Lightning strike­induced cauda equina syndrome: a case report.

Peripheral nerve injuries after being struck by lightning have been documented. Here, we report a case of cauda equina syndrome induced by lightning. A 27-year-old man presented with numbness, a burning sensation in the saddle region, and increased urinary urgency after being struck by lightning. He had absent Achilles reflexes and paresthesia in the saddle region upon neurological examination, and magnetic resonance imaging of the spine was normal. Electrophysiological studies indicated involvement of bilateral L5, S1, and S2 myotomes and revealed cauda equina lesions. 
Peripheral nerve injury induced by lightning is rare, and the evaluation of people with neurological complaints using electromyography will help determine the true incidence.

Patient with recurrent neuralgic amyotrophy; right brachial plexitis and left posterior interosseous neuropathy.

Neuralgic amyotrophy (NA), also known as Parsonage-Turner syndrome or idiopathic brachial plexopathy, is a multifocal inflammatory neuropathy that usually affects the upper limbs. The classic picture is a patient with acute onset of asymmetric upper extremity symptoms, excruciating pain, rapid onset of multifocal paresis often involving winged scapula, and a monophasic course of the disease. 
We present an unusual case of recurrent NA characterized first by right brachial plexitis and then isolated left posterior interosseous nerve palsy. 

Dropped Head Syndrome As a Presenting Sign of Different Diseases: Report of Three Cases.

Dropped head is an abnormal forward flexion of the cervical spine. Patients can straighten their heads with support. This condition, which is seen as neck extensor muscle weakness, is defined as 'head ptosis' or 'dropped head syndrome' and is seen in various central and neuromuscular diseases. Myasthenia gravis, inflammatory myopathy, amyotrophic lateral sclerosis, facio-scapulo-humeral dystrophy, nemaline myopathy, carnitine deficiency and spinal muscular atrophy are some of the neuromuscular diseases seen in dropped head cases. We aimed to present 3 different cases with a diagnosis of myasthenia gravis, inflammatory myopathy, and amyotrophic lateral sclerosis presenting with dropped head.

Proximal median neuropathy due to schwannoma: Two case reports.

Although schwannoma is the most common benign tumor of the peripheral nervous system, median nerve schwannomas are extremely rare. These cases are usually silent and may get misdiagnosed. In this article, we presented two cases of schwannoma. They presented with normal electroneuromyography in their routine evaluation, and the provisional clinical diagnosis was median neuropathy. After examining the upper elbow segment, the definitive diagnosis was proximal median neuropathy, which was histopathologically confirmed.

Proximal sciatic neuropathy secondary to hamstring tendon avulsion.

We herein present the exceptional case of a patient, who injured a sciatic nerve due to avulsion of proximal hamstring tendon in a motorcycle accident. The 63-year-old man was diagnosed firstly with an incomplete fracture of distal femur. A foot drop on the right side was observed when the full-length cast was removed two months later. The patient was referred to the neurology clinic and was diagnosed with a sciatic nerve lesion at the proximal level of the biceps femoris. Magnetic resonance imaging of the thigh showed a proximal avulsion of hamstring muscles tendon. The patient did not improve by short-term physiotherapy and neurosurgical intervention. Sciatic nerve injury can be a result of proximal hamstring avulsion in events such as motorcycle accidents even in the absence of complete or major femur fracture.

Bilateral Wrist Drop Caused by Non-invasive Continuous Monitoring of Blood Pressure During Severe COVID-19 Pneumonia: A Case Report.

Compressive peripheral nerve injury can be observed as a long-term outcome during the treatment of severe COVID-19 pneumonia. In this case study, we report a man with bilateral wrist drop due to prolonged noninvasive blood pressure monitoring. A 52-year-old man who had undergone invasive ventilation because of severe COVID-19 pneumonia was admitted with bilateral loss of function of the wrist, digital, and thumb extensors and hypoesthesia in the dorsum of the forearm and hand. The patient had not been treated with prone positioning respiratory therapy. However, he had undergone bilateral automated sphygmomanometry that measured his blood pressure every ten minutes during his ICU stay. His electrophysiological findings were compatible with the presence of bilateral radial nerve compression at the level of the spiral groove. Awareness of potential compressive peripheral nerve injury is important for rehabilitation after the treatment of COVID-19-associated pneumonia.

Leptomeningeal carcinomatosis presenting with acute motor axonal neuropathy.

Leptomeningeal carcinomatosis is a rare, devastating, and mostly late-stage complication of various solid tumors and hematologic malignancies. The diagnosis can be challenging especially if malignancy is not in active phase or treatment was discontinued. A literature search revealed various unusual presentations of leptomeningeal carcinomatosis including cauda equina syndrome, radiculopathies, acute inflammatory demyelinating polyradiculoneuropathy, and others. To the best of our knowledge, this is the first case of leptomeningeal carcinomatosis presenting with acute motor axonal neuropathy variant of Guillain-Barré Syndrome and unusual cerebrospinal fluid findings known as Froin's syndrome.

