Neurological Examination Findings Research Articles

Rare combination of a persistent anterior falcine sinus with developmental venous anomaly: A case report and literature review

Abstract A 21-year-old woman was admitted with a 1-day history of headache. Her neurological examination findings were normal. Computed tomography angiography revealed an oval, well-enhanced dilated vascular lesion in the anterior interhemispheric fissure with a developmental venous anomaly characterized by caput medusae centripetally in the right hemisphere. On the magnetic resonance image, an anterior persistent falcine sinus was connected with the middle portion of the superior sagittal sinus. Cerebral angiography revealed the persistent falcine sinus located in the anterior falx and the parenchymal developmental venous anomaly with caput medusae. In addition, the venous phase of cerebral angiography demonstrated the obstruction of both the inferior sagittal sinus and the bridging vein between the superior thalamostriate and the internal cerebral vein. To our knowledge, this is a very rare case of the combination of an anterior persistent falcine sinus and a developmental venous anomaly.

Pharmacokinetics of Single Oral Dose Extended-Release Levetiracetam in Healthy Cats.

BackgroundRepeated PO dosing of anti‐epileptic drugs may contribute to poor compliance in treated cats. Intermediate‐release levetiracetam has been used safely in cats, but must be given q8h to maintain serum concentrations in the therapeutic interval for humans (5–45 μg/mL). Approved extended‐release levetiracetam (XRL) for human use may require less frequent dosing, but the large dosing unit has limited its use in cats.HypothesesIn healthy cats, serum levetiracetam concentration will remain above 5 μg/mL for at least 24 hours after administration of a single dose of XRL PO and will be well tolerated.Animals7 healthy cats.MethodsExtended‐release levetiracetam (500 mg) was administered PO. Blood was collected and neurologic examination findings recorded at scheduled times over 30 hours. Serum levetiracetam concentration was quantitated by an immunoassay validated in cats. Data were subjected to noncompartmental analysis. Descriptive statistics were reported.ResultsThe median dosage of 86.2 mg/kg, (range, 80–94.3) achieved a mean maximum concentration (C max) of 89.8 ± 25.8 μg/mL at 4.9 ±1.57 hours. Serum levetiracetam was >5 μg/mL in all cats by 90 minutes. Mean concentrations were 43.7 ± 18.4 and 4.9 ± 3.4 μg/mL at 12 and 24 hours, respectively. The half‐life was 4.1 ± 1.0 hours. The drug was well tolerated.Conclusions and Clinical ImportanceA single 500 mg PO dose of XRL safely maintained serum levetiracetam concentration ≥5 μg/mL in healthy cats for at least 21 hours. Clinical efficacy studies in epileptic cats receiving XRL are indicated; however, monitoring should be implemented for individual cats.

Questionnaire-based Analysis of Owner-reported Scratching andPain Signs in Cavalier King Charles Spaniels Screened for Chiari-like Malformation and Syringomyelia.

BackgroundChiari‐like malformation (CM) and syringomyelia (SM) cause a pain syndrome in Cavalier King Charles spaniels (CKCS). Clinical signs are not consistently apparent on neurologic examination, and owner reporting of signs provides vital clinical history. However, owner questionnaires for this disease are not well developed.ObjectivesTo develop a tool to capture owner‐reported clinical signs for use in clinical trials and to compare owner‐reported signs with the presence of pain on neurologic examination and SM on magnetic resonance imaging (MRI).AnimalsFifty client‐owned CKCS.MethodsOwners completed a questionnaire and pain/scratch map. Each dog underwent a neurologic examination and craniocervical magnetic resonance imaging (MRI). Questionnaire responses were developed into scores, area of shading for pain/scratch maps was measured, and consistency of responses between these tools was assessed. Owner‐reported findings were compared with neurologic examination findings and presence and severity of SM on MRI.ResultsThirty‐three dogs were symptomatic and 17 asymptomatic; 30 had SM. The most common sign of pain was crying out when lifted (n = 11). Extent of shaded areas on maps positively correlated with questionnaire scores for pain (r 2 = 0.213, P = 0.006) and scratch (r 2 = 0.104, P = 0.089). Owner‐reported findings were not significantly associated with presence or severity of SM or neurologic examination findings. Owner‐reported lateralization of signs was significantly associated with SM lateralization (P < 0.0001).ConclusionsThe questionnaire and maps may be useful for clinical trials. Lack of association of owner‐reported signs with SM highlights our lack of understanding of the pathophysiology of pain in this disease.

