Sir,We report a 51-year-old woman with coma and high-anion-gap metabolic acidosis following a supposed transdermal methanol intoxication. She had a 7-year history of epilepsy. The patient was admitted to the emergency service with an episode of tonic-clonic convulsions similar to previous attacks. Cranial computed tomography showed no abnormalities. She was discharged from hospital. Eighteen hours later, she was brought to the emergency service again with a Glasgow coma scale score of 3. The patient's vital signs included a heart rate of 105 beats/min, blood pressure of 80/60 mmHg and body temperature of 36.7 8C. Her pupils were dilated with an absent light reflex. Laboratory examinations showed the following results: serum sodium, 138 mmol/l; potassium, 4.5 mmol/l; chloride, 105 mmol/l; creatinine, 1 mg/dl; blood urea nitrogen, 20 mg/dl; glucose, 138 mg/dl. The arterial blood gases were as follows: pH 7.10; Po 2 ¼ 159 mmHg (21.2 kPa); Pco 2 ¼ 17.9 mmHg (2.4 kPa); HCO 3 ¼ 9.1 mmol/l, with an anion gap of 28 mmol/l. The lactate level was 3.7 mmol/l. Urinary ketones were negative. She was mechanically ventilated and intravenous sodium bicarbonate infusion was given to correct the acidosis. Despite bicarbonate infusion, the acidosis could not be corrected; therefore, a period of haemodialysis was performed on the third day. Salicylate and methanol analyses could not be performed in our hospital. Therefore, samples were sent to another hospital, revealing a normal S-salicylate level and an S-methanol value of 3.3 mg/dl. The patient's relatives denied oral intake of cologne, spirit or ethanol, but the patient had suffered from headache on the days prior to hospitalization, and used spirit to massage her head on several occasions. One more period of dialysis was performed. The high-anion-gap acidosis resolved, but the neurological status did not improve. She died on the fourth day of hospitalization.Fatal methanol poisoning can result from many sources and routes. Although almost all reported cases in the literature have occurred after oral ingestion, absorption via the transdermal route may lead to intoxication (1, 2). It may be difficult to make a diagnosis of methanol poisoning if no history of ingestion has been obtained. In this patient, the absence of a history of ingestion resulted in a delay in diagnosis. As the patient had a history of epilepsy, the possibility of a metabolic condition precipitating the convulsions was not considered.Various factors complicate the correlation of serum methanol concentrations with clinical effects, including differences in sampling time, individual variation in methanol metabolism, concentration of toxic metabolites and the concomitant ingestion of ethanol (3). The low serum methanol concentration in this patient can be correlated with the sampling time of 3 days after admission and the increase in elimination as a result of dialysis. In the absence of S-methanol analyses, the use of osmolal and anion gaps to establish an early diagnosis is crucial (4). In this patient, a suspi...

Bir üniversite hastanesi noroloji yoğun bakım ünitesinde gelişen enfeksiyonların değerlendirilmesi Evaluation of nosocomial infections in a neurological intensive care unit of a university hospital Amaç: Hastane enfeksiyonları (HE) sıklığı, uzamış yaşam, gelişen teknoloji, artmış invaziv girişimler ve uzamış yatış nedeniyle giderek artmaktadır. Yoğun bakım üniteleri (YBÜ) HE'nin en sık görüldüğü hastane birimleridir. Nöroloji YBÜ (NYBÜ)'de gelişen HE'ler altta yatan primer hastalıklar, genel durum bozukluğu, artmış invaziv işlemler sebebi ile artmış mortaliteye yol açar. Bu çalışmada NYBÜ'de bir yıl içinde invaziv alet kullanımı gelişen enfeksiyonları, izolatlarını değerlendirmeyi planladık. Gereç ve Yöntem: Çalışmaya 2017 yılı içerisinde takip edilen 232 hasta alınmış, enfeksiyon kontrol komitesi (EKK) hemşireleri ve Enfeksiyon Hastalıkları Anabilim Dalı'nca NYBÜ'ne gerçekleştirilen vizitlerde HE tanısı almış hastalar, izolatlar, direnç profilleri, tutulum tanımları incelenmiştir. Bulgular: Çalışmamızda NYBÜ'de yatan hastalarda mortalite %27,15, HE gelişen grupta ise mortalite %56,66 olarak bulunmuştur. En sık görülen enfeksiyon %43,3 ile ventilatör ilişkili pnömoni (VIP) en sık etken ise %28,9 ile Acinetobacter baumannii saptanmıştır. Sonuç: NYBÜ'de EKK'nın sık rastlanan nozokomiyal patojenlerin yayılma ve bulaşmasına karşılık alacağı tedbirlere uyum sağlamak, standart önlemlere ve el hijyenine riayet etmek ve gereksiz invaziv alet kullanımından kaçınmak gerekmektedir. Enfeksiyon oran ve hızları değerlendirilmeli, ulusal sürveyans verileri ile karşılaştırılmalıdır. Sık karşılaşılan patojenler ve antibiyotik direnç özelliklerinin iyi tanımlanması ampirik tedavinin uygun ve vaktinde başlanmasında, morbidite ve mortalite azalmasında önemlidir. Anahtar Sözcükler: Enfeksiyon; enfeksiyon Kontrol; yoğun bakım ünitesi. Introduction: The frequency of nosocomial infections (NI) are gradually increasing because of prolonged life, advancing technology, increasing invasive procedures. NI are mostly seen in intensive care units. NI, developed in neurology intensive care unit (NICU), lead to increased mortality because of underlying primer diseases, general medical condition disorder, and increased invasive operations. In this study, we aimed to evaluate the use of invasive instrument,developing infections,and isolations in a year. Methods: 232 patients (followed in 2017) are included in this study. Patients diagnosed with NI, isolates, resistance profiles, and involvement are examined in the visits to NICU by the nurses of infection control committee(ICC) and the Department of Infectious Diseases. Results: In our study, the mortality in NICU patients is %27,15 and in NI group the mortality is %56,66. The most common infection is ventilator-associated pneumonia with %43,3 (VAP) and the most common factor is Acinetobacter baumannii with %28,9. Discussion and Conclusion: It is necessary to coordinate with precautions (taken by ICC) against to extension and contagion of common nosocomial pathogens, to consider standart precautio...

