Browsing by Author "Ak, AK"

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    An Adverse Event Associated with Antifungal Therapy: Clinic-Like Posterior Reversible Encephalopathy Syndrome
    Ak, AK; Erbüyün, S; Heppekcan, D; Batum, M; Boyaci, R; Mavioglu, H; Tok, DA
    Posterior reversible encephalopathy syndrome (PRES) is a diagnosis characterized by headache, changes in consciousness, epileptic seizures, visual symptoms (decreased visual acuity and blurred vision), vasospasm, and perfusion abnormalities in the posterior systemic vessels of the brain. The most common clinical findings of PRES include headache, epileptic seizure, altered consciousness, motor deficits, and loss of vision. In the patient who presented with symptoms similar to those in PRES after the use of anidulafungin and had a history of trauma, other causes of PRES (like carotid and/or vertebral artery dissection, intra-abdominal trauma, and head trauma etc.) were excluded. In our case, visual disturbance was assessed as being secondary to central nervous system pathology. There are no similar cases in the literature that presented with clinical features of PRES and normal imaging findings. The primary aim of this study was to draw attention to the fact that anidulafungin may cause symptoms similar to those in PRES.
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    IMPORTANCE OF BERLIN, STOP, AND STOP-BANG QUESTIONNAIRES IN EVALUATING OBSTRUCTIVE SLEEP APNEA SYNDROME IN THE BUS DRIVERS
    Esrefoglu, N; Ak, AK; Göktalay, T; Batum, M; Yilmaz, H
    Objective: To investigate the prevalence of obstructive sleep apnea syndrome (OSAS) symptoms in public transportation drivers, and the importance of the Berlin questionnaire (BQ), STOP questionnaire (SQ), and STOP-BANG questionnaire (SBQ) in OSAS screening, and the to evaluate correlations among these tests. Material and Method: This cross-sectional study was conducted after obtaining ethics committee approval. Demographic data and risk factors were categorized as high-risk and low-risk for snoring and OSAS. Results: All the drivers (n:392) were men and their mean age was 37.8 +/- 6.3(27-58). Even in the presence of any of the individual parameters of snoring, witnessed apnea, and increased daytime sleepiness in 392 drivers, a high risk was found in all for questionnaires developing OSAS (p<0.001). Body mass index >= 30 kg/m(2) and neck circumference >= 40 cm were associated with snoring (p<0.05) but not with age (p>0,05). The highest agreement was found between SQ and SBQ (p<0.001, kappa: 0.609, McNemar Test), a moderate agreement was present between BQ and ST (p=0.05, kappa: 0.607), and the weak correlation was found between BQ and SBQ questionnaires (p<0.001, kappa: 0.472, McNemar). Conclusion: It will be possible to eliminate a preventable cause of traffic accidents by evaluating OSAS risks in vehicle drivers with valid and easily-applicable tests such as the SBQ and SQ, and to direct drivers to appropriate units for polysomnography.
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    Ak, AK; Çinar, C; Dogan, GN; Ataç, C; Gökçay, F; Çelebisoy, N
    Patients with indirect carotid cavernous fistulas (CCF) were reviewed to emphasize the importance of diagnosing patients even with trivial findings and to raise awareness. Eighteen patients diagnosed as CCF were included. Neuro-ophthalmological findings before and after treatment, diagnostic investigations, treatment, clinical course was noted. Twelve patients were female (67%), 6 were males (33%) and the mean age at presentation was 54 years (range: 29-70 years). Conjunctival hyperemia was present in all patients. Seventeen (94%) patients had proptosis and diplopia, nine (50%) had orbital pain and/or headache, four (22%) had blurred vision, one (5.5%) had ptosis. On examination, 17 patients (94%) had restricted eye movements, four (22%) had low visual acuity and five patients had (28%) increased intraocular pressure (IOP). One patient had been diagnosed as myasthenia gravis and two as thyroid orbitopathy and had been on treatment accordingly before CCF was diagnosed. In two patients, bilateral findings were present despite unilateral CCF on angiography. Barrow Type B fistula was found in 7 (38%), Barrow Type D in 11 (62%) patients. In three bilateral CCF was detected. All were treated by endovascular intervention. Residual deficits at the sixth month control were, eye movement deficits in seven (39%), decrease in visual acuity in one (5.5%) and elevated IOP in one (5.5%) patient. Indirect CCF patients generally present with mild symptoms and the diagnosis may be overlooked. Mild progressive ophthalmoparesis with conjunctival hyperemia must be warning. Though rare bilateral CCF can be detected as well as unilateral CCF with bilateral findings.
