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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.

Background: Dysphagia is a life-threatening symptom. The present study aims to evaluate the swallowing function and dysphagia status of MS patients and to find factors that may cause dysphagia. Also, to bring attention to the importance of the early dysphagia examination in MS patients. Methods: A total of 30 MS patients who applied to the neurology clinic of Mustafa Kemal University were included in the study. Dysphagia was evaluated using GUSS (Gugging Swallowing Screen) test for quantitative evaluation of swallowing function. Demographic data (age, gender) of all patients were recorded. Disease duration, if present dysphagia duration, MS type, and Kurtzke's Expanded Disability Status Scale (EDSS) indicating the patient's level of disability was all recorded. Results: According to the GUSS test classification; while 14 patients had mild dysphagia, the remaining 16 patients did not reveal any dysphagia or aspiration risk. We found a weak correlation between EDSS and GUSS(r=-0.227), and between EDSS and Subjective Duration of Dysphagia (r=-0.227). There was a moderate and negative correlation between GUSS and duration of disease (-0.543), GUSS, and teeth status (r=-0.535) but a weak correlation between GUSS and age; GUSS and duration of dysphagia. There was a significant difference in teeth status and GUSS score Conclusion: As a result, individuals with MS may have swallowing dysfunction due to different conditions, so these patients should be evaluated closely in terms of swallowing function from the early stages of the disease immediately upon diagnosis. Thus, serious problems related to aspiration can be prevented.

Amaç: Multipl skleroz (MS) merkezi sinir sistemini etkileyen kronik inflamatuvar bir patolojidir. Günümüze kadar MS’e karşı birçok tedavi seçeneği onaylanmıştır. Bu çalışmada, fingolimod tedavisinin (FT) relapsing-remitting multipl skleroz (RRMS) hastalarının karaciğer enzim düzeylerine etkisinin araştırılması amaçlanmıştır. Gereç ve Yöntemler: Yüz iki RRMS hastasının (66 kadın, 36 erkek, ortalama yaş 40,9±10,9 yıl) vücut kitle indeksi, FT (0,5 mg/gün) süreleri ve karaciğer enzim (alanin aminotransferaz, ALT; gama glutamil transferaz, GGT) seviyeleri poliklinik kayıtlarından geriye dönük olarak incelendi. Bulgular: MS hastalarının FT süresi 0,5 ile 6 yıl arasındaydı. Üç ay ve daha fazla FT süresi olan RRMS hastalarında ALT ve GGT seviyelerinin arttığı tespit edildi. FT sonrası, ALT ve GGT seviyeleri erkeklerde kadınlara kıyasla yaklaşık olarak 2 kat daha yüksekti. Kadınlarda ALT ve GGT seviyelerinin sırasıyla 1,3 ve 1,5 kat, erkeklerde ise bu seviyelerin 1,6 ve 1,9 kat arttığı görüldü. FT sonrası transaminaz seviyesi artan MS hastalarından 9 (%34,6) erkek ve 14 (%32,6) kadın GGT için normalin üst seviyesindeyken, 7 (%23,3) erkek ve 8 (%17,4) kadın ALT için normalin üst seviyesindeydi. Yaş ve FT süresi, ALT ve GGT seviyelerini etkilemiyordu. Sonuç: Sonuç olarak, FT RRMS hastalarının ALT ve GGT seviyelerini yükseltmiştir. Bundan dolayı, MS hastalarının FT süresince takibi oldukça önemlidir. Bu yüzden, MS hastalarında olası karaciğer hasarı ya da diğer sistemik hastalıkların önlenmesi için FT sırasında ve sonrasında ALT ve GGT seviyelerinin takip edilmesini öneriyoruz.

