Renal Dysfunction Is an Independent Risk Factor for Poor Outcome in Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis: A New Cutoff Value

Objective. This study was set to assess the effect of renal dysfunction on outcome of stroke patients treated with intravenous thrombolysis (IVT). Methods. This multicenter research involved 403 patients from January 2009 to March 2015. Patients were divided into two groups: (1) control group with GFR ≥ 45 mL/min/1.73 m2 and (2) low GFR group with GFR < 45 mL/min/1.73 m2. Outcome measurements were poor outcome (mRS 3–6) and mortality at 3 months and symptomatic intracerebral hemorrhage (SICH) within the first 24–36 hours. Univariate and multivariate regression analyses were performed, and odds ratios (ORs) were determined at 95% confidence intervals (CIs). Results. Univariate analyses determined that every decrease of GFR by 10 mL/min/1.73 m2 significantly increased the risk of poor outcome (OR 1.19, 95% CI 1.09–1.30, p<0.001) and mortality (OR 1.18, 95% CI 1.06–1.32, p=0.002). In multivariate regression, adjusted for all variables with p value < 0.1, low GFR (GFR < 45 versus GFR equal to or more than 45) was associated with poor outcome (OR adjusted 2.15, 95% CI 1.01–4.56, p=0.045). Conclusion. In IVT for acute stroke, renal dysfunction with GFR < 45 mL/min/1.73 m2 before treatment determined increased odds for poor outcome compared to GFR of more than 45 mL/min/1.73 m2

Turkish version of the scales used for relationship between stroke and atrial fibrillation

In this article, user-friendly Turkish version for Turkish speaking people of the scales used for relationship between stroke and atrial fibrillation were defined

Functional Transcranial Doppler and Migraine Headache

In recent years, a lot of studies have been performed in order to understand of migraine pathogenesis. All of these studies suggested that neuronal and vascular factors played important roles with a tight integration. Cortical hyper excitability was seemed to be a more important trigger factor for starting a migraine headache with a high probability of serotonergic and aminergic impulses coming from locus ceruleus and dorsal raphe nucleus which may have effect on regional blood flow in relation to cortical excitability. In this review, general information of functional transcranial Doppler ultrasonography and the usage in migraine were mentioned. Briefly, cortical hyperexcitability and cognitive habituation phenomenon were analyzed and discussed in migraine patients during headache and headache-free period. Studies in headache-free period gave inconsistent results. Normal or hyporeactivity to simple and complex stimuli were obtained in a few studies in patients with migraine during headache-free period in terms of functional transcranial Doppler, however, hyperactivity to simple stimuli was also suggested. Non-standardized methods, selection of patients and technical advances of Doppler instruments may be causative factors in these studies. When considering cognitive habituation phenomenon, it was demonstrated to either simple or complex stimuli using functional transcranial Doppler in healthy subjects similar as shown in the electrophysiological studies. While habituation phenomenon was not revealed in patients with migraine with or without aura during headache-free period, potentiation was demonstrated. Functional transcranial Doppler examinations in patients with migraine without aura does not give any significant difference during headache period when comparing to headache-free period. However, lower vascular reactivity in the posterior circulation and/or hyporeactivity in the occipital neuronal structure was demonstrated during headache period in patients with migraine with aura. These observations are consistent with aura symptoms. Finally, all of these studies by means of functional transcranial Doppler strongly suggested that, this simple investigating technique may be an important role in understanding the pathogenesis of migraine and similar disorders

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

Risk factors for multiple recurrent ischemic strokes

BACKGROUND: Cardiovascular diseases, hypertension, diabetes mellitus, dyslipidemia, and atrial fibrillation are the most common modifiable risk factors for recurrent ischemic stroke. In this study, we aimed to find the risk factors associated with more than two recurrent ischemic strokes after the first-ever stroke. METHODS: We collected the ischemic stroke patients in our stroke registry data bank, and the eligible patients were followed for recurrent ischemic stroke after 2008. Our study consisted of 927 patients who were followed up for 9 years after the first-ever stroke. RESULTS: We found that 185 (20%) patients had a recurrent ischemic stroke, and another 32 (3.5%) patients had more than one recurrence after the first-ever ischemic stroke. The mean time for the first stroke recurrence was 1 year, and the mean time for the multiple stroke recurrences was 3 years. Significant risk factors for multiple recurrences were congestive heart disease (P < 0.015) and diabetes mellitus (P < 0.006). CONCLUSIONS: We concluded that even with the appropriate treatments, patients with congestive heart disease and diabetes mellitus have a higher rate of multiple recurrences for ischemic stroke after the first-ever ischemic stroke, indicating that more attention should be paid to this issue

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

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