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    Evaluation of Cognitive Function Using Objective and Subjective Tests in the Obstructive Sleep Apnea Syndrome
    Ak, AK; Sari, ÜS; Oktan, B; Korkmaz, T; Horasan, GD; Selçuki, D; Yilmaz, H
    Objective: The primary and secondary consequences which related to obstructive respiration to occur during sleep cause cognitive, emotional and behavioral changes indirectly. Aim of the present study was to evaluate quality of sleep and relationship between quality of sleep and cognitive function at baseline and during treatment in the patients having diagnosis of severe Obstructive Sleep Apnea syndrome (OSAS) being followed in sleep laboratory. Materials and Methods: Pittsburg, Epworth and Stroop tests to assess patient attention; P300 test was applied for the evaluation of memory and attention. Results: When the pre-treatment and post-treatment cognitive functions of the patients were compared; there was a significant decrease in daytime sleepiness after treatment (p=0.000) and a significant improvement in latency of P300 test (p=0.000-p=0.001-p=0.004). In Pittsburgh study; the pre-treatment total sleep quality scores were consistent with poor sleep quality, while the mean value obtained after treatment was found to be related to the healthy sleepiness (p=0.000). In the Stroop test for measuring attention, the rate of error correction obtained after treatment was significantly improved (p=0.010). Conclusion: In patients diagnosed with severe OSAS; the negative effects of disease on attention, alertness, and memory, challenges on maintaining the attention and its negative effects on the structure of sleep has been shown by using Stroop, Pittsburgh, P300 and Epworth tests unlike other publications. As a result of the tests performed after the treatment, the fact that it is an important development in the disease shows us how the treatment is important and necessary.
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    What is the optimal dose of acetazolamide in the treatment of idiopathic intracranial hypertension
    Ak, AK; Tata, G; Gokcay, F; Celebisoy, N
    Objective: Acetazolamide is preferred as the first-line drug for the medical treatment of idiopathic intracranial hypertension. In this study, the efficacy of different doses of the drug on visual functions; visual acuity, optic disc appearance- papilledema grade and visual field-mean deviation (VF-MD) were evaluated. Methods: The medical records of 73 patients diagnosed as idiopathic intracranial hypertension based on Modified Dandy Criteria and treated with acetazolamide who were on follow-up between 2010 and 2017 at the Neuro-ophthalmology Unit of Ege University Medical School, Department of Neurology were analyzed. Improvement in the visual functions at the end of the sixth month in three groups taking different doses of the drug; low (500, 750, 1000 mg/day), moderate (1500, 1750, 2000 mg/day) and high (3000, 4000 mg/day) were compared. Results: Improvement in visual acuity (p: 0.784), was not affected from different doses of the drug whereas papilledema grade (p: 0.014) and VF-MD (p<0.001) were affected. Binary comparisons revealed significant improvement in the high dose group when compared with the moderate and low dose groups both for the papilledema grade (low-high: p: 0.003, moderate-high: p: 0.024) and VF-MD (low-high: p<0.001, moderate-high: p: 0.001) Conclusion: Treatment with high doses of acetazolamide is associated with improvement in visual field defects and regression of optic disc edema in idiopathic intracranial hypertension.
