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Background & aims: There is a change in the mass and composition of paretic and non-paretic skeletal muscles in the chronic phase of stroke. The multi-center, prospective, and observational Muscle Assessment in Stroke Study (MASS) was performed to evaluate the degree of muscle loss during the in-hospital acute stroke setting and determine factors contributing to this loss. Methods: Acute dysphagic ischemic stroke patients (n = 107) admitted to neuro-intensive care units were evaluated by computed tomography on days 1 and 14 after admission to determine the cross-sectional muscle area (CSMA) at the level of the mid-humerus, mid-thigh, and third lumbar vertebra. The percentage change in CSMA and variables associated with this change were evaluated by univariate and multivariate analyses. Results: There were significant reductions in CSMA in all the muscle groups analyzed; the most prominent change was observed in the arms (both: 14.2 ± 10.7%; paretic: 17.7 ± 11.6%; non-paretic: 10.1 ± 12.5%), followed by the muscles in the legs (both: 12.4 ± 8.7%; paretic: 12.9 ± 9.9%; non-paretic: 12.0 ± 9.3%) and L3-vertebra level (5.6 ± 9.8%) (P < 0.001 for all). Higher calorie (r = −0.378, P < 0.001) or protein (r = −0.352, P < 0.001) intake was negatively associated with the decrease in CSMA of upper extremities. A substantial protein (≥0.4 g/kg/d) or calorie (≥5 kcal/kg/d) gap between targeted or actual intake was related to a larger decrease in CSMA in all the anatomic regions (P ≤ 0.05 for all). Other significant predictors of muscle loss included history of diabetes mellitus, male sex, higher BMI, in-hospital infections, and the necessity for invasive mechanical ventilation. Conclusions: There is a considerable degree of loss in the global muscle mass in acute ischemic stroke patients over a two-week period. Along with several factors, falling significantly behind the daily protein or calorie targets was related to the decrease in the muscle area. Trial registration information: clinicaltrials.gov identifier NCT03825419.

GİRİŞ ve AMAÇ: Bu çalışmada, üçüncü basamak bir merkezde serebral venöz tromboz (SVT) olan hastalarda tam kan sayımından elde edilen kolay erişilebilir bir parametre olan eritrosit dağılım genişliğinin (RDW) tanısal ve prognostik değerinin değerlendirilmesi amaçlandı.YÖNTEM ve GEREÇLER: Kliniğimizde takip edilen serebral ven trombozu olan 69 hastanın tıbbi kayıtları incelendi. Demografik özellikler, biyokimyasal parametreler, hemogram parametreleri, etkilenen venöz yapıların lokalizasyonu, başvuru NIHSS skorları ve taburculuk mRS skorları kaydedildi. Ayrıca 60 yaş-cinsiyet uyumlu sağlıklı yetişkinin demografik özellikleri ve hemogram değerleri kaydedildi.BULGULAR: RDW'nin hasta grubunda(14,58±2,33) kontrollere (12,99±0,76) göre anlamlı derecede yüksek olduğu gösterildi (p%13,11'lik bir RDW değerinin, SVT tanısı için %73.9 duyarlılık ve %61.7 özgüllüğe sahip olduğu bulundu (AUC: 0.746 %95 CI: 0.662-0.829, pTARTIŞMA ve SONUÇ: Bu çalışma, RDW ile SVT varlığı arasında bağımsız bir ilişki olduğunu göstermektedir. RDW, rutin hemogram incelemelerinden elde edilen basit ve kolay erişilebilir bir belirteçtir ve sonuçlarımız, SVT hastalarında tanısal ve prognostik amaçlar için kullanımını desteklemektedir. INTRODUCTION: This study aimed to assess the diagnostic and prognostic value of red cell distribution width (RDW)which is an easily accesible parameter obtained from complete blood count in patients with cerebral venous thrombosis (CVT) in a single tertiary center.METHODS: Medical records of 69 patients with cerebral venous thrombosis who were followed in our clinic were reviewed. Demographic characteristics, biochemical parameters, hemogram parameters, localization of the affected venous structures, admission NIHSS scores and mRS scores at discharge were recorded. Demographic characteristics and hemogram values of 60 age-sex matched healthy adults were also recorded.RESULTS: RDW was demonstrated to be significantly higher in patient group(14.58± 2.33) when compared to controls(12.99± 0.76) (p13.11% was found to have a sensitivity of 73.9% and specificity of 61.7% for diagnosis of CVT (AUC: 0.746 95% CI: 0.662-0.829, pDISCUSSION AND CONCLUSION: This study demonstrates an independent association between RDW and presence of CVT. RDW is a simple and easily accessible marker obtained from routine hemogram examinations and our results support its use for diagnostic, as well as prognostic purposes in CVT patients.