Case 1: A term infant with apnea and stiffening.

A term male infant born via spontaneous vaginal delivery with Apgar scores of 8 and 9 at 1 and 5 minutes, respectively, has an episode of apnea with stiffening and nonsuppressible whole body jerking for 2 minutes, occurring 5 hours after birth. Around 8 hours after birth, he has another episode but with exaggerated startle reflex, lip smacking, and eyelid fluttering. General examination shows no dysmorphic features, and findings are otherwise normal. Initial neurologic examination findings are unremarkable. Continuous electroencephalographic (EEG) monitoring with full neonatal montage is significant for intermittent sharp waves. Over the next day, the infant has 3 episodes of apnea with stiffening and nonsuppressible whole body jerking after each episode. These events are captured but EEG does not show them to be seizures. Initial management with phenobarbital and levetiracetam does not ameliorate spells. His antenatal course is unremarkable. Family history is remarkable for consanguineous parentage of Middle Eastern descent (parents are first cousins of first cousins). Laboratory evaluation including serum and cerebrospinal fluid studies for infectious and metabolic etiologies shows normal findings. Magnetic resonance imaging (MRI) on day 5 after birth reveals normal brain structure with nonspecific hyperintense basal ganglia signal and minimal subdural hemorrhage from the birthing process. Five days later, findings of a repeat MRI with added spectroscopy are normal. ### Diagnosis and Further Progress Given the clinical suspicion for hyperekplexia, the patient was started on a trial of carbamazepine (15 …

Late (> 7 days) systemic postnatal corticosteroids for prevention of bronchopulmonary dysplasia in preterm infants.

Many preterm infants who survive go on to develop bronchopulmonary dysplasia, probably as the result of persistent inflammation in the lungs. Corticosteroids have powerful anti-inflammatory effects and have been used to treat individuals with established bronchopulmonary dysplasia. However, it is unclear whether any beneficial effects outweigh the adverse effects of these drugs. To examine the relative benefits and adverse effects of late systemic postnatal corticosteroid treatment (> 7 days) for preterm infants with evolving or established bronchopulmonary dysplasia. For the 2017 update, we used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 1); MEDLINE via PubMed (January 2013 to 21 February 2017); Embase (January 2013 to 21 February 2017); and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; January 2013 to 21 February 2017). We also searched clinical trials databases, conference proceedings, and reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. We selected for inclusion in this review randomised controlled trials (RCTs) comparing systemic postnatal corticosteroid treatment versus placebo or nothing initiated more than seven days after birth for preterm infants with evolving or established bronchopulmonary dysplasia. We used the GRADE approach to assess the quality of evidence.We extracted and analysed data regarding clinical outcomes including mortality, bronchopulmonary dysplasia, death or bronchopulmonary dysplasia, failure to extubate, complications during primary hospitalisation, and long-term health outcomes. Twenty-one RCTs enrolling a total of 1424 participants were eligible for this review. All were RCTs, but methods used for random allocation were not always clear. Allocation concealment, blinding of the intervention, and blinding of outcome assessments most often were satisfactory. Late steroid treatment was associated with a reduction in neonatal mortality (at 28 days) but no reduction in mortality at 36 weeks, at discharge, or at latest reported age. Benefits of delayed steroid treatment included reductions in failure to extubate by 3, 7, or 28 days; bronchopulmonary dysplasia both at 28 days of life and at 36 weeks' postmenstrual age; need for late rescue treatment with dexamethasone; discharge on home oxygen; and death or bronchopulmonary dysplasia both at 28 days of life and at 36 weeks' postmenstrual age. Data revealed a trend towards increased risk of infection and gastrointestinal bleeding but no increase in risk of necrotising enterocolitis. Short-term adverse affects included hyperglycaemia, glycosuria, and hypertension. Investigators reported an increase in severe retinopathy of prematurity but no significant increase in blindness. Trial results showed a trend towards reduction in severe intraventricular haemorrhage, but only five studies enrolling 247 infants reported this outcome. Trends towards an increase in cerebral palsy or abnormal neurological examination findings were partly offset by a trend in the opposite direction involving death before late follow-up. The combined rate of death or cerebral palsy was not significantly different between steroid and control groups. Major neurosensory disability and the combined rate of death or major neurosensory disability were not significantly different between steroid and control groups. There were no substantial differences between groups for other outcomes in later childhood, including respiratory health or function, blood pressure, or growth, although there were fewer participants with a clinically important reduction in forced expired volume in one second (FEV1) on respiratory function testing in the dexamethasone group.GRADE findings were high for all major outcomes considered, but review authors degraded the quality of evidence by one level because we found evidence of publication bias (bronchopulmonary dysplasia at 36 weeks). Benefits of late corticosteroid therapy may not outweigh actual or potential adverse effects. This review of postnatal systemic corticosteroid treatment for bronchopulmonary dysplasia initiated after seven days of age suggests that late therapy may reduce neonatal mortality without significantly increasing the risk of adverse long-term neurodevelopmental outcomes. However, the methodological quality of studies determining long-term outcomes is limited in some cases (some studies assessed surviving children only before school age, when some important neurological outcomes cannot be determined with certainty), and no studies were sufficiently powered to detect increased rates of important adverse long-term neurosensory outcomes. Evidence showing both benefits and harms of treatment and limitations of available evidence suggests that it may be prudent to reserve the use of late corticosteroids for infants who cannot be weaned from mechanical ventilation, and to minimise both dose and duration for any course of treatment.

