Gözde Baran

Background: This study aims to evaluate sleep quality, insomnia severity, and daytime sleepiness in patients with hemifacial spasm (HFS) and to investigate their associations with clinical characteristics and depressive symptoms. Materials and Methods: This multicenter, prospective, cross-sectional study included 34 patients with HFS evaluated between September 2024 and December 2024. All participants completed the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), Beck Depression Inventory-II (BDI-II), and the Jankovic Hemifacial Spasm Rating Scale. Associations between clinical variables and sleep-related measures were assessed using Spearman correlation analysis. Results: A total of 34 patients (16 males, 18 females; median age: 49.5 years; range, 26 to 64 years) with HFS were clinically evaluated. Poor sleep quality was identified in 47.1% of the patients. Based on the ISI, 26.5% had subthreshold insomnia and 5.9% had moderate insomnia, whereas none exhibited excessive daytime sleepiness according to the ESS. Patients with poor sleep quality were older (p = 0.013), had lower educational levels (p = 0.003), and had higher ISI (p < 0.001) and ESS (p < 0.001) scores than those with good sleep quality. PSQI scores were positively correlated with age (r = 0.429), HFS severity (r = 0.360), ISI (r = 0.892), and ESS (r = 0.684) and negatively correlated with educational level (all p < 0.05). The BDI-II scores were positively correlated with ISI (r = 0.425, p = 0.012), whereas the association with PSQI approached statistical significance (p = 0.058). Conclusion: Sleep disturbances are common in patients with HFS and are associated with older age and lower educational level. Although disease severity showed a significant correlation with sleep quality, depressive symptoms were more closely associated with insomnia severity. Routine assessment of sleep and mood symptoms may facilitate a more comprehensive clinical evaluation of patients with HFS.

Uncommon Presentation of Subacute Sclerosing Panencephalitis: Two Cases of Rapidly Progressive Parkinsonism

Aims: Hemifacial spasm (HFS) is a movement disorder consisting of involuntary and synchronous contractions of facial nerve innervated muscles, usually involving one half of the face. Sexual health is an important aspect of mental health and has been frequently investigated in movement disorders such as Parkinson’s disease. The aim of this study was to investigate the relationship between sexual dysfunction and factors such as age, depression, disease duration, and disease severity in patients with HFS. Methods: This prospective, descriptive study included 50 patients with HFS. Data were collected using the beck depression inventory (BDI), the HFS severity scale, and the Arizona Sexual Experiences Rating Scale (ASLS) for sexual dysfunction. Results: The mean age of the patients included in the study was 50.05±9.42 years. 58.2% were female and 41.8% were male. It was observed that sexual dysfunction was more common in female HFS patients and patients with low educational level. In addition, the frequency of sexual dysfunction increased with increasing age and depression level. Although there was a statistically significant relationship between the severity of HFS and sexual dysfunction, the duration of the disease had no significant effect on sexual dysfunction. Conclusion: This study shows that sexual dysfunction is common in HFS patients and associated with gender and age. Sexual dysfunction has been shown to increase with depression and HFS severity.

Purpose: It is not clear whether cognitive functions are impaired in young patients with acute coronary syndrome (ACS). This study aims to detect whether or not there is cognitive impairment and cerebral changes in young patients with ACS undergoing percutaneous coronary intervention (PCI). Patients and Methods: All 50 patients with ACS who were treated with primary PCI were eligible for this prospective study. All participants had normal cognitive function before ACS. Brain magnetic resonance imaging (MRI) was performed to quantify changes in brain white and gray matter. Cognitive functions (CFs) were evaluated by seven cognitive tests. Patients were categorized by MRI findings and test scores were compared from the first day to after the first month. Results: We determined 25 patients with impaired CFs on the first day. After the first month, we identified 18 patients with transient impaired CFs. No structural difference was observed between impaired CF and normal CF. While 25 patients had a score of 1 according to Fazekas, 10 patients had a score of 1 according to MTLA. While the mean Stroop test completion time and Stroop test error rate scores were significantly higher on the first day than after the first month in the Fazekas+ group (p = 0.003, p < 0.001, respectively), other cognitive test scores—except clock drawing test, digital span forwards, and backwards—were significantly lower on the first day compared to after the first month in the Fazekas+ group (p < 0.05). Conclusions: Patients with ACS have transient impairment in cognitive functions. Acute coronary syndrome is not associated with structural changes in the brain.

