Person: KAHRAMAN KOYTAK, PINAR
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KAHRAMAN KOYTAK
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PINAR
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Publication Metadata only Peripheral nervous system assessment in acromegaly patients under somatostatin analogue therapy(SPRINGER, 2017) YAVUZ, DİLEK; Alibas, H.; Yavuz, D. Gogas; Koytak, P. Kahraman; Uygur, M.; Tanridag, T.; Uluc, K.Purpose Acromegaly is known to affect peripheral nervous system (PNS) causing carpal tunnel syndrome (CTS) and polyneuropathy. The frequency of these disorders and the evaluation methods vary among studies. In the present study, we aimed to examine PNS of acromegaly patients under somatostatin analogue (SSA) therapy. Methods Forty-eight acromegaly patients (26 F/22 M, 45.58 +/- 11.6 years) under SSA treatment and 44 healthy controls (25 F/19 M, 47.46 +/- 8.7 years) were assessed by symptom questionnaires, neurologic examination and electrophysiological studies. Results 87.5 % of the acromegaly patients had at least one abnormal finding regarding PNS. With the incorporation of palm-wrist median nerve conduction velocity method, we detected CTS in 50 % of patients. Polyneuropathy was less frequent (29.2 %). Both conditions were independent from the coexisting diabetes mellitus (p = 0.22 for CTS, p = 0.71 for polyneuropathy). Polyneuropathy but not CTS was more common among biochemically uncontrolled acromegaly patients rather than those under control (p = 0.03; p = 0.68, respectively). Conculsion Our findings emphasize the high prevalence of peripheral nervous system involvement in acromegaly patients under SSA therapy and importance of neurological evaluation of these patients. Early diagnosis and treatment of the disease may reduce the PNS involvement.Publication Metadata only Medial plantar-to-radial amplitude ratio: does it have electrodiagnostic utility in distal sensory polyneuropathy?(TAYLOR & FRANCIS LTD, 2017) ULUÇ, KAYIHAN; Koytak, Pinar Kahraman; Alibas, Hande; Ozden, Hatice Omercikoglu; Tanridag, Tulin; Uluc, KayihanPurpose of the study: We proposed a new electrophysiological parametermedial plantar (MP)-to-radial amplitude ratio (MPRAR), similar to sural-to-radial amplitude ratio (SRAR), in the diagnosis of distal sensory polyneuropathy (DSP), based on the concept that distal nerves are affected more and earlier than proximal nerves in axonal neuropathies. We aimed to investigate the diagnostic sensitivity of this parameter in diabetic DSP, together with sensitivities of SRAR and MP nerve action potential (NAP) amplitude. Materials and Methods: In 124 healthy controls and 87 diabetic patients with clinically defined DSP and normal sural responses, we prospectively performed sensory nerve conduction studies (NCS), and evaluated the MP NAP amplitude, MPRAR and SRAR values. We determined the lower limits of normal (LLN) of these parameters in the healthy controls and calculated their sensitivities and specificities in detecting DSP in diabetic patients. Results: MP nerve amplitude and MPRAR values were significantly lower in the patient group, compared to controls. However, SRAR values did not differ significantly between the two groups. The LLN of MP NAP amplitude was found to be 4.1 mu V. The cutoff values for SRAR and MPRAR were determined as 0.24 and 0.16, respectively. MPRAR was abnormal in 21.8% of patients. However, the most sensitive parameter in detection of DSP was MP NAP amplitude, which showed a sensitivity of 31% and a specificity of 100%. Conclusions: Although MPRAR is more sensitive than SRAR in detecting DSP, it does not provide additional diagnostic yield to the assessment of MP NCS alone in diabetic DSP patients with normal sural responses.Publication Metadata only The reliability of medial and lateral plantar nerve recordings in healthy elderly individuals(SPRINGER-VERLAG ITALIA SRL, 2015) ULUÇ, KAYIHAN; Keskin, Gokce; Koytak, Pinar Kahraman; Bastan, Birgul; Tanridag, Tulin; Us, Onder; Uluc, KayihanThe aim of this study was to investigate the reliability of medial plantar (MP) and lateral plantar (LP) nerve conduction studies (NCS) in healthy individuals aged > 65 years, and to obtain reference values for this age group. The study included 81 healthy subjects. MP response was absent in only 2 subjects, but LP response could not be obtained bilaterally in 43 of the 81 subjects. Regression analysis showed that MP NCS could be reliably performed in those aged a parts per thousand currency sign72 years and normal values for MP nerve in individuals aged 66-72 years would be strongly against a large-fiber neuropathy. However, LP response was absent in 53.1 % of the healthy elderly subjects; therefore, we think it is unreliable to study the LP nerve in this age group.Publication Open Access Brainstem Reflexes in Systemic Lupus Erythematosus Patients Without Clinical Neurological Manifestations(AVES, 2017-05-08) SÜNTER, GÜLİN; Salcini, Celal; Bastan, Birgul; Sunter, Gulin; Kahraman Koytak, Pinar; Yilmaz, Orhan; Tanridag, Tlin; Us, Onder; Uluc, KayihanIntroduction: We aimed to assess central and peripheral nervous system involvement in systemic lupus erythematosus (SLE) patients without any neurological signs and symptoms by performing electrophysiological investigations. Methods: Thirty-eight SLE patients and 35 healthy volunteers participated in this study. Peripheral nerve conduction and brainstem reflexes were evaluated by performing nerve conduction studies (NCSs) and blink reflex (BR) and masseter inhibitory reflex (MIR) recordings. Results: Eleven patients (29%) had an abnormality in at least 1 NCS parameter, and 1 (2.6%) patient was diagnosed with polyneuropathy. The number of patients with abnormal BR and MIR was 23 (60.5%) and 14 (37%), respectively. The contralateral R2 latency of BR and the silent period 1 (SP1) latency of MIR were significantly prolonged in the patients compared with the controls (p=0.015 and p<0.001, respectively). Conclusion: This study showed that irrespective of peripheral nervous system involvement, brainstem reflexes could be affected in SLE patients even without clinical neurological findings. Brainstem reflex abnormalities suggested that the functional integrity of the inhibitory or excitatory interneurons in the lateral caudal pons and lateral medulla is disturbed in SLE patients.Publication Metadata only Progressive dysarthria and dysphagia in an otherwise healthy girl(PERGAMON-ELSEVIER SCIENCE LTD, 2013) EKİNCİ, GAZANFER; Koytak, Pinar Kahraman; Alibas, Hande; Ekinci, Gazanfer; Uluc, KayihanPublication Metadata only Accuracy and reliability of magnetic resonance imaging in the diagnosis of idiopathic intracranial hypertension(2022-10-01) ULUÇ, KAYIHAN; ÇİMŞİT, NURİ ÇAGATAY; ILGIN, CAN; DERİCİOĞLU, VOLKAN; KAHRAMAN KOYTAK, PINAR; Kuzan B. N. , ILGIN C., Kuzan T. Y. , DERİCİOĞLU V., KAHRAMAN KOYTAK P., ULUÇ K., ÇİMŞİT N. Ç.© 2022 Elsevier B.V.Purpose: To determine the diagnostic utility of brain magnetic resonance imaging (MRI) findings in patients with idiopathic intracranial hypertension (IIH) and to investigate the significance of evaluating radiological findings together with neurological and ophthalmological data in the diagnosis of IIH. Materials and Methods: All consecutive patients diagnosed with IIH in our tertiary neuro-ophthalmology center between January 1, 2018 and March 15, 2020, were included in the study. The clinical, radiological, and ophthalmological findings of IIH patients were compared with the control group with similar demographic characteristics. Results: A total of 98 patients, 49 cases and 49 controls, were included in the study. Lateral ventricular index had the highest area under the curve (AUC) value (0.945) for prediction of disease group followed by sella height category (AUC = 0.915) and optic nerve tortuosity (AUC = 0.855) According to the multivariate model we developed, caudate index (OR = 0.572, 95% CI 0.329–0.996), lateral ventricle index (OR = 3.969, 95% CI 1.851–8.509) and bilateral optic nerve tortuosity (OR = 22,784, 95% CI 2.432–213.450) were significant predictors for disease group. Conclusion: Tortuosity in the optic nerve, lateral ventricular index and caudate index can be used as