COVID 19 AND NEUROLOGY / COVİD 19 VE NÖROLOJİ

    ENGLİSH VERSİON BELOW 

   COVİD 19 VE NÖROLOJİK TUTULUMU 

    COVID 19 ( koronavirus hastalığı 2019 ) hayvanlardan geçtiği düşünülen yeni nesil bir korona virüsün etken olduğu ve pandemiye sebep olan hastalıktır. Ateş, öksürük nefes darlığı en sık ve tipik semptomlarıdır. Yaşlılar ve  hipertansiyon, kalp hastalığı, demans, diyabet gibi kronik hastalığı olanlar daha riskli gruptadır.  Koronavirüsler maalesef nörotropik özellikler gösterebilmekte, beyin, sinir dokusunda ve beyin omurilik sıvısında (BOS) bulunabilmektedir. Virüs direk olarak sinir sistemi hasarı yapabileceği gibi, kan beyin bariyerini bozabilir veya ikincil viral bakteriyel enfeksiyonlara neden olabilmektedir.

    COVİD-19 ' un nörolojik komplikasyonları ile ilgili veriler de netlik kazanmaya ve artık yayınlanmaya başlamakta. Ateş, öksürük, solunum yetmezliği gibi enfeksiyon kliniği ağır olanlarda, hastaneye yatma endikasyonu olanlarda veya solunum tutulumu  belirgin olanlar da nörolojik  tutulumun görülme ihtimali artığı belirtilmektedir. Ancak bazı çalışmalar ise genç yaş inmesi ve koku, tad duyu değişikliklerinin ağır enfeksiyondan bağımsız olduğunu da göstermektedir. Asemptomatik bireylerde ilk bulgu olarak da görülebilmektedir. Yani eğer sizin gribal yakınmalarınız  yoksa tamamıyla güvende değilsiniz demektir. Bir hekim için de pür nörolojik yakınma ile başvuran hastada enfeksiyon kliniği olmaksızın bu şikayetler var ise aklınıza korona virüs taraması yapmak gelmelidir.
     Genel olarak bu virüs sersemlik hissi, dengesizlik, baş ağrısı, bulantı, kusma, kas ağrısı, halsizlik, kol ve bacaklarda güçsüzlük veya tutmama, felç yapabildiği belirtilmiştir. Ensefalopatiye bağlı bilinç değişikliğine sebep olabilmektedir. Akut hemorajik nekrotizan ensefalopati vakası bildirilmiştir. Serebrovasküler hastalık ( inme, stroke, beyin kanaması) riski arttığı belirtilmektedir. Genç hastalarda özellikle büyük damar embolilerine neden olabileceği bildirilmiştir. santral sinir sistemi tutulumuna bağlı epileptik nöbet gözlenebildiği belirtilmiştir. Santral sinir sistem etkilerinin kanda lenfosit sayısının hakim olduğu bir immunsupresyon durumuna bağlı olabileceği teorisi mevcuttur.  Koku alma kaybı (anosmi) , tad duyusunun kaybı (ageusia) veya azalmasına (hiposmi, hypogeusia) sebep olabiliyor. Akut polinöropati ye neden olarak Gullian Barre sendromu benzeri bir klinik tabloya neden olabildiği belirtilmiştir. Kas hasarı çok sık görülen bir birlikteliktir.
      Bütün bunlara ek olarak bir yayında COVİD 19 a spesifik olmasa da SARS CoV enfeksiyonunda deney hayvanları ve hasta bireylerde beyin sapında yoğun tutulum gösterilmiştir. Bundan yola çıkarak bu hastalarda solunum probleminin sadece akciğer hastalığına sekonder değil beyinde solunum merkezinin reseptör düzeyinde bir tutulumu sonucu da olabileceği öne sürülmektedir.


     COVID 19 NEUROLOGICAL SYMPTOMS AND COMPLICATIONS 

     Coronavirus disease 2019 ( COVID 19 ) is an infectious disease and cause a pandemi. The virus is a novel corona virus that suggested transmitted from an animal source. Fever, cough and respiratory distress are typical symptoms. The elderly population and the people who have chronic disease ( like heart disease, hypertension, diabetes, dementia , alzheimer disease etc ) are more risky. Coronaviruses  have neurotropic effect and can be in brain tissue and cerebrospinal fluid. It may damage the brain, destroy the blood brain barrier directly or may cause secondary bacterial or viral infections in nervous system. 
     The new informations have reported about the complications of  COVID-19  as the disease become clear. The severity of the infectious presentation, the presence of  hospitalization indication and the severity of respiratory distress are more associated with neurological complications. But unlike that it has reported that young stroke and dysosmia, dysgeusia has no correlation between the severity of infection. It can be seen as a first symptom in asymptomatic patient. That 's mean if you have no infection symptoms like fever, cough you are not in comfort zone. Moreover if a patient has just because of a neurological complaint in your office, we are not in a comfort zone out of the COVID 19 as a doctor. We should be awareness about the neurological symptoms.
       Generally dizziness, ataxia, headache, vomiting, myalgia,  weakness is defined clinically. Moreover paresis, paresthesia , confusion can be seen because of the involvement of the nervous system. Mental state alteration can be as a result of encephalopathy. Acute  hemorrhagic necrotizing encephalopathy is reported. The cerebrovascular condition like stroke, hemorrhage increase with the infection. This virus can cause stroke in young patient as a result of large vessel occlusions and embolism. Epileptic seizure is another symptom of infection. There is a theory about a immunosuppression condition in central nervous system relation with the lymphocytes count in plasma. The effect on cranial nerves can be result differences on the sence of smell and taste like anosmi, ageusia or hiposmi, hypogeusia. Peripheral nervous system involvement acute polyneuropathies like GBS is reported.
       There is another suspicion  between the link neurological symptoms and respiratory failure because of the a results of SARS CoV ( not in COVID 19) infection. In those infection the brainstem of experiment animals and patients is heavily infected with the virus. As a result the respiratory distress may be a result of the involvement medullary cardiorespiratory center.

