Browsing by Author "Batum, M"

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    CADASIL with Atypical Clinical Symptoms, Magnetic Resonance Imaging, and Novel Mutations: Two Case Reports and a Review of the Literature
    Sari, US; Kisabay, A; Batum, M; Tarhan, S; Dogan, N; Coskunoglu, A; Cam, S; Yilmaz, H; Selcuki, D
    Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary microangiopathy with adult onset caused by a missense mutation in the NOTCH3 gene in chromosome 19p13. It presents with autosomal dominant arteriopathy, subcortical infarctions, and leukoencephalopathy. Its common clinical presentations are seen as recurrent strokes, migraine or migraine-like headaches, progressive dementia, pseudobulbar paralysis, and psychiatric conditions. Two patients with CADASIL syndrome, whose diagnosis was made based on clinical course, age of onset, imaging findings, and genetic assays in the patients and family members, are presented here because of new familial polymorphisms. The first patient, with cerebellar and psychotic findings, had widespread non-confluent hyperintense lesions as well as moderate cerebellar atrophy in cranial magnetic resonance scanning. The other patient, with headache, dizziness, and forgetfulness, had gliotic lesions in both cerebral hemispheres. CADASIL gene studies revealed a new polymorphism in exon 33 in the first patient. In the other patient, the NOTCH3 gene was identified as a new variant of p.H243P (c.728A>C heterozygous). By reporting a family presenting with various clinical symptoms in the presence of new polymorphisms, we emphasize that CADASIL syndrome may present with various clinical courses and should be considered in differential diagnoses.
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    How Should Antiepileptic Drugs Be Selected During Pregnancy
    Batum, M; Kisabay, A; Yilmaz, H
    Although the risk of prematurity, growth retardation, and major malformations is higher in infants of mothers using antiepileptic medications than in those of the mothers not using them, the harmful effects of the convulsive seizures on the maternal and fetal health are much more. Thus, the risks introduced by the antiepileptic medications to the fetus as well as the effects of the seizures occurring during gestation on maternal and fetal health should be evaluated carefully. Both antiepileptic medications and seizures may negatively impact the fetus. Given that recently introduced antiepileptic medications have fewer side effects they are used widely and due to their high tolerability rates, several investigations regarding their efficacy have been prompted in pregnant women. On the contrary, the teratogenic effects of the old-generation antiepileptics and their negative effects on cognition warrant more careful use of these medications. The primary objective in choosing antiepileptic medications for pregnant women is to control the seizures and minimize the risk of developing both physical and cognitive malformations.
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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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    Investigation of Sleep Breathing Disorders in Young Patients (Under 55 years) with Mild Stroke
    Kisabay, AKA; Saritas, AS; Batum, M; Göktalay, T; Horasan, GD; Selcuki, D; Yilmaz, H
    Introduction: Many patients with stroke also have sleep breathing disorders (SBD), most of which is obstructive sleep apnea (OSA). Methods: Sixty patients with a history of stroke aged under 55 years were included in our study. The demographic characteristics (age at stroke, sex, body mass index) of the patients and etiology of stroke was evaluated according to the Trial of Org 10712 in Acute Stroke (TOAST) classification. The National Institute of Health Stroke Scale (NIHSS) and Modified Rankin Scale (MRS) were used to evaluate functionality. All patients underwent polysomnography (PSG) investigations. Findings: Based on PSG investigations, seven patients were normal, 10 had primary snoring, and 14 had mild, 11 had moderate, and 18 had severe OSA. The demographic characteristics did not differ significantly between the groups. No significant correlation was found between disease severity and NIHSS, MRS or TOAST classifications. Large artery atherosclerosis in the etiology, facial paralysis and dysarthria in the neurological examination, and brain stem involvement in the stroke location were observed to accumulate in the severe OSA group. When the anterior system, posterior system, and association of both were compared for vessel location, no significant difference was found regarding circulatory systems. Conclusions: It is considered that SBD has also a role in the etiology of stroke in patients aged under 55 years, and it should be taken into consideration as much as other risk factors. This is the first study to emphasize the importance of this topic in the literature.
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    Ischemic chiasmal syndrome associated with posterior communicating artery (PCoA) and tuberothalamic artery (TA) infarction: a case report
    Ataç, C; Kisabay, AA; Batum, M; Ari, S; Ovali, GY; Çelebisoy, N
    Lesions affecting the body of the optic chiasm typically produce bitemporal hemianopia. The blood supply comes from the anterior communicating artery, anterior cerebral, posterior communicating, posterior cerebral, and basilar arteries. We herein report a young patient admitted to the emergency department with acute confusion, left-sided hemiparesis, hemihypoesthesia, and dysarthria. Bitemporal hemianopia was detected after resolution of confusion. On cranial magnetic resonance imaging (MRI), infarction in the right anterolateral thalamus in the territory of tuberothalamic artery (TA) and in posterior chiasma in the territory of the posterior communicating artery (PCoA) was revealed. Cerebral MR angiography showed luminal irregularity of the PCoA. The patient was presented to draw attention to the rare entity ischemic chiasmal syndrome.
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    Evaluation of the Severity of Sleep Complaints According to the Stages of Chronic Obstructive Pulmonary Disease
    Batum, M; Batum, Ö; Can, H; Kisabay, A; Göktalay, T; Yilmaz, H
    Objective: Impairment of continuity of the sleep due to arousals and stage changes commonly experienced by the patients with chronic obstructive pulmonary disease (COPD) cause sleep problems associated with insomnia or hypersomnia. These resultant sleep problems lead to impaired quality of life in the patients with COPD. The aim of this study was to evaluate complaints related to sleep-alertness in the patients with COPD in the setting in which subjective sleep tests and polysomnography investigation using scales of quality of life are unavailable. Materials and Methods: The present study included 70 patients with COPD (33 were men and 37 were women). First, the patients with symptoms of COPD were evaluated clinically and COPD was staged based on degree of restriction of airflow (GOLD 2011). Sleep-alertness situation of all patients was evaluated using Epworth Sleepiness Scale (ESS) and Pittsburgh Scale of Seep Quality (PSSQ). Results: No statistically significant relationship was observed between stage of COPD and results of subjective sleep tests. Conclusion: Although these results indicate that stage of disease does not impact sleepiness and quality of sleep in the patients with COPD, they support the fact that presence of COPD alone negatively affected quality of sleep.
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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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    Exercise-induced acute renal failure with posterior reversible encephalopathy syndrome
    Toraman, A; Kisabay, A; Eren, BG; Batum, M; Kursat, S
    Posterior reversible encephalopathy syndrome (PRES) is characterized by headache, mental changes, epileptic seizures. visual disttubances, and transient changes in the posterior circulation system of the brain. Rhabdomyolysis is a clinical condition characterized by muscle pain, weakness, dark-colored urine, and elevated creatine kinase levels. The common causes of rhabdomyolysis are trauma, excessive fatigue and intense exercise. A 23-year-old male soldier developed rhabdomyolysis-induced acute kidney injury after intense exercise and secondary PRES. The patient also had generalized convulsive seizures. There is no similar case of PRES from acute renal failure induced by muscle injury previously reported in the literature.
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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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    Oligoclonal Band Number Affect On Cognitive Function Of Multiple Sclerosis Patients
    Gemici, YI; Batum, M; Saritas, AS; Kisabay, A; Mavioglu, H
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    DIAGNOSTIC VALUE OF VIDEO EEG PSG IN EPILEPSY DIAGNOSIS
    Batum, M; Kisabay, A; Oktan, B; Yilmaz, H
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