Assessment of Patients with Intracerebral Hemorrhage or Hemorrhagic Transformation in the VENOST Study.

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.

Impact of Temperature Optimization of ITO Thin Film on Tandem Solar Cell Efficiency.

This study examined the impact of temperature optimization on indium tin oxide (ITO) films in monolithic HJT/perovskite tandem solar cells. ITO films were deposited using magnetron sputtering at temperatures ranging from room temperature (25 °C) to 250 °C. The sputtering target was ITO, with a mass ratio of In2O3 to SnO2 of 90% to 10%. The effects of temperature on the ITO film were analyzed using X-ray diffraction (XRD), spectroscopic ellipsometry, and sheet resistance measurements. Results showed that all ITO films exhibited a polycrystalline morphology, with diffraction peaks corresponding to planes (211), (222), (400), (440), and (622), indicating a cubic bixbyite crystal structure. The light transmittance exceeded 80%, and the sheet resistance was 75.1 Ω/sq for ITO deposited at 200 °C. The optical bandgap of deposited ITO films ranged between 3.90 eV and 3.93 eV. Structural and morphological characterization of the perovskite solar cell was performed using XRD and FE-SEM. Tandem solar cell performance was evaluated by analyzing current density-voltage characteristics under simulated sunlight. By optimizing the ITO deposition temperature, the tandem cell achieved a power conversion efficiency (PCE) of 16.74%, resulting in enhanced tandem cell efficiency.

Headache as the sole presenting symptom of cerebral venous sinuses thrombosis: Subgroup analysis of data from the VENOST study.

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.

Phenotypic differences in a large family with Kennedy's disease from the Middle Black Sea region of Turkey.

We report the clinical and electrophysiological features of a large Turkish family with genetically confirmed X-linked spinal and bulbar muscular atrophy (SBMA). Family members were identified by field work. A detailed history was obtained from each subject, and each subject received a detailed neurological examination. To confirm the CAG repeat expansion in the AR gene, genomic DNA was extracted from the peripheral blood of patients. The family consisted of 128 individuals over five generations, with two consanguineous parents, one slightly affected female, and 12 affected males with SBMA. We studied the five surviving male patients and one surviving female carrier. The age at disease onset, phenotypic features, and disease severity varied among the family members. DNA analysis was performed on five individuals, belonging to five generations of the family. Four affected males and a slightly affected female carrier were shown to carry an expanded CAG repeat in the androgen receptor gene. This family report is consistent with previous studies suggesting that SBMA may be present with a wide clinical spectrum in affected family members. Further descriptions of SBMA affected families with different ethnic backgrounds may assist in identifying possible phenotypic and genetic features of the disease.

Intra-familial incidence and characteristics of hot water epilepsy.

OBJECTIVE: To assess the clinical features of several members of the same family diagnosed with both hot water epilepsy (HWE) and cerebral lesions. METHODS: Age at onset and types of seizure, precipitating factors, EEG findings, and neuroimages were evaluated. RESULTS: The family consisted of six generations, including one consanguineous parent. Of eight family members diagnosed with epilepsy, seven suffered from HWE. Age at onset of seizures ranged within childhood. Seven patients with HWE experienced complex partial seizures, with or without secondary generalization; one experienced simple partial seizures as well as complex partial seizures. Three patients experienced spontaneous seizures as well as HWE. Interictal EEG revealed abnormalities in two patients. Magnetic resonance imaging revealed cerebral lesions in one patient, probably attributable to ischemic changes. Magnetic resonance images were consistent with findings of ischemic gliosis in two patients, and either demyelinating or ischemic gliosis in one patient. CONCLUSIONS: Descriptions of HWE families with different ethnic backgrounds may permit more definite conclusions regarding the mechanisms epileptogenesis, and the genetic defects that underlie this disease.

Carpal tunnel syndrome in postmenopausal women.

OBJECTIVE: Hormonal changes that accompany menopause have a significant impact on the nervous and other physiological systems. Our objective was to evaluate the relationship between carpal tunnel syndrome (CTS) and the clinical features of menopause in postmenopausal women, in comparison to age-matched healthy controls. METHODS: Overall, 6230 women were seen during the study period. Of these, 5587 were not eligible because they were premenopausal or perimenopausal. 537 women did not meet the criteria used in the study for a diagnosis of idiopathic CTS and were excluded. Finally, one hundred and six patients with CTS and 115 controls were examined. The presence of CTS was confirmed both clinically and electrophysiologically. Socio-demographic variables and reproductive histories were evaluated via a structured interview. RESULTS: In comparison to healthy controls, patients with CTS showed a significantly greater number of pregnancies and an earlier age at menopause. Regarding the type of menopause, patients and controls showed similar frequencies for natural versus surgical menopause. The frequency of natural menopause was significantly higher than that of surgical menopause in both groups. CONCLUSION: Our results suggest that age at menopause may be a significant factor in the development of CTS. Pregnancy-related hormonal changes may have long-term effects that increase the incidence of CTS in postmenopausal women.

