Cerebral venous sinus thrombosis in pregnancy and puerperium

Cerebral venous sinus thrombosis (CVST) is more common in women than in men, possibly due to gender-specific risk factors in young adults. The purpose of this study was to investigate whether the clinical and radiological findings, other risk factors, and clinical course of CVST associated with pregnancy and puerperium differ from those of other CVST cases. We retrospectively reviewed patients diagnosed with CVST in our hospital between September 2007 and December 2019. The risk factors, clinical and radiological characteristics, and follow-up data for female patients with CVST were compared between cases associated with pregnancy and puerperium with those of other cases. A total of 50 female patients with CVST were included in the study. Twenty-four (48%) cases occurred during pregnancy and puerperium. The mean age of the pregnant or puerperal patients was lower than that of the other patients (p = 0.007). There was no significant difference between the groups in terms of clinical and neuroradiological findings or presence of any additional risk factors including hereditary thrombophilia. There was also no difference in terms of in-hospital mortality rates and modified Rankin Scale (mRS) scores at 6 months between the groups. The clinical presentation of CVST and the frequencies of the presence of other risk factors including genetic thrombophilia in pregnant and puerperal patients were similar to those of non-pregnant female patients. Screening for additional risk factors, especially genetic thrombophilia, should therefore not be neglected in CVST occurring during pregnancy and puerperium.

The Role of Thrombo-Inflammatory Biomarkers in the Prognosis of Cerebral Venous Sinus Thrombosis

BACKGROUND

The role of inflammation in the prognosis of cerebral venous sinus thrombosis (CVST) has been demonstrated in a small number of studies. The platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and the systemic immune-inflammatory index (SII) have been studied as prognostic inflammatory biomarkers in numerous thrombo-embolic diseases. However, the number of studies evaluating the relationship between these parameters and CVST is very low.

OBJECTIVES

The purpose of this retrospective study was to investigate the relationship between PLR, NLR, and SII values on admission and long-term prognosis in patients with CVST in the acute-subacute period.

METHODS

Fifty-one patients diagnosed with CVST and 51 healthy controls were included in the study. The patient and control groups were compared in terms of NLR, PLR, and SII values. Patients were classified into good and poor prognosis groups, based on sixth-month modified Rankin scale scores (mRS) (0 - 2: good prognosis, 3 - 6: poor prognosis). Clinical and radiological features and PLR, NLR, and SII values were compared between the good and poor prognosis groups. Multivariate logistic regression analysis was used to identify independent prognostic factors for poor prognosis. The Receiver Operating Curve (ROC) was used to demonstrate the predictive power of PLR, NLR, and SII.

RESULTS

Higher NLR and SII emerged as independent factors for poor prognosis in patients with CVST. NLR was the strongest parameter in predicting poor prognosis in CVST (AUC: 0.817, 95% CI: 0.63 - 1.00, sensitivity: 70%, specificity: 92.7%, p: 0.002).

CONCLUSION

Higher NLR and SII on admission may be a predictor of poor long-term prognosis in patients with acute-subacute CVST.

Decreased second to fourth digit ratios in female multiple sclerosis patients

BACKGROUND

Sex-related differences in multiple sclerosis (MS) suggest a possible role of prenatal sex hormones in the pathogenesis. The aim of this study was to investigate whether the 2D:4D ratio, considered a predictor of prenatal hormonal exposure, in MS patients differ from that in healthy controls.

METHODS

Two hundred MS patients and one hundred seventy healthy control subjects with similar age and sex distribution enrolled. All participants were right-handed. The right hands of all participants were scanned using a digital scanner. Measurements of second and fourth digit lengths were made from digital scans. The 2D:4D ratio was calculated by dividing the length of the second digit by the length of the fourth digit.

RESULTS

A total of 171 MS patients' and 159 healthy controls' digit scans included in the study. The MS group consisted of 94 females (mean age 38.32 ± 10.5) and 77 males (mean age 42.06 ± 11.8) and the control group of 86 females (mean age 40.24 ± 9.7) and 73 males (mean age 38.49 ± 11.6). 2D:4D ratios of female MS patients were significantly lower than those of healthy females (p=0.004). Although 2D:4D ratios of male patients with MS were lower than those of healthy males, this difference was not statistically significant (p=0.33). There was no significant correlation between the 2D:4D ratio, EDSS levels or duration of the disease in male or female MS patients (p<0.05).

CONCLUSION

Although our results suggest that a prenatal hormonal balance in favor of androgenic activity may be a risk factor for MS, complex factors mediating the actions of sex hormones on target cells should always be considered when evaluating the effects of sex hormones.

