Effect of maternal migraine on children's quality of sleep.

BACKGROUND AND PURPOSE: Sleep disorders are common problems associated with migraine. These sleep disorders are known to have a debilitating impact on daily lives of migraine patients. The purpose of this study is to assess the effects of sleep disorders experienced by individuals suffering from migraine on their children as well as the presence of sleep disorders in their children. METHODS: This study included 96 mothers diagnosed with migraine and their 96 healthy children, and a control group formed of 74 healthy mothers and their children. Exclusion criteria were chronic systemic disease or central nervous system disease or a history of smoking/alcohol use for mothers, and chronic disease or regularly occurring headaches or recurrent abdominal pain for children. For maternal evaluation, the Visual Analogue Scale (VAS), Migraine Disability Assessment Scale (MIDAS), Pittsburgh Sleep Quality Index (PSQI), Beck Depression Index (BDI) and Beck Anxiety Index (BAI) were used and for the assessment of the children's quality of sleep, the Children's Sleep Habits Questionnaire (CSHQ) was used. The SPSS 21.0 program was employed for statistical analysis, with statistical significance set at p<0.05. RESULTS: The mean age of the group with migraine was 36.6±7.1 years, while that of the control group was 38.01±4.7. Mood and sleep disorders were more frequently observed in the participants with migraine (p<0.05). Sleep disorders were significantly low in children with migraineur mothers (p=0.02); and child sleep anxiety is significantly high in control group (p=0.048). Maternal BAI scores had a significant influence on their children's quality of sleep. CONCLUSION: In our study, the presence of migraine-type headache in mothers was observed to have a positive effect on reducing sleep disorders in the children. Recurrent headaches of the migraineur mothers with or without sleep disorders and psychiatric comorbidities did not influence the quality of sleep in their children directly, but the sleep anxiety of the children may have had an impact on it.

Relationship Between Carotid Stenosis and Infarct Volume in Ischemic Stroke Patients.

BACKGROUND Stroke is a serious health problem all over the world. Ischemia causes 85% of strokes and 75% of these ischemic strokes occur within the area supplied by the internal carotid artery (ICA). MATERIAL AND METHODS This study included 47 acute stroke patients who were in the large-artery atherosclerosis group according to Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification and who had an infarct in the area supplied by the internal carotid artery. We sought to determine whether there was a significant correlation between the infarct volume of the patients as measured by diffusion-weighted magnetic resonance imaging (DW MRI), their National Institutes of Health Stroke Scale (NIHSS), and degree of carotid stenosis as identified by carotid computed tomography angiography (CTA). RESULTS A significant correlation was observed between the percentage of carotid artery stenosis and infarct volume (p<0.001). In addition, there was a significant positive correlation between the NIHSS and infarct volume; the correlation was of moderate strength (r=0.366, p=0.001). CONCLUSIONS Our findings indicate that the percentage of carotid artery stenosis could be useful in predicting the infarct volume of the stroke.

Predictors of periprocedural complications of carotid artery stenting - a multivariate analysis of a single-centre experience.

BACKGROUND: Carotid artery stenting (CAS) is currently used as an alternative treatment to carotid endarterectomy (CEA). The objective of this study was to analyse our 5-year experience performing CAS. Secondarily, we sought to determine independent risk factors which predict periprocedural complications. PATIENTS AND METHODS: A total of 146 patients who underwent 153 CAS procedures were analysed. The majority of patients (123, 84.2%) had symptomatic carotid stenosis. Demographic and interventional data, angiographic lesion characteristics, and periprocedural complications were recorded. Using univariate and multivariate logistic regression analyses, risk factors associated with adverse clinical outcomes were determined. RESULTS: Periprocedural neurological complications, including four (2.7 %) major strokes, three (2 %) transient ischaemic attacks, one (0.7%) amaurosis fugax, and two (1.3 %) cases of hyperperfusion syndrome occurred in ten (6.8%) patients. The incidence of periprocedural complications significantly increased in female patients (r = 0.214, p = 0.009) and patients with longer lesions (r = 0.183, p = 0.027), contralateral stenosis ≥50 % (r = 0.222, p = 0.007), the presence of complicated plaques (r = 0.478, p < 0.001) and inadequate glycaemic control (r = 0.259, p = 0.002). Multivariate regression analysis also determined four variables to be potential independent risk factors for 30-day adverse events: higher age (Odds ratio [OR] = 1.283; 95 % CI, 1.051 to 1.566, p = 0.014); longer lesions (OR = 1.459, 95 % CI, 1.124 to 1.893, p = 0.004); higher tortuosity index (OR = 1.015, 95 % CI, 1.001 to 1.030, p = 0.034), and the presence of complicated plaque morphology (OR = 4.321, 95 % CI, 1.621 to 10.23, p = 0.001). CONCLUSIONS: Patient and lesion characteristics including age, lesion length, complicated plaque morphology and tortuosity index, may be associated with periprocedural complications.

