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Objective: There are a handful of studies investigating peri-ictal headache (PIH) and its clinical associations in patients with idiopathic/genetic epilepsies (I/GE). This multi-center study aimed to investigate PIH, which is an ignored comorbid condition in patients with I/GE, by headache experts and epileptologists working together. Methods: The data were collected from a cross-sectional large study, using two structured questionnaires for headache and epilepsy features, fulfilled by neurologists. Headaches were classified according to the International Classification of Headache Disorders, third edition, whereas seizure and syndrome types were diagnosed according to International League Against Epilepsy criteria. The patients with a headache starting 24 hours before the onset of the seizure (preictal) or within 3 hours after the seizure (postictal) were defined as patients with PIH. We compared demographic and clinical differences between two groups of patients with and without PIH statistically and used ROC curves to determine a threshold of the total number of seizure triggers associated with the occurrence of PIH. Results: Among 809 (531 females, 65.6%) consecutive patients with I/GE, 105 (13%) patients reported PIH (22 preictal, 82 postictal headaches, and one with both types). Peri-ictal headache was more frequently reported by females and those having a family history of migraine or epilepsy, and it was significantly associated with lower rates of seizure freedom for more than five years, drug resistance, and use of polytherapy, remarkably. Moreover, ROC curves showed that having more than 3 seizure triggers was associated with the presence of PIH. Conclusion: Our findings revealed that PIH may be linked to poor outcomes in I/GEs and seems to be related to a lower ictal threshold precipitated by multiple triggers. Future prospective studies will illuminate the unknown underlying mechanisms and appropriate management strategies for PIH to improve the prognosis.

Background/aim: Juvenile myoclonic epilepsy (JME), which is a fairly common form of generalized epilepsy syndrome has attracted attention by providing focal findings in some electrophysiological, neuropsychological, and neuroimaging studies. These findings are considered to be based on frontal lobe dysfunction. Furthermore, it is known that Cluster B personality disorders that are related to impulsive behavior are frequently seen in JME patients. Materials and methods: In this study, 23 JME patients and 20 healthy control subjects were included. All subjects were assessed using neuropsychological tests for executive functions and the Temperament and Character Inventory (TCI) for personality traits. Results: JME patients performed poorly in the digit span test and the Stroop Color and Word Interference Test. When the TCI scores were compared, there was no significant difference between the patients and the control subjects compatible with the literature. In addition, cooperativeness-character dimension (C1-social acceptance) scores were significantly lower in the patient group. Conclusion: Our findings support that JME patients have frontal lobe dysfunction. Although several studies are available in the literature, no significant results related to personality traits were detected. Key words: Juvenile myoclonic epilepsy, executive functions, temperament and character inventory

Objective Psychogenic nonepileptic seizures (PNES) are associated with high alexithymia, social cognition problems and low quality of life (QoL). Theory of Mind (ToM) has been studied in several conditions as a significant predictor of QoL. We aimed to assess the relationship between ToM abilities, alexithymia and subjective QoL in PNES patients and compare with generalised epilepsy (ES) patients and healthy controls. Method Patients with PNES (n = 28), ES (n = 28) and healthy volunteers (n = 28) were evaluated for alexithymia and quality of life (QoL) with Toronto Alexithymia Scale-20 (TAS-20) and Short Form-36 (SF-36). Reading the Mind in the Eyes test was used for assessment of affective ToM and Hinting Task and Strange Stories tests for cognitive ToM abilities. Results Analyses revealed lower SF-36 scores and poorer ToM performance in the PNES group compared to healthy group and poorer cognitive ToM performance than ES group. Cognitive ToM performance was inversely correlated with TAS-20 “difficulty identifying feelings” subscale and “physical functioning” subscale of SF-36 in the PNES group. Conclusion These results are consistent with previous research on PNES and other somatoform disorders and suggest that PNES is associated with impaired ToM task performance. ToM task performance might be related to specific aspects of alexithymia and QoL.

