Silent Micro-Infarct in Carotid Artery Stenting: Who Has it and Why?

AIM: To compare the postprocedural cerebral diffusion-weighted imaging (DWI) findings in cases of carotid stenosis (CS)-related carotid plaques in terms of plaque morphology, degree of stenosis, and the use of a distal protection filter. Moreover, we used DWI to assess the asymptomatic cerebral embolism rates during carotid artery stending (CAS) operations performed for noncalcified versus calcified carotid plaques. MATERIAL AND METHODS: Our study included 99 patients admitted to the Ankara City Hospital Stroke Center in 2022. All of our patients have been evaluated and scheduled for CAS as a result of a decision made by the council. Cases of stenosis of > 50% in symptomatic patients and > 70% in asymptomatic patients were included. The patients were grouped according to their Doppler ultrasonography results. All of the patients underwent DWI within the first 24 hours after the procedure, and then two groups of patients were compared. RESULTS: A statistically significant difference was found between the distributions of the presence of silent micro-infarcts on DWI in terms of plaque characteristics (p < 0.001). In the patients with normal DWI findings, the percentage of calcified plaques was 38.7%, while the percentages of hypoechoic plaques, plaques with low echogenicity, and ulcerated plaques were 91.3%, 85.7%, and 78.8%, respectively. The rates of calcified plaques and ulcerated plaques differed in the group of patients with silent microinfarcts. The rate of silent micro-infarcts was 61.3% in the patients with calcified plaques, 8.7% in those with hypoechoic plaques, 14.3% in those with low-echogenicity plaques, and 21.2% in those with ulcerated plaques. CONCLUSION: The study found that carotid stents implanted in calcified and ulcerated plaques had a higher correlation with the presence of periprocedural asymptomatic ipsilateral DWI findings than those implanted in hypoechoic plaques and low-echogenicity plaques.

Craniovertebral junction aneurysms.

OBJECTIVE: The course of the vertebral artery and its relationship to the C0-1-2 structures render it particularly vulnerable to mechanical trauma. In the present study, we investigated the course of vertebral arteries along the craniovertebral junction (CJ) to cast light on the biomechanical aspects of aneurysm formation, focusing mainly on the relation of the vertebral artery injuries to the CJ bony landmarks. Herein, we report our experience with fourteen cases of craniovertebral junction vertebral artery (CJVA) aneurysms and their presentations, management, and outcomes. MATERIALS AND METHODS: We extracted from 83 vertebral artery aneurysms only those 14 cases whose aneurysms were located at the C0-1-2. We reviewed all medical records, including operative reports and radiologic images. We divided the CJVA into 5 segments and then carefully reviewed the cases, largely focusing on the CJVA segments involved in the aneurysm. Angiographic outcomes were determined by angiography, which was scheduled at 3-6 months, 1, 2.5, and 5 years postoperatively. RESULTS: A total of 14 patients with CJVA aneurysms were included in the present study. 35.7 % had cerebrovascular risk factors, while 23.5 % had other predisposing factors such as an AVM, an AVF, or a foramen magnum tumor. Predisposing factors in the form of neck trauma, both direct and indirect, were identified in 50 % of cases. The segmental distribution of aneurysms was as follows: three (21.4 %) at CJV 1, one (7.1 %) at CJV 2, four (28.6 %) at CJV 3, two (14.3 %) at CJV 4, and four (28.6 %) isolated to the CJV 5 segment. Of the 6 indirect traumatic aneurysms, 1 (16.7 %) was located at CJV 1, 4 (66.7 %) were located at CJV 3 and 1 (16.7 %) was located at CJV 5. The 1/1 direct traumatic aneurysm (100 %) from the penetrating injury was located at CJV 1. 100 % of cases with cerebrovascular risk factors, the affected vessels were on the dominant side. 42.9 % of cases presented symptoms of a vertebrobasilar stroke. All 14 aneurysms were managed only endovascularly. 85.8 % of patients we implemented flow diverters only. 57.1 % of follow-up cases were completely occluded angiographically, and 42.9 % of cases were near-completely or incompletely occluded at 1, 2.5, and 5-year follow-ups. CONCLUSIONS: The current article is the first report of a series of vertebral artery aneurysms located in CJ. Herein, the association of vertebral artery aneurysm, hemodynamics, and trauma is well established. We clarified all segments of the CJVA and showed that the segmental distribution of CJVA aneurysms significantly differs between traumatic and spontaneous cases. We showed that treatment with flow diverters should be the mainstay of CJVA aneurysm treatment.

