Background: Timely reperfusion in acute ischemic stroke (AIS) is critical to minimize irreversible brain damage. Intravenous tissue plasminogen activator (IV tPA) and endovascular thrombectomy (EVT) are the current standard treatments. This study aimed to evaluate the impact of stroke team implementation on treatment rates and workflow efficiency in a tertiary hospital. Methods: This retrospective, cross-sectional study included patients diagnosed with AIS and treated with IV tPA and/or EVT between January 2009 and January 2022. Demographic data, treatment-related time metrics, and admission characteristics were recorded. Patients were categorized based on admission time (weekday/weekend, working hours/off-hours) and according to whether they were treated before or after the stroke team was implemented in 2014. Optimal workflow targets were defined according to international guidelines. Statistical analysis was conducted using SPSS v26, with significance set at p<0.05. Results: A total of 396 patients were included (53.8% male). IV tPA was administered to 68.2% and EVT to 31.8% of the patients. After 2014, EVT procedures expanded from limited weekday hours to 24/7 coverage (p=0.006). Significant improvements were observed in door-to-neurologist (p=0.042), door-to-imaging (p=0.013), and door-to-needle (p=0.021) times after stroke team organization. However, door-to-stroke unit transfer time increased (p=0.003). The pandemic period was associated with delays in transfer time (p<0.001). Time metrics were less optimal during off-hours and weekends. Conclusions: The establishment of a dedicated stroke team significantly improved access to EVT and reduced several critical treatment delays. However, challenges remain in optimizing night-shift and inter-hospital referral processes. Stroke systems of care should include regular workflow monitoring and public awareness campaigns to enhance early recognition and access.

Backgrond & Objective: Absence status epilepticus (ASE) is a generalized, prolonged absence seizure that can persist for hours or even days. In adults, it is often misdiagnosed or overlooked, frequently mistaken for focal impaired consciousness non-convulsive status epilepticus or, particularly in the elderly, for confusional episodes related to cerebrovascular disorders. In this study, we retrospectively analyzed adult patients with absence status, considering their clinical and electrophysiological characteristics, as well as their prognosis. Methods: We reviewed hospital records from 2002 to 2023 to analyze clinical symptoms, ictal and interictal electroencephalography (EEG) findings, blood test results, cranial imaging, and treatment approaches in adult patients with absence status at our clinic. Results: Five cases were identified as exhibiting ASE. The mean age at the first ASE episode was 48 years. The primary clinical symptom during ASE episodes was varying degrees of confusion. Ictal EEG findings were consistent with typical absence status. Three patients had a prior diagnosis of genetic generalized epilepsy before developing ASE, while two patients were diagnosed with ASE following recurrent ASE episodes. The main triggering factors included noncompliance with antiseizure medications (ASMs), inappropriate ASMs, and lithium therapy. Valproate and levetiracetam were effective in terminating ASE episodes. Conclusion: This study presents the clinical and electrophysiological findings of ASE in adults and evaluates prognosis with feasible treatment approaches.

OBJECTIVES:Lingual seizures are rare hyperkinetic tongue movements with significant clinical implications due to their epileptogenic origin. Despite their diagnostic value, these seizures are often underrecognized, particularly when electroencephalographic (EEG) findings are inconclusive. This study aims to characterize their clinical features, EEG patterns, imaging findings and underlying causes, emphasizing the need for increased awareness and improved diagnosis. METHODS:A retrospective review identified patients with isolated lingual seizures or those with additional motor involvement. Data on demographics, seizure characteristics, EEG findings, imaging results and underlying causes were collected and analyzed. Seizures were classified based on the International League Against Epilepsy (ILAE) 2017 framework to refine their clinical and diagnostic profiles. RESULTS:Thirteen patients were identified: 11 with focal-aware and 1 with focal-unaware seizures. Seven had epilepsia partialis continua, and five experienced frequent seizures. Seizure involvement was limited to the tongue in four cases, extended to cranial muscles in seven and affected the tongue, cranial and extremity muscles in two. Significant ictal EEG findings were noted in only three patients with extensive motor involvement. However, nine patients had acute cerebral lesions, associated with glial tumors, encephalitis, chronic gliosis or cortical hemorrhage. CONCLUSIONS:This study provides a detailed characterization of lingual seizures, highlighting their clinical, electrophysiological and imaging features. Given their rarity and underdiagnosis, our findings offer valuable guidance for clinicians, underscoring the importance of improved recognition and diagnostic strategies for this distinct seizure type.

