Neurology

Neurology is the field of medicine concerned with the diagnosis and treatment of diseases and injuries related to the human nervous system.
Due to the complex structure of the nervous system, the number of neurological pathologies and the complaints and symptoms they cause can be highly diverse. The most common complaints can be listed as follows:

• Headache
• Dizziness
• Weakness
• Gait, balance, and coordination disorders
• Sensory disturbances
• Consciousness disorders
• Vision, hearing, and smell problems
• Speech impairment

If any of these complaints are present, a neurologist should be consulted as soon as possible. As in all fields of medicine, delays in the diagnosis of neurological diseases can lead to irreversible damage.

At the Emsey Hospital Neurology Department, services are provided in accordance with national and international standards, and within the framework of evidence-based medicine, the diagnosis and treatment of all neurological diseases can be performed on an outpatient or inpatient basis. Some of these diseases include:

• Headache, migraine
• Epilepsy (seizures)
• Cerebral vascular occlusions or hemorrhages (stroke, paralysis)
• Dementia – Alzheimer’s disease
• Dizziness
• Parkinson’s disease – neurodegenerative diseases
• Infections of the nervous system (encephalitis, meningitis, brain abscess, etc.)
• Demyelinating diseases (ALS)
• Inflammatory or autoimmune diseases of the spinal cord
• Neuromuscular diseases (Myasthenia Gravis)
• Sleep disorders and sleep-related breathing disorders
• Restless legs syndrome

In the follow-up of neurological diseases, changes in medication or dosage may often be required, making highly effective communication between patient and physician and regular follow-ups essential. At Emsey Hospital Neurology Department, personalized follow-up systems are used. In addition, all radiological imaging methods are utilized for diagnosis and follow-up, along with electromyography (EMG), polysomnography (sleep test), and electroencephalography (EEG), which are successfully performed.

Differential Diagnosis of Neurodegenerative and Non-Neurodegenerative Parkinsonian Syndromes

Parkinsonian syndrome includes a group of diseases characterized by bradykinesia, rigidity, tremor, and postural instability. Apart from idiopathic Parkinson’s disease, other disease groups that clinically present with Parkinsonian findings are:

1. Neurodegenerative Parkinsonian Diseases (Parkinson plus):

• Lewy Body Dementia
• Idiopathic Multiple System Atrophy
• Corticobasal Degeneration

2. Non-Neurodegenerative Parkinsonian Diseases:

• Vascular Parkinsonism
• Drug-induced Parkinsonism
• Essential Tremor

In Nuclear Medicine, iodine-123-labeled ioflupane (DaTSCAN) is used as a presynaptic dopaminergic transporter ligand for imaging in this field. DaTSCAN offers scintigraphic imaging using the SPECT technique with a gamma camera.

 Clinical Indications

1.    Differential diagnosis between neurodegenerative Parkinsonian diseases (Parkinson’s and Parkinson plus) and non-neurodegenerative Parkinsonian diseases

2.    Cannot distinguish between different neurodegenerative Parkinsonian diseases

3.    Primarily, differential diagnosis between essential tremor and Parkinson’s or Parkinson plus

4.    Differential diagnosis between Lewy Body Dementia and other types of dementia (especially Alzheimer’s dementia)

5.    Early diagnosis of presynaptic Parkinsonian syndrome

The test consists of an imaging protocol of approximately 30–45 minutes, performed after a waiting period of 3–4 hours following IV injection.

 Diagnostic Criteria

1.    Normally, striatal activity is typically observed bilaterally in a “comma shape” form.

2.    In idiopathic Parkinson’s disease, in the early stages—unilaterally (hemiparkinsonism) or bilaterally in later stages—there is a loss of putamen activity, forming a “dot shape” appearance.

3.    In advanced idiopathic Parkinson’s disease, complete loss of bilateral striatal activity with a marked increase in background activity may be observed.

4.    In Lewy Body Dementia, more pronounced pathology may be observed in the caudate nucleus than in the putamen bilaterally.

Quantitative Evaluation

For DaTSCAN, the specially developed “DaTQUANT” software program enables the selection of regions of interest in the striatal area and provides quantitative evaluations that can be compared with normal reference values.