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Stroke (Cerebral Vascular Diseases)

In Neurology Clinic, Neurology Service, Intensive Care and Emergency Service are provided on a 24-hour basis. All cerebrovascular diseases are examined and treated in our clinics. Our clinics offer clot dissolving in early cerebral vascular occlusions.  (thrombolytic therapy) and interventional endovascular treatments are among the centers.

Cerebrovascular Occlusion Treatment

1.Fibrinolytic Treatment

Cerebral vascular occlusion is a life-threatening brain disease caused by the occlusion of one or more of the vessels leading to the brain. Fibrinolytic therapy (also known as thrombolytic therapy, t-PA) is a form of treatment applied to patients with cerebral vascular occlusion to dissolve the clot that forms in the vein and blocks the vein. Dissolving the clot with fibrinolytic therapy and restoring the flow in the cerebral vessels provides significant benefits to the patient in the early and late periods. Especially in life-threatening cerebral vascular occlusion, within the first 4.5 hours after the onset of the complaints.  administration of this treatment reduces disability in patients with stroke. Opening the vein with fibrinolytic therapy reduces disability due to stroke, depending on how early the patient applied, the characteristics of the patient, and the extent of the obstruction.

2.Endovascular Treatment

Neurology Team,  It serves in our stroke center. In cases of cerebral vascular occlusion, patients who apply to our hospitals especially in the early period (up to 24 hours) are evaluated and attempts are made to remove clots with angiography in suitable patients. Clot removal is performed with aspiration and/or retractable stents in the vein. By intervening in neck vascular occlusions, the risk of stroke of the patients (with stenting method) is reduced. Patients with bubbles (aneurysm) and vascular clumps (brain arteriovenous malformation -AVM) in the brain are treated by our stroke team 24/7. The Neurology team, which provides services with high-level medical devices in terms of technical equipment, where the latest technologies are applied in the best way, has approximately 12 years of experience. All of the current treatments applied in the world are carried out in our hospitals.

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Epilepsy

Epilepsy is also known as "epilepsy disease" among the people. It is a picture that occurs as a result of sudden and excessive electrical activity of neurons in the brain. In attacks that start suddenly, sometimes individuals feel that these attacks may begin, but sometimes they may occur unexpectedly. In the periods between attacks, individuals are usually completely healthy. Different types of seizures can be seen. While there may be seizures without contractions such as absent-mindedness, freezing, feeling of fear, there may also be attacks with symptoms such as sudden loss of consciousness, falling to the ground, constant contractions in the arms and legs, foaming at the mouth, incontinence, locking in the teeth and bruising. As it may occur as a result of many diseases of the brain or in case of genetic predisposition, the cause cannot be clearly defined in many patients. Epileptic seizures should be observed very well by the relatives of the patient because these observations are very important in informing the physician and in the diagnosis stages. In fact, thanks to the opportunities offered by technology today, it will be very valuable data for the relatives of the patients to document the situation of the patients during the attack with phone video recordings and present them to the relevant physician during the examination application. The definitive diagnosis and treatment of epilepsy is made by neurologists. With regular follow-up and treatment, satisfactory results can be obtained.

Multiple Sclerosis (MS)

Multiple sclerosis (MS) is a disease that progresses with the formation of multiple plaques in the brain and spinal cord as a result of a disorder in the immune system of the person. Disease symptoms occur when the cells responsible for defending the body, for an unknown reason, perceive the myelin sheath around the nerve cells as a foreign substance to the body and try to destroy it. It is seen with a prevalence of 50-300 per 100 thousand people. It is estimated that there are approximately 2.5 million MS patients in the world and approximately 50,000-60,000 in Turkey. It is mostly a young age disease and is seen 3 times more in women than in men. These patients are usually diagnosed between the ages of 20 and 40. However, the onset of the disease is considered to be before the onset of symptoms. The diagnosis of the disease is rarely made under the age of 12 and over the age of 55. In MS, which can involve any part of the brain and spinal cord, symptoms of that region occur in whichever region is involved. These symptoms last for a few days to a few weeks. Symptoms such as blurred vision, double vision, numbness or weakness in one arm, ipsilateral arm and leg, or both legs, instability in walking, tremor in one or both hands, speech disorder, urinary incontinence or inability to do so are the disorders that occur in MS. The diagnosis of the disease is made by history and detailed neurological examination, as well as by magnetic resonance imaging. Supportive diagnostic tests such as VEP, SEP, and Lumbar puncture can also be performed. MS treatment can be grouped into three main groups: treatment of attacks, treatments to stop the progression of the disease, and treatment of symptoms. Many treatment options to stop the progression of the disease can be applied in our hospitals.

