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BACKGROUND Previous studies demonstrating the association between renal functions and cerebral small vessel diseases have usually focused on white matter hyperintensity in the general population or lacunar stroke patients. This study aimed to investigate the effects of renal function on imaging markers of cerebral small vessel disease and etiologic subtypes of stroke in patients with acute ischemic stroke or transient ischemic attack. MATERIALS AND METHODS A total of 356 consecutive patients with acute ischemic stroke or transient ischemic attack who were admitted to the Stroke Unit and underwent brain magnetic resonance imaging were evaluated. Demographic data, vascular risk factors, stroke etiology, estimated glomerular filtration rate and severity of cerebral small vessel disease markers, and total cerebral small vessel disease burden were evaluated. RESULTS There was a significant inverse correlation between estimated glomerular filtration rate and total number of lacunes, periventricular and deep subcortical Fazekas scores, grade of enlarged perivascular spaces in the centrum semiovale, lobar and total cerebral microbleeds, and total cerebral small vessel disease burden. Impaired renal function was an independent risk factor for the presence of lacunes, deep cerebral microbleeds, and increased total burden. Renal function impairment and periventricular white matter hyperintensities were significantly associated with the etiologic subgroup of small vessel occlusion. The results were still significant after the exclusion of patients below 50 years of age. CONCLUSION Our results indicate that there is a relationship between renal function impairment and increased total burden, as well as acute ischemic stroke/transient ischemic attack due to small vessel occlusion.

The classically affected cranial nerve from intracranial hypertension is the sixth nerve. Carcinomatous meningitis can cause persistent or progressive cranial nerve palsies by infiltrating them in the subarachnoid space. Here we present a rare case of episodic, short-lasting, and unilateral oculomotor nerve palsy associated with carcinomatous meningitis and intracranial hypertension in a 44-year-old woman diagnosed with metastatic lung adenocarcinoma. As the survival rates enhance for metastatic cancers, neurologists should expect more perplexing neurologic presentations and consider leptomeningeal metastasis and intracranial hypertension in patients who have cancer and present with short episodes of diplopia and unilateral third nerve palsy.

INTRODUCTION[|]Modifiable risk factors constitute approximately 90% of the cumulative risk factor burden in stroke. One out of 4 strokes were preventable by optimization of these vascular risk factors according to Fisher's preventable stroke score (FPSS). However, the threshold values and coding criteria of the score are outdated. The 'Life's Simple 7 score (LS7S)' schematized in the Ankara ACROSS study was designed to make this update. [¤]METHODS[|]The study prospectively enrolled 787 acute ischemic stroke patients admitted to three university affiliated comprehensive stroke centers in Ankara. The preventability of stroke was evaluated according to the success attained in control of LS7S metrics (hypertension, diabetes, hyperlipidemia, active smoking, obesity, diet, physical activity), and were then compared to FPSS (0-10). [¤]RESULTS[|]A total of 386 (49%) patients had highly preventable stroke according to LS7S, while 196 (25%) were classified as preventable according to the criteria of previous study. Seventy-six percent of patients with highly preventable stroke according to LS7S were not classified as such by FPSS, while 53% of patients with high preventability per FPSS were not considered as preventable according to LS7S. Young age, DM, absence of stroke history, and small artery occlusion were associated with highly preventability according to LS7S; coronary artery disease, atrial fibrillation, high NIHSS score, large artery atherosclerosis and cardio-aortic embolism were associated with highly preventability according to FPSS. [¤]DISCUSSION AND CONCLUSION[|]Despite the importance of preventable stroke, its criteria has not been fully clarified yet. An ideal and practical scoring could be critical for stroke prevention strategies.[¤]

