Abdulkadir Tunç

Objective: Subarachnoid hemorrhage (SAH) remains a substantial neurological emergency. Data on diagnostic timing, etiologic distribution, and prognostic factors across SAH subtypes are limited in emergency department (ED)-based cohorts.Methods: We retrospectively reviewed 110 patients presenting with suspected SAH between 2018-2024. Demographic and clinical features, imaging patterns, etiology, comorbidities, complications, and treatments were extracted. Outcomes were assessed at one month using Glasgow Coma Scale (GCS), modified Rankin Scale (mRS), and Hunt & Hess (H&H) grades.Results: The cohort (mean age 53.2 ± 16.8 years; 60.9% male) frequently exhibited hypertension (24.5%). Leading presentations were trauma (32.7%) and headache (33.6%); sentinel headache occurred in 12.7%. Nearly all patients (89.1%) underwent non-contrast CT within 6 hours. SAH etiology was traumatic (53.6%), aneurysmal (24.5%), and spontaneous (21.8%). Mean admission GCS was 12.6 ± 3.6. Complication rates were low (rebleeding 4.5%, delayed cerebral ischemia 2.7%, vasospasm 0.9%). Traumatic SAH, despite lower admission GCS, was associated with higher rates of functional improvement (GCS 61.0%, mRS 74.6%) and fewer comorbidities compared to spontaneous/aneurysmal subtypes. Younger age (mRS and H&H analyses) and absence of comorbidities (GCS analysis) were associated with improvement, whereas patients who were fully alert at admission were less likely to meet the improvement criterion. Sentinel headache and nimodipine use clustered among non-improvers, likely reflecting disease severity. CT bleed pattern and H&H grade were not significantly associated with outcome.Conclusions: Traumatic SAH predominated in this ED-based cohort and showed more favourable one-month recovery than spontaneous subtypes. Admission clinical severity was the factor most consistently associated with functional change, although this association is constrained by the ceiling inherent to a change-based outcome definition. Early imaging and rigorous vascular evaluation remain essential, and larger etiology-stratified studies using absolute outcome measures are warranted.

Background and Objectives: Visual evoked potentials (VEPs) are established tools for detecting optic pathway involvement in multiple sclerosis (MS); however, the distinct clinical significance of longitudinal changes in latency and amplitude remains unclear. This exploratory study aimed to evaluate the clinical utility of serial VEP assessments in patients with relapsing–remitting MS (RRMS) by examining the associations between temporal changes in latency and amplitude and concurrent markers of disease activity and disability. Materials and Methods: We retrospectively analyzed 83 patients with RRMS from three centers who underwent at least two pattern-reversal VEP assessments ≥ 1 year apart. Patients with recent optic neuritis were excluded. Longitudinal changes in VEP latency and amplitude were evaluated in relation to relapse activity during the same inter-assessment interval, baseline MRI and CSF findings, and disability assessed by the Expanded Disability Status Scale (EDSS). Sensitivity analyses were stratified and adjusted for disease-modifying therapy (DMT) efficacy tier, and progression independent of relapse activity (PIRA) was examined using a formal definition. Results: Over a median follow-up of 2 years, 43.4% of patients developed P100 latency prolongation, which was independently associated with a higher annualized relapse rate during the same interval (odds ratio [OR] 2.91, p = 0.005; area under the curve (AUC) 0.72 for concurrent on-study relapse activity), an association that persisted after adjustment for DMT efficacy tier, but not with disability worsening. In contrast, 56.6% of patients exhibited amplitude reduction, which was associated with greater disability accumulation at the group level, with higher EDSS scores at follow-up despite similar baseline values (p < 0.05); the corresponding inverse correlation between amplitude decline and EDSS change was only nominally significant (ρ = −0.231, p = 0.036), did not survive correction for multiple comparisons, and was attenuated after adjustment for baseline EDSS. Formally defined PIRA events were rare (n = 3), precluding inference. Baseline magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) findings differed in the latency group, with fewer MRI lesions and a lower immunoglobulin G (IgG) index, whereas no corresponding differences were observed in the amplitude group. Conclusions: In this exploratory cohort, longitudinal prolongation of VEP latency was associated with concurrent relapse activity, whereas amplitude decline showed a weaker, group-level association with disability. These findings are consistent with, but do not demonstrate, distinct inflammatory and neurodegenerative substrates, and warrant prospective validation before serial VEP monitoring can inform individualized management in MS.

