Search

Objective: Acute reperfusion therapy is a critical intervention for stroke patients with the aim of restoring blood flow. The presence of anatomical anomalies, such as fetal posterior cerebral artery (fPCA) and posterior communicating artery (PCOM) variations, can impact treatment outcomes and patient prognosis. This study aimed to assess the potential influence of these anomalies on patients undergoing acute reperfusion therapy. Materials and Methods: Demographic characteristics of patients who underwent acute reperfusion therapy for stroke were considered among three distinct groups: the PCOM group, fPCA group, and control group. The demographic attributes examined for each group included gender distribution, mean age, presence of comorbidities, thrombolysis in cerebral infarction, national institutes of health stroke scale (NIHSS), and European cooperative acute stroke study II (ECASS II) scores. The significance of differences in these attributes among the groups was assessed. Results: The study included a total of 106 patients: 42 patients in the PCOM group, 31 patients in the fPCA group, and 33 patients in the control group. No significant differences in demographic data were observed among the groups. The greatest decrease in NIHSS at the 24th hour was observed in the PCOM group, whereas the least decrease on day 7 was observed in the fPCA group. No differences were detected in the NIHSS values on the 24th hour and 7th day among the groups. When the 24th hour computed tomography scans of the groups were evaluated according to the ECASS II criteria, no significant differences were observed among the groups. Hemorrhage was not observed in 52.4% of patients in the PCOM group and 66.7% of patients in the control group. Conclusion: The impact of fPCA and PCOM anomalies on patients undergoing acute reperfusion therapy for stroke was evaluated. Although no significant demographic differences were found among the groups, the study highlights the importance of further research to better understand their potential impact on treatment outcomes.

Background: The aim of this study is to examine the hematological and biochemical variables in patients diagnosed with cancer-related stroke who have different types of cancer and to evaluate the effects of these variables. Methods: This retrospective study was conducted at a tertiary hospital stroke center and included 153 patients diagnosed with cancer-related stroke. Comprehensive etiological investigations were performed, and patients were classified according to the Trial of Org 101072 in Acute Stroke Treatment (TOAST) classification. Laboratory parameters including d -dimer, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and fibrinogen levels were collected from blood samples taken at the time of stroke. Statistical analysis was performed using 1-way analysis of variance to assess differences in laboratory parameters across different cancer types. Results: The study found significant variations in hematological and biochemical parameters among different cancer types. Specifically, glomerular filtration rate, activated partial thromboplastin time, prothrombin time, and international normalized ratio levels showed significant differences across cancer types ( 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.

Background: Atrial fibrillation (AF) is the most common cause of cardioembolic ischemic strokes. It causes large-vessel occlusions and a poor prognosis. Regardless of ischemic stroke etiology, hyperacute therapy strategies are effective treatment modalities. Methods: Patients who were diagnosed as having AF were classified as AF (+) and others without AF were classified as AF (-). It is not clear which treatment should be preferred in patients with stroke who are AF (+). We studied demographic characteristics, recanalization rates, and clinical outcomes in acute patients with ischemic stroke with or without nonvalvular AF who underwent hyperacute treatments. Results: We detected that clinical findings were more severe and the NIHSS scores were significantly higher at admission inpatients who were AF (+). In our study, mechanical thrombectomy rates were high in patients who were AF (+), whereas intravenous tissue plasminogen activator treatment rates were higher in patients who were AF (-). Thrombolysis in cerebral infarction scores were similar in our patient groups. We found high rates of both symptomatic (PH 2) and asymptomatic hemorrhagic transformation in patients who were AF (+) in 24th-h cranial computed tomography. A positive correlation was found between symptom-admission, symptom-needle, and symptom-groin times and discharge-modified Rankin Scale scores regardless of the hyperacute treatments in all patient groups. Conclusion: As a result, physicians should focus on the diagnosis of AF, and appropriate anticoagulant treatment is important for primary prevention.

Aim: The Willis polygon variant, specifically the presence of a fetal posterior cerebral artery (fPCA), can have implications for the treatment and prognosis of patients with acute stroke. This study aimed to investigate the effect of fPCA variations on treatment, follow-up, and prognosis in patients with acute stroke who underwent reperfusion therapies. Materials and Methods: The study analyzed a total of 62 patients, including 33 without any posterior system variant (normal group) and 29 with only the fPCA variant (variant group). Demographic characteristics, clinical features, and computed tomography (CT) findings were compared between the two groups. Treatment methods, acute stroke therapies, and clinical outcomes were evaluated. Results: No significant differences were observed in age, sex, smoking status, or comorbidities between the normal and fPCA groups. Cardiac parameters were similar between the groups. Treatment approaches, artery territories, acute stroke therapies, and time intervals did not differ significantly between the two groups. The National Institutes of Health Stroke Scale scores, modified Rankin Scale scores, and CT findings were also similar between the groups. A significant difference was observed in the presence of hemorrhage at 24 h, with higher rates in the normal group. Conclusion: The presence of fPCA does not significantly influence age-related risk factors or comorbidities in patients with acute stroke. Treatment approaches and clinical outcomes were similar regardless of the presence of fPCA, except for a higher risk of hemorrhage in the normal group. The lateral status of the variants did not significantly impact the distribution of risk scores and CT findings.