Restless legs syndrome in patients with chronic obstructive pulmonary disease.

OBJECTIVE: To evaluate the prevalence of restless legs syndrome (RLS) in patients with chronic obstructive pulmonary disease (COPD) and the relationship between RLS and clinical/laboratory findings of COPD. METHODS: One hundred and thirty-four COPD patients without secondary causes of RLS were included. Thirty-nine (29.1%) patients were diagnosed with RLS and classified as Group 1. The control group consisted of 65 age-matched COPD patients without RLS. Group 1 was divided into subgroups according to the Johns Hopkins Severity (JHS) scale. Patients with a score of 0, 1, or 2 were classified as JHS 0-2 and those with a score of 3 as JHS 3. Group 1 and the control group and subgroups were compared for clinical and laboratory characteristics. RESULTS: We found that the duration of COPD was longer and that airway obstruction, hypercapnia, and hypoxia were more evident in patients with RLS than those without. Similar differences were also detected between JHS subgroups 3 (more severe) and 0-2. Polyneuropathy frequency was significantly higher in Group 1 compared to controls. However, Group 1 subgroups showed a similar frequency of polyneuropathy. In a multivariate analysis, hypercapnia made a significant independent contribution to both JHS 0-2 and JHS 3 patients when RLS severity was set as the dependent variable. Polyneuropathy and the duration of COPD were significant independent variables for patients in the JHS 3 subgroup. Polyneuropathy was the strongest predictor for the JHS 3 patients. CONCLUSIONS: We conclude that RLS is frequent in COPD, particularly in patients with severe hypoxemia/hypercapnia and in late stages of the disease.

Association between restless legs syndrome and Chiari type 1 malformation.

Chiari type 1 malformations (CM-1) consist of the downward displacement of the cerebellar tonsils out of the inferior opening of the skull and into the spinal canal. In relation to this, a few studies in the literature have drawn attention to the possible role of the upper brainstem, diencephalon, red nucleus, and cerebellum in the pathogenesis of restless legs syndrome (RLS). Herein, we present five cases of RLS who were also found to have CM-1 malformations. The cases were notable for an early onset of RLS and a poor response to dopaminergic treatment. The patients fulfilled the diagnostic criteria for RLS according to the International RLS Study Group. None of the patients had a family history of RLS or any other condition known to be associated to RLS. The patients ranged in age from 20 to 31 years old. Four of the patients indicated occasional pain in the occipital-suboccipital area upon questioning about CM-1-related symptoms. All cases had used at least two different drugs known to be effective in RLS treatment. Our opinion is that CM-1-related involvement of the cerebellum and/or connections of the cerebellum with the basal ganglia may have contributed to the development of RLS in these cases.

Chronic migraine associated with the Chiari type 1 malformation.

OBJECTIVE: Our objective was to assess the frequency and clinical characteristics of migraine in the patients with CM-1. METHODS: We analyzed migraine in 73 patients with CM-1. Migraine was classified according to the new International Headache Society criteria. We did not include patients who had intracranial, parenchymal, or cervical lesions other than CM-1 on brain and cervical magnetic resonance imaging. RESULTS: Of the 73 patients diagnosed as having CM-1, 11 (15.06%) had migraines; of them, 8 (10.95%) had chronic migraines, 2 (2.73%) had migraines with auras, and 1 (1.36%) had migraines without auras. The patients who had both migraines and CM-1 (group 1) were compared regarding clinical characteristics and demographic features to the control group having chronic migraines. The control group comprised subjects free of CM-1. Onset age of pain was earlier and the frequency of headache days per month, baseline pain intensity, exacerbation of pain intensity, nausea, vomiting, and pain aggravated by physical activity were significantly higher in group 1. CONCLUSIONS: Although we found the frequency of migraine to be similar to that in population-based studies, we detected a threefold increased frequency of chronic migraine in this special population. We believe that CM-1 may be a factor associated with chronic migraine.

Epidemiological and clinical characteristics of headache in university students.

