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Öğe CADASIL syndrome in a large Turkish kindred caused by the R90C mutation in the Notch3 receptor(Blackwell Publishing Ltd, 2002) Utku, U; Celik, Y; Uyguner, O; Yüksel-Apak, M; Wollnik, BMutations in the Notch3 gene are the cause of the autosomal dominant disorder CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy). The CADASIL is an adult-onset neurologic disorder (average age of onset is 45 years) characterized by recurrent strokes and dementia. Clinical features combined with cerebral magnetic resonance imaging (MRI), showing a diffuse leukoencephalopathy with subcortical infarcts in the basal ganglia and white matter, are highly contributive to the diagnosis. We present a Turkish family with CADASIL, in which 12 individuals in four generations were affected showing the typical clinical features of recurrent strokes. Mutation analysis of the Notch3 receptor gene identified the recently described R90C mutation in the N-terminal part of the gene in affected individuals. Interestingly, migraine without aura was found as an initial symptom of the disease in two young mutation carriers (22 and 25 years, respectively), who did not show any additional clinical features or any MRI abnormalities. This indicates that migraine without aura in the absence of MRI abnormalities may represent an early initial symptom of CADASIL, which is difficult to diagnose in the absence of molecular diagnosis. Therefore, the used molecular screening method for Notch3 mutations provides a rapid and accurate diagnostic tool in addition to the standard diagnostic procedures.Öğe A case of acquired stuttering resulting from left parietal infarction(Blackwell Munksgaard, 2002) Turgut, N; Utku, U; Balci, KObjective - Acquired stuttering is uncommon. and is reported anecdotally after head injury and cerebrovascular diseases. Although this entity is described to occur in lesions of dominant hemisphere, it is rarely shown to occur in non-dominant hemispheric and subcortical lesions, too. Therefore we described a case with this rare syndrome and we discussed the possible mechanisms, lesion locations and medical treatment of stuttering according to previous reports. Case report A 61-year-old right-handed man with sudden onset of right hemiparesia and stuttering without aphasia is reported. There was a circumscribed cortical infarction in the left parietal cortex on computerized tomography (CT) and magnetic resonance imaging (MRI) showed a recent infarct. Single photon emission computed tomography (SPECT) images evidenced perfusion abnormalities in the same region. He never Stuttered before and has no family history of stuttering. He has been maintained on antiaggregant and paroxetine treatment. Conclusion - A rare presentation of stroke associated with stuttering is reported and the treatment of stuttering with paroxetine is discussed.Öğe Clinical and neuroradiological predictors of mortality in patients with primary pontine hemorrhage(Elsevier Science Bv, 2005) Balci, K; Asil, T; Kerimoglu, M; Celik, Y; Utku, UBackground and purpose: Primary pontine hemorrhage (PPH) accounts aproximately for about 5-10% of intracranial hemorrhages, and PPHs are known to have a much less uniform prognosis. We aimed to evaluate the clinical and radiological predictors affecting the mortality in 32 patients with PPH. Material and methods: We retrospectively evaluated the data of 32 patients with PPH admitted to our clinic between 1994 and 2004. We divided the patients into two groups: (1) patients who survived (14 patients), and (2) patients who died (18 patients). The two groups were compared for age, gender, diabetes mellitus, hypertension, initial clinical status, initial GCS, pupillary abnormalities, ophthalmoparesis, volume and localisation of hemorrhage, intraventricular and extrapontine extension, necessity of mechanical ventilation and hydrocephalus. The hematoma volumes were measured with the formulation described by Broderick. Results: Eighteen patients (56%) died and 14 patients (44%) survived. The patients who died (61.3 +/- 8.8) were older than the survivors (56.4 +/- 11.0), but the difference was not statistically significant. The mean GCS was 4.4 +/- 0.2, the mean hematoma volume was 9.9 +/- 3.3 ml for patients who died and the mean GCS was 10.1 +/- 3.3, the mean hematoma volume was 3.3 +/- 1.2 ml for survivors (p < 0.001). Coma on admission (p = 0.001), extrapontine extension (p = 0.001), intraventricular extension (p = 0.019), necessity of mechanical ventilation (p = 0.007), hydrocephalus (p = 0.024), massive and bilateral tegmental localisation (p = 0.006) were found statistically significant predictors for mortality with univariate comparison, and coma on admission (p = 0.038) was the only significant predictor with multivariate regression analysis. Conclusion: In patients with PPH, it is important to know the prognostic factors for mortality for planning the treatment protocol, and coma and bad clinical status on admission was found the only significant prognostic predictor for mortality with multivariate regression analysis. (c) 2005 Elsevier B.V. All rights reserved.