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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. Amaç: Akut nörovasküler hastalıklarda nütrisyonel durum ve disfaji değerlendirmesi ve enteral beslenme kararı önemli prognoz belirleyicilerindendir. Gereç ve Yöntem: NöroTek, 10 Mayıs 2018’de (Dünya İnme Farkındalık Günü) Türkiye’nin tüm sağlık alt bölgelerine yayılmış 87 hastanenin katılımıyla gerçekleştirilen bir nokta prevalans çalışmasıdır. Hastanede yatan ve bu alt çalışma için toplanan verisi tam olan toplam 972 nörovasküler hasta (kadın: %53, yaş: 69±14 yıl; 845’i akut iskemik inme; 119’u intraserebral hematom ve 8’i post-resüsitasyon ensefalopatisi) analiz edildi. Bulgular: Gastrostomi iskemik inmeli hastaların %10,7, intraserebral kanamalıların %10,1 ve post-resusitasyon ensefalopatisi olanların %50’sine uygulanmıştır. Perkütan endoskopik gastrostomi (PEG) gereksiniminin bağımsız belirleyicileri, iskemik inme grubunda kabul NIHSS [exp (β): 1,09, %95 güven aralığı (GA): 1,05-1,14, puan başına] ile hem iskemik hem de hemorajik inmelerde mekanik ventilasyon uygulanmış olmasıdır [iskemik için: exp (β): 6,18, %95 GA: 3,16- 12,09] ve hemorajik inme için: [exp (β): 26,48, 95% GA: 1,36-515,8]. İnme olgularında PEG uygulaması hastane içi mortalite için bağımsız belirleyici değildi [exp (β): 1,731, 95% GA: 0,785-3,829]. Ancak, PEG uygulanmış olması taburculuk esnasında iyi prognoza (modifiye Rankin skoru 0-2) sahip olabilme için anlamlı bir negatif etmen olarak bulundu [exp (β): 0,032, %95 GA: 0,004-0,251]. Hastanede yatan nörovasküler hastaların yaklaşık üçte ikisinde malnütrisyon ve yutma bozukluğu açısından değerlendirme yapılmıştı. Nutrisyonel status değerlendirmesinin %69’u ve disfaji değerlendirmesinin %76’sı ilk 48 saat içinde gerçekleştirilmişti. Tüple enteral nütrisyon uygulama oranı %39’du. Beslenme tüplerinin %83,5’i ilk 2 gün içinde yerleştirilirken beslenme tüpü olan hastaların %28’ine daha sonra PEG açılmıştı. Sonuç: NöroTek çalışması ile Türkiye’de hastanede yatan akut inme hastalarında nutrisyonel uygulamaların temel kalite ölçütlerine ilişkin ilk güvenilir ve büyük ölçekli veri sağlanmıştır. Ekonomik olması ve doğruluğu açısından nokta yaygınlık yönteminin bu tip verilerin temini için daha fazla kullanılması mantıklıdır.

Background: Stroke is a morbid and potentially mortal complication among patients hospitalized with acute medical illness. The potential of extended-duration thromboprophylaxis with the factor Xa inhibitor betrixaban to reduce the risk of stroke compared with standard-dose enoxaparin in this population was assessed in this retrospective APEX trial substudy (Acute Medically Ill Venous Thromboembolism Prevention With Extended Duration Betrixaban). Methods: Hospitalized acutely medically ill subjects (n=7513) were randomized in a double-dummy double-blind fashion to either extended-duration oral betrixaban (80 mg once daily for 35–42 days) or standard-dose subcutaneous enoxaparin (40 mg once daily for 10±4 days) for venous thromboprophylaxis. Stroke events were adjudicated by an independent, blinded event adjudication committee. Results: The mean age of study participants was 76 years; 45% were male; 13% had had a stroke; and 45% had congestive heart failure. There were fewer all-cause strokes (0.54% versus 0.97%; relative risk [RR]=0.56; 95% confidence interval, 0.32–0.96; P =0.032; adjusted RR=0.43%; number needed to treat=233) and ischemic strokes (0.48% versus 0.91%; RR=0.53; 95% confidence interval, 0.30–0.94; P =0.026; adjusted RR=0.43%; number needed to treat=233) among patients treated with betrixaban versus enoxaparin through 77 days of follow-up. Among high-risk subjects, those with congestive heart failure or ischemic stroke as their index event, betrixaban reduced the risk of all-cause stroke (0.72% versus 1.48%; RR=0.49; 95% confidence interval, 0.26–0.90; P =0.019; adjusted RR=0.76%; number needed to treat=132) and ischemic stroke (0.63% versus 1.38%; RR=0.45; 95% confidence interval, 0.24–0.87; P =0.014; adjusted RR=0.75%; number needed to treat=134) compared with enoxaparin. Conclusions: Among hospitalized medically ill patients, extended-duration betrixaban significantly reduced all-cause stroke and ischemic stroke through 77 days of follow-up Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique identifier: NCT01583218.

