Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Rare Presentation of Midbrain Infarction: Isolated Medial Rectus Palsy(2015) Derle, Eda; Ocal, Ruhsen; Kibaroglu, Seda; Can, Ufuk; 0000-0001-8689-417X; 0000-0002-3964-268X; 0000-0003-2122-1016; 26183888; AAJ-2999-2021; AAJ-2956-2021; AAI-8830-2021; V-3553-2017A 69-year-old woman presented with sudden onset of diplopia. In neurologic examination left medial rectus palsy without abduction nystagmus was detected. Brain magnetic resonance imaging revealed acute ischemic lesion in mesencephalon on diffusion-weighted images. Sponteneous resolution was observed after 1 month. Medial rectus palsy is a rare presention of acute ischemic stroke and early neuroimaging is important to establish such lesions. (C) 2015 S. Karger AG, BaselItem Neurologic Complications After Liver Transplant: Experience at a Single Center(2015) Derle, Eda; Kibaroglu, Seda; Ocal, Ruhsen; Kirnap, Mahir; Can, Ufuk; Benli, Sibel; Haberal, Mehmet; 0000-0003-2122-1016; 0000-0002-3964-268X; 0000-0001-8689-417X; 0000-0002-3462-7632; 0000-0002-9975-3170; 25894184; V-3553-2017; AAH-9198-2019; AAI-8830-2021; AAJ-2956-2021; AAJ-2999-2021; AAJ-8097-2021; AAJ-4403-2021Objectives: Neurologic complications occur frequently after liver transplants. Up to 43% of patients experience severe postsurgical neurologic complications. These complications are significantly associated with longer hospital stay, morbidity, and mortality. The aim of this retrospective study was to evaluate the type and incidence of neurologic complications after liver transplants in adult patients. Materials and Methods: We retrospectively evaluated the medical records of 176 adult patients who had undergone liver transplants between 1995 and 2013. We recorded the demographic data, type of neurologic complications, type, and level of immunosuppressive treatment, and cause of liver failure. Results: Our study sample consisted of 48 deceased-donor liver transplants and 128 living-donor transplants (n = 176). Fifty-three of the patients (30.1%) were female. The age range of the total sample was 18 to 66 years (mean age, 43.1 +/- 13.7 y). As immunosuppressive treatment, most patients received tacrolimus alone (52%) or tacrolimus combined with mycophenolate mofetil (33%). Neurologic complications occurred in 74 of the patients (42%). The most common neurologic complications were diffuse encephalopathy (22.2%) and seizure (14.2%). Other neurologic complications were posterior reversible encephalopathy (1.7%), peripheral neuropathy (1.7%), cerebrovascular disease (1.1%), and central nervous system infection (1.1%). Age, cause of liver failure, and type of transplant were not associated with occurrence of neurologic complications. Conclusions: There was a high incidence of neurologic complications after liver transplants. Diffuse encephalopathy and seizure were common complications. Physicians should be aware of the high risk of neurologic complications after liver transplants. Factors such as immunosuppressive toxicity and metabolic imbalance that predispose patients to neurologic complications after liver transplants should be evaluated immediately, and treatment of postoperative neurologic complications should be initiated as early as possible.Item Seizure as a Neurologic Complication After Liver Transplant(2015) Derle, Eda; Kibaroglu, Seda; Ocal, Ruhsen; Kirnap, Mahir; Kilinc, Munire; Benli, Sibel; Haberal, Mehmet; 0000-0002-3462-7632; 0000-0001-7979-0276; 0000-0003-2122-1016; 0000-0002-3964-268X; 0000-0002-9975-3170; 25894183; AAJ-8097-2021; AAJ-8674-2021; AAI-8830-2021; AAJ-2956-2021; AAH-9198-2019; AAJ-4403-2021; V-3553-2017Objectives: Seizure is a common complication after liver transplant and has been reported to occur in up to 42% of patients in different case series. Multiple factors can trigger seizures, including immunosuppressive toxicity, sepsis, metabolic imbalance, and structural brain lesions. The aim of this retrospective study was to evaluate seizure types and associated factors in adult liver transplant patients. Materials and Methods: We retrospectively