Endovascular angioplasty-stenting as a definitive treatment for isolated spontaneous common carotid artery dissection. A case report.

Isolated spontaneous common carotid artery (CCA) dissection is rare. So far, surgical or medical treatment have only been reported in a few cases in the literature. We report a 39-year-old man, diagnosed as isolated spontaneous CCA dissection one year ago, who experienced a new minor stroke despite medical treatment. Because of the presence of new ischemic lesions on new magnetic resonance imaging despite medical treatment, and critical narrowing of internal carotid artery (ICA) orifice with jet and turbulence flow pattern at the bulbar portion of the ICA, endovascular management was performed with carotid stent deployment. To the best of our knowledge, this is the first case of spontaneous isolated CCA dissection treated with stenting of the carotid artery reported in literature. - ÖZET - Izole spontan common carotid arter (CCA) diseksiyonu nadirdir. Literatürde sadece birkaç adet, medikal veya cerrahi tedavi uygulanan, CCA diseksiyonu olgusu bildirilmistir. Bildirimizde, bir yil önce izole spontan CCA diseksiyonu tanisi almis ve medikal tedavi altinda iken yeni minor strok geçiren 39 yasinda erkek olguyu sunuyoruz. Olgunun yeni magnetik rezonans görüntülemesinde (MRG), sol posterior frontal ve pariyetal loblarda yeni iskemik lezyonlarin ortaya çiktigi görüldü. Renkli Doppler ultrasonografi (RDUS) incelemesinde eski incelemesine gore darligin arttigi izlendi. Karotis anjiografide de internal karotis arter baslangicinda jet ve türbülans akima neden olan kritik darlik saptanmasi üzerine endovasküler tedavi planlandi. Femoral girisimle koruyucu filtre kullanilarak self ekspandibl stent yerlestirildi ve postdilatasyon balon uygulandi. Islemden 24 saat sonra alinan difüzyon MRG incelemesinde yeni iskemik alan görülmedi. Birinci ve 3. ay kontrollerinde, nörolojik muayenesinde yeni bulgu saptanmadi. RDUS incelemelerinde stentin açik oldugu görüldü. Karotis artere stent yerlestirimesi cerrahiye alternatif bir tedavi olup daha az invazivdir. Stent uygulamasi, spontan ve travmatik internal karotis arter darliklarinda kullanilmis, ancak izole spontan CCA diseksiyonunda kullanilmamistir. Olgumuz nadir görülen izole spontan CCA diseksiyonu olgularindan biri olup stent yerlestirilerek tedavi edilmistir. Sonuç olarak, medikal tedaviye ragmen tekrarlayan semptomlari olan izole spontan CCA diseksiyonu olgularda tromboemboli kaynaginin kontrol altina alinmasi ve yeterli karotis akiminin saglanmasi için stent yerlestirilmesi gerekebilir.

Auditory P300 event related potentials and serotonin reuptake inhibitor treatment in patients with fibromyalgia.

BACKGROUND: The P300 components of auditory event related potentials (ERPs) are objective measures related to information and cognitive processing. OBJECTIVES: To assess P300 ERPs in female patients with fibromyalgia (FM) in comparison with healthy age matched controls. To investigate the relationship between P300 potentials and pain threshold levels of patients, and subsequent effect of sertraline treatment on P300 potentials. METHODS: P300 auditory ERPs were studied in 13 untreated female patients with FM and 10 healthy controls matched for age, sex, and education. Pain pressure thresholds and total myalgic scores (TMS) were assessed with an algometer. Patients were evaluated for clinical measures and P300 potentials (recorded from the vertex) at the first visit, and then in the fourth and eighth weeks of sertraline treatment. RESULTS: Patients with FM had significantly lower P300 amplitudes, but not significantly different P300 latencies, than controls at entry. P300 latencies in patients correlated negatively with TMS (r(s)=-0.79, p<0.01) and P300 amplitudes correlated significantly with TMS (r(s)=0.53, p<0.05). Anxiety and depression scores did not correlate significantly with P300 latencies or amplitudes at the study entry. P300 auditory ERPs had increased amplitudes that had reached nearly the same levels as those of the controls at the eighth week without any significant change in their latencies. CONCLUSION: The results show reduced P300 amplitudes in patients with FM. Further studies assessing the relationship between P300 ERPs and neuropsychiatric tests are required for better clarification of the clinical relevance of P300 potentials in FM.

R-R interval variation and the sympathetic skin response in the assessment of the autonomic nervous system in leprosy patients.

