Objective: This study aimed to compare the frequency of admission to hospital in patients with ac... more Objective: This study aimed to compare the frequency of admission to hospital in patients with acute ischemic stroke before the COVID 19 pandemic, during the pre-vaccination period, and after the start of vaccination for COVID 19, and to evaluate the time window period between symptom onset to door time, door to CT scan time, door to needle time, and door to puncture time. In addition, it aimed to investigate the effects of the COVID-19 pandemic on the admission, evaluation, and initiation of acute treatment of patients with acute ischemic stroke. Methods: Patients presenting with acute ischemic stroke between March 2019 -December 2019 (pre-pandemic), March 2020 -December 2020 (prevaccination pandemic period), and March 2021 -December 2021 (post-vaccination pandemic period) were included in the study. NIHSS was calculated by accordance with the neurological examination findings of the patients, cranial CT for the exclusion of bleeding and CT angiography images for the large vessel occlusions were performed, and the vital signs of the patients were recorded. IV tPA treatment was applied within the first 4.5 hours, and mechanical thrombectomy (MT) was performed in patients with large vessel occlusion. Results: Three hundred nineteen patients were included in the study. The times from symptom onset to emergency admission and from symptom onset to CT scan were found to be similar in all periods. The time from symptom onset to examine by a neurologist was found to be significantly longer in the vaccination period compared to the pandemic period. It was observed that the time from the door to needle time and the time from examine by a neurology doctor to needle time was statistically significantly shorter during the pandemic period (p<0.05). In our study in a tertiary hospital in Turkey, it was determined that the number of patients who was admitted with acute stroke clinic during the pandemic period was similar to other years and there was no delay in the initiation of treatment during the pandemic period. Door to needle times, as well as the time taken by the neurologist to examine and initiate IV-tPA treatment, were found to be shorter in the pre-vaccination pandemic period than in the pre-pandemic and post-vaccination periods.
The aim of this study was to evaluate the type, duration, etiology, treatment, and outcome of sta... more The aim of this study was to evaluate the type, duration, etiology, treatment, and outcome of status epilepticus (SE) episodes, among patients aged 16-50 years. A total of 101 SE episodes in 88 young adult patients fulfilled our criteria. The mean age was 32 years. Status epilepticus episodes were most frequently observed in patients 21-30 years of age. A total of 53% of the patients were male, and 57% had pre-existing epilepsy. Seventy of the 101 episodes were convulsive SE. The most common etiology was withdrawal of or change in antiepileptic drugs (AEDs), seen in 31% of the SE episodes. This study included treatment of SE with traditional AEDs. Sixty-six episodes were treated successfully with intravenous infusion of 18-mg/kg phenytoin, and six episodes were treated with 10-mg/kg phenytoin. A total of 28% of the SE episodes remained refractory to first-line treatment, which was related to the duration of SE and mortality. The outcome was death in 14% of the patients due to underlying etiologies in the hospital.
The aim of this comparative, controlled, cross-sectional study is to evaluate the voice quality i... more The aim of this comparative, controlled, cross-sectional study is to evaluate the voice quality in patients with multiple sclerosis (MS) by subjective and objective methods. Female patients with MS (n 5 27) and ageand sex-matched healthy controls (n 5 27) were included in this study. Vocal functions were evaluated by a multidimensional set composed of videolaryngostroboscopic examination, acoustic analysis, and subjective measurements (GRBAS and ''Voice Handicap Index''). Jitter percent, shimmer percent, and soft phonation index (SPI) values were higher in MS patients compared to controls (Jitt, P 5 0.001; Shim, P 5 0.033; SPI P ! 0.0001). Maximum phonation time was significantly shorter for MS patients compared to controls (P ! 0.0001). Stroboscopic examination revealed that 16 out of 27 MS patients have a ''posterior chink'' as glottic closure pattern with higher SPI values (40%). Noise to harmonic ratio (NHR) and mean fundamental frequency (F 0) values were similar for MS and control groups (NHR, P 5 0.737; F 0 , P 5 0.976). In this study, most of the MS patients had dysphonia due to weakness of voice. MS tends to worsen acoustic parameters including fundamental frequency, SPI, and jitter values. These results are consistent with the more asthenic voice quality observed in MS group.
