Cognitive Profile of Inpatients

Objective: Cognitive deterioration has negative effects on the duration of a patient’s hospital stay. Pre-recognition of patients’ cogitive characterictics affects treatment success. We want to put forward the cognitive profiles of inpatients.Material and Methods: One hundred-six hospitalized patients over 50 years of age were assessed between 01-15 February 2009. Patients, not coooperative because of loss of consciousness and those who stayed in hospital because of primary cognitive disorder, have been excluded from study. At first evaluation, patients having cognitive deterioration have been re-evalued at a dementia clinic and the patients’cognitive profile identified. Groups with or without cognitive deterioration were compared for demographic properties. Results: Fifty-seven (%53.7) of 106 patients took 24, under 24 score from MMSE. 30 patients (28.3%) of 106 had mild cognitive deficiency. 8 patients (7.5%) had primary dementia syndrome. When groups with and without cognitive deterioration were examined, there was no difference in gender and family history (p=0.48, p=0.58). The mean age of the group with cognitive deterioration was higher, but lower educational level (p=0.008, p=0.006). MMSE scores were orderly 18.7±2.3, 25.5±2.2 (p<0.001). Interestingly, complaints of forgetfulness were higher than normal in the patients (33%, 67%). 71% of patients believed that forgetfullness is not a disease and could not be treated. Conclusion: Cognitive failure are seen more frequently in inpatients. Relatives, responsible for the patient and medical staff are not aware of failure

Babinski-Nageotte Syndrome Diagnosed in Postpartum Period

Babinski-Nageotte Syndrome (BNS) is one of the brainstem syndromes characterized by muscle weakness in the opposite half of the body with classic Wallenberg findings. According to our literature survey, only a few cases have been reported and none of them was in the postpartum period. We report a case of a typical BNS in a postpartum woman with an ischemic lesion in the medulla oblongata shown on magnetic resonance imaging

Factors Associated with Prognosis in Patients with Guillain-Barré Syndrome

Objective: We aimed to evaluate the demographic, clinical, laboratory and electrophysiological findings of patients with inpatient Guillain-Barré syndrome in our clinics and to investigate the effect of these parameters on the prognosis of the disease. Materials and Methods: Between January 2014 and April 2018, file records of patients admitted to our clinics with the diagnosis of Guillain-Barré syndrome were retrospectively reviewed. Demographic characteristics, clinical, laboratory and electrophysiological findings of the patients at the time of admission were recorded. Patients were clinically graded according to the Hughes classification at the time of admission and on the 3rd month after discharge. Results: In the study, 25 of the 51 patients were male (49%) and 26 were female (51%) and the mean age was 54.21±17.32 years. According to clinical and electrophysiologic diagnosis, 34 patients (66.7%) had acute inflammatory demyelinating polyradiculoneuropathy, 9 patients (17.6%) had acute motor axonal neuropathy, 6 patients (11.8%) had acute motor sensory axonal neuropathy and 2 patients (3.9%) had Miller Fisher syndrome. According to Hughes scoring on the 3rd month after discharge, 31 patients (60.8%) had in good prognosis (Hughes score ≤2) and 20 patients (39.2%) had in poor prognosis group (Hughes score >2). In the comparison between the two groups according to clinical, demographic, and laboratory parameters, older age (≥50), high Hughes score at admission, weakness in extremities as first complaint, the presence of complications, need for mechanical ventilation and presence of gastroenteritis as a leading infection were evaluated as prognostic factors. Conclusion: The most common variant of Guillain-Barré syndrome in our study was acute inflammatory demyelinating polyradiculoneuropathy. Older age (≥50), high Hughes score at admission, weakness in extremities as the first symptom, presence of complications, need for mechanical ventilation, and presence of gastroenteritis as a precursor infection were poor prognostic factors

Bilateral thalamic infarction that is secondary thrombosis to the deep venous structures: report of two cases

