Publications by authors named "Vesile Oztürk"

24 Publications

  • Page 1 of 1

[Internal carotid artery dissection which mimicry trigeminal neuralgia and cluster headache].

Agri 2020 Jan;32(1):55-57

Department of Neurology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey.

Cervical artery dissection is an acute arterial disease. Although it is not a common disease, 40-60% cerebral infarction and 20-30% transient ischemic attack could be seen. Thus, cervical artery dissection is important to recognize. Fifty-three years old female patient consulted with head, neck and face endaural pain that started after than spread directly left face half, effect of sometimes orbita and sometimes submaxillary area, occasionally accompanied by redness in the eye, extending from a few minutes to a few hours, it has been sharp and pulsatil characteristics and she never experienced before similar. Although not typical, with the initial diagnosis was trigeminal neuralgia and cluster headache (CH), carbamazepine and tramadol treatment were started. The patient who had neck pain was severe during USG, and with atypical features was BT angioed to the brain and neck concerning differential diagnosis of the patient. It was detected profile compatible with dissection at left ICA proximal. In the literature, there are rare cases of ICA dissection mimicking CH and other trigeminal autonomic cephalalgias. A common recommendation in CH case reports is the need for neurovascular imaging in cases with atypical features.
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http://dx.doi.org/10.5505/agri.2017.76094DOI Listing
January 2020

A new tool to assess amnestic mild cognitive impairment in Turkish older adults: virtual supermarket (VSM).

Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 2020 09 4;27(5):639-653. Epub 2019 Sep 4.

Department of Neurology, School of Medicine, Dokuz Eylul University , Izmir, Turkey.

The purpose of this study was to investigate cognitive functioning by administering the Virtual Supermarket (VSM) test in patients with amnestic mild cognitive impairment (aMCI, N = 37) and age and education-matched healthy controls (HCs, N = 52). An extensive neuropsychological test battery and the VSM were administered to all participants. The aMCI group exhibited lower performance and required more time to complete the VSM compared to HCs. Also, aMCI-Multiple Domain (aMCI-MD) patients performed worse in the "Correct Types", "Correct Quantities", "Bought Unlisted", "Correct Money" variables compared to HCs. Moreover, aMCI-SD patients displayed lower performance in "Bought Unlisted" and "Correct Money" variables compared to HCs. The VSM variables correlated with established neuropsychological test scores. The VSM test was found to discriminate between aMCI and HCs with a correct classification rate (CCR) of 81%. This is a preliminary study showing that the VSM is a valid, brief and user-friendly test. .
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http://dx.doi.org/10.1080/13825585.2019.1663146DOI Listing
September 2020

Anti-N-methyl-d-aspartate receptor encephalitis during pregnancy: A case report.

J Obstet Gynaecol Res 2019 Apr 20;45(4):935-937. Epub 2019 Feb 20.

Department of Neurology, Izmir Dokuz Eylul University Faculty of Medicine, Izmir, Turkey.

Following a generalized tonic-clonic seizure, a previously healthy 27-year-old pregnant woman (18-week pregnancy) was admitted to our emergency department. She experienced lethargy, forgetfulness and persecutory hallucinations the day before hospitalization. Cerebrospinal fluid examination revealed moderate pleocytosis, and abdominal ultrasonography did not detect neoplasia. Orofacial dyskinesia, catatonia and central hypoventilation gradually developed despite medical intervention to ameliorate the symptoms. At 32 weeks of pregnancy, vaginal bleeding and hypotension occurred. Further, owing to septic shock due to fetal demise, the patient died. N-methyl-d-aspartate antibody test results obtained after the patient's death were positive (2++). Currently, no consensus exists on the appropriate treatment and follow-up for pregnant women with anti-N-methyl-d-aspartate receptor encephalitis; however, immunomodulators and teratoma resection may be helpful. Second line immunotherapy (rituximab, cyclophosphamide) and teratoma resection may be necessary in pregnant patients with high N-methyl-d-aspartate receptor antibody titers and inadequate response to first-line treatment.
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http://dx.doi.org/10.1111/jog.13892DOI Listing
April 2019

Comparison of conventional and modern methods in determining ischemic stroke etiology by general and stroke neurologists

Turk J Med Sci 2019 Feb 11;49(1):170-177. Epub 2019 Feb 11.

Background/aim: This study aimed to investigate the consistency between stroke and general neurologists in subtype assignment using the Trial of ORG-10172 in Acute Stroke Treatment (TOAST) and Causative Classification of Stroke (CCS) systems.