ABSTRACT A 62-year-old man with untreated diabetes complained of diplopia and headache. Neurologi... more ABSTRACT A 62-year-old man with untreated diabetes complained of diplopia and headache. Neurological examination demonstrated left abducens nerve palsy. MRI showed a mass lesion in the left orbital apex. Total left ophthalmoplegia and visual loss rapidly developed in the next two weeks. A craniotomy was performed to decompress the orbital apex and remove the mass. The optic nerve was tightly encased by fibrous tissue. The pathological diagnosis was mucormycosis. Systemic administration of amphotericin B and fluconazole was started immediately. But the lesion rapidly invaded the cavernous sinus and occluded the left internal carotid artery. Finally, the patient died with intracranial extension of mucormycosis four months after the operation. Rhinocerebral mucormycosis is a rapidly progressive fatal disease. Successful treatment seems to be based on early diagnosis, control of the underlying disease, radical surgical resection, and systemic administration of amphotericin B. Mucormycosis should be considered as a differential diagnosis of orbital apex syndrome.
ABSTRACT Coincidence of ischemic and hemorrhagic stroke in the acute phase is a rare condition. A... more ABSTRACT Coincidence of ischemic and hemorrhagic stroke in the acute phase is a rare condition. A patient with uncontrolled hypertension and hypercholesterolemia presented with a sudden onset mild hand paresis that rapidly evolved to hemiparesis over the next few hours. Neuroradiologic investigations revealed a right-sided acute hemipons infarct and a hemorrhage in the anterior territory of infarction. Uncontrolled atherosclerotic risk factors such as hypertension and hyperlipidemia together with antithrombotic therapy seem to be the major reasons for the coincidental presence of both ischemic and hemorrhagic lesions in this patient.
Background: Coronary artery disease (CAD) and ischemic stroke share the same risk factors. Object... more Background: Coronary artery disease (CAD) and ischemic stroke share the same risk factors. Objective: The aim of the study was to explore the prevalence and predictors of concomitant CAD in acute ischemic stroke patients. Methods: One hundred and five patients (64.3 ± 15.0 years, 61 male) presenting with acute ischemic stroke documented by neuroimaging were consecutively included. All patients were carefully evaluated to determine their cardiovascular disease risk scores. The patients who had been previously shown to have ≥50% stenosis in at least one of the major coronary arteries by coronary angiography were grouped as CAD patients. Results: Of the 105 stroke patients, 27 patients had documented concomitant CAD. The stroke patients with CAD had higher cardiovascular risk scores and troponin I levels and carotid plaques were more prevalent. ROC analysis determined cut-off values as ≥22% for Framingham Heart Study Risk Score, ≥0.05 ng/mL for Troponin I, and ≥0.80 mm for carotid artery intima-media thickness to predict concomitant CAD. During 6 months of follow-up, among the 78 stroke patients without documented CAD, 16 patients had experienced major cardiovascular events including myocardial infarction, recurrent stroke, or cardiovascular death. These patients had higher Framingham Heart Study Risk Score and high-sensitive C reactive protein levels. Conclusion: Our study suggests stroke patients with higher Framingham Heart Study Risk Score and troponin I levels and carotid plaques be further investigated for the presence of concomitant CAD.
