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Öğe A Case of Oxcarbazepine-Induced Severe Hyponatremia(Kare Publ, 2011) Degirmenci, Yildiz; Yilmaz, Yeliz; Ors, Ceyda Hayretdag; Karaman, Handan Isin OzisikOxcarbazepine is a keto-analogue of carbamazepine. Hyponatremia seen in the patients treated with oxcarbazepine is usually asymptomatic and rarely severe which leads to drug withdrawal. Here we presented a 51-year old female patient with epilepsy under oxcarbazepine and valproate treatment, who presented to our outpatient neurology clinic with vertigo, nausea and vomitting after the usage of her antiepileptic drugs. Routine biochemistry evluations revealed a decresed serum sodium level with increased urine sodium and osmolarity levels. Renal ultrasonography was normal. The patient was pre-diagnosed as inappropriate antidiuretic hormone secretion syndrome. Three days after the oxcarbazepine withdrawal, serum and urine sodium levels were found to be normal.Öğe A Case of Psychogenic Movement Disorders: Dark Side of Neurology and Neuropsychiatry(Turkish Neuropsychiatry Assoc-Turk Noropsikiyatri Dernegi, 2012) Degirmenci, Yildiz; Oyekcin, Demet Gulec; Karaman, Handan Isin OzisikOur aim was to describe a patient with psychogenic movement disorder (PMD) who presented with tremor dominant involuntary movements, as well as to emphasize the clinical features important for establishing a correct diagnosis. A 48-year-old man presented to our outpatient neurology clinic with gait and speech disturbance. He had jerky, tremor-like involuntary movements occurring during gait, voluntary movements and/or at rest. The involuntary movements of the patient, who benefited from risperidone treatment and supportive interviews, substantially disappeared. Since PMDs are complex disorders, a multidisciplinary approach with cooperation of neurologistand psychiatrist is needed for proper diagnoses and treatment. (Archives of Neuropsychiatry 2012; 49: 235-237)Öğe An Etiological Cause of Epilepsia Partialis Continua that Should Not be Forgotten: Hyperglycemia(Kare Publ, 2014) Sen, Halil Murat; Ozkan, Adile; Karaman, Handan Isin OzisikEpilepsia partialis continua is generally epileptic seizures, resistant to treatment, consisting of clonic jerks localized to one side of the body that may last from hours to months. In the adult population, brain ischemic lesions, extensive lesions and infections should be ruled out of the etiology. The etiology of easier-to-diagnose metabolic disorders, especially hyperosmolar nonketotic hyperglycemia, should not be forgotten. This is because a significant number of nonketotic hyperglycemia cases develop epilepsia partialis continua; in fact in some patients without diabetes diagnosis, it may be the first finding of diabetes.Öğe Case of Cytomegalovirus Infection Causing Isolated Oculomotor Nerve Palsy(Derman Medical Publ, 2014) Sen, Halil Murat; Tosum, Yeliz Yilmaz; Ors, Ceyda Hayretdag; Karaman, Handan Isin OzisikThe third cranial nerve is called the oculomotor nerve. The pathology is revealed by limitation of eye movement inward-up-down, mydriasis, loss of light reflex and ptosis. Oculomotor nerve pathologies are frequently seen in neurology practice and are situations that may be very difficult for differential diagnosis. Differential diagnosis first involves disqualifying intracranial etiologies by imaging because these intracranial etiologies may be situations that can result in death and should be primarily evaluated. If intracranial events are ruled out, generally rarer etiologic reasons with generally difficult differentiation should be researched. Viral infections are among the rare etiological reasons causing 3rd cranial nerve involvement. Our case was a 71-year old female with etiological research due to 3rd cranial nerve palsy. The patient with diabetes-linked immune deficiency was found to have cranial nerve involvement developed secondary to cytomegalovirus (CMV) infection. We report this case as 3rd cranial nerve involvement is rarely observed developing linked to CMV infection.