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Öğe A case of neurobrucellosis(Turkish Society of Cerebrovascular Diseases, 2011) Okuyucu, E. Esra; Yilmazer, Serkan; Dede, Hava Özlem; Melek, Ismet; Duman, TaşkinCausing serious morbidities and having so many different clinic formes are the clinical importances of brucellosis, which is a zoonotic infections. Neurobrucellosis, can appear with cranial nerve pathologies, optic stasis, menengitis, myelitis, radiculopathy, periferic neuropathy etc. The case is the woman who is 69 years old. Her complaints began as lumbar pain 3 years ago. She has not been able to stand unaided for a year. In the periventricular white matter chronic ischemic lessions, and in the right serebellar hemisfer an encephalomalasia were determined in the kranial MRI. Brucella tube agglitunation was 1/160(+). Clinic remission observed after neurobrucellosis treatment. The neurobrucellosis is a manifestation that can appear in a lot of different clinic formes; and it requires attention in the differential diagnoastics of several diseases.Öğe Causes of headache in childhood(2006) Incecik, Faruk; Sangün, Özlem; Ako?lu, Ertap; Melek, Ismet; Öksüz, Hüseyin; Duman, TaşkinHeadaches in childhood can be the result of serious organic events as well as the benign causes. In this paper, it is aimed to investigate the etiology of the headache complaint in childhood. This research is made retrospectively in 62 cases; 40 females and 22 males, who are 6-14 years old and admitted with the complaint of headache. The age of the beginning of the headache, duration, frequency, character, localization, intensity, accompanying factors, triggering factors, family history, physical and neurological examination, waters graphy, EEG, BBT and MRG datas are recorded. There were tension headache in 14 cases (22.6%), sinusitis in 11 (17.7%), migraine in 9 (14.5%), epilepsy in 6 (9.7%), posttraumatic headache in 5 (8.1%), headache related with eye disorders in 2 cases (6.4%), arachnoid cyst in 2 cases (3.2%), intracranial tumor in 1 case (3.2%) and unclassified headache in 10 cases (16.2%). In this study, the mostly seen causes of headaches in childhood are determined as tension headaches, migraine and sinusitis.Öğe Effect of tamsulosin therapy on lower urinary tract symptoms in Parkinson's disease(2008) Görür, Sadik; Melek, Ismet Murat; Okuyucu, Esra; Helli, Ali; Duman, Taşkin; Kiper, Ahmet NamikIntroduction: The aim of this study is to evaluate the intensity of lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia (BPH) with and without Parkinson's disease (PD). We also investigated the efficacy of tamsulosin therapy in the management of the subjective and objective symptoms in these patients. Materials and Methods: This study included 80 (40 patients with and 40 without PD) clinically diagnosed BPH patients treated with tamsulosin. International Prostate Symptom score (IPSS), quality of life (QoL), maximum flow rate (Qmax) and post-void residual urine volume (PVR) were determined at baseline and after the 3 months of therapy. The PD group also evaluated with Unified Parkinson's Disease Rating Scale (UPDRS). All patients had received tamsulosin 0.4 mg/per day for 3 months period. The relationship between PD duration and UPDRS and mean changes of IPSS, QoL, Qmax and PVR after tamsulosin therapy were also investigated in PD group. Results: Three patients (7.5%) in PD group were discontinuied the therapy due to the severe hypotension attack. Initial data of IPSS, QoL, Qmax and PVR were different between two groups (p<0.001). After tamsulosin treatment, LUTS improved significantly in both groups (p<0.05). Improvement rates of the IPSS, QoL, Qmax and PVR were significantly higher in non-PD group (p<0.05). When relationship were investigated between PD duration and UPDRS and mean changes of IPSS, QoL, Qmax and PVR after tamsulosin therapy, all parameters were found in correlation except PVR. Conclusion: Tamsulosin therapy appears to useful in PD patient with BPH. But its efficacy is changed with PD duration and severity. After all, tamsulosin therapy can be given to these patients group with close follow-up.