The utility of magnetic resonance imaging in addition to computed tomography scans in the evaluation of cervical spine injuries: a study of obtunded blunt trauma patients.

Evidence guiding the use of CT and MRI scans in blunt trauma patients who are obtunded remains controversial. This study aims to determine and predict if computed tomography (CT) scans alone can be performed without risking oversight of substantial injuries found on follow-up magnetic resonance imaging (MRI). This is a retrospective cohort study of 63 blunt trauma patients with a Glasgow Coma Scale of <8. Data were collated from electronic medical records and included patient demographics, premorbid mobility, mechanism of injury, suspected level of injury and neurological examination findings. Patients were urgently evaluated using CT scans, followed by non-contrast MRI scans within 48h of admission. The accuracy of CT scan was evaluated using MRI as a reference. Adjusted multivariable analysis was also performed to identify predictors for findings detected on MRI but not on CT. The mean age of patients was 42.3years and 90.5% were males. CT scans had a high specificity of 100% and sensitivity of 87.2%. Predictors of MRI abnormalities include females, patients with relatively milder mechanisms of injury, patients with suspected thoracic spine injury, and CT scan findings of facet dislocation and intracranial haemorrhage. There was no predictor for spinal cord oedema. MRI should be performed in the presence of the aforementioned predictive factors and in the presence of neurological deficits. Otherwise, patients can be treated medically without the fear of missing a substantial cervical injury.

Trends in Dementia Incidence in a Birth Cohort Analysis of the Einstein Aging Study

