Hot Water Epilepsy in a Pregnant Woman: A Case Report

Hot water epilepsy is a unique form of reflex epilepsy precipitated by the stimulus of bathing with hot water poured over the head. It is mostly seen in infants and children, with a predominance in males. Unlikely, we present a 32-year-old pregnancy woman with the incipient of reflex seizures triggered by pouring hot water over the head while having a bath during the gestation period and treated successfully with carbamazepine 400 mg/day therapy. Hot water epilepsy is known as a benign and self-limited reflex epilepsy, by firstly avoiding hot water or long showers and secondly using intermittent benzodiazepines or conventional antiepileptic drugs, may be sufficient to be seizure-free

Evaluation of Patients with Cerebral Venous Sinus Thrombosis

OBJECTIVE: The aim of this article is to point out the etiology, risk factors, the rate of recanalization and mortality of cerebral venous sinus thrombosis patients. METHODS: The current study was planned as retrospectively and fifty patients were included. All the patients were analyzed according to the clinical presentation, etiologic causes, risk factors, presence of MR lesion, the involvement of anatomic localization, recanalization and mortality. RESULTS: The most frequent risk factors of the cases were prothrombotic conditions (34%), pregnancy (14%) and puerperium (8%). The most frequent involvement was transverse sinus and secondly more than one sinüs thrombosis. As clinical application symptoms we detected headache (68%) and then focal neurologic deficiency (30%). On the other hand, at least 3 month’s incidence rate of recanalization in the patients was 70.7%. Except for 2 cases that ended with death, the mortality of the cases was low. We could not find a significant association between risk factors and the presence of cerebral MR lesion or not (p=0.42) and also the presence of recanalization or not in the follow-up MR venography (p=0.625). CONCLUSION: We have concluded that, in the diagnosis and follow-up of cerebral venous sinus thrombosis, MR venography is the best method; through early diagnosis and proper treatment, the rate of recanalization will be fairly high and mortality will be low. In etiology, besides trombotic conditions, pregnancy and puerperium must be considered as one of the frequent risk factors

The Association between Insulin-like Growth Factor-1 and Insulin-like Growth Factor Binding Protein-3 Levels and Clinical Prognosis in Patients with Ischemic Stroke

OBJECTIVE: Recent studies report that the insulin-like growth factor system may be involved in stroke pathogenesis, and is reported to increase myelination, maturation, cell proliferation and neuronal sprouting of the central nervous system. The aim of the present study is to demonstrate the role of insulin-like growth factor system in ischemic stroke pathogenesis and its association with the prognosis by investigating insulin-like growth factor-1 and insulin-like growth factor binding protein-3 levels in patients diagnosed with acute ischemic stroke. METHODS: : Sixty-eight patients and 20 healthy individuals were included to this study. Clinical evaluation of the patients was performed according to National Institute of Health Stroke Scale and functional outcomes were graded according to Modified Rankin Scale. Bamford classification was used for the clinical classification of ischemic strokes, and the TOAST system for etiological classification. Each patient's levels of insulin-like growth factor-1 and insulin-like growth factor binding protein-3 were measured on the first, fifth and thirtieth day of ischemic stroke. RESULTS: Only the levels of insulin-like growth factor binding protein-3 on the day of 5 were significantly decreased compared to the control group. The decrease in IGF-1 values was associated with an increased risk of death and was accompanied by clinical worsening and decreased functionality. CONCLUSION: It has been concluded that the levels of investigating insulin-like growth factor-1 and insulin-like growth factor binding protein-3 may affect mortality risk, clinical condition and functionality outcomes in patients presenting with ischemic stroke, and further studies are needed for the investigation of different effects of insulin-like growth factor-1 in future

Ischemic stroke in a young man with MTHFR A1298C and ACE I/D polymorphism

Ischemic stroke is a leading cause of death and disability worldwide. Mutations in several candidate genes involving angiotensin-converting enzyme (ACE) and methylenetetrahydrofolate reductase (MTHFR) gene have been found to be associated with ischemic stroke. This report describes the case of a 29 year-old man who presented with sudden onset left hemiparesis and hemihipoestesia. Magnetic resonance imaging investigations showed acute ischemic infarct in the right parietal region. Mutation analysis revealed homozygout MTHFR A1298C and ACE I/D polymorphisms and laboratory invastigations showed mild hyperhomocysteinemia. No other risk factor was detected for ischemic stroke etiology