Öğe Effect of valproic acid usage on serum lipid profile in patients with epileps(2006) Incecik, Faruk; Sangün, Özlem; Melek, Ismet; Duman, TaşkinThe effect of antiepileptic drugs on serum lipid concentrations is well known. We investigate the effect of VPA usage on lipid profile. Serum lipid profiles of 25 epileptic patients followed with the VPA mono treatment and a control group consisting of 25 cases with similar sex ratio and ages were measured. The age and sex ratio of the cases in VPA using group and control group were not significantly different. According to control group it is detected that VPA usage has no effects on lipid profile. In the group of patients on VPA treatment, TK, HDL-C, LDL-C, VLDL-C, TG, TK/HDL and LDL/HDL levels were not affected from age, gender, serum level of VPA and the dose and duration of VPA treatment. Conclusion: Because different results were reported in several reports about the effect of VPA on serum lipid profile, which must be used in long term period for the treatment of epilepsy, no consensus has been made. So that we agreed that serum lipid profile must be regularly measured in patients using VPA.Öğe The effectiveness of the Epley maneuver for the treatment of BPPV and the role of nystagmus direction as an early indicator of successful treatment(2007) Ako?lu, Ertap; Okuyucu, Semsettin; Okuyucu, Esra; Melek, Ismet Murat; Duman, Taşkin; Da?li, Ali SafakOBJECTIVES: We investigated the role of the direction of nystagmus that might occur during the Epley maneuver as an early indicator for treatment success in benign paroxysmal positional vertigo (BPPV). PATIENTS AND METHODS: The study included 47 patients (24 males, 23 females; mean age 46+/-12 years; range 29 to 70 years) who underwent the Epley maneuver for BPPV. The occurrence and the direction of nystagmus were observed. RESULTS: Nystagmus occurred in 16 patients during the maneuver, being ipsilateral in nine patients and contralateral in seven patients. The treatment was successful in seven patients (77.8%) with ipsilateral nystagmus, whereas none of the patients with contralateral nystagmus benefited from the maneuver. While there was no significant relationship between ipsilateral nystagmus and the success of the treatment (p=0.625), a significant correlation was found between contralateral nystagmus and treatment failure (p=0.000). CONCLUSION: The occurrence of contralateral nystagmus during the Epley maneuver may be a sign of an unsuccessful result.Öğe Leg ulcer, pulmonary hypertension and silent cerebral infarct in two patients with sickle cell disease(Turkish Society of Cerebrovascular Diseases, 2006) Serarslan, Gamze; Melek, Ismet Murat; Akgül, Ferit; Serarslan, Yurdal; Duman, TaşkinSickle cell disease is an inherited hemoglobinopathy and polymerization of deoxygenated HbS lead to clinical manifestations of the disease. The stroke rate in sickle cell disease patients with silent cerebral infarct is 14-fold higher than in those with normal MRI. We present two patients of sickle cell disease with leg ulcer, pulmonary hypertension and silent cerebral infarct and the only symptom was the leg ulcer.Öğe Neuralgiform pain in a patient with sickle cell anemia and stroke(Turkish Society of Cerebrovascular Diseases, 2010) Okuyucu, E. Esra; Dede, Hava Özlem; Melek, Ismet; Duman, TaşkinSickle cell disease (SCD) is characterized by intermittent vaso-occlusive events and chronic hemolytic anemia. This genetic disease has mortal complications. Vaso-occlusive events result in tissue ischemia leading to acute and chronic pain as well as organ damage. People who hasn't have any organ damage, can live to fifth decade ,and 22% of these people die because of stroke. The woman is a carrier of sickle cell disease with complaints of neuralgia headache. No pathological symptom was encountered during the neuralogical exam. However subacute infarct on right corpus striatum and chronic infarct on the periventricular white matter were determined in the cranial MRI. Magnetic resonance venography of the brain indicated left sigmoid sinus thrombosis. The case is important because of having different cerebrovascular accident formes which were produced by sickle cell anemia.