Emel Oguz Akarsu

Wernicke's encephalopathy (WE) is an acute neurologic condition caused by thiamine (vitamin B1) deficiency that can lead to permanent neurologic damage if not diagnosed and treated early. In this retrospective study, the demographic, clinical, etiologic, and radiologic characteristics and functional outcomes of 26 patients aged over 18 years who were diagnosed as having WE and whose diagnoses were supported through magnetic resonance imaging (MRI) findings at our center between January 2000 and September 2025 were examined. The mean age of the patients was 48.35 years, and the majority were female. The most common clinical findings were altered mental status, ataxia, and oculomotor disorders. Etiologically, the most frequent causes were systemic conditions such as chronic alcoholism, cancer, dialysis, and total parenteral nutrition, followed by malabsorption, malnutrition, persistent vomiting, and bariatric surgery. Imaging findings showed medial thalamus involvement as the most prominent feature, and hyperintensity was frequently observed in T2/FLAIR sequences. Patients followed for at least 1 month had an average follow-up period of 14.1 months, and functional status was assessed using the modified Rankin Scale, with an average score of 0.9 ± 1.29. In contrast, diffusion-weighted imaging (DWI) positivity was significantly higher, particularly in cases associated with cancer, dialysis, and total parenteral nutrition (p=0.016). WE is a condition that can arise from various etiologies, requiring careful clinical and radiologic evaluation. Early diagnosis and thiamine treatment are critically important in preventing neurologic sequelae, especially in high-risk patient groups.

Objectives: This study aimed to characterize the clinical features of incident cerebral microbleeds (CMBs) following internal carotid artery (ICA) stenting and identify related risk factors. Patients and methods: This retrospective observational study included 80 patients who underwent ICA stenting between January 2021 and June 2021. All patients underwent cranial magnetic resonance imaging (MRI), diffusion MRI, arterial spin labelling perfusion MRI, and susceptibility-weighted imaging, which were performed before the ICA stenting procedure and 72 h after the procedure. Risk factors associated with CMBs were analyzed by comparing patients who developed new CMBs following ICA stenting with those who did not. Results: The mean age of the patients was 64.95 ± 11.14 years. Fourteen patients (17.50%) were female, and 66 (82.50%) were male. New CMBs were detected in 25% of the patients following the ICA stenting procedure. A statistically significant association was found between the development of new CMBs and the presence of symptomatic ICA stenosis and anemia but not with any of the other parameters. Conclusion: Considering the development of new CMBs as a potential predictor of intracranial hemorrhage may facilitate closer monitoring and the adoption of personalized treatment strategies for this patient population.

Idiopathic intracranial hypertension (IIH) is characterized by increased intracranial pressure in the absence of secondary causes and is most commonly associated with headache and visual disturbances. The aim of this study was to investigate the demographic and clinical characteristics, headache phenotypes, associated symptoms, and neuroimaging findings of patients with IIH. This retrospective observational study included 80 patients diagnosed with IIH between 2020 and 2025. Clinical information including headache characteristics, associated symptoms, cerebrospinal fluid opening pressure, and magnetic resonance imaging (MRI) findings was obtained from medical records. Migraine-like headache was defined by using the International Classification of Headache Disorders, 3rd edition (ICHD-3). The majority of patients were women (78.8%), and the median age at diagnosis was 38 years. Headache was the most frequent presenting symptom (87.5%), followed by transient visual obscurations (70.0%) and pulsatile tinnitus (46.3%). Migraine-like headache was identified in 37.1% of patients with headache. Typical MRI findings of IIH—including empty or partially empty sella, perioptic subarachnoid space distension, optic nerve tortuosity, and transverse sinus stenosis—were observed at varying frequencies. Acetazolamide was prescribed to all patients, while topiramate was used in approximately one-third; surgical interventions were required in a minority of cases. The findings of this study underscore the heterogeneous clinical presentation of IIH, with substantial overlap between IIH-related and migraine-like headache phenotypes. Recognition of these clinical features, together with supportive neuroimaging findings, may facilitate earlier diagnosis and reduce misclassification with primary headache disorders.