INTRODUCTION[|]Recent studies have highlighted that most strokes can possibly be prevented by risk factor modification and lifestyle changes.Female gender and lower educational level are two critical sociodemographic factors that are related to increased stroke risk. In this study,we investigated the interplay between these two features,which are considered to be disadvantageous in terms of stroke, and stroke preventability. [¤]METHODS[|]The study was prospectively conducted by evaluation of 787 ischemic stroke patients admitted to three university-affiliated comprehensive stroke centers in Ankara.The preventability of stroke was evaluated according to the success attained in control of 'Life's simple 7' metrics (hypertension,diabetes,hyperlipidemia,active smoking,obesity,diet and physical activity) at the time of stroke.The effect of education level and gender on stroke preventability was investigated by bivariate and multivariate analysis. [¤]RESULTS[|]A primary level or lower degree of education was present in 65% of the study population.Forty-two percent of our patients were female.A lower education level was significantly associated with suboptimal control of diabetes,active smoking,obesity,sedentary lifestyle and bad dietary habits.Preventable stroke(suboptimal control of ≥4 factors) was present among 52% of patients with lower education levels,while the corresponding proportion was 43% among those with high school or university education(p= 0.012).The percentage of obesity and sedentary lifestyle was significantly higher in females,while active smoking was more common in males. The education level was lower among female patients in comparison to males.Preventable stroke was encountered more commonly in females(52% vs. 47%, p= 0.108).In multivariate analysis,female gender (p=0.021) and lower education level (p=0.006) were independently associated with suboptimal control of risk factors.A lower education level mediated 31% of the relationship between female gender and preventable stroke. [¤]DISCUSSION AND CONCLUSION[|]Both female gender and lower education level are closely related to preventable stroke.Patients with such sociodemographic features, who are also considered to have a higher risk of stroke,necessitate additional strategies to optimize control of preventable stroke factors.[¤]

INTRODUCTION[|]Diabetes mellitus (DM) is an important risk factor for ischemic stroke. The results for the prevention of stroke recurrence with antidiabetic therapy have been contraversial. The some of data may indicate the positive effects of metformin treatment on stroke recurrence, stroke severity and prognosis. The aim of this study was to investigate the effect of metformin therapy usage on severity and pronosis of acute ischemic stroke.[¤]METHODS[|]The consecutive patients who were admitted to acute ischemic stroke with DM and accepted to participate in the study from January 2017 to April 2019 were evaluated, prospectively. The demographic data, risk factors, NIHSS scores at admission, etiologic stroke subtypes and mRS scores at discharge were recorded. The patients were divided into two groups. The patients with usage metformin or metformin plus other antidiabetic therapy were in group 1 and the patients taking antidiabetic therapy other than metformin or patients with type 2 DM receiving no antidiabetic therapy were in group 2. [¤]RESULTS[|]Of the 70 patients included in the study, 42 patients (60%) were in group 1 and 28 patients (40%) were in group 2. There was not any significant difference between the groups of severity and pronosis of acute ischemic stroke (p>0.05). [¤]DISCUSSION AND CONCLUSION[|]The usage of metformin and other antidiabetic therapy had no effect on the severity and prognosis of ischemic stroke. However, further controlled studies are needed with larger samples.[¤]

Migraine is thought to be a neurovascular disorder and increases the likelyhood to develop ischemic complications. Studies have shown that vascular disorders such as ischemic optic neuropathy, retinal artery and vein obstructions are more common in patients with migraine. This study aimed to evaluate the differences between retinal and optic disc microvasculature between migraine patients with and without aura and healthy controls using optical coherence tomography angiography (OCTA) imaging. Thirty-three patients with migraine and 28 healthy subjects were included in this prospective cross sectional study. Optical coherence tomography angiography imaging was performed for the macula and optic disc. Vessel densities (VD) and choriocapillaris flow values were compared between three groups: control group, migraine with aura (MWA), and migraine without aura (MWOA). There was no difference between the three groups for the VDs of the foveal, perifoveal, parafoveal, and the whole area. The choriocapillaris flow of patients with MWA was significantly less than that of the MWOA and control groups. The VDs of the optic disc revealed no significant difference between the three groups. A lack of choriocapillaris autoregulatory mechanisms may be a possible cause of the decrease in choriocapillaris flow in patients with MWA.

The objective of our study was to provide a comparative assessment of previously reported magnetic resonance imaging (MRI) parameters in primary and secondary pseudotumor cerebri (PTC) patients, to examine their diagnostic contribution, and to evaluate their association with symptoms, neuro-ophthalmological findings, laboratory results, and cerebrospinal fluid characteristics. Twenty-eight consecutive patients with PTC were included in the study. Age- and sex-matched 20 individuals with normal neurologic examination served as the control group. Modified Dandy Criteria were used for the diagnosis of PTC. Orbital and cranial MRI and MR venography of all patients and controls were assessed by three radiologists. According to our study, posterior flattening of the globe (64% sensitive, 100% specific), optic nerve sheath distention (46% sensitive, 100% specific), vertical tortuosity of the optic nerve (30% sensitive, 95% specific), and partial empty sella (43% sensitive, 100% specific) emerged as particularly valuable markers for a diagnosis of PTC.

In this guideline, the brief information about primary prevention of stroke by the recent developments will be presented. Recommendation regarding the risk factors including hypertension, diabetes, dyslipidemia, smoking and alcohol usage, physical activity, dietary habits, obesity, atrial fibrillation, patent foramen ovale, asymptomatic carotid artery occlusions, sickle-cell anaemia, anticoagulant and antiagreggant usage will be offered.

