Can we distinguish stroke and stroke mimics via red cell distribution width in young patients?

INTRODUCTION: Discrimination of stroke and stroke mimics is problematic in young patients. The aim of the study was to determine whether arterial ischemic stroke and stroke mimics can be differentiated via the red cell distribution width (RDW) value in young patients. MATERIAL AND METHODS: In this retrospective cross-sectional study, a total of 236 patients hospitalized at the neurology ward were investigated. The patients were divided into 3 groups: the 1(st) group included young stroke patients, the 2(nd) group included patients with epilepsy, and the 3rd group included patients with multiple sclerosis (MS). Complete blood count and computed tomographic brain imaging tests were performed in all patients, and magnetic resonance imaging was done when necessary. RESULTS: A total of 236 patients were included in this study. Ninety-five (40%) patients were young stroke patients, 71 (30%) had epilepsy and 70 (30%) had MS. The mean RDW values of young patients with stroke were significantly higher than patients with epilepsy or MS (14.9 ±1.2, 13.3 ±1.2, 13.4 ±0.6, p < 0.0001, respectively). The diagnostic power of RDW in the differentiation of patients with stroke is good (area under the curve (AUC) = 0.89). When an RDW cut-off value of 14.05% is accepted for differentiating young patients with stroke from other disorders, the sensitivity, specificity, positive predictive and negative predictive values were 73.7%, 87.9%, 6.1 and 0.043, respectively. CONCLUSIONS: Red cell distribution width is a promising, rapid, easy and inexpensive parameter to distinguish young stroke from stroke mimics (such as epilepsy and MS) in young patients.

Red cell distribution width identifies cerebral venous sinus thrombosis in patients with headache.

BACKGROUND: Diagnosing cerebral venous sinus thrombosis (CVST) in patients referring to emergency service or neurology outpatient unit with complaints of headache is a challenging task. Magnetic resonance (MR) venography is the gold standard, but there are limitations regarding its use. AIM: To evaluate the validity of red cell distribution width (RDW) in CVST diagnosis in patients presenting with headache. METHODS: A total of 138 patients comprising 37 patients with CVST and 101 control primer headache cases were included in this retrospective cross-sectional study. Control group consists of hospitalized patients with primary headache. Venous blood hemoglobin (Hb), platelet, mean corpuscular volume (MCV), RDW, fibrinogen, and vitamin B12 levels of the patients were recorded at the first referral. Diagnosis of CVST was established by MR venography. RESULTS: The RDW ratio of patients with a diagnosis of CVST was significantly higher than that in patients with primary headache (15.3 ± 1.4 vs 13.3 ± 0.5; P <.0001). Fibrinogen and vitamin B12 levels were not significantly different between the 2 groups. In a total of 11 patients, there was more than 1 thrombosis. In 21 of the patients with CVST, gene mutation was detected. There was no significant difference between the patients with and without mutations regarding RDW values. Diagnostic validity of RDW was found to be excellent in differentiating patients with CVST and primary headache (area under the curve = 0.996; 95% CI: 0.990-1.000). Optimum RDW cutoff value was determined as 14.1% (sensitivity: 91.9%, specificity: 99%, positive predictive value: 92.8, negative predictive value: 0.082). CONCLUSION: We suppose that among patients presenting with the complaint of headache, RDW value may lead to diagnose CVST.

Parallel development of choroid plexus degeneration and meningeal inflammation in subarachnoid hemorrhage - experimental study.

