Painless Legs and Moving Toes: Idiopathic or Not?

Painless legs and moving toes (PoLMT) is a rare variant of painful legs and moving toes (PLMT). The difference is the absence of pain, which is usually hard to manage in PLMT. An involuntary movement in the toes is a compound of both. Although there are many medication options for this disease, most fail to treat it successfully. Here, we report on a 62-year-old female with involuntary movements in her toes for five years. The rarity and unclear etiology of the disease are the reasons we wanted to present it.

The role of neutrophils and interleukin-8 in acute ischemic stroke.

OBJECTIVE: To investigate the crucial role of interleukin 8 (IL-8) as an inflammatory marker in infarct evolution, and course of the disease. METHODS: The study included 76 patients that were admitted to Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey between September 2001 and June 2002 with an initial diagnosis of acute ischemic stroke, and 28 control subjects with a corresponding mean age. The serum IL-8 levels obtained within 24 hours of the stroke were assessed by the enzyme-linked immunoabsorbent assay method. The patients were divided into 4 groups according to the extent, and localization of the ischemic lesions. Prognosis was evaluated by modified Rankin Scale. RESULTS: In comparison between patients and control groups, there was a statistically significant difference in (p<0.001) IL-8, and neutrophil (net) levels (p=0.000). The serum IL-8 levels were associated with the extent of the lesion (p<0.01). Though the serum IL-8 levels were significantly higher in the dependent group (p<0.05), there was no significant difference between net levels, and prognosis (p>0.05). There was also no significant difference according to age, gender, and etiology between IL-8 and net levels. CONCLUSION: The high serum IL-8 levels are associated with prognosis. The development of new neuroprotective treatments aimed to prevent neutrophil-mediated-inflammation induced by IL-8 is critical in the treatment of stroke, and prevention of clinical worsening.

Optic neuropathy related to hydrogen peroxide inhalation.

Optic neuropathy related to toxins is a complex, multifactorial disease potentially affecting individuals of all ages. We report a case of presumed toxic optic neuropathy secondary to H2O2 exposure. This has not been previously reported, and the temporal relationship of the exposure to the optic neuropathy is compelling, although not definite, evidence of a causal relationship.

Tumor necrosis factor alpha serum levels and inflammatory response in acute ischemic stroke.

OBJECTIVE: To assess the implication of tumor necrosis factor alpha (TNF-alpha) and interleukine-6 (IL-6) in acute ischemic stroke and to correlate this with lesion size, vascular risk factors, and neurological impairment. METHODS: We included 70 patients consecutively admitted to the Department of 1st Neurology, Haydarpasa Numune Educational and Research Hospital, Istanbul, Turkey, between September 2001 and April 2002, with first-ever ischemic cerebral infarction within the first 24 hours from onset. The TNF-alpha, IL-6, fibrinogen, C-reactive protein, erythrocyte sedimentation rate (ESR) and leukocytes were determined in plasma on admission. Neurological impairment was evaluated with the modified Rankin Scale. RESULTS: We found higher baseline levels of TNF-alpha and IL-6 in the plasma of patients with acute ischemic stroke and neurological impairment in comparison to control subjects. In the large infarct group, TNF-alpha, IL-6, low-density lipoprotein-cholesterol and fibrinogen were found significantly higher compared to the small infarct group. While an association between TNF-alpha and IL-6 values and lesion size were determined, no relation was found between localization and etiology. The TNF-alpha level was found to be in positive correlation with IL-6, fibrinogen, and ESR. The IL-6 level was found to be in positive correlation with ESR fibrinogen, and leukocytes. CONCLUSION: Inflammatory findings are associated with the early stage of ischemic stroke. The TNF-alpha and IL-6 were also higher in patients with clinical worsening. The release of proinflammatory cytokines after focal cerebral ischemia indicates a step leading to tissue necrosis or reflects the amount of ischemic brain injury, since the higher concentrations of TNF-alpha and IL-6 are found in patients with large infarctions.

Gender differences in older adults with chronic migraine in Turkey.

AIM: Chronic migraine is a growing and disabling subtype of migraine with different risk factors and clinical features, even in older adults. We sought to define and differentiate clinical features of chronic migraine in older adults. We also aimed to compare major clinical features of chronic migraine in older adults with those in younger people of both sexes. METHODS: We used electronic dataset (Turkish Headache Database) from 13 tertiary headache centers in Turkey. Electronic dataset included detailed headache-defining features according to ICHD-II criteria based on face-to-face interviews and examination by a headache specialist. Using statistical methods, clinical variables of chronic migraine in older adults were compared with those of younger adults. We included 915 patients with chronic migraine (mean age 43.80 ± 13.95 years); 83.3% were females. In total, 301 patients (32.9%) with chronic migraine aged >50 years were compared with 614 patients aged <50 years. RESULTS: There was no significant change in men with increasing age. However, duration of headache history, severity of attacks, previous histories of motion sickness and positive family history of headaches were significantly different in women with increasing age. Further sex-related differences have been shown in parameters such as attack duration, quality and associated nausea. CONCLUSION: Chronic migraine is an infrequent type of migraine and shows age-related changes in some phenotypic characteristics, such as severity of attacks, especially in women aged older than 50 years. Furthermore, positive family history of headaches and history of motion sickness increase the likelihood of developing chronic migraine in older women, indicating involvement of some gender-related, but as-yet unknown, genetic factors.

Interleukin-6 levels in tension headache patients.

OBJECTIVE: Cytokines are pain mediators in neurovascular inflammation. This study examined interleukin 6 (IL-6) levels in the serum of tension-type headache (TTH) patients, to determine if inflammation plays a role in the pathogenesis of this condition. METHODS: Serum IL-6 levels were studied in 42 patients and 37 healthy controls from the same region. Of the patients, 20 (47.6%) experiencing TTH less than 15 days per month were placed in episodic tension-type headache (ETTH) group, and 22 (52.3%) with TTH more than 15 days per month were placed in chronic tension-type headache (CTTH) group. RESULTS: The IL-6 level was significantly higher in the patients than in the controls. The IL-6 level of CTTH patients was higher than the controls (P<0.01). The IL-6 level was similar between ETTH and CTTH patients. Correlation analysis revealed a positive relationship only between age and IL-6 level in the patients. CONCLUSIONS: CTTH and ETTH patients had an elevated serum IL-6 level compared with controls. Therefore, we believe that IL-6 may be involved in pain induction or inflammatory mechanisms in TTH. Furthermore studies of the possible connection between chronicity of headaches and cytokine levels are needed.