The Assessment of Early Stage Computed Tomography Findings in Acute Ischemic Stroke

The imaging techniques have become important tools during diagnostic stage of acute ischemic stroke during the last 30 years. The improvement in these techniques further increased the clinical areas that these tools could be used. As computerized brain tomography (CT) is a rapid, cheap, non-invasive and highly available imaging tool in most hospitals, it remains to be the primary scanning method for all acute patients.The aim of this study was to evaluate the early stage CT findings in the ischemic stroke patients which have been scanned in the first 8 to 12 hours after the incidence. Sixty four cases (26 male, 38 female) who had clinical symptoms of ischemic stroke have been included in this study. CT scan was performed twice to these patients; first in the first 8 to 12 hours, and second in between 24 hours and 48 hours after the stroke. The middle cerebral artery perfused area was the most common arterial area affected among cases who had CT findings in early scans. Hypodense lesions were most common lesions encountered in CT findings. Hyperdense middle cerebral artery sign in early CT findings could be an indicator of ischemia due to arterial occlusion. We determined that the CT images obtained at the beginning of developing stroke appeared to show the lesions smaller than what they really were. There were significant differences between the emergency room evaluation and detailed clinical evaluation of CT scans. More findings have been observed in late CT scans performed between 24 hours and 48 hours than the ones performed in the first 8 hours and 12 hours. There was no correlation between the presence of CT findings in early scans and severity of clinical features of ischemia. CT appears to be an important tool in diagnosing ischemic strokes even at early stages. Developments in diagnostic precision of CT tools will further increase our understanding of ischemic strokes and their clinical progress

Stężenia transformującego czynnika wzrostu β1 i białka C-reaktywnego u chorych na migrenę

Background and purpose Migraine is a frequent form of headache. Although many mechanisms describing onset of migraine with and without visual aura have been suggested, the aetiology of migraine headaches is still not clear. Neurogenic inflammation may play a key role in the development of migraine headaches. We evaluated the discriminative power of serum levels of C-reactive protein (CRP) and transforming growth factor beta 1 (TGF-β1) in patients who presented to our clinic with migraine headaches with or without visual aura. Material and methods We designed a prospective case-control study of 51 patients with migraine (27 with migraine with aura and 24 with migraine without aura; all had headache) and compared them with 27 healthy subjects during the study period. Demographic and clinical characteristics recorded were age, sex, marital status, occupation, characteristics of headache, laboratory values, and serum CRP and TGF-β1 levels. Statistical analyses used Student t-test, the χ2 test, and ANOVA followed by the post-hoc Bonferroni test for multiple comparisons. Receiver operator characteristic (ROC)-curve analysis for CRP and TGF-β1 was also conducted. Results There was no difference between the groups in terms of demographic characteristics, marital status, and socioeconomic status. Statistically, white blood cell levels, serum glucose levels, triglyceride levels, high-density lipoprotein levels, and serum CRP and TGF-β1 were significantly higher in patients with migraine (p < 0.05). The ROC curve results in this study identified that CRP and TGF-β1 may discriminate patients who have different types of migraine headache. Conclusions This study suggests that serum CRP and TGF-β1 levels may be diagnostic factors to differentiate migraine patients with and without aura. These findings show that neurogenic inflammation may have a role in the aetiology of migraines.Wstęp i cel pracy Migrena jest częstą postacią bólów głowy. Wskazywano wiele mechanizmów biorących udział w inicjowaniu napadu migreny z aurą wzrokową lub migreny bez aury, ale etiologia migrenowych bólów głowy nadal pozostaje niejasna. Kluczową rolę w rozwoju migreny może odgrywać zapalenie neurogenne. W pracy oceniono moc dyskryminacyjną stężeń białka C-reaktywnego (CRP) i transformującego czynnika wzrostu β1 w surowicy pacjentów, którzy zgłaszali się do poradni z powodu bólów głowy w przebiegu migreny z aurą wzrokową lub bez aury. Materiał i metody W prospektywnym badaniu klinicznym z grupą kontrolną wzięło udział 51 chorych na migrenę (27 osób z migreną z aurą oraz 24 osoby z migreną bez aury; u wszystkich występował ból głowy) oraz 27 osób zdrowych. Rejestrowane zmienne demograficzne i kliniczne obejmowały: wiek, płeć, stan cywilny, zawód, charakterystykę bólu głowy oraz wyniki badań laboratoryjnych, w tym stężeń CRP i TGF-β1 w surowicy. W analizach statystycznych wykorzystano test t Studenta, test χ2 oraz analizę wariancji z testem post-hoc Bonferroniego ze względu na mnogie porównania. Przeprowadzono również analizę krzywych ROC dla CRP i TGF-β1. Wyniki Nie stwierdzono różnic między grupami w odniesieniu do charakterystyki demograficznej, stanu cywilnego lub społeczno-ekonomicznego. U chorych na migrenę obserwowano większą liczbę leukocytów we krwi obwodowej oraz większe stężenia glukozy, triglicerydów, lipoprotein o dużej gęstości, CRP i TGF-β1 (p < 0,05). W analizie krzywych ROC stwierdzono, że CRP i TGF-β1 mogą służyć do rozróżniania pacjentów z różnymi rodzajami bólów głowy. Wnioski Wyniki badania wskazują, że stężenia CRP i TGF-β1 mogą służyć do odróżniania pacjentów z migreną z aurą od chorych na migrenę bez aury. Wyniki te sugerują, że zapalenie neurogenne może odgrywać rolę w etiologii migreny