Materials And Methods: Fifty consecutive acute ischemic stroke patients admitted to the stroke unit were recruited. Patients were classified by two stroke and two general neurologists, each from different medical centers, according to TOAST followed by the CCS. Each neurologist was assessed for consistency and compliance in pairs. Concordance among all four neurologists was investigated and evaluated using the kappa (ĸ) value.

Results: The kappa (ĸ) value of diagnostic compliance between stroke neurologists was 0.61 (95% CI: 0.45–0.77) for TOAST and 0.78 (95% CI: 0.62–0.94) for CSS-5. The kappa (ĸ) value was 0.64 (95% CI: 0.48–0.80) for TOAST and 0.75 (95% CI: 0.60–0.91) for CCS-5 for general neurologists. Compliance was moderate [ĸ: 0.59 (95% CI: 0.52–0.65)] for TOAST and was strong [ĸ: 0.75 (95% CI: 0.68–0.81)] for CCS-5 for all 4 neurologists. ‘Cardioembolism’ (91.04%) had the highest compliance in both systems. The frequency of the group with ‘undetermined etiologies’ was less in the CCS (26%) compared to TOAST.

Conclusion: The CCS system improved compliance in both stroke and general neurologists compared with TOAST. This suggests that the automatic, evidence-based, easily reproducible CCS system was superior to the TOAST system.
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http://dx.doi.org/10.3906/sag-1806-29DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7350849PMC
February 2019

Psychometric Testing of the Turkish Version of the Stroke Self-Efficacy Questionnaire.

J Nurs Res 2019 Aug;27(4):e35

MD, Professor, Faculty of Medicine, Neurology Department, Dokuz Eylul University, Izmir, Turkey.

Background: When stroke survivors return to their lives in society, they often face issues such as physical or cognitive impairment, dependence on others, social isolation, and reduced self-esteem, which may lead to disastrous consequences in patients' self-perceived self-efficacy and self-confidence in everyday life. Self-efficacy plays an important role in the well-being of stroke patients. Accurate assessment of the stroke patients' self-efficacy by health professionals is critical to obtaining data regarding their functioning levels.

Purpose: The aim of this study was to evaluate the psychometric properties of the Turkish version of the Stroke Self-Efficacy Questionnaire (T-SSEQ).

Methods: A sample of 185 stroke patients (mean age = 64.78 ± 10.7) was recruited from a university hospital in Izmir, Turkey. Data were collected between April and October 2016. Translation and back-translation processes were used to translate the T-SSEQ into Turkish. Data were analyzed using the Rasch partial credit model with the Winsteps program to investigate the response scale analysis, tests of fit to the model, unidimensionality, local dependency, item and person separation reliability, separation index, and differential item functioning.

Results: The Rasch analysis showed goodness of fit for both the activity and self-management subscales. Moreover, both scales were identified as being unidimensional in structure. Furthermore, the participants were able to distinguish between the categories of the response options, and scale reliability was supported for both subscales using Rasch analyses.

Conclusions/implications For Practice: These results indicate that the T-SSEQ is acceptable for use with Turkish stroke patients in both practice and research settings. Furthermore, the questionnaire is suitable for nurses to use in designing interventions and evaluating stroke patients' self-efficacy in clinics, home care, and rehabilitation centers.
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http://dx.doi.org/10.1097/jnr.0000000000000308DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6641097PMC
August 2019

Effects on urinary outcome of patients and caregivers' burden of pelvic floor muscle exercises based on the health belief model done at home by post-stroke patients.

Top Stroke Rehabil 2019 03 11;26(2):128-135. Epub 2018 Dec 11.

e Faculty of Medicine, Department of Physical Medicine and Rehabilitation , Dokuz Eylul University , Inciralti/Izmir , Turkey.

Objective: The purpose of this study is to investigate the effects of pelvic floor muscle exercises (PFMEs) done by stroke patients at home in line with the health belief model (HBM) on patient care outcomes and caregivers' burdens.

Method: In the study, a quasi-experimental design with a pre- and post-test control group was used. The study was conducted with 20 patients in the experimental group and 18 patients in the control group. The patients and caregivers were evaluated at baseline and after the 12-week PFME intervention performed at home. The data were analyzed with the chi-square, Mann-Whitney U, Wilcoxon signed rank test and multiple regression analysis.

