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Öğe An alternative treatment approach in tetanus: Botulinum toxin(SAGE PUBLICATIONS INC, 2015) Demir, Nazlim Aktug; Sumer, Sua; Ural, Onur; Ozturk, Serefnur; Celik, Jale BengiTetanus is a preventable infectious disease caused by tetanus toxin (tetanospasmin) produced by Clostridium tetani. Tetanus is still an important health problem in low- and middle-income countries (LMICs). Botulinum toxin administration is a treatment approach that has been used in recent years to reduce rigidity and spasms in tetanus patients. This case report focuses on its efficacy.Öğe Characteristics of Isolated Headache patients in Cerebral Venous Sinus Thrombosis (CVST): The Results of VENOST - national survey(SPRINGEROPEN, 2018) Uluduz, Derya; Yalin, Osman Ozgur; Duman, Taskin; Domac, Fusun Mayda; Ozturk, Serefnur; Yayla, Vildan; Karahan, Ali Yavuz[Abstract not Available]Öğe Epidemiology and the Global Burden of Stroke-Situation in Turkey(ELSEVIER SCIENCE INC, 2014) Ozturk, Serefnur[Abstract not Available]Öğe AN EVALUATION OF METABOLIC SYNDROME AND ITS COMPONENTS IN ALZHEIMER'S DISEASE: DOES GENDER MAKE A DIFFERENCE?(GUNES KITABEVI LTD STI, 2011) Ege, Fahrettin; Ozturk, Serefnur; Yapar, Gulhan; Ozbakir, ScnayIntroduction: Recent studies have indicated that vascular risk factors and metabolic syndrome may contribute to the process of Alzheimer's disease. The aim of this study was to evaluate the metabolic syndrome and its components in etiopathogenesis of Alzheimer's disease and the possible influences of these factors and gender. Materials and Method: Fifty-one patients were included in the study. Global deterioration scale and Standardized Mini-Mental Test (SMMT) were applied to all patients. Forty-two individuals with no cognitive complaint and normal results for SMMT were included as the control group. NCEP-ATP III criteria were used for the diagnosis of metabolic syndrome. Findings: Fifty-one patients (18 male, 33 female) and 42 controls (25 male, 17 female) were matched for age (73.47 +/- 6.49 and 73.04 +/- 4.61, respectively). The frequencies of metabolic syndrome (p=0.013) and its components [high waist circumference (p=0.001), hyperglycemia (p=0.05) and hypertriglyceridemia (p=0.040)] were significantly higher in female patients when compared to the male patients. Conclusion: Our results support a relation between Alzheimer's disease and metabolic syndrome and its components of high waist circumference, hyperglycemia and hypertriglyceridemia in women and suggest that different physiopathological mechanisms with respect to gender may be effective in this neurodegenerative process. Furthermore metabolic factors in women may contribute more prominently to the disease pathogenesis.Öğe A FICTITIOUS DEMENTIA-DEMENTIA IN MODERN LITERATURE(GUNES KITABEVI LTD STI, 2013) Ege, Fahrettin; Ozturk, SerefnurThe accumulating data about brain localizations associated with language processing not only weakens the conservative neurological models, but also suggests a novel Sense concept, which is fairly different from the traditional one. Author Paul Auster has created works of art that demolished the prevailing opinions regarding what constitutes language. We herein discuss philosophically the approach of Auster, taking into account particularly the works of philosopher Gilles Deleuze. Gilles Deleuze suggests pragmatism instead of communication models for language. According to pragmatism, speech acts are performed not for communicating, but to affect the bodies. Incorporeal transformations are the expression of statements but are attributed to bodies. The purpose of speech acts is not to represent bodies but to move them. An expression does not follow a content, it is on the same level with the latter. Auster's "Travels in the Scriptorium" conveys the story of an old man, Mr. Blank, who is affected by his own scripts (pragmatism). Moreover, this novel, as a cluster of literary expressions, is also a real act on forgetfulness, since Auster does not represent forgetfulness in the story, but transforms it to an impressive experience of language; that is, the pragmatism of Auster's literature.