Magnetic Resonance Imaging Findings in Cerebral Venous Thrombosis due to Behcet's Disease and the Importance of Susceptibility-Weighted Imaging: Case Report

Cerebral venous thrombosis (CVT) is an uncommon disorder that can lead to an unfavorable prognosis and even be fatal in some cases.CVT is seen mainly in females, especially those between the ages of 20 and 35 years. The disorder has many etiologic factors. This report presents the case of a 34-year-old male patient with Behçet’s disease admitted with complaints of headache and vomiting. The major venous vascular structures that were visible in cranial magnetic resonance imaging (MRI) and MR venography were found to be filled with thrombosis. The patient’s susceptibility-weighted imaging (SWI) revealed marked hypointensities consistent with thrombosis in the transverse sinus, sigmoid sinus, and in the venous vascular structures of the posterior fossa. Thus, it was found that cerebral venous thrombosis due to Behçet disease could clearly be determined by the SWI sequence; in addition, thrombosis by the venous vascularity in veins of the posterior fossa were more visible than via the other MR sequences. The conclusion was made that SWI can promptly demonstrate cerebral venous thrombosis, contribute to the diagnosis, and provide useful additional information

Role of modified TAN score in predicting prognosis in patients with acute ischemic stroke undergoing endovascular therapy

Objective: The study aimed to evaluate the prognostic role of modified TAN collateral score in predicting functional independence in ischemic stroke patients, who underwent endovascular therapy. Introduction: Identifying the group of patients, who will benefit most from arterial recanalization in patients with acute ischemic stroke, is the basis of success. Collateral circulation is a physiological condition that protects the brain against ischemia and inhibits the growth of a damaged area. The presence of collaterals is a well-known determinant for functional independence. Numerous collateral scoring systems are used for this purpose. The aim of this study was to evaluate the prognostic role of modified TAN collateral score (MTCS) in predicting functional independence in patients, who received endovascular therapy. Materials and methods: Prospective data of 101 patients, who received endovascular therapy from the stroke team of Eskisehir Osmangazi University (ESOGU) between 2016 and 2017, were examined retrospectively for this purpose. Collateral assessments were performed in Computed Tomography Angiography (CTA) according to the modified TAN scoring system (= 50% refers to good collateral status). Good clinical outcome was assessed as mRS 0-2 in the 3rd month. The TICI scoring system was used in the evaluation of recanalization. Patients treated within the first 6 h of symptom onset, patients with NCCT and contrast CTA, patients with internal carotid artery and middle cerebral artery occlusion were included in the study. Posterior system stroke was not included in the study. Conclusion: Of the 101 patients, 50 (49%) had poor MTCS. Presentation and 24th hour NIHSS values of the patients with poor MTCS were higher (p:0.003). The third month mRS values were low in patients with good MTCS on admission, while these values were high in patients, who presented with poor MTCS. Mortality rates were significantly higher in the patient group with poor collateral circulation score (32-5.9%) (p:0.001). No significant differences were found in the presentation ASPECT values and (TICI 2b/3) recanalization rates of the patients. The rate of futile recanalization was significantly higher in the group with poor collateral circulation (52-8%) (p:0.0001). Presentation glucose, NIHSS, mTAN, symptom-puncture time, and good ASPECT score were found to be predictive markers for good outcome by univariate analysis. The major risk factors were determined by performing multiple logistic regression analysis. Presentation glucose, NIHSS, and mTAN (OR:1.013, 1.29, 0.198, respectively) were found to be strong and independent predictors for good clinical outcome. According to Multiple Binary Logistic Regression analysis Backward-ward model, Baseline NIHSS, poor collaterals and baseline glucose are found as predictors for poor outcome. Discussion: This study shows that good collateral score is associated with good clinical response, small final infarct volume, third month low mRS, low admission, and 24-hour NIHSS rates. The likelihood of having long term prognosis is 7 fold higher in patients with poor collaterals. The use of the MTCS system is recommended and supported due to its easy and rapid applicability

Predictors of Symptomatic Hemorrhage After Endovascular Treatment for Anterior Circulation Occlusions: Turkish Endovascular Stroke Registry

