Alzheimer's Disease
What is Alzheimer's Disease?
Alzheimer's disease is a chronic disease that begins insidiously in the brain and results in the destruction of brain cells. About 70% of dementia syndrome is Alzheimer's disease.
Symptoms
It most often begins with forgetfulness. In the beginning, there is a memory impairment, such as asking, repeating and telling the same things over and over again, forgetting what they heard or read. There is no significant problem in not recalling past events. However, deterioration in decision making, decreased organizational ability can be seen. They may not be able to cook the dishes that they could do before. They may not be able to continue their hobbies. Problems with money management can be like forgetting to pay bills.
There may be speech disorders. Not being able to find words can be in the form of using inappropriate words. They may not be able to name objects. It may be getting lost in familiar places, confusing the roads he previously knows while driving. The patient may not be able to locate the rooms in his house. There may be changes in personality and behaviors, inappropriate strange behaviors, being very upset or angry, being indifferent to the environment. Deterioration of reasoning ability may be seen. They may act unfittingly to the circumstances. Self-care is reduced. Introversion and avoidance of social life can be seen in the first stages.
What is the importance of early diagnosis in Alzheimer's Disease?
There are many causes - other than Alzheimer - that can be treated in patients with forgetfulness and similar complaints, and these can be detected. Although there is no definitive cure for Alzheimer's disease, currently used drugs delay the progression of the disease. Improvements are observed in the day-to-day activities of patient. When the disease is diagnosed at an early stage, before it progresses, the patient can make his own decisions about his future financial and legal affairs. It gives the patient's family time to make arrangements for care. Starting early follow-up with early diagnosis allows timely intervention for every problem encountered.
Neuropsychiatric Evaluation-Neuropsychological Tests
The brain is a complex system. Our behaviors and decisions occur with the functions and interactions of these systems. There are various structures in our brain that undertake certain tasks in the first degree. For example, memory and decision making are activities of different systems, but they interact.
We use neuropsychological tests to distinguish Alzheimer's disease from other diseases. We also use it for monitoring the course of the disease, planning the treatment or evaluating the treatment.
Parkinson’s Disease
Parkinson’s Disease is a chronic disease with the destruction of brain cells. There are brain cells that produce dopamine in certain areas of the human brain. Dopamine enables people to perform smooth and harmonious movements. Loss of dopamine-producing cells leads to Parkinson's disease. It often starts over the age of 60. In the form that occurs at a young age, genetic causes are at the forefront. The earliest symptoms of Parkinson's disease appear in the intestinal nervous system, brain stem, and olfactory pathways. Decreased sense of smell, sleep disorders, constipation are thought to start years before the motor symptoms of the disease.
Symptoms:
Tremors: Often occurs in one of the hands. It is observed at rest.
Slowing down in movements: The successive repetition of movements has decreased.
Muscle stiffness: Resistance to passive movements
Gait disorders: They walk with small steps, dragging their feet and swaying their arms a little.
Posture disorders: Forward, hunched posture.
Dullness in facial expression
Monotonous, low-pitched speech
Early diagnosis and treatment
Early diagnosis of Parkinson's disease, choosing the right treatment with appropriate drugs, physiotherapy and exercise are very important. Thus, the disease can be brought under significant control, improving the quality of life. When Parkinson's is diagnosed, it is thought that the disease will progress rapidly and will end in a wheelchair in a short time. However, with appropriate time and appropriate interventions, it is possible to lead an independent and quality life.
Headaches
The patient's story is the basis for the diagnosis of patients who visits with headache complaint. It is possible to avoid diagnostic errors and unnecessary examinations by sparing enough time to the patients and evaluating their complaints correctly.