Results: A statistically significant difference was found between the two groups in terms of the mean scores they obtained from the ICIQ-SF and I-QOL, the number of urinary incontinence episodes, pad test after interventions and quality of life scores (p < 0.05), while no statistically significant difference was found between the groups in terms of the mean scores for the Burden Interview (p > 0.05). An increase was determined in the self-efficacy of the patients in the experimental group after the PFMEs (p < 0.05).

Conclusions: Given the results of the present study, it is recommended that in the management of post-stroke urinary incontinence, post-stroke patients should be encouraged to do PFME at home in line with the HBM, and they should be monitored periodically.
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http://dx.doi.org/10.1080/10749357.2018.1552741DOI Listing
March 2019

Spinal Epidural and Intracranial Subdural Haemorrhage that is a Complication of Spinal Anaesthesia.

Turk J Anaesthesiol Reanim 2018 Aug 1;46(4):319-322. Epub 2018 Aug 1.

Department of Anaesthesiology and Reanimation, Division of Algology, Dokuz Eylül University School of Medicine, İzmir, Turkey.

Haemorrhage in the neuraxial region following spinal and epidural interventions is a rare and unexpected complication. Subdural haemorrhage is the most frequently occurring type. A 64-year-old male patient was admitted with complaints of severe headache and intermittent fever after 14 days of spinal anaesthesia and inguinal hernia operation. Neurological examination and systemic examination showed no features other than that for postural tremor. Cranial and spinal magnetic resonance (MR) imaging were requested for the differential diagnosis of the patient with secondary headaches. In MR, subacute subdural haemorrhage adjacent to the dura, limiting the posterior sulcus, and extra axial distance (not clearly distinguishable epidural-subdural distinction) along the entire spinal canal were detected. The patient who had no neurological deficit and no culture recruitment underwent conservative treatment. We would like to emphasize here that the coexistence of both intracranial subdural and spinal subdural-epidural haemorrhage can be seen as a complication after spinal anaesthesia, which has not been previously observed in the literature, along with the importance of headache after regional anaesthesia.
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http://dx.doi.org/10.5152/TJAR.2018.28044DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6101718PMC
August 2018

Experiences Related to Urinary Incontinence of Stroke Patients: A Qualitative Descriptive Study.

J Neurosci Nurs 2018 Feb;50(1):42-47

Questions or comments about this article may be directed to Gulcihan Arkan, MSc RN, at She is a Lecturer, Faculty of Nursing, Public Health Nursing Department, Dokuz Eylul University, Izmir, Turkey. Ayse Beser, PhD FAAN, is Professor, Faculty of Nursing, Public Health Nursing Department, Koc University, Istanbul, Turkey. Vesile Ozturk, PhD, is Professor, Faculty of Medicine, Neurology Department, Dokuz Eylul University, Izmir, Turkey.

Introduction: Poststroke urinary incontinence is a common problem, with a prevalence ranging from 32% to 79%. Urinary incontinence after stroke has negative physiological, psychological, and economic effects, which lead to lifestyle changes for both patients and caregivers. Nurses play an important role in preventing and improving incontinence, understanding the experiences of individuals experiencing incontinence, providing healthcare for them, and implementing behavioral therapy methods. The aim of this study was to determine the experience related to urinary incontinence of stroke patients.

Methods: In this qualitative descriptive study, using semistructured interviews, 15 participants with urinary incontinence after stroke selected through purposeful sampling were interviewed. Data were collected with a semistructured interview form prepared within the framework of the Health Belief Model. All data were analyzed using content analysis.

Results: Three main themes were identified: "perception of urinary incontinence," "effects of urinary incontinence," and "management of urinary incontinence." The respondents explained that urinary incontinence also adversely affected their caregivers. They experienced many daily life and psychological problems because of urinary incontinence. In addition, they made several changes to management urinary incontinence such as limiting fluid intake, changing underwear frequently, using waterproof mattress protectors, applying traditional practice, and taking medicine.

Conclusions: This study revealed that stroke patients needed help and support for urinary incontinence management. Nurses should provide information about management and urinary incontinence after stroke.
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http://dx.doi.org/10.1097/JNN.0000000000000336DOI Listing
February 2018

Analyses of the Turkish National Intravenous Thrombolysis Registry.

J Stroke Cerebrovasc Dis 2016 May 4;25(5):1041-1047. Epub 2016 Feb 4.

Department of Neurology, University of Hacettepe, Ankara, Turkey.

