Neurovascular Reactivity in Patients with Acute Ischemic Stroke

INTRODUCTION: We aimed to assess the motor evoked blood flow velocity (BFV) changes in both middle cerebral arteries (MCA) using transcranial Doppler (TCD) monitoring in patients with acute ischemic strokes and healthy subjects. METHODS: Eighty-two patients with acute territorial infarction in the MCA territory, 83 patients with acute lacunar infarction in MCA territory and 21 control subjects were investigated. A long term TCD monitoring device was used for the simultaneous recording of both MCA during 10 cycles of 20 seconds while the subjects performed hand gripping with a frequency of one per second, and subsequently 20 seconds when they were resting to assess BFV changes on activated cortical motor areas. Neurovascular reactivity was defined as a relative increase in blood flow velocities which were calculated as the percentage change in baseline value. RESULTS: Hand gripping showed a marked rise in the blood flow velocities in both MCAs in all subjects (p<0.001 for all vessels). Patients with territorial infarction had significantly lower neurovascular reactivity (15.0%±9.5) than those of patients with lacunar infarction (19.9%±11.5 p<0.007). DISCUSSION AND CONCLUSION: Our results suggest that unilateral cerebrovascular ischemic events can affect blood flow in both MCAs in patients with acute ischemic events in the MCA territory, and neurovascular reactivity was preserved in patients with lacunar stroke in contrast to territorial stroke

Obstructive sleep apnea syndrome and ischemic stroke

Obstructive sleep apnea is a sleep-related disorder and it is characterised by decreased or suspended airflow although effort to breath. Sleep-disordered breathing is seen in more than 50% of patients with cerebrovascular diseases. In this review, we aimed to overview the relationship of obstructive sleep apnea and ischemic stroke, the mechanisms which caused stroke in sleep apnea, the hemodynamic results of sleep apnea and its effect on autonomic dysfunction and, the relationship between sleep apnea and risk factors of ischemic stroke

Obstructive sleep apnea syndrome and ischemic stroke

Obstructive sleep apnea is a sleep-related disorder and it is characterised by decreased or suspended airflow although effort to breath. Sleep-disordered breathing is seen in more than 50% of patients with cerebrovascular diseases. In this review, we aimed to overview the relationship of obstructive sleep apnea and ischemic stroke, the mechanisms which caused stroke in sleep apnea, the hemodynamic results of sleep apnea and its effect on autonomic dysfunction and, the relationship between sleep apnea and risk factors of ischemic stroke

Raeder’s Syndrome “Paratrigeminal Neuralgia” Beyond Headache: A Case Report

Raeder’s syndrome (paratrigeminal neuralgia), which sometimes radiates to the maxillary section, is defined as a constant and unilateral pain in the distribution area of the ophthalmic branch of the trigeminal nerve accompanied by Horner’s syndrome and caused by a defect in the carotid artery or in the middle cranial fossa. Although Raeder’s syndrome is accompanied with the irritation of the trigeminal nerve, it can be easily confused with Horner’s syndrome and mistakenly called “painful Horner’s syndrome”. This picture, which contains incomplete Horner’s syndrome with orbital pain and without anhydrosis, is an important clinical entity because it shows the location of the lesion and is different from the etiologic and prognostic perspective. Due to these reasons, we wanted to present a patient who was diagnosed as having paratrigeminal oculosympathetic Raeder syndrome in our clinical department of neurology to draw attention to differences in underlying resemblance to Horner’s syndrom

A Rare Syndrome: Balint Syndrome

Balint’s syndrome is a rare disorder affecting the ability to perceive the visual field as a whole, most commonly following damage to the bilateral occipital and parietal regions. This syndrome has three components as simultanagnosia, optic ataxia, and oculomotor apraxia. Simultanagnosia play a key role in this syndrome. Sixty-two years old male patient who applied the blindness symptom has been evaluated in outpatient clinic. We observed that there are some deficits in perceive of visual field rather than blindness in neurologic examination of the patient. He had simultanagnosia, optic ataxia and oculomotor apraxia. There are multiple infarcts in bilaterally occipital and parietal regions in the patient’s cerebral MRI. In this case, we have present a rare disorder of the Balint’s syndrome

Relationship between Pulsatility Index and Clinical Course of Acute Ischemic Stroke after Thrombolytic Treatment

Background. The relationship between the arterial recanalization after intravenous recombinant tissue plasminogen activator (rtPA) and outcomes is still uncertain. The aim of our study was to evaluate whether there is an association between the pulsatility indexes (PI) of the middle cerebral artery (MCA) measured by transcranial Doppler (TCD) after iv rtPA treatment and short- and long-term outcomes in ischemic stroke patients. Methods. Forty-eight patients with acute ischemia in the MCA territory who achieved complete recanalization after the administration of intravenous thrombolytic treatment were included in the study. The TCD was applied to patients after the iv rtPA treatment. Clinical and functional outcomes were assessed by National Institutes of Health Stroke Scale (NIHSS) scores and modified Rankin Scores (mRS), respectively. Results. Significant positive correlations were found between the PI value and NIHSS score at 24 hours, NIHSS score at 3 months, and mRS at 3 months ( for all). The cut-off value for PI in predicting a favorable prognosis and a good prognosis might be less than or equal to 1.1 and less than or equal to 1.4, respectively. Conclusions. PI may play a role in predicting the functional and clinical outcome after thrombolytic therapy in acute ischemic stroke patients

Evaluation of Seizure After Stroke in Stroke Unit

Objective: Patients with stroke may experience epileptic seizures as acute phase (usually defined as the first 15 days) or late phase complications. Risk factors are young age, male sex, cortical involvement and hemorrhagic transformation. Our aim was to investigate the etiologic factors and to determine the high-risk groups for the 1 year seizure rate of patients who are followed up in our clinic with a diagnosis of acute ischemic stroke. Materials and Methods: This study was included in a retrospective review of 299 patients who underwent regular out-patient clinic visits for 1 year followed by a diagnosis of acute ischemic stroke in the Department of Neurology at the Eskisehir Osmangazi University Faculty of Medicine between January 1st, 2012, and January 1st, 2015. Results: We found that thrombolytic therapy in patients with ischemic stroke decreased post-stroke seizure (p=0.043), whereas decompressive craniectomy (p=0.048), endovascular treatment (p=0.032), and cortical involvement (p=0.003) increased post-stroke seizures. Conclusion: According to our study, patients with cortical involvement, modified Rankin Scale score 4 and 5 at discharge, presence of major vascular occlusion treated with endovascular treatment, and those with decompressive craniectomy were high-risk groups. Prospective observational drug trials can be performed because double-blind placebo drug studies are not possible in high-risk groups

Migraine and cardiovascular risk factors: A clinic-based study

Objective: The relation between migraine and vascular risk factors is an unclear issue. Furthermore, the reasons for chronification are still unknown. Probably, the age-related risk and other factors leading to migraine progression will also change in the future. Under these questions, we aimed to investigate whether or not there is a specific association with vascular risk factors between several age groups and subtypes of migraine and also in their families

Comorbidity: Guidelines Of Turkish Society Of Cerebrovascular Diseases – 2015

In this section, updated information and recommendation about stroke-related comorbidities including migraine, respiratory impairments and sleep disorders will be offered