Sibel Çıplak

Background/Objectives: Quantitative magnetic resonance imaging (MRI) volumetry may provide an objective approach for detecting subtle longitudinal structural brain changes in patients with epilepsy. This retrospective longitudinal study investigated regional and global brain volume changes observed during levetiracetam (LEV) monotherapy. Methods: Thirty-seven adults with epilepsy who underwent brain MRI before initiation of LEV monotherapy (MRI-1) and approximately 12 months later (MRI-2) were included. Automated volumetric segmentation was performed using volBrain, and within-subject changes in macrostructural, subcortical, and cortical volumes were evaluated. Results: No significant longitudinal changes were detected in global macrostructural measures, including white matter, gray matter, cerebrospinal fluid, total intracranial cavity, cerebral, cerebellar, brainstem, or ventricular volumes (all p > 0.05). In contrast, significant volume reductions were observed in the bilateral putamen, caudate nuclei, and thalami, as well as the left nucleus accumbens, bilateral insular cortex, and left occipital cortex (p < 0.05), whereas the right globus pallidus volume increased significantly. Conclusions: These findings demonstrate region-specific longitudinal volumetric changes during LEV monotherapy despite preserved global brain volumes. However, because this study lacked a longitudinal healthy control group, the observed changes cannot be definitively attributed to LEV and may also reflect epilepsy-related processes, normal aging, or other clinical factors. Automated MRI volumetry may represent a promising quantitative approach for longitudinal assessment, but its potential biomarker utility requires validation in larger prospective studies incorporating protocol-harmonized healthy controls and detailed clinical and treatment-exposure measures.

Background/Objectives: Persistent postural–perceptual dizziness (PPPD) and anxiety disorder (AD) share overlapping clinical features that make differentiation with conventional assessments challenging. This study examined whether virtual reality (VR)-based vestibular assessment and immersive phobic scenarios can reveal distinct response profiles between these conditions. Methods: In this preliminary, single-center, cross-sectional study, 32 participants (PPPD: n = 15, AD: n = 17) underwent joint otorhinolaryngological/audiological and psychiatric evaluation, including the Clinical Test of Sensory Interaction and Balance-VR (CTSIB-VR), Limits of Stability (LOS), Dizziness Handicap Inventory (DHI), Beck Anxiety Inventory (BAI), and two immersive VR scenarios (CrowdVR and Supermarket Scrolling). Symptom onset latency, maximum tolerated intensity, avoidance behavior, and post-scenario Simulator Sickness Questionnaire (SSQ) scores were recorded after each scenario. Results: Groups did not differ on any LOS parameter. CTSIB-VR Visual Preference was significantly higher in the PPPD group (74.07 ± 7.44 vs. 60.82 ± 2.46, p < 0.001). SSQ Disorientation scores during the CrowdVR and Supermarket Scrolling scenarios were significantly elevated in PPPD (p = 0.004 and p = 0.002, respectively); at baseline VR exposure, SSQ Disorientation showed the same directional pattern but did not reach significance (p = 0.069), and the SSQ Total Severity score at baseline was numerically higher in PPPD (51.61 ± 17.62 vs. 41.13 ± 11.83) at a trend level (p = 0.055). BAI Total was markedly higher in the AD group (29.82 ± 4.86 vs. 19.27 ± 6.43, p < 0.001). Symptom onset latency during CrowdVR exposure was longer in PPPD (median 5.36 vs. 3.10 min, p = 0.007), whereas avoidance behavior was more pronounced in the AD group (p = 0.027). Conclusions: PPPD and AD showed divergent, exploratory VR-based response profiles: PPPD was marked by visual dependence, prolonged tolerance, and greater disorientation, while AD showed higher anxiety burden and earlier avoidance. These preliminary, hypothesis-generating findings suggest scenario-based VR assessment may merit further study as an adjunct in differentiating PPPD from anxiety disorder, pending diagnostic-accuracy validation in larger, multicenter cohorts.

Kalıtsal kas hastalıkları, iskelet sisteminin yapısal veya fonksiyonel bozukluklarıyla karakterize olan ve genellikle genetik geçiş gösteren nadir hastalık gruplarıdır. Tanı sürecinde klinik öykü ve fizik muayenenin yanı sıra kreatin kinaz seviyeleri, elektromiyografi (EMG), kas biyopsisi ve moleküler genetik testler kritik rol oynamaktadır. Günümüzde bu hastalıkların kesin bir tedavisi bulunmamakla birlikte, fizik tedavi ve destekleyici yaklaşımların yanı sıra bazı spesifik türlerde enzim replasman tedavileri uygulanmaktadır. Hereditary muscle diseases are rare conditions characterized by structural or functional disorders of the skeletal system, typically following various genetic inheritance patterns. The diagnostic process relies on clinical history and physical examination, supported by laboratory markers like creatine kinase, electromyography (EMG), muscle biopsy, and molecular genetic testing. While a definitive cure is not yet available, management focuses on supportive care such as physical therapy, with enzyme replacement therapies used for specific metabolic myopathies.