Ischemic stroke cases presenting with hand weakness mimicking peripheral neuropathy.

Pure motor monoparesis due to ischemic stroke involving a single extremity is a rare condition that can be easily misdiagnosed. Herein, we present three cases with isolated upper extremity monoparesis. All of our patients had weakness in the left hand. They were previously evaluated in other centers and were diagnosed with peripheral neuropathy by electromyography. When patients whose complaints did not resolve were admitted to our clinic, we performed electromyography again and observed that it was normal. Hereupon, we detected ischemic infarctions in cranial magnetic resonance imaging that would explain the patients' complaints. Isolated monoparesis mimicking peripheral neuropathy is a rare symptom in stroke patients. Pure motor monoparesis should be kept in mind in every patient presenting with acute-isolated monoparesis, and neuroradiological imaging should be performed.

Sjogren's syndrome associated with bilateral peripheral facial paralysis.

Sjogren's Syndrome (SS) is a chronic autoimmune disorder that may be complicated by neurological dysfunctions. The involvement of cranial nerves in SS was described as a very rare complication. Moreover, bilateral peripheral facial paralysis associated with SS has been described only in 3 patients in the literature and the first case was described by Henrik Sjogren himself in 1935. We report a 59-year-old female with bilateral peripheral facial paralysis associated with Sjogren's syndrome. She was treated with 5-day IVIG consecutively and continued oral methylprednisolone 16mg/day and almost fully recovered at 2 months of follow-up examination. Acute bilateral peripheral facial palsy in SS is a very rare condition and Lyme disease, Guillain-Barré syndrome, HIV infection, and central nervous system lymphoma should be considered in the differential diagnosis. As a result, SS should be considered as an underlying cause of bilateral facial paralysis.

Maternal and paternal quality of life in children with epilepsy: Who is affected more?

INTRODUCTION: This study aimed to evaluate and compare parental quality of life (QoL), anxiety, and depression in mothers and fathers of children with epilepsy (CWE). MATERIAL AND METHODS: Thirty-three mothers and 33 fathers of 33 CWE (aged 1-16 years) completed the World Health Organization Quality of Life-Brief Form (WHOQOL-BREF), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) questionnaires. Scores for the questionnaires were compared for 36 mothers and 36 fathers of 36 healthy children (aged 1-16 years). The control group consisted of hospital staff who had healthy children. RESULTS: Mothers of CWE had significantly lower scores for the environmental domain of the WHOQOL-BREF, BDI, and BAI questionnaires compared with mothers of healthy children (p < 0.05), while fathers showed no significant difference (p > 0.05). Furthermore, mothers of CWE had significantly lower scores for the psychological domain of the WHOQOL-BREF compared with fathers (p < 0.05). The environmental domain of the WHOQOL-BREF questionnaire was negatively correlated with the number of children for all parents (r = -0.342, p = 0.005), and the BAI and BDI scales were positively correlated with the number of children (r = 0.386, p = 0.001; r = 0.395, p = 0.001, respectively). CONCLUSION: Mothers of CWE showed lower scores for the psychological domain in QoL analysis compared with fathers of CWE, as well as decreased emotional wellbeing and lower QoL compared with mothers of healthy children. These results reveal that parents of CWE with a larger family size are more affected and that mothers of CWE are more affected. The reasons for these findings and possible interventions that might improve QoL, particularly in mothers with CWE, require further research.

Diagnostic value of the near-nerve needle sensory nerve conduction in sensory inflammatory demyelinating polyneuropathy.

INTRODUCTION: In this study we report the diagnostic value of the near-nerve needle sensory nerve conduction study (NNN-SNCS) in sensory inflammatory demyelinating polyneuropathy (IDP) in which the routine nerve conduction study was normal or non-diagnostic. METHODS: The NNN-SNCS was performed to identify demyelination in the plantar nerves in 14 patients and in the median or ulnar nerve in 2 patients with sensory IDP. RESULTS: In 16 patients with sensory IDP, routine NCSs were either normal or non-diagnostic for demyelination. Demyelination was identified by NNN-SNCS by dispersion and/or slow nerve conduction velocity (NCV) below the demyelination marker. Immunotherapy was initiated in 11 patients, 10 of whom improved or remained stable. DISCUSSION: NNN-SNCS played an essential role in identifying demyelinaton in 16 patients with sensory IDP, leading to proper treatment. Muscle Nerve 57: 414-418, 2018.