Öğe Factors affecting haemorrhagic transformation in middle cerebral artery infarctions(Churchill Livingstone, 2004) Çelik, Y; Utku, U; Asil, T; Balci, KObjective: Haemorrhagic transformation (HT) affects treatment and prognosis in patients with acute ischaemic stroke. The factors affecting haemorrhagic transformation in infarcts due to occlusion of middle cerebral artery (MCA) stem or branch were investigated. Materials and methods: Of 412 patients who were followed in our clinic between January 2001 and December 2001 with acute ischaemic stroke, 86 patients with occlusion in MCA stem or branch were enrolled in this study. These patients were divided into 2 groups, those with HT (n = 35) and without HT (n = 51). Age, sex, systemic arterial hypertension, diabetes mellitus, blood glucose level in the acute period, renal and liver function tests, systolic and diastolic arterial blood pressure in the acute period, previous cerebrovascular disease, leukoaraiosis, modified Rankin Disability Score (mRDS) and stroke subtype were evaluated. Results: High blood glucose level in the acute period and presence of leukoaraiosis on cranial computerized (CCT) tomography were detected as risk factors in development of HT. HT was seen more frequently in MCA stem infarction than branch infarction. mRDS were worse in the group with HT. In multivariate analysis, there were independent relationships between mean blood glucose level on admission, mRDS, presence of diabetes mellitus, and MCA stem infarction and development of haemorrhagic transformation in patients with MCA territorial infarction. (C) 2003 Elsevier Ltd. All rights reserved.Öğe Factors affecting the outcome of decompressive craniectomy for large hemispheric infarctions: a prospective cohort study(Springer Wien, 2005) Kilincer, C; Asil, T; Utku, U; Hamamcioglu, MK; Turgut, N; Hicdonmez, T; Simsek, OBackground. Although surgical decompression of large hemispheric infarction is often a life-saving procedure, many patients remain functionally dependent. The aims of this study were to identify specific factors that can be used to predict functional outcome, thus establish predictive criteria to reduce poor surgical results. Method. In this non-randomized prospective study, we performed decompressive craniectomy in 32 patients (age range, 27 to 77 years) with large hemispheric infarctions. Based on their modified Rankin Score (RS), which was calculated 6 months postoperatively, patients were divided into two functional groups: good (RS 0-3, n = 7) and poor (RS 4-6, n = 25). The characteristics of the two groups were compared using statistical analysis. Findings. One-month mortality was 31%. However, most of the surviving patients were severely disabled (RS 4 or 5), and 6-month total mortality reached 50%. Increased age (>= 60 years) (P = 0.010), preoperative midline shift greater than 10 mm (P = 0.008), low preoperative Glasgow Coma Score (GCS <= 7) (P = 0.002), presence of preoperative anisocoria (P = 0.032), early (within the first three days of the stroke) clinical deterioration (P = 0.032), and an internal carotid artery infarct (P = 0.069) were the positive predictors of a poor outcome. Interpretation. We view decompressive craniectomy for space-occupying large hemispheric infarction as a life-sparing procedure that sometimes yields good functional outcomes. A dominant hemispheric infarction should not be an exclusion criterion when deciding to perform this operation. Early operation and careful patient selection based on the above-mentioned factors may improve the functional outcome of surgical management for large hemispheric infarction.