Şiddetli akut solunum yolu sendromu koronavirüsü 2 (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2) solunum sistemini en çok etkileyen ve akciğerdeki çok sayıda ACE2 reseptörü nedeniyle hızla yayılan bulaşıcı bir ajandır. Artralji ve miyalji en sık görülen romatolojik bulgulardır, ancak artrit nadirdir. Sitokin fırtınası adı verilen hiperinflamatuar durum, akut solunum sıkıntısı sendromu (acute respiratory distress syndrome, ARDS)’na neden olarak ölüme neden olur. Koronavirüs hastalığı 2019 (coronavirus disease 2019, COVID-19) çoğu durumda hafif veya asemptomatik olmasına rağmen, özellikle ileri yaş ve komorbiditeleri olan hastalarda pnömoni ve ARDS'ye ilerleyebilir. Enflamatuar yanıtı baskılayan ve sitokin fırtınasını azaltan tosiluzumab gibi ilaçlar, COVID-19 pnömonisinin tedavisinde etkili olabilir. Nedeni tam olarak anlaşılamayan ve bağışıklık sistemindeki birçok yapının birbiriyle etkileşime girdiği sitokin fırtınası oldukça karmaşıktır ve buna katkıda bulunan farklı mekanizmalara sahiptir. Tedavide hidroksiklorokin gibi antimalaryal ilaçlar kullanılsa da etkili olduklarına dair kesin bir kanıt yoktur. Romatizmal hastalıklarda COVID-19 sıklığının ve seyrinin genel popülasyona benzer olduğu, artan yaş ve ek komorbid durumların mortalite riskini artırdığı gösterilmiştir. Romatizmal hastalıkların tedavisinde kullanılan anti-romatizmal ilaçların, hasta COVID-19 ile enfekte olmadıkça kesilmemesi önerilmektedir.

Salgın doğaları nedeniyle; koronavirüs hastalığı 2019 (coronavirus disease 2019, COVID-19) pandemisi gibi enfeksiyonlar, bilinen diğer enfeksiyonlardan önemli ölçüde farklı olan nöropsikolojik ve sosyal sorunlara neden olur. COVID-19 pandemisi ile ilgili birçok çalışma, özellikle hastalarda ve risk grubunda yer alan bireylerde anksiyete, depresyon, panik bozukluğu ve obsesif kompulsif bozukluk gibi zihinsel problemlerin daha yüksek seviyelerde olduğunu göstermiştir. İnsanın biyopsikososyal özelliklere sahip olmasından dolayı; enfeksiyonlar, özellikle salgın enfeksiyonlar, kişinin biyoloji, psikoloji ve sosyal yaşam kalitesi olmak üzere, bu üç yapıyı da sarsıcı derecede etkileyerek yaşam kalitesini ciddi şekilde düşürmektedir. Çok sayıda çalışmanın gösterdiği gibi, insan doğal ve adaptif bağışıklık sisteminin bütünü ve bir bireyin psikolojik ve zihinsel durumu doğrudan bağlantı içindedir. Karantina ve sosyal kısıtlamaların anksiyete, takıntı ve anhedoni gibi depresif belirtileri tetikleyebileceği birçok çalışmada bildirilmiştir. Bazı araştırmacılar, sosyal medyadan elde edilen kaynağı belirsiz bilgilerin obsesyon, kaygı ve ölüm korkusunun psikolojik ve psikososyal belirtilerini artırdığını iddia etmişlerdir. Sonuç olarak, koronavirüs pandemisinin tedavisinde ve önlenmesinde multidisipliner çalışma gereklidir.

