Chiari Malformation Drop Attacks
Chiari Malformation Drop AttacksChiari Malformation is a neurological condition that can cause a range of symptoms, including drop attacks. These sudden and unexpected falls can significantly impact an individual’s quality of life and require a comprehensive understanding of the underlying condition. By recognizing the symptoms, understanding the causes, and exploring the available treatment options, individuals experiencing drop attacks related to Chiari Malformation can find relief and regain control of their lives.
Recognizing Symptoms of Chiari Malformation
Chiari Malformation is a neurological condition characterized by structural defects in the base of the skull and cerebellum. It can manifest with a range of symptoms, some of which may lead to drop attacks. Recognizing these symptoms is crucial for early detection and appropriate medical intervention.
Here are some common Chiari Malformation symptoms to be aware of:
- Headaches: Persistent headaches that tend to worsen with coughing, sneezing, or straining.
- Neck pain: Chronic neck pain that radiates to the shoulders and upper back.
- Dizziness and balance problems: A sensation of dizziness, unsteadiness, and difficulty maintaining balance.
- Visual disturbances: Blurred vision, double vision (diplopia), or sensitivity to light.
- Numbness and tingling: Numbness or tingling in the hands, arms, or legs, commonly referred to as paresthesia.
- Weakness: Muscle weakness in various parts of the body, including the arms, legs, or face.
- Speech difficulties: Slurred speech or difficulty articulating words.
- Swallowing problems: Difficulty swallowing (dysphagia) or a sensation of food getting stuck in the throat.
- Sleep disturbances: Sleep apnea, insomnia, or frequent nighttime awakenings.
- Drop attacks: Unexpected falls due to a sudden loss of muscle tone and control.
If you are experiencing any of these symptoms, it is important to consult with a healthcare professional who specializes in Chiari Malformation. They can perform a thorough evaluation and recommend appropriate diagnostic tests to determine the underlying cause of your symptoms.
Early diagnosis and intervention can help manage the symptoms and improve the quality of life for individuals with Chiari Malformation. It is essential not to ignore the signs and seek prompt medical attention.
Symptom | Description |
---|---|
Headaches | Persistent headaches that worsen with coughing, sneezing, or straining. |
Neck pain | Chronic neck pain that radiates to the shoulders and upper back. |
Dizziness and balance problems | Sensation of dizziness, unsteadiness, and difficulty maintaining balance. |
Visual disturbances | Blurred vision, double vision (diplopia), or sensitivity to light. |
Numbness and tingling | Numbness or tingling in the hands, arms, or legs (paresthesia). |
Weakness | Muscle weakness in the arms, legs, or face. |
Speech difficulties | Slurred speech or difficulty articulating words. |
Swallowing problems | Difficulty swallowing (dysphagia) or sensation of food getting stuck in the throat. |
Sleep disturbances | Sleep apnea, insomnia, or frequent nighttime awakenings. |
Drop attacks | Unexpected falls due to sudden loss of muscle tone and control. |
Understanding Causes of Chiari Malformation
Chiari Malformation, a condition characterized by the displacement of the brain’s cerebellar tonsils into the spinal canal, can sometimes be associated with drop attacks. In this section, we delve into the underlying causes of Chiari Malformation, shedding light on its potential link to drop attacks.
ACIBADEM Health Point: Your Health is Our Priority!
ACIBADEM Health Point, we are dedicated to providing exceptional healthcare services to our patients. With a team of highly skilled medical professionals and state-of-the-art facilities, we strive to deliver the highest standard of care to improve the health and well-being of our patients. What sets ACIBADEM Health Point apart is our patient-centered approach. We prioritize your comfort, safety, and satisfaction throughout your healthcare journey. Our compassionate staff ensures that you receive personalized care tailored to your unique needs, making your experience with us as seamless and comfortable as possible.Congenital Anomalies
Congenital anomalies, such as structural abnormalities in the skull and brain, can contribute to the development of Chiari Malformation. These anomalies affect the normal flow of cerebrospinal fluid (CSF) and may result in the downward displacement of the cerebellar tonsils, leading to Chiari Malformation and its associated symptoms.
Genetic Predisposition
Research suggests that there may be a genetic component to Chiari Malformation. Certain genetic mutations or variations can increase an individual’s susceptibility to developing the condition. Familial cases of Chiari Malformation have been reported, indicating a potential hereditary influence.