Brain edema is a common problem after stroke. Elevation of intracranial pressure causes high mortality anad morbidity rates by impairing cerebral perfusion and causing cerebral herniation. The neurologist who take care of acute stroke patients should guess the possibility of brain edema, take precautions for the development of brain edema, diagnose intracranial pressure elevation and cerebral herniation both clinically and raidologically, and treat brain edema rapidly. This expert opinion is a consensus declaration of 60 Neurologists who work on cerebrovascular diseases and neurocritical care under Turkish Society of Cerebrovascular Diseases.

The prevalence of headache in stroke has been reported between 8% and 34%. Determining the preva-lence, features, and effects on prognosis of cerebellar ischemic strokes that presented with headache solely and/or with other cerebellar signs were the aims of our study. All patients diagnosed with cerebel-lar ischemia were included. Electronic medical records were reviewed. Patients have been followed up for 6th month. Descriptive statistics were generated. A total of 4763 patients were evaluated retrospectively, 200 patients had cerebellar ischemia and 22 patients of these cerebellar ischemias (11%) had a headache at initial presentation. Ataxia, dysarthria, dysmetria were the most common neurological findings. There was no significant difference whether ischemic lesion single or multiple and whether above or below 1.5 cm diameter. Ischemic lesions generally were in cortical/ juxtacortical layer. According to vascular perfusion areas, 54.5% patients & rsquo; ischemia was located in PICA (posterior inferior cerebellar artery) terri-tory. Patients presenting with a headache, predominantly had left hemispheric (vermian > hemispheric > pedincular) involvement. Although these patients generally had high modified Rankin Scale scores at the first evaluation, they had low NIHSS (National Institutes of Health Stroke Scale) scores (0 & ndash;5), and nearly all patients recovered, with low mRS at the 6-month follow-up. Cerebellar ischemic strokes with headache presentation are significantly prevalent in patients with left hemispheric, cortical/juxtacortical, PICA perfusion territory ischemias and are associated with low morbidity unless there was a conscious disorder. We believe this is one of the first studies that evaluated the clinical and radiological parameters of cerebellar stroke patients with headache.

INTRODUCTION[|]Neurodevelopmental-Bobath (NDT-B) approach is a problem-solving method used in assessment and treatment of individuals with neurological conditions. The purpose of this study is to investigate the effects of NDT-B approach on functional recovery in patients with acute ischemic stroke.[¤]METHODS[|]Thirty-nine patients with acute ischemic stroke were included in the study. The patients were randomly assigned to NDT-B (n: 21) and standard rehabilitation (SR) (n: 18) groups. The patients were evaluated with Stroke Rehabilitation Assessment of Movement Scale (STREAM), Trunk Impairment Scale (TIS), Berg Balance Scale (BBS) and Barthel Index (BI) before initiation of the rehabilitation program and before discharge. In the NDT-B group, the rehabilitation program was applied according to the Bobath method, five days per week, 60 minutes per session. In the SR group, exercises were applied according to the hospital routine.[¤]RESULTS[|]NDT-B reduced hospitalization period (median 8 days vs. 11.5 days, p=0.02) and was more effective than SR in improving mobility and balance. When the treatment methods were compared, it was observed that lower extremity and basic mobility skills improved more in the NDT-B group. Significant improvements were achieved only in the NDT-B group in BBS. Improvements were observed in TIS and BI in both groups following treatment (p

INTRODUCTION[|]Modifiable risk factors constitute approximately 90% of the cumulative risk factor burden in stroke. One out of 4 strokes were preventable by optimization of these vascular risk factors according to Fisher's preventable stroke score (FPSS). However, the threshold values and coding criteria of the score are outdated. The 'Life's Simple 7 score (LS7S)' schematized in the Ankara ACROSS study was designed to make this update. [¤]METHODS[|]The study prospectively enrolled 787 acute ischemic stroke patients admitted to three university affiliated comprehensive stroke centers in Ankara. The preventability of stroke was evaluated according to the success attained in control of LS7S metrics (hypertension, diabetes, hyperlipidemia, active smoking, obesity, diet, physical activity), and were then compared to FPSS (0-10). [¤]RESULTS[|]A total of 386 (49%) patients had highly preventable stroke according to LS7S, while 196 (25%) were classified as preventable according to the criteria of previous study. Seventy-six percent of patients with highly preventable stroke according to LS7S were not classified as such by FPSS, while 53% of patients with high preventability per FPSS were not considered as preventable according to LS7S. Young age, DM, absence of stroke history, and small artery occlusion were associated with highly preventability according to LS7S; coronary artery disease, atrial fibrillation, high NIHSS score, large artery atherosclerosis and cardio-aortic embolism were associated with highly preventability according to FPSS. [¤]DISCUSSION AND CONCLUSION[|]Despite the importance of preventable stroke, its criteria has not been fully clarified yet. An ideal and practical scoring could be critical for stroke prevention strategies.[¤]

