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Öğe Airplane headache: An atypical case with autonomic symptoms and long duration(Asean Neurological Assoc, 2020) Atac, Ceyla; Ak, Aysin Kisabay; Cetin, Guldeniz; Batum, Melike; Gokcay, Figen; Selcuki, DenizAirplane Headache (AH) which is classified under headache attributed to disorder of homeostasis in International Classification of Headache Disorders (ICHD)-3 is a severe, unilateral, orbitofrontal headache that occurs during and caused by airplane travel. It remits after landing. AH cases with autonomic symptoms had rarely been reported. We present a 35-year-old male complained of five attacks of right-sided, unilateral, orbitofrontal headache accompanied with lacrimation, conjunctival injection and eye redness ipsilaterally, starting 20-30 minutes prior to landing. The headache duration varied between 30-90 minutes. AH diagnosis was made in the light of anamnesis and neurological examination. The secondary causes and primary headaches with autonomic symptoms were ruled out. As far as we know this is the first reported longer duration AH case with autonomic symptoms in the literature. AH is an underdiagnosed headache. We report this atypical AH case to call attention to this rare but treatable headache.Öğe c, Ceyla Atac d, e, Nes , e C,elebisoy e(Elsevier, 2021) Ak, Aysin Kisabay; Cinar, Celal; Dogan, Gozde Nur; Atac, Ceyla; Gokcay, Figen; Celebisoy, NesePatients with indirect carotid cavernous fistulas (CCF) were reviewed to emphasize the importance of diagnosing patients even with trivial findings and to raise awareness. Eighteen patients diagnosed as CCF were included. Neuro-ophthalmological findings before and after treatment, diagnostic investigations, treatment, clinical course was noted. Twelve patients were female (67%), 6 were males (33%) and the mean age at presentation was 54 years (range: 29-70 years). Conjunctival hyperemia was present in all patients. Seventeen (94%) patients had proptosis and diplopia, nine (50%) had orbital pain and/or headache, four (22%) had blurred vision, one (5.5%) had ptosis. On examination, 17 patients (94%) had restricted eye movements, four (22%) had low visual acuity and five patients had (28%) increased intraocular pressure (IOP). One patient had been diagnosed as myasthenia gravis and two as thyroid orbitopathy and had been on treatment accordingly before CCF was diagnosed. In two patients, bilateral findings were present despite unilateral CCF on angiography. Barrow Type B fistula was found in 7 (38%), Barrow Type D in 11 (62%) patients. In three bilateral CCF was detected. All were treated by endovascular intervention. Residual deficits at the sixth month control were, eye movement deficits in seven (39%), decrease in visual acuity in one (5.5%) and elevated IOP in one (5.5%) patient. Indirect CCF patients generally present with mild symptoms and the diagnosis may be overlooked. Mild progressive ophthalmoparesis with conjunctival hyperemia must be warning. Though rare bilateral CCF can be detected as well as unilateral CCF with bilateral findings.Öğe Calcitonin gene-related peptide (CGRP) levels in peripheral blood in patients with idiopathic intracranial hypertension and migraine(Elsevier, 2024) Ak, Aysin Kisabay; Gemici, Yagmur Inalkac; Batum, Melike; Karakas, Burak; Ozmen, Eser Yildirim; Gokcay, Figen; Celebisoy, NeseBackground: Calcitonin gene-related peptide (CGRP) plays a dominant role in migraine. This prospective study was designed to investigate CGRP levels in patients with idiopathic intracranial hypertension (IIH) and compare the results of migraine patients and healthy controls (HC). As a second objective, CGRP levels obtained from IIH patients defining sustained headache after the resolution of papilledema were compared with those not defining post-IIH headache. Methods: Thirty-six patients with IIH, 36 with episodic migraine (EM), 18 with chronic migraine (CM), and 36 HC were included in the study. CGRP levels were studied from blood samples obtained from the antecubital vein by using a commercial ELISA kit. Results: Serum CGRP levels of the patient groups were significantly higher than the HC (p < 0.001). As compared with controls, both CM (p Adj<0.001) and IIH (p Adj=0.039) had significantly increased levels of CGRP. Levels recorded from EM patients did not differ from the HC (p Adj=0.661). In 16 IIH patients, persistent headache was reported after the normalization of intracranial pressure (ICP). Twenty patients did not report post-IIH headaches. Comparison of serum CGRP levels of these two groups revealed significantly higher CGRP levels in patients with sustained headaches obtained from blood samples both at the initial and control visit (p Adj <0.001). Conclusions: CGRP levels of the patient groups were higher than the HC. High levels recorded in patients with IIH indicates the role of CGRP in IIH related headache and even higher levels in patients with sustained headache after normalization of ICP strengthens this finding.