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    Calcitonin gene-related peptide (CGRP) levels in peripheral blood in patients with idiopathic intracranial hypertension and migraine
    Ak, AK; Gemici, YI; Batum, M; Karakas, B; Özmen, EY; Gökçay, F; Çelebisoy, N
    Background: Calcitonin gene-related peptide (CGRP) plays a dominant role in migraine. This prospective study was designed to investigate CGRP levels in patients with idiopathic intracranial hypertension (IIH) and compare the results of migraine patients and healthy controls (HC). As a second objective, CGRP levels obtained from IIH patients defining sustained headache after the resolution of papilledema were compared with those not defining post-IIH headache. Methods: Thirty-six patients with IIH, 36 with episodic migraine (EM), 18 with chronic migraine (CM), and 36 HC were included in the study. CGRP levels were studied from blood samples obtained from the antecubital vein by using a commercial ELISA kit. Results: Serum CGRP levels of the patient groups were significantly higher than the HC (p < 0.001). As compared with controls, both CM (p Adj<0.001) and IIH (p Adj=0.039) had significantly increased levels of CGRP. Levels recorded from EM patients did not differ from the HC (p Adj=0.661). In 16 IIH patients, persistent headache was reported after the normalization of intracranial pressure (ICP). Twenty patients did not report post-IIH headaches. Comparison of serum CGRP levels of these two groups revealed significantly higher CGRP levels in patients with sustained headaches obtained from blood samples both at the initial and control visit (p Adj <0.001). Conclusions: CGRP levels of the patient groups were higher than the HC. High levels recorded in patients with IIH indicates the role of CGRP in IIH related headache and even higher levels in patients with sustained headache after normalization of ICP strengthens this finding.
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    Airplane headache: An atypical case with autonomic symptoms and long duration
    Ataç, C; Ak, AK; Çetin, G; Batum, M; Gökçay, F; Selçuki, D
    Airplane Headache (AH) which is classified under headache attributed to disorder of homeostasis in International Classification of Headache Disorders (ICHD)-3 is a severe, unilateral, orbitofrontal headache that occurs during and caused by airplane travel. It remits after landing. AH cases with autonomic symptoms had rarely been reported. We present a 35-year-old male complained of five attacks of right-sided, unilateral, orbitofrontal headache accompanied with lacrimation, conjunctival injection and eye redness ipsilaterally, starting 20-30 minutes prior to landing. The headache duration varied between 30-90 minutes. AH diagnosis was made in the light of anamnesis and neurological examination. The secondary causes and primary headaches with autonomic symptoms were ruled out. As far as we know this is the first reported longer duration AH case with autonomic symptoms in the literature. AH is an underdiagnosed headache. We report this atypical AH case to call attention to this rare but treatable headache.
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    Cognıtıve functıons in idiopathic intracranial hypertensıon
    Ak, AK; Saritas, AS; Batum, M; Gemici, YI; Karakas, B; Celebisoy, N
    ObjectiveCognitive problems in idiopathic intracranial hypertension (IIH) is generally overlooked in the presence of disabling headache and threat to visual function. The aim of this study was to search for cognitive deficits in patients with IIH using neuropsychologic tests in addition to P300 potential recordings to assess cognition related brain activity.MethodsFifty IIH patients were examined using Montreal Cognitive Assessment Test, Stroop Test and Visual Aural Digit Span Test to measure different domains of cognition at the time of diagnosis. P300 potentials were recorded by using an oddball paradigm. Hospital Anxiety and Depression Scale was used to determine anxiety and depression. Quality of life (QoL) was assessed by SF-36. The results were compared with fifty healthy controls with matching age, gender and body mass index.ResultsNeuropsychologic tests revealed wide cognitive impairment including attention, working memory, executive function, naming, language, delayed recall and orientation in IIH patients. In addition, quality of life was affected in the sub-parameters of general health perceptions, emotional role functioning, vitality, mental health and bodily pain. P300 potential latencies were long and the amplitudes were reduced indicating deficits in attention and working memory. Anxiety scores were high, and health-related QoL was low mainly involving vitality, emotional and mental health. Cognitive dysfunction was not correlated with the levels of anxiety and the correlation with headache severity was mild.ConclusionA multidomain cognitive decline mainly involving attention and working memory was recorded in IIH patients. It was not correlated with anxiety and only a mild correlation with headache severity was present which may indicate a casual relationship between raised intracranial pressure and cognitive deficits. Screening is important as neuropsychological rehabilitation might be relevant in these patients.