INTRODUCTION[|]Recent studies have highlighted that most strokes can possibly be prevented by risk factor modification and lifestyle changes.Female gender and lower educational level are two critical sociodemographic factors that are related to increased stroke risk. In this study,we investigated the interplay between these two features,which are considered to be disadvantageous in terms of stroke, and stroke preventability. [¤]METHODS[|]The study was prospectively conducted by evaluation of 787 ischemic stroke patients admitted to three university-affiliated comprehensive stroke centers in Ankara.The preventability of stroke was evaluated according to the success attained in control of 'Life's simple 7' metrics (hypertension,diabetes,hyperlipidemia,active smoking,obesity,diet and physical activity) at the time of stroke.The effect of education level and gender on stroke preventability was investigated by bivariate and multivariate analysis. [¤]RESULTS[|]A primary level or lower degree of education was present in 65% of the study population.Forty-two percent of our patients were female.A lower education level was significantly associated with suboptimal control of diabetes,active smoking,obesity,sedentary lifestyle and bad dietary habits.Preventable stroke(suboptimal control of ≥4 factors) was present among 52% of patients with lower education levels,while the corresponding proportion was 43% among those with high school or university education(p= 0.012).The percentage of obesity and sedentary lifestyle was significantly higher in females,while active smoking was more common in males. The education level was lower among female patients in comparison to males.Preventable stroke was encountered more commonly in females(52% vs. 47%, p= 0.108).In multivariate analysis,female gender (p=0.021) and lower education level (p=0.006) were independently associated with suboptimal control of risk factors.A lower education level mediated 31% of the relationship between female gender and preventable stroke. [¤]DISCUSSION AND CONCLUSION[|]Both female gender and lower education level are closely related to preventable stroke.Patients with such sociodemographic features, who are also considered to have a higher risk of stroke,necessitate additional strategies to optimize control of preventable stroke factors.[¤]

INTRODUCTION[|]Nowadays early rehabilitation studies in stroke patients have gained momentum. Although early rehabilitation is reported to be more effective, what is really meant of the term 'early' is not clear. The term early can sometimes refer to minutes, sometimes to hours, while sometimes even to days. The aim of the present study was to determine whether the initiation time of rehabilitation has an effect on impairment, trunk function and degree of recovery in ischemic stroke patients.[¤]METHODS[|]Twenty-one patients with acute ischemic stroke diagnosis who were admitted to the hospital were included in the study. The rehabilitation was initiated as early as possible and the elapsed time; from the stroke occurrence to initiation of rehabilitation, was noted. Glasgow Outcome Scale, National Institutes of Health Stroke Scale and Trunk Impairment Scale were used to measure the effect of treatment. Evaluations were made at baseline and at discharge.[¤]RESULTS[|]All of the patients were discharged and no complication aroused in any patient. The elapsed time; from the stroke occurrence to initiation of rehabilitation was 12 hours in the earliest patient and 234 hours at the latest (median (IQR): 79.5 (58,5/107,5). When the results were examined, no statistically significant relationship was present in between the initiation time of rehabilitation on impairment, trunk function and on degree of recovery (p> 0,05).[¤]DISCUSSION AND CONCLUSION[|]The results of this study showed that time of initiation of rehabilitation does not have a direct effect on recovery. Ischemic stroke patients included in the early rehabilitation program have shown improvements when compared to baseline. However, controlled studies are needed to determine the extent to which early rehabilitation contributes to recovery.[¤]

Patients with cerebellar ischemic stroke may be misdiagnosed and may exhibit a delayed time to acute stroke treatment compared with patients with anterior circulation ischemic stroke. The posterior circulation Alberta stroke program early computed tomography score (pc-ASPECT) score has been used to evaluate hyperacute stroke, much as the ASPECT in anterior circulation stroke recently. Our main objective was to evaluate the associations of the clinical and etiological characteristics of ischemic cerebellar infarction patients on admission with their pc-ASPECT scores, as well as the correlations of the pc-ASPECT score with morbidity and mortality rates.We include 114 patients with cerebellar infarction who underwent 1 year of follow-up into the study.Patients with a pc-ASPECT score7 were more likely to present with impaired consciousness ( P0.001), multiple posterior circulation infarcts ( P0.001), hydrocephalus ( P0.001), lesions of the vermis ( P =0.028), and peduncle ( P =0.024), perfusion deficits in the total of posterior inferior cerebellar artery, anterior inferior cerebellar artery, superior cerebellar artery ( P0.05), and basilar artery stenosis ( P =0.005), ischemia in additional anatomical structures in the posterior circulation ( P0.001) compared with those with a score ≥7.Although the pc-ASPECT score alone is insufficient in some cases like vertebral artery dissection, using it together with the National Institutes of Health Stroke Scale (NIHSS) score and clinical findings may be beneficial during the hyperacute period of cerebellar ischemia. Presentation with impaired consciousness, basilar artery pathologies, vermian ischemia, and ischemia in additional anatomical structures in the posterior circulation other than the cerebellum appeared as important clinical and radiologic parameters predicting long-term prognosis.

