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Introduction: Multiple sclerosis (MS) is an autoimmune disease that causes scar tissue in the nervous system and seriously affects the quality of life of people. Muscle weakness, spasticity and coordination problems are seen primarily in the lower extremities. Strengthening exercises improve muscle strength in people with multiple sclerosis, but there is no consensus on their effect on walking capacity. Methods: To determine the relationship between gluteus maximus muscle strength, ataxia, balance and walking capacity in Multiple Sclerosis. An experimental study design was applied. Gluteus maximus muscle strength was measured using a dynamometer. Walking capacity was determined by the 6-minute walk test (6MWT) and dynamic gait index (DGI). Balance was evaluated with the one-leg standing test (SLS). The severity of ataxia was measured with the International Ataxia Rating Scale (ICARS). Fatigue was evaluated with VAS and quality of life of all patients with SF36 short form. Results: EDSS mean of the study = 3.39 ± 1.4; 2 men and 16 women with mean age = 37.17 ± 9.16 years were included. 6MWT, DGI, ALS, ICARS, VAS were different before and after treatment (p0.05). Correlation of muscle strength with ataxia, gait and balance was not significant (p>0.05) Conclusion: In individuals with MS, the fact that the treatment program consists of modalities that include balance and sensory exercises as well as muscle strengthening exercises increases the success of rehabilitation.

Background Movement-related cortical potentials (MRCPs) are electrophysiological activities that reflect neurological mechanisms that occur in the cortex during the planning of and preparation for movement. We aimed to evaluate the MRCPs that occur due to saccadic eye movement in multiple sclerosis (MS). Methods Twenty-five patients aged 18–55 years with good cognitive functions who were diagnosed with MS according to the McDonald criteria and scored 0–5 on the Expanded Disability Status Scale (EDSS) were included. Twenty healthy volunteers in a similar age range also participated. Voluntary horizontal conjugate gaze and MRCPs were recorded and averaged. Results It was observed that the latency of the Bereitshaftpotential (BP; preparation potential) was longer in the patient group, and the latency values were consistent with the values reported in the literature. The peak-pit (PP) amplitude, which can be regarded as a component of the negative slope (NS) and motor potential (MP), was higher in the patient group and may indicate that the target movement was more difficult for the patient group. Conclusion Studies on cognitive impairment in MS have generally been conducted using neuropsychological tests. Although we could not obtain a record that corresponded to the typical MRCP pattern reported in the literature, our findings make a contribution to the field of MCRP-based studies by raising new questions about the measurement and use of MRCP values.

Aim:This study aimed to examine the relationship between short-term mortality and blood glucose values (BGV) obtained during the first week of ischemic stroke, when neurological causes, such as increased intracranial pressure, are mainly predominant in mortality prediction.Materials and Methods:This is a retrospective study that includes 417 patients with acute ischemic stroke (AIS), who were admitted to our hospital within the first 24 hours of the stroke. Data were recorded using the International Classification of Diseases Code. On the first, third, fifth, and seventh days of the stroke, the effect of BGV on the patient’s functional outcome was evaluated.Results:Of 417 patients, 90 (21.58%) died within a one-month follow-up period. There was no difference between the mortality and survival groups in terms of diabetes mellitus (DM) history (χ2=0.783; p=0.224). On the first, third, fifth, and seventh day of the stroke, BGV were significantly higher in the mortality group (130.5 mg/dL, 124.5 mg/dL, 133.5 mg/dL, and 132.5 mg/dL, respectively, according to the receiver operating characteristic analysis) than in the survival group (p

Background and Aim: Carotid artery stenting (CAS) is an alternative approach to carotid endarterectomy in cerebrovascular diseases. The applicability of this procedure has increased as a result of development of cerebral protection devices. In the trial, the clinical and radiological characteristics and early and late outcomes of patients who received CAS were investigated. Methods: The study had a retrospective design. The clinical and radiological characteristics and early and late outcomes after CAS of 76 patients (54 male, 22 female) who were admitted to a university hospital between 2008 and 2014 due to a diagnosis of internal carotid artery stenosis (ICA) were retrospectively reviewed. Results: All patients were symptomatic during their admissions, and after their workups were completed, ICA stenosis was determined. Unilateral (Right ICA 34.2%, left ICA 47.4%) stenosis in 62 patients and bilateral stenosis (18.4%) in 14 patients were determined. The mean degree of stenosis was 82.1 (SD:11.36, range: 60-99%). All patients were treated with stenting for ICA stenosis (technical success rate: 100%). No complications occurred during these procedures. During the one-year follow-up, no recurrent ischemic attack occurred in any patients. Carotid artery disease is highly associated with hypertension, hyperlipidemia, diabetes mellitus, coronary artery disease, a history of cerebrovascular accidents and transient ischemic attack. Conclusions: Carotid artery disease is a critical factor with co-morbidities and history of cerebrovascular incidents. The carotid artery stenting (CAS) procedure is a method that can be used safely because its serious complication rate is low in cases that are well-selected and have had risk analyses performed regarding medical treatments.

