Combination among VEP, OCT and TCD data in patients with relapsing-remitting multiple sclerosis during attack-free period.

AIMS: Multiple sclerosis (MS) is characterized by inflammation, demyelination, glial cell pathology and axonal injury in the central nervous system, and also progressive axonal loss of the optic nerve in cases with optic neuritis (ON). The previous transcranial Doppler (TCD) investigations suggest cortical hyperreactivity in patients with relapsing-remitting Multiple sclerosis (RRMS). We investigated the effect of ON involvement on visual reactivity. MATERIAL AND METHODS: One hundred thirty patients with RRMS during attack-free period and 12 healthy subjects were enrolled to the study. Visual evoked potential (VEP), optic coherence tomography (OCT) and TCD examinations of all subjects were performed. RESULTS: Cerebrovascular reactivity measured with breath holding (BH) test was found to be normal. VEP amplitude, visual reactivity and peripapillary retinal nerve fibre layer (pRNFL) measurements were found to be low in patients with ON involvement, whereas VEP latencies were long. Visual reactivity was negatively correlated with VEP amplitude and RFNL measurements, and positively correlated with VEP latency. CONCLUSIONS: The present study supports that cerebrovascular reactivity is preserved in patients with RRMS except for attacks, and neurovascular reactivity is increased in patients without ON involvement.

Risk factors for multiple recurrent ischemic strokes.

BACKGROUND: Cardiovascular diseases, hypertension, diabetes mellitus, dyslipidemia, and atrial fibrillation are the most common modifiable risk factors for recurrent ischemic stroke. In this study, we aimed to find the risk factors associated with more than two recurrent ischemic strokes after the first-ever stroke. METHODS: We collected the ischemic stroke patients in our stroke registry data bank, and the eligible patients were followed for recurrent ischemic stroke after 2008. Our study consisted of 927 patients who were followed up for 9 years after the first-ever stroke. RESULTS: We found that 185 (20%) patients had a recurrent ischemic stroke, and another 32 (3.5%) patients had more than one recurrence after the first-ever ischemic stroke. The mean time for the first stroke recurrence was 1 year, and the mean time for the multiple stroke recurrences was 3 years. Significant risk factors for multiple recurrences were congestive heart disease (P < 0.015) and diabetes mellitus (P < 0.006). CONCLUSIONS: We concluded that even with the appropriate treatments, patients with congestive heart disease and diabetes mellitus have a higher rate of multiple recurrences for ischemic stroke after the first-ever ischemic stroke, indicating that more attention should be paid to this issue.

Headache as the sole presenting symptom of cerebral venous sinuses thrombosis: Subgroup analysis of data from the VENOST study.

OBJECTIVES: Headache is the most common complaint in cerebral venous sinus thrombosis (CVST) and it may sometimes be the only symptom in these patients. This retrospective and prospective study was an investigation of any differences in terms of clinical risk factors, radiological findings, or prognosis in patients with CVST who presented with isolated headache (IH) and cases with other concomitant findings (non-isolated headache [NIH]). METHODS: A total of 1144 patients from a multicenter study of cerebral venous sinus thrombosis (VENOST study) were enrolled in this research. The demographic, biochemical, clinical, and radiological aspects of 287 IH cases and 857 NIH cases were compared. RESULTS: There were twice as many women as men in the study group. In the IH group, when gender distribution was evaluated by age group, no statistically significant difference was found. The onset of headache was frequently subacute and chronic in the IH group, but an acute onset was more common in the NIH group. Other neurological findings were observed in 29% of the IH group during follow-up. A previous history of deep, cerebral, or other venous thromboembolism was less common in the IH group than in the NIH group. Transverse sinus involvement was greater in the IH group, whereas sagittal sinus involvement was greater in the NIH group. The presence of a plasminogen activator inhibitor (PAI) mutation was significantly greater in the IH group. CONCLUSION: IH and CVST should be kept in mind if a patient has subacute or chronic headache. PAI, which has an important role in thrombolytic events, may be a risk factor in CVST. Detailed hematological investigations should be considered. Additional studies are needed.