BACKGROUND: The choroid plexuses (CPs) are brain structures located in the brain ventricles, involved in the production and reabsorption of cerebrospinal fluid (CSF) components, cerebral immune surveillance, and various endocrine-enzymatic activities and acts as a CSF-blood barrier. This study investigated to determine if there is a link between ischemic CP injury and meningo-cerebral inflammation processes. MATERIAL AND METHODS: This study was conducted on 18 rabbits. Four rabbits were used as the baseline group to examine the normal structures. Fourteen of the rabbits were used as the study group by injecting 1.00cc of homologous blood into their cisterna magna. The animals were followed by daily monitoring for ten days and then slaughtered. Apoptotic degeneration of the CP cells was determined and statistical analyses were carried out using normal and apoptotic CP cell numbers. Data analyses were comprised of Mann-Whitney U tests. Differences were considered to be significant if p < 0.005. RESULTS: Five animals belonging to the study group died between the 5th and 8th days. Unconsciousness, neck stiffness, convulsion, fever, apnea, cardiac arrhythmia, and breathing disturbances were observed in all of the animals who subsequently died. Intraventricular blood leakage was detected in all the dead and three surviving animals. Choroidal artery spasm, choroidal ependymal cell injury, choroidal cell apoptosis, pia-arachnoid thickening, meningocortical adhesions and blood cell density in the subarachnoid spaces were more severe in the more CP degenerated animals than those of the others. There were significant differences between the apoptotic CP cell density and blood cell density in the subarachnoid spaces (p < 0.005). CONCLUSIONS: Subarachnoid hemorrhage (SAH) extending to brain ventricles causes ischemic degeneration of the CP by way of triggered choroidal artery vasospasm. It should be emphasized that the prevention of CP function may be an important part of the protection of the brain in SAH.

The relationship of median nerve F-wave parameters with severity and subtypes of carpal tunnel syndrome.

PURPOSE: F-wave analysis may help affirm or disprove a compression neuropathy. In this study we have analysed the effects of focal median nerve injury on F wave in Carpal Tunnel Syndrome (CTS). METHOD: We studied 57 patients (100 hands) with clinical and electrophysiological CTS and 31 (62 hands) healthy subjects. Median nerve F-waves were evaluated following 10 supramaximal stimuli and recording from abductor pollicis brevis muscles. Minimum, maximum, and mean F-wave latencies, frequency of the F wave (Fp), chronodispersion (F_{CD}), mean F/M amplitude ratios (mF/M-amp) and F-wave conduction velocity (FwCV) were evaluated. RESULTS: The CTS patients showed prolonged F-wave latencies, decreased Fp, and an increase of the F_{CD} as compared with normative values. Absent F wave was presented in 8 of 34 hands (23.5%) with severe CTS patients. In the severe group, the FwCV was significantly slower (p< 0.001) and the mF/M-amp was significantly higher (p< 0.001) than that of mild and moderate groups, respectively. Also, the mF/M-amp was significantly greater and Fp was lower in the axonal type than in the demyelinating type. The F_{CD} was not different among groups. A strong positive correlations between mMDL with Fmin (r=0.81, p< 0.000), Fmean (r=0.80, p< 0.000) and Fmax (r=0.71, p< 0.000) were revealed. CONCLUSION: Results support the differing effects of demyelinating and axonal injury on F-waves and suggest that the mF/M-amp ratio and FwCV, which is influenced by neuronal damages in the distal segment of the median nerve, is useful in the discrimination of CTS severity.

Migraine prevalence, disability, and sociodemographic properties in the eastern region of Turkey: a population-based door-to-door survey.

BACKGROUND/AIM: To determine the frequency of migraine in the eastern part of Turkey and its sociodemographic characteristics, impact on disability, and clinical aspects. MATERIALS AND METHODS: The study was conducted door-to-door in the eastern part of Turkey. Those who suffered from headaches were diagnosed with migraine as per the 2004 diagnosis criteria of the International Headache Society and its frequency was determined. Demographic data and Migraine Disability Assessment Scale (MIDAS) scores were recorded. RESULTS: Of the individuals evaluated, 60.4% (883) suffered from headaches, of which 43.6% (637) were evaluated as nonmigraine and 16.8% (246) as migraine headaches. Migraine prevalence was detected to be 10.3% (75) in men and 23.1% (171) in women. When the MIDAS scale was considered, 7.3% of the patients were classified with mild pain, 36.9% with mild to moderate pain, 41% with moderate pain, and 14.6% with severe pain. CONCLUSION: Migraine headache has a wide and complex range of symptoms and is frequently observed in women and young adults. The prevalence of migraine among the general population of eastern Turkey was found to be similar to the averages in the rest of the country, as well to the averages of studies in Europe.

Role of the trigeminal system on posterior communicating artery remodelization after bilateral common carotid artery ligation.

