Neurology



NEUROLOGY

 

Treatment and Diagnosis

 

Generally, Neurology offers diagnostic treatment for brain, brain stem, spinal cord, nerves and muscular diseases, excluding surgery.

 

Headache

Dizziness

Dementia (senility)

Epilepsy

Movement Disorders

Stroke (cerebrovascular diseases)

Muscular diseases

Multiple sclerosis

Parkinson's disease

Polyneuropathy

Entrapment Neuropathies (nerve compressions)

Gait disorders

 

Neurology Department offers service in MH3 Neurology Orthopedics Hospital with 66 beds. Neurology Service is located on the seventh floor, Neurology Intensive Care Unit with 48 beds is located on the second floor, Neurology polyclinics and Electrophysiology Laboratories are located on the ground floor.

 

Stroke (cerebrovascular diseases)

 

Service is provided in the neurology Wards, intensive care unit and emergency on the basis of 24 Hours in The Department of Neurology. All the cerebrovascular diseases are diagnosed and treated in our department. Our clinic is one of the rare centers in where clot-busting (thrombolytic therapy) and interventional endovascular treatments are carried out for early stage brain/cerebral embolism.

Cerebrovascular Occlusion Treatment

 

1.Fibrinolytic Therapy

 

Cerebrovascular Occlusion is a life-threatening brain disease in which one or several arteries supplying brain are occluded. Fibrinolytic Therapy (also known as thrombolytic therapy, t-PA) is a type of treatment applied to patients who have cerebrovascular occlusion before to dissolve the clots occured inside the artery and occluded the artery. Dissolving clots by Fibrinolytic Therapy for cerebral revascularization has benefits for patients in early and late periods. Applying this therapy especially to Cerebrovascular Occlusion which threatens lives within 4.5 hours after the time when complaints start reduces the risk of disabilities in patients who become paralyzed. Dilatation of arteries by Fibrinolytic Therapy decreases the risk of developmental disabilities due to stroke as it depends how a patient applies as earlier as possible, characteristics of the patient and dimention of occlusion.

 

2. Endovascular Treatment

 

Ankara City Hospital Interventional Neurology Team offers service in our Stroke Polyclinic. Patients who apply to our hospital especially in early period (within 24 hours) undergo an evaluation and angiography-guided clot-removal-directed interventions are carried out for the approved among those in     cerebrovascular occlusions. Clot dissolution is performed by intravenous aspiration and/or retrievable stents. Risks of having a stroke are reduced (by stenting technique) by intervention on cerebrovascular occlusions. Patients with bubbles in the brain (aneurysm) and tangle of vessels (brain arteriovenous malformation - AVM) are responsed by our 'stroke team' 7 days 24 hours. Our Interventional Neurology Team who offer service by applying the latest technologies with technically high level medical devices, has approximately 12 years experience. All the contemporary treatments applied in the world are carried out in our hospital. Follow-ups of patients having stroke before are also carried out in Stroke Polyclinic.

 

Electrophysiology Laboratory

 

Electroencephalography (EEG) and electroneuromyography (ENMG) records are accompanied by the experienced academician staff in The Electrophysiology Laboratory which is located on the ground floor.

 

Electroencephalography

 

EEG is a record technique of change between electrical potentials which are generated a bit different in a state of stimulation by activation techniques and  spontaneous constant rhythmic electrical potentials during brain activities. EEG rather provides information about the functional state of the brain than structure of brain. The main objective of EEG record is evaluation of electrical currents generated from brain cells. EEG provides clarification on what type of disrupted electric from which part of the brain flows. EEG can be used as a technique to help to make diagnosis in all types of diseases which disrupt brain's electrical activity. EEG is an essential investigation technique in the diagnosis of epilepsy disease and determination of its types. Brain's electrical waves are recorded only during EEG. Electricity is not passed through the body. There is no radiation effect. It is a painless and harmless investigation technique. EEG can be applied to people of all ages. Patients are approved in EEG on condition that they are referred from our in-hospital polyclinics.

 

Electroneuromyography

 

ENMG is a neurological inspection based on investigation of electrical potentials of nerve and muscles. It consists of nerve conduction studies and needle EMG. Nerves are stimulated by low voltage electrical stimulation and activities of muscles are investigated during rest and also during voluntary contraction by a sterile needle. Repetitive (sequential) nerve stimuli and Single-fibre electromyography (SFEMG) tests are the tests to enable the evaluation of neuromuscular junction function. ENMG investigations can be carried out for anterior horn cells of spinal cord (motor neuron disorders), nerve roots (herniated disc, cervical disc hernia), neural networks (congenital or traumatic injuries), nerves (facial palsy, nerve compressions and injuries, carpal tunnel syndrome and other entrapment neuropathies, polyneuropathy), neuromuscular junction (myasthenia gravis) or muscle fibre cramp (myopathy) in our Laboratory. Investigation of stimulation potentials (Brainstem Auditory Evoked Potential, Somatosensory Evoked Potential, Visual Evoked Potential) that are defined as the electrical response of central nervous system to specific peripheral stimulation can be performed in our Laboratory. Patients are approved in ENMG on condition that they are referred from our in-hospital polyclinics.

