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    Capecitabine-related neurotoxicity presenting with agraphia
    (Sage Publications Ltd, 2023) Iscan, Dilek; Tolay, Rumeysa; Bayram, Ertugrul; Demir, Turgay; Bicakci, Sebnem
    Introduction Capecitabine is a pre-metabolite of 5-fluorouracil and is used as a chemotherapeutic agent. Among the common side effects of capecitabine, there are gastrointestinal side effects including nausea, vomiting, and diarrhea, and dermatological side effects including hand-foot syndrome and skin pigmentation change. However, neurological side effects of capecitabine are very rare. We describe herein a patient who developed neurological side effects in the form of agraphia and dysarthria on the 7th day of capecitabine treatment. Case Report A 34-year-old male patient, who was being followed up with the diagnosis of colon cancer, presented with speech and writing disorder that developed while under capecitabine treatment. Dysarthria and agraphia were detected in his neurological examination. Diffusion-weighted magnetic resonance imaging (MRI) revealed acute diffusion restriction in the splenium of the corpus callosum and at the level of the bilateral centrum semiovale. Brain MRI revealed symmetrical T2-weighted fluid-attenuated inversion recovery (T2-FLAIR) signal increases at the right temporoparietal medial, corpus callosum level, and bilateral white matter level. Management & Outcome The capecitabine treatment was terminated, and methylprednisolone treatment was administered and plasmapheresis procedure was carried out. Subsequently, significant improvement was observed in the clinical findings and neuroimaging. Discussion Capecitabine is used as an oral agent; thus, it provides ease of use. Neurological side effects associated with the use of capecitabine reportedly occur very rarely. The findings of this case demonstrated that leukoencephalopathy can be seen during the use of capecitabine, imaging results are very important in the diagnosis of leukoencephalopathy, and improvement can be achieved with the termination of the capecitabine treatment.
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    Cardiac autonomic involvement in Huntington's disease
    (Springer-Verlag Italia Srl, 2024) Iscan, Dilek; Cetinkaya, Yakup
    IntroductionHuntington's disease (HD) is known as a neurodegenerative disease with movement disorder and cognitive impairment; autonomic involvement is also becoming common in some recent studies. The aim of this study is to demonstrate the presence of cardiac autonomic involvement in HD patients.MethodTime and frequency domain parameters obtained from the 24-h Holter ECG(hECG) were compared between 20 HD patients and 20 healthy control subjects.ResultsFourteen HD patients had tachycardia, bradycardia, and extra beats. Interval between two heartbeats, normal-to-normal (NN), standard deviation of all normal-to-normal (SDNN), square root of the mean of the sum of the squares of the differences between consecutive N-N intervals in ms (rMSSD), and the ratio of the number of consecutive pairs of N-N intervals that differ by more than 50 ms to the total number of N-N intervals (pNN50) were all significantly higher in the patient group than in the control group during 24-h hECG monitoring. However, hECG monitoring showed that the patient group had significantly higher values of the frequency-domain metrics high frequency (HF) than the control group did (P = 0.003). Very low frequency (VLF) was lower in the patient group (P = 0.009). There was no difference in low frequency (LF) in both groups. In comparison to the control group, LF/HF was much reduced in the patient group (P = 0.001).ConclusionCardiac disfunction increases, and autonomic functions change in HD, but more comprehensive studies are needed to distinguish sympathetic and parasympathetic involvement.
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    Etiologic and demographic characteristics of patients with anisocoria
    (Bayrakol Medical Publisher, 2023) Bicer, Gamze Yildirim; Iscan, Dilek
    Aim: In this study, we aimed to present the etiological causes and clinical features of the patients followed for anisocoria and to determine the most common causes according to age groups.Material and Methods: The medical records of the patients aged 18 years and over who were followed up for anisocoria between June 2017 and December 2022 were retrospectively reviewed. Two groups were formed including patients aged 18-45 as Group 1 and patients over 45 years old as Group 2. The etiological causes were divided into 4 groups as physiological anisocoria, pharmacological anisocoria, ocular pathologies and nervous system pathologies. It was examined whether there was a difference between the two groups in terms of four main etiological reasons.Results: A total of 99 patients followed for anisocoria between January 2017 and December 2022 were included in the study analysis. The most common cause of anisocoria was found to be due to ocular pathologies (64 eyes, 64.6%). The second most common etiologic cause was found to be physiological anisocoria (20 eyes, 20.2%). Anisocoria was observed in 12 (12.1%) patients due to neurogenic dysfunction and in 3 (3%) patients due to pharmacological effects. There was no statistically significant difference between groups 1 and 2 according to etiological causes (p=0.089).Discussion: The ocular pathologies were found to be the most common cause of anisocoria. The most common ocular causes detected also varied in parallel to demographic changes. There is a need for descriptive studies of the etiology of anisocoria with a higher number of participants.