Cerebral venous sinus Thrombosis: Clinical Features, Long-Term outcome and recanalization

Recanalization and prognosis of cerebral venous sinus thrombosis (CVST) are generally considered to be good, and various factors have been reported to be associated with recanalization in previous studies. Fifty patients diagnosed with CVST between September 2007 and July 2016 were analyzed retrospectively. Modified Rankin scale (mRS) scores at six months and results of follow-up imaging of patients with at least six months follow-up were also reviewed for the assessment of long term outcome, recanalization rates and factors associated with recanalization. The mean age of the patients (39 female, 11 male) was 34.6±11.2years (17-69). Of the 50 patients enrolled, 31 (62%) had at least six months follow-up with available data and 26 (83.9%) of these had favorable outcomes (mRS 0-1) at six months. Complete recanalization was observed in 15 patients (48.4%), partial recanalization in 14 (45.2%) and no recanalization in 2 (6.5%). Univariate analysis revealed that complete recanalization rates were higher in female patients (p=0.013) and lower in patients with multiple thrombosis in more than one dural sinus (p=0.03). The prognosis and recanalization rates of CVST were good, and complete or partial recanalization of venous sinuses was not associated with clinical outcome.

Lack of Association between Pulse Steroid Therapy and Bone Mineral Density in Patients with Multiple Sclerosis

Multiple sclerosis (MS) has been associated with reduced bone mineral density (BMD). The purpose of this study was to determine the possible factors affecting BMD in patients with MS. We included consecutive 155 patients with MS and 90 age- and sex-matched control subjects. Patients with MS exhibited significantly lower T-scores and Z-scores in the femoral neck and trochanter compared to the controls. Ninety-four (61%) patients had reduced bone mass in either the lumbar spine or the femoral neck; of these, 64 (41.3%) had osteopenia and 30 (19.4%) had osteoporosis. The main factors affecting BMD were disability, duration of MS, and smoking. There was a negative relationship between femoral BMD and EDSS and disease duration. No association with lumbar BMD was determined. There were no correlations between BMD at any anatomic region and cumulative corticosteroid dose. BMD is significantly lower in patients with MS than in healthy controls. Reduced BMD in MS is mainly associated with disability and duration of the disease. Short courses of high dose steroid therapy did not result in an obvious negative impact on BMD in the lumbar spine and femoral neck in patients with MS.

Diagnostic value of plasma signal peptide-Cub-Egf domain-containing protein-1 (SCUBE-1) in an experimental model of acute ischemic stroke

OBJECTIVES

This study was intended to examine possible diagnostic value of plasma Signal Peptide-Cub-Egf domain-containing protein-1 (SCUBE1) levels in an experimental model of acute ischemic stroke.

METHODS

Twenty-four female Sprague Dawley rats were divided into four groups. Blood and brain tissue specimens were collected immediately following artery ligation (control; Group 1), 1h after ligation (Group 2), 2 h after ligation (Group 3) and 6h after ligation (Group 4). SCUBE1 levels were investigated in the serum specimens. The brain samples were examined histopathologically. Correlation analysis was performed between the values.

RESULTS

Median SCUBE1 values were 1.75 ng/ml in the control group, 3.80 ng/ml, 3.71 ng/ml and 4.19 ng/ml in the groups 2, 3 and 4, respectively (n=6 for each, P=0.004, for each group compared to control values). Histopathological analysis revealed median atrophic neuron percentages of 16% (in group 1), 42%, 55% and 76% in group 2, 3 and 4 respectively (n=6 for each, P=0.004, for each group compared to control group). A higly significant correlation was determined between SCUBE-1 levels and percentage of atrophic neurons (r=0.744 P=0.000).

CONCLUSIONS

In this experimental model of acute ischemic stroke plasma SCUBE1 levels rose from the 1st hour of induced stroke and remained high up to 6th hour tested. Results of this experimental study has a potential to become the basis for a clinical study to confirm whether SCUBE1 can be used as a biomarker in the early diagnosis of acute ischemic stroke patients.

Evaluation of temperament and character features as risk factors for depressive symptoms in patients with restless legs syndrome

BACKGROUND AND PURPOSE

Restless legs syndrome (RLS) is a common sleep-related movement disorder that is frequently associated with psychological disturbances. Personality traits are of considerable importance with respect to coping with chronic illness and disease vulnerability. This study assessed the temperament and character traits of RLS patients using an approach that involves the psychobiological model of personality.

METHODS

The personality features of 65 newly diagnosed and untreated RLS patients with no neurological or psychiatric diseases and 109 healthy controls were determined using the Temperament and Character Inventory and compared using covariance analyses. The International RLS Study Group Severity Scale was used to assess the severity of the RLS symptoms, and the Beck Depression Inventory was used to assess the presence and severity of depressive symptoms.