Background\ud Patients with acute medical illnesses are at prolonged risk for venous thrombosis. However, the appropriate duration of thromboprophylaxis remains unknown.\ud \ud Methods\ud Patients who were hospitalized for acute medical illnesses were randomly assigned to receive subcutaneous enoxaparin (at a dose of 40 mg once daily) for 10±4 days plus oral betrixaban placebo for 35 to 42 days or subcutaneous enoxaparin placebo for 10±4 days plus oral betrixaban (at a dose of 80 mg once daily) for 35 to 42 days. We performed sequential analyses in three prespecified, progressively inclusive cohorts: patients with an elevated d-dimer level (cohort 1), patients with an elevated d-dimer level or an age of at least 75 years (cohort 2), and all the enrolled patients (overall population cohort). The statistical analysis plan specified that if the between-group difference in any analysis in this sequence was not significant, the other analyses would be considered exploratory. The primary efficacy outcome was a composite of asymptomatic proximal deep-vein thrombosis and symptomatic venous thromboembolism. The principal safety outcome was major bleeding.\ud \ud Results\ud A total of 7513 patients underwent randomization. In cohort 1, the primary efficacy outcome occurred in 6.9% of patients receiving betrixaban and 8.5% receiving enoxaparin (relative risk in the betrixaban group, 0.81; 95% confidence interval [CI], 0.65 to 1.00; P=0.054). The rates were 5.6% and 7.1%, respectively (relative risk, 0.80; 95% CI, 0.66 to 0.98; P=0.03) in cohort 2 and 5.3% and 7.0% (relative risk, 0.76; 95% CI, 0.63 to 0.92; P=0.006) in the overall population. (The last two analyses were considered to be exploratory owing to the result in cohort 1.) In the overall population, major bleeding occurred in 0.7% of the betrixaban group and 0.6% of the enoxaparin group (relative risk, 1.19; 95% CI, 0.67 to 2.12; P=0.55).\ud \ud Conclusions\ud Among acutely ill medical patients with an elevated d-dimer level, there was no significant difference between extended-duration betrixaban and a standard regimen of enoxaparin in the prespecified primary efficacy outcome. However, prespecified exploratory analyses provided evidence suggesting a benefit for betrixaban in the two larger cohorts. (Funded by Portola Pharmaceuticals; APEX ClinicalTrials.gov number, NCT01583218. opens in new tab.)

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.

Primary ıntracerebral hemorrhages are the leading cause of nontravmatic hemoırhages that are seen in adults. Arterial hypertension, aneurismal rupture, and cerebral amyloid angiopathies are the frequent causes of cerebral hemorrhage. The most frequent cause is the arterial rupture in the hypertensive background. They are mostly seen in order of sequence in putamen, capsule interna, temporal, frontal, parietal white matter, thalamus, cerebellar hemispheres, and in pons. 50 patients between April 1989 and December 1998 who admitted Gazi University Medical Faculty because ol ıntracerebral hemorrhage are included in this study. The causes, localisation, the percentage of operation and mortality rates are discussed., Primer intraserebral kanamalar erişkinlerdeki nontravmatik intraserebral kanamaların en sık nedenini oluşturur. Arteıyal hipertansiyon, anevrizma ve serebral amiloid anjiopati spontan serebral kanama nedenleridir. En sık neden ise kronik hipertansiyon zemininde küçük arterlerin rüptürüdür. Primer intraserebral kanamalar sıklık sırasına göre putamen ve kapsüla interna, temporal, pariatal ve frontal loblann beyaz cevheri, talamus, serebellar hemisfer ve ponsda görülmektedir. GÜTF Nöroloji A.B.D'da Nisan 1989 ile Aralık 1998 yılları arasında demografik özellikleri benzer olan 50 serebral kanama olgusu kanama nedenleri, lokalizasyonları, operasyon ve mortalite oranları verilerek sunulmaktadır.