Background: The relatively late approval of use of recombinant tissue plasminogen activator (rt-PA) for acute ischemic stroke in Turkey has resulted in obvious underuse of this treatment. Here we present the analyses of the nationwide registry, which was created to prompt wider use of intravenous thrombolysis, as well as to monitor safe implementation of the treatment in our country.

Methods: Patients were registered prospectively in our database between 2006 and 2013. Admission and 24-hour National Institutes of Health Stroke Scale and 3-month modified Rankin Scale scores were recorded. A "high-volume center" was defined as a center treating 10 or more patients with rt-PA per year.

Results: A total of 1133 patients were enrolled into the registry by 38 centers in 18 cities. A nearly 4-fold increase in the study population and in the number of participating centers was observed over the 6 years of the study. The mean baseline NIHSS score was 14.5 ± 5.7, and the prevalence of symptomatic hemorrhage was 4.9%. Mortality at 3 months decreased from 22% to 11% in the 6 years of enrollment, and 65% of cases were functionally independent. Age older than 70 years, an NIHSS score higher than 14 upon hospital admission, and intracranial hemorrhage were independently associated with mortality, and being treated in a high-volume center was related to good outcome.

Conclusions: We observed a decreasing trend in mortality and an acceptable prevalence of symptomatic hemorrhage over 6 years with continuous addition of new centers to the registry. The first results of this prospective study are encouraging and will stimulate our efforts at increasing the use of intravenous thrombolysis in Turkey.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2016.01.015DOI Listing
May 2016

Management of free-floating thrombus within the arcus aorta and supra-aortic arteries.

Clin Neurol Neurosurg 2014 Oct 15;125:198-206. Epub 2014 Aug 15.

Department of Neurology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey. Electronic address:

Introduction: Clinical management strategy and the best treatment option of free floating thrombus (FFT), detected in patients with acute ischemic cerebrovascular diseases is still uncertain due to the rarity of these conditions. Recent studies emphasize that FFT within cerebral vessels may not be a surgical emergency since complete dissolution without any further neurologic progression occurred in 86% of patients treated medically. The aim of this study was to investigate the effect of medical treatment on the fate of thrombus and the clinical status in acute cerebrovascular event patients with detected FFT in the artery feeding the compromised brain territory at the time of diagnosis.

Materials And Methods: We have retrospectively reviewed the initial and follow up computed tomography angiography, diffusion-weighted magnetic resonance imaging examinations of 37 acute ischemic stroke patients with detected FFT and treated medically. The patients were evaluated for any change of the FFT, residual stenosis after the FFT shrunk or disappeared and neurologic outcome.

Results: FFT was located in cervical carotid artery, intracranial artery and arcus aorta in 23, 6 and 5 of the patients respectively. Dissection accompanied the FFT in 3 patients. Recanalization was maintained in 34 patients however, three of them suffered from new infarctions. A total occlusion was detected in three patients. Two of them had new infarcts while one was stable during clinical follow-up period.

Conclusion: The results of our retrospective study have shown that FFT in the proximal aorta and supra-aortic arteries tend to resolve with anticoagulant and/or antiplatelet treatment without causing recurrent adverse events in most of the cases. Furthermore, resolution of the clot seems to provide a safer ground for a recanalization procedure like stenting or endarterectomy if needed.
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http://dx.doi.org/10.1016/j.clineuro.2014.08.008DOI Listing
October 2014

Acute Treatment of Migraine.

Authors:
Vesile Öztürk

Noro Psikiyatr Ars 2013 Aug 1;50(Suppl 1):S26-S29. Epub 2013 Aug 1.

Dokuz Eylül University, Medical Faculty, Department of Neurology, İzmir, Turkey.

Migraine is one of the most frequent disabling neurological conditions with a major impact on the patient's quality of life. Migraine has been described as a chronic disorder that characterized with attacks. Attacks are characterized by moderate-severe, often unilateral, pulsating headache attacks, typically lasting 4 to 72 hours. Migraine remains underdiagnosed and undertreated despite advances in the understanding of its pathophysiology. This article reviews management of migraine acute pharmacological treatment. Currently, for the acute treatment of migraine attacks, non-steroidal anti-inflammatory drugs (NSAIDs) and triptans (serotonin 5HT1B/1D receptor agonists) are recommended. Before intake of NSAID and triptans, metoclopramide or domperidone is useful. In very severe attacks, subcutaneous sumatriptan is first choice. The patient should be treated early in the attack, use an adequate dose and formulation of a medication. Ideally, acute therapy should be restricted to no more than 2 to 3 days per week to avoid medication overuse.
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http://dx.doi.org/10.4274/Npa.y7299DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5353074PMC
August 2013

Efficacy and safety of 400 and 800 mg etodolac vs. 1,000 mg paracetamol in acute treatment of migraine: a randomized, double-blind, crossover, multicenter, phase III clinical trial.