Trends in dementia incidence rates have important implications for planning and prevention. To better understand incidence trends over time requires separation of age and cohort effects, and few prior studies have used this approach. To examine trends in dementia incidence and concomitant trends in cardiovascular comorbidities among individuals aged 70 years or older who were enrolled in the Einstein Aging Study between 1993 and 2015. In this birth cohort analysis of all-cause dementia incidence in persons enrolled in the Einstein Aging Study from October 20, 1993, through November 17, 2015, a systematically recruited, population-based sample of 1348 participants from Bronx County, New York, who were 70 years or older without dementia at enrollment and at least one annual follow-up was studied. Poisson regression was used to model dementia incidence as a function of age, sex, educational level, race, and birth cohort, with profile likelihood used to identify the timing of significant increases or decreases in incidence. Birth year and age. Incident dementia defined by consensus case conference based on annual, standardized neuropsychological and neurologic examination findings, using criteria from the DSM-IV. Among 1348 individuals (mean [SD] baseline age, 78.5 [5.4] years; 830 [61.6%] female; 915 [67.9%] non-Hispanic white), 150 incident dementia cases developed during 5932 person-years (mean [SD] follow-up, 4.4 [3.4] years). Dementia incidence decreased in successive birth cohorts. Incidence per 100 person-years was 5.09 in birth cohorts before 1920, 3.11 in the 1920 through 1924 birth cohorts, 1.73 in the 1925 through 1929 birth cohorts, and 0.23 in cohorts born after 1929. Change point analyses identified a significant decrease in dementia incidence among those born after July 1929 (95% CI, June 1929 to January 1930). The relative rate for birth cohorts before July 1929 vs after was 0.13 (95% CI, 0.04-0.41). Prevalence of stroke and myocardial infarction decreased across successive birth cohorts, whereas diabetes prevalence increased. Adjustment for these cardiovascular comorbidities did not explain the decreased dementia incidence rates for more recent birth cohorts. Analyses confirm decreasing dementia incidence in this population-based sample. Whether decreasing incidence will contribute to reduced burden of dementia given the aging of the population is not known.

Computed tomographic findings in dogs with head trauma and development of a novel prognostic computed tomography-based scoring system.

OBJECTIVE To characterize CT findings and outcomes in dogs with head trauma and design a prognostic scale. ANIMALS 27 dogs admitted to the Koret School Veterinary Teaching Hospital within 72 hours after traumatic head injury that underwent CT imaging of the head. PROCEDURES Data were extracted from medical records regarding dog signalment, history, physical and neurologic examination findings, and modified Glasgow coma scale scores. All CT images were retrospectively evaluated by a radiologist unaware of dog status. Short-term (10 days after trauma) and long-term (≥ 6 months after trauma) outcomes were determined, and CT findings and other variables were analyzed for associations with outcome. A prognostic CT-based scale was developed on the basis of the results. RESULTS Cranial vault fractures, parenchymal abnormalities, or both were identified via CT in 24 of 27 (89%) dogs. Three (11%) dogs had only facial bone fractures. Intracranial hemorrhage was identified in 16 (59%) dogs, cranial vault fractures in 15 (56%), midline shift in 14 (52%), lateral ventricle asymmetry in 12 (44%), and hydrocephalus in 7 (26%). Hemorrhage and ventricular asymmetry were significantly and negatively associated with short- and long-term survival, respectively. The developed 7-point prognostic scale included points for hemorrhage, midline shift or lateral ventricle asymmetry, cranial vault fracture, and depressed fracture (1 point each) and infratentorial lesion (3 points). CONCLUSIONS AND CLINICAL RELEVANCE The findings reported here may assist in determining prognoses for other dogs with head trauma. The developed scale may be useful for outcome assessment of dogs with head trauma; however, it must be validated before clinical application.

46-Year-Old Man With Lower Back Pain

46-Year-Old Man With Lower Back Pain

Early insights into Zika's microcephaly physiopathology from the epicenter of the outbreak: teratogenic apoptosis in the central nervous system.

Fetal infection by the Zika virus has been implicated in the exceptional rise in the number of microcephalic newborns recorded by the end of 2015 in Brazil. The mechanism by which this teratogenic effect is produced in the developing brain has not been fully established. Very early in the outbreak, we addressed this question by evaluating available initial data from a gestational and postnatal clinical investigation in the Brazilian state of Pernambuco. The present study was undertaken to test the hypothesis that the subtractive dysmorphic brain malformations observed in Zika-related microcephaly are primarily due to the massive induction of apoptosis of neuroprogenitor cells. We designed a physiopathological algorithm based on the examination of the following medical findings: epidemiological data, ultrasound images, computed tomography scans, placental tissue, cerebral fluid analysis, eye fundoscopy, neurological examination and necroscopy findings.

Case 2: Beware of Lumps and Bumps after Cooling!

