The objective of our study is to detect the patient group that will most benefit from intravenous (IV) thrombolytic therapy by showing predictive factors of good functional outcomes. The present ...study covers 88 patients who were admitted to our clinic within the first 4.5 hours from the onset of stroke symptoms, diagnosed with acute ischemic stroke and who received IV thrombolytic therapy between May 2014 and June 2017 as a result of a retrospective analysis of a database prospectively collected. The patients with a score of ≤2 on modified Rankin scale within 3 months were accepted as good functional outcome and those with a score of >2 were accepted as poor functional outcome. As a result, within the period of 3 months posttreatment, good functional outcomes were obtained in 45 (51.1%) patients and poor functional outcomes were obtained in 43 (48.9%) patients. In comparisons, cardioembolic stroke group was statistically significantly higher in the good functional outcome group (P = .03). Pretreatment National Institute of Health Stroke Scale (NIHSS) scores (P < .001), presence of proximal hyperintense middle cerebral artery sign in noncontrast computed brain tomography (P = .03), and being aged ≥80 and older (P = .04) were markedly higher in the group with poor functional outcomes. In conclusion, our study demonstrated that cardioembolic strokes may have an impact on good functional outcomes and being aged 80 and older, presence of proximal HMCAS in computed brain tomography, and pretreatment NIHSS scores may have an impact on poor functional outcomes.
Objective: Hypothalamic-pituitary-adrenal (HPA) axis dysfunction is thought to be found in patients with multiple sclerosis (MS). Copeptin is a serum protein that is indicated as an indirect marker ...of HPA axis. The aim of this study was to evaluate the relationship between HPA axis and clinically silent MS (CSMS) by evaluating copeptin levels. Materials and Methods: Sixty patients with CSMS which was defined as relapsing-remitting MS without attack and progression, and 60 healthy individuals were included in the study from September 2016 to September 2017. All patients were in the remission period. HPA axis dysfunction was examined by measuring serum copeptin levels in all individuals. Copeptin level was compared with clinical parameters in patients with MS. Results: A total of 120 individuals were composed of 60 patients with CSMS and 60 healthy controls. The average ages of the patients and the control group were 37.1+-8 (20-52) and 35.1+-8.9 (18-54), respectively. The copeptin level was significantly lower in patients compared to the control group (p<0.001). In both groups, gender played no differential role in copeptin levels (p<0.05). No significant correlation was determined between copeptin levels, age (r=0.121, p=0.188), last Expanded Disability Status Scale score (r=-0.035, p=0.790) and disease duration (r=0.032, p=0.810). Conclusion: These results indicate that HPA axis may also be hypoactive in remission period in patients with CSMS. According to our findings, we consider that copeptin levels can be used as a prognostic marker in patients with clinically inactive MS in the future.
Objective: We aimed to determine the association between a polymorphism in the promoter region of the IL-1beta gene resulting in enhanced gene transcription and the clinical phenotype of temporal ...lobe epilepsy with hippocampal sclerosis (TLE+HS). Materials and Methods: The frequency of a single nucleotide polymorphism (SNP) that results in a C>T transition of 511 base pairs that are five prime to the transcription start site of the IL-1beta gene in a group of 21 patients with TLE+HS, 21 patients with temporal lobe epilepsy without hippocampal sclerosis (TLE-HS), and 23 healthy volunteers. Results: The frequency of the -511T allele was 11/21 in the TLE-HS group, 13/21 in the TLE+HS group, and 12/23 in the control group. Chi-square analysis of genotype and allele distribution showed no significant difference between the patients in TLE+HS, TLE-HS, and control group Conclusion: There was no association between the -511/C>T SNP variation and TLE+HS.