Multipl Skleroz: Sitokinler, Mr Lezyon Y�K�, G�Rsel Uyar�Lm��� Potensiyeller Ve Sakatl�K Puanlar� Aras�Ndaki Ili��kiler

Aim: The aim of this study was to investigate the relationships between the disability (EDSS) scores, magnetic resonance imaging (MRI) lesion burden, the visual evoked potential (VEP) latencies and the cytokine levels in patients with multiple sclerosis (MS) that previously not studied. Method: Study group consisted of 40 MS patients with either relapsing-remitting (RR) (n=29) or secondary progressive course (n=11) and control group comprised 35 matched healthy subjects. Student’s t test, Mann-Whitney U, Chi-squared and correlation analyses were used for statistical analyses. Result: In patient group EDSS scores varied from 1.5 to 8.5, all had abnormal MRI T2 plaque burden and 65.0% had abnormal VEP latencies. Serum levels of tumor necrosis factor-alpha (TNF-а) and interleukin-2 receptor (IL-2R) were significantly higher in patients compared to controls (P<0.001 and P<0.001, respectively). Serum levels of IL-6 and IL-10 were similar in patients and controls (P> 0.05). The total EDSS scores significantly correlated with the T2 plaque counts (r=0.637, P<0.001). Among all measured cytokines, only IL-8 levels were significantly correlated with the total EDSS scores and MRI lesion burden (r=0.590, P<0.001 and r=0.535, P<0.001, respectively). Other cytokine levels did not correlate with the disability scores, the amount of MRI lesions or the VEP latencies (P> 0.05). Conclusion: Our data indicate that despite clinical stability, immunological activity is not interrrupted in MS and the production of different cytokines were not uniformly affected by the immunomodulator medication. New therapeutic strategies correcting cytokine balance may be useful in MS.Amaç: Bu çalışmanın amacı multipl sklerozlu (MS) hastalarda sakatlık puanları (EDSS), magnetik rezonans görüntülemedeki (MRI) lezyon yükü, görsel uyarılmış potansiyel (VEP) gecikmeleri ve sitokin düzeyleri ilişkisini incelemektir. Metod: Çalışma grubu 40 MS’li hasta (29’u relaps-remisyon yapan tip, 11’i ikincil ilerleyici tip), kontrol grubu ise 35 eşlendirilmiş sağlıklı bireyden oluşturuldu. İncelenen değişkenler hast ve kontrol grubu arasında Student t testi, Mann-Whitney U testi, Ki-kare testi ile karşılaştırıldı ve korelasyon analizi kullanıldı. Bulgular:Hasta grubunun EDSS puanları 1.5-8.5 arasında değişiyordu, hepsinde anormal MRI T2 plak yükü vardı ve %65’inde anormal VEP gecikmesi mevcuttu. Serum TNF-alfa ve interlökin 2 reseptör düzeyleri hastalarda kontrol grubundan anlamlı yüksek bulundu (ırasıyla, p<0.01 ve p<0.001). Serum interlökin-6 (IL-6) ve IL-10 düzeyleri hasta ve kontrol gruplarında farklı bulunmadı (p>0.05). Total EDSS puanları T2 plak sayısı ile korele bulundu (r=0.637, p<0.001). Ölçülen tüm sitokinler içinde sadece IL-8 düzeyi total EDSS puanları ve MRI lezyon yükü ile korele bulundu (sırasıyla, r=0.590, p<0.001 ve r=0.535, p<0.001). Diğer sitokin düzeyleri sakatlık puanları, MRI lezyon yükü ve VEP gecikmeleri ile ilişkili bulunmadı (p>0.05). Sonuç: Elde ettiğimiz veriler klinik stabiliteye rağmen, MS’de immunolojik aktivitenin kesintiye uğramadığını farklı sitokinlerin üretiminin immunomodülatör tedaviyle tek düze etkilenmediğini göstermektedir. Sitokin dengesini düzeltecek yeni tedavi stratejileri MS’de yararlı olabilir

