Gökçe Zeytin Demiral

OBJECTIVE: Migraine is a chronic neurological disorder characterized by recurrent headache attacks that substantially impair quality of life. This study aims to investigate changes in hematological parameters such as neutrophil-to-lymphocyte ratio (NLR) and red blood cell distribution width (RDW) in migraine patients, and to evaluate the involvement of inflammatory processes and oxidative stress in migraine pathophysiology.MATERIAL AND METHODS: The study included 35 migraine patients evaluated during an attack and a control group of 76 healthy individuals matched for age and gender. The diagnosis of migraine was made according to the International Classification of Headache Disorders (ICHD-3) criteria by the International Headache Society. Demographic data and hematological parameters obtained from participants were analyzed using SPSS 26.0 software.RESULTS: A total of 111 participants were included in the study; 35 were migraine patients experiencing an attack, and 76 were healthy controls. The average age of the migraine group was 34, while the control group had an average age of 33.5. In the migraine group, 30 (85.7%) participants were female, whereas 60 (78.9%) participants in the control group were female. Neutrophil count and NLR were found to be significantly higher in the migraine group compared to the control group (p=0.018). Additionally, RDW and lymphocyte count were significantly higher in the control group (p=0.042, p=0.028).CONCLUSIONS: Our study suggests that hematological parameters may vary in migraine patients and these changes may be associated with the inflammatory mechanisms of the disease. Although a significant relationship between RDW and migraine attacks was not found, NLR may be a meaningful parameter for migraine attacks. Additional research is necessary to evaluate the clinical impact of these findings.

Purpose: Stroke is the second leading cause of death and the third leading cause of disability worldwide. The highest recurrence rates are observed in subtypes such as large artery atherosclerosis (LAA) and cardioembolic (CE) stroke. Atrial fibrillation (AF) is a common cause of CE. However, the role of increased left atrial (LA) size as a potential risk factor for ischemic stroke remains controversial. This study aimed to evaluate whether LA size is associated with the long-term risk of stroke recurrence in patients with non-valvular atrial fibrillation.Materials and methods: This retrospective study included 191 patients diagnosed with ischemic stroke by a specialist neurologist at Afyonkarahisar University of Health Sciences between January 1, 2024, and June 1, 2024. Patients aged >18 years with acute ischemic stroke were included. Patients with a history of ischemic stroke who had not undergone transthoracic echocardiography were excluded. The etiological subtype of ischemic stroke was determined according to the TOAST (Trial of Org 10172 in Acute Stroke Treatment) criteria.Results: A total of 191 patients were included. Of these, 155 (81.2%) had non-recurrent stroke, while 36 (18.8%) experienced recurrent stroke. Smoking was significantly more common in patients with recurrent ischemic stroke (30.6% vs. 16.1%; p=0.046). The prevalence of AF was also higher in the recurrent stroke group (33.3% vs. 12.9%; p=0.003). Moreover, LA diameter was significantly greater in patients with recurrent ischemic stroke (median [interquartile range]: 43 [35.75-47] vs. 35 [33-37]; p<0.001).Conclusion: This study demonstrates that increased LA diameter, smoking, and AF are associated with a higher risk of recurrent ischemic stroke. Notably, larger LA diameter may contribute to blood stasis and thrombus formation in the left atrium, thereby elevating the risk of CE events. Further research is warranted to confirm these associations and strengthen the current evidence base.

This study aims to evaluate the effectiveness of combined antiplatelet and oral anticoagulant (OAC) therapy versus OAC therapy alone on one-year post-stroke outcomes in patients with non-valvular atrial fibrillation (NVAF) and systemic atherosclerosis. A retrospective study was conducted using the recorded data of patients diagnosed with ischemic cerebrovascular disease between January 1, 2022, and January 1, 2023, at the Neurology Clinic, Afyonkarahisar Health Sciences University. Patients with non-valvular atrial fibrillation (NVAF) and systemic atherosclerosis were included in the study. Collected data included demographic information, medical history. Patients were divided into two groups based on the treatment regimen used at discharge: those receiving OAC alone and those receiving a combination of OAC and antiplatelet therapy. Clinical outcomes were evaluated within one year following the stroke. A total of 671 stroke patients were screened, and 565 (84.2%) had ischemic stroke. Among these, 113 (20%) had NVAF, and 53 had both NVAF and systemic atherosclerosis. Data from these 53 patients were analyzed. The mean age was 71.81±11.90 years, with a female gender ratio of 52.8%. Logistic regression analysis showed no statistically significant differences between the two treatment groups in terms of all-cause mortality, bleeding, recurrent stroke, and hemorrhagic stroke (p>0.05 for all comparisons). The combination of antiplatelet and OAC therapy did not demonstrate superiority over OAC therapy alone in reducing the risks of recurrent ischemic stroke, hemorrhagic stroke, myocardial infarction, and mortality in patients with NVAF and systemic atherosclerosis. These findings suggest that OAC therapy alone may provide sufficient protection in this patient population. Prospective studies with larger samples are needed to confirm these results.