The purpose of this study is to evaluate the cognitive functions in cases with relapsing remittin... more The purpose of this study is to evaluate the cognitive functions in cases with relapsing remitting MS during the period in which the physical disability is seen in a lower level, as well as to examine the level and predominant domain of cognitive loss while relating it with the duration of the disease, degree of disability, and number of the episodes. Materials and Methods: Twenty five (25) patients with relapsing remitting MS were included in the study.Neuropsychological test battery which is used for the assessment of cognitive functions included tests for verbal and visual memory, simple attention and sustained attention, executive functions, visuospatial ability and language. The results were compared with 17 healthy controls matched for age, gender and education level. Results: When the patient and control groups were compared, a significant impairment was observed in MS patients on short and long time free recall and clue recall, recognition processes, recent memory and free recall processes, attention and ability to maintain attention, verbal fluency and categoric fluency during memory tests, while impairment was detected in frontal functions such as difficulty in response inhibition, perseverations in Luria drawings. Conclusion: Cognitive impairment affects the quality of life independent from disability scores, and highly informative during follow-ups as it indicates the progression of the disease. Therefore, cognitive assessment should be included in routine follow-ups. Further studies are warranted to improve the definition of the limits of cognitive impairment, to highlight the physiopathogenic mechanisms and to develop treatment principles in MS
Objective: This study aimed to compare the frequency of admission to hospital in patients with ac... more Objective: This study aimed to compare the frequency of admission to hospital in patients with acute ischemic stroke before the COVID 19 pandemic, during the pre-vaccination period, and after the start of vaccination for COVID 19, and to evaluate the time window period between symptom onset to door time, door to CT scan time, door to needle time, and door to puncture time. In addition, it aimed to investigate the effects of the COVID-19 pandemic on the admission, evaluation, and initiation of acute treatment of patients with acute ischemic stroke. Methods: Patients presenting with acute ischemic stroke between March 2019 -December 2019 (pre-pandemic), March 2020 -December 2020 (prevaccination pandemic period), and March 2021 -December 2021 (post-vaccination pandemic period) were included in the study. NIHSS was calculated by accordance with the neurological examination findings of the patients, cranial CT for the exclusion of bleeding and CT angiography images for the large vessel occlusions were performed, and the vital signs of the patients were recorded. IV tPA treatment was applied within the first 4.5 hours, and mechanical thrombectomy (MT) was performed in patients with large vessel occlusion. Results: Three hundred nineteen patients were included in the study. The times from symptom onset to emergency admission and from symptom onset to CT scan were found to be similar in all periods. The time from symptom onset to examine by a neurologist was found to be significantly longer in the vaccination period compared to the pandemic period. It was observed that the time from the door to needle time and the time from examine by a neurology doctor to needle time was statistically significantly shorter during the pandemic period (p<0.05). In our study in a tertiary hospital in Turkey, it was determined that the number of patients who was admitted with acute stroke clinic during the pandemic period was similar to other years and there was no delay in the initiation of treatment during the pandemic period. Door to needle times, as well as the time taken by the neurologist to examine and initiate IV-tPA treatment, were found to be shorter in the pre-vaccination pandemic period than in the pre-pandemic and post-vaccination periods.
The aim of this study was to evaluate the type, duration, etiology, treatment, and outcome of sta... more The aim of this study was to evaluate the type, duration, etiology, treatment, and outcome of status epilepticus (SE) episodes, among patients aged 16-50 years. A total of 101 SE episodes in 88 young adult patients fulfilled our criteria. The mean age was 32 years. Status epilepticus episodes were most frequently observed in patients 21-30 years of age. A total of 53% of the patients were male, and 57% had pre-existing epilepsy. Seventy of the 101 episodes were convulsive SE. The most common etiology was withdrawal of or change in antiepileptic drugs (AEDs), seen in 31% of the SE episodes. This study included treatment of SE with traditional AEDs. Sixty-six episodes were treated successfully with intravenous infusion of 18-mg/kg phenytoin, and six episodes were treated with 10-mg/kg phenytoin. A total of 28% of the SE episodes remained refractory to first-line treatment, which was related to the duration of SE and mortality. The outcome was death in 14% of the patients due to underlying etiologies in the hospital.
The aim of this comparative, controlled, cross-sectional study is to evaluate the voice quality i... more The aim of this comparative, controlled, cross-sectional study is to evaluate the voice quality in patients with multiple sclerosis (MS) by subjective and objective methods. Female patients with MS (n 5 27) and ageand sex-matched healthy controls (n 5 27) were included in this study. Vocal functions were evaluated by a multidimensional set composed of videolaryngostroboscopic examination, acoustic analysis, and subjective measurements (GRBAS and ''Voice Handicap Index''). Jitter percent, shimmer percent, and soft phonation index (SPI) values were higher in MS patients compared to controls (Jitt, P 5 0.001; Shim, P 5 0.033; SPI P ! 0.0001). Maximum phonation time was significantly shorter for MS patients compared to controls (P ! 0.0001). Stroboscopic examination revealed that 16 out of 27 MS patients have a ''posterior chink'' as glottic closure pattern with higher SPI values (40%). Noise to harmonic ratio (NHR) and mean fundamental frequency (F 0) values were similar for MS and control groups (NHR, P 5 0.737; F 0 , P 5 0.976). In this study, most of the MS patients had dysphonia due to weakness of voice. MS tends to worsen acoustic parameters including fundamental frequency, SPI, and jitter values. These results are consistent with the more asthenic voice quality observed in MS group.
