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Multifocal motor neuropathy (MMN) is an immune-mediated and acquired demyelinating motor polyneuropathy. Several cases of polyneuropathy associated with severe acquired respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination have been reported. However, MMN has not been reported as a complication of SARS-CoV-2 vaccination. In this study, we report a case of MMN with progressive muscle weakness following the second dose of the Pfizer-BioNTech mRNA vaccine. It was diagnosed by clinical evaluation and electroneuromyography. SARS-CoV-2 vaccination is increasing rapidly all over the world. Some cases of polyneuropathy, especially Guillain–Barré syndrome, have been reported after vaccination. This is the first case report of MMN after SARS-CoV-2 vaccination.

Introduction and AimStroke is a disease with high mortality and morbidity. Although studies are generally performed on all patients with stroke, it is known that gender has an effect on etiology and prognosis. This study aimed to determine the importance of clinical stroke scales and laboratory markers in determining the short-term prognosis of female patients with ischemic stroke of anterior circulation.Materials and MethodsThe study was planned as a retrospective and cross-sectional study. SEDAN score, the National Institutes of Health stroke scale (NIHSS), the Modified Rankin Scale (mRS), the Glasgow Coma Scale (GCS), and THRIVE score applied to the patients at the time of admission were recorded. Admission blood glucose, hemoglobin, leukocyte, urea, albumin, and blood lipid levels were evaluated. The relationship of all these parameters with in-hospital prognosis, mortality, and disability at discharge was examined. The relationship between groups and data was analyzed using the SPSS package program after the normality analysis.ResultsIn this study, there were 733 female patients with stroke with a mean age of 69.53 ± 14.51 years and 858 male patients with stroke with a mean age of 64.27 ± 13.29 years. Hospitalization time, length of stay in the intensive care unit, ventilation need rate, mortality, and dependency rate were higher in female patients (p = 0.001). The NIHSS, SEDAN, and THRIVE scores were higher in female patients who had in-hospital mortality, had a poor prognosis, and who were discharged as dependent (p = 0.001). GCS was lower in this patient group (p = 0.001). Blood glucose, creatinine, leukocytes, urea, and CRP levels were higher; the albumin and hemoglobin levels was lower in female patients who had fatal outcomes (p = 0.009, 0.001, 0.001, 0.001, 0.001, and 0.020; respectively). In female patients who were dependent at discharge, blood urea, glucose, and CRP levels were higher and the albumin levels were lower than those in female patients who achieved functional independence (p = 0.001, 0.016, 0.002, and 0.001, respectively).ConclusionOur study showed that the short-term prognosis is worse in female patients who had an ischemic stroke of anterior circulation. It also revealed some clinical and laboratory parameters that could predict this situation. More intensive monitoring may be needed to improve prognosis in female patients.

Objective: Some comorbid diseases are recognized as specific risk factors for stroke. Rheumatological diseases constitute an important group of these diseases. In our study, we evaluated patients who were followed up for stroke in our clinic. We included patients with additional rheumatological diagnoses in a separate group and attempted to determine their differences from patients without a diagnosis. In this way, we aim to investigate the effect of rheumatological comorbidity on prognosis in stroke patients. Material and methods: We included patients diagnosed with ischemic stroke, hemorrhagic stroke, transient ischemic attack, and hemorrhagic infarction, who were admitted to our hospital between 2016-2020 and were hospitalized, in the study. Age, gender, stroke subtype, need for intensive care, and exitus status of these patients was recorded. We compared patients with a rheumatological diagnosis to patients with other stroke diagnoses using appropriate statistical methods.Results: 2053 patients with an average age of 66.22±14.33 participated in the study. A total of 37 patients were diagnosed with at least 1 rheumatological disease. We calculated the average age of these patients as 51.62±15.88. Compared to patients without a diagnosis of rheumatological disease, the age was significantly lower(p