Objectives: The present study aimed to examine the effects of diabetes complications on the ischemic stroke risk among patients with type 2 diabetes mellitus (T2DM). Patients and methods: The medical records of all patients (n=5,468) who were admitted to a tertiary care hospital between January 1, 2021, and June 1, 2022, were retrospectively reviewed. Of 911 patients diagnosed with T2DM for at least two years, 37 patients with a history of hemorrhagic cerebrovascular disease were excluded. Consequently, the study was conducted with 874 patients (460 males, 414 females; mean age: 65.5±12.1 years; range, 39 to 92 years) with T2DM. Demographic data, presence of chronic disease other than diabetes, duration of diabetes, retinopathy, nephropathy, peripheral arterial disease, and diabetes medications were recorded. The patients were divided into two groups: those with and without a history of ischemic stroke. The two groups were compared in terms of demographic characteristics and diabetes complications. Results: The prevalence of ischemic stroke was 18.6% (n=163). Patients with ischemic stroke were older than those without ischemic stroke, had longer diabetes durations, and had higher rates of hypertension, hyperlipidemia, and insulin use (p=0.001, pConclusion: Examining the relationship between diabetes complications and ischemic stroke risk from a broader perspective, the present study provided important implications for clinical management. Large-scale studies are needed in the future.

Horner Syndrome is a clinical syndrome caused by disruption of the sympathetic pathway, typically characterized by ipsilateral ptosis, miosis, and facial anhidrosis. Complications can arise during interventional procedures in the thoracic region due to proximity to the upper preganglionic nerve. A 21-year-old female patient who developed drooping of the right eyelid and Horner's syndrome following tube thoracostomy procedure is presented here. It is important to keep in mind that the tube has been removed and the condition may be reversible in terms of treatment.

Background: Population-based studies examining the prevalence of trigeminal neuralgia (TN) and persistent idiopathic facial pain (PIFP) are rare, and data on TN prevalence in Türkiye are very limited, with the prevalence of PIFP being unknown. This study aimed to determine the prevalence of TN and PIFP in Türkiye. Materials and Methods: This population-based epidemiological study has a cross-sectional and descriptive design, and it was carried out in Afyonkarahisar, Türkiye. Participants aged 18 years and older were screened by using a self-assessment form to determine potential patients with TN or PIFP. Results: A total of 19,237 individuals were included in this study, of which 17,223 responded to the survey questions. TN was diagnosed in 17 individuals, and the prevalence of TN was calculated as 98.5 per 100,000. PIFP was diagnosed in 35 patients, and the prevalence of PIFP was calculated as 202 per 100,000. The mean age of the patients with TN was 54.29 ± 12.98 years, the mean age of patients with PIFP was 49.80 ± 16.10 years, and the female-to-male ratio was 1.13/1 for TN and 2.18/1 for PIFP. Conclusion: The prevalence of PIFP in Türkiye has been reported for the first time by this study. Additionally, a much higher prevalence of TN was found when compared to previous study.