Background Unhealthy lifestyle and inadequate control of vascular risk factors are the major contributors of stroke burden. Failure in achieving the target levels in control of these factors, not only designate missed opportunities contributing to the preventability of an incident stroke, but also set the post-stroke treatment goals in a case wise basis. In this study, we analyzed pre-event clinical features that play a role in stroke preventability, and determined the cumulative burden of risk factors that necessitate optimization following the ischemic insult. Methods Information about the pre-stroke optimal control of seven major modifiable risk factors (Life's Simple 7: hypertension, diabetes mellitus, hyperlipidemia, smoking, obesity, diet, and physical activity) was prospectively collected in ischemic stroke patients admitted to three tertiary academic centers in Ankara. Stroke preventability was evaluated by the overall number of factors requiring optimization with patients ≥4 risk factor conditions categorized as those suffering from a preventable stroke. Bivariate and multivariate analyzes were performed to uncover predictors of stroke preventability. Results Among 787 patients, 386 (49.0%) had ≥4 risk factor conditions requiring optimization. Preventable stroke was more common in younger patients, and patients with small artery occlusion. Multivariate analyses taking into account the pre-stroke antithrombotic treatment regimen, have highlighted age (OR: 0.99, 95%CI 0.98-1.00), female gender (1.59, 95%CI 1.17-2.16), coronary artery disease (1.54, 95%CI 1.10-2.14), small artery occlusion (1.90, 95%CI 1.13-3.18), and cardio-aortic embolism (0.53, 95%CI 0.35-0.82) as significant factors associated with preventability. Conclusions Approximately half of the ischemic stroke patients have preventable stroke from the perspective of risk factor control. Extra care should be given to strategies directed to risk factor control and lifestyle interventions in certain high-risk groups for the prevention of future complications.

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.

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.

Background: Obesity affects all major organ systems and leads to increased morbidity and mortality. Whole blood viscosity is an important independent regulator of cerebral blood flow. The aim of the present study was to evaluate the effect of whole blood viscosity on cerebral artery blood flow velocities using transcranial Doppler ultrasound in pediatric patients with obesity compared to healthy controls and analyze the effect of whole blood viscosity and blood pressure status to the cerebral artery blood flow velocities. Methods: Sixty patients with obesity diagnosed according to their body mass index (BMI) percentiles aged 13–18 years old were prospectively enrolled. They were grouped as hypertensive or normotensive according to their ambulatory blood pressure monitoring. Whole blood viscosity and middle cerebral artery velocities by transcranial Doppler ultrasound were studied and compared to 20 healthy same aged controls. Results: Whole blood viscosity values in hypertensive (0.0619±0.0077 poise) and normotensive (0.0607±0.0071 poise) groups were higher than controls (0.0616±0.0064 poise), with no significance. Middle cerebral artery blood flow velocities were higher in the obese hypertensive (73.9±15.0 cm/s) and obese normotensive groups (75.2±13.5 cm/s) than controls (66.4±11.5 cm/s), but with no statistical significance. Conclusions: Physiological changes in blood viscosity and changes in blood pressure did not seem to have any direct effect on cerebral blood flow velocities, the reason might be that the cerebral circulation is capable of adaptively modulating itself to changes to maintain a uniform cerebral blood flow.

Background This study aimed to identify the reversibility of MRI findings indicative of increased intracranial hypertension in idiopathic intracranial hypertension (IIH) patients after treatment. Methods This retrospective, observational study included demographic and clinical data from 10 patients with IIH and 10 controls. Brain MRI findings in IIH patients were recorded twice: once when patients had papilledema and again after resolution of papilledema. Neuroradiologists graded MRI findings in both groups based on an imaging grading scale. Results After resolution of papilledema, all patients showed improvement in 2 or more of the MRI characteristics of IIH. This was especially the case for the height of the midsagittal pituitary gland and optic nerve sheath thickness (ONST), which were significantly different in all pairwise group comparisons. Sellar configuration, globe configuration, and horizontal orbital optic nerve tortuosity were different between the IIH pre-treatment group and controls, but not between controls and the IIH post-treatment group. We found no difference in optic nerve head hyperintensity or optic nerve thickness among the 3 groups. Conclusions We demonstrated that several morphometric MRI characteristics in IIH are reversible to a certain extent after treatment. Enlarged subarachnoid spaces filled with cerebrospinal fluid seem to remain reduced, and the ONST and height of the pituitary gland are not fully normalized after treatment.

BACKGROUND Balance disorders cause disability in stroke and increase risk of falls. The Balance Evaluation Systems Test (BESTest), examines balance, determines parameters causing balance disorders, provides information on risk factors for falls. OBJECTIVE To investigate the sensitivity and specificity of the BESTest in determining the risk of falls in stroke patients. METHODS Fifty patients with chronic stroke were included in the study. Balance was assessed using BESTest, Berg Balance Scale (BBS), Activity Specific Balance Confidence scale (ABC) and Biodex-BioSway Balance System. To examine the content validity of BESTest, the relationship between BESTest and other balance assessment methods was examined. The internal consistency reliability of BESTest was evaluated by Cronbach's α coefficient. Analysis of receiver operating characteristics (ROC) was performed to determine cut-off point, sensitivity and specificity. RESULTS BESTest, BBS, ABC and Biodex-BioSway Balance System results of faller stroke patients were worse than that of non-faller (p