ABSTRACT A 62-year-old man with untreated diabetes complained of diplopia and headache. Neurologi... more ABSTRACT A 62-year-old man with untreated diabetes complained of diplopia and headache. Neurological examination demonstrated left abducens nerve palsy. MRI showed a mass lesion in the left orbital apex. Total left ophthalmoplegia and visual loss rapidly developed in the next two weeks. A craniotomy was performed to decompress the orbital apex and remove the mass. The optic nerve was tightly encased by fibrous tissue. The pathological diagnosis was mucormycosis. Systemic administration of amphotericin B and fluconazole was started immediately. But the lesion rapidly invaded the cavernous sinus and occluded the left internal carotid artery. Finally, the patient died with intracranial extension of mucormycosis four months after the operation. Rhinocerebral mucormycosis is a rapidly progressive fatal disease. Successful treatment seems to be based on early diagnosis, control of the underlying disease, radical surgical resection, and systemic administration of amphotericin B. Mucormycosis should be considered as a differential diagnosis of orbital apex syndrome.
ABSTRACT Coincidence of ischemic and hemorrhagic stroke in the acute phase is a rare condition. A... more ABSTRACT Coincidence of ischemic and hemorrhagic stroke in the acute phase is a rare condition. A patient with uncontrolled hypertension and hypercholesterolemia presented with a sudden onset mild hand paresis that rapidly evolved to hemiparesis over the next few hours. Neuroradiologic investigations revealed a right-sided acute hemipons infarct and a hemorrhage in the anterior territory of infarction. Uncontrolled atherosclerotic risk factors such as hypertension and hyperlipidemia together with antithrombotic therapy seem to be the major reasons for the coincidental presence of both ischemic and hemorrhagic lesions in this patient.
Background: Coronary artery disease (CAD) and ischemic stroke share the same risk factors. Object... more Background: Coronary artery disease (CAD) and ischemic stroke share the same risk factors. Objective: The aim of the study was to explore the prevalence and predictors of concomitant CAD in acute ischemic stroke patients. Methods: One hundred and five patients (64.3 ± 15.0 years, 61 male) presenting with acute ischemic stroke documented by neuroimaging were consecutively included. All patients were carefully evaluated to determine their cardiovascular disease risk scores. The patients who had been previously shown to have ≥50% stenosis in at least one of the major coronary arteries by coronary angiography were grouped as CAD patients. Results: Of the 105 stroke patients, 27 patients had documented concomitant CAD. The stroke patients with CAD had higher cardiovascular risk scores and troponin I levels and carotid plaques were more prevalent. ROC analysis determined cut-off values as ≥22% for Framingham Heart Study Risk Score, ≥0.05 ng/mL for Troponin I, and ≥0.80 mm for carotid artery intima-media thickness to predict concomitant CAD. During 6 months of follow-up, among the 78 stroke patients without documented CAD, 16 patients had experienced major cardiovascular events including myocardial infarction, recurrent stroke, or cardiovascular death. These patients had higher Framingham Heart Study Risk Score and high-sensitive C reactive protein levels. Conclusion: Our study suggests stroke patients with higher Framingham Heart Study Risk Score and troponin I levels and carotid plaques be further investigated for the presence of concomitant CAD.
The purpose of this study is to evaluate the cognitive functions in cases with relapsing remittin... more The purpose of this study is to evaluate the cognitive functions in cases with relapsing remitting MS during the period in which the physical disability is seen in a lower level, as well as to examine the level and predominant domain of cognitive loss while relating it with the duration of the disease, degree of disability, and number of the episodes. Materials and Methods: Twenty five (25) patients with relapsing remitting MS were included in the study.Neuropsychological test battery which is used for the assessment of cognitive functions included tests for verbal and visual memory, simple attention and sustained attention, executive functions, visuospatial ability and language. The results were compared with 17 healthy controls matched for age, gender and education level. Results: When the patient and control groups were compared, a significant impairment was observed in MS patients on short and long time free recall and clue recall, recognition processes, recent memory and free recall processes, attention and ability to maintain attention, verbal fluency and categoric fluency during memory tests, while impairment was detected in frontal functions such as difficulty in response inhibition, perseverations in Luria drawings. Conclusion: Cognitive impairment affects the quality of life independent from disability scores, and highly informative during follow-ups as it indicates the progression of the disease. Therefore, cognitive assessment should be included in routine follow-ups. Further studies are warranted to improve the definition of the limits of cognitive impairment, to highlight the physiopathogenic mechanisms and to develop treatment principles in MS
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