Objective: To reveal the profile and practice in patients with acute stroke who received intravenous tissue plasminogen activator (IV tPA) and/or neuro-interventional therapy in Türkiye. Materials and Methods: On World Stroke Awareness Day, May 10, 2018, 1,790 patients hospitalized in 87 neurology units spread over 30 health regions were evaluated retrospectively and prospectively. Results: Intravenous tPA was administered to 12% of 859 cases of acute ischemic stroke in 45 units participating in the study. In the same period, 8.3% of the cases received neurointerventional treatment. The rate of good prognosis [modified Rankin score (mRS) 0–2] at discharge was 46% in 83 patients who received only IV tPA [age: 67 +- 12 years; National Institutes of Health Stroke Scale (NIHSS): 12 +- 6; hospital stay, 24 +- 29 days]; 35% in 51 patients who underwent thrombectomy (MT) alone (age: 64 +- 13 years; NIHSS: 14.1 +- 6.5; length of hospital stay, 33 +- 31 days), 19% in those who received combined treatment (age: 66 +- 14 years; NIHSS: 15.6 +- 5.4; length of hospital stay, 26 +- 35 days), and 56% of 695 patients who did not receive treatment for revascularization (age: 70 +- 13 years; NIHSS: 7.6 +- 7.2; length of hospital stay, 21 +- 28 days). The symptom-to-door time was 87 +- 53 minutes in the IV treatment group and 200 +- 26 minutes in the neurointerventional group. The average door-to-needle time was 66 +- 49 minutes in the IV tPA group. In the neurothrombectomy group, the door-to-groin time was 103 +- 90 minutes, and the TICI 2b-3 rate was 70.3%. In 103 patients who received IV tPA, the discharge mRS 0–2 was 41%, while the rate of mRS 0–1 was 28%. In 71 patients who underwent neurothrombectomy, the mRS 0–2 was 31% and mRS 0–1 was 18%. The door-to-groin time was approximately 30 minutes longer if IV tPA was received (125 +- 107 and 95 +- 83 minutes, respectively). Symptomatic bleeding rates were 4.8% in IV recipients, 17.6% among those who received only MT, and 15% in combined therapy. Globally, the hemorrhage rate was 6.8% in patients receiving IV tPA and 16.9% in MT. Conclusion: IV thrombolytic and neurointerventional treatment applications in acute ischemic stroke in Türkiye can provide the anticipated results. Heterogeneity has begun to be reduced in our country with the dissemination of the system indicated by the 'Directive on Health Services to be Provided to Patients with Acute Stroke.'

Objective: Atrial fibrillation (AF) is the most common directly preventable cause of ischemic stroke. There is no dependable neurology-based data on the spectrum of stroke caused by AF in our country. Within the scope of NeuroTek-Turkey, hospital-based data on acute stroke patients with AF were collected to contribute to the creation of acute stroke algorithms. Materials and Methods: Atrial fibrillation (AF) is the most common directly preventable cause of ischemic stroke. There is no dependable neurology-based data on the spectrum of stroke caused by AF in Türkiye. Within the scope of NöroTek-Türkiye (TR), hospital-based data on acute stroke patients with AF were collected to contribute to the creation of acute-stroke algorithms. Results: The rate of AF in patients hospitalized for ischemic stroke/TIA was 29.8%, of which 65% were known before stroke, 5% were paroxysmal, and 30% were diagnosed after hospital admission. The proportion of patients with AF who received 'effective' treatment [international normalization ratio ≥2.0 warfarin or non-vitamin K antagonist oral anticoagulants (NOACs) at a guideline dose] was 25.3%, and, either no medication or only antiplatelet was used in 42.5% of the cases. The low dose rate was 50% in 42 patients who had a stroke while taking NOACs. Anticoagulant was prescribed to the patient at discharge at a rate of 94.6%; low molecular weight or unfractionated heparin was prescribed in 28.1%, warfarin in 32.5%, and NOACs in 31%. The dose was in the low category in 22% of the cases discharged with NOACs, and half of the cases, who received NOACs at admission, were discharged with the same drug. Conclusion: NöroTekTR revealed the high but expected frequency of AF in acute stroke in Türkiye, as well as the aspects that could be improved in the management of secondary prophylaxis. AF is found in approximately one-third of hospitalized acute stroke cases in Türkiye. Effective anticoagulant therapy was not used in three-quarters of acute stroke cases with known AF. In AF, heparin, warfarin, and NOACs are planned at a similar frequency (one-third) within the scope of stroke secondary prophylaxis, and the prescribed NOAC dose is subtherapeutic in a quarter of the cases. Non-medical and medical education appears necessary to prevent stroke caused by AF.