Objective: This prospective observational study aimed to identify the effects of labor on cerebral hemodynamics by measuring the middle cerebral artery (MCA) blood flow velocity by transcranial Doppler ultrasound (TCD), and the related factors just before delivery and within the 24 h after delivery. Methods: The study included 35 healthy pregnant women with a gestational age of >37 weeks who were in labor and a control group including healthy, age-matched, nonpregnant women (n = 24). Demographic characteristics and significant clinical information of pregnant women were recorded. The MCA blood flow velocity was assessed by TCD just before and within 24 h after delivery. The parameters assessed by TCD were mean cerebral blood flow velocity (MCBFV), peak systolic velocity (PSV), pulsatility index (PI), resistance index (RI), and systolic/diastolic ratio. Results: There was no significant difference between the pregnant and nonpregnant women regarding age (27 +/- 5 years versus 28 +/- 7 years; p = .751). The MCBFV, PSV, PI, and RI showed a significant increase within the 24 h after delivery as compared with those before delivery. Comparison of the pregnant women with the control group in terms of the values of all parameters related to the MCA blood flow velocity revealed that the values that were significantly low before delivery reached to the level of the control group after delivery Conclusion: The findings of this study demonstrated that the blood flow velocity of the MCA decreased during the late pregnancy period and increased in the early postpartum period to the level similar to that of the nonpregnant group.

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.

Aim: The aim of the present study was to evaluate serum levels of S-100B which is an acidic calcium-binding protein within the first 36 hours following an acute ischemic stroke and to determine the correlation between S-100B levels and National Institutes of Health Stroke Scale (NIHSS) scores. Material and Methods: Fifty patients with ischemic stroke (25 male, 25 female; mean age=64) and 30 healthy volunteers (14 male, 16 female; mean age=61) serving as age and sex matched controls were included in this study. Venous blood samples were taken within the first 36 hours following the acute stroke. The quantitative determination of S-100B in serum was carried out using an enzyme linked immunosorbent assay.Results: Patients with acute ischemic stroke had significantly higher serum S-100B protein concentrations (42 pg/ml) than those of normal controls (31.5 pg/ml) (p0.001). S-100B concentrations were correlated with NIHSS scores (r=0.443; p=0.001), which is considered an indicator of the degree of neurological deficit.Conclusion: The present study demonstrates that S-100B concentrations in both the large artery atherosclerosis (LAA), cardio embolic infarct (CEI) subtypes of acute stroke are increased in the early phases of stroke and are correlated with NIHSS scores upon admission. S-100B appears to be a valuable biomarker of ongoing brain injury.

S Karacay Ozkalayci,B Nazliel,HZ Batur Caglayan,C Irkec Department of Neurology, Faculty of Medicine, Gazi University, Ankara, Turkey Introduction: The present study seeks to use transcranial Doppler ultrasound to evaluate cerebral blood flow velocities in anterior and posterior circulation arteries, during an attack-free episode in migraine patients, with and without aura, as well as in chronic tension-type headache patients who were not receiving prophylactic medication. Methods: A total of 50 patients (35 female, 15 male) were evaluated during a headache-free episode: 30 migraine patients without aura (mean age: 32±8 years), 10 migraine patients with aura (mean age: 34±4 years), and 10 patients with chronic tension-type headache (mean age: 34±5 years). Results: No significant difference was present between anterior, middle, and posterior cerebral and vertebral arteries’ blood flow velocities between migraine patients, with and without aura, or in patients with a tension-type headache, and normal controls (p>0.05). However, a significant increase in basilar artery cerebral blood flow velocities relative to controls was present in patients with a tension-type headache (p>0.001). Conclusion: It is difficult to predict the main reason for the significant increase in basilar artery blood flow velocities in patients with chronic tension-type headache. It may be due to constriction of conductance or the dilatation of the resistance vessels. Keywords: cerebral blood flow, migraine without aura, migraine with aura, tension-type headache, transcranial Doppler ultrasonography&nbsp

© 2015, IPNA.Background: Hypertension (HT) is a major comorbidity of obesity that is associated with an increased risk of cardiovascular disease and higher mortality. The aim of our study was to evaluate cardiac function in obese hypertensive (OHT) and obese normotensive (ONT) pediatric patients and determine the effects of plasma nitric oxide (NOx) values on cardiac function, while demonstrating the role of plasma NOx in HT in obese pediatric patients. Methods: The study population consisted of 62 patients (27 boys, 35 girls), aged 13–18 years and 21 age-matched healthy controls. All subjects enrolled in the study underwent echocardiography (Echo) evaluation and ambulatory blood pressure monitoring for HT. Plasma NOx and biochemical values were studied in both patient groups separately. Results: Plasma NOx levels were found to be lower in the OHT group than in the ONT and control groups (p < 0.001) and to be negatively correlated with left ventricular mass index values (p < 0.05). Both the OHT and ONT groups had concentric hypertrophy of the heart. Conclusions: Plasma NOx plays an essential role in obesity-induced HT. Concentric hypertrophy of the left ventricle was found in both the OHT and ONT groups, indicating structural deformation of the heart.