Objective: This study compared the impact of two different oral care methods on the incidence of stroke-associated pneumonia in patients who were fed via nasogastric tube and had no oral intake after a stroke.Methods: This randomized controlled trial was conducted at the Neurology Intensive Care Unit of Ege University Hospital between August 2020 and April 2021. Different oral care protocols were administered to both groups for seven days. Data were collected using the Patient Information Form, the National Institutes of Health Stroke Scale, the Glasgow Coma Scale, the Bedside Oral Exam and Patient Follow-up Form. Oral care was applied to both the intervention and control groups for seven days, with oral health and saliva pH measured and recorded. The diagnosis of pneumonia was made by the Infectious Diseases unit based on physical examination, blood tests, and chest X-rays.Results: The difference in the seven-day oral health assessment scores between the intervention and control groups was found to be significant (P

Background/Objectives: Autoimmune encephalitis (AIE) comprises a heterogeneous group of inflammatory central nervous system (CNS) disorders characterized by variable clinical presentations and antibody profiles. This study aimed to identify poor prognostic factors in AIE by retrospectively evaluating patients diagnosed based on clinical, radiological, and serological findings. Methods: Forty-four patients diagnosed with AIE between 2014 and 2024 were included. Demographic, clinical, radiological, and serological data were collected retrospectively. Patients were grouped based on antibody localization (intracellular, surface, and seronegative) and classified by treatment response. Poor prognosis was defined as a lack of objective clinical improvement to treatment or death. Results: The mean age was 57.8 ± 13.6 years, with a female-to-male ratio of approximately 1:1. Limbic encephalitis (LE) was the most common clinical presentation (43.2%). Malignancy was detected in 33.3% of patients, most frequently in those with SOX1 (83.3%), anti-Hu (60.0%), and anti-Yo (50.0%) antibodies. Anti-SOX1 positivity was significantly associated with both malignancy (OR = 27.5, p = 0.007) and mortality (OR = 13.2, p = 0.009), while anti-LGI1 positivity correlated with the absence of malignancy (p = 0.036). Patients with LE showed significantly better treatment responses (OR = 14.0, p = 0.019). Mortality was 20.1% overall and highest among anti-SOX1-positive patients (66.7%). The presence of multiple antibodies was associated with higher mortality and poorer prognosis, although not statistically significantly. Conclusions: Anti-SOX1 positivity is a key indicator of poor prognosis in AIE and is strongly associated with both malignancy and mortality. In contrast, LE presentation was linked to a better treatment response. Antibody profile, clinical features, and malignancy screening are critical for risk stratification and guiding management in AIE.

BACKGROUND AND OBJECTIVES:The optimal endovascular treatment (EVT) strategy for acute tandem occlusion patients has not been decided yet, and a knowledge gap still exists in the literature. Therefore, we aimed to compare the two different interventional strategies, stenting and non-stenting, for the treatment of acute tandem occlusion patients. METHODS:This was a single-center, retrospective, observational cohort study, which was conducted in a tertiary referral center. We reviewed all acute stroke patients between January 2016 and January 2024. We assessed the effects of the two strategies, stenting and non-stenting, on seven outcome measures, namely: hemorrhagic transformation after EVT, number of days in the neurology intensive care unit (N-ICU), number of days in the hospital, in-hospital mortality, functional outcome at discharge, 3-month functional outcome, and 3-month mortality. RESULTS:We included 54 acute tandem occlusion patients who were treated with EVT in the study. Thirty-five (64.8%) patients underwent emergency carotid stenting during EVT and 19 patients (35.2%) did not receive emergency carotid stenting. Hemorrhagic transformation after EVT, number of days in N-ICU, number of days in the hospital, in-hospital mortality, functional outcome at discharge, and 3-month functional outcome did not differ between the two groups ( P > 0.05). Emergency stenting during EVT significantly reduced the probability of 3-month mortality (odds ratio = 0.21, confidence interval: 0.04 to 0.96, P = 0.04). CONCLUSIONS:This study showed that emergency stenting in the acute tandem occlusion patients decreased the probability of mortality. Further research is needed on this.

