İNMEDE BEYİN ÖDEMİ VE KAFA İÇİ BASINÇ ARTIŞI: TÜRK BEYİN DAMAR HASTALIKLARI DERNEĞİ UZMAN GÖRÜŞÜ

Beyin ödemi inmeden sonra sık karşılaşılan bir sorundur. İntrakranial basınç artışı serebral perfüzyonu bozarak veserebral herniasyona yol açarak mortalite ve morbiditeyi artırır. İnme hastası takip eden nörologların, hangi inmedensonra beyin ödemi gelişeceğini kestirebilmesi, beyin ödemi gelişmemesi için önlemler alabilmesi, gelişirse intrakranialbasınç artışı ve serebral herniasyonu klinik ve radyolojik olarak tanıyabilmesi, ve önlenemezse beyin ödemi veintrakranial basınç artışını hızlı ve etkin şekilde tedavi edebilmesi gerekir. Bu uzman görüşü Türk Beyin DamarHastalıkları Derneği bünyesinde aktif olarak çalışan 60 uzmanın ortak görüşü ile hazırlanmış bir klinik rehberniteliğindedir

Transcranial Doppler ultransonography as a confirmative diagnostic test in brain death: a review

Before the invention of modern technologies death was defined as the cessation of cardiac and respiratoty functions. After the advances in mechanical ventilation and cardiopulmonary resucitation techniques the term “brain death” has been used instead and with the worldwide increase in cadaveric organ transplantation this term has increasingly gained importance. Brain death is a state which is diagnosed by neurological examination in patients who fulfill some specific criteria. In patients who cannot be examined thoroughly or in whom an apnoea test cannot be performed a confirmatory test is mandatory. Diagnostic tests for brain death can either be those who show neural activity or those who evaluate cerebral circulation. The cause that leads to the development of brain death is cessation of cerebral blood flow therefore diagnostic tests which evaluate the cerebral circulation are preferred in brain death. Transcranial Doppler ultrasonography steps forward among diagnostic tests that evaluate cerebral circulation because it is non-invasive, repeatable and can be performed at bedside. In order to use transcranial Doppler ultrasonography in the diagnosis of brain death one has to have very good knowledge about the effects of increasing intracranial pressure on the Doppler spectra and the various spectral forms of cerebral circulatory arrest. In this review the utility of transcranial Doppler ultrasonography in the diagnosis of brain death will be discussed

Is there an association between migraine and atopic disorders? The results of multicenter migraine attack study

Siva, Aksel/0000-0002-8340-6641; Demir, Necdet/0000-0003-2865-798XWOS: 000259840600001We designed this multicenter study to evaluate the abnormalities related to the mast cell activation during attacks in a large group of migraineurs and to compare the findings both with episodic tension type headache (ETTH) and matched healthy control subjects. After the evaluation of diagnostic criteria, 213 subjects were included in this study after giving consent. Of all 146 subjects (67.8%) were migraineurs, 38 (19.4%) were ETTH patients and 29 others were healthy controls matched according to age and sex. Immunological screening showed significantly high ratios of IL-beta, IL-2, IL-6 and TNF-alpha in the migraine group compared to ETTH (16.6% vs 10.5%, 20.0% vs 5.3%, 13.8% vs 2.6% and 15.9% vs 5.3%, respectively) and to the healthy controls. Logistic regression analysis showed that only duration of headache has an important effect on having IL-2 abnormality (Exp-B: 0.322, 95% CI: 0.151-0.688, p=0.003) in patients with migraine. There was no important effect of clinical variables on serological abnormalitites or each other. In conclusion, our multicenter clinical and laboratory based study suggests that primary headache disorders (migraine and ETTH) are associated with atopic changes and they might share the inflammatory mechanism (pro-inflammatory as well as anti-inflammatory cytokine abnormalities) during headache attacks

Validity and Reliability of the Turkish Migraine Disability Assessment (MIDAS) Questionnaire

Objectives.-The aim of this study is to assess the comprehensibility, internal consistency, patient-physician reliability, test-retest reliability, and validity of Turkish version of Migraine Disability Assessment (MIDAS) questionnaire in patients with headache. Background.-MIDAS questionnaire has been developed by Stewart et al and shown to be reliable and valid to determine the degree of disability caused by migraine. Design and Methods.-This study was designed as a national multicenter study to demonstrate the reliability and validity of Turkish version of MIDAS questionnaire. Patients applying to 17 Neurology Clinics in Turkey were evaluated at the baseline (visit 1), week 4 (visit 2), and week 12 (visit 3) visits in terms of disease severity and comprehensibility, internal consistency, test-retest reliability, and validity of MIDAS. Since the severity of the disease has been found to change significantly at visit 2 compared to visit 1, test-retest reliability was assessed using the MIDAS scores of a subgroup of patients whose disease severity remained unchanged (up to +/- 3 days difference in the number of days with headache between visits 1 and 2). Results.-A total of 306 patients (86.2% female, mean age: 35.0 +/- 9.8 years) were enrolled into the study. A total of 65.7%, 77.5%, 82.0% of patients reported that "they had fully understood the MIDAS questionnaire" in visits 1, 2, and 3, respectively. A highly positive correlation was found between physician and patient and the applied total MIDAS scores in all three visits (Spearman correlation coefficients were R = 0.87, 0.83, and 0.90, respectively, P 0.7) or excellent (>0.8) levels in both patient and physician applied MIDAS scores, respectively. Total MIDAS score showed good test-retest reliability (R = 0.68). Both the number of days with headache and the total MIDAS scores were positively correlated at all visits with correlation coefficients between 0.47 and 0.63. There was also a moderate degree of correlation (R = 0.54) between the total MIDAS score at week 12 and the number of days with headache at visit 2 + visit 3, which quantify headache-related disability over a 3-month period similar to MIDAS questionnaire. Conclusion.-These findings demonstrated that the Turkish translation is equivalent to the English version of MIDAS in terms of internal consistency, test-retest reliability, and validity. Physicians can reliably use the Turkish translation of the MIDAS questionnaire in defining the severity of illness and its treatment strategy when applied as a self-administered report by migraine patients themselves