Pain Pract 2013 Mar 25;13(3):191-7. Epub 2012 Jun 25.

Department of Neurology, Medical Faculty, Dokuz Eylül University, İzmir, Turkey.

Aim: We aimed to determine the efficacy and safety of etodolac, in acute migraine attacks in comparison with paracetamol (acetaminophen).

Methods: We designed a randomized, double-blind, crossover phase III clinical trial for patients diagnosed with migraine for at least 1 year, according to ICHD-II criteria. Two hundred and twenty-nine adult patients having 2 to 8 attacks monthly from 17 centers were included. The patients were instructed to use 3 attack treatment packages consisting of 1,000 mg paracetamol, 400 mg etodolac, and 800 mg etodolac on 3 migraine attacks of moderate-severe intensity each in a 3-month treatment period, interchangeably.

Results: Any pain medication was used in 1,570 migraine attacks while study treatments were used in 1,047 attacks. The results for 1,000 mg paracetamol, 400 mg etodolac, and 800 mg etodolac were as follows: response of headache at 2 hours 44.9%, 48.3% and 46.1%; pain-free at 2 hours 19.2%, 19.3% and 24.1%; sustained pain-free from 2 to 24 hours 34.3%, 38.3% and 41.1%; relapse rates in 2 to 24 hours 7.3%, 14.3% and 9.7%. There were no statistically significant differences between the groups regarding the headache response, pain-free, sustained pain-free, and relapse rates. Nausea, vomiting, phonophobia, or photophobia decreased similarly in all groups within 24 hours of treatment administration. Drug-related adverse events were noted in 8 patients with 1,000 mg paracetamol, in 9 patients with 400 mg etodolac and in 9 patients for 800 mg etodolac during the study.

Comment: Our study showed that etodolac is a safe and effective alternative in acute migraine treatment and showed comparable efficacy to paracetamol 1,000 mg. Etodolac may be considered as an alternative option for acute treatment of migraine.
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http://dx.doi.org/10.1111/j.1533-2500.2012.00572.xDOI Listing
March 2013

A longitudinal study of balance in migraineurs.

Acta Otolaryngol 2012 Jan 18;132(1):27-32. Epub 2011 Dec 18.

Department of Neurology, Dokuz Eylül University, Faculty of Medicine, Inciralti, Izmir, Turkey.

Conclusion: Balance in migraineurs, even in those without vestibular symptoms, deteriorates slightly over 1 year in the most challenging test conditions, when measured with posturography.

Objective: To discover by a longitudinal study of a group of migraineurs and their controls, whether the well-known, mild imbalance found on posturography in migraineurs is static or progressive.

Methods: Posturographic measures of sway under incrementally more challenging conditions (up to eyes closed standing on a foam surface with the head extended) using the modified clinical test of sensory interaction on balance, limits of stability test, and tandem gait tests in a group of 19 migraineurs and 19 age- and gender-matched controls, all of whom who had been tested over 1 year before.

Results: After 1 year migraineurs showed a slight but statistically significant deterioration: in postural sway especially, when measured with eyes closed standing on a foam surface with the head extended backwards; in reaction time; and in maximal excursion on the limits of the stability test; and perhaps in walk speed and step width on the tandem walk test.
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http://dx.doi.org/10.3109/00016489.2011.616532DOI Listing
January 2012

Intravenous thrombolytic treatment in a patient with transient ischemic attack associated with mural carotid thrombi.

Clin Neurol Neurosurg 2011 Jun 25;113(5):416-8. Epub 2011 Feb 25.

Dokuz Eylül University, Faculty of Medicine, Department of Neurology, İzmir, Turkey.