Behcet's disease (BD) may present with life threating complications including neurological and cardiovascular involvement. Neuro-Behcet's disease (NBD) is one of the most important causes of morbidity and mortality in patients with BD. The aim of the present study is to investigate whether patients with NBD are different than BD patients with other manifestations in terms of subclinical myocardial dysfunction.Forty patients with NBD (23 female, mean age: 42.4 ± 9.4 years), 40 patients with BD (9 female, mean age: 39.7 ± 9.0 years) and 40 controls (20 male, mean age: 41.8 ± 6.5 years) were consecutively included in the study. All subjects underwent a transthoracic echocardiography for evaluation of left ventricular (LV) and atrial (LA) functions with two-dimensional (2D) speckle tracking echocardiography (STE).Baseline characteristics, clinical data, LV dimensions, systolic and diastolic functions were all in normal range among the groups. LV global longitudinal strain (LV-GLS) was significantly lower in patients with NBD and BD patients without neurologic involvement compared to controls. LA conduit strain was significantly lower in patients with NBD compared to controls. Patients with both parenchymal NBD and vascular NBD manifestations had significantly lower LV-GLS and LA conduit strain compared to controls. Linear regression analysis demonstrated that among cardiovascular risk factors only presence of NBD was the independent predictor of LV-GLS.BD is associated with impaired LV and LA functions. LV-GLS and LA conduit strains of the patients with NBD were lower. NBD was an independent predictor of LV-GLS, suggesting a link between neurological manifestations and cardiac dysfunction in BD patients.

Headache is a common symptom of cervical artery dissections (CAD). Sometimes, it can be the only symptom and mimic migraine. We aimed to investigate headache characteristics and previous history of migraine in CAD patients, and to compare headache features between patients with internal carotid artery dissection (ICAD) and vertebral artery dissection (VAD). We investigated 53 CAD patients (n = 28 with ICAD, n = 25 with VAD). Demographic and clinical data were evaluated retrospectively. Headache information was obtained from the patient interviews with a structured questionnaire (based on the International Headache Society criteria). The patients with headache were assessed by headache specialist with a face-to-face interview. Headache was evaluated according to International Classification Committee of the International Headache Society ICHD. Headache (n = 38, 71.7%) was the most common symptom in CAD patients, which was mostly thunderclap, throbbing, intense and ipsilateral to dissection. Headache frequency and neck pain were significantly higher in VAD patients (p = 0.002, p

INTRODUCTION[|]To evaluate the data of patients admitted to emergency department of our hospital with acute posterior circulation stroke who underwent intravenous thrombolytic (IVT) and/or mechanical thrombectomy (MT).[¤]METHODS[|]Twenty-two patients with acute posterior circulation stroke between April 2019 and November 2020 who received IVT and/or MT treatment were included in the study. Our hospital has been serving as a comprehensive stroke center since April 2019.[¤]RESULTS[|]55 % (12 M, 10 F) of the patients were male patients, and the average age of all patients was 68 (29-87). 11 of the patients was applied IVT, 3 was IVT+MT and 8 was MT. The mean time between the symptoms onset and their admitting to the emergency service was 95 minutes. The mean time between the door to computerized tomography was 33 minutes, the neurological evaluation to needle time was 73 minutes and to the femoral puncture was 128 minutes. 9% of patients (41%) had mRS≤2 at 3 months, and this was associated with a good prognosis. Due to the fact that our hospital is a pandemic hospital and serves a large group of COVID patients, there have been delays in both imaging and treatment process of acute stroke patients during this period. [¤]DISCUSSION AND CONCLUSION[|]Posterior circulation infarcts are one fifth of all ischemic strokes, and basilar artery occlusions (BAO) constitute 1%. In our study, the prognosis of 27% of patients resulted in death. Altho-ugh the male gender was more dominant in these patients and their age was more advanced, statistical significance could not be obtained due to the small number of patients. However, it was determined that the prognosis of cases with high NIHSS at 24th hours and bazilar artery involvement were poor (p