Trauma
In some cases, trauma, such as head injuries or accidents, can trigger the onset of Chiari Malformation. The impact of trauma can disrupt the normal positioning of the brain and spinal cord, leading to the displacement of the cerebellar tonsils. This displacement can result in the compression of vital structures and the manifestation of Chiari Malformation symptoms, including drop attacks.
Other Factors
While congenital anomalies, genetic predisposition, and trauma are significant factors, it’s essential to note that the development of Chiari Malformation can also be influenced by other factors that are still being researched. These may include abnormal development of the skull and spinal cord during fetal growth or conditions that affect CSF flow, such as hydrocephalus.
The understanding of Chiari Malformation causes is an ongoing area of research, and further studies are necessary to gain a comprehensive understanding of the condition’s origins. By exploring these potential causes, we can work towards better diagnosis, prevention, and treatment strategies for individuals experiencing drop attacks associated with Chiari Malformation.
Causes of Chiari Malformation | Potential Explanation |
---|---|
Congenital Anomalies | Structural abnormalities in the skull and brain can lead to the displacement of cerebellar tonsils, resulting in Chiari Malformation. |
Genetic Predisposition | Specific genetic mutations or variations may increase the risk of developing Chiari Malformation. |
Trauma | Head injuries or accidents can disrupt the normal positioning of the brain and spinal cord, leading to Chiari Malformation. |
Other Factors | Abnormal fetal development of the skull and spinal cord and conditions affecting cerebrospinal fluid flow may also contribute to Chiari Malformation. |
Diagnosing Chiari Malformation
Diagnosing Chiari Malformation requires a comprehensive evaluation by medical professionals with expertise in the condition. There are various methods and tests used to confirm the presence of Chiari Malformation, enabling accurate diagnosis and appropriate treatment planning.
Diagnostic Methods
Medical professionals rely on a combination of clinical evaluation and diagnostic imaging techniques to diagnose Chiari Malformation. These methods include:
- Meticulous medical history assessment and physical examination to identify symptoms and signs of Chiari Malformation.
- Neurological examination to evaluate nerve function and identify any abnormalities.
- Diagnostic imaging, such as magnetic resonance imaging (MRI), to visualize the brain and spinal cord, allowing for the identification of structural abnormalities indicative of Chiari Malformation.
The Role of Magnetic Resonance Imaging (MRI)
Magnetic resonance imaging (MRI) is a crucial tool in diagnosing Chiari Malformation. It provides detailed images of the brain and spinal cord, allowing healthcare professionals to assess the position and size of the cerebellar tonsils, as well as any obstruction of cerebrospinal fluid flow. MRI helps differentiate between different types of Chiari Malformation and facilitates accurate treatment planning.
Diagnostic Method | Advantages | Limitations |
---|---|---|
Medical history assessment and physical examination |
|
|
Neurological examination |
|
|
Magnetic Resonance Imaging (MRI) |
|
|
It is essential to consult with specialists experienced in Chiari Malformation diagnosis to ensure a comprehensive evaluation and accurate diagnosis.
Advanced Treatment Options for Chiari Malformation
When it comes to managing Chiari Malformation, there are various advanced treatment options available, catering to individual needs and symptom severity. These treatment options include both non-surgical and surgical approaches, offering relief and improved quality of life for those affected by this condition.
Non-Surgical Treatment:
In less severe cases of Chiari Malformation, non-surgical treatment modalities may be recommended to manage symptoms and prevent further progression. These treatment options focus on symptom management and may include:
- Physical Therapy: Targeted exercises and stretches can help alleviate pain and improve muscle strength and coordination.
- Pain Management: Medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or muscle relaxants, may be prescribed to alleviate pain and discomfort.
- Lifestyle Modifications: Making lifestyle changes, such as avoiding activities that worsen symptoms or adopting a healthier diet, can contribute to symptom improvement.
- Monitoring: Regular check-ups with a healthcare professional specializing in Chiari Malformation can help track the progression of the condition and adjust treatment accordingly.
Surgical Treatment:
In cases where non-surgical treatment options prove ineffective or when symptoms are severe and progressive, surgical intervention may be necessary. Chiari Malformation surgery, specifically decompression surgery, is the most common surgical treatment approach. This procedure involves removing a small section of the bone from the back of the skull to relieve pressure and allow the cerebrospinal fluid to flow more freely around the brain and spinal cord.
