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Background: The present study aimed to evaluate resting middle cerebral artery (MCA) blood flow velocities using transcranial Doppler ultrasound (TCD) in healthy women at different stages of pregnancy, and to compare these velocities with those of normal controls., Methods: A total of 105 healthy normotensive pregnant women and 25 non-pregnant healthy controls were included in the study. We formed 3 groups according to gestational age: first trimester (7 to 13 wk pregnant), second trimester (14 to 28 wk pregnant), and third trimester (29 to 42 wk pregnant). Age, body mass index, heart rate, arterial blood pressure, and hematological data were recorded and TCD was performed on the subjects. Regarding TCD, we evaluated the mean cerebral blood flow velocity, the peak systolic velocity, the end-diastolic flow velocity, S/D ratio, the pulsatility Index (PI) and the resistance Index (RI)., Results: The MCA mean blood flow velocities differed significantly among the groups ( P <0.001) and were higher in the controls than those of the first trimester, second trimester, and third trimester groups ( P <0.01, P <0.001, P <0.001 respectively). The MCA mean and peak blood flow velocities, and the PI and RI decreased significantly with advancing gestation., Conclusions: TCD is a noninvasive and non-toxic method of monitoring the adaptation of the maternal cerebral blood flow in pregnancy. The progressive decreases in the MCA mean and peak blood flow velocities, PI, and RI during gestation may be the result of chemical and neuronal factors. This study supports the need for additional studies using TCD to establish normative cerebral blood flow volumes throughout pregnancy., Competing Interests: The authors declare no conflict of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: This study assessed the consequences of hemodialysis (HD) on hemodynamic parameters of cerebral circulation by measuring middle cerebral artery blood flow velocities using transcranial Doppler ultrasound before and after a single dialysis session in patients with end-stage renal disease (ESRD)., Materials and Methods: Fifty clinically stable patients with ESRD undergoing HD and 40 healthy controls were recruited for the study. Blood pressure, heart rate, and body weight were measured. Transcranial Doppler ultrasound evaluations and blood analyses were performed immediately before and after a single dialysis session., Results: The mean cerebral blood flow velocities (CBFVs) in the ESRD patients before HD was 65 ± 17 cm/second and did not differ from that of the normal controls (64 ± 14 cm/s) ( P = 0.735). The postdialysis CBFV also did not differ from that of the controls ( P = 0.054)., Conclusion: Compensatory cerebral autoregulation and chronic adjustment to therapy may be the reason for the nondeviation of the CBFV values from normality observed in both sessions., Competing Interests: The authors declare no conflict of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Patients with cerebellar ischemic stroke may be misdiagnosed and may exhibit a delayed time to acute stroke treatment compared with patients with anterior circulation ischemic stroke. The posterior circulation Alberta stroke program early computed tomography score (pc-ASPECT) score has been used to evaluate hyperacute stroke, much as the ASPECT in anterior circulation stroke recently. Our main objective was to evaluate the associations of the clinical and etiological characteristics of ischemic cerebellar infarction patients on admission with their pc-ASPECT scores, as well as the correlations of the pc-ASPECT score with morbidity and mortality rates., Materials and Methods: We include 114 patients with cerebellar infarction who underwent 1 year of follow-up into the study., Results: Patients with a pc-ASPECT score <7 were more likely to present with impaired consciousness ( P <0.001), multiple posterior circulation infarcts ( P <0.001), hydrocephalus ( P <0.001), lesions of the vermis ( P =0.028), and peduncle ( P =0.024), perfusion deficits in the total of posterior inferior cerebellar artery, anterior inferior cerebellar artery, superior cerebellar artery ( P <0.05), and basilar artery stenosis ( P =0.005), ischemia in additional anatomical structures in the posterior circulation ( P <0.001) compared with those with a score ≥7., Conclusions: Although the pc-ASPECT score alone is insufficient in some cases like vertebral artery dissection, using it together with the National Institutes of Health Stroke Scale (NIHSS) score and clinical findings may be beneficial during the hyperacute period of cerebellar ischemia. Presentation with impaired consciousness, basilar artery pathologies, vermian ischemia, and ischemia in additional anatomical structures in the posterior circulation other than the cerebellum appeared as important clinical and radiologic parameters predicting long-term prognosis., Competing Interests: The authors declare no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