Environment psychologically affects individuals. According to the base of cognitive psychology, there is a direct relationship between human behavior, environment, and emotional process. Assuming that pleasantness and unpleasantness are associated with peripheral nervous system activation, the current study aims to explore if the pleasant or unpleasant architectural places can stimulate the brain regions engaged in emotions or not. As the main contribution, we used functional magnetic resonance imaging (fMRI) measuring blood oxygenation level-dependent (BOLD) changes to effectively detect the brain's region that mainly responds to the emotional-perceptual processes. Based on the results of examining the emotional assessment model of “Pleasure-Arousal” applied to 140 students, 30 most-rated images representing 15 pleasant and 15 unpleasant places were shown to 32 participants in a 1.5-T MRI scanner. After applying standard preprocessing steps (re-alignment, slice-timing, co-registration, segmentation, normalization, and smoothing) to functional MR images, first-level analysis was applied to each subject. The results were evaluated using statistical corrections at different levels for female and male participants with the second-level analysis. In conclusion, it has been shown that there is a significant linkage between environmental experience and brain activation so that the architectural qualities can change blood flow in specific brain regions.

Objective: Nutritional status assessment, dysphagia evaluation and enteral feeding decision are important determinants of prognosis in acute neurovascular diseases. Materials and Methods: NöroTek is a point prevalence study conducted with the participation of 87 hospitals spread across all health sub regions of Turkey conducted on 10-May-2018 (World Stroke Awareness Day). A total of 972 hospitalized neurovascular patients [female: 53%, age: 69+-14; acute ischemic stroke in 845; intracerebral hematoma (ICH) in 119 and post-resuscitation encephalopathy (PRE) in 8] with complete data were included in this sub-study. Results: Gastrostomy was inserted in 10.7% of the patients with ischemic stroke, 10.1% of the patients with ICH and in 50% of the patients with PRE. Independent predictors of percutaneous endoscopic gastrostomy (PEG) administration were The National Institutes of Health Stroke Scale score at admission [exp (β): 1.09 95% confidence interval (CI): 1.05-1.14, per point] in ischemic stroke; and mechanical ventilation in ischemic [exp (β): 6.18 (95% CI: 3.16-12.09)] and hemorrhagic strokes [exp (β): 26.48 (95% CI: 1.36-515.8)]. PEG was found to be a significant negative indicator of favorable (modified Rankin's scale score 0-2) functional outcome [exp (β): 0.032 (95% CI: 0.004-0.251)] but not of in-hospital mortality [exp (β): 1.731 (95% CI: 0.785-3.829)]. Nutritional and swallowing assessments were performed in approximately two-thirds of patients. Of the nutritional assessments 69% and 76% of dysphagia assessments were completed within the first 2 days. Tube feeding was performed in 39% of the patients. In 83.5% of them, tube was inserted in the first 2 days; 28% of the patients with feeding tube had PEG later. Conclusion: The NöroTek study provided the first reliable and large-scale data on key quality metrics of nutrition practice in acute stroke in Turkey. In terms of being economical and accurate it makes sense to use the point prevalence method.

Dünya Sağlık Örgütü tarafından 11 Mart 2019’da pandemi olarak kabul edilen COVID-19 hastalığının pandeminin ilk döneminde öncelikle solunum yollarını etkileyen ve ciddi akut solunum yetmezliğine (SARS) neden olan bir viral enfeksiyon olduğu kabul edilmiştir. Zaman içinde vasküler sistemler başta olmak üzere diğer organ sistemlerini ve en önemlisi de diğer sistemlerle beraber nörolojik sistemleri ve hatta bazen sadece nörolojik sistemleri etkilediği ortaya konmuştur. Ciddi semptomu olmayan hastalarda bile koku alma kaybı sık olarak görülmekte olup bazı hastalarda ilk veya tek belirti olabilmektedir. Viral enfeksiyonun iyileşmesine rağmen koku alma fonksiyonunun aynı hızla kazanılamaması yaşam kalitesini etkileyen önemli bir nörolojik tutulumdur. Dünyada pandemi sürecinde vaka bildirimleri ve klinik verilerin analizleri ile hızlı bilgi akışı devam etmektedir. Bu yazıda literatür incelemesi ile dünyada bildirilen nörolojik tutulumlar ışığında kranial sinir tutulumları, serebrovasküler hastalıklar ve inme, ansefalit, epilepsi, Guillain Barré sendromu, psikiyatrik bozukluklar ile ilgili güncel bilgilerin paylaşılması amaçlanmıştır.