Background and Objectives: Visual evoked potentials (VEPs) are a simple, noninvasive method for detecting subclinical visual pathway involvement in multiple sclerosis. This study investigated the frequency of VEP abnormalities and their associations with baseline clinical, radiological, and cerebrospinal fluid (CSF) features in treatment-naïve patients with clinically isolated syndrome (CIS) or early relapsing-remitting multiple sclerosis (RRMS) without prior optic neuritis. Materials and Methods: We retrospectively reviewed newly diagnosed, treatment-naïve CIS/early RRMS patients evaluated between January 2022 and July 2024 who underwent CSF analysis. Pattern-reversal VEPs were recorded under standardized conditions. VEP abnormalities were analyzed as any or bilateral, and associations were assessed using group comparisons and multivariable logistic regression. Results: In 101 patients (mean age 31.8 ± 9.7 years; 72% female; median EDSS 1.0), latency prolongation occurred in 69 (42 any,27 bilateral) and amplitude reduction in 33 (22 any, 11 bilateral). Among patients with latency prolongation, both the number of OCB bands and the IgG index were higher (bilateral p = 0.032; any p = 0.007). In multivariable analysis, male sex (p = 0.032) and pyramidal/brainstem-onset presentation (p = 0.006) were independently associated with any amplitude reduction; neither was associated with latency abnormalities. Conclusions: VEP abnormalities are common early in the disease, even without a history of optic neuritis. Male sex and pyramidal/brainstem-onset presentation were associated with reduced amplitude, suggesting that amplitude decrease may reflect early tissue dysfunction and may be related to adverse baseline clinical features. Associations between intrathecal immune activation and prolonged latency may indicate subclinical demyelination of the visual pathways related to inflammatory activity. Larger longitudinal studies are needed to clarify the clinical significance of VEP abnormalities in early RRMS.

Rituximab, a B-cell-depleting monoclonal antibody, has gained increasing attention as a therapeutic option for myasthenia gravis (MG), particularly in refractory cases. However, its long-term efficacy across different serological subtypes remains to be investigated. This study aimed to evaluate the long-term clinical outcomes of rituximab treatment in patients with generalized myasthenia gravis (MG), including those with anti-acetylcholine receptor (AChR) antibodies, anti-muscle-specific kinase (MuSK) antibodies, and double-seronegative profiles. A retrospective cross-sectional study was conducted at the Neuromuscular Unit between 2012 and 2024. Thirty-six patients who received rituximab and had a minimum follow-up of 12 months were included. Treatment outcomes were assessed using MGFA and MGFA-PIS scores at baseline, at 6 months, and at the final evaluation. Subgroup analyses were performed based on antibody status. Sustained clinical improvement was observed in all serological subgroups. At six months, 70% of patients showed improvement or remission according to MGFA-PIS, increasing to 100% at final evaluation. AChR+ and MuSK+ patients demonstrated early and persistent responses, while a delayed but significant benefit was seen in double-seronegative patients. Rituximab appears to be a safe and effective long-term treatment for generalized MG, with benefits observed across all major antibody subtypes. The lack of a significant difference between the 6-month and final follow-up in AChR+ and MuSK+ patients suggests that the early improvement was sustained in the long term.

