Browsing by Author "Kisabay, A"

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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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    Manifestation of Hashimoto's Encephalopathy with Psychotic Signs: a Case Presentation
    Kisabay, A; Balikci, K; Sari, S; Selcuki, D
    Hashimoto's encephalopathy (HE) is a rare autoimmune disease with unclear pathophysiology, developing on the basis of Hashimoto's thyroiditis (HT), associated with antithyroid antibodies, that presents with autoimmune, neuroendocrine, and neuropsychiatric findings. The disease is characterized by generalized or focal slowing in the EEG, elevated antithyroid antibody titration in the serum, elevated cerebrospinal fluid protein level, and the presence of antithyroid antibodies. HE is known as an autoimmune disorder of the central nervous system. With this feature, it is differentiated from cognitive alterations observed in hypothyroidism or hyperthyroidism. The response to treatment with corticosteroids in line with the autoimmune nature of HE supports this diagnosis. This report shows a case presenting with neuropsychiatric symptoms, elevated antithyroid antibody titration in the serum, and complete response to steroid therapy. A clear indicator for the diagnosis of HE has not yet been found. Therefore, other potential causes need to be considered in the differential diagnosis of this clinical picture until they can be excluded after investigations. With this case report, we want to emphasize that in differential diagnosis of patients presenting with a variety of neuropsychiatric symptoms, Hashimoto's encephalopathy - though being seen quite rarely - should not be disregarded, given the dramatic improvement of patients receiving a correct diagnosis and appropriate treatment.
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    Idiopathic intracranial hypertension: Are there predictors for visual outcome or recurrences?
    Tata, G; Kisabay, A; Gokcay, F; Celebisoy, N
    Objective: To find out the predictors of final visual outcome and recurrences in idiopathic intracranial hypertension (IIH). Patients and methods: Medical records of 75 patients with IIH were analyzed retrospectively. Gender, age of disease onset (AODO), body mass index (BMI), lumbar puncture opening pressure (LP-OP), visual acuity (VA) in logMAR, optical disc appearance (ODA), visual field (VF) mean deviation (MD), treatment results and recurrence rates were considered. Results: Mean age at onset age was 32.4 years, BMI was 311 kg/m(2) and median LP-OP was 380 mm H2O. All patients were treated with acetazolamide with a median dose of 1500 mg. The mean follow-up period was 44.8 months. AODO, BMI, LP-OP were not correlated with any of the examination parameters (VA, ODA, VF) at the first or last visit. The correlation between the VA and VF both at the first and last visit was not very powerful. VA of the last visit was fairly correlated with the VA of the first visit. However, the correlation between the last and first visit VF was very good. A very significant improvement in both VA and VF was recorded after treatment. Recurrences were noted in 23%. Demographic and clinical features of the recurring and non-recurring patients were not significantly different in terms of AODO, BMI, LP-OP, VA, VF or ODA. Conclusions: The patients with IIH respond to treatment with acetazolamide. First visit VF is the main determinant of the final visual outcome. Recurrences cannot be predicted by the demographic or clinical features at presentation.
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    Risk for generalization in ocular onset myasthenia gravis: experience from a neuro-ophthalmology clinic
    Kisabay, A; ÖOzdemir, HN; Gökçay, F; Celebisoy, N
    Conversion to generalized myasthenia gravis (GMG) within the first 2 years has been reported in 18-85% of patients with ocular myasthenia gravis (OMG). The aim of the study was to investigate the risk factors for generalization in patients with OMG admitted to a neuro-ophthalmology clinic and to determine if there were differences between patients with GMG with predominant bulbar (GMG-B) or extremity muscle (GMG-E) involvement according to the 6th and 24th-month Myasthenia Gravis Foundation of America classification ranks. Patients with OMG who were followed-up for at least 24 months were retrospectively analyzed. Demographic, clinical, laboratory features and treatment strategies that can be associated with generalization and time to generalization were evaluated. Of the 139 patients with OMG, 54 (39%) showed generalization with a mean time of 10.3 (range 2-24) months. GMG-B and GMG-E were diagnosed in 31 (22.3%) and 23 patients (16.5%), respectively. Seropositivity for acetylcholine receptor and muscle-specific tyrosine kinase antibodies, abnormal single-fiber electromyography (SFEMG), and the presence of thymic abnormalities (thymoma and hyperplasia) were factors associated with generalization on multivariate analysis without a significant difference between the GMG-B and GMG-E groups. In addition, an abnormal repetitive nerve stimulation test was related to a shortened time to generalization. Bilateral ptosis at onset was found as a risk factor for generalization. In a neuro-ophthalmology clinic, bilateral ptosis as an initial feature of OMG must be approached cautiously because it may be the first sign of impending GMG.