Öğe Headache-like Subarachnoid Hemorrhage After Digital Subtraction Angiography: A Case Report(TURKISH NEUROLOGICAL SOC, 2018) Eren, Fettah; Ekmekci, Ahmet Hakan; Karabagli, Hakan; Ozturk, SerefnurSubarachnoid hemorrhage (SAH) is a clinical condition with acute-onset, sudden, and severe headache. In addition to headache, severe nausea, vomiting, dizziness, confusion, agitation, focal neurologic deficits, and hypertension can be detected. Findings of meningeal irritation may accompany to these clinical features, 6-24 hours after the hemorrhage. Digital subtraction angiography (DSA) is used for surgical or endovascular treatment planning in order to identify vascular abnormalities, in addition to other imaging studies. After DSA, the frequency of all neurologic complications is between 0.2% and 4.5%. Headache may occur after DSA in an average 50% of patients. This rate is especially higher in female patients. Headache types are usually classified as migraine, tension or postoperative atypical headaches The incidence of severe headache after DSA is low. Vascular wall rupture should be considered first in severe headache after the procedure. It should also be kept in mind that after all other secondary causes are excluded; SAH-like headaches after DSA can be detected.Öğe Hospital Infection Rates in a Neurology Intensive Care Unit in a One-year Period: Pathogenic and Clinical Evaluation(TURKISH NEUROLOGICAL SOC, 2017) Eren, Fettah; Ongun, Gozde; Ural, Onur; Ozturk, SerefnurObjective: Nosocomial infections (NI) are serious threats for patients, especially those treated in intensive care units (ICU), which have high risk. Therefore, determining the infectious agents in this area and treating the infections are crucial for both the prognosis of primary disease and the time of stay in hospital. In this study, we aimed to perform an active infection surveillance in the neurological ICU (NICU). Materials and Methods: Two hundred ninety-one patients who stayed in NICU over a twelve-month period were included in the study. Data obtained by infection control committee of our faculty according to "Centres for Disease Control and Prevention" diagnostic criteria were used for the diagnosis of NI. Isolated microorganisms and their systemic involvement were examined. Results: The infections in NICU constituted 6.39% of all NI in the hospital. These were skin and soft tissue infections (3.13%), bloodstream infections (9.38%), pneumonia not associated with mechanical ventilator (9.38%), pneumonia associated with mechanical ventilator (6.25%), and urinary tract infections (UTI) (71.88%). Fourteen different microorganisms were determined in the unit over the twelve months. Conclusion: Caution is advised regarding urinary catheter insertion and care because catheters are the most common cause of infection, UTI, in the ICU. Also, diagnosis of NI and determining the antibiotic sensitivity of the causal microorganisms are very important for the determination of empiric treatment and reducing mortality and morbidity.Öğe Hyperemesis Gravidarum and Cerebral Electrophysiology Determination of Cerebral Localization through Electroencephalography Signal Processing(TURKISH NEUROLOGICAL SOC, 2016) Ekmekci, Hakan Ahmet; Yilmaz, Arzu Setenay; Ozic, Muhammet Usame; Ozbay, Yuksel; Kerimoglu, Ozlem Secil; Celik, Cetin; Ozturk, SerefnurObjective: Hyperemesis gravidarum (HG) is a disease characterized by excessive vomiting and nausea during pregnancy. It differs from normal pregnancy where simple nausea and vomiting are seen frequently with unknown cause. The place and role of the brain in HG is unknown. Materials and Methods: Thirty-three healthy pregnant women and 30 patients diagnosed with HG admitted to Selcuk University Faculty of Medicine, Obstetrics and