We evaluated the predictive factors of symptomatic intracranial hemorrhage (SICH) in endovascular treatment of stroke. We included 975 ischemic stroke patients with anterior circulation occlusion. Patients that had hemorrhage and an increase of >= 4 points in their National Institutes of Health Stroke Scale (NIHSS) after the treatment were considered as SICH. The mean age of patients was 65.2 +/- 13.1 years and 469 (48.1%) were women. The median NIHSS was 16 (13-18) and Alberta Stroke Program Early CT 9 (8-10). In 420 patients (43.1%), modified Rankin Scale was favorable (0-2) and mortality was observed in 234 (24%) patients at the end of the third month. Patients with high diastolic blood pressure (P<.05) had significantly higher SICH. SICH was significantly higher in those with high NIHSS scores (P<.001), high blood glucose (P<.001), and leukocyte count at admission (P<.05). Diabetes mellitus (DM) (OR 1.90; P<.001), NIHSS (OR 1.07; P<.05), adjuvant intra-arterial thrombolytic therapy (IA-rtPA) (OR, 1.60; P<.05), and puncture-recanalization time (OR 1.01; P<.05) were independent factors of SICH. Higher baseline NIHSS score, longer procedure time, multiple thrombectomy maneuvers, administration of IA-rtPA, and the history of DM are independent predictors of SICH in anterior circulation occlusion

Epileptic seizures in cerebral venous sinus thrombosis: Subgroup analysis of VENOST study

Purpose: The aim of this study is to evaluate the presence and prognostic impact of early seizures in cerebral venous sinus thrombosis patients (CVST).Method: VENOST is a retrospective and prospective national multicenter observational study. CVST patients with or without epileptic seizures (ES) were analyzed and compared in terms of demographic and imaging data, causative factors, clinical variables, and prognosis in a total of 1126 patients.Results: The mean age of the patients in the ES group was 39.73 +/- 12.64 and 40.17 +/- 14.02 years in the non-ES group (p > 0.05). Epileptic seizures were more common (76.6 %) in females (p < 0.001). Early ES occurred in 269 of 1126 patients (23.9 %). Epileptic seizures mainly presented in the acute phase (71.4 %) of the disease (p < 0.001). Majority of these (60.5 %) were in the first 24 h of the CVST. The most common neurological signs were focal neurologic deficits (29.9 %) and altered consciousness (31.4 %) in the ES group. Superior sagittal sinus (SSS) and cortical veins (CV) involvement were the most common sites of thrombosis and the mostly related etiology were found puerperium in seizure group (30.3 % vs 13.9 %). Patients with seizures had worse outcome in the first month of the disease (p < 0.001) but these did not have any influence thereafter.Conclusions: In this largest CVST cohort (VENOST) reported female sex, presence of focal neurological deficits and altered consciousness, thrombosis of the SSS and CVs, hemorrhagic infarction were risk factors for ES occurrence in patients with CVST

İNME KLİNİK PRATİĞİNDE NOAK KULLANIMI:TÜRK BEYİN DAMAR HASTALIKLARI DERNEĞİ UZMAN GÖRÜŞÜ

Non-vitamin K oral antikoagülanların (NOAK) atrial fibrilasyonda inmenin önlenmesi amacıyla on yılı aşan bir süredirbaşarı ile kullanıldığı açıktır. Varfarine göre belirgin derecede az kanamaya yol açmaları ve inmeyi de eşit veya daha fazlaoranda önleyebilmeleri yanı sıra kolay kullanım özellikleri primer proflakside atrial fibrilasyona bağlı inmeyi azaltmakonusunda öne çıkmaktadır. Bunlar aynı zamanda genel inme prevalansının azalması anlamına gelmektedir. Yani AFnedenli inmenin engellenmesi toplum sağlığı için çağdaş bir gereklilik olarak algılanmalıdır. İnme klinik pratiğindekardiyoloji uzmanları ile birlikte bu bağlamda çaba sarf eden nöroloji uzmanları için Türk Beyin Damar HastalıklarıDerneği bu uzman görüşünü hazırladı. Görüşler NOAK grubu ilaçların kullanımında sıkça karşılaşılan sorunlar ve buproblemler için güncel çözüm önerilerini içermektedir.It is clear that nonvitamin K oral anticoagulants (NOACs) have been used successfully for more than ten years to preventstroke in atrial fibrillation. In addition to the fact that they cause significantly less bleeding compared to warfarin and canprevent stroke equally or more, their easy-to-use features stand out in reducing stroke due to atrial fibrillation in primaryprophylaxis. These also mean a decrease in the overall prevalence of stroke. For sure, prevention of AF-induced strokeshould be perceived as a contemporary requirement for public health. Turkish Society of Cerebrovascular Diseases hasprepared this expert opinion for neurologists who strive for this purpose together with cardiologists in the clinicalpractice of stroke. The article contains frequently encountered problems in the use of NOACs and current solutions forthese problems