Nöroloji/Makale Koleksiyonu
Bu koleksiyon için kalıcı URI
Güncel Gönderiler
Öğe The Assessment of the Effects of Synthetic Collagen Membrane Use on the Prevention of Epidural Fibrosis Development in Patients Undergoing Lumbar Discectomy by Magnetic Resonance Imaging Findings(Selçuk Üniversitesi, 2023 Haziran) Kaya, MehmetBacground/Aims: The aim of study to evaluate the effects of synthetic collagen membrane placed on dura mater on the prevention of arachnoiditis and fibrosis development by magnetic resonance imaging (MRI) findings in patients undergoing lumbar discectomy. Methods: A total of 40 patients who underwent single level unilateral discectomy for lumbar disc hernia were retrospectively evaluated. Sixteen patients with collagen membranes placed on the dura and 24 patients without any material on the dura were included in the study. Postoperative MRI images of the patients with and without collagen membranes were examined and evaluated whether the material used was effective in preventing arachnoiditis and / or epidural fibrosis and granulation tissue formation. Results: Nine female patients (37.5%) and 15 male patients (62.5%) of 24 patients were in the collagen membrane-free group. Four of the patients in the collagen membrane group were female (25%) and 12 were male (75%). The mean age of the non-membrane group was 35.47 ± 9.06, and the mean age of the membrane group was 37.40 ± 8.92 years. According to MRI findings, granulation tissue and epidural fibrosis were not observed in 8 (50%) of 16 patients with collagen membranes, whereas granulation tissue was observed in 8 (50%) patients. Granulation tissue was not observed in 10 (41.7%) of 24 patients without collagen membrane, whereas epidural fibrosis and granulation tissue formation was observed in 14 (58.3%). Based on these results, there was no statistically significant relationship between type-I collagen membrane use and granulation tissue formation. (P = 0.604 <0.05). There was no difference between the rate of granulation tissue (50%) and absence (50%) in patients with type-I collagen membranes. Conclusion: According to these results and MRI findings, it was found that peroperative type-I collagen membrane use in lumbar discectomy did not have a statistically significant effect on granulation tissue or epidural fibrosis formation.Öğe Saf Duyusal İnme Sendromu Şeklinde Ortaya Çıkan Talamik Bölge Serebrovasküler Hastalığı: Olgu Sunumu(Selçuk Üniversitesi, 2017 Eylül) Eren, Fettah; Öztürk, Şerefnur; Ekmekci, Ahmet HakanSaf duyusal inme, derin ya da yüzeyel duyuların ayrı ayrı veya beraber tutulduğu, duysal veya irritatif bozukluklar ile kendini gösteren klinik sendromdur. Bu sendromda en sık talamusun ventro-posterior nükleusu etkilenir. Talamik etkilenmeleri olan hastalarda yukarı bakış felci, hemiparezi, hemihipoestezi, konfüzyon, uykuya meyil, duygusal labilite olabilmektedir. Talamus tüm duyu modalitelerinin (koku hariç) ortak kesişim noktası olduğundan tat, işitme, dokunma ve ağrı gibi duyusal modaliteler saf duyusal inmelerde etkilenebilmektedir. 56 yaşında erkek hasta sol kol, bacak, yüz ve gövde yarısında uyuşma yakınması ile başvurdu. Manyetik rezonans görüntülemede sağ talamusta iskemi ile uyumlu lezyon belirlendi. Sonrasında santral nörojenik ağrı sendromu gelişti. Nadir görülmesi, ek belirti olmadan hemihipoestezi ile başvurabilmesi ve hızla tanınıp tedavi başlanması gerektiğinden sunulmaya değerli görülmüştür.