Saglikta yasam kalitesi gunumuzde daha da artan bir onemle tibbin tani ve tedaviyi iceren butun alanlarinda tedavi ve izlemin ayrilmaz bir parcasi olmustur. Noro-yogun bakimda norolojik acidan en agir, tani ve tedavi sureci en yogun hasta grubu izlenmektedir. Yogun bakimda izlenmesi gereken norolojik hastaliklar, kronik donemde oldugu gibi akut ve siddetli evrelerinde de yasam kalitesini etkileyebilme potansiyeline sahip pek cok parametre icermektedir. Hastaliklarin kendilerine ait yasam kalitesi etkileri disinda, cok sayida onemli parametre vardir. Bunlari baslica yogun bakimda beslenme yetersizligi, ajitasyon, agri, cilt butunlugunun bozulmasi, kas iskelet sistemi etkilenmeleri, kardiyovaskuler ve otonom etkilenmeler, ilac yan etkileri ve coklu ilac etkilesimleri olarak siralamak mumkundur. Bu derlemede noro-yogun bakimda beslenme ile saglikta yasam kalitesi arasindaki iliski gozden gecirilecektir.

Amaç: Klinik seyir üzerine yapılan çalışmalar inme progresyonunu takip etmede çok önemli bir yer tutar. Perfüzyon MR görüntülemelerinin akut iskemik inmede kullanıma girmesi penumbral alanın tespiti ve kurtarılması adına önemli bir köşe taşı olmuştur. Gereç ve Yöntem: İlk 24 saat içinde akut iskemik inme atağı geçiren hastaların geliş difüzyon ve perfüzyon ağırlıklı manyetik rezonans görüntülemeleri (MRG) tespit edildi. Perfüzyon-difüzyon uyumsuzluğu ciddi, orta-hafif ve olmama durumlarına göre 3 gruba ayrıldı. İyi klinik yanıt (İKY)gelişip gelişmediği başlangıç ve 15. gün klinik skorları (The National Institute of Health Stroke Scale, European Stroke Scale and Modified Rankin Scale) kullanılarak tespit edildi. Finalde lezyon hacim (FLH) büyümesi tespiti için 15. gün çekilen T2 ağırlıklı MRG ile başlangıç difüzyon ağırlıklı MRG hacim farkları alındı. Bulgular: Ciddi uyumsuzluğun olduğu grupta FLH de büyüme, hafif-orta uyumsuzluk olan gruba ve uyumsuzluğu olmayan gruba göre anlamlı derecede yüksek idi (sırasıyla, median: 37 cm3, %95 CoI: 26.0-55.0; median: 10 cm3, %95CoI: 0-16.0; median: - 1.50 cm3, %95 CoI: -4.0 /8.0, χ2 = 8.294, p=0.017). Uyumsuzluk ciddiyetinin İKY ile sonlanmaya etkisi ise istatistiksel olarak anlamlı değildi (χ2:1.959, p:0,162). İKY’nin elde edilme oranı FLH de büyüme olmayan grupta büyüme olan gruba göre istatistiksel olarak anlamlı düzeyde yüksek bulundu (χ2:7,62, p:0,02). Ancak ile İKY elde etme adına FLH hacim değişiminin bağımsız bir prediktör özelliği bulunmamıştır (p:0.086, OR:0.972, %95CI:0.942-1.004). Sonuç: Bu çalışmanın sonuçları şiddetli difüzyon-perfüzyon uyumsuzluğu olan akut iskemik inmeli hastaların radyolojik ve klinik gidişatları daha ciddi olabilir ve tedavide daha dikkatli olunmalıdır., Objective: Clinical outcome studies take an important place in following the progression of stroke. The use of perfusion weighted MR imaging in acute ischemic stroke has been an important cornerstone for the detection and treatment of the penumbral area. Material and Method: In the first 24 hours, diffusion and perfusion-weighted magnetic resonance imaging (MRI) were performed in patients with acute ischemic stroke. The perfusion-diffusion mismatch was divided into three groups as the patients with severe, with mild to moderate, and patients without mismatch. Clinical scores changes (The National Institute of Health Stroke Scale, European Stroke Scale and Modified Rankin Scale) at the admission and 15th day were examined to determine whether or not good clinical response (GCR) develops. Final lesion volume (FLV) was calculated as the difference of T2-weighted MRI taken on the 15th day from the initial diffusion-weighted MRI volume. Results: The increase in FLV was significantly higher in the group with severe mismatch than the group with mild to moderate mismatch and group without mismatch. (respectively, median: 37 cm3, %95CoI: 26.0-55.0; median: 10 cm3, %95CoI: 0-16.0; median: - 1.50 cm3, %95CoI: -4.0 /8.0, χ2 = 8.294, p=0.017). The effect of mismatch severity on GCR was not statistically significant (χ2:1.959, p:0,162). The rate of the GCR was found to be lower in the FLV growth group than the non-growth group with statistically significant difference (x² = 7.62, p = 0.02), but FLV change is not a independent predictor for GCR (p:0.086, OR:0.972, %95CI:0.942-1.004). Conclusion: Results of this study has suggested that among patients with acute stroke and severe mismatch, radiological and clinical outcomes can be more serious and treatment should be carefully considered.