Deep cerebral venous thrombosis cases are the %6 of the cerebral venous thrombosis (CVT) cases. The recognition of these patients is difficult since this disease is rarely observed and its clinical presentation is nonspecific and variable. In its etiology, the most frequently observed reasons are hypercoagulopathy, oral contraceptive use, pregnancy, puerperium, dehydration, and head trauma. Less frequently observed reasons are vasculitis, inflammatory bowel disease, malignancies, anemia, and tumor invasion through venous sinuses. In this report, were presented two cases who were admitted to the hospital with headache complaint and cognitive changes.According to the advanced magnetic resonance imaging, acute infarction was detected in bilateral thalamus. We observed CVT with adversely affected deep cerebral venous system structures. CVT development was associated with the use of oral contraceptives in the first case and it was associated with anemia in the second case. Both patients were discharged from the hospital upon healing with anticoagulant therapy. In this study, it has been emphasized by representing these two patients that CVT should be thought in the etiology of bilateral thalamic ischemia. Furthermore, it is also crucial to known that these patients can be fully improved clinically and radiologically in case appropriate medical treatment is applied

Intravenous thrombolytic treatment experiences in patients with acute ischemic stroke at the University of Kocatepe, Neurology Clinics

INTRODUCTION: This study aimed to discuss the results of the intravenous thrombolytic treatment (IV-tPA) to acute ischemic stroke patients, in the light of the literature. METHODS: We performed our study with forty acute ischemic stroke patients who were receiving the IV-tPA in the intensive care unit of our neurology clinic between 2011 and 2015.. The demographic, clinical and radiological data were collected retrospectively. The intracranial hemorrhage detected within 3 months after discharge and neurological status at the end of the 3rd month were evaluated by using modified Rankin scale (MRS) and National Institutes of Health Stroke Scale (NIHSS) scores. The symptom-to-needle time, Alberta stroke programe early computed tomography score (ASPECT) and initial and follow-up scores of NIHSS were analyzed. RESULTS: Fifteen patients were female, twenty-five were male, and the mean age was 66.45±10.56. The initial mean NIHSS score was 13±4.33, whereas it was 4,10±3,37at 3rd month. The initial mean ASPECT score was 8.23±1.20. Symptomatic intracranial hemorrhage was detected in 1 patient and asymptomatic intracranial hemorrhage was detected in 6. The mean symptom-to-needle time was 139,0±48,1 minutes. The neurological disability of 13 patients ( %32.5) were fully recovered at the end of the 3rd month, while 7 patients were died. (% 17,5) The initial NIHSS and ASPECT scores were significantly different between group of patients with a MRS score between 0-2 and between 3-6 (p=0.03 and p=0.006; respectively), while the symptom-to-needle time was not different (p=0.79). DISCUSSION AND CONCLUSION: The results of the current study are in accordance with previous studies in the literature. These results have shown that the IV-tPA treatment is efficient and safe treatment modality in acute ischemic stroke, and reduces disability at the end of the 3rd month

Gastrostomy in hospitalized patients with acute stroke: "NoroTek" Turkey point prevalence study subgroup analysis