Investigation of Mean Platelet Volume in Patients with Multiple Sclerosis

OBJECTIVE: Alterations in platelet function have been observed in patient with multıple sclerosis (MS). Mean platelet volume (MPV) is a marker of the platelet activity and is reported to increase in vascular diseases. The aim of this retrospective study was to investigate the correlation between MPV and MS. METHODS: The patient group consisted of 46 MS patients who were presented to MS attacks (males/females: 10/36, mean age: 34.3±9.4). In the MS patients, during the attack MPV value compared with the value of MPV after attack. Also, their MPV values were compared with those of 38 age/sex-matched healthy individuals (males/females: 14/24, mean age: 36.4±10.4). RESULTS: No difference was found in terms of MPV values between during the attack of MS (8.0±1.2) and after MS attack (7.9±1.2), and no relation was found between MPV and EDSS parameters (p>0.05). No difference was found in terms of MPV values between the MS group (8.1±1.3) and control group (8.1±1.1) (p>0.05). CONCLUSION: As a result, no significant change in MPV was seen between the during the MS attack and after the MS attack. This finding support that platelet activation not an important role pathogenesis in MS. But, relation between MS and MPV should investigated with prospectively

The Changes in Status of Antioxidant Defence System on Temporary Cerebral Ischemia and the Protective Effect of Vitamin E and C

Time-dependent changes in antioxidant defence system and the effect ofvitamin C and E supplementation on temporary cerebral ischemia wasinvestigated in this study. This study was performed in 140 male Wistaralbino rats weighting 300-400g. Before 30 minutes cerebral ischemiavitamin E (α-tocopherol) 10 mg/kg/day and vitamin C 30 mg/kg/day wereapplied intraperitoneally for a week period. Animals were sacrifiedfollowing 24 h and 72 h ischemia and the brain was removed as quick aspossible. Brain water content, süperoxide dismutase (SOD) ) and catalase(CAT) activities and the level of nonenzymatic antioxidant, reduced vitaminC and α-tocopherol levels were measured. Moreover the level ofmalondialdehyde (MDA) as an indicator of lipid peroxidation wasdetermined. At 24 h of reperfusion superoxide dismutase (SOD) andcatalase (CAT) activities, vitamin C and E level decreased significantly inischemic brain area (p<0.05, p<0.05, p<0.01 and p<0.01 respectively). After72 h of reperfusion SOD and CAT activities surpassed the pre-ischemiclevel (p<0.01 and p<0.05 respectively). The level of vitamin C and Eincreased significantly at 72 hours after ischemia but, did not reach preischemiclevels (p<0.01 and p<0.01 respectively). Administration of vitaminC and E a week before cerebral ischemia prevented the decrease in SODand CAT activities after 24 hours of reperfusion (p<0.01 and p<0.01respectively). Furthermore, the increase in ischemia induced lipidperoxidation and cerebral edema were decreased significantly byadministration of these vitamins (p<0.01 and p<0.01 respectively). Invitamins applied groups, increase in SOD and catalase activities at 72 hoursafter ischemia was similar to control. The results indicated that there isnegative correlation between vitamin C or E level and lipid peroxidation orcerebral edema. Similar relationship was found between SOD or CATactivitiy and lipid peroxidation or cerebral edama.Temporary cerebral ischemia changed the state of anti-oxidant defencesystem and these changes were significantly prevented by treatment with Cand E vitamins before ischemia

The Increase of The Mean Platelet Volume in Patients With Intracerebral Haemorrhage