OBJECTIVES: The aim of this study was to evaluate possible autonomic nervous system (ANS) dysfunction in leprosy patients with the sympathetic skin response (SSR) and the heart rate (R-R) interval variation (RRIV) measurements which are easy and reliable methods for evaluation of autonomic functions. MATERIAL AND METHODS: We studied 37 lepromatous leprosy patients (mean age: 38 +/- 17 years, range 23-62 years, 20 females and 17 males) and 35 age-matched healthy subjects (mean age: 34.19 +/- 12.74 years, range 24-48 years, 20 females and 15 males). Non-invasive bedside tests (orthostatic test, Valsalva ratio), R-R interval variation (RRIV) during at rest and deep breathing, the SSR latency and amplitude from both palms, and nerve conduction parameters were studied in all the subjects. RESULTS: The mean values of RRIV in leprosy patients during at rest [mean RRIV in patients, 17.42 +/- 8.64% vs controls, 22.71 +/- 3.77% (P < 0.05)] and during deep breathing [mean RRIV in patients, 21.64 +/- 9.08% vs controls, 30.70 +/- 5.99% (P < 0.005)] was significantly lower compared with the controls. The mean latency of SSR in leprosy patients [mean SSR latency in patients, 1.72 +/- 1.13 ms vs controls, 1.30 +/- 0.41 ms (P < 0.05)] was significantly prolonged compared with the controls. The mean amplitude of SSR in leprosy patients [mean SSR amplitude in patients, 0.54 +/- 0.57 microV vs controls, 1.02 +/- 0.56 microV (P > 0.05)] was smaller compared with the controls, but this difference was not significant. The mean Valsalva ratio in leprosy patients [mean in patients, 1.11 +/- 0.13 vs controls, 1.16 +/- 0.07 (P > 0.05)] was smaller compared with the controls, but not statistically significant. The mean difference of systolic and diastolic blood pressure between supine rest and during standing in leprosy patients were higher compared with the controls [mean systolic pressure in patients, 7 +/- 6 mmHg vs controls, 6 +/- 8 mmHg (P > 0.05) and mean diastolic pressure in patients, 3 +/- 3 mmHg vs controls, 3 +/- 2 mmHg (P > 0.05)], but they did not reach statistical significance. Furthermore, lower RRIV and the prolonged SSR latencies in leprosy patients were closely correlated to some parameters of sensorimotor nerve conduction and each other [median nerve distal latency and RRIV, r = -0.67 (P < 0.05), ulnar nerve distal latency and RRIV, r = -0.59 (P < 0.05), RRIV and SSR latency, r = -0.33 (P < 0.02)]. These data indicate that leprosy patients have the functional abnormalities of ANS. CONCLUSION: We conclude that combined use of these two tests, both of which can be easily and rapidly performed in the electromyogram (EMG) laboratory using standard equipment, allows separate testing of parasympathetic and sympathetic function, and are very sensitive methods in assessing of ANS function in peripheral neuropathy in leprosy patients.

Study of visual evoked potentials in the assessment of the central optic pathways in leprosy patients.

We evaluated the possible involvement of central optic pathways (COP) in leprosy patients with visual evoked potentials, an easy, sensitive and reliable noninvasive method for evaluation of COP. In 37 patients with lepromatous leprosy and in 37 age-matched controls, we measured reversal pattern visual evoked potentials (RP-VEP) and nerve conduction parameters. The mean latency value of positive peak P100 in leprosy patients was significantly delayed compared to that of controls (patients, 108.02+/-9.61 ms in left eye and 108.23+/-8.51 ms in right eye; controls, 96.22+/-4.20 ms in left eye and 95.75+/-4.03 ms in right eye; p<0.05). Abnormally delayed P100 latency was recorded in 5 of 37 leprosy patients (13.5%). The mean amplitude of P100 latency in leprosy patients was smaller than that of controls (patients, 8.7+/-5.6 micro V in left eye and 9.5+/-4.8 micro V in right eye; controls, 10.7+/-4.6 micro V in left eye and 10.5+/-5.1 micro V in right eye), but this difference was not significant. No correlation was observed between abnormalities of RP-VEP and sensorimotor nerve conduction parameters. This study suggests that involvement of COP may develop in patients with lepromatous leprosy. RP-VEP measurement, which can be easily and rapidly performed in an EMG laboratory using standard equipment, can show these alterations.