© 2022 International League Against Epilepsy.Objective: The link between headache and epilepsy is more prominent in patients with idiopathic/genetic epilepsy (I/GE). We aimed to investigate the prevalence of headache and to cluster patients with regard to their headache and epilepsy features. Methods: Patients aged 6–40 years, with a definite diagnosis of I/GE, were consecutively enrolled. The patients were interviewed using standardized epilepsy and headache questionnaires, and their headache characteristics were investigated by experts in headache. Demographic and clinical variables were analyzed, and patients were clustered according to their epilepsy and headache characteristics using an unsupervised K-means algorithm. Results: Among 809 patients, 508 (62.8%) reported having any type of headache; 87.4% had interictal headache, and 41.2% had migraine. Cluster analysis revealed two distinct groups for both adults and children/adolescents. In adults, subjects having a family history of headache, ≥5 headache attacks, duration of headache ≥ 24 months, headaches lasting ≥1 h, and visual analog scale scores > 5 were grouped in one cluster, and subjects with juvenile myoclonic epilepsy (JME), myoclonic seizures, and generalized tonic–clonic seizures (GTCS) were clustered in this group (Cluster 1). Self-limited epilepsy with centrotemporal spikes and epilepsy with GTCS alone were clustered in Cluster 2 with the opposite characteristics. For children/adolescents, the same features as in adult Cluster 1 were clustered in a separate group, except for the presence of JME syndrome and GTCS alone as a seizure type. Focal seizures were clustered in another group with the opposite characteristics. In the entire group, the model revealed an additional cluster, including patients with the syndrome of GTCS alone (50.51%), with ≥5 attacks, headache lasting >4 h, and throbbing headache; 65.66% of patients had a family history of headache in this third cluster (n = 99). Significance: Patients with I/GE can be clustered into distinct groups according to headache features along with seizures. Our findings may help in management and planning for future studies.

INTRODUCTION[|]Spontaneous carotid and vertebral artery dissection involves 1-2% of all ischemic stroke and 10-25% of stroke cases among young adults. The aim of our study was to identify the dissection cases and neurological symptoms and signs, to investigate the etiological risk factors, to reveal the vascular involvement and to evaluate the demographic characteristics and treatment practices particularly in young patients. [¤]METHODS[|]A total of 53 cranio-cervical dissection patients who were hospitalized in our hospital between January 2010 - July 2019 were examined retrospectively. Age, sex, risk factors, and trauma history in the last month, neurological symptoms and signs were noted. Cranial MRI, cranial and cervical MR-anjio, T1-weighed fat sat cervical MRI, DSA were applied for suspected patients. [¤]RESULTS[|]Of the 53 patients with dissection, 23 were female and 30 were male. The mean age for vertebral artery dissection (VAD) was 40,8 and carotis artery dissection (CAD) was 42,2 years. Thirty patients were VAD, 23 patients were CAD. Four patients had bilateral carotid and one patient had bilateral vertebral artery dissection. In the subgroup analysis, 30 patients had extracranial, 23 had intracranial dissection. When risk factors were evaluated, cigarette smoking and hypertension were most common. Major or minor trauma story was observed in 41,5% of patients. Antiaggregant treatment was used in 88,6% of patients. [¤]DISCUSSION AND CONCLUSION[|]In the present study, VAD was more common and can be different from the other studies in literature. Extracranial dissections were dominant and nearly 40% of all dissections had a history of minor or major trauma. Smoking and hypertension were the most common risk factors. It needs more patients with multi center study to understand the incidence of craniocervical dissections in Turkish population. Arterial dissection has to be considered in differential diagnosis in young stroke patients. [¤]

Background & Objective: The aim of this study was to investigate the relationship of neutrophil to lymphocyte ratio (NLR) and other blood cells markers in craniocervical artery dissection patients and the dynamic changes of these biomarkers during the disease course, and effects on prognosis of the patients. Method: Cranial MR imaging, cranial and cervical MR angiography and DSA were examined, and diffusion weighted imaging (DWI) was performed to show the acute lesion(s). Results: Forty-six patients with craniocervical artery dissection were included in this study; they had a mean age of 42 years. Almost 60% of the patients (n=27) were admitted during acute state. Almost 2/3 of cases had extracranial dissection (n=31) and nearly 40% of the patients (n=18) had trauma. Neutrophil to lymphocyte ratio (NLR) was observed to be higher in the acute phase of the disease while the ratio decreased in the chronic phase. Low hemoglobin, high lymphocyte and a high NLR were found to have a negative correlation with the National Institutes of Health Stroke Scale (NIHSS). Conclusion: Elevation of neutrophil was higher in acute craniocervical artery dissection as a marker of acute inflammatory response. High NLR, low hemoglobin and high eosinophil levels were associated with worse prognosis and functional outcomes.

