İskemik İnmede Penumbral Alanın Sonuç İnfarkt Hacmi ve Klinik Prognozu Üzerine Etkisi

Amaç: Klinik seyir üzerine yapılan çalışmalar inme progresyonunu takip etmede çok önemli bir yer tutar. Perfüzyon MR görüntülemelerinin akut iskemik inmede kullanıma girmesi penumbral alanın tespiti ve kurtarılması adına önemli bir köşe taşı olmuştur. Gereç ve Yöntem: İlk 24 saat içinde akut iskemik inme atağı geçiren hastaların geliş difüzyon ve perfüzyon ağırlıklı manyetik rezonans görüntülemeleri MRG tespit edildi. Perfüzyon-difüzyon uyumsuzluğu ciddi, orta-hafif ve olmama durumlarına göre 3 gruba ayrıldı. İyi klinik yanıt İKY gelişip gelişmediği başlangıç ve 15. gün klinik skorları The National Institute of Health Stroke Scale, European Stroke Scale and Modified Rankin Scale kullanılarak tespit edildi. Finalde lezyon hacim FLH büyümesi tespiti için 15. gün çekilen T2 ağırlıklı MRG ile başlangıç difüzyon ağırlıklı MRG hacim farkları alındı. Bulgular: Ciddi uyumsuzluğun olduğu grupta FLH de büyüme, hafif-orta uyumsuzluk olan gruba ve uyumsuzluğu olmayan gruba göre anlamlı derecede yüksek idi sırasıyla, median: 37 cm3, %95 CoI: 26.0-55.0; median: 10 cm3, %95CoI: 0-16.0; median: - 1.50 cm3, %95 CoI: -4.0 /8.0, χ2 = 8.294, p=0.017 . Uyumsuzluk ciddiyetinin İKY ile sonlanmaya etkisi ise istatistiksel olarak anlamlı değildi χ2:1.959, p:0,162 . İKY’nin elde edilme oranı FLH de büyüme olmayan grupta büyüme olan gruba göre istatistiksel olarak anlamlı düzeyde yüksek bulundu χ2:7,62, p:0,02 . Ancak ile İKY elde etme adına FLH hacim değişiminin bağımsız bir prediktör özelliği bulunmamıştır p:0.086, OR:0.972, %95CI:0.942-1.004 . Sonuç: Bu çalışmanın sonuçları şiddetli difüzyon-perfüzyon uyumsuzluğu olan akut iskemik inmeli hastaların radyolojik ve klinik gidişatları daha ciddi olabilir ve tedavide daha dikkatli olunmalıdır

Delirium in patients with acute ischemic stroke admitted to the non-intensive stroke unit: Incidence and association between clinical features and inflammatory markers

Background Stroke patients with development of delirium have unfavorable outcomes, higher mortality, longer hospitalizations, and a greater degree of dependence after discharge. Studies suggest that delirium is associated with abnormal immunological responses and a resultant increase in inflammatory markers. Objective Our aim was to determine whether there is an entity relationship between delirium, inflammation and acute ischemic stroke (AIS). Methods Sixty AIS patients admitted to the hospital were consecutively recruited. Delirium was diagnosed with the clinical assessment according to the Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria. Enzyme-linked immunosorbent assay (ELISA) was used to measure serum levels of Interleukin-1 beta (IL-1 beta), Interleukin 18 (IL-18), Tumor Necrosis Factor-alpha (TNF-alpha), Brain-Derived Neurotrophic Factor (BDNF), and Neuron Specific Enolase (NSE) at admission. Results Eleven (18.3%) of 60 patients were diagnosed with delirium, and the majority (n=8, 72.7%) was the hypoactive type. Delirious and non-delirious patients had similar demographic and clinical features. Delirious patients had significantly higher lengths of hospital stay, National Institutes of Health Stroke Scale (NIHSS) at admission and discharge compared to non-delirious patients. In addition, there was no significant statistical difference between delirious and non-delirious patients with AIS in respect of levels of TNF-alpha, IL-1 beta, IL-18, BDNF and NSE. This study suggests that delirium is not scarce in patients with AIS admitted to the non-intensive stroke unit, and that delirium developing after AIS seems not to be associated with serum TNF-alpha, IL-1 beta, IL-18, BDNF and NSE but is associated with length of hospital stay and stroke severity

Effects of Gluteus Maximus Muscle Strength on Ataxia, Gait, and Equilibrium in Multiple Sclerosis

