Idiopathic intracranial hypertension (IIH) is a syndrome characterized by increased intracranial pressure of unknown cause, leading to severe headache, papilledema and visual disturbances. Its former name, pseudotumor cerebri, has gained popularity recently. The strongest and most consistent risk factors of IIH are obesity and female gender. Infrequently, IIH may present in the absence of papilledema showing a headache profile similar to chronic daily headache with migrainous features. There have been several proposed mechanisms to explain the etiology of this disorder associated with various clinical conditions. In recent years, some inflammatory factors, natriuretic peptides and aquaporins have been proposed as possible contributors of the pathogenesis. On the other hand, some investigators have reported that bilateral transverse sinus stenosis is seen in the majority of IIH patients; therefore, dural sinus stent placement is used in some patients. No single theory has been able to provide a comprehensive answer, and there is no consensus about the exact cause of IIH. The aim of this review was to discuss the new insights on the mysterious pathogenesis of IIH.

Objectives: Patients with RLS suffer nonrestorative sleep, daytime sleepiness, fatigue, and concentration problems. In addition, dialysis itself effects the psychological and social life of the patient negatively. The aim of this study was to determine the prevalence of RLS in patients on regular hemodialysis, and its relationship with patients’ quality of life, socio-demographic and laboratory data.
Methods: One hundred and eighteen stable chronic hemodialysis (HD) patients referring to the hemodialysis unit of Turkish Kidney Foundation and 49 patients that met IRLSSG diagnostic criteria were included into the study. IRLSSG Diagnostic Criteria and International Restless Leg Syndrome rating scale were used as a guideline to diagnose and evaluate the severity of RLS. Short form-36 health survey was used to evaluate the quality of life. For statistical analysis, the “SPSS for Windows” package program was used.
Results: A total of forty-nine patients, of whom 26 were female and 23 were male, that met IRLSSG diagnostic criteria were included into the study. Mean age of the patients was 61.35±13.17 years. There was a negative correlation between the IRLSS score and SF36 Physical Score, Mental Score and Total Score, respectively (p=0.018 r=-0.351, p=0.01 r=-0.380, p=0.00 r=-0.499). There was no significant correlation between the IRLSS score and dialysis duration, blood ferritin and parathyroid hormone and other comorbid diseases.
Conclusion: RLS is a common distressing problem in patients with ESRD, which negatively impacts functional health status. Clinicians should be aware of the symptoms of RLS to decrease morbidities related with quality of life.

Objectives: The aim of this study was to evaluate the pain level of each muscle during an EMG study and also search for any association between the pain levels and gender.
Methods: Two hundred and twenty-seven subjects (166 females and 111 males) participated in the present study. Numeric analogue scale (NAS) was obtained from the patients after needle EMG for each muscle.
Results: In total, 1242 muscles were examined. The highest pain levels among examined muscles were found on Abductor Pollicis Brevis (APB) (5.8±2.6), First Dorsal Interosseous (4.2±2.6) and Vastus Lateralis (4.0±2.6). NAS levels of the female patients (4.3±2.7) were apparently higher than those of the male patients (2.8±2.3) (p<0.01).
Conclusion: First Dorsal Interosseous muscle was found less painful than APB muscle for the patients. Our study displayed greater pain sensitivity among females compared with males during the needle EMG; however, the pain levels of examined muscles were not higher than moderate for both genders.

Objectives: Transforaminal anterior steroid injections are frequently used for low back pain. In the current study, It was aimed to investigate the effects of transforaminal anterior epidural steroid injection (TAESI) in patients with low back pain in regards to quality of life and sleep, and neuropathic pain.
Methods: Ethics committee approval and patient consent were obtained. Patients with low back pain scheduled to receive transforaminal epidural steroid injections between October 2011 and October 2012 were included into the study. Pittsburgh Sleep Quality Index (PSQI), Short form 12 (SF 12), DN4 tests and Visual Analog Scale Score (VAS) were measured prior to procedure and three months later. All the tests were compared with baseline evaluations prior to injections.
Results: One hundred and two (female/male: 52/50) patients with a mean age of 53.3±1.4 were included. Primary diagnoses were lumbar disc herniation in eighty-seven patients, spinal stenosis in seven and failed back surgery syndrome in eight patients. Statistically significant improvement was seen in the total VAS, DN4 and PSQI scores (p=0.0001) of the patients at the third month follow-up. Sleep duration (p=0.0001), habitual sleep efficiency (p=0.0001), subjective sleep quality (p=0.003), sleep latency (p=0.014), sleep disturbances (p<0.001), sleep medication use (p=0.003), and day time dysfunction (p=0.015) showed a significant decrease in sub-components. There was no significant difference in SF 12 quality of life.
Conclusion: It was determined in the study that transforaminal epidural steroid injection provided a substantial improvement in patients’ pain and neuropathic pain and quality of sleep, but had no effect on the quality of life.