A 77-year old man experiencing frequent transient ischemic attacks for five days was admitted to our hospital. Radiological examinations including brain computed tomography, supraaortic computed tomography angiography were performed. Supraaortic computed tomography angiography revealed two thrombi in common carotid artery. Thrombi were located proximally, one of which was elongated and adhared to the arterial wall and the other one was located below bifurcation of left carotid artery. Since the case has been categorized as a high risk patient for ischemic stroke despite the normal neurological status, intravenous recombinant tissue plasminogen activator was given. Ischemic attacks completely ceased soon after thrombolysis. Control computed tomography angiography revealed normal findings with patent carotid artery, without any clot. To our knowledge this is the only case of transient ischemic attack treated with intravenous recombinant tissue plasminogen activator in the literature with the score of 0 on the National Institutes of Health Stroke Scale.
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http://dx.doi.org/10.1016/j.clineuro.2010.12.017DOI Listing
June 2011

Is balance normal in migraineurs without history of vertigo?

Headache 2009 Mar;49(3):419-25

Dokuz Eylül University Faculty of Medicine Department of Neurology, Inciralti, Izmir, Turkey.

Objective: To investigate by static posturography the occurrence of balance disorder in migraineurs without a history of vertigo during the interictal period.

Background: The link between migraine and balance disorders has long been known but postural balance in migraineurs without manifest vestibulopathy has been rarely studied.

Methods: We studied 25 migraineurs and age- and gender-matched controls. With static posturography we measured: (1) postural sway with eyes open or closed on a platform or on foam with 4 different head positions; (2) limits of stability as patients change their center of gravity to reach to 8 different points; (3) tandem walking.

Results: With eyes open, sway velocity was significantly greater in migraineurs than in controls while standing on a firm surface with head backwards or on a foam surface in all head positions. With eyes closed, sway velocity was significantly greater in migraineurs than in controls only while standing on a foam surface with head backwards or turned sideways. Migraineurs also had an offset center of gravity alignment in all conditions and their average reaction time and maximal excursions were significantly greater in the limits of stability test. In tandem walking, step width was significantly wider and walk speed was significantly slower in migraineurs.

Conclusion: Our findings support the notion that there is a slight but significant postural instability in migraineurs and it is of central vestibular origin.
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http://dx.doi.org/10.1111/j.1526-4610.2008.01256.xDOI Listing
March 2009

[Rare primary headache syndromes].

Authors:
Vesile Oztürk

Agri 2007 Jan;19(1):5-16

Dokuz Eylül University, Department of Neurology, Izmir, Turkey.

Primary headaches include common forms such as migraine, tension-type headache, and the less frequent cluster headache. Besides, several uncommon primary headaches were included in the section on 'Cluster headache and other trigeminal autonomic neuralgias' (section 3) and 'Other primary headaches' (section 4) in the second edition of the International Classification of Headache Disorders (ICHD-II, 2004). Since the prevalences of these uncommon headaches are quite low, datas related to clinical features, physiopathology and management are still controversial. While paroxysmal hemicrania, short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) are listed in the third section, hemicrania continua (HC) with not prominent autonomical signs are classified in the fourth section in the ICHD-II classification. The fourth section also includes other rare primary headache syndromes. In this review, some of the uncommon primary types of headache will be discussed. Even though these headaches are reported seldomly, the prevalences are possibly higher than known. It is of importance to recognize these uncommon disorders, since their management differs from common primary headaches.
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January 2007

Basilar artery blood flow velocity changes in patients with panic disorder following 35% carbon dioxide challenge.

Prog Neuropsychopharmacol Biol Psychiatry 2007 Jan 20;31(1):115-22. Epub 2006 Sep 20.

Department of Psychiatry, Medical Faculty of Dokuz Eylül University, Izmir, Turkey.

Purpose: We compared the mean basilar artery blood flow velocity (BABFV) between patients with panic disorder and healthy subjects both at rest and immediately following carbon dioxide (CO(2)) challenge, and examined the effects of treatment on BABFV.

Methods: Twenty four patients with panic disorder with or without agoraphobia and 12 healthy comparison subjects were studied. Visual Analog Anxiety Scale was used to evaluate the anxiogenic effect of 35% CO(2) inhalation. Mean BABFV was monitored using transcranial Doppler ultrasonography at rest and 10, 20, 30, 60, 90, 120 s after 35% CO(2) challenge both before and after four weeks treatment with paroxetine.

Results: The hemodynamic response pattern of basilar artery to CO(2) inhalation was significantly different between two groups. CO(2) rapidly triggered blood flow velocity in basilar artery amongst panic patients but not in healthy comparisons. The mean time to normalization of BABFV was significantly longer in panic patients. Four weeks of treatment with paroxetine led to a significantly reduced mean BABFV after 35% CO(2) inhalation in comparison with pretreatment.