Background: Extended interval dosing (EID) of natalizumab (NTZ) every 6 weeks may reduce adverse events while maintaining efficacy. This study compared the effectiveness and safety of EID versus standard interval dosing (SID) in relapsing–remitting multiple sclerosis (RRMS) patients, focusing on treatment adherence and its impact on clinical and radiological outcomes.Methods: This retrospective study involved 80 patients with RRMS from seven clinics: 52 received SID (300 mg every 4 weeks), and 28 received EID (300 mg every 6 weeks). Clinical and radiological disease activity, treatment adherence, and adverse events were assessed.Results: The SID and EID groups differed significantly in sex distribution (78.8% female in SID vs. 46.4% in EID, p = 0.007), but median age was similar (32 vs. 36 years, p = 0.209). Clinical and radiological worsening rates were similar between the groups, with no significant differences (combined worsening: 9.6% in the SID group vs. 17.9% in the EID group, p = 0.308; radiological worsening: 5.8% in the SID group vs. 7.1% in the EID group, p = 1.00; clinical worsening: 9.6% in the SID group vs. 10.7% in the EID group, p = 1.00). Adherence rates were comparable across both dosing regimens, and no significant differences were observed in terms of treatment discontinuation. No progressive multifocal leukoencephalopathy cases were reported.Conclusion: Both SID and EID provide comparable efficacy and safety profiles, with similar adherence rates. Despite the observed sex distribution imbalance, additional analyses confirmed no significant sex‐ or group‐related differences in baseline disability or clinical worsening, strengthening the interpretation that EID preserves efficacy. Findings should still be interpreted with caution due to the study's retrospective nature and limited sample size.

Background: Mobility impairments in multiple sclerosis (MS) significantly affect quality of life. This study evaluated the clinical utility and sensitivity of the Backward Timed 25-Foot Walk Test (B-T25FW) and its associations with key clinical measures in MS. Methods: A cross-sectional study was conducted with 129 ambulatory patients with MS from two centers. Disability (Expanded Disability Status Scale, EDSS), cognition (Symbol Digit Modalities Test, SDMT), manual dexterity (Nine-Hole Peg Test, 9HPT), fatigue, and forward and backward walking were assessed. Correlation and receiver operating characteristic (ROC) analyses were performed. Results: The participants included in the study were 76% female, with a mean age of 38 years, and the majority were diagnosed with relapsing–remitting MS (86.8%). Backward and forward walking times significantly correlated with key clinical measures, including the EDSS, SDMT, and 9HPT. Backward walking times showed moderate correlations with EDSS (r = 0.469) and weaker but significant correlations with 9HPT (r = 0.452) and disease duration (r = 0.245). Both walking tests were negatively correlated with SDMT scores. For prognostic purposes, forward walking exhibited slightly higher predictive power compared to backward walking. Conclusions: The B-T25FW is a clinically relevant, practical, and sensitive tool for assessing mobility impairments in individuals with MS. Its integration into clinical practice could complement forward walking assessments, enhancing disease monitoring and guiding interventions. Future research should validate its longitudinal utility.

Background and Objectives: Telerehabilitation (TR) offers an innovative approach to overcome accessibility challenges in managing multiple sclerosis (MS). This exploratory study evaluated the efficacy of integrating respiratory exercises into TR programs for improving respiratory function, fatigue, and quality of life. Materials and Methods: A randomized controlled trial involving 48 MS patients randomized into TR and control groups was conducted. Both groups performed respiratory exercises over eight weeks. Pulmonary function, fatigue severity (FSS), quality of life (MSQOL-54), and functional capacity (6MWT) were assessed before and after the intervention. Results: Both groups demonstrated significant within-group improvements in FEV1 (L), PEF (L), FEF%25–75 (L), FSS, MSQOL-54 physical and mental subscales, and the 6MWT distance (p < 0.05). The TR group exhibited unique improvements in FEV1 (%) and slightly greater reductions in fatigue, although the intergroup differences were not statistically significant. Conclusions: Telerehabilitation incorporating respiratory exercises effectively enhances the respiratory function, fatigue, and quality of life of MS patients, suggesting a viable alternative to conventional rehabilitation. Future studies should focus on advanced-stage MS, long-term sustainability, and technological integration to optimize the potential of TR.

This case report describes a woman in her 50s with a rare coexistence of neuromyelitis optica spectrum disorder (NMOSD) and myasthenia gravis (MG), highlighting the diagnostic challenges and therapeutic considerations. Initially diagnosed with acetylcholine receptor antibody-positive MG, she later developed progressive visual impairment, leading to a diagnosis of NMOSD. Rituximab treatment was effective in managing both conditions, demonstrating the benefits of targeted therapies in reducing complications related to polypharmacy. This case underscores the importance of clinical vigilance and a multidisciplinary approach in managing overlapping autoimmune disorders, offering insights into their inter-relationships and therapeutic strategies.