Study of visual evoked potentials in the assessment of the central optic pathways in leprosy patients

We evaluated the possible involvement of central optic pathways (COP) in leprosy patients with visual evoked potentials, an easy, sensitive and reliable noninvasive method for evaluation of COP. In 37 patients with lepromatous leprosy and in 37 age-matched controls, we measured reversal pattern visual evoked potentials (RP-VEP) and nerve conduction parameters. The mean latency value of positive peak P100 in leprosy patients was significantly delayed compared to that of controls (patients, 108.02+/-9.61 ms in left eye and 108.23+/-8.51 ms in right eye; controls, 96.22+/-4.20 ms in left eye and 95.75+/-4.03 ms in right eye; p<0.05). Abnormally delayed P100 latency was recorded in 5 of 37 leprosy patients (13.5%). The mean amplitude of P100 latency in leprosy patients was smaller than that of controls (patients, 8.7+/-5.6 micro V in left eye and 9.5+/-4.8 micro V in right eye; controls, 10.7+/-4.6 micro V in left eye and 10.5+/-5.1 micro V in right eye), but this difference was not significant. No correlation was observed between abnormalities of RP-VEP and sensorimotor nerve conduction parameters. This study suggests that involvement of COP may develop in patients with lepromatous leprosy. RP-VEP measurement, which can be easily and rapidly performed in an EMG laboratory using standard equipment, can show these alterations.

R-R interval variation and the sympathetic skin response in the assessment of the autonomic nervous system in leprosy patients

OBJECTIVES: The aim of this study was to evaluate possible autonomic nervous system (ANS) dysfunction in leprosy patients with the sympathetic skin response (SSR) and the heart rate (R-R) interval variation (RRIV) measurements which are easy and reliable methods for evaluation of autonomic functions. MATERIAL AND METHODS: We studied 37 lepromatous leprosy patients (mean age: 38 +/- 17 years, range 23-62 years, 20 females and 17 males) and 35 age-matched healthy subjects (mean age: 34.19 +/- 12.74 years, range 24-48 years, 20 females and 15 males). Non-invasive bedside tests (orthostatic test, Valsalva ratio), R-R interval variation (RRIV) during at rest and deep breathing, the SSR latency and amplitude from both palms, and nerve conduction parameters were studied in all the subjects. RESULTS: The mean values of RRIV in leprosy patients during at rest [mean RRIV in patients, 17.42 +/- 8.64 per cent vs controls, 22.71 +/- 3.77 per cent (P 0.05)] was smaller compared with the controls, but this difference was not significant. The mean Valsalva ratio in leprosy patients [mean in patients, 1.11 +/- 0.13 vs controls, 1.16 +/- 0.07 (P > 0.05)] was smaller compared with the controls, but not statistically significant. The mean difference of systolic and diastolic blood pressure between supine rest and during standing in leprosy patients were higher compared with the controls [mean systolic pressure in patients, 7 +/- 6 mmHg vs controls, 6 +/- 8 mmHg (P > 0.05) and mean diastolic pressure in patients, 3 +/- 3 mmHg vs controls, 3 +/- 2 mmHg (P > 0.05)], but they did not reach statistical significance. Furthermore, lower RRIV and the prolonged SSR latencies in leprosy patients were closely correlated to some parameters of sensorimotor nerve conduction and each other [median nerve distal latency and RRIV, r = -0.67 (P < 0.05), ulnar nerve distal latency and RRIV, r = -0.59 (P < 0.05), RRIV and SSR latency,...

Continuous infusion of midazolam in the treatment of refractory generalized convulsive status epilepticus.

We studied the efficacy and safety of midazolam given as a continuous infusion in the treatment of refractory generalized convulsive status epilepticus (RGCSE). We carried out a prospective, open study, in 19 patients (11 men) with RGCSE in the intensive care unit at Firat Medical Center in Elazig. When intravenous administration of 0.3 mg/kg diazepam (three times at 5-min intervals), 20 mg/kg phenytoin, and 20 mg/kg phenobarbital failed to bring the episode under control, patients were administered an intravenous bolus of midazolam (200 microg/kg) followed by a continuous infusion at 1 microg/kg min. The dose was increased by 1 microg/kg min every 15 min until the episode of seizure was brought under control. The time from beginning of treatment to control of seizures, infusion rate, and side-effects were monitored. The mean age of the patients was 40.4 years (range 16-87 years). The clinical etiology of RGCSE was idiopathic epilepsy (6 cases), anoxicischemic cerebral insult due to cardiac arrest (3), viral encephalitis (2), intrahemispheric hematoma due to hemorrhagic stroke (1), cerebral infarct due to ischemic stroke (1), pituitary adenoma (1), post-traumatic epilepsy (1), renal failure (1), tuberculous meningitis (1), and unknown (2). In eighteen (94.7%) patients, seizures were completely controlled in a mean time of 45 min (range, 5-120 min) at a mean infusion rate of 8 microg/kg min (range, 3-21 microg/kg min). In one patient seizures did not stop. Midazolam administration did not cause any significant change in blood pressure, heart rate, oxygen saturation, or respiratory status. The mean time to full consciousness for patients after stopping the infusion was 1.6 hours (range, 2.0-8.5 hours). The mean infusion duration of midazolam was 14.5 hours (range, 12-25 hours). Midazolam is an effective and safe drug to control RGCSE, and may represent a substantial improvement over current therapeutic approaches such as pentobarbital anesthesia.