How we perceive the shapes? How we read?

           

         My 20 months old son love the shapes. He can get excited for the shape of nightstands handle or a plate. Nowadays the letters are our new love. We sing all the day the song of shapes and letters. He can recognise the shapes by itself and but he can't read the letter rightly. He knows letter's name by heart, perceives it to be letter but can't call it correct. He has not a visual perception of letters as much as geometrical shapes. So why? He grows very fast up, his brain too. Every skill is loading separately him with his development. What is the differences between shapes and letters for his brain? Because the different parts of neurons run if he see a geometrical shape or letter to define it. Actually we read the letter which we’ve seen. Reading is more complicated for our brain. 

         When we look at a object, the form of the shape is copied to retina in our eyes. So the visual pathway carry the stimulus to the visual cortex. Visual cortex is at the back of the skull and 17-18-19. areas in the Broadman map. It define the color, size, dimension, motion and brightness and creates visual memory. Let’s talk about the amusing and famous right brain! It recognises geometrical shapes, objects, spatial forms. Painting, design, color and such entertaining things are its job. It can make 3 d design from 2 d. The brain use like a computer the angles, lines, edges while processing. The denomination is learned on our own language. 
      The brain have to start a different procedure by reading. Visual cortex (on the back of the skull) see the letter, recognise it and send the database to the left (most of us dominant side ) peri sylvian area. Specially the left angular gyrus is important for perceiving the symbol of letter and word form. It translate the writing to speaking and reverse. The left inferooccipitotemporal area works by reading. This region is above the intersection point between the line from top of ear and  the temporal region. After that the frontal region works while reading. The huge part of brain!!! My toddler need more time for this skill. But it should not be confused with dyslexia. Aleksi means a problem in this pathway, so a person cannot read even though it is able to read. 

kırmızı acı biber / chili pepper

Türkçe versiyon

      Medscape kırmızı acı biberin ölüm riskini azaltmasına dair çalışmaları paylaştı. İnsanların normal beslenme şekillerinden bağımsız olarak günlük biber tüketiminin önemsendiği bir İtalya çalışmasında kardiyovasküler, serebrovasküler, ve diğer nedenlerde ölüm oranı bol tüketenlerde daha düşükmüş. Ama kanserden ölümde arada fark olmamış. Tam olarak etki sebebi bilinmiyor ama içindeki kapsaisin olabilir denilmiş. Bunu destekleyen başka çalışmalar da litaretürde mevcut. Şimdi peki bizim yediğimiz o acı ama yeşil biberler, balık biberleri boşa mı gitti? Acılığı veren şey kapsaisinmiş ama rengi veren şey karotenoidlermiş. Kapsaisinden ise işe yeşil biber de işe yarar gibi duruyor. Ben ikisinin birlikte etki ettiğini düşünüyorum açıkçası. Neyse garanti olsun diye bundan sonra pul biber yiyelim artık. 

English Version 

        The positive effect on death of chili peppers is talked on medscape. The style of your daily eating routine doesn’t important in a this Italian research. The important thing is your consumption of chili pepper. Cardiovascular, cerebrovascular and the others death risks decrease with the consumption. There is no differences in cancer death ratio. So what about the green bitter peppers? The bitter taste is because of #apsaicin in the pepper. But the carotenoids give the color to the pepper. If this effect is because of the capsaicin so the green one works too. In my opinion both of hem are important. If you want to guarantee, prefer the red pepper. 

MEMORY TYPES

          There are different classifications of memory in cognitive neuroscience,traditional term. Traditional terms are immediate memory,short-term memory,long-term memory and motor memory.There are four types of memory in cognitive neuroscience too,which are working memory,episodic memory,semantic memory and procedural memory.I will summarize memory types as clinical neurologist inspired by the book Bradley.

           
           1 stage: Immediate (Working)  Memory
         
            It is about conscious awareness.The true capacity of working memory is 5-9 meaningful items.Without rehearsal the items lost in 18-20 seconds.Relaying primarily on prefrontal brain regions,working memory decline with normal aging.It is effected of the damage of superior frontal neocortex Broadman area 8/9 and left frontal lobe.Example;when we see a phone number,we can call it but after the call end,we start to forget the numbers.
             
           2 Stage: Short-term (Recent Episodic) (Recent) Memory
         
            It means the ability to encode and retrieve items such as words, events after a delay of minutes,hours.The function of hippocampus and parahippocampal areas of the medial temporal lobe work for it. Amygdala is not in recent episodic memory but important for the encoding of emotional or social context to the medial temporal cortex.The retrieval of the data from recent memory is about interaction between prefrontal regions and temporal lobe.
            
            3 Stage: Remote (Long-Term) Memory 
         
            It works by retrieving the events,words,items after weeks,months or years.The data which we learn goes to consolidation process with snaps ans systems.Consolidation with synapse is about long term potentiation and protein synthesis in the first few hours of learning in the hippocampus.Consolidation on a systematically level is over long periods of time.It is about hippocampal dependent memory representations which are stored in the neocortex.

           4  Semantic Memory

            It's about meanings of the words, unterstanding and interpreting items, conseptial datas about the world. For example it is the knowledge of the famous people, wars, political leaders. It depends on the personal long term memory. Semantic memory resides different cortical regions. Visual memeory is in the visual cortex, auditory memory is int the temporal cortex, meanings of words is left temporal cortex etc.