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    Vestibular migraine and persistent postural perceptual dizziness: Handicap, emotional comorbidities, quality of life and personality traits
    Ak, AK; Çelebisoy, N; Özdemir, HN; Gökçay, F
    Objective: To compare vestibular migraine (VM) and persistent postural-perceptual dizziness (PPPD) regarding dizziness associated handicap, emotional and somatic disorders, health-related quality of life (QoL) and per-sonality traits.Methods: Thirty patients for each group [VM, PPPD and healthy volunteers (HC)] were studied. Dizziness Handicap Inventory (DHI), Beck depression and anxiety scales, Somatic Symptom Scale-8 (SSS-8), Short Form (36) Health Survey (SF 36) and the Big Five Inventory (BFI) were used.Results: DHI sub-scores were significantly high in both patient groups in comparison with the HC (p < 0.001 for all). Emotional (p = 0.001) and functional (p = 0.022) sub-scores of the PPPD patients were worse. Anxiety and somatic symptom scores of VM (p = 0.026 and p < 0.001 respectively) and PPPD (p < 0.001 for both) and depression scores of the PPPD (p = 0.003) were higher than the HC. Both anxiety (p = 0.009) and somatization (p = 0.005) scores of the PPPD patients were higher than the VM. SF-36subscales were affected in both groups (p < 0.05). Vitality (p = 0.002), mental health (p = 0.045) and social role functioning (p = 0.006) of the PPPD group were worse than the VM. Higher scores for neuroticism (p < 0.001) was present for both groups. Scores for extraversion was low in PPPD patients (p = 0.010) in comparison with the HC.Conclusion: Dizziness associated handicap, anxiety and somatic symptom burden is high in both groups, even higher in PPPD with additional depression. Severe impairment in QoL is present with more severe impairment in emotional aspects in patients with PPPD. Neuroticism is a common personality trait for both groups with additional introversion in PPPD.
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    Trigeminal neuralgia following Tolosa-Hunt syndrome
    Durmaz, GS; Ak, AK; Gökçay, F; Çelebisoy, N
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    RETRACTED: Evaluation of macular thickness and visual pathways using optic coherence tomography and pattern visual evoked potential in different clinical stages of obstructive sleep apnea syndrome (Retracted Article)
    Ak, AK; Batum, M; Göktalay, T; Mayali, H; Kurt, E; Selçuki, D; Yilmaz, H
    Aim The present study aimed to investigate and compare possible changes in amplitude and latency of pattern visual evoked potentials (PVEP) and thickness of quadrants of the macula (TQM) using optic coherence tomography (OCT). Materials and Methods According to polysomnography examinations, 30 mild, 30 severe, 30 controls were included in the study after approval from the ethics committee. Results No significant difference was found in age and gender between the groups (p = 0.184 andp = 0.954). Significant difference was found between external and internal superior TQM, mean thickness of ganglion cell layer in comparison of all three groups (p = 0.011,p = 0.047,p = 0.030). In comparison between severe OSAS and control groups, significant difference was found in internal nasal, internal superior and external superior TQM (p = 0.048,p = 0.033,p = 0.014) while no significant difference was found TQM in comparison between the mild OSAS and control groups. In comparison between the group of severe OSAS and controls, significant increase was found in P100 as well as N145 latencies whereas only P100 latency was found to increase when mild OSAS was compared with controls. No significant correlation was found between TQM and PVEP parameters in mild and severe OSAS patients. Discussion Latency and amplitude of PVEP altered in OSAS because edema and inflammation was remarkable in mild as well as severe stages of the disease. Furthermore, thinning in the macula was observed only in severe stages of the disease, explained with level of atrophy and exposure to extended hypoxia.
