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    A case of cerebral venous thrombosis accompanying with intracranial hypotension: Headache that changing character
    (Kare Publ, 2013) Guler, Sibel; Deniz, Cigdem; Utku, Ufuk; Kehaya, Sezgin
    Spontaneous intracranial hypotension was first described by Schalternbarn. Severe complications like cerebral venous thrombosis and subdural hemorrhage are seldomly seen. A 40-year-old man was examined for weakness of right arm started 9 months earlier and aggravated in last 3 months. He was undergo a lumbar punction because of a demyelinating plaque at C2 level in MRI. After 10 days of lumbar punction he experienced a generalised tonic clonic seizure. At cranial MRI and venography thrombosed superior sagittal and right transverse sinus and image of pachymeningitis, caused by intracranial hypotension were observed. Coincidence of these two situations together was seldomly found at literature. Thrombosis can both effect the sinuses and cortical veins. Spontaneous intracranial hypotension is a risk factor for CVT, but at only 2% CVT is seen as a complication. We think that our case can add addition to literature by having this coincidence.
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    A case of painful legs and moving toes syndrome treated with gabapentin
    (Kare Publ, 2016) Guler, Sibel; Yavuz, Selcuk; Nakus, Engin; Dogru, Yuce
    A 58-year-old woman was evaluated following complaints of pain in both lower extremities and brief involuntary movements in her toes, which had begun 2 years prior. No signs were present beyond a curling, flexion/extension, abduction/adduction movement in the toes of both lower extremities, voluntarily stoppable during neurologic examination. During investigation into etiology, lumbar vertebrae MRI revealed a posterior annular protrusion causing partial compression of the dural sac and neural elements by the L3-4 and L4-5 discs. Semirhythmic repetitious movements were detected on electromyography performed on right extensor digitorum brevis (EDB) muscle with 200 mV and 1 Hz frequency. Patient was put on a gradually increased dose of gabapentin, starting at 1200 mg/day. A brief regression in pain and involuntary movements in feet and toes was observed. GABAergic agents are very effective treatment of painful legs and moving toes syndrome. The present clinically and electrophysiologically diagnosed case was considered worth reporting, as painful legs and moving toes syndrome is a very rare condition.
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    A Case with Symmetrical Intracranial Calcifications and Systemic Lupus Erythematosus Presenting with Optic Neuropathy
    (Turkish Neurological Soc, 2012) Guler, Sibel; Donmez, Salim; Utku, Ufuk; Yavuz, Selcuk
    53 years old female patient presented with sudden loss of sight of her right eye. The patient's neurological examination revealed a decrease in visual acuity (2/20) in her right eye. Her optical disc was hyperemic with edema. The patient's brain CT scans showed symmetrical calcifications in cerebellar peduncles, cerebral hemispheres, putamens and thalamus bilateraly. Laboratory examinations showed positive ANA, positive anti-DNA antibodies and lymphopenia leading to the diagnosis of systemic lupus erythematosus (SLE). We report this case with SLE because of the rare comorbity of optic neuropathy with bilateral calcifacitions.