Decompression surgery can significantly alleviate symptoms, reduce the risk of drop attacks, and improve overall neurological function. The success rate of this procedure is generally high, with many patients experiencing long-term symptom relief.
Surgical Treatment Options for Chiari Malformation
Surgical Treatment Option | Description |
---|---|
Decompression Surgery | A common surgical approach where a small section of the skull is removed to relieve pressure on the brain and spinal cord. |
Spinal Cord Diverting Shunt | A shunt system is implanted to divert excess cerebrospinal fluid, managing symptoms associated with Chiari Malformation. |
Syringomyelia Drainage | In cases where syringomyelia is present alongside Chiari Malformation, a drainage procedure may be performed to remove excess fluid. |
It is essential to consult with a qualified healthcare professional specializing in Chiari Malformation to determine the most suitable treatment approach based on individual circumstances. They can assess the severity of symptoms, evaluate medical history, and provide personalized guidance to achieve the best possible outcome.
Specialized Care for Chiari Malformation
When it comes to managing Chiari Malformation, seeking specialized care is essential. Consulting with healthcare providers who have expertise in treating this condition is crucial for accurate diagnosis, comprehensive treatment, and ongoing support. These Chiari Malformation specialists possess in-depth knowledge and experience to address the unique challenges faced by individuals experiencing drop attacks.
But how can you find qualified specialists who can provide the specialized care you need?
Finding Chiari Malformation Specialists
Locating reputable Chiari Malformation specialists may seem like a daunting task, but there are several avenues to explore:
- Ask your primary care physician or neurologist for recommendations. They can refer you to trusted specialists within their network.
- Reach out to local hospitals or medical centers that have specialized departments focusing on neurological disorders.
- Utilize online resources such as the American Association of Neurological Surgeons (AANS) and the American Academy of Pediatrics (AAP) to find healthcare professionals specializing in Chiari Malformation.
Take your time to research and consider the reputation, credentials, and experience of potential specialists. It’s important to find a healthcare provider who not only understands Chiari Malformation but also actively stays up-to-date with the latest advancements in treatment.
Comprehensive Treatment and Support
Chiari Malformation specialists are equipped to offer comprehensive treatment and support to individuals experiencing drop attacks. They understand the complexities of this condition and can tailor treatment plans to address the unique needs of each patient. These specialists may utilize a multidisciplinary approach, collaborating with other healthcare professionals such as neurologists, physiotherapists, and psychologists to provide holistic care.
Specialized care for Chiari Malformation may include:
Treatment Options | Description |
---|---|
Medical Management | Non-surgical approaches such as medications to alleviate symptoms and improve overall well-being. |
Physical Therapy | Exercises and techniques to strengthen muscles, improve posture, and manage pain. |
Decompression Surgery | A surgical procedure to relieve pressure on the brain and spinal cord, reducing the occurrence of drop attacks. |
Psychological Support | Therapy and counseling to address the emotional and psychological impact of living with Chiari Malformation and drop attacks. |
By choosing Chiari Malformation specialists, individuals can benefit from a tailored treatment plan, ongoing monitoring of their condition, and access to the latest advancements in the field. These specialists are committed to improving the quality of life for their patients and providing the necessary support throughout their healthcare journey.
Acibadem Healthcare Group’s Approach to Chiari Malformation
At Acibadem Healthcare Group, we are committed to providing exceptional care for individuals with Chiari Malformation. Our approach combines cutting-edge medical technologies, a multidisciplinary team of healthcare professionals, and a patient-centered care model to ensure optimal outcomes for every patient.
When it comes to diagnosing Chiari Malformation, we employ advanced imaging techniques such as magnetic resonance imaging (MRI) and computed tomography (CT) scans. These tests allow us to accurately assess the extent of the malformation and identify any associated abnormalities.
