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Aims: Anticoagulation is not justified unless atrial fibrillation (AF) is detected in cryptogenic stroke (CS) patients. We sought to explore whether left atrial (LA) remodelling is associated with embolic stroke of undetermined source (ESUS)., Methods and Results: In this prospective study, we evaluated consecutively 186 patients in sinus rhythm who presented with an acute ischaemic stroke (embolic and non-embolic) and sex- and age-matched controls. We performed continuous electrocardiogram (ECG) monitoring to capture paroxysmal AF episodes as recommended by the guidelines. After 12 months of follow-up, continuous ECG monitoring was repeated in patients with undetected AF episodes. We quantified LA reservoir and contraction strain (LASr and LASct) by speckle-tracking, LA volumes by 3D echocardiography. Out of 186 patients, 149 were enrolled after comprehensive investigation for the source of ischaemic stroke and divided into other cause (OC) (n = 52) and CS (n = 97) groups. CS patients were also subdivided into AF (n = 39) and ESUS (n = 58) groups. Among CS patients, LA strain predicted AF independently from CHARGE-AF score and LA volume indices. ESUS group, despite no captured AF, had significantly worse LA metrics than OC and control groups. AF group had the worst LA metrics. Moreover, LASr predicted both CS (embolic stroke with and without AF) and ESUS (embolic stroke with no detected AF) independently from LAVImax and CHA2DS2-VASc score. LASr >26% yielded 86% sensitivity, 92% specificity, 92% positive, and 86% negative predictive values for the identification of ESUS (areas under curve: 0.915, P < 0.0001, 95% confidence interval: 0.86-0.97)., Conclusion: Echocardiographic quantification of LA remodelling has great potential for secondary prevention from ESUS., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.)

Background and Purpose: Platelets have a crucial role on vascular disease which are involved in pathogenesis of ischemic stroke. Platelet size is measured as mean platelet volume (MPV) and is a marker of platelet activity. Platelets contain more dense granules as the size increases and produce more serotonin and tromboglobulin (b-TG) than small platelets. In this study, the alteration of MPV values were investigated in patients with acute stroke, who had MPV values before stroke, during acute ischemic stroke and 7 days after the stroke. The relationship between this alteration and risk factors, etiology and localization of ischemic stroke were also investigated., Methods: Sixty-seven patients with clinically and radiologically established diagnoses of ischemic stroke were enrolled into the study and stroke etiology was classified by modified Trial of Org 10 172 in Acute Stroke Treatment (TOAST) classification and, modified Bamford classification was used for localization and stroke risk factors were also evaluated. The platelet counts and MPV values from patient files in patients who had values before stroke (at examination for another diseases), within 24 hours of symptom onset and after 7 further days were analysed., Results: MPV values increased after stroke (10.59±2.26) compared with acute stroke values (9.84±1.64) and the values before stroke (9.59±1.72) (p<0.0001); this alteration of MPV values occured 7 days after stroke (p<0.016). There was a positive correlation between age and MPV values during acute stroke (r=0.270; p<0.05). Patients with atrial fibrillation had higher alteration in the time of MPV compared with patients without atrial fibrillation (p>0.006). We assessed for gender, men (n=38) had a higher alteration in the time of MPV compared with women (n=29) (p=0.013)., Conclusion: Although there was no alteration of platelet counts, MPV values were increased 7 days after stroke in patients with acute ischemic stroke.