Objectives: Contrast extravasations (CE) are frequently seen on postprocedural computed tomography after endovascular therapy (EVT). This study aimed to investigate the relationship between patients' outcomes and CE after EVT. Methods: Stroke patients who had received EVT between 2019 and 2021 were reviewed retrospectively. The CEs were mapped using MRIcroGL software. The rate of in-hospital mortality and modified Rankin Scale at 90 days were taken as outcome measures. Stepwise logistic regression analyses were performed. Three models were created with and without pure CE to predict the patients' outcomes. Results: There were 126 patients included in the study. According to the univariable analysis, CE (OR = 0.70, 95% CI = 0.18-2.68, P = 0.26) and CE-ASPECTS (OR = 1.21, 95% CI=0.60-2.44, P = 0.57) were not related with in-hospital mortality after EVT. The lesion mapping showed that the most common CE locations among the patients with a poor prognosis was the M6 area. The multivariable logistic regression analysis showed that CE in the M6 area (OR = 6.87, 95% CI = 1.27-144.92, P = 0.006) increased the risk of a 3-month poor outcome. The study showed that adding CE to the well-known risk factors for poor prognosis improves the predictive power of the models (Delta AUC of 0.07, P = 0.02). Conclusion: CE has a prognostic value after EVT in anterior stroke patients. The prognostic value is the highest when present in the M6 area.

Objective: To reveal the profile and practice in patients with acute stroke who received intravenous tissue plasminogen activator (IV tPA) and/or neurointerventional therapy in Turkiye. Materials and Methods: On World Stroke Awareness Day, May 10, 2018, 1,790 patients hospitalized in 87 neurology units spread over 30 health regions were evaluated retrospectively and prospectively. Results: Intravenous tPA was administered to 12% of 859 cases of acute ischemic stroke in 45 units participating in the study. In the same period, 8.3% of the cases received neurointerventional treatment. The rate of good prognosis [modified Rankin score (mRS) 0-2] at discharge was 46% in 83 patients who received only IV tPA [age: 67 +/- 12 years; National Institutes of Health Stroke Scale (NIHSS): 12 +/- 6; hospital stay, 24 +/- 29 days]; 35% in 51 patients who underwent thrombectomy (MT) alone (age: 64 +/- 13 years; NIHSS: 14.1 +/- 6.5; length of hospital stay, 33 +/- 31 days), 19% in those who received combined treatment (age: 66 +/- 14 years; NIHSS: 15.6 +/- 5.4; length of hospital stay, 26 +/- 35 days), and 56% of 695 patients who did not receive treatment for revascularization (age: 70 +/- 13 years; NIHSS: 7.6 +/- 7.2; length of hospital stay, 21 +/- 28 days). The symptom-to-door time was 87 +/- 53 minutes in the IV treatment group and 200 +/- 26 minutes in the neurointerventional group. The average door-to-needle time was 66 +/- 49 minutes in the IV tPA group. In the neurothrombectomy group, the door-to-groin time was 103 +/- 90 minutes, and the TICI 2b-3 rate was 70.3%. In 103 patients who received IV tPA, the discharge mRS 0-2 was 41%, while the rate of mRS 0-1 was 28%. In 71 patients who underwent neurothrombectomy, the mRS 0-2 was 31% and mRS 0-1 was 18%. The door-to-groin time was approximately 30 minutes longer if IV tPA was received (125 +/- 107 and 95 +/- 83 minutes, respectively). Symptomatic bleeding rates were 4.8% in IV recipients, 17.6% among those who received only MT, and 15% in combined therapy. Globally, the hemorrhage rate was 6.8% in patients receiving IV tPA and 16.9% in MT. Conclusion: IV thrombolytic and neurointerventional treatment applications in acute ischemic stroke in Turkiye can provide the anticipated results. Heterogeneity has begun to be reduced in our country with the dissemination of the system indicated by the "Directive on Health Services to be Provided to Patients with Acute Stroke."

