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

INTRODUCTION: Many studies are examining the relationship between cardiovascular diseases and triglyceride levels, and it has been shown that hypertriglyceridemia significantly increases the risk independently. In this study, we wanted to investigate whether there is a similar relationship for stroke. METHODS: A total of 619 patients hospitalized with a diagnosis of acute ischemic stroke in our stroke center were included in the study. Demographic information, accompanying risk factors, hemoglobin level, thrombocyte count, triglyceride level, and C reactive protein level at the time of admission, and the National Institutes of Health Stroke Scale (NIHSS) scores in the first evaluation were recorded. Also, information about mortality in hospital, recurrent stroke, and the modified Rankin Scale (mRS) scores in the follow-up period was entered in our local database. RESULTS: While 182 patients(32.3%) [78 females (42.9%) and 104 males (57.1%); mean age 64.5 +- 12.01 years] were diagnosed with hypertriglyceridemia, this number was 25(4.4%) patients (13 females (52%) and 12 males (48%); mean age 70.9 +- 17.4 years) for hypotriglyceridemia. Among the risk factors studied, only diabetes mellitus was found to be associated with hypertriglyceridemia in patients with acute ischemic stroke(P

BACKGROUND Previous studies demonstrating the association between renal functions and cerebral small vessel diseases have usually focused on white matter hyperintensity in the general population or lacunar stroke patients. This study aimed to investigate the effects of renal function on imaging markers of cerebral small vessel disease and etiologic subtypes of stroke in patients with acute ischemic stroke or transient ischemic attack. MATERIALS AND METHODS A total of 356 consecutive patients with acute ischemic stroke or transient ischemic attack who were admitted to the Stroke Unit and underwent brain magnetic resonance imaging were evaluated. Demographic data, vascular risk factors, stroke etiology, estimated glomerular filtration rate and severity of cerebral small vessel disease markers, and total cerebral small vessel disease burden were evaluated. RESULTS There was a significant inverse correlation between estimated glomerular filtration rate and total number of lacunes, periventricular and deep subcortical Fazekas scores, grade of enlarged perivascular spaces in the centrum semiovale, lobar and total cerebral microbleeds, and total cerebral small vessel disease burden. Impaired renal function was an independent risk factor for the presence of lacunes, deep cerebral microbleeds, and increased total burden. Renal function impairment and periventricular white matter hyperintensities were significantly associated with the etiologic subgroup of small vessel occlusion. The results were still significant after the exclusion of patients below 50 years of age. CONCLUSION Our results indicate that there is a relationship between renal function impairment and increased total burden, as well as acute ischemic stroke/transient ischemic attack due to small vessel occlusion.

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.

Objective: It has been reported that the mortality due to ischemic stroke is higher and the prognosis is worse in women compared with men. The aim of this study was to determine the etiologic subtypes, risk factors, and prognosis of acute ischemic stroke (AIS) in females. Materials and Methods: We reviewed the medical records of 957 patients who were admitted with AIS between January 2011 and May 2017. The patients’ records were analyzed and the demographic data, risk factors, National Institutes of Health Stroke Scale (NIHSS) scores at admission, and modified Rankin Scale (mRS) in the follow-up were recorded. We determined etiologic stroke subtypes using the Automated Causative Classification System. Results: In the study, 432 (45.1%) female patients [mean age: 71.2±14.7 (range: 21-100) years] and 525 (54.9%) male patients [mean age: 67.2±12.9 (range: 25-103) years] were included. The women were older than the men (p

The classically affected cranial nerve from intracranial hypertension is the sixth nerve. Carcinomatous meningitis can cause persistent or progressive cranial nerve palsies by infiltrating them in the subarachnoid space. Here we present a rare case of episodic, short-lasting, and unilateral oculomotor nerve palsy associated with carcinomatous meningitis and intracranial hypertension in a 44-year-old woman diagnosed with metastatic lung adenocarcinoma. As the survival rates enhance for metastatic cancers, neurologists should expect more perplexing neurologic presentations and consider leptomeningeal metastasis and intracranial hypertension in patients who have cancer and present with short episodes of diplopia and unilateral third nerve palsy.

