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Objective: to study the anamnestic, clinical and laboratory features of the acute period of ischemic stroke (IS) and to determine the risk factors for its development in young patients.Patients and methods. Clinical and statistical processing of data of 256 patients aged 18 to 44 years included, who had IS, confirmed by computed and/or magnetic resonance imaging of the brain in the acute period, was carried out. Furthermore, in 154 patients and in 117 healthy participants, who made up the control group, eight polymorphisms of the thrombophilic spectrum genes were determined – FGB: -455G>A, F2: 20210G>A, F5: 1691G>A, F7: 10976G>A, F13: 103 G>T, ITGA2: 807C>T, ITGB3: 1565 T>C, PAI-1: -675 5G>4G.Results and discussion. 154 (60.15%) patients demonstrated good recovery (achievement of a level of ≤2 points on the Rankin scale by the patient). None of the patients died during their hospitalization. In the evaluated group of patients, we identified allelic variants of the thrombophilic spectrum genes and gene-gene combinations, the carriage of which increased the likelihood of IS development at the young age by 1.74 and 2.19 times, respectively. Taking into consideration additional examination methods, the pathogenetic variant of IS according to the TOAST classification was verified in 226 (88%) patients.Conclusion. In IS at a young age a detailed assessment of risk factors is required, including an analysis of carrier variants and combinations of procoagulant and prothrombotic spectrum gene polymorphisms.

Objectives: There are scarce data regarding pontine arteries anatomy, which is the basis for ischemic lesions following their occlusion. The aim of this study was to examine pontine vasculature and its relationships with the radiologic and neuro-logic features of pontine infarctions. Materials and methods: Branches of eight basilar arteries and their twigs, including the larger intrapontine branches, were microdis-sected following an injection of a 10% mixture of India ink and gelatin. Two addi-tional brain stems were prepared for microscopic examination after being stained with luxol fast blue and cresyl violet. Finally, 30 patients with pontine infarctions underwent magnetic resonance imaging (MRI) in order to determine the position and size of the infarctions. Results: The perforating arteries, which averaged 5.8 in number and 0.39 mm in diameter, gave rise to paramedian and anteromedial branches, and also to anterolateral twigs (62.5%). The longer leptomeningeal and cere-bellar arteries occasionally gave off perforating and anterolateral twigs, and either the lateral or posterior branches. Occlusion of some of these vessels resulted in the para-median (30%), anterolateral (26.7%), lateral (20%), and combined infarctions (23.3%), which were most often isolated and unilateral, and rarely bilateral (10%). They were located in the lower pons (23.3%), middle (10%) or rostral (26.7%), or in two or three portions (40%). Each type of infarction usually produced characteristic neurologic signs. The clinical significance of the anatomic findings was discussed. Conclusions: There was a good correlation between the intrapontine vascular territories, the position, size and shape of the infarctions, and the type of neurologic manifestations. (c) 2022 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Stroke is the second leading cause of death and the third leading cause of disability worldwide and its burden is increasing rapidly in low-income and middle-income countries, many of which are unable to face the challenges it imposes. In this Health Policy paper on primary stroke prevention, we provide an overview of the current situation regarding primary prevention services, estimate the cost of stroke and stroke prevention, and identify deficiencies in existing guidelines and gaps in primary prevention. We also offer a set of pragmatic solutions for implementation of primary stroke prevention, with an emphasis on the role of governments and population-wide strategies, including task-shifting and sharing and health system re-engineering. Implementation of primary stroke prevention involves patients, health professionals, funders, policy makers, implementation partners, and the entire population along the life course.

Posterior cerebral artery (PCA) aneurysms comprise

Background The outcome of childhood acute lymphoblastic leukemia has improved because of intensive chemotherapy and supportive care. The frequency of adverse events has also increased, but the data related to acute central nervous system complications during acute lymphoblastic leukemia treatment are sparse. The purpose of this study is to evaluate these complications and to determine their long term outcome. Patients and Methods We retrospectively analyzed the hospital reports of 323 children with de novo acute lymphoblastic leukemia from a 13-year period for acute neurological complications. The central nervous system complications of leukemic involvement, peripheral neuropathy, and post-treatment late-onset encephalopathy, and neurocognitive defects were excluded. Results Twenty-three of 323 children (7.1%) suffered from central nervous system complications during acute lymphoblastic leukemia treatment. The majority of these complications (n = 13/23; 56.5%) developed during the induction period. The complications included posterior reversible encephalopathy (n = 6), fungal abscess (n = 5), cerebrovascular lesions (n = 5), syndrome of inappropriate secretion of antidiuretic hormone (n = 4), and methotrexate encephalopathy (n = 3). Three of these 23 children (13%) died of central nervous system complications, one from an intracranial fungal abscess and the others from intracranial thrombosis. Seven of the survivors (n = 7/20; 35%) became epileptic and three of them had also developed mental and motor retardation. Conclusions Acute central neurological complications are varied and require an urgent approach for proper diagnosis and treatment. Collaboration among the hematologist, radiologist, neurologist, microbiologist, and neurosurgeon is essential to prevent fatal outcome and serious morbidity.