Koronavirüsü, nöroinvazyon adını verdiğimiz yayılımla sinir sistemini tutmakta, ‘sitokin fırtınası’ hastalığın gidişatını etkileyen önemli bir faktör olmaktadır. Sitokin fırtınası sonucunda beyin ve diğer organlarda ciddi hasarlar ortaya çıkmaktadır. Tüm dünyada milyonlarca kişiyi enfekte eden koronavirüsün solunum yollarının yanı sıra hem merkezi hem de periferik sinirleri ve kas sistemini etkilediğini gösteren kanıtlar gün geçtikçe birikmektedir. Artan kanıtlar, hastaların %36-54’ünde yani neredeyse her 2 veya 3 hastanın birinde nörolojik tutulumu ortaya koymuştur. Şiddetli akut solunum yolu sendromu koronavirüsü 2 (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2) hastalarında koku ve tat bozuklukları, yorgunluk ve kas ağrısı, baş ağrısı, bulantı, kusma, bilinç bozukluğu, el ve ayaklarda uyuşma gibi nörolojik belirtilerle sıkça karşılaşıyoruz. Daha az olarak ise baş dönmesi, beyin zarı iltihapları, sinir dokusunda miyelin kaybı, kas iltihabı, ağır kas yıkımı gibi nörolojik handikaplara rastlıyoruz. SARS-CoV-2 hastalığına eşlik eden sinir sistemi hastalıklarının bir kısmı tam ya da kısmi sekel ile iyileşmektedir. Nörolojik bulgu gösteren hastalarda kalıcı fonksiyon kaybının gözlenmesi, bu olguların değerlendirilmesinde ayrıntılı nörolojik değerlendirmenin önemine dikkati çekmektedir.

Abstract Background Headache is a leading disabler in adults worldwide. In children and adolescents, the same may be true but the evidence is much poorer. It is notable that published epidemiological studies of these age groups have largely ignored headaches not fulfilling any specific set of ICHD criteria, although such headaches appear to be common. A new approach to these is needed: here we introduce, and investigate, a diagnostic category termed “undifferentiated headache” (UdH), defined in young people as recurrent mild-intensity headache of

Objective: Telerehabilitation (TR) is not used very widely in our country. Our study was planned to evaluate the usefulness and effect of TR in patients with hemiplegia. Materials and Methods: The study was performed at Mustafa Kemal University Health Practice and Research Hospital. After the demographic data were questioned, cognitive levels were assessed using the Mini Mental State Examination, balance using the Berg Balance Scale, and quality of life using the Short Form-36 (SF-36) Quality of Life Scale. A TR program was performed for 3 weeks with 3 sessions per week, a total of 9 sessions. After the therapy program was planned, TR was applied by contacting the patients via laptops with a camera and microphone and an internet connection. The first and last assessments were done at the clinic. Results: According to the results of the study, the balance levels of patients significantly improved after the TR program (p=0.026). There was no difference in terms of quality of life and mental status before and after TR (p>0.05). Conclusion: It was concluded that TR could improve the functionality of patients with stroke and routine use of TR would be beneficial. However, our country’s technological equipment for TR application has been found not sufficient in the countryside

OBJECTIVE: The aim of this study was to provide information concerning the impact of electrophysiological tests in the clinical management and diagnosis of patients, and to evaluate the consistency between referring clinical diagnoses and electrophysiological diagnoses. METHODS: The study included 957 patients referred to the electroneuromyography (ENMG) laboratory from different clinics with different clinical diagnoses in 2008. Demographic data, referring clinical diagnoses, the clinics where the requests wanted, and diagnoses after ENMG testing were recorded and statistically evaluated. RESULTS: In all, 957 patients [644 (67.3%) female and 313 (32.7%) male] were included in the study. Mean age of the patients was 45.40 ± 14.54 years. ENMG requests were made by different specialists; 578 (60.4%) patients were referred by neurologists, 122 (12.8%) by orthopedics, 140 (14.6%) by neurosurgeons, and 117 (12.2%) by physical treatment and rehabilitation departments. According to the results of ENMG testing, 513 (53.6%) patients’ referrals were related to their referral diagnosis, whereas 397 (41.5%) patients had normal ENMG test results, and 47 (4.9%) patients had a diagnosis that differed from the referring diagnosis. Among the relation between the referral diagnosis and electrophysiological diagnosis according to the clinics where the requests were made, there was no statistical difference (p= 0.794), but there were statistically significant differences between the support of different clinical diagnoses, such as carpal tunnel syndrome, polyneuropathy, radiculopathy-plexopathy, entrapment neuropathy, and myopathy based on ENMG test results (p< 0.001). CONCLUSION: ENMG is a frequently used neurological examination. As such, referrals for ENMG can be made to either support the referring diagnosis or to exclude other diagnoses. This may explain the inconsistency between clinical referring diagnoses and diagnoses following ENMG

