Can TG/HDL Ratio be an Accurate Predictor in the Determination of the Risk of Cerebrovascular Events in Youngsters?

OBJECTIVES: There is good evidence that shows that modification of modifiable risk factor will reduce the risk of stroke. Hyperlipidemia is one of these risk factors. Studies have shown that nontraditional serum lipid variables may be better predictors of vascular risk rather than others.The objective of the present study was to assess the relationships of traditional and nontraditional serum lipid measurements between young and elder patients with stroke and healthy young adults. METHODS: One hundred twelve young patients with ischemic stroke, 113 healthy adults, and 110 patients with ischemic stroke aged >45 years were included in the study. Laboratory tests for total cholesterol (TC), its fractions, and triglycerides (TGs) were performed using standard techniques, and we computed four nontraditional lipid variables.Statistical analyses were performed using chi-square test, Student's t-test, and SPSS version 16.0 software. A p value of <0.05 was considered statistically significant. RESULTS: The mean age of 112 young patients with stroke was 38.46±5.96 years. There were 63 male and 49 female patients. Measurements of lipid parameters were as follows: low-density lipoprotein (LDL) 121.42±36.56 mg/dl, high-density lipoprotein (HDL) 38.84±12.47 mg/dl, TG 186.10±176.14 mg/dl, TC 194.76±45.35 mg/dl, LDL/HDL 3.39±1.46, TG/HDL 5.44±6.36, and TC/HDL 5.40±6.36. All lipid measurements were significantly higher in young patients with stroke than in healthy adults.The mean age of 110 patients with stroke aged >45 years was 69.53±12.34 years. There were 63 male and 47 female patients. Measurements of lipid parameters were as follows: LDL 125.18±35.97 mg/dl, HDL 41.47±14.16 mg/dl, TG 117.53±59.03 mg/dl, TC 190.16±42.96 mg/dl, LDL/HDL 3.32±1.55, TG/HDL 3.46±3.43, and TC/HDL 5.01±2.08. TG level and TG/HDL ratio were significantly higher in young patients with stroke than in older cases. CONCLUSION: All lipid measurements were significantly higher in young patients with ischemic stroke than in young healthy adults. TG level and TG/HDL ratio were significantly higher in male than in female patients. In addition, TG level and TG/HDL ratio were significantly higher in young patients with stroke than in older cases. As the TG/HDL ratio has proven to be a highly significant independent prognostic predictor of stroke, it should be calculated in young patients with ischemic stroke.

THE DIAGNOSTIC AND MANAGEMENT CHALLENGES FOR POSTERIOR REVERSIBLE LEUCOENCEPHALOPATHY SYNDROME.

Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological entity characterized by epileptic seizures, headaches, altered mental status and focal neurological signs. Hypertension is the second most common condition associated with PRES. The 50-year-old-male patient with, right-sided hemiparesis and speech disturbances admitted to our clinic. His blood pressure at the emergency service was 220/140 mmHg. A left putaminal hematoma was seen in his CT and MRI. In his brain MRI, FLAIR and T2 -weighted sequences showed bilateral symmetric diffuse hyperintensities in the brain stem, basal ganglia, and occipital, parietal, frontal, and temporal lobes. After the intense antihypertensive drug treatment, his blood pressure came to normal limits within a week. During his hospitalisation he had a recurrent speech disturbance lasting an hour. His electroencephalography was normal. In his repeated diffusion weighted MRI, an acute lacunary infarct was seen on right centrum semiovale. Two months later, the control MRI showed only the previous lacuner infarcts and the chronic putaminal hematoma. We presented a case developping either a cerebral hemorrhage or a lacunar infarction due to PRES. The main reason of the following complications of the disease was delayed diagnosis. Uncontrolled hypertension was guilted for the events.

A RARE COMPLICATION OF A RARE DISEASE; STROKE DUE TO RELAPSING POLYCHONDRITIS.

Relapsing polychondritis (RP) is an episodic and progressive inflammatory disease of cartilaginous structures. Its diagnosis is based primarily on clinical features such as laboratory parameters, biopsy. Neurological complications occur in 3% of the cases and are classified as an important cause of death. The cranial nerve disorders are most common but hemiplegia, ataxia, myelitis, polyneuritis, seizures, confusion, hallucination and headache can also happen. The aetiology of central nervous system involvement is still unknown. Moreover stroke has rarely reported in these patients. The diagnosis of stroke is challenging because of its rarity among these patients. Perhaps vasculitis is the common underlying mechanism. Also meningitis and encephalitis can occur during the course of RP. A 44 year-old woman was admitted with uncontemplated left hemiparesis, redness, swelling, and tenderness of the metacarpophalangeal and interphalangeal joints of the right hand and the cartilaginous portion. White blood cell count, C-reactive protein and the erythrocyte sedimentation rate were elevated. Vasculitis biomarkers were normal in our patient. Carotid and vertebral artery doppler ultrasonography, cranial and cervical MR Angiography were normal. Echocardiography showed a mild mitral valve prolapse and regurgitation. Our patient had the history of auricular polychondritis but she had not been diagnosed. Hemiparesis was her first neurological manifestation that led her to doctors for diagnosis. Our patient fulfilled the criteria of RP so no biopsy was needed. She was treated with oral prednisolone (80 mg/day) and aspirin (300 mg/day) and now she is on 10 mg prednisolone and 150 mg azathioprine. Two months later her physical and neurological symptoms returned to normal.