Analyzing the Effect of Comorbidities and Drug Usage in Clopidogrel Unresponsive Patients

INTRODUCTION: OBJECTIVE: Clopidogrel is a widely used antiplatelet in vascular events. However multiple drug prescriptions increase the risk for drug-drug interactions. The purpose of the study is to rule out the factors leading to clopidogrel responsiveness including the comorbidities and drugs. METHODS: In this retrospective study, ischemic stroke patients who were being treated with clopidogrel for at least one year were eligible for enrollment.Clopidogrel resistance was measured with MEA. The comorbities and the medical treatment of the patients were noted. RESULTS: 92 patients were included the study. 49 % of them were male and the median age was 69,19±12,08. 44.6 % of the patients were unresponsive to clopidogrel. Hypertension, hyperlipidemia and diabetes mellitus were not associated with a decreased response to clopidogrel. Similarly, we did not observe any drug-drug interactions between clopidogrel and oral antidiabetics, insulin, antihypertensives, antilipidemics and proton pump inhibitors. Age and gender were also not associated with clopidogrel responsiveness. DISCUSSION AND CONCLUSION: CONCLUSION: Our study indicates that 45% of patients had a decrease response to clopidogrel. However we found no relation between clopidogrel resistance and the factors mentioned in previous studies. This could be attributed to other unknown factors leading to drug resistance

An internal cerebral artery dissection presented with anterior choroidal artery infarction

Anterior choroidal artery (AchA) is a branch of internal carotid artery. AchA infarcts are frequently presented by lacunar syndromes. Hemiparesis is the most common presenting symptom. Horner syndrome and cranial nerve palsies are unusual findings for AChA infarcts. In case of presentation with these, etiopathogenesis should be reconsidered and reevaluated. A 42 year old man was admitted to our neurology clinic with right hemiparesis. He had Horner syndrom and hypoglossal nerve palsy. An acute AChA infarction was seen in cranial and diffusion-weighted magnetic resonance imaging (MRI). As there was a suspicious sign of carotid dissection in extracranial MR angiography, digital substraction angiography was performed and dissection of left carotid artery in the subpetrosal region was observed. The patient was diagnosed with left carotid artery dissection and was started on oral anticoagulan therapy. Presentation of an acute AChA infarction due to the dissection of ICA is rarely observed. ICA dissections can sometimes be presented by Horner syndrome and/or cranial nerve palsies. Especially in young stroke patients, dissection should be considered even if the patient does not mention headache

Pseudo subarachnoid Hemorrhage: A Finding of Diffuse Cerebral Edema Leading to Misdiagnosis

Increased attenuation of the basal cisterns and subarachnoid spaces on CT scans is a characteristic finding of acute subarachnoid hemorrhage. CT mimics of SAH have been called pseudo-SAH. Our case is presented to underline the differentiation of two diagnosis. A 63-year-old man was admitted to the emergency room with right-sided hemiparesis and aphasia. He had middle cerebral artery enfarct on his CT. A week after his hospitalisation his neurological examination was deteriorated. A plain CT-scan of brain was consistent with sub-arachnoid hemorrhage. His antiagregant therapy was ended and anti edema therapy started. Urgent neurosurgical consultation was sought & surgery was not planned. Brain death was the finding in his CT angiography. So the CT-scan findings turned out to be `pseudo sub-arachnoid haemorrhage’.Pseudo sub-arachnoid haemorrhage is a rare CT scan finding that has been reported in different cerebral disease with cerebral edema. MR imaging studies, CSF examination by lumbar puncture and the criterias proposed by Yazawa can be useful to make the diagnosis. The aim is the unnecessary termination of antiagregant and anticoagulant therapy

The role of genetics in stroke risk factors; the discussion of two rare genetic syndroms associated with stroke and review of the literature

Stroke is defined as a focal or at times global neurological impairment of sudden onset, that lasts more than 24 hours or that leads to death. The nonmodifiable risk factors for stroke include age, race, gender and acquired risk factors include smoking, hypertension, diabetes and obesity. Previous studies have shown that these mentioned risk factors might be responsible for approximately 50% of patients presenting stroke. However for the remaining half of the stroke patients no risk factors could be detected and genetics might be responsible for this group. In this manuscript we would like to present 2 cases who were being followed-up with the rare genetic syndromes as Marfan syndrome and Robinow syndrome respectively. These patients presented to our clinic with stroke and no identifiable risk factors other than these genetic syndromes could be detected. By this case-series we would like to further discuss the relationship between genetic syndromes and stroke

A Case of Neurosyphilis Presenting with Multiple Cranial Neuropathy

Syphilis is a sexually-transmitted disease caused by the spirochete bacterium Treponema pallidum. Central nervous system involvement can occur in every stage of the disease. It is classified into: acute syphilitic meningitis, meningovascular syphilis, and parenchymatous neurosyphilis. Acute basilar syphilitic meningitis is characterized primarily by the presence of cranial nerve involvement. As cranial nerve enhancement may be seen in a broad range of diseases, it can be the only clinical feature of neurosyphilis