In this guideline, the brief information about primary prevention of stroke by the recent developments will be presented. Recommendation regarding the risk factors including hypertension, diabetes, dyslipidemia, smoking and alcohol usage, physical activity, dietary habits, obesity, atrial fibrillation, patent foramen ovale, asymptomatic carotid artery occlusions, sickle-cell anaemia, anticoagulant and antiagreggant usage will be offered.

In this section of guideline, a brief information will be offered about the stages of first and early intervention to stroke patients. Essential requirements for the transportation of patients to related centers, emergency departments and stroke units or stroke centres will be reviewed.

Background/aim: The aim of the study was to investigate the effects of whole blood viscosity and plasma nitric oxide on cerebral and cardiovascular risks associated with chronic kidney disease. Materials and methods: The study group consisted of 40 pediatric patients and 21 healthy control subjects. Hematologic and biochemical variables, viscosity and plasma nitric oxide levels, echocardiographic findings, and middle cerebral artery blood flow velocity were examined. Results: Viscosity values of patients were significantly lower than those of the control group. Lower values of hematocrit, total protein, and albumin and higher values of ferritin in all patient groups resulted in significantly low viscosity levels. Plasma nitric oxide levels were higher in all patient groups than those in the controls. No statistically significant difference was present in middle cerebral artery blood flow velocity between the patient and control groups. Even when systolic functions were normal, the patient group had significant deterioration in diastolic functions, suggesting morbidity and mortality risks. Conclusions: Cerebral blood flow velocities were not affected by viscosity and nitric oxide levels, suggesting that cerebral circulation has the ability to make adaptive modulation. The metabolism of nitric oxide levels needs further investigation and studies in patients with chronic renal disease.

© 2017, Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).Purpose: This study was designed to present our preliminary experience with the Roadsaver® double-layer micromesh (DLM) stent in the endovascular treatment of supra-aortic and visceral aneurysms and to utilize the flow-diverting effect of this new design in the treatment of these aneurysms. Methods: DLM stent (Roadsaver®, Terumo, Tokyo, Japan) was used in five patients (median age 61.8 years; three men) for treating arterial aneurysms (one common carotid artery, one vertebral artery V1 segment, one superior mesenteric artery, and two renal artery aneurysms). Results: All stents were successfully deployed. Follow-up imaging with conventional catheter angiography or computed tomography showed successful treatment of all aneurysms. Conclusions: The new DLM stent appears to be promising for the treatment of supra-aortic and visceral aneurysms.

WOS: 000407019200036, PubMed ID: 28583818, Background: Based on a number of small observational studies, cerebral venous sinus thrombosis has diverse clinical and imaging features, risk factors, and variable outcome. In a large, multicenter cerebral venous thrombosis (VENOST) study, we sought to more precisely characterize the clinical characteristics of Caucasian patients. Methods: All data for the VENOST study were collected between the years 2000 and 2015 from the clinical follow-up files. Clinical and radiological characteristics, risk factors, and outcomes were compared in terms of age and sex distribution. Results: Among 1144 patients 68% were women, and in older age group (>50 years) male patients were more prevalent (16.6% versus 27.8%). The most frequent symptoms were headache (89.4%) and visual field defects (28.9%) in men, and headache (86.1%) and epileptic seizures (26.8%) in women. Gynecological factors comprised the largest group in women, in particular puerperium (18.3%). Prothrombotic conditions (26.4%), mainly methylenetetrahydrofolate reductase mutation (6.3%) and Factor V Leiden mutation (5.1%), were the most common etiologies in both genders. 8.1% of patients had infection-associated and 5.2% had malignancy-related etiology that was significantly higher in men and older age group. Parenchymal involvement constitutively hemorrhagic infarcts, malignancy, and older age was associated with higher Rankin score. Epileptic seizures had no effect on prognosis. Conclusions: Clinical and radiological findings were consistent with previous larger studies but predisposing factors were different with a higher incidence of puerperium. Oral contraceptive use was not a prevalent risk factor in our cohort. Malignancy, older age, and hemorrhagic infarcts had worse outcome. (c) 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

BACKGROUND: Pilates is an exercise method which increases strength and endurance of core muscles and improves flexibility, dynamic postural control and balance. OBJECTIVE: To analyze and compare the effects of Mat and Reformer Pilates methods in Patients with Multiple Sclerosis (MS). METHODS: Thirty-eight patients with MS were included in the study. Participants were randomly divided into 3 groups as Mat Pilates, Reformer Pilates and control groups. The subjects in the Pilates groups did Mat or Reformer Pilates for 8 weeks, 2 days a week. The control group did breathing and relaxation exercises at home. Balance, functional mobility, core stability, fatigue severity and quality of life were evaluated. RESULTS: Balance, functional mobility, core stability, fatigue severity and quality of life improved after Pilates in Mat and Reformer Pilates groups (p < 0.05). On the other hand, we could not find any changing in the control group (p > 0.05). When the gain obtained in the Pilates groups is compared, it has been observed that progress has been more in trunk flexor muscle strength in the Reformer Pilates group (p < 0.05) and that the gain has been similar in the other parameters (p > 0.05). CONCLUSIONS: As a result, patients with MS have seen similar benefits in Reformer Pilates and Mat Pilates methods.