Objectives: To investigate the effects of low bone mineral density (BMD) on pain, quality of life (QoL), and fatigue in epileptic patientswho use anticonvulsants.Patients and Methods: Epileptic patients aged 18 years or older who use anticonvulsant drugs were recruited into the study.Demographic and clinical features were recorded, including the duration of epilepsy, number of anticonvulsants used, previousfracture history and BMD scores. The functional parameters included back pain measured with the visual analogue scale (VAS) andbrief pain inventory (BPI) scale, QoL assessed with the Qualeffo-41 questionnaire, and fatigue assessed with the fatigue severity scale(FSS).Results: Of the 100 patients screened for inclusion in the study, 63 epileptic patients met the inclusion criteria. The mean age andmean disease duration of all participants was 39.5 (±11.2) and 19.3 (±11.6) years, respectively. The median scores for VAS back pain,VAS low back pain, Qualeffo-41, FSS, pain severity, and pain interference (BPI) were significantly higher in patients with secondaryosteoporosis compared to patients with normal BMD. There were significant correlations between lumbar spinal BMD and VASback pain (rho = – 0.58, p < 0.0005), BPI pain severity (rho = – 0.56, p < 0.0005), BPI pain interference (rho = – 0.52, p < 0.0005),Qualeffo-41 (rho = – 0.56, p < 0.0005), and FSS (rho = – 0.41, p = 0.001).Conclusion: Epileptic patients suffering from low BMD showed increased pain, fatigue and impaired QoL. Therefore, BMDmeasurement should be recommended for the evaluation and management of epileptic patients.

Background: Coronary artery disease (CAD) and ischemic stroke share the same risk factors. Objective: The aim of the study was to explore the prevalence and predictors of concomitant CAD in acute ischemic stroke patients. Methods: One hundred and five patients (64.3 ± 15.0 years, 61 male) presenting with acute ischemic stroke documented by neuroimaging were consecutively included. All patients were carefully evaluated to determine their cardiovascular disease risk scores. The patients who had been previously shown to have ≥50% stenosis in at least one of the major coronary arteries by coronary angiography were grouped as CAD patients. Results: Of the 105 stroke patients, 27 patients had documented concomitant CAD. The stroke patients with CAD had higher cardiovascular risk scores and troponin I levels and carotid plaques were more prevalent. ROC analysis determined cut-off values as ≥22% for Framingham Heart Study Risk Score, ≥0.05 ng/mL for Troponin I, and ≥0.80 mm for carotid artery intima-media thickness to predict concomitant CAD. During 6 months of follow-up, among the 78 stroke patients without documented CAD, 16 patients had experienced major cardiovascular events including myocardial infarction, recurrent stroke, or cardiovascular death. These patients had higher Framingham Heart Study Risk Score and high-sensitive C reactive protein levels. Conclusion: Our study suggests stroke patients with higher Framingham Heart Study Risk Score and troponin I levels and carotid plaques be further investigated for the presence of concomitant CAD.

Objective: To assess the localizing value of interictal scalp EEG in epileptic focal cortical dysplasia (FCD) patients.Methods: A retrospective observational study of EEG records of epileptic patients seen at the Marmara University Hospital was performed. EEG and MRI findings were evaluated to detect a possible correlation. Results: EEG findings were consistent with MRI findings in 6 patients (37.5%).Conclusion: EEG findings were irrelevant in 62.5% (n:10) of patients. Additional imaging techniques such as ictal SPECT, MEG etc. will clearly augment the success of lesion localisation in FCD patients.

Multipl Skleroz (MS) hastalığının seyrinde ve tedavi sürecinde homosistein, vitamin B12 ve folik asit düzeylerindeki değişiklikler bildirilmiş ancak tam mekanizması aydınlatılamamıştır. Çalışmamızda, akut atak ile başvuran hastalarda yüksek doz metilprednizolon tedavisi öncesinde, sonrasında ve interferon-β tedavisi sonrasında serum B12, folik asit ve homosisitein düzeylerindeki değişiklikler incelenmiştir. Çalışmaya 1 yıl içinde akut atak ile başvuran, klinik kesin MS tanısı konarak takip edilen 31 hasta (8 erkek, 23 kadın) ve 10 kontrol olgusu dahil edildi. 20 hasta akut atak ile başvurdu 7 gün süreyle 1000 mg/gün metilprednizolon uygulandı. 27 hastaya interferon-β tedavisi başlandı. Yüksek doz steroid tedavi sonrası 1. ay düzeyleri ve interferon-β tedavisi alan hastaların 3. ay sonundaki serum vitamin B12, folik asit ve plazma homosistein düzeyleri ölçülerek kontrol grubu ve tedavisi öncesi düzeyleri ile karşılaştırıldı. Kontrol grubuna göre MS hastalarının bazal B12 değerleri daha önceki bulgularla tutarlı olarak daha düşüktü. Hem metilprednizolon, hem de interferon-β tedavisi sonrası B12 ve folik asid değerlerinde yükselme saptandı ancak sadece metilprednizolon tedavisi sonrasındaki artış istatiksel olarak anlamlıydı. Çalışmamızda saptanan metilprednizolon sonrası yükselen B12 ve folik asid düzeyleri ve istatistiksel anlamlılığa ulaşmayan homosistein düzeylerindeki düşme eğilimi farklı tartışmalar yaratmaktadır.