OBJECTIVE: Epidemiological studies regarding headache are abundant in developed countries; however, the data in developing countries are scarce. This study aims to detect the prevalence and clinical features of headache in Gaziosmanpasa University students in Tokat, Turkey. PATIENTS AND METHODS: 2168 subjects were selected with randomized stratified sampling, and 92.5% of them participated in the study (2023 students). Two neurologists from our medical faculty interviewed and examined the students with headache. Assessment was done according to The International Classification of Headache Disorders, 2nd edition. RESULTS: In our study, 22.64% of the students had tension-type headache (TTH), 17.89% had migraine headache, 0.29% TTH plus migraine headache, 0.20% had cluster and variants type of headache. Migraine type of headache was more common in females than in males (p=0.0001); however, no significant difference was present between males and females who had migraine with aura and tension-type headache. DISCUSSION: The clinical features of tension-type headache and migraine in our university students were similar to the ones of general population and to the studies conducted on university students.

Obesity and carpal tunnel syndrome: is there a causal relationship?

OBJECTIVES: Obesity is defined as a risk factor for carpal tunnel syndrome (CTS). In this study, the presence or absence of recovery in median nerve conduction velocities after weight loss in obese patients was assessed in order to determine whether excess weight or other factors influence the higher prevalence of CTS in obese patients. METHODS: Patients with body mass indexes (BMIs) >or=30 were included in the study. CTS symptoms, age, gender, height, body weight, and concomitant diseases were evaluated. Nerve conduction studies (NCS) were obtained on one upper extremity. All patients were included in dietetic programs. Three months later, NCS were repeated and compared with the first NCS. RESULTS: BMIs were statistically significantly lower on the second visits 3 months later (p = 0.0001). No statistically significant difference was observed in the second NCS of electromyographically diagnosed cases with CTS (p > 0.05). CONCLUSION: We expected a recovery in median nerve conduction velocities in patients with CTS after weight loss. In the literature, even in untreated cases with CTS, spontaneous improvements in second NCS have been reported. This finding suggests that factors other than excess body weight may be influential in the higher prevalence of CTS in obese patients. A more detailed, genetic-factor-targeted investigation may prove more beneficial to clarify this issue.

What are the Predictors of Death in Patients With Cranio-Cervical Artery Dissection?

INTRODUCTION: Few studies have reported the predictive factors related to mortality in patients with cranio-cervical artery dissections (CCAD). Our aim was to investigate the predictors related to in-hospital mortality in patients with CCAD and its subgroups. METHODS: Sixty-seven patients diagnosed with carotid artery dissection (CAD) or vertebral artery dissection (VAD), admitted to our clinic between 2000 and 2013, were retrospectively reviewed. Age, gender, modified Rankin Scale scores (pre-stroke and at admission), clinical presentation type, location of the dissection, risk factors, and treatments were analyzed as mortality-related prognostic factors. Of the 67 patients, 12 (17.9%) died, five (7.46%) with CAD and seven (10.44%) with VAD. We compared the prognostic characteristics of the surviving versus deceased patients with CCAD and in the subgroups with CAD and VAD. RESULTS: Age above 45 years, severe disability at admission, presentation with stroke, and intracranial VAD occurred more frequently in deceased patients and were independent variables related to mortality in patients with CCAD and its subgroup with VAD. Severe disability at admission alone was related to mortality in patients with CAD. Hypertension and hypercholesterolemia were independent variables related to mortality in patients with CCAD. CONCLUSION: Severe disability at admission was a mortality predictor in both CAD and VAD. Although the initial severity of stroke is reportedly related to poor outcomes in patients with CCAD, it has not previously been directly identified as a predictor of mortality in patients with CAD or VAD.

Evaluation of Early Postoperative Neurological Complications Following Living Donor Liver Transplantation.

INTRODUCTION: Liver transplantation is one of the best treatment options for end-stage liver disease. In Turkey, living donor liver transplantation (LDLT) is performed more frequently than cadaveric transplantation, because organ donation is unpopular in our country. Neurological complications contribute to poor postoperative outcomes after liver transplantation. In the present study, we aimed to evaluate the outcomes of LDLT patients in whom such complications developed early during postoperative follow-up in the intensive care unit. METHODS: Of 217 LDLTs performed between August 2011 and August 2012, neurology consultations were arranged for 29 patients (13.36%) because of development of new-onset neurological symptoms and/or findings in patients with neurologically uneventful preoperative histories. We retrospectively collected data on age, gender, primary disease, Model for End-Stage Liver Disease (MELD) score, and postoperative hospitalization duration of those who survived. The indications for neurological consultation and diagnoses were categorized into acute confusion/encephalopathy, epileptic seizures, leukoencephalopathy, and focal neurological deficits. The immunosuppressive treatment regimens prescribed were also considered. The outcomes of the 2 groups (with and without neurological complications) were compared. RESULTS: The mean patient age was 44.52±16.24 years, and males predominated (65.5%, n=19). Acute confusion/encephalopathy was the most frequent complication (62.1%, n=18), followed by epileptic seizures (27.6%, n=8), cerebrovascular disease (6.9%, n=2), and leukoencephalopathy (3.4%, n=1). Statistically significant between-group differences in age (44.5±16.2 vs. 34.33±20.98 years; p<0.001), and proportions of patients with a disease of viral etiology (55.17% vs. 35.63%, p<0.05), were evident. Mortality was significantly higher in the group with neurological complications (65.5% vs. 37.32%, p<0.05). The duration of postoperative hospitalization was also significantly longer in this group (29.80±15.04 vs. 10.00±5.47 days; p<0.05). CONCLUSION: Mortality was significantly higher and the duration of postoperative hospitalization significantly longer in LDLT patients with new-onset neurological complications than in those without such complications.

