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Küresel Hastalýk Yükü sistemi kullanýlarak Türkiye’ye dair en güncel inme istatistikleri sunulmuþtur. 2019 yýlýnda Türkiye için inme insidansý 125.345 (yüz binde 154), prevalansý 1.080.380 (yüzde 1,3), inme nedenli ölüm hýzý 48.947 kiþi ve inmeye baðlý ölüm/sakatlýk nedeniyle kaybedilen yaþam yýllarý sayýsý 993.082 yýl olarak tahmin edilmiþtir. Ýnmelerin %17,4’ü elli yaþ altýnda, %58,5’i yetmiþ yaþ altýnda ve %54,3’ü de kadýnlarda görülmüþtür. Ýnmelerin %65,1’i akut iskemik inme, %24’ü intraserebral kanama ve %10,9’u subaraknoid kanamadýr. Ülkemiz popülasyonunun yaþlanmasý ile birlikte tüm inme tiplerinde sayýsal artýþ olmakla birlikte yaþa göre standardizasyon yapýldýðýnda özellikle hemorajik inmelerin sýklýk artýþýnýn zaman içinde sýnýrlandýrýlmýþ olduðu görülmüþtür.

The most up-to-date stroke statistics for Turkey are presented using the Global Burden of Disease e-research system. In 2019, the incidence of stroke for Turkey was estimated as 125,345 (154 per hundred thousand), the prevalence was 1,080,380 (1.3%), the death rate due to stroke was 48,947 and the number of life years lost due to stroke-related death/disability was estimated to be 993,082 years. Of strokes 17.4% occurred under the age of fifty, 58.5% under the age of seventy, and 54.3% in women. 65.1% of strokes are acute ischemic stroke, 24% intracerebral and 10.9% subarachnoid hemorrhage. Although there is a numerical increase in all stroke types with the aging of our country’s population, it has been observed that the increase in the frequency of hemorrhagic strokes are limited over time when frequency standardization is made according to age.

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Amaç: Akut inme sonrasý çok erken dönemde prognozun deðerlendirilmesine yardýmcý olacak parametrelere halen ihtiyaç vardýr. Nötrofil-lenfosit oranýnýn (NLO) vasküler olaylarda prognostik bir gösterge olarak kullanýlabileceði bildirilmiþtir ancak zamanla iliþkili deðiþiklikleri yeterince araþtýrýlmamýþtýr. Bu çalýþmada iskemik inme hastalarýnda hastaneye ilk yatýþ günündeki NLO’nun inmenin klinik aðýrlýðý, hastanede kalýþ süresi, enfeksiyon geliþme riski gibi bazý klinik bulgular ve laboratuvar bulgularla iliþkili olup olmadýðýnýn ve günler içinde NLO’da deðiþiklik bulunup bulunmadýðýnýn araþtýrýlmasý amaçlanmýþtýr.
Gereç ve Yöntem: Ardý ardýna baþvuran 80 iskemik inme hastasýnýn sosyodemografik özellikleri, klinik verileri, laboratuvar sonuçlarý ve hastanedeki takip bilgileri retrospektif olarak deðerlendirilerek önceden hazýrlanan forma kaydedilmiþ ve ilk baþvuru gününde ve bundan en az beþ gün sonra alýnan kontrol kanlarýndan hesaplanan NLO arasýnda iliþki olup olmadýðý istatistiksel olarak araþtýrýlmýþtýr. Çalýþma retrospektif sistem taramasý olarak yapýldýðýndan hastalardan onam alýnmadý.
Bulgular: Farklý günlerde bakýlan NLO oranlarý arasýnda farklýlýk izlenmemiþtir (p=0,873). Ýnme þiddetine göre yapýlan deðerlendirmede; baþvuru günündeki NLO kesme noktasý 2,86 idi (sensitivite %88,9, spesifite %72,6). Hastane yatýþý sýrasýnda enfeksiyon geliþen ve geliþmeyen hastalar ayrý ayrý gruplanarak yapýlan istatistik deðerlendirmede enfeksiyon bulgusu izlenmeyen hastalarda NLO için belirlenmiþ olan kesim noktasý olan 2,86’nýn sensitivite ve spesifitesinin daha yüksek olduðunu göstermiþtir (sensitivite %100, spesifite %83). NLO 2,9’dan düþük hastalarýn yaþ ortalamasý, lökosit, trombosit deðerleri, enfeksiyon geliþme riskleri ve hastanede yatýþ süreleri NLO ≥2,9 olanlardan istatistiksel açýdan anlamlý olarak daha düþük bulunmuþtur.
Sonuç: Hastaneye ilk baþvuru gününde hesaplanan NLO deðerleri inmenin aðýrlýðýnýn deðerlendirilmesinde, hastanede yatýþ süresini ve yatýþ sýrasýnda enfeksiyon geliþme riski yüksek olan hastalarý öngörmede yararlý ve yeterli olabilir.

Objective: Prognostic predictors in the very early period of acute stroke are still needed. Neutrophil-lymphocyte ratio (NLR) was reported as a useful prognostic indicator for vascular diseases. However, its’ time-related changes are not sufficiently studied. In the present study, we aimed to investigate if the NLR at the first day of hospitalization is associated with some clinical and laboratory findings in patients with ischemic stroke and if they change in the following days.
Materials and Methods: The hospital data of 80 consecutive acute ischemic stroke patients were retrospectively documented and evaluated. NLR values that were calculated twice; on the day of admission and at least five days later, were compared to check if there are any significant changes. Since the study was conducted as a retrospective registry analysis, consent was not obtained from the patients.
Results: NLR ratios were similar in the two follow-up blood samples (p=0.873). In the evaluation according to stroke severity; the NLR cut-off point on the day of admission was 2.86 (sensitivity 88.9%, specificity 72.6%). This cut-off value showed a higher sensitivity and specificity in the cases who did not have an infection during hospital stay (sensitivity 100%, specificity 83%). Age, leukocyte and thrombocyte counts, risk of hospital infection and duration of hospital stay were significantly lower in the cases with NLR <2.9 than those with NLR ≥2.9.
Conclusion: NLR calculated on the first day of admission can be useful and adequate for assessing the severity of stroke, predicting the length of hospital stay and the risk of infection during hospitalization.

