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INTRODUCTION: Objective data on the profile of acute stroke patients receiving inpatient treatment in Turkey are limited. However, this is essential for optimizing the relevant system of healthcare delivery, including regional acute stroke management. The NoroTek study aimed to collect the characteristics of ischemic stroke, intracerebral hemorrhage and cardiopulmonary arrest patients from a perspective of basic in-hospital quality metrics. METHODS: NöroTek is a point prevalence study conducted on World Stroke Awareness Day on May 10, 2018 with the participation of 87 centers (16 Hospitals, 26 stroke units and 45 stroke centers) representing 30 health care regions in Turkey. A total of 1802 in-patients (Female: 50.4%; age: 61.4+-18.4 years) were included. A form containing about hospital processes, including information on clinical, imaging, treatment and prognosis of the index acute neurovascular event (49 questions in 6 categories on the inclusion day; 52 questions in 7 categories at the time of discharge) was filled. RESULTS: There were a total of 1070 patients with neurovascular diseases (TIA 3.7%, ischemic stroke 48.4%, intracerebral hemorrhage 7%, cardiopulmonary arrest 0.4% and vegetative status 0.1%) and 732 (40.4%) with other neurological disease. Two-thirds of neurovascular disease patients had an established diagnosis of hypertension. Among ischemic stroke and TIA patients, diabetes was present in two-thirds, dyslipidemia in one-third, and recurrent events in one-third, all of which were more common than intracerebral hemorrhages. Diagnosis of deep vein thrombosis was 3.9% in ischemic stroke and 2.9% in intracerebral hemorrhage, while hospital infections were less frequent in ischemic stroke compared to intracerebral hemorrhages (pneumonia 30.8% vs 40.6%, urinary tract infection 10.9% vs. 13.9%). The mean length of hospital stay was longer in neurovascular diseases than in others (22 vs. 17, in days). In-hospital mortality was 10.3% in ischemic stroke and 15.5% in intracerebral hemorrhage, 60% of which was due to infection. DISCUSSION AND CONCLUSION: NöroTek, the first point prevalence study in the stroke clinical literature, revealed the profile of the main quality metrics of stroke patients hospitalized in Turkey. The presented data will be key in determining the gaps in current acute stroke management, providing actionable targets to improve the care of stroke patients.

Background/aim: While C-reactive protein (CRP) is a well-studied marker for predicting treatment response and mortality in sepsis, it was aimed to assess the efficacy of the neutrophil lymphocyte ratio (NLR) as a predictor of mortality and treatment response in sepsis patients in the intensive care unit (ICU). Materials and methods: In this retrospective cross-sectional study, sepsis patients were divided according to the presence of septic shock on the 1st day of ICU stay, and then subgrouped according to mortality. Patient demographics, acute physiologic and chronic health evaluation II and sequential organ failure assessment scores, NLR and CRP (on the 1st, 3rd, and last day in the ICU), microbiology data, antibiotic responses, ICU data, and mortality were recorded. Receiver operating characteristic (ROC) curves for the area under curve (AUC) were calculated for the inflammatory markers and ICU severity scores for mortality.Results: Of the 591 (65% male) enrolled patients, 111 (18.8%) were nonsurvivors with shock, 117 (19.8%) were survivors with shock, 330 (55.8%) were survivors without shock, and 33 (5.6%) were nonsurvivors without shock. On the 1st day of ICU stay, the NLR and CRP were similar in all of the groups. On the 3rd day of antibiotic response, the NLR was increased (11.8) in the nonresponsive patients when compared with the partially responsive (11.0) and responsive (8.5) patients. If the NLR was ≥15 on the 3rd day, the mortality odds ratio was 6.96 (CI: 1.4?34.1, P < 0.017). The NLR and CRP on the 1st, 3rd, and last day of ICU stay (0.52, 0.58, 0.78 and 0.56, 0.70, 0.78, respectively) showed a similar increasing trend for mortality. Conclusion: The NLR can predict mortality and antibiotic responsiveness in ICU patients with sepsis and septic shock. If the NLR is >15 on the 3rd day of postantibiotic initiation, the risk of mortality is high and treatment should be reviewed carefully.