Coronavirus disease-2019 (COVID-19) can be associated with wide-range neurologic symptoms and complications. Parainfectious manifestations that are seen during the active infection period include stroke, olfactory and taste disturbance, encephalopathy, encephalitis, neuropathies, and myopathies. The main postinfectious complications are acute disseminated encephalomyelitis, transverse myelitis, Guillain-Barré syndrome, cognitive disorders, and sleep disorders. COVID-19 commonly causes neurological mid-to-long-term disability. The disease prognosis can be improved with sufficient knowledge, prompt recognition, and effective management of neurological complications.

Abstract Stroke triggers a systemic inflammatory response over the ensuing days after the cerebral insult. The age and comorbidities of the stroke population make them a vulnerable population for low muscle mass and sarcopenia, the latter being another clinical condition that is closely associated with inflammation, as shown by increased levels of pro-inflammatory biomarkers, including neutrophil-to-lymphocyte ratio (NLR). In this study, we evaluated the relationship between post-stroke NLR changes and muscle mass in a prospective cohort of acute ischemic stroke patients (n = 102) enrolled in the Muscle Assessment in Stroke Study Turkey (MASS-TR). Admission lumbar computed tomography images were used to determine the cross-sectional muscle area of skeletal muscles at L3 vertebra level and calculate the skeletal muscle index (SMI). The median (IQR) SMI was 44.7 (39.1–52.5) cm2/m2, and the NLR at admission and follow-up were 4.2 (3.0–10.5) and 9.4 (5.7–16.2), respectively. While there was no relationship between SMI and admission NLR, a significant inverse correlation was observed between SMI and follow-up NLR (r = − 0.26; P = 0.007). Lower SMI remained significantly associated (P = 0.036) with higher follow-up NLR levels in multivariate analysis. Our findings highlight the importance of muscle mass as a novel factor related to the level of post-stroke stress response.

Background: Non-invasive vagus nerve stimulation (nVNS) using a hand-held stimulator placed on the neck is an FDA-approved treatment for primary headache disorders. The safety of nVNS is unknown in stroke patients. Objective: To assess the safety and feasibility of nVNS for the acute treatment of stroke. Methods: TR-VENUS (clinicaltrials.gov identifier NCT03733431) was a randomized, sham-controlled, open-label, multicenter trial conducted in patients with acute ischemic stroke (IS) or intracerebral hemorrhage (ICH). Patients were randomly assigned to standard-dose nVNS, high-dose nVNS, or sham stimulation. The primary endpoint was a composite safety outcome defined as bradycardia or reduction in mean arterial blood pressure during treatment or progression of neurological or death within 24 h of treatment. The feasibility endpoints were the proportion of eligible subjects receiving nVNS within 6 h of symptom onset and the proportion completing all pre-specified treatment doses. Efficacy assessments included infarct growth from baseline to 24 h after treatment. Results: Sixty-nine patients (61 IS, 8 ICH) completed the study. The composite safety outcome was achieved in 32.0% in sham and 47.7% in nVNS group (p = 0.203). Treatment was initiated in all but two randomized patients. All dosed subjects received 100% of prespecified stimulations. A non-significant reduction in infarct growth was observed in the high-dose nVNS group (184.2% in sham vs. 63.3% in high-dose nVNS; p = 0.109). Conclusions: The results of this study suggest that nVNS may be safe and feasible in the setting of acute stroke. These findings support further development of nVNS as a potential treatment for acute ischemic stroke.

Background Tranexamic acid reduced haematoma expansion and early death, but did not improve functional outcome in the tranexamic acid for hyperacute spontaneous intracerebral haemorrhage-2 (TICH-2) trial. In a predefined subgroup, there was a statistically significant interaction between prerandomisation baseline systolic blood pressure (SBP) and the effect of tranexamic acid on functional outcome (p=0.019).Methods TICH-2 was an international prospective double-blind placebo-controlled randomised trial evaluating intravenous tranexamic acid in patients with acute spontaneous intracerebral haemorrhage (ICH). Prerandomisation baseline SBP was split into predefined ≤170 and >170 mm Hg groups. The primary outcome at day 90 was the modified Rankin Scale (mRS), a measure of dependency, analysed using ordinal logistic regression. Haematoma expansion was defined as an increase in haematoma volume of >33% or >6 mL from baseline to 24 hours. Data are OR or common OR (cOR) with 95% CIs, with significance at p170 mm Hg. Tranexamic acid was associated with a favourable shift in mRS at day 90 in those with baseline SBP≤170 mm Hg (cOR 0.73, 95% CI 0.59 to 0.91, p=0.005), but not in those with baseline SBP>170 mm Hg (cOR 1.05, 95% CI 0.85 to 1.30, p=0.63). In those with baseline SBP≤170 mm Hg, tranexamic acid reduced haematoma expansion (OR 0.62, 95% CI 0.47 to 0.82, p=0.001), but not in those with baseline SBP>170 mm Hg (OR 1.02, 95% CI 0.77 to 1.35, p=0.90).Conclusions Tranexamic acid was associated with improved clinical and radiological outcomes in ICH patients with baseline SBP≤170 mm Hg. Further research is needed to establish whether certain subgroups may benefit from tranexamic acid in acute ICH.Trial registration number ISRCTN93732214.