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Parkinson's Disease and Other Movement Disorders

Parkinson's Disease is a movement disorder disease characterized by loss of brain cells and manifested by slowed movements and tremors as a result of dopamine deficiency. It is typically a middle and advanced age disease, but it can also be seen in young ages. Knowing the expected effect and possible side effects of the treatment, it is necessary to follow up closely, review the doses with regular doctor checks, adjust the dose if necessary, and take timely measures against side effects. Movement Disorders Drug treatment of Parkinson's patients is organized in our outpatient clinics. Other diseases that cause Parkinsonism are evaluated. Apart from Parkinson's Disease, patients with movement disorders with involuntary movements such as tremor, dystonia (involuntary contraction), chorea (dancing movements), ataxia (gait disorders) are also evaluated in our Movement Disorders Polyclinics.

Huntington's Disease

Huntington's Disease is a genetically inherited disease that affects movement, behavior and recall, typically beginning at the age of 30-50, in which nerve cells in the brain are destroyed over time. Patients mostly present with involuntary movements. If one of the parents has an abnormal gene, the probability of the child getting sick is 50%. It is thought that there are much more Huntington's patients in our country than expected. In our polyclinics, patients and their relatives are followed up, gene tests are carried out after genetic counseling, and our psychiatrists approach our patients in a multidisciplinary manner.

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Deep Brain Stimulation ( Brain Battery Application)

As Parkinson's Disease progresses, oral medications may be insufficient and need to be taken more frequently or in higher doses, which may lead to increased side effects. If, despite all the adjustments, the slow periods of the patient reach more than 4-5 hours in total, and involuntary movements reduce their quality of life, our patients are followed up in our Advanced Stage Parkinson's Polyclinic. These patients are candidates for device-assisted therapies. In our hospitals, deep brain stimulation (brain pacing) is applied to patients who are suitable for surgery with neurosurgeons. Levodopa carbidopa intestinal gel (duodopa) can be applied to patients who are not suitable for surgery by turning on the apomorphine pump or peg-j. In our advanced Parkinson's Outpatient Clinic, battery adjustments are made and regular follow-up of patients who have been administered apomorphine or duodopa pumps is performed.

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Neuromuscular Diseases

neuromuscular disease  means neuromuscular disease. Diagnosis, treatment and follow-up of diseases with widespread nervous system involvement, called polyneuropathy, which may occur mainly due to myasthenia gravis (MG) and other muscle-nerve junction diseases, inherited or acquired muscle diseases, genetically transmitted or later due to various reasons. Neuromuscular disease polyclinic is done in.

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Headache

Headache, which can develop due to many reasons and is the most common neurological complaint in the society, is one of the leading causes of workforce loss. Headaches without any other underlying cause are called primary headaches. Migraine and tension-type headache are the most common primary headache diseases. Secondary headaches are used to describe headaches that develop as a result of other underlying diseases. There may be headaches due to sinusitis, infection, vascular diseases, intracranial tumors or secondary causes that increase intracranial pressure. Headache outpatient clinic is the branch polyclinic where the examination, treatment and follow-up of primary headaches that are evaluated in the general neurology outpatient clinic and which may be resistant to basic treatment methods are performed. Treatments such as nerve blockade and trigger point injection are applied in appropriate patients.

