Time­dependent changes in blood cells, NIHSS and mRS according to reperfusion treatment type in stroke patients who developed hemorrhagic complication.

Hemorrhagic complications may be seen following reperfusion therapy with rtPA and/or thrombectomy after acute ischemic stroke (AIS). Neutrophils, lymphocytes, and platelets have important roles in the inflammatory and immune responses that develop in these patients. We investigated time­dependent changes in blood cells, NIHSS and mRS values according to type of reperfusion therapy in AIS patients who developed cerebral hemorrhage. In AIS patients who underwent rtPA and/or thrombectomy and developed cerebral hemorrhage within the first 24 hours after treatment, leukocyte, neutrophil, lymphocyte, platelet counts and their ratios were recorded on admission, 1st, 3rd, and 7th days. NIHSS values on admission, 3rd days and mRS values on admission, discharge, and the 3rd month were recorded. These values were compared according to the type of reperfusion therapy. Out of 436 AIS patients, rtPA was applied in 50.5%, thrombectomy in 28.2%, and rtPA+thrombectomy in 21.3%. Hemorrhage developed in 25.5% of the patients. Patients treated with thrombectomy had a greater rate of cerebral hemorrhage. Pre­stroke mRS values were lower in all therapy types than mRS scores at discharge and the 3rd month. The NIHSS scores did not differ significantly in 3 days. Depending on the type of reperfusion treatment, there are a few time­dependent significant changes observed in the blood cell counts and ratios. In conclusion, there is a relation between the type of reperfusion therapy and the time­dependent changes in blood cells and ratios as well as mRS scores among AIS patients who have undergone rtPA and/or thrombectomy and developed cerebral hemorrhage.

Autoimmune encephalitis and paraneoplastic syndromes in Turkey: a multi-centre study.

BACKGROUND: Autoimmune encephalitis (AIE) and paraneoplastic syndromes (PNS) are both rare groups of neurological diseases that are difficult to diagnose. AIM: We aimed to determine the common and distinct aspects of these two aetiologies of encephalitis as well as the characteristics of our patient group. METHODS: We respectively analysed the records of the patients including symptoms, demographic features, neurological examination, cranial-magnetic-resonance-imaging (MRI), electroencephalography (EEG) findings, cerebrospinal fluid results (CSF) findings. Autoimmune/paraneoplastic autoantibodies in blood and/or CSF were all documented. RESULTS: Forty-six patients fulfilled the diagnostic criteria. Thirty-eight of them were diagnosed with AIE, and 8 of them were diagnosed with PNS. The PNS group had higher nonconvulsive status epilepticus than the AIE (2/8 vs 0/38; p=0.027). PNS patients were diagnosed with a malignancy in their follow-ups more than those in the AIE group [4/38 vs 8/8] (p<0.001). When the symptoms of antibody-positive and negative patients were compared in the AIE group, the rates of consciousness/memory problems (13/15 vs 11/23; p=0.020) and speech impairment (8/15 vs 2/23; p=0.004) were significantly higher in patients without antibodies (n: 15) than in antibody-positive patients (n: 23). In antibody-negative groups, the rates of memory problems in neurological examination (13/15 vs 12/23 p=0.028) and temporal findings on electroencephalography were more prominent than antibody-positive groups (1/23 vs 5/15; p=0.027). The number of patients with cerebellar signs was higher in antibody-positive patients (6/23 vs 0/15; p=0.038). CONCLUSION: Although the positivity of autoantibodies is critical in the diagnosis of AIE and PNS, even minor differences in clinical and laboratory findings of patients are helpful in the diagnosis, especially in the autoantibody-negative patients. Comparing the data with other population studies has shown that several inherited and environmental factors may contribute to the pathophysiology of AIE and PNS, as well as clinical and laboratory differences.

Initial experience with the CatchView thrombectomy device for acute ischemic stroke.