Background:Although there are evidences as to Pilates developing dynamic balance, muscle strength and flexibility in healthy people, evidences related to its effects on Multiple Sclerosis patients are insufficient. Objectives:The aims of this study were to investigate the effects of Pilates on balance, mobility, and strength in ambulatory patients with Multiple Sclerosis. Methods:Twenty six patients were divided into two groups as experimental (n = 18) and control (n = 8) groups for an 8-week treatment program. The experimental group underwent Pilates and the control group did abdominal breathing and active extremity exercises at home. Balance and mobility were measured with Berg Balance Scale and Timed up and go test, upper and lower muscle strength with hand-held dynamometer. Confidence in balance skills while performing daily activities was evaluated with Activities Specific Balance Confidence Scale. Results:Improvements were observed in balance, mobility, and upper and lower extremity muscle strength in the Pilates group (p < 0.05). No significant differences in any outcome measures were observed in the control group (p > 0.05). Conclusion:Due to its structure which is made up of balance and strengthening exercises, Pilates training may develop balance, mobility and muscle strength of MS patients. For this reason, we think that, Pilates exercises which are appropriate for the disability level of the patient may be suggested.

Multiple Sclerosis (MS) patients are often referred to aquatic physical therapy, but unfortunately, researches on the effects of aquatic therapy in MS patients are limited.The purpose of this study was to investigate the effects of Ai-Chi on balance, functional mobility, strength and fatigue in ambulatory patients with MS.Twenty-three ambulatory female patients were divided into two groups as experimental (n = 15) or control (n = 8) for an 8-week treatment program. The experimental group underwent Ai-Chi exercises in a swimming pool and the control group performed active arm and leg exercises combined with abdominal breathing exercises at home. Static standing balance was measured with duration of one-leg stance, functional mobility was evaluated with Timed-up and Go test and 6 minute walk test, upper and lower muscle strength was assessed with hand-held dynamometer and fatigue was evaluated with Fatigue Severity Scale.Improvements were observed in static standing balance, functional mobility, upper and lower extremity muscle strength and fatigue in the Ai-Chi group (p0.05), but no significant differences in any outcome measures were observed in the control group (p0.05) after the intervention.According to these findings Ai-Chi may improve balance, functional mobility, upper and lower extremity muscle strength and fatigue in patients with MS.

This study was designed to present our preliminary experience with the RoadsaverDLM stent (RoadsaverAll stents were successfully deployed. Follow-up imaging with conventional catheter angiography or computed tomography showed successful treatment of all aneurysms.The new DLM stent appears to be promising for the treatment of supra-aortic and visceral aneurysms.

Introduction Previous studies have shown that olfactory functioning is affected by multiple sclerosis (MS). This study assessed the level of the olfactory impairment in early MS by using the Sniffin' Sticks Test. Methods This study included 30 patients with MS and 30 healthy controls. We collected demographic and clinical data from participants and administered the Sniffin' Sticks Test. Results We found no differences between the MS and control groups in odor discrimination, odor identification, and threshold discrimination identification scores, but odor threshold (OT) scores were higher in the control group than in the MS group (P=0.49). In addition, we did not find any correlation between MS patients' olfactory test scores and their scores on the Mini-Mental State Examination (MMSE), Expanded Disability Status Scale (EDSS), disease duration, history of optic neuritis, or being on immunomodulatory therapy. Conclusion In recent studies, odor threshold impairment seemed to be the most striking finding in patients with MS. Although the present study found a mild alteration in odor threshold, olfactory dysfunction appears to be a consequence of neurodegeneration in the higher order olfactory brain regions, which is thought to be a time-dependent process.

The purpose of this study was to investigate the relationships between the upper extremity functions, upper extremity strength and hand sensation in patients with Multiple Sclerosis (MS). Twenty-two patients with MS (mean age: 38.5 +/- 8.31 years, median Expanded Disability Status Scale (EDSS): 2) and 10 healthy subjects were included. Upper extremity function was measured with the Nine-hole peg test, upper extremity strength (shoulder flexion-abduction, elbow flexion, pinch and grip) with hand-held dynamometer, hand grip dynamometer and manual pinch meter, threshold of light touch-pressure with Semmes-Weinstein monofilament, duration of vibration with 128-Hz frequency tuning fork, and distance of two-point discrimination with an aesthesiometer. Strength and functional level of the upper extremity, light touch-pressure, two-point discrimination, vibration sensations of the hand were lower in patients with MS compared with healthy controls (p < 0.05). Light touch-pressure sensation of thumb and index fingers, two-point discrimination of index finger and elbow flexion strength were found to be related with upper extremity function in patients with MS (p < 0.05). These results indicate that the hand sensation, upper extremity strength and function were affected in MS patients. Additionally upper extremity functions seem to be related with light touch-pressure and two-point discrimination sensations of the hand and elbow flexion strength. Upper extremity strengthening and sensorial training of the hand may contribute to the upper extremity function in patients with MS.