INTRODUCTION[|]Despite the lower frequency in the young than the older population, ischemic stroke has a significant impact on the patients and their families, and the society. In this study, ischemic stroke patients under the age of 50 years registered in our stroke database were compared with elderly patients in terms of risk factors and etiologic classification. Furthermore, ischemic stroke etiology with emphasis on uncommon causes in the young population was evaluated.[¤]METHODS[|]In this study, we retrospectively reviewed the data of 619 patients who were admitted with acute ischemic stroke to our hospital between January 2011 and November 2014. The patients were divided into two groups as young ischemic stroke group (patients under the age of 50) and the others with the age of ≥50 years. All registered demographic, clinical and paraclinical data of the patients were evaluated. [¤]RESULTS[|]Thirty-two (5.2%) patients were under 50 years of age and 587 (94.8%) were ≥50 years of age. As vascular risk factors, hypertension, diabetes mellitus, atrial fibrillation, and coronary artery disease were found to be significantly higher in the ≥50 age group (p˂0.05). Patent foramen ovale as a risk factor of stroke was significantly more frequent in the young group. In terms of stroke etiology, cardioembolic causes were the most common in both age groups, but the etiologic subgroup of uncommon causes was found to be more frequent in the younger population.[¤]DISCUSSION AND CONCLUSION[|]In our study, the risk factors and etiologic subgroups of stroke in patients younger than fifty years were found different from those in older patients. The relatively higher frequency of uncommon causes of ischemic stroke in the young population should be considered in etiology research and treatment strategies.[¤]

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[|]Diabetes mellitus (DM) is an important risk factor for ischemic stroke. The results for the prevention of stroke recurrence with antidiabetic therapy have been contraversial. The some of data may indicate the positive effects of metformin treatment on stroke recurrence, stroke severity and prognosis. The aim of this study was to investigate the effect of metformin therapy usage on severity and pronosis of acute ischemic stroke.[¤]METHODS[|]The consecutive patients who were admitted to acute ischemic stroke with DM and accepted to participate in the study from January 2017 to April 2019 were evaluated, prospectively. The demographic data, risk factors, NIHSS scores at admission, etiologic stroke subtypes and mRS scores at discharge were recorded. The patients were divided into two groups. The patients with usage metformin or metformin plus other antidiabetic therapy were in group 1 and the patients taking antidiabetic therapy other than metformin or patients with type 2 DM receiving no antidiabetic therapy were in group 2. [¤]RESULTS[|]Of the 70 patients included in the study, 42 patients (60%) were in group 1 and 28 patients (40%) were in group 2. There was not any significant difference between the groups of severity and pronosis of acute ischemic stroke (p>0.05). [¤]DISCUSSION AND CONCLUSION[|]The usage of metformin and other antidiabetic therapy had no effect on the severity and prognosis of ischemic stroke. However, further controlled studies are needed with larger samples.[¤]

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.

Migraine is thought to be a neurovascular disorder and increases the likelyhood to develop ischemic complications. Studies have shown that vascular disorders such as ischemic optic neuropathy, retinal artery and vein obstructions are more common in patients with migraine. This study aimed to evaluate the differences between retinal and optic disc microvasculature between migraine patients with and without aura and healthy controls using optical coherence tomography angiography (OCTA) imaging. Thirty-three patients with migraine and 28 healthy subjects were included in this prospective cross sectional study. Optical coherence tomography angiography imaging was performed for the macula and optic disc. Vessel densities (VD) and choriocapillaris flow values were compared between three groups: control group, migraine with aura (MWA), and migraine without aura (MWOA). There was no difference between the three groups for the VDs of the foveal, perifoveal, parafoveal, and the whole area. The choriocapillaris flow of patients with MWA was significantly less than that of the MWOA and control groups. The VDs of the optic disc revealed no significant difference between the three groups. A lack of choriocapillaris autoregulatory mechanisms may be a possible cause of the decrease in choriocapillaris flow in patients with MWA.

