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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.

Cerebrovascular diseases comprise the most common category of inpatient cases taken care of by neurologists. Dysphagia and malnutrition are not rare after stroke. It is strongly recommended for neurologists to screen and treat swallowing disturbances and malnutrition in stroke patients. However, present scientific literature lacks clear evidence with regards to nutritional treatment strategies for stroke patients. This review and recommendation paper is written with the aim to standardize nutritional screening and treatment algorithms during acute and chronic phases of cerebrovascular diseases and guide neurologists in Turkey for their daily practice.

OBJECTIVE: Dysphagia and malnutrition are not so rare in stroke patients, and have an unfavorable influence on recovery. Nutritional support may reduce infections, duration of hospital stay and mortality. However, there is no clear evidence about the modality of nasogastric nutrition. In this study, intermittent and continuous enteral nutrition is compared by means of pulmonary infections and gastrointestinal tolerance, among acute cerebrovascular patients. METHODS: Sixty two acute cerebrovascular patients with dysphagia were included the study. The same volume of nutrition product was infused 4 times daily to 31 patients, and continuously for 24 hours to the remaining 31. After 10 days of follow-up, the rates of pulmonary infections, diarrhea, increased gastric residual volumes, vomiting and tube occlusion were compared between two groups. RESULTS: Twenty patients developed pneumonia (32%) and 8 diarrhea (13%). Mortality due to complications associated with tube feeding was 6%. Aspiration and related pneumonia was present in 11 patients in the intermittent nutrition group (35%), and in 9 patients in the continuous nutrition group (29%). The rate of pulmonary infection was not statistically different between two groups (p>0.05). Diarrhea was observed in 7 intermittently fed patients (23%), while was present only in 1 patient (3%) in the continuously fed group. Diarrhea was more common in the intermittent nutrition group, just at the statistical border (p=0.05). None of the patients developed tube occlusion, vomiting and gastric retention. The rate of mortality and the interruption of feeding was not significantly different between two groups (p>0.05). CONCLUSION: Diarrhea and pulmonary infections are more prevalent with intermittent tube feeding with respect to continuous enteral nutrition, though the difference is not so conspicuous. The reason may be contamination of the equipments and the feeding solution because of frequent manipulation and interruption of infusion. Continuous infusion should be preferred for the acute stroke patient requiring nasogastric feeding

OBJECTIVE: Dysphagia and malnutrition are not so rare in stroke patients, and have an unfavorable influence on recovery. Nutritional support may reduce infections, duration of hospital stay and mortality. However, there is no clear evidence about the modality of nasogastric nutrition. In this study, intermittent and continuous enteral nutrition is compared by means of pulmonary infections and gastrointestinal tolerance, among acute cerebrovascular patients. METHODS: Sixty two acute cerebrovascular patients with dysphagia were included the study. The same volume of nutrition product was infused 4 times daily to 31 patients, and continuously for 24 hours to the remaining 31. After 10 days of follow-up, the rates of pulmonary infections, diarrhea, increased gastric residual volumes, vomiting and tube occlusion were compared between two groups. RESULTS: Twenty patients developed pneumonia (32%) and 8 diarrhea (13%). Mortality due to complications associated with tube feeding was 6%. Aspiration and related pneumonia was present in 11 patients in the intermittent nutrition group (35%), and in 9 patients in the continuous nutrition group (29%). The rate of pulmonary infection was not statistically different between two groups (p>0.05). Diarrhea was observed in 7 intermittently fed patients (23%), while was present only in 1 patient (3%) in the continuously fed group. Diarrhea was more common in the intermittent nutrition group, just at the statistical border (p=0.05). None of the patients developed tube occlusion, vomiting and gastric retention. The rate of mortality and the interruption of feeding was not significantly different between two groups (p>0.05). CONCLUSION: Diarrhea and pulmonary infections are more prevalent with intermittent tube feeding with respect to continuous enteral nutrition, though the difference is not so conspicuous. The reason may be contamination of the equipments and the feeding solution because of frequent manipulation and interruption of infusion. Continuous infusion should be preferred for the acute stroke patient requiring nasogastric feeding.