Öğe Divalproex Sodium and Topiramate for Migraine ProphylaxisMigren(Derman Medical Publ, 2012) Degirmenci, Yildiz; Karagoz, Erkan Taner; Karaman, Handan Isin OzisikAim: To compare the efficacy, safety of topiramate and extended-release divalproex sodium in migraine prophylaxis. Material and Method: Study groups consisted of 22 patients with chronic migraine, randomly administered 1000mg extended-release divalproex sodium (first group), 21 patients given 100mg topiramate (second group).Study was 28-week randomized, prospectivetrial including 4-week baseline, 4-week titration, 20-week maintenancephase.Primary efficacy measure was reduction from baseline in 4-weekmigraine frequency.Secondary efficacy measures included responder rates,mean reduction in migraine duration,severity.Severity of headache wasquantified by using 10-point visual analogue scale (VAS). Responder rateswere defined as percentage of patients who demonstrated = 50%. reductionin migraine frequency per month. Results: Reduction from baseline migrainefrequency at the end of six month was primary outcome measure.Meanmigraine frequency at the end of study was 1.27 +/- 1 (baseline; mean +/- SD:3.6 +/- 2) in the first, 1.2 +/- 1.2 (baseline; mean +/- SD: 3.5 +/- 2.3) (p<0.0001) inthe second gr nt in frequency was observed in 16 patients (72.7%) in the first group, and 16 patients (76.2%) in the second group.Only a limited number of patients were excluded from the study due to side effects as 2 patients from the first group and 1 patient from the second group.The most common side effect was weight gain in the first and paresthesia in the second group. Discussion: Both divalproex sodium, topiramate were almost equally effective in reducing migraine frequency, duration, severity.Total relief from migraine attacks were more in topiramate than extended-release divalproex sodium.Öğe EPILEPSY MANAGEMENT AT WORK ENVIRONMENT: ASPECTS OF OCCUPATIONAL HEALTH AND SAFETY(Nobel Ilac, 2016) Cevizci, Sibel; Erginoz, Ethem; Karaman, Handan Isin OzisikObjective: There is a need to manage epilepsy, which is a common neurological disease, in terms of occupational health and safety at work environment. Numerous individuals with epilepsy is a part of the working population. Main problems are disease perception of patients, employers and coworkers, the severity and control of seizures, social acceptance by community, negative beliefs, attitudes and behaviors that affect negatively quality of life of both patients and their relatives at work environment for managing epilepsy. In order to cope with these difficulties in the management of epilepsy, every country needs to develop, implement and renew periodically their own epilepsy guides according to the socio-cultural structure. Various guidelines which are used for managing epilepsy and followed by occupational health and safety organizations are available in most of the countries. There are recommendations, which are including sample case presentations, to protect physical, mental and social health of employees with a disability such as epilepsy at work environment in these guidelines. These recommendations consist of valuable informations in terms of coping with problems that especially workers with epilepsy may encounter when they do job work. In this study, it was aimed to present knowledge on perception of epilepsy, epidemiology and epilepsy management through international epilepsy guides, publications, and case presentations in the work environment. In conclusion, we consider that developing and renewing periodically of epilepsy guidelines and training with case presentations may be beneficial in order to be successful in the management of epilepsy at work environment accordingly socio-cultural organizational structure in Turkey.Öğe Evaluation of clinical features and the factors related to nutrition in home care patients with pressure ulcer(2021) Çetiner, Mustafa; Ari, Selma Akkaya; Eşkut, Neslihan; Ocak, Özgül; Kabaya, Sibel Canbaz; Karaman, Handan Isin OzisikIntroduction: In this study, we aimed to determine the demographic and clinical characteristics of patients with pressure ulcers who received home health care in Kutahya city and to investigate the relationship between the factors related to nutrition and pressure ulcer grades. Methods: This study is designed as a retrospective and cross-sectional. The files of 500 patients who were registered at home health services unit of Kutahya Health Sciences University Training and Research Hospital between December 2016 and May 2017 were reviewed retrospectively. Of these, sixty-three patients with pressure ulcers were included in the study. Results: In this study, 26 (41.3%) were male and 37 (58.7%) were female. The mean age of the patients with pressure ulcers was 74.41 ± 12.30 (years). 