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.

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

The objective of our study was to provide a comparative assessment of previously reported magnetic resonance imaging (MRI) parameters in primary and secondary pseudotumor cerebri (PTC) patients, to examine their diagnostic contribution, and to evaluate their association with symptoms, neuro-ophthalmological findings, laboratory results, and cerebrospinal fluid characteristics. Twenty-eight consecutive patients with PTC were included in the study. Age- and sex-matched 20 individuals with normal neurologic examination served as the control group. Modified Dandy Criteria were used for the diagnosis of PTC. Orbital and cranial MRI and MR venography of all patients and controls were assessed by three radiologists. According to our study, posterior flattening of the globe (64% sensitive, 100% specific), optic nerve sheath distention (46% sensitive, 100% specific), vertical tortuosity of the optic nerve (30% sensitive, 95% specific), and partial empty sella (43% sensitive, 100% specific) emerged as particularly valuable markers for a diagnosis of PTC.

Objective: Stroke in people aged less than 45 years is less frequent than in older patients, but has major impacts on both the individual and society. The aim of this study was to determine the etiologic subtypes of acute ischemic stroke in the young. Materials and Methods: We reviewed the hospital records of 619 patients who were admitted with acute ischemic stroke between January 2011 and November 2014. Acute ischemic stroke in the young was defined as patients aged 45 years and under. Demographic data, the National Institutes of Health Stroke Scale (NIHSS) scores at admission and detailed investigations aimed at determining etiologic cause were recorded. Etiologic stroke subtypes were determined using the automated Causative Classification System. Modified Rankin Scale (mRS) scores were recorded in the follow-up. Results: There were 32 (5.2%) young patients with acute ischemic stroke. The rates of hypertension, diabetes mellitus, atrial fibrillation, and coronary artery disease were significantly lower in young patients compared with patients aged more than 45 years (p

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, the brief information about secondary prevention of stroke by the recent developments will be presented. Recommendation regarding the secondary risk factors including hypertension, diabetes, dyslipidemia, atrial fibrillation, symptomatic carotid occlusions, arterial dissections and patent foramen ovale and their treatment approaches will be offered.

Background/aim: Intracranial stenosis (ICS) is identified in 2.2%?70.4% of patients with ischemic stroke and transient ischemic attack. This study aimed to determine the prevalence of ICS in a single center registry from Turkey. Materials and methods: We reviewed the charts of 619 patients with acute ischemic stroke. ICS was defined as any ICS > 50% on cerebrovascular imaging. The demographic data, risk factors, NIHSS scores and C reactive protein level at admission, mortality in hospital, recurrent stroke, and mRS in the follow-up period were recorded. Results: A total of 72 (11.6%) patients with ICS (45 males (62.5%); mean age 68.3 ± 12.6 years) were included. Sixty-seven patients (10.8%) had symptomatic ICS and 44 patients (7.1%) had ICS without extracranial stenosis. Diabetes mellitus (DM) was significantly higher in the ICS group compared to the others (P = 0.017). Disability was significantly better in patients with ICS compared to the others (P < 0.001). On logistic regression analysis, DM and follow up mRS were significantly associated with ICS (P < 0.05). Conclusion: ICS was seen in 11.6% of acute ischemic stroke cases in our registry. DM appears to be the major risk factor for ICS. Disability was better in patients with ICS. Ethnicity could be a factor causing better disability.

We present three patients with Behçet’s disease associated with intracardiac thrombus and pulmonary vascular involvement. One of these patients had also Budd-Chiari syndrome. All patients were treated with corticosteroid plus monthly intravenous cyclophosphamide as first line treatment and with no recurrences. Immunosuppressive therapy was successful in the treatment of intracardiac thrombus and also in the regression of pulmonary vascular thromboses in these patients. Intracardiac thrombus in Behçet’s disease is rarely seen. Behçet’s disease should be remembered in the differential diagnosis of the patients with intracardiac mass, especially in patients from the Mediterranean and Middle East populations.