BACKGROUND: We report our initial experience with the CatchView (CV) thrombectomy device in patients with acute ischemic stroke (AIS). METHODS: A retrospective analysis of 53 of 284 AIS patients (mean age 66.6±14.8 years, range 37-94) treated with a CV device between January 2019 and February 2020 was performed. The baseline characteristics (gender, age, comorbidities, National Institutes of Health Stroke Scale (NIHSS) score, intravenous tissue plasminogen activator (IV-tPA) administration, and occlusion localization) of these subjects were recorded. Modified Thrombolysis in Cerebral Ischemia (mTICI) scores of 2b and 3 were considered to indicate successful recanalization, and subjects with a modified Rankin Scale score of ≤2 on day 90 was considered a good clinical outcomes. RESULTS: The mean NIHSS score was 12.3±3. Successful recanalization was achieved in 45 subjects (84.90%), and the rate of good clinical outcomes on day 90 was 43.39%. The secondary distal embolus rate was 5.66%. Symptomatic hemorrhage was observed in 3.77% of the subjects, and the mortality rate was 13.2%. CONCLUSIONS: Mechanical thrombectomy devices include a wide array of endovascular tools for removing clots in AIS patients. In terms of successful recanalization and good clinical outcomes on day 90, our initial experience with the CV devices was encouraging.

Changes in neutrophil, lymphocyte, platelet ratios and their relationship with NIHSS after rtPA and/or thrombectomy in ischemic stroke.

BACKGROUND AND AIMS: Various reactive oxygen radicals and inflammatory mediators emerge in ischemic stroke, and changes occur in the number of leukocytes and platelets. Variations in the counts and ratios of these cells may be related to the early and late course and prognosis of stroke. In this study, the relationship between changes in counts or ratios of neutrophil, lymphocyte, platelet, and National Health Institute Stroke Scale (NIHSS) scores was investigated in patients who presented with an ischemic stroke and treated with recombinant tissue plasminogen activator (rtPA) and/or thrombectomy. METHODS: Changes in neutrophil, lymphocyte, platelet counts; neutrophil-to-leukocyte ratio (NLR), neutrophil-to-lymphocyte ratio, platelet-to-leukocyte ratio (PLR), and platelet-to- lymphocyte ratio between day of admission (day 0), and 1st, 3rd, and 7th days after application of treatment modalities in 296 patients presented with acute ischemic stroke who underwent rtPA within the first 4,5 hours and / or thrombectomy within 6 hours after stroke and the relationship between these changes and the NIHSS (National Health Institute Stroke Scale) scores were evaluated retrospectively. RESULTS: In our study, leukocyte and neutrophil counts were higher on the first day after acute ischemic stroke. Platelet counts decreased on the 1st and 3rd days relative to baseline values. Lymphocyte values decreased on day 1, 3 and 7 compared to day 0. There was a significant increase in neutrophil-to-lymphocyte ratios at day 1 and 3 compared to day 0. On the 7th day, neutrophil-to-lymphocyte ratios were significantly lower. There was an increase in platelet-to-lymphocyte ratios at day 1 compared to day 0. The increase in NLR values was more evident on day 1. The increase in PLR on the 7th day was also significant. The patients who underwent rtPA and/or thrombectomy had significantly lower NIHSS scores at the 72th hour of the stroke compared to the NIHSS values at hospital admissions. A positive correlation was found between NIHSS difference values and neutrophil-to-lymphocyte and platelet-to-lymphocyte percent changes. CONCLUSIONS: There are dynamic changes in platelet, neutrophil, lymphocyte counts and ratios in early period after treatment with rtPA and/or thrombectomy in acute ischemic stroke. Variations in the counts and ratios of these cells may be related to NIHSS, which determines the degree of neurological damage of stroke.

Knowledge of epilepsy among persons with epilepsy in Turkey.

PURPOSE: It has been shown in studies that there are knowledge gaps about epilepsy in both developing and developed countries all around the world. Lack of knowledge exists even among people with epilepsy (PWE), and this may affect their lives negatively. This study aimed to evaluate what PWE in Turkey know about their disease. METHOD: A self-completed questionnaire consisting of demographic details, an item about perceived stigmatization, and 24 items about general knowledge of medical and social aspects of epilepsy was developed. Applicants were asked to answer 'true', 'false', or 'do not know' to each statement. The scores of the questionnaire were defined as low (< 15 point), medium (≥ 15-20), and high (≥ 20). RESULTS: The mean score on the questionnaire was 15.17 ± 3.74 (range, 4-24). One hundred twenty-five PWE (37.9%) scored low, 170 PWE (51.5%) scored medium, and 35 PWE (10.6%) scored high. The education level and household income were highly correlated with the knowledge level. Higher education level (r: 0.31) and high income (r: 0.25) were correlated with higher mean scores (p < 0.01). Lack of information was present particularly in terms of etiology, management of seizures, and medication during pregnancy. CONCLUSION: We documented the knowledge deficit of PWE about their disease, a situation that may lead to suboptimal management and negative attitudes. We concluded that study programs should be organized and more education should be provided to PWE in order to overcome these issues.