Öğe Akut İskemik İnmede İntravenöz Trombolitik Tedavi: Klinik Değerlendirme(Selçuk Üniversitesi, 2019 Aralık) Eren, Fettah; Öngün, Gözde; Yıldoğan, Aydın Talip; Işık, Melike; Öztürk, ŞerefnurAmaç: İnme tedavisinde asıl amaç, oklüde vasküler yapının belirli süre içerisinde rekanalizasyonudur. Medikal tedavide rekombinant doku plazminojen aktivatörü (tPA) kullanılmaktadır. Bu çalışmada, tPA tedavisi verilen iskemik inme hastaları değerlendirilmiştir. Gereç ve Yöntem: Temmuz 2015-Ağustos 2017 arasında tPA tedavisi uygulanan 97 akut iskemik inme hastası retrospektif incelendi. Demografik veriler, başvuru semptomları ve tedavi saatleri kaydedildi. Klinik durum ve prognoz ‘National Institutes of Health Stroke Skalası’ (NIHSS) ve fonksiyonel durum ölçeği ile değerlendirildi. Hemorajik dönüşüm bilgisayarlı tomografi ile değerlendirildi. Bulgular: Çalışmaya 61(%62,8) erkek ve 36 (%37,2) kadın hasta alındı. Yaş ortalamaları 60,29±12,62 idi. 7 (%7,2) hastaya 1. saate, 5(%25,8) hastaya 1-2 saat arasında, 31(%32) hastaya 2-3 saat arasında, 34 (%35,1) hastaya 3-4,5 saat arasında tPAbaşlandı. Başvuruda en sık semptom hemi/monoparezi idi (%92,8).%69,1 oranında parsiyel anterior, %16,5 total anterior, %15,8 posterior vasküler oklüzyon saptandı. NIHSS sonuçları 10,39±4,36 (tedavi öncesi) ve 6,63±3,76 (taburculuk) idi. Hastalartam bağımsız (%20,6), kısmi bağımlı (%43,3) ve tam bağımlı (%21,6) olarak taburcu edildi.Hastaların %12’sinde hemorajik dönüşüm izlendi.Platelet değeri düşük olan hastalarda hemorajik transformasyon daha fazlaydı (P<0,05).Hemorajik dönüşüm olan hastalarda mortalite %41,7 idi.Hemorajik dönüşüm gelişimi mortaliteyi artırmaktaydı (p <0,05). Sonuç: İnmede trombolitik tedavi özürlülükte azalma sağlamaktadır. Ancak hemorajik transformasyon mortaliteyi artırmaktadır. Bu da platelet değerindeki düşüklük ile ilişkili olabilir.Öğe Bal Arısı Sokması Sonrası Beyin Sapında Gelişen Akut İskemik İnme(Selçuk Üniversitesi, 2018 Aralık) Eren, Fettah; Öztürk, ŞerefnurArı sokmaları, tüm böcek sokmaları içerisinde en sık olanıdır. Nörolojik etkilenme nadirdir. Ancak ensefalit, akut dissemine ensefalomiyelit, polinöropati ve ekstrapiramidal tutulum ortaya çıkabilmektedir. 79 yaşında erkek hasta sol hemiparezi ve dizartri yakınması ile başvurdu. 1 gün önce 10 tane bal arısı tarafından sokulduğu öğrenildi. Sol kol ve bacakta 4/5 kas gücü, ataksik yürüme ve dizartri bulunmaktaydı. Difüzyon ağırlıklı manyetik rezonans görüntülemede sağ ponsta akut iskemi ile uyumlu lezyon belirlendi. Asetilsalisilik asit (300 mg/gün) vemetformin (1000 mg/gün) başlandı. Arı sokması sonrası salgılanan kimyasal moleküller ile tromboza eğilim artmaktadır. Bu nedenle iskemik inme riski olan hastalar yakın takip edilmelidir. Gerekirse hastalar bu moleküllerin inaktivasyonunu sağlayan ilaçlar ile tedavi edilmelidir. Ancak hipotansiyon ve vazokonstriksiyon oluşturabilen antialerjik ilaçlar başlanmamalıdır.Öğe Kistikintraserebral Görüntüleme Örneği ile Başvuran Multiple Skleroz Hastalığı(Selçuk Üniversitesi, 2018 Mart) Eren, Fettah; Öngün, Gözde; Gezer, Aslıhan; Ekmekci, Ahmet Hakan; Öztürk, ŞerefnurMultipl skleroz (MS) tanısında ve ayırıcı tanısında bazı olgularda çeşitli güçlükler yaşanmaktadır. Klinik belirti ve bulgular yanında, manyetik rezonans görüntüleme (MRG), beyin omurilik sıvısı (BOS) incelemesi ve uyarılmış potansiyeller tanıyı kesinleştirmek için önemlidir. Tüm bunlara rağmen bu testlerin tanısal duyarlılık ve özgüllüğü sınırlıdır. Elli yedi yaşında tavuk çiftliği işletmecisi olan erkek hasta, 35 gün önce başlayan sağ yüz yarısında uyuşma ve denge bozukluğu yakınması ile başvurdu. Sağ yüz yarısında objektif hipoestezi ve sağda Babinski bulgusu saptandı. Beyin MRG incelemesindeki; 2 cm çapında, halkasal kontrast tutulumu olan homojen lezyon öncelikle kistik bir oluşumu düşündürdü. BOS ve görsel uyarılmış potansiyel neticesinde hastanın MS olduğu anlaşıldı. Bu hastaların klinik ve nörogörüntüleme ile takibi ayırıcı tanıda değerli bilgiler sağlayabilmektedir.