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Yayın Are cerebrospinal fluid protein levels and plasma neutrophil/lymphocyte ratio associated with prognosis of Guillain BarrE syndrome?(PAGEPRESS PUBL, 2017) Sahin, Sevki; Cinar, Nilgun; Karsidag, SibelGuillain Barre syndrome (GBS) is a post-infectious acute autoimmune polyradiculopathy. Cerebrospinal fluid (CSF) total protein level and plasma neutrophil/lymphocyte ratio (NLR) are related with autoimmune response. We aimed to reach a prognostic indicator for GBS by using electrophysiological findings, protein level of CSF, and plasma NLR based on Medical Research Council (MRC) sum score data. Cases who met diagnostic criteria of GBS and followed at least six months were enrolled in the study. Nerve conduction study (NCS) and lumbar puncture were performed one week after symptom onset. Routine CSF findings and complete blood count were recorded. Plasma NLR was calculated as the ratio of neutrophil cell count to lymphocyte cell count. All patients received intravenous immunoglobulin. MRC sum scores were calculated on administration time (1(st)) and six months later (2(nd)) for evaluation of recovery. Mean values of baseline CSF protein level, NCS parameters and NLR were compared with mean scores of MRC1st and MRC(2n)d. Increased CSF protein levels showed negative correlation with MRC(2n)d scores but no correlation with NCS. Increased NLR levels were positively correlated with age, MRC2nd scores and NCS. Facial diplegia was observed in 42% of patients. A positive correlation was found between high level of NLR and MRC1st, and there was no relationship with MRC2nd. Regression analyses showed that only CSF protein level was an independent factor on both MRC1st and MRC2nd. A positive association was found between baseline data included young age high plasma NLR, low level of CSF protein and good prognosis in our study. Also a positive correlation was found between high level of NLR and baseline disability in GBS cases with facial diplegia. Calculation of NLR is an easy and inexpensive method. On the other hand it may be influenced by age and immunotherapy. Our results showed that CSF protein level is still a liable parameter for prognosis. NLR could be a candidate prognostic marker of GBS cases. Further investigations including more cases are needed.Yayın Attenuated lactate response to ischemic exercise in migraine(INT SCIENTIFIC LITERATURE, INC, 2010) Sahin, Sevki; Cinar, Nilgun; Aksungar, Fehime Benli; Ayalp, Sunay; Karsidag, SibelBackground: Although the pathogenesis of migraine still remains unclear, certain metabolic studies done on patients with migraine indicate possible deficits in mitochondrial activity. Previously, the forearm ischemic exercise test (FIT) has been used as a screening tool to evaluate mitochondrial dysfunction in metabolic myopathies. Material/Methods: We studied the response of migraine patients to exercise using the modified FIT and compared this to the responses in a healthy group. After baseline venous blood samples were drawn, a sphygmomanometer cuff placed around the upper arm was inflated to 30 mmHg above systolic blood pressure and the subject performed a maximal isometric contraction of the forearm flexors using a hand-grip dynamometer with a 9-contraction: 1-relaxation duty cycle for a total time of 60 seconds. Results: In migraine patients, attenuated lactate response after the FIT in the 1(st), 3(rd) and 5(th) minutes were significantly different when compared to the control group. Conclusions: Our results show that there may be defects in the anaerobic or proximal glycolytic pathways in migraine patients, evident in stressful situations. We also conclude that the FIT may be useful for research on migraine pathophysiology.Yayın A Case of Intracranial Hypotension after Horse Riding(KOREAN NEUROLOGICAL ASSOC, 2019) Karsidag, Sibel; Cinar, Nilgun; Sahin, Sevki; Ates, Miruna Florentina; Tabak, Necati Alp…Yayın Cerebral Venous Sinus Thrombosis in