Introduction: Cerebral venous and sinus thrombosis (CVST) may lead to cerebral edema and increased intracranial pressure; besides, ischemic or hemorrhagic lesions may develop. Intracerebral hemorrhages occur in approximately one-third of CVST patients. We assessed and compared the findings of the cerebral hemorrhage (CH) group and the CVST group. Materials and Methods: In the VENOST study, medical records of 1,193 patients with CVST, aged over 18 years, were obtained from 35 national stroke centers. Demographic characteristics, clinical symptoms, signs at the admission, radiological findings, etiologic factors, acute and maintenance treatment, and outcome results were reported. The number of involved sinuses or veins, localizations of thrombus, and lesions on CT and MRI scans were recorded. Results: CH was detected in the brain imaging of 241 (21.1%) patients, as hemorrhagic infarction in 198 patients and intracerebral hemorrhage in 43 patients. Gynecologic causes comprised the largest percentage (41.7%) of etiology and risk factors in the CVST group. In the CH group, headache associated with other neurological symptoms was more frequent. These neurological symptoms were epileptic seizures (46.9%), nausea and/or vomiting (36.5%), altered consciousness (36.5%), and focal neurological deficits (33.6%). mRS was ≥3 in 23.1% of the patients in the CH group. Discussion and Conclusion: CVST, an important cause of stroke in the young, should be monitored closely if the patients have additional symptoms of headache, multiple sinus involvement, and CH. Older age and parenchymal lesion, either hemorrhagic infarction or intracerebral hemorrhage, imply poor outcome.

Cryptococcus neoformans is generally observed with immunosuppressive conditions. Rarely, it may be seen in immunocompetent individuals and presented with non-specific conditions. We described an immunocompetent case of cryptococcal meningitis presented with multiple cerebral infarcts. Despite the late diagnosis and emergence of hydrocephalus during treatment, the patient was recovered without any sequelae. In immunocompetent patients, the conventional diagnostics tests may be negative because of the low fungal load. If it is available, the Biofire FilmArray meningitis panel has high sensitivity and specificity for diagnosis. (C) 2021 The Authors. Published by Elsevier Ltd.

Juvenile myoclonic epilepsy (JME), which is a fairly common form of generalized epilepsy syndrome has attracted attention by providing focal findings in some electrophysiological, neuropsychological, and neuroimaging studies. These findings are considered to be based on frontal lobe dysfunction. Furthermore, it is known that Cluster B personality disorders that are related to impulsive behavior are frequently seen in JME patients.In this study, 23 JME patients and 20 healthy control subjects were included. All subjects were assessed using neuropsychological tests for executive functions and the Temperament and Character Inventory (TCI) for personality traits.JME patients performed poorly in the digit span test and the Stroop Color and Word Interference Test. When the TCI scores were compared, there was no significant difference between the patients and the control subjects compatible with the literature. In addi-tion, cooperativeness-character dimension (C1-social acceptance) scores were significantly lower in the patient group.Our findings support that JME patients have frontal lobe dysfunction. Although several studies are available in the literature, no significant results related to personality traits were detected.