Öğe Covid-19 ve Nörolojik Bozukluklar(Selçuk Üniversitesi, 2021) Işık, Melike; Yılmaz, Ecem S.; Özgüncü, Cihat; Topbaş, Furkan; Özkan, Duran; Ildız, Ömer F.; Tekneci, Sevde; Ersoy, Ayşenur; Özaltın, M. Seda; Kuruçay, Buket; Öztürk, ŞerefnurDünya Sağlık Örgütü tarafından 11 Mart 2019’da pandemi olarak kabul edilen COVID-19 hastalığının pandeminin ilk döneminde öncelikle solunum yollarını etkileyen ve ciddi akut solunum yetmezliğine (SARS) neden olan bir viral enfeksiyon olduğu kabul edilmiştir. Zaman içinde vasküler sistemler başta olmak üzere diğer organ sistemlerini ve en önemlisi de diğer sistemlerle beraber nörolojik sistemleri ve hatta bazen sadece nörolojik sistemleri etkilediği ortaya konmuştur. Ciddi semptomu olmayan hastalarda bile koku alma kaybı sık olarak görülmekte olup bazı hastalarda ilk veya tek belirti olabilmektedir. Viral enfeksiyonun iyileşmesine rağmen koku alma fonksiyonunun aynı hızla kazanılamaması yaşam kalitesini etkileyen önemli bir nörolojik tutulumdur. Dünyada pandemi sürecinde vaka bildirimleri ve klinik verilerin analizleri ile hızlı bilgi akışı devam etmektedir. Bu yazıda literatür incelemesi ile dünyada bildirilen nörolojik tutulumlar ışığında kranial sinir tutulumları, serebrovasküler hastalıklar ve inme, ansefalit, epilepsi, Guillain Barré sendromu, psikiyatrik bozukluklar ile ilgili güncel bilgilerin paylaşılması amaçlanmıştırÖğe The Relationship Between Structural Measurements of the Corpus Callosum and Disability in Patients with Multiple Sclerosis(Selçuk Üniversitesi, 2022) Demir, Ayşegül; İslamoğlu, Necat; Yılmaz, Süeda Ecem; Eren, FettahPurpose: The corpus callosum (CC) is the largest commissural pathway connecting both cerebral cortices. Materials and Methods: Forty MS patients and 40 healthy controls were included in this research, which was planned as a case-control study. Disability was evaluated with the expanded disability rating scale. The number of attacks, disease duration, and MS disease subtype were determined. CC genu, truncus, splenium, and anterior-posterior diameters were measured in brain magnetic resonance imaging TSE/T1 sagittal sequence, and the corpus callosum index (CCI) was calculated using these measurements. The relationship of all these parameters with each other was examined. Results: There were 40 patients (29 females, 11 males) with a mean age of 36.47±11.14 years in the study. In the CC morphometric measurements of the patients, the genu (mean±SD) was 11.46±1.60, truncus (median, min-max) 5.29 (4.6-6.52), splenium 11.09±1.82, anterior-posterior diameter 65.20 (63.64-67.22) and CCI was determined as 0.43±0.05 millimeters. The anterior-posterior diameter was smaller in MS patients (p=0.022). A negative correlation was determined between CCI and disease duration, the number of attacks, and EDSS scores in MS patients (p<0.05; r=-0.319; r=-0.316; r=-0.349; respectively). In the severe disability group, CC splenium, AP diameter, and CCI were lower (p=0.007; p=0.020; p=0.046; respectively). Conclusion: In MS disease, the CC structure is affected, as in many central nervous system regions. The study results revealed that changes in the corpus callosum could be examined as a parameter in evaluating the disease process in MS patients.Öğe The relationship between the findings of vestibular evoked myogenic potentials and severity of obstructive sleep apnea syndrome(SPRINGER, 2020) Ulusoy, Bülent.; Gül, Osman.; Elsürer, Çagdaş.; Bozkurt, Mete Kaan.; Tülek, Baykal.; Körez, Muslu Kazım.; Ekmekçi, Hakan.; Çolpan, Bahar.Purpose Our study aimed to evaluate the effects of chronic hypoxic state in Obstructive Sleep Apnea Syndrome (OSAS) on brainstem pathways using Vestibular Evoked Myogenic Potential (VEMP) test and to investigate the presence of new markers likely to be correlated with the severity of the