Women: Subgroup Analysis of the VENOST Study(Hindawi, 2020) Uluduz, Derya; Sahin, Sevki; Duman, Taskin; Ozturk, Serefnur; Yayla, Vildan; Afsar, Nazire; Uzuner, Nevzat; Midi, Ipek; Cinar, Nilgun; Sungur, Mehmet Ali; Domac, Fusun Mayda; Ince, Birsen; Goksan, Baki; Misirli, Cemile Handan; Bakar, Mustafa; Kozak, Hasan Huseyin; Colakoglu, Sena; Karahan, Ali Yavuz; Goksu, Eylem Ozaydin; Ozdag, Fatih; Senol, Mehmet Guney; Yurekli, Vedat Ali; Aluclu, Ufuk; Demir, Serkan; Kucukoglu, Hayriye; Oruc, Serdar; Yesilot, Nilufer; Nazliel, Bijen; Tokuc, Firdevs Ezgi Ucan; Bektas, Hesna; Aytac, Emrah; Gokce, Mustafa; Caglayan, Hale Zeynep Batur; Tufekci, Ahmet; Uzuner, Gulnur; Orken, Dilek Necioglu; Yalin, Osman Ozgur; Utku, Uygar; Yılmaz, Arda; Genc, Hamit; Cabalar, Murat; Milanlioglu, Aysel; Ekmekci, Hakan; Zeydan, Burcu; Baybas, Sevim; Kablan, Yuksel; Goksel, Basak Karakurum; Acikgoz, Mustafa; Kurucu, Hatice; Demirci, Seden; Gunes, TaskinBackground. Early diagnosis of cerebral venous sinus thrombosis (CVST) associated with reproductive health-related risk factors (RHRF) including pregnancy, puerperium, and oral contraceptive (OC) use can prevent severe neurological sequelae; thus, the symptoms must be documented in detail for each group.Methods. Out of 1144 patients with CVST, a total of 777 women were enrolled from a multicenter for the study of cerebral venous sinus thrombosis (VENOST). Demographic, biochemical, clinical, and radiological aspects were compared for 324 cases with RHRF and 453 cases without RHRF.Results. The mean age of the RHRF (-) group (43.2 +/- 13 years) was significantly higher than of the RHRF (+) group (34 +/- 9years). A previous history of deep venous thrombosis (3%), isolated cavernous sinus involvement (1%), cranial neuropathy (13%), comorbid malignancy (7%), and its disability scores after 12 months (9%) were significantly higher in the RHRF (-) group. The RHRF (+) group consisted of 44% cases of puerperium, 33% cases of OC users and 23% of pregnant women. The mean age was found to be higher in OC users (38 +/- 9years). A previous history of deep venous thrombosis was slightly higher in the pregnancy subgroup (4%). Epileptic seizures were more common in the puerperium group (44%).Conclusion. The results of our study indicate that the risk of CSVT increases parallel to age, OC use, and puerperium period. In addition, when considering the frequency of findings and symptoms, epileptic seizures in the puerperium subgroup of the RHRF (+) group and malignancies in the RHRF (-) group may accompany the CSVT. In daily practice, predicting these risks for the CSVT and early recognition of the symptoms will provide significant benefits to patients.Yayın Coagulation status and biochemical and inflammatory markers in multiple sclerosis(ELSEVIER SCI LTD, 2008) Aksungar, Fehime B.; Topkaya, Aynur E.; Yildiz, Zeynep; Sahin, Sevki; Turk, UlkuMultiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system and is the most common cause of neurologic disability in young adults. in this study, the coagulation status and biochemical and non-specific inflammatory markers in patients with MS were investigated. Plasma prothrombin time, activated partial thrombin time, fibrinogen, D-dimer, serum high sensitive C-reactive protein, homocysteine, blood urea nitrogen, creatinine, calcium, total protein, albumin, total cholesterol, vitamin B 12, folate levels and erythrocyte sedimentation rate were measured in 42 patients with MS and 31 healthy subjects as a control group. There was a positive correlation between homocysteine and D-dimer levels (r = 0.84, p < 0.01). However, there was no significant correlation between homocysteine, vitamin B12 (r = 0.18) and folate (r = 0.23) levels. Serum total protein, albumin and calcium levels of MS patients were lower than the control group. There are some alterations in the coagulation and biochemical status in MS patients. These findings may contribute to better understanding of the etiopathogenesis and