Conclusions: Patients with panic disorder had impaired cerebral regulatory mechanisms observed as a change in response characteristics in BABFV in response to CO(2) inhalation. Treatment with paroxetine reduced the increase of BABFV seen in patients after the CO(2) challenge.
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http://dx.doi.org/10.1016/j.pnpbp.2006.08.004DOI Listing
January 2007

Economic impact of primary headaches in Turkey: a university hospital based study: part II.

J Headache Pain 2006 Apr 15;7(2):75-82. Epub 2006 Mar 15.

Department of Neurology, School of Medicine University of Uludag, 16059, Gorukle, Bursa, Turkey.

This study was planned to investigate the economic impact of headache on Turkish headache sufferers attending a tertiary care outpatient headache clinic.A total of 937 headache patients were included in this study and questioned using a questionnaire for the profile of patients and headache, quality of life of patients and economic impact of headache. The median total direct cost was found to be 88.0 USD and the median total cost was 160.7 USD. The drug treatment cost was the highest item followed by the specialist outpatient care cost. The average lost and inefficient work/school days was 1.5 (0-45) and 8.4 (0-100) days for one year. It was shown that loss of productivity was higher for migraine without aura group when compared with the episodic and chronic tension-type headache groups. The results of this nationwide university hospital based study methshowed that headache, especially migraine, has considerable economic impact on patients.
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http://dx.doi.org/10.1007/s10194-006-0273-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3451708PMC
April 2006

Improvement in Tc-99m HMPAO brain SPECT findings during donepezil therapy in a patient with pure akinesia.

Ann Nucl Med 2005 Oct;19(7):607-9

Department of Neurology, Dokuz Eylül University, Medical School, Izmir, Turkey.

A 58-year-old man presented with a history of disturbance in initiating gait. His history revealed meningoencephalitis five years prior to admission. Neurological examination included gait disturbance as difficulty in initiation and a hesitating speech with many freezing episodes and micrographia Magnetic resonance imaging (MRI) showed diffuse hyperintensity of frontal subcortical white matter on T2 weighted images. He was diagnosed with PA. L-Dopa up to the dosages of 1000 mg/ day and selegiline 10 mg/day were given. First brain SPECT using technetium-99m labeled D,L-hexamethylpropylene amine oxime (Tc-99m HMPAO) was performed when he was taking L-dopa and selegiline. In visual evaluation, hypoperfusion in bilateral frontoparietal cortex was seen (Fig. 2). Treatment with L-dopa and selegiline produced no benefit. Donepezil 10 mg/day was begun. This therapy regimen resulted in dramatic clinical improvement within several days that was confirmed by blinded raters who watched the patient's video recordings. During this response second brain perfusion SPECT study was repeated during donepezil therapy. Markedly increased perfusion in bilateral frontoparietal cortex was observed. This is the first case of PA to develop possibly after an episode of bacterial pneumococcal meningoencephalitis and who responded to donepezil as documented by changes in clinical findings and Tc-99m HMPAO brain SPECT studies.
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http://dx.doi.org/10.1007/BF02985055DOI Listing
October 2005

Cerebral haemodynamic response to acute intracranial hypertension induced by head-down tilt.

Funct Neurol 2004 Jan-Mar;19(1):31-5

Neurovascular Unit, IRCCS C. Mondino Institute of Neurology, Pavia, Italy.

The aim of this study was to evaluate, in a context of general inhibition of the sympathetic nervous system, the cerebral haemodynamic response to -30 degrees head-down tilt (HDT), a manoeuvre that produces an increase in intracranial arterial pressure. Nineteen healthy subjects were studied according to the following protocol: 10 min lying in supine position, 10 min HDT, 10 min recovery. Inhibition of the sympathetic system was confirmed by the decrease in heart rate (-3.6 bpm) and arterial blood pressure (-5.9 mmHg, p<0.05) in the late phase of the test. Blood velocity and blood pusatility index initially increased (+3.2 cm s(-1) and +9% respectively, p<0.01) then returned towards baseline before the end of HDT, while the cerebrovascular resistance index (=arterial blood pressure/blood velocity) dropped significantly and remained below control level (-7%, p<0.01) throughout the test. The changes in both these indices were opposite to those reported in several sympathetic activation tests, such as the handgrip and cold pressor tests. Conversely, arterial pressure at cranial level increased during HDT (as it also does during sympathetic activation tests), due to the development of a hydrostatic pressure gradient between heart and brain levels. Therefore, the effects observed on the pulsatility and resistance indices are not secondary to the increase in intracranial arterial pressure. It is suggested that the changes in these cerebrovascular indices are mediated by a reduction of sympathetic tone that presumably involves the cerebral as well as the peripheral vascular bed.
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August 2004

Headache in sleep apnea syndrome.

