The coronavirus disease-2019 pandemic, one of many global threats to human health, provides an opportunity to analyze how to detect, minimize, and even prevent the spread of future viral zoonotic agents with pandemic potential. Such analysis can utilize existing risk assessment techniques that seek formally to define the hazard, assess the health risk, characterize the health threat, and estimate the probability of occurrence.
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Transient global amnesia (TGA) is a clinical syndrome characterized by sudden-onset anterograde amnesia, accompanied by repetitive questioning, sometimes with a retrograde component, lasting up to 24 hours, and without compromise of other neurologic functions. Typically, it occurs in individuals aged 50-80 years, with a decreased incidence in younger and older populations. There may be many causes of TGA. Hippocampal ischemia also contributes to the cause of TGA. In this case report, a 67-year-old woman who presented with TGA clinical features accompanied by right hippocampal diffusion-weighted imaging hyperintensity is presented.
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Multiple sclerosis (MS) and Parkinson’s disease (PD) are progressive central nervous system diseases that cause significant activity limitation and participation restrictions by causing motor and non-motor symptoms in patients. With this case report, we aimed to present the effects of the game-supported rehabilitation in a patient with co-occurrences of MS and PD that we rarely encounter. A 54-year-old female patient with co-occurrence of MS and PD who was mobilized with a wheelchair was evaluated as a case. The patient was treated for 1 hour, 3 days a week for 8 weeks. After a 30-minute neurophysiologic exercise program, the patient was taken to 30-minute game therapy using the “Smart Physiotherapy Game System (USE-IT)”. USE-IT, a game console developed in line with our clinical experience, is also a TUBITAK 1512 project. On the game console, the patient played six games using different grip materials. Before and after the treatment, diseases levels and findings were evaluated using the expanded disability status scale, the modified Hoehn and Yahr scale, and the unified PD rating scale. Frequency of falling was asked to the patient and relatives, rigidity was determined using manual evaluations, muscle strength was assessed through gross muscle strength assessment, cognitive status was evaluated using the Montreal cognitive assessment scale, posture was evaluated with New York posture rating scale, manual skills were evaluated with the Minnesota manual dexterity test, and fatigue was evaluated with fatigue impact scale. Functional condition was evaluated using the functional independence measurement and quality of life was evaluated with MS quality of life questionnaire and PD questionnaire. As a result, it is seen that there are clinically significant improvements in the severity of disease, fatigue, falling, postural disorders, manual skills, physical, cognitive and emotional state, mobility, activities of daily living and quality of life of the patient.
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Pisa syndrome (PS) has been described for the first time as a side effect of neuroleptic treatment in patients with schizophrenia. After its first description, PS was reported in patients on dopamine receptor antagonists, cholinesterase inhibitors, and antidepressants. PS was also associated with neurodegenerative diseases such as Alzheimer’s disease, multiple system atrophy, and dementia of Lewy bodies (DLB). Dopaminergic treatment in Parkinson’s disease (PD) may also lead to PS in PD patients. Here, we report a patient with probable DLB who developed PS after the initiation of piribedil treatment. After cessation of piribedil, PS disappeared entirely. We want to highlight that PS related to dopaminergic treatment may be reversible, and like other dopamine agonists, piribedil has the potential to cause PS in patients with parkinsonism.
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Objective: To screen cognitive functions using the Montreal Cognitive Assessment (MoCA) test and to determine the most common central nervous system complications in adults with sickle cell anemia (SCA). Materials and Methods: One hundred adult patients with SCA and 82 healthy controls participated in this study. Controls were matched for age, sex, and education level. We reviewed the demographic information and laboratory values of all patients. The patients were questioned about common CNS complications including headache, ischemic or hemorrhagic stroke, epilepsy, and cerebral venous sinus thrombosis. The MoCA test was used to assess neurocognitive function in all participants. Results: Of the 100 patients with SCA, 38 patients had chronic or recurrent headaches, 10 had a history of depression, and four patients had a history of ischemic stroke. None of the patients had a history of epilepsy, hemorrhagic stroke or cerebral venous sinus thrombosis. The median MoCA score of the patients was significantly decreased compared with that of the control group (p<0.001). MoCA scores below 21 points were observed in 50% of the patients. The MoCA scores were negatively correlated with age but positively correlated with education level (r=-0.181 p=0.015, r=0.483, p<0.001 respectively). There was a significant correlation between a history of chronic or recurrent headaches and lower MoCA (p=0.003). Conclusion: Cognitive impairment was the most prevalent neurologic symptom in Turkish adult patients with SCA. The MoCA test may be a useful and easy screening test to evaluate and follow cognitive impairment. A history of first ischemic stroke during adulthood was observed in one patient. Two patients had severe neurologic sequela findings due to ischemic stroke.