The Medical Bulletin of Sisli Etfal Hospital

Introduction – Methanol is a colorless and highly toxic liquid similar to ethanol in odor and taste. Methanol intake can lead to severe metabolic acidosis, loss of vision, permanent neurological damage, and death. Case report – We report a case of a 19-year-old female patient who had no known disease history. A large portion of her back was covered in spirits for back pain and kept on for 2 days. Cranial magnetic resonance imaging (MRI) on the 5th day showed hyperintense pathologic signal changes in the T2 sequence without contrast enhancement in the bilateral frontal corticalsubcortical regions and basal ganglia. Following neurological examination of the patient, she was found to have bradymimia, marked resting tremor, bradykinesia, and dystonia on the right upper and lower extremities. Our case is important because it is the only case where parkinsonism developed as a result of acute transdermal methanol intoxication.

Despite the inadequate evidence of effi cacy and safety of opioid use for the treatment of migraine, it has been reported that patients with moderate to severe migraine headaches are prescribed opioids. Migraineurs may experience serious health impacts from opioids such as headache-related disability, psychiatric and cardiovascular comorbidities. The reduction of the risk of opioid abuse and prevention of an opioid epidemic are important public health challenges. The aim of this study was to assess the awareness of opioid therapy for migraine and the frequency of use among Turkish patients with episodic and chronic migraine. Materials and methods: consecutive migraine patients were enrolled in this cross-sectional study. A semi-structured questionnaire was developed and used by the researchers to assess the patients’ awareness of an opiod treatment option and the frequency of use of opioids for migraine treatment. Results. One hundred two patients were enrolled, of which 72 had episodic migraine and 30 had chronic migraine. All subjects reported that they had not been offered or prescribed any kind of opioids by general practitioners and neurologists for their headache. Besides, only 7 % of patients declared that they had heard of opioid treatment for migraine but they had never consulted their doctors about its effects. Conclusions. Our fi ndings demonstrated that opioids were not preferred as an option for acute or preventive migraine treatment by Turkish migraineurs and their physicians. The reduction of opioid prescription will help to prevent the development of medication overuse and opiate-induced headaches and drug addiction.

Objectives: Epicardial adipose tissue is metabolically active and is an important predictor of metabolic and cardiovascular diseases. This study investigated the echocardiographic epicardial adipose tissue measurement in young patients with embolic stroke of undetermined source (ESUS). Materials and Methods: We studied 77 volunteers, including 40 patients with ESUS (mean age 43±8 y, 16 female patients) and 37 healthy subjects (mean age 38±7 y, 20 female subjects). All necessary biochemical parameters were analyzed, and epicardial fat thickness (EFT) was measured by echocardiography in all subjects. Additional related diagnostic work-up was conducted in each patient, according to the patients’ clinical presentation. Results: The patients with ESUS had a significantly higher EFT than the control group (5.51±0.82 vs. 3.96±0.51; Pr=0.284; P<0.05). As an optimal cut-off point, a high-risk EFT value of 4.6 mm was determined to predict ESUS, with an 87.5% sensitivity and an 81.1% specificity. Conclusion: We found that echocardiographic EFT was significantly higher in young patients with ESUS than in healthy individuals. Increased EFT might be a novel risk factor in these patients

Background and purpose: To assess the anatomical distribution of the ischemic strokes of the brainstem, the effect of anatomical distribution on clinical features and prognosis, and the association between etiology and anatomical involvement. Methods: A retrospective search of the patient database of our institution was performed for a total of 227 patients who were admitted to the Department of Neurology, Medical Faculty of Bezmialem Vakif University between January 2012 and September 2014. Patients with adequate diagnostic data and 3-month follow-up visit were included in the study. Results: Twenty-one (9%), 136 (60%), and 65 (29%) patients had an infarction only at the mesencephalon, pons, and medulla, respectively. However, a single patient (0.5%) had an infarction both at the mesencephalon and pons, 3 (1.5%) at the pons and medulla, and 1 (0.5%) at the mesencephalon, pons, and medulla. While anterior involvement was more common in the mesencephalon and pons, posterior and lateral involvement occurred more frequently in the medulla. Large arterial atherothrombosis was the predominant cause of the strokes in all anatomical sites, particularly in infarcts involving the pons. Cardioembolic events were more common in patients with mesencephalic infarcts. Also, ischemia due to dissection was more common in infarctions involving the medulla, especially the lateral medulla. In subjects with simultaneous infarcts at other sites in addition to the brainstem, there was a significantly higher co-occurrence of medullary infarcts with cerebellar infarcts, mesencephalic infarcts with posterior cerebral artery infarcts, and pons infarcts with anterior circulation and multiple infarcts. Conclusion: Determination of risk factors and infarct localization as well as prediction of etiological parameters may assist in improving survival rates and therapeutic approaches.