Gynecology Department were included and electroencephalograph (EEG) signals of all patients obtained at Neurology Department were examined. These signals were evaluated with high math and examined with developed engineering methods. The sampling frequency of the EEG was 200 Hz. Data were obtained in the frequency-power axis using 0.1 Hz frequency resolution, Hamming windowing, and 0.5 overlap ratio with signals on the time axis on all channels. All sub-bands have formed with unearthed power spectral density as delta, theta, alpha, and beta and after being created was calculated spectral densities. Results: As a result, while showing significant changes as delta band for Fp1F3, theta band for C3P3, F3C3, Fp1F3, P3O1, T5O1, for other channels and sub-bands has not seen any significant changes with regard to average power spectral density. Conclusion: HG and normal pregnancies, when examined in terms of power spectral density, abnormalities were observed in the EEG signals in the left hemisphere frontal area of the delta band, fronto-centro-parietal, and parietal-occipital areas of the theta band. In light of the literature, neither cerebral abnormalities in HG could be displayed nor the place of abnormality could be shown. However, this study is the first to clearly show abnormalities of theta-delta band activity and differences of locations in the left cerebral hemisphere.Öğe Idiopathic and unexplanable Thromboctopenia after Fingolimod Usage.(SAGE PUBLICATIONS LTD, 2016) Ekmekci, Hakan; Eren, Fettah; Ozturk, Serefnur[Abstract not Available]Öğe Incidence and predictors of early seizures in intracerebral haemorrhage and the effect of tranexamic acid(SAGE PUBLICATIONS LTD, 2019) Law, Zhe Kang; England, Timothy J.; Mistri, Amit K.; Woodhouse, Lisa J.; Cala, Lesley; Dineen, Rob; Ozturk, SerefnurIntroduction Seizures are common after intracerebral haemorrhage. Tranexamic acid increases the risk of seizures in non-intracerebral haemorrhage population but its effect on post-intracerebral haemorrhage seizures is unknown. We explored the risk factors and outcomes of seizures after intracerebral haemorrhage and if tranexamic acid increased the risk of seizures in the Tranexamic acid for IntraCerebral Haemorrhage-2 trial. Patients and methods Seizures were reported prospectively up to day 90. Cox regression analyses were used to determine the predictors of seizures within 90 days and early seizures (<= 7 days). We explored the effect of early seizures on day 90 outcomes. Results Of 2325 patients recruited, 193 (8.3%) had seizures including 163 (84.5%) early seizures and 30 (15.5%) late seizures (>7 days). Younger age (adjusted hazard ratio (aHR) 0.98 per year increase, 95% confidence interval (CI) 0.97-0.99; p = 0.008), lobar haematoma (aHR 5.84, 95%CI 3.58-9.52; p < 0.001), higher National Institute of Health Stroke Scale (aHR 1.03, 95%CI 1.01-1.06; p = 0.014) and previous stroke (aHR 1.66, 95%CI 1.11-2.47; p = 0.013) were associated with early seizures. Tranexamic acid did not increase the risk of seizure within 90 days. Early seizures were associated with worse modified Rankin Scale (adjusted odds ratio (aOR) 1.79, 95%CI 1.12-2.86, p = 0.015) and increased risk of death (aOR 3.26, 95%CI 1.98-5.39; p < 0.001) at day 90. Discussion and conclusion: Lobar haematoma was the strongest independent predictor of early seizures after intracerebral haemorrhage. Tranexamic acid did not increase the risk of post-intracerebral haemorrhage seizures in the first 90 days. Early seizures resulted in worse functional outcome and increased risk of death.