Effects of continuous theta burst transcranial magnetic stimulation on cortical excitability in patients with idiopathic generalized epilepsy.

INTRODUCTION: Transcranial magnetic stimulation (TMS) is a noninvasive technique for investigating cortical physiologic functions in the brain. In this study, the effects of continuous theta burst stimulation (cTBS) on motor evoked potential (MEP) parameters in patients with idiopathic generalized epilepsy (IGE) were investigated. MATERIALS AND METHODS: Fifteen patients with IGE were included. Motor threshold (MT) and cortical silent period (CSP) were determined before cTBS application. Next, cTBS was applied to the dominant (left) hemisphere M1 hand area as the first application. After 1 day, cTBS was applied first to the left M1 hand area and then to the right lateral cerebellar area as the second application. Parameters were again determined after the applications. RESULTS: There was no difference in resting MT values before and after cTBS application (p>0.05). Although CSP increased after stimulation (p<0.05), it was not significantly different between applications (p>0.05). CONCLUSION: For patients with epilepsy, cTBS is a safe technique when applied at a low intensity. The inhibitory effect of cTBS, a noninvasive technique, on cortical excitability in patients with IGE was determined using MEP parameters. The effect lasted at least 1 h. To our knowledge, this is the first study to assess the effect of cTBS on cortical excitability in patients with IGE. Our findings indicate that cTBS decreases cortical excitability in patients with IGE.

Clinical, Radiological and Electrophysiological Comparison of Immunomodulatory Therapies in Multiple Sclerosis.

INTRODUCTION: Although it has been shown that immunomodulatory therapies (IMTs) in multiple sclerosis (MS) can modify the course of the disease by reducing the relapse rate and delaying the progression of disability, no study comparing IMTs head-to-head in terms of clinical, radiological, and electrophysiological changes is available. We aimed to investigate the effects of interferon-beta (IFN-B) 1b, IFN-B-1a subcutaneous (sc), IFN-B-1a intramuscular (im), and glatiramer acetate (GA) therapies on clinical, electrophysiological, and radiological findings. METHODS: We studied a cohort of 85 MS patients who were followed up for at least 2 years and had complete charting, including pre-treatment and post-treatment clinical, radiological, and electrophysiological findings. We compared the IMTs' effects on these findings retrospectively. RESULTS: Annual relapse rates were 0.1 for IFN-B-1a sc, 0.2 for IFN-B-1b, 0.3 for GA, and 0.5 for IFN-B-1 a im (p=0.01). The percentages of relapse-free patients after one year were 54.5% for IFN-B-1a im and GA, 82.9% for IFN-B-1a sc, and 86.4% for IFN-B-1b, and after two years the percentages were 27.3% for IFN-B-1a im, 54.5% for GA, 72.7% for IFN-B-1b, and 78% for IFN-B-1a sc (p<0.05). Disability scores after 2 years increased for IFN-B-1a im, decreased for IFN-B-1a sc (with a 0.1-point increase compared to the first year), and did not change for IFN-B-1b or GA compared to before treatment. Within the 2-year treatment period, no significant increase in the number of magnetic resonance T2 lesions was observed. No significant differences were found for any of the therapies in terms of evoked potentials. CONCLUSION: Our results revealed that high dose and more frequent regimens were more effective in terms of reducing the relapse rate, whereas there were no differences in terms of efficacy on radiological and electrophysiological findings between groups. Additional prospective studies comparing the efficacy of IMTs on MS are needed.

Transcallosal conduction in paroxysmal kinesigenic dyskinesia.

OBJECTIVES: Detecting whether a possible disequilibrium between the excitatory and inhibitory interhemispheric interactions in paroxysmal kinesigenic dyskinesia (PKD) exists. METHODS: This study assessed measures of motor threshold, motor evoked potential latency, the cortical silent period, the ipsilateral silent period and the transcallosal conduction time (TCT) in PKD patients. Data were compared between the clinically affected hemisphere (aH) and the fellow hemisphere (fH). RESULTS: The transcallosal conduction time from the aH to the fH was 11.8 ms (range = 2.3-20.7) and 13.6 ms (range = 2.8-67.7) from the fH to the aH. The difference in TCT in the affected side was significant (p = .019). CONCLUSION: The findings demonstrated that, although inhibitory interneurons act normally and symmetrically between the motor cortices and transcallosal inhibition was normal and symmetrical between both sides, the onset of transcallosal inhibition was asymmetrical. The affected hemisphere's inhibition toward the unaffected hemisphere is faster compared to the inhibition provided by the fellow hemisphere. These results are consistent with an inhibitory deficit in the level of interhemispheric interactions. SIGNIFICANCE: This study revealed a defect in inhibition of the motor axis could be responsible in the pathological mechanisms of kinesigenic dyskinesia.