Carpal tunnel syndrome and nerve conduction studies in fibromyalgia patients.

INTRODUCTION: The aim of this study is to evaluate ENMG results of female patients with Fibromyalgia Syndrome (FMS) with a preliminary diagnosis of carpal tunnel syndrome (CTS) and to examine whether there are differences in ENMG results compared to control group. MATERIAL AND METHODS: Ethical approval was obtained for this study on 30.12.2022 with number E. Kurul-2022-20/32 and recorded retrospectively between January 2021 and January 2023. 201 female patients who were diagnosed with FMS in Physical Therapy and Rehabilitation polyclinic and who were requested to have ENMG testing with a preliminary diagnosis of CTS were included in study as patient group. 201 patients were included as control group. RESULTS: While the number of patients with right CTS was 39 (25.49%) in the FMS group, the number of patients with right CTS was 38 (24.20%) in control group. While the number of patients with left CTS was 34 (25%) in the FMS group, number of patients with left CTS in the control group was 36 (24.65%). When we analyzed a total of 592 ENMG results in our study, we found a high normal ENMG rate of 75%. CONCLUSION: We found that there was no difference between the FMS and the control group in terms of compatibility between the pre-diagnosis and electroneurophysiological diagnosis in the ENMG results requested with the pre-diagnosis of CTS in our study. The ENMG examination should be requested for right patient in right indication, by first evaluating the patient well.

Cognitive impairment in epilepsy patients and its correlations.

OBJECTIVE: Epilepsy is a severe disease in which seizures play the leading role. Striking clinical manifestations of the attacks take most of the attention of healthcare professionals. Apart from epilepsy itself, it is well known that epilepsy patients may also have psychiatric comorbidities. These disorders, such as anxiety and depression, are mostly thought to be related to epileptic seizures or antiepileptic medications. In clinical practice, cognitive impairment is another disrupted area of interest in epileptic patients. Our study aimed to detect this deterioration and its correlations with mood disorders and epileptic disease features such as seizure frequency and illness duration. MATERIALS AND METHODS: After obtaining verbal and written consent, we enrolled 52 epilepsy patients in our study. A short demographic form indicating their gender, epileptic disease features, and medication usage information was completed for each patient. The Quick Mild Cognitive Impairment Screen (QMCI) test, the Hamilton Anxiety Rating Scale (Ham-A), and the Hospital Anxiety and Depression Scale (HADS) were applied by an experienced psychologist. Abnormal brain magnetic resonance imaging findings (e.g., encephalomalacia, large arachnoid cysts, a considerable amount of white matter gliotic lesions, neoplastic or vascular space-occupying lesions, hippocampal malformations), vitamin and electrolyte imbalances, other chronic diseases as well as thyroid dysfunction were considered as exclusion criteria since they might interfere with cognition. We excluded abnormalities to this extent because we wanted to acquire a homogenous sampling population without structural disadvantages. Thus, we could be able to determine slight changes in cognition properly. RESULTS: We found decreased cognitive scores directly proportional to lower education level, higher seizure frequency, longer disease duration, generalized tonic-clonic (GTC) type of seizure, and antiepileptic polytherapy. Also, complying with the literature, a high frequency of depression was found in our study group. Interestingly, decreased anxiety levels of the patients were statistically related to higher seizure frequency, which may indicate adaptive mechanisms to frequent seizures. Finally, a multivariate regression analysis revealed a significant negative impact of GTC type of seizure on cognition. CONCLUSION: Epilepsy and epileptic seizures affect cognition negatively. Thus, newly diagnosed epilepsy patients should be assessed for cognitive status as soon as possible. This assessment will allow epileptologists to understand future deteriorations in their patients' cognition. In our study, it is shown that QMCI is an effective and practical way to assess the cognitive statuses of epilepsy patients.

The significance of ONSD, ONSD/ETD ratio, and other neuroimaging parameters in idiopathic intracranial hypertension.

Background: The measurement of the optic nerve sheath diameter (ONSD) has been suggested to be used in the evaluation of intracranial pressure of several etiologies. However, its potential utility in the clinical evaluation of patients with idiopathic intracranial hypertension (IIH) needs to be clarified.Methods: We recruited all the IIH patients who had been admitted to our neurology clinics and had a cranial MRI before lumbar puncture investigation. A control group of patients with migraine was also included. Studies were reviewed blindly by a radiologist, and ONSD and ONSD/ eyeball transverse diameter (ETD) for both eyes were measured.Results: Ultimately, we have enrolled 50 patients with IIH and 53 migraineurs. The right ONSD values were higher in the IIH group (p = 0.024) whereas the values of ONSD/ETD were found to be both higher in the IIH group (right: p = 0.006, left: p = 0.043). The ROC curve demonstrated an area under the curve of 0.620 (95% CI = 0.508 to 0.731) for ONSD, and it was 0.642 for ONSD/ETD. Using a cut-off of 6.3 mm, ONSD had the following performance characteristics: sensitivity 18%, specificity 81%.Conclusions: The ONSD and ONSD/ETD values may be utilizable in the evaluation processes of IIH patients; however, they do not solely reach sufficient discriminative accuracy. The potential significance of these parameters in rather monitoring the IIH patients may constitute a strictly crucial topic of interest for future research.

The prevalence of papilledema in patients with migraine: a crucial cooccurrence of migraine and idiopathic intracranial hypertension.