Background and objectivesBotulinum toxin injection has been used for many years for various indications such as cervical dystonia, blepharospasm, oromandibular dystonia, hemifacial spasm in neurology. Botulinum toxin injections have been made in our clinic for about ten years. We want to report our experiences about botulinum toxin treatment in neurologic disease.MethodsIn this study, the data of the patients receiving BoNT injection between January 2018 and December 2019 was retrospectively analyzed. Age, gender, botulinum toxin indications, and mean dose, duration of efficacy, side effects noted for each injection were recorded.ResultsThere were 122 patients who received botulinum toxin injections between January 2018 and December 2019. Of the 122 patients identified, 28 had cervical dystonia, 61 had HFS, 21 had blepharospasm, 4 had generalized dystonia, 1 had hemidystonia following thalamic bleeding, 1 had tardive dystonia, 4 had migraine, 1 had bruxism and 1 had both migraine and bruxism.ConclusionBoNT injection is a treatment that has been used for various indications in neurology for almost 40 years. Side effects are limited and temporary with appropriate injections. We also had a wide range of indication profiles and high numbers of patients to whom we administered the BoNT treatment.

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Multipl miyelom plazma hücrelerinin neoplastik proliferasyonuyla seyreden sistemik bir hastalıktır (1). Multipl miyelomun ekstramedüller tutulumu nadirdir ve sadece hastaların %3-5'inde görülür. Genellikle deri, nazofarinks, larinks, üst solunum yolu ve merkezi sinir sistemi (MSS) etkilenir. MSS tutulumu, hastaların tahminen %1'inde görülür (2). Multipl miyelomlu hastalarda orbital tutulum, santral sinir sistemi tutulumları içinde seyrektir (3). İkinci, 3. ve 6. kraniyal sinir tutulumu sık görülür, 6. kraniyal sinir tutulumu bunlar içinde en sık olanıdır (2). Kavernöz sinüs tutulumu ise çok nadirdir ve tedaviye dirençli hastalıkla ve kötü sonuçla birliktedir (5). Multipl myeloma is a systemic disease with neoplastic proliferation of plasma cells. Cavernous sinus involvement is rare in multipl myeloma. The role of imaging with MRI to exclusion of involvement is great because the cavernous sinus can be evaluated very well by magnetic resonance imaging (MRI). Our case, a seventy seven-year-old female patient, applied to our policlinic with visual disturbance in the left eye. In the neurological examination of the patient; left eye was inside in the primer position, bilateral external view limitation was present marked in the left eye and downward view limitation was present in the left eye. Patient's brain MRI showed patchy and nodal signals in the frontoparietal lob borderzone area may be compatible with infarct and causing asymmetric enhancement of the left cavernous sinus and expanding soft tissue lesion was detected. The patient was evaluated as multiple myeloma-associated left cavernous sinus involvement and the patient was directed to oncologic treatment center to re-evaluate her oncologic therapy. Since cavernous sinus involvement is rare in multiple myeloma, we found this patient worthy to present.

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