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Amaç: Multipl sklerozlu (MS) hastalarda beyin omurilik sývýsýndaki (BOS) oligoklonal bantlar (OKB) ile klinik profil arasýndaki iliþki henüz net deðildir. Bu çalýþmada, MS’li hastalarda OKB ile klinik ve manyetik rezonans görüntüleme (MRG) özellikleri arasýndaki iliþkiyi araþtýrmayý amaçladýk.
Gereç ve Yöntem: Hastalýðýn baþlangýcýndan itibaren ilk 3 ayda MS tanýsý alan 18-65 yaþ arasý hastalar dahil edildi. OKB pozitif ve negatif hastalarýn klinik (cinsiyet, hastalýðýn baþlangýç yaþý, klinik prezentasyon ve hastalýk alt tipi) ve MRG özellikleri ile tedavi rejimi seçimi arasýndaki fark deðerlendirildi. Hastalarýn verileri retrospektif olarak hastane kayýtlarýmýzdan elde edildi.
Bulgular: Çalýþmaya kriterleri karþýlayan 64 hasta dahil edildi. Elli OKB pozitif (grup 1) MS’li hasta ve 14 OKB negatif (grup 2) MS’li hastadan iki grup oluþturuldu. BOS parametrelerinden hücre sayýsý (p=0,001) ve IgG indeksi OKB (+) hastalarda OKB (-) hastalara göre istatistiksel olarak anlamlý derecede yüksekti (p<0,001). MRG’de, OKB (-) hastalara göre OKB (+) hastalarda alt servikal spinal segmentte daha fazla sayýda lezyon saptandý. Hastalýðýn seyri, ilk atak semptomlarý ve ciddiyeti, nüks oraný veya hastalýk modifikasyon terapisi ile iliþkili olarak OKB pozitif ya da negatif MS’li hastalar arasýnda önemli bir fark yoktu.
Sonuç: Çalýþmamýzda MS’li hastalarda OKB varlýðýnýn servikal MRG’yi olumsuz etkilediði gösterilmiþtir. Bu sonuçlar doðrultsunda MS’li hastalarda bu iliþkiyi inceleyen daha büyük çalýþmalara ihtiyaç vardýr.

Objective: The data for oligoclonal bands (OCB) in cerebrospinal fluid (CSF) and their association with clinical profiles of patients with multiple sclerosis (MS) are limited. In this study, we aimed to investigate the relationship between OCB and clinical and magnetic resonance imaging (MRI) features in patients with MS.
Materials and Methods: Patients between the ages of 18-65 who were diagnosed as having MS in the first 3 months of the onset of the disease were included. The difference between the clinical (gender, age of onset of disease, clinical presentation and subtypes of disease) and MRI characteristics as well as the choice of the treatment regimen of OCB-positive and negative patients were evaluated. The data of the patients were obtained retrospectively from our hospital records.
Results: Sixty-four patients who met the criteria were included in the study. Two groups were formed. Group 1 involved 50 OCB positive patients with MS and group 2 involved 14 OCB negative patients with MS. In CSF parameters, cell number (p=0.001), and IgG index were statistically significantly higher in OCB (+) patients compared to OCB (-) patients (p<0.001). In MRI, higher lesion number in the lower cervical spinal segment was found in OCB (+) patients compared to OCB (-) patients. There were no significant differences between OCB (+) and (-) patients with MS in relation to the course of the disease, symptoms of the first attack and severity, relapse rate, or disease modifying therapy.
Conclusion: Our results showed that the presence of OCB had a negative effect on MRI in patients with MS. Larger studies are warranted in patients with MS.

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Amaç: Multipl skleroz (MS), genellikle çalýþma çaðýnda (20-45 yaþ) teþhis edilen ve hastalarýn iþ performanslarýný ve çalýþma becerilerini olumsuz etkileyebilen merkezi sinir sisteminin kronik bir hastalýðýdýr. Bu çalýþmanýn amacý, MS’li hastalarda iþe dönüþte mesleki, bireysel ve hastalýkla ilgili faktörleri araþtýrmaktýr.
Gereç ve Yöntem: Bu çalýþma, Eylül 2019’dan Nisan 2020’ye kadar bir nöroloji kliniðine sevk edilen McDonald kriterlerine göre klinik olarak kesin MS’li hastalar üzerinde gerçekleþtirildi. Saðlýk ve Güvenlik Yöneticisi anketi ve Çok Boyutlu Yorgunluk Envanteri anketi iþ stresi ve yorgunluk düzeyini deðerlendirmek için kullanýldý. Engellilik düzeyi, Geniþletilmiþ Sakatlýk Durum Ölçeði’nin (EDSS) doðrulanmýþ versiyonu aracýlýðýyla hastalarda deðerlendirildi. Hastalarýn iþe dönüþ durumuna göre bireyler iþe dönen (tam zamanlý, yarý zamanlý) ve iþe dönmeyen hastalar olarak iki gruba ayrýldý. Daha sonra bu iki grup mesleki, bireysel ve hastalýkla ilgili faktörler açýsýndan karþýlaþtýrýldý.
Bulgular: MS’li 191 hastadan 127’si (%64) taný konulduktan bir yýl sonra iþine döndü. Ýþe dönüþ oraný genç hastalarda, erkeklerde ve relaps ve remisyonlarla seyreden MS’li hastalarda daha yüksekti. Fiziksel iþler, orta düzeyde nörolojik özürlülük (EDSS >3) ve þiddetli yorgunluk baðýmsýz olarak iþsizlikle iliþkilendirildi.
Sonuç: Çalýþmamýzýn bulgularý, ileri yaþ, kadýn cinsiyet, fiziksel bir iþe sahip olma, nörolojik dizabilite ve þiddetli yorgunluðun MS’li hastalarda iþe geri dönmeme ile iliþkili olduðunu göstermiþtir. Çalýþma çaðýndaki gençlerde MS prevalansýnýn yüksek olmasý nedeniyle, istihdamý kolaylaþtýrýcý çalýþma ortamýna iliþkin faktörlerin ayarlanmasý, meslektaþlarýn ve yöneticilerin desteði, bu hastalarda stresin azaltýlmasýnda ve hastalýðýn genel durumunun iyileþtirilmesinde önemli rol oynayabilir.