Migraine and cardiovascular risk factors: A clinic-based study.

OBJECTIVE: The relation between migraine and vascular risk factors is an unclear issue. Furthermore, the reasons for chronification are still unknown. Probably, the age-related risk and other factors leading to migraine progression will also change in the future. Under these questions, we aimed to investigate whether or not there is a specific association with vascular risk factors between several age groups and subtypes of migraine and also in their families. METHODS: A dataset (the Turkish Headache Database) from four tertiary headache centres in Turkey was used. This database included headache-defining features according to ICHD criteria based on face-to-face interviews and examinations by a Neurologist. Vascular risk factors of migraine without aura (MwoA), migraine with aura (MwA) and chronic migraine (CM) were compared between three age groups (under 30 years, 30-50 years and over 50 years) and in first-degree relatives of the patients. Our study included 2712 patients comprising 1868 (68.9 %), 246 (9.1 %) and 598 (22.1 %) subjects with MwoA, MwA and CH, respectively. RESULTS: This study showed that both the patients and the first-degree relatives were more frequently associated with vascular risk factors in CM than episodic MwA and MwoA. MwoA showed a weaker association with vascular risk factors than MwA and CM. CONCLUSION: Chronic migraine was associated with vascular risk factors at all ages and first-degree relatives as well. Vascular risk factors should be investigated with greater focus on chronic migraine.

Assessment of Patients with Intracerebral Hemorrhage or Hemorrhagic Transformation in the VENOST Study.

INTRODUCTION: Cerebral venous and sinus thrombosis (CVST) may lead to cerebral edema and increased intracranial pressure; besides, ischemic or hemorrhagic lesions may develop. Intracerebral hemorrhages occur in approximately one-third of CVST patients. We assessed and compared the findings of the cerebral hemorrhage (CH) group and the CVST group. MATERIALS AND METHODS: In the VENOST study, medical records of 1,193 patients with CVST, aged over 18 years, were obtained from 35 national stroke centers. Demographic characteristics, clinical symptoms, signs at the admission, radiological findings, etiologic factors, acute and maintenance treatment, and outcome results were reported. The number of involved sinuses or veins, localizations of thrombus, and lesions on CT and MRI scans were recorded. RESULTS: CH was detected in the brain imaging of 241 (21.1%) patients, as hemorrhagic infarction in 198 patients and intracerebral hemorrhage in 43 patients. Gynecologic causes comprised the largest percentage (41.7%) of etiology and risk factors in the CVST group. In the CH group, headache associated with other neurological symptoms was more frequent. These neurological symptoms were epileptic seizures (46.9%), nausea and/or vomiting (36.5%), altered consciousness (36.5%), and focal neurological deficits (33.6%). mRS was ≥3 in 23.1% of the patients in the CH group. DISCUSSION AND CONCLUSION: CVST, an important cause of stroke in the young, should be monitored closely if the patients have additional symptoms of headache, multiple sinus involvement, and CH. Older age and parenchymal lesion, either hemorrhagic infarction or intracerebral hemorrhage, imply poor outcome.

Cerebral Venous Sinus Thrombosis in Women: Subgroup Analysis of the VENOST Study.