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    Evaluation of retinal fiber thickness and visual pathways with optic coherence tomography and pattern visual evoked potential in different clinical stages of obstructive sleep apnea syndrome
    Ak, AK; Batum, M; Göktalay, T; Mayali, H; Kurt, E; Selçuki, D; Yilmaz, H
    Purpose To investigate the possible changes in retinal nerve fiber layer (RNFL) by optic coherence tomography and in the amplitudes and peak times (PTs) in pattern visual evoked potential (pVEP) and to compare them in obstructive sleep apnea syndrome (OSAS). Methods This prospective study included patients with mild OSAS (n = 30), severe OSAS (n = 30), and 30 control subjects. All patients were assessed after obtaining the approval from our hospital's ethics committee. Results There was no difference in age and gender between the groups (p = 0.184, p = 0.954). By analysis of variance, there was a significant difference in RNFL values among patients with mild OSAS, severe OSAS, and control for three measures of RNFL (average p = 0.044, nasal p = 0.003, inferior p = 0.027). In severe OSAS group, nasal and inferior quadrants of the RNFL were found to be thinner than the control group (p = 0.008, p = 0.031). We showed that the PT of P100 and N145 was prolonged in severe OSAS compared to the control group (p < 0.001) and that PT of P100 was prolonged in mild OSAS compared to the control group (p < 0.05). The amplitude of N75-P100 was significantly decreased in patients with both severe OSAS and mild OSAS compared to the control group (p < 0.001). Correlation of RNFL and pVEP values showed that the inferior quadrant RNFL thickness is correlated with both P100 and N145 PTs (r = 0.271*, p = 0.036 and r = 0.290*, p = 0.043, respectively) and N75-P100 amplitude (r = 0.378**, p = 0.003) in severe OSAS group. Conclusions In mild and severe stages of the disease, edema and inflammation were evident and VEP PT and amplitudes were affected in both groups. Furthermore, thinning in RNFL in the severe stage of the disease might be associated with higher atrophy levels and prolonged exposure to hypoxia.
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    Sleep Sex Disease
    Yilmaz, H; Ak, AK
    Sleep sex disease, or sexsomnia, is a non-rapid eye movement (NREM) parasomnia manifesting with making sexual voices, talking/yelling, masturbation, caressing another person, sexual intercourse, or agitated/aggressive sexual actions during the sleep. During the N3 period of NREM sleep these manifestations are observed: seeing sexual dreams, frequently experiencing erection-ejeculation in the sleep, masturbation, starting the sexual activity with abnormally increased desire without caring about desire of the partner during sleep, staring vacantly and absently, exhibiting actions and fantasies during the intercourse that are very different from those of normal, caressing, screaming, groaning, making orgasm voices, coitus with or without orgasm, cursing, physical or emotional violence against their partner, and insulting the partner. The facts that its diagnostic criteria are currently not known well, the physicians other than sleep medicine experts don't query the signs of the condition, and the patients and/or partners don't want to share what they experience because of the sexual nature of the manifestations make detecting the true frequency of this disease very difficult. Enhancing awareness of this parasomnia which also has medicolegal aspects will make the diagnosis and treatment easier.
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    Clinical Approach Hypersomnia of Central Origin and Differential Diagnosis
    Ak, AK; Saritas, AS; Gemici, YI; Yilmaz, H
    Hypersomnia and excessive daytime sleepiness are commonly encountered by physicians dealing with sleep medicine. Although these are common symptoms associated with sleep disorders, they can be ignored. The tendency of excessive daytime sleepiness, which might be caused by sleep deprivation that continues for a while in our society, makes it difficult to diagnose diseases with hypersomnia. Hypersomnia is used as a comprehensive definition for excessive daytime sleepiness and/or excessive need for sleep or increased amount of sleep. Clinically, it presents with prolonged sleep times at night, falling asleep easily and everywhere, recurrent sleep attacks, and excessive daytime sleepiness. Hypersomnia can be either a symptom of neurological and metabolic diseases, especially sleep disorders, or develop due to substance, drug use, and trauma. Sleep attacks occurring during the day can affect individuals' academic or professional performance, disrupt their cognitive functions and social relations, and cause life-threatening traffic or work accidents. It is crucial to examine this symptom, which causes a significant deterioration in the quality of life of people, and to diagnose and treat the diseases causing it. This review article plans to address the epidemiological, pathophysiological, clinical aspects of sleep disorders that cause hypersomnia, treatment and emphasize the critical points in the differential diagnosis.
