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Öğe Anterior Circulation Ischemia Due to Dolichoectatic Internal Carotid Artery(Elsevier Science Bv, 2010) Kumral, Emre; Gulec, Feray; Calli, GemIntracranial dolichoectatic carotid and middle cerebral artery (ICDA) may cause ischemia by multiple mechanisms, including thrombosis, embolism, and occlusion of the involved arteries. We sought clinical and hemodynamic mechanisms in 8 patients with ICDA and stroke, corresponding to 0.4% of our patients with ischemic stroke, and compared these data with those for patients having ICDA without stroke. Hypertension and transient ischemic attack were the significant findings in patients with stroke compared with those without stroke. Patients with stroke were more likely to have an embolism from the stagnated vascular bed and less frequently had compression of the neighboring structure of the elongated arteries.Öğe Balance in posterior and horizontal canal type benign paroxysmal positional vertigo before and after canalith repositioning maneuvers(Elsevier Ireland Ltd, 2009) Celebisoy, Nese; Bayam, Ece; Gulec, Feray; Kose, Timur; Akyurekli, OenderBenign paroxysmal positional vertigo (BPPV) is characterized by acute, brief and rotatory vertigo attacks provoked by changes in head position. Most patients complain of a loss of equilibrium and unstable gait during and between the vertigo attacks. Canalith repositioning maneuvers (CRM) relieve attacks and improve Postural stability. In this study balance ability of 32 patients with PC BPPV and 12 patients with HC BPPV before and after treatment with CRM was investigated. 50 healthy volunteers served as the control group. Static balance was measured as mean center of gravity sway velocity recorded in four different conditions: on a static platform and on foam with eyes open and closed. Dynamic balance was measured in tandem walk test. PC BPPV patients demonstrated greater sway velocity in stance on foam with eyes closed. After CRM the velocity decreased significantly. The results of the HC BPPV patients were not different from the healthy volunteers all through the four test conditions. Walking speed of the patients both with PC BPPV and HC BPPV was significantly low. It increased after treatment in both groups. In conclusion, patients with PC BPPV had impaired static balance ability due to a clot in the affected canal. Dynamic balance ability measured by walking speed was impaired both in PC and HC BPPV patients. Static and dynamic deficits improved significantly after CRM. (C) 2008 Elsevier B.V. All rights reserved.Öğe THE COURSE AND BRANCHING PATTERN OF THE MEDIAN NERVE IN THE FOREARM(Nobel Ilac, 2014) Gulec, Feray; Sengul, GulgunObjective: Determination of the course, distribution and branching patterns of the median nerve in forearm is aimed. Material and Method: Fifty forearms of 25 (23 male and 2 female) formaldehyde fixed cadavers were dissected and the cours and branching patterns of the median nerve were recorded. Results: In 6 of the 50 forearms (12%), the median nerve showed atypical course by sliding over the medial epicondyl. The terminal motor branches to the forearm muscles were formed very early before leaving the nerve trunk and could be followed macroscopically for long distances till the proximal sites. Individual variations of branching of these nerves were frequent and the most seen 6 variation patterns were existant in 33 of the 50 forearms. Martin Gruber anastomosis was detected in totally 6 forearms (12%); one cadaver bilaterally, onthe left side in one and on the right side in three forearms unilaterally. Conclusion: Complex motor functions specific to human hand are very important for functionality and life quality of the individual. Maintanance of these functions is an important issue in routine clinical practice mainly for practitionars in orthopedics, neurology and physical therapy and rehabilitation. The advance in medical technology needs more details than the classical contents of anatomy textbooks and detailed anatomical studies of the forearm and the median nerve maintain their importance.Öğe A dopamine dysregulation syndrome case presented with psychotic manic epizode(Journal Neurological Sciences, 2008) Gulec, Feray; Colakoglu, Zafer; Eker, Cagdas; Ozaskinli, SuhaA psychotic manic episode developed in a patient with Parkinson's disease as a consequence of the dopamine dysregulation syndrome due to high dose dopaminergic drug abuse. Manic episode is a rare incident caused by dopamine dysregulation syndrome or dopaminergic replacement treatment in the Parkinson's disease. In this case report, dopamin dysregulation syndrome and neurophsychiatric neuropsychiatric advers effects of dopaminergic drugs are discussed.Öğe Longitudinal Myelitis As The First Manifestation of Systemic Lupus Erythematosus(Journal Neurological Sciences, 2009) Celebisoy, Nese; Gulec, Feray; Bayrakci, Adem; Yargucu, FigenAcute longitudinal myelitis (ALM) as the initial manifestation of systemic lupus erythematosus (SLE) has been reported in just two cases. We herein present the third case associated with antiphospholipid antibodies with an unfavorable outcome. All patients with ALM should be tested for SLE and urgent treatment with intravenous pulse methylprednisolone and cyclophosphamide must be started. Alternative treatment trials must also be established as there are patients with permanent neurologic disability like ours despite appropriate therapy.