Decreased retinal nerve fiber layer thickness in patients with cerebral venous thrombosis

Background

To identify thickness variations in the retinal nerve fiber layer around the optic disc and macula in patients with cerebral vein thrombosis (CVT) without papilledema.

Methods

This study included 28 patients with CVT diagnosis and appropriate treatment. Detailed ophthalmologic examination found bilateral vision 10/10, vision field test normal and fundus examination found no papilledema images. The patients had macular and optic retinal nerve fiber layer thickness (RNFL) measured with spectral domain-optical coherence tomography (SD-OCT) (Optovue, Fremont, CA). Patients had retinal nerve fiber thickness compared with a control group.

Results

When the effect on the macula and RNFL near the optic nerve disk is investigated, there was significant thinning identified in the macula inferior inner, temporal inner, superior inner and temporal outer quadrants (p = 0.009, 0.001, 0.026, 0.014, respectively) and in the inferior temporal quadrant of the optic nerve disk (p = 0.020) in CVT patients compared to normal individuals.

Conclusions

Even after appropriate treatment of CVT patients, axonal loss was identified with OCT. As a result, it may be important to use OCT measurements to monitor CVT treatment.

Cytological and cytometric analysis of oral mucosa in patients with Alzheimer's and Parkinson's disease

BACKGROUND

Alzheimer's disease (AD) and Parkinson's disease (PD) are the two most common neurodegenerative diseases. Recent studies have sought to identify precursor symptoms of AD and PD that occur before the onset of the disease. We evaluated changes in the oral mucosa of patients with AD and PD using a stereological method.

PATIENTS AND METHODS

The study included 29 patients with AD, 30 patients with idiopathic PD, and 30 healthy volunteers. Brush biopsies were obtained from all participants, and the nucleator method was used to estimate the volume of cells obtained from the buccal mucosa.

RESULTS

Cytomorphometric analysis revealed that the nuclear volume was 484.39±117.10 µm³ in the AD group, 509.71±132.26 µm³ in PD patients, and 509.30±100.21 µm³ in the control group. The cytoplasmic volume was 115,456.60±30,664.98 µm³ in the AD group, 103,097.93±25,034.65 µm³ in PD patients, and 109,528.45±28,381.43 µm³ in the control group. The nuclear and cytoplasmic volumes were not significantly different among groups (P>0.05).

CONCLUSION

The cytomorphometric analysis revealed no significant differences in the cytoplasmic and nuclear volumes of buccal cells obtained from patients with AD and PD and healthy volunteers.

Frequency of subclinical peripheral neuropathy in cases of untreated brucellosis

INTRODUCTION

Brucellosis is a common zoonotic disease in some areas of the world. It may affect several organs and is known to involve the nervous system in 2.7-17.8% of affected patients. During the progression of brucellosis, peripheral neuropathies (PNs) have been reported. However, there are few studies investigating the presence of subclinical neuropathy in asymptomatic patients. In our study, we aimed to evaluate the presence of peripheral neuropathy using electrophysiological methods in newly-diagnosed untreated brucellosis patients.

METHODOLOGY

The study included a control group of 60 healthy volunteers and 60 untreated brucellosis patients with a positive result of 1/160 or above on a brucella tube agglutination test. The patient and control groups were evaluated by electrophysiological methods.

RESULTS

In the patient group, all investigated motor nerves had slower average motor conduction speeds, reduced compound muscle action potential (CMAP) amplitudes and delayed F response and terminal latency compared to the control group. The sural nerve sensory conduction speed was slower and the sensory nerve action potential (SNAP) was found to be reduced.

CONCLUSION

Among the 60 patients with acute brucellosis, 18% had sensorimotor peripheral neuropathy of widespread axonal character. Brucellosis can have many effects in the nervous system, including clinical or subclinical peripheral neuropathy in the peripheral nervous system. Brucellosis should be considered for differential diagnosis of patients with unexplained neurological and clinically relevant electrophysiological findings, especially in regions with endemic brucellosis.

Is there a correlation between the pineal gland calcification and migraine?