Objective: Multiple sclerosis (MS) is a chronic disease of the central nervous system that is usually diagnosed at the working-age (20-45 years) and can negatively affect patients’ job performance and ability in work. The purpose of this study was to investigate occupational, individual, and disease-related factors in the return to work in patients with MS.
Materials and Methods: This study was performed on all patients with clinically definite MS according to the McDonald criteria who were referred to a neurology clinic from September 2019 to April 2020. The Health and Safety Executive Questionnaire and Multidimensional Fatigue Inventory Questionnaire were used to assess job stress and fatigue level. Level of disability was assessed in patients through the validated version of the Expanded Disability Status Scale (EDSS). Based on the patients’ return to work status, individuals were divided into two groups: the patients who returned to work (full time, part-time) and who did not return to work. Then, these two groups were compared in terms of occupational, individual, and disease-related factors.
Results: Of 191 patients with MS, 127 (64%) returned to work after one year of diagnosis. The rate of returning to work was higher among younger patients, males and patients with the relapsing-remitting MS. Physical jobs, moderate level of neurological disability (EDSS >3) and severe fatigue were independently associated with unemployment.
Conclusion: Findings of our study showed that older age, female gender, having a physical job, neurological disability, and severe fatigue were associated with no return to work in MS patients. Due to the high prevalence of MS in young people at working age, facilitating employment, adjusting factors related to the work environment, and support of colleagues and supervisors can play an important role in reducing stress and improving the general condition of the disease in these patients.

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Amaç: Akut iskemik inme (AÝÝ) tüm dünyada önemli bir mortalite ve morbidite nedenidir. Terapötik pencerede baþvuran akut inmeli hastalara intravenöz tromboliz (ÝVT) ve endovasküler tedaviler (EVT) önerilmektedir. Bu çalýþmada Ýstanbul Bakýrköy Prof. Dr. Mazhar Osman Ruh ve Sinir Hastalýklarý Eðitim ve Araþtýrma Hastanesi’nde 2017-2020 yýllarý arasýnda ÝVT ve EVT yöntemleri ile tedavi edilen AÝÝ hastasýnýn verileri retrospektif olarak deðerlendirildi.
Gereç ve Yöntem: Bu çalýþmaya intravenöz ve/veya EVT uygulanan 590 hasta dahil edilmiþtir. Bu hastalarýn demografik, klinik, radyolojik özellikleri, risk faktörleri ve tedavi sonrasý klinik özellikleri analiz edilmiþtir.
Bulgular: Beþ yüz doksan hastanýn 324’üne (%54,9) ÝVT, 164’üne (%27,8) EVT ve 102’sine (%17,3) kombine ÝVT+EVT uygulandý. Baþvuruda medyan National Institutes of Health Stroke Scale (NIHSS) skorlarý iv tPA grubunda 9 (1-21), EVT grubunda 13 (3-27), kombine tedavi grubunda 12 (4-23) idi. ÝVT grubunda 220 hastada endovasküler giriþim gerektirecek arter týkanýklýðý yoktu (%67,9), 32 hasta (%9,9) ile MCA M2 segmenti en çok týkanan arter olarak bulundu. EVT ve kombine ÝVT+EVT gruplarýnda, MCA’nýn M1 segmenti en yüksek oklüzyon oranýna sahipti [sýrasýyla 76 (%44,2), 49 (%45)]. EVT grubunda asemptomatik kanama oraný diðer gruplara göre daha yüksekti. Semptomatik kanama oraný ÝVT grubunda diðer gruplara göre daha düþüktü. ÝVT, EVT ve kombine ÝVT+EVT gruplarýnda sýrasýyla 182 (%56,2), 67 (%39) ve 53 (%48,6) hastada iyi sonuç alýndý.
Sonuç: Ýnme tüm dünyada mortalitenin en önde gelen sebeplerinden biri olmakla birlikte, saðkalým sonrasý çoðu hastada sekelli iyileþme yüzünden yüksek oranda morbiditeye neden olmaktadýr. AÝÝ tedavisinin inmenin hastalar, bakým veren kiþiler, ve topluma oluþturduðu yükü önemli oranda azalttýðý kanýtlanmýþtýr. Bu nedenle toplum acil baþvuru konusunda daha bilinçli hale getirilmeli ve doðru tedaviyi uygulayan merkezlerin sayý ve kapasiteleri artýrýlmalýdýr.

Objective: Acute ischemic stroke (AIS) is a major cause of mortality and morbidity throughout the world. Intravenous thrombolysis (IVT) and endovasculary treatments (EVT) are recomended currently in eligible patients admitted within the therapeutic window. In this study, the data of AIS patients who were treated with intravenous and EVT methods in Istanbul Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital between 2017-2020 were evaluated retrospectively
Materials and Methods: Five hundred and ninety patients who received IVT and/or EVT were included in the study. Demographic, clinical, radiological characteristics, risk factors and post-treatment clinical characteristics of these patients were analyzed.
Results: Of the 590 patients, 324 (54.9%) underwent IVT, 164 (27.8%) EVT and 102 (17.3%) combined IVT+EVT. The median National Institutes of Health Stroke Scale (NIHSS) scores were 9 (1-21) in the iv tPA group, 13 (3-27) in the EVT group, 12 (4-23) in the combined treatment group at admission In the IVT group, 220 patients had no artery occlusion (67.9%), M2 segment of the middle cerebral artery (MCA) was found to be the most frequently occluded artery with 32 patients (9.9%). In the EVT and combined IVT+EVT groups, the M1 segment of the MCA had the highest occlusion rate [76 (44.2%), 49 (45%), respectively]. Asymptomatic hemorrhage rate was higher in the EVT group than the other groups. Symptomatic hemorrhage rate was lower in the IVT group compared to the other groups. A total of 182 (56.2%), 67 (39%) and 53 (48.6%) patients in the IVT, EVT and combined IVT+EVT groups had good outcome, respectively.
Conclusion: Acute stroke treatment has been proven to significantly reduce the serious burden of stroke on patients, caregivers and society. For this reason, the societal awareness of the importance of urgent admission to emergency departmentsand the number and capacity of centers that provide AIS treatments should be increased.