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., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Ethem Murat Arsava Dr Arsava receives honoraria from Fresenius Kabi, Bayer AG, Daiichi-Sankyo, Pfizer, Sanofi, Abbott, and Nutricia. He serves on the advisory boards of Abbott, Daiichi-Sankyo, Bayer AG, Pfizer, Fresenius Kabi, and Nutricia. Mehmet Akif Topcuoglu Dr Topcuoglu receives honoraria from Fresenius Kabi, Daiichi-Sankyo, Sanofi, and Abbott. He serves on the advisory boards for Abbott, Fresenius Kabi, Daiichi-Sankyo, and Pfizer. Hakan Ay Hakan Ay is an employee of Takeda Pharmaceutical Company and holds an academic appointment at the Massachusetts General Hospital, Harvard Medical School. The remaining authors declare no conflict of interest., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: This study evaluated the hemodynamic effects of carotid artery stenting (CAS) on cerebral blood flow velocity (CBFV) in patients with carotid artery stenosis, before, 3 d, and 3 months after the procedure using transcranial Doppler ultrasound (TCD)., Methods: The study included 36 patients with atheromatous carotid artery stenosis. Cerebral computed tomography (CT) or magnetic resonance imaging (MRI) was performed in every patient, and carotid stenosis was evaluated using duplex sonography, CT, and MRI angiography before the procedure. To obtain baseline values, the CBFV was evaluated 1 d before CAS. Follow-up TCD evaluations were performed 3 d and 3 months postoperatively., Results: The median degree of internal carotid artery (ICA) stenosis in the participants was 90% (range 50%-99%). The median CBFV at the anterior cerebral artery (ACA) was significantly lower on the ipsilateral side than on the contralateral side before stenting; however, there were no significant differences in CBFV in the ipsi and contralateral middle cerebral artery (MCA). The median CBFV in the ipsilateral MCA increased significantly 3 d after the procedure and remained higher than the basal values after 3 months., Conclusions: We observed significant increases in the median CBFV and pulsatility index (PI) in the MCA bilaterally, especially on the stented side, measured 3 d and 3 months after stenting in patients with severe ICA stenosis., Competing Interests: None

The prevalence of headache in stroke has been reported between 8% and 34%. Determining the prevalence, features, and effects on prognosis of cerebellar ischemic strokes that presented with headache solely and/or with other cerebellar signs were the aims of our study.All patients diagnosed with cerebellar ischemia were included. Electronic medical records were reviewed. Patients have been followed up for 6th month. Descriptive statistics were generated. A total of 4763 patients were evaluated retrospectively, 200 patients had cerebellar ischemia and 22 patients of these cerebellar ischemias (11%) had a headache at initial presentation. Ataxia, dysarthria, dysmetria were the most common neurological findings. There was no significant difference whether ischemic lesion single or multiple and whether above or below 1.5 cm diameter. Ischemic lesions generally were in cortical/ juxtacortical layer. According to vascular perfusion areas, 54.5% patients' ischemia was located in PICA (posterior inferior cerebellar artery) territory. Patients presenting with a headache, predominantly had left hemispheric (vermian > hemispheric > pedincular) involvement. Although these patients generally had high modified Rankin Scale scores at the first evaluation, they had low NIHSS (National Institutes of Health Stroke Scale) scores (0-5), and nearly all patients recovered, with low mRS at the 6-month follow-up.Cerebellar ischemic strokes with headache presentation are significantly prevalent in patients with left hemispheric, cortical/juxtacortical, PICA perfusion territory ischemias and are associated with low morbidity unless there was a conscious disorder. We believe this is one of the first studies that evaluated the clinical and radiological parameters of cerebellar stroke patients with headache., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objectives: Headache is the most common complaint in cerebral venous sinus thrombosis (CVST) and it may sometimes be the only symptom in these patients. This retrospective and prospective study was an investigation of any differences in terms of clinical risk factors, radiological findings, or prognosis in patients with CVST who presented with isolated headache (IH) and cases with other concomitant findings (non-isolated headache [NIH])., Methods: A total of 1144 patients from a multicenter study of cerebral venous sinus thrombosis (VENOST study) were enrolled in this research. The demographic, biochemical, clinical, and radiological aspects of 287 IH cases and 857 NIH cases were compared., Results: There were twice as many women as men in the study group. In the IH group, when gender distribution was evaluated by age group, no statistically significant difference was found. The onset of headache was frequently subacute and chronic in the IH group, but an acute onset was more common in the NIH group. Other neurological findings were observed in 29% of the IH group during follow-up. A previous history of deep, cerebral, or other venous thromboembolism was less common in the IH group than in the NIH group. Transverse sinus involvement was greater in the IH group, whereas sagittal sinus involvement was greater in the NIH group. The presence of a plasminogen activator inhibitor (PAI) mutation was significantly greater in the IH group., Conclusion: IH and CVST should be kept in mind if a patient has subacute or chronic headache. PAI, which has an important role in thrombolytic events, may be a risk factor in CVST. Detailed hematological investigations should be considered. Additional studies are needed.

Background: Early diagnosis of cerebral venous sinus thrombosis (CVST) associated with reproductive health-related risk factors (RHRF) including pregnancy, puerperium, and oral contraceptive (OC) use can prevent severe neurological sequelae; thus, the symptoms must be documented in detail for each group., Methods: Out of 1144 patients with CVST, a total of 777 women were enrolled from a multicenter for the study of cerebral venous sinus thrombosis (VENOST). Demographic, biochemical, clinical, and radiological aspects were compared for 324 cases with RHRF and 453 cases without RHRF., Results: The mean age of the RHRF (-) group (43.2 ± 13 years) was significantly higher than of the RHRF (+) group (34 ± 9 years). A previous history of deep venous thrombosis (3%), isolated cavernous sinus involvement (1%), cranial neuropathy (13%), comorbid malignancy (7%), and its disability scores after 12 months (9%) were significantly higher in the RHRF (-) group. The RHRF (+) group consisted of 44% cases of puerperium, 33% cases of OC users and 23% of pregnant women. The mean age was found to be higher in OC users (38 ± 9 years). A previous history of deep venous thrombosis was slightly higher in the pregnancy subgroup (4%). Epileptic seizures were more common in the puerperium group (44%)., Conclusion: The results of our study indicate that the risk of CSVT increases parallel to age, OC use, and puerperium period. In addition, when considering the frequency of findings and symptoms, epileptic seizures in the puerperium subgroup of the RHRF (+) group and malignancies in the RHRF (-) group may accompany the CSVT. In daily practice, predicting these risks for the CSVT and early recognition of the symptoms will provide significant benefits to patients., Competing Interests: The authors declared that they have no conflicts of interest for this article., (Copyright © 2020 Derya Uluduz et al.)