OBJECTIVE

The pineal gland calcifications have been associated with some diseases such as cerebral infarction, Alzheimer's disease and intracerebral hemorrhage while most cases are considered idiopathic and physiologic. However, there are limited data in the current literature about the association of pineal calcification and migraine. Our aim was to evaluate this association between migraine and pineal calcification by computed tomography of the brain.

PATIENTS AND METHODS

In our study, we assessed the computed tomography images of patients, who referred to the neurology outpatient clinic with the complaint of headache and were diagnosed with migraine without aura based according to 2004 criteria of the International Headache Society. 503 migraine patients and 500 control subjects without migraine diagnosis were included in this study.

RESULTS

When migraine and control groups were compared by pineal calcification, the rates were determined as 80, 6% and 55% in migraine and control group, respectively. The difference was statistically significant (p < 0.001). In addition, it was seen that pineal calcifications, detected in migraine patients, did not show age-related increase.

CONCLUSIONS

According to our data, we can point that pineal calcification may be associated with migraine.

Advanced oxidation protein products and ischaemia-modified albumin in obstructive sleep apnea

BACKGROUND

Several studies have shown that obstructive sleep apnea increases incidence of cardiovascular morbidity and mortality. The high systemic oxidative stress in obstructive sleep apnea has been considered as a major pathogenic mechanism leading to cardiovascular disease. Oxidative stress-related lipid and DNA oxidation in obstructive sleep apnea have been reported in the previous studies. In contrast, there is limited and contradictory information regarding protein oxidation in obstructive sleep apnea patients such as ischaemia-modified albumin and advanced oxidation protein products. Therefore, we aimed to investigate plasma ischaemia-modified albumin and advanced oxidation protein products and their correlation with total oxidative status and total antioxidative capacity in the obstructive sleep apnea patients.

METHODS

Plasma ischaemia-modified albumin, advanced oxidation protein products, total oxidative status and total antioxidative capacity were measured in 25 healthy volunteers and 59 obstructive sleep apnea patients diagnosed with polysomnography.

RESULTS

Plasma total antioxidative capacity was significantly lower (P = 0·012) and total oxidative status was significantly higher (P < 0·001) in the patients compared to the controls demonstrating increased oxidative stress in the patients. Plasma advanced oxidation protein products were significantly higher in the patients than the controls (P = 0·024). Plasma ischaemia-modified albumin levels were not statistically different between the obstructive sleep apnea patients and controls (P = 0·74).

CONCLUSIONS

We conclude that high systemic oxidative stress in obstructive sleep apnea is reflected by increased advanced oxidation protein products without causing an increase in ischaemia-modified albumin.

Relationship between Structural and Functional Assessment of the Visual System in Mildly Disabled Relapsing-Remitting Multiple Sclerosis Patients

Studies that explored the anterior visual pathway in the patients with multiple sclerosis (MS) have demonstrated contradictory results about the correlation between structural and functional status of optic nerve and retina. We aimed to investigate the functional and structural findings in our cohort of mildly disabled relapsing-remitting MS patients. A total of 134 eyes (80 eyes of the patients with MS and 54 eyes of the control group) were investigated. Eyes of MS patients were divided into two groups-as eyes with history of optic neuritis (ON group) and without history of optic neuritis (NON group). Ophthalmological investigation including visual evoked potentials, standard automated perimetry, and optical coherence tomography were performed for all participants. Retinal and macular thicknesses were significantly decreased in ON and NON groups compared with controls. Also, visual evoked potential latencies and visual field loss were worse in the both MS groups compared with control group. We did not find any correlation between visual evoked potentials and retinal or macular thickness values but visual field parameters were correlated between retinal and macular layer loss in the NON group. According to our results and some previous studies, although both functional and structural changes were detected in patients with MS, functional status markers do not always show parallelism (or synchrony) with structural changes, especially in eyes with history of optic neuritis.

