evaluate the prevalence of CVD in Turkey.

Peripheral neuropathy in chronic obstructive pulmonary disease.

The aim of this study was to evaluate the frequency and characteristics of peripheral nervous system involvement in chronic obstructive pulmonary disease and its relation with proinflammatory cytokines such as TNF-alpha, IL-6, IGF-1 and CRP. Forty chronic obstructive pulmonary disease patients with a mean age 62.8 +/- 5.5 years and 33 healthy controls with a mean age of 61.8 +/- 7.4 were included into this study. All subjects were evaluated with standard motor and sensory nerve conduction studies. Serum TNF-alpha, IL-6, CRP and IGF-1 were measured. The muscle strengths of three muscle groups (knee extensors, shoulder abductors and flexors) were assessed with a hand-held dynamometer. Peripheral neuropathy was detected at 15% of chronic obstructive pulmonary disease patients. Ulnar motor and sensory nerves, left sural nerve distal latencies were found significantly prolonged than healthy volunteers (p = 0.011), peroneal nerve conduction velocities was found lower in patients than in healthy controls (p = 0.021), tibial nerve amplitudes was found lower in patients than healthy controls (p = 0.046). CRP and TNF-alpha were found significantly higher in chronic obstructive pulmonary disease patients and IGF-1 was found significantly lower in chronic obstructive pulmonary disease patients. There was no correlations between proinflammatory cytokines, CRP and electrophysiological findings. Left sural nerve's sensory nerve action potential amplitude was correlated positively with FEV(1)% (r = 0.425; p = 0.009). Muscle strength at the shoulder and knee were significantly reduced in patients with COPD when compared with controls. The frequency of neuropathy was higher in chronic obstructive pulmonary disease when compared with the healthy controls. Chronic obstructive pulmonary disease patients have subclinical peripheral nerve involvements.

Intracranial calcifications on CT.

Computed tomography (CT) is very sensitive for detection and localization of intracranial calcifications. We reviewed in this pictorial essay the diseases associated with intracranial calcifications and emphasized the utility of CT for the differential diagnosis.

Bilateral symmetric junctional infarctions of the cerebellum: a case report.

The advances in neuroimaging have improved clinicoanatomic correlations in patients with stroke. Junctional infarct is a distinct term, used to describe border zone infarcts of the posterior fossa. We presented computed tomography (CT) and magnetic resonance imaging (MRI) findings in a rare case of bilateral symmetrical junctional infarcts between the superior cerebellar artery (SCA) and posterior inferior cerebellar artery (PICA) territories. In addition to precise knowledge of arterial territories required to achieve accurate localization of ischemic lesions on CT and MRI, the radiologist must also be aware of radiologic features and geographic territories of cerebellar arteries and their junctional infarctions.

Giant arachnoid granulation in a patient with benign intracranial hypertension (2009: 1b).

We report magnetic resonance (MR), computed tomography (CT) and angiographic imaging of an unusual giant arachnoid granulation 7(GAG) in the superior sagittal sinus in a man with headache and vertigo. Intrasinus pressure measurements revealed a significant pressure gradient across the lesion. MR imaging is useful to identify GAG and dural sinus thrombosis, whereas dural sinus pressure measurement in certain cases of GAGs can be used to evaluate the lesion as the cause of the patient's symptoms.

The relationship between electrodiagnostic severity and Washington Neuropathic Pain Scale in patients with carpal tunnel syndrome.

OBJECTIVES: We undertook this study to examine the relationships between clinical symptoms as evaluated by Washington Neuropathic Pain Scale (NPS) and electrodiagnostic classification in patients with carpal tunnel syndrome (CTS). METHODS: Eighty patients with unilateral CTS were included in this study. After diagnosis of CTS by electromyography, all patients completed a 10-item questionnaire (NPS). RESULTS: A statistically significant correlation between total NPS score and severity of CTS was found (p=0.013, r=0.276). CONCLUSION: The present study indicates that using NPS might be useful in evaluating the clinical outcome of patients with CTS.

Hypertrophy of intima media of the carotid artery due to L-dopa therapy in Parkinson's disease.

