Background Fahr’s syndrome (or Fahr’s disease) is a rare, neurological disorder characterized by bilateral calcification in the cerebellum, thalamus, basal ganglia, and cerebral cortex as a result of calcium and phosphorus metabolism disorder. The patients may be asymptomatic and clinical symptoms represent a wide range of neurologic manifestations and nonspecific neuropsychiatric disorders. We report an unusual case of Fahr’s syndrome which was asymptomatic and incidentally diagnosed by generalized tonic-clonic seizure in a patient with SARS-CoV-2 (COVİD-19) pneumonia. Case presentation The patient was a 68-year-old female and admitted to our emergency department suffering from cough and fatigue. After thorax computed tomography (CT) and SARS-CoV-2 PCR test, she was diagnosed as COVID-19 pneumonia. In the intensive care unit, the patient had a tonic-clonic convulsion starting from the left arm and spreading to the whole body. Fahr’s syndrome was diagnosed after a cranial CT scan and blood metabolic panel test. Conclusions As a result of the clinical, radiological, and biochemical evaluations, the patient was diagnosed incidentally as Fahr’s syndrome associated with hypoparathyroidism. Seizures could be induced by hydroxychloroquine that was in the COVID-19 treatment or the inflammation caused by COVID-19 pneumonia. The association between the mortality of COVID-19 pneumonia and Fahr’s syndrome is unknown which needs further research.

Aim. Ischemic strokes are about 80-85% of the strokes, third common cause of mortality in the world. Due to ischemia, neurons are damaged, blood brain barrier (BBB) is disrupted and inflammation is triggered. Although the cell mediated immun response in ischemic stroke has been showed by previous studies,there is no excessive database is available for humoral immun response. In this study, we aim to determine presence and amount of intrathecal immunglobulins after ischemic strokes as a result of humoral immun response in patients with the first and recurrent ischemic stroke. Thus,we could elucidate the presence of humoral immune response effect in long-term prognosis of ischemic stroke. Methods. In this study, 51 patient were included. 32 patients had first and 19 patients had recurrent ischemic stroke. Cerebrospinal fluid (CSF) samples were taken within 72 hours from the symptoms onset by lomber punction. Cell count, CSF Ig G, M, A and microalbumin levels were assessed in CSF samples, also serum Ig G, M, A and albumin levels were measured simultaneously. Albumin and Ig G index and CSF Ig G/CSF albumin ratios were calculated. Infarct volumes of the patients were calculated from computed cranial tomography (CCT) and/or magnetic resonance diffusion weighted imaging (DW MRI). Glasgow Coma Scale (GCS) and National İnstitutes of Health Stroke Scale (NIHSS) were used at the admission, modified Rankin Scale (MRS),Barthel index (BI) and NIHSS were used at the time of discharge from the hospital. Results. Albumin index was normal in the patients with their first ischemic stroke but slightly elevated in the recurrent ischemic stroke group. The CSF Ig G levels (p<0.001), CSF Ig G/CSF albumin ratio (0.32 ± 0.04) and CSF Ig G index, (1.13 ± 0.16) were higher in the recurrent ischemic stroke group. Also unlike the first group, in the recurrent ischemic stroke, there was a a significant positive correlation between the infarct volumes and levels of IgG (p<0.001). Considering to MRS and BI, MRS was higher in recurrent ischemic stroke group (p=0.001) and Barthel index was lower (p=0.009). Conclusion. Our results showed the intrathecal synthesis of IgG in recurrent ischemic stroke and the role of humoral immune system in the pathophysiology of recurrent ischemic stroke. However the effect of humoral immune system on the patients'clinic, the prognosis of stroke and disability due to stroke is contraversial.Keywords: Ischemic stroke, cerebrospinal fluid, blood brain barrier, intrathecal immunoglobulin synthesis, humoral immune system, inflamation Özet Amaç. İskemik inme, dünya genelinde mortalitenin 3. en sık nedeni olan inmenin, yaklaşık %80-85'ini oluşturur. İskemiye bağlı olarak nöronlarda yıkım meydana gelir, kan beyin bariyeri(KBB) bozulur ve inflamasyon tetiklenir. İskemik inmede hücresel immün yanıtın rolü önceki çalışmalarda gösterilmiş olup humoral immun yanıtla ilgili oldukça sınırlı sayıda veri mevcuttur. Bu çalışmayla iskemik inmeli hastalarda humoral immun cevabın sonucu olarak intratekal sentezlenen immunglobu...

Background: Medication overuse headache (MOH) is the worsening of an underlying headache due to the overuse of its acute treatment. Unintentionally, healthcare professionals may contribute to this condition. Health professionals play an important role in preventing this increasingly frequent and difficult-to-treat condition. Objective: To investigate MOH awareness among physicians with headache through a survey conducted among medical doctors on our university campus. Methods: This was an observational cross-sectional study about MOH awareness. The total number of medical doctors working in the Dokuz Eylül University Health Campus was provided by the administrative unit. A total of 18 questions were prepared and administered on a voluntary basis to obtain information about MOH awareness. Results: A total of 312 medical doctors were surveyed, including 198 (63.5%) from internal medical sciences, 81 (26%) from surgical medical sciences, and 33 (10.5%) from basic medical sciences. Half of the physicians in our sample were unaware of MOH. Our results showed that awareness of MOH, was quite low even among medical doctors. Conclusions: MOH causes both labor and financial losses to countries and impairs the quality of life of patients. Preventing excessive use of medications by raising awareness among doctors is an important step to prevent the development of MOH.

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Background. In Parkinson’s disease (PD), dopamine deficiency is present not only in the nigrostriatal pathway but also in the retinal and visual pathways. Optic coherence tomography (OCT) can be used as morphological evidence of visual influence from early nonmotor symptoms. The aim of this study was to investigate the relationship of OCT and visual evoked potentials (VEPs) of eyes with the severity of clinical findings and ocular findings in PD. Methods. A group of 42 patients diagnosed with idiopathic PD and a control group of 29 people between the ages of 45–85 were included in our study. VEP was recorded in the patient and control groups. OCT measurement was made with the Optovue spectral-domain device. Foveal thickness and macular volume were measured in the foveal region and in the parafoveal and perifoveal regions in the temporal, superior, nasal, and inferior quadrants. RNFL (retinal nerve fiber layer) was measured in temporal, superior, nasal, and inferior quadrants. Ganglion cell complex (GCC) was evaluated in the superior and inferior quadrants. Using the UPDRS clinical scale, the relationship between measurements and the differences between the control group and the patient group were evaluated. Results. Among the OCT values in our study, foveal, parafoveal, perifoveal thickness, macular volume, RNFL, and GCC measurements were performed for the right and left eyes, and no difference was found between the patient group and the control group. There was no difference in VEP amplitude and latency values between the patient and control groups. The relationships between UPDRS and modified Hoehn Yahr staging and OCT and VEP measurements in the patient revealed no correlation. Conclusions. Studies on whether OCT measurements can functionally be a marker or which segments are more valuable for disease progression in patients with PD are needed. Visual dysfunction in PD cannot be attributed only to retinal pathology; however, the retina may provide monitoring of the status of dopaminergic neurodegeneration and axonal loss in PD.