36 patients (57.1%) had cerebrovascular disease, 5 patients (7.9%) had dementia, 9 patients (14.3%) had malignancy, 8 patients (12.7%) had osteoarthritis, 4 patients 6.3%) had peripheral vascular disease, and 1 patient (1.6%) had previous traffic accident. The majority (62.1%) were neurological disease-sequenced and nursing-care group. When all the patients were examined, the region with the most pressure was the sacrum (35.3%). Hemoglobin level was found to be related to pressure ulcer grade (One-way ANOVA, p = 0.019). There was no significant relationship between other nutrition-related parameters and pressure ulcer stage. Conclusion: Patients with cerebrovascular disease constitute a significant proportion of patients receiving home care services. Low hemoglobin increases the severity of the pressure ulcer. Therefore, determining risk factors that contribute to pressure ulcer formation and efforts to prevent them should be the primary target of the home health care unit.Öğe Experiences in an Epilepsy Polyclinic: Epilepsy in the Elderly(Kare Publ, 2015) Ozkan, Adile; Candan, Fatma; Canturk, Ilknur Aydin; Gokceer, Sevda Yildiz; Isik, Nihal; Karaman, Handan Isin OzisikObjectives: Epilepsy is one of the most common serious neurological disorders in the elderly. In this study the demographic and clinical features, etiological factors, seizure types and response ratios to treatment are presented for a group of patients aged 60 years and over diagnosed with epilepsy. Results: Twenty-five patients aged 60 years and over who applied to the epilepsy polyclinic were retrospectively investigated. Results: Average patient age was 75.0 +/- 7.1 years and average disease duration was 2.32 +/- 1.8 years. Sixteen patients were male and 9 female. Among the patients, cerebrovascular disease (17 patients), brain tumor (1 patient), arachnoid cyst (1 patient), aneurysm (1 patient) and myocardial infarction (1 patient) were considered as the underlying factors in seizure development. In the remaining 4 cases, no etiological cause was determined. Seizure types were; secondary generalized tonic-clonic seizure (20 patients), simple partial seizure (2 patients), status epilepticus seizure (2 patients), and complex partial seizure (1 patient). EEG findings were abnormal in 32% of the patients (n=8). When evaluated for treatment, 18 patients received monotherapy; 6 patients used double, and 1 patient used triple drugs. The follow-up period in 21 cases was without seizure. Conclusion: In the study, the most common etiological cause of epilepsy seen in the elderly was cerebrovascular disease. Seizure type was mainly secondary generalized tonic-clonic. The patients responded well to monotherapy and prognosis was improved.Öğe Headache Could Be Finding of Sinus Vein Thrombosis in Behcets Patients(Derman Medical Publ, 2014) Sen, Halil Murat; Ozkan, Adile; Balci, Cagdas; Karaman, Handan Isin OzisikGlobally Behcet's disease (BD) is most frequently seen in Turkey and takes its name from the Turkish dermatologist Hulusi Behbet. Basic findings of the disease are the triad of genital ulcers, oral ulcers and uveiti's. Neurological involvement in BD appears an average of 5 years after the beginning of disease, or the first appearance of the disease may be neurological findings. Sinus vein thrombosis (SVT) is among neurological involvements observed in BD. However diagnosis of SVT is difficult and it is a situation that may cause disability or mortality. Our case was a 24-year old female patient with diagnosed SVT who had a diagnosis of BD from 5 years. In spite of the patient frequently applying to health services, SVT diagnosis was delayed until 15 days after the initial symptoms. BD can cause SVT and SVT may cause disability or mortality but SVT may be diagnosed late, just as in our case. Therefore we present this case to increase awareness of this disease.