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    CEREBRAL VASOMOTOR REACTIVITY IN FIBROMYALGIA PATIENTS AND ITS RELATIONSHIP TO CENTRAL NEUROPATHIC PAIN
    (Literatura Medica, 2016) Guler, Sibel; Kurtoglu, Hakan S.; Kehaya, Sezgin; Pamuk, Nuri; Celik, Yahya
    Background - Cerebral vasomotor reactivity, defined as the cerebral vasculature response to hypoxia, is not well understood in fibromyalgia (FM) patients. This study investigated the difference in the cerebrovascular reactivity (i.e., responsiveness to hypercapnia was evaluated by use of breath-holding index) to the breath-holding index (BHI) between patients with fibromyalgia and a group of normal controls. Methods - The study included 40 FM patients and 40 healthy subjects. Cerebrovascular reactivity was evaluated using the BHI, which is a nonaggressive, well-tolerated, real-time, reproducible screening method to study cerebral haemodynamics. Insonation depth and basal velocity were symmetrical and not significantly different between the two groups (p>0.05). All patients completed the Revised Fibromyalgia Impact Questionnaire (FIQR), Hospital Anxiety and Depression Scale (HADS), visual analogue scale (VAS), and the somatization subscale of the SCL-90-R symptom checklist. Results - The BHI ranged from 0.30 to 2.20 (mean 1.11 +/- 0.45) in the FM patients and 1.10 to 2.80 (mean 1.90 +/- 0.35) in the control group (p<0.001). Disease duration and right BHIaverage and left BHIaverage values exhibited a significant negative correlation (r=-61377; p<0.001, r=-0.842; p<0.001, respectively). As pain and fatigue scores increased, the right BHIaverage and left BHIaverage values decreased (r=-0.431; p=0.005, r=-0.544; p<0.001, r=-0.341; p=0.031, r=-0.644; p<0.001, respectively). Conclusions - BHI values showed that cerebrovascular reactivity in FM patients decreased in comparison to healthy individuals. BHI decreased as disease duration and severity increased. Cerebrovascular reactivity decreased in FM patients, and this phenomenon should be accepted as an abnormality. Additionally, this outcome may have been the result of a mechanism responsible for central neuropathic pain.
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    Early Clinical Signs, Lesion Localization, and Prognostic Factors in Unilateral Symptomatic Internal Carotid Artery Occlusion
    (Elsevier Science Bv, 2014) Guler, Sibel; Utku, Ufuk; Aynaci, Ozer
    Background: The aim of this study was to assess infarct localization, clinical signs, and prognostic factors in cases with unilateral symptomatic total internal carotid occlusion. Methods: In total, 101 patients who had a diagnosis of symptomatic unilateral carotid occlusion in the Department of Neurology, Trakya University Faculty of Medicine, between January 2008 and May 2012, were included in this study. The relationship between infarct localizations and prognosis of patients was evaluated by cranial magnetic resonance imaging (MRI) and diffusion-weighted MRI. The condition of ipsilateral middle cerebral artery (MCA) and posterior communicating arteries (PCoAs) was assessed by cranial and cervical magnetic resonance angiography besides opposite carotid. Patients were evaluated by modified Rankin Scale in terms of prognosis at discharge and after 3 months. Furthermore, they were evaluated in terms of risk factors, such as cigarette and alcohol use, presence of temporary ischemic attack and stroke history, hypertension, diabetes mellitus, coronary artery disease, previous myocardial infarction, hyperlipidemia, and peripheral vascular disease. Results: Territorial infarct was commonly seen as acute ischemic stroke pattern especially in cases with a poor MCA circulation and insufficient collateral circulation. Development of territorial stroke, occlusion of MCA, and nonvisualization of PCoA were found to be associated with poor prognosis. Conclusions: In unilateral symptomatic intracranial carotid artery occlusion, poor prognosis and high mortality-associated territorial stroke pattern is frequently observed. Besides, presence of severe stenosis or occlusion and absence of collateral circulation in MCA are associated with poor prognosis.
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    Effect of activity-based training versus strengthening exercises on upper extremity functions in Parkinson?s patients; A randomized controlled, single blind, superiority trial
    (Elsevier, 2022) Zare, Maryam; Ozdemir, Hande; Tavsan, Merve Yalcin; Tuna, Filiz; Sut, Necdet; Guler, Sibel; Kabayel, Derya Demirbag
    Background:Idiopathic Parkinson's disease is a neurodegenerative disease which is appeared by symptoms such as resting tremor, bradykinesia, rigidity, and postural instability. Such symptoms as tremor, bradykinesia, and rigidity significantly affect patients' upper extremity function. Rehabilitation programs should be implemented to improve the upper extremity functions of patients. Objective:Activity-based training would improve dexterity and functional activities to a larger extent than strengthening exercises. This study aimed at evaluating the effect of activity-based training and strengthening exercises on upper extremity functions in Parkinson's disease and to compare the two methods. Method:40 Parkinson's patients with mean of 64.45 +/- 9.13 age were randomized and divided into two groups as activity-based training and strengthening exercise group. Patients were evaluated at the beginning and after 6 weeks of treatment with Unified Parkinson's Disease Rating Scale, Parkinson's Disease Questionnaire-39, Duruo spacing diaeresis z Hand Index, Jebsen Taylor Hand Function Test, Nine-Hole Peg Test, Jamar dynamometer, Jamar pinch meter, Semmes Weinstein Monofilament Test and two-point discrimination. Result:In both groups, upper extremity functions, handgrip strengths and quality of life of patients improved significantly. Tactile sense improved only in the activity-based training group. Conclusion:Activity-based training is not superior to strengthening exercise programs at improving upper extremity functions and dexterity of Parkinson's patients.