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Objective: The retina layer belongs to the end-stream region of the internal carotid artery, and thus various ophthalmic symptoms can present in patients with carotid artery stenosis. The aim of this study was to examine the changes in retinal nerve fiber layer thickness (RNFLT), central macular thickness (CMT), retinal ganglion cell layer (RGCL), and choroidal thickness (CT) in patients who had unilateral (symptomatic or asymptomatic) carotid artery stenosis (CAS) using optical coherence tomography (OCT). Materials and Methods: In this prospective observational study, patients with confirmed unilateral CAS (symptomatic or asymptomatic) in computed tomography angiography were recruited. RNFLT, CMT, and RGCL were compared using spectral domain-OCT. CT was analyzed using enhanced depth imaging- OCT. Results: A total of 28 patients with unilateral CAS (17 asymptomatic, 11 symptomatic) were recruited. There were no significant differences between the eye on the stenotic side and the fellow eye according to RNFLT, CMT, RGCL, and CT in the asymptomatic group (p=0.986, p=0.945, p=0.569, and p=0.796, respectively). Similarly, in the symptomatic group, no significant differences were found between the eye on the stenotic side and the fellow eye according to the same parameters (p=0.693, p=0.409, p=0.792, and p=0.597, respectively). When comparing the eyes on the stenotic sides in both groups, no significant differences were found (p=0.85, p=0.24, p=0.7, p=0.98 respectively). Conclusion: The decrease in retinal artery blood flow did not lead to morphologic or functional changes of the retina in symptomatic or asymptomatic carotid artery disease.
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Dysphagia, which is frequently seen in patients with multiple sclerosis (MS) and defined as difficulty in swallowing, can lead to serious complications such as aspiration pneumonia, dehydration, malnutrition, and increases morbidity and mortality rates and decreases quality of life. In patients with MS, dysphagia can be intervened by pharmacologic or surgical methods; this symptom can also be controlled by non-pharmacologic and non-invasive methods such as sensory stimulation techniques, swallowing maneuvers, dietary modifications, and positional swallowing techniques. No previous systematic reviews on the effects of non-pharmacologic or non-invasive methods on dysphagia in MS have been published. The main objective of this study was to summarize and qualitatively analyze published studies on non-pharmacologic or non-invasive methods effects for dysphagia in MS. Within the scope of the study, a detailed literature review was performed and four studies were examined considering the inclusion criteria. The non-pharmacologic applications in the studies are as follows: Traditional dysphagia rehabilitation methods, which include methods such as oral motor exercises and swallowing maneuvers; electrical stimulation, and respiratory muscle exercises. In these studies, dysphagia and/or swallowing-related quality of life were measured with similar scales. It is seen that all of the related interventions have a significant effect on dysphagia and/or swallowing-related quality of life in patients with MS. In conclusion, in light of the information in the literature, non-pharmacologic methods can be said to be effective in the control of dysphagia in patients with MS. In addition, it may be suggested to conduct experimental and more comprehensive studies in this field.
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Objective: Neurological manifestations associated with coronavirus disease-2019 (COVID-19) are broad and heterogeneous. Although the predominant clinical presentation is respiratory dysfunction, concerns have been raised about the neurological hallmarks. Many reports suggest some findings on electroencephalography (EEG) can be relevant to COVID-19. Materials and Methods: Patients with COVID-19 admitted to hospital and referred for EEG from March 1, 2020 to February 15, 2021, were retrospectively enrolled. When research databases were queried with the terms “COVID-19 (ICD code:10: U07.3) and “EEG”, total number of patients obtained was 32. Number of patients excluded due to unconfirmed diagnose with COVID-19 was 12. Twenty adult patients with certain diagnose of COVID-19 who underwent 21-electrode routine EEG during the outbreak with neurological deterioration were identified. Results: Background abnormalities was evident in one of fourth patients (n=5, 25%). Mild diffuse slowing (n=3, 15%) and focal slowing (n=3, 15%) with left frontotemporal tendency (n=2, 10%) were observed. Epileptiform abnormalities and seizures were detected showing focal (n=4, 20%) or generalized onset (n=1, 5%). Conclusion: Here we performed a retrospective single-centre study to evaluate the electroencephalographic findings in patients diagnosed with COVID-19 since it remains unknown. it needs to be more clarified with increasing number of recordings.
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