Purposes: To evaluate changes in ocular blood flow and subfoveal choroidal thickness in patients with symptomatic carotid artery stenosis after carotid artery stenting. Methods: We included 15 men (mean age, 63.6 ± 9.1 years) with symptomatic carotid artery stenosis and 18 healthy volunteers (all men; mean age, 63.7 ± 5.3 years). All participants underwent detailed ophthalmologic examinations including choroidal thickness measurement using enhanced depth-imaging optic coherence tomography. The patients also underwent posterior ciliary artery blood flow measurements using color Doppler ultrasonography before and after carotid artery stenting. Results: Patients lacked ocular ischemic symptoms. Their peak systolic and end-diastolic velocities increased to 10.1 ± 13.1 (p=0.005) and 3.9 ± 6.3 (p=0.064) cm/s, respectively, after the procedure. Subfoveal choroidal thicknesses were significantly thinner in patients with carotid artery stenosis than those in the healthy controls (p=0.01). But during the first week post-procedure, the subfoveal choroidal thicknesses increased significantly (p=0.04). The peak systolic velocities of the posterior ciliary arteries increased significantly after carotid artery stenting (p=0.005). We found a significant negative correlation between the mean increase in peak systolic velocity values after treatment and the mean preprocedural subfoveal choroidal thickness in the study group (p=0.025, r=-0.617). Conclusions: In patients with carotid artery stenosis, the subfoveal choroid is thinner than that in healthy controls. The subfoveal choroidal thickness increases after carotid artery stenting. Carotid artery stenting treatment increases the blood flow to the posterior ciliary artery, and the preprocedural subfoveal choroidal thickness may be a good predictor of the postprocedural peak systolic velocity of the posterior ciliary artery.

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.

To investigate the effect and superiority of fluoroscopy-guided intraarticular shoulder injection (IAI), suprascapular nerve block (SSNB), and combination treatment in hemiplegic shoulder pain (HSP). We included 30 patients diagnosed with HSP. Patients were divided into three groups: IAI, SSNB, and combination treatment. Patients were assessed using a visual analogue scale (VAS) prior to the injection and at hour 1, week 2, and month 2 after the injection, with goniometry at two angles at the moment that pain started and maximum passive range of motion (ROM) of the shoulder and Modified Barthel Index prior to the injection, at week 2 and month 2 after the injection. Significant decrease in the VAS and increase in shoulder passive ROMs were detected at all follow-ups in groups. In comparison, there was no significant difference in VAS scores. Change in the internal rotation at the moment that pain started was found to be higher in the patients treated with the combined method than the other methods. Change in maximum passive ROMs was similar between treatment groups. IAI, SSNB, and the combination treatments are reliable and effective treatment modalities that provide pain relief and an increase in shoulder passive ROMs in HSP.

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

Intravenous thrombolysis and acute neurointerventional therapies such as or neurothrombectomy / aspiration should be compleed by two approaches in order to achieve meaningful success in acute stroke clinical practice. The first is the 'acute stroke system of care' that will ensure the timely and safe transfer and triage of acute patients to the centers, and the second is the management of these patients in the hospital stay during the acute period. In-hospital acute stroke practice is a comprehensive process that begins in neurological intensive care or stroke units, and the results are directly affected by the level and quality of stroke nursing practice. Acute stroke nursing consists of, but not limited to, effective and safe application of stroke-specific treatments; management of blood pressure, blood sugar, swallowing, nutrition and hydration; patient's posture, mobilization, early physical therapy and rehabilitation plan; monitoring of consciousness and neurological examination; venous thromboembolism, gastric ulcer and infection prophylaxis; prevention of complications such as KIBAS, infection, respiratory failure and bleeding and intensive care unit management and very effective patient, patient relative and team interaction and communication. This manuscript presents the fundamental practices and metrics adapted for our country from many current guidelines of acute stroke nursing.

The transverse sinus (TS) is a frequent location of cerebral venous thrombosis. However, unilateral TS hypoplasia is a frequent variation and radiological imaging pitfall in the diagnosis because it may mimic unilateral TS thrombosis. The purpose of this study is to find a cutoff value for bilateral jugular foramen (JF) diameter ratios on magnetic resonance imaging (MRI) for differentiating TS thrombosis from TS hypoplasia. We retrospectively reviewed magnetic resonance venography results for 174 patients with reduced unilateral TS caliber resulting from either unilateral thrombosis (80 patients) or unilateral hypoplasia (94 patients). We calculated the ratio by proportioning the diameter of the JF ipsilateral to the TS with caliber reduction to the diameter of the contralateral JF. The Mann–Whitney U test was used to compare the ratios between thrombosis and hypoplasia groups, and the cutoff value was calculated by receiver-operating characteristic curve analysis. The ratio of bilateral JF diameters was lower in patients with hypoplasia than those with thrombosis (P

Diffuse alveolar hemorrhage (DAH) following fibrinolytic therapy is a rare but a life-threatening complication. In acute ischemic stroke (AIS), DAH as a complication was not reported following intravenous thrombolytic therapy (ITT). The demographic, clinical, radiologic, and prognostic data of 4 patients with AIS who developed DAH after ITT are presented in this case series, along with a literature review.

