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The involvement of the autonomic nervous system is less common than that of the central and peripheral nervous system in systemic lupus erythematosus (SLE) patients. However, its involvement can negatively affect the quality of life of the patient and cause life-threatening situations. In this study, autonomic function was evaluated in SLE patients who did not show any sign of autonomic involvement using R-R interval variation (RRIV) and sympathetic skin response (SSR) electrophysiological tests. SSR was used to evaluate the sympathetic nervous system, whereas RRIV was used for the parasympathetic nervous system. We included 23 SLE patients and 21 healthy volunteers in the study. Of the 23 SLE patients, 20 (86.9 %) were female and 3 (13.1 %) were male. The age range of the patients was between 19 and 52 years, with a mean age of 32.5 ± 9.1 years. Routine nerve conduction studies and autonomic tests were performed on patients in the electromyography (EMG) laboratory. Lower extremity SSR latencies were prolonged and a significant loss of amplitude was observed in comparison to the control group. Furthermore, deep-breath RRIV values for the patient group were significantly lower than that of the control group. Both sympathetic and parasympathetic nervous system involvement was seen in our study. In conclusion, EMG can reveal a possible underlying involvement in the absence of signs of autonomic involvement.

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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Fallot Tetralojisi (FT) en sık gözlenen konjenital siyanotik kalp hastalığıdır. FT temel olarak ventriküler septal defekt, sağ ventrikül çıkış yolu obstriksiyonu, pulmoner stenoz ve sağ ventrikül hipertrofisini içermekle beraber ayrıca dekstropoze aorta (ata binen aorta), atrial septal defekt ve korener arter anomalileri gibi ek malformasyonlar da eşlik edebilir. Hastalara yaşamın ilk haftasında pulmoner arter ile subklavian arter arasında paliatif olarak anastamoz yapılıp ve major cerrahiyi kaldırabilecek duruma geldikten sonra total düzeltme ameliyatı yapılır. Nörolojik tutulum olarak hastalarda atreriel veya venöz inme, senkop ve nöbetler ortaya çıkabilir. Genellikle klinik tablo serebral venöz tombozdur. İnme çocuklarda hiperviskosite ve mikrostaz ile ilişkilendirilmiş iken erişkinlerde ise flebotomi, mikrositoz, hipertansiyon, diabetes mellitus ve ritim bozuklukları gibi geleneksel inme risk faktörleri ilişkilendirilmiştir. Erişkin yaşlarda düzel-tilmemiş FT'li hastalara nadiren rastlanır. Bu çalışmada tam düzeltme operasyonu geçirmeden 39 yaşına kadar yaşayabilen ve çoğunlukla beklenen tablo olan venöz inmenin yerine arteriyel inme gelişen bir hasta olası inme mekanizmaları literatür ışığında tartışılarak sunulmuştur. Anahtar Kelimeler: Fallot tetralojisi, iskemik inme, hiperkoagulabiliteTetralogy of Fallot (FT) is the most common cyanotic congenital heart disease. FT is mainly composed of ventricular septal defect, right ventricular outflow tract obstruction, pulmonary stenosis and right ventricular hypertrophy, but also can include dextrapositioned aorta (overriding aorta), additional malformations such as atrial septal defect, and coronary artery anomalies. In the first week of life patients undergo palliative anastamosis between a pulmonary artery and subclavian artery and after they become eligible for major surgery total correction isperformed. With neurological involvement ischemic or venous stroke, syncope and seizures can occur. Generally, clinical presentation is cerebral venous thrombosis. Iİschemic stroke in children is associated with hyperviscosity and microstasis, and in adults with phlebotomy, microcytosis and traditional stroke risc factors such as hypertension, diabetes mellitus and cardiac rhythm disorders. Patients with uncorrected FT rarely survive adulthood. In this study, we present a case without total correction, who lived up to the age of 39 years and presented with arterial stroke instead of expected venous thrombosis, along with stroke mechanisms in the literature. Key Words: Tetralogy of fallot, ischemic stroke, hypercoagulability GirişFallot Tetralojisi (FT) en sık gözlenen konjenital siyanotik kalp hastalığıdır (1, 2). İlk kez 1888'de Fransız Etienne-Louis Arthur Fallot tarafından tarif edilmiştir (3). FT bileşenlerinde ventriküler septal defekt (VSD), sağ ventrikül çıkış yolu obstriksiyonu, pulmoner stenoz ve sağ ventrikül hipertrofisi bulunur (3). Hastalara hayatın ilk haftasında Blalog ve Tousing tarafından tariflenen pulmoner arter ile subklavian arter arasında paliatif o...

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A 58-year-old woman was evaluated following complaints of pain in both lower extremities and brief involuntary movements in her toes, which had begun 2 years prior. No signs were present beyond a curling, flexion/extension, abduction/adduction movement in the toes of both lower extremities, voluntarily stoppable during neurologic examination. During investigation into etiology, lumbar vertebrae MRI revealed a posterior annular protrusion causing partial compression of the dural sac and neural elements by the L3-4 and L4-5 discs. Semirhythmic repetitious movements were detected on electromyography performed on right extensor digitorum brevis (EDB) muscle with 200 mV and 1 Hz frequency. Patient was put on a gradually increased dose of gabapentin, starting at 1200 mg/day. A brief regression in pain and involuntary movements in feet and toes was observed. GABAergic agents are very effective treatment of painful legs and moving toes syndrome. The present clinically and electrophysiologically diagnosed case was considered worth reporting, as painful legs and moving toes syndrome is a very rare condition.