OBJECTIVE: To examine whether or not there is a possible relationship between the neuron density of trigeminal ganglion (TGG) and the severity of posterior communicating artery (PComA) vasodilation values after permanent bilateral common carotid artery ligation (BCCAL). STUDY DESIGN: This study included 25 rabbits. Both the common carotid arteries of 20 rabbits were explored and denervated. Five animals served as controls. Permanent BCCAL was applied in 15 of the 20 rabbits, and the other 5 were used as the SHAM group without ligation. All animals were followed for 2 months and then sacrificed. Their brains and cranial nerves were extracted and fixed in 10% formalin solution. The relationship between PComA vasodilation values and TGG neuron densities were compared. RESULTS: Elongation, convolution and enlargement were detected in all the basilar arteries of all ligated animals and 2 from the SHAM group. On histopathogical examination vascular wall thinning, luminal enlargement, flattened inner elastic membrane, flattened vessel muscle cells, endothelial desquamation and intimal erosions were detected. An inverse relationship was discovered between the neuron density of TGG and the severity of PComA vasodilation index. CONCLUSION: BCCAL may lead to important beneficial and hazardous histomorphological changes at the posterior communicating artery. The high neuron density of TGG may provide a beneficial effect by facilitating PComA enlargement via its vasodilatory properties for the increase of decreased cerebral circulation, although this situation may be hazardous for certain subjects with congenital or acquired cerebrovascular pathologies.

Assessment of nasal parameters in determination of olfactory dysfunction in Parkinson's disease.

OBJECTIVES: To assess nasal cycle, nasal mucosal pH and mucociliary clearance time in patients with Parkinson's disease and healthy control subjects. METHODS: Patients with idiopathic Parkinson's disease and healthy control subjects were recruited. Presence of the nasal cycle, nasal mucosa pH and mucociliary clearance time were investigated in all participants. RESULTS: The study included 27 patients and 24 control subjects. The nasal cycle was present in significantly fewer patients than controls. Nasal pH and mucociliary clearance time were significantly higher in patients than in controls. CONCLUSIONS: Parkinson's disease is associated with alterations in nasal cycle, nasal mucosa pH and mucociliary clearance time. Measurements of these nasal parameters may be useful for the early diagnosis of autonomic and olfactory dysfunction in Parkinson's disease.

Investigation of the prevalence of essential tremor in individuals aged 18-60 in Erzurum.

Essential tremor (ET) is one of the common neurological diseases and it is the most common movement disorder in adults. The main clinical finding in patients with ET is kinetic tremor in the arms. There is no adequate study investigating the prevalence of ET in Turkey. Therefore, this study was planned in the center of the city of Erzurum in order to determine the prevalence of essential tremor in our region. This study was performed door to door in the center of the city of Erzurum. ET screening questionnaires were administered to all participants between the ages of 18-60 at first stage. Those who answer yes to any of the first five questions of the questionnaire were evaluated. Patients without a clear differential diagnosis were called for examination to the neurology department and they were re-evaluated by a faculty member specializing in movement disorders. Patients were classified by using Washington Heights-Inwood Genetic Study of Essential Tremor diagnostic and clinical evaluation scale. The prevalence of ET was calculated as 1.60 % (64 out of 4,024 participants). 30 of the cases were male and 34 were female. First-degree relatives of 30 patients with ET had a history of tremor. While 52 patients had tremor only in their hands, 11 patients had in various organs including hands. There was isolated head tremor in one patient. ET prevalence was increasing with age. The prevalence of ET in people between the ages of 18 and 60 was calculated as 1.60 %. This value is compatible with other measurements of the prevalence of ET.

Effects of ischemic phrenic nerve root ganglion injury on respiratory disturbances in subarachnoid hemorrhage: an experimental study.