C-reactive protein/albumin ratio as a novel predictor for nutritional status of geriatric patients.

BACKGROUND AND AIMS: The C-reactive protein to albumin ratio (CAR) is a novel parameter that has been reported as a significant prognostic marker in some diseases. The purpose of the present research was to investigate the predictive value of this ratio with regard to nutritional status in geriatric patients. METHODS AND RESULTS: A total of 154 geriatric patients (age ≥65 years) who consecutively presented to the internal medicine outpatient clinic were included in this cross-sectional study. The Mini Nutritional Assessment (MNA) was used as a reference to determine the nutritional status of the patients. Based on the MNA results, the patients were divided into two groups: normal nutrition and malnourished or at risk of malnutrition. The median CAR of malnourished patients or those at risk of malnutrition was significantly higher than that of patients with normal nutritional status (p = .012). A significant negative correlation was also observed between the MNA score and the CAR (r = -0.196, p = .015). The receiver operating characteristic curve analysis indicated that the CAR was a significant predictor of malnourishment or the risk of malnutrition (p = .012). CONCLUSION: The CAR could predict which geriatric patients were malnourished or at risk of malnutrition. CAR may be used as a new tool in the nutritional screening of geriatric patients.

Three years' interventional neurology experience in Turkey with the Thrombite thrombectomy device in large vessel occlusion in the anterior circulation: safety, efficacy, and clinical outcome.

Introduction: While the Thrombite device differs from the Solitare stent with its Helical open-side structure feature, it shows great similarity with its other features. We assessed the Thrombite device's effectiveness and safety in this study. Materials and methods: The study was a retrospective analysis of patients who were included in the Turkish Interventional Neurology database and who had mechanical thrombectomy with the Thrombite device as the first choice between January 2020 and January 2023. The type of study is descriptive research. Result: Using the Thrombite thrombectomy device, 525 patients received treatment. The median baseline National Institutes of Health Stroke Scale (NIHSS) score was 13, the median initial Alberta Stroke Program Early Computed Tomography (ASPECT) score was 8, and the mean patient age was 68.6+11.7 years. Between the groin puncture and the successful recanalization, the median time was 34 minutes (interquartile range [IQR]: 15-45). 48.2% (modified treatment in cerebral infarction; mTICI) 2b/3% and 33.9% (mTICI 2c/3) were the first-pass recanalization rates. In the end, 87.7% of patients had effective recanalization (thrombolysis in cerebral infarction 2b/3). In the "first-pass" subgroup, the favorable functional result (modified Rankin Scale 0-2) was 51.8%, while it was 41.6% for the entire patient population. The rate of embolization into new territory/different territory were 2.1/0.1%. 23 patients (4.5%) had symptomatic hemorrhage. Conclusion: The Thrombite device showed a good safety profile and high overall successful recanalization rates in our experience.

Hemiballism and chorea with acute/subacute onset: a retrospective series.