Objective: Nutritional status assessment, dysphagia evaluation and enteral feeding decision are important determinants of prognosis in acute neurovascular diseases. Materials and Methods: NöroTek is a point prevalence study conducted with the participation of 87 hospitals spread across all health sub regions of Turkey conducted on 10-May-2018 (World Stroke Awareness Day). A total of 972 hospitalized neurovascular patients [female: 53%, age: 69±14; acute ischemic stroke in 845; intracerebral hematoma (ICH) in 119 and post-resuscitation encephalopathy (PRE) in 8] with complete data were included in this sub-study. Results: Gastrostomy was inserted in 10.7% of the patients with ischemic stroke, 10.1% of the patients with ICH and in 50% of the patients with PRE. Independent predictors of percutaneous endoscopic gastrostomy (PEG) administration were The National Institutes of Health Stroke Scale score at admission [exp (β): 1.09 95% confidence interval (CI): 1.05-1.14, per point] in ischemic stroke; and mechanical ventilation in ischemic [exp (β): 6.18 (95% CI: 3.16-12.09)] and hemorrhagic strokes [exp (β): 26.48 (95% CI: 1.36-515.8)]. PEG was found to be a significant negative indicator of favorable (modified Rankin’s scale score 0-2) functional outcome [exp (β): 0.032 (95% CI: 0.004-0.251)] but not of in-hospital mortality [exp (β): 1.731 (95% CI: 0.785-3.829)]. Nutritional and swallowing assessments were performed in approximately two-thirds of patients. Of the nutritional assessments 69% and 76% of dysphagia assessments were completed within the first 2 days. Tube feeding was performed in 39% of the patients. In 83.5% of them, tube was inserted in the first 2 days; 28% of the patients with feeding tube had PEG later. Conclusion: The NöroTek study provided the first reliable and large-scale data on key quality metrics of nutrition practice in acute stroke in Turkey. In terms of being economical and accurate it makes sense to use the point prevalence method.Amaç: Akut nörovasküler hastalıklarda nütrisyonel durum ve disfaji değerlendirmesi ve enteral beslenme kararı önemli prognoz belirleyicilerindendir. Gereç ve Yöntem: NöroTek, 10 Mayıs 2018’de (Dünya İnme Farkındalık Günü) Türkiye’nin tüm sağlık alt bölgelerine yayılmış 87 hastanenin katılımıyla gerçekleştirilen bir nokta prevalans çalışmasıdır. Hastanede yatan ve bu alt çalışma için toplanan verisi tam olan toplam 972 nörovasküler hasta (kadın: %53, yaş: 69±14 yıl; 845’i akut iskemik inme; 119’u intraserebral hematom ve 8’i post-resüsitasyon ensefalopatisi) analiz edildi. Bulgular: Gastrostomi iskemik inmeli hastaların %10,7, intraserebral kanamalıların %10,1 ve post-resusitasyon ensefalopatisi olanların %50’sine uygulanmıştır. Perkütan endoskopik gastrostomi (PEG) gereksiniminin bağımsız belirleyicileri, iskemik inme grubunda kabul NIHSS [exp (β): 1,09, %95 güven aralığı (GA): 1,05-1,14, puan başına] ile hem iskemik hem de hemorajik inmelerde mekanik ventilasyon uygulanmış olmasıdır [iskemik için: exp (β): 6,18, %95 GA: 3,16- 12,09] ve hemorajik inme için: [exp (β): 26,48, 95% GA: 1,36-515,8]. İnme olgularında PEG uygulaması hastane içi mortalite için bağımsız belirleyici değildi [exp (β): 1,731, 95% GA: 0,785-3,829]. Ancak, PEG uygulanmış olması taburculuk esnasında iyi prognoza (modifiye Rankin skoru 0-2) sahip olabilme için anlamlı bir negatif etmen olarak bulundu [exp (β): 0,032, %95 GA: 0,004-0,251]. Hastanede yatan nörovasküler hastaların yaklaşık üçte ikisinde malnütrisyon ve yutma bozukluğu açısından değerlendirme yapılmıştı. Nutrisyonel status değerlendirmesinin %69’u ve disfaji değerlendirmesinin %76’sı ilk 48 saat içinde gerçekleştirilmişti. Tüple enteral nütrisyon uygulama oranı %39’du. Beslenme tüplerinin %83,5’i ilk 2 gün içinde yerleştirilirken beslenme tüpü olan hastaların %28’ine daha sonra PEG açılmıştı. Sonuç: NöroTek çalışması ile Türkiye’de hastanede yatan akut inme hastalarında nutrisyonel uygulamaların temel kalite ölçütlerine ilişkin ilk güvenilir ve büyük ölçekli veri sağlanmıştır. Ekonomik olması ve doğruluğu açısından nokta yaygınlık yönteminin bu tip verilerin temini için daha fazla kullanılması mantıklıdır