Multiple Sclerosis: What Methods are Available for the Assessment of Subclinical Visual System Damage?

We aimed to assess the visual fields and optical coherence tomography (OCT) measurements in patients with multiple sclerosis (MS) to detect subclinical visual system disease. The study included 15 MS patients with previous optic neuritis (Group I), 17 MS patients without previous optic neuritis (Group II), and 14 healthy controls (Group III). Each subject underwent standard automated perimetry (SAP), frequency doubling technology perimetry (FDTP), and OCT. The mean deviation of SAP in Group I was lower than those in Groups II (p = .018) and III (p = .001). The pattern standard deviation of SAP in Group I was higher than those in Group III (p < .0001). The mean deviation of FDTP in Groups I and II was lower than those in Group III (p = .0001 and p = .016, respectively). The temporal quadrant of the retinal nerve fibre layer in Group I was thinner than those in Groups II and III (p = .005 and p = .003, respectively). The mean macular volume in Group I was thinner than those in Groups II and III (p = .004 and p = .002, respectively). A single method is inadequate for establishing early and/or mild visual impairment in MS. All conventional and non-conventional techniques are complementary in demonstrating subclinical visual damage in MS.

Endovascular Stroke Therapy Focused on Direct Clot Aspiration Using the SOFIATM Catheter for Acute Ischemic Stroke.

AIM: To report our experience of mechanical thrombectomy using the SOFIA < sup > TM < /sup > catheter, in terms of its effectivenessicacy and safety. MATERIAL AND METHODS: Acute ischemic stroke patients with large vessel occlusions who underwent mechanical thrombectomy, with the SOFIA < sup > TM < /sup > aspiration catheter as the first-line approach, were retrospectively identified. For all patients, the data, including reperfusion success (modified Thrombolysis in Cerebral Infarction [mTICI]), procedural details, clinical status at the baseline and post-discharge at 90 days, and complications, were analysed. RESULTS: During the study period (January 2017-July 2020), 73 patients underwent endovascular thrombectomy. The mean age and the baseline National Institutes of Health Stroke scores were 72 (41-83) and 16 (12-25), respectively. Successful reperfusion (mTICI≥2b-3) was obtained in 80.8 % (n=59) of the patients. Using ADAPT, a first-pass effect was achieved in 63.01% (n=46) of the patients. Rescue stent retriever (SRV) had to be utilized in 36.98% (n=27) of the patients; all presented with a favourable clinical outcome (modified Rankin score ≤0-2) at 90 days. The complication rate in the study was 13.7% (n=10). CONCLUSION: The contact aspiration approach with SOFIA < sup > TM < /sup > catheters as a first-line device appears to be fast, safe, and effective. Our results were comparable to the findings of other series. In the case of insufficient response on contact aspiration, we could easily modify the SOFIA < sup > TM < /sup > catheter approach for an additional stent retriever rescue treatment.

Assessment of voiding dysfunction in Parkinson's disease: Reliability and validity of the Turkish version of the Danish Prostate Symptom Score.