INTRODUCTION: Chorea is a hyperkinetic movement disorder with sudden, irregular, random, dance-like involuntary movements, and ballism is usually one-sided, high-amplitude movements at the proximal of the extremities. In the etiology of acute chorea/hemiballismus, it is necessary to distinguish drugs first and then focus on metabolic causes. The most important etiological causes that may provoke acute/subacute onset chorea/hemiballismus are hypo-hyperglycemia and electrolyte disorders. In this study, we aim to present 19 patients who were admitted to our clinic with movement disorder with acute/subacute onset and diagnosed with chorea/hemiballismus. METHODS: The study was completed with 19 patients. Routine biochemistry, HbA1c level, hemogram, sedimentation, CRP, hepatitis panels, detailed infective parameters, HIV, vitamin B12 level, folate levels, and thyroid function tests were studied. All patients underwent neuro-imaging. RESULTS: 16(84.2%) were female and 3(15.8%) were male. The lowest age of the patients was 48 years, the highest age was 89 years, and the mean age was 72.21 years. Thirteen (68.42%) patients had a diagnosis of diabetes mellitus in their history. The blood glucose levels of these patients at the time of admission: the lowest was 99 mg/dl and the highest was 1200 mg/dl. HbA1c values of 11(84.61%) of the 13 patients were also found elevated. Thirteen (68.4%) patients had hemiballismus, 4(21.1%) patients had bilateral choreoathetosis in the four extremities, and 2(10.2%) patients had ballism limited to one upper extremity. CONCLUSIONS: Chorea/hemiballismus is a movement disorder that is rare and can occur due to a wide range of etiologies. The most common metabolic cause is NKHHS.

Correlates of Zonulin and Claudin-5, markers of intestinal and brain endothelial permeability, in Parkinson's Disease: A pilot study.

INTRODUCTION: Idiopathic Parkinson's Disease is a chronic, progressive, neurodegenerative disease that affects the substantia nigra pars compacta and dopaminergic neurons in the brain stem. Since zonulin and claudin-5 are involved in intestinal and brain endothelial permeability and it is hypothesized that the brain-gut axis is relevant in IPD, the aim of our study is to evaluate whether the relationship between Zonulin and Claudin-5 levels and Parkinson's Disease patients. METHODS: A total of 139 patients, including 34 mild, 33 moderate, 39 severe stage patients and 33 healthy controls were included. The patients' demographic data, age of onset, disease duration, disease type and drugs were noted. UPDRS and H&Y scores were evaluated. Prodromal stage symptoms and non-motor symptoms were noted. Zonulin and Claudin-5 levels in the serum were studied. RESULTS: The mean Zonulin value was significantly higher in the IPD group compared to the control one (16.0 ± 10.5 vs. 11.1 ± 4.3; p = 0.0012). Likewise, the mean Claudin-5 value in the IPD group was again significantly higher than in the control group (8.4 ± 5.5 vs. 6.2 ± 3.4; p = 0.0003). The combined ROC curve, though, showed only modest albeit significant discriminant ability. Moreover, neither zonulin nor claudin-5 related to age, phenotype or disease duration, and in terms of non-motor symptoms there was only a significant association between zonulin and urine problems and between claudin-5 and sleep symptoms. CONCLUSION: Our results suggest an association of these markers of intestinal and brain endothelial permeability and IPD, although these remain modest and preliminary and warrant further consideration in larger studies including prodromal cases.

Evaluation of the relationship between idiopathic restless legs syndrome and serum hepcidin levels.

INTRODUCTION: The relationship between restless legs syndrome (RLS) and iron deficiency is a well-known topic. However, the etiology of the disease has not been determined. As the central iron deficiency is the most critical biological abnormality for RLS, we planned a study examining the relationship between RLS and hepcidin, which is the only regulatory hormone of iron metabolism known so far. METHODS: International Restless Legs Syndrome Study Group diagnostic criteria (2014) were taken as a basis. A total of 40 RLS patients and 40 healthy controls were included in the study. To avoid the potential variables that might cause secondary RLS, all the participants were asked to provide hemogram, ferritin, iron, thyroid function tests, and sedimentation analysis. The hepcidin levels were measured with a Human Hepcidin (Hepc 25) ELISA kit (MyBioSource). RESULTS: The statistically significant results of our analysis show that the red blood cell count, the neutrophil count, the percentage of lymphocytes and neutrophils, and, more distinctively, hepcidin levels were higher in RLS patients in comparison with the control group. CONCLUSION: In this study, no differences were found in iron and ferritin values. High levels of hepcidin, the main regulator of iron metabolism, in those with primary RLS support the possibility that hepcidin may play a role in the pathogenesis of RLS. We think that larger studies on this subject can give clearer ideas.