Background: Multiple sclerosis (MS) is an inflammatory and neurodegenerative autoimmune chronic neurological disease. Currently, there are no effective serum biomarkers to verify MS diagnosis, to assess disease prognosis, and evaluate response to MS treatment. Objective: The present study is a preliminary assessment of irisin and nesfatin-1 serum levels in patients with relapsing- remitting MS (RRMS). Methods: A total of 86 participants, 42 patients with RRMS diagnosis and 44 healthy controls were included in the study. The serum irisin and nesfatin-1 parameters of the patients and control group members were analyzed. Results: Irisin and nesfatin-1 levels of the RRMS patients were significantly lower than the controls (z: -3.82, p

Background: Increased interest in the relationship between affective disorder and long-term health consequences has generated recent examinations of depression and stroke. Observations suggest that depressive disorder is associated with abnormal physiological and immunological responses and a resultant increase in inflammatory markers. Given the high prevalence of stroke and associated costs for the community, it is important to understand the mechanisms that may impact on the outcome to achieve the best possible prognosis. Aims: The view that inflammatory factors contribute to depression is predicated on findings that circulating cytokines and other inflammatory factors are increased in depressed patients. Therefore, it has been hypothesized that inflammation could be one of the mechanisms by which depression increases risk for ischemic stroke. Our aim was to determine whether there is any relationship between major depression and tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), IL-18, brain-derived neurotrophic factor (BDNF), and neuron-specific enolase (NSE) in patients with acute ischemic stroke (AIS). Study Design: This was as a cross-sectional design. Materials and Methods: This study has a cross-sectional design, and it was conducted in Necmettin Erbakan University, the Meram Faculty of Medicine in Konya, Turkey, between 2014 and 2015. Fifty-three AIS patients admitted to the hospital within the first 24 h after stroke onset were recruited. Major depression was ascertained by means of the structured clinical interview for the diagnostic and statistical manual of mental disorders, Fourth Edition/Clinical Version. The enzyme-linked immunosorbent assay was used to measure the serum levels of TNF-α, IL-1 β, IL-18, BDNF, and NSE at admission. Results: A total of 53 patients with a mean age of 65.9 years were recruited. Of these patients, 17 (32.1%) had major depression. Depressive and nondepressive patients had similar demographical and clinical features. There was no significant statistical difference between depressive and nondepressive patients with AIS with respect to levels of TNF-α, IL-1 β, IL-18, BDNF, and NSE. Conclusion: This study suggests that in patients who have experienced AIS, there is no significant relationship between major depression and basal proinflammatory cytokines (TNF-α, IL-1 β, IL-18), BDNF, and NSE.

Background/aim: We aimed to investigate the associations between endothelial nitric oxide synthase(eNOS) gene polymorphisms [G894T (rs1799983)], intron 4 (27-bpTR) variable number tandem repeat (VNTR) and T786C (rs2070744), and ischemic stroke in the Anatolian population.Materials and methods: This case-control study included 112 patients with "stroke of undetermined etiology" and 160 controls. Real-time polymerase chain reaction (RT-PCR) analysis was used to analyze these polymorphisms. Between-group frequencies of alleles and genotypes were compared using binary logistic regression analysis.Results: No significant difference was observed between the two groups in terms of the genotype and allele distributions of the eNOS G894T (rs1799983) polymorphism (P > 0.05). The a alleles and the 4b/a and 4a/a genotypes of the intron 4 (27-bpTR) VNTR polymorphism had significantly higher frequencies in the patient group than in the control group (OR: 2.715, P < 0.001; OR: 3.396, P < 0.001; OR: 10.631, P = 0.016, respectively). On the contrary, the TC genotype and C alleles of the T786C (rs2070744) polymorphism had a significantly lower frequency in the patient group than in the control group (OR: 0.244, P < 0.001, OR: 0.605, P = 0.006, respectively).Conclusion: Our findings indicate that the eNOS G894T and T786C [rs2070744] polymorphisms are not associated with the risk of ischemic stroke, whereas the intron 4 [27-bpTR] VNTR may be a risk factor in the Anatolian population.