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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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    Evaluation of neurodegeneration through visual evoked potentials in restless legs syndrome
    Kisabay, A; Sari, US; Korkmaz, T; Dinçhorasan, G; Yilmaz, H; Selçuki, D
    Restless legs syndrome (RLS) is a disease characterized by some type of dysesthesia, an indescribable abnormal sensation in the extremities. Our objective was to determine whether the visual evoked potentials (VEP) can be used as a quantitative monitoring method to evaluate demyelination-remyelination and neurodegeneration in the patients with RLS. The present study was carried out prospectively. It was planned to determine normal or pathological conditions in the form of increased latency or decreased amplitude of VEP and to evaluate possible pathologies in the visual and retinal pathways at early stages and at months 3 and 6 of follow-up in the patients with RLS (with or without iron deficiency anemia), in those without RLS (at the time of diagnosis prior to any medical therapy) without any visual symptoms. It was observed that latency of VEP improved but didn't return to normal limits following treatment with dopamin agonists, iron, or combination of both and that there was no significant difference between the post-treatment data and those of the control group. These results in combination with the fact that the latencies and amplitudes didn't return to normal levels despite the 6-month-treatment but showed a progressive course with partial regeneration suggests that there was incomplete remyelination. It should be kept in mind that this syndrome is likely to be a part of neurodegenerative process.
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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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    Micturition Syncope: Report of Two Cases
    Sari, US; Kisabay, A; Selcuki, D
    Syncope is a symptom which is a transient loss of consciousness and very common in society and is one of the most important referral causes to emergency services. Micturition syncope ( MS) appears as a rare cause of neurally-mediated syncope. MS is caused by reflex which results with vasodilatation and bradycardia, like defecation syncope. In the clinical setting, the MS is presented with transient loss of consciousness during supine position or micturition following after a sleep period mostly in otherwise healthy men. It is a reflex state in which standing triggers vasodilatation and bradicardia. MS covers 2-8% of all syncopes. There is still no consensus about treatment and outcome of MS. In this article two male patients with MS are presented. With these two cases, we aimed to give detailed information about micturition syncope which is a rare type of syncope.
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    Evaluation of visual pathways using visual evoked potentials in the patients with impaired fasting glucose and impaired glucose tolerance
    Korkmaz, T; Kisabay, A; Hekimsoy, Z; Senol, E; Selçuki, D
    Purpose: There are many studies on degeneration of the ganglion cells using visual evoked potential (VEP) in Diabetes mellitus (DM). The present study intended to investigate whether the retinopathy findings would be helpful for detecting the degeneration to develop or not in retinal ganglion cells with the VEP test before being detectable in ophthalmoscopic examination on prediabetic patients. Materials and methods: The present study was conducted prospectively after obtaining approval from the Ethics Committee. In our study, the subjects were divided into three groups as impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and normal patients. They also underwent physical, ophthalmological and VEP examination. Three main components of VEP obtained from these groups were N75, P100, and N145 latency and N75-P100 amplitude. Results: The study participants consisted of the IFG group (n: 30, female/male ratio: 21/9; mean age: 49.17 +/- 10.52 years), the IGT group (n: 30, female/male ratio: 23/7; mean age: 47.00 +/- 11.09 years), and the Control Group (n: 40, female/male ratio: 30/10; mean age: 48.03 +/- 10.96 years). Difference in sex and age between the study groups (p > 0.05). P100 latency was found to increase significantly in comparison between the IGT and Control Group for both eyes (p right: 0.003, p left: 0.001) whereas it did not increase significantly in the comparison between the IFG and the Control Group (p right: 0.065, p left: 0.116). Conclusion: It was observed that VEP may be a parameter of predictive value that might be used in evaluating prediabetic cases in terms of retinopathies similar to DM.
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    Review of Antiepileptic Therapy of a Case Associated With Eclampsia and PRESS
    Kisabay, A; Oktan, B; Sari, S; Mavioglu, H; Yilmaz, H
    Posterior reversible encephalopathy syndrome (PRES) is a syndrome characterized by headache, changes in mental status, epileptic seizure, visual disturbances, and typically alterations in posterior circulation of the brain. Ictal findings of this type of epileptic seizures and their response to the treatment vary. It is observed that single and/ or combined anti-epileptic drugs have been used in treatment of the seizures. Radiological involvement doesn't always correlate with clinical findings. The same also applies for the relationship between epileptic-seizure activity and distribution of radiological involvement. Simple partial seizures rapidly and well responding to the isolated treatment as well as course of status epilepticus may occur. The present study discussed how the current approach to epileptic seizures was associated with posterior reversible encephalopathy syndrome by presenting a report whose prognosis was good although the condition involved both basal ganglia and cerebral deep structures, and whose seizures ceased with magnesium replacement.
