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Objective: To reveal the profile and practice in patients with acute stroke who received intravenous tissue plasminogen activator (IV tPA) and/or neuro-interventional therapy in Türkiye. Materials and Methods: On World Stroke Awareness Day, May 10, 2018, 1,790 patients hospitalized in 87 neurology units spread over 30 health regions were evaluated retrospectively and prospectively. Results: Intravenous tPA was administered to 12% of 859 cases of acute ischemic stroke in 45 units participating in the study. In the same period, 8.3% of the cases received neurointerventional treatment. The rate of good prognosis [modified Rankin score (mRS) 0–2] at discharge was 46% in 83 patients who received only IV tPA [age: 67 +- 12 years; National Institutes of Health Stroke Scale (NIHSS): 12 +- 6; hospital stay, 24 +- 29 days]; 35% in 51 patients who underwent thrombectomy (MT) alone (age: 64 +- 13 years; NIHSS: 14.1 +- 6.5; length of hospital stay, 33 +- 31 days), 19% in those who received combined treatment (age: 66 +- 14 years; NIHSS: 15.6 +- 5.4; length of hospital stay, 26 +- 35 days), and 56% of 695 patients who did not receive treatment for revascularization (age: 70 +- 13 years; NIHSS: 7.6 +- 7.2; length of hospital stay, 21 +- 28 days). The symptom-to-door time was 87 +- 53 minutes in the IV treatment group and 200 +- 26 minutes in the neurointerventional group. The average door-to-needle time was 66 +- 49 minutes in the IV tPA group. In the neurothrombectomy group, the door-to-groin time was 103 +- 90 minutes, and the TICI 2b-3 rate was 70.3%. In 103 patients who received IV tPA, the discharge mRS 0–2 was 41%, while the rate of mRS 0–1 was 28%. In 71 patients who underwent neurothrombectomy, the mRS 0–2 was 31% and mRS 0–1 was 18%. The door-to-groin time was approximately 30 minutes longer if IV tPA was received (125 +- 107 and 95 +- 83 minutes, respectively). Symptomatic bleeding rates were 4.8% in IV recipients, 17.6% among those who received only MT, and 15% in combined therapy. Globally, the hemorrhage rate was 6.8% in patients receiving IV tPA and 16.9% in MT. Conclusion: IV thrombolytic and neurointerventional treatment applications in acute ischemic stroke in Türkiye can provide the anticipated results. Heterogeneity has begun to be reduced in our country with the dissemination of the system indicated by the 'Directive on Health Services to be Provided to Patients with Acute Stroke.'

Objective: Atrial fibrillation (AF) is the most common directly preventable cause of ischemic stroke. There is no dependable neurology-based data on the spectrum of stroke caused by AF in our country. Within the scope of NeuroTek-Turkey, hospital-based data on acute stroke patients with AF were collected to contribute to the creation of acute stroke algorithms. Materials and Methods: Atrial fibrillation (AF) is the most common directly preventable cause of ischemic stroke. There is no dependable neurology-based data on the spectrum of stroke caused by AF in Türkiye. Within the scope of NöroTek-Türkiye (TR), hospital-based data on acute stroke patients with AF were collected to contribute to the creation of acute-stroke algorithms. Results: The rate of AF in patients hospitalized for ischemic stroke/TIA was 29.8%, of which 65% were known before stroke, 5% were paroxysmal, and 30% were diagnosed after hospital admission. The proportion of patients with AF who received 'effective' treatment [international normalization ratio ≥2.0 warfarin or non-vitamin K antagonist oral anticoagulants (NOACs) at a guideline dose] was 25.3%, and, either no medication or only antiplatelet was used in 42.5% of the cases. The low dose rate was 50% in 42 patients who had a stroke while taking NOACs. Anticoagulant was prescribed to the patient at discharge at a rate of 94.6%; low molecular weight or unfractionated heparin was prescribed in 28.1%, warfarin in 32.5%, and NOACs in 31%. The dose was in the low category in 22% of the cases discharged with NOACs, and half of the cases, who received NOACs at admission, were discharged with the same drug. Conclusion: NöroTekTR revealed the high but expected frequency of AF in acute stroke in Türkiye, as well as the aspects that could be improved in the management of secondary prophylaxis. AF is found in approximately one-third of hospitalized acute stroke cases in Türkiye. Effective anticoagulant therapy was not used in three-quarters of acute stroke cases with known AF. In AF, heparin, warfarin, and NOACs are planned at a similar frequency (one-third) within the scope of stroke secondary prophylaxis, and the prescribed NOAC dose is subtherapeutic in a quarter of the cases. Non-medical and medical education appears necessary to prevent stroke caused by AF.