Öğe The prevalence of silent cerebral infarct in patients with sickle cell disease(Turkish Society of Cerebrovascular Diseases, 2008) Balcı, Ali; Okuyucu, Esra; Duman, Taşkin; Gali, Edip; Karazincir, Sinem; Melek, Ismet; Yanmaz, RasimObjective: To determine the prevalence of silent cerebral infarct and abnormal brain magnetic resonance imaging (MRI) findings in patients with sickle cell disease (SCD). Materials and methods: Fifty-two brain MR images of the asymptomatic patients with SCD have been reviewed retrospectively. The abnormal MRI findings were recorded. Results: Forty-four of the 52 patients with SCD were homozygous (S/S) and remaining 8 heterozygous (S/ßthal) for SCD. Twelve (27.2%) of the 44 patients with S/S and 2 (25%) of the 8 patients with S/ßthal had silent infarcts. Ten (22.7%; 7 diffuse cerebral, 2 focal cerebral and 1 cerebellum) of the 44 S/S patients demonstrated atrophy. None of the 8 patients with S/ßthal had cerebral atrophy. Conclusion: Patients with SCD living in Hatay demonstrated a high rate of silent cerebral infarct and cerebral atrophy. These findings concur with the results of the literature.Öğe Primary and secondary prevention in stroke: Approact to diabetes mellitus cases(Turkish Society of Cerebrovascular Diseases, 2014) Uludüz, Derya; Duman, TaşkinMicroangiopathy and macroangiopathy are induced by increased the tendency of atherosclerosis caused by metabolic impairment. The prerevalance of diabetes mellitus is 15-33% in cases with ischemic stroke. Diabetes mellitus is an independent risk factor especially for stroke and it can increase the relative risk (RR) 1.8-6 times for initial stroke. The risk of ischemic stroke is higher in women with diabetes. Individual adjustment of glycemic targets is performed but treatment regulation as to set ? 7.0% of HbA1C is recommended for decreasing the microvascular and macrovascular complications if the history of stroke or TIA are present. The targeted fasting plasma glucose levels should be ranged from 4.0 to 7.0 mmol/L and the targeted plasma glucose levels at postprandial second hour should be ranged from 5.0 to 10.0 mmol/L. Daily physial activity, weight control, blood pressure control, lipid control and life style changes are recommended to all diabetic patients. Also, medical treatment is commonly needed for targeted HbA1C levels. In diabetic patients, Metformin is an effective first-line pharmacotherapy to decrease the stroke risk. Also, monotherapy with fibrates can be considered. It is proposed to set the blood preassure at < 130/80 mmHg with ACEI or ARB hypertension treatments in diabetic patients. Diabetic adults with additionally risk factors should be treated with statins to decrease the risk of initial stroke. The benefit of antiagregant usage to decrease the stroke risk is not clear yet, however aspirin usage can suitable in diabetic patients with increased cardiovascular event risk.Öğe Probability of stroke in the couples of stroke patients; using Framingham Stroke Risk Profi?le(Turkish Society of Cerebrovascular Diseases, 2012) Duman, Taşkin; Okuyucu, Esra E.; Melek, Ismet M.; Yilmazer, Serkan; Inandi, Tacettin; Mengüllüo?lu, NecdetINTRODUCTION: Environmental and personal factors may be of importance for stroke risk. We determined the stroke risk factors among the stroke patients' couples and controls. MATERIAL AND METHODS: A prospective study was conducted on 221 participants (71 stroke patients, 71 stroke patients' couples, 79 controls) aged more than 54 years. Framingham Stroke Risk Profile was used to measure the stroke risk. RESULTS: In subjects aged 54 years and older, became a couple of stroke patient were not associated with an increased risk of stroke. CONCLUSION: In this study, environmental and personal factors were an independent risk factor for stroke in stroke patients' couples and controls older than 54 years.Öğe Prognostic faktors of stroke: The review of factors related to patients(Turkish Society of Cerebrovascular Diseases, 2010) Duman, Taşkin; Dede, Hava ÖzlemCerebrovascular diseases, the most frequently encountered diseases of neurology clinics, are important because they cause high morbidity and mortality rates (1). As well as being important, they are also complex diseases since they are difficult to treat and the prevision of their progression is vague (2). Doctors who are dealing with cerebrovascular diseases need to anticipate the prognosis in order to direct the treatment and to modify the expectations of the patient's relatives. Inquiries and problems of the patients and their relatives can be guided through sound responses