Guillain Barre Syndrome: A Single Center Experience.

OBJECTIVES: To investigate the clinical, electrophysiological and epidemiological features of the patients who were diagnosed as Guillain Barre Syndrome (GBS) in our clinic. METHODS: The clinical and demographical properties of 30 patients with GBS who were hospitalized in our neurology clinic between March 2013 and August 2017 were retrospectively examined in this study. Patients were divided into two groups according to the requirement of stay in the intensive care unit (ICU). RESULTS: Patients were between 18-71 years range with 46.9 and 19.61 mean age. Seven of 30 patients (23.3%) were female, and 23 of them (76.7%) were male. Males were more dominant in the ICU (-) group (81% and 62%). A recent infection was found in 86.7% of patients. Upper respiratory tract infection (URTI) was more common in ICU (+) group whereas lower respiratory tract infection (LRTI) and acute gastroenteritis (AGE) were more common in the ICU (-) patients (p=0.007). Lower limb weakness was more frequent in the ICU (+) group (p=0.011). ICU (+) patients were lack of diplopia and dysarthria. Ataxia and dysphagia were relatively frequent in the ICU (+) group. Electrophysiological examinations revealed demyelinating polyneuropathy (26.7%), acute axonal polyneuropathy (30.1%) and acute sensorial polyneuropathy (13.3%). Demyelinating polyneuropathy was more common in the ICU (-) group, whereas acute motor and sensorial polyneuropathy (AMSAN) was more frequent in the ICU (+) group. In this study, 26.7 % of study patients required mechanical ventilation, and mortality rate was 6.8 %. CONCLUSION: URTI in ICU (+), LRTI and AGE in ICU (-) patients might be major trigger factors of GBS. Ascending weakness, dysphagia and ataxia was more frequent in ICU (+) GBS patients. Demyelinating PNP was predominant in the ICU (-) group, whereas AMSAN was more frequent in the ICU (+) patients. Multicenter randomized studies would be more useful for highlining the epidemiology of GBS.

Electrodiagnosis of ulnar nerve entrapment at the elbow.

OBJECTIVE: To evaluate the different localizing electrodiagnostic techniques of ulnar nerve entrapment at the elbow (UNE), particularly, comparison of the sensitivities of long segment stimulation across the elbow, versus short segment stimulation. METHODS: Patients who were referred to the Neurophysiology Laboratory of Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey between 2000-2004 with a preliminary diagnosis of UNE were retrospectively evaluated. We compared the sensitivity of studying long segments (8-12 cm) versus short segments (3 cm) for the diagnosis of UNE in 93 limbs. RESULTS: The study group consisted of 55 females and 31 males. Slowing of the conduction velocity (<50 m/sn) across the elbow was recorded in 48.4% of the limbs with long segment studies, and 73% of the limbs with short segment studies. In 82% of cases, an amplitude drop of the compound muscle action potential (CMAP) was also recorded. A CMAP amplitude drop of 10-30% between the wrist and elbow was recorded in 35 limbs (37.6%), while a drop of more than 50% was only recorded in 5 limbs (5.4%). CONCLUSION: Short segment studies are sensitive for the electrodiagnosis of UNE, and although a CMAP amplitude drop is recorded in most patients, an amplitude drop consistent with a conduction block (>50%) is rare.

Does prior aspirin use reduce stroke mortality?

BACKGROUND: Millions of people around the world regularly consume aspirin, but its value in determining stroke severity is still not clear. It has been stated that prior aspirin use might reduce the severity of ischemic stroke by reducing the size of fibrin-platelet emboli or by ameliorating platelet hyperaggregability that occurs in the microcirculation. However there are only few large studies focusing on the early outcome of stroke patients including both ischemic stroke and primary intracerebral hemorrhage patients with prior aspirin therapy. REVIEW SUMMARY: We retrospectively analyzed the medical records of 2509 consecutive stroke patients who were hospitalized in the 2nd Neurology Clinic of Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey, during the period of 1993-2003. We compared the early mortality rates in the patients with prior aspirin use versus the patients without. Of the patients without prior aspirin use, 20.1% died during the first 3 weeks of the stroke, while only 11.5% of the patients with prior aspirin use died during the same period. The difference in early mortality rate between 2 groups was extremely significant (P = 0.0008). Logistic regression analysis indicated that aspirin use was a significant (P < 0.01) and independent predictor of early stroke mortality. CONCLUSION: Daily low dose (100-300 mg) aspirin has a protective effect in reducing the risk of early death in stroke.

PON1 55/192 polymorphism, oxidative stress, type, prognosis and severity of stroke.

We investigated the association of PON1 55/192 polymorphisms with type, severity and prognosis of stroke and oxidative markers. Paraoxonase1 (PON1), Glutathione Reductase (GSH-Rd) and Malondialdehyde (MDA) levels were measured at day 1 and at day 5 following the onset of stroke. Genotypes were determined by polymerase chain reaction and restriction digestion. The frequencies of QQ and MM genotypes of PON1 192 and PON1 55, respectively, were significantly higher in controls than in patients. However, the allele frequencies of PON1 192 R and PON1 55 L were significantly more frequent in patients compared to controls. The frequency of combined genotype of RR/LL was significantly higher in cardioembolic group than in atherothrombotic group. PON1 activities were significantly diminished in stroke patients compared to controls. In contrast, serum MDA levels were significantly greater in patients than the values in controls. GSH-Rd activity was higher in patients with small lesion and good prognosis than those with large and poor prognosis. Low density lipoprotein (LDL) levels in patients with large lesions were higher than those with small lesions. PON1 55/192 polymorphisms influence activity of the enzyme. PON1 55/192 genotypes have been associated with MDA levels. In conclusion, PON1 genetic variations are associated with risk factors, severity, type and prognosis of stroke and oxidative stress.