A case of idiopatic intracranial hypertension with rapidly progressive vision loss and that benefits from pulse steroid therapy In this report, a 28-year-old patient who had idiopathic intracranial hypertension with rapidly progressive visual loss was reported. Etiological factors were polycystic ovarian disease, short-term oral contraceptive use and iron deficiency. She was administrated oral acetozolamid and metilprednizolon IV 1g/day. In addition to drug therapy, the patient underwent repeat lumbar punctures and lumboperitoneal shunt. In idiopathic intracranial hypertension, it is very rare but loss of vision may rapidly develop. In this case, high-dose intravenous corticosteroid therapy might be a god option in terms of save time to improve vision.

levels in etiological diagnosis of ischemic stroke and relationship the prognosis Objective-Ischemic stroke is a disease with a variety of etiological factors. D-dimer (DD) is one of markers established in the etiological diagnosis of stroke. In this study, differential diagnosis of the subgroups of stroke and the relationship between the severity of stroke and the prognosis is investigated in association with the DD levels. Material and Metod: In this study, the patients who had a stroke and applied to the Clinic of Neurology at Sisli Etfal Education and Resarch Hospital in 24 hours has been included prospectively. All patients' plasma D-dimer levels has been measured for two times firstly in 24 hours and the second between 8.-10. days. The etiological subgroups were determined according to TOAST criterias. The stroke severity has been evaluated in acute periode by National Insitutes of Health Stroke Scale (NIHSS), the prognosis has been evaluated subsequent periode by Modifiye Rankin scala (mRS) and Barthell scala. Results: In this study 40 patients with stroke including 15 women and 20 healthy control patients including 12 women were included. In our study, the level of DD in ischemic stroke patients in the early period is found to be higher compared with the healthy controls(p=0,018 p=0,019). But DD levels are not significantly higher in the atrial fibrillation and cardioembolic stroke patients compared with the other groups (p=0,490 p=0,251 and p=0,333 p=0,519). When the relationship between the severity of the stroke and the prognosis is investigated, high DD levels are found to be associated with disabilities. Conclusion: DD is an applicable biomarker in the early period of ischemic stroke. Although there are many factors that affect the level of DD, DD levels may be an indicator of progressive stroke and can provide information about prognosis seems to be able to say.

Objective: Respiratory complications are frequently observed in chronic neurological diseases because of loss of the airway protective reflexes and respiratory muscle weakness. In this study, we investigated the survival of this patient group in the intensive care unit (ICU) and after discharge. Method: A retrospective cohort study was conducted in a level III respiratory ICU of a tertiary hospital for chest diseases between January 1st, 2010 and June 15th, 2015. Patiens that have acute respiratory failure due to neurological dysfunction were included into the study. Results were analyzed with descriptive statistics and Kaplan-Meier survival analyses were performed. Results: 220 patients (65.5% male) whose median (interquartile ratio, IQR) age was 76 (16-93) were included into the study. The most frequent neurological diagnosis were dementia (37.3%), cerebrovascular disease (22.7%), motor neuron disease (14.1%) and myopathy (6.8%). 45% of patients had hypoxemic respiratory failure while 45.9% had both hypoxemia and hypercapnia. 86.8% of patients were diagnosed with pneumonia, while 34.5% had septic shock within 24 hours of admission. ICU mortality rate was 33.6% (n=74). Four years follow-up, the patients who use longterm noninvazive mechanical ventilation survived significantly longer (kaplan meier p: 0.004). According to cox regression hazard analysis, it was found that male gender, hypoxemy, septic shock and requirement of nasogastric tube feeding increased risk for mortality. Conclusion: Long-term mechanical ventilation support may contribute to better survival of patients who suffer from respiratory complications of progressive neurological diseases.

Nonconvulsive status epilepticus (NCSE) is defined as a condition causing mental status or behavioral changes clinically, which are associated with continuous ictal activity on electroencephalography (EEG) in the absence of convulsive seizures. Delay in the diagnosis of NCSE may increase morbidity and mortality. Several EEG patterns have been identified in NCSE. Triphasic waves accepted as pathognomonic for hepatic encephalopathy are also seen in NCSE. In this presentation, we discuss a differential diagnosis of metabolic encephalopathy and NCSE with the help of a case thought to be NCSE clinically and associated with continuous triphasic waves in EEG.