evaluated the medical records of 142 adult patients who received a liver transplant between 2005 and 2013. We recorded demographic data, immunosuppressive treatment, seizure type, cause, recurrence, and treatment. Results: Of the 146 patients, 23 (15.7%) had a seizure after the liver transplant. This group included 10 females and 13 males, with ages ranging between 18 and 63 (39.9 +/- 14.8 y). Generalized tonic-clonic seizures were the most common, occurring in 20 patients (87%). We observed complex partial seizure and status epilepticus in 1 and 2 patients. Immunosuppressive drug-related seizure occurred in 8 patients (34.8%) with normal drug blood levels, and all but 1 of these patients experienced seizure within the first week after transplant. Multiple factors (26.1%), metabolic imbalance (17.4%), structural lesion (13%), and sepsis (8.7%) were the other factors identified as underlying conditions. Conclusions; In conclusion, seizure occurred in a significant proportion of patients who underwent liver transplant. Immunosuppressive drugs were the most common factor associated with seizure occurrence and drug cessation prevented seizure recurrence.Item Crimean-Congo Hemorrhagic Fever Presented with Headache: A Case Report(2014) Ocal, Ruhsen; Delikan, Okan; Cebi, Kazim; Ocal, Serkan; Bulut, Cemal; Bayazit, Tolga; https://orcid.org/0000-0003-3719-9482; ABH-4817-2020Headache is one of the most common symptoms of patients applying to emergency departments. In the majority of these patients the cause is usually primary. Although secondary headaches are less common, the diagnosis of the underlying reasons is important since they may be due to a potentially dangerous cause. Headache is also a common symptom of infection. The first symptom of infection can be a serious headache. Headaches which do not respond to medical treatment usually suggest secondary headache. Crimean-Congo haemorrhagic fever (CCHF) is an endemic disease with high mortality. Timely diagnosis as well as treatment of patients with high rates of transmission is also important in terms of disease prevention measures. In this study, a patient diagnosed as CCHF as a cause of secondary headache has been reported.Item Lentiform Fork Sign in A Case with End-Stage Renal Disease and Metabolic Acidosis(2015) Derle, Eda; Kibaroglu, Seda; Cinar, Pinar; Ocal, Ruhsen; Can, Ufuk; 0000-0002-3964-268X; 0000-0001-8689-417X; 0000-0003-2122-1016; 25381213; AAJ-2956-2021; V-3553-2017; AAJ-2999-2021; AAI-8830-2021Item The Nutritional Risk Screening 2002 Tool For Detecting Malnutrition Risk in Hospitalised Patients: Perspective From A Developing Country(2014) Gokcan, Hale; Selcuk, Haldun; Tore, Emin; Gulseren, Pinar; Cambaz, Hatice; Saritas, Seniz; Ocal, Ruhsen; Basaran, Ozgur; Yilmaz, Ugur; Akin, Ebru; https://orcid.org/0000-0001-5663-0683; https://orcid.org/0000-0002-8445-6413; 25599788; AAR-8893-2020; AAJ-6976-2021; V-3553-2017Background/Aims: To verify the validity of the Nutritional Risk Screening (NRS) 2002 test in a Turkish population. Materials and Methods: We prospectively investigated 2566 patients at a tertiary referral hospital. Nutritional status was screened using NRS 2002, and the length of the stay (LOS) was the main outcome measure. Hospital stays >10 days were accepted as prolonged LOS. NRS scores >= 3 were accepted as indicating risk for malnutrition. Statistical analyses were performed to determine the independent risk factors for malnutrition risk and prolonged LOS. Results: The mean age of patients was 56.6 +/- 16.9 years. According to the NRS 2002, 964 patients (37.6%) were without risk, 1320 (51.4%) warranted surveillance and 282 (11%) were at high risk for malnutrition. Malnutrition rate was the highest in the intensive care unit (22.01%). Prolonged LOS was seen in 24.4% of patients. Intensive care unit stay [odds ratio (OR): 0.585; confidence interval (CI): 1.45-2.22; p<0.001] and an NRS score >= 3 (OR: 0.88; CI: 1.87-3.13; p<0.001) were independent risk factors for prolonged LOS. Conclusion: Improving healthcare outcomes while avoiding preventable healthcare costs