Can C-reactive protein/albumin ratio be a prognostic factor in acute stroke patients undergoing mechanical thrombectomy?

INTRODUCTION: C-reactive protein (CRP) and albumin are markers synthesized by the liver and may reflect inflammatory responses. CRP/Albumin ratio (CAR) serves better to reflect the inflammatory state and therefore the prognosis. Worse prognosis is reported in previous studies when CAR rate on admission is high in patients with stroke, aneurysmal subarachnoid hemorrhage, malignancy or patients followed in intensive care units. We aimed to investigate the relation of CAR with prognosis in mechanical thrombectomy performed acute stroke patients. MATERIALS AND METHODS: Stroke patients admitted to five different stroke centers between January 2021 and August 2022 undergoing mechanical thrombectomy were included and retrospectively analyzed. The CAR ratio was calculated as the ratio of CRP to albumin level in the venous blood samples. Primary outcome was the relation between CAR and functional outcome at 90 days determined by modified Rankin Scale (mRS). RESULTS: This study included 558 patients with a mean age of 66,5 ± 12.5 years (age range:18-89 years) best cutoff value of the CAR was 3.36, with 74.2 % sensitivity and 60.7 % specificity (Area under the curve: 0.774; 95 %CI: 0.693-0.794). There was no significant correlation between CAR rate and age, CAR rate and NIHSS on admission, and also between CAR rate and symptom recanalization (p > 0.05). CAR ratio in the mRS 3-6 group was statistically significantly higher (p < 0.001). In the multivariate analyses, CAR showed an association with 90-day mortality (odds ratio, 1.049; 95 % CI, 1.032-1.066) CONCLUSION: In acute ischemic stroke patients treated with mechanical thrombectomy, CAR may be one of the factors affecting poor clinical outcome and/or mortality in patients undergoing mechanical thrombectomy. Upcoming similar studies in this patient group may better clarify the prognostic role of CAR.

Investigation of the relationship between serum irisin level in the idiopathic restless legs syndrome: Could be a marker independent of physical activity?

INTRODUCTION: Restless legs syndrome (RLS) is a common but underdiagnosed neurological syndrome. It is characterized by the feeling of discomfort and desire to move, especially in the lower extremities, which often occurs at night, and the cure or relief of symptoms with movement. Irisin is a hormonelike polypeptide that was first identified in 2012, weighs 22 kDa, consists of 163 amino acids, and is mainly synthesized in muscle. Its synthesis increases with exercise. Here in this study, we planned to investigate the relationship among serum irisin level, physical activity, lipid profile, and RLS. MATERIAL AND METHODS: A total of 35 patients with idiopathic RLS and 35 volunteers were included in the study. Then, venous blood was taken from the participants in the morning after 12 h of night fasting. RESULTS: The mean value of serum irisin level was 16.9 ± 14.1 ng/mL in the case group and 5.1 ± 5.9 ng/mL in the control group, which was statistically quite significant (p < .001). A significant efficiency (under the curve area 0.886 [0.804-0.967]) of irisin value was observed in the differentiation of patients in the case and control groups. DISCUSSION: Serum irisin level was significantly higher in the case group than in the control group. In conclusion, we suggest that irisin may play a role in the pathophysiology of RLS independently of the intensity and duration of physical activity and anthropometric data, such as body weight, body mass index, and waist/hip ratio.

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 (ESOGÜ) 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 poor collateral status, ≥ 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.

HaNDL Syndrome Presenting With Confusion: A Rare Case Report.

