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

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

Clinical and Demographic Characteristics and Two-Year Efficacy and Safety Data of 508 Multiple Sclerosis Patients with Fingolimod Treatment

Introduction: Fingolimod is the first oral immunomodulatory treatment used as secondary care therapy in the treatment of multiple sclerosis for the last 10 years. The objective of our study is to reveal the experiences of the first generic fingolimod active ingredient treatment in different centers across Turkey. Method: The first generic fingolimod efficacy and safety data of patients followed-up in 29 different clinical multiple sclerosis units in Turkey were analyzed retrospectively. Data regarding efficacy and safety of the patients were transferred to the data system both before the treatment and on the 6th, 12th and 24th month following the treatment. The data were analyzed using the IBM SPSS 20.00. P value of <0.05 was considered to be statistically significant. Results: A total of 508 multiple sclerosis patients, 331 of whom were women, were included in the study. Upon comparing the Expanded Disability Status values before and after the treatment, a significant decrease was observed, especially at month 6 and thereafter. Since bradycardia occurred in 11 of the patients (2.3%), the first dose had to be longer than 6 hours. During the observation of the first dose, no issues that could prevent the use of the drug occured. Side effects were seen in 49 (10.3%) patients during the course of fingolimod treatment. Respectively, the most frequent side effects were bradycardia, hypotension, headache, dizziness and tachycardia. Conclusion: The observed results regarding efficacy and safety were similar to clinical trial data in the literature and real life data in terms of the first equivalent with fingolimod active ingredient