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

Aim: To describe a patient with lumbar angiolipoma mimicking schwannoma in the posterolateral side of the spinal canal with expansion of the left lumbar foramen and to discuss the clinical, radiologic, and surgical features of these lesions with literature. Methods: Without language restriction in this paper, the electronic databases; The Cochrane Collaboration the Cochrane, The Cochrane Library (Issue 2 of 12, Feb. 2011), ProQuest, US National Library of Medicine, National Institutes of Health (NLM) and PubMed dating from 1966 September to January Week 2 2017, were searched for comparative experimental studies using the terms: “OR”, “AND”. On-line literature searches were conducted using the key words “lumbar angiolipoma”, “schwannoma “, “spinal angiolipoma”, “spinal cord”, and “spinal canal”. We compared this research with our patient. Results: Bilateral L2 total laminectomy, excision of the tumors and bilateral L2-L3 transpedicular stabilization were performed, and complaints improved prominently. Pathological examination was reported as angiolipoma. Conclusion: The research shows that a probable diagnosis in such tumor cases could be made by sufficient pre-op scanning before surgical operations and although angiolipoma has been rarely seen in lumbar posterolateral space, it can be seen in lumbar region and mimic schwannoma as producing symptoms and signs of spinal cord and nerve root compression.

The most important adverse effect of antithrombotic treatment is the occurrence of bleeding. in case of serious or even life-threatening bleeding in a patient who uses anticoagulant agents or when patient on anticoagulants needs to undergo an urgent invasive procedure, anticoagulant treatment can be reversed by various specific strategies. heparin and heparin derivatives can be counteracted by protamine sulphate, whereas the anticoagulant effect of vitamin K antagonists may be neutralised by administration of vitamin K or prothrombin complex concentrates. the antihaemostatic effect of aspirin and other antiplatelet strategies can be corrected by the administration of platelet concentrate and/or desmopressin, if needed. recently, a new generation of anticoagulants with a greater specificity towards activated coagulation factors has been introduced and most of these agents are currently being evaluated in clinical studies, showing promising results. the new-generation anticoagulants include specific inhibitors of factor iia or factor Xa (including pentasaccharides) and antiplatelet agents belonging to the class of thienopyridine derivatives. a limitation of the new class of anti-iia and anti-Xa agents may be the lack of an appropriate strategy to reverse the effect if a bleeding event occurs, although in some cases the administration of recombinant factor VIIa may be an option. © Van Zuiden Communications B.V. All rights reserved.

Purpose: Nilvadipine is a dihydropyridine-type calcium channel blocker with emanating neuroprotective properties in various models of neuronal diseases. This study aimed at investigating the prophylactic effect of nilvadipine on memory impairment and hippocampal malodialdehyde (MDA) levels in global brain ischemia model induced by 4-vessel occlusion ischemia (4-VO) in rat. Materials and methods: The 4-VO ischemia was induced in Wistar rats by occluding the vertebral arteries permanently by cauterization. The common carotid arteries were twice occluded bilaterally for 10 minute at 60 minute interval. One week after 4-VO the memory was evaluated measuring the correct and error choices in 8-armed radial maze. The ischemiareperfusion- induced damage was evaluated measuring level of MDA in the hippocampus using thiobarbituric acid method. The study involved three groups: sham, ischemia-control and ischemia nilvadipin. Nilvadipine (3.2 mg/kg/day) was administerd for 7 days prior to 4-VO Results: The 4-VO impaired memory performance by decreasing the correct choices (long termreference memory) and increasing the error choices (short term-working memory) (p

