Decompressive hemicraniectomy in acute ischemic stroke

INTRODUCTION: Cerebral edema is the leading cause of mortality and morbidity in ischemic stroke patients. Decompressive hemicraniectomy may be beneficial to patients that fail to respond to medical treatment. In this study, clinical features and prognostic factors of patients that underwent decompressive hemicraniectomy due to acute ischemic stroke were evaluated. METHODS: We examined 21 ischemic stroke patients who underwent decompressive hemicraniectomy. Demographic features and neuroimaging findings were recorded. Functional status of patients were evaluated with modified Rankin Scale. Clinical features and neuroimaging findings of the patients who died were compared with the survivors during hospitalization. RESULTS: Twenty-one patiens were included in this study. Twelve of the patients were male, 9 were female. The mean age of these patiens was 58.7±8.2 (46 - 78). The main initial NIHSS score was 12.5±4.5. Territory of infarctions were supplied by middle cerebral arter in 17 patients, internal carotis arter in 4 patients. The mean time of decompressive hemicraniectomy was 2.9±2.5 days, hospitalization duration was 42.6±39.2 days. Five (% 23.8) patiens died in-hospital. There were no relation between clinical features, neuroimaging findings and mortality. DISCUSSION AND CONCLUSION: Decompressive hemicraniectomy is a significant treatment option for ischemic stroke patients who deteriorate despite receiving medical treatment

A Patient with Bilateral Subdural Hematoma due to Spontaneous Intracranial Hypotension

WOS: 00050405630001

Epilepsi Hastalarında Lamotrijin Deneyimi

Objectives:The aim of the present study was to investigate the effect and side effects of lamotrigine (LTG) on seizures.Methods:Epilepsy outpatient clinic records for 416 patients who had been monitored for at least 6 months were studied retrospectively. Age, sex, seizure type, number of seizures, additional drugs used in treatment, duration of treatment, and drug side effects were analyzed.Results:Of the 416 patients, 244 (58.7%) were female, and 162 were male (41.3%). Mean age was 33.2±10.7. Monthly seizure rates were reduced 67.3% with LTG treatment, and 328 patients (78.8%) were still receiving treatment, while 88 (21.2%) had stopped usage due to side effects or for other reasons. Of these side effects, dizziness (5.5%) and rash (4.3%) were the most common. Pregnancy occurred in 18 patients on LTG treatment, and no malformation was detected at birth.Conclusion:In refractory epileptic patients, LTG has a high activity level and an acceptable side effect profile

Eagle Syndrome: Case Report

Eagle syndrome is an aggregate of symptoms caused by an elongated styloid process, most frequently resulting in headache, facial pain, dysphagia and sensation of foreign body in throat. The proper diagnosis is not difficult with clinical history, physi- cal examination and radiographic assessment if there is a sufficient degree of suspicion. The treatment is very effective. We report here a typical case of Eagle syndrome which was misdiagnosed as trigeminal neuralgia for many years and was treated with carbamazepine. We aim to point the place of Eagle syndrome in the differential diagnosis of facial pain. We also re- emphasize the usefulness of the three-dimensional computed tomography in the diagnosis of Eagle syndrome. Even though Eagle syndrome is a rare condition, in cases of facial pain refractory to treatment or unexplained complaints of the head and neck region, it should be considered in the differential diagnosis as it has therapeutic consequences.Eagle sendromu, elonge stiloid çıkıntının neden olduğu belirtiler topluluğudur. Eagle sendromunda başağrısı, yüz ağrısı, disfaji ve boğazda yabancı cisim varlığı hissi sık görülür. Öykü, fizik muayene ve görüntüleme bulgularıyla kolayca tanı konulabilir. Cerrahi tedavi etkindir. Olgu yüz ağrısı şikayeti nedeniyle trigeminal nevralji tanısı almış ve uzun yıllardır karbamazepin kullanmaktadır. Düz kafa grafisi ve boyun bölgesinin üç boyutlu bilgisayarlı tomografisi tipik Eagle sendromu bulgularını göstermektedir. Bu olgu ile yüz ağrısı ayırıcı tanısında Eagle sendromunun yerine dikkat çekilmiş ve Eagle sendromu tanısında üç boyutlu bilgisayarlı tomog- rafinin kullanımı üzerinde durulmuştur. Eagle sendromu, nadir bir durum olarak düşünülse de, özellikle cerrahi tedaviye iyi yanıtı nedeniyle baş ve boyun bölgesiyle ilgili açıklanamayan şikayetleri olan, tıbbi tedaviye dirençli hastalarda akla gelmelidir