Background: Unhealthy lifestyle and inadequate control of vascular risk factors are the major contributors of stroke burden. Failure in achieving the target levels in control of these factors, not only designate missed opportunities contributing to the preventability of an incident stroke, but also set the post-stroke treatment goals in a case wise basis. In this study, we analyzed pre-event clinical features that play a role in stroke preventability, and determined the cumulative burden of risk factors that necessitate optimization following the ischemic insult., Methods: Information about the pre-stroke optimal control of seven major modifiable risk factors (Life's Simple 7: hypertension, diabetes mellitus, hyperlipidemia, smoking, obesity, diet, and physical activity) was prospectively collected in ischemic stroke patients admitted to three tertiary academic centers in Ankara. Stroke preventability was evaluated by the overall number of factors requiring optimization with patients ≥4 risk factor conditions categorized as those suffering from a preventable stroke. Bivariate and multivariate analyzes were performed to uncover predictors of stroke preventability., Results: Among 787 patients, 386 (49.0%) had ≥4 risk factor conditions requiring optimization. Preventable stroke was more common in younger patients, and patients with small artery occlusion. Multivariate analyses taking into account the pre-stroke antithrombotic treatment regimen, have highlighted age (OR: 0.99, 95%CI 0.98-1.00), female gender (1.59, 95%CI 1.17-2.16), coronary artery disease (1.54, 95%CI 1.10-2.14), small artery occlusion (1.90, 95%CI 1.13-3.18), and cardio-aortic embolism (0.53, 95%CI 0.35-0.82) as significant factors associated with preventability., Conclusions: Approximately half of the ischemic stroke patients have preventable stroke from the perspective of risk factor control. Extra care should be given to strategies directed to risk factor control and lifestyle interventions in certain high-risk groups for the prevention of future complications., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Purpose: The aim of this study is to evaluate the presence and prognostic impact of early seizures in cerebral venous sinus thrombosis patients (CVST)., Method: VENOST is a retrospective and prospective national multicenter observational study. CVST patients with or without epileptic seizures (ES) were analyzed and compared in terms of demographic and imaging data, causative factors, clinical variables, and prognosis in a total of 1126 patients., Results: The mean age of the patients in the ES group was 39.73 ± 12.64 and 40.17 ± 14.02 years in the non-ES group (p > 0.05). Epileptic seizures were more common (76.6 %) in females (p < 0.001). Early ES occurred in 269 of 1126 patients (23.9 %). Epileptic seizures mainly presented in the acute phase (71.4 %) of the disease (p < 0.001). Majority of these (60.5 %) were in the first 24 h of the CVST. The most common neurological signs were focal neurologic deficits (29.9 %) and altered consciousness (31.4 %) in the ES group. Superior sagittal sinus (SSS) and cortical veins (CV) involvement were the most common sites of thrombosis and the mostly related etiology were found puerperium in seizure group (30.3 % vs 13.9 %). Patients with seizures had worse outcome in the first month of the disease (p < 0.001) but these did not have any influence thereafter., Conclusions: In this largest CVST cohort (VENOST) reported female sex, presence of focal neurological deficits and altered consciousness, thrombosis of the SSS and CVs, hemorrhagic infarction were risk factors for ES occurrence in patients with CVST., Competing Interests: Declaration of Competing Interest The authors have no conflict of interest to disclose., (Copyright © 2020. Published by Elsevier Ltd.)

Background: This study aimed to identify the reversibility of MRI findings indicative of increased intracranial hypertension in idiopathic intracranial hypertension (IIH) patients after treatment., Methods: This retrospective, observational study included demographic and clinical data from 10 patients with IIH and 10 controls. Brain MRI findings in IIH patients were recorded twice: once when patients had papilledema and again after resolution of papilledema. Neuroradiologists graded MRI findings in both groups based on an imaging grading scale., Results: After resolution of papilledema, all patients showed improvement in 2 or more of the MRI characteristics of IIH. This was especially the case for the height of the midsagittal pituitary gland and optic nerve sheath thickness (ONST), which were significantly different in all pairwise group comparisons. Sellar configuration, globe configuration, and horizontal orbital optic nerve tortuosity were different between the IIH pre-treatment group and controls, but not between controls and the IIH post-treatment group. We found no difference in optic nerve head hyperintensity or optic nerve thickness among the 3 groups., Conclusions: We demonstrated that several morphometric MRI characteristics in IIH are reversible to a certain extent after treatment. Enlarged subarachnoid spaces filled with cerebrospinal fluid seem to remain reduced, and the ONST and height of the pituitary gland are not fully normalized after treatment.