The most important adverse effect of antithrombotic treatment is the occurrence of bleeding. in case of serious or even life-threatening bleeding in a patient who uses anticoagulant agents or when patient on anticoagulants needs to undergo an urgent invasive procedure, anticoagulant treatment can be reversed by various specific strategies. heparin and heparin derivatives can be counteracted by protamine sulphate, whereas the anticoagulant effect of vitamin K antagonists may be neutralised by administration of vitamin K or prothrombin complex concentrates. the antihaemostatic effect of aspirin and other antiplatelet strategies can be corrected by the administration of platelet concentrate and/or desmopressin, if needed. recently, a new generation of anticoagulants with a greater specificity towards activated coagulation factors has been introduced and most of these agents are currently being evaluated in clinical studies, showing promising results. the new-generation anticoagulants include specific inhibitors of factor iia or factor Xa (including pentasaccharides) and antiplatelet agents belonging to the class of thienopyridine derivatives. a limitation of the new class of anti-iia and anti-Xa agents may be the lack of an appropriate strategy to reverse the effect if a bleeding event occurs, although in some cases the administration of recombinant factor VIIa may be an option. © Van Zuiden Communications B.V. All rights reserved.

Serum lipoperoxidation products such as malondialdehyde (MDA) reflect oxidative stress. There are contradictory results addressing the levels of lipoperoxidation products in chronic phase of ischemic stroke. In the present study, we aimed to determine the serum MDA levels in stroke patients 6 months after the cerebrovascular accident. We also compared serum MDA levels in two major groups of patients with ischemic stroke resulting from small vessel and large vessel diseases, respectively. Serum MDA levels of thirty-eight patients who had ischemic stroke (19 with atherothrombotic ischemic stroke and 19 with lacunar infarction) and 30 healthy volunteers were measured. While there was no significant difference in serum MDA levels between the chronic ischemic stroke subgroups (p = 0.795), the serum MDA levels of patients with atherothrombotic ischemic stroke (p < 0.001) or with lacunar infarction (p < 0.001) were significantly higher compared to the control group. We also demonstrated that serum MDA levels of the patients with and those without hypertension (p = 0.846), diabetes mellitus (p = 0.891), or dyslipidemia (p = 0.38) were not significantly different. In conclusion, serum MDA levels were elevated in chronic stroke patients with small or large vessel diseases. To the best of our knowledge, this is the first report showing that serum MDA levels of these two groups are not sigificantly different. Furthermore, serum MDA levels do not differ solely by the existence or nonexistence of hypertension, diabetes mellitus or hyperlipidemia. © 2006 Tohoku University Medical Press.

WOS: 000223843200001, PubMed ID: 15626013, This study analyzes the data of thrombotic children who were followed up in different pediatric referral centers of Turkey, to obtain more general data on the diagnosis, risk factors, management, and outcome of thrombosis in Turkish children. A simple two-page questionnaire was distributed among contact people from each center to standardize data collection. Thirteen pediatric referral centers responded to the invitation and the total number of cases was 271. All children were diagnosed with thromboembolic disease between January 1995 and October 2001. Median age at time of first thrombotic event was 7.0 years. Of the children 4% of the cases were neonates, 12% were infants less than 1 year old, and 17% were adolescents. Thromboembolic event was mostly located in the cerebral vascular system (32%), deep venous system of the limbs, femoral and iliac veins (24%), portal veins (10%), and intracardiac region (9%). Acquired risk factors were present in 86% of the children. Infection was the most common underlying risk factor. Inherited risk factors were present in 30% of the children. FVL was the most common inherited risk factor. Acquired and inherited risk factors were present simultaneously in 19% of the patients. Eleven children had a history of familial thrombosis. Due to the local treatment preferences, the treatment of the children varied greatly. Outcome of the 142 patients (52%) was reported: 88 (62%) patients had complete resolution, 47 (33%) had complications, 12 (9%) had recurrent thrombosis, and 34 (24%) died. Three children (2.1%) died as a direct consequence of their thromboembolic disease. The significant morbidity and mortality found in this study supports the need for multicentric prospective clinical trials to obtain more generalizable data on management and outcome of thrombosis in Turkish children.

The expression of interleukin-1 beta (IL-1 beta) mRNA in the brain in response to cerebral ischaemia in rats was examined using in situ hybridization histochemistry. Focal cerebral ischaemia was induced in spontaneously hypertensive rats by permanent occlusion of the left middle cerebral artery (MCAO). Whereas no IL-1 beta mRNA could be detected in non-operated and sham-operated rats, middle cerebral artery occlusion induced the expression of IL-1 beta mRNA within 15 min in the ischaemic brain regions prone to become necrotic after 1-2 days. The message appeared as spot-like signals, reached a peak after 3 h and then declined to undetectable levels within 4 days. Additionally, a pronounced but brief induction of IL-1 beta mRNA could be detected 1 h after MCAO in the meninges near the watershed zone. The results demonstrate that the inflammatory cytokine IL-1 beta is induced in a time-dependent way after brain ischaemia.