This case with unilateral complete blepharoptosis and slight limitation of upgaze as ocular findings due to midbrain infarction represents an unusual form of intra-axial oculomotor nerve involvement. A 65-year-old man was admitted with acute unilateral ptosis of the left eyelid and gait ataxia. He had chronic hypertension in the medical history. The neurologic examination revealed that he had a complete ptosis of the left eyelid, slight limitation of elevation in the left eye, bilateral dysmetria, and gait ataxia. Magnetic resonance imaging showed acute infarction in the central part of midbrain tegmentum. Previous models for arrangement of oculomotor fascicle in the midbrain suggest that a lesion involving the most caudal fibres for levator palpebrae and superior rectus without affecting other extraocular muscles and pupillomotor fibres is the most likely aetiology.

Amaç: Trombolitik tedavinin amacı akut iskemik inmede rekanalizasyonu sağlayarak penumbrayı kurtarmaktır. Bu çalıșmanın amacı bizim intravenöz trombolitik tedavi uyguladığımız hastalarımızda tedavinin etkinliğini ve komplikasyon oranlarını değerlendirmektir. Hastalar ve Yöntem: Semptomların bașlamasından itibaren ilk 4.5 saatte bașvuran ve intravenöz trombolitik tedavi alan 32 hastayı retrospektif olarak inceledik. Hastaların tedavi öncesi ve tedavi sonrası Ulusal Sağlık Enstitüsü Strok Skalası (NIHSS) ve modifiye Rankin Skalası skorları (mRS) değerlendirildi. Bulgular: Tedavi öncesi, tedavi sonrası 24. saatte, 7. günde ve üçüncü aydaki NIHSS ortalamaları sırası ile 15±6, 10±6, 8±6 ve 8±7 idi. Tedavi sonrası 24. saatteki ve 3. aydaki mRS ortalaması ise 4±1 ve 3±2 olarak izlenmiștir. NIHSS karșılaștırıldığında tedavi alan grupta anlamlı düzelme tespit edildi (p=0.001). Tedavi sonrası 5 (%15.6) hastada intrakraniyal kanama tespit edildi. Yalnızca bir (%3.1) hastada ölümcül kanama oldu. Yorum: İlk 4.5 saatte akut iskemik inme ile bașvuran uygun hastalarda intravenöz trombolitik tedavi uygulaması kolay ve etkili bir yöntemdir. İnme bir halk sağlığı sorunudur ve bu tedavi ile bağımsız olarak yașamını sürdüren hasta sayısını arttırabiliriz.

We report a case of bilateral uveitis and optic disc swelling with Chiari I malformation. A 16-year-old girl was admitted to our clinic due to conjunctival hyperaemia and blurred vision in her right eye. Ophthalmologic and systemic examinations were performed. Visual acuity was 0.7 (OD) and 1.0 (OS). Bilateral optic disc swelling was observed. Fluorescein angiography demonstrated bilateral retinal vasculitis as well as optic disc hyperflourescence due to leakage. Laboratory examinations were within normal limits. Cranial magnetic resonance venography imaging revealed neither cranial mass nor cerebral venous thrombosis but a Chiari I malformation. The patient was started oral cetazolamid, topical and oral corticosteroids. After six months follow-up, bilateral optic disc swelling was resolved completely and visual acuity was 1.0 in both eyes. Optic disc swelling may be associated with intraocular inflammation; however, patients with bilateral optic disc swelling should be suspected of having an accompanying intracranial pathology.