Risk Factors For Diabetic Polyneuropathy.

INTRODUCTION: The aim of this study was to investigate the risk factors for distal symmetric sensory-motor polyneuropathy (DSP) in patients with type 2 diabetes mellitus (DM). METHOD: Sixty seven patients with type 2 DM (33 males and 34 females) were included in the study. In addition to a detailed neurological examination, the Michigan Neuropathy Screening Instrument was administered to all patients and their total neuropathy scores were calculated. Nerve conduction examinations were performed for all patients. RESULTS: The mean age of the patients was 52.83±.87 years. The mean glycosylated hemoglobin (HbA1C) value was 8.56±2.07% (normal: 3-6.5%). The total neuropathy score significantly correlated with diabetes duration, hypertension, retinopathy, and HbA1C. CONCLUSION: This study confirms the previous reports regarding the association of neuropathy with poor glycaemic control and duration of the disease. The association of neuropathy with retinopathy and hypertension is important.

Toxocara seroprevalence in patients with idiopathic Parkinson's disease: chance association or coincidence?

Most cases of idiopathic Parkinson disease (IPD) are believed to be due to a combination of genetic and environmental factors. The purpose of this study is to investigate the relationship between toxocariasis and Parkinson disease (PD). Patients were selected from people who were admitted to the Movement Disorders Branch, Neurology Department of Elazig University Faculty of Medicine Elazig, Turkey. We studied specific IgG antibodies against Toxocara canis (T. canis) in 50 patients with idiopathic Parkinson and 50 healthy volunteers. We investigated the clinical history of three patients infected with T. canis. We also studied specific IgG antibodies against Toxoplasma gondii in these groups. Antibodies anti-Toxocara canis were found in 3 idiopathic PD (6%) (P = 0.121) and antibody titer was not found in control. A patient had history of the presence of dog in current dog ownership. We did not detect any statistically significant association between T. canis and IPD. But, we believe that further comprehensive studies are required for understanding whether there is a causal relation between toxocariasis and PD. We didn't find possible association between Toxoplasma gondii and IPD (P = 0.617).

Neuromuscular transmission in hypoxemic patients with chronic obstructive pulmonary disease.

Many studies have focused on the systemic effects of chronic obstructive pulmonary disease (COPD), but none has examined neuromuscular junction transmission (NMT). We evaluated NMT dysfunction using single-fiber electromyography (SFEMG) in patients with COPD. Twenty patients with COPD and 20 age-matched healthy controls were included in the study. All patients and controls underwent SFEMG. Abnormal NMT was found in seven of 20 patients (35%), but in none of the control subjects. The COPD patients were subgrouped according to the presence of hypoxemia. The patients with normoxemia were classified as Group 1, and the patients with hypoxemia were classified as Group 2. Abnormal NMT was found in six patients in Group 2 and in one in Group 1. While there was significant difference in terms of abnormal NMT between Group 2 and the controls, there was none between Group 1 and the controls. Our results show that NMT abnormalities can be present in hypoxemic patients with COPD.

Combination of myotonic dystrophy and hereditary motor and sensory neuropathy.

Myotonic Dystrophy Type 1 (DM1) in combination with demyelinating neuropathy is very rare in literature. In this study, DM1 and demyelinating neuropathy were demonstrated clinically and electromyographically in a 43-year-old female patient from Turkey. In the patient an expanded CTG repeat in the Myotonic Dystrophy Protein Kinase (DMPK) gene was confirmed in combination with a duplication in the Charcot-Marie-Tooth Disease (CMT1A) gene. DM1 was also determined in her 25-year-old son.

Epilepsy and kleptomania.

Kleptomania, defined in the American Psychiatric Association's Diagnostic and Statistical Manua of Mental Disorders, Text Revision: DSM-IV-TR, as the inability to resist the impulse to steal objects that are not needed for personal use or for their monetary value, may reflect a form of obsessive-compulsive spectrum disorder and/or affective spectrum disorder. We report on a patient who developed kleptomania and left temporal lobe epilepsy around the same time; both disorders were completely resolved in this patient with topiramate.