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    The effect of social support, depression, and illness perception on treatment adherence in patients with multiple sclerosis
    (Marmara Univ, Fac Medicine, 2022) Girgin, Derya; Tosun, Zeynep; Turgut, Nilda; Guler, Sibel
    Objective: This study was planned to determine the treatment adherence levels of multiple sclerosis (MS) patients and the factors affecting treatment adherence. Patients and Methods: This descriptive and cross-sectional study was conducted with 211 people with MS. Data for this study was obtained through face-to-face interviews with MS patients who presented at the neurology outpatient clinics of two university hospitals between April and October 2018. The Morisky, Green, and Levine Adherence Scale, Beck Depression Inventory, Multidimensional Perceived Social Support Scale, and the Illness Perception Scale were used in data collection. Results: The mean age of the sample was 40.03 +/- 10.82, and 70.1% were female. Treatment adherence was not good in half of the patients (51.7%). Patients with good adherence were found to have higher Multidimensional Perceived Social Support Scale scores (p<0.01) and lower Beck Depression Inventory scores (p<0.01). The illness perceptions of the patients regarding MS did not affect treatment adherence (p>0.05). Conclusion: Treatment adherence was insufficient in half of the MS patients. According to our findings, ensuring more cooperation with the families of patients, which constitute the strongest source of social support, increasing treatment adherence can be suggested as well as screening patients with regard to depressive symptomology during follow-up.
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    Evaluation of psychiatric characteristics in children of parents with multiple sclerosis
    (Cumhuriyet Univ Tip Fak Psikiyatri Anabilim Dali, 2020) Araz Altay, Menguhan; Gorker, Isik; Guler, Sibel; Demirci Sipka, Begum; Atas, Tugce
    Objective: This study aims to investigate the psychiatric disorders in children with parental multiple sclerosis (MS) and to research the differences between without parental chronic disease. Methods: The children of the parents with MS diagnosis in the neurology department and the children of parents without chronic medical and psychiatric diseases were included in the study. Kiddie Schedule for Affective Disorders and Schizophrenia for School Aged Children Present and Lifetime Version (K-SADS-PL) was applied to the children. Structured Clinical Interview for DSM-IV Axis I Disorders, Clinical Version (SCID-I-CV) was applied to parents with MS. Psychiatric characteristics of the parents and children were determined. The accompanying psychiatric disorders in children and adolescents with paternal MS and the clinical features affecting these disorders were analyzed. Results: Fifty children and adolescents with parental MS were included in the study group and 75 children and adolescents without a chronic disease in the parents were included in the control group. The mean age of children in the study group was 12.7 +/- 2.9 years and 58% were girls. 52% of the parents with MS were diagnosed with a psychiatric disorder. As a result of the evaluation, 54% of the children with parental MS were diagnosed with psychiatric disorder. The most common psychiatric diagnoses were anxiety disorders (30%), attention deficit and hyperactivity disorder (ADHD) (22%), and tic disorders (16%), respectively. The Expanded Disability Status Scale scores of the parents of children with psychiatric diagnoses were significantly higher than those of the children with no diagnosis. Conclusion: Children of MS patients have a high rate of psychiatric disorder. As the severity of MS increases, it is more common for children to be affected psychosocially. Children with parental MS should be follow-up for psychiatric disorders, especially for anxiety disorders and ADHD.