The infant is born to a 31-year-old primigravida mother by cesarean delivery due to nonreassuring fetal heart rate and chorioamnionitis. Rupture of membranes is prolonged at 47 hours with meconium-stained amniotic fluid. At birth, the newborn is noted to have poor tone and respiratory effort. He undergoes intubation and is admitted to the NICU for further observation and management. Apgar scores are 2, 5, and 7 at 1, 5, and 10 minutes, respectively. Arterial cord gas has a pH of 6.8 and a base deficit of 24 mEq/L (24 mmol/L). The patient demonstrates signs and symptoms of moderate hypoxic-ischemic encephalopathy and meets the criteria for whole body hypothermia therapy. He is started on parental nutrition. He has evidence of pulmonary hypertension on echocardiography and requires inhaled nitric oxide for 2 days while undergoing hypothermia treatment. He maintains adequate blood pressures and does not have any hemodynamic decompensation. He receives 2 doses of fresh frozen plasma to correct laboratory indices that demonstrate abnormal coagulation profiles. Following rewarming and after obtaining a brain magnetic resonance imaging scan (which is unremarkable) he undergoes successful extubation on the 4th postnatal day. His respiratory support is gradually weaned and he remains in room air from day 6 of age onwards. He is slowly introduced to enteral feeds and reaches full oral feeds by 9 days of age. His neurologic examination findings are normal. Erythematous, indurated plaques are noted over the upper back, …

A report of three cases with lupus myelitis.

Lupus myelitis (LM) is a rare but serious complication of systemic lupus erythematosus (SLE). In 2009, Birnbaum et al. suggested that LM could be classified into two subtypes, namely gray and white matter myelitis, based on neurological examination findings. Here we describe three cases of this disorder, one with signs of white matter dysfunction and two with signs of gray matter dysfunction. We discuss the potential role of autoantibodies in the development of LM.

Clinical reasoning in feline epilepsy: Which combination of clinical information is useful?

We sought to identify the association between clinical risk factors and the diagnosis of idiopathic epilepsy (IE) or structural epilepsy (SE) in cats, using statistical models to identify combinations of discrete parameters from the patient signalment, history and neurological examination findings that could suggest the most likely diagnosis. Data for 138 cats with recurrent seizures were reviewed, of which 110 were valid for inclusion. Seizure aetiology was classified as IE in 57% and SE in 43% of cats. Binomial logistic regression analyses demonstrated that pedigree status, older age at seizure onset (particularly >7years old), abnormal neurological examinations, and ictal vocalisation were associated with a diagnosis of SE compared to IE, and that ictal salivation was more likely to be associated with a diagnosis of IE than SE. These findings support the importance of considering inter-ictal neurological deficits and seizure history in clinical reasoning.

Status epilepticus in dogs and cats, part 1: etiopathogenesis, epidemiology, and diagnosis.

To review current knowledge of the etiopathogenesis, diagnosis, and consequences of status epilepticus (SE) in veterinary patients. Human and veterinary literature, including clinical and laboratory research and reviews. Status epilepticus is a common emergency in dogs and cats, and may be the first manifestation of a seizure disorder. It results from the failure of termination of an isolated seizure. Multiple factors are involved in SE, including initiation and maintenance of neuronal excitability, neuronal network synchronization, and brain microenvironmental contributions to ictogenesis. Underlying etiologies of epilepsy and SE in dogs and cats are generally classified as genetic (idiopathic), structural-metabolic, or unknown. Diagnosis of convulsive SE is usually made based on historical information and the nature of the seizures. Patient specific variables, such as the history, age of seizure onset, and physical and interictal neurological examination findings can help hone the rule out list, and are used to guide selection and prioritization of diagnostic tests. Electroencephalographic monitoring is routinely used in people to diagnose SE and guide patient care decisions, but is infrequently performed in veterinary medicine. Nonconvulsive status epilepticus has been recognized in veterinary patients; routine electroencephalography would aid in the diagnosis of this phenomenon in dogs and cats. Status epilepticus is a medical emergency that can result in life-threatening complications involving the brain and systemic organs. Status epilepticus often requires comprehensive diagnostic testing, treatment with multiple anticonvulsant agents, and intensive supportive care.