Öğe Can vestibular migraine development be predicted in patients with new onset migraine headaches?(Asean Neurological Assoc, 2022) Celebisoy, Nese; Ak, Aysin Kisabay; Atac, Ceyla; Ozdemir, Huseyin Nezih; Gokcay, Figen; Durmaz, Gulsum Saruhan; Karti, Dilek TopObjective: This study aims to determine the clinical features associated with the development of vestibular migraine (VM) in patients with migraine headaches. Methods: A cross-sectional, multicenter study was performed in nine tertiary neurology clinics. Patients with migraine without vestibular symptoms were classified as having migraine only (MO) and compared with patients with VM to determine any differences in clinical features, associated disorders, past medical history, and family history of migraine headaches. Moreover, we investigated the features that might predict the development of VM. Results: Two hundred forty-four patients with MO and 461 patients with VM were included. The age of onset of headache attacks was later in life for patients with VM (p<0.001). Migraine without aura (MwoA) was significantly more common than migraine with aura (MwA) in patients with VM (p=0.016). All associated features of migraine headaches were significantly more frequent in patients with MO than patients with VM (p<0.005). The same was true for all triggers, including fasting, sleep disturbances, menstruation, stress, flickering lights, and smartphones/computer games (p<0.005). A family history of migraine headaches was more common in MO patients (p=0.002). However, a previous history of motion sickness was significantly more common in patients with VM (p<0.001), as was aural fullness/tinnitus accompanying attacks (p<0.001). Logistic regression analysis indicated that aural fullness/tinnitus accompanying attacks and a previous history of motion sickness were risk factors for the development of VM. Conclusion: Patients with migraine reporting aural symptoms accompanying attacks and motion sickness in their past medical history are at increased risk of vestibular attacks fulfilling the diagnosis of VM later in life.Öğe Central Nervous System Angiosarcoma: A Case Report(Turkish Neurological Soc, 2018) Sari, Ummu Serpil; Ak, Aysin Kisabay; Ovali, Gulgun Yilmaz; Mavioglu, Hatice; Zeybek, Sinem; Ozgiray, Erkin; Sari, Muhammed Fatih; Ertan, YesimÖğe Cognıtıve functıons in idiopathic intracranial hypertensıon(Springer Heidelberg, 2024) Ak, Aysin Kisabay; Saritas, Aysegul Seyma; Batum, Melike; Gemici, Yagmur Inalkac; Karakas, Burak; Celebisoy, NeseObjectiveCognitive problems in idiopathic intracranial hypertension (IIH) is generally overlooked in the presence of disabling headache and threat to visual function. The aim of this study was to search for cognitive deficits in patients with IIH using neuropsychologic tests in addition to P300 potential recordings to assess cognition related brain activity.MethodsFifty IIH patients were examined using Montreal Cognitive Assessment Test, Stroop Test and Visual Aural Digit Span Test to measure different domains of cognition at the time of diagnosis. P300 potentials were recorded by using an oddball paradigm. Hospital Anxiety and Depression Scale was used to determine anxiety and depression. Quality of life (QoL) was assessed by SF-36. The results were compared with fifty healthy controls with matching age, gender and body mass index.ResultsNeuropsychologic tests revealed wide cognitive impairment including attention, working memory, executive function, naming, language, delayed recall and orientation in IIH patients. In addition, quality of life was affected in the sub-parameters of general health perceptions, emotional role functioning, vitality, mental health and bodily pain. P300 potential latencies were long and the amplitudes were reduced indicating deficits in attention and working memory. Anxiety scores were high, and health-related QoL was low mainly involving vitality, emotional and mental health. Cognitive dysfunction was not correlated with the levels of anxiety and the correlation with headache severity was mild.ConclusionA multidomain cognitive decline mainly involving attention and working memory was recorded in IIH patients. It was not correlated with anxiety and only a mild correlation with headache severity was present which may indicate a casual relationship between raised intracranial pressure and cognitive deficits. Screening is important as neuropsychological rehabilitation might be relevant in these patients.