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    Evaluation of the visual system with visual evoked potential and optical coherence tomography in patients with idiopathic Parkinson's disease and with multiple system atrophy
    Batum, M; Ak, AK; Ari, MS; Mayali, H; Kurt, E; Selçuki, D
    Background In addition to motor findings, non-motor findings including alterations in visual acuity, decrease in blink reflex, and pupil reactivity cause the impaired quality of life in idiopathic Parkinson's disease (PD) and multiple system atrophy (MSA). Our study aimed to examine possible latency and amplitude changes in pattern visual evoked potentials (pVEP) along with retinal and macular changes in optical coherence tomography (OCT) in PD and MSA groups. We also intended to investigate whether any OCT parameters could be a biomarker for Parkinson's or MSA. Methods Our study included 50 patients with PD, 15 with MSA, and 50 healthy control subjects. All patients in the study underwent neurological and ophthalmological examination and investigations of OCT to measure the retinal and macular thickness and pVEP to assess visual pathways. Results When PD, MSA, and control groups were compared, a significant difference was found in all retinal thickness values in average, nasal, and superior retinal nerve fiber thickness (pRNFL), and in all macular thickness values except nasal outer and inferior outer quadrants and in ganglion cell complex (GCC) thicknesses (p < 0.05). Moreover, a significant difference was found in N75, P100, and N145 latencies and N75-P100 amplitude (p < 0.05). The thickness of both pRNFL, inner and outer macular quadrants, was thinner in the MSA group than in PD but GCC thickness was thinner in PD group. Conclusions The present study compared pVEP and OCT parameters in PD and MSA groups. It was concluded that pVEP and OCT examinations were of importance in that they were easily accessible, affordable, noninvasive biomarkers that might be used in early periods and progression of the disease and in follow-up.
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    Evaluation of cognitive functions in idiopathic Parkinson's disease and multiple system atrophy
    Batum, M; Ak, AK; Ari, MS; Selçuki, D
    Background & Objective: Cognitive impairment is one of the non-motor symptoms impairing life quality in idiopathic Parkinson's disease (PD) and multiple system atrophy (MSA). In our study, both groups' possible cognitive impairments were evaluated and compared, and the relationship between cognitive profile and motor, non-motor scores, and disease duration was evaluated. Methods: Fifty two PD, 18 MSA, 30 healthy controls were included in the study. Demographic information, scores of Unified Parkinson's Disease Rating Scale (UPDRS), Parkinson's Disease Questionnaire (PDQ), Addenbrooke's Cognitive Examination-Revised (ACE-R), and Frontal Assessment Battery (FAB) tests were recorded. In addition to the ACE-R test's total scores, sub-scores measuring attention-orientation, memory, verbal fluency, language, and visual-spatial abilities were also evaluated. Results: There was no difference between the groups in age, gender, years of education, and levodopa dose in treatment (p> 0.05). In the inter-group comparison, FAB, ACE-R total, ACE-R sub-scores and PDQ values were significantly different (p <0.05). Significant impairment was found in FAB, ACE-R total, memory, verbal fluency, speaking, and PDQ scores in PD and in all tests in MSA compared to the control group (p <0.05). All tests except memory were more impaired in the MSA group than the PD group. The motor scores in PD showed a strong correlation with FAB, ACE-R total, visual-spatial abilities, speaking, and PDQ scores, whereas motor scores in MSA only correlated poorly with PDQ scores. Conclusion: MSA progressing with multi-systemic involvement showed worse cognitive performance than PD in executive functions and visual-spatial functions, regardless of the disease duration.