Evaluation of IL-10, IFN-γ, and thiol-disulfide homeostasis in patients with drug-resistant epilepsy.

AIM: This study compared dynamic thiol-disulfide homeostasis (an oxidative stress marker), anti-inflammatory interleukin-10 (IL-10) levels, and proinflammatory interferon gamma (IFN-γ) levels in drug-resistant epilepsy patients with those in patients with well-controlled epilepsy and healthy controls. METHOD: This prospective cross-sectional study enrolled 89 people: 27 with drug-resistant epilepsy, 30 with well-controlled epilepsy, and 32 healthy controls matched in demographic characteristics. RESULTS: The mean serum IL-10 levels were significantly lower and the mean serum IFN-γ levels significantly higher in the drug-resistant epilepsy patients compared to the well-controlled epilepsy and healthy control groups. The mean serum native thiol (SH) and total thiol (TT) levels were significantly lower, and the disulfide (SS) levels were significantly higher in the drug-resistant group than in the other two groups. CONCLUSIONS: The significant differences in thiol-disulfide homeostasis and IL-10 and IFN-γ levels in the drug-resistant epilepsy group suggest that these markers indicate a poor prognosis in epilepsy.

Diffuse alveolar hemorrhage following intravenous thrombolytic treatment in acute ischemic stroke: a case series.

Diffuse alveolar hemorrhage (DAH) following fibrinolytic therapy is a rare but a life-threatening complication. In acute ischemic stroke (AIS), DAH as a complication was not reported following intravenous thrombolytic therapy (ITT). The demographic, clinical, radiologic, and prognostic data of 4 patients with AIS who developed DAH after ITT are presented in this case series, along with a literature review.

Acute effect of sphenopalatine ganglion block with lidocaine in a patient with SUNCT.

Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing/short-lasting unilateral neuralgiform headache with cranial autonomic features (SUNCT/SUNA) is a rare severe headache. At the time of an attack, it can hinder a patient from eating and requires acute intervention. The sphenopalatine ganglion is an extracranial parasympathetic ganglion with both sensory and autonomic fibers. Sphenopalatine ganglion block has long been used in the treatment of headache, particularly when conventional methods have failed. Here, we present a patient who was resistant to intravenous lidocaine, but responded rapidly to sphenopalatine ganglion block during an acute episode of SUNCT/SUNA.

The relationship among neutrophil to lymphocyte ratio, stroke territory, and 3-month mortality in patients with acute ischemic stroke.

BACKGROUND: Stroke therapy options have focused on limiting the infarct volume. Neutrophil to lymphocyte ratio (NLR) can be valuable to detect the patients that required intensive treatment at early stage by predicting infarct volume. The aim of this study is to evaluate the relationship between NLR and infarct volume according to the stroke territory, and to determine the prognostic value of NLR for predicting 3-month mortality in acute ischemic stroke (AIS) patients. METHODS: A total of 107 patients with AIS were enrolled and followed up 3 months in terms of mortality. Study population was divided into two groups according to the stroke territory: anterior circulating stroke (ACS) and posterior circulating stroke (PCS). All patients underwent magnetic resonance imaging. The complete blood count and venous blood samples were obtained from the patients on admission to the emergency department. RESULTS: There were no difference between ACS and PCS groups regarding baseline characteristics and co-morbid diseases. Also, C-reactive protein and NLR were similar between two groups. In correlation analyses, infarct volume was significantly correlated with CRP and NLR in ACS (r = 0.350, p = 0.001 and r = 0.482, p ≤ 0.001, respectively), but not correlated with infarct volume in PCS. Also, NLR was correlated with NIHHS in only ACS group (r = 0.326, p = 0.002). Multivariate analysis showed that NLR was the only independent predictor of 3-month mortality (OR 1.186, 95% CI 1.032-1.363, p = 0.016). CONCLUSION: NLR is significantly correlated with ACS infarct volume, but not with PCS infarct volume in AIS. Also, NLR was an independent predictor of 3-month mortality in AIS patient.

Assessment of relationship between C-reactive protein to albumin ratio and 90-day mortality in patients with acute ischaemic stroke.

AIM AND CLINICAL RATIONALE FOR THE STUDY: It is now known that inflammation is involved in the pathophysiology of acute ischaemic stroke (AIS). It has been proven that CRP and albumin alone are useful in predicting a prognosis for stroke patients. A combination of these two parameters, namely the ratio of CRP to albumin (CAR), is believed to be a more accurate indicator of inflammatory status than CRP or albumin alone, and may be more valuable than either of them separately in predicting the prognosis of ischaemic stroke patients. However, the role of CAR as a predictor of mortality in patients with AIS remains unclear. MATERIALS AND METHODS: We retrospectively enrolled 260 patients who were referred to our clinic within the first 24 hours of symptom presentation and who were diagnosed with AIS between January 2015 and December 2018. The patient group was classified into two groups according to 90-day mortality. These groups were compared in terms of C-reactive protein, albumin, and CAR. RESULTS: The C-reactive protein and CAR values were higher, and the albumin level was lower, in non-surviving patients. The CAR value was also found to be a significant independent variable of 90-day mortality in patients with AIS (p < 0.001). The optimum cut-off value of CAR in predicting the 90-day mortality for patients with AIS was 0.50, with 64.1% sensitivity and 56.2% specificity. CONCLUSIONS AND CLINICAL IMPLICATIONS: Our study demonstrated that a high CAR value is an independent predictor of 90-day mortality in patients with AIS.

Surgical treatment of pseudotumor cerebri.

AIM: To share our experience with idiopathic intracranial hypertension. MATERIAL AND METHODS: All patients believed to have pseudotumor cerebri underwent a fundus oculi examination to confirm the existence of papillary stasis and lumbar puncture (LP) to measure cerebrospinal fluid (CSF) pressure. Patients who did not respond to medical treatment underwent fundus oculi examinations at 3-week intervals. Patients with CFS pressures exceeding 240 mm H2O underwent at least three LPs at 3-day intervals. Patients with higher CFS pressures were treated surgically. RESULTS: The mean patient age was 40.8 (range 31-58) years and the mean body mass index (BMI) was 30.9 (range 28.8-36.4) kg/m2. Papillary stasis was observed in 15 (46.8%) cases. The mean initial CSF pressure was 455.6 (range 360-560) mmHg, and after a mean of 4.3 (range 3-6) repeat measurements, this decreased to 213.4 (range 160-320) mmHg (Table I). Complications in our series included a lumbar pouch in three patients, and an abdominal pouch, meningitis, and abdominal migration in one patient each. DISCUSSION: Surgical treatment of idiopathic intracranial hypertension is necessary when the intracranial pressure does not decrease despite medical treatment and repeat LP. CONCLUSIONS: Idiopathic intracranial hypertension is a clinical syndrome of unclear pathogenesis that is closely related to obesity. KEY WORDS: Cerebrospinal fluid, Idiopathic intracranial hypertension, Pseudotumor cerebri, Obesity.