Aspirin resistance occurs in 5-45% of high-risk patients, with various mechanisms proposed for its development. This study aimed to determine the relationships among aspirin resistance, aspirin dosage, type of aspirin and glycoprotein IIIa P1A1/A2 polymorphism in patients with vascular risk factors. Two hundred and eight (75 symptomatic, 133 asymptomatic) patients with vascular risk factors who were using aspirin for primary or secondary prevention were prospectively included. The symptomatic group was further classified into two groups according to aspirin use at the time of stroke. Aspirin resistance was measured by the PFA-100 system (collagen/epinephrine cartridge) and glycoprotein IIIa P1A1/A2 polymorphism was determined by PCR. The overall prevalence of aspirin resistance was 32.2%. The mean age of patients with aspirin resistance was significantly higher than that in those who did not have resistance (P = 0.009). The prevalence of aspirin resistance was similar for the symptomatic and asymptomatic under aspirin therapy groups. The resistance rate was found to be highest with 100 mg enteric-coated preparation use (39.3%). Increasing the aspirin dosage and/or shifting to uncoated preparations caused a change in aspirin sensitivity of 36-60%. Repeated measurements showed development of aspirin resistance in 14% of patients who were sensitive to aspirin in previous measurements. Glycoprotein IIIaP1A1/A2 polymorphism, aspirin resistance and development of atherothrombotic stroke were not significantly related. The effect of aspirin can change by time, dosage and type of preparation used. There are no relationships among glycoprotein IIIa P1A1/A2 polymorphism, aspirin resistance and development of atherothrombotic stroke.

The aim of this study was to evaluate the prevalence of factor V Leiden (FVL), prothrombin G20210A, methylenetetrahydrofolate reductase (MTHFR) C677T gene mutations, and angiotensin-converting enzyme (ACE) I/D polymorphism in ischemic stroke (IS) patients. A total of 162 Turkish IS patients were included and analyzed according to stroke subtype by the TOAST classification. Their genotype data were compared with those of the control group, representing the healthy population, using the chi(2) test. The frequency of FVL heterozygocity was 12.3% in this series-higher than that in the normal population (9.8%; statistically insignificant, P = .478). The frequency of the ACE D/D genotype in all stroke patients and those with stroke of undetermined etiology was higher than that in our population (52.5% and 59.2%, respectively, vs 39.3%; statistically significant, P = .034, P = .020). Our results may suggest that ACE D/D genotype is a risk factor for IS, particularly in those with stroke of undetermined etiology in the Turkish population.

Aims  Anticoagulation is not justified unless atrial fibrillation (AF) is detected in cryptogenic stroke (CS) patients. We sought to explore whether left atrial (LA) remodelling is associated with embolic stroke of undetermined source (ESUS). Methods and results  In this prospective study, we evaluated consecutively 186 patients in sinus rhythm who presented with an acute ischaemic stroke (embolic and non-embolic) and sex- and age-matched controls. We performed continuous electrocardiogram (ECG) monitoring to capture paroxysmal AF episodes as recommended by the guidelines. After 12 months of follow-up, continuous ECG monitoring was repeated in patients with undetected AF episodes. We quantified LA reservoir and contraction strain (LASr and LASct) by speckle-tracking, LA volumes by 3D echocardiography. Out of 186 patients, 149 were enrolled after comprehensive investigation for the source of ischaemic stroke and divided into other cause (OC) (n  = 52) and CS (n  = 97) groups. CS patients were also subdivided into AF (n  = 39) and ESUS (n  = 58) groups. Among CS patients, LA strain predicted AF independently from CHARGE-AF score and LA volume indices. ESUS group, despite no captured AF, had significantly worse LA metrics than OC and control groups. AF group had the worst LA metrics. Moreover, LASr predicted both CS (embolic stroke with and without AF) and ESUS (embolic stroke with no detected AF) independently from LAVImax and CHA2DS2-VASc score. LASr >26% yielded 86% sensitivity, 92% specificity, 92% positive, and 86% negative predictive values for the identification of ESUS (areas under curve: 0.915, P  < 0.0001, 95% confidence interval: 0.86–0.97). Conclusion  Echocardiographic quantification of LA remodelling has great potential for secondary prevention from ESUS. [ABSTRACT FROM AUTHOR]