In this section, the brief information about secondary prevention of stroke by the recent developments will be presented. Recommendation regarding the secondary risk factors including hypertension, diabetes, dyslipidemia, atrial fibrillation, symptomatic carotid occlusions, arterial dissections and patent foramen ovale and their treatment approaches will be offered.

Background/aim: Intracranial stenosis (ICS) is identified in 2.2%?70.4% of patients with ischemic stroke and transient ischemic attack. This study aimed to determine the prevalence of ICS in a single center registry from Turkey. Materials and methods: We reviewed the charts of 619 patients with acute ischemic stroke. ICS was defined as any ICS > 50% on cerebrovascular imaging. The demographic data, risk factors, NIHSS scores and C reactive protein level at admission, mortality in hospital, recurrent stroke, and mRS in the follow-up period were recorded. Results: A total of 72 (11.6%) patients with ICS (45 males (62.5%); mean age 68.3 ± 12.6 years) were included. Sixty-seven patients (10.8%) had symptomatic ICS and 44 patients (7.1%) had ICS without extracranial stenosis. Diabetes mellitus (DM) was significantly higher in the ICS group compared to the others (P = 0.017). Disability was significantly better in patients with ICS compared to the others (P < 0.001). On logistic regression analysis, DM and follow up mRS were significantly associated with ICS (P < 0.05). Conclusion: ICS was seen in 11.6% of acute ischemic stroke cases in our registry. DM appears to be the major risk factor for ICS. Disability was better in patients with ICS. Ethnicity could be a factor causing better disability.

We present three patients with Behçet’s disease associated with intracardiac thrombus and pulmonary vascular involvement. One of these patients had also Budd-Chiari syndrome. All patients were treated with corticosteroid plus monthly intravenous cyclophosphamide as first line treatment and with no recurrences. Immunosuppressive therapy was successful in the treatment of intracardiac thrombus and also in the regression of pulmonary vascular thromboses in these patients. Intracardiac thrombus in Behçet’s disease is rarely seen. Behçet’s disease should be remembered in the differential diagnosis of the patients with intracardiac mass, especially in patients from the Mediterranean and Middle East populations.

Amaç: Trombolitik tedavinin amacı akut iskemik inmede rekanalizasyonu sağlayarak penumbrayı kurtarmaktır. Bu çalıșmanın amacı bizim intravenöz trombolitik tedavi uyguladığımız hastalarımızda tedavinin etkinliğini ve komplikasyon oranlarını değerlendirmektir. Hastalar ve Yöntem: Semptomların bașlamasından itibaren ilk 4.5 saatte bașvuran ve intravenöz trombolitik tedavi alan 32 hastayı retrospektif olarak inceledik. Hastaların tedavi öncesi ve tedavi sonrası Ulusal Sağlık Enstitüsü Strok Skalası (NIHSS) ve modifiye Rankin Skalası skorları (mRS) değerlendirildi. Bulgular: Tedavi öncesi, tedavi sonrası 24. saatte, 7. günde ve üçüncü aydaki NIHSS ortalamaları sırası ile 15±6, 10±6, 8±6 ve 8±7 idi. Tedavi sonrası 24. saatteki ve 3. aydaki mRS ortalaması ise 4±1 ve 3±2 olarak izlenmiștir. NIHSS karșılaștırıldığında tedavi alan grupta anlamlı düzelme tespit edildi (p=0.001). Tedavi sonrası 5 (%15.6) hastada intrakraniyal kanama tespit edildi. Yalnızca bir (%3.1) hastada ölümcül kanama oldu. Yorum: İlk 4.5 saatte akut iskemik inme ile bașvuran uygun hastalarda intravenöz trombolitik tedavi uygulaması kolay ve etkili bir yöntemdir. İnme bir halk sağlığı sorunudur ve bu tedavi ile bağımsız olarak yașamını sürdüren hasta sayısını arttırabiliriz.

We report a case of bilateral uveitis and optic disc swelling with Chiari I malformation. A 16-year-old girl was admitted to our clinic due to conjunctival hyperaemia and blurred vision in her right eye. Ophthalmologic and systemic examinations were performed. Visual acuity was 0.7 (OD) and 1.0 (OS). Bilateral optic disc swelling was observed. Fluorescein angiography demonstrated bilateral retinal vasculitis as well as optic disc hyperflourescence due to leakage. Laboratory examinations were within normal limits. Cranial magnetic resonance venography imaging revealed neither cranial mass nor cerebral venous thrombosis but a Chiari I malformation. The patient was started oral cetazolamid, topical and oral corticosteroids. After six months follow-up, bilateral optic disc swelling was resolved completely and visual acuity was 1.0 in both eyes. Optic disc swelling may be associated with intraocular inflammation; however, patients with bilateral optic disc swelling should be suspected of having an accompanying intracranial pathology.