Thank you for the opportunity to respond to the letter from Dr. Josef Finsterer and to discuss his questions about our article. We read his letter with great interest and we would like to provide the following clarifications about our article. Dr. Finsterer focussed especially on patient 6 in our cases [[1]Tabakoglu A. Ciftci S. Ekinci S.A. et al.Epileptic nystagmus with different localization of lesions in magnetic resonance imaging in a patient with MELAS.Neurological Sci Neurophysiol. 2018; 35: 189-192https://doi.org/10.5152/NSN.2018.10003Crossref Scopus (2) Google Scholar]. This patient had been diagnosed with mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes (MELAS). Dr. Finsterer expressed concerns about this patient's cranial magnetic resonance imaging (MRI) findings and treatment. In our article, we did not describe this patient in detail, because we had previously published a detailed description in a case report, which included cranial MR images of this patient's acute stroke-like lesions as well as an account of the electroencephalographic (EEG) findings during episodes of epileptic nystagmus. The published case report also mentions that, apart from antiseizure medications, this patient also received l-carnitine and coenzyme Q10 [[1]Tabakoglu A. Ciftci S. Ekinci S.A. et al.Epileptic nystagmus with different localization of lesions in magnetic resonance imaging in a patient with MELAS.Neurological Sci Neurophysiol. 2018; 35: 189-192https://doi.org/10.5152/NSN.2018.10003Crossref Scopus (2) Google Scholar]. We note that, in our case series, we referred to the fact that more information about this case can be obtained from the previously published case report [[1]Tabakoglu A. Ciftci S. Ekinci S.A. et al.Epileptic nystagmus with different localization of lesions in magnetic resonance imaging in a patient with MELAS.Neurological Sci Neurophysiol. 2018; 35: 189-192https://doi.org/10.5152/NSN.2018.10003Crossref Scopus (2) Google Scholar]. We agree with Dr. Finsterer that cases have been described in which epileptic vertical or torsional nystagmus was observed [[2]Tarodo S.G. Nguyen T. Ranza E. Vulliémoz S. Korff C.M. A triad of infantile spasms, nystagmus, and a focal tonic seizure.Epileptic Disord. 2018; 20: 295-300https://doi.org/10.1684/epd.2018.0984Crossref PubMed Scopus (5) Google Scholar]. In our article, this rare manifestation of epileptic nystagmus was only mentioned briefly. However, since horizontal nystagmus was observed in all of our adult cases, we placed a greater emphasis on horizontal nystagmus. During ictal seizure activity, the level of consciousness was defined as the status of awareness as described in the classification of seizure types by the International League Against Epilepsy [[3]Fisher R.S. Cross J.H. French J.A. Higurashi N. Hirsch E. Jansen F.E. Lagae L. Moshé S.L. Peltola J. Roulet Perez E. Scheffer I.E. Zuberi S.M. Operational classification of seizure types by the international league against epilepsy: position paper of the ILAE commission for classification and terminology.Epilepsia. 2017; 58: 522-530https://doi.org/10.1111/epi.13670Crossref PubMed Scopus (1953) Google Scholar]. Loss of awareness was the most commonly observed co-manifestation of seizures with epileptic nystagmus in our patient cohort. Moreover, we stated that loss of awareness was seen in 10 patients and intact awareness was seen in 2 patients. However, we are more interested in additional findings with greater localizing value and therefore we chose to highlight the association of epileptic nystagmus with a tonic deviation of the head, eyes, or both, vision changes, and focal motor symptoms. And we detected that preceding gaze deviation was seen in 62% and head with gaze deviation was seen in 29% of our cases. In our article, we stated that we define type 1 and type 2 nystagmus according to whether the slow phase of nystagmus crosses the midline or not. We explained that these types of nystagmus occur with the activation of the cortical saccadic or smooth pursuit eye regions. It might be assumed that the nystagmus type would provide information about the activated brain region. However, no correlation was found between the type of epileptic nystagmus and the location of the seizure onset zone. In our patient cohort, the type of epileptic nystagmus did not therefore accurately indicate whether ictal discharges originated from cortical saccadic or smooth pursuit areas. Studies have reported that epileptic nystagmus classification based on the disruption of cortical control over saccades or smooth pursuit cannot be applied to the majority of patients with the condition in clinical practice [[4]Choi S.Y. Kim Y. Oh S.W. Jeong S.H. Kim J.S. Pursuit-paretic and epileptic nystagmus in MELAS.J Neuroophthalmol. 2012; 32: 135-138https://doi.org/10.1097/WNO.0b013e31824d2a15Crossref PubMed Scopus (15) Google Scholar]. This is due to a lower likelihood of the epileptic discharges exclusively stimulating either the saccadic or the smooth pursuit region during an ictus. However, the epileptic nystagmus type does not have any effect on diagnosis, treatment, and prognosis. Epileptic nystagmus is a rarely seen ictal phenomenon. Especially in acutely presenting neurological diseases, it is a useful guide to the lateralization and localization of cerebral lesions. Epileptic nystagmus may be a manifestation of a wide range of neurological diseases including acute stroke, encephalitis, MELAS, etc. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Epileptic nystagmus in MELAS and non-mitochondrial disordersSeizure - European Journal of EpilepsyVol. 104PreviewWe eagerly read the article by Aykac et al. about 20 patients with horizontal epileptic nystagmus [1]. One of these patients was reported as having mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome [1]. It was found that the ictal discharge pattern was rhythmic fast activity with a mean frequency of 15 Hz, that ictal discharges originated from the parieto-occipital, temporo-occipital, parieto-occipito-temporal, temporal, occipital, or centro-parietal areas, that the fast phase of the nystagmus was beating away from the side of ictal discharges, and that the origin of the ictal discharges was compatible with the lesion localization on cerebral magnetic resonance imaging (MRI) [1]. Full-Text PDF Open Archive