BACKGROUND: Early diagnosis of cerebral venous sinus thrombosis (CVST) associated with reproductive health-related risk factors (RHRF) including pregnancy, puerperium, and oral contraceptive (OC) use can prevent severe neurological sequelae; thus, the symptoms must be documented in detail for each group. METHODS: Out of 1144 patients with CVST, a total of 777 women were enrolled from a multicenter for the study of cerebral venous sinus thrombosis (VENOST). Demographic, biochemical, clinical, and radiological aspects were compared for 324 cases with RHRF and 453 cases without RHRF. RESULTS: The mean age of the RHRF (-) group (43.2 ± 13 years) was significantly higher than of the RHRF (+) group (34 ± 9 years). A previous history of deep venous thrombosis (3%), isolated cavernous sinus involvement (1%), cranial neuropathy (13%), comorbid malignancy (7%), and its disability scores after 12 months (9%) were significantly higher in the RHRF (-) group. The RHRF (+) group consisted of 44% cases of puerperium, 33% cases of OC users and 23% of pregnant women. The mean age was found to be higher in OC users (38 ± 9 years). A previous history of deep venous thrombosis was slightly higher in the pregnancy subgroup (4%). Epileptic seizures were more common in the puerperium group (44%). CONCLUSION: The results of our study indicate that the risk of CSVT increases parallel to age, OC use, and puerperium period. In addition, when considering the frequency of findings and symptoms, epileptic seizures in the puerperium subgroup of the RHRF (+) group and malignancies in the RHRF (-) group may accompany the CSVT. In daily practice, predicting these risks for the CSVT and early recognition of the symptoms will provide significant benefits to patients.

A Rare Clinical Antity; Pure Gerstmann Syndrome.

Gerstmann syndrome is defined as a tetrad including agraphia, acalculia, finger agnosia, and right-left disorientation. In the case studies presented in the literature, it has been reported that Gerstmann syndrome usually appears as an incomplete tetrad of symptoms or accompanied by cognitive deficits including aphasia, alexia, apraxia and some perceptual disorders. Here, we present of the patient with left angular and supramarginal gyrus infarction affecting the parietal lobe. In addition to the symptoms mentioned above, the patient had alexia and anomic aphasia as well. We discussed the clinic appearance and reviewed the current literature.

Epileptic seizures in cerebral venous sinus thrombosis: Subgroup analysis of VENOST study.

PURPOSE: The aim of this study is to evaluate the presence and prognostic impact of early seizures in cerebral venous sinus thrombosis patients (CVST). METHOD: VENOST is a retrospective and prospective national multicenter observational study. CVST patients with or without epileptic seizures (ES) were analyzed and compared in terms of demographic and imaging data, causative factors, clinical variables, and prognosis in a total of 1126 patients. RESULTS: The mean age of the patients in the ES group was 39.73 ± 12.64 and 40.17 ± 14.02 years in the non-ES group (p > 0.05). Epileptic seizures were more common (76.6 %) in females (p < 0.001). Early ES occurred in 269 of 1126 patients (23.9 %). Epileptic seizures mainly presented in the acute phase (71.4 %) of the disease (p < 0.001). Majority of these (60.5 %) were in the first 24 h of the CVST. The most common neurological signs were focal neurologic deficits (29.9 %) and altered consciousness (31.4 %) in the ES group. Superior sagittal sinus (SSS) and cortical veins (CV) involvement were the most common sites of thrombosis and the mostly related etiology were found puerperium in seizure group (30.3 % vs 13.9 %). Patients with seizures had worse outcome in the first month of the disease (p < 0.001) but these did not have any influence thereafter. CONCLUSIONS: In this largest CVST cohort (VENOST) reported female sex, presence of focal neurological deficits and altered consciousness, thrombosis of the SSS and CVs, hemorrhagic infarction were risk factors for ES occurrence in patients with CVST.

Neurological Symptoms and Evaluation of Cerebral Blood Flow Changes with Synthetic Cannabinoids Use.

OBJECTIVE: To describe the cerebral haemodynamic changes that occur in patients presenting to the emergency department (ED) after synthetic cannabinoid (SC) use in order to clarify the pathophysiology of neurologic adverse effects of SCs. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Emergency Department of Kocaeli Derince Training and Research Hospital, Turkey, from June 2017 to January 2018. METHODOLOGY: Patients in whom tetrahydrocannabinol was detected in the urinalysis due to SC use were included in the study. Healthy controls were also included. All the participants were evaluated using transcranial Doppler ultrasonography (TCD). The peak systolic flow rate, mean flow rate, pulsatility index and resistivity index of the right and the left anterior carotid arteries, middle cerebral arteries and posterior cerebral arteries were measured. RESULTS: A total of 74 patients were included in this study - 38 patients in the SC group and 36 patients in the control group. The mean age of all of the subjects was 29.6 ±9.1 years, whereas, 91.9% of them were males. In the synthetic cannabinoids group, statistically significant decrease in the cerebral blood flow peak systolic and mean values as well as increases in the pulsatility index; and resistivity index were found via TCD when compared to the control group. CONCLUSION: Cerebral blood flow and resistance changes due to SC use are likely to play a role in the main pathogenesis of the neurological symptoms, increasing the frequency of ischemic or haemorrhagic strokes.