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    Fabry Disease Frequency Among Young Cryptogenic Stroke Patients in the City of Edirne, Turkey
    (Lippincott Williams & Wilkins, 2021) Guler, Sibel; Sunal, Asli Sert
    Background: We sought to determine the incidence of Fabry disease (FD) in young cryptogenic stroke patients who lived in the City of Edirne, Turkey, and to define the clinical features helping to recognize patients with FD. Methods: Acute ischemic stroke patients aged 18 to 55 years who were admitted to our hospital between January 2017 and September 2019 were evaluated for inclusion. The screening was performed for alpha-galactosidase A activity on dried blood spot, and DNA was sequenced for GLA mutation in patients with low-plasma alpha-galactosidase A activity. Results: Two proband cases were detected. The first proband patient was identified as having a 427G>A (rs 104894845) (p.A143T) hemizygous mutation along with his family; 3 patients were identified as having the same hemizygous mutation; and 6 patients were identified as having the same heterozygous mutations. The second proband patient was identified as having a c.352C>T (rs 148158093) (p.R118C) heterozygote mutation along with her family; 5 patients were identified as having the same heterozygote mutation; and 1 patient was identified as having the same hemizygous mutation. Our study identified the FD incidence as 3.27%. Conclusions: This research is just one of a few studies conducted on FD screening studies in Turkish stroke patients. Our results underlined the importance of considering FD during the etiologic evaluation of young cryptogenic stroke patients, as it is a rare but potentially treatable entity.
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    Factors determining the treatment ineffectiveness in multiple sclerosis
    (Taylor & Francis Ltd, 2022) Guler, Sibel
    Background In patients with multiple sclerosis (MS), the suboptimal response should be well evaluated at every step of treatment. Review Summary Determining patients with moderate or high activity and suboptimal response to treatment (clinical variables, MRI activity, perception of the patient and physician, side effects, serious risks, etc.) and timely intervention in the treatment are very important in achieving the desired effectiveness in the long term. Within the early stages, there is a limited time interval for effective treatment of MS patients. During this time, intervention is critical to achieve long-term positive results. After diagnosis, an early and individualized specific treatment for MS, depending on the severity of the disease, can prevent radiological and physical disability in the medium/long term. Conclusions With the emergence of a number of new treatments each with their own benefits and risks, a change in the nature of interactions between patients and MS physicians has been anticipated and will be required in the patient-related clinical decision-making process in the developing MS landscape.
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    Intracranial hypotension is a rare cause of orthostatic headache: a review of the etiology, treatment and prognosis of 13 cases
    (Kare Publ, 2013) Guler, Sibel; Cagli, Bekir; Utku, Ufuk; Unlu, Ercument; Celik, Yahya
    Objectives: The aim of this investigation is to examine the causes, clinical picture, treatment, and prognosis of spontaneous intracranial hypotension, a rare cause of orthostatic headache, among the cases presenting in our clinic. Methods: Thirteen cases (5 males and 8 females), diagnosed with spontaneous intracranial hypotension in our clinic between January 1st, 2009 and October 30th, 2011, were included in this study. The presenting symptoms, treatment, findings on cranial magnetic resonance imaging, cerebrospinal fluid pressure measured at lumbar puncture (in available patients), and the healing period of the patients were recorded. Results: Five patients with orthostatic headache and accompanying symptoms were treated with bed rest, increase in oral fluid intake, intravenous hydration and caffeine, and experienced a complete recovery. Complete recovery was observed in two patients (15.3%) within 10 days, in another two (15.3%) within 15 days and in one patient (7.6%) within 21 days. Headache and other clinical symptoms significantly regressed within 30 days in four patients (37.6%) who received similar treatment, but a mild headache persisted intermittently during follow-up in these individuals. As the headache had not resolved after 30 days, an epidural blood patch was applied in these four cases (37.6%) and the clinical picture completely improved within 10 to 15 days. Conclusion: Spontaneous intracranial hypotension should primarily be suspected in cases complaining about postural headache and contrast-enhanced cranial imaging should be performed. The presence of cranial nerve paralysis and pyramidal tract signs should b considered. Conservative treatments should be considered initially, however if conservative treatments fail, epidural blood patches must be applied.