Background Stroke patients with development of delirium have unfavorable outcomes, higher mortality, longer hospitalizations, and a greater degree of dependence after discharge. Studies suggest that delirium is associated with abnormal immunological responses and a resultant increase in inflammatory markers. Objective Our aim was to determine whether there is an entity relationship between delirium, inflammation and acute ischemic stroke (AIS). Methods Sixty AIS patients admitted to the hospital were consecutively recruited. Delirium was diagnosed with the clinical assessment according to the Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria. Enzyme-linked immunosorbent assay (ELISA) was used to measure serum levels of Interleukin-1 beta (IL-1 beta), Interleukin 18 (IL-18), Tumor Necrosis Factor-alpha (TNF-alpha), Brain-Derived Neurotrophic Factor (BDNF), and Neuron Specific Enolase (NSE) at admission. Results Eleven (18.3%) of 60 patients were diagnosed with delirium, and the majority ( n = 8, 72.7%) was the hypoactive type. Delirious and non-delirious patients had similar demographic and clinical features. Delirious patients had significantly higher lengths of hospital stay, National Institutes of Health Stroke Scale (NIHSS) at admission and discharge compared to non-delirious patients. In addition, there was no significant statistical difference between delirious and non-delirious patients with AIS in respect of levels of TNF-alpha, IL-1 beta, IL-18, BDNF and NSE. This study suggests that delirium is not scarce in patients with AIS admitted to the non-intensive stroke unit, and that delirium developing after AIS seems not to be associated with serum TNF-alpha, IL-1 beta, IL-18, BDNF and NSE but is associated with length of hospital stay and stroke severity.

Metanol nadir fakat ciddi santral sinir sistemi etkileri olan bir toksindir. Ağır görme bozuklukları ve ölüme neden olabilir. Bu yazıda ispirto ile diş pansumanı sonrasında gelişen bilateral total görme kaybı nedeniyle kliniğimize başvuran 44 yaşın- da bir erkek hasta sunuldu. Pansumandan sonra gelişen ka- rın ağrısı, bulantı, kusma, halsizlik, dengesizlik ve iki taraflı görme kaybı şikayetleri ile metanol intoksikasyonu tanısı alan hastanın bilinci açıktı. Muayenesinde gözde ışık persepsiyonu yokluğu ve ışık refleksinde bilateral zayıflık belirlendi. Görsel uyarılmış potansiyel (P100) elde edilemedi. Manyetik rezo- nans görüntülerinde bilateral putamen lokalizasyonunda hipe- rintens lezyonlar ve fundus fotoğrafında bilateral papil ödemi izlendi. Hastaya metil prednizolon ve intravenöz B1 vitamin tedavisi verildi. Görme bulgularındaki dalgalanmaları takiben beşinci günde ışık refleksi kaybı ve pupilla dilatasyonu gelişti. Birinci ve altıncı aylardaki muayenesinde total görme kaybı ve bilateral optik atrofi tespit edildi. Oldukça düşük doz metanol maruziyeti sonrası bilateral putaminal tutulumu olduğunu gös- termesi açısından örnek bir vakadır., Methanol is a toxin with rare but serious effects on the central nervous system. It may cause severe visual dysfunction and mortality. This study presents the case of a 44-year-old man admitted to our clinic with bilateral amaurosis which developed after dental intervention for gingivitis. The patient was conscious and presented with stomach ache, nausea, vomiting, weakness, imbalance, and bilateral amaurosis; methanol poisoning was diagnosed. Upon examination, the absence of light perception in the eye and bilateral weakness in light reflexes were detected. Visually-evoked potentials (P100) could not be obtained. Hyper-intense lesions with bilateral putaminal localisation were observed on magnetic resonance imaging and bilateral pupil oedema was observed by fundus photography. The patient was treated with methyl prednisolone and intravenous vitamin B1. On the fifth day after admission, fluctuations in visual findings were observed, and light reflex loss and pupillary dilatation developed. Upon examination one and six months later, bilateral (total) amaurosis and bilateral optic atrophy were detected. This case demonstrates bilateral putaminal involvement after exposure to a very low dose of methanol.