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.

Objectives: Idiopathic Parkinson's Disease (IPD) is a movement disorder that cause tremor, rigidity, bradykinesia, postural instability and deterioration quality of life. To assess the disease different scales can be used: The Unified Parkinson's Disease Rating Scale (UPDRS) for clinical severity, Parkinson's Disease Questionnaire (PDQ39) to assess quality of life, Beck Depression Scale (BD) for mood assessment and Hoehn Yahr Scale (HY) for clinical staging. The International Classification of Functioning, Disability and Health (ICF) is a classification to develop an international common language for the evaluation of the functionality and disability of patients. We aimed to compare validity and efficacy of ICF classification with other scales. Materials and Methods: Thirty-one patients with idiopathic Parkinson's disease were evaluated. PDQ39, UPDRS, Hoehn Yahr, Beck Depression Scale and 'Brief ICF core set for hand condition' which was recommended for Parkinson's disease were applied to patients. The brief ICF core set and other scales were compared and assessed if there was any correlation. For analyzes, the MedCalc Statistical Software version 12.7.7 programme was used. Results: The mean age of the IPD patients was 68.3 ± 6.9 years and 71% of them were female (22) and 29% were male (9). According to ICF codes, patients who have eight or more corrupted codes were recorded as 'major code impairment patients', and those with less than eight codes recorded as 'minor code impairment patients'. The total UPDRS score of major code impairment patients was 58.4 ± 29.8, while the mean score of minor code impairment patients was 21.2 ± 14.05. The PDQ39 score of major code impairment patients was 66.4 ± 24.1, while the mean score of minor code impairment patients was 19.3 ± 13.5. According to Hoehn Yahr stage, the ratio of stage 1 were higher in minor ICF patients. Conclusion: While assessing the functioning of the Parkinson's disease patients, we need comprehensive scales that include many parameters. The ICF coding system is an international system, which is very important to develop a common language. The significant correlation between ICF coding system and other scales in our Parkinson's patients, shows the validity of the coding system.

Aim This study aims to investigate the intricate interplay between lesion localization and kappa light chain (KLC) levels in patients diagnosed with Secondary Progressive Multiple Sclerosis (SPMS), unraveling the underlying mechanisms contributing to lesion distribution and potential drivers of the observed relentless progression of neurological disability in SPMS.Material and Methods An observational study was conducted with a cohort of 23 SPMS patients meeting diagnostic criteria. Clinical, demographic data, and MRI scans were collected of 14 patients who had received any treatment in the past year. Serum KLC levels were measured, and statistical analyses were performed to identify correlations between age, KLC levels, and lesion distribution.Results The study revealed a significant positive correlation between age and the number of periventricular lesions, indicating a potential influence of aging processes on lesion distribution dynamics. Serum KLC levels showed a noteworthy positive correlation with the number of infratentorial lesions. However, no significant correlations were observed between Expanded Disability Status Scale (EDSS) scores and lesion counts.Conclusion The findings underscore the complex and multifaceted nature of SPMS pathogenesis. While age and serum KLC levels demonstrated associations with periventricular and infratentorial lesions, the lack of correlation between EDSS scores and lesion counts emphasizes the heterogeneous aspects of SPMS progression. These insights highlight the importance of a comprehensive understanding beyond lesion quantification to unravel the intricate mechanisms driving disability progression in SPMS.

A 51-year-old male presented with dysarthria and weakness on his left side. In his history, he had an operation due to aortic coarctation 13 years ago, and 5 years ago, he had a transient ischemic attack along with difficulty in speaking. During his neurological examination, he was conscious, cooperative, and oriented. Mild dysarthria and left hemiparesis were seen (4/5, 4/5). He smoked at least one cigarette packet per day for 30 years. Vascularization was performed only by narrowed right vertebral artery on cranial and cervical magnetic resonance angiography. He had a mild increase in his left hemiparesis during his stay in the hospital (2/5, 4/5). A stent had been inserted into his right vertebral artery during digital subtraction angiography. In his last neurological examination, he was conscious, cooperative, and oriented. We started prasugrel (10 mg/day) and acetylsalicylic acid (300 mg/day) for his mild dysarthria and mild hemiparesis. In this case, we explain that although there was three-vessel occlusion and narrowing in the right vertebral artery, the patient’s neurologic status was not too bad due to collateral circulation around the cerebral arteries. This showed us the importance of collateral circulation between cerebral arteries.