Introduction: Multiple sclerosis (MS) is an autoimmune disease that causes scar tissue in the nervous system and seriously affects the quality of life of people. Muscle weakness, spasticity and coordination problems are seen primarily in the lower extremities. Strengthening exercises improve muscle strength in people with multiple sclerosis, but there is no consensus on their effect on walking capacity. Methods: To determine the relationship between gluteus maximus muscle strength, ataxia, balance and walking capacity in Multiple Sclerosis. An experimental study design was applied. Gluteus maximus muscle strength was measured using a dynamometer. Walking capacity was determined by the 6-minute walk test (6MWT) and dynamic gait index (DGI). Balance was evaluated with the one-leg standing test (SLS). The severity of ataxia was measured with the International Ataxia Rating Scale (ICARS). Fatigue was evaluated with VAS and quality of life of all patients with SF36 short form. Results: EDSS mean of the study = 3.39 ± 1.4; 2 men and 16 women with mean age = 37.17 ± 9.16 years were included. 6MWT, DGI, ALS, ICARS, VAS were different before and after treatment (p\u3c0.05). There was no significant difference other than physical function and general health among the sub-parameters of SF36 (p\u3e0.05). Correlation of muscle strength with ataxia, gait and balance was not significant (p\u3e0.05) Conclusion: In individuals with MS, the fact that the treatment program consists of modalities that include balance and sensory exercises as well as muscle strengthening exercises increases the success of rehabilitation

Evaluation of antihyperlipidemic drug-treatment with regard to optimum effectiveness and neurologic side effects in adults with dyslipidemia

Antihiperlipidemik ilaç gruplarının birbirleri arasında etki yan etki profilinde bir fark olup olmadığını araştırmak amacıyla, Nöroloji ve Kardiyoloji anabilim dalları polikliniklerine başvuran 37-77 yaşlan arasında 129 (42 kadın, 87 erkek) dislipidemik hasta çalışmaya alındı. Çalışmaya alman hastalar 5 gruba ayrıldı. Tüm hastalara ideal kilolarına ulaşmaları ve standart lipidden fakir beslenme tarzı önerildi. Çalışmamız 10 mg atorvastatin (67 kişi), 10 mg pravastatin (13 kişi), 10 mg simvastatin (10 kişi), 200 mg fenofıbrat (15 kişi), 10 mg atorvastatin + 200 mg fenofıbrat (24 kişi) gruplarından oluşuyordu. Tedavi öncesi ve tedavi sonrası 3., 6. ve 12. aylarda lipid değerleri "TK, LDL-K, HDL-K, TG" ve CK, SCOT, SGPT enzimleri biyokimyasal olarak takip edildi. Grupların istatistiksel olarak değerlen karşılaştırıldı. 1 yıllık takip sonunda; TK seviyelerindeki düşmeye olan etkilerinde, istatistiksel olarak bir fark gözlenmedi (p^-0.05). 6. aydan sonra fenofibratm pravastatine oranla istatistiksel olarak anlamlı bir şekilde TG'de düşme sağladığını gözlemledik (p0.05). Özellikle ilk 3 ayda atorvastatinin fenofıbrata oranla LDL-K değerlerinde istatistiksel olarak anlamlı bir düşme sağladığı görüldü (p0.05). İlaç grupları arasında HDL-K değerlerini artırma yönünden anlamlı bir farklılık tespit edilmedi (p>0.05). 79Tüm ilaç gruplarında yaklaşık 3. aydan sonra kan lipid seviyelerinin stabil bir seyir izlediğini gözlemledik. İlk 6 ayda pravastatinin atorvastatine oranla CK seviyelerinde istatistiksel olarak anlamlı artışa neden olduğu tespit edildi (p0.05). Pravastatinin miyalji yapma oram diğer gruplara göre daha yüksekti ancak pravastatin de dahil tüm ilaç grupları arasında istatistiksel olarak anlamlı bir fark tespit edilmedi (p>0.05). Karaciğer fonksiyonları üzerine tüm grup ilaçların etkisinin olmadığı gözlendi. Çalışmamızda bazı nörolojik hastalıkların tedavisinde önem kazanmaya başlayan antihiperlipidemik ilaç tedavi ve takiplerinin önemini vurgulamayı amaçladık.Tiıis study comprised 129 patients (42 women, 87 men) between ages of 37- 77 who had to Neurology and Cardiology clinics, in order to search for any difference on the effect-side effect profile among antihypcrlipimedic drag groups. Patients were grouped in 5 in the study. All patients were asked to follow a diet low in standart lipids and reach their ideal weigh!. Groups were determined as 10 mg astorvastatin receiving group (67 patients), 10 mg pravastatin receiving group (13 patients), 10 mg simvastatin receiving group (10 patients), 200 mg fenofibrat receiving group (15 patients), and 10 mg atorvastatin +200 mg fenofibrat receiving group (24 patients). Lipid levels "TK, LDL-K, HDL-K, TG" and CK, SCOT, SGPT enzymes were tracked/ followed biochemically in the 3.,6., and 12. months pretreatment and after treatment. No difference was observed statistically on the effects causing drop in TK levels (p>0.05). We observed a statistically meaningful drop in TG levels with fenofibrat compared to pravastatine after 6 months (p0.05). Atorvastatin provided a statistically meaningful drop in LDL-K levels compared to fenofibrat especially in the first 3 months (p 0.05). No meaningful difference in increasing HDL-K valves among drug groups was observed (p> 0.05). SiWe observed a stable course on the blood lipid levels after the 3. month in all drug groups. Pravastatin was found to have resulted in a statistically meaningful increase in CJC levels compared to atorvastatin in the first 6 months (p0.05). No effect on liver functions was obtained with all drug groups. We aimed to emphasize on the treatment and following of aniihyperlipidemic drugs gaining, more importance in same Neurological illnesses' treatment