Ischemia is associated with the pathological changes caused by the accumulation of reactive oxygen metabolites (ROM) in cerebrovascular accident (CVA). The aim of this study was to determine red cell copper/zinc-superoxide dismutase (Cu/Zn-SOD) and catalase activities and copper and zinc concentrations both in plasma and in red cells in CVA. Cu/Zn-SOD and catalase activities of 16 patients, with an average age of 64 yr, were measured spectrophotometrically; copper and zinc concentrations were determined by atomic absorption spectrophotometer. The results showed that Cu/Zn-SOD activity was increased markedly in patients compared to the young controls and reached a peak on the d 5 of the disease, whereas the catalase activity of the patients on d 3 and d 5 were in the normal range, but higher on d 10. The enzyme activities of the elderly group were generally increased compared to the young controls. Copper and zinc concentrations showed corresponding alterations. These findings suggested that the effects of oxidative stress in CVA might be reflected in red cell and plasma parameters.

We present a case of transient ischemic attack (TIA) as an extremely rare presentation of cerebral vein thrombosis. A 41-year-old man presented with a headache and episodes of hypoesthesia on his left side lasting approximately 30 minutes. Several vascular risk factors were remarkable in his medical history. The neurologic examination was normal. TIA of arterial origin was excluded by detailed investigations. Magnetic resonance imaging revealed acute thrombosis of the right superficial middle cerebral vein and the vein of Trolard. TIA-like episodes stopped with anticoagulation. Head trauma a few days earlier was the most likely mechanism of venous thrombosis. We suggest that the patients with TIA and headache should be carefully investigated in terms of cerebral venous thrombosis.

Background: The pronation test reveals slight paresis in the upper limbs. Patients hold their arms outstretched in front of them with the hands supinated while they keep their eyes closed. Position changes such as pronation, abduction, or drift indicate a positive pronation test. However, proprioceptive disorders also result in position changes when the eyes are closed. Aim: To evaluate the effects of vision on the pronation test and the relation of test results to electrophysiological findings. Methods: Sixteen patients with slight unilateral paresis due to recent stroke were included in the study. Two pronation tests, one while the patients’ eyes were open and the other while the eyes were closed (in randomized order), were performed in all patients and recorded with a video camera. Two neurologists double-blinded to the position of the patients’ eyes then assessed the position changes in each recording. Electrophysiological examination included median sensory and motor evoked potentials in both upper limbs. Sensory and motor central conduction times (CCTs) were determined for all patients. Results: Assessments of position changes by two physicians were concordant. Ten patients had position changes more evident in the pronation test with the eyes closed (group 1), while 6 patients had similar position changes in both tests (group 2). Motor CCT difference between two sides was similar in the two groups. However, sensory CCT difference longer than 1.0 ms was significantly more frequent in group 1 (p < 0.01). Conclusion: All patients who developed more obvious position changes during the pronation test with eyes closed had sensory CCT abnormalities. Therefore, we suggest that patients should keep their eyes open and then close them during the pronation test in order to distinguish motor or proprioceptive involvement.

BACKGROUND: The effects of age and hematocrit on transcranial Doppler (TCD) velocities have not been evaluated in a large patient group with recent ischemic stroke. AIM: This study assessed the effects of age and hematocrit on TCD measurements in patients with recent ischemic stroke compared to patients with non-vascular diseases. SETTINGS AND DESIGN: University Hospital, retrospective study. MATERIALS AND METHODS: TCD records and data files of 862 consecutive patients (mean age, 57±16 years) with various neurological diagnoses were reviewed retrospectively. The peak systolic, end diastolic and mean flow velocities (FV), systolic/diastolic ratios and pulsatility indices (PI) in the middle cerebral arteries were averaged and the effect of age and hematocrit values on these TCD values was studied. Independent samples t test, Pearson's coefficients of correlation, and linear regression test were used for statistical analysis. RESULTS: Among 862 patients, 413 were women (mean age, 53±17 years) and 449 were men (mean age, 60±13 years). Peak systolic and mean FV were higher and hematocrit concentration was lower in women compared to men (P