Öğe Insulinoma May Present as Epilepsy: A Case Report(Derman Medical Publ, 2014) Sen, Halil Murat; Balci, Cagdap; Ozkan, Adile; Karaman, Handan Isin OzisikHypoglycemia developing linked to insulinoma may present with clinical findings similar to epileptic seizures and electroencephalography findings may be in accordance with epilepsy. As a result some insulinoma patients are followed as epilepsy resistant to treatment for years. Our case was a 20-year old female patient and was followed for epilepsy. The blood tests indicated hypoglycemia and the result of examination, the patient diagnosis was insulinoma. We present this case with the aim of emphasizing the importance of not forgetting insulinoma as an etiology in epilepsy resistant to treatment.Öğe Investigation of auditory potentials and cognitive impairment in premenstrual syndrome(Springer-Verlag Italia Srl, 2018) Ors, Ceyda Hayretdag; Karaman, Handan Isin OzisikPremenstrual syndrome is a term which is used for describing of somatic, cognitive, emotional, and behavioral symptoms that occur during the luteal phase of menstrual cycle in women of reproductive age; symptoms rapidly improve at the onset of menstruation. In this study, we aimed to reveal if cognitive functions are affected or not in PMS and if the subjects are affected, we try to explain this situation by an objective diagnostic test. Ethical committee approval was taken for this project on 09.03.2012 and numbered 050.99-60. In this study, in order to determine premenstrual syndrome, Premenstrual Syndrome Scale that is developed by Gen double dagger dogan (2006) with 44 items, Likert type, and 9 subgroups was used. Sample size was calculated using simple random sampling with a confidence level of 95% and confidence interval of 0.05. A total of 60 participants were included in the study (calculated sample size was 30 for each group). Each group was recorded in the ENMG-UP laboratory using the OIP auditory warning and the oddball two-tone discrimination task method. Latency measurements were taken from the highest point of the peak, and amplitude measurements were taken from peak to peak with a cursor. Comparisons of P300 wave latencies obtained via sparse auditory stimulus in PMS and non-PMS groups were made and findings were summarized in one of the tables. Recordings are taken from three scalp regions: parietal and central, respectively. PMS women have longer P300 wave latencies in all regions compared to non-PMS group, whereas there is no significant difference between P300 amplitude.Öğe Is Multiple Sclerosis Patients Receiving Adequate Medical Assesment for Urological Problems?(Derman Medical Publ, 2015) Sen, Halil Murat; Sancak, Eyup Burak; Uludag, Aysegul; Karaman, Handan Isin OzisikAim: The aim of the study was to determine the medical assesment and treatment services for frequently seen urological problems in multiple sclerosis patients. Material and Method: In this study, 50 MS patients were enrolled. Patients were evaluated about appropriate and adequate medical care for low urinary tract symptoms (LUTS) by questionnaire that was prepared by researchers. Results: Eighty percent of patients (n = 40) had LUTS in study. There were 76% of patients (n = 38) declared that they had never been questioned by doctors even had no complaints about LUTS. Only 7.5% (n = 3) of MS patients with LUTS were under treatment. Discussion: Our study showed that MS patients with urological problems were not questioned and evaluated appropriately and adequately.Öğe Isolated lingual dystonia induced by speaking: a rare form of focal dystonia(Acta Medica Belgica, 2011) Degirmenci, Yildiz; Ors, Ceyda Hayretdag; Yilmaz, Yeliz; Karaman, Handan Isin OzisikFocal lingual dystonia is a rare condition that can be misdiagnosed as a psychogenic problem because it may interfere with chewing, swallowing, and speaking. We present a patient with an uncommon type of dystonia (speech-induced primary lingual dystonia), that responded well to botulinum toxin injection.Öğe Lightning strike: a first case of unilateral diaphragmatic paralysis(Pagepress Publ, 2011) Alar, Timucin; Degirmenci, Yildiz; Karaman, Handan Isin OzisikLightning injury is the second most common cause of weather-related deaths in the United States. Despite the several neurological complications such as polyneuropathy, myelopathy, spinal cord injury, motor neuron disease due to the lightning-induced injury, there is no documented case of unilateral diaphragmatic paralysis. We describe the case of a patient with a history of lightning strike at childhood period, prior the onset of isolated, diaphragmatic paralysis, unilaterally. Clinical and electrophysiological findings suggest an injury restricted to the phrenic nerve, unilaterally.