HaNDL syndrome (Syndrome of Transient Headache and Neurologic Deficit with Cerebrospinal Fluid Lymphocytosis) characterized by sudden onset headache, transient neurological deficits, and cerebrospinal fluid (CSF) lymphocytosis, is a self-limited clinical entity that is rarely seen. In this article, we present a case with HaNDL syndrome in a 28-year-old male patient who presented with confusion and agitation after sudden onset of headache, right hemiparesis, and lymphocytosis pleocytosis.

Central nervous system involvement in rheumatoid arthritis: possible role of chronic inflammation and tnf blocker therapy.

Rheumatoid arthritis (RA) is a chronic disease, the etiology of which has yet to be clarified, which causes activation of proinflammatory pathways that bring about joint and systemic inflammation. Although peripheral nervous system anomalies are observed widely in RA, very few case reports on changes in the central nervous system (CNS) have been published. In recent years, the pathophysiology of CNS involvement that can occur in RA has attracted a great deal of attention. Emphasis has focused on the possibility that CNS involvement occurs due to blood-brain barrier (BBB) damage associated with chronic inflammation. The present study was performed to investigate the possible effects of BBB dysfunction and tumor necrosis factor (TNF) blocker therapy on BBB function, which may cause CNS damage in patients with RA. 58 RA patients [47 (81.0%) females, 11 (19.0%) males] and 34 healthy controls [24 (70.6%) females, 10 (29.4%) males] were included in the study. All RA patients were on synthetic DMARD therapy at the beginning. Thirty patients continued DMARD therapy, and 28 patients with high disease activity were started on TNF blocker therapy. All demographic characteristics of the patients were recorded. Disease activity was evaluated using the Disease Activity Score 28-joint count C reactive protein. The Mini-Mental State Examination was used to evaluate cognitive function, and the Fazekas scale was used to assess cranial lesions visualized by magnetic resonance imaging (MRI). Patients' peripheral blood S100ß, glial fibrillary acidic protein (GFAP), claudin, interleukin (IL)-17, and IL-1ß levels were measured at the beginning of the study and after 6 months. Demographic characteristics (including sex, age, and body mass index) were similar in the RA and control groups. S100ß and GFAP levels were significantly higher in the patient group than in the control group. In the group that was started on TNF blocker therapy, S100ß and GFAP levels were significantly decreased 6 months after commencement of treatment. No difference was observed between the RA and control groups in terms of hyperintense lesions seen on cranial MRI. The S100ß levels increased with lesions in the deep white matter seen on cranial MRI in patients with RA. In conclusion, next to decreasing disease activity and joint erosions by suppressing inflammation, anti-TNF therapy in RA can also suppress potential CNS involvement linked to BBB (blood-brain barrier) dysfunction. Further studies with broader participation and longer patient follow-up are needed to reinforce this hypothesis.

Demographic characteristics and neurological comorbidity of patients with COVID-19.

ABSTRACT: The COVID-19 infection that started in the Wuhan Province of the People's Republic of China and has now spread throughout the world is not limited to the respiratory system, but also causes other systemic symptoms through viremia. Recent data show that the central and peripheral nervous system involvement is particularly substantial. Thus, the present study aims to investigate the current neurological comorbidities and symptoms of patients with COVID-19 who were followed up by our clinic physicians.

Essential Tremor is not Only a Movement Disorder; Its Relationship with Sleep and Anxiety.

INTRODUCTION: Essential tremor (ET) is the most common movement disorder, and some studies suggest that there are non-motor symptoms as well as motor symptoms. This study aims to investigate the relationship between ET and anxiety and sleep disorder. METHODS: The study was conducted with 38 healthy individuals in the control group and 40 patients who admitted to the neurology clinic of our hospital and had definite ET according to the Consensus statement of the Movement Disorder Society on Tremor. Pittsburgh Sleep Quality Index (PSQI) and Hamilton Anxiety Rating Scale (HAM-A) were applied to both groups. Statistical analysis was carried out with SPSS 22.0 for Windows. RESULTS: The patient and control groups were similar in terms of age, gender and educational status. The PSQI and HAM-A scores in the patient group were significantly higher than the control group (p<0.000, p<0.000, respectively). Both scores were higher in female patients compared to male patients (p<0.05, p<0.05, respectively), and in married patients compared to single patients (p<0.05, p<0.05, respectively). CONCLUSION: Sleep disorder and anxiety are more common in patients with ET than in healthy individuals. We believe that more severe sleep disorders and anxiety in female and/or married patients are indicative of the psychosocial component of the disorder, and that this condition should not be overlooked and should be studied more comprehensively in this regard.