disease. Methods The study was planned as prospective and double blind. A total of 60 patients (120 ears) diagnosed with mild, moderate and severe OSAS were included in the study and the patients are grouped as 20 patients in each group. Twenty volunteer healthy individuals (40 ears) shown to be without OSAS were included in the study. VEMP measurements were made in 60 study group patients (120 ears) and in 20 healthy controls (40 ears). The groups were compared in terms of variables such as the acquisition rate of oVEMP and cVEMP waves, interval between the waves, latency and amplitude of the waves. p < 0.05 values were considered as significant. Results The results of cVEMP test showed that the rate of wave acquisition in the moderate and severe OSAS groups was significantly lower than the control group and mild OSAS groups (p = 0.008). There was no difference between the control group and the mild OSAS group in terms of the rate of obtaining the wave (p > 0.05). In the moderate and severe OSAS groups, P1N1 amplitude and N1P2 amplitude values were found to be significantly lower than the mild OSAS group (p = 0.007 and p = 0.017, respectively). In the oVEMP test, there was no significant difference between the mild OSAS group and the control group in terms of the wave yield (p > 0.05); however, it was found that the rate of wave acquisition in the moderate and severe OSAS groups was significantly lower than the mild OSAS group (p = 0.041). There was inverse correlation between the N1P2 interval and P1N1 amplitude value and AHI in simple regression analysis and multiple regression analysis (p = 0.012 and p = 0.021; p = 0.009 and p = 0.040, respectively). Conclusion The negative effects of chronic intermittent hypoxia related with OSAS on the brainstem and vestibular system can be demonstrated by VEMP tests. Especially, the inability to obtain the wave is the most important finding showing this situation. Also, we think that N1P2 interval and P1N1 amplitude markers can be used to detect the subclinical negative effect of chronic hypoxia on vestibular nuclei in the brainstem.Öğe Noncontrast computed tomography signs as predictors of hematoma expansion, clinical outcome, and response to tranexamic acid in acute intracerebral hemorrhage(LIPPINCOTT WILLIAMS & WILKINS, 2020) Law, Zhe Kang.; Ali, Azlinawati.; Krishnan, Kailash.; Bischoff, Adam.; Appleton, Jason P.; Scutt, Polly.; Woodhouse, Lisa.; Pszczolkowski, Stefan.; Cala, Lesley A.; Dineen, Robert A.; England, Timothy J.; Ozturk, Serefnur.; Roffe, Christine.; Bereczki, Daniel.; Ciccone, Alfonso.; Christensen, Hanne.; Ovesen, Christian.; Bath, Philip M.; Sprigg, Nikola.Background and Purpose- Blend, black hole, island signs, and hypodensities are reported to predict hematoma expansion in acute intracerebral hemorrhage. We explored the value of these noncontrast computed tomography signs in predicting hematoma expansion and functional outcome in our cohort of intracerebral hemorrhage. Methods- The TICH-2 (Tranexamic acid for IntraCerebral Hemorrhage-2) was a prospective randomized controlled trial exploring the efficacy and safety of tranexamic acid in acute intracerebral hemorrhage. Baseline and 24-hour computed tomography scans of trial participants were analyzed. Hematoma expansion was defined as an increase in hematoma volume of >33% or >6 mL on 24-hour computed tomography. Poor functional outcome was defined as modified Rankin Scale of 4 to 6 at day 90. Multivariable logistic regression was performed to identify predictors of hematoma expansion and poor functional outcome. Results- Of 2325 patients recruited, 2077 (89.3%) had valid baseline and 24-hour scans. Five hundred seventy patients (27.4%) had hematoma expansion while 1259 patients (54.6%) had