Prevalence and Treatment of Neuropathic Pain in Kidney and Liver Transplant Recipients.

Neurologic complications are common after kidney and liver transplant. Neurologic complications affect mortality and morbidity in transplant recipients, and neuropathic pain is an important symptom affecting a patient's quality of life. The aim of the present study was to provide readers with our experience regarding causes and treatment of neuropathic pain in patients undergoing kidney and liver transplant at our transplantation center. The medical data of 553 kidney transplant recipients and 258 liver transplant recipients who received transplant procedures at the Baskent University Transplantation Center between 2008 and May 2016 were retrospectively reviewed. Fifty-one patients who were examined by an expert neurologist and diagnosed with neuropathic pain on the basis of clinical, neurologic examination, and laboratory findings were included for analyses. Among 811 transplant recipients, 51 patients (6.2%) were diagnosed with neuropathic pain. Of these, 22 were female and 38 were male patients, and 42 were kidney transplant recipients and 9 were liver transplant recipients. Causes of neuropathic pain included uremia, diabetes mellitus, ischemic peripheral arterial disease, inflammatory neuropathy, vasculitis, discopathy, postherpetic neuralgia, carpal tunnel syndrome, and multiple myeloma. Patients with symptoms too mild to affect daily life activities were treated conservatively. Plasmapheresis, gabapentin, pregabalin, alpha-lipoic acid, and duloxetine were administered as treatment modalities and medications. Neuropathic pain was lower in our transplant recipients than in the general population. Treatment medications were effective for transplant recipients at lower doses for the management of neuropathic pain impairing quality of life than doses for the general population.

66-Year-Old Woman With Falls and Confusion

66-Year-Old Woman With Falls and Confusion

Neurological and psychiatric manifestations of post Ebola syndrome in Sierra Leone

BackgroundNeurological and psychiatric sequelae in survivors of Ebola virus disease have been noted in previous epidemics, but few details have been documented. One case-report reported abnormal CT brain findings in one survivor. We aimed to document full neurological history and clinical examination findings, psychiatric screening, and the need for brain imaging in people who survived Ebola virus disease. MethodsAdults (>16 years) in Sierra Leone who had survived Ebola virus disease with defined criteria of confirmed disease and one major or two minor symptoms were invited to attend clinic. Patients underwent full history, neurological examination, and psychiatric screening. Patients were referred, as necessary, to a tertiary neurology and psychiatric clinic, where brain CT scans were requested. Findings87 (25%) of 354 patients in the initial cohort fitted the defined criteria. 38 of 45 patients who were contactable attended our screening clinic (24 women [63%], median age 34 years [IQR 25–43]). Median length of initial stay in hospital during Ebola virus disease was 21 days (13–28) and median time to our screening clinic post discharge was 431 days (402–497). 17 (45%) of the 38 clinic attenders reported loss of consciousness and seven (18%) reported seizures during their acute phase. In the screening clinic, 14 (50%) of 28 patients with headache reported eye symptoms (eye pain, itching, redness, blurred vision, or altered vision), seven (25%) photophobia, six (21%) intermittent fevers, five (18%) dizziness or vertigo, two (7%) tinnitus, and two (7%) scotoma. Headaches were usually intermittent and localised as frontal, unilateral, or band-like. 23 (61%) of the clinic attenders were offered referral to a tertiary neurological and psychiatric clinic, and 17 (42%) required CT brain scanning. At the screening clinic, psychiatric symptoms included insomnia (21/38, 55%), depression (12/38, 32%), and anxiety (11/38, 29%). InterpretationA broad range of important neurological and psychiatric sequelae were present in our selected group of Ebola virus disease survivors over a year after initial discharge. Intermittent headaches, associated with photophobia, intermittent fever, and dizziness or vertigo, were the most frequent neurological features. Common psychiatric symptoms included insomnia, depression, and anxiety. Our experience suggests that there is a need for tertiary level neurological and psychiatric clinics. FundingJTS is supported by the Wellcome Trust. MGS is supported by the UK National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections. This project is supported by the Enhancing Research Activity in Epidemic Situations.