Öğe Fou rire prodromique associated with simultaneous bilateral capsular genu infarction(Elsevier Sci Ltd, 2005) Uzunca, I; Utku, U; Asil, T; Celik, YPathological laughter is exaggerated, uncontrollable, and inappropriate laughter usually unrelated to a true emotion or a congruent mood. Fou rire prodromique is a rare form of prodromal pathological laughter of uncertain pathophysiology that heralds an ischaemic neurologic deficit. We report a case of prodromal pathological laughter marking the onset of bilateral capsular genu infarction. T2-weighted cranial magnetic resonance imaging (MRI) showed bilateral capsular genu infarction. There was also a diffusion defect in the same areas on diffusion-weighted imaging (DWI). Although it is known that bilateral subcortical lesions can cause pathological laughter, this is the first demonstration of simultaneous associated bilateral capsular genu infarction on cranial DWI MRI. (c) 2004 Elsevier Ltd. All rights reserved.Öğe Hepatic myelopathy with spastic paraparesis(Elsevier, 2005) Utku, U; Asil, T; Balci, K; Uzunca, I; Çelik, YProgressive myelopathy is a rare neurological complication of chronic liver disease with portal hypertension and there is no special diagnostic tool for hepatic myelopathy. Neuropathological studies of the patients with hepatic myelopathy have demonstrated demyelination of the lateral corticospinal tracts with various degree of axonal loss. Transcranial magnetic stimulation (TMS) is widely utilized as an indicator of changes in exitability and conductivity of the motor pathways. TMS studies are also used for the diagnosis of hereditary spastic paraparesis in the literature. In this study, we described two patients who presented with spastic paraparesis; TMS studies suggested that they had myelopathy and diagnosed as hepatic myelopathy when all the other possible diagnoses were ruled out. (c) 2004 Elsevier B.V. All rights reserved.Öğe Marchiafava-Bignami disease(Elsevier Science Bv, 2002) Çelik, Y; Kaya, M; Sengün, S; Utku, UMarchiafava-Bignami disease (MBD) associated with chronic alcoholism is a fatal disorder characterized by demyelination of the corpus callosum. It is diagnosed by the imaging of demyelination at the corpus callosum with MRI. This lesion is not only limited to the corpus callosum but also affects the cortico-cortical and cortico-subcortical projections due to disconnection and causes frontal lobe syndromes and dementia. In this article, we presented a case that MBD associated with chronic alcoholism. (C) 2002 Elsevier Science B.V. All rights reserved.Öğe Migraine prevalence and some related factors in Turkey(Wiley, 2005) Çelik, Y; Ekuklu, G; Tokuç, B; Utku, UObjectives.-The aim of our study is to determine the prevalence of migraine in Provincial Center of Edirne. Methods.-A systematic random sample of 386 inhabitants over 14 years old were interviewed face to face. Diagnosis of migraine was based on the International Headache Society (IHS) classification. Results.-Migraine was identified in 77 subjects (60 female, 17 male). The lifetime prevalence of migraine was found to be 19.9% (95% CI: 18.3-21.5) (9.34% (95% CI: 8.6-10) in males, 29.3% (95% CI: 27-31.6) in females). Conclusions.-These results show that while migraine prevalence in Turkish females is higher than that reported in previous studies from Europe and United States, lifetime prevalence is similar in all populations.Öğe Monitoring of increased intracranial pressure resulting from cerebral edema with transcranial Doppler sonography in patients with middle cerebral artery infarction(Wiley, 2003) Asil, T; Uzunca, I; Utku, U; Berberoglu, UObjective. Cerebral herniation resulting from postischemic brain edema is the most common cause of death in patients with large cerebral infarctions. Early monitoring of intracranial pressure and application of necessary treatment procedures may have life-saving value. In this study, the data obtained by transcranial Doppler sonography were compared with clinical examination and the neuroradiologic findings. Methods. Eighteen patients with first-ever strokes and large middle cerebral artery infarction who were admitted within the first 12 hours after stroke onset were included. Clinical findings were evaluated according to the daily Glasgow Coma Scale and Rankin disability scores on the 10th day. Initial cerebral computed tomography was performed at admission to the hospital. Midline shift and ventricular displacement were evaluated on the third day. Follow-up tomographic scans of some patients were per-formed on subsequent days if necessary. Systolic, diastolic, and mean blood flow velocities and pulsatility indices of all patients were measured by transcranial Doppler sonography daily for 10 days. Results. The pulsatility indices were higher on the third hospital day than on the first day. The increases in the pulsatility indices were correlated with the midline shift measured on the third day. The prognoses of the patients whose maximal pulsatility indices during the first 10 days were higher than 1.5 were poorer than those of the patients whose maximal pulsatility indices were lower than 1.5. Conclusions. Transcranial Doppler sonography enables noninvasive monitoring of raised intracranial pressure in patients with large infarctions. It also provides information for detecting cerebral herniation and deciding on the medical or surgical therapy.