Introduction: In the midst of the coronavirus disease of 2019 pandemic, active immunization by effective vaccination gained utmost importance in terms of global health. The messenger RNA (mRNA) vaccines are novel strategies requiring clinical surveillance for adverse events. Case Report: We report a 43-year-old previously healthy female with an optic neuritis attack 24 hours following immunization with the second dose of coronavirus disease of 2019 mRNA BNT162b2 vaccine. A second transverse myelitis attack together with an elevated anti-AQP-4 antibody titer confirmed the diagnosis of neuromyelitis optica spectrum disorder. Conclusion: Our case identifies the BNT162b2 vaccine as a possible trigger for neuromyelitis optica spectrum disorder. This rare and potentially coincidental event has no implications for vaccine administration practices. However, further research is needed to elucidate the effects of mRNA vaccines on humoral and cell-mediated immunity.

Objective We aimed to research the effect of cognitive tasks on interictal electroencephalographic (EEG) recordings in patients with epilepsy who had reported cognitive functions as a seizure trigger. We investigated the usefulness of cognitive function tasks as a method of activation in standard-awake EEG in daily practice. Methods Standard-awake EEG with cognitive activation tasks consisting of verbal and arithmetic tasks was administered to 35 (11.7%) of 299 patients with epilepsy who reported cognitive functions as a reflex seizure stimulus. During the background EEG, patients were divided into 2 groups: group 1 (17 patients) with interictal epileptiform discharges (IEDs), and group 2 (18 patients) without IEDs. Results IEDs were activated by a verbal task in 11.4% of patients and by an arithmetic task in 5.7%. All activated patients were in the genetic/idiopathic generalized epilepsy (IGE) group. In group 1, IEDs were activated in 17.6% of patients by a verbal task and in 5.9% by an arithmetic task. Both verbal and arithmetic tasks showed provocative effect in one patient in group 2. Hyperventilation was the most effective activation method, followed by cognitive activation tasks and photic stimulation. The provocative effects of verbal and arithmetic tasks were comparable to those of photic stimulation. Conclusion Cognitive tasks might activate the IEDs in patients reporting cognitive functions as a seizure trigger, particularly in IGE. Brief and standardized cognitive activation tasks should be developed and applied as a method of activation during standard-awake EEG recordings to increase the diagnostic yield of EEG.

Re cei ved/Ge lifl Ta ri hi: 13.08.2013 Ac cep ted/Ka bul Ta ri hi: 14.02.2014 Cranial neuralgia is a rare form of headache disorders characterized with transient and unilateral attacks. Inflamatuar diseases and cervical compression are amongst the most common etiological factors even so idiopathic forms might be observed. International Classification of Headache Disorders (ICHD-2) made the classification of cranial neuralgias in 18 different groups. Occipital neuralgia, being a subgroup of cranial neuralgies, is a headache that involves anatomically at major, minor or third occipital nerve areas sometimes accompanying with sensory deficits or dysesthesia. Occipital neuralgia includes aching burning or throbbing headache that is often unilateral and continuous with intermittent shocking and shooting pain on the occipital nerve area. Patients with occipital neuralgia can be divided into those with structural causes and those with idiopathic causes. Structural lesions are cervical disc diseases, trauma, compression of the cervical discs. Tumors rarely metastasize to the paravertebral region and compression of the cervical nerve roots may result in occipital neuralgia. Our aim is to present a case with late onset medical refractory occipital neuralgia due to metastatic prostate cancer, emphasizing that relevant medical history should alert clinicans to the possibility of metastasis causing occipital neuralgia. Sum maryOksipital nevralji, büyük ve küçük oksipital sinirlerin bulunduğu arka oksipital bölgede hissedilen paroksismal bir baş ağrısıdır. Ağrı sıklıkla unilateral, zaman zaman şiddetlenerek elektrik çarpmasına benzer özellik gösteren, sürekli yanıcı-batıcı karakterdedir. Oksipital sinir alanı üzerine bası ile ağrı tetiklenir ve ağrıya duyarlılık eşlik edebilir. Oksipital nevralji sıklıkla idyopatik nedene bağlı olmakla birlikte nadiren enfeksiyonlar, osteoartrit veya vaskülit gibi enflamatuar hastalıklar, kök veya sinir basıları, travma, diyabet veya gut gibi sistemik hastalıklar ve C2-C3 sinir kökünü etkileyen tümörler gibi sekonder nedenlere bağlı olarak da ortaya çıkabilir. Özellikle atipik klinik sergileyen oksipital nevralji olgularında sekonder nedenler göz önünde bulundurulmalıdır. Bu bağlamda, ileri yaşta yeni başlayan ve medikal tedavilere dirençli bir oksipital nevralji olgusunu sunarak atipik olgularda ayrıntılı etiyolojik araştırmanın gerekliliğini vurgulamayı amaçladık. (Türk Nöroloji Dergisi 2014; 20:135-137 Özet

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