Objective: To report a rare case with central-variant posterior reversible encephalopathy syndrome due to sulfasalazine. Clinical Presentation and Intervention: A 55-year-old female patient presented with seizure and acute-onset hemiparesia. Thirty days earlier, treatment with sulfasalazine was commenced in response to a diagnosis of psoriatic arthritis. Laboratory examinations were normal. Brain magnetic resonance imaging showed symmetric edema within basal ganglia and thalami with sparing of the cerebral cortices. After stopping the treatment of sulfasalazine, clinical and radiological findings regressed dramatically. Conclusion: This was a case of central-variant posterior reversible encephalopathy syndrome due to sulfasalazine, and atypical imaging findings should be kept in mind for early diagnosis.

The Covid-19 pandemic is a big challenge for all of us and has brought us suffering, death, and fear. This issue is an unprecedented situation and requires an unprecedented response. Fortunately, COVID-19 vaccines have been developed rapidly and in a short period, they were demonstrated to be safe and effective. Also, World Health Organization is working to promote fair access to safe and effective COVID-19 vaccines and coordinates key steps in this process. Nowadays, thankfully more than ten different vaccines have been administered. The vaccination programs started in early December 2020 and more than 20% of the world population has received at least one dose of a COVID-19 vaccine by the end of June 2021 (1,2). Some of the COVID-19 vaccines have been the first to be produced using the messenger RNA (mRNA) platform. While high effectivity is an expectation of these vaccines also, they are “reactogenic,” meaning that they’re likely to cause a noticeable immune response. So, according to reports, about side effects following vaccination with the Pfizer and Moderna mRNA vaccines the side effects of the COVID-19 vaccine vary with the type of the vaccine (3,4). While the soreness of the site of injection is the most common side effect, other side effects such as headache, fatigue, muscle aches, joint pain, chills, and fever usually last 24 to 48 hours (3,4). Maybe not as a side effect but, an imbalance was reported in the incidence of facial paralysis following the vaccination. Facial paralysis (FP) was reported during the phase 3 clinical trials of mRNA COVID-19 vaccines (3,4). Seven cases were observed in vaccine groups among the 35611 participants (3,4). Also, facial nerve-related disorders such as facial paresis, facial spasms, and nerve disorders were reported as a drug reaction with mRNA COVID-19 vaccines (5). According to reports, we see symptoms of nerve pathology can vary from one to another and range in severity from mild weakness to total paralysis (5). According to World Health Organization Pharmacovigilance Database, almost half of the patients with FP were reported from the United States of America (USA) and the United Kingdom (UK) (5). According to our current knowledge, there is no case reported from Turkey. In June 2021, we had the opportunity to treat two patients with FP who developed nerve damage following the Pfizer COVID-19 vaccine. The purpose of this letter is to describe the individual situation of two FP patients in detail and to help health professionals make a decision about how to do things in similar features.

GİRİŞ ve AMAÇ: İskemik inme hastalarında gelişen serebral ödem mortalite ve morbiditenin en önemli nedenidir. Medikal tedaviye cevap alınamayan hastalarda dekompresif hemikraniyektomi yararlı olabilir. Bu yazıda, kliniğimizde akut iskemik inme nedeniyle dekompresif hemikraniyektomi uygulanan hastaların klinik özellikleri ve prognoz ile ilişkili faktörler değerlendirilmiştir. YÖNTEM ve GEREÇLER: Bu çalışmaya iskemik inme nedeni ile dekompresif hemikraniyektomi uygulanan 21 hasta alındı. Hastaların demografik özellikleri ile görüntüleme bulguları kaydedildi. Hastaların fonksiyonel durumu modifiye Rankin Skalası ile değerlendirildi. Hastanedeki izlem süresinde eksitus olan ve yaşayan hastaların klinik özellikleri ve görüntüleme bulguları karşılaştırıldı.BULGULAR: Çalışmaya 12’si erkek, 9’u kadın, yaş ortalaması 58.7±8.2 (46 - 78) olan 21 hasta alındı. Hastaların başvuru NIHSS skoru ortalaması 12.5±4.5 idi. İnfarkt 17 hastada orta serebral arter, 4 hastada internal karotis arter alanındaydı. Dekompresif hemikraniyektomi uygulama zamanı ortalama 2.9±2.5 gün ve hastanede ortalama kalış süresi 42.6±39.2 gün idi. Hastanedeki izlem süresinde beş (% 23.8) hasta eksitus oldu. Dekompresif hemikraniyektomi uygulanan hastalarda klinik özellikler ve görüntüleme bulguları mortalite ile ilişkili bulunmadı.TARTIŞMA ve SONUÇ: İskemik inmede dekompresif hemikraniyektomi medikal tedavi uygulanmasına rağmen kötüleşen hastalarda önemli bir tedavi seçeneğidir.