Öğe Post-stroke mania in late life due to right temporoparietal infarction(Blackwell Publishing Asia, 2004) Celik, Y; Erdogan, E; Tuglu, C; Utku, U[Abstract Not Available]Öğe Recovery from aphasia after decompressive surgery in patients with dominant hemispheric infarction(Lippincott Williams & Wilkins, 2005) Asil, T; Utku, U; Balci, K; Kilincer, C[Abstract Not Available]Öğe Reversible MR angiographic findings in a patient with autoimmune Graves disease(Amer Soc Neuroradiology, 2004) Utku, U; Asil, T; Çelik, Y; Tucer, DA 45-year-old woman presented with subacute encephalopathy due to autoimmune Graves disease. MR angiography (MRA) demonstrated stenosis of the major intracerebral arteries. After high-dose methylprednisolone therapy and plasmapheresis, her neurologic status improved dramatically, and the MRA findings resolved after 3 months. The angiographic findings in Graves disease that resemble those in Moyamoya disease are temporary.Öğe Reversible postictal MRI change mimicking structural lesion(Elsevier, 2003) Hicdonmez, T; Utku, U; Turgut, N; Cobanoglu, S; Birgili, BA reversible change on magnetic resonance imaging (MRI) following generalised seizure mimicking a tumour-like structural lesion is reported in a 15-year-old patient. MRI revealed a left fronto-parietal cortico-subcortical lesion on T2 weighted images. The control MRI after 5 weeks from the onset revealed no pathological finding. The reversible MRI changes may be the result of a local brain swelling, and a defect of cerebral autoregulation during seizure at the site of activity. The transient nature of such neuroradiological findings have to be taken into consideration in the differential diagnosis because of their similar appearance on imaging to intrinsic brain tumours. (C) 2003 Elsevier B.V. All rights reserved.Öğe Risk factors of status epilepticus in children(Wiley, 2003) Karasalihoglu, S; Öner, N; Çeltik, C; Çelik, Y; Biner, B; Utku, UBackground : Although there is abundant literature about the morbidity and mortality rates of status epilepticus (SE), little is known about the risk factors of this medical emergency. The aim of the present study is to assess the risk factors of SE in children. Methods : The authors reviewed the medical records of 83 patients admitted to the Pediatric Neurology Unit of Trakya University Hospital, Edirne, Turkey from January 1994 to December 2001 with the diagnosis of SE. Eighty-three patients were compared with 166 controls who were admitted to the same unit due to non-status epilepticus (non-SE) seizure. Results : The univariate analysis demonstrated that SE episodes were significantly associated with a history of birth asphyxia, neonatal seizure, discontinuation of antiepileptic medication, epilepsy, partial seizure evolving to secondary generalized seizures, myoclonic seizure, generalized abnormalities in the neurological examination, neuromotor retardation, generalized background abnormalities on electroencephalogram (EEG), generalized abnormalities on neuroimaging and polypharmacy than non-SE episodes. Logistic regression was used to test the independence of these parameters as predictors of SE risk. Four parameters emerged as significant independent predictors of SE in children in multiple logistic regression: polypharmacy (Odds ratio (OR) 5.17, P = 0.0004), discontinuation of antiepileptic medication (OR 4.04, P = 0.0095), neuromotor retardation (OR 4.03, P = 0.0016) and generalized background abnormalities on EEG (OR 2.48, P = 0.0419). Conclusion : Polypharmacy, discontinuation of antiepileptic medication, neuromotor retardation and generalized background abnormalities on EEG are indicators in children of a higher risk of SE.Öğe An uncommon central nervous system manifestation in systemic lupus erythematosus(Blackwell Science Ltd, 2000) Aydin, N; Utku, U; Özer, TEH[Abstract Not Available]Öğe Utility of dorsal sural nerve in early determination of diabetic polyneuropathy(Blackwell Publishing, 2005) Balci, K; Karacayir, S; Varol, G; Utku, U[Abstract Not Available]