AMAÇ: Multipl skleroz (MS), merkezi sinir sisteminin (CNS) sık görülen bir otoimmün demiyelinizan hastalığıdır. Bu çalışmada retrospektif olarak MS tanılı hastaların toplanması Türk toplumunda ailesel ve sporadik MS hastalarının özelliklerini karşılaştırmak ve ailesel özellik gösteren MS hastalarının sıklığı ve bu hastaların klinik ve demografik özelliklerini belirlemek amaçlandı. GEREÇ VE YÖNTEM: Bu kesitsel kayıt tabanlı çalışma, 01 Ocak 2022-01 Haziran 2022 tarihleri arasında Afyonkarahisar Sağlık Bilimleri Üniversitesi Nöroloji Anabilim Dalı’nda 2017 McDonald kriterlerine göre MS tanısı ile takipli hasta verileri ile yapıldı. Hastaların demografik verileri, klinik bulguları, başlangıç yaşları, ortalama hastalık süresi, başlangıç semptomları ve MS subtipleri değerlendirildi. BULGULAR: Türk populasyonunda ailesel MS (FMS) sıklığı %7.3 olarak saptandı. FMS varlığı erken hastalık yaşı ile ilişkili bulunmadı. En sık başlangıç semptomu duyusal semptomlar en sık MS subtipi relapsing remitting MS olarak değerlendirildi ve genişletilmiş durum özürlülük skalası skoru hesaplandı ve FMS varlığı ile yüksek hastalık aktivitesi arasında ilişki saptanmadı. SONUÇ: Türk populasyonunda FMS oranı daha çok Avrupa-Latin ülkelerine benzer bulunmuştur. Klinik ve demografik özellikler ise Avrupa ve Orta doğu ile benzer bulunmuştur.

OBJECTIVE: Nerve injuries, often resulting from various causes, pose serious health issues that typically require prolonged rehabilitation. Conventional methods used in the treatment of these injuries are often inadequate, necessitating the exploration of new treatment approaches. Research on the effects of plant-derived active compounds on nerve regeneration may offer potential new treatment options. In this context, this study investigating the effects of Myrtus communis on nerve regeneration aims to fill an important gap in the field of nerve injury treatment. MATERIAL AND METHODS: In this study, the efficacy of Myrtus communis was evaluated in an experimental sciatic nerve injury model. Thirty-two female Wistar Albino rats were divided into four groups: Control, Sham, Group I, and Group II. Sciatic nerve injury was induced, and Myrtus communis treatment was administered via gastric lavage. The animals' motor functions, sensory functions, electrophysiological measurements, biochemical parameters, and histopathological evaluations were examined. RESULTS: The results demonstrated that Myrtus communis contributed to rapid improvement in sciatic functional index (SFI) values. Similarly, positive effects were observed in sensory assessment and electrophysiological measurements. Biochemical analyses indicated that Myrtus communis increased antioxidant capacity and reduced oxidative stress. Histopathological examinations revealed less axon degeneration, edema, and vacuolization in the groups treated with Myrtus communis. CONCLUSIONS: This study concludes that Myrtus communis could be used as a potential therapeutic agent in the treatment of sciatic nerve injury. These findings suggest that Myrtus communis may play a supportive role in post-nerve injury recovery. However, it should be noted that further research is needed before these results can be translated into clinical applications.

Objective: Migraine, a condition requiring long-term preventive therapy, especially for individuals with frequent and severe attacks. This study aims to compare the effectiveness of GON and SON (Greater Occipital Nerve and Supraorbital Nerve) blockades with amitriptyline in migraine management. Method: This retrospective study included 57 patients diagnosed with migraines. The first group consisted of patients who received a daily dose of 25 mg of amitriptyline for six months. The second group consisted of patients who initially received bilateral GON and SON blockades administered weekly for one month, followed by monthly blockade treatments for a total of 5 months. Pain frequency, analgesic consumption, and VAS (Visual Analog Scale) scores recorded in patients’ follow-up files were compared between the groups before treatment and at the 1st, 3rd, and 6th months. Results: Records of 57 patients, comprising 5 males and 52 females, were examined. Among them, 25 received GON and SON blockades, while 32 were treated with amitriptyline. Both groups showed a decrease in pain frequency and fewer painful days over time, with significant differences observed at all time points compared to baseline and between the 1st and 3rd months. Regardless of time factors, a significant difference in pain intensity (VAS) existed between the groups, with lower VAS scores in the GON and SON blockades group. Both groups experienced a statistically significant reduction in VAS scores over time, with notable differences from baseline to subsequent assessments. Conclusion: This study suggests that GON and SON blockades could be an effective prophylactic treatment for migraines, highlighting its potential as an alternative to amitriptyline therapy.