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    Investigation of Relationship Between Small Noncoding RNA (sncRNA) Expression Levels and Serum Iron, Copper, and Zinc Levels in Clinical Diagnosed Multiple Sclerosis Patients
    (Springer, 2023) Ay, Arzu; Alkanli, Nevra; Atli, Engin; Gurkan, Hakan; Gulyasar, Tevfik; Guler, Sibel; Sipahi, Tammam
    In our study, we aimed to investigate the relationship between microRNA (miRNA) expression levels and serum iron (Fe), copper (Cu), and zinc (Zn) levels in Multiple sclerosis (MS) patients. Total RNA was isolated from peripheral venous blood containing ethylenediaminetetraacetic acid (EDTA) of MS patients and controls. Total RNA was labeled with Cy3-CTP fluorescent dye. Hybridization of samples was performed on microarray slides and arrays were scanned. Data argument and bioinformatics analysis were performed. Atomic absorption spectrophotometer method was used to measure serum Fe, Cu, and Zn levels. In our study, in bioinformatics analysis, although differently expressed miRNAs were not detected between 16 MS patients and 16 controls, hsa-miR-744-5p upregulation was detected between 4 MS patients and 4 controls. This may be stem from the patient group consisting of MS patients who have never had an attack for 1 year. Serum iron levels were detected significantly higher in the 16 MS patients compared to the 16 controls. This may be stem from the increase in iron accumulation based on inflammation in MS disease. According to the findings in our study, hsa-miR-744-5p upregulation has been determined as an early diagnostic biomarker for the development together of insulin resistance, diabetes mellitus associated with insulin signaling, and Alzheimer's diseases. Therefore, hsa-miR-744-5p is recommended as an important biomarker for the development together of diabetes mellitus, Alzheimer's disease, and MS disease. In addition, increased serum Fe levels may be suggested as an important biomarker for neurodegenerative diseases such as Parkinson's disease, Alzheimer's disease, and MS disease.
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    Matrix Metalloproteinase-9, MMP-3 and MMP-7 Functional Polymorphism in Multiple Sclerosis Patients
    (Sage Publications Ltd, 2019) Guler, Sibel
    [Abstract Not Available]
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    Prevalence and Clinical Features of Idiopathic Parkinson's Disease in Western Turkey
    (Turkish Neuropsychiatry Assoc-Turk Noropsikiyatri Dernegi, 2022) Guler, Sibel; Caylan, Ayse; Turan, Nesrin; Dagdeviren, Nezih
    Introduction: We aimed to determine the prevalence and risk factors of idiopathic Parkinson's disease (IPD) in Western Turkey, which encompasses Edirne and its surrounding districts. Methods: In this study, 9887 individuals, able to communicate and agreed to participate in the study, were evaluated. The data was obtained by answering a face-to-face questionnaire consisting of 53 questions from volunteers living at 30 randomly selected family health centers in Edirne and its counties. The questionnaire included demographic information, questions to evaluate potential concomitant conditions, and questions regarding the symptomatology used in IPD diagnosis. Following the questionnaire, it was planned to determine the degree of IPD with the Unified Parkinson's Disease Rating Scale (UPDRS) and the Hoehn and Yahr scale (HY) clinical rating scale in patients diagnosed with IPD to assess disease severity in patients diagnosed with IPD Results: Of the 9887 individuals, 118 were diagnosed with IPD according to the questionnaire results from Edirne and its districts, and the prevalence of IPD was 1.2%. Approximately, 58.4% of the patients with IPD were male and 41.6% were female, which was not significantly different (p=0.214). Non-motor symptoms such as difficulty urinating, anxiety, depression, fatigue, REM sleep behavior disorder, and difficulty falling asleep or staying asleep were also examined in patients diagnosed with IPD. Depression was identified in 45.7% of the cases, while the control group was 4.3% (p=0.001). Fatigue was identified in 46.8% of the cases and control group was 3.5% (p=0.002). Conclusions: IPD prevalence studies will increase the awareness in the community and provide early diagnosis and treatment as well as serve as a basis to increased life expectancy, reduce morbidity, and improve life quality.