Cerebral Venous Sinus Thrombosis as a Rare Complication of Systemic Lupus Erythematosus: Subgroup Analysis of the VENOST Study.

AIM: Systemic lupus erythematosus (SLE) is an unusual risk factor for cerebral venous sinus thrombosis (CVST). As few CVST patients with SLE have been reported, little is known regarding its frequency as an underlying etiology, clinical characteristics, or long-term outcome. We evaluated a large cohort of CVST patients with SLE in a multicenter study of cerebral venous thrombosis, the VENOST study, and their clinical characteristics. MATERIAL AND METHOD: Among the 1144 CVST patients in the VENOST cohort, patients diagnosed with SLE were studied. Their demographic and clinical characteristics, etiological risk factors, venous involvement status, and outcomes were recorded. RESULTS: In total, 15 (1.31%) of 1144 CVST patients had SLE. The mean age of these patients was 39.9 ± 12.1 years and 13 (86.7%) were female. Presenting symptoms included headache (73.3%), visual field defects (40.0%), and altered consciousness (26.7%). The main sinuses involved were the transverse (60.0%), sagittal (40.0%), and sigmoid (20.0%) sinuses. Parenchymal involvement was not seen in 73.3% of the patients. On the modified Rankin scale, 92.9% of the patients scored 0-1 at the 1-month follow-up and 90.9% scored 0-1 at the 1-year follow-up. CONCLUSIONS: SLE was found in 1.31% of the CVST patients, most frequently in young women. Headache was the most common symptom and the CVST onset was chronic in the majority of cases. The patient outcomes were favorable. CVST should be suspected in SLE patients, even in those with isolated chronic headache symptoms with or without other neurological findings.

Behçet's disease as a causative factor of cerebral venous sinus thrombosis: subgroup analysis of data from the VENOST study.

OBJECTIVE: This study was performed to determine the rate of cerebral venous sinus thrombosis (CVST) among cases of Behçet's disease (BD) included in a multicentre study of cerebral venous sinus thrombosis (VENOST). METHODS: VENOST was a retrospective and prospective national multicentre observational study that included 1144 patients with CVST. The patients were classified according to aetiologic factors, time of CVST symptom onset, sinus involvement, treatment approach and prognosis. RESULTS: BD was shown to be a causative factor of CVST in 108 (9.4%) of 1144 patients. The mean age of patients in the BD group was 35.27 years and 68.5% were men, whereas in the non-BD CVST group, the mean age was 40.57 years and 28.3% were men (P < 0.001). Among the aetiologic factors for patients aged 18-36 years, BD was predominant for men, and puerperium was predominant for women. The onset of symptoms in the BD group was consistent with the subacute form. The transverse sinuses were the most common sites of thrombosis, followed by the superior sagittal sinuses. The most common symptom was headache (96.2%), followed by visual field defects (38%). CONCLUSIONS: BD was found in 9.4% of patients in our VENOST series. Patients with BD were younger and showed a male predominance. The functional outcome of CVST in patients with BD was good; only 12% of patients presenting with cranial nerve involvement and altered consciousness at the beginning had a poor outcome (modified Rankin Score ⩾2).

Alterations in cerebral blood flow in children with congestive heart failure due to ventricular septal defect.