INTRODUCTION: Phrenic nerves have important roles on the management of respiration rhythm. Diaphragm paralysis is possible in phrenic nerve roots ischemia in subarachnoid hemorrhage (SAH). We examined whether there is a relationship between phrenic nerve root ischemia and respiratory disturbances in SAH. MATERIAL AND METHODS: This study was conducted on 5 healthy control and 14 rabbits with experimentally induced SAH by injecting autologous blood into their cisterna magna. Animals were followed up via monitors for detecting the heart and respiration rhythms for 20 days and then decapitaed by humanely. Normal and degenerated neuron densities of phrenic nerve root at the level of C4 dorsal root ganglia (C4DRG) were estimated by Stereological methods. Between the mean numerical density of degenerated neurons of C4DRG and respiratory rate/minute of groups were compared statistically. RESULTS: Phrenic nerve roots, artery and diaphragm muscles degeneration was detected in respiratory arrest developed animals. The mean neuronal density of C4DRG was 13272 ±1201/mm3 with a mean respiration rate of 23 ±4/min in the control group. The mean degenerated neuron density was 2.240 ±450/mm(3) and respiration rhythm was 31 ±6/min in survivors. But, the mean degenerated neuron density was 5850 ±650/mm(3) and mean respiration rhythm was 34 ±7/min in respiratory arrest developed animals (n = 7). A linear relationship was noticed between the degenerated neuron density of C4DRG and respiraton rate (r = -0.758; p < 0.001). CONCLUSIONS: Phrenic nerve root ischemia may be an important factor in respiration rhythms deteriorations in SAH which has not been mentioned in the literature.

Relationship between plasma metalloproteinase-9 levels and volume and severity of infarct in patients with acute ischemic stroke.

Matrix metalloproteinases (MMP) constitute an endopeptidase family involved in various physiological and pathological processes. It was demonstrated that plasma MMP-9 level was increased in patients with acute ischemic stroke. In this study, it was investigated whether there was a relationship between the levels of plasma MMP-9 and the severity of stroke and infarct volume in patients with acute ischemic stroke. A total of 32 patients with acute ischemic stroke, (16 males and 16 females) and 30 healthy controls were included in the study. Plasma MMP-9 levels were measured using ELISA method. Computed tomography was performed at 48th hour and infarct volume was calculated using the Cavalieri method. The National Institute of Health Stroke Scale (NIHSS) was checked at baseline, 12, 24, and 48th hour. Plasma MMP-9 levels of the patient group at baseline, 12, 24, and 48th hour were found significantly higher compared to the control group (p < 0.05). An important correlation between MMP-9 levels and the infarct volume was observed at baseline, 12, 24, and 48th hour (p < 0.001). Furthermore, a positive correlation was recorded between plasma MMP-9 levels and NIHSS scores at baseline, 12, 24, and 48th hour (p < 0.001). Plasma MMP-9 levels of those of suffering medium and heavy damages were found significantly higher when compared to those of having slight damage (p < 0.05). A significant relationship was also observed between infarct volumes and neurological deficits (p < 0.05). Plasma MMP-9 levels of the patients at 48th hour were found to be significantly lower in recovered patients compared to those who did not improved or worsened (p < 0.05). A positive correlation was recorded between the infarct volume and infarct progression (p < 0.05). In conclusion, this study showed that plasma MMP-9 level substantially increased during the acute period of ischemic cerebrovascular disease and correlated with the severity of the disease and infarct volume. The definition of the exact role of plasma MMP-9 after ischemic stroke will have important diagnostic implications for stroke and for the development of therapeutic strategies aimed at modulating plasma MMP-9.

Versatile use of the muscle and nerve sparing latissimus dorsi flap.

In this report, we describe the technique of muscle and nerve sparing latissimus dorsi (LD) flap and evaluate the outcomes of reconstruction of various defects with 12 free and 2 pedicled muscle and nerve sparing LD flaps in 14 patients. The LD muscle functions at operated and nonoperated muscles were evaluated clinically and with electroneuromyography. All flaps survived completely but one which had a partial necrosis. The mean follow-up time was 12.3 months. Adduction and extention ranges of the shoulders were the same bilaterally in all patients. In electroneuromyography, no significant difference was available statistically between the sides. This muscle and nerve sparing latissimus dorsi flap has advantages of thinness, muscle preservation and reliability, and thus can be a good option to other fasciocutaneous flaps in reconstruction surgery.

The effect of local corticosteroid injection on F-wave conduction velocity and sympathetic skin response in carpal tunnel syndrome.