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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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    POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME (PRES): A CASE REPORT
    Yilmaz, H; Mavioglu, H; Kisabay, A; Oktan, B
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    Cerebral Venous Thrombosis: A Case Series and Literature Review
    Kisabay, A; Çakiroglu, E; Selçuki, D
    In this study, 15 patients who were being followed in a cerebrovascular diseases outpatient clinic with the diagnosis of cerebral venous thrombosis were retrospectively reviewed. The study aimed to assess and review their complaints at the time of presentation and during the clinical course as well as assess the etiological risk factors using new imaging modalities and new and old therapeutic modalities. Cerebral venous thrombosis was recognized as a rare and fatal condition when it was first defined; however, it currently presents with a better prognosis because of increased awareness, advanced neuroimaging techniques, and therapeutic methods. The use of dabigatran, which is a new therapeutic option, remains on the agenda particularly for avoiding drug interaction with warfarin in the patients with comorbidities and history of multiple medications. Dabigatran has a high rate of success with low incidence of side effects.
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    Miller Fisher Syndrome/Pharyngeal-Cervical-Brachial Variant of GBS Overlap and Human Herpes Virus-6 Reinfection: May There BE A Relationship?
    Mavioglu, H; Kisabay, A; Sari, S; Akçali, S; Oktan, B
    Miller Fisher Syndrome (MFS) is a rare variant of Gulliain Barre syndrome (GBS) characterized by external ophthalmoplegia, ataxia, areflexia, and usually by positive anti GQ1b antibody. It occurs through an autoimmune mechanism most frequently after Campylobacter jejuni, followed by Haemophilus influenzae infection. Although occurrence with other viruses and bacteria has been reported, the concurrence of MFS and Human Herpes Virus-6 (HHV-6) has not been reported so far. There are a few publications reporting association of GBS with HHV-6. In the present study, HHV-6 DNA with PCR was detected in the cerebrospinal fluid (CSF) of a 59 year-old female patient diagnosed with MFS/pharyngeal-cervical-brachial variant of GBS overlap from clinical findings and positive anti-GQ1b antibody in the serum. This article aims to create awareness of a possible relationship between MFS, GBS and HHV-6.
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    EPILEPSY AND SLEEP DISORDERED BREATHING
    Yilmaz, H; Kisabay, A; Oktan, B
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    Effects of CPAP (Continous Positive Airway Pressure) Treatment on Oxidative Stress and Pro-Inflammatory Process
    Kisabay, A; Sari, US; Cakiroglu Aldemir, E; Oktan, B; Korkmaz, T; Dinç Horasan, G; Yilmaz, H
    Introduction: Obstructive sleep apnea syndrome (OSAS) is an independent risk factor for development of atherosclerotic processes because it leads to hypertension, impaired glucose metabolism, obesity and metabolic syndrome, cardiac diseases, elevated blood pressure, and increased level of cholesterol, triglycerides, homocysteine, and coagulation. Materials and Methods: Our aim was to evaluate presence of subclinical atherosclerosis prior to CPAP treatment in the patients with OSAS without any history of previous diseases and any pathological finding in their investigations. After obtaining approval from the Ethics Board, we planned to compare the results of investigations for risk factors for atherosclerosis (fasting blood glucose [FBG], total cholesterol, Triglycerides, HDL- and LDL-cholesterol, thyroid function test, homocysteine, fibrinogen, high sensitivity C-reactive protein [hsCRP]) before and after CPAP treatment and to examine the effect of CPAP treatment on these parameters between July 2013 and July 2015. Findings: Findings obtained before CPAP treatment (homocysteine, hsCRP, HbA1c, subclinical hypothyroidism) suggested subclinical atherosclerosis. In comparative evaluation between the findings before and after CPAP treatment, no statistically significant difference was found in levels of triglycerides, HDL-cholesterol and fT4 (P = 0.346, 0.540, 0.060, respectively) whereas significant differences were found in leukocyte and platelet counts, hemoglobin level, fasting blood glucose, LDL-cholesterol, homocysteine, fibrinogen, fT3, TSH, CRP, and HbA1c (P = 0,003,-0,010,-0,000,-0,001,-0,008-0,004-0,000-0,000-0,0250,000- 0,000-0,000, respectively). Subclinical hypothyroidism was present in 12 (20%) patients before CPAP and in 5 (7%) patients after CPAP treatment. Conclusions: Improvement has been seen even in early markers of atherosclerosis with effective CPAP.