 

Botulinum Toxin Injection

 

Botulinum toxin is administered as a muscle relaxer for diseases which cause involuntary and uncontrollably muscle contraction such as dystonia. Duration of action of botulinum toxin varies from person to person as it may take 3-6 months depending upon the individual's muscle activity. Generally the more it is performed, the wider the time gap between the practices becomes. Botulinum Toxin Therapy varies from person to person. Practice sites and dose are determined based on gender and muscular strength during contraction. Patients are approved for Botulinum Toxin Injection on condition that they are referred from our in-hospital general neurology polyclinics.

 

 

 

Stroke Polyclinic

The Polyclinic offers service on Mondays, Tuesdays, Wednesdays, Thursdays and Fridays in Neurology Orthopedics Hospital on the ground floor. Patients who underwent stroke before are followed in Stroke Polyclinic.  Appointments for Stroke Polyclinics are arranged by the secretaries of the general neurology polyclinics.

 

Epilepsy

Epilepsy disease is also defined as "falling sickness" in society. It is a clinical picture manifesting itself after the sudden and excessive electrical activities of neurons in the brain. While sometimes individuals predict those attacks starting suddenly, sometimes it arises     unexpectedly. Individiuals are completely healthy in the periods between the attacks usually. Different types of seizures can be seen. Seizures with states such as staring spell, absence or fear without contradiction may occur as attacks with symptoms such as sudden loss of consciousness, falling to the ground, continuous contradiction in the arms and legs, foaming at the mouth, wetting/soiling pants, clenched teeth, cyanosis may occur. It may arise in consequence of many brain diseases or based on genetic predisposition, but generally the cause is not identified clearly in most of the patients. Epilepsy attacks must be observed very carefully by the relatives of the patient because those observations plays a crucial role in informing your physician and in the diagnostic phase. In fact, thanks to the opportunities that the technology offers nowadays, patient relatives can record the states of the patients during attack by telephone video footages for evidence so that they present it to the respective physician during examination visit which leads to precious parameters. Definitive diagnosis and treatment are determined by neurology specialists. Results which put a smile on your face are obtained by regular follow-up and treatment.

 

Epilepsy Polyclinic

The Polyclinic offers service on Mondays, Tuesdays, Wednesdays, Thursdays and Fridays in Neurology Orthopedics Hospital on the ground floor. Appointments for Epilepsy Polyclinic is arranged by the secretaries of the general neurology polyclinics.

 

Multiple Sclerosis

The course of Multiple Sclerosis (MS) manifests itself as many plaques are formed in the brain and spinal cord caused by immune system dysfunction. The cells having a function of defense of the body sense the myelin sheath existing around nerve cells as a foreign substance in the body and try to destroy it with an unknown reason. Prevalence rate is 50-300 out of every 100 thousand people. It is estimated that there are approximately 2.5 million MS patients in the world and 50.000 - 60.000 MS patients in TURKIYE. It is usually a youth's disease as it is seen three times more in women than men. Generally those patients are diagnosed between 20 and 40 years old. However, it is accepted that the onset of the disease begins before the symptoms. The diagnosis is rarely made for children under 12 years old and adults above 55 years old. Symptoms appear in the involved parts. MS involves any part of the brain and spinal cord. Those symptoms continue from a couple of days to a couple of weeks. Complaints such as blurry vision, double vision, numbness in one arm, one side arm and leg numbness or numbness in both legs or weakness, unsteady gait, tremor in one or two hands, speech disorders, urinary incontinence, urinary retention are the disorders that emerge in Multiple Sclerosis. The diagnosis is made through history and detailed neurological examination with Magnetic Resonance Imaging. Supportive Tests such as such as VEP, SEP and Lumber Puncture can be performed. MS treatment can be divided into three main groups as attack treatment, treatments to halt the progression of the disease and the treatment of the findings. Various treatment options can be applied to halt the progression of the disease in our hospital.

 

MS Polyclinic

The Polyclinic offers service on Mondays, Tuesdays, Wednesdays, Thursdays and Fridays in Neurology Orthopedics Hospital on the ground floor. Appointments for MS Polyclinic is arranged by the secretaries of the general neurology polyclinics.