Öğe Intravenous Thrombolytic Therapy in Acute Stroke: Frequent Systemic Problems and Solutions(TURKISH NEUROLOGICAL SOC, 2018) Topcuoglu, Mehmet Akif; Arsava, Ethem Murat; Ozdemir, Atilla Ozcan; Gurkas, Erdem; Orken, Dilek Necioglu; Ozturk, SerefnurOne of the most important reasons why the use of the intravenous (IV) tissue plasminogen activator (tPA), which is one of the key elements of acute ischemic stroke treatment, is not sufficiently widespread is the fact that many common questions have not been adequately answered. In this review, questions about systemic non-neurologic conditions, problems related with IV tPA treatment and complications of treatment, which were collected from our colleagues practicing in Turkey and which are more important in clinical practice, were answered on the basis of the current literature and clear recommendations are made.Öğe Intravenous Thrombolytic Therapy in Acute Stroke: Problems and Solutions(TURKISH NEUROLOGICAL SOC, 2017) Topcuoglu, M. Akif; Arsava, E. Murat; Ozdemir, A. Ozcan; Gurkas, Erdem; Orken, Dilek Necioglu; Ozturk, SerefnurUse of intravenous tissue plasminogen activator (tPA) is one of the key elements of acute ischemic stroke management. Its use has not become widespread, and has faced significant problems in our country for more than a quarter of a century most probably due to many unanswered questions about issues related with daily practice. However, recent developments, which adequately focused and found solutions for most of these problems and questions, have led to a major change of point of view and understanding of the hyperacute management of stroke. This article, in the light of the relevant literature, discusses and provides clear recommendations for questions directed by neurologists practicing in Turkey mainly about typical neurologic issues faced in the setting of tPA use for acute stroke.Öğe It is safe to use transdermal glyceryl trinitrate to lower blood pressure in patients with acute ischaemic stroke with carotid stenosis(BMJ PUBLISHING GROUP, 2019) Appleton, Jason P.; Woodhouse, Lisa J.; Belcher, Andrew; Bereczki, Daniel; Berge, Eivind; Caso, Valeria; Chang, Hui Meng; Christensen, Hanne K; Collins, Ronan; Gommans, John; Laska, Ann C; Ntaios, George; Ozturk, Serefnur; Sare, Gillian M; Szatmari, Szabolcs; Wang, Yongjun; Wardlaw, Joanna M; Sprigg, Nikola; Bath, Philip MBackground There is concern that blood pressure (BP) lowering in acute stroke may compromise cerebral perfusion and worsen outcome in the presence of carotid stenosis. We assessed the effect of glyceryl trinitrate (GTN) in patients with carotid stenosis using data from the Efficacy of Nitric Oxide in Stroke (ENOS) Trial. Methods ENOS randomised 4011 patients with acute stroke and raised systolic BP (140-220 mm Hg) to transdermal GTN or no GTN within 48 hours of onset. Those on prestroke antihypertensives were also randomised to stop or continue their medication for 7 days. The primary outcome was the modified Rankin Scale (mRS) at day 90. Ipsilateral carotid stenosis was split: <30%; 30-<50%; 50-<70%; >= 70%. Data are ORs with 95% CIs adjusted for baseline prognostic factors. Results 2023 (60.5%) ischaemic stroke participants had carotid imaging. As compared with <30%, >= 70% ipsilateral stenosis was associated with an unfavourable shift in mRS (worse outcome) at 90 days (OR 1.88, 95% CI 1.44 to 2.44, p<0.001). Those with >= 70% stenosis who received GTN versus no GTN had a favourable shift in mRS (OR 0.56, 95% CI 0.34 to 0.93, p=0.024). In those with 50-<70% stenosis, continuing versus stopping prestroke antihypertensives was associated with worse disability, mood, quality of life and cognition at 90 days. Clinical outcomes did not differ across bilateral stenosis groups. Conclusions Following ischaemic stroke, severe ipsilateral carotid stenosis is associated with worse functional outcome at 90 days. GTN appears safe in ipsilateral or bilateral carotid stenosis, and might improve outcome in severe ipsilateral carotid stenosis.