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dizziness

It is an illusion state in which the patient feels as if he has a non-existent movement and thinks that the objects around him are moving. Vertigo is often used to mean vertigo, and it is not a diagnosis of a disease but only a finding. This complaint, which affects 20-30% of the society, causes many patients to apply to emergency services and polyclinics; If left untreated, it can lead to significant limitations and loss of workforce. Symptoms and treatment methods of vertigo vary according to the detected and underlying disease. Causes of ear origin (such as positional dizziness, Meniere's disease, vestibular neuronitis…), neurological diseases (such as vestibular migraine, stroke, multiple sclerosis…), trauma-related, internal diseases and psychological diseases can be counted. In our polyclinics; Patients with complaints are evaluated with detailed neurological examination and neuroimaging methods. With a multidisciplinary approach, the underlying disease is diagnosed and treatment (appropriate positional therapy, drug therapy or vestibular rehabilitation) and clinical follow-up are applied.

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dementia

Dementia is a progressive neurological disease that is often recognized by the complaint of forgetfulness. Today, its incidence has increased considerably with the prolongation of life expectancy. Awareness of patient relatives is very important in early detection of the disease. Dementia is a general term. Although it is often used synonymously with forgetfulness, it is actually a disease in which progressive destruction occurs in the brain. The most common type is Alzheimer's disease. In addition, there are subtypes such as frontotemporal dementia, vascular dementia, Parkinson's disease dementia. The leading symptom in Alzheimer's disease is memory impairment. At first, patients experience forgetfulness in the recent past, and later on, deterioration in self-care functions, inability to recognize their relatives, and sleep and behavioral disorders develop. Early diagnosis and initiation of treatment slows down the progression of the disease process and improves the quality of life of both the patient and the caregiver. In addition, not all dementias are Alzheimer's disease. Frontotemporal dementia, which is another type of dementia that initially progresses with loss of direction, behavior disorder, and skill loss without a significant loss in memory, and vascular dementia, which occurs due to damage to the brain vessels, which occurs with chronic diseases such as high blood pressure, diabetes, or There are subtypes of Parkinson's disease such as dementia that occur in patients with known Parkinson's disease.

There is currently no definitive treatment for dementia. However, with the drugs used, it is possible to slow down the course of the disease and increase the patient's adaptation to society.

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Electrophysiology Laboratory

Electroencephalography (EEG) and electroneuromyography (ENMG) shots are performed in the electrophysiology laboratory in the company of our experienced doctors.

ENMG

It is a neurological examination based on the examination of the electrical potentials of nerves and muscles and consists of nerve conduction studies and needle EMG. Nerves are stimulated with a low-voltage electrical stimulus, and the activity of the muscles both at rest and during voluntary muscle is examined with a sterile needle. Repetitive (sequential) nerve stimulation and Single fiber EMG (SFEMG) examinations are other examinations that make it possible to evaluate neuromuscular junction function. In our laboratory, anterior horn cells of the spinal cord (motor neuron diseases), nerve roots (lumbar and neck hernias), nerve networks (congenital or traumatic injuries), nerves (facial paralysis, nerve compressions and injuries, carpal tunnel syndrome and other entrapment neuropathies, polyneuropathy) ENMG examinations for neuromuscular junction (myasthenia gravis) or muscle fiber involvement (myopathy) can be performed. Evoked Potential (BAEP, SEP, VEP) examinations, which are defined as the electrical response of the central nervous system to specific peripheral stimuli, are also performed in our laboratory.

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EEG

EEG is the method of recording the change of electrical potentials that occur slightly differently while the brain is stimulated by continuous rhythmic electrical potentials that occur spontaneously during the activities of the brain. EEG gives information about the functional state of the brain rather than its structural functions. The main purpose of EEG recording is to evaluate the electrical currents emanating from the brain cells. EEG allows you to see which brain region emits what type of disordered electricity. EEG can be used as an auxiliary method in the diagnosis of any disease that disrupts the electrical activity of the brain. It is an indispensable examination method in the diagnosis and determination of epilepsy disease. During EEG, only the electrical waves of the brain are recorded. No electricity is supplied to the body. It has no radiation effect. A painless and harmless  examination method. EEG can be taken at any age.

Botulinum Toxin Injection

Botulinum toxin is used as a muscle relaxant in diseases such as dystonia and involuntary and uncontrolled muscle contraction. Although the duration of the effect of botulinum toxin varies from person to person, it can last 3-6 months depending on the use of the person's muscle. As the number of applications increases, applications can generally be opened. Botulismus toxin treatment is personal. Application points and dose are adjusted according to gender and muscle contraction strength.

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