Background and purpose Epilepsy is a disease known to occur with autonomous phenomenons. Earlier studies indicate decreased heart rate variability (HRV) during ictal and interictal periods among epilepsy patients. In this study, we aim to investigate cardiac rhythm abnormalities and HRV during interictal period between drug-naive patients with idiopathic generalized epilepsy (IGE) and healthy control group. Methods Twenty-six patients with IGE and 26 healthy individuals included in the study. In order to eliminate any structural cardiac pathology, transthoracic echocardiography was performed in all subjects and time and frequency domain parameters of HRV were evaluated after 24-hour rhythm holter monitoring. Results Between two groups, no significant difference was detected in terms of mean heart rate and maximum duration between the start of the Q waves and the end of the T waves (QT intervals). In the time domain analysis of HRV, no statically significant difference was detected for standard deviation of all R - R intervals and root-mean-square of successive differences between patient and control group (p = 0,070 and p = 0,104 respectively). In the frequency domain analysis of HRV, patients tended to display lower total power and very low frequency power than did healthy subjects, but the differences were not statistically significant. Conclusions Our results suggest that there is no major effect of the epilepsy on HRV in patients with IGE. It should be emphasized that, in this study, HRV was evaluated only in patients with IGE and that the results are not proper to be generalized for patients with partial seizures.

WOS: 000465130500010, PubMed: 29992235, Objective This study was performed to determine the rate of cerebral venous sinus thrombosis (CVST) among cases of Behcet's disease (BD) included in a multicentre study of cerebral venous sinus thrombosis (VENOST). Methods VENOST was a retrospective and prospective national multicentre observational study that included 1144 patients with CVST. The patients were classified according to aetiologic factors, time of CVST symptom onset, sinus involvement, treatment approach and prognosis. Results BD was shown to be a causative factor of CVST in 108 (9.4%) of 1144 patients. The mean age of patients in the BD group was 35.27 years and 68.5% were men, whereas in the non-BD CVST group, the mean age was 40.57 years and 28.3% were men (P < 0.001). Among the aetiologic factors for patients aged 18-36 years, BD was predominant for men, and puerperium was predominant for women. The onset of symptoms in the BD group was consistent with the subacute form. The transverse sinuses were the most common sites of thrombosis, followed by the superior sagittal sinuses. The most common symptom was headache (96.2%), followed by visual field defects (38%). Conclusions BD was found in 9.4% of patients in our VENOST series. Patients with BD were younger and showed a male predominance. The functional outcome of CVST in patients with BD was good; only 12% of patients presenting with cranial nerve involvement and altered consciousness at the beginning had a poor outcome (modified Rankin Score 2).

Kozak, Hasan Huseyin/0000-0001-6904-8545; Sahin, Sevki/0000-0003-2016-9965; Batur Caglayan, Hale/0000-0002-3279-1842; GUNES, TASKIN/0000-0002-9343-0573; Afsar, Nazire/0000-0001-8123-8560; Uzuner, Nevzat/0000-0002-4961-4332 WOS: 000498868800011 PubMed: 31562041 Aim: Systemic lupus erythematosus (SLE) is an unusual risk factor for cerebral venous sinus thrombosis (CVST). As few CVST patients with SLE have been reported, little is known regarding its frequency as an underlying etiology, clinical characteristics, or long-term outcome. We evaluated a large cohort of CVST patients with SLE in a multicenter study of cerebral venous thrombosis, the VENOST study, and their clinical characteristics. Material and Method: Among the 1144 CVST patients in the VENOST cohort, patients diagnosed with SLE were studied. Their demographic and clinical characteristics, etiological risk factors, venous involvement status, and outcomes were recorded. Results: In total, 15 (1.31%) of 1144 CVST patients had SLE. The mean age of these patients was 39.9 +/- 12.1 years and 13 (86.7%) were female. Presenting symptoms included headache (73.3%), visual field defects (40.0%), and altered consciousness (26.7%). The main sinuses involved were the transverse (60.0%), sagittal (40.0%), and sigmoid (20.0%) sinuses. Parenchymal involvement was not seen in 73.3% of the patients. On the modified Rankin scale, 92.9% of the patients scored 0-1 at the 1-month follow-up and 90.9% scored 0-1 at the 1-year follow-up. Conclusions: SLE was found in 1.31% of the CVST patients, most frequently in young women. Headache was the most common symptom and the CVST onset was chronic in the majority of cases. The patient outcomes were favorable. CVST should be suspected in SLE patients, even in those with isolated chronic headache symptoms with or without other neurological findings.