poor functional outcome. The prevalence of noncontrast computed tomography signs was blend sign, 366 (16.1%); black hole sign, 414 (18.2%); island sign, 200 (8.8%); and hypodensities, 701 (30.2%). Blend sign (adjusted odds ratio [aOR] 1.53 [95% CI, 1.16-2.03]; P=0.003), black hole (aOR, 2.03 [1.34-3.08]; P=0.001), and hypodensities (aOR, 2.06 [1.48-2.89]; P<0.001) were independent predictors of hematoma expansion on multivariable analysis with adjustment for covariates. Black hole sign (aOR, 1.52 [1.10-2.11]; P=0.012), hypodensities (aOR, 1.37 [1.05-1.78]; P=0.019), and island sign (aOR, 2.59 [1.21-5.55]; P=0.014) were significant predictors of poor functional outcome. Tranexamic acid reduced the risk of hematoma expansion (aOR, 0.77 [0.63-0.94]; P=0.010), but there was no significant interaction between the presence of noncontrast computed tomography signs and benefit of tranexamic acid on hematoma expansion and functional outcome (P interaction all >0.05). Conclusions- Blend sign, black hole sign, and hypodensities predict hematoma expansion while black hole sign, hypodensities, and island signs predict poor functional outcome. Noncontrast computed tomography signs did not predict a better response to tranexamic acid.Öğe Selective intra-arterial recombinant tissue-plasminogen activator in a case of acute posterior inferior cerebellar artery occlusion(Springer-Verlag Italia s.r.l., 2019) Özdemir, GökhanStroke is the third leading cause of death and the most common cause of serious long-term disability in the world. Posterior circulation ischemic stroke (PCIS) accounts for approximately 20% of the total number of ischemic strokes and is associated with high rates of morbidity and mortality [1]. Endovascular procedures in large-artery occlusions havebeen demonstrated to provide clinical beneft in selected patients with acute ischemic stroke. The posterior inferior cerebellar artery (PICA) is the largest branch of the vertebral artery and is one of the largest arteries in the brain. Despite the fact that PICA infarcts are rare, rapid clinical deterioration and sudden death may develop due to their presence[2]. Intravenous recombinant tissue-plasminogen activator (IV rt-PA) has been administered in cases of acute PICA occlusion. There is no case report about selective intraarterial rt-PA treatment in cases of acute PICA occlusion in the literature. In this case report, we show that selective intra-arterial rt-PA administration for acute PICA occlusion is safe and efective.Öğe What is the effect of accompanying ankylosing spondylitis in treatment of Multiple Sclerosis? Is there a resistance(TURKISH NEUROLOGICAL SOC, 2019) Tezcan, Ezgi Akyıldız.; Ekmekçi, Hakan.; Özdemir, Gökhan.; Gümüş, Haluk.; Öztürk, Şerefnur.Multiple sclerosis (MS) is an autoimmune central nervous system disease characterized by inflammation, demyelination, and axonal damage (1). Ankylosing spondylitis (AS) is a common inflammatory rheumatic disease affecting the axial skeleton, which can cause structural and functional disorders and decreased quality of life, and cause a characteristic back pain and position (2). The coexistence of MS and AS is rare. Besides the neurogenetic and neuroepidemiologic aspects of this association, there may be an interactive interaction in the treatment. It may be necessary to examine the effect of this situation on the roadmap to be followed in the treatment of both diseases.