The Relationship Between Pain and Clinical Features in Multiple Sclerosis

OBJECTIVE: Multiple Sclerosis(MS) is an autoimmune-neurodegenerative disease of the central nervous system. The pain prevalence differentiates between 29% and 86 % in this disease and besides the neuropathic, somatic pain types might emerge together or separately. In this study we aimed to analyse the relationship between pain and other clinical featuresin MS. METHODS: 100 cases,of whom are followed in MS polyclinic and who have complaints of pain, have been included to this study.By ensuring the forms that we prepared to be filled by the cases, we examined the pain type and localization. Thereafter we applied Visual Pain Scale (VPS), Ashworth Spasticity Scale (ASS) and Beck Depression Scale(BDS). RESULTS: When female and male patients are compared, significant difference has not been observed statistically among age, disease period and EDDS scores. 77 % of the cases have suffered from neuropathic pain, 21 % of the cases have displayed Lhermitte symptoms, trigeminal neuralgia has been observed in 1 % of the cases and 55 % of the cases have had complaints of neuropathic extremity pain. In 60 % of the cases nociceptive pains, in 12 % of the cases joint-extremity-muscle pain, in 47 % headache and in 1 % painful tonic spasms have existed. Pain depending on the treatment has been observed only in 2 % of the cases. The pain score has been detected significantly on patients with spasticity and depression (p= 0.008, p= 0.001 in return). While there has been reasonable positive correlation between age, EDDS score and VPS (p= 0.010, p= 0.002 in return), poor correlation has been obtained between disease period and number of attacks (p= 0.002, p= 0.045 in return). CONCLUSION: These findings indicate that MS pain is related with spasticity, disability and depression and these clinical findings should be taken into account during pain treatment and the above factors should be treated

Movement Releated Cortical Potentials Obtained by Saccadic Eye Movements In Multiple Sclerosis

Background Movement-related cortical potentials (MRCPs) are electrophysiological activities that reflect neurological mechanisms that occur in the cortex during the planning of and preparation for movement. We aimed to evaluate the MRCPs that occur due to saccadic eye movement in multiple sclerosis (MS). Methods Twenty-five patients aged 18–55 years with good cognitive functions who were diagnosed with MS according to the McDonald criteria and scored 0–5 on the Expanded Disability Status Scale (EDSS) were included. Twenty healthy volunteers in a similar age range also participated. Voluntary horizontal conjugate gaze and MRCPs were recorded and averaged. Results It was observed that the latency of the Bereitshaftpotential (BP; preparation potential) was longer in the patient group, and the latency values were consistent with the values reported in the literature. The peak-pit (PP) amplitude, which can be regarded as a component of the negative slope (NS) and motor potential (MP), was higher in the patient group and may indicate that the target movement was more difficult for the patient group. Conclusion Studies on cognitive impairment in MS have generally been conducted using neuropsychological tests. Although we could not obtain a record that corresponded to the typical MRCP pattern reported in the literature, our findings make a contribution to the field of MCRP-based studies by raising new questions about the measurement and use of MRCP values