Changes in blood homocysteine, vitamin B12 andfolic acid levels have been reported during multiple sclerosis (MS) andtreatment period; however, the exact mechanism has not been enlightened. We investigated the changes of serumB12, folic acid, and plasma homocysteine levels before and after high-dose IVmethylprednisolone treatment and after interferon-β treatment in patientsadmitted with an acute attack of MS.31 patients followed for clinicallydefinite MS (8 male, 23 female) and 10 control individuals were included in thestudy. 20 patients were admitted with an acute attack and were administered 1000 mg/day methylprednisolone for 7 days. 27patients started interferon-β treatment. Serum B12, folic acid, and plasmaHomocysteine levels measured before and after the 1 month after high dosesteroid treatment and after 3-month interferon-β treatment were compared withpre-treatment levels and healthy controls. Baseline B12 levels were lower in patients with MS than in healthycontrols, which is consistent with previous findings. Both methylprednisolone and interferon-β treatments increasedserum B12 and folic acid levels compared with baseline; however, only theincrease following methylprednisolone treatment was statistically significant.Inour study, elevated B12 and folic acid levels and decreasing of homocysteinelevels without reaching statistical significance following methylprednisolonehave caused different debates., Multipl Skleroz (MS) hastalığınınseyrinde ve tedavi sürecinde homosistein, vitamin B12 ve folik asitdüzeylerindeki değişiklikler bildirilmiş ancak tam mekanizmasıaydınlatılamamıştır. Çalışmamızda, akut atak ile başvuranhastalarda yüksek doz metilprednizolon tedavisi öncesinde, sonrasında ve interferon-β tedavisi sonrasındaserum B12, folik asit ve homosisitein düzeylerindeki değişikliklerincelenmiştir. Çalışmaya 1 yıl içinde akut atak ile başvuran,klinik kesin MS tanısı konarak takip edilen 31 hasta (8 erkek, 23 kadın) ve 10 kontrol olgusu dahil edildi. 20 hastaakut atak ile başvurdu 7 gün süreyle 1000 mg/gün metilprednizolon uygulandı. 27hastaya interferon-β tedavisibaşlandı. Yüksek doz steroid tedavi sonrası 1. ay düzeyleri ve interferon-β tedavisi alan hastaların 3. ay sonundaki serum vitamin B12, folik asit ve plazma homosistein düzeyleri ölçülerek kontrol grubu ve tedavisiöncesi düzeyleri ile karşılaştırıldı. Kontrol grubuna göre MS hastalarınınbazal B12 değerleri daha önceki bulgularla tutarlı olarak daha düşüktü. Hemmetilprednizolon, hem de interferon-β tedavisi sonrası B12 ve folik asid değerlerindeyükselme saptandı ancak sadece metilprednizolon tedavisi sonrasındaki artış istatikselolarak anlamlıydı. Çalışmamızda saptanan metilprednizolon sonrası yükselen B12 ve folik asid düzeylerive istatistiksel anlamlılığa ulaşmayan homosistein düzeylerindeki düşme eğilimi farklıtartışmalar yaratmaktadır.

To investigate the effect and superiority of fluoroscopy-guided intraarticular shoulder injection (IAI), suprascapular nerve block (SSNB), and combination treatment in hemiplegic shoulder pain (HSP).We included 30 patients diagnosed with HSP. Patients were divided into three groups: IAI, SSNB, and combination treatment. Patients were assessed using a visual analogue scale (VAS) prior to the injection and at hour 1, week 2, and month 2 after the injection, with goniometry at two angles at the moment that pain started and maximum passive range of motion (ROM) of the shoulder and Modified Barthel Index prior to the injection, at week 2 and month 2 after the injection.Significant decrease in the VAS and increase in shoulder passive ROMs were detected at all follow-ups in groups. In comparison, there was no significant difference in VAS scores. Change in the internal rotation at the moment that pain started was found to be higher in the patients treated with the combined method than the other methods. Change in maximum passive ROMs was similar between treatment groups.IAI, SSNB, and the combination treatments are reliable and effective treatment modalities that provide pain relief and an increase in shoulder passive ROMs in HSP.