Objective: Nutritional status assessment, dysphagia evaluation and enteral feeding decision are important determinants of prognosis in acute neurovascular diseases. Materials and Methods: NöroTek is a point prevalence study conducted with the participation of 87 hospitals spread across all health sub regions of Turkey conducted on 10-May-2018 (World Stroke Awareness Day). A total of 972 hospitalized neurovascular patients [female: 53%, age: 69+-14; acute ischemic stroke in 845; intracerebral hematoma (ICH) in 119 and post-resuscitation encephalopathy (PRE) in 8] with complete data were included in this sub-study. Results: Gastrostomy was inserted in 10.7% of the patients with ischemic stroke, 10.1% of the patients with ICH and in 50% of the patients with PRE. Independent predictors of percutaneous endoscopic gastrostomy (PEG) administration were The National Institutes of Health Stroke Scale score at admission [exp (β): 1.09 95% confidence interval (CI): 1.05-1.14, per point] in ischemic stroke; and mechanical ventilation in ischemic [exp (β): 6.18 (95% CI: 3.16-12.09)] and hemorrhagic strokes [exp (β): 26.48 (95% CI: 1.36-515.8)]. PEG was found to be a significant negative indicator of favorable (modified Rankin's scale score 0-2) functional outcome [exp (β): 0.032 (95% CI: 0.004-0.251)] but not of in-hospital mortality [exp (β): 1.731 (95% CI: 0.785-3.829)]. Nutritional and swallowing assessments were performed in approximately two-thirds of patients. Of the nutritional assessments 69% and 76% of dysphagia assessments were completed within the first 2 days. Tube feeding was performed in 39% of the patients. In 83.5% of them, tube was inserted in the first 2 days; 28% of the patients with feeding tube had PEG later. Conclusion: The NöroTek study provided the first reliable and large-scale data on key quality metrics of nutrition practice in acute stroke in Turkey. In terms of being economical and accurate it makes sense to use the point prevalence method.

Objectives:This study aimed to evaluate health-related quality of life in patients with epilepsy and to investigate the role of sociodemographic attributes and clinical features.Methods:Two hundred five patients diagnosed with epilepsy and under the follow-up of epilepsy outpatient clinics of our tertiary center were enrolled. Gender, age, age of epilepsy onset, disease duration, seizure type, epilepsy etiology, frequency of seizures, anti-seizure drugs, electroencephalography, and magnetic resonance imaging findings were noted. The Short Form-36, valid and reliable in our country, was used to assess health-related quality of life. The Short Form-36 physical and mental scores were calculated.Results:All Short Form-36 subscores of patients were low when compared to the normative data of our country. Some physical and mental health scores of women with epilepsy were lower than the scores of men with epilepsy. All Short Form-36 subscores of patients under polytherapy were lower than the ones under monotherapy. Some quality of life scores were negatively correlated with disease duration; yet the range of age, age of epilepsy onset, seizure type, etiology of epilepsy, cranial magnetic resonance imaging, and electroencephalography findings were not significantly correlated with Short Form-36 scores.This study revealed that health-related quality of life of patients with epilepsy was lower than that of healthy individuals. It should be noted that Conclusions:women with epilepsy, patients with longer disease duration, patients suffering from frequent seizures, and the ones under polytherapy could have a lower quality of life. Patients with epilepsy should be supported in means of quality of life and modifiable factors.