Ischemia is associated with the pathological changes caused by the accumulation of reactive oxygen metabolites (ROM) in cerebrovascular accident (CVA). The aim of this study was to determine red cell copper/zinc-superoxide dismutase (Cu/Zn-SOD) and catalase activities and copper and zinc concentrations both in plasma and in red cells in CVA. Cu/Zn-SOD and catalase activities of 16 patients, with an average age of 64 yr, were measured spectrophotometrically; copper and zinc concentrations were determined by atomic absorption spectrophotometer. The results showed that Cu/Zn-SOD activity was increased markedly in patients compared to the young controls and reached a peak on the d 5 of the disease, whereas the catalase activity of the patients on d 3 and d 5 were in the normal range, but higher on d 10. The enzyme activities of the elderly group were generally increased compared to the young controls. Copper and zinc concentrations showed corresponding alterations. These findings suggested that the effects of oxidative stress in CVA might be reflected in red cell and plasma parameters.

We present a case of transient ischemic attack (TIA) as an extremely rare presentation of cerebral vein thrombosis. A 41-year-old man presented with a headache and episodes of hypoesthesia on his left side lasting approximately 30 minutes. Several vascular risk factors were remarkable in his medical history. The neurologic examination was normal. TIA of arterial origin was excluded by detailed investigations. Magnetic resonance imaging revealed acute thrombosis of the right superficial middle cerebral vein and the vein of Trolard. TIA-like episodes stopped with anticoagulation. Head trauma a few days earlier was the most likely mechanism of venous thrombosis. We suggest that the patients with TIA and headache should be carefully investigated in terms of cerebral venous thrombosis.

Background: The pronation test reveals slight paresis in the upper limbs. Patients hold their arms outstretched in front of them with the hands supinated while they keep their eyes closed. Position changes such as pronation, abduction, or drift indicate a positive pronation test. However, proprioceptive disorders also result in position changes when the eyes are closed. Aim: To evaluate the effects of vision on the pronation test and the relation of test results to electrophysiological findings. Methods: Sixteen patients with slight unilateral paresis due to recent stroke were included in the study. Two pronation tests, one while the patients’ eyes were open and the other while the eyes were closed (in randomized order), were performed in all patients and recorded with a video camera. Two neurologists double-blinded to the position of the patients’ eyes then assessed the position changes in each recording. Electrophysiological examination included median sensory and motor evoked potentials in both upper limbs. Sensory and motor central conduction times (CCTs) were determined for all patients. Results: Assessments of position changes by two physicians were concordant. Ten patients had position changes more evident in the pronation test with the eyes closed (group 1), while 6 patients had similar position changes in both tests (group 2). Motor CCT difference between two sides was similar in the two groups. However, sensory CCT difference longer than 1.0 ms was significantly more frequent in group 1 (p < 0.01). Conclusion: All patients who developed more obvious position changes during the pronation test with eyes closed had sensory CCT abnormalities. Therefore, we suggest that patients should keep their eyes open and then close them during the pronation test in order to distinguish motor or proprioceptive involvement.

BACKGROUND: The effects of age and hematocrit on transcranial Doppler (TCD) velocities have not been evaluated in a large patient group with recent ischemic stroke. AIM: This study assessed the effects of age and hematocrit on TCD measurements in patients with recent ischemic stroke compared to patients with non-vascular diseases. SETTINGS AND DESIGN: University Hospital, retrospective study. MATERIALS AND METHODS: TCD records and data files of 862 consecutive patients (mean age, 57±16 years) with various neurological diagnoses were reviewed retrospectively. The peak systolic, end diastolic and mean flow velocities (FV), systolic/diastolic ratios and pulsatility indices (PI) in the middle cerebral arteries were averaged and the effect of age and hematocrit values on these TCD values was studied. Independent samples t test, Pearson's coefficients of correlation, and linear regression test were used for statistical analysis. RESULTS: Among 862 patients, 413 were women (mean age, 53±17 years) and 449 were men (mean age, 60±13 years). Peak systolic and mean FV were higher and hematocrit concentration was lower in women compared to men (P