Öğe Myelin basic protein and ischemia modified albumin levels in acute ischemic stroke cases(Professional Medical Publications, 2015) Can, Serdar; Akdur, Okhan; Yildirim, Ahmet; Adam, Gurhan; Cakir, Dilek Ulker; Karaman, Handan Isin OzisikObjective: To investigate early diagnostic effects of serum myelin basic protein (MBP) and ischemic modified albumin (IMA) levels in patients with ischemic stroke. Methods: Fifty patients who presented to an emergency service with acute ischemic stroke between June 2013 to March 2014 were evaluated with the National Institute of Health Stroke Scale (NIHSS) and diffusion-weighted magnetic resonance imaging (MRI). Thirty four healthy cases were included as control group. All patients' serum IMA and MBP level were assessed. Results: Mean IMA value was 0.52 +/- 0.25 cases with acute ischemic stroke and serum IMA levels were significantly higher than the control group (p<0.01). No statistical significance was observed between acute ischemic stroke group and control group related to the MBP serum levels (P>0.05). Statistically significant correlation was detected between the volumes of diffusion restriction on MRI and NIHSS score (P=0.002,r=0.43) and IMA (P=0.015,r=0.344) levels. Conclusions: We have found that serum IMA levels are elevated in acute ischemic stroke cases and these levels are correlated with the ischemic tissue volume. MBP levels do not increase in early period of stroke cases.Öğe Osmotic Demyelination Syndrome in A Normonatremic Patient with Chronic Kidney Disease(Galenos Yayincilik, 2020) Ocak, Ozgul; Urfali, Furkan Erturk; Korkmazer, Bora; Karaman, Handan Isin OzisikOsmotic demyelination syndrome (ODS), also known as central pontine myelinolysis, is a neurological disorder characterised by myelin loss in the central pons and other parts of the brain, such as the basal ganglia, lateral geniculate bodies, external and internal capsules and cerebellum. ODS is a demyelinating disorder associated with rapid correction of hyponatraemia. Classically, this is associated with hyponatraemia, but it can also occur in the presence of normonatremia. Changes in osmolality are found to be responsible in the pathogenesis of the lesions. Rarely, pontine myelinosis with delirium was also described in normonatremic patients. We report the clinical and radiological findings of a normonatremic 45-year-old female patient with chronic kidney disease, who experienced central pontine myelinolysis. This report aims to show that pontine myelinolysis may also occur in normonatremic circumstances, and early, rapid management of the disorder is important to prevent permanent damage.Öğe Parotid Abscess with Involvement of Facial Nerve Branches(Coll Physicians & Surgeons Pakistan, 2015) Ozkan, Adile; Ors, Ceyda Hayretdag; Kosar, Sule; Karaman, Handan Isin OzisikFacial nerve paresis is only rarely seen with benign diseases of the parotid gland. A 22-year male had muscle loss in the preauricular region of the right side of his face that extended towards the mandibular angle for the last 6 months. The neurological examination did not reveal any pathology other than right preauricular region muscle atrophy that was limited by the mandibular angle. The Electroneuronography (EnoG) provided a ratio of 55.38%, compared the affected side to left side. Ultrasonography of the defined region showed two mass lesions 13.5 x 7 mm and 10 x 5 mm in size in the anteromedial section of the right parotid gland that were close to each other, without internal calcific foci, and heterogenous hyperechogenic structure without internal vascularization. Fine needle aspiration obtained many polymorphonuclear leukocytes, cell debris, a few mononuclear inflammatory cells and many crystalloid structures: The lesion was diagnosed as a parotid abscess. Antibiotic treatment was started for the parotid gland abscess.