Öğe Comparison of clinical features in patients with vestibular migraine and migraine(Springer Heidelberg, 2023) Celebisoy, Nese; Ak, Aysin Kisabay; Atac, Ceyla; Ozdemir, Hueseyin Nezih; Gokcay, Figen; Durmaz, Gulsum Saruhan; Karti, Dilek TopVestibular migraine (VM) is accepted as the most common cause of spontaneous episodic vertigo. In most patients, vestibular symptoms follow migraine headaches that begin earlier in life. The aim of this multicenter retrospective study was to find out the differences between migraine patients without any vestibular symptoms (MwoV) and VM patients and to delineate the specific clinical features associated with VM. MwoV and VM patients were compared regarding demographic features, migraine headache years, headache attack frequency, intensity, symptoms associated with headache and vertigo attacks, presence of menopause, history of motion sickness and family history of migraine. Four-hundred and forty patients with MwoV and 408 patients with VM were included in the study. Migraine with aura was more frequent in patients with MwoV (p = 0.035). Migraine headache years was longer (p < 0.001) and headache intensity was higher in patients with VM (p = 0.020). Aural fullness/tinnitus was more common in patients with VM (p < 0.001) when all other associated symptoms were more frequent in patients with MwoV (p < 0.001) as well as attack triggers (p < 0.05). Presence of menopause and motion sickness history was reported more frequently by VM patients (p < 0.001). Logistic regression analysis indicated that longstanding history of migraine with severe headache attacks, aural fullness/tinnitus accompanying attacks, presence of menopause, previous motion sickness history were the differentiating clinical features of patients with VM.Öğe Factors determining the response to treatment in patients with vestibular migraine(Taylor & Francis Ltd, 2022) Ak, Aysin Kisabay; Celebisoy, Nese; Ozdemir, Huseyin Nezih; Gokcay, Figen; Durmaz, Gulsum Saruhan; Karti, Dilek Top; Toydemir, Hulya ErtasogluPurpose To find out clinical features associated with poor response to treatment in vestibular migraine (VM) Methods VM patients treated with drugs recommended in migraine prophylaxis were included in this multicenter study. Migraine features including type, age of onset of headache and vertigo attacks, attack frequency, intensity, associated symptoms, triggering factors, presence of interictal dizziness/imbalance, anxiety, depression, history of motion sickness, and family history of migraine were noted. Amitriptyline, flunarizine, propranolol, topiramate and venlafaxine were chosen depending on patients' individual requirements. Maximum dose of each drug was tried for 2 months to decide its efficacy. In the case of inefficacy, it was changed with another preventive drug of different class. If there was still no improvement, two drugs of different classes were combined. >= 50% reduction in attack frequency and severity in patients using one drug and a combination of two drugs was compared, with patients showing <50% reduction despite combination therapy, regarding their clinical features. Results The results of 430 VM patients, 65 men and 365 women with a mean age of 42.2 +/- 12.2 years (range: 17-74 years), were analyzed. Conclusion Cutaneous allodynia frequently associated with female sex, comorbid anxiety and depression and interictal dizziness/imbalance enhanced with comorbid anxiety were risk factors for reduced treatment response. Aural fullness might be the clue of impending concomitant Meniere's disease not responding to migraine preventives.Öğe Ischemic chiasmal syndrome associated with posterior communicating artery (PCoA) and tuberothalamic artery (TA) infarction: a case report(Springer-Verlag Italia Srl, 2020) Atac, Ceyla; Ak, Aysin Kisabay; Batum, Melike; Ari, Semih; Ovali, Gulgun Yilmaz; Celebisoy, NeseLesions affecting the body of the optic chiasm typically produce bitemporal hemianopia. the blood supply comes from the anterior communicating artery, anterior cerebral, posterior communicating, posterior cerebral, and basilar arteries. We herein report a young patient admitted to the emergency department with acute confusion, left-sided hemiparesis, hemihypoesthesia, and dysarthria. Bitemporal hemianopia was detected after resolution of confusion. on cranial magnetic resonance imaging (MRI), infarction in the right anterolateral thalamus in the territory of tuberothalamic artery (TA) and in posterior chiasma in the territory of the posterior communicating artery (PCoA) was revealed. Cerebral MR angiography showed luminal irregularity of the PCoA. the patient was presented to draw attention to the rare entity ischemic chiasmal syndrome.Öğe Quality of Life in Patients with Idiopathic Intracranial Hypertension and the Impact of the COVID-19 Pandemic(Taylor & Francis As, 2022) Celebisoy, Nese; Ak, Aysin Kisabay; Ozdemir, Huseyin Nezih; Gokcay, Figen; Eser, ErhanThe COVID-19 pandemic became a challenge to maintain care for patients with idiopathic intracranial hypertension (IIH). We aimed to find out how they were affected during lockdown. Thirty IIH patients admitted to hospital during the COVID-19 pandemic were studied. Their demographic and neuro-ophthalmological findings were evaluated. The World Health Organization - Five Well-Being Index (WHO-5), the EUROHIS Quality of Life (QOL) 8-item index, National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25), Headache Impact Test (HIT-6), and COVID-19 Fear Scale were used to assess QOL and pandemic-associated fear. Thirty age, sex, and body mass index matched volunteers constituted the control group. Apart from the COVID-19 Fear Scale and colour vision subscale of the NEI-VFQ-25, all scale scores were worse in IIH patients than in healthy control subjects. Patients with severe visual field defects had higher HIT-6 scores (p = .036). Both vision-specific and overall QOL was reduced in patients with IIH. Headache severity and disability were more prominent in patients with severe visual loss. Fear caused by the COVID pandemic was not different in IIH patients than in healthy control subjects.