Factors Associated with Hemorrhagic Transformation in Infarctions Involving the Posterior Circulation System

PubMed ID: 31138479Backgrounds and Purpose: Hemorrhagic transformation (HT) following stroke of the posterior circulation is a rare occurrence, and its risk factors remain relatively unknown. This study aimed at examining the rate of HT and its risk factors in patients enduring acute ischemic stroke in the territories of the vertebral, basilar, and posterior-cerebral arteries. Materials and Methods: A total of 217 consecutive patients the risk factors for ischemic stroke were recorded and comprehensive biochemical, cardiac assessments, and neuroimaging were performed. National Institutes of Health Stroke Scale (NIHSS) scores were calculated for each patient. Those with HT as documented with neuroimaging based on the European Cooperative Acute Stroke Study criteria and potential risk factors were assessed. Results: There were 217 participants with a mean age of 67.33 ± 12.44 years. Among 17 patients (7.8%) developing HT, 8 (47%) had parenchymal hematoma, and 9(53.5%) had hemorrhagic infarction. Cardioembolism was the most frequent etiological factor both in the overall group (31.0%) as well as in those with HT (41.2%). Factors that emerged as significant predictors of HT included high systolic (odds ratio [OR] 1.14; 95% confidence interval [CI] 1.08-1.20; P< .001) and diastolic blood pressure (P= .001) on the day of admission and the infarction volume of greater than or equal to 3.60 ± 3.29 cm³(OR 1.00, 95% CI 1.00-1.01; P< .001). While NIHSS scores were not significantly different on Day 1, HT patients had higher NIHSS scores at Day 10(OR 1.22; 95% CI 1.09-1.36; P< .001), and this difference was also reflected in mRS at the end of the 3 month period. Conclusion: HT is a rare complication of the infarction of the posterior circulation that is associated with increased morbidity and mortality. Identification of predictive factors for HT in patients with the acute infarction of the posterior circulation may facilitate patient selection for thrombolytic treatment. © 2019 Elsevier Inc

ACUTE ISCHEMIC STROKE IN PATIENTS WITH CANCER: RISK FACTORS, CLINICAL AND IMAGING OUTCOMES

WOS: 000403079700010Introduction: Cancer patients have higher risk of stroke compared with the normal population. The relationship between this increased risk and traditional vascular risk factors is not known exactly. The aims of this study were to investigate ischemic strokes, who had a history of cancer or diagnosed cancer during etiologic scanning, in terms of the cancer type, likely causes of stroke and demographic data. Materials and methods: In this retrospective study, the stroke patients with known cancer or diagnosed with cancer during follow-up were selected by screening the data of 1002 acute ischemic stroke patients who were followed-up in the hospital between 2012 and 2015 and demographic, clinical and imaging findings were recorded. Temporal association between cancer type, presence of metastasis, treatment administered, response to therapy, cancer and stroke, possible stroke etiology and stroke risk factors of the patients were investigated. Results: An association was determined between acute ischemic stroke and cancer in 58 (5.8%) of our patients. Sixty-nine percent of our patients were males and the mean age was 66.5-year. Cancers most commonly found were lung (20.7%), colorectal (15.5%) and prostate cancer (13.8%). The most frequently found risk factors for ischemic stroke were hypertension and diabetes mellitus. Twelve point one percent of the patients did not have any traditional risk factors for ischemic stroke. Eight point six percent of the patients had ischemic stroke as a presenting symptom of cancer. Sixty-eight point nine percent of the patients had supratentorial infarcts and 10.3% of them infratentorial infarcts. Supratentorial infarcts were most commonly located in the middle cerebral region, and infratentorial infarcts were located in the brainstem. Conclusion: Cancer patients with ischemic stroke showed different risk factors, stroke etiology and infarct localizations. Therefore, cancers need to be particularly studied in patients who do not have traditional risk factors for ischemic stroke