Objective: Warfarin treatment is a partially preferred prophylactic treatment in patients with ischemic stroke with advanced age due to possible adverse events/ drug interactions. In this study, we aimed to investigate the frequency of warfarin use, possible adverse events, and reasons for discontinuation of treatment in patients with stroke aged over 80 years. Materials and Methods: One hundred eighty-nine of 589 patients with stroke were detected retrospectively who were over 80 years and were followed up for cardioembolic stroke between 2014 and 2018. Demographic/clinical/laboratory/radiologic data together with the reasons for discontinuation of the drug were gathered from their medical records and noted in an Excel form. Results: One hundred eighty-nine patients (88 women) were included in the study. The mean duration of warfarin use was noted as 5.02±3.4 years (minimum 6 months, maximum 11 years). Ninety-four (49.7%) were treated with new oral anticoagulants in the last 2 years due to adverse events and/or social reasons, and 90 (47.6%) were on regular follow-up with warfarin. Gastrointestinal (GIS) bleeding was noted as the most common adverse event causing drug discontinuation (41.4%), and the most important risk factor for GIS symptoms was antihyperlipidemic drug use (p=0.001). Irregular hypertension was the most important risk factor for adverse events due to its triggering impact on bleeding (p

Aim:Awareness of the community and healthcare professionals is crucial in the management of stroke. In this study, we aimed to investigate stroke awareness of patient relatives and healthcare professionals (excluding medical doctors) and how much they can show proper behavior towards patients during acute stroke.Methods:Healthcare professionals working in our hospital, relatives of patients who were hospitalized or were attending our outpatient clinics for follow-up due to stroke between August 2018 and November 2018 and community-dwelling healthy subjects (control group) who have not met any stroke patients were included in the study. Sociodemographic characteristics of the participants were recorded and a questionnaire investigating stroke findings, emergency approaches and risk factors prepared by the researchers was administered to the participants.Results:A total of 669 people, 236 healthcare professionals, 268 patient relatives and 165- controls, participated in this study. It was revealed that the patient relatives and the controls obtained information regarding stroke mostly on the internet (p=0.001). The relatives of patients received information from healthcare professionals at the third frequency. Healthcare professionals were found to be aware of the fact that stroke was treatable (p≤0.005) whereas the patient relatives and controls did not have adequate information 77% of the health professionals, 46% of the patient relatives and 34% of the controls stated that calling medical emergency service was the first choice approach. Seventy-three point seven percent of the health professionals, 38% of the relatives and 24% of the controls chose the correct answer which is “stroke patient should be transferred to emergency department within the first 4.5 hours following a stroke attack”.Conclusion:In terms of stroke awareness, three groups had a high level of awareness about stroke. It was observed that the three groups did not have sufficient information of early treatment of stroke.

INTRODUCTION[|]Aspirin is the basic agent of antithrombotic treatment in ischemic cerebrovascular disease (CVD) patients. However several patients don't respond to treatment and therefore aspirin resistance term has been used lately. Recent studies have shown that aspirin resistance incidence is between 3-85% among CVD patients. In this study, we aimed to determine the frequency of aspirin resistance in CVD and their relationship with demographic characteristics, risk factors, and stroke subtypes were evaluated. [¤]METHODS[|]In a 6 months period 163 (106 Male-57 Female) acute ischemic stroke patients followed-up and treated with aspirin (100mg-300mg daily) were evaluated. Aspirin resistance was measured by a Multiplate® platelet analyser. Correlation between aspirin resistance and stroke subtypes, age, sex, weight, height, hypertension (HT), diabetes mellitus (DM), history of CVD, smoking, alcohol, hyperlipidemia (HL) and fasting blood glucose level were analyzed.[¤]RESULTS[|]Aspirin resistance was found in 16 male, 9 female, totally 25 (15.3%) of 163 patients. There was no statistically significant relationship between aspirin resistance and stroke-related clinical and laboratory parameters.[¤]DISCUSSION AND CONCLUSION[|]Our results needed to be confirmed with larger prospective trials in order to clarify which of the patients with ischemic stroke should be tested and how to treat the patients with resistance.[¤]

Kluver-Bucy syndrome (KBS) is characterized by visual agnosia, hypersexuality, emotional behavior changes, hyperorality, hypermetamorphosis, and cognitive dysfunction. The syndrome is often seen in pathologic states that destroy the anterior and medial temporal lobes, often bilaterally. Herpes simplex encephalitis (HSE) is the leading infectious cause of KBS owing to its frequent involvement of the temporal lobes. HSE is also the most common cause of KBS in general. In this paper, we present a rare case of KBS after HSE.

