1.Evaluation of posterior reversible encephalopathy syndrome from different aspects: What is the role of serum LDH and albumin level in pathogenesis?
Ayse Guler ; Seyma Ciftci ; Cenk Eraslan ; Nese Celebisoy ; Hadiye Sirin
Neurology Asia 2016;21(2):169-176
Background: Posterior reversible encephalopathy syndrome (PRES), is characterized by headache,
lethargy, visual complaints and epileptic seizures. Brain imaging findings include abnormalities of the
white matter and the grey matter.The diagnosis currently relies on clinical manifestations and typical
neuroimaging findings. Different pathophysiological factors can play role in the disease process. The
purpose of this study is to review causes, clinical aspects, imaging-laboratory findings and prognosis in
patients diagnosed with PRES. Method: Patients who showed clinical and magnetic resonance imaging
(MRI) findings consistent with PRES between January 2011 and December 2014 were included in
the study. Patient data were collected retrospectively from hospital records.
Results:Total number of patients was 22 (18 female, 4 male). Median age was 28 years (range 18-84).
Comorbid conditions included eclampsia (n=10, 45%), pre-eclampsia (n=1, 4.5%), HELLP (hemolysis,
elevated liver enzymes, low platelet count) syndrome (n=1), primary kidney disease (n=3, 13%). Acute
elevation of blood pressure was found in 9 patients (40%). Five patients (22%) were using steroids or
immunosupressive drugs. Typical PRES imaging pattern with bilateral parieto-occipital involvement
was present in 15/22 patients (68%) and occipital involvement was present in 3/22 patients (14%).
Atypical neuroimaging features included frontal involvement in 10 patients (45%), basal ganglia gray
matter lesion in 1 patient (4%) and the cerebellum was involved in 3 patients (14%). Serum LDH
level was high in 13 patients (59%). Hypoalbuminemia was detected in 12 patients (54%).
Conclusion: Although hypertension is thoughtto be the main pathologic factor in the disease process,
endothelial dysfunction seems to be equally important.
Posterior Leukoencephalopathy Syndrome
2.What is the optimal dose of acetazolamide in the treatment of idiopathic intracranial hypertension
Aysin Kisabay Ak ; Gulten Tata ; Figen Gokcay ; Nese Celebisoy
Neurology Asia 2020;25(1):47-51
Objective: Acetazolamide is preferred as the first-line drug for the medical treatment of idiopathic
intracranial hypertension. In this study, the efficacy of different doses of the drug on visual functions;
visual acuity, optic disc appearance- papilledema grade and visual field-mean deviation (VF-MD) were
evaluated.
Methods: The medical records of 73 patients diagnosed as idiopathic intracranial hypertension
based on Modified Dandy Criteria and treated with acetazolamide who were on follow-up between
2010 and 2017 at the Neuro-ophthalmology Unit of Ege University Medical School, Department of
Neurology were analyzed. Improvement in the visual functions at the end of the sixth month in three
groups taking different doses of the drug; low (500, 750, 1000 mg/day), moderate (1500, 1750, 2000
mg/day) and high (3000, 4000 mg/day) were compared. Results: Improvement in visual acuity (p:
0.784), was not affected from different doses of the drug whereas papilledema grade (p: 0.014) and
VF-MD (p<0.001) were affected. Binary comparisons revealed significant improvement in the high dose group when compared with the moderate and low dose groups both for the papilledema grade (lowhigh: p: 0.003, moderate-high: p: 0.024 ) and VF-MD (low-high: p<0.001, moderate-high: p: 0.001)
Conclusion: Treatment with high doses of acetazolamide is associated with improvement in visual
field defects and regression of optic disc edema in idiopathic intracranial hypertension.
3.Neuro-Behçet’s disease mimicking cerebral abscesscomplicated by metronidazole-induced encephalopathy
Ayse Guler ; Ece Cinar ; Tuncer Turhan ; Husnu Pullukcu ; Taner Akalin ; Figen Gokcay ; Nese Celebisoy
Neurology Asia 2015;20(3):291-295
This is the report of a 32-year-old man with Behçet’s disease described dizziness, double vision and
headache. The cranial MRI demonstrated a ring enhancing nodular lesion in left medial occipital lobe,
and T2 hyperintense lesion in diencephalon mimicking abscesses. A stereotactic biopsy was performed.
The histology showed features of neuro-Behçet’s disease and an abscess was ruled out. During the
procedure till the histopathologic results were gathered he was given ceftriaxone and metronidazole
when cerebellar signs appeared. Cranial MRI showed additional symmetrical hyperintensities in bilateral
cerebellar dentate nuclei which was attributed to metronidazole toxicity. Repeat MRI performed forty
days later showed complete resolution of both dentate hyperintensities and diencephalic and occipital
ring enhancing lesions. This is the first case of neuro-Behcet’s disease complicated by metronidazoleinduced
encephalopathy. This case also showed that nodular ring enhancing lesions can be seen in
neuro-Behçet’s disease and can lead to difficulties in diagnosis and management.
Dizziness
4.Rebound intracranial hypertension after noninvasive treatment of intracranial hypotension: Case report and literature review
Ceren Cetin Akkoc ; Dilek Top Karti ; Figen Gokcay ; Nese Celebisoy
Neurology Asia 2019;24(3):271-275
Intracranial hypotension is a clinical syndrome characterized by orthostatic headache and low
cerebrospinal fluid pressure. Noninvasive management is the usual first line treatment. Epidural
blood patch is the treatment of choice if noninvasive treatments are ineffective. Cases with rebound
intracranial hypertension after epidural blood patch treatment have been reported in the medical literature
previously. We report here three patients with rebound intracranial hypertension who were treated
noninvasively for intracranial hypotension. This phenomenon has not been reported previously. The
underlying cause of intracranial hypotension was epidural anesthesia in the first, lumbar disc surgery
in the second patient, and idiopathic in the third patient. They had been treated either with bed rest
or with medical treatment not requiring epidural blood patch. After a short remission the patients
were seen with a different headache pattern. They all had papilledema on examination. Automated
perimetry revealed bilateral blind spot enlargement in Patient 1 and peripheral constriction in Patient
2. Cranial MRI and MRV in all three patients were normal. All the patients recovered very quickly
with acetazolamide 1.5 or 2gm/day. In conclusion, rebound intracranial hypertension should be kept in mind in patients with intracranial hypotension who developed changes in the headache pattern, had new symptoms of nausea, vomiting, blurred or double vision during follow-up. Rebound intracranial hypertension can develop after conservative treatment of intracranial hypotension.