Background:Endovascular thrombectomy (EVT) improves outcomes and reduces mortality in acute ischemic stroke. However, despite achieving successful recanalization in most patients, a subset still experiences poor functional outcomes at 3 months. This failure, despite complete vessel reopening, is termed futile recanalization (FR). We investigated clinical and radiological predictors of FR in a multicenter cohort in Türkiye. Methods:We retrospectively analyzed 497 consecutive patients with middle cerebral artery (M1 or M2) occlusion who underwent EVT and achieved modified Thrombolysis in Cerebral Infarction (mTICI) 3 recanalization within 6 h of symptom onset at 19 stroke centers. FR was defined as a modified Rankin Scale (mRS) score ≥4 at 3 months. Clinical and radiological parameters were recorded, and logistic regression was used to identify independent predictors of FR. Results:Among 497 patients, 133 (26.7%) experienced FR despite complete recanalization. Independent predictors included older age (adjusted odds ratio [aOR] 1.07; 95% CI 1.03-1.10; p < 0.001), longer puncture-to-recanalization time (aOR 1.03; 95% CI 1.02-1.05; p < 0.001), higher admission C-reactive protein (aOR 1.01; 95% CI 1.00-1.02; p = 0.03), intracranial hemorrhage on 24-h CT (aOR 0.46; 95% CI 0.23-0.95; p = 0.04), lower collateral score (aOR 42.98; 95% CI 6.15-30.62; p < 0.001), and higher 24-h NIHSS score (aOR 1.34; 95% CI 1.24-1.44; p < 0.001). Conclusion:Even with early and complete recanalization, elderly patients and those with poor collateral circulation remain at risk for futile recanalization. Identifying these predictors can guide patient selection, procedural planning, and post-procedural management to optimize functional outcomes.

Background: Aneurysmal subarachnoid hemorrhage (aSAH), a life-threatening neurological emergency, is characterized by blood accumulation in the subarachnoid space due to the rupture of an aneurysm. In this study, we investigated the effect of the Prognostic Nutritional Index on the prognosis and quality of life in patients with aneurysmal subarachnoid hemorrhage. Methods: A total of 126 aSAH patients who underwent endovascular treatment at the Stroke Center of Dicle University, Department of Neurology between January 1, 2020, and January 1, 2024, were included. After excluding 2 patients with chronic kidney failure, 1 with malignancy, 1 with a procedure-related complication, and 8 due to early mortality, 114 patients were included in the study. Results: As a result of our study, a relationship was found between preoperative and postoperative 72-hour PNI values and functional status. Additionally, a relationship was identified between postoperative 72-hour PNI values and mortality as well as infection. In our study, multivariable logistic regression analysis was used to evaluate the relationship between postoperative 72-hour PNI values and mortality. Postoperative 72-hour PNI was found to have a statistically significant relationship with the SF-36 energy subscale (p = 0.007). Discussion and Conclusion: Albumin and lymphocyte values used to calculate PNI can be utilized to predict prognosis in patients with aSAH. The simplicity, low cost, and non-invasive nature of PNI calculation make it a clinically valuable tool.

Isolated cervical dystonia (iCD) is the most common form of focal dystonia and is characterized by sustained or intermittent neck muscle contractions that lead to abnormal postures and pain. These motor symptoms, together with the limited and temporary effects of current treatments, may be associated with psychological distress and reduced quality of life (QoL). To examine the associations between psychological symptoms—specifically anxiety and depression—and QoL in individuals with iCD. This cross-sectional study included 47 patients with iCD for ≥ 1.5 years and 40 age- and sex-matched healthy controls. Participants completed the Short Form-36 Health Survey (SF-36) to assess QoL and the Hospital Anxiety and Depression Scale (HADS) to evaluate psychiatric symptoms. Ethical approval was obtained from the local committee (No: 154, Date: 23.06.2017). Patients with iCD had significantly higher HADS-Anxiety and HADS-Depression scores compared with controls (p < 0.001). SF-36 scores were lower across six of the eight domains, reflecting impaired QoL. Higher HADS scores were significantly associated with poorer SF-36 outcomes, indicating a strong relationship between psychological burden and diminished QoL. Anxiety and depression are significantly more common in individuals with iCD than in healthy controls and are strongly linked to poorer QoL. These findings suggest that routine screening and integrated management of psychiatric symptoms may be beneficial in iCD.