Carpal tunnel syndrome (CTS), majority of cases are considered to be idiopathic, is the most commonly encountered peripheral neuropathy causing disability. We asserted that thick and big hands may ...more prone to idiopathic CTS (ICTS) than others. The study included 165 subjects admitted to our electrophysiology lab with pre-diagnosis of CTS between May 2014 and April 2015. Eighty-five of the subjects were diagnosed as ICTS. The parameters analyzed were: age, gender, occupation, BMI, hand dominance, grade of ICTS, wrist circumference, proximal/distal width of palm, hand/palm length, hand volume and palm length/proximal palm width. Female gender was significantly higher in both groups. The mean age of study group was 44.02 ± 9.11 years, and control group was 41.25 ± 9.94 years. BMI, wrist circumference and hand volume were significantly higher in the study group (
p
< 0.05). However, palm length/prox.palm width ratio was higher in the control group (
p
= 0.00). There were also significant differences among CTS groups in terms of age (
p
= 0.001). Mean age was higher in severe CTS group. Female gender, older age and high BMI are risk factors for ICTS. Higher hand volume, wrist circumference and lower palm length/prox. palm width ratio can also be anthropometric risk factors. Large hand volumes, big and coarse hands are more prone to ICTS.
Objective: Patients with pain or numbness without motor deficits are the most common group referred to electrophysiology laboratories as suspected radiculopathy.
We wanted to investigate whether ...electromyography (EMG) was useful for this group in the diagnosis or therapy of radiculopathy. Our aim was to investigate the
correlation and classification of EMG and magnetic resonance imaging (MRI) findings in the diagnosis of suspected radiculopathy.
Materials and Methods: We included 74 patients with a ≥2-month history of numbness and pain in the neck and back that radiated into the arm or leg.
Patients with diabetes mellitus, previous disc or spine operation, polyneuropathy, spinal cord diseases (tumor, infection or syrinxs), motor deficits, and abnormal
nerve conduction studies were excluded.
Results: The mean age of the patients was 51.58±11.53 years. In total, 41 (55.4%) patients were women and 33 (44.6%) were men; 48.8% (n=36) showed
cervical radiculopathy and 51.2% (n=38) exhibited lumbosacral radiculopathy. The most common MRI finding was protrusion (37.8%), and the most common
EMG finding was re-innervation (59.5%). The correlation of MRI and EMG findings was significant in lumbar radiculopathy (p=0.007), but not in the cervical
radiculopathy results (p=0.976).
Conclusion: EMG and MRI findings were compatible for lumbar radiculopathy, but not for cervical radiculopathy in mild to moderate grades.
A 66-year-old female admitted to neurology clinic with forgetfulness, which she had had for 2 years. She was hospitalized for further investigation because cranial magnetic resonance imaging (MRI) ...showed bilateral hypointense signal changes in the basal ganglia and thalamus, which suggested accumulation of heavy metals. Neurologic examination was normal except mild dysarthria and impaired tandem walk. There were no remarkable features in her past and family history. A severe difficulty in ability to sustain attention, decline in verbal fluency, and impairment in all processes of memory were found in the cognitive assessment. Abdominal MRI showed a decrease in the signal of liver parenchyma due to accumulation of metal (Figure 1, 2). Liver biopsy showed ballooning degeneration of hepatocytes and an accumulation of iron was observed in hepatocytes and Kupffer cells in the form of small and large granules.