Objective: This study was performed to determine the rate of cerebral venous sinus thrombosis (CVST) among cases of Behçet's disease (BD) included in a multicentre study of cerebral venous sinus thrombosis (VENOST)., Methods: VENOST was a retrospective and prospective national multicentre observational study that included 1144 patients with CVST. The patients were classified according to aetiologic factors, time of CVST symptom onset, sinus involvement, treatment approach and prognosis., Results: BD was shown to be a causative factor of CVST in 108 (9.4%) of 1144 patients. The mean age of patients in the BD group was 35.27 years and 68.5% were men, whereas in the non-BD CVST group, the mean age was 40.57 years and 28.3% were men (P < 0.001). Among the aetiologic factors for patients aged 18-36 years, BD was predominant for men, and puerperium was predominant for women. The onset of symptoms in the BD group was consistent with the subacute form. The transverse sinuses were the most common sites of thrombosis, followed by the superior sagittal sinuses. The most common symptom was headache (96.2%), followed by visual field defects (38%)., Conclusions: BD was found in 9.4% of patients in our VENOST series. Patients with BD were younger and showed a male predominance. The functional outcome of CVST in patients with BD was good; only 12% of patients presenting with cranial nerve involvement and altered consciousness at the beginning had a poor outcome (modified Rankin Score ⩾2)., (© The Author(s) 2018. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Objective: This prospective observational study aimed to identify the effects of labor on cerebral hemodynamics by measuring the middle cerebral artery (MCA) blood flow velocity by transcranial Doppler ultrasound (TCD), and the related factors just before delivery and within the 24 h after delivery., Methods: The study included 35 healthy pregnant women with a gestational age of >37 weeks who were in labor and a control group including healthy, age-matched, nonpregnant women (n = 24). Demographic characteristics and significant clinical information of pregnant women were recorded. The MCA blood flow velocity was assessed by TCD just before and within 24 h after delivery. The parameters assessed by TCD were mean cerebral blood flow velocity (MCBFV), peak systolic velocity (PSV), pulsatility index (PI), resistance index (RI), and systolic/diastolic ratio., Results: There was no significant difference between the pregnant and nonpregnant women regarding age (27 ± 5 years versus 28 ± 7 years; p = .751). The MCBFV, PSV, PI, and RI showed a significant increase within the 24 h after delivery as compared with those before delivery. Comparison of the pregnant women with the control group in terms of the values of all parameters related to the MCA blood flow velocity revealed that the values that were significantly low before delivery reached to the level of the control group after delivery Conclusion: The findings of this study demonstrated that the blood flow velocity of the MCA decreased during the late pregnancy period and increased in the early postpartum period to the level similar to that of the nonpregnant group.

Background: Balance disorders cause disability in stroke and increase risk of falls. The Balance Evaluation Systems Test (BESTest), examines balance, determines parameters causing balance disorders, provides information on risk factors for falls., Objective: To investigate the sensitivity and specificity of the BESTest in determining the risk of falls in stroke patients., Methods: Fifty patients with chronic stroke were included in the study. Balance was assessed using BESTest, Berg Balance Scale (BBS), Activity Specific Balance Confidence scale (ABC) and Biodex-BioSway Balance System. To examine the content validity of BESTest, the relationship between BESTest and other balance assessment methods was examined. The internal consistency reliability of BESTest was evaluated by Cronbach's α coefficient. Analysis of receiver operating characteristics (ROC) was performed to determine cut-off point, sensitivity and specificity., Results: BESTest, BBS, ABC and Biodex-BioSway Balance System results of faller stroke patients were worse than that of non-faller (p <0.05). Internal consistency of BESTest was found to be Cronbach's α = 0.960. The BESTest value of area under curve (AUC) was 0.844, with a cut-off point of 69.44%, a sensitivity of 75% and a specificity of 84.6% (p < 0.01)., Conclusion: BESTest is reliable and valid with high sensitivity and specificity in determining the risk of fall in stroke patients.

Background: Obesity affects all major organ systems and leads to increased morbidity and mortality. Whole blood viscosity is an important independent regulator of cerebral blood flow. The aim of the present study was to evaluate the effect of whole blood viscosity on cerebral artery blood flow velocities using transcranial Doppler ultrasound in pediatric patients with obesity compared to healthy controls and analyze the effect of whole blood viscosity and blood pressure status to the cerebral artery blood flow velocities., Methods: Sixty patients with obesity diagnosed according to their body mass index (BMI) percentiles aged 13-18 years old were prospectively enrolled. They were grouped as hypertensive or normotensive according to their ambulatory blood pressure monitoring. Whole blood viscosity and middle cerebral artery velocities by transcranial Doppler ultrasound were studied and compared to 20 healthy same aged controls., Results: Whole blood viscosity values in hypertensive (0.0619±0.0077 poise) and normotensive (0.0607±0.0071 poise) groups were higher than controls (0.0616±0.0064 poise), with no significance. Middle cerebral artery blood flow velocities were higher in the obese hypertensive (73.9±15.0 cm/s) and obese normotensive groups (75.2±13.5 cm/s) than controls (66.4±11.5 cm/s), but with no statistical significance., Conclusions: Physiological changes in blood viscosity and changes in blood pressure did not seem to have any direct effect on cerebral blood flow velocities, the reason might be that the cerebral circulation is capable of adaptively modulating itself to changes to maintain a uniform cerebral blood flow.