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Aim: To investigate the left atrial dilatation in an undetermined etiological group according to Trial of Org 10172 in Acute Stroke Treatment (TOAST) and to evaluate the relationship between left atrial dilatation and stroke volume and localization. Materials and methods: Files of patients admitted to our hospital (2000-2010) with acute ischemic stroke diagnosis were investigated. The size of their left atrium was registered using the data from transthoracic echocardiogram. Lesion size and localization were registered using brain MRI. Stroke etiology was categorized according to TOAST classification. The relationship between left atrial dilatation and stroke volume and localization in the undetermined group was investigated. Results: It was detected that 47% patients had left atrial dilatation. A significant difference was observed in the occurrence of left atrium dilatation for the undetermined group compared to the other groups and infarct volume was found to be larger in patients having left atrial dilation (P < 0.038). Conclusion: Left atrial dilatation is an important etiological factor in the undetermined-cause group and it also affects stroke volume. [ABSTRACT FROM AUTHOR]

Objective: We sought to determine whether each of mitral annular calcification (MAC), left ventricular hypertrophy (LVH) and aortic calcification (AC) contribute to the increased risk of acute ischemic stroke in patients with cryptogenic stroke. Material and Methods: Three hundred and thirty patients with acute ischemic stroke were evaluated with transthoracic echocardiography for MAC, LVH and AC. and these echocardiography findings were analyzed for any correlation with stroke etiology. Results: Three hundred and thirty patients with acute ischemic stroke were classified according to the etiology as cardioembolic (n=83), atherothrombotic (n=48), lacunar (n=49), cryptogenic (n=125), multiple etiological groups (n=25). Twenty (24.1%) patients with cardioembolic, 7 (14.6%) patients with atherotrombotic, 8 (16.3%) patients with lacunar, 20 (16%) patients with cryptogenic, 5 (8.3%) patients with multiple etiological factor had MAC (p>0.05). Sixty-four (77.1%) patients with cardioembolic, 41 (85.4%) patients with atherotrombotic, 41 (83.7%) patients with lacunar, 95 (76%) of patients with cryptogenic, 2 (8%) patients with multiple etiological factors had LVH (p>0.05). Forty-two (50.6%) patients with cardioembolic, 29 (60.4%) of patients with atherothrombotic, 31 (63.3%) of patients with lacunar, 76 (60.8%) patients with cryptogenic, 15 (10.6%) patients with multiple etiological factor had AC (p>0.05). Conclusion: This study shows that there is no association between the presence of mitral annular calcification, left ventricular hypertrophy and aortic calcification with cryptogenic stroke. [ABSTRACT FROM AUTHOR]

A 69-year-old woman presented with sudden onset of diplopia. In neurologic examination left medial rectus palsy without abduction nystagmus was detected. Brain magnetic resonance imaging revealed acute ischemic lesion in mesencephalon on diffusion-weighted images. Sponteneous resolution was observed after 1 month. Medial rectus palsy is a rare presention of acute ischemic stroke and early neuroimaging is important to establish such lesions. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: Neutrophil to lymphocyte ratio is an easily evaluated systemic inflammation indicator. However, there are limited reports on neutrophil to lymphocyte ratio and functional outcome in ischemic stroke. In this study, we aimed to evaluate the association of neutrophil to lymphocyte ratio and stroke severity, short term functional outcomes and mortality in patients with acute ischemic stroke. Methods: The clinical data of patients who were > 18 age-old and hospitalized with acute ischemic stroke in Baskent University Hospital, Ankara, Turkey between January 2018 and May 2019 were studied retrospectively. Neutrophil to lymphocyte ratio were measured. The neutrophil to lymphocyte ratio and National Institute of Health Stroke Scale (NIHSS) score at admission, mortality during hospitalization and Modified Rankin Scale (mRS) score at discharge of the patients with acute ischemic stroke were correlated. Results: Among the acute ischemic stroke patients due to the exclusion criteria, the data of 134 patients were evaluated. Median age of the patients were 76± 12.5 years and 82 patients (61.2%) were male. The median NIHSS scores of the patients at admission was 5±4.5. Mortality during the hospitalization was seen in 8 patients (6%). The median neutrophil to lymphocyte ratio value of the patients at admission were found to be 2.6±3.4. Neutrophil to lymphocyte ratio and NIHSS scores of the patients at admission, duration of the hospitalization, mRS scores at discharge and mortality during hospitalization were found to be positively correlated. Conclusion: Neutrophil to lymphocyte ratio is a simple and easily measured marker and can be used as a potential indicator for prognosis in acute ischemic stroke. However further prospective multicenter investigations are required to confirm the role of neutrophil to lymphocyte ratio for predicting the prognosis in acute ischemic stroke patients. [ABSTRACT FROM AUTHOR]