Objective: Although endovascular treatment (EVT) is widely accepted as the standard approach for acute ischemic stroke (IS), the prognostic determinants are not yet fully clarified. This study was designed to investigate the prognostic value of serum Maresin-1 (MaR1) and Maresin-2 (MaR2) levels in IS patients treated with EVT.Method: In this prospective study at Dicle University Faculty of Medicine, Department of Neurology, Stroke Center, 59 IS patients undergoing EVT and 24 healthy controls were enrolled between March 1 and August 1, 2024. Serum levels of MaR1, MaR2, albumin, hemoglobin A1C, neutrophils, platelets, lipid profile, vitamin D, C-reactive protein, and ferritin were measured. Clinical data included baseline NIHSS, 3-month mRS, TICI recanalization, and pre-stroke comorbidities. Multivariable logistic regression analyses were performed to evaluate associations between MaR1, MaR2, stroke severity, and mortality.Results: MaR1 and MaR2 concentrations were markedly reduced in the ischemic stroke group compared with healthy controls (p = 0.04 and p = 0.02). In parsimonious multivariable logistic regression analyses for 3-month mortality, neither MaR1 nor MaR2 showed an independent association, although both demonstrated borderline relationships after adjustment for age and baseline NIHSS. In contrast, stroke severity analysis revealed that higher MaR1 levels were independently associated with increased stroke severity (OR = 2.123; 95% CI, 1.18–3.25; p = 0.047), whereas MaR2 was not. Additionally, lower serum albumin levels emerged as an independent predictor of greater stroke severity in both models.Conclusions: These findings suggest that MaR1 may reflect stroke severity rather than mortality, while albumin represents a key systemic determinant of disease severity. Maresins appear to act as inflammation-related biomarkers whose prognostic effects are modulated by overall metabolic and inflammatory status.

Amaç: İnme, vasküler nedenler dışında belirgin bir sebep olmaksızın beyin kan akımının bozulmasıyla fokal serebral fonksiyon kaybı belirtilerinin hızla ortaya çıkması ve 24 saatten uzun sürmesi olarak tanımlanır. İnme, morbidite ve mortalitenin önde gelen nedenlerinden biridir ve hastalar sıklıkla ilk olarak acil servislere başvurmaktadır. İnme, iskemik (%80-85) ve hemorajik (%15-20) olmak üzere iki ana tipe ayrılır. İskemik inmede erken tanı ve uygun tedavi ile iskemik beyin hasarı önlenebilir. Bu amaçla son yıllarda skorlama yöntemleri üzerine yoğun çalışmalar yapılmakta olup FAST-ED (Sahada İnme Triajı Skoru) skorlaması da bunlardan biridir. Yaptığımız çalışmamızda, inme hastalarında FAST-ED skoru, laboratuvar değerleri, başvuru şekli ve zamanı, verilen tedaviler ve demografik özellikler gibi çeşitli faktörlerin mortalite ve prognoz üzerindeki etkileri incelendi. Ayrıca hastaların uygun inme merkezine yönlendirilmeleri için kolay uygulanabilen FAST-ED skoru ile LVOS (büyük damar tıkanıklı inme) olasılıklarını tespit etmek ve NLR gibi kolay erişilebilir parametrelerin inme prognozu ve mortalite açısından önemini ortaya koymak amaçlandı. Yöntemler: 20 ağustos 2018 ve 31 ağustos 2019 tarihleri arasında hastanemiz acil servisine inme tanısı ile yatırılan 327 hasta dosyası incelendi. Homojen grup oluşturmak için katı dışlama kriterleri sonrası İskemik inmeli 163 hasta FAST-ED skoru (Field Assessment Stroke Triage for Emergency Destination) ile düşük (0-1 puan), orta (2-3 puan) ve yüksek (≥4 puan) risk olarak üç gruba ayrılarak sırasıyla grup 1-2-3 olarak adlandırıldı. Bu gruplar başvuru şekli, süresi, mortalite oranları, trombolitik tedavi ve laboratuvar parametreleri açısından değerlendirildi. İstatistiksel analizlerde Ki-Kare, Student-T, Kruskal Wallis ve Mann-Whitney U testleri kullanıldı; p