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Amaç: Multipl sklerozlu (MS) hastalarda hipotalamus-hipofiz-adrenal (HPA) aksýn disfonksiyonunun ortaya çýktýðý düþünülmektedir. Kopeptin, HPA ekseninin dolaylý bir belirteci olarak belirtilen bir serum proteinidir. Bu çalýþmanýn amacý, kopeptin düzeylerini deðerlendirerek HPA aksý ile klinik sessiz MS (KSMS) arasýndaki iliþkiyi deðerlendirmektir.
Gereç ve Yöntem: Eylül 2016-Eylül 2017 tarihleri arasýnda atak ve progresyon göstermeyen 60 KSMS tanýlý hasta (ataksýz ve progresyonsuz relapsingremitting MS’li hastalar) ve 60 saðlýklý birey çalýþmaya dahil edildi. Tüm hastalar remisyon dönemindeydi. HPA aksýn disfonksiyonu serum kopeptin düzeyleri ölçülerek deðerlendirildi. Kopeptin düzeyleri MS’li hastalarda klinik parametrelerle karþýlaþtýrýldý.
Bulgular: Altmýþ KSMS’li hasta ve 60 saðlýklý kontrol olmak üzere toplam 133 birey çalýþmaya alýndý. Hastalarýn ve kontrol grubunun yaþ ortalamalarý sýrasýyla 37,1±7,8 (18-60) ve 34,9±8,6 (18-54) idi. Kontrol grubuna göre hastalarda kopeptin düzeyi anlamlý olarak daha düþüktü (p=0,001). Her iki grupta da cinsiyet ile kopeptin düzeyleri arasýnda anlamlý fark yoktu (p<0,05). Kopeptin düzeyleri ile yaþ (r=0,255, p=0,064), son Geniþletilmiþ Özürlülük Durum Ölçeði skoru (Expanded Disability Status Scale) (r=-0,126, p=0,325) ve hastalýk süresi (r=0,168, p=0,187) arasýnda anlamlý bir iliþki saptanmadý.
Sonuç: Bu sonuçlar, KSMS’li hastalarda remisyon döneminde HPA aksýnýn de hipoaktif olabileceðini göstermektedir. Bulgularýmýza göre, kopeptin düzeylerinin klinik olarak aktivite göstermeyen MS’li hastalarda gelecekte prognostik belirteç olarak kullanýlabileceðini düþünmekteyiz.

Objective: Hypothalamic-pituitary-adrenal (HPA) axis dysfunction is thought to be found in patients with multiple sclerosis (MS). Copeptin is a serum protein that is indicated as an indirect marker of HPA axis. The aim of this study was to evaluate the relationship between HPA axis and clinically silent MS (CSMS) by evaluating copeptin levels.
Materials and Methods: Sixty patients with CSMS which was defined as relapsing-remitting MS without attack and progression, and 60 healthy individuals were included in the study from September 2016 to September 2017. All patients were in the remission period. HPA axis dysfunction was examined by measuring serum copeptin levels in all individuals. Copeptin level was compared with clinical parameters in patients with MS.
Results: A total of 120 individuals were composed of 60 patients with CSMS and 60 healthy controls. The average ages of the patients and the control group were 37.1±8 (20-52) and 35.1±8.9 (18-54), respectively. The copeptin level was significantly lower in patients compared to the control group (p<0.001). In both groups, gender played no differential role in copeptin levels (p<0.05). No significant correlation was determined between copeptin levels, age (r=0.121, p=0.188), last Expanded Disability Status Scale score (r=-0.035, p=0.790) and disease duration (r=0.032, p=0.810).
Conclusion: These results indicate that HPA axis may also be hypoactive in remission period in patients with CSMS. According to our findings, we consider that copeptin levels can be used as a prognostic marker in patients with clinically inactive MS in the future.

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Amaç: Hiperhomosisteinemi, kardiyovasküler hastalýklar açýsýndan baðýmsýz bir risk faktörüdür. Hem antifibrinolitik hem de kanama eðilimine neden olabilecek etkileri vardýr. Çalýþmamýzda, akut iskemik inmede trombolitik tedavi üzerine etkileri incelendi.
Gereç ve Yöntem: Çalýþmada, 2005-2021 yýllarý arasýnda hastanemizde intravenöz (iv) doku plazminojen aktivatörü (tPA) tedavisi alan ve 3 gün içinde bakýlmýþ homosistein (Hcy) düzeyi olan hastalar tPA etkinliði, prognoz ve intraserebral kanama açýsýndan deðerlendirildi. iv tPA tedavisi etkinliði, 24. saat NIHSS skorunda azalma durumuna göre etkin cevap (en az 4 puan azalma veya skorun sýfýr olmasý) ve dramatik cevap (en az 8 puan azalma veya skorun sýfýr ya da bir olmasý) olarak kategorize edildi. Üçüncü ayda deðerlendirilen modifiye Rankin skalasýna göre 0 ve 1 puan “mükemmel sonlaným”; 0, 1 ve 2 puan “iyi sonlaným” olarak sýnýflandýrýldý. iv tPA sonrasý serebral kanama sýnýflandýrmasý için kontrastsýz beyin bilgisayarlý tomografide (BT) Fiorelli’s sýnýflamasý kullanýldý.
Bulgular: Çalýþmaya dahil edilen 182 hastanýn (yaþ ortalamasý 71±14 yýl; 99 kadýn) %46,7’sinde etkin cevap, %31,3’ünde dramatik cevap izlendi. Hastalarýn %33’ünde mükemmel sonlaným, %53,3’ünde iyi sonlaným görüldü. iv tPA sonrasý kontrol beyin BT’de hastalarýn %15,9’unda herhangi bir þiddette serebral kanama, %,5,5’inde parankimal hematom tip 2 tespit edildi. Prognoz, tPA cevabý ve tPA sonrasý serebral hemoraji durumuna göre yapýlan analizlerde Hcy düzeyi ve farklý kesim deðerleri ile oluþturulan subgruplar arasýnda bir farklýlýk saptanmadý.
Sonuç: Çalýþmamýzda, fibrinolizis ve vasküler bütünlük üzerine negatif etkileri olduðu bilinen hiperhomosisteineminin iv tPA etkinliði, prognozu ve komplikasyonlarý üzerine belirgin bir etkisi gösterilememiþtir. Bu etkilerin daha iyi ortaya konulabilmesi için prospektif ve geniþ katýlýmlý çalýþmalara ihtiyaç vardýr.