is an important goal of healthcare provision in developing countries. NRS 2002 was predictive of LOS, and thus, of patient prognosis. Further community-based studies are warranted to assess the impact of NRS 2002 on reducing healthcare costs.Item Aspirin Resistance in Cerebrovascular Disease and the Role of Glycoprotein IIIa Polymorphism in Turkish Stroke Patients(2016) Derle, Eda; Ocal, Ruhsen; Kibaroglu, Seda; Celikkol, Ceyda; Bayraktar, Nilufer; Verdi, Hasibe; Atac, Belgin F.; Can, Ufuk; https://orcid.org/0000-0002-3964-268X; https://orcid.org/0000-0002-7886-3688; https://orcid.org/0000-0003-0591-009X; https://orcid.org/0000-0001-6868-2165; https://orcid.org/0000-0001-8689-417X; 26809135; V-3553-2017; AAJ-2956-2021; Y-8758-2018; V-5499-2017; ABG-9966-2020; AAJ-2999-2021Aspirin resistance occurs in 5-45% of high-risk patients, with various mechanisms proposed for its development. This study aimed to determine the relationships among aspirin resistance, aspirin dosage, type of aspirin and glycoprotein IIIa P1A1/A2 polymorphism in patients with vascular risk factors. Two hundred and eight (75 symptomatic, 133 asymptomatic) patients with vascular risk factors who were using aspirin for primary or secondary prevention were prospectively included. The symptomatic group was further classified into two groups according to aspirin use at the time of stroke. Aspirin resistance was measured by the PFA-100 system (collagen/epinephrine cartridge) and glycoprotein IIIa P1A1/A2 polymorphism was determined by PCR. The overall prevalence of aspirin resistance was 32.2%. The mean age of patients with aspirin resistance was significantly higher than that in those who did not have resistance (P=0.009). The prevalence of aspirin resistance was similar for the symptomatic and asymptomatic under aspirin therapy groups. The resistance rate was found to be highest with 100mg enteric-coated preparation use (39.3%). Increasing the aspirin dosage and/or shifting to uncoated preparations caused a change in aspirin sensitivity of 36-60%. Repeated measurements showed development of aspirin resistance in 14% of patients who were sensitive to aspirin in previous measurements. Glycoprotein IIIaP1A1/A2 polymorphism, aspirin resistance and development of atherothrombotic stroke were not significantly related. The effect of aspirin can change by time, dosage and type of preparation used. There are no relationships among glycoprotein IIIa P1A1/A2 polymorphism, aspirin resistance and development of atherothrombotic stroke. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.Item Comparison of Brain MRI Angiography and Brain MRI Cisternography in Patients with Hemifacial Spasm(2016) Ocal, Ruhsen; Tunc, Tuba; Ayas, Zeynep Ozozen; Yilmaz, Omer; Inan, Levent Ertugrul; 26908032The aim of this study was to compare the ability of brain magnetic resonance imaging angiography and brain magnetic resonance imaging cisternography of showing the neurovascular contiguity of the facial nerve in patients with hemifacial spasm. This study included a total of 35 patients (28 females, 7 males), with an average age of 57.5 +/- 13.8 years, who presented to our outpatient clinic of movement disorders. All patients were prospectively applied brain magnetic resonance imaging angiography and brain magnetic resonance imaging cisternography, and the results were evaluated by a radiologist who was blind to study protocol. The study included 35 patients, of whom 28 (80 %) were female and 7 (20 %) were male. Brain magnetic resonance imaging angiography demonstrated facial nerve compression of vascular origin in 5 (14.3 %) patients presenting with the clinical presentation of hemifacial spasm. Neurovascular compression of facial nerve was shown by brain magnetic resonance imaging cisternography in 13 (37.1 %) patients. No statistically significant difference was found between brain magnetic resonance imaging angiography and brain magnetic resonance imaging cisternography techniques in detecting a compressive interaction causing hemifacial spasm between facial nerve and adjacent vascular structures (p > 0.05).Item Relationship Between White Matter Hyperintensities and Retinal Nerve Fiber Layer, Choroid, and Ganglion Cell Layer Thickness in Migraine Patients(2018) Iyigundogdu, Ilkin; Derle, Eda; Asena, Leyla; Kural, Feride; Kibaroglu, Seda; Ocal, Ruhsen; Akkoyun, Imren; Can, Ufuk; 0000-0001-7860-040X; 0000-0003-2122-1016; 0000-0002-6848-203X; 0000-0002-4226-4034; 0000-0002-3964-268X; 0000-0002-2860-7424; 0000-0001-8689-417X; 28952336; AAJ-2053-2021; AAI-8830-2021; E-5914-2016; AAL-9808-2021; AAJ-2956-2021; V-3553-2017; AAK-7713-2021; AAJ-2999-2021Aim To compare the relationship between white matter hyperintensities (WMH) on brain magnetic resonance imaging and retinal nerve fiber layer (RNFL), choroid, and ganglion cell layer (GCL) thicknesses in migraine patients and healthy subjects. We also assessed the role of cerebral hypoperfusion in the formation of these WMH lesions. Methods We enrolled 35 migraine patients without WMH, 37 migraine patients with WMH, and 37 healthy control subjects examined in the Neurology outpatient clinic of our tertiary center from May to December 2015. RFNL, choroid, and GCL thicknesses were measured by optic coherence tomography. Results There were no differences in the RFNL, choroid, or GCL thicknesses between migraine patients with and without WMH (p>0.05). Choroid layer thicknesses were significantly lower in migraine patients compared to control subjects (p<0.05), while there were no differences in RFNL and GCL thicknesses (p>0.05). Conclusions The only cerebral hypoperfusion' theory was insufficient to explain the pathophysiology of WMH lesions in migraine patients. In addition, the thinning of the choroid thicknesses in migraine patients suggests a potential causative role for cerebral hypoperfusion and decreased perfusion pressure of the choroid layer.Item Complications of Liver Transplant in Adult Patients With the Hepatic Form of Wilson Disease(2018) Ocal, Ruhsen; Ocal, Serkan; Kirnap, Mahir; Moray, Gokhan; Haberal, Mehmet; 0000-0003-3719-9482; 0000-0003-2498-7287; 0000-0002-3462-7632; 29527989; V-3553-2017; ABH-4817-2020; AAH-9198-2019; AAE-1041-2021; AAJ-8097-2021Objectives: Wilson disease is an autosomal, recessive, inherited disorder of copper metabolism that results in the accumulation of copper in many organs and tissues. This disease is mainly characterized by dysfunction due to copper accumulation in the liver, kidney, brain, cornea, bone, heart, and blood cells. The clinical spectrum is broad in Wilson disease. Asymptomatic Wilson disease may be present, but findings related to the involvement of an individual organ or multiple organ failure can be seen. These findings can include neurologic and neuropsychiatric complications. Our aim here was to examine the neurologic complications and our clinical experience in patients who underwent liver transplant for Wilson disease in our clinic. Materials and Methods: We retrospectively reviewed the medical records of transplant patients with Wilson disease who were seen at Baskent University Faculty of Medicine Transplantation Science between 2005 and 2017. Patient demographics, neurologic complaints, findings from neurologic examinations, and imaging findings were recorded. We also recorded the presence of the Kayser-Fleischer ring, serum ceruloplasmin, 24-hour copper urine levels, and levels of dry copper in liver in each patient. Results: Our study included 19 patients who ranged in age range from 18 to 44 years (mean age of 26 years). Seven of 19 patients (36.8%) had neurologic symptoms, including epileptic seizures in 2 patients (10.5%), encephalopathy in 1 patient (5.2%), tremor in 3 patients (15.7%), and headache in 1 patient (5.2%).The cause of these long-term neurologic complications was the immunosuppressive drugs. Patients with epileptic seizures were provided with seizure control medication (levetiracetam).Tremor did not need treatment. Conclusions: In Wilson disease, neurologic complications can be severe. The most common complication seen in our patients was tremor. Early diagnosis and treatment may slow down neurologic disability.