WOS: 000301065000003, PubMed: 22211098, Background: Detection of paroxysmal atrial fibrillation (PAF) in acute ischemic stroke patients poses diagnostic challenge. The aim of this study was to predict the presence of PAF by means of 12-lead ECG in patients with acute ischemic stroke. Our hypothesis was that P-wave dispersion (P-d) might be a useful marker in predicting PAF in patients with acute ischemic stroke. Methods: 12-lead resting ECGs, 24-hour Holter recordings and echocardiograms of 400 patients were analyzed retrospectively. PAF was detected in 40 patients on 24-hour Holter monitoring. Forty out of 360 age and gender matched patients without PAF were randomly chosen and assigned as the control group. Demographics, P-wave characteristics and echocardiographic findings of the patients with and without PAF were compared. Results: Maximum P-wave duration (p=0.002), P-d (p

The goal of the study described here was to evaluate interictal heart rate variability (HRV) in young patients with epilepsy, a patient population in whom sudden unexpected death in epilepsy (SUDEP) is known to be more common.Twenty-four-hour ambulatory ECG Holter recordings of 37 patients (15-40 years old) and 32 healthy controls were compared.All of the time domain indices (SDNN, SDANN, RMSSD, and HRV triangular index) were significantly suppressed (P0.001), and there was a marked reduction in parasympathetic tone (reduced HF(nu,)P0.001) and an increase in sympathetic tone (increased LF(nu) and LF/HF ratio, P0.001) in the patient group. Stepwise linear regression analysis revealed that polytherapy and epilepsy duration10 years were independent variables associated with a reduction in SDNN.Our data suggest that the major determinants of suppressed SDNN are polytherapy and epilepsy duration10 years. Analysis of spectral measures of frequency domain indices suggests that an increased sympathetic tone in association with a decreased parasympathetic tone may constitute the mechanism underlying SUDEP in young people with epilepsy.

Background: Cerebellar infarct is a rare condition with very nonspecific clinical features. The aim of this study was to assess the full spectrum of the clinical characteristics, neuroimaging findings and neurofunctional analyses of cerebellar infarction, and the relationship between them. Materials and Methods: Data were collected from 59 patients admitted to our department during an 8-year period. We retrospectively analyzed the relationship between demographic characteristics, clinical symptomatology, etiological factors, functional condition, vascular distribution, frequency of subcortical white matter lesions (WMLs), and concomitant lesion outside the cerebellum in patients with acute cerebellar infarct (ACI) at time of admission. Results: The mean age in our series was 65.2 years, with most being male (57.6%). The posterior inferior cerebellar (PICA) artery was the most commonly affected territory at 62.7%. There was concomitant lesion outside the cerebellum in 45.7%. The main etiology in PICA was cardioembolism. While mean National Institutes of Health Stroke Scale on admission was 2.08 ± 1.67 in study group, modified Rankin Scale (mRS) on admission was detected to be mRS1 (n: 44, 74.5%) and mRS2 (n: 12, 20.3%) most frequently. Fourteen (35%) patients were detected to be in Fazekas stage 0; 11 (27.5%) patients in Fazekas stage 1; 6 (15%) patients in Fazekas stage 2; and 9 (22.5%) patients in Fazekas stage 3. Conclusion: Cerebellar infarct is very heterogeneous. The other cerebral area infarcts which accompany ACI negatively affect neurologic functional scores. Although it is difficult to detect the relationship between WMLs and neurologic functional severity, timely detection of risk factors and their modulation may be associated with prevention and treatability of WMLs, and this may be one of the important points for prevention of stroke-related disability.

Behçet's disease (BD) is an inflammatory systemic disorder with oral and genital ulcers, as well as ophthalmologic and cutaneous symptoms. Neurological manifestations in BD represent between 2.2% to 50% of the cases. The 25-year-old male patient, diagnosed with BD three years earlier, was admitted to our clinic with complaints of recurrent headaches. Tumor-like-parenchimal involvement was detected on a cranial magnetic resonance imaging. The lesion was removed surgically and then he suffered from right hemiparesis and epilepsy. Pathological examination of the lesion noted a demyelinating non-tumoural etiology. A neuro-Behğet's case with parenchymal involvement has been examined in light of the literature, in terms of a tumor and a demyelinating disease differential diagnosis.