A. Primary headaches
1. Migraine
2. Tension-type headache
3. Cluster headache and other trigeminal autonomic headaches
4. Other primary headaches
B. Secondary headaches
5. Headaches attributed to head and/or neck trauma
6. Headache attributed to cranial or cervical vascular disorders headache
7. Headache attributed to non-vascular intracranial disorders
8. Headache attributed to substance (use) or withdrawal
9. Headache attributed to infection (nervous system or systemic)
10. Headache attributed to homeostasis disorder
11. Headache or facial ache attributed to cranium, neck, eyes, ears, nose, sinuses, teeth, mouth, or other facial or cranial structures
12. Headache attributed to psychiatric disorders
C. Cranial neuralgias, central and primary facial pain and other headaches
13. Cranial neuralgias and causes of central facial pain
14. Other headache, cranial neuralgia, central or primary facial ache
Migraine
Migraine is a headache syndrome that worsens, often unilateral, accompanied by nausea-vomiting and sensitivity to light and sound. Although it can start at any age, the first attack usually occurs in adolescence. In women, attacks can be observed frequently before the menstrual cycle.
The disease occurs with attacks of varying frequency and severity throughout life.
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During attacks, patients usually prefer to stay in a still, dark and quiet room.
Criteria used for diagnosing migraine,
Headache attacks lasting 4-72 hours without treatment or under ineffective treatment should have 2 of the following 4 symptoms
1) Unilateral location
2) Throbbing
3) Moderate or severe, severe enough to prevent activities of daily living
4) Increases with physical activity.
Presence of one of the following during pain
1) Nausea and/or vomiting
2) Phonophobia and photophobia
In migraine, temporary visual, sensory or language disturbances called aura can often be seen before or together with the pain attack. Migraine aura usually lasts between 20 and 60 minutes.
Migraine Treatment
There is preventive treatment that reduces the frequency and severity of attacks in migraine patients, and symptomatic treatment that reduces symptoms such as pain, nausea and vomiting.
Situations that trigger migraine attacks include walking around in sunny weather without glasses, being in high-noise environments, smelling strong odors, weather changes, such as exposure to southwester wind, red wine, fermented foods, delicatessen products, taking monosodium glutamate foods, experiencing extreme stress, sleeping less, such as sleeping too much, consuming too much chocolate, excessive caffeine intake.
Multiple Sclerosis (MS)
It is a disease that is usually seen in young adults between the ages of 20-40, affects the brain and spinal cord, and can lead to disability. Multiple means that too much tissue is involved in the brain and spinal cord, and sclerosis means that sclerosing plaques, that is, tissue stiffness, are formed. The reason is not known exactly. Viral infections are thought to be related to genetics and the autoimmune system's destruction of its own cells.
Symptoms
Initial symptoms in patients may differ from each other. Over time, different symptoms may occur in the same person.
-Loss of strength in the arms and legs, loss of sensation
-Blurred vision, double vision
-Imbalance
-Speech disorders
-Bladder problems etc...
Diagnosis
Brain MRI isabsolutely necessary for people who are clinically suspected of MS disease. Additional auxiliary tests such as cerebrospinal fluid collection and evoked potentials can be used.
Importance of Early Diagnosis
MS disease catches young adults in the most active period of their lives. The patient and his family are worn out both materially and spiritually.
Functional and cognitive losses caused by MS can be reduced with early diagnosis and drug treatments that affect the course of the disease. In addition to their neurological follow-ups, MS patients receive help from psychiatry units for mental difficulties and physiotherapy units for physical problems. Multi-disciplinary work is required.
Stroke - Paralysis (Cerebrovascular Disease)
Cerebrovascular disease
It occurs when the blood flow to the brain is suddenly reduced or stopped due to the occlusion of the vessel with a clot, or when the cerebral vessels rupture and the blood bleeds into the brain tissue or brain membranes. Depending on the affected area in the brain, speech disorder, weakness in the arms and legs, numbness, numbness, loss of balance, and consciousness disorders occur. Damage occurs due to reversible or non-reversible blood flow deficiencies in the affected brain area.
Epilepsy (Sara)
Epilepsy is due to short-term brain dysfunction and occurs as a result of temporary abnormal electrical conduction in brain cells. Epilepsy is a disease that affects approximately 1% of the world's population. The disease is seen equally in men and women, regardless of race. Epileptic seizures can occur at any age, but most often the youngest and oldest are affected.
There are two types of epileptic seizures: partial (that is, seizures that begin limited to one area of the brain) and generalized (those that begin widely in the brain). This distinction is important in terms of treatment. The patient has a clinically limited impairment of consciousness, behavior, emotion, movement or perception functions. In general, sudden loss of consciousness, contraction, foaming at the mouth is considered as a seizure. However, sometimes a seizure can occur even with a blank stare or two. Clinical findings and EEG are used in diagnosis.