Objective: Skeletal muscle loss is a common problem in patients admitted to the intensive care unit (ICU) following acute ischemic stroke and adversely affects prognosis. This study aimed to monitor the changes in rectus femoris muscle (RFM) thickness over time using ultrasound and to evaluate whether plasma C-terminal agrin fragment (CAF) levels reflect muscle loss. Methods: A total of 44 patients (23 women, 21 men) diagnosed with acute ischemic stroke and requiring ICU care were included in the study. Demographic data and body mass index (BMI) were recorded. RFM thickness was measured on days 1, 7, and 21 using a 7.5 MHz ultrasound probe. Plasma CAF levels were measured from venous blood samples on days 7 and 21. RFM thickness and CAF levels were analyzed statistically. Results: Mean RFM thickness (right and left) (in mm) was 11.98 (range: 6.00 to 20.45) on day 1, 10.84 (range: 4.70 to 17.95) on day 7, and 9.74 (range: 3.95 to 17.55) on day 21 (p < 0.001). Plasma CAF levels also showed a significant change between day 7 and day 21 (p < 0.001). However, the difference in RFM thickness between days 7 and 21 showed a weak, non-significant negative correlation with the corresponding difference in CAF levels (r = –0.023, p > 0.05). Conclusions: Patients with acute ischemic stroke in the ICU experience significant and progressive muscle loss. While plasma CAF has been proposed as a biomarker of muscle mass and function, its utility in tracking muscle loss remains uncertain.

BACKGROUND:A substantial proportion of patients undergoing mechanical thrombectomy (MT) for acute ischemic stroke (AIS) experience futile recanalization (FR), defined as poor functional outcome despite successful reperfusion. The multi-inflammatory index (MII) has been proposed as a novel biomarker of systemic inflammation. This study evaluated the predictive value of MII-1, MII-2, and MII-3 for FR in AIS patients treated with MT. METHODS:A total of 277 AIS patients who underwent MT were retrospectively analyzed. FR was defined as a modified Rankin Scale (mRS) score ≥ 4 at 90 days despite successful recanalization (mTICI ≥2b). Multivariable logistic regression was performed to assess the association between MIIs and FR, adjusting for established covariates. RESULTS:Among 205 patients with successful recanalization, 58 (28.3 %) experienced FR. Patients with FR had higher baseline NIHSS scores (p = 0.007), more frequent hypertension and diabetes (p = 0.013 and p < 0.001, respectively), elevated HbA1c levels (p < 0.001), and significantly higher MII-1, MII-2, and MII-3 values (all p < 0.05). Multivariable analysis confirmed MIIs as independent predictors of FR. ROC analysis demonstrated moderate discriminative ability of MIIs for FR, while predictive performance for technical recanalization failure (mTICI <2b) was limited. CONCLUSION:Elevated MII-1, MII-2, and MII-3 independently predict futile recanalization in AIS patients undergoing MT and may assist in refining patient selection and tailoring post-procedural management strategies.