Öğe Vagal nerve stimulation has robust effects on neuropsychiatric assessment in resistant epilepsy: A clinical series with clinical experiences(TURKISH NEUROSURGICAL SOC, 2019) Ekmekci, Hakan.; Kaptan, Hulagu.AIM: To evaluate the resistant epileptic patients who had vagal nerve stimulation (VNS) devices implanted over five years, and to evaluate the neuropsychological aspects of VNS. MATERIAL AND METHODS: Patients with pharmacoresistant epilepsy (PRE) were followed from 2012 to 2017. Totally seven patients were found eligible for VNS in this period. In the pre-surgical period, patients were neuro-psychiatrically assessed by an independent psychiatric committee for mental status, which included assessment of intelligence quotient (IQ), Wechsler adult intelligence scale-revised (WAIS-R) IQ, Stroop test and mini-mental state examination (MMSE), Hamilton depression scale (HDS) and the Beck anxiety inventory (BAI). RESULTS: The positive effects of VNS on patients' well-being and neuropsychiatric status may be the most as important as the treatment's cost effectiveness. The patients' quality of life (QoL) was calculated just before and 12th / 24th months after VNS implantation. The pre-VNS scores for Quality of Life in Epilepsy (QoLiE-31-P) ranged from 14-59, and average score was 37.14.The post-VNS scores ranged from 31-72, and the average score was 52.86. CONCLUSION: VNS has intense effects on QoL of epileptic patients. The best approach for comparing and evaluating QoL in PRE patients may be the QoLiE-31-P inventory, which can be adapted and used in epilepsy centers to evaluate energy, mood, daily activity, cognition, medication effects, seizure worry and overall QoL.Öğe TNF-Alpha and IL-6 as biomarkers of impaired lung functions in dimethylacetamide exposure(SCIENDO, 2019) Tutkun, Lütfiye; İritaş, Servet Birgin; Deniz, Serdar; Öztan, Özgür; Abuşoğlu, Sedat; Ünlü, Ali; Türksoy, Vugar Ali; Çetintepe, Sultan PınarBackground: Tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) are well-known biomarkers of systemic inflammation that have been associated with many diseases in the past. In this study, we aimed to determine the relationship between impaired lung functions and the levels of these biomarkers in DMAc exposed people. Methods: 101 non-exposed control subjects (Group 1) and 109 DMAc-exposed workers from the polyvinyl chloride (PVC) industry were included in the study. In the next step, the exposed group was divided into two groups according to the level of exposure (Group 2 and 3). DMAc, TNF-alpha, IL-6, creatinine, ALT, AST, GFR and standard spirometry measurements were carried out in all subjects. Results: When compared to the control group, TNF-alpha and IL-6 levels were significantly high compatible with the increase of DMAc levels, in the exposed groups. Urinary DMAc Levels were 0.06 mg/L in the control group. This level is significantly low when compared to exposed and severely exposed group (2.43 mg/L and 3.17 mg/L). TNF-alpha levels were 56.86 pg/mL, 145.52 pg/mL and 230.52 pg/mL in control, exposed and severely exposed groups. IL-6 levels were found to be 38.08 pg/mL, 89.19 pg/mL and 116 pg/mL for control, exposed and severely exposed groups, respectively. Similarly, the FEV1/FVC ratio decreased especially in the severely exposed group (p 0.001). Conclusions: In our study, results have revealed that TNF-and IL-6 levels are promising biomarkers in the early diagnosis of lung function impairment in inhalational DMAc exposure.Öğe The World Federation of Neurology and the challenges in Environment Neurology(MASSON EDITEUR, 2019) Reis, J.; Grisold, W.; Öztürk, S.; Wasay, M.; Roman, G. C.; Carroll, W. M.Since its establishment the World Federation of Neurology (WFN) has manifested a keen interest in the environment and its relation to neurological diseases. Thus, in 2007 the WFN renamed the "Neurotoxicological Research Group" to "Environmental Neurology Research Group". In this short article, we review some recent events which illustrate the WFN involvement in Environmental Neurology as well its concerns about global health matters involving environmental issues. (C) 2019 Elsevier Masson SAS. All rights reserved.