 

 

 

Parkinson's Disease and Other Movement Disorders

Parkinson's Disease is a movement disorder. The course of Parkinson's Disease manifests itself as death of brain cells and slowness of movements and tremor due to dopamine deficiency. Typically, it is a middle age and older adult disease, but it can be seen in youth. It is necessary that the effects of treatment, its possible side effects must be known and closely followed, doses must be reviewed by periodic doctor checkups, dose adjustment must be made if required and precautions must be taken against side effects in time. Drug administration is performed for Parkinson patients in our Movement Disorders Polyclinic. Other diseases cause Parkinsonism setting is also evaluated. The other movement disorders manifesting themselves as involuntary movements excepting Parkinson's Disease are tremor, dystonia (involuntary contraction), Chorea (movements in the manner of dancing), ataxia (gait disorders) Patients with such symptoms are also followed in our Movement Disorders Polyclinic.

Advanced Stage Parkinson's Disease Polyclinic

The polyclinic offers service on Fridays in Neurology Orthopedics Hospital on the ground floor. Patients are accepted in Advanced Stage Parkinson's Disease Polyclinic after a referral from Movement Disorders Polyclinic.

Movement Disorders Polyclinic

The Polyclinic offers service on Tuesdays and Fridays in Neurology Orthopedics Hospital on the ground floor. Patients are accepted in Movement Disorders Polyclinic after a referral from our general neurology polyclinics.

Huntington's Disease

Huntington Disease is a genetic disorder affecting movements, behaviors and reminiscence, typically starting at the age of 30-50. Nerve Cells are degenerated gradually in Huntington's disease. Patients with involuntary movements apply most of the time. If either of the parents has genetic abnormality, the possibility of becoming ill is %50. It is believe that there are much more Huntington patients than estimated in our country. Patients and patient relatives are followed in our polyclinic. Genetic tests are performed after genetic counselling. A multidisciplinary approach is applied to our patients with our psychiatrists.

 

Huntington's Disease Polyclinic

It offers service on Wednesdays in Neurology Orthopedics Hospital on the ground floor.

 

Deep Brain Stimulation (Brain Pacemaker Procedure)

When Parkinson Disease progresses, orally taken medicine may be insufficient, requesting more frequent or higher doses which causes the side effects to increase. If the periods when patients are slow reach more than 4-5 hours per day and involuntary movements deteriorate patients' quality of life despite all the dose adjustments, those patients are followed in Advanced Stage Parkinson's Disease Polyclinic. Those patients are candidates for device-aided treatments. Deep Brain Stimulation (brain pacemaker) is performed for patients who are eligible for surgery by neurosurgeons in our hospital. Apomorphine pump or Levodopa-Carbidopa Intestinal Gel (duodopa) by Percutaneous endoscopic transgastric jejunostomy placement can be performed for patients who are not eligible for surgery. Pacemaker adjustment is carried out and patients who apomorphine or duodopa pump is performed are followed in our Advanced Stage Parkinson's Disease Polyclinic.

Neuromuscular Diseases

Neuromuscular disease is also known as muscle-nerve disease. Mainly myasthenia gravis (MG) and other diseases involving neuromuscular junction, genetic muscle diseases or subsequently emerged muscle diseases, diseases ongoing with peripheral nervous system involvement called genetic polyneuropathy or polyneuropathy subsequently emerged due to several causes are diagnosed, treated and followed in Neuromuscular Diseases Polyclinic.

 

Neuromuscular Diseases Polyclinic

It offers service on Tuesdays and Fridays in Neurology Orthopedics Hospital on the ground floor. Appointments for Neuromuscular Diseases Polyclinic are made by the general neurology polyclinic secretaries.

 

Headache

Headache which may occur due to several causes is the most common neurologic complaint in society and one of the primary reasons of labour loss. Headaches without an underlying cause are defined as primary headache. Migrane and tension headaches are the most common primary headache disorders.  Secondary headaches are defined as the disorders which occur due to underlying diseases such as sinusitis, infection, vascular diseases, intracranial tumors or headaches due to secondary causes which elevate intracranial pressure. Headache Polyclinic is a specialty polyclinic where primary headaches which are evaluated in the general neurology polyclinics and are resistant to basic treatment techniques are diagnosed, treated and followed. Treatments such as nerve block and trigger point injection therapy are applied to suitable patients.

Headache Polyclinic

It offers service on Tuesdays, Thursdays and Fridays in Neurology Orthopedics Hospital on the ground floor. Appointments are made for Headache Polyclinic by general neurology secretaries.