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    The prevalence of essential tremor in Edirne and its counties accompanied comorbid conditions
    (Taylor & Francis Ltd, 2019) Guler, Sibel; Caylan, Ayse; Turan, F. Nesrin; Dagdeviren, Nezih
    Objective: We aimed to determine the prevalence and risk factors of Essential Tremor (ET) in Edirne and its districts, located in Western Thrace, which is the most western part of Turkey. Methods: In this study, 3008 individuals who could communicate and agreed to participate in the study were evaluated. To obtain the data from the applicants in 30 Family Health Centres in Edirne and its districts, a face-to-face questionnaire that consisted of 37 questions was prepared by the researchers. The questionnaire included general information, questions to evaluate potential concomitant comorbid conditions and questions regarding the symptomatology used in ET diagnosis, as well as questions to evaluate ET severity, was examined with the spiral test. Patients were classified by using the Washington Heights-Inwood Genetic Study of Essential Tremor (WHIGET) diagnostic and clinical evaluation scale. According to the diagnostic criteria for ET (used in participants who were examined and in those whose medical records were reviewed) were similar to those used in astudy conducted in Turkey. Results: Of 3008 individuals, 173 were diagnosed with ET according to the questionnaire results from Edirne and its districts, and the prevalence of ET was 5.8%. Approximately, 43.4% of the patients with ET were male, and 56.6% were female, which was not significantly different (p > 0.05). Participants with tremor related to alcohol withdrawal, hyperthyroidism, anxiety, depression other known causes of tremor were not considered to have ET. Thyroid disease was identified in 0.0% of the cases, and the control group was detected in 1.4%, which was not significantly different (p = 0.170). Psychiatric disease was identified in 0.0% of the cases, and the control group was detected in 1.3%, which was not significantly different (p = 0.271). Conclusions: ET prevalence studies will increase the awareness of the community and provide early diagnosis and treatment, as well as serve as a basis to reduce morbidity and improve the quality of life.
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    The prevalence of restless legs syndrome in Edirne and its districts concomitant comorbid conditions and secondary complications
    (Springer-Verlag Italia Srl, 2015) Guler, Sibel; Caylan, Ayse; Turan, F. Nesrin; Dagdeviren, Nezih; Celik, Yahya
    We aimed to determine the prevalence and risk factors of restless legs syndrome in Edirne and its districts, located in Western Thrace, which is the most western part of Turkey. In this study, 4003 individuals who could communicate and agreed to participate in the study were evaluated. To obtain the data from the applicants in 30 Family Health Centres in Edirne and its districts, a face-to-face questionnaire that consisted of 54 questions was prepared by the researchers. The questionnaire included general information, questions to evaluate potential concomitant comorbid conditions and questions regarding the symptomatology used in restless legs syndrome (RLS) diagnosis, as well as questions to evaluate insomnia and tension-type headache secondary to insomnia according to the ICD-II Criteria (International Classification of Sleep Disorders-II Criteria). Of 4003 individuals, 282 were diagnosed with RLS according to the questionnaire results from Edirne and its districts, and the prevalence of RLS was 7 %. Approximately, 47.9 % of the patients with RLS were male, and 52.1 % were female, which was not significantly different (p > 0.05). Anaemia was identified in 41.1 % of the cases and control group was detected in 19.4 %, which was significantly different (p < 0.001). Secondary insomnia was identified in 64.2 % of the cases with RLS and was not detected in 35.8 %, which was significantly different (p < 0.001). RLS prevalence studies will increase the awareness of the community and provide early diagnosis and treatment, as well as serve as a basis to reduce morbidity and improve the quality of life.
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    Pruritus: Do A? fibers play a role?
    (Wiley, 2014) Tekatas, Aslan; Arican, Ozer; Guler, Sibel; Aynaci, Ozer; Dincer, Nejla
    Neuropathological and molecular basis of pruritus has not been clarified and the presence of certain specific neural circuits have been proposed. Our aim in this study was to evaluate the role of A fibers in the neural circuits of pruritus by cutaneous silent period (CSP). Thirty-six patients with chronic idiopathic generalized pruritus and 32 healthy controls were enrolled in the study. CSP and nerve conduction studies of upper and lower extremities were performed in both groups. Latencies of CSP in the upper and lower extremities were observed to be prolonged in the patient group compared with the controls while durations were shortened (all P<0.001). However, these values were not correlated with sex, age, duration or severity of the disease (all P>0.05). Our data suggest that pruritus may be developed by a nerve conduction abnormality in the afferent fibers of A, or cortical hypersensitivity, abnormality of the cortical inhibitory mechanisms or lack of inhibition in the intermediate spinal inhibitory neurons generating CSP. This topic needs to be evaluated thoroughly in larger series with more detailed studies.