clinical characteristics of this disease. (C) 2007 Elsevier Ltd. All rights reserved.Yayın Cognitive Assessment in Early Stage of Parkinson's Disease(LIPPINCOTT WILLIAMS & WILKINS, 2012) Cinar, Nilgun; Sahin, Sevki; Bozdemir, Meral; Okluoglu, Tugba; Batum, Kubra; Karsidag, Sibel…Yayın Complications of botulinum toxin application: differences between hemifacial spasm and post-facial palsy synkinesis(SPRINGER HEIDELBERG, 2014) Cakmak, M. Aysen; Sahin, Sevki; Cinar, Nilgun; Karsidag, Sibel…Yayın Correlation between Nerve Conduction Study and CSF Protein Level in Acute and Chronic Demyelinating Polyradiculopathies(LIPPINCOTT WILLIAMS & WILKINS, 2013) Cinar, Nilgun; Sahin, Sevki; Batum, Kubra; Karsidag, Sibel…Yayın COULD APOMORPHINE BE AN EFFECTIVE TREATMENT OPTION FOR REFRACTORY TREMOR IN PARKINSON'S DISEASE? A PILOT STUDY(NOBEL ILAC, 2013) Cinar, Nilgun; Sahin, Sevki; Karsidag, SibelObjective: We aimed to evaluate the extent of the clinical efficacy of intermittent subcutaneous apomorphine in addition to oral treatment in patients with Idiopathic Parkinson's Disease experiencing serious, refractory tremor despite the use of optimal oral dopaminergic medication. Treatment response was assessed with the motor section of the Unified Parkinson's Disease rating scale (UPDRS). Tremor rigidity and bradykinesia were scored by using specific items of the UPDRS. Material and Method: The study group included 13 consecutive patients with Parkinson's disease who have refractory tremor Increasing doses of 1 mg, 2 mg, 4 mg subcutaneous apomorphine were used; peak improvement dose and UPDRS scores were determined after 30 minutes. The patients have used oral dopaminergic treatment plus subcutaneous apomorhine and they have been followed on weekly phone calls. The completion of the study was defined as the end of the 1st month. Finally, the UPDRS motor scores of the patients were compared to the basal scores. Results: Three patients dropped out due to side effects. The average reduction rate of total UPDRS, tremor, bradykinesia and rigidity scores were found as 20.6%, 38.5%, 30.1% and 16.6% respectively. At the end of the first month, tremor, bradykinesia and rigidity scores were statistically improved in comparison to those of the baseline. Conclusion: Subcutaneous apomorphine combined to oral dopaminergic medications may provide effective relief in serious and refractory rest tremor as well as bradykinesia and rigidity in selected Parkinson patients.Yayın Cutaneous drug eruptions by current antiepileptics: Case reports and alternative treatment options(LIPPINCOTT WILLIAMS & WILKINS, 2008) Sahin, Sevki; Comert, Asuman; Akin, Ozlem; Ayalp, Sunay; Karsidag, SibelSerious cutaneous drug eruptions due to antiepileptics have been defined for many drugs like carbamazepine, diphenylhydantoin, phenytoin and valproate. In recent years, adverse cutaneous reactions due to the current antiepileptic drugs have also been reported. in this paper, two cases are presented: a 48-year-old female receiving gabapentin for postherpetic neuralgia who developed leukocytoclastic vasculitis after 8 weeks and a 23-year-old male receiving lamotrigine for epileptic seizures who developed toxic epidermal necrolysis (TEN) in. 15 days. Alternative therapy approaches with practical suggestions are also discussed.Yayın Determination of nerve conduction abnormalities in patients with impaired glucose tolerance(SPRINGER, 2009) Sahin, Sevki; Karsidag, Sibel; Ayalp, Sunay; Sengul, Ahmet; Us, Onder; Karsidag, KubilayRecent studies have shown that impaired glucose tolerance (IGT) is associated with dysfunction in the peripheral and autonomic nerves. The aim of this study was to determine the electrophysiological abnormalities of IGT. To determine electrophysiological abnormality in the large sensorimotor and sudomotor autonomic nerves with IGT patients, 43 patients and 34 healthy subjects have been studied. Subjective neuropathy symptoms, neurological examination and the electrophysiological