H3: Comprehensive Treatment Plans and Innovative Surgical Procedures
We understand that each individual’s case is unique, which is why our team of specialists develops personalized treatment plans tailored to the specific needs of our patients. Depending on the severity of the Chiari Malformation and the presence of drop attacks, our treatment options may include:
- Medication management to control symptoms
- Physical therapy to improve strength and coordination
- Pain management techniques
- Surgical intervention, if necessary
Innovative Surgical Procedures
In cases where surgical intervention is recommended, we utilize state-of-the-art techniques to provide the most effective and least invasive treatments. Our skilled neurosurgeons are experienced in performing decompression surgery, a procedure aimed at relieving pressure on the brain and spinal cord by removing a small portion of the skull and vertebrae. This surgical approach not only alleviates symptoms but also minimizes the risk of drop attacks associated with Chiari Malformation.
H3: Collaborative Approach and Expert Care
At Acibadem Healthcare Group, we believe in the power of collaboration. Our team of neurologists, neurosurgeons, radiologists, and other specialists work together to ensure our patients receive comprehensive and integrated care. This multidisciplinary approach allows us to address all aspects of Chiari Malformation and provide holistic treatment plans that meet the unique needs of each patient.
To support our patients throughout their treatment journey, we also offer a range of supportive services, including physical therapy, pain management programs, and psychological counseling. Our goal is to not only provide expert medical care but also to enhance patients’ overall well-being and quality of life.
Acibadem Healthcare Group’s Outcome
Our commitment to excellence and patient-centric care has resulted in successful outcomes for many individuals with Chiari Malformation. Through our advanced medical technologies, innovative surgical procedures, and comprehensive approach, we strive to improve the lives of our patients and reduce the occurrence of drop attacks associated with Chiari Malformation.
Treatment Approach | Advantages |
---|---|
Individualized Treatment Plans | – Tailored care based on each patient’s unique needs – Comprehensive approach addressing all aspects of Chiari Malformation |
Innovative Surgical Techniques | – Minimally invasive procedures for better patient outcomes – Specialized decompression surgery to alleviate symptoms and reduce drop attacks |
Multidisciplinary Team | – Collaborative approach involving neurologists, neurosurgeons, and other specialists – Holistic care that addresses both physical and psychological well-being |
Supportive Services | – Physical therapy, pain management, and psychological counseling to enhance overall well-being – Patient-centered care throughout the treatment journey |
Long-Term Outlook for Individuals with Chiari Malformation
Living with Chiari Malformation can be challenging, particularly for individuals experiencing drop attacks. However, with appropriate treatment and management, there is hope for symptom improvement and long-term well-being. A comprehensive approach that combines medical intervention, lifestyle modifications, and supportive measures is crucial for optimizing outcomes.
Medical Treatment and Symptom Management
The primary goal of Chiari Malformation treatment is to alleviate symptoms and prevent the occurrence of drop attacks. This typically involves a combination of non-surgical and surgical interventions, depending on the severity of the condition. Non-surgical options may include pain management strategies, physical therapy, and the use of assistive devices to enhance mobility and function.
It is important to work closely with healthcare professionals specializing in Chiari Malformation to develop a personalized treatment plan that addresses individual needs and goals. Regular follow-up appointments and ongoing communication with the healthcare team are essential for monitoring progress and making any necessary adjustments to the treatment plan.
Lifestyle Modifications
In addition to medical treatment, certain lifestyle modifications can contribute to better symptom management and overall well-being for individuals with Chiari Malformation. These may include:
- Engaging in regular exercise within physical limitations
- Practicing stress management techniques, such as meditation or deep breathing exercises
- Adopting a balanced and nutritious diet
- Prioritizing quality sleep and establishing a consistent sleep routine
- Avoiding activities or positions that worsen symptoms
Supportive Measures
The emotional and psychological impact of living with Chiari Malformation and experiencing drop attacks should not be underestimated. It is important to seek support and connect with others who can provide empathy and understanding. Supportive measures may include:
- Joining support groups or online communities for individuals with Chiari Malformation
- Attending counseling or therapy sessions to address emotional challenges
- Developing coping strategies to manage stress and anxiety related to the condition
- Accessing educational resources and information to stay informed about the latest advancements and research in Chiari Malformation
Long-Term Prognosis
The long-term outlook for individuals with Chiari Malformation varies depending on the severity of the condition and the effectiveness of the chosen treatment approach. While complete resolution of symptoms may not be possible for everyone, many individuals experience significant symptom improvement and are able to lead fulfilling lives.
Consistent medical care, adherence to treatment plans, and implementing supportive measures can greatly contribute to enhancing quality of life and minimizing the impact of Chiari Malformation and drop attacks.
