Mechanical Thrombectomy for Minor Stroke Patients (NIHSS<6) With Large Vessel Occlusion

INTRODUCTION: Large vessel occlusion can present with minor stroke in 30% of cases. Although the efficacy of mechanical thrombectomy in minor stroke National Institute of Health Stroke Scale (NIHSS<6) has been shown in subgroups of clinical trials, there is no randomized clinical trial focusing on this patient group. METHODS: 8 patients (3 female, 5 male) presenting with minor stroke (NIHSS<6) with large vessel occlusion on CT angiography were included. Thrombolytic treatment was administered in 5 patients presenting in 4.5 hours. Mechanical thrombectomy was performed within 6 hours in 5 patients and in 3 patients presenting beyond 6 hours. Modified treatment in cerebral ischemia (mTICI) 2b-3 was considered as successful recanalzation, functional outcome was evaluated at 90 day. RESULTS: 8 patients with ages between 40 and 81 years were included in the study. Successful recanalization (mTICI 2b-3) was achieved in all cases. 3 patients were not eligible for intravenous thrombolysis due to late arrival time. In these cases, after clinical deterioration occured mechanical thrombectomy was performed. 90 day mRS were 2, 4 and 5 in these 3 cases. 90 day modified Rankin Scale (mRS) were between 0-2 in all 5 patients treated within 6 hours. DISCUSSION AND CONCLUSION: Although there are few cases, our study demonstrated that mechanical thrombectomy is more efficaceous in minor stroke patients when performed earl, as demonstrated in other studies

Akut İskemik İnmede Yeni Bir Biyobelirteç Olan Serum NR2 Düzeyinin İnmenin Şiddeti ve Prognozu ile İlişkisi

Giriş: Akut iskemik inme tanısı için klinik deneyim ve görüntüleme bulgularını destekleyecek kan testine ihtiyaç vardır. Bu çalışma- da serum NR2 antikor düzeyinin akut iskemik inme tanısındaki değerinin ortaya konması amaçlandı. Gereç ve yöntem: Çalışmaya prosfektif olarak, çalışmaya alınma kriterlerini dolduran 64 iskemik inmeli hasta ile 68 sağlıklı gönüllü dahil edildi. İskemik inmenin akut döneminde serum NR2 anikor düzeyi ELİSA yöntemi ile ölçüldü. İnmenin şiddeti ve prognozu, giriş NIH İnme Skalası, 3. Ay modifiye Rankin Skalası ve Barthel indexi skorları ile, enfarkt hacmi AXBXC/2 hesaplamasıyla belirlendi. Sonuçlar Kolmogorov Smirnov, Tukey HSD, Wilcoxon ve Mann-Whitney U Testi kullanılarak NR2 düzeyi ile kıyaslandı. Bulgular: Ortalama serum NR2 antikor düzeyi iskemik inme grubunda 2.64±1.43 iken, kontrol grubunda 2.28±1.13 idi. Gruplar arasındaki fark istatistiksel olarak anlamlı değildi. S100B değerlerinin yaş, cinsiyet, koroner arter hastalığı, diyabetes mellitus, hiperlipidemi, hipertansiyon, periferik damar hastalığı, sigara içiminden etkilenmediği görülmüştür. Sonuç: Bu çalışma sonuçları NR2 antikor düzeyinin akut iskemik inmeli hastalardaki serum düzeylerinin normal kontrollere göre farklı olmadığını gösterdi. Bu verilere göre iskemik inmede NR2 antikor düzeyinin etkili bir rol almadığını düşünüyoru

Subclavian Steal Syndrome Treated by Endovascular Approach in the Interventional Neurology Clinic

Subclavian steal syndrome is a clinical feature displayed due to decrease or reverse of blood flow in the ipsilateral vertebral artery resulting from severe stenosis or occlusion of the proximal subclavian artery. Subclavian steal syndrome was first described and defined by angiography. The best treatment of subclavian steal syndrome is still controversial, although balloon angioplasty and/or stenting procedures have been generally accepted during the past decade. We report a case of subclavian steal syndrome successfully treated by stenting of the left subclavian artery in our interventional neurology clini

A Case of Systemic Lupus Erythematosus Presenting with the Clinical Picture of Recurrent Cerebral Venous Thrombosis and Devic-Like Syndrome

Systemic lupus erythematosus(SLE) which is generally related to central or peripheral nervous system abnormality is a complex and multisystem involving disease. Neurological involvement in SLE is known as bad prognostic criteria and considered as the major cause of mortality. 27 year old female patient was admitted to our clinic with the clinical pictures of recurrent cerebral venous thrombosis and myelitis accompanying to optic nerve involvement. While she has been evaluated for the etiology she was diagnosed as systemic lupus erythematosus because of establishment of the antibodies ANA ve Anti SS-A. Her response to endoxan and steroid treatment was good.In this paper we aimed to emphasize the significances of consideration of the diagnosis of SLE and immediate and appropriate immunosupressive treatment in patients applying in the clinical pictures of cerebral venous thrombosis and myelitis with optic nerve involvement eventhough they do not have the cardinal symptoms of the disease

Understanding the Burden of Atrial Fibrillation and Importance of Screening: A Global Perspective and Recommendations for Turkey