Objectives: This study aimed to investigate the relationships between serum S100 calcium binding protein, neuron-specific enolase, matrix metalloproteinase-9, interleukin-6, N-terminal probrain natriuretic peptide, and N-methyl-D-aspartate receptor subunit NR2 biomarkers and futile recanalization in patients with acute ischemic stroke who were successfully recanalized with endovascular treatment. Patients and methods: In this study, 44 patients (25 males, 19 females; mean age: 62.2 +/- 14.1 years; range, 26 to 81 years) with acute ischemic stroke due to acute anterior circulation large-vessel occlusion were prospectively analyzed between May 15, 2020 and October 15, 2020. Blood samples were taken at admission, as well as 6 and 24 h after endovascular treatment. A modified Rankin Scale (mRS) was used on the 90th day to identify futile reperfusion. Patients with mRS scores <= 2 were included in the favorable reperfusion group (n=20), while patients with mRS scores >= 3 were considered to exhibit futile reperfusion (n=24). Results: There were no significant differences between the biomarker levels of the groups (p>0.05). There was no statistically significant correlation between biomarkers and 90-day mRS scores (p>0.05). Higher National Institute of Health Stroke Scale (NIHSS) scores (p=0.004), higher number of retriever passes (p=0.032), and higher diastolic blood pressure (p=0.037) were associated with futile recanalization. Multivariate logistic regression analysis showed that a higher NIHSS score at admission was an independent predictor of futile recanalization (odds ratio=1.216, 95% confidence interval 1.01-1.46, p=0.038). Conclusion: A higher NIHSS score at admission was an independent predictor for futile recanalization. However, we concluded that biomarker levels were not associated with futile recanalization.

People with multiple sclerosis (MS) have a higher risk of cardiovascular disease than the general population, but the data are limited. Evaluation with strain echocardiography, a new echocardiographic method, can provide more objective data to evaluate global and segmental left ventricular systolic functions. Left ventricular Global Longitudinal Strain (GLS) may be useful in demonstrating subclinical myocardial dysfunction in MS, therefore we planned such a study. We aim to evaluate LV functions with GLS obtained with basal tissue doppler in people with MS. A comparison of the demographic laboratory and echocardiographic findings of the multiple sclerosis patients with strain echocardiography records registered in our hospital and the control group with similar age and gender was performed. 80 RRMS patients and 65 control group were compared. Those with another chronic disease, those who received exacerbation treatment within the last month, those outside the age range of 18–65, and other forms of progressive MS were excluded from the study. GLS scores was significantly lower in the MS group(-17.05 ± 1.33 vs.18.99 ± 1.08, p < 0.001). The optimal GLS score predicted poor LV functional status in people with MS with high EDSS scores with cut-off value ≤ 17.10, sensitivity of 73

Background: The prognostic value of the neutrophil-lymphocyte ratio (NLR) in ischemic stroke remains debated due to cohort variability and treatment heterogeneity across studies. This study evaluates the relationship between admission NLR, stroke severity and 90-day outcomes in patients with anterior circulation large vessel occlusion (LVO) undergoing early, successful revascularization. Methods: A retrospective multicenter study was conducted with 1082 patients treated with mechanical thrombectomy for acute ischemic stroke. The relationship between admission NLR, baseline National Institutes of Health Stroke Scale (NIHSS), 24 h NIHSS and 90-day modified Rankin Scale (mRS) outcomes was analyzed using logistic regression. Results: Admission NLR correlated weakly but significantly with both baseline (p = 0.018) and 24 h (p = 0.005) NIHSS scores, reflecting stroke severity. However, multivariate analysis showed that higher 24 h NIHSS scores (OR 0.831, p = 0.000) and prolonged puncture-to-recanalization times (OR 0.981, p = 0.000) were independent predictors of poor 90-day outcomes, whereas NLR was not (p = 0.557). Conclusions: Admission NLR is associated with stroke severity but does not independently predict clinical outcomes at 90 days in patients achieving early and successful revascularization. These findings underscore the critical role of inflammation in the acute phase of stroke but suggest that its prognostic value for long-term outcomes is limited in this context.

Background: Diabetic amyotrophy, also known as diabetic proximal neuropathy, is a rare neuropathic complication of diabetes mellitus. It is most commonly characterized by severe pain in the hip and thigh, followed by asymmetric weakness and wasting of the proximal muscles of the lower limbs.Case Report: This paper presents the case of a 68-year-old man with an 8-month history of poorly controlled Type-2 diabetes mellitus who developed progressive asymmetrical weakness and atrophy in his left thigh. After a physical examination, magnetic resonance imaging, and electrophysiological studies, diabetic amyotrophy was diagnosed. Conclusion: Physicians should consider the possibility of diabetic amyotrophy in patients with diabetes mellitus who exhibit primary involvement of proximal muscles of the lower limbs, marked by pain, weakness, and atrophy.

