A comparative ID migraine screener study in ophthalmology, ENT and neurology out-patient clinics

Migraine is more likely to be misdiagnosed in patients with comorbid diseases. Not only primary care physicians, but also specialists might misdiagnose it due to the lack of diagnostic criteria awareness. The ID migraine test is a reliable screening instrument that may facilitate and accelerate migraine recognition. This study aimed to compare the prevalence and characteristics of migraine in a large sample of patients admitted to clinics of ophthalmology (OC), ear, nose and throat diseases (ENTC) and neurology (NC), as well as to validate the use of the ID migraine test in OC and ENTC settings. This was a multicentre (11 cites) study of out-patients admitting either to NC, ENTC or OC of the study sites during five consecutive working days within 1 week. From each of the clinics, 100 patients were planned to be recruited. All recruited patients were interviewed and those having a headache complaint received an ID migraine test and were examined for headache diagnosis by a neurologist, blinded to the ID migraine test result. A total of 2625 subjects were recruited. Only 1.3% of OC patients and 5.4% of ENTC patients have been admitted with a primary complaint of headache, whereas the percentage of NC patients suffering from headache was 37.6%. Whereas 138 patients (19.3%) in OC, 154 (17.3%) in ENTC and 347 (34%) in NC were found to be ID migraine test positive, 149 patients (20.8%) in OC, 142 (16%) in ENTC and 338 (33.1%) in NC were diagnosed with migraine. The sensitivity, specificity, and positive and negative predictive ratios of the ID migraine test were found to be similar in all clinics. An important fraction of the patients admitted to NC, as well as to OC and ENTC, for headache and/or other complaints were found out to have migraine by means of a simple screening test. This study validated the ID migraine test as a sensitive and specific tool in OC and ENTC, encouraging its use as a screening instrument.Pfizer-Türkiy

Non-Convulsive Status Epilepticus Features with Electroencephalography Monitoring in the Neurological Intensive Care Unit: A Prospective Study

Objectives:Since non-convulsive status epilepticus (NCSE) is a reversible cause of coma and/or change in consciousness in the neurological intensive care unit (NICU), its early diagnosis and treatment are necessary. Continuous electroencephalography monitoring (cEEG) is an important diagnostic tool, but since access to cEEG may be limited, it is critical to choose which patients will be referred to cEEG for diagnosing NCSE. In our study, we aimed to investigate patients with an unexplained altered level of consciousness who should be directed to cEEG according to clinical features and emergency EEG (EmEEG) features.Methods:In 40 consecutive patients who were admitted to the NICU and whose reason for the altered mental status could not be explained, 30 min EmEEG and cEEG starting in the first 24 h were performed and their clinical features, Glasgow Coma Score (GCS), four score (FS), and prognosis were noted.Results:The frequency of NCSE was 22.5%. cEEG did not detected NCSE in patients who were not diagnosed in the EmEEG. No causality relationship was found between NCSE etiology, low GCS score, low FS, and the level of consciousness. The 55% of the NCSE patients had minor motor movements. The poor prognosis was 55% in the NCSE patients, but it did not differ significantly from the non-NCSE patients. In conclusion, EmEEG is a useful tool for NCSE screening in NICU patients at the early phase of changes in consciousness. Apart from minor motor movements, clinical and history characteristics do not predict the high NCSE risk. The unfavorable prognosis is probably related to the underlying etiology and is not affected by the presence of NCSE.Conclusion:When there is no access to cEEG, EmEEG may be helpful for the diagnosis of NCSE in the early clinical period. The presence of minor motor movements and EmEEG findings together can be useful tools to guide high-risk patients with NCSE to cEEG monitoring