Purpose: This study was designed to present our preliminary experience with the Roadsaver ® double-layer micromesh (DLM) stent in the endovascular treatment of supra-aortic and visceral aneurysms and to utilize the flow-diverting effect of this new design in the treatment of these aneurysms., Methods: DLM stent (Roadsaver ® , Terumo, Tokyo, Japan) was used in five patients (median age 61.8 years; three men) for treating arterial aneurysms (one common carotid artery, one vertebral artery V1 segment, one superior mesenteric artery, and two renal artery aneurysms)., Results: All stents were successfully deployed. Follow-up imaging with conventional catheter angiography or computed tomography showed successful treatment of all aneurysms., Conclusions: The new DLM stent appears to be promising for the treatment of supra-aortic and visceral aneurysms.

Introduction: Previous studies have shown that olfactory functioning is affected by multiple sclerosis (MS). This study assessed the level of the olfactory impairment in early MS by using the Sniffin' Sticks Test., Methods: This study included 30 patients with MS and 30 healthy controls. We collected demographic and clinical data from participants and administered the Sniffin' Sticks Test., Results: We found no differences between the MS and control groups in odor discrimination, odor identification, and threshold discrimination identification scores, but odor threshold (OT) scores were higher in the control group than in the MS group (P=0.49). In addition, we did not find any correlation between MS patients' olfactory test scores and their scores on the Mini-Mental State Examination (MMSE), Expanded Disability Status Scale (EDSS), disease duration, history of optic neuritis, or being on immunomodulatory therapy., Conclusion: In recent studies, odor threshold impairment seemed to be the most striking finding in patients with MS. Although the present study found a mild alteration in odor threshold, olfactory dysfunction appears to be a consequence of neurodegeneration in the higher order olfactory brain regions, which is thought to be a time-dependent process.

Background: We thought that the application of Kinesio Tape (KT) on the foot and ankle in stroke patients may improve the quality of somatosensory information and may activate ankle muscles which have an important role in postural control and that ultimately balance could be improved in stroke patients., Objective: The purpose of this study was to evaluate the effects of KT on balance in stroke patients., Methods: Nineteen stroke patients and 16 healthy controls were included in the study. The study group was evaluated with and without KT. Balance of the all subjects was evaluated Sensory Organization Tests (SOT) by using the Computerized Dynamic Posturography. Equilibrium, Strategy Analysis and Composite Equilibrium Scores were investigated in SOT., Results: Statistically significant differences were observed in all of the SOT parameters between stroke patients and healthy controls (p <  0.05). When the results with and without KT application were compared, the Equilibrium Scores in the conditions 3, 4, 6, Strategy Analysis Score in the conditions 2, 4, 6 and the Composite Equilibrium Score of the SOT were found to be improved in stroke patents (p <  0.05)., Conclusions: The results obtained from KT application are promising in improving balance in stroke patients.

Congenital, infectious, toxic, and demyelinating disorders are common etiological causes of deafness. Tuberculous meningitis, as one of the infectious causes, should be considered in the differential diagnosis since tuberculosis represents an endemic public health problem in developing countries. Multiple cranial nerve palsies can be expected due to basal meningitis; however, presentation with bilateral hearing loss is quite rare. Early diagnosis and treatment are crucial to prevent mortality and residual neurologic deficits. The focus of this discussion is a 42-year-old female presenting with bilateral hearing loss and nonspecific complaints who was finally diagnosed with chronic tuberculous meningitis. We also demonstrate the characteristic radiological and histopathological findings.

Susac's syndrome is an uncommon neurologic disorder of unknown cause. It has been described as a clinical triad of encephalopathy, hearing loss, and branch retinal artery occlusions. Clinically the diagnosis is difficult when the patient presents only a portion of a triad. We present a case with vision loss and sensorineural deafness and who had been diagnosed with MS for 20 years. Susac's syndrome is presumed to be an autoimmune endotheliopathy. Neurologic symptoms and signs are diffuse and multifocal, acute or subacute in onset, and progress during the active phase of the disease. In some patients the onset was stroke like and in others that of subacute dementia. Headache, often with migrainous features, was a prominent feature initially in more than one half of the patients. A high index of suspicion leading to correct diagnosis and early appropriate therapy may reduce the permanent sequel seen with this disease. Misdiagnosis is common. In patients in whom diagnosis and treatment are delayed permanent morbidity is higher in terms of visual loss, hearing loss, and neurologic debility. In patients in whom rapid diagnosis has led to early administration of immunosuppressive therapy, recovery can be almost complete.

Background: Although there are evidences as to Pilates developing dynamic balance, muscle strength and flexibility in healthy people, evidences related to its effects on Multiple Sclerosis patients are insufficient., Objectives: The aims of this study were to investigate the effects of Pilates on balance, mobility, and strength in ambulatory patients with Multiple Sclerosis., Methods: Twenty six patients were divided into two groups as experimental (n = 18) and control (n = 8) groups for an 8-week treatment program. The experimental group underwent Pilates and the control group did abdominal breathing and active extremity exercises at home. Balance and mobility were measured with Berg Balance Scale and Timed up and go test, upper and lower muscle strength with hand-held dynamometer. Confidence in balance skills while performing daily activities was evaluated with Activities Specific Balance Confidence Scale., Results: Improvements were observed in balance, mobility, and upper and lower extremity muscle strength in the Pilates group (p < 0.05). No significant differences in any outcome measures were observed in the control group (p > 0.05)., Conclusion: Due to its structure which is made up of balance and strengthening exercises, Pilates training may develop balance, mobility and muscle strength of MS patients. For this reason, we think that, Pilates exercises which are appropriate for the disability level of the patient may be suggested.