 

Dizziness

It is a state of illusion that the patient feels a nonexistent motion as if it actually happens and suppose that the objects around him/her move. Vertigo is often used in the meaning of dizziness as it is not a diagnosis for a disease, but a finding.  This complaint affecting 20-30 percent of the society and leading to serious limitations and labour loss without treatment causes many patients to apply to emergency department and polyclinics. Symptoms and treatment methods of dizziness vary depending upon identified and underlying disease. Mainly ear-derived causes such as positional dizziness, Ménière's disease, vestibular neuritis, neurologic diseases such as vestibular migrane, stroke, multiple sclerosis, trauma-induced causes, internal diseases-related and psychological diseases-related causes can be considered. Patients with complaints are evaluated by detailed neurologic examination and neuroimaging techniques in our polyclinic. The underlying disease is diagnosed by a multidisciplinary approach and treatment (suitable positional treatment, pharmacotherapy or vestibular rehabilitation) and clinical follow-up are applied.   

 

Dizziness Polyclinic

It offers service on Mondays in Neurology Orthopedics Hospital on the ground floor. Appointments are made for Dizziness Polyclinic by the secretaries in the general neurology polyclinics.

 

Dementia

Dementia is a progressive neurologic disease noticed by amnesia. Incidence rate has been increased nowadays due to prolonged lifespan. Consciousness of the patient relatives is pretty important in early diagnosis of the disease. Dementia is a general term. It is a disease which a progressive deterioration in the brain emerges although the term is often used as a synonym of forgetfulness. In fact, the most frequently seen type of it is Alzheimer's Disease. In addition, it has sub-types such as frontotemporal dementia, vascular dementia, Parkinson's Disease dementia. Early sign in Alzheimer's Disease is memory loss. Short term memory loss is seen in patients at the beginning, then impairment in self care abilities, not recognizing family members, sleep and behavioral disorders develop in the upcoming periods. Making an early diagnosis and starting treatment slows down the progression of the disease course, leading to improve the quality of life of the patient and the caregiver. Moreover, every dementia is not Alzheimer's Disease. It has sub types such as frontotemporal dementia rather ongoing with disorientation in ground and direction without a significant memory loss at the beginnings, behavioural disorder and loss of ability and following manifestation of abnormal movements and behaviors, vascular dementia caused by damage in brain vessels and emerged with chronic diseases such as hypertension or diabetes or Parkinson's dementia occured in patients with diagnosed Parkinson's Disease. Dementia has no definitive therapy today. However, progression of the disease is slowed down by taken medicine and enhancement of adaptation of patients to the society is provided.

 

Dementia Polyclinic

It offers service on Mondays and Thursdays in Neurology Orthopedics Hospital. Dementia Polyclinic appointments are made by general neurology polyclinic secretaries.

 

Sleep Study Polyclinic

 

It offers service on Wednesdays in Neurology Orthopedics on the ground floor. Sleep Study Polyclinic appointments are made by general neurology polyclinic secretaries.

 

Polyclinic:

 

It offers service for patients having appointment and outpatients in the General Neurology polyclinics on the ground floor. It also offers polyclinic service based on appointment system for specific neurologic diseases by Academicians and specialists having expertise in the field.

 

Stroke Polyclinic: Assoc. Prof. Hesna Bektaş, Assoc. Prof. Berna Arlı, Assoc. Prof. Oğuzhan Kurşun, Spec. Dr. Hasan Bayındır, Spec. Dr. Ümit Görgülü

 

Epilepsy Polyclinic: Assoc. Prof. Ayşe Pınar Titiz Mutlu, Assoc. Prof. Abidin Erdal, Assoc. Prof. Şadiye Gümüşyayla,Assoc. Prof. M.İlker Yön, Assoc. Prof. Güray Koç

 

Multiple Sclerosis (MS) Polyclinic: Assoc. Prof. Gürdal Orhan, Assoc. Prof. Gönül Vural, Assoc. Prof. Semra Mungan Öztürk, Assoc. Prof. Berna Arlı, Assoc. Prof. M. İlker Yön, Assoc. Prof. Ersin Kasım Ulusoy

 

Movement Disorders Polyclinic: Prof.Dr. Yeşim Sücüllü Karadağ, Spec. Dr. Ebru Bilge Dirik

 

Huntington's Disease Polyclinic:  Prof.Dr. Yeşim Sücüllü Karadağ

 

Dementia Polyclinic: Spec. Dr. Görkem Tutal Gürsoy, Spec. Dr. Hatice Yüksel

 

Neuromuscular Diseases Polyclinic: Spec. Dr. Özlem Beton, Assoc. Prof. Şule Bilen

 

Botulinum Toksin Injection: Assoc. Prof. Şule Bilen, Prof. Dr. Yeşim Sücüllü Karadağ, Spec. Dr. Ebru Bilge Dirik

 

Headache Polyclinic: Assoc. Prof. Ersin Kasım Ulusoy, Spec. Dr. Merve Önerli Yener, Spec. Dr. İnci Mülkem Şimşek

 

Dizziness Polyclinic: Spec. Dr. Özlem Öztürk Tan

 

Sleep Study Polyclinic: Assoc. Prof. Güray Koç

 


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Clinical News

07 Mayıs 2020