Öğe The correlation of optical cohorence tomography findings with serum cytokine levels, TNF-alpha, serum neopterin levels in relapsing and remitting periods of MS(SAGE PUBLICATIONS LTD, 2019) Ekmekci, Hakan.; Eren, Fettah.; Ongun, Gözde.; Gedik, Şansal.; Ünlü, Ali.; Öztürk, Şerefnur.Background: Optical Coherence Tomography (OCT) is an improved technique in the last 20 years that allows quantitative measurement of retinal nerve fiber layer (RNFL) thickness, which provides important information on approach to optic nerve diseases in neurology and ophtalmology area. Therefore, OCT is now being used in various neuro-ophthalmic situations. On the other hand it is known that MS is also involved in a highly complexity of countless biomarkers that are elucitaded an autoimmune disease of the central nervous system. Serum and Cerebrospinal fluid Cytokines, TNF-?, neopterin (a marker of INF-? activity) may play important role in cell swelling, synaptic transmission and neural integration.Öğe Stenting of carotid artery using the brachial artery approach(TURKISH NEUROLOGICAL SOC, 2019) Özdemir, Gökhan.; Ongun, Gözde.[Abstract not Available]Öğe Retrospective evaluation of carotid artery stenting experience of Neurology clinic of Selcuk University(TURKISH NEUROLOGICAL SOC, 2019) Özdemir, Gökhan.; Öztürk, Şerefnur.Objective: Thirty percent of all acute ischemic strokes cause is the internal carotid artery stenosis or occlusion. The carotid artery stenting (CAS) was rarely performed in early time, was used more frequently with the development of angiographic method and materials. In this study, we aimed to evaluate the success rates, clinical outcomes and complications of carotid scenting due to carotid stenosis in the Neurology Department of Selcuk University. Materials and Methods: The patients who underwent conventional angiography between November 2017 and August 2018 were evaluated retrospectively in the Neurology Department of Selcuk University. Ninety four patients who underwent conventional angiography due to carotid artery stenosis were included in the study. Fifty four of 94 patients underwent CAS. Control carotid doppler and/or carotid CT angiography was performed at 1 month after discharge. Neurological examinations of the patients were also repeated. Results: The operation success rate was 96.3% (two patients developed minor stroke at the 2 hours after the procedure). No deaths or major stroke occurred in any of these patients with CAS. No ischemic cerebrovascular event or transient ischemic attack occurred in any of the patients at 1 months follow-up. No restenosis was observed in any of the carotid doppler follow-ups or CT anjiyography. Conclusion: In conclusion, we have shown that CAS performed by neurology clinics is effective and reliable. We have also shown that a protective device is not necessary for the risk of distal embolism in these patients.Öğe It is safe to use transdermal glyceryl trinitrate to lower blood pressure in patients with acute ischaemic stroke with carotid stenosis(BMJ PUBLISHING GROUP, 2019) Appleton, Jason P.; Woodhouse, Lisa J.; Belcher, Andrew; Bereczki, Daniel; Berge, Eivind; Caso, Valeria; Chang, Hui Meng; Christensen, Hanne K; Collins, Ronan; Gommans, John; Laska, Ann C; Ntaios, George; Ozturk, Serefnur; Sare, Gillian M; Szatmari, Szabolcs; Wang, Yongjun; Wardlaw, Joanna M; Sprigg, Nikola; Bath, Philip MBackground There is concern that blood pressure (BP) lowering in acute stroke may compromise cerebral perfusion and worsen outcome in the presence of carotid stenosis. We assessed the effect of glyceryl trinitrate (GTN) in patients with carotid