OBJECTIVE: The mean platelet volume (MPV) is a biomarker of platelet function and activity. The influence of platelet function disorders on the aetiology of intracerebral haemorrhages (ICH) and mortality is not clear yet. The purpose of this study is to investigate the change in the MPV values in patients with ICH and to observe its influence on mortality in a retrospective manner. METHODS: Sixty-six patients with intracerebral haemorrhage (32 males, 34 females; mean age: 61.9± 16.9) were enrolled in the study. Patients with ICH were divided into two groups as those who died within the first 10 days and those who survived. The MPV values and the haematoma volumes were compared between the groups. Also, the MPV values and platelet counts of the patients with ICH were compared with the values of healthy volunteers from similar age and sex groups (27 males, 17 females; mean age: 59.9 ±3.2). RESULTS: The MPV values of the patients with ICH measured within 24 hours following the intracerebral haemorrhage (8.33 ± 1.27 fl/mL) were statistically significantly higher than the MPV values of the control group (7.76 ± 1.14 fl/mL) (p=0.018). The platelet counts of the patients with ICH also measured within the first 24 hours (235.8±94.9 x103/mL) were statistically significantly lower than the platelet counts of the control group (279.1 ± 94.9 x103/mL) (p=0.022). No statistically significant difference in terms of the MPV values and platelet counts was observed between the patients with ICH who died within the first 10 days and those who survived (p>0.05). However, the difference observed in the haematoma volume between the patients with ICH who died within the first 10 days (31.1 ±33.7 ml) and those who survived (8.7± 13.4 ml) was statistically significant (p<0.001). No correlation was found between the haematoma volume and the MPV value in the patients with ICH. CONCLUSION: The increase observed in the mean platelet volume in patients with ICH may point to a disorder in the platelet function. No relationship was found between the increase in the MPV and the mortality rates

Evaulation of Matrix Metalloproteinase-2 and Matrix Metalloproteinase-9 Levels in Acute and Subacute Periods of Ischemic Stroke

Objective: Atherosclerosis and inflammatory mechanisms play an important role in the pathogenesis of cerebral isch­emia. The activity of Matrix metalloproteinases (MMP) is essential for many of the processes involved in atherosclerotic plaque formation, such as infiltration of inflammatory cells, smooth muscle cell migration and proliferation. There are a few studies referring to the importance of MMP-2 and MMP-9 levels for the stroke severity and prognosis in acute ischemic stroke In this study, MMP-2 and MMP-9 levels in acute and subacute periods and the relationship between Glasgow coma scale (GCS) will was assessed. Methods: Seventy ischemic stroke patients who fulfilled the study criteria are included to our study prospectively. Serum MMP-2 and MMP-9 antibody levels calculated by ELISA method at period of the acute and subacute ischemic stroke. Results: Average serum MMP2 antibody levels are 4.28 ± 3.36 acute period and 2.27 ± 2.62 (p˂0.05) in subacute period. Also average serum MMP9 antibody levels are 4.28 ± 3.36 acute period and 2.83 ± 3.83 (p˂0.05). It was not observed correlation between MMP-2 and MMP-9 levels and GCS. Conclusion: These results suggest that MMP-2 levels in the patients with ischemic stroke show a statistically significant difference when compared acute and subacute period. We conclude that MMP-2 may important role on the ischemic stroke

Serum vitamin B12, folic acid and ferritin levels in patients with migraine

OBJECTIVE: It has been reported that disability due to migraine may be reduced with homocysteine-lowering treatment including folic acid and vitamin B12. In addition, recently the periaqueductal gray matter iron deposits have been found to be increased in migraine patients. There are few studies regarding vitamin B12, folic acid, ferritin and transferrin levels in patients with migraine. The aims of this study was to measure vitamin B12, folic acid, ferritin and transferrin levels in patients with migraine and compare them with the control group. METHODS: Fifty-one consecutive newly diagnosed migraine patients who did not receive any vitamin supplement medication were enrolled. The study group consisted of 51 patients, suffering from migraine with aura (n= 23) and migraine without aura (n= 28). The control group consisted of 28 healthy participants without history of headache, anemia and vitamin supplement. Serum vitamin B12, folic acid, ferritin and transferin levels were measured using a chemiluminescence method. RESULTS: Migraine patients had significantly lower concentrations of vitamin B12 and folic acid compared with the healthy controls (for vitamin B12; 215.6±133.7 pg/ml vs. 289.9±12 pg/ml, respectively, p=0.005; for folic acid; 6.74 ± 4.31 pg/ml vs. 8.47 ± 1.85 pg/ml, respectively, p=0.048). The vitamin B12 levels were found to be significantly lower during attacks in migraine patients than in interictal periods (177.3 ± 139.2 pg/ml vs 252.5 ± 119.5 pg/ml, p=0.043). There were no differences in folic acid, ferritin, and transferritin levels between during attacks and in interictal period of patients with migraine (p>0.05). The ferritin levels were found to be significantly lower during attacks in migraine patients than in interictal periods (43.4 ± 41.1 mg/ml, vs 75.4 ± 51.7, mg/ml, p=0.018). CONCLUSION: Migraine patients had lower serum vitamin B12 and folic acid levels than healthy subjects. These findings supported that vitamin B12 and folic acid may have a role in migraine pathogenesis and they may be given in migraine prophylaxis. Also, this study indicated that iron homeostasis was disturbed in migraine attacks