OBJECTIVE: If the present data defining the prognostic predictors is examined carefully, a serious contradiction is noticed. In this study, we tried to determine which factors affect the sixth month mortality, recurrence and functional recovery measured quantitatively after ischemic stroke, among our own patients followed in a tertiary health care center. METHODS: Age, sex, the presence of hypertension, coronary heart disease, atrial fibrillation, diabetes mellitus, hyperlipidemia, previous stroke, stroke subtype, admittance mean blood pressure, admittance blood sugar, hemotocrit, the presence of left ventricle hypertrophy and ejection fraction was recorded for 223 patients with ischemic stroke. The scores for National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS) and Barthel Index (BI) were recorded at the beginning and at the end of six months. The correlation of these 14 clinical and laboratory parameters with mortality, recurrence and recovery was examined statistically. RESULTS: Mortality rate was 33%, recurrence rate was 3.8%. Factors related with mortality were age, female gender, coronary artery disease, atrial fibrillation, low ejection fraction, low hematocrit and high admittance blood glucose (p< 0.05). Mortality was significantly low among patients with hyperlipidemia (p< 0.05). There was no statistically significant correlation between stroke recurrence and any of parameters investigated (p> 0.05). In the multivariate analyses, only, the effect of age, gender and hyperlipidemia on mortality was persisting (p< 0.05). Considering NIHSS, patients with high mean admittance blood pressure, considering mRS and BI younger patients and patients with lacunar infarcts had better recovery levels, while patients with previous strokes had poorer recovery (p< 0.05). CONCLUSION: Higher age and high admittance blood sugar were the most important determinants of mortality after ischemic stroke. Hyperlipidemia reduces the risk of death after stroke probably because of the neuroprotective effects of lipid lowering drugs. None of these parameters clearly affect functional recovery at the end of six month.

OBJECTIVE: If the present data defining the prognostic predictors is examined carefully, a serious contradiction is noticed. In this study, we tried to determine which factors affect the sixth month mortality, recurrence and functional recovery measured quantitatively after ischemic stroke, among our own patients followed in a tertiary health care center. METHODS: Age, sex, the presence of hypertension, coronary heart disease, atrial fibrillation, diabetes mellitus, hyperlipidemia, previous stroke, stroke subtype, admittance mean blood pressure, admittance blood sugar, hemotocrit, the presence of left ventricle hypertrophy and ejection fraction was recorded for 223 patients with ischemic stroke. The scores for National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS) and Barthel Index (BI) were recorded at the beginning and at the end of six months. The correlation of these 14 clinical and laboratory parameters with mortality, recurrence and recovery was examined statistically. RESULTS: Mortality rate was 33%, recurrence rate was 3.8%. Factors related with mortality were age, female gender, coronary artery disease, atrial fibrillation, low ejection fraction, low hematocrit and high admittance blood glucose (p< 0.05). Mortality was significantly low among patients with hyperlipidemia (p< 0.05). There was no statistically significant correlation between stroke recurrence and any of parameters investigated (p> 0.05). In the multivariate analyses, only, the effect of age, gender and hyperlipidemia on mortality was persisting (p< 0.05). Considering NIHSS, patients with high mean admittance blood pressure, considering mRS and BI younger patients and patients with lacunar infarcts had better recovery levels, while patients with previous strokes had poorer recovery (p< 0.05). CONCLUSION: Higher age and high admittance blood sugar were the most important determinants of mortality after ischemic stroke. Hyperlipidemia reduces the risk of death after stroke probably because of the neuroprotective effects of lipid lowering drugs. None of these parameters clearly affect functional recovery at the end of six month

Central pontine myelinolysis is a neurological disorder characterized by loss of myelin in the central pons as well as in the other parts of the brain like basal ganglia, lateral geniculate bodies, external and internal capsules, and cerebellum. We report the clinical and radiological findings of three patients with central pontine myelinolysis and one patient with both pontine and extrapontine myelinolysis.

Central pontine myelinolysis is a neurological disorder characterized by loss of myelin in the central pons as well as in the other parts of the brain like basal ganglia, lateral geniculate bodies, external and internal capsules, and cerebellum. We report the clinical and radiological findings of three patients with central pontine myelinolysis and one patient with both pontine and extrapontine myelinolysis