Considering the aging population, the increase in predisposing factors, and the improvement in healthcare with increased survival rates, atrial fibrillation has been the most common cardiac arrhythmia in adults with a rise in the estimated lifetime risk over recent years. While aging is a powerful risk factor for atrial fibrillation, the leading prevalent comorbidities are hypertension, heart failure, obesity, obstructive sleep apnea, diabetes mellitus, and chronic kidney disease. Atrial fibrillation is associated with substantial morbidity, impaired quality of life, and increased mortality and healthcare costs. As a significant proportion of the total atrial fibrillation population is asymptomatic or mildly symptomatic, early identification and initiation of appropriate treatment for atrial fibrillation may prevent potentially detrimental outcomes such as stroke and heart failure and decrease all-cause mortality. Although screening via evolving health technologies has recently been emerging, verification of the electrocardiogram track recording over at least 30 seconds by a physician with expertise is still required for a definite diagnosis. Based on the global and national data and the current healthcare environment in Turkey, this targeted review with cardiology, neurology, and family physicians' perspectives highlights the importance of early detection by implementing the advancing screening modalities as well as the need for raised awareness of both patients and healthcare professionals and establishment of a multidisciplinary clinical approach for a better outcome in atrial fibrillation management.PfizerThis study is funded by Pfizer

Intravenous Thrombolytic Therapy in Acute Stroke: Problems and Solutions

Akut iskemik inme tedavisinin kritik elementlerinin başında gelen intravenöz doku plazminojen aktivatörü (tPA) kullanımının yirmi yılı aşkın süre içinde ülkemizde yeterince yaygınlaşamamasının başta gelen nedenlerinden biri, kullanımına dair birçok sorunun yanıtsız kalmasıdır. Ancak, son gelişmeler ile bu soruların pek çoğuna yeterli açıklamanın getirilebilmiş olması önemli bir anlayış değişikliğine yol açmaktadır. Bu makalede akut inmede tPA tedavisi ile ilgili uzmanlarımızın yönelttiği birincil olarak nörolojik sorulara ilişkin yanıt ve açıklamalar mevcut literatür ışığında etraflıca ele alınmış ve herbiri için net tavsiyelerde bulunulmuşturUse of intravenous tissue plasminogen activator (tPA) is one of the key elements of acute ischemic stroke management. Its use has not become widespread, and has faced significant problems in our country for more than a quarter of a century most probably due to many unanswered questions about issues related with daily practice. However, recent developments, which adequately focused and found solutions for most of these problems and questions, have led to a major change of point of view and understanding of the hyperacute management of stroke. This article, in the light of the relevant literature, discusses and provides clear recommendations for questions directed by neurologists practicing in Turkey mainly about typical neurologic issues faced in the setting of tPA use for acute strok

DSA Experience In Interventional Neurology Clinic: Analysis of Patients

OBJECTIVE: In recent years, Digital Subtraction Angiography (DSA) and endovascular treatment’s importance increases gradually. We aimed to emphasize the importance of the Interventional Neurology in neurology practice and we aimed to share our experience about DSA examination which we have done for a short time in our Neurology clinic. MATERIAL and METHODS: 27 patients with a diagnosis of carotid stenosis or aneurisym were included in the study between June 2011 and June 2012. Patients were between the ages of 24 and 78 and the average was 59.7 years old. DSA examination was applied in our Interventional Neurology Clinic and their results were analysed. RESULTS: Seven female and 20 male, total 27 patient, with the average age of 59.7, were analyzed. One patient with the diagnosis of subclavian steal syndrome, 4 patient with the diagnosis of the aneurisym, 22 patient with the diagnosis of the carotid stenosis were underwent to DSA examination. Dural arteriovenous fistula was determined in one of four patients with the diagnosis of aneurysm and in another patient, vertebrobasilar and bilateral carotid dolichoectasia was determined. In DSA examination, over 70% of the internal carotid artery stenosis were found in five of 22 patients with the diagnosis of carotid stenosis. In six patients right total internal carotid artery stenosis was determined. Carotid stent implantation were applied in four of 5 patients. CONCLUSION: Despite advances in noninvasive diagnostic neuroimaging, diagnostic cervicocerebral angiography remains the criterion standard for the evaluation of patients with cerebrovascular disease

Intravenous Thrombolytic Therapy in Acute Stroke: Frequent Systemic Problems and Solutions

Akut iskemik inme tedavisinin ana elementlerinin başında gelen intravenöz (IV) doku plazminojen aktivatörü (tPA) kullanımının yeterince yaygınlaşamamasının en önemli nedenlerinden biri sık karşılaşılan birçok soruya yeterince yanıt veril(e)memiş olmasıdır. Bu derlemede akut inmede IV tPA tedavisi ile ilgili olarak meslektaşlarımızdan toplanan, daha çok uygulamada önemi olan sistemik soru ve sorunlar ile tedavinin komplikasyonlarına dair, sorulara güncel literatür temelinde yanıt verilmiş ve net tavsiyelerde bulunulmuşturOne of the most important reasons why the use of the intravenous (IV) tissue plasminogen activator (tPA), which is one of the key elements of acute ischemic stroke treatment, is not sufficiently widespread is the fact that many common questions have not been adequately answered. In this review, questions about systemic nonneurologic conditions, problems related with IV tPA treatment and complications of treatment, which were collected from our colleagues practicing in Turkey and which are more important in clinical practice, were answered on the basis of the current literature and clear recommendations are mad