Ultrasound elastographic evaluation in the diagnosis of carpal tunnel syndrome: initial findings

The purpose of this study was to investigate ultrasound (US)- and US elastography-detected changes in the median nerve of patients with carpal tunnel syndrome (CTS). Seventy-four wrists of 41 female patients with CTS (mean age, 47.73 ± 11.45 y) and 45 wrists of 24 asymptomatic female controls (mean age, 42.83 ± 10.66 y) were examined with US and US elastography. Electromyography results confirmed the diagnosis of CTS in the patients. The mean median nerve perimeter (MN-P = 15.26 ± 2.18 mm) and median nerve cross-sectional area (MN-CSA = 11.81 ± 4.05 mm²) of patients with CTS were higher than those of controls (12.08 ± 1.54 mm and 7.76 ± 1.40 mm², respectively) (p < 0.05). Mean tissue strain was lower in the patients with CTS (0.094 ± 0.045 than in the controls (0.145 ± 0.068) (p < 0.05). The most sensitive cut-off value for tissue strain was 0.0635, and the most specific was 0.19. US and US elastography, in addition to electromyography, proved to be beneficial in the diagnosis of CTS. US elastography is a new technique that may well find a place in the diagnosis of nerve entrapment syndromes.

Optical Coherence Tomography in Patients with Relapsing-Remitting Multiple Sclerosis without Optic Neuritis: A 20-Month Longitudinal Study

Optical coherence tomography is supported and used as a technique for visualisation of neuro-axonal loss in multiple sclerosis, but there are also a few studies expressing the opposite view. The aim of our study was to investigate retinal nerve fibre layer and optic nerve head parameters in patients with multiple sclerosis without a history of prior optic neuritis and symptoms of a new clinical attack during the follow-up for a total of 20-month period. Full ophthalmic evaluation was performed for all of the participants. The baseline retinal nerve fibre layer and macular thicknesses and focal and global loss of macular volume values were significantly lower in the eyes of the patients with multiple sclerosis compared with the healthy controls. No significant change between baseline and follow-up scans were found in all optical coherence tomography parameters in the multiple sclerosis group. Statistical analyses revealed significant retinal nerve fibre layer and macular thickness differences between baseline and second measurements in the controls. No significant difference in percent change between baseline and second measurements was observed between the patient and control groups. We conclude that whereas healthy subjects have an age-related tendency toward a decrease in retinal nerve fibre layer thickness, patients with multiple sclerosis patients are likely to pass through different stages of retinal thinning and thickening due to subclinical optic neuritis and, as a result, we could not detect any statistically significant change between baseline and second measurements in our multiple sclerosis patients.

Is there a relationship between sleep apnea and central corneal thickness?

PURPOSE

The objective of this study was to determine the central corneal thickness (CCT) measurements in patients with Sleep Apnea Syndrome (SAS) and the relationship between the severity of SAS and minimal arterial oxygen saturation (min. SpO2) with respect to CCT.

MATERIALS AND METHODS

Two hundred and fourteen eyes of 107 patients (58 males, 49 females) who were diagnosed as SAS and 80 eyes of 40 healthy subjects (20 males, 20 females) were included in the study. The SAS patients were divided into subgroups according to their Apnea-Hypopnea Index (AHI) values as: AHI values between 5 and 15 as subgroup 1, between 15 and 30 as subgroup 2, and the values ≥30 as subgroup 3. The CCT was measured by an ultrasonic pachymetric system. Statistical analyses were an analysis of variance test and, for post-hoc analysis, the Dunnett C test.

RESULTS

Mean age was 52.5 ± 10.96 years in the study group, and 40.7 ± 10.14 years in the control group. There were 58 (54.2%) males and 49 (45.8%) females in the study group, and 20 (50%) males and 20 (50%) females in the control group. Mean CCT values were 526.65 ± 25.06, 525.26 ± 29.25, 512.93 ± 43.20 and 539.90 ± 17.28 in subgroup 1, subgroup 2, subgroup 3 and the control group, respectively. There were no statistically significant differences between gender and age groups with respect to CCT (p > 0.05). When the mean CCT values of each subgroups were compared with the control group, the differences were statistically significant (p < 0.05). There was a negative correlation between CCT and AHI values and a positive correlation between CCT and min. SpO2 values.

CONCLUSIONS

CCT measurements differ significantly in patients with SAS compared with healthy control subjects. It should be taken into consideration that SAS may reduce CCT over time and that CCT should be measured in each ophthalmic examination.