AIMS: To investigate the reliability and validity of the Turkish version of the Danish Prostate Symptom Score (Dan-PSS) questionnaire in patients with Parkinson's disease (PD) and to compare the burden of LUTS (Lower urinary tract symptoms) in men and women. METHODS: For analysis of test-retest reliability, the Turkish version of the Dan-PSS scale was developed using the back translation method, and it was administered on the day of admission and repeated 1 week after in 60 patients with PD. The OAB-q (Overactive Bladder Questionnaire) and PDQ-39 (Parkinson's Disease Questionnaire-39) were administered to 73 patients for validity analysis. RESULTS: Both the internal consistency (Cronbach's alpha coefficient: 0.99-1.00) and the test-retest reliability (intraclass correlation coefficient: 0.99-1.00) of the Dan-PSS were found to be high in patients with PD. Although weak to moderate correlations were found between the subscales of the Dan-PSS and PDQ-39 (r: 0.20-0.42; P < 0.05), a strong correlation was found with the OAB-q (r: 0.60-0.79; P < 0.05). Nocturnal urination was the most frequent (93.2%), and bothersome (54.8%) symptom. The majority of the symptom and bother responses were similar in men and women. CONCLUSIONS: Current study shows that the Turkish version of the Dan-PSS questionnaire is an internally consistent, reliable, and valid scale for patients with PD. Therefore, it can be used to evaluate frequency and severity of LUTS in PD. LUTS are commonly seen in patients with PD in both sexes. It is suggested that all patients with PD should be referred for urological assessment.

Clinical and polysomnographic features of patients with Restless Legs Syndrome.

OBJECTIVE: To reveal clinical and polysomnographic features in patients treated for restless leg syndrome, and to examine the compatibility of sleep data and clinical features. METHODS: The study was conducted at the Department of Neurology, Ankara Numune Training and Education Hospital, Ankara, Turkey, and comprised patients who presented to the outpatient clinic between January and July 2014 who were diagnosed with restless leg syndrome based on the International RestIess Leg Syndrome Study Group criteria. Patients underwent polysomnography test in spontaneous sleep in a single room. SPSS 18 was used for statistical analyses. RESULTS: Of the 18 patients, 13(72%)were females and 5(28%)were males. Overall mean age was 51.56±11.57years (range: 23-66 years). Fourteen (77.8%) patients reported insomnia; 10(55.5%) patients had excessive daytime sleepiness; 13(72.2%) reported snoring; and 3(17%) had apnoea. Mean International Restless Legs Syndrome Study Group Rating Scale score was 26.11±7.9 (range: 16-40).Mean Epworth Sleepiness Scale score was 9.17±5.1 (range: 0-20). CONCLUSIONS: Restless leg syndrome was more common in women and the most common complaint was insomnia.

Comparison of Cognitive Functions Between Obstructive Sleep Apnea Syndrome and Simple Snoring Patients: OSAS May Be a Modifiable Risk Factor for Cognitive Decline.

By comparing neurocognitive test results from patients with obstructive sleep apnea syndrome (OSAS) and those from patients with simple snoring, we aimed to establish whether OSAS negatively influences cognition. Patients with mild-to-severe OSAS (n = 29) and nonhypoxic simple-snoring patients (n = 30) were admitted to the study. All participants in both groups were evaluated with polysomnography and neurocognitive tests, including the Stroop Test, Rey Auditory Verbal Learning Test, Judgment of Line Orientation, Trail-Making Test, and Symbol Digit Modalities Test (SDMT). Significant differences were identified between the groups for test scores on the Rey 1, SDMT, and Stroop tests. We propose that accurate OSAS diagnosis and treatment might help to prevent cognitive decline.

Comparison of efficiencies of michigan neuropathy screening instrument, neurothesiometer, and electromyography for diagnosis of diabetic neuropathy.

Aim. This study compares the effectiveness of Michigan Neuropathy Screening Instrument (MNSI), neurothesiometer, and electromyography (EMG) in detecting diabetic peripheral neuropathy in patients with diabetes type 2. Materials and Methods. 106 patients with diabetes type 2 treated at the outpatient clinic of Ankara Numune Education and Research Hospital Department of Endocrinology between September 2008 and May 2009 were included in this study. Patients were evaluated by glycemic regulation tests, MNSI (questionnaire and physical examination), EMG (for detecting sensorial and motor defects in right median, ulnar, posterior tibial, and bilateral sural nerves), and neurothesiometer (for detecting alterations in cold and warm sensations as well as vibratory sensations). Results. According to the MNSI score, there was diabetic peripheral neuropathy in 34 (32.1%) patients (score ≥2.5). However, when the patients were evaluated by EMG and neurothesiometer, neurological impairments were detected in 49 (46.2%) and 79 (74.5%) patients, respectively. Conclusion. According to our findings, questionnaires and physical examination often present lower diabetic peripheral neuropathy prevalence. Hence, we recommend that in the evaluation of diabetic patients neurological tests should be used for more accurate results and thus early treatment options to prevent neuropathic complications.