The aim of this study was to evaluate the efficacy of steroid injection for the treatment of the carpal tunnel syndrome (CTS), with F-wave parameters and sympathetic skin response (SSR). Seventeen hands of 10 women patients were treated with local steroid injection with 2-month follow-up. All patients underwent single injection into the carpal tunnel. Response to injection was measured nerve conduction studies (NCSs), median nerve F waves, and SSR before and after treatment. To determine the normal values, 42 hands of 21 healthy women were also studied. There was a significant improvement of sensory and motor nerve conduction values when compared to baseline values (P < 0.01). At the end of follow-up period, the median sensory distal latency and the sensory latency differences between the median and the ulnar nerve were improved 35 and 65%, respectively. The maximum, mean F-wave amplitudes and chronodispersion showed a slight improvement with respect to baseline values and controls, but statistical significance was not achieved after treatment. Although no statistically significant improvements were observed in SSR parameters, slightly decreased amplitudes and increased habituation of SSR were noted at the end of the treatment. The present study shows that the local steroid injection results in improvement in NCSs values, but the F-wave parameters were not effectual in short-term outcome of CTS treatment. These findings suggest that the sensory latency differences between the median and the ulnar wrist-to-digit 4 are better parameters in the median nerve recovery after treatment than the median sensory distal latency. Furthermore, the SSR does not seem to be a sensitive method in follow-up of CTS treatment.

The effect of interferon beta 1B on bone mineral density in multiple sclerosis patients.

OBJECTIVE: Osteoporosis is a secondary problem in multiple sclerosis (MS) patients. There have been only a few reports about the effect of interferon beta (IFNB) 1b on bone mineral density (BMD). We aimed to determine bone mass in patients using IFNB 1b. METHODS: We enrolled 17 patients taking IFNB 1b (group I), 15 patients not taking IFNB (group II). We measured the BMD and T scores values and the patients were distinguished as normal, osteopenia and osteoporosis. RESULTS: In the lumbar spine, there was no difference between groups I and II (p=0.3). In the left femur, no significant difference was detected between groups I and II (p=1). There was an inverse correlation between the BMD at the both regions and the Expanded Disability Status Scale score (r= -0.39, p=0.03; r=-0.52, p=0.002, respectively). CONCLUSION: IFNB 1b may be used safely in MS patients, even in those undergoing pulse steroid therapies, because IFNB 1b has no effect on BMD.

Antihypertensive role of glossopharyngeal nerve stimulation by nifedipine using as calcium channel blocking agent in hypertension: an experimental study.

Nifedipine is a therapeutic drug in acute attacks of hypertension because of its rapid absorption from oral mucosa. Taste receptors are innervated by glossopharyngeal nerves (GPN) as well as by facial and vagal nerves. Sensory neurons of the GPNs are localised in the petrous ganglion (PG). Transection of the taste sensitive GPN fibres causes taste bud and PG degeneration and spontaneous hypertension. In this study, the role of chemical stimulation of the taste buds of the GPN by nifedipine and its role in treatment of hypertension were investigated in rabbits. Nifedipine was dropped sublingually (20 mg) for 4 days in the study group, followed by measuring blood pressures again. Then, the lingual branches of GPNs were cut. One month later, blood pressures were measured for 4 days. All animals were sacrificed humanely at the end of the experiment, and normal and degenerated neuron densities in the petrosal ganglions were enumerated stereologically. The antihypertensive effect of nifedipine decreased after GPNs denervation, in accordance with the increase of degenerated neurons in the PG. The chemical stimulation of taste buds of the GPNs by nifedipine may be an important effect of nifedipine application in addition to its calcium channel blocking effect. The rapid decrease in blood pressure following sublingual use of nifedipine may also result from the direct stimulation of taste buds innervated by the GPNs.

Neopterin levels in patients with cerebrovascular disease.