Background: Muscle strength and standing balance decrease in patients with Multiple Sclerosis (MS)., Objective: The aim of the present study was to investigate the relationship between the lower extremity isometric muscle strength and standing balance in patients with MS., Methods: Forty-seven patients with MS and 10 healthy volunteers were included. Neurological disability level was assessed using Expanded Disability Status Scale (EDSS). Isometric strength of seven lower extremity muscles (hip flexor-extensor-abductor-adductor, knee flexor-extensor, and ankle dorsal flexor) was assessed using hand-held dynamometer. Duration of static one-leg standing balance was measured using digital chronometer., Results: Hip flexor-extensor-abductor-adductor, knee flexor-extensor, and ankle dorsal flexor isometric muscle strength, and duration of one-leg standing balance were decreased in patients with MS when compared with controls (p < 0.05). All assessed lower extremity isometric muscle strength and EDSS level was related duration of one-leg standing balance in patients with MS. All assessed lower extremity isometric muscle strength (except ankle dorsal flexor) was related with EDSS., Conclusions: Hip flexor-extensor-abductor-adductor, knee flexor-extensor, and ankle dorsal flexor isometric muscle strength decreases in ambulatory MS patients. Lower extremity muscle weakness and neurological disability level are related with imbalance in MS population. Hip and knee region muscles weakness increases the neurological disability level. For the better balance and decrease neurological disability level whole lower extremity muscle strengthening should be included in rehabilitation programs.

Background: Multiple Sclerosis (MS) patients are often referred to aquatic physical therapy, but unfortunately, researches on the effects of aquatic therapy in MS patients are limited., Objective: The purpose of this study was to investigate the effects of Ai-Chi on balance, functional mobility, strength and fatigue in ambulatory patients with MS., Methods: Twenty-three ambulatory female patients were divided into two groups as experimental (n = 15) or control (n = 8) for an 8-week treatment program. The experimental group underwent Ai-Chi exercises in a swimming pool and the control group performed active arm and leg exercises combined with abdominal breathing exercises at home. Static standing balance was measured with duration of one-leg stance, functional mobility was evaluated with Timed-up and Go test and 6 minute walk test, upper and lower muscle strength was assessed with hand-held dynamometer and fatigue was evaluated with Fatigue Severity Scale., Results: Improvements were observed in static standing balance, functional mobility, upper and lower extremity muscle strength and fatigue in the Ai-Chi group (p < 0.05), but no significant differences in any outcome measures were observed in the control group (p > 0.05) after the intervention., Conclusions: According to these findings Ai-Chi may improve balance, functional mobility, upper and lower extremity muscle strength and fatigue in patients with MS.

Objectives: Metabolic disease affect all systems in the body, including the peripheral nervous system, but there is a controversy as whether to consider hyperlipidemia is a cause of peripheral neuropathy. The aim of the present study was to evaluate whether hyperlipidemic subjects with no clinical symptom or sign of peripheral neuropathy showed nerve conduction abnormalities or subclinical peripheral neuropathy according to the universally accepted electrophysiological criteria., Methods: The study group consisted from 29 female and 16 male patients (mean age: 47±7) while the control group consisted from 22 female and 10 male healthy volunteer subjects with a mean age of (43±9). All participants underwent an electrographic study in the classical manner described in the literature. Median and ulnar nerves in one upper, peroneal posterior tibial and sural nerves were studied in both lower extremities., Results: Median nerve 2nd digit-wrist segment sensory nerve conduction velocity were slow and sensory nerve action potential amplitude (SNAP) were low relative to controls. Sural nerve sensory nerve conduction velocity in the lower extremities were low relative to controls., Discussion: In this study the hyperlipemic group consisted from subjects with a relatively young age and with not very high serum lipid levels. Finding abnormal nerve conduction in distal sensory nerves in both upper and lower extremities in these hyperlipidemic patients made us think that; aging or uncontrolled hyperlipidemia may make these subjects susceptible to generalized peripheral neuropathy in the future., Conclusion: Hyperlipidemia may affect nerve conduction in peripheral nerves and precede peripheral neuropathy.

Objective: To compare functional exercise capacity, pulmonary function and respiratory muscle strength in fully ambulatory patients with multiple sclerosis with different disability levels and healthy controls, and to elucidate the determinant factors of functional exercise capacity., Methods: Forty-three fully ambulatory patients with multiple sclerosis and 30 healthy controls were included in the study. Patients were grouped according to Expanded Disability Status Scale (EDSS); Group I (EDSS 0-2), Group II (EDSS 2.5-4.5). Functional exercise capacity was evaluated using a six-minute walk test, and measurement of pulmonary function, and maximal inspiratory and expiratory pressures (MIP, MEP). The Pulmonary Index was used as a clinical predictor of respiratory dysfunction., Results: Respiratory muscle strength was lower in multiple sclerosis groups compared with controls, but the difference in MIP and %MIP did not reach statistical significance in Group I. The six-minute walk test distance was significantly shorter and peak expiratory flow was lower in multiple sclerosis groups (p < 0.05). Of the variance in the six-minute walk test distance, 75% was explained by EDSS (R2 = 0.55, p < 0.001), difference in heart rate (R2 = 0.06, p = 0.007), age (R2 = 0.05, p = 0.009) and gender (R2 = 0.09, p = 0.003)., Conclusion: Respiratory muscles are weakened, functional exercise capacity is reduced and pulmonary function is affected even in the early phase of multiple sclerosis. Ambulatory patients with multiple sclerosis who have a higher level of disability have lower pulmonary function, respiratory muscle strength and functional capacity than less disabled ones and controls. Neurological disability level, age, gender and heart rate difference on exertion are the determinants of functional exercise capacity.