Objectives: The aim of the present study was to determine the effects of perceived pain on quality of sleep and life in patients hospitalized in a pain clinic.
Methods: Population of the present descriptive study composed of patients (>18 years old) treated as inpatients in the algology clinic of a university located at the city center of Sivas, who consented to participate in the study (122 patients). Data were collected through Personal Information Form, Visual Analog Scale (VAS), Pittsburg Sleep Quality Index (PSQI) and Short Form 36. Data were analyzed using independent t-test, Mann Whitney U test, Kruskal Wallis test and Pearson correlation test. Statistical significance level was set at p<0.05.
Results: A moderate negative correlation was found between VAS and three dimensions of SF-36, namely Physical Functioning, Role-Physical and Role-Emotional. VAS was weakly and negatively correlated to Vitality and Mental Health. There was a good linear correlation between VAS and quality of life (QoL), pain score while there was a moderate linear correlation between VAS and the total sleep score. It was found that quality of life was not statistically significantly correlated to General Health and Social Functioning.
Conclusion: There is a relationship between pain, sleep quality and quality of life. Quality of sleep and life was found to decrease as the level of pain increased, and quality of life was affected negatively when the quality of sleep was poor. Applications towards resolving pain would have a positive effect on the quality of sleep and life.

Objectives: The percentage of chronic pain in adults having inguinal hernia repair is 5-35%. Although this pain is thought to be related to some reasons, there is not an exact conclusion about this. In this study, the aim was to point out the incidence of chronic pain after inguinal hernia repair and determination of the risk factors.
Methods: Two hundred and four patients having inguinal hernia surgery between January 2011 and December 2012 were included into this study. The patients’ pain was measured with VAS within 24 hours and at the third and the sixth month after surgery. The patients whose VAS was>3 three months after surgery were evaluated to have chronic pain.
Results: The incidence of pain continuing 3 months after surgery was 18.6% and 11.2% six months after surgery. 78.3% of the patients had already had pain before surgery, and in 28% of them, chronic pain had evolved. The measure of VAS within 24 hours postoperatively was found higher in patients who developed chronic pain (3.13±1.12/1.71±1.27). 5.2% of the patients had re-operation for reparation and chronic pain developed in all. Chronic pain was neuropathic in 48% of the patients, and its severity was moderate.
Conclusion: The incidence of chronic pain after inguinal hernia repair was found %18, compatible with similar studies. Compared with other risk factors, preoperative pain, postoperative severe acute pain and reoperations were thought to be the most important risk factors for the development of chronic pain.

Objectives: The purpose of this study was to determine the symptoms observed during admission to palliative care in patients that would be provided palliative support, to measure their intensity, and to evaluate the effect of palliative care on patient symptoms by recording changes during the first week after admission to hospital.
Methods: The sample of the study was determined as 108 according to the population mean significance test conducted by using preliminary application data. Patients who were able to complete the Edmonton Symptom Assessment Scale during admission to hospital, on the 3rd and 7th days of hospitalization were included into the evaluation. The Introductory Characteristics Questionnaire, Edmonton Symptom Assessment Scale and Palliative Performance Scale were used for the collection of the data.
Results: While 50% of the patients defined pain intensity as 5 and over during admission, this rate was determined to be 6.5% on the 7th day. Mean values of the symptoms of pain, insomnia, loss of appetite, and status of well-being decreased significantly on the 3rd and 7th days after admission compared to the time of admission to the hospital. Besides, no statistically significant difference was found among the symptoms of nausea, anxiety, shortness of breath, and constipation.
Conclusion: In this study, it was determined that the intensity of symptoms deteriorating the life quality of cancer patients such as pain, fatigue, insomnia, loss of appetite, and status of well-being improved rapidly with palliative care support.

Hemiplegic migraine, whose etiology is unclear, is a specific form of migraine with aura including hemiparesis. In this study, it was aimed to present the case of a 39-year-old women, suffering from sporadic hemiplegic migraine. The patient suffered recurrent severe headaches, and existing focal neurological symptoms, including alternant hemiparesis. On the basis of the history, thorough clinical observation and numerous accessory investigations, a diagnosis of sporadic hemiplegic migraine was established. Differential diagnoses of SHM were highlighted.

A seventy-seven year-old male patient had a stroke two years ago. Following the stroke, the patient had continuous, excruciating, severe pain between the left knee, which increased when standing and walking. We looked into the change in the character of the patient’s pain after treatment. This study aimed to present our treatment approaches to the patients who develop central neuropathic pain, degenerative disk disease-related peripheral neuropathic pain and radicular nociceptive pain, and gonarthrosis-related nociceptive pain in the left leg following stroke.

Cluster headache is a neurological disorder characterized by recurrent, sudden, short-lasting, very severe, unilateral temporal-periorbital pain. It is a rare subtype of primary headache; and very rarely secondary forms have been reported in the literature. Here is reported a patient with secondary cluster headache due to cavernous sinus meningioma, who have presented with typical features of primary cluster headache fulfilling the criteria defined by the international headache committee.

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