Nörolojik İzlem Protokolü Kullanımının Beyin Ölümü Tanı Oranlarına Etkisi

Amaç: Bu çalışma, akut yapısal beyin hasarı olan komatöz hastalarda nörolojik izlem protokolü kullanımı öncesi ve sonrası beyin ölümü tanı oranlarını karşılaştırmayı amaçladı. Gereç ve Yöntem: Akut yapısal beyin hasarı ve Glasgow koma skoru ?8 ile erişkin yoğun bakım ünitelerine kabul edilen komatöz hastalar değerlendirildi. 2018-2019 arası “dönem 1”, nörolojik izlem protokolünün kullanıldığı 2019- 2020 arası “dönem 2” olarak incelendi. Bulgular: Dönem-1’de 92 hasta, dönem-2’de 83 hasta takip edildi. Dönem- 1’de klinik beyin ölümü tanı oranı % 3,3 iken dönem-2’de klinik beyin ölümü tanı oranı % 20,5 (p=0,001) idi. Dönem-1’de beyin ölümü deklarasyon oranı % 1,1 iken dönem-2’de beyin ölümü deklarasyon oranı % 13,3 idi (p=0,001). Yoğun bakım mortalitesi ise dönem-2’de daha düşüktü (dönem-1’de % 73,9, dönem-2’de % 60,2), ancak bu düşüklük istatistiksel olarak anlamlı değildi (p=0,054). Sonuç: Bu çalışmada nörolojik izlem protokolü uygulanması ile dönem-2’de beyin ölümü deklarasyon oranlarının belirgin olarak arttığı gösterildi. Ayrıca protokol uygulanması ile yoğun bakım mortalitesinde düşüş gözlendi. Bu bulgular ile vardığımız sonuç, akut beyin hasarı olan hastalarda hastanelerin kendi özel stratejilerini geliştirmesi ve komatöz hastaların belirli bir protokol çerçevesinde takip edilmesi faydalı olacağı şeklindedir

NÖROLOJİK YOĞUN BAKIM ÜNİTESİNDE PROGNOZ

[Abstract Not Available

Prognosis in Neurological Intensive Care Units

Objective: Neurocritical care, or neurological intensive care, provides critical care for patients with neurological or neurosurgical diseases. These patients need to receive medical care for their primary critical illnesses, comorbidities, and complications. This study aims to compare the clinical outcomes of patients with neurological or neurosurgical diseases treated in general ICUs and those of patients treated in neurological intensive care units (neuro-ICU). Materials and Methods: Patients with neurological and neurosurgical diseases who were treated in the ICUs by a neurointensivist were included in the study. The patients were categorized into two groups according to their ICU types and the study periods: patients in the mixed general ICU (period-1) and patients in the neuro-ICU (period-2). The records in the hospital automation system and this study's database of patients were evaluated retrospectively. Results: Sixty-one patients in period-1 and 58 patients in period-2 were evaluated. The ICU mortality rate and the ICU and hospital stay duration were lower in the neuro-ICU patients, but this difference was not statistically significant (P > 0.05). ICU readmission and in-hospital mortality rates were significantly lower in the neuro-ICU patients (P < 0.05). Conclusion: This study analyzed the effect of specialized neurocritical care and neuro-ICU organization on patient clinical outcomes. To achieve better patient management in the neuro-ICU, it is necessary to provide quality improvements in the process's structure, performance, and standardization. In Turkiye, there is a need for studies regarding this subject to establish and agree on standards for neurocritical care

Pentoxifylline reduces injury of the brain in transient ischaemia

Objective - The beneficial effect of pentoxifylline (PTX) on ischaemic-reperfusion injury was assessed in a rat model of transient global cerebral ischaemia. Design - Randomized, controlled, prospective study. Setting - University research laboratory. Subjects - Thirty-six male Wistar albino rats. Interventions - Ischaemia was induced with a four-vessel occlusion technique in 24 animals with the duration of 15 minutes. Group I animals (n = 12) received PTX treatment started 20 minutes before the occlusion of carotid arteries (60 mg/kg bolus followed by infusion at 0.1 mg/kg/min). A similar volume of saline solution was used in animals of the control group (group 2, n = 12). The animals in group 3 (sham group, n = 12) were anaesthetized and subjected to operative dissections without vascular occlusion. Measurements - Physiological parameters and somatosensory evoked potentials (SEP) were monitored in animals before ischaemia, during ischaemia and in the first 30 minutes of reperfusion. Their neurological outcome had been clinically evaluated and scored up to 4 days post ischaemia. The intergroup differences were compared. Then the animals were sacrificed and their brains were processed for histopathological examination. Main results - In group 3, SEP amplitudes did not change during the procedures, and all animals recovered without neurologic deficits. At the end of the ischaemic period, the average amplitude was reduced to 4 ± 3% of the baseline in all ischaemic animals. This was followed by a gradual return to 92 ± 9% and 82 ± 8% of the initial amplitude after 30 minutes of reperfusion in group 1 and group 2, respectively (p < 0.05). The average neurological score was significantly higher in group 1 than in group 2 in the post-ischaemia period (p < 0.05). Histological observations were clearly correlated with the neurological findings. Conclusion - The results suggest that PTX reduces cerebral injury and preserves neurologic function in transient global ischaemia in rats