Headache 2004 Jun;44(6):603-6

Department of Neurology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey.

Objective: To find out whether there is a relationship between the headache characteristics and polysomnographic findings in patients with prediagnosis of the sleep apnea syndrome (SAS) and, if there is, to search for its possible cause.

Background: Chronic morning headache is considered by many to be an important part of the SAS. Some reports support this relationship, and some do not.

Methods: We questioned 75 patients with SAS about headache. Headaches were classified according to the International Headache Society (IHS-88) system. We evaluated the relationship between headache and polysomnographic findings.

Results: There was no statistically significant relationship between headache and apnea hypopnea index (AHI) or minimal oxygen saturation (P >.05).

Conclusions: We could not demonstrate a statistically significant relationship between headache, AHI, and minimal oxygen saturation in our patients with SAS.
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http://dx.doi.org/10.1111/j.1526-4610.2004.446009.xDOI Listing
June 2004

Multiple sclerosis and parkinsonism: a case report.

Funct Neurol 2002 Jul-Sep;17(3):145-7

Department of Neurology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey.

Multiple sclerosis (MS) is a well-known disease characterized by the distribution of plaques in the periventricular and subcortical white matter. Although plaques can also be found in the striatum, pallidum and thalamus, extrapyramidal symptoms are very rare in MS. However, the association of MS and parkinsonism is still a controversial topic as it has not been established whether these two conditions occur coincidentally or causally. In the literature, eleven cases of parkinsonism associated with MS have been described. Here, we report a patient with clinically definite MS and signs of parkinsonism. Our patient had slow progressive bradykinesia, static tremor and bradymimia that were not associated with exacerbation or progression of the MS. This rare and interesting association of multiple sclerosis with parkinsonism is discussed in the light of literature reports.
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March 2003

Comparison of cortical excitability in chronic migraine (transformed migraine) and migraine without aura. A transcranial magnetic stimulation study.

J Neurol 2002 Sep;249(9):1268-71

Dokuz Eylül University, Medical School, Department of Neurology, 35340, Izmir, Turkey.

We studied the excitability of the motor cortex in patients with migraine without aura (MWOA) (n = 20) and with chronic migraine (CM) (n = 20) using transcranial magnetic stimulation (TMS). By using a 90-mm circular coil placed over the vertex and recording of the first dorsal interosseous muscle, we measured thresholds, latencies and amplitudes of motor evoked potentials and duration of cortical silent periods in patient groups and in controls (n = 20). No differences were found between groups for threshold, latency and amplitude values. However, the duration of the cortical silent period was longer in CM patients, being significantly different from both controls and MWOA. We suggest that either this difference in cortical excitability may develop during transformation from MWOA to CM or different pathophysiological mechanisms may play a role in these two headache syndromes.
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http://dx.doi.org/10.1007/s00415-002-0834-xDOI Listing
September 2002

Comparison of preseptal and pretarsal injections of botulinum toxin in the treatment of blepharospasm and hemifacial spasm.

J Neurol 2002 Jan;249(1):64-8

Dokuz Eylül Universitesi, Tip Fakültesi, Nöroloji Klinigi, Inciralti Izmir, Turkey.

Although the beneficial effect of subcutaneous injections of botulinum toxin type A (BTX-A) is well known in both blepharospasm and hemifacial spasm, the position of the injection sites around the orbicularis oculi may influence the effectiveness and side effects. Here we report results of preseptal and pretarsal BTX-A injections in 53 patients (25 blepharospasm and 28 hemifacial spasm) in whom we used both injection techniques successively. Pretarsal injections were used in 102 out of 186 treatments in blepharospasm group and in 84 out of 202 treatments in hemifacial spasm group. Pretarsal BTX-A treatment produced significantly higher response rate and longer duration of maximum response in both patient groups. This technique was also associated with a lower frequency of major side effects such asptosis. We concluded that injections of BTX-A into the pretarsal, rather than the preseptal portion of the orbicularis oculiis more effective for treatment of involuntary eyelid closure due to contractions of this muscle.
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http://dx.doi.org/10.1007/pl00007849DOI Listing
January 2002