EEG
It is the measurement and recording of the electrical activity of the brain. It is complementary to imaging such as brain tomography (CT) or brain MRI. It reflects the current state of the brain. Correct interpretation of EEG requires high quality recording. Electrodes should be placed meticulously, device controls should be performed and trained technicians should work. EEG is most commonly used in epilepsy. In epileptic patients, the diagnosis of epilepsy can be confirmed and its type determined by EEG findings. Apart from epilepsy, EEG is also used in disorders of consciousness, some inflammatory diseases of the brain such as encephalitis, dementia such as Alzheimer's disease.
Vertigo (Dizziness – Imbalance)
Dizziness is the most common complaint of patients visiting a physician after headache. Studies have shown that it affects 20-30% of the population. Since these complaints are very common in daily practice, such patients should be carefully evaluated and guided. It can occur for different reasons. Vertigo may be of psychogenic or neurological origin.
Causes of Vertigo
Ear-related causes: Positional vertigo is the most common cause. The diagnosis is finalized by the cooperation of the inner ear examination by the ENT. It can be caused by Meniere's disease, benign positional vertigo, and less blood supply to the inner ear after ear infections.
Traumas, vertigo may occur after head traumas, which may be of varying duration.
Neurological diseases: Bleeding or blockage in the central nervous system consisting of organs such as the brain and cerebellum, multiple sclerosis (MS), brain tumors, Parkinson's disease, migraine, etc. diseases. Additional neurological findings are diagnosed during consultation.
Internal diseases: It may occur in conditions such as heart diseases, thyroid gland diseases, anemia, high blood pressure, low blood pressure due to posture, rhythm disorders, fluid loss.
Psychological balance disorders: Panic attacks, stress, depression.
Neuromuscular Diseases (Spinal Cord, Muscle, Peripheral)
Spinal Cord Diseases
Neuromuscular diseases
Neuromuscular diseases are diseases of the muscles and nerves responsible for the movement of our body. The most important findings are numbness, burning, tingling, weakness, muscle wasting and muscle cramps. Diagnosis is made via -Disease History- Neurological examination- Necessary blood tests (CK)- Electromyography examination (EMG)- Biopsy. It can be caused by genetics or diseases caused by the body's immune system, thyroid disorders, diabetes, vitamin B12 deficiency, toxins, some drugs that are harmful to muscle-nerve tissue. Examples include Amyotrophic lateral sclerosis (ALS), spinal muscular atrophy (SMA), Cervical and lumbosacral radiculopathies, Brachial and lumbosacral plexopathies, Polyneuropathies, Polymyositis, dermatomyositis, myotonic dystrophy, myotonia congenital diseases, myotonia congenital diseases.
EMG
With EMG, we examine the muscles and nerves in our body. It consists of two parts; 1. Examination of the peripheral nerves coming out of the brain and spinal cord, called the nerve conduction study. 2. Needle electromyography which is the examination of both peripheral nerves and muscles, performed by entering special needles into the muscle to be examined. It should be done by experienced doctors. EMG can be used in cases related to nerve roots as in waist and neck hernias, in localized peripheral nervous system as in facial palsy, carpal tunnel syndrome, in common diseases of peripheral nervous system due to metabolic diseases as in diabetes mellitus, traumatic injuries of peripheral nerves, motor neuron disease, myasthenia It is used in the diagnosis of diseases such as gravis and myopathy.
Movement Disorders
Restless leg syndrome
It is a lifelong disorder that usually begins in middle and older ages. The symptoms are sensory sensations such as chills in the legs, feeling of something walking on own body, burning, pain, tingling, cramping, knife cutting or heat increase at rest. In order to reduce these feelings, the patient needs to move his legs. Sometimes these symptoms are felt in the arms and body. As the symptoms increase at night and in bed, insomnia often accompanies it.
Restless legs disease sometimes occurs with or due to certain conditions or diseases. These can be listed as iron deficiency, folate deficiency, polyneuropathy, Parkinson's, diabetes, antidepressant drug use, etc. Drugs that increase dopamine are used in its treatment. Usually the response to treatment is rapid.