OBJECTIVE: We aimed to investigate the effect of ventricular septal defect (VSD) and heart failure on cerebral blood flow (CBF) in children, whether heart failure treatment improves CBF, and if there is any relationship between CBF and serum N-terminal pro-brain natriuretic peptide (NT-proBNP) level. METHOD: Forty children with VSD (13 with heart failure) aged between 1 and 36 months were studied. The control group comprised 25 healthy children in the same age group. Maximum, minimum, and mean blood flow velocities and pulsatility indices of the right and left middle cerebral arteries were assessed using transcranial Doppler ultrasonography. Measurements of CBF and serum NT-proBNP levels were repeated in patients with heart failure a month post-heart failure treatment initiation. The groups were also compared in terms of defect diameters, cardiac structural changes, left ventricular systolic function, and findings related to pulmonary hypertension determined by echocardiography. Correlations between echocardiographic measurements and CBF parameters were analyzed. RESULTS: Although no significant difference was found between patient and control groups for CBF, right and left maximum CBF velocities significantly increased posttreatment in patients with heart failure (P = .04 and P = .01, respectively). Serum NT-proBNP levels in children with VSD associated with heart failure were significantly higher than those in children with VSD alone (P = .04) or in healthy children (P < .001). NT-proBNP levels were negatively correlated with right and left maximum CBF velocities (r = -0.39, P = .013 and r = -0.32, P = .043, respectively). CONCLUSION: Although no significant difference was found in CBF velocity among the study groups, increase in the CBF velocity post heart failure treatment and negative correlations between CBF velocity and both the VSD diameter and NT-proBNP levels indicate that the hemodynamic status due to VSD associated with heart failure has an effect on CBF.

Renal Dysfunction Is an Independent Risk Factor for Poor Outcome in Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis: A New Cutoff Value.

Objective. This study was set to assess the effect of renal dysfunction on outcome of stroke patients treated with intravenous thrombolysis (IVT). Methods. This multicenter research involved 403 patients from January 2009 to March 2015. Patients were divided into two groups: (1) control group with GFR ≥ 45 mL/min/1.73 m2 and (2) low GFR group with GFR < 45 mL/min/1.73 m2. Outcome measurements were poor outcome (mRS 3-6) and mortality at 3 months and symptomatic intracerebral hemorrhage (SICH) within the first 24-36 hours. Univariate and multivariate regression analyses were performed, and odds ratios (ORs) were determined at 95% confidence intervals (CIs). Results. Univariate analyses determined that every decrease of GFR by 10 mL/min/1.73 m2 significantly increased the risk of poor outcome (OR 1.19, 95% CI 1.09-1.30, p < 0.001) and mortality (OR 1.18, 95% CI 1.06-1.32, p = 0.002). In multivariate regression, adjusted for all variables with p value < 0.1, low GFR (GFR < 45 versus GFR equal to or more than 45) was associated with poor outcome (OR adjusted 2.15, 95% CI 1.01-4.56, p = 0.045). Conclusion. In IVT for acute stroke, renal dysfunction with GFR < 45 mL/min/1.73 m2 before treatment determined increased odds for poor outcome compared to GFR of more than 45 mL/min/1.73 m2.

Neurovascular coupling in patients with relapsing-remitting multiple sclerosis.

OBJECTIVES: Also to the inflammatory demyelinating lesions and degenerative process, altered cerebrovascular reactivity or neurovascular coupling (NVC) might be considered as playing another role in the pathogenesis of multiple sclerosis. The objective of this study is to assess the NVC of patients with relapsing-remitting multiple sclerosis (RRMS) during the acute exacerbation period. PATIENTS AND METHODS: Four hundred fifty-eight patients with RRMS and 160 healthy subjects were screened for this study during the last 14 years. We performed transtemporal transcranial Doppler recordings from the P2-segments of both posterior cerebral arteries simultaneously during simple or complex visual stimulation. The NVC was defined as a relative increase of the blood flow velocities as a percentage change of the baseline values during visual stimulation. RESULTS: The NVC to simple visual stimulation was significantly higher in the patients on both sides (37.2±13.5% and 36.0±14.8%; right and left side, respectively) from those of the controls (30.9±9.9% and 30.0±8.8%; right and left side, respectively) (p<0.01). Similarly, the NVC to complex visual stimulation was significantly higher in the patients (43.3±14.1% and 41.7±13.5%; right and left side, respectively) from those of the controls (38.6±14.2% and 37.6±14.1%; right and left side, respectively) (p<0.05). CONCLUSION: Our results suggest that patients with RRMS during exacerbation period have more reactive neurovascular units in the occipital cortex.