OBJECTIVE: The recovery period in ischemic cerebrovascular disease is sometimes long and complicated. It is thought that a systemic inflammatory response plays an important role in this process. Therefore, promising studies have reported that neopterin and other cytokines serve as indicators of the inflammatory response. The present study investigated the effects of cerebrovascular diseases on plasma neopterin. MATERIALS AND METHODS: We studied 68 consecutive patients under 65 years of age with cerebrovascular disease; the mean age was 52.08±5.74 years (yrs) (ranging from 39 yrs to 64 yrs; 28 female and 40 male). We also studied 29 randomly selected age-matched healthy subjects (control); the mean age was 49.76±13.11 years (yrs) (ranging from 41 yrs to 62 yrs; 12 female and 17 male). Blood samples for assessing plasma levels of neopterin were usually taken within seven days after admission to the hospital and stored at -20°C until analysis. Serum neopterin levels in all the subjects were measured by Enzyme Immunoassay (EÝA) using the BRAHMS method (Neopterin; Diagnostic GmbH, 16761 Berlin, Germany). Differences between the groups' means were analyzed with the Mann-Whitney U test. RESULTS: The mean values of neopterin levels in patients (mean neopterin levels in patients, 18.51 ± 11.56 nmol/L; vs. control, 12.26 ± 3.87 nmol/L [p=.001]) were significantly different when compared with the controls. CONCLUSION: It has been suggested that the mortality and morbidity associated with cerebrovascular disease could be prevented by a reduction in the inflammatory response. We suggest that plasma neopterin levels were significantly increased. So, the levels of plasma neopterin may be useful monitoring of treatment and course of diseases.

Plasma values of oxidants and antioxidants in acute brain hemorrhage: role of free radicals in the development of brain injury.

The levels of oxidants xanthine oxidase (XO), nitric oxide (NO), and malondialdehyde (MDA) and of the antioxidant enzymes superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and glutathione reductase (GRD) were determined in plasma within 24 h after onset of hemorrhagic stroke in 17 patients (9 men and 8 women, aged 60.7+/-11.5 yr) and in 20 healthy controls (12 men and 8 women, aged 62.5+/-8.3 yr). Compared to controls, the plasma SOD and total superoxide scavenger activities (TSSA) were significantly lower and the NO levels were significantly higher among the stroke patients. XO showed a slight, nonsignificant increase in the patients, but the levels of MDA, NSSA, GRD, and GSH-Px did not show any significant differences between the two groups. The hemorrhage volume was negatively correlated with the initial score of the Glasgow Coma Scale and a positive correlation with lethal outcome, but it did not correlate significantly with any of the measured parameters. The results suggest that free radicals might play a role in the development of brain injury following brain hemorrhage.

Handedness, eyedness, and crossed hand-eye dominance in male and female patients with migraine with and without aura: a pilot study.

The possible relationships of migraine to left-handedness and left-eyedness, as well as sex and aura-related differences, were examined. 146 migraine patients (M age=32.1 yr., SD=9.5) and 141 controls (M age=30.0 yr., SD=9.3) participated. Hand preference was assessed by the modified version of the Edinburgh Handedness Inventory. Ocular dominance was measured by means of the near-far alignment test. Migraine diagnoses were made on the basis of criteria provided from the International Headache Society. In the overall sample and in women, left-handedness and left-eyedness were not significantly correlated with migraine. In men, the incidence of left-handedness and left-eyedness were significantly higher in patients than in controls. The presence of aura in patients with migraine was significantly associated with the incidence of left-eyedness and crossed hand-eye dominance, but not handedness, for the total sample and women. These results suggest that there may be a tendency towards anomalous dominance, especially left-eyedness, in migraine patients particularly those with aura.

Determination of sensitive electrophysiologic parameters at follow-up of different steroid treatments of carpal tunnel syndrome.