Introduction: The aim of this study was to compare routine awake electroencephalography (r-EEG), melatonin-induced sleep EEG (m-EEG) and EEG (d-EEG) after sleep deprivation studies in terms of ...epileptiform anomalies (EA), and to compare d-EEG and m-EEG studies in terms of sleep induction in patients requiring differential diagnosis of epileptic seizure/nonepileptic seizure. Methods: The study included 45 patients aged 18-45 years who had at least one seizure suspected to be epileptic but could not be diagnosed with epilepsy with clinical and laboratory findings. Each patient underwent r-EEG on the 1st day, d-EEG on the 2nd day after 24 h of sleeplessness, and m-EEG on the 3rd day after the administration of 6 mg melatonin following 7 h night sleep. Three separate EEG tracings of the patients were compared for EA. The d-EEG and m-EEG methods were examined for their ability to achieve sleep, total sleep time (ST), and sleep latency (SL). Results: When the detection rate of EA in d-EEG and m-EEG was compared with that of r-EEG, it was found to be significantly higher (P < 0.001) (73.3% with d-EEG, 75.6% with m-EEG, and 35.6% with r-EEG). Sleep was achieved at a rate of 100% after receiving melatonin and at a rate of 97.8% with sleep deprivation. There was no significant difference between d-EEG and m-EEG in terms of mean ST and SL (ST = 58.6 ± 12.6 min and 59.7 ± 8.3 min, respectively; SL = 287.6 ± 484.3 s and 152.2 ± 178.7 s after the start of the EEG, respectively). Conclusions: Sleep EEG is superior to awake EEG in terms of detecting EA. In an EEG study, where melatonin was used to induce sleep, the sleep rate and SL were similar to those of d-EEG, and melatonin did not have an EA increasing or suppressing effect on EEG. Given the ease of application and low side effect profile, it is thought that m-EEG may be an applicable method in the diagnosis of epilepsy.
BACKGROUND: Transient ischemic attack (TIA) is a common neurovascular disorder associated with a higher risk of stroke within the first 24 h after the first event. Acute cerebral and arterial ...neuroimaging combined with long-term electrocardiography (ECG) monitoring have been proven to be useful in determining etiology. Cardio-embolism constitutes 20%-26% etiology of TIAs most of them with atrial fibrillation (AF). Investigation of AF after TIA is very important because oral anticoagulants can reduce the risk of subsequent stroke by two thirds.
MATERIALS AND METHODS: The present study included 45 patients suffering from TIA with undetermined source according to the Trial of Org 10172 in Acute Stroke Treatment criteria; the control group (n = 45) was selected from the patients admitted to cardiology outpatient clinic with nonspecific complaints without cerebrovascular and/or cardiovascular disease. All patients underwent echocardiography and 24 h Holter ECG monitoring (HM).
RESULTS: There was no significant difference between the patient group and the control group in terms of age and gender. Cholesterol, low-density lipoprotein and urea levels, left atrium diameters and the incidence of hypertension, coronary artery diseases, and AF were significantly higher in TIA group (P < 0.05). In the results of HM, there were six patients with AF in the study group, and in the control group, there was no patients with AF (P = 0.03).
DISCUSSION AND CONCLUSION: In acute phase of TIA, 24 h HM is important for determining the etiology and selecting an appropriate treatment that can protect patients from subsequent strokes.
Objective: Acute ischemic stroke has an effect on electrocardiography (ECG) results and cardiac enzyme levels, but its mechanism has not been clearly established. Our aim was to research ECG and ...cardiac enzyme changes in acute ischemic stroke and to investigate the association between these changes and stroke localizations and prognosis.
Materials and Methods: The study included 241 patients with acute ischemic stroke. Patients without cardiac arrhythmia, history of previous stroke, use of drugs affecting the pattern and duration of ECG rhythm and without acute or chronic myocardial infarction history and electrolyte imbalance were included. The vascular risk factors for stroke, creatine kinase-MB (CK-MB), and troponin I (TnI) levels, and ECG results were examined.
Results: One hundred twenty-three patients had right hemisphere infarcts and 118 patients had left hemisphere infarcts with the same mean ages. HT was more prevalent in right hemisphere infarcts (p=0.013). The most common ECG abnormalities were QTc prolongation (31%) and ST depression (24%). CK-MB and TnI levels were significantly higher in patients with right hemispheric and cerebellar infarcts. QRS durations were longer in cerebellar infarcts (p=0.05).
Conclusion: The most common ECG abnormality was QTc prolongation in patients with acute ischemic stroke within 24 hours. CK-MB and TnI levels were higher in patients with right hemisphere and cerebellar infarcts.
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