The clinical efficiency of positive airway pressure treatment.

OBJECTIVES: The aim of this study was to evaluate the clinical efficiency and compliance of positive airway pressure (PAP) treatment. MATERIALS AND METHODS: This study was conducted on moderate-severe obstructive sleep apnea syndrome (OSAS) patients who admitted to Ankara Numune Hospital Sleep Center between 2008 and 2012. Seventy-five patients with moderate-severe OSAS who were using PAP treatment regularly were enrolled in the study. Patient's usage data, Epworth sleepiness scale (ESS) scores, and the differences in complaints of OSAS were recorded. RESULTS: The overall complaints were improved when compared to pretreatment period. Particularly there was improvement in apnea, snoring, excessive daytime sleepiness, fatigue, and sleep quality. CONCLUSION: PAP is effective in reducing symptoms in people with moderate and severe OSAS. To inform the patients with details and the creation of strategies for close followup are necessary for improving the compliance of the patients. TRIAL REGISTRATION NUMBER: ACTRN12613000373774.

Fractalkine gene receptor polymorphism in patients with multiple sclerosis.

BACKGROUND: Although the immunopathogenesis of multiple sclerosis (MS) has been intensely investigated in recent years, some associated molecules still have not been examined. For instance, no study has been conducted to investigate a possible polymorphism in the fractalkine receptor gene. METHODS: In order to examine fractalkine gene receptor polymorphisms, 3 mL of serum from 92 MS patients and 91 controls were stored at -20°C. DNA was extracted from the serum samples that were purified, and the gene regions in CX3CR1 (i.e., the fractalkine regions) containing the T280M and V294I fractalkine receptor haplotypes were amplified via the polymerase chain reaction (PCR) technique. The obtained fragments were then cut using restriction enzymes, and agarose gel electrophoresis was performed. RESULTS: In a comparison of the patients and controls, we found that the median values of the Expanded Disability Status Scale (EDSS) scores among genotypes of the V294I polymorphism in the fractalkine gene receptor were statistically higher in genotype II than genotype VI. Also, relapsing/remitting MS (RRMS) was statistically higher in genotype VI than in genotype II, whereas the frequency of secondary progressive MS (SPMS) was statistically higher in genotype VV than in the genotype VI for the same polymorphism. CONCLUSIONS: Although many polymorphism studies have focused on patients with MS, there is no polymorphism study about the fractalkine receptor which is a chemokine and plays an important role in neuroinflammation and neurodegeneration. Our results provide information about disease progression and may also be beneficial in developing new strategies for the treatment of the disease.

Serum iron, vitamin B12 and folic acid levels in Parkinson's disease.

We aimed to investigate possible associations between systemic iron metabolism deficiency and Parkinson's disease, and also to research any possible correlations between stage of the disease and vitamin B12 and folic acid levels. 33 male and 27 female patients diagnosed with idiopathic Parkinson's disease and 22 male and 20 female age- and sex-matched controls were enrolled in the study. Having the diagnosis of secondary Parkinsonism or Parkinson plus syndromes, and for the females, not being in the menopausal stage were considered as exclusion criteria. Recordings of blood samples of both groups collected after 8 h fasts were assessed in terms of serum iron, ferritin levels and iron-binding capacity, vitamin B12 and folic acid levels. The Hoehn and Yahr scale was used to determine the stage of the disease. No statistically significant difference was found with respect to mean serum iron, median serum ferritin levels and median serum iron-binding capacity between the groups. A statistically significant but inverse correlation was found between symptoms' duration and serum iron and ferritin levels. There was no statistically significant difference between the groups with respect to vitamin B12 and folic acid levels. However, a statistically significant but inverse correlation was determined between the patients' vitamin B12 levels and the Hoehn and Yahr scores. As Parkinson's disease progresses, serum iron, ferritin and vitamin B12 levels may decrease. The lower levels of these parameters may be the cause of the progression or may be the result of it.