MRI parameters supporting the diagnosis of IIH in clinically suspicious cases. A holistic approach to the clinical and radiological findings of the cases in the diagnosis of IIH can prevent overdiagnosis and enable early correct diagnosis.Publication Metadata only Headache During Air Travel: An Unusual Cause of Reversible Cerebral Vasoconstriction Syndrome(WILEY-BLACKWELL, 2015) MİDİ, İPEK; Alibas, Hande; Ceferova, Shebnem; Koytak, Pinar Kahraman; Uluc, Kayihan; Midi, Ipek; Elmaci, Nese Tuncer; Aktan, Sevinc; Tanridag, TulinPublication Open Access Motor-Unit Number Estimation Is Sensitive in Detecting Motor Nerve Involvement in Patients with Carpal Tunnel Syndrome(KOREAN NEUROLOGICAL ASSOC, 2016) SÜNTER, GÜLİN; Yilnnaz, Orhan; Sunter, Gulin; Salcini, Celal; Koytak, Pinar Kahraman; Tanridag, Tulin; Us, Onder; Uluc, KayihanBackground and Purpose We compared the motor-unit number estimation (MUNE) findings in patients who presented with signs and/or findings associated with carpal tunnel syndrome (CTS) and healthy controls, with the aim of determining if motor-unit loss occurs during the clinically silent period and if there is a correlation between clinical and MUNE findings in CTS patients. Methods The study investigated 60 hands of 35 patients with clinical CTS and 60 hands of 34 healthy controls. Routine median and ulnar nerve conduction studies and MUNE analysis according to the multipoint stimulation method were performed. Results The most common electrophysiological abnormality was reduced conduction velocity in the median sensory nerve (100% of the hands). The MUNE value was significantly lower for the patient group than for the control group (p=0.0001). ROC analysis showed that a MUNE value of 121 was the optimal cutoff for differentiating between patients and controls, with a sensitivity of 63.3% and a specificity of 68.3%. MUNE values were lower in patients with complaints of numbness, pain, and weakness in the median nerve territory (p<0.05, for all comparisons), and lower in patients with hypoesthesia than in patients with normal neurological findings (p=0.023). Conclusions The MUNE technique is sensitive in detecting motor nerve involvement in CTS patients who present with sensorial findings, and it may be useful in detecting the loss of motor units during the early stages of CTS. Larger-scale prospective clinical trials assessing the effect of early intervention on the outcome of these patients would help in confirming the possible benefit of detecting subclinical motor-unit loss in CTS.Publication Metadata only Reference jitter values for the sternocleidomastoid muscle with concentric needle electrodes(WILEY, 2021) ULUÇ, KAYIHAN; Kula, Ezgi; Tanridag, Tulin; Kahraman Koytak, Pinar; Uluc, KayihanBackground The aim of this study was to establish reference jitter values for the voluntary activated sternocleidomastoid (SCM) muscle using a concentric needle electrode (CNE). Methods The study included 39 healthy participants (20 female and 19 male) aged 18-77 y. Jitter was expressed as the mean consecutive difference (MCD) of 80-100 consecutive discharges. Filters were set at 1 and 10 kHz. The mean MCDs for all participants were pooled, and the mean value +2.5 SD was accepted as the upper limit for the mean MCD. The upper limit for individual MCD was calculated using +2.5 SD of the upper 10th percentile MCD for individual participants. Results Mean age of the participants was 45 +/- 14.5 y. Mean MCD was 16.20 +/- 2.23 mu s (range: 12-21 mu s), and the upper limit of normal for mean MCD was 21.8 mu s. The mean value for 823 individual jitters was 23.3 +/- 4.61 mu s (range: 6.6-36.9 mu s), and the upper limit of normal for each individual jitter was 34.6 mu s. Conclusions The present findings indicate that upper normal limit for mean MCD is 22 mu s and for individual data it is 35 mu s.Publication Metadata only A Case with Leukoencephalopathy with Brainstem and Spinal Cord Involvement and Elevated Lactate (LBSL) with Its Characteristic Clinical and Neuroimaging Findings(SPRINGER HEIDELBERG, 2014) ULUÇ, KAYIHAN; Alibas, H.; Koytak, P. K.; Ekinci, G.; Uluc, K.