The aims of the present study were to investigate the relationship between the foot sensations and standing balance in patients with Multiple Sclerosis (MS) and find out the sensation, which best predicts balance. Twenty-seven patients with MS (Expanded Disability Status Scale 1-3.5) and 10 healthy volunteers were included. Threshold of light touch-pressure, duration of vibration, and distance of two-point discrimination of the foot sole were assessed. Duration of static one-leg standing balance was measured. Light touch-pressure, vibration, two-point discrimination sensations of the foot sole, and duration of one-leg standing balance were decreased in patients with MS compared with controls (p < 0.05). Sensation of the foot sole was related with duration of one-leg standing balance in patients with MS. In the multiple regression analysis conducted in the 27 MS patients, 47.6% of the variance in the duration of one-leg standing balance was explained by two-point discrimination sensation of the heel (R(2) = 0.359, p = 0.001) and vibration sensation of the first metatarsal head (R(2) = 0.118, p = 0.029). As the cutaneous receptors sensitivity decreases in the foot sole the standing balance impairs in patients with MS. Two-point discrimination sensation of the heel and vibration sensation of the first metatarsal head region are the best predictors of the static standing balance in patients with MS. Other factors which could be possible to predict balance and effects of sensorial training of foot on balance should be investigated. (C) 2011 Elsevier B.V. All rights reserved.

The prevalence of pathological laughing and crying in multiple sclerosis (MS) is 10%. It has been speculated that the anatomical lesion responsible for the pathological laughing is located in the pontine base, prefrontal cortex, and cerebellum. We report an 18-year-old male patient presenting with pathological laughing and hypomania. In his neurological examination, he had a euphoric effect with ataxic walking and dysarthria speech. He had a bilateral conjugated gaze limitation, with a prominent bilateral horizontal nystagmus on left gaze, dysmetria, dysdiadokokinesia, and remarkable dysfunction in a heel-to-shin test on the left. The IgG index in cerebrospinal fluid was normal with an oligoclonal band was present. In cranial MRI, there was a lesion on central pons which was hypointense in T1 images with contrast enhancement and hyperintense in T2 and flair images. Also another lesion in right brachium pontis which did not contrast enhancement but was hyperintense on T2 and flair images was present. There was an elevation of myoinositol/creatine ratio and choline and a reduction of NAA in proton MR spectroscopy. MR spectroscopic evaluation of the patient demonstrated the demyelination process. There has been no report of patients in whom pathological laughter was the presenting symptom of clinically isolated brainstem syndrome.

In order to evaluate the effect of alcohol consumption and the effect of abstinence on central nervous system generated parameters, we performed pattern visual evoked potential (PVEP) recordings on chronic alcoholics. The study was conducted on forty patients diagnosed as chronic alcoholics according to DSM IV criteria. They were aged mean: 42, and had histories of alcohol abuse for at least six years (mean: 21). 15% of the patients demonstrated abnormal VEP results at least in one tested eye. In order to test the effect of abstinence period on P100 latency values, alcoholics were divided in to two subgroups. Group I (Gr I) consisted twenty-four alcoholics who had been abstinent for less than thirty days (mean: 14), and Group II (Gr II) consisted sixteen alcoholics who had been abstinent for more than thirty and less than seventy-six days (mean: 38) The mean P100 latency of Gr I and Gr II was 101 and 102 milliseconds (ms) respectively; and when compared to normal controls the difference was statistically significant (p: 0.016, p: 0.009). Abnormal VEP in asymptomatic chronic alcoholics suggests that they may be useful in the detection of early changes and in following the progress of patients with the disorder. (C) 2006 Elsevier Ltd. All rights reserved.

We performed sympathetic skin response (SSR) studies on 29 male patients diagnosed as chronic alcoholics according to DSM-IV criteria. The average age was 43 years and the mean duration of alcohol abuse was 21 years, with all patients having a history of alcohol abuse for a minimum of 4 years. None of the patients had any symptoms and/nor signs related to autonomic nervous system dysfunction and all demonstrated normal nerve conduction velocities. Hand and foot latencies in alcoholics were prolonged relative to controls and the difference was statistically significant: reflected by p values of 0.02 and 0.004, respectively. Forty-four percent of patients demonstrated abnormal results. The unilateral prolongation of the lower extremity latency was the most commonly found abnormality (24%). Finding abnormal SSR in this patient population has made us aware that SSR has the potential to detect subclinical autonomic nervous system dysfunction even in patients who do not have autonomic complaints or neuropathy and to provide information about a part of the peripheral nervous system small unmyelinated C fibers that can not be assessed by currently performed techniques used in clinical EMG laboratories or by physical examination. © 2006 Elsevier Ltd. All rights reserved.