Myiasis is a parasitic infestation of tissues and body cavities of vertebrates by Diptera larvae. Nasal myiasis is mostly caused by the Sarcophagidae and Calliphoridae families. Many predisposing factors play a role in the appearance of nasal myiasis. In the treatment of the disease, the use of antiseptics together with mechanical cleaning is recommended. In this report, a case of nasopharyngeal myiasis in a 75-year-old patient hospitalized in the intensive care unit is presented. Nine larvae were detected in the patient's nose. Larvae were removed from the area and were cleaned with iodine solution for three days. As a result of macroscopic and microscopic examination, the larvae were identified as the third stage of Sarcophaga sp. in order to prevent myiasis infestations, personnel working in places where the patient is unconscious, such as intensive care units, should daily check the patient's body cavities such as nose, mouth and ear cavities, and perform their care and cleaning. Keywords: Myiasis, Sarcophaga sp., nasopharyngeal myiasis, intensive care.

Myiasis is a parasitic infestation of tissues and body cavities of vertebrates by Diptera larvae. Nasal myiasis is mostly caused by the Sarcophagidae and Calliphoridae families. Many predisposing factors play a role in the appearance of nasal myiasis. In the treatment of the disease, the use of antiseptics together with mechanical cleaning is recommended. In this report, a case of nasopharyngeal myiasis in a 75-year-old patient hospitalized in the intensive care unit is presented. Nine larvae were detected in the patient's nose. Larvae were removed from the area and were cleaned with iodine solution for three days. As a result of macroscopic and microscopic examination, the larvae were identified as the third stage of Sarcophaga sp. in order to prevent myiasis infestations, personnel working in places where the patient is unconscious, such as intensive care units, should daily check the patient's body cavities such as nose, mouth and ear cavities, and perform their care and cleaning.Miyazis, Diptera sınıfı larvaların omurgalı doku ve vücut boşluklarını istila etmesi anlamına gelen bir terimdir. Nazal miyaz çoğunlukla Sarcophagidae ve Calliphoridae ailesi üyelerinin neden olduğu bir enfestasyondur. Bulaşında birçok predispozan faktörün rol aldığı hastalığın tedavisinde mekanik temizleme ile beraber antiseptiklerin kullanımı tavsiye edilmektedir. Bu olguda, 75 yaşında yoğun bakımda yatan bir hastada görülen nazofarengeal miyaz sunuldu. Hastanın burnunda dokuz adet larva tespit edilmiştir. Larvalar bölgeden uzaklaştırılarak üç gün boyunca bölge %5’lik iodin solüsyonuyla temizlendi. Makroskobik ve mikroskobik incelemeler sonunda etkenin Sarcophaga sp.’nin üçüncü evre larvaları olduğu belirlendi. Miyaz enfestasyonlarını engellemek için yoğun bakım ünitelerini gibi hastanın bilincinin kapalı olduğu yerlerde görev yapan personeller hastaların burun, ağız ve kulak boşluğu gibi vücut boşluklarını günlük olarak kontrol etmeli, bakım ve temizliğini en uygun şekilde yapmalıdır.

