Background and objectives: Cranial magnetic resonance imaging findings of patients considered to be cryptogenic stroke may be useful in determining the clinical and prognostic significance of arrhythmias, such as atrial premature beats and atrial run attacks, that are frequently encountered in rhythm Holter analysis. This study was conducted to investigate the relationship between short atrial runs and frequent premature atrial contractions detected in Holter monitors and infarct distributions in cranial magnetic resonance imaging of patients diagnosed with cryptogenic stroke. Materials and Methods: We enrolled the patients with acute ischemic stroke whose etiology were undetermined. We divided the patients in two groups according to diffusion-weighted magnetic resonance imaging as single or multiple vascular territory acute infarcts. The demographic, clinical, laboratory, echocardiographic, and rhythm Holter analyses were compared. Results: The study investigated 106 patients diagnosed with cryptogenic stroke. Acute cerebral infarctions were detected in 31% of the investigated patients in multiple territories and in 69% in a single territory. In multivariate logistic regression analysis, the total premature atrial contraction count (OR = 1.002, 95% CI: 1.001–1.004, p = 0.001) and short atrial run count (OR = 1.086, 95% CI: 1.021–1.155, p = 0.008) were found as independent variables that could distinguish between infarctions in a single or in multiple vascular territories. Conclusions: Rhythm Holter monitoring of patients with infarcts detected in multiple vascular territories showed significantly higher premature atrial contractions and short atrial run attacks. More effort should be devoted to the identification of cardioembolic etiology in cryptogenic stroke patients with concurrent acute infarcts in the multiple vascular territories of the brain.

Spontaneous intracranial hypotension was first described by Schalternbarn. Severe complications like cerebral venous thrombosis and subdural hemorrhage are seldomly seen. A 40-year-old man was examined for weakness of right arm started 9 months earlier and aggravated in last 3 months. He was undergo a lumbar punction because of a demyelinating plaque at C2 level in MRI. After 10 days of lumbar punction he experienced a generalised tonic clonic seizure. At cranial MRI and venography thrombosed superior sagittal and right transverse sinus and image of pachymeningitis, caused by intracranial hypotension were observed. Coincidence of these two situations together was seldomly found at literature. Thrombosis can both effect the sinuses and cortical veins. Spontaneous intracranial hypotension is a risk factor for CVT, but at only 2% CVT is seen as a complication. We think that our case can add addition to literature by having this coincidence.

Bu çalışma Multipl Skleroz (MS) tanılı hastalarda yorgunluk ile aktivite-rol yeterliliği ve önemi arasındaki ilişkiyi incelemek amacıyla gerçekleştirildi. Gereç ve Yöntem: Çalışma, Trakya Üniversitesi Hastanesinde Şubat-Haziran 2018 tarihleri arasında 26 MS hastası ile gerçekleştirildi. Bireylerin, engellilik durumları Genişletilmiş Özürlülük Durum Ölçeği (GÖDÖ), yorgunluk düzeyleri Yorgunluk Şiddet Ölçeği (YŞÖ), aktivite-rol yeterlilikleri ile bu yeterliliklere verilen önem düzeyi Aktivite Öz-Değerlendirme Ölçeği (AÖDÖ) ile değerlendirildi. Sonuçlar: Kişilerin yorgunluk düzeyi ile engellilik durumları arasında pozitif yönde orta düzeyde, yorgunluk düzeyi ile aktivite-rol yeterliliği negatif yönde orta düzeyde istatistiksel ilişki saptandı (p<0,05). Kişilerin yorgunluk düzeyi ve engellilik durumları ile aktivite-rol önemi arasında istatistiksel olarak ilişki saptanmadı (p>0,05). Tartışma: Aktivite-rol yeterlilik düzeyini arttırmak ergoterapistlerin rehabilitasyon hedeflerinden biridir. Bu bağlamda, MS tanılı hastaların günlük yaşamdaki fonksiyonelliğine ve aktivite-rol yeterliliğine yönelik müdahaleler planlanırken, bireyin yorgunluk seviyesi dikkate alınmalıdır.

Dear Editor, Transient global amnesia (TGA) is a clinical syndrome characterized by temporary loss of anterograde memory, followed by retrograde amnesia, with preserved consciousness, attention and awareness. It usually lasts 1-8 hours and recovers without need for treatment. TGA usually occurs as a single attack and does not recur. The annual recurrence rate is reported to be 6-10%. Time and place orientation may be impaired and patients may repeat the same questions, leading to anxiety and agitation. However, consciousness is not affected and higher cortical activities such as driving and talking are preserved. TGA is often seen in patients aged over 50 years and is equally common in both sexes.Although TGA was first described in 1956, no definite pathogenesis has been revealed. Ischemic, epileptic, metabolic, migrainous, and psychological factors are thought to be responsible. The affected brain regions are memory-related structures such as the thalamus, hippocampus (especially CA1 domain), splenium of the corpus callosum, fornix, and cingulate gyrus (1,2). In contrast, there are usually no etiologic factors in patients. Ischemia (vasospasm, venous congestion) or changes in neurotransmitter concentrations are usually listed among the causes of TGA. To the best of our knowledge, TGA accompanied by hyponatremia has never been identified in the literature.A man aged 56 years was admitted to our neurology clinic with memory loss lasting 5-6 hours. He did not remember where he lived and how he had been brought to the hospital during this time. He was asking the same questions again and again. The patient was fully conscious, he could recognize his relatives and could fulfill instructions given by the physician. It was observed that he could solve mathematical problems and count backwards from 100 by 7 (93, 86…) in serial 7 examination. It was learned that there had had no such previous attacks, and that he only had arterial hypertension in his medical history; he was not on any antihypertensive drugs. The patient's wife said that the patient was on salt restriction and he drank about 6 liters of water that day. His blood pressure was normal and the neurologic examination was normal except for the amnestic situation. The other blood tests were within normal limits except that the serum sodium level, which was 120 mEq/L. No lesions were detected in computed tomography and diffusion-weighted magnetic resonance imaging (MRI) scans. Electroencephalography (EEG) of the patient was reported as normal. After sodium replacement, the patient returned to normal, recalling events that occurred before the attack, but he could not remember the 8-hour symptomatic period. The patient was diagnosed as having sodium electrolyte imbalance mimicking TGA.Ad dress for Cor res pon den ce/Ya z›fl ma Ad re si: Babürhan Güldiken MD,

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