findings were evaluated. When conduction of large somatic fibers only was evaluated, the ratio of electrophysiological abnormality was found to be 21%. In addition, where sympathetic skin response was evaluated the sudomotor autonomic abnormality ratio was 28% in upper extremities, 53% in lower extremities, and 16% in upper and lower extremities together. The percentages of abnormal electrophysiological parameters in different motor and sensory nerves were 39.5% in the peroneal motor nerve, 20.9% in the median motor and sural sensory nerves, 18.6% in the median sensory nerve, 16.3% in the tibial motor nerve, 14% in the ulnar sensory nerve, and 2.3% in the ulnar motor nerve. While distal motor latency was the most frequent abnormal parameter in the median and tibial motor nerves, the amplitude changes in the peroneal and ulnar motor nerves were also prominent. In sensory evaluation, the onset latency in the median-ulnar sensory nerves and the amplitude in the sural sensory nerve were found to be evident abnormalities.Yayın Distinguishing age-related cognitive decline from dementias: A study based on machine learning algorithms(ELSEVIER SCI LTD, 2017) Er, Fusun; Iscen, Pinar; Sahin, Sevki; Cinar, Nilgun; Karsidag, Sibel; Goularas, DionysisBackground and aim: This study aims to examine the distinguishability of age-related cognitive decline (ARCD) from dementias based on some neurocognitive tests using machine learning. Materials and methods: 106 subjects were divided into four groups: ARCD (n = 30), probable Alzheimer's disease (AD) (n = 20), vascular dementia (VD) (n = 21) and amnestic mild cognitive impairment (MCI) (n = 35). The following tests were applied to all subjects: The Wechsler memory scale-revised, a clock drawing, the dual similarities, interpretation of proverbs, word fluency, the Stroop, the Boston naming (BNT), the Benton face recognition, a copying-drawings and Oktem verbal memory processes (0VMPT) tests. A multilayer perceptron, a support vector machine and a classification via regression with M5-model trees were employed for classification. Results: The pairwise classification results show that ARCD is completely separable from AD with a success rate of 100% and highly separable from MCI and VD with success rates of 95.4% and 86.30%, respectively. The neurocognitive tests with the higher merit values were O-VMPT recognition (ARCD vs. AD), 0VMPT total learning (ARCD vs. MCI) and semantic fluency, proverbs, Stroop interference and naming BNT (ARCD vs. VD). Conclusion: The findings show that machine learning can be successfully utilized for distinguishing ARCD from dementias based on neurocognitive tests. (C) 2017 Elsevier Ltd. All rights reserved.Yayın Distinguishing Depressive Pseudodementia from Alzheimer Disease: A Comparative Study of Hippocampal Volumetry and Cognitive Tests(KARGER, 2017) Sahin, Sevki; Onal, Tugba Okluoglu; Cinar, Nilgun; Bozdemir, Meral; Cubuk, Rahmi; Karsidag, SibelBackground and Aim: Depressive pseudodementia (DPD) is a condition which may develop secondary to depression. The aim of this study was to contribute to the differential diagnosis between Alzheimer disease (AD) and DPD by comparing the neurocognitive tests and hippocampal volume. Materials and Methods: Patients who met criteria of AD/DPD were enrolled in the study. All patients were assessed using the Wechsler Memory Scale (WMS), clock-drawing test, Stroop test, Benton Facial Recognition Test (BFRT), Boston Naming Test, Mini-Mental State Examination (MMSE), and Geriatric Depression Scale (GDS). Hippocampal volume was measured by importing the coronal T1-weighted magnetic resonance images to the Vitrea 2 workstation. Results: A significant difference was found between the AD and DPD groups on the WMS test, clock-drawing test, Stroop test, Boston Naming Test, MMSE, GDS, and left hippocampal volume. A significant correlation between BFRT and bilateral hippocampal volumes was found in the AD group. No correlation was found among