Background: Autoimmune diseases (ADs) frequently coexist with myasthenia gravis (MG), suggesting shared genetic and immunological mechanisms. However, the impact of comorbid ADs on MG prognosis remains unclear. This study aimed to investigate the prevalence, clinical characteristics, and prognosis of MG patients with comorbid ADs in a Turkish cohort. Methods: We retrospectively analyzed 302 MG patients treated at a tertiary center between 2010 and 2024. Patients were grouped based on the presence of comorbid ADs. Clinical characteristics, disease severity, treatment response, and prognosis were compared. Results: Among 302 MG patients, 41 (13.6%) had at least one comorbid AD, with autoimmune thyroid disease (AITD) being the most common (10.6%). ADs were more frequent in females. Patients with and without comorbid ADs showed no significant differences in MG severity, thymectomy rates, myasthenic exacerbations, or overall outcomes (p > 0.05). However, female patients with ADs experienced more frequent myasthenic exacerbations and had a higher rate of rituximab use (p < 0.05). Conclusions: Comorbid ADs do not significantly impact MG severity or prognosis. Female MG patients with ADs have a higher frequency of myasthenic exacerbations and rituximab use, warranting further research. Early identification of ADs remains essential for optimal patient management.

Isolated cranial nerve palsy as the first clinical relapse in multiple sclerosis is very rare. In multiple involvement, the abducens and facial nerve are most commonly affected together. Herein, we report a newly diagnosed case of multiple sclerosis presenting as eight and a half plus syndrome, which is very rare and involving the facial colliculus and its neighbourhood as the first clinical relapse.

Based on the frequency of attacks, migraine is classified into two subtypes: episodic (EM) and chronic (CM). Migraine progression from EM to CM is supposed to be affected by various factors, which is known as "migraine chronification. However, the pathophysiology of migraine chronification is multifactorial and still not fully understood. Ion channels are hypothesized to play a role in migraine pathophysiology and are essential for generating and suppressing action potentials, which lie under the pain and related symptoms. Two sodium channel genes, SCN9A and SCN10A, have been reported to be associated with various pain sensitivities. Studies have shown that patients with EM and CM are more sensitive to chronic pain and that pain sensitivity may be a risk factor for chronification. Thus, the current study aimed to determine whether pain sensitivity-related SCN9A and SCN10A polymorphisms affect the EM-to-CM transition. For this purpose, genotyping was performed using TaqMan SNP Assay for the (i) SCN9A rs7595255, rs12622743, and rs11898284, (ii) SCN10A rs6795970, rs6801957 SNPs in Turkish EM and CM patients. The results showed that SCN9A and SCN10A polymorphisms did not play a role in the development of chronicity. However, the results indicated that the SCN10A rs6795970 polymorphism was associated with osmophobia (p = 0.036). SCN10A rs6795970 polymorphism may be necessary to predict the EM-to-CM transition and identify therapeutic targets. However, further studies are required to confirm the osmophobia association of the SCN10A rs6795970 polymorphism and to investigate the role of these SNPs in chronification.

Objectives: Multiple sclerosis (MS) usually relapses, about half become progressive after a period of time, few are progressive from the onset. Leptomeningeal ectopic lymphoid follicles with cell flow from the cranial bone marrow may be associated with progression. The aim of this retrospective study was to determine the predictive value of cranial bone signal intensity and to correlate it with other clinical features. Methods: Retrospective clinical and radiological characteristics of 96 MS patients (16 primary progressive multiple sclerosis, 80 relapsing-remitting multiple sclerosis (RRMS)) and 60 controls (tension-type headache) were recorded. Frontal (F), occipital (O), clivus (C) and vitreous body (V) signal intensities were measured. The relationship between clinical features, disease course and radiological findings were analyzed. Results: The mean age was 39.58±0.84 years. Twenty-five patients converted to secondary progressive multiple sclerosis (SPMS). Changes in the ratio of F, O, C density to V were similar between groups. At baseline, ratio of frontal bone marrow intensity to vitreous body intensity (F/V) was lower in SPMS and RRMS compared to control, and ratio of occipital bone marrow intensity to vitreous body intensity (O/V) was lower in SPMS compared to control. Low F/V on initial magnetic resonance imaging had diagnostic potential for RRMS, and low F/V and low O/V had diagnostic marker potential for conversion to SPMS. Conclusions: Cranial bone intensity in multiple sclerosis patients may be a clue for future disease severity or conversion to SPMS.