Effective INR Level May Be Delayed in Secondary Prevention of Stroke Due to Atrial Fibrillation with Warfarin in the Patients with Diabetes Mellitus.

INTRODUCTION: Warfarin is a drug used for anticoagulation in diseases, especially atrial fibrillation (AF). The effectiveness of warfarin is monitored by the International Normalized Ratio (INR) and should be kept between 2.0 and 3.0 in the AF clinic. This drug the significant variability in dose response and the narrow therapeutic index among individuals. However, the effective INR level may not be achieved due to some reasons, or the time to achieve the effective INR level may lengthen. Our aim in this study is to investigate whether there is a difference in terms of dose and duration in achieving the effective INR level by the warfarin treatment due to the coexistence of AF and stroke between patients with and without diabetes mellitus (DM). METHODS: A total of 70 patients whose warfarin treatment was initiated due to non-valvular AF and who were diagnosed with acute ischemic stroke were included in the study, 30 of these patients were DM patients and 40 were non-DM patients. The total dose and time values at achieving the effective INR level after the initiation of warfarin treatment according to the clinical protocol during follow-ups in hospital were statistically compared between the two groups. RESULTS: In the study, it was found that the total warfarin dose was significantly higher in the DM group compared to the non DM group (p<0.05). It was detected that the time to achieve the effective INR level was also significantly longer in the DM group than in the non-DM group (p<0.05). CONCLUSION: In the presence of DM diagnosis, the higher dose warfarin and longer follow-up are required to achieve effective INR levels in stroke patients whose warfarin treatment was initiated due to non-valvular AF.

Impact of emergency room meetings on improvement of door-to-needle times in acute ischemic stroke patients: A single center's experience.

OBJECTIVE: One major limitation of the use of intravenous tissue plasminogen activator (IV-tPA) is the short treatment window of acute ischemic stroke (AIS). In this article, we analyze the impact of emergency room meetings on step-by-step improvement of door-to-needle times (DTN). METHODS: This study used prospectively recorded data of AIS patients treated with IV-tPA admitted to the Sakarya University Education and Research Hospital between January 2015 and August 2017. Time benchmarks of DTN were recorded on a case-by-case basis. Meetings were held in the emergency room if there was an increase of more than 25% in DTN of subsequent AIS patients treated with IV-tPA. Guideline-recommended stroke management methods and feedback from our previous DTN data were both considered. The goal was to improve DTN within 60 minutes for at least 50% of AIS patients. RESULTS: Mean DTN of 20 patients was 76.9±32.4 minutes. Nine patients experienced ≤60 minute DTN times, while two were under 30 minutes. Six meetings were conducted, with two each in 2015, 2016, and 2017. Without exception, there was a reduction in DTN after all meetings. Considering the intervals of the six meetings, the ratios of patients treated at ≤60 minutes were 0%, 0%, 60%, 66.6%, 40 and 100%, respectively. CONCLUSION: Meetings in the emergency room, when conducted according to certain rules, can be effective in improving DTN.

Patients with primary restless legs syndrome have higher prevalence of autonomic dysfunction and irritable bowel syndrome.