parameters in DPD patients. Conclusions: Our results suggest that evaluation of facial recognition and left hippocampal volume may provide more reliable evidence for distinguishing DPD from AD. Further investigations combined with functional imaging techniques including more patients are needed. (C) 2017 The Author(s) Published by S. Karger AG, BaselYayın Effects of Anthropometric Factors on Nerve Conduction An Electrophysiologic Study of Feet(AMER PODIATRIC MED ASSOC, 2013) Cinar, Nilgun; Sahin, Sevki; Sahin, Mustafa; Okluoglu, Tugba; Karsidag, SibelBackground: Previous studies have shown that age, sex, and body mass index (BMI) affect the amplitude of sensory nerve action potentials (SNAPs), but the total effects of multiple factors and the most prominently affected nerves have not been elucidated. We systematically investigated the effects of these factors on motor and sensory nerves of the feet. Methods: The amplitude, latency, and conduction velocity of compound muscle action potential (CMAP), SNAP, and mixed nerve action potential (MNAP) of the posterior tibial, calcaneal, distal posterior tibial, medial and lateral plantar, and sural nerves were measured in 30 healthy individuals (60 feet). The effects of age, sex, height, and BMI on each nerve were estimated by correlation and linear regression analyses. Results: The amplitude of posterior tibial CMAP and distal posterior tibial MNAP decreased with BMI. The amplitude of medial plantar MNAP and sural SNAP decreased with height. The conduction velocity of calcaneal SNAP and distal posterior tibial and lateral plantar MNAP decreased with height and BMI. The conduction velocity of medial plantar MNAP decreased only with height. The latency of posterior tibial CMAP increased with age and height. The latency of lateral plantar CMAP and calcaneal SNAP increased with height. The latency of lateral plantar MNAP increased with BMI. Conclusions: The effects of age, sex, height, and BMI in foot nerve conduction studies are not identical. Height and BMI were shown to strongly affect motor, sensory, and mixed nerve conduction. Further investigations are needed. (J Am Podiatr Med Assoc 103(1): 43-49, 2013)Yayın Epileptic seizures in cerebral venous sinus thrombosis: Subgroup analysis of VENOST study(W B SAUNDERS CO LTD, 2020) Uluduz, Derya; Midi, Ipek; Duman, Taskin; Yayla, Vildan; Karahan, Ali Yavuz; Afsar, Nazire; Goksu, Eylem Ozaydin; Mengulluoglu, Necdet; Aytac, Emrah; Sungur, Mehmet Al; Yesilot, Nilufer; Ince, Birsen; Yalin, Osman Ozgur; Oruc, Serdar; Senol, Mehmet Guney; Yilmaz, Arda; Gokce, Mustafa; Demirci, Seden; Kusbeci, Ozge Yilmaz; Uzuner, Gulnur; Caglayan, Hale Zeynep Batur; Acikgoz, Mustafa; Kurucu, Hatice; Ozdag, Fatih; Baybas, Sevim; Ekmekci, Hakan; Cabala, Murat; Yaman, Mehmet; Yurekli, Vedat Ali; Tekeli, Hakan; Genc, Hamit; Utku, Uygar; Sahin, Sevki; Tokuc, Firdevs Ezgi Ucan; Uzuner, Nevzat; Bektas, Hesna; Kablan, Yuksel; Goksel, Basak Karakurum; Milanlioglu, Aysel; Orken, Dilek Necioglu; Aluclu, Ufuk; Colakoglu, Sena; Tufekci, Ahmet; Bakar, Mustafa; Nazliel, BijenPurpose: The aim of this study is to evaluate the presence and prognostic impact of early seizures in cerebral venous sinus thrombosis patients (CVST). Method: VENOST is a retrospective and prospective national multicenter observational study. CVST patients with or without epileptic seizures (ES) were analyzed and compared in terms of demographic and imaging data, causative factors, clinical variables, and prognosis in a total of 1126 patients. Results: The mean age of the patients in the ES group was 39.73 +/- 12.64 and 40.17 +/- 14.02 years in the non-ES group (p > 0.05). Epileptic seizures were more common (76.6 %) in females (p < 0.001). Early ES occurred in 269 of 1126 patients (23.9 %). Epileptic seizures mainly presented in the acute phase (71.4 %) of the disease (p < 0.001). Majority of these (60.5 %) were in the first 24 h of the CVST. The most common neurological signs were focal neurologic deficits (29.9 %) and altered consciousness (31.4 %) in the ES group. Superior sagittal sinus (SSS) and cortical veins (CV) involvement were the most common sites of thrombosis and the mostly related etiology were found puerperium in seizure group (30.3 % vs 13.9 %). Patients with seizures had worse outcome in the first month of the disease (p < 0.001) but these did not have any influence thereafter. Conclusions: In this largest CVST cohort (VENOST) reported female sex, presence of focal neurological deficits and altered consciousness, thrombosis of the SSS and CVs, hemorrhagic infarction were risk factors for ES occurrence in patients with CVST.Yayın Eye-related visual hallucinations: Consider 'Charles Bonnet syndrome'(ALL INDIA OPHTHALMOLOGICAL SOC, 2011) Cinar, Nilgun; Sahin, Sevki; Karsidag, SibelThe Charles Bonnet Syndrome (CBS) is typically characterized by visual hallucinations in elderly people without cognitive defects. This article presents the case of an 80-year-old male patient with a one-year history of visual hallucinations, secondary to glaucoma, in both eyes. Neither a dopamine agonist nor cholinesterase inhibitor therapy improved his symptoms. In this case, the hallucinations were gradually improved after administration of a GABAergic drug, pregabalin, for diabetic polyneuropathy. Placebo-controlled clinical trials would be needed to support this effect of pregabalin, as suggested by this association.Yayın Frequently Seen But Rarely Diagnosed: Musical Ear Syndrome(AVES, 2016) Cakmak, Mirac Aysen; Sahin, Sevki; Cinar, Nilgun; Karsidag, Sibel…Yayın Intramuscular Hematomas Caused by Anticoagulant Therapy: Is Advanced Age a Risk Factor?(GALENOS YAYINCILIK, 2010) Cinar, Nilgun; Sahin, Sevki; Karaoglan, Alper; Karsidag, SibelOral anticoagulant therapy (OAT) is very effective in the prevention of cerebral embolism, especially in certain cardiac diseases. Hematomas are the major complication of OAT. It may threaten the patient's life by bleeding into the vital structures. Herein, we describe four patients with hematomas in the psoas, quadriceps, pectoral, or rectus abdominis muscles accompanied by anemia during warfarin therapy for atrial fibrillation and artificial heart valves. Computed tomography and magnetic resonance imaging helped us establish a definitive diagnosis in each case. Our patients were three women and one man. Their international normalized ratios were within the therapeutic range during this period. They suffered from minor traumas, such as falls or a hit while taking warfarin therapy. All anticoagulation treatments were discontinued for approximately 1 week after the episode of bleeding. Although conservative management was sufficient for three patients, one patient had surgical decompression due to a rectus abdominis hematoma with retroperitoneal hemorrhage. There were no episodes of bleeding or other complications after starting oral anticoagulant therapy during the follow-up. The common aspects of our cases were older age and a history of minor trauma. As a result, we suggest that special attention needs to be paid to the patients under anticoagulant therapy, especially those at an advanced age, and to warn them avoid trauma. (Archives of Neuropsychiatry 2010;47:267-70)Yayın Isolated third-nerve palsy after cardiac surgery(W B SAUNDERS CO-ELSEVIER INC, 2007) Aksoy, Tamer; Karaca, Pelin; Atasoy, M. Mahir; Sahin, Sevki…Yayın Nine Years with Munchausen Syndrome: A Case of Psychogenic Dystonia(COLUMBIA UNIV LIBRARIES, CENTER DIGITAL RESEARCH & SCHOLARSHIP, 2015) Cakmak, Mirac A.; Sahin, Sevki; Cinar, Nilgun; Tiyekli, Utkan; Karsidag, SibelBackground: Munchausen syndrome presenting with psychogenic dystonia is a rare condition. Phenomenology Shown: A psychogenic dystonia case presenting with an acute onset of retrocollis, lower limb dystonia and bizarre gait was diagnosed as Munchausen syndrome. Educational Value: Recognizing psychogenic dystonia avoids unnecessary investigations and provides successful treatment.