Analyses of the Turkish National Intravenous Thrombolysis Registry.

BACKGROUND: The relatively late approval of use of recombinant tissue plasminogen activator (rt-PA) for acute ischemic stroke in Turkey has resulted in obvious underuse of this treatment. Here we present the analyses of the nationwide registry, which was created to prompt wider use of intravenous thrombolysis, as well as to monitor safe implementation of the treatment in our country. METHODS: Patients were registered prospectively in our database between 2006 and 2013. Admission and 24-hour National Institutes of Health Stroke Scale and 3-month modified Rankin Scale scores were recorded. A "high-volume center" was defined as a center treating 10 or more patients with rt-PA per year. RESULTS: A total of 1133 patients were enrolled into the registry by 38 centers in 18 cities. A nearly 4-fold increase in the study population and in the number of participating centers was observed over the 6 years of the study. The mean baseline NIHSS score was 14.5 ± 5.7, and the prevalence of symptomatic hemorrhage was 4.9%. Mortality at 3 months decreased from 22% to 11% in the 6 years of enrollment, and 65% of cases were functionally independent. Age older than 70 years, an NIHSS score higher than 14 upon hospital admission, and intracranial hemorrhage were independently associated with mortality, and being treated in a high-volume center was related to good outcome. CONCLUSIONS: We observed a decreasing trend in mortality and an acceptable prevalence of symptomatic hemorrhage over 6 years with continuous addition of new centers to the registry. The first results of this prospective study are encouraging and will stimulate our efforts at increasing the use of intravenous thrombolysis in Turkey.

Relationship between pulsatility index and clinical course of acute ischemic stroke after thrombolytic treatment.

Background. The relationship between the arterial recanalization after intravenous recombinant tissue plasminogen activator (rtPA) and outcomes is still uncertain. The aim of our study was to evaluate whether there is an association between the pulsatility indexes (PI) of the middle cerebral artery (MCA) measured by transcranial Doppler (TCD) after iv rtPA treatment and short- and long-term outcomes in ischemic stroke patients. Methods. Forty-eight patients with acute ischemia in the MCA territory who achieved complete recanalization after the administration of intravenous thrombolytic treatment were included in the study. The TCD was applied to patients after the iv rtPA treatment. Clinical and functional outcomes were assessed by National Institutes of Health Stroke Scale (NIHSS) scores and modified Rankin Scores (mRS), respectively. Results. Significant positive correlations were found between the PI value and NIHSS score at 24 hours, NIHSS score at 3 months, and mRS at 3 months (P < 0.005 for all). The cut-off value for PI in predicting a favorable prognosis and a good prognosis might be less than or equal to 1.1 and less than or equal to 1.4, respectively. Conclusions. PI may play a role in predicting the functional and clinical outcome after thrombolytic therapy in acute ischemic stroke patients.

An analysis of changes in cerebral blood flood velocities in depressive pseudo-dementia and Alzheimer disease patients.