Treatment Options for Chiari Malformation
Treatment Approach | Description |
---|---|
Non-surgical interventions | – Pain management strategies- Physical therapy- Assistive devices |
Surgical interventions | – Decompression surgery to relieve pressure on the brain and spinal cord |
Lifestyle modifications | – Regular exercise within physical limitations- Stress management techniques- Balanced and nutritious diet- Quality sleep- Avoidance of triggering activities or positions |
Supportive measures | – Joining support groups or online communities- Counseling or therapy sessions- Developing coping strategies- Accessing educational resources |
Ongoing follow-up care | – Regular medical check-ups to monitor progress and make adjustments to treatment plans |
Supportive Measures for Individuals with Chiari Malformation
Alongside medical treatment, implementing supportive measures is crucial for individuals with Chiari Malformation. These measures aim to enhance overall well-being, manage symptoms, and provide emotional support. Here are some key supportive measures:
Lifestyle Modifications:
Adopting lifestyle modifications can help individuals with Chiari Malformation better manage their condition and reduce the frequency of drop attacks. Some recommended modifications include:
- Avoiding activities that put excessive strain on the neck and spine
- Practicing good posture
- Incorporating regular exercise to strengthen supporting muscles
- Maintaining a healthy weight
- Getting enough rest and sleep
- Implementing stress management techniques, such as meditation or yoga
Psychological Support:
The emotional and psychological impact of living with Chiari Malformation and experiencing drop attacks should not be underestimated. Seeking psychological support can help individuals cope with the challenges and improve overall mental well-being. Some ways to access psychological support include:
- Talking to a licensed therapist or counselor specializing in chronic conditions and neurological disorders
- Joining support groups or online communities to connect with others facing similar challenges
- Engaging in relaxation techniques and mindfulness exercises
Resources for Coping:
Various resources are available to support individuals with Chiari Malformation and their loved ones. These resources can provide valuable information, guidance, and assistance in navigating the condition.
- Online educational platforms that offer comprehensive information about Chiari Malformation and related drop attacks
- Advocacy organizations dedicated to raising awareness, providing support, and funding research for Chiari Malformation
- Books, articles, and research papers that explore the condition and offer insights into coping strategies
Supportive Measures | Description |
---|---|
Lifestyle Modifications | Avoid activities straining the neck and spine, practice good posture, exercise regularly, maintain a healthy weight, get enough rest and sleep, manage stress |
Psychological Support | Seek therapy/counseling, join support groups or online communities, engage in relaxation techniques and mindfulness exercises |
Resources for Coping | Access online educational platforms, connect with advocacy organizations, explore books, articles, and research papers |
Staying Informed about Chiari Malformation
Staying informed about Chiari Malformation and its associated drop attacks is crucial for individuals impacted by this condition. By understanding the causes and symptoms of Chiari Malformation, individuals can take proactive steps towards diagnosis, treatment, and overall well-being.
Chiari Malformation is characterized by the abnormal positioning of the brain’s cerebellum, which can lead to various neurological symptoms. These symptoms may include severe headaches, neck pain, balance issues, and in some cases, drop attacks. By recognizing the early signs, individuals experiencing drop attacks can seek timely medical attention and gain access to appropriate treatment options.Chiari Malformation Drop Attacks
It is important to note that the causes of Chiari Malformation are not fully understood. However, research suggests that congenital anomalies, genetic predisposition, and trauma may play a role. By staying informed about the possible causes, individuals can make informed decisions about their health and explore preventive measures if applicable.
By staying informed about Chiari Malformation, individuals can actively engage in their healthcare journey. They can advocate for themselves, seek specialized care from healthcare providers experienced in managing the condition, and access resources for support and guidance. Additionally, raising awareness about Chiari Malformation can contribute to early detection, improved treatment outcomes, and a supportive community for individuals impacted by this condition.
FAQ
Drop attacks refer to sudden episodes of falling or collapsing without losing consciousness. These attacks can be associated with Chiari Malformation, a condition where the brain tissue extends into the spinal canal, causing compression and disruption of the normal flow of cerebrospinal fluid. The pressure on the brainstem and spinal cord can lead to neurological symptoms, including drop attacks.
What are the common symptoms of Chiari Malformation?