Objective: Hyperhomocysteinemia is an independent risk factor for cardiovascular diseases. It has paradoxically both antifibrinolytic and pro-hemorrhagic effects. In the study, we investigated the effect of homocysteine (Hcy) levels on thrombolytic therapy in patients with acute ischemic stroke.
Materials and Methods: Patients who received intravenous (iv) tissue plasminogen activator (tPA) between 2005 and 2021 and had Hcy levels measured within the first 3 days were reviewed in terms of tPA efficacy, prognosis and intracerebral hemorrhage. The efficacy of tPA treatment was categorized as effective response (decrease of at least 4 points or a decrease in score to zero) and dramatic response (decrease of at least 8 points or a decrease in score to either zero or one) according to NIHSS score at 24 hours. Scores of 0 and 1 were classified as “excellent outcome”, and scores of 0, 1, and 2 were classified as “good outcome” on the modified Rankin scale evaluated at 3 months. Hemorrhagic transformation was evaluated according to Fiorelli’s classification.
Results: Effective response was observed in 46.7% of the 182 patients (mean age 71±14 years; 99 women) included in the study, and dramatic response in 31.3%. Excellent outcome was reported in 33% of the patients, and good outcome in 53.3%. Cerebral hemorrhage of any severity was detected in 15.9% of the patients, and parenchymal hematoma type 2 in 5.5%. In the analyses made for assessing iv tPA response and cerebral hemorrhage status, no difference was found in terms of Hcy level and between the subgroups formed with different cut-off values of Hcy level.
Conclusion: In our study, hyperhomocysteinemia, which is known to have negative effects on fibrinolysis and vascular integrity, did not show a significant effect on iv tPA efficacy, prognosis and complications. Prospective and large-sample sized studies are needed to better demonstrate these effects.

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Amaç: Alzheimer hastalýðýnýn (AH) subjektif biliþsel gerileme (SBG), hafif biliþsel bozukluk (HBB) ve olasý Alzheimer hastalýðý (OAH) demansý evrelerinde hastalarýn ve eþlerinin/bakým verenlerin biliþsel bozulma ile ilgili perspektiflerinin nasýl deðiþtiðinin incelenmesi amaçlanmýþtýr.
Gereç ve Yöntem: Yirmi üç SBG, 33 HBB ve 17 OAH tanýlý hasta çalýþmaya dahil edildi. Katýlýmcýlara standardize minimental test (SMMT), sayý menzili testi ve semantik akýcýlýk testleri uygulandý. Kognitif fonksiyon enstrümaný (KFE) biliþsel bozukluðun subjektif deðerlendirmesi için kullanýldý. Ayný sorular hastalar tarafýndan katýlýmcý bildirimi (KFE-KB), çalýþma partnerleri tarafýndan ise çalýþma partneri bildirimi (KFE-ÇPB) kullanýlarak yanýtlandý.
Bulgular: SBG ve HBB gruplarýnda KFE-KB skorlarýnýn KFE-ÇPB skorlarýna göre daha yüksek olduðu görüldü. OAH grubunda ise tam tersi bir durum gözlendi ve KFE-ÇPB skorlarýnýn KFE-KB skorlarýna göre daha yüksek olduðu görüldü. Ayrýca OAH grubunda SMMT skorlarý ile KFE-KB skorlarý arasýnda pozitif korelasyon saptandý ve biliþsel bozukluðu daha aðýr olan hastalarýn KFE-KB skorlarýnýn daha düþük olduðu, biliþsel bozukluðu daha hafif olan hastalarýn ise KFE-KB skorlarýnýn daha yüksek olduðu görüldü. Gruplarýn hiçbirinde KFE-ÇPB skorlarý ile SMMT skorlarý arasýnda anlamlý korelasyon saptanmadý ancak HBB grubunda negatif korelasyon eðilimi görüldü. KFE-KB ve KFE-ÇPB skorlarý arasýnda anlamlý korelasyon sadece HBB grubunda gözlendi.
Sonuç: Biliþsel bozukluklarýn subjektif deðerlendirmesi özellikle AH’nin erken evrelerinde bilgilendirici olabilir. Ancak, OAH olgularýnda içgörü kaybý geliþmesi nedeniyle hastalarýn perspektifine dayanan subjektif biliþsel deðerlendirme yanýltýcý olabilir. Hastalarýn ve eþlerinin perspektifleri arasýnda en yüksek uyumluluk SBG ve OAH arasýnda bir geçiþ dönemini temsil eden HBB evresinde saptanmýþtýr.