Objective: This study evaluated the association between hypoxia parameters with white matter hyperintensity (WMH) and silent cerebral infarcts (SCI) on brain magnetic resonance (MR) images of patients with obstructive sleep apnea (OSA). Methods: In this retrospective study, the study group was composed of 453 patients who were evaluated by overnight polysomnography (PSG). Data on hypoxia parameters, such as total sleep duration with oxygen saturation < 90% (ST90), percentage of cumulative time with oxygen saturation < 90% (CT90), and the lowest oxygen saturation (min SaO2), were obtained from PSG. The presence of WMH and SCI was evaluated in all participants using brain MR images. Results: Hypoxia parameters, such as ST90, CT90, and min SaO2, were significantly associated with WMH (P < 0.001). The multiple regression analysis showed that CT90 was independently associated with SCI (P = 0.038). In addition, when participants were divided into two groups according to CT90 < 10% and CT90 = 10%, age (P = 0.002), sex (P = 0.015), body mass index, Apnea-Hypopnea Index score, Epworth Sleepiness Scale score, and the presence of WMH, hypertension, and diabetes mellitus were significantly higher in the CT90 ≥ 10% group compared with the CT90 < 10% group (P < 0.001 for all parameters). CT90 ≥ 10% increased the risk of WMH 2.34-fold (95% confidence interval, 1.44-3.85; P = 0.006). Conclusion: The severity of nocturnal intermittent hypoxia may contribute to the pathogenesis of WMH and SCI in patients with OSA. Amaç: Çalışmanın amacı obstruktif uyku apne sendrom'lu (OSA) olgularda hipoksi parametreleri ile beyin manyetik rezonans görüntülemede saptanan beyaz cevherde hiperintens odaklar (WMH) ve sessiz serebral infarkt (SCI) ile ilişkisini değerlendirmek. Metod: Bu retrospektif çalışmada tüm gece polisomnografi yapılmış toplam 453 olgu alındı. Hipoksi parametreleri toplam uyku süresinde oksijen saturasyonun %90'nın altında kaldığı süre (ST90), ST90'nın toplam uyku süresine oranı (CT90) ve en düşük oksijen saturasyonu (minSaO2) polisomnografiden (PSG) elde edildi. Tüm olguların beyin manyetik rezonans görüntülemerinde WMH ve SCI varlığı değerlendirildi. Bulgular: Hipoksi parametreleri ST90, CT90 ve min SaO2 WMH varlığı ile anlamlı ilişkiliydi (P < .001). Multipl regresyon analizinde CT90 bağımsız olarak SCI ile birlikteydi (P = 0.038). İlave olarak, katılımcılar CT90 < %10 ve CT90 ≥ %10 olarak iki gruba ayrıldığında, CT90 ≥ %10 grubunda yaş (P = .002), cinsiyet (P= .015), vücut kitle indeksi, apne-hipopne indeksi, Epworth uykululuk ölçeği, WMH varlığı, hipertensiyon ve diabetes mellitus CT90 < %10 grubuna oranla anlamlı olarak daha yüksekti (P < .001, tüm parametrelerde). CT90 ≥ %10 olması WMH riskini 2.34 kat (95% CI 1.44 to 3.85, P= 0.006) arttırmaktadır. Sonuç: OSA'de nokturnal intermittent hipoksi şiddeti WMH ve SCI patogenezine katkı sağlıyor olabilir. [ABSTRACT FROM AUTHOR]