Purpose: The aim of this study is to analyze the utility of lipid parameters individually and the low-density lipoprotein cholesterol/high-density lipoprotein cholesterol (LDL-C/HDL-C) ratio as a possible risk marker for intracerebral hemorrhages (ICH). Materials and Methods: This was a multicenter, retrospective case-control study that included 226 patients with ICH and 226 controls. Lipid parameters were evaluated after 12 h of fasting in patients whose ICH was confirmed by brain computed tomography, and no underlying vascular, traumatic, or metabolic cause could be found. Results: The mean LDL-C levels and mean total cholesterol (TC) levels did not differ in in the patient and control groups. The mean HDL-C levels in the patient groups were significantly lower whereas triglyceride (TG) levels were significantly higher. In the patient and control groups, LDL-C/HDL-C ratio was 2.65±1.10 and 2.94±1.13 (p=0.006), TG/HDL-C ratio was 3.60±2.72 and 4.47±3.25 (p=0.002), and TC/HDL-C ratio was 4.37±1.49 and 4.83 ± 1.56 (p=0.002), respectively. Conclusion: Increased TG and decreased HDL-C levels were found to be associated with ICHs. However LDL-C/HDL-C, TC/HDL-C, and TG/HDL-C ratios were low in the patient group. Therefore, we can conclude that these lipid ratios give clearer and more significant results in determining the risk of hemorrhage.

Background: Hyperglycemia during acute ischemic stroke is associated with worse outcomes, and this glucose altitude may persist in the initial days. In this study, we investigate the effect of glucose fluctuations in the first 4 days in patients diagnosed with acute ischemic stroke and who underwent ivr-tPA ± interventional thrombectomy or only interventional thrombectomy on stroke prognosis. Study was designed bicentered retrospective case series. Patients older than 18 years were included and those suitable for acute treatment, treatment indications, contraindications, and treatment management of hyperglycemia were selected according to the 2018 American Stroke Association guidelines. The effect of fasting glucose values of patients in the first 4 days on admission and 24th hour NIHSS scores, duration of hospitalization, disability, mortality, and prognosis were analyzed. We aimed to demostred the effect of the first 4-day glucose values measured in patients treated in a stroke center on clinical prospect. Results: One hundred and seventy-six patients were included in the study. Group 1 included 30 (17%) patients with severe clinical condition (NIHSS at admission ≥ 16), and Group 2 comprised 146 (83%) patients with moderate and mild clinical condition (NIHSS at admission < 16). The glucose values of Groups 1 and 2 were found as follows: day 1 (admission): 178.7 ± 10.3 mg/dl and 138.3 ± 54.9 mg/dl, day 2: 197.7 ± 99.8 mg/dl and 137.6 ± 51.8 mg/dl, day 3: 186.1 ± 97.6 mg/dl and 127.5 ± 50.0 mg/dl, and day 4: 169.2 ± 85.0 mg/dl and 126.7 ± 49.3 mg/dl (p < 0.05). Mortality risk of patients with glucose ≥ 200 mg/dl was 43.5% on day 1 (p > 0.05), 57.1% on day 2, 68.4% on day 3, and 76.5% on day 4 (p < 0.05). Conclusions: The glucose level of patients in severe clinical condition peaked on the second day and that 4 days of resilient severe hyperglycemia is a negative risk factor for sequela and mortality.

Giriş: D vitamini; immün cevabı, endotel fonksiyonu ve hücre proliferasyonu düzenlenmesi yanında antienflamatuar ve antioksidan fonksiyonları bulunabilen bir hormondur. Bu çalışmamızda amacımız, ülkemizde sık görülen yaşam kalitesini ve çalışma hayatını olumsuz etkileyen migrenin etyopatogenezine ışık tutmak ve gelecekte tedavisine katkı sağlayabilmektir. Materyal ve method: Migren tanısı alan 50 hasta ile 50 sağlıklı birey kontrol grubu olarak alındı. Hasta ve kontrol grubunda serum vitamin D [25(OH)vit D], parathormon, kalsiyum, fosfor, albümin düzeyleri çalışıldı. Bulgular: Migrenli hastalarda D vitamini düzeyi ortalama 18.51±12.05 ng/ml iken kontrol grubunda 12.82±9.06 ng/ml olup, p=0.005 saptandı. Kalsiyum ve albümin düzeyi ise migren hastalarında daha düşük bulundu. Sonuç: Çalışmamızda migren hastalarında D vitamini düzeyi daha yüksek bulunmuştur. Birçok çalışmada D vitamini epizodik migrenli hastalarda düşük saptanmış olmasına rağmen çok sayıda çalışmada da bir ilişki saptanamamıştır ve az sayıda çalışmada da bizim çalışmamızda olduğu gibi D vitamin düzeyi yüksek saptanmıştır. Sonuç olarak migren, kalsiyum ve D vitamini arasındaki ilişki hala tam olarak bilinmemektedir. Bu ilişki belirlenmesi için randomize kontrollü çalışmaların yanı sıra moleküler düzeyde çalışmaların da yapılması patogenezle ilgili daha net bilgiler verebilir.