RESULTS

RLS patients scored significantly higher than healthy controls on the temperament dimension of harm avoidance (HA, p=0.02) and significantly lower on self-directedness (SD, p=0.001). No significant difference was observed in terms of the temperament dimension of novelty seeking (p=0.435). HA scores were significantly correlated with the BDI score but not with the RLS severity or duration.

CONCLUSIONS

High HA and low SD scores are the main characterizing personality features of RLS patients. These personality dimensions may be among the factors predisposing patients to development of the depressive symptoms that are frequently associated with RLS.

Factors associated with early hospital arrival in acute ischemic stroke patients

Early diagnosis and treatment in acute ischemic stroke are crucial in terms of survival and disability. Many stroke patients remain disabled because of the treatment delay. The purpose of this study was to investigate the factors associated with the early hospital arrival in acute ischemic stroke patients. 113 patients diagnosed with acute ischemic stroke were included in this prospective study performed at the Karadeniz Technical University Medical Faculty Hospital. Patients' characteristics and patients' and relatives' emotional and behavioral reactions were compared between early (within 3 h) and late (after 3 h) arrival groups. 72.6 % of patients arrived at hospital within 3 h from symptoms onset. Univariate analysis revealed that history of atrial fibrillation (p = 0.04) and coronary heart disease (p = 0.02), sudden onset of symptoms (p = 0.001), loss of consciousness (p = 0.03), recognizing symptoms as stroke (p = 0.01), seeking immediate medical attention (p < 0.001), feelings of fear and panic (p = 0.001), arriving at hospital by ambulance having called the emergency medical services (p = 0.04) and National Institute of Health Stroke Scale (NIHSS) score (p = 0.001) were associated with hospital arrival within 3 h. A multivariate regression model demonstrated that recognizing symptoms as stroke (OR, 3.4; 95 % CI, 1.2-9.3) and atrial fibrillation (OR, 4.3; 95 % CI, 1.1-15.7) were independent factors associated with early arrival. The role in early arrival at hospital of recognizing symptoms as stroke and seeking immediate medical attention with transportation by ambulance emphasize the importance of public awareness concerning recognizing the symptoms of stroke and accessing emergency medical assistance.

Cerebral venous thrombosis after high dose steroid in multiple sclerosis: a case report

Cerebral venous thrombosis (CVT) is a clinical condition which is caused by the partial or complete occlusion of the dural sinuses and cerebral veins. Cases of associated CVT and multiple sclerosis (MS) have been reported and CVT development has been attributed to the previous lumbar puncture (LP) in majority of these cases. We report a case of 32-year-old woman with no previous history of recent LP, who developed CVT after high dose intravenous methylprednisolone and discuss the possible role of high dose steroids in development of CVT in MS patients.

Magnetic resonance imaging in bilateral brachial neuritis with pure sensory involvement

Brachial neuritis is characterized by shoulder and arm pain followed by weakness and atrophy of affected muscles and sensory loss in the arm. Isolated sensory involvement of the brachial plexus is very rare. Diagnosis of brachial neuritis is usually based on clinical history and examination, with the confirmation by electrodiagnostic tests. A 72-year-old woman presented with numbness and tingling in the bilateral upper extremities. While nerve conduction examination revealed only sensory abnormalities of the bilateral upper extremities, magnetic resonance imaging (MRI) showed thickening and hyperintensity of the bilateral brachial plexus. We report a case of bilateral brachial neuritis with clinical and electrophysiological pure sensory involvement diagnosed using brachial plexus MRI. Although electrophysiological examination is thought to be the best diagnostic technique in the diagnosis of brachial neuritis, its findings sometimes indicate a distal lesion, while the involvement of the whole brachial plexus can be seen in MRI.

Electrodiagnosis of carpal tunnel syndrome in patients with diabetic polyneuropathy

OBJECTIVE

Diagnosis of carpal tunnel syndrome (CTS) is difficult in patients with diabetic polyneuropathy as both conditions may affect median nerve conduction in a similar manner. There is no agreement about which electrodiagnostic tests are more efficient in determining CTS accurately in these patients. In this study, we aimed to define the best electrodiagnostic test in the diagnosis of CTS in diabetic polyneuropathy patients.

METHODS

We prospectively investigated 72 patients with CTS (140 hands), 32 patients with diabetic polyneuropathy without CTS (61 hands), 35 patients with diabetic polyneuropathy with CTS (62 hands) and 43 healthy controls (86 hands). Standard nerve conduction studies, segmental and comparative median nerve conduction tests were performed in all subjects. Cut-off values, sensitivities and specificities of each test for the diagnosis of CTS in diabetic polyneuropathy patients were determined by using receiver operating characteristic (ROC) curve.