INTRODUCTION: Recent studies have shown that L-dopa therapy used in patients with Parkinson's disease might cause thickening of the carotid artery intima media. It is known that intima-media thickening is a sign of systemic atherosclerosis. The purpose of this study was to clarify the correlation between L-dopa medication and carotid artery intima-media thickness (IMT) in patients with Parkinson's disease. METHODS: Twenty-five patients with Parkinson's disease who used L-dopa (LD+) and 17 patients who did not use L-dopa (LD-) treatment were included in this study. Colour Doppler with B-mode carotid ultrasonography was performed. The Hoehn-Yahr scale was used for staging of Parkinson's disease in an 'on' state. The Student t test was used for statistical analysis. RESULTS: The IMT of the left internal carotid and external carotid arteries were found to be thicker in patients treated with L-dopa. The mean IMT of the left internal carotid artery was 0.937+/-0.391 mm in the LD+ group and 0.677+/-0.138 mm in the LD-group (P=0.013). The mean IMT of the left external carotid artery was 0.956+/-0.531 mm in the LD+ group and 0.646+/-0.18 mm in the LD-group (P=0.037). CONCLUSION: The IMT of the carotid artery was found to be thicker in patients who were treated with L-dopa. In conclusion, patients treated with L-dopa appear to be at a higher risk of thickening of the intima media of the carotid artery.

Cerebral lateral ventricular asymmetry on CT: how much asymmetry is representing pathology?

PURPOSE: The purpose of this study was to evaluate the association of asymmetric lateral ventricle (ALV) with clinical and structural pathologies and assess its clinical importance. MATERIALS AND METHODS: We analyzed 170 consecutive ALV cases on computed tomography (CT) and 170 control group patients with normal head CT. Patients who had apparent etiologic causes for ALV were excluded. The differential diagnosis of ALV and unilateral hydrocephalus (UH) was made by using three different ventricle-brain ratios (VBRs). The measurements of the ALV were made at the frontal horn level. Patients with asymmetry were divided into three subgroups including mild, moderate and severe groups to eloborate the grade of the ventricular asymmetry. Additional CT findings including septal deviation, diffuse enlargement, atrophy and the densities of constant sites were also recorded systematically for each patient. Clinical and handedness data were collected and analyzed. RESULTS: The prevalence of ALV in the study population was 6.1%. Headache was the most common reason for head CT examination and was significantly more common in the asymmetry group (61.7% in group A, 42.9% in group B, P = 0.001). Transient ischemic attack, focal neurologic findings, vertigo, ataxia, visual and hearing disturbances were similar in both groups (P > 0.5). There was no difference in smoking and alcohol habits in both patient groups. Ten (5.8%) patients in group A and 16 (9.4%) patients in group B had neuropsychiatric disorders, which did not achieve statistical significance. In group A patients, the larger ventricle was more common in the left side than in the right (left = 70.0%, right = 30.0%). Group A consisted of 57.0% mild (grade 1, n = 97), 26.5% moderate (grade II, n = 45) and 16.5% severe (grade III, n = 28) patients. There was no significant correlation between handedness and ALV. The density of different brain sites was found close similar on both sides in ALV and control group (P > 0.5). Choroidal cystic or solid neoplasm or periventricular dysplasia was detected in six ALV patients in group A (3.5%), on their additional MR examinations. CONCLUSION: The physician should not overlook an ALV finding on unenhanced CT, particularly in cases with severe degree of asymmetry or diffuse ventricular enlargement, and search for possible accompanying disorders.

Plasma cortisol levels in migraineurs between attacks.

We have studied the plasma cortisol levels between attacks in order to investigate the role of hypothalamic-pituitary-adrenal axis in migraine patients. We have not found any statistically significance between plasma cortisol levels of patients and control group, after taking the blood of 25 patients and 24 healthy controls between 8.30-9.30 am.

Involuntary movements associated with vitamin B12 deficiency.

Involuntary movements are not a known feature of vitamin B12 (vB12) deficiency in adults, though they are a characteristic feature of vB12 deficiency in infants. This case report presents an adult patient with vB12 deficiency in whom, myoclonus-like muscular contractions appeared soon after the initiation of vB12 and disappeared after the first week of this therapy. To our knowledge, this is the first report of involuntary movements in an adult patient with vB12 deficiency. Although the mechanism remains unknown, involuntary movements similar to myoclonus should be considered as one of the extraordinary neurological manifestations of vB12 deficiency in adults.