in the future. There are various variables defined to determine the prognosis of cerebrovascular diseases. The variables that will guide the doctor in the determination of the prognosis depending on the patients, the medical clinic, diagnostic methodology and treatment approach. The age, the gender, ethnicity, educational level, family history, elements of risk (atrial fibrillation, hypertension, hyperglycemia, atherosclerosis, vasculitis, fibrinogenemia etc.) of the patient, the family and social support, genetics and biomarkers are the variables depending on the patient. Characteristics of the lesion; localization and its extents are the variables depending on the diseas. Motor deficits, aphasia, anosognosia, dementia, urinary incontinence, presence of sleep disorder, the improvement rate of the symptoms are the variables of clinics of the stroke. Monitoring methods are the variables of diagnostics. Antiaggregant and thrombolytic treatment, cognitive therapy constitutes the variables at the treatment approaches. The rehabilitation therapy is also dealt with this review from its prognostic aspects. The cerebrovascular disease's prognostic factors which is depending on patients were reviewed in the first episode. The studies on the stroke prognosis are compared and evaluated. Dependent variables of the disease and diagnostic factors were reviewed in the second episode of the paper.Öğe The review of prognostic factors in cerebrovascular diseases: Factors of clinical monitoring(Turkish Society of Cerebrovascular Diseases, 2010) Duman, Taşkin; Dede, Hava ÖzlemCerebrovascular diseases which has high morbidity and high mortality rates are among the disease that doctors interested in neurology require to master the most and predict with precise knowledge of it. However, in the cases of stroke, it is hard to forecast the medical prognosis due to the various parameters that are effective in the disease. The parameters that can lead the doctors in cerebrovascular disease prognosis can be classified as the parameters that depend on the patient, the parameters that depend on the observed variables in the clinical monitoring, the parameters that depend on the diagnostic methodology and the parameters that depend on the treatment modality. The presence of motor deficits, aphasia, anosognosia, hemianopsi, motor deficit, dementia, urinary incontinance, post ischaemia hypoxia, high fever, sleep disorder, recovery rate of symptoms, prognostical rates of the presence of movement disorder are the observed variables in the clinical monitoring and they are investigated in the scope of this review.Öğe Stroke in children with sickle cell anemia(Turkish Society of Cerebrovascular Diseases, 2004) Melek, Ismet M.; Duman, Taşkin; Gali, EdipPatient groups at high risk with respect to cerebrovascular disease has a particular importance in terms of etiological and clinic evaluations. Sickle cell anemia has an important place in the etiology of patients who have had stroke before the age of 20. Among the risk factor of cerebrovascular diseases occurring during childhood, sickle cell anemia is the second important cause following the congenital heart diseases. The probability of a patient with sickle cell anemia to have cerebral infarction is 250 times higher when compared to those who don't have this disease at same age. Those who are born in Hatay forms the 17.49% of the all hemoglobinopathy cases reported in Turkey. In this study, the data on stroke obtained from 506 cases by hemoglobin electrophoresis since 1994 in Hatay, where 10.5% of the population is the carrier, was reported. Of the cases, 403 (79,6%), 99 (19,6%), 2 (0,4%) and 2 (0,4%) were HbSS, HbSS+Thalessemia, HbSD and HbSE, respectively. During a period of 10 year, 5 patients had stroke. Among them, the youngest one was 3 yr old while the oldest one was 15 yr old. The data on hemopatolgical parameters and on clinical and etiological were investigated. Being an autosomal recessive disease and arising from the mutation of hemoglobin beta gene, sickle cell anemia is considered to be a high risk factor for stroke besides the hematological features. In the regions where gene carriers are densely populated, studies on early diagnosis and monitoring appears to be highly important in the detection and prevention of childhood strokes.