Öğe Shift in Time Zone: The Biologic Clock and Neurology(Turkish Neurological Soc, 2018) Gulec, Feray; Durusoy, Raika; Celebisoy, NeseÖğe Single-shot, low-dose intratympanic gentamicin in Meniere disease: role of vestibular-evoked myogenic potentials and caloric test in the prediction of outcome(W B Saunders Co-Elsevier Inc, 2011) Gode, Sercan; Celebisoy, Nese; Akyuz, Aycan; Gulec, Feray; Karapolat, Hale; Bilgen, Cem; Kirazli, TayfunObjective: The aim of this study was to assess the efficacy and safety of single and low-dose intratympanic gentamicin therapy in patients with Meniere disease and who were monitored both with caloric tests and vestibular-evoked myogenic potentials (VEMPs) to see if VEMPs have an additional role in predicting the efficacy of the drug. Study design: This is a prospective cohort study. Setting: Tertiary referral center is the study setting. Patients: Twenty-five intractable Meniere disease patients were included as the study group. Intervention(s): Low-dose (16 mg/mL), single-shot intratympanic gentamicin was applied. VEMP and caloric test were applied 2 weeks after the application. Main outcome measure(s): Safety and efficacy of protocol were evaluated at the sixth month postoperatively with tonal audiogram and visual analog scale, respectively. Results: Mean average pure-tone hearing threshold at 0.5, 1, 2, 4, and 8 kHz was 49.6 and 51.0 dB before and after the application, respectively (P > .05). Mean pretreatment and posttreatment visual analog scale scores of patients were 17.6 mm (10-30 mm) and 74.6 mm (41-100 mm), respectively (P < .01). Posttreatment VEMPs were absent in 17, deteriorated in 2, and not changed in 6 patients. VEMP was a significant predictor of posttreatment visual analog scale score, whereas caloric test was not (P < .01). Conclusions: Low-dose, single-shot intratympanic gentamicin treatment proved to be effective and safe among intractable Meniere patients. VEMPs obtained at posttreatment second week were significant predictors of patients posttreatment sixth-month dizziness status and vertigo control. (C) 2011 Elsevier Inc. All rights reserved.Öğe Vestibular Evoked Myogenic Potentials in Splenius Capitis Muscle(Aves, 2013) Gulec, Feray; Celebisoy, Nese; Kose, TimurObjectives: Vestibular evoked myogenic potentials (VEMPs) are biphasic responses recorded from tense anterior neck muscles [sternocleidomastoids (SCM)] with loud sound stimulus. The aim of this study was to record VEMPs from the splenius capitis muscles (SPC). Method: Seventy-four healthy controls were studied. Recordings were performed from the ipsilateral SCM, contralateral and ipsilateral SPC muscles when the subjects were seated and turned their head contralaterally to the ear being tested. The recording sites were named as I, II and III respectively. Results: The responses were recorded in 100% at site I, in 98.6 % at site II, in 97.9 % at site III. The earliest responses were detected at sites II and I, followed by site III. The potential amplitude was determined by the muscle tension. The responses recorded both from flexor and extensor muscles had positive/negative polarity. Conclusions: Extensor neck muscles can also be used for VEMP studies and the responses can be recorded even from mildly contracted muscles which make it easier to study in patients with poor cooperation. Significance: Positive/negative polarity of the muscles recorded from all sites may indicate that sacculo-collic connections are mainly inhibitory in nature.Öğe Vestibular Evoked Myogenic Potentials in Splenius Capitis Muscle(Aves, 2013) Gulec, Feray; Celebisoy, Nese; Kose, TimurObjectives: Vestibular evoked myogenic potentials (VEMPs) are biphasic responses recorded from tense anterior neck muscles [sternocleidomastoids (SCM)] with loud sound stimulus. The aim of this study was to record VEMPs from the splenius capitis muscles (SPC). Method: Seventy-four healthy controls were studied. Recordings were performed from the ipsilateral SCM, contralateral and ipsilateral SPC muscles when the subjects were seated and turned their head contralaterally to the ear being tested. The recording sites were named as I, II and III respectively. Results: The responses were recorded in 100% at site I, in 98.6 % at site II, in 97.9 % at site III. The earliest responses were detected at sites II and I, followed by site III. The potential amplitude was determined by the muscle tension. The responses recorded both from flexor and extensor muscles had positive/negative polarity. Conclusions: Extensor neck muscles can also be used for VEMP studies and the responses can be recorded even from mildly contracted muscles which make it easier to study in patients with poor cooperation. Significance: Positive/negative polarity of the muscles recorded from all sites may indicate that sacculo-collic connections are mainly inhibitory in nature.Öğe Vestibular Evoked Myogenic Potentials in Subject With Superior Canal Dehiscence Syndrome(Journal Neurological Sciences, 2012) Gulec, Feray; Celebisoy, NeseSuperior canal dehiscence syndrome (SCDS) is characterized by absence of the roof of the superior semicircular canal. Sound stimuli of higher decibels can cause vertigo and oscillopsia in these patients. A 38-year-old lady complaining about vertigo attacks associated with loud sounds as well as coughing and sneezing was evaluated. Her audiogram revealed a mild conductive type hearing loss on the left side. The caloric responses were normal. Vestibular evoked myogenic potential (VEMP) latencies recorded from the sternocleidomastoid muscles (SCM) were normal bilaterally (p13 and n 23 latencies were 13.0 ms, 20.7 ms on the left side and 12.7 ms, 22.6 ms on the right side). The amplitude of the n13-p23 potential was 204 mu V on the left and 78 mu V on the right side. Repeated recordings showed that the amplitude asymmetry was persisting. Dehiscence of the superior canal acts as a third window and causes pressure and sound sensitivity. VEMPs can be recorded easily in patients with the abovementioned complaints to support the diagnosis before a high resolution temporal bone CT is performed.