The incidence of dementia increases with aging. It is known that the disease brings with it many problems for patients and caregivers. Studies on the development of various treatment modalities for the disease continue. However, the main step in the management of this process is the identification of dementia risk factors. The prevalence of dementia is higher in those living in urban areas where exposure to air pollution and chemical effects is higher. This situation supports the relationship of air pollution, which has increased especially in the last decade, with the increase in cognitive decline and dementia frequency. Exposure to air pollution is one of the well-known causes of neurological diseases. This condition was associated with significant disability and early mortality. Although the close relationship between cerebrovascular diseases and air pollution is known, current studies also reveal the relationship between neuropsychiatric diseases and air pollution. It has been shown that microparticles inhaled through the respiratory system are responsible for this situation. Although individual sensitivity is prominent in the disease, the etiopathogenetic process remains relatively uncertain. Researchers have detected that the relationship between dementia and air pollution is because of the effects of increased proinflammatory mediators and reactive oxygen radicals. Evaluation of air pollution, which plays a role in the etiopathogenesis of dementia, in the light of current literature and revealing this relationship will provide important contributions in taking the necessary measures to prevent the disease.

Aim:Monocyte/high-density lipoprotein (HDL) ratio (MHR) is an inflammatory marker associated with vascular diseases. The aim of this study is to evaluate the MHR in patients with symptomatic carotid artery stenosis and to examine its relationship with the degree of stenosis.Methods:The study was conducted as a case-control study, with data obtained from patients’ files between January 2020 and May 2021. Ninety patients with symptomatic carotid stenosis and 40 healthy controls were included in the study. For vascular imaging, computed tomography angiography and/or digital subtraction angiography were used. Carotid artery stenosis was grouped according to North American Symptomatic Carotid Endarterectomy Trial criteria. Tests for monocyte and HDL cholesterol were performed, and the MHR was calcu-lated.Results:There were 67 male and 23 female patients with a mean age of 65.10±12.26 years in the study. In 46 (51.1%) of the patients, there was 50% or more carotid artery stenosis. The HDL cholesterol level was lower, and the MHR was higher in the patient group (p=0.042, p=0.041, respectively). Monocyte and MHR levels were higher in patients with 50% or more carotid stenosis (p=0.04).Conclusion:The MHR is a predictive biomarker for the degree of symptomatic stenosis in the carotid artery.

The coronavirus disease-2019 pandemic, one of many global threats to human health, provides an opportunity to analyze how to detect, minimize, and even prevent the spread of future viral zoonotic agents with pandemic potential. Such analysis can utilize existing risk assessment techniques that seek formally to define the hazard, assess the health risk, characterize the health threat, and estimate the probability of occurrence.

Summary: Background: It is not known whether to continue or temporarily stop existing antihypertensive drugs in patients with acute stroke. Methods: We performed a prospective subgroup analysis of patients enrolled into the Efficacy of Nitric Oxide in Stroke (ENOS) trial who were randomised to continue vs stop prior antihypertensive therapy within 12 h of stroke onset. The primary outcome was functional outcome, assessed with the modified Rankin Scale at 90 days by observers blinded to treatment assignment, and analysed with ordinal logistic regression. Findings: Of 4011 patients recruited into ENOS from 2001 to 2014, 2097 patients were randomised to continue vs stop prior antihypertensive treatment, and 384 (18.3%, continue 185, stop 199) were enrolled within 12 h of ictus: mean (SD) age 71.8 (11.8) years, female 193 (50.3%), ischaemic stroke 342 (89.1%) and total anterior circulation syndrome 114 (29.7%). As compared with stopping, continuing treatment within 12 h of onset lowered blood pressure by 15.5/9.6 mmHg (p