OBJECTIVE: We aimed to investigate the prevalence of idiopathic intracranial hypertension (IIH) in patients with migraine by screening for papilledema. MATERIALS AND METHODS: We have included all the patients with migraine who applied to our neurology clinic during December 2019 and accepted to participate in the study. The demographic and clinical characteristics including migraine subtype (episodic/chronic), headache frequency per month, and headache characteristics of all patients were interrogated. Besides, the presence of fibromyalgia (FM) and chronic fatigue syndrome (CFS) was noted. Fundus examination was performed in all of the patients and the presence of papilledema was noted. RESULTS: Overall, 158 consecutive migraineurs were included in this study. The mean age of the group was 35.9 ± 9.9 and the female/male ratio was 134/24. Papilledema was determined in 10 (6%) patients. There was a past medical history of having IIH in one of these patients. In four of the patients, the diagnosis of IIH was newly established. Comparative analyses between episodic migraineurs and chronic migraineurs revealed that female gender was more prevalent in chronic migraineurs (p = 0.00) and the comorbidities of FM and CFS were more common in chronic migraineurs. Remarkably, papilledema was found to be more common in chronic migraineurs. The results of the logistic regression analyses revealed that obesity was the only predictor for the presence of papilledema (p = 0.014). CONCLUSION: Our results may suggest that IIH should be kept in mind as a notable comorbidity in migraineurs, particularly in the subgroup of obese patients with chronic migraine.

Posterior ocular blood flow in preeclamptic patients evaluated with optical coherence tomography angiography.

OBJECTIVE: The aim of the present study was to examine the effects of preeclampsia on posterior ocular blood flow through optic coherence tomography angiography (OCTA). STUDY DESIGN: The study included preeclamptic pregnant women (group PPW), healthy pregnant women (group HPW) and control non-pregnant women (group CNPW). The blood flow area of retina, optic nerve head and choriocapillaris were assessed through OCTA. RESULTS: Retinal superficial blood flow area (RSBFA) was similar in group PPW, HPW and CNPW (p = 0.101); likewise, there was not any difference in retinal superficial parafoveal vessel density (RSPFD) between the groups (p = 0.685). There was not any difference detected in retinal deep blood flow area (RDBFA) in group PPW, HPW and CNPW), likewise retinal deep parafoveal vessel density (RDPFD) was found similar between the groups (p = 0.184). The choriocapillaris blood flow area (CBFA) was different between the groups (p = 0.000) and less in the group PPW than in group HPW. The CBFA was 1.875 ±â€¯0.05 mm2 in group the PPW, 1.928 ±â€¯0.05 mm2 in the group HPW and 1.464 ±â€¯0.06 mm2 in the group CNPW. Similarly, the optic nerve head blood flow area was lower in the group PPW compared to the group HPW (1.567 ±â€¯0.38 mm2, 1.690 ±â€¯0.20 mm2 and 1.592 ±â€¯0.25 mm2 in the group PPW, group HPW and group CNPW respectively; p = 0.002). CONCLUSION: Posterior segment ocular blood flow may be diminished in preeclamptic women. OCTA may enable to monitor ocular blood flow dynamics and give important clues in the diagnosis of retinal vascular pathologies accompanied by systemic diseases.

May headache be the first sign of mutation in the MTHFR gene?

BACKGROUND: Cerebral venous thrombosis (CVT) is a rare disease and it has different etiologies. Inherited or acquired prothrombotic state plays a key role in the development of CVT. METHODS: A 28-year-old man who presented to our emergency department with persistent headache and accompanied by complaints of nausea and vomiting over a week. Neurologic examination revealed bilateral papilledema. Brain computed tomography showed a hyperdense area on the posterior part of the occipital lobe. Brain magnetic resonance imaging and magnetic resonance venography revealed thrombosis of CVT. Homozygous mutations were found for methylenetetrahydrofolate reductase (MTHFR). MTHFR CG677T gene mutation and blood tests showed elevated homocysteine levels on the etiological screening. There was no other etiology for CVT. RESULTS: Headache and other complaints were improved after treatment of heparin, warfarin, and vitamin B12. No recurrence of symptoms was observed upon outpatient follow-up. CONCLUSION: Since CVT is an important cause of headache, we recommend etiology screening for patients who present with CVT for MTHFR gene mutations and family counseling should be provided.

May headache be the fi rst sign of mutation in the MTHFR gene? / 世界急诊医学杂志（英文）

BACKGROUND: Cerebral venous thrombosis (CVT) is a rare disease and it has different etiologies. Inherited or acquired prothrombotic state plays a key role in the development of CVT.METHODS: A 28-year-old man who presented to our emergency department with persistent headache and accompanied by complaints of nausea and vomiting over a week. Neurologic examination revealed bilateral papilledema. Brain computed tomography showed a hyperdense area on the posterior part of the occipital lobe. Brain magnetic resonance imaging and magnetic resonance venography revealed thrombosis of CVT. Homozygous mutations were found for methylenetetrahydrofolate reductase (MTHFR). MTHFR CG677T gene mutation and blood tests showed elevated homocysteine levels on the etiological screening. There was no other etiology for CVT.RESULTS: Headache and other complaints were improved after treatment of heparin, warfarin, and vitamin B12. No recurrence of symptoms was observed upon outpatient follow-up.CONCLUSION: Since CVT is an important cause of headache, we recommend etiology screening for patients who present with CVT for MTHFR gene mutations and family counseling should be provided.