Öğe Language Disorders due to Posterior System Strokes - An Ignored Dysfunction(GALENOS YAYINCILIK, 2014) Ozturk, Serefnur; Ege, Fahrettin; Ekmekci, HakanThe anterior system is primarily responsible for the clinical picture in a patient that presents with clinical aphasia. However, recent reports have shown that injuries to posterior structures, the cerebellum in particular, may have a role in language processing. Herein, we will look first at the linguistic role of the cerebellum in light of the literature, then of the thalamus and some described clinical syndromes, and finally, specific syndromes resulting from occipital lobe lesions, all of which are supported by the posterior vascular system. The human brain is such a complex organization that in addition to the thalamus and occipital cortex, we can see the involvement of the cerebellum in high cognitive functions. Posterior system strokes may lead to clinical findings of cognitive deficits, including neurolinguistic components. Determining these defects in stroke patients may precipitate changes in current management strategies.Öğe Lentiform Fork Sign: Neuroradiologic Features and Differential Diagnosis(TURKISH NEUROLOGICAL SOC, 2018) Eren, Fettah; Ekmekci, Ahmet Hakan; Ozturk, Serefnur[Abstract not Available]Öğe Magnetic Resonance Findings in Recurrent Painful Ophthalmoplegic Neuropathy with Reversible Enhancement of Oculomotor Nerve(MODESTUM LTD, 2015) Kivrak, Ali Sami; Nayman, Alaaddin; Paksoy, Yahya; Ozturk, SerefnurRecurrent painful ophthalmoplegic neuropathy is a rare disorder characterized by repeated attacks of paresis of one or more ocular cranial nerves, with ipsilateral headache. We describe a 24-year-old man with recurrent painful ophthalmoplegic neuropathy and oculomotor nerve palsy, in whom clinical features and magnetic resonance imaging findings on pre and post treatment period.Öğe Mills' Syndrome - A Clinical Variant -Case Report(JOURNAL NEUROLOGICAL SCIENCES, 2013) Ekmekci, Hakan; Ozturk, Serefnur; Demir, AysegulThe Mills' syndrome was first described by Mills in 1900, the syndrome included progressive, ascending or descending hemiplegia, with no significant sensory impairment. Opposing to be a variant of primary lateral sclerosis, this syndrome is accepted as degeneration of the corticospinal tract unilaterally. Fifty six years old, right handed female patient was admitted to our clinic outpatient outpatient clinic with left spastic hemiparesis, dysphagia, dysarthria and bilaterally prominent lower extremity spasticity and behavioral disturbances, sudden loughing, spastic contractility of arms and legs, gait disturbance for the last three years. Following the dysartria, the loss of power belonging to left lower extremity was proceeded by spasticity prominently left side and cognitive impairment with slow progression. On neurological evaluation, she was concious and cooperative partially. The cranial nerves examination were yielded dysphagia and dysphonia, there were spastic plegia on upper and lower left sided extremities. Deep tendon reflexes were hyperactive with Babinski sign on the right. The cerebral MRI showed mild generalised atrophy prominently right sided, cervical MRI showed both spondylosis and significant spinal cord atrophy. EMG investigation revealed significant neurogenic motor unit changes on left sided extremities especially lower area. Our case is carrying a rare clinical specifications of hemiplegic ascending ALS type of Mills and also unilateral cerebral atrophy is discussed in the light of the literature.Öğe Mills' Syndrome A Clinical Variant -Case Report(2013) Ekmekci, Hakan; Ozturk, Serefnur; Demir, AysegulMills sendromu 1900 yılında Mills tarafından tanımlanan unilateral progresif assendan veya dessendan hemipleji ile duysal tutulum olmaksızın ortaya çıkan nadir bir motor nöron hastalığıdır. Primer lateral sklerozun bir varyantı olduğu da ileri sürülen bu sendromun kortikospinal yolun tek taraflı dejenerasyonuna bağlı olduğu düşünülmektedir. Sol spastik hemiparezi, yutma ve konuşma güçlüğü, bilateral alt ekstremitelerde belirgin spastisite ile kliniğimize başvuran 56 yaşında, sağ elli kadın hastanın yakınmalarının 3 yıldır davranış bozukluğu, ani gülme atakları, kol ve bacaklarda kasılmalar, yürüme bozukluğu, yutma güçlüğünü takiben, önce yavaş bir şekilde başlayan