Optic disc and retinal nerve fiber layer parameters as indicators of neurodegenerative brain changes in patients with obstructive sleep apnea syndrome

PURPOSE

Retina is a unique part of the central nervous system (CNS) for visualizing the processes of axonal and neuronal degeneration. Optical coherence tomography (OCT) allows direct visualization and measurement of retinal nerve fiber layer (RNFL) thickness, macular volume, and optic disc (OD) parameters. One of the disorders associated with atrophy in different brain regions is obstructive sleep apnea syndrome (OSAS). In the present study, we aimed to determine OD and RNFL changes measured by OCT for investigating the progress of neurodegeneration development in OSAS, excluding all the other conditions that can directly affect RNFL thickness and optic nerve parameters.

METHODS

Both eyes of 101 patients with OSAS and 20 controls were investigated by OCT. Full-night polysomnography (PSG) and ophthalmologic examination including automated visual field (VF) examination and OCT were performed in all of the patients.

RESULTS

According to the OSAS grading, patients were grouped as mild (n=15), moderate (n=27), and severe (n=59). We found significant decrease in RNFL thickness only in the patients with severe OSAS compared with the other groups and decreased macular ganglion cell thickness in the severe OSAS group compared with the control group. VF parameters were significantly worsened in all the OSAS subgroups compared to the control group. We found different data such as normal or increased optic nerve parameters as result of subtle OD edema, which may mask possible peripapillar axonal loss.

CONCLUSIONS

We think that evaluation of neurodegeneration in OSAS is not always possible by examining OD and RNFL because there are difficulties due to the confounding issues of cerebral atrophy and OD edema.

Low serum copeptin levels in patients with obstructive sleep apnea

PURPOSE

Copeptin, the C-terminal fragment of antidiuretic hormone (ADH), is a new biomarker that has been found to be elevated in several cardiovascular disorders and is related with prognosis. Patients with obstructive sleep apnea demonstrate a tendency to develop coronary and cerebral atherosclerotic disease. Our aim was to investigate copeptin levels in untreated new diagnosed obstructive sleep apnea patients without manifest cardiovascular disorders in order to determine whether copeptin could be used as a biomarker in this group.

METHODS

A total of 60 patients with obstructive sleep apnea, diagnosed with polysomnography, and 23 healthy volunteers were enrolled into this study. Blood samples were collected after overnight fasting, and copeptin level was measured with an enzyme immunoassay method.

RESULTS

Patients with obstructive sleep apnea had a higher incidence of hypertension and body mass index but lower serum copeptin level (0.48 ± 0.24. vs. 0.64 ± 0.28 ng/ml, p = 0.007) compared with the healthy controls. There was no significant difference regarding to serum copeptin levels between the moderate (n = 13) and severe (n = 47) obstructive sleep apnea patients (0.42 ± 0.18 vs. 0.49 ± 0.26 ng/ml, p = 0.409).

CONCLUSIONS

Rather than reflecting a reduced risk for cardiovascular disorders, we consider that reduced copeptin level is related with disturbed ADH secretion in obstructive sleep apnea patients. Therefore, it would not be advisable to measure copeptin levels in obstructive sleep apnea patients to determine cardiovascular risk, while this marker could be valuable to demonstrate impairment in ADH regulation in this patient group.

Prevalence and risk factors of epilepsy among school children in eastern Turkey

Epilepsy is a serious chronic brain disorder of childhood. We performed a cross-sectional prevalence study, determined the prevalence of childhood epilepsy, and identified the significance of certain risk factors for epilepsy among 1625 primary-school students aged 6-14 years, living in the center of Kars province. A questionnaire was prepared according to the definitions and principles of the Commission on Epidemiology and Prognosis, International League Against Epilepsy. Twenty-two children were diagnosed as epileptic. The point prevalence of active epilepsy in males was 4.9/1000, and in females 12.4/1000, representing a total of 8.6/1000. The cumulative prevalence in males was 11.0/1000, and 16.1/1000 in females, representing a total of 13.5/1000. Febrile convulsions, family history of epilepsy, serious maternal illness during pregnancy, a history of head trauma, antenatal/postnatal problems, and a history of neonatal jaundice were statistically significantly related to the development of epilepsy.