Background and purpose: We aimed to identify the relationship of total antioxidant status, total oxidant status, and copper (Cu) and zinc (Zn) situations with the short-term prognostic and stroke severity in acute ischemic stroke cases who were successfully recanalized by mechanical thrombectomy. Methods: A study of 36 acute ischemic stroke patients and 22 controls were prospectively studied. Tube samples were attained at admission and 24 h after recanalization. In patients who were successfully recanalized (thrombolysis in cerebral infarction >= 2b), a 3-month modified Rankin scale (mRS) score of 0-2 was considered a good prognosis, and a score of 3-6 was considered a poor prognosis. Results: Admission Cu levels were significantly higher in the poor prognosis group (p = 0.031). In the multivariate logistic regression analysis, Cu was not associated with poor prognosis (p = 0.357). Cu and Zn levels were lower in the patients group compared to controls (p = 0.014 and p = 0.010, respectively). There was no correlation between National Institute of Health Stroke Scale and biomarkers (p > 0.05). The temporal variation of biomarkers did not differ significantly between the good prognosis and poor prognosis groups (p interaction > 0.05). Conclusions: High admission Cu levels were associated with poor prognosis, but this association was limited. In addition, Cu and Zn levels were statistically lower in patients. There was no relationship between total antioxidant/oxidant status and short-term prognosis or stroke severity

Objective: The prevalence of malnutrition in patients with acute ischemic stroke (AIS) can range from 8% to 34%. It has been shown that prognostic nutritional index (PNI) and control nutritional status (CONUT) scores can provide an opportunity to make prognostic predictions in some disease groups. Previous studies have shown a close relationship between malnutrition scores and stroke prognosis. We evaluated the effect of nutritional scores on in-hospital and long-term mortality in AIS patients undergoing endovascular therapy (EVT).Patients and methods: 219 patients who underwent EVT for the AIS were included in this retrospective design and cross-sectional study. The primary endpoint of the study was accepted as all-cause death including in-hospital death, 1-year death, and 3-years death.Results: A total of 57 patients died in the hospital. In-hospital mortality rate was higher in the high CONUT group [36 (49.3%), 10 (13.7%), 11 (15.1%), p < 0.001]. A total of 78 patients died within one year, and 1-year mortality was higher in the high CONUT group [43 (58.9%), 21 (28.8), 14 (19.2), p < 0.001]. At the end of the 3-year follow-up, 90 patients had died, and the 3-year mortality rate was significantly higher in groups with a high CONUT score than in those with a low CONUT score (p < 0.001).Conclusions: A higher CONUT score, calculated easily by simple scoring with parameters studied from peripheral blood before the EVT procedure, is an independent predictor of in-hospital, 1-year, and 3-years all-cause mortality.

OBJECTIVE:Thrombolysis in Cerebral Infarction(TICI) score is used to objectively evaluate cerebral perfusion after intervention in acute stroke with mechanical thrombectomy. In our study, we aimed to compare the results of patients with successful TICI perfusion score (TICI ≥ 2c) with the results of patients with poor TICI perfusion score (TICI < 2c) and to investigate the relationship of the CHA2DS2-VASc scoring system with the final TICI perfusion score and other endpoints. METHODS:For this retrospective, single-center, cross-sectional study, 278 patients who underwent endovascular thrombectomy were screened consecutively by the interventional neurology department of hospital. The primary endpoint of the study was in-hospital and 1-year all-cause death. All patients underwent cranial imaging to evaluate hemorrhagic transformation after the procedure. RESULTS:It was observed that CHA2DS2-VASc score was significantly higher in the poor cerebral perfusion group than in the succesful cerebral perfusion group (3.19 ± 1.8 vs 2.72 ± 1.73, p = 0.046). According to Kaplan Meier's analysis, a significant difference was observed in the group with a CHA2DS2-VASc score > 2.5 in terms of all-cause mortality at follow-up compared to the group with a low CHA2DS2-VASc score (p = 0.002). According to Kaplan Meier's analysis, a significant difference was observed in the group with a poor TICI score compared to the group with a succesful one in terms of all-cause mortality at follow-up (p < 0.001). Cox regression model showed that poor TICI score group, Age ≥ 75 years, lower glomerular filtariton rate (GFR), higher high-sensitiveC-reactiveprotein (Hs-CRP), and higher admission NIHSS score were independent predictors of 1-year all-cause mortality. CONCLUSION:High CHA2DS2-VASc score has been shown to be a predictor of unsuccessful cerebral perfusion score and 1-year mortality after mechanical thrombectomy in stroke patients. As a result of our research, it has been shown that complete or nearly complete reperfusion has more positive results than partial reperfusion.