The purpose of this study was to investigate the relationships between the upper extremity functions, upper extremity strength and hand sensation in patients with Multiple Sclerosis (MS). Twenty-two patients with MS (mean age: 38.5 ± 8.31 years, median Expanded Disability Status Scale (EDSS): 2) and 10 healthy subjects were included. Upper extremity function was measured with the Nine-hole peg test, upper extremity strength (shoulder flexion-abduction, elbow flexion, pinch and grip) with hand-held dynamometer, hand grip dynamometer and manual pinch meter, threshold of light touch-pressure with Semmes-Weinstein monofilament, duration of vibration with 128-Hz frequency tuning fork, and distance of two-point discrimination with an aesthesiometer. Strength and functional level of the upper extremity, light touch-pressure, two-point discrimination, vibration sensations of the hand were lower in patients with MS compared with healthy controls (p < 0.05). Light touch-pressure sensation of thumb and index fingers, two-point discrimination of index finger and elbow flexion strength were found to be related with upper extremity function in patients with MS (p< 0.05). These results indicate that the hand sensation, upper extremity strength and function were affected in MS patients. Additionally upper extremity functions seem to be related with light touch-pressure and two-point discrimination sensations of the hand and elbow flexion strength. Upper extremity strengthening and sensorial training of the hand may contribute to the upper extremity function in patients with MS.

The aims of the present study were to investigate the relationship between the foot sensations and standing balance in patients with Multiple Sclerosis (MS) and find out the sensation, which best predicts balance. Twenty-seven patients with MS (Expanded Disability Status Scale 1-3.5) and 10 healthy volunteers were included. Threshold of light touch-pressure, duration of vibration, and distance of two-point discrimination of the foot sole were assessed. Duration of static one-leg standing balance was measured. Light touch-pressure, vibration, two-point discrimination sensations of the foot sole, and duration of one-leg standing balance were decreased in patients with MS compared with controls (p<0.05). Sensation of the foot sole was related with duration of one-leg standing balance in patients with MS. In the multiple regression analysis conducted in the 27 MS patients, 47.6% of the variance in the duration of one-leg standing balance was explained by two-point discrimination sensation of the heel (R(2)=0.359, p=0.001) and vibration sensation of the first metatarsal head (R(2)=0.118, p=0.029). As the cutaneous receptors sensitivity decreases in the foot sole the standing balance impairs in patients with MS. Two-point discrimination sensation of the heel and vibration sensation of the first metatarsal head region are the best predictors of the static standing balance in patients with MS. Other factors which could be possible to predict balance and effects of sensorial training of foot on balance should be investigated., (Copyright © 2011 Elsevier B.V. All rights reserved.)

The prevalence of pathological laughing and crying in multiple sclerosis (MS) is 10%. It has been speculated that the anatomical lesion responsible for the pathological laughing is located in the pontine base, prefrontal cortex, and cerebellum. We report an 18-year-old male patient presenting with pathological laughing and hypomania. In his neurological examination, he had a euphoric effect with ataxic walking and dysarthria speech. He had a bilateral conjugated gaze limitation, with a prominent bilateral horizontal nystagmus on left gaze, dysmetria, dysdiadokokinesia, and remarkable dysfunction in a heel-to-shin test on the left. The IgG index in cerebrospinal fluid was normal with an oligoclonal band was present. In cranial MRI, there was a lesion on central pons which was hypointense in T1 images with contrast enhancement and hyperintense in T2 and flair images. Also another lesion in right brachium pontis which did not contrast enhancement but was hyperintense on T2 and flair images was present. There was an elevation of myoinositol/creatine ratio and choline and a reduction of NAA in proton MR spectroscopy. MR spectroscopic evaluation of the patient demonstrated the demyelination process. There has been no report of patients in whom pathological laughter was the presenting symptom of clinically isolated brainstem syndrome.

Spinal, general, and epidural anesthesia have been implicated in the exacerbation of multiple sclerosis. However, to date, no attack has been reported following usage of mandibular block articaine anesthesia. This article describes the case of a 30-year-old man who presented with a sudden occurrence of diplopia on lateral gaze the day after extraction of the mandibular right second and third molars. Two times 1.8 mL 4% articaine solution with 1/100,000 adrenaline was used for local anesthesia. On neurological examination, a restriction on external gaze of his left eye was observed. Immunoglobulin G index was high, and oligoclonal band was present in spinal fluid evaluation. MRI revealed demyelinated plaques on the left side of the midpons, right cerebellar hemisphere, and bilateral white matter and supraventricular spaces. The left abducens palsy completely improved after treatment with intravenous methylprednisolone. Mandibular block articaine anesthesia may precipitate multiple sclerosis onset or attack. This case indicates that dental clinicians and neurologists may be alerted to isolated abducens palsy as a possible adverse effect of mandibular block articaine anesthesia.