sol alt ekstremitede kuvvet kaybı, göz hareketlerinde beceriksizlik, solda belirgin spastisitesi ve kognitif yıkım süreci ile devam ettiği öğrenildi. Nörolojik muayenede, bilinç açık, kısmen koopere idi. Kranial sinir muayenesinde disfaji ve disfoni, motor muayenesinde sol alt ve üst ekstremite spastik plejik, sağ alt ve üst ekstremitede spastisite dışında motor kuvvet tamdı. Derin tendon refleksleri bütün odaklarda hiperaktifdi. Babinski sağda pozitifti. Duyu muayenesi normaldi. Kranial MRI sağ hemisferde belirgin atrofi dışında normal, torakal ve servikal MRI'da spondilozun yanısıra belirgin spinal kord atrofisi izlendi. EMG'de altda altta daha belirgin sol ekstremitelerde belirgin nörojenik motor ünit değişiklikleri, yer yer fasikülasyonlar dışında normal sınırlarda sinir ileti değerleri elde edildi. Mills sendromunun tanımlanan hemiplejik asendan ALS klinik özelliklerine sahip olmanın yanı sıra, literatürde tanımlanmamış ünilateral serebral atrofisi de bulunan vakamız literatür ışığında tartışıldı.Öğe Neurosyphilis Presenting with Ptosis and Diplopia as the First Complaints: Case Report(TURKISH NEUROLOGICAL SOC, 2018) Eren, Fettah; Aygul, Recep; Ekmekci, Ahmet Hakan; Ozturk, SerefnurSyphilis is a spirochete disease that occurs due to Treponema pallidum infection. It can be sexually transmitted and can be transmitted from mother to baby vertically. Neurological involvement is more common in the late period. The use of common antibiotics may alter the natural course of the disease. Because of this, syphilis may present with different neurological findings. A 49-year-old male patient was admitted to our clinic with complaints of fluctuating double vision and droopy left eyelid for two months. In the neurological examination, pupils were mid-dilated, direct and indirect pupillary light reflexes were bilaterally absent, movements of the left eye in all directions and rightward movement of the right eye were restricted. Also, bilateral ptosis was detected. Brain magnetic resonance imaging and electrophysiological studies including repetitive stimulation were normal. Syphilis was diagnosed with blood and cerebrospinal fluid (CSF) tests. He was treated with long-term high-dose intravenous penicillin. Ocular findings are an important indicator of neurosyphilis. Ocular involvement due to primary disease process is rare. If meningitis-related CSF absorption defect develops, eye movement disorders and pupil abnormalities may occur. The diagnosis of neurosyphilis may be delayed due to different clinical manifestations. Neurosyphilis should be considered in case of ocular findings.Öğe Parathyroid Hormone Levels in the Prediction of Ischemic Stroke Risk(HINDAWI PUBLISHING CORP, 2017) Celik, Guner; Dogan, Ali; Dener, Sefik; Ozturk, Serefnur; Kulaksizoglu, Sevsen; Ekmekci, HakanObjective. It was examined whether PTH and 25-dihydroxyvitamin D(25(OH)D) levels, together or separately, are indicators of the risk of stroke. Materials and Methods. This prospective study was performed at two centers. In the study, 100 patients diagnosed with acute ischemic stroke and 100 control individuals in the same age range were examined. In addition to neurological examination, cranial imaging, extensive routine blood chemistry, PTH, and 25(OH) D levels were evaluated in all cases. Stroke risk factors were determined. Logistic regression was used for statistical analysis. Results. A total of 60 patients and 79 control individuals were included in the study. Different estimation models were designed in order to examine the relationship between PTH and 25(OH) D levels with stroke. According to modeling results, it was determined that the most effective predictor for risk of stroke was 25(OH) D levels, followed by hypertension and PTH levels, respectively. Conclusion. PTH and 25(OH) D levels together can make important contributions to determination of stroke risk, and further investigations are needed to understand this relationship more fully.