28 VI. ÖZET Tek lif EMG'sinde analiz, genellikle kayıt sırasında `on-line` yöntemi ile yapılmaktadır. Ancak bu yöntem, tetkik süresini uzatmakta ve yeniden analize olanak tanımamaktadır. Anolog teyple analiz sırasında, teyp bandının getirdiği latans gecikmesi nedeni ile, yayınlanan normal değerler kullanılamaz. Nöromuskuler ileti bozukluğu bulunmayan normal deneklerde `off-line` analizle bulunan jitter değerlerini, evvelce yayınlanmış `on-line` analiz normalleri ile karşılaştırdık. Jüvenil myastenia gravis hastalarının akrabalarından oluşan 25 gönüllü denekte, ekstensör digitorum komunis kasında, volonter aktivasyon yöntemi ile, tek lif EMG yapılarak analog teybe kaydedildi. 20 noktadan lif yoğunluğu ölçüldü. Her denekte 5 ile 18 potansiyel çifti incelendi. Lif yoğunluğu ortalaması (SS) (% 95 üst güvenilirlik sınırı) 1.60(0.18)(1.90) bulundu. Her denekte en yüksek jitter gösteren çift ortalaması 31.24(6.87)(47.00) mikrosaniye idi. Ortalama jitter 25.08(5.04)(43.00) mikrosaniye, potansiyeller arası ortalama latans 0.67(0.1 1)(0.91) milisaniye olarak tespit edildi. Analog teyple analizle, her bîr çiftte, jitter üst sınırının `on-line` analiz değerleriyle farklılık göstermediğini, buna karşın ortalama jitterin üst sınırının 5 mikrosaniye kadar gecikmiş olduğunu gördük. Bunu, kullanılan teyp yönteminin oluşturduğu bir gecikme olarak değerlendirdik. Bu değerlerin Türk popülasyonunda kullanılabileceği düşünüldü. Çalışma, görece genç bir popülasyonda yapıldığından, 60 yaş üstü vakaların değerlendirilmesinde Gilchrist'in değerleri önerilir. 29 VII. SUMMARY Single fiber EMG analysis is usually performed with `on-line` method during recording. However, this technique usually prolongs the study and makes re- analysis impossible. Published normal values can not be used with analogous tape recordings due to the additional latency brought about by the elasticity of the tape. We compared jitter values obtained from normal volunteers without neuromuscular transmission disorders with `on-line` measurement peviously puplished. We performed single fiber EMG with voluntary activation on extensor digitorum communis muscle of 25 first-degree relatives of juvenile myasthenia gravis patients. All potentials were recorded on tape. Fiber density was estimated from 20 different recording sites. 5 to 18 potential pairs were studied in each subject. Mean(SD) (95th percentile) fiber density was 1.60(0.18)(1.90). Mean highest jitter was 31.24(6.87)(47.00). Mean jitter was 25.08(5.04)(43.00) microseconds. Mean interpotential interval was 0.67(0.1 1)(0.91) miliseconds. Although upper normal limit for individual pairs did not significantly differ from values obtained by `on-line` analysis, upper normal limit for mean jitter was increased about 5 miliseconds. We believe that this variation results from the tape recorder technique. These values can be used in the investigation of native population. Due to the fact that relatively young age of the group we studied, previously puplished values should be utilized in the evaluation of subjects over 60 years of age. 35

Aim: In this study, we aimed to evaluate the blood flow velocities of middle cerebral artery via transcranial doppler ultrasonography TCD and to assess subclinical vasculer involvement in premenopausal young women diagnosed with PCOS.Material and Methods: This prospective and observational study included 28 female patients with polcystic over syndrome and 23 healthy female hospital staff as controls. Demographic characteristics of the participants were recorded and TCD examination was performed on the middle cerebral arteries. TCD parameters; mean cerebral blood flow velocity MCBFV , peak systolic velocity PSV , pulsatility index PI , resistance index RI and systolic /diastolic ratio S / D were assessed.Results: PCOS and control groups were similar in terms of age. Body mass index BMI , diastolic and mean blood pressures were higher in the PCOS group than those in the control group. There were no significant differences between TCD parameters; MCBFV, PSV, PI, RI, S/D of PCOS and control group on the middle cerebral arteries. In the PCOS group, no correlation was found in between TCD parameters and age, BMI.Conclusion: In our study, cerebral blood flow velocities evaluated with TCD in early premenopausal PCOS patients were not different from healthy controls. However, the increased risk of cardiovascular and cerebrovascular diseases in postmenopausal PCOS patients suggests that the metabolic processes and microvascular effects initiated by PCOS are time-dependent and increase with age., Amaç: Bu çalışmada amacımız, PKOS tanısıyla izlenen premenapozal genç kadınlarda transkraniyal doppler ultrasonografi TCD ile orta serebral arter kan akım hızlarını incelemek ve subklinik vaskuler tutulumu araştırmaktır.Gereç ve Yöntemler: Prospektif ve gözlemsel olarak planlanan bu çalışmaya polikistik over sendromu tanısı almış 28 kadın hasta ve 23 sağlıklı kadın hastane personeli kontrol olarak dahil edildi. Katılımcıların demografik özellikleri kaydedilerek, orta serebral arterlere TCD incelemesi yapıldı. TCD parametreleri; ortalama serebral kan akım hızı OSKAH , pik sistolik hız PSH , pulsatilite indeksi PI , rezistans indeksi RI , sistolik/ diastolik oranı S/D değerlendirildi.Bulgular: PKOS ve kontrol grubu, yaş bakımından benzerdi. Vücut kitle indeksi, diastolik ve ortalama kan basıncı değerleri PKOS grubunda kontrol grubuna göre yüksek bulundu. PKOS ve kontrol grubunun orta serebral arterden yapılan TCD parametreleri; OSKAH, PSH, PI, RI, S/D arasında anlamlı farklılık yoktu. PKOS grubunda, TCD parametreleri ile yaş, VKİ arasında herhangi korelasyon saptanmadı.Sonuç: Bu çalışmada, erken premenapozal PKOS hastalarında TCD ile serebral kan akım hızları normal kontrollerden farklı bulunmamıştır. Ancak postmenapozal PKOS hastalarında ortaya konmuş olan artmış kardiyovaskuler ve serebrovaskuler risk, PKOS’un başlattığı metabolik süreçler ve mikrovaskuler etkilenmelerin zaman bağımlı olup yaşlanmayla arttığını düşündürmektedir.