Objective: This study investigated the presence of sub-clinical cognitive dysfunction in patients with clinically isolated syndrome (CIS) and the abnormalities of cognitive event-related potentials (ERPs)., Methods: Subclinical cognitive dysfunction was assessed in 20 patients with CIS and in 20 healthy controls., Results: Patients had impairments in verbal learning and long-term memory, evaluating attention, executive function and visuospatial skills, in decreasing order of frequency. SDLT and SIT were the most, and COWAT and BNT were the least affected tests. The N200 and P200 latencies were prolonged, and N100, N200 and P200 amplitudes were reduced in the patients relative to the controls, from the Fz, Cz and Pz electrode positions (p<0.05)., Conclusion: Detailed cognitive testing is valuable in determining subclinical cognitive dysfunction in CIS patients. ERP abnormalities as well as abnormalities in detailed cognitivetesting in patients with CIS are helpful in the diagnosis of sub-clinical cognitive dysfunction.

Background and Purpose: The Los Angeles Motor Scale (LAMS) is a brief 3-item stroke severity assessment measure designed for prehospital and Emergency Department use., Methods: The LAMS and NIHSS were scored in under-12-hour acute anterior circulation ischemic stroke patients. Stroke severity ratings were correlated with cervicocerebral vascular occlusion on CTA, MRA, and catheter angiography. Receiver operating curves, c statistics, and likelihood ratios were used to evaluate the predictive value for vascular occlusion of stroke severity ratings., Results: Among 119 patients, mean age was 67 (+/-18), 45% were male. Time from onset to ED arrival was mean 190 minutes (range 10 to 660). Persisting large vessel occlusions (PLVOs) were present in 62% of patients. LAMS stroke severity scores were higher in patients harboring a vascular occlusion, median 5 (IQR 4 to 5) versus 2 (IQR 1 to 3). Similarly, NIHSS stroke severity scores were higher in PLVO patients, 19 (14 to 24) versus 5 (3 to 7). ROC curves demonstrated that the LAMS was highly effective in identifying patients with PLVOs, c statistic 0.854. At the optimal threshold of 4 or higher, LAMS scores showed sensitivity 0.81, specificity 0.89, and overall accuracy 0.85. LAMS performance was comparable to NIHSS performance (c statistic 0.933). The positive likelihood ratio associated with a LAMS score > or = 4 was 7.36 and the negative likelihood ratio 0.21., Conclusions: Stroke severity assessed by the LAMS predicts presence of large artery anterior circulation occlusion with high sensitivity and specificity. The LAMS is a promising instrument for use by prehospital personnel to identify select stroke patients for direct transport to Comprehensive Stroke Centers capable of endovascular interventions.

In order to evaluate the effect of alcohol consumption and the effect of abstinence on central nervous system generated parameters, we performed pattern visual evoked potential (PVEP) recordings on chronic alcoholics. The study was conducted on forty patients diagnosed as chronic alcoholics according to DSM IV criteria. They were aged mean: 42, and had histories of alcohol abuse for at least six years (mean: 21). 15% of the patients demonstrated abnormal VEP results at least in one tested eye. In order to test the effect of abstinence period on P100 latency values, alcoholics were divided in to two subgroups. Group I (Gr I) consisted twenty-four alcoholics who had been abstinent for less than thirty days (mean: 14), and Group II (Gr II) consisted sixteen alcoholics who had been abstinent for more than thirty and less than seventy-six days (mean: 38) The mean P100 latency of Gr I and Gr II was 101 and 102 milliseconds (ms) respectively; and when compared to normal controls the difference was statistically significant (p: 0.016, p: 0.009). Abnormal VEP in asymptomatic chronic alcoholics suggests that they may be useful in the detection of early changes and in following the progress of patients with the disorder.

Different papers have emphasized the presence of visual-evoked potential (VEP) abnormalities in metabolic disorders. The aim of this study was to perform pattern VEP (PVEP) recordings in patients with chronic renal failure just before and 24 h after dialysis to test the effect of this procedure on visual pathway generated parameters. Twenty-four haemodialysis patients (M/F:14/10; mean age: 48.8 +/- 14.1 years) were examined. None of them were complaining from visual difficulties or from visual loss. The recording sessions were performed just before and 24 h after dialysis. The control group consisted from 27 healthy subjects matched for age and sex. Eight (33%) patients demonstrated abnormal P100 latency prolongation in at least one tested eye (six patients in one tested eye, two in both eyes) in the recording session just prior to dialytic treatment. In the post-treatment session, it was found that the abnormal P100 latencies that were present in six patients (75%) before dialysis had returned to normal, while in the remaining two (25%), the latency abnormality persisted. No correlation was found between VEP parameters and dialysis duration, serum blood urea nitrogen (BUN), creatinine, parathyroid hormone and haematocrit levels. However, a positive correlation in the intradialytic percentage variation of bodyweight with P100 latencies was found. Visual evoked potential is a reliable, simple and non-invasive technique that can be used for the investigation and follow up of subclinical involvement of visual pathways in patients with chronic renal failure. Detected abnormalities in some uraemic patients are reversible by using dialysis.