BACKGROUND: Patients with pseudo-dementia are at particular risk of being labeled as Alzheimer dementia. We thus need better diagnostic methods. In this study, we evaluated the cerebral reactivity of the posterior cerebral arteries (PCAs) during visual stimulation by transcranial Doppler ultrasonography. METHODS: The study group consisted of 13 and 11 patients suffering from pseudo-dementia and Alzheimer disease (AD), respectively, and 10 healthy controls. Visual reactivity was defined as the differences of cerebral blood flow velocity (CBFv) against the visual stimulus. Mini Mental State Examination and Montgomery-Asberg Depression Rating Scales were used as psychometric tests. The transcranial Doppler ultrasonography device was applied for simultaneous recording of both PCAs. Obtained data were evaluated by Student t test, and 1-way analysis of variance tests, with a priori as P<0.05. RESULTS: Subjects with AD had a lower CBFv following visual stimuli (P<0.001). Mean CBFv throughout the procedure [P<0.001; right and left sides, in AD and depressive pseudo-dementia (DPD), respectively], velocity at rest (P<0.001 in each side for both groups), and velocity at stimulation (P<0.001; each side for both groups) on both PCAs were significantly lower in patients with AD and DPD than those of the controls. Compared with the controls, the relative (r) CBFvs (%) were found to be significantly lower in AD (P<0.05, P<0.01, for the right and left side, respectively). CONCLUSIONS: We have shown that CBFv decreased in patients with AD and DPD, but vasoneuronal activity was only impaired in patients with AD. On the other hand, although the results do not show significant differences between depressive and demented groups by TCD, further studies will be needed for differentiating these diseases.

Cerebrovascular manifestations of Behçet's disease.

Behçet's disease (BD) is a systemic inflammatory disease commonly characterized by oral and genital ulcerations, with skin and eye involvement. Its cause is still unknown, but vasculitis is the major pathologic feature. BD is a rare condition, seen more commonly in Turkey, as well as in Middle Eastern, Mediterranean and Far Eastern countries. Neurological involvement is reported to manifest as brainstem or corticospinal tract syndromes, increased intracranial pressure mostly related to venous sinus thrombosis or aseptic meningitis, isolated behavioral symptoms or isolated headache. This report presents a 34-year-old BD patient with secondary cerebral infarction due to head trauma. The clinical and central nervous system findings of BD are discussed.

Cerebral vasomotor reactivity of patients with acute ischemic stroke: Cortical versus subcortical infarcts: an Israeli-Turkish collaborative study.

BACKGROUND: Cerebral hemodynamic features of patients with different types of acute ischemic stroke are still obscure. We compared cerebral vasomotor reactivity (VMR) in acute cortical (CI) and subcortical (SI) brain infarcts. METHODS: Acute stroke patients (within 72 h of stroke onset) underwent transcranial Doppler and the Diamox test (1 g acetazolamide IV). The percent difference between blood flow velocities in the middle cerebral arteries before and after acetazolamide was defined as VMR%. CI and SI infarcts were confirmed by computerized tomography and/or magnetic resonance imaging. Clinical status and disability were assessed by means of the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) respectively.VMR% values and stroke severity and disability parameters were compared between CI and SI groups using ANOVA and Pearson's correlation (r) coefficients. RESULTS: VMR% values of the ipsilateral side to the brain infarct in the CI group were significantly lower as compared with SI group (12.2+/-15.9% and 25.6+/-24.4% respectively, P=0.03). VMR% values in both groups were not correlated with stroke severity and disability (P<0.2). CONCLUSIONS: Our results suggest greater vulnerability of resistance arterioles in the setting of cortical gray matter infarcts. Although gray matter VMR is physiologically higher than white matter VMR, patients with acute CI have impaired cerebral vascular reserve.

Economic impact of primary headaches in Turkey: a university hospital based study: part II.

This study was planned to investigate the economic impact of headache on Turkish headache sufferers attending a tertiary care outpatient headache clinic.A total of 937 headache patients were included in this study and questioned using a questionnaire for the profile of patients and headache, quality of life of patients and economic impact of headache. The median total direct cost was found to be 88.0 USD and the median total cost was 160.7 USD. The drug treatment cost was the highest item followed by the specialist outpatient care cost. The average lost and inefficient work/school days was 1.5 (0-45) and 8.4 (0-100) days for one year. It was shown that loss of productivity was higher for migraine without aura group when compared with the episodic and chronic tension-type headache groups. The results of this nationwide university hospital based study methshowed that headache, especially migraine, has considerable economic impact on patients.