Nonsurgical treatment for carpal tunnel syndrome (CTS) is frequently offered to those with mild to moderate symptoms. However, the most sensitive electrophysiological parameters at follow-up, and most effective type of different methods of steroid treatment for CTS, remain unknown. The aim of this study was to compare the efficacy of local corticosteroid injection, phonophoresis, and iontophoresis for the treatment of CTS, and to evaluate the most sensitive electrophysiologic parameters at the follow-up visit. Different conservative treatments were applied in this prospective study. Fifty-six hands of 31 patients were randomly treated with local steroid injection, iontophoresis, or phonophoresis with 2- and 4-month follow-up visits. Conventional and new neurophysiologic sensorimotor nerve conduction parameters for CTS diagnosis were performed on the initial visit and at 2 and 4 months after treatment. The local steroid injection group showed a significant improvement in the mean nerve conduction parameters after the second and fourth months when compared with basal values, whereas no significant changes except the difference between the median and ulnar distal latency to the fourth digit (D4M-D4U), difference between sensory median distal latency to second digit and ulnar distal latency to the fifth digit (D2M-D5U), and median motor distal latency were observed in the iontophoresis and phonophoresis groups. At the end of follow-up period, the most sensitive parameters were D4M-D4U and D2M-D5U; the D4M-D4U was improved 60% in the injection group, 33% in iontophoresis group, and 39% in phonophoresis group, and the improvement of the D2M-D5U was 70%, 28%, and 28%, respectively, in the injection, iontophoresis, and phonophoresis groups. These findings show that steroid injection is superior to iontophoresis and phonophoresis in the treatment of CTS, and that the most sensitive neurophysiologic parameters in follow-up are D4M-D4U and D2M-D5U, being the objective measures of the outcome of CTS treatment.

The clinical properties of a migrainous population in eastern Turkey-Erzurum.

OBJECTIVES: The purpose of this study was to determine the clinical and demographic characteristics of patients with migraine headache, in the vicinity of Erzurum, Turkey. METHODS: A uniform questionnaire was given to 185 patients diagnosed as having migraine according to the International Headache Society diagnostic criteria between August 2001 and July 2002. One hundred forty five females (78.4%) and 40 males (21.6%) were included in the study. The male to female ratio was 1:3.2. The mean age of the cases was 32.4 +/- 10.2 years and the mean age of onset was 22.8 +/- 9.1 years. RESULTS: One hundred and thirty seven patients (74.6%) fulfilled the criteria for migraine without aura (MwA) whereas forty-eight patients (25.4%) fulfilled the criteria for migraine with aura (MA). The males had been suffering from migraine headaches for a mean of 8.3 +/- 6.3 years versus a mean of 9.3 +/- 7.6 years in females. More than half (61.4%) of the females were housewives, and 84.3% of the cases were living in urban areas. About half (48.7%) of them had at least 11 years of education, most (79.5%) reported low or medium income level. Also, 70.8% were married. There was a high rate of headache in family history (72.4%). A majority of patients (75.7%) complained of severe headaches. One fourth (24.9%) had more than three attacks per month. Headache was unilateral in 71.9% and was throbbing in 77.8%. In 117 patients (63.2%) the symptoms were aggravated by physical activity. Attacks were accompanied by nausea in 84.9%, vomiting in 50.3%, photophobia in 80.0%, and phonophobia in 78.4%. In 58% of the cases, the headache was severe enough to disturb daily activities. CONCLUSIONS: This study showed that migraine is more commonly seen in urban areas, in females, and is associated with high education plus low income, and is comprised of a wide complex of symptoms.

Auditory p300 event-related potentials in fibromyalgia patients.

This study assessed the cognitive brain function measured by the cognitive P300 auditory event-related potentials (ERPs) in female fibromyalgia (FM) patients and compared the results with those from healthy age and education-matched controls. The relationship of the P300 potentials to the pain threshold of patients was also investigated. The P300 component of the auditory ERPs were studied in 11 female FM patients and 10 age and education-matched healthy controls. None of the patients were taking antidepressants such as amitriptyline or serotonin-reuptake inhibitors. The P300 latencies of the patients were not significantly different whereas the N2P3 amplitudes were significantly lower than the controls. The P300 latencies in the patients negatively correlated with the total myalgic scores (TMS) (r= -0.73) and the control point scores (CPS) (r=-0.85). On the other hand, the P300 amplitudes showed a significant correlation with the TMS (r=0.61) and the CPS (r=0.60). There was no significant correlation between the anxiety and depression scores with the P300 latency or amplitudes. These results showed cognitive impairment, which was mainly expressed by the lower N2P3 amplitudes in patients with FM, and its clinical relevance requires further research.