The symptoms of Chiari Malformation may vary, but common signs include headaches, neck pain, dizziness, difficulty swallowing, vision problems, balance issues, and numbness or tingling in the arms or hands. In cases where drop attacks occur, sudden falls or collapses can also be experienced.
What causes Chiari Malformation and associated drop attacks?
Chiari Malformation is typically present at birth, but it may go unnoticed until symptoms appear later in life. The exact causes are not fully understood, but it can be associated with certain congenital anomalies, such as a smaller posterior fossa or abnormalities in the skull and spine. Trauma, genetic predisposition, and other factors may also contribute to the development of Chiari Malformation and the occurrence of drop attacks.
How is Chiari Malformation diagnosed?
Diagnosis of Chiari Malformation usually involves a comprehensive evaluation by a neurologist or neurosurgeon. They may perform a physical examination, review the patient's medical history, and order imaging tests, such as MRI or CT scans, to visualize the brain and spinal cord. These tests can confirm the presence of Chiari Malformation and help determine the appropriate treatment approach.
What are the treatment options for Chiari Malformation and associated drop attacks?
The treatment options for Chiari Malformation aim to alleviate symptoms and improve the quality of life. Non-surgical approaches may include medications for pain management and physical therapy for strengthening muscles and improving coordination. In more severe cases, surgical intervention, such as decompression surgery, may be recommended to relieve pressure on the brain and spinal cord, reducing the occurrence of drop attacks.
Are there specialists who specialize in Chiari Malformation?
Yes, it is important to seek specialized care from healthcare providers who have expertise in managing Chiari Malformation. Neurosurgeons and neurologists with experience in treating Chiari Malformation and associated conditions can provide comprehensive evaluation, accurate diagnosis, and personalized treatment plans for individuals experiencing drop attacks.
How does Acibadem Healthcare Group approach the diagnosis and treatment of Chiari Malformation?
Acibadem Healthcare Group offers a comprehensive approach to the diagnosis and treatment of Chiari Malformation. Their team of experienced neurologists and neurosurgeons utilizes advanced medical technologies to accurately diagnose the condition. They provide personalized treatment plans, which may include both non-surgical and surgical options, to address the unique needs of each patient and improve their quality of life.
What is the long-term outlook for individuals with Chiari Malformation?
With appropriate treatment and management, individuals with Chiari Malformation can experience symptom improvement and have a good long-term outlook. The severity of the condition and the specific symptoms experienced can vary among individuals. Regular follow-up appointments with healthcare providers, adherence to treatment plans, and appropriate lifestyle modifications can help manage symptoms and reduce the frequency of drop attacks.
Are there supportive measures available for individuals with Chiari Malformation?
Alongside medical treatment, implementing supportive measures can significantly contribute to the overall well-being of individuals with Chiari Malformation. This may include lifestyle modifications, such as avoiding activities that exacerbate symptoms, practicing stress management techniques, and seeking psychological support. Additionally, various resources and support groups are available to help individuals cope with the challenges posed by drop attacks and Chiari Malformation.
How can individuals stay informed about Chiari Malformation and its associated drop attacks?
Staying informed about Chiari Malformation and its associated drop attacks is crucial for individuals affected by the condition. They can educate themselves by accessing reliable sources of information, attending patient conferences or support groups, and engaging with healthcare providers who specialize in Chiari Malformation. Raising awareness and sharing personal experiences can also help enhance understanding and support for the Chiari Malformation community.
ACIBADEM Healthcare Group Hospitals and Clinics
With a network of hospitals and clinics across 5 countries, including 40 hospitals, ACIBADEM Healthcare Group has a global presence that allows us to provide comprehensive healthcare services to patients from around the world. With over 25,000 dedicated employees, we have the expertise and resources to deliver unparalleled healthcare experiences. Our mission is to ensure that each patient receives the best possible care, supported by our commitment to healthcare excellence and international healthcare standards. Ready to take the first step towards a healthier future? Contact us now to schedule your Free Consultation Health session. Our friendly team is eager to assist you and provide the guidance you need to make informed decisions about your well-being. Click To Call Now!*The information on our website is not intended to direct people to diagnosis and treatment. Do not carry out all your diagnosis and treatment procedures without consulting your doctor. The contents do not contain information about the therapeutic health services of Acıbadem Health Group.