Öğe Trigeminal neuralgia following Tolosa-Hunt syndrome(Springer Heidelberg, 2021) Durmaz, Gulsum Saruhan; Ak, Aysin Kisabay; Gokcay, Figen; Celebisoy, Nese[No Abstract Available]Öğe Vestibular migraine and persistent postural perceptual dizziness: Handicap, emotional comorbidities, quality of life and personality traits(Elsevier, 2022) Ak, Aysin Kisabay; Celebisoy, Nese; Ozdemir, Huseyin Nezih; Gokcay, FigenObjective: To compare vestibular migraine (VM) and persistent postural-perceptual dizziness (PPPD) regarding dizziness associated handicap, emotional and somatic disorders, health-related quality of life (QoL) and per-sonality traits.Methods: Thirty patients for each group [VM, PPPD and healthy volunteers (HC)] were studied. Dizziness Handicap Inventory (DHI), Beck depression and anxiety scales, Somatic Symptom Scale-8 (SSS-8), Short Form (36) Health Survey (SF 36) and the Big Five Inventory (BFI) were used.Results: DHI sub-scores were significantly high in both patient groups in comparison with the HC (p < 0.001 for all). Emotional (p = 0.001) and functional (p = 0.022) sub-scores of the PPPD patients were worse. Anxiety and somatic symptom scores of VM (p = 0.026 and p < 0.001 respectively) and PPPD (p < 0.001 for both) and depression scores of the PPPD (p = 0.003) were higher than the HC. Both anxiety (p = 0.009) and somatization (p = 0.005) scores of the PPPD patients were higher than the VM. SF-36subscales were affected in both groups (p < 0.05). Vitality (p = 0.002), mental health (p = 0.045) and social role functioning (p = 0.006) of the PPPD group were worse than the VM. Higher scores for neuroticism (p < 0.001) was present for both groups. Scores for extraversion was low in PPPD patients (p = 0.010) in comparison with the HC.Conclusion: Dizziness associated handicap, anxiety and somatic symptom burden is high in both groups, even higher in PPPD with additional depression. Severe impairment in QoL is present with more severe impairment in emotional aspects in patients with PPPD. Neuroticism is a common personality trait for both groups with additional introversion in PPPD.Öğe Vestibular migraine, demographic and clinical features of 415 patients: A multicenter study(Elsevier, 2022) Celebisoy, Nese; Ak, Aysin Kisabay; Ozdemir, Huseyin Nezih; Gokcay, Figen; Durmaz, Gulsum Saruhan; Karti, Dilek Top; Toydemir, Hulya ErtasogluObjective: To evaluate demographic and clinical features of vestibular migraine (VM) patients Methods: Four hundred fifteen patients with VM were evaluated by using a structured questionnaire in addition to clinical examination. Results: The mean age of headache and vertigo onset was 25 years and 39 years, respectively. In 12.3%, benign paroxysmal positional vertigo (BPPV) was detected during the interictal period. Ten percent had hearing loss on audiometry, in 8.7% it was one-sided low-frequency sensory-neural hearing loss below 2000 Hz and the history was typical for Meniere's disease (MD) in addition to VM. Tinnitus was present in 94.4%, aural fullness in 83.4%, nausea in 72.2% and vomiting in 30.5% of patients with VM/MD. The prevalence of these symptoms was higher in patients with VM/MD than in pure VM. Median attack severity determined by visual analog scale measured in centimeters from 0 to 10 was 8 for headache and 7 for vertigo for the whole group. Severe headache was significantly correlated with age of < 43 years (OR: 6.831, 95% CI: [4.10-11.63]; p < 0.001) and severe vertigo was significantly correlated with age > 41 years (OR: 7.073, 95% CI: [4.55-10.98]; p < 0.001). Motion sickness was revealed from past medical history in 51.8%. Family history of migraine was present in 72.5% and the age of onset of both migraine headaches (p = 0.008) and vertigo attacks (p = 0.004) was lower in these patients. Conclusion: Younger patients suffered more severe headache attacks whereas vertigo attack severity was higher in the elderly. BPPV and MD were commonly associated with VM and VM/MD was accompanied by aural and autonomic features more frequently than pure VM. Previous history of motion sickness was detected in more than half of the whole group. Family history of migraine was associated with younger onset of migraine headaches and vertigo attacks.Öğe What is the optimal dose of acetazolamide in the treatment of idiopathic intracranial hypertension(Asean Neurological Assoc, 2020) Ak, Aysin Kisabay; Tata, Gulten; Gokcay, Figen; Celebisoy, NeseObjective: 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 (low-high: 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.