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    RESTLESS LEGS SYNDROME AND INSOMNIA FREQUENCY IN PATIENTS WITH PSORIASIS
    (Literatura Medica, 2015) Guler, Sibel; Tekatas, Asian; Arican, Ozer; Kaplan, Ozlem Sari; Dogru, Yuce
    Background - To assess the prevalence and severity of RLS in psoriasis patients and to investigate its effects on sleep and quality of life. Methods - Seventy patients with psoriasis in Trakya University Medical Faculty Dermatology Department and also applied to Neurology Department in the same center and 70 volunteer controls were enrolled in the study. Severity of the Restless Legs Syndrome (RLS) was determined using International Restless Legs Syndrome Study Group (IRLSSG) criteria among the patients who have been diagnosed with RLS based on IRLSSG criteria. The presence of insomnia in patients was detected using International Classification of Sleep Disorders (ICSD-II) criteria. Additionally, to evaluate the severity of the disease and quality of life, Psoriasis Area Severity Index (PASI) and Dermatology Life Quality Index (DLQI) tests were applied to the patients with psoriasis. Results - RLS frequency in patients with psoriasis was 28 (40%) compared to the control group 10 (14.2%), and the difference was statistically significant (p<0.001). IRLSSG severity scores were higher in patients with psoriasis who had insomnia secondary to RLS compared to those who did not have insomnia (p<0.001). The mean values of PASI were 7.54 +/- 6.52 in the presence of insomnia and 3.27 +/- 2.69 in the absence of insomnia. The difference was statistically significant (p<0.001). No significant difference was found in DLQI scores between patients with RLS and without RLS or between patients with and without insomnia (p>0.05). Discussions - RLS frequency in patients with psoriasis was significantly higher than in the control group. In addition, we found that RLS is more common but RLS severity was mildly high in patients with psoriasis relative to controls. However, there was a correlation between the increase in severity of RLS with secondary insomnia patients who were diagnosed with RLS. It may be beneficial to consider RLS and insomnia for each patient diagnosed with psoriasis.
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    Reversible cerebral vasoconstriction syndrome and recurrent headache triggered by antihistamine use
    (Kare Publ, 2017) Guler, Sibel; Utku, Ufuk; Celebi, Canan
    Reversible cerebral vasoconstriction syndrome (RCVS), also known as Call-Fleming syndrome, is one of the rare causes of thunderclap headaches, which are most often seen in females aged 20-40 years and which can cause neurological deficits. The cause of RCVS is thought to be multifocal arterial constriction and dilatation caused by transient disregulation of cerebral vascular tonus. Presently described is case of 63-year-old female patient who presented with complaint of sudden onset of recurrent headaches located on the left side. Physical and neurological examinations were normal. Cranial magnetic resonance imaging (MRI) angiography examination showed vasoconstrictions in the distal, particularly in middle cerebral arteries and posterior cerebral arteries. Primary angitis of central nervous system (CNS), first considered in differential diagnosis, was excluded because no parenchymal lesion was seen in cranial MRI and no protein increase was observed in cerebrospinal fluid. Dexamethasone sodium phosphate 4 mg/mL (4 mg/day) and nimodipine 90 mg/day treatment was initiated. Nimodipine dose was gradually increased to 120 mg/day. Headache resolved significantly after discontinuation of antihistaminic agents. The most important feature of RCVS to be highlighted is that clinical signs are reversible, unlike subarachnoid hemorrhage or primary angitis of CNS, which have similar clinical presentations. Although clinical signs of RCVS usually resolve, it should be considered that permanent neurological deficits may occur.