stenosis using data from the Efficacy of Nitric Oxide in Stroke (ENOS) Trial. Methods ENOS randomised 4011 patients with acute stroke and raised systolic BP (140-220 mm Hg) to transdermal GTN or no GTN within 48 hours of onset. Those on prestroke antihypertensives were also randomised to stop or continue their medication for 7 days. The primary outcome was the modified Rankin Scale (mRS) at day 90. Ipsilateral carotid stenosis was split: <30%; 30-<50%; 50-<70%; >= 70%. Data are ORs with 95% CIs adjusted for baseline prognostic factors. Results 2023 (60.5%) ischaemic stroke participants had carotid imaging. As compared with <30%, >= 70% ipsilateral stenosis was associated with an unfavourable shift in mRS (worse outcome) at 90 days (OR 1.88, 95% CI 1.44 to 2.44, p<0.001). Those with >= 70% stenosis who received GTN versus no GTN had a favourable shift in mRS (OR 0.56, 95% CI 0.34 to 0.93, p=0.024). In those with 50-<70% stenosis, continuing versus stopping prestroke antihypertensives was associated with worse disability, mood, quality of life and cognition at 90 days. Clinical outcomes did not differ across bilateral stenosis groups. Conclusions Following ischaemic stroke, severe ipsilateral carotid stenosis is associated with worse functional outcome at 90 days. GTN appears safe in ipsilateral or bilateral carotid stenosis, and might improve outcome in severe ipsilateral carotid stenosis.Öğe Giant carotid aneurysm causing acute ischemic stroke(TURKISH NEUROLOGICAL SOC, 2019) Eren, Fettah.; Öztürk, Şerefnur.[Abstract not Available]Öğe European academy of neurology guideline on the diagnosis of coma and other disorders of consciousness(WILEY, 2020) Kondziella, D.; Bender, A.; Diserens, K.; van Erp, W.; Estraneo, A.; Formisano, R.; Laureys, S.; Naccache, L.; Ozturk, S.; Rohaut, B.; Sitt, J. D.; Stender, J.; Tiainen, M.; Rossetti, A. O.; Gosseries, O.; Chatelle, C.Background and purpose Patients with acquired brain injury and acute or prolonged disorders of consciousness (DoC) are challenging. Evidence to support diagnostic decisions on coma and other DoC is limited but accumulating. This guideline provides the state-of-the-art evidence regarding the diagnosis of DoC, summarizing data from bedside examination techniques, functional neuroimaging and electroencephalography (EEG). Methods Sixteen members of the European Academy of Neurology (EAN) Scientific Panel on Coma and Chronic Disorders of Consciousness, representing 10 European countries, reviewed the scientific evidence for the evaluation of coma and other DoC using standard bibliographic measures. Recommendations followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The guideline was endorsed by the EAN. Results Besides a comprehensive neurological examination, the following suggestions are made: probe for voluntary eye movements using a mirror; repeat clinical assessments in the subacute and chronic setting, using the Coma Recovery Scale - Revised; use the Full Outline of Unresponsiveness score instead of the Glasgow Coma Scale in the acute setting; obtain clinical standard EEG; search for sleep patterns on EEG, particularly rapid eye movement sleep and slow-wave sleep; and, whenever feasible, consider positron emission tomography, resting state functional magnetic resonance imaging (fMRI), active fMRI or EEG paradigms and quantitative analysis of high-density EEG to complement behavioral assessment in patients without command following at the bedside. Conclusions Standardized clinical evaluation, EEG-based techniques and functional neuroimaging should be integrated for multimodal evaluation of patients with DoC. The state of consciousness should be classified according to the highest level revealed by any of these three approaches.