Neuropsychiatric systemic lupus erythematosus in a geriatric patient: A case report

Systemic lupus erythematosus (SLE) is a multisystem connective tissue disorder with varied clinical presentations with late onset SLE occurring after the age of 50. Involvement of the central nervous system (CNS) in SLE may range from non-focal symptoms of cognitive dysfunction, an acute confusional state, to focal symptoms of transient ischaemic attacks and strokes. We report a case of an elderly male who presented with confusion, functional decline and fevers. On admission, he was febrile with a Glasgow Coma Scale (GCS) of 11 with no other focal neurological or systemic examination findings. Initial investigations pointed towards a diagnosis of possible tuberculous meningitis with a differential diagnosis of unidentified sepsis and malignancy still being entertained. However, a newly developed purpuric skin rash helped clinch the diagnosis of SLE and he was finally diagnosed as a case of late-onset neuropsychiatric systemic lupus erythematosus (NPSLE). He was started on intravenous (IV) hydrocortisone which was later switched to a tapering dose of oral prednisolone and made a significant improvement.

Colloid cyst of the third ventricle: a clinical series of 19-cases

Aim: Colloid cysts are benign tumors originating from primitive neuroepithelial or endodermic origin in the third ventricle. Asymptomatic, as well as paroxysmal headache, gait disturbance, nausea, vomiting, learning difficulty and death may occur. Computed tomography (CT) is also seen as a round or oval, non-contrasting lesion. Magnetic resonance imaging (MRI) also shows hyperintense at T1 weighed and isointens at T2 weighed sequences. Stereotactic aspiration, microscopic or endoscopic approaches, shunt can be applied. Total excision should be targeted.Materials and Methods: We aimed to investigate the age, sex, complaint, hydrocephalus presence, neurological examination findings, surgical method and results of 19 cases of colloid cyst in our clinic between 2012-2017.Results: Eleven of 19 cases were female (57.9%) and 8 were male (42.1%).The average age was 27.2 (2-62). The most common complaint was headache. Ptosis due to visual disturbance was seen in 5.3% (1 patient), ataxia in 10.5% (2 patients), hydrocephalus with memory loss in 31.5% (6 patients). Six patients underwent cystectomy with endoscopic third ventriculostomy (ETV) and transcranial surgery in 13 patients. Ventriculoperitoneal shunt was performed to one patient at eight months after surgery. Rhinorrhea and menengitis was seen in one patient. Medical theraphy was given to this patient. One patient died because of acute cerebral anfarct.Conclusion: Asymptomatic old patients must be followed periodically. Symptomatic patients must be treated surgically and it must be combined by V-P shunt if patients had hydrocephalus. One of the surgical endoscopic or transcranial technique can be selected. Transcortical or interhemispheric techniques may be preferred to transcranial techniques.Keywords: Colloid Cyst; Total Resection; Hydrocephalus; Endoscopic Third Ventriculostomy.

Cardiovascular risk factors and white matter hyperintensities in patients with migraine without aura.

White matter hyperintensities (WMHs) are observed in patients with migraine with aura (MWA) and without aura (MWO), but there are a limited number of studies regarding patients with MWA. In this study, we aimed to investigate the cardiovascular risk factors which may play a role in the development of WMHs in patients with MWO. This observational, analytical, case-control study was conducted between June 2016 and January 2017. It included 21 patients with MWO who had WMHs on brain MRI and 19 patients with MWO who tested normal on MRI (control group) at the Neurology Department Outpatient Polyclinic, Ankara Training and Research Hospital. The patients' data (history, family history, neurological examination findings, echocardiography findings, and cerebral MRI findings) were retrospectively reviewed. Age, gender, body mass index, blood lipid level, migraine duration, localization of headache, average number of headache per month, medication for headache attack, and echocardiography findings were similar between the two groups. (p>0.05). In this study, we did not find any association between cardiovascular risk factors and WMHs development in patients with MWO. The association of risk factors other than cardiovascular risk factors (genetic factors and oxidative stress) with the development of WMHs in patients with MWO should also be studied in future.