RESULTS

Distoproximal latency ratio (DPLR) with a sensitivity of 90% and specificity of 81% for the cut-off value of 1 and median and ulnar sensory latency difference to digit 4 (MUDD4) with a sensitivity of 90% and specificity of 85% for the cut-off value of 0.35 showed the highest sensitivity and specificity in the diagnosis of CTS in diabetic polyneuropathy patients among all nerve conduction tests. Wrist-palm median sensory conduction velocity (W-P SCV) and median and radial sensory latency difference to digit 1 (MRDD1) also showed high sensitivity and specificity.

CONCLUSIONS

Segmental median nerve conduction studies like DPLR and W-P SCV and sensory comparative tests such as MUDD4 and MRDD1 in combination with standard nerve conduction tests should result in more accurate diagnosis of CTS in diabetic polyneuropathy patients.

SIGNIFICANCE

These results could be helpful to overcome the diagnostic difficulty of CTS in patients with diabetic polyneuropathy.

VEMP responses are not affected in non-insulin-dependent diabetes mellitus patients with or without polyneuropathy

CONCLUSION

Vestibular evoked myogenic responses (VEMPs) are not affected in non-insulin-dependent diabetes mellitus (NIDDM) patients with or without polyneuropathy.

OBJECTIVE

To compare VEMP responses of NIDDM patients and healthy subjects.

SUBJECTS AND METHODS

VEMP responses were collected from 25 NIDDM patients with polyneuropathy (PNP), 13 NIDDM patients without PNP and 21 healthy subjects using click stimulation. After excluding ears with hearing loss (HL) (worse than 25 dB) the VEMP responses (p13 and n21 latencies and amplitude) recorded in 105 dB stimulus intensity were compared.

RESULTS

There was no statistically significant difference between groups. VEMP responses were found to be normal in NIDDM patients with or without PNP.

Effect of serotonergic antidepressant therapy on temperament and character scales in patients with chronic tension-type headache

The purpose of the present study was to assess a group of patients with chronic tension-type headache (CTTH) and control subjects using the personality questionnaire proposed by Cloninger and to determine possible changes in the Temperament and Character Inventory (TCI) patterns of CTTH patients after therapy with serotonergic antidepressants. Forty-five patients with CTTH filled out the TCI and Beck Depression Inventory (BDI) before and after 4-month prophylactic therapy with serotonergic antidepressants. A total of 50 age-, sex- and education level-matched healthy subjects were selected as a control group. During the pretreatment period patients were found to have higher harm avoidance and lower self-directedness scores than healthy comparison subjects. During the post-treatment period, although harm avoidance scores decreased and self-directedness scores increased, harm avoidance scores were still significantly higher and self-directedness scores significantly lower in CTTH patients than in controls. After using BDI score and age as covariates at the post-treatment period, harm avoidance scores were still higher in patients with CTTH while self-directedness scores did not differ between CTTH patients and controls. These findings suggest state and trait dependence of harm avoidance, and strong state dependence of self-directedness scores in CTTH patients. When interpreting data regarding personality measured by the TCI in CTTH patients, the effects of depressive symptomatology should be taken into account.

Local cold effect on the excitability recovery curve of the sympathetic skin response

The sympathetic skin response (SSR) is an established technique used to assess the activity of the sympathetic sudomotor pathway, but it is limited in application by the habituation process. The nature of habituation is not clear. In this study we aimed to further understand the role of the peripheral mechanism in the habituation of the SSR. We recorded SSRs to paired stimuli with interstimulus intervals of 1, 2, 3, 4 and 5 seconds on both hands of 15 volunteers simultaneously, while the right hand was cooled to 23-24 degrees C and the left hand was between 32 and 33 degrees C. The amplitude and latency generated by the first stimulus (SSR1) and the second stimulus (SSR2) were measured. While SSR2 first occurred at ISI 2 in 7 subjects and ISI 3 in 8 subjects on the normal side, SSR2 first occurred at ISI 4 in 7 subjects and ISI 3 in 8 subjects on the cooled side. The SSR amplitude recovery percentage, which was obtained by dividing the amplitude of SSR2 by the amplitude of SSR1, was significantly different on the cooled side. No significant differences were found between SSR1 and SSR2 latencies, which were measured at ISI 3, 4 and 5 on the normal side and at ISI 5 on the cooled side. Our findings further support that a peripheral component might be involved in the modification and habituation of the SSR in terms of amplitude, but not of latency.