Objective: To understand how the patients’ and their study partners’/caregivers’ perspectives on cognitive decline change at the subjective cognitive decline (SCD), mild cognitive impairment (MCI), and probable Alzheimer’s disease (PRAD) stages of the Alzheimer’s disease (AD) continuum.
Materials and Methods: Twenty-three individuals with the diagnosis of SCD, 33 individuals with the diagnosis of MCI, and 17 individuals with the diagnosis of PRAD were included. A cognitive testing battery including the standardized mini-mental state examination (MMSE), digit span forward and backwards tests, and the semantic fluency test were administered to all patients. The cognitive function instrument (CFI) was used for the subjective assessment of cognitive decline. The same questions in the CFI were answered both by the patients (CFI-self report) and the study partners (CFI-partner report).
Results: In the SCD and the MCI groups, the CFI-self report scores were higher than the CFI-partner report scores, whereas an opposite pattern was found in the PRAD group with higher CFI-partner report scores and lower CFI-self report scores. The CFI self report scores positively correlated with the MMSE scores in the PRAD group showing higher ratings in cognitively less impaired individuals, and vice versa. The CFI partner-report scores did not show a significant correlation with the MMSE scores in any of the groups, however a trend for a negative correlation was observed in the MCI group. Finally, the CFI-self report and partner report scores significantly correlated only in the MCI group.
Conclusion: Report-based assessment of cognitive decline can be informative, particularly in the early stages of the AD continuum. THowever, the loss of insight in PRAD may mask the symptoms when the subjective cognitive assessment relies on the patients’ perspective. The greatest concordance between the patients’ and their partners’ perspectives was evident in the MCI stage which represented a transitional period between SCD and PRAD.

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Amaç: Ultrason (US), gebelikte fetüsün kontrol edilmesi gibi çeþitli uygulamalarda kullanýlan bir görüntüleme iþlemidir. Bildiðimiz kadarýyla hiçbir çalýþma tanýsal US dalgalarýnýn ve etanol maruziyetinin hücre içi kalsiyum ([Ca2+]i) süreçleri ve reaktif oksijen türleri (ROS) üzerindeki eþzamanlý etkisini araþtýrmamýþtýr. Bu nedenle, bu çalýþmada öncelikle fetal yaþam sýrasýnda tanýsal US’nin sýçanlarýn hipokampal hücrelerindeki [Ca2+]i ve ROS üzerindeki etkilerini; daha sonra da tanýsal US’nin bu iki deðiþken üzerinde etanolün etkilerini artýrýp artýrmadýðýný araþtýrmayý amaçladýk.
Gereç ve Yöntem: Eriþkin diþi Wistar sýçanlar, çiftleþme sonrasý; kontrol grubu, etanol grubu (5 g/kg), 11-13. gebelik günlerinde 10 dakika boyunca 3 ve 5 MHz frekanslarýnda tanýsal US uygulanan gruplar ve ayný gebelik döneminde etanol eþliðinde US dalgalarý uygulanan gruplar olmak üzere 6 gruba ayrýldý. Doðumdan 14 gün sonra yavrulara anestezi uygulandý, hipokampus izole edildi ve hücre kültüründen sonra Flou 3-AM ve florimetri cihazý kullanýlarak [Ca2+]i ölçüldü.
Bulgular: Bu çalýþmada 3 ve 5 MHz frekanslý tanýsal US’nin kontrol grubuna göre [Ca2+]i düzeylerini %17,8 ve %21,8; ROS düzeylerini ise %81,18 ve %128,51 oranlarýnda artýrdýðýný gösterdi. Ayrýca 3 ve 5 MHz frekanslý etanol ve US’ye ayný anda maruz kalan gruplarda [Ca2+]i seviyeleri etanol grubuna göre %19,19 ve %23,33 oranlarýnda daha yüksekti. Ayrýca 3 ve 5 MHz frekanslý etanol ve US’ye ayný anda maruz kalan gruplarda ROS miktarý etanol grubuna göre sýrasýyla %77,5 ve %172,5 oranlarýnda daha yüksekti. Ancak etanol tek baþýna hücre içi [Ca2+]i ve ROS seviyelerini deðiþtirmedi.
Sonuç: 3 ve 5 MHz frekanslý tanýsal US’nin [Ca2+]i ve ROS seviyelerini artýrdýðý ve etanolün [Ca2+]i ve ROS seviyeleri üzerindeki etkilerini de þiddetlendirdiði sonucuna varýldý.

Objective: Ultrasound (US) is an imaging procedure with various applications, such as checking the fetus during pregnancy. To the best of our knowledge no study have investigated the simultaneous effect of diagnostic US waves and ethanol exposure on intracellular calcium ([Ca2+]i) processes and reactive oxygen species (ROS). Thus, in the current study, we first aimed to investigate the impacts of diagnostic US during fetal life on [Ca2+]i and ROS in rats’ hippocampal cells; then whether the diagnostic US has intensified ethanol effects on these two variables.
Materials and Methods: After mating, adult female Wistar rats were divided into six groups as follows: Control group, ethanol group (5 g/kg), groups that were exposed to diagnostic US at frequencies of 3 and 5 MHz for 10 minutes on the 11-13 days of pregnancy, and groups that underwent US waves accompanied with ethanol on the same term of pregnancy. Fourteen days after delivery, the offspring were anesthetized, the hippocampus was isolated, and [Ca2+]i was measured using the Flou 3-AM and fluorimetry instrument after cell culture.
Results: The results showed that the diagnostic US with 3 and 5 MHz frequencies significantly increased [Ca2+]i levels up to 17.8% and 21.8 %, as well as ROS levels by 81.18% and 128.51% compared to the control group. In addition, [Ca2+]i levels in the groups with simultaneous exposure to ethanol and US with frequencies 3 and 5 MHz were 19.19% and 23.33% higher than the ethanol group. Besides, the amount of ROS in the groups with simultaneous exposure to ethanol and US with frequencies 3 and 5 MHz were 77.5% and 172.5% higher than the ethanol group, respectively. However, ethanol alone did not alter intracellular [Ca2+]i and ROS levels.
Conclusion: It is concluded that diagnostic US with 3 and 5 MHz frequencies increase the [Ca2+]i and ROS rate, and it also intensifies the effects of ethanol on the [Ca2+]i and ROS levels.