Abstract Many multiple sclerosis (MS)-associated common risk variants as well as candidate low-frequency and rare variants have been identified; however, approximately half of MS heritability remains unexplained. We studied seven multiplex MS families, six of which with parental consanguinity, to identify genetic factors that increase MS risk. Candidate genomic regions were identified through linkage analysis and homozygosity mapping, and fully penetrant, rare, and low-frequency variants were detected by exome sequencing. Weighted sum score and polygenic risk score (PRS) analyses were conducted in MS families (24 affected, 17 unaffected), 23 sporadic MS cases, 63 individuals in 19 non-MS control families, and 1272 independent, ancestry-matched controls. We found that familial MS cases had a significantly higher common risk variation burden compared with population controls and control families. Sporadic MS cases tended to have a higher PRS compared with familial MS cases, suggesting the presence of a higher rare risk variation burden in the families. In line with this, score distributions among affected and unaffected family members within individual families showed that known susceptibility alleles can explain disease development in some high-risk multiplex families, while in others, additional genetic contributors increase MS risk.

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.

Obstructive sleep apnea syndrome (OSAS) and narcolepsy are two diseases causing excessive daytime sleepiness (EDS). As they are often confused, these two disorders can also coexist. Therefore there is need to distinguish these disorders in patients with EDS. We would like to present a case on a patient who sent to our sleep laboratory with a preliminary diagnosis of OSAS and suspicion of narcolepsy in detailed history. The case is a 24 year-old male. He was diagnosed with OSAS and narcolepsy while being investigated for OSAS. Neurological examination revealed an additional diagnosis of multiple sclerosis. In this case report, we emphasize that in patients with EDS, particularly if EDS cannot be explained with OSAS, investigation for narcolepsy should also be done. In addition, when narcolepsy is detected; neurological examination is actually necessary considering the possibility of secondary narcolepsy.

Aims: To assess sleep quality in patients with primary headaches before and after prophylactic treatment using a validated sleep-screening instrument. Materials and Methods: A total of 147 patients, including 63 tension type headache (TTH) and 84 migraine patients were included. Patients were examined in terms of frequency and severity of headaches and sleep quality before and 12 weeks after prophylactic treatment with either propranolol or amitriptyline. Results: Baseline Visual Analogue Score (VAS) in migraine patients was 7.99 ± 1.39 compared with 6.86 ± 1.50 in TTH group (P < 0.001). VAS score after the first month of treatment was 6.08 ± 1.88 in migraine patients and 5.40 ± 1.61 in TTH (P = 0.023). VAS scores decreased after the third month of treatment to 4.32 ± 2.29 in migraine patients and 4.11 ± 1.66 in TTH patients (P = 0.344). The decrease was significant for patients treated with amitriptyline but not for those with propranolol. Baseline Pittsburgh Sleep Quality (PSQI) scores were 5.93 ± 2.43 in migraine patients and 6.71 ± 2.39 in TTH patients. Poor quality of sleep (PSQI ≥ 6) prior to prophylactic treatment was observed in 61.4% of migraine patients and in 77.7% of TTH patients. Comparison of PSQI scores before and 3 months following treatment showed significantly improved quality of sleep in all treatment groups; the greatest significance was detected in migraine patients with initial PSQI scores of ≥6 and treated with amitriptyline (P < 0.001). Conclusions: Increased understanding of routine objective sleep measures in migraine patients is needed to clarify the nature of sleep disturbances associated with primary headaches. This may in turn lead to improvements in headache treatments.