Çalışmada 38 yazar bulunmaktadır. Bu yazarlardan sadece Bursa Uludağ Üniversitesi mensuplarının girişleri yapılmıştır. 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.

Objectives: Headache is the most common complaint in cerebral venous sinus thrombosis (CVST) and it may sometimes bethe only symptom in these patients. This retrospective and prospective study was an investigation of any differences in termsof clinical risk factors, radiological findings, or prognosis in patients with CVST who presented with isolated headache (IH) andcases 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 inthis 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 byage group, no statistically significant difference was found. The onset of headache was frequently subacute and chronic in the IHgroup, but an acute onset was more common in the NIH group. Other neurological findings were observed in 29% of the IH groupduring follow-up. A previous history of deep, cerebral, or other venous thromboembolism was less common in the IH group thanin the NIH group. Transverse sinus involvement was greater in the IH group, whereas sagittal sinus involvement was greater in theNIH 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 importantrole in thrombolytic events, may be a risk factor in CVST. Detailed hematological investigations should be considered. Additional studies are needed. Amaç: Baş ağrısı serebral venöz sinüs trombozunda (SVST) en sık görülen şikayettir ve bazen CVST ile başvuran hastalarda görülen tek semptom olabilir. Bu retrospektif ve prospektif çalışmada, izole başağrısı (IB) ile başvuran SVST olgularında ve baş ağrısı ile ilişkili diğer bulguları olan (izole olmayan başağrısı-İOBA) olgularda klinik risk faktörleri, radyoloji ve prognoz açısından herhangi bir farklılık olup olmadığını araştırdık. Gereç ve Yöntem: Serebral venöz sinüs trombozu (VENOST) çok merkezli çalışmasından 1144 hasta çalışmamıza alındı. Tüm demografik, biyokimyasal, klinik ve radyolojik yönler 287 IBA vakası ve 857 İOBA vakası için karşılaştırılmıştır. Bulgular: Toplam grup içinde kadın oranı iki kat daha yüksekti. İBA grubunda cinsiyet dağılımını yaş gruplarına göre değerlendirildiğinde istatistiksel olarak anlamlı bir fark bulunmadı. İBA grubunda, baş ağrısının başlangıcı sıklıkla subakut ve kronikti, ancak akut başlangıç, İOBA grubunda daha yaygındı. İBA grubunda% 29’luk takip sırasında diğer nörolojik bulgular eklenmiştir. Daha önce serebral, derin ve diğer venöz tromboembolizm öyküsü İBA grubunda İOBA grubuna göre daha azdı. Transvers sinüs tutulumu İBA grubunda daha yüksek iken sagital sinüs tutulumu İOBA grubunda daha fazlaydı. Plazminojen aktivatör inhibitörü (PAI) mutasyonu IBA grubunda anlamlı olarak daha yüksekti. Sonuç: Hastaların subakut veya kronik baş ağrısı varsa SVST tanısı için IBA akılda tutulmalıdır. Trombolitik olaylar için önemli bir role sahip olan PAI, SVST’da bir risk faktörü olabilir, bu nedenle ayrıntılı hematolojik araştırmalar düşünülmelidir. Daha ileri çalışmalara ihtiyaç vardır WOS:000644197800002 2-s2.0-85105266958

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.