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Amaç: Endo-opioid ve endo-kannabinoid sistemler aðrýnýn regülasyonunda önemli rol oynar ve migren fizyopatolojisi ile iliþkilendirilmiþlerdir. Kronik migrende (KM) olduðu gibi sýk atak geçiren hastalarda ilaç aþýrý kullaným baþaðrýsý (ÝAKBA) geliþebilmektedir. Ancak tüm kronik baþaðrýsý olan hastalarda ÝAKBA geliþmemektedir. Bunun nedeni tam olarak bilinmemektedir. Bu çalýþmanýn amacý bu sistemlerin epizodik ve KM’de ve ÝAKBA’daki rolünün belirlenmesidir.
Gereç ve Yöntem: (Epizodik migren; n=29), (KM; n=15), ÝAKBA (n=16) ve 31 saðlýklý kontrol çalýþmaya alýnarak nosiseptin ve anandamid (AEA) kan seviyeleri ölçüldü ve bunlarýn kan seviyeleri gruplar arasýnda ve baþaðrýsý parametreleri ile karþýlaþtýrýldý.
Bulgular: AEA seviyeleri tüm migren gruplarý birleþtirilerek karþýlaþtýrýldýðýnda kontrol grubundan anlamlý olarak düþüktü (p=0,009) ancak gruplarýn teke tek karþýlaþtýrýlmasýnda fark bulunamadý (p=0,062). Anlamlýlýk olmamakla birlikte median nosiseptin deðerleri KM grubunda çok yüksek (235,76 ng/l), ÝAKBA grubunda ise çok düþüktü (30,08 ng/l).
Sonuç: Migrende düþük olarak bulduðumuz AEA seviyeleri migrende endokannabinoid sistem iþleyiþinin bozulmuþ olduðu hipotezini desteklemektedir. Epizodik ve KM gruplarý arasýnda bir fark bulamamýza raðmen literatürde bildirilen sonuçlarýn yorumlanmasý bize KM’deki devamlý baþaðrýsýnýn, düþük endokannabinoid inhibisyon düzeyinin katkýda bulunduðu nosiseptif fasilitasyona baðlý süregelen santral sensitizasyon sonucunda oluþabileceðini düþündürmüþtür. Anlamlýlýða ulaþmamakla birlikte nosiseptin düzeyleri KM grubunda en yüksekken ÝAKBA grubunda en düþüktü. KM’de bozulmuþ olan endokannabinoid sistemi kompanse etmek amacýyla endo-opioid sistemin devreye girmeye çalýþmasý ve endo-opioid seviyelerinin yükselememesi durumunda hastanýn aþýrý aðrý kesici almaya itilerek ÝAKBA geliþtirmesi olasýdýr. Bu hipotezi tam olarak doðrulayamamakla birlikte bunun daha geniþ çalýþmalarda incelenmeye deðer olduðunu düþünmekteyiz.

Objective: The endo-opioid and endo-cannabinoid systems are important in regulating pain and have been implicated in migraine pathophysiology. Patients with frequent attacks, such as patients with chronic migraine (CM), frequently develop medication overuse headache (MOH). Not all patients with chronic headache develop MOH, the reason for which is not exactly known. We aimed to assess the involvement of these neurotransmitter systems in episodic and CM and in MOH.
Materials and Methods: Patients with (episodic migraine; n=29), (CM; n=15), MOH (n=16) and 31 healthy controls were recruited and blood levels of nociceptin and anandamide (AEA) were compared between groups, as well as their levels with headache parameters.
Results: AEA levels were significantly lower in the combined migraine groups compared to controls (p=0.009), but head to head comparison of the groups revealed no significant difference (p=0.062). Median nociceptin levels were found to be very high in CM (235.76 ng/l) group and very low in MOH (30.08 ng/l) group, but the difference was not statistically significant.
Conclusion: Our finding of low AEA levels in migraine supports the hypothesis of a dysfunctional endocannabinoid system in migraine. Although our results failed to reveal any differences between episodic and CM, an interpretation of findings reported in the literature suggested that this low endocannabinoid inhitory tone might contribute to nociceptive facilitation resulting in maintained central sensitization and therefore sustained pain in CM. Although not significant, nociceptin levels were much higher in CM group and the lowest levels were found in MOH group. It is possible that in CM, the opioid system tries to counterbalance the endocannabinoid dysfunction and if the opioid levels fail to rise, the patient is driven to an excessive use of analgesics and MOH develops. Although we were unable to prove this hypothesis we think it would be worthwhile studying this hypothesis in a larger group of patients.

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Akut süpüratif otomastoidit (ASOM), çoðunlukla çocukluk çaðýnda ortaya çýkan süpüratif akut otitis media ve akut mastoiditin birlikte görülmesini ifade eder. Son dönemde geniþ spektrumlu antibiyotiklerin geliþmesi ile komplikasyonlar nadirdir. Ancak, mukoperiostal tutulum osteomiyelite (OM) ilerlediðinde ciddi komplikasyonlar geliþebilir. Bu, genellikle baðýþýklýðý baskýlanmýþ hastalarda veya diabetes mellitus (DM) gibi kemik vaskülaritesinde azalma ile iliþkili bazý hastalýklar olduðunda ortaya çýkar. Bu yazýda, koalesan mastoidit sonucu geliþen, kafa tabanýný ve bilateral fallop kanallarý etkileyen OM’ye baðlý bilateral periferik fasial palsi ile baþvuran 58 yaþýndaki erkek hastamýzý sunuyoruz. ASOM tedavisinde, özellikle DM gibi risk faktörlerinin varlýðýnda, takip görüntüleme mastoid kemiðin OM’sini kafa tabanýna yayýlmadan ve kafa içi yayýlým ile komplike hale gelmeden önce ortaya çýkarmak için önemlidir. Radyolojik görüntülemede kemik algoritmalý temporal bilgisayarlý tomografi, OM’nin erken kemik rezorpsiyonlarýný ortaya çýkarmak için ilk tercih edilen yöntemdir.