INTRODUCTION: Given the limited data on autonomic dysfunction in patients with primary restless legs syndrome (pRLS), we compared autonomic dysfunction and presence of irritable bowel syndrome (IBS) between patients with pRLS and control patients. METHODS: Consecutive adult drug-naïve patients with pRLS, and age- and gender-matched healthy control patients were enrolled in this study. Diagnoses, based on validated self-reported questionnaires, were made using the following guidelines: Rome III classification system for functional gastrointestinal disorders for IBS; Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) for the presence of anxiety and depression, respectively; Pittsburgh Sleep Quality Index (PSQI) for severity of sleep disturbances; and Scales for Outcomes in Parkinson's disease-Autonomic (SCOPA-AUT) for autonomic dysfunction. RESULTS: There were 88 patients with pRLS (18 male, 70 female) and 128 control patients (40 men, 88 women). The mean age of the pRLS patients and control patients was 50.3 ± 9.3 years and 49.7 ± 8.2 years, respectively. Overall, 41 (46.6%) of the patients with pRLS and 16 (12.5%) of the control patients had IBS. Among patients with pRLS, IBS was significantly more common and the total autonomic SCOPA-AUT scores were higher than those found among control patients. Among pRLS patients with IBS, total autonomic SCOPA-AUT, PSQI, BAI and BDI scores were significantly higher than among pRLS patients without IBS. The presence of IBS did not affect the severity of restless legs syndrome. CONCLUSION: The presence of autonomic nervous system impairment in patients with pRLS and the strong link between IBS and pRLS merit further, more extensive investigation.

The effect of maternal migraine headache on their children's quality of life.

Migraine is an episodic disease characterized by a throbbing and generally unilateral headache, often accompanied by nausea, vomiting and light and sound sensitivity. Migraine is known to affect one's quality of life; not only the person with migraine but also his/her family and social environment are affected by this condition. Our study aimed to evaluate the effects of maternal migraine on children's quality of life. The patient group comprised 70 mothers with migraine diagnoses and their 111 healthy children, while 50 healthy mothers and their 86 children were included in this study as the control group. The Visual Analog Scale (VAS), Migraine Disability Assessment Scale, Beck Depression Index (BDI) and Beck Anxiety Index (BAI) were used for evaluation of mothers; 3 to 7-year old KINDL and 7- to 17-year-old KINDL-R Quality of Life Scales were used to evaluate the quality of life of children. The SPSS 21.0 program was used for statistical analysis and p < 0.05 was assumed to be statistically significant. The mean age of the migraine group was 37.09 ± 6.94 years, and the mean age of the control group was 38.2 ± 4.5. Symptoms of depression and anxiety were more frequently found in subjects with migraine (p < 0.05). In comparison with the control group: 3 to 7-year old KINDL total scores, self-esteem and school subscales, 7- to 17-year-old KINDL total scores, self-esteem and the social relationships subscale scores were lower in migraine group. It was found to be significant that VAS, BDI and BAI scores of the mothers were negatively correlated with the children's quality of life. Our study concluded that the presence of migraine-type headache in mothers worsen the relations in school, self-esteem and quality of life in younger children and social relations, relations in school and quality of life in older children. The maternal age, disease severity, and anxiety and depression symptoms were shown to predict the quality of life in children. Performing preventive interventions by individually assessing bio-psycho-social elements for the treatment of mothers with migraine will preserve other family member's and especially children's quality of life.

Paroxysmal posterior variant alien hand syndrome associated with parietal lobe infarction: case presentation.

Alien hand syndrome (AHS) is an involuntary and rare neurological disorder emerges at upper extremity. AHS is a disconnection syndrome with the symptoms of losing sense of agency and sense of ownership, and presence of involuntary autonomic motor activity. There are frontal, callosal and posterior types of AHS and each of them occurs depend on the lesions of different of the brain. Posterior variant is a rarely encountered AHS type compared to others. AHS, generally regarded as persistent, but rarely maybe observed as paroxysmal. In this article, we present 71 year old patient with right posterior parietal lobe infarction and developed posterior variant AHS on left arm 1 month after discharge from the hospital. To discriminate AHS from conditions such as extrapyramidal movement disorders and epileptic seizures that take part in differential diagnosis should be kept in mind by the clinicians. Wrong and unnecessary treatments could be prevented in this way.