Introduction Occlusive thrombi in acute ischemic stroke can be in various types which limits the success of the thrombectomy.The NeVaTM(Vesalio, Nashville, Tennessee) thrombectomy device was originally designed for all types of clot. Our aim was to evaluate the efficacy and safety of the NeVaTMdevice for mechanical thrombectomy. Methods Retrospective review of prospectively collected mechanical thrombectomy database revealed 145 patients who had fullfilled the inclusion criteria.The data collected includes clinical patient characteristics, procedural measures, timestamp at each stage, and patient outcome. IV thrombolytics application, pre and post‐intervention imaging findings, device related adverse event and any type of intracranial hemorrhage were recorded. Results There was female pre‐dominance (54.5%). Median presenting NIHSS was 16 (IQR, 3–32). 88 MCA‐m1 (60,6%), 43 ICA‐tip (29,6%), 11 MCA‐m2 (7,5%), 2 ACA (1,4%) and 1 basilar (0,7%) occlusions were underwent for mechanical thrombectomy. Median procedure time was 25 min (IQR, 7–136). First‐pass reperfusion scores were mTICI 0–2a 22.7%, mTICI 2b 23.4%, mTICI 2c 17.9% andmTICI 3 35.9%.Mean number of pass was1,84±1,14.Final mTICI 2b‐3 score was 97.9% and TICI2c‐3 score was 87.6%. No device related adverse event occurred. The mean 24‐hour NIHS score was 6 (IQR 0–33). Conclusions In conclusion, the NeVa thrombectomy device offers a high rate of first‐pass success along with favorable safety profile. Larger series and multi‐center studies are needed for further investigation

Objectives:This study aims to investigate the remission and relapse in patients with epilepsy after the withdrawal of AEDs due to seizure-free, and to review the criteria for withdrawal of AEDs.Methods:The records of 105 patients who were followed up regularly in our epilepsy outpatient clinic and were planned to be discontinued due to seizurefree were analyzed retrospectively in this study. Seventeen patients were excluded from this study because they did not meet the criteria. The sociodemographic and clinical features of the patients, the duration of the seizure, and the EEG findings before and after the drug discontinuation were recorded.Results:In this study, 46 (52.3%) patients were female and 42 (47.7%) were male. Mean age was 28.8±12.3 (10–63). Seventy-one patients (80.7%) were in complete remission at least one year after drug treatment. Seventeen patients (19.3%) had seizure recurrence. Four (23.5%) patients had recurrent seizures in the first 12 months, with 14 (82.4%) patients in the first three months. It was observed that the age of onset of epilepsy and the age of onset of AED were higher in patients with seizure recurrence, and this difference was statistically significant (p=0.036, p=0.005). EEG examinations performed after discontinuation of the drug showed that the rate of recurrence of patients with pathological findings increased (p

Objectives:Zonisamide (ZnS) is a new generation antiepileptic agent used in the treatment of epilepsy patients with partial and generalized seizures. In this study, we aim to investigate the safety and efficacy of ZnS in the treatment of patients with refractory epilepsy who were being followed.Methods:Forty-five refractory epilepsy patients who received ZnS treatment were included in this study. Patients who received ZnS treatment for less than six months were excluded. Age, sex, types of seizures, examination findings, magnetic resonance imaging and electroencephalography findings, concurrent use of non-ZnS antiepileptic drugs, decrease in the seizure frequency and side effects of the drug were recorded.Results:Thirty-nine patients, whose mean age was 34.3±9.3 years, were evaluated. Complex partial seizures (CPS) and generalized tonic-clonic seizure (GTCS) were observed in 74.4% of the patients, whereas 10.3% had GTCS alone, 7.7% had CPS alone, 5.2% had GTCS and myoclonia and 2.6% of them had absence and myoclonia. In the follow-up, treatment was observed to be discontinued in 19 of the 39 patients due to drug side effects, or where there was an increase, or no change, in seizure frequency. Twenty patients responded to treatment. Seizure frequency was decreased by 25% in one patient; 50% in five patients, and 75% in seven patients. Three patients were seizure-free. Although there was no change in seizure frequency, seizure duration was shortened in four patients. Treatment-responsive patients were using ZnS at doses that ranged from 100 to 400 mg/day for 7 to 80 months.Conclusion:ZnS is a safe, tolerable and effective option for the additional treatment of refractory epilepsy patients at our center.