Öğe Parotid abscess with involvement of facial nerve branches(College of Physicians and Surgeons Pakistan, 2015) Ozkan, Adile; Ors, Ceyda Hayretdag; Kosar, Sule; Karaman, Handan Isin OzisikFacial nerve paresis is only rarely seen with benign diseases of the parotid gland. A 22-year male had muscle loss in the preauricular region of the right side of his face that extended towards the mandibular angle for the last 6 months. The neurological examination did not reveal any pathology other than right preauricular region muscle atrophy that was limited by the mandibular angle. The Electroneuronography (EnoG) provided a ratio of 55.38%, compared the affected side to left side. Ultrasonography of the defined region showed two mass lesions 13.5 x 7 mm and 10 x 5 mm in size in the anteromedial section of the right parotid gland that were close to each other, without internal calcific foci, and heterogenous hyperechogenic structure without internal vascularization. Fine needle aspiration obtained many polymorphonuclear leukocytes, cell debris, a few mononuclear inflammatory cells and many crystalloid structures. The lesion was diagnosed as a parotid abscess. Antibiotic treatment was started for the parotid gland abscess.Öğe Perception of epilepsy in Turkey in the light of two different cities(2013) Degirmenci, Yildiz; Kabay, Sibel Canbaz; Yilmaz, Zahide; Bakar, Coskun; Karaman, Handan Isin OzisikThe aim of this study was to investigate the perception of epilepsy in Turkey, from west to east, in Kutahya and Yuksekova, two cities of different sociocultural and ethnic status. This was a retrospective comparison study which evaluated the results of two prior studies investigating stigmatization of patients diagnosed with epilepsy and their first-degree relatives in two different cities of Turkey, Kutahya and Yuksekova. The Survey of Epileptic Patient Relatives on the Knowledge, Attitudes, and Behavior Regarding the Disorder was used and included questions on descriptive characteristics, familiarity with epilepsy, attitudes toward epilepsy, and understanding of epilepsy. Data collected by use of the SPSS 15.0 software were analyzed with ?2-test. In Yuksekova group, 88.5% of first-degree relatives of people with epilepsy felt primarily fear when they heard the diagnosis of epilepsy in their relatives; in Kutahya group, the respective rate was 19.1% (p<0.05). The number of participants who objected their child marrying someone with epilepsy was significantly higher in Yuksekova group (p<0.05); however, if married, the Yuksekova group significantly stated that they should have a baby, revealing the importance of children as an indicator of power and dignity in the eastern region of Turkey (p<0.05). Although understanding of epilepsy was favorable, educating the community about epilepsy and personal contacts are the major strategies against epileptic stigmatization.Öğe PERCEPTION OF EPILEPSY IN TURKEY IN THE LIGHT OF TWO DIFFERENT CITIES(Sestre Milosrdnice Univ Hospital, 2013) Degirmenci, Yildiz; Kabay, Sibel Canbaz; Yilmaz, Zahide; Bakar, Coskun; Karaman, Handan Isin OzisikThe aim of this study was to investigate the perception of epilepsy in Turkey, from west to east, in Kutahya and Yuksekova, two cities of different sociocultural and ethnic status. This was a retrospective comparison study which evaluated the results of two prior studies investigating stigmatization of patients diagnosed with epilepsy and their first-degree relatives in two different cities of Turkey, Kutahya and Yuksekova. The Survey of Epileptic Patient Relatives on the Knowledge, Attitudes, and Behavior Regarding the Disorder was used and included questions on descriptive characteristics, familiarity with epilepsy, attitudes toward epilepsy, and understanding of epilepsy. Data collected by use of the SPSS 15.0 software were analyzed with chi(2)-test. In Yuksekova group, 88.5% of first-degree relatives of people with epilepsy felt primarily fear when they heard the diagnosis of epilepsy in their relatives; in Kutahya group, the respective rate was 19.1% (p<0.05). The number of participants who objected their child marrying someone with epilepsy was significantly higher in Yuksekova group (p<0.05); however, if married, the Yuksekova group significantly stated that they should have a baby, revealing the importance of children as an indicator of power and dignity in the eastern region of Turkey (p<0.05). Although understanding of epilepsy was favorable, educating the community about epilepsy and personal contacts are the major strategies against epileptic stigmatization.