Acute suppurative otomastoiditis (ASOM) refers to the concurrent occurrence of suppurative acute otitis media and acute mastoiditis, occurring mostly in childhood. Complications are rare in the recent era with the development of wide spectrum antibiotics. However, when the mucoperiosteal involvement evolves into osteomyelitis (OM), severe complications may develop. This generally occurs in immunocompromised patients or patients with some illnesses associated with decreased bone vascularity such as diabetes mellitus (DM). We report a 58-year-old male patient presenting with bilateral peripheral facial palsy in whom OM resulting from coalescent mastoiditis affected the skull base and the bilateral fallopian canals. In the management of ASOM, especially with the presence of the risk factors such as DM, follow up imaging is important to reveal OM of the mastoid bone before it spreads to the skull base and further it is complicated with intracranial extensions. On radiological imaging, temporal computed tomography with bone algorithm is the first method of choice to reveal early bony resorptions of OM.

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Kapesitabin, esas olarak kolorektal kanser ve meme kanseri tedavisinde kullanýlan oral kemoterapötik bir ajandýr. Bu olgu sunumunda acil servise kapesitabinin yan etkisi olarak inme benzeri semptomlarla baþvuran bir hasta bildirilmiþtir. Beyin manyetik rezonans görüntülemede tipik ak madde lezyonlarý saptanmýþtýr. Ýskemik inme semptomlarý ile acile gelen hastalarda kliniði taklit edebilecek komorbid durumlarýn da göz önünde bulundurulmasý tedavi yaklaþýmý açýsýndan önemlidir.

Capecitabine is an oral chemotherapeutic agent used primarily in the treatment of colorectal cancer and breast cancer. With this case report, we aimed to report a patient admitted to the emergency department with stroke-like symptoms as a side effect of capecitabine. Magnetic resonance imaging showed signal changes in the cerebral white matter typical of capecitabine leukoencephalopathy. Since the mechanism of action is not fully understood, clinicians should be aware of this rare complication in order to make appropriate therapeutic decisions.

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Amaç: Yoðun bakým yan dal eðitimine baþlamýþ ve/veya yoðun bakým yan dal eðitimini tamamlamýþ nöroloji uzmanlarýnýn nöroloji ve yoðun bakým eðitimlerini, nörolojik yoðun bakým organizasyonlarý hakkýnda görüþlerini deðerlendirmeyi amaçladýk.
Gereç ve Yöntem: Yoðun bakým yan dal eðitimine baþlamýþ ve/veya tamamlamýþ tüm nöroloji uzmanlarý, çevrimiçi anket formunun baðlantýsýný içeren 30 soruluk bir ankete e-posta veya cep telefonundan mesaj aracýlýðýyla katkýda bulunmaya davet edildi.
Bulgular: Türkiye’de yoðun bakým yan dal eðitimine baþlamýþ ve/veya yoðun bakým yan dal eðitimini tamamlamýþ 29 nöroloji uzmaný bulunmakta olup bu uzmanlarýn tümü anketi tamamladý. Nöroloji uzmanlarýndan 12’si yoðun bakým yan dal eðitimini tamamladýðýný, 12’si yoðun bakým yan dal eðitimine devam ettiðini, 5’i eðitim sürecinden ayrýldýðýný bildirdi. Nöroloji uzmanlarýnýn % 86,2’si nörolojik yoðun bakým ünitelerinde çalýþmak istediðini, % 79,3’ü nörolojik ve nöroþirürjikal yoðun bakým ünitelerinin birleþmesi gerektiðini, % 75,9’u bu ortak yoðun bakým ünitelerinde çalýþabileceklerini belirtti. Ancak 12 nöroloji kökenli yoðun bakým uzmanýnýn hiçbirisinin nörolojik yoðun bakým ünitelerinde çalýþamadýðý saptandý.
Sonuç: Çalýþmalar; nörokritik bakým hizmetleri saðlamanýn, nörolojik yoðun bakým ünitelerinin ve nörointensivistlerin nörokritik hastalýðý olan hastalarda klinik sonuçlarý iyileþtirebileceðini göstermiþtir. Çalýþmamýzda nöroloji kökenli yoðun bakým uzmanlarý, nörolojik yoðun bakým ünitelerinde çalýþamadýklarýný bildirdi. Dünya genelinde nörointensivistlerin, nörolojik yoðun bakým ünitelerinde hastalarýn sadece beþte birine baktýðý saptanmýþtýr. Gerek dünyada gerekse Türkiye’de hasta sonlanýmlarýnýn iyileþtirilmesi için nörointensivistlerin nörolojik yoðun bakým ünitelerini yönetmesi gerekmektedir.

Objective: We aimed to evaluate the neurology and intensive care training of neurology specialists who have started and/or completed intensive care subspecialty training and their views on neurological intensive care organizations.
Materials and Methods: All neurology specialists who have started and/or completed intensive care subspecialty training were invited to contribute a 30 question survey via e-mail or text message from mobile phone, which contained a link to the online questionnaire form.
Results: There are 29 neurology specialists in Turkey who have started and/or completed intensive care subspecialty training, and all of these specialists completed the survey. Of the neurologists, 12 reported that they completed the intensive care subspecialty training, 12 continued their intensive care subspecialty training, and 5 left the training process. Of the neurologists, 86.2% stated that they wanted to work in neurological intensive care units, 79.3% stated that neurological and neurosurgical intensive care units should be combined, 75.9% stated that they could work in these common intensive care units. However, it was determined that none of the 12 neurology-based intensive care specialists could work in the neurological intensive care units.
Conclusion: Studies have shown that providing neurocritical care services, neurological intensive care units and neurointensivists could improve clinical outcomes in patients with neurocritical illnesses. In our study, neurology-based intensive care specialists reported that they could not work in neurological intensive care units. Worldwide neurointensivists cared for only a fifth of patients in neurological intensive care units. Neurointensivists need to manage neurological intensive care units to improve patient outcomes both in the world and in Turkey.

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