Objective: Atrial fibrillation (AF) is the most common directly preventable cause of ischemic stroke. There is no dependable neurology-based data on the spectrum of stroke caused by AF in Turkiye. Within the scope of NoroTek-Turkiye (TR), hospital-based data on acute stroke patients with AF were collected to contribute to the creation of acute-stroke algorithms.Materials and Methods: On May 10, 2018 (World Stroke Awareness Day), 1,790 patients hospitalized at 87 neurology units in 30 health regions were prospectively evaluated. A total of 929 patients [859 acute ischemic stroke, 70 transient ischemic attack (TIA)] from this study were included in this analysis.Results: The rate of AF in patients hospitalized for ischemic stroke/TIA was 29.8%, of which 65% were known before stroke, 5% were paroxysmal, and 30% were diagnosed after hospital admission. The proportion of patients with AF who received "effective" treatment [international normalization ratio >= 2.0 warfarin or non-vitamin K antagonist oral anticoagulants (NOACs) at a guideline dose] was 25.3%, and, either no medication or only antiplatelet was used in 42.5% of the cases. The low dose rate was 50% in 42 patients who had a stroke while taking NOACs. Anticoagulant was prescribed to the patient at discharge at a rate of 94.6%; low molecular weight or unfractionated heparin was prescribed in 28.1%, warfarin in 32.5%, and NOACs in 31%. The dose was in the low category in 22% of the cases discharged with NOACs, and half of the cases, who received NOACs at admission, were discharged with the same drug.Conclusion: NoroTekTR revealed the high but expected frequency of AF in acute stroke in Turkiye, as well as the aspects that could be improved in the management of secondary prophylaxis. AF is found in approximately one-third of hospitalized acute stroke cases in Turkiye. Effective anticoagulant therapy was not used in three-quarters of acute stroke cases with known AF. In AF, heparin, warfarin, and NOACs are planned at a similar frequency (one-third) within the scope of stroke secondary prophylaxis, and the prescribed NOAC dose is subtherapeutic in a quarter of the cases. Non-medical and medical education appears necessary to prevent stroke caused by AF.

Objective: Nutritional status assessment, dysphagia evaluation and enteral feeding decision are important determinants of prognosis in acute neurovascular diseases. Materials and Methods: NoroTek is a point prevalence study conducted with the participation of 87 hospitals spread across all health sub regions of Turkey conducted on 10-May-2018 (World Stroke Awareness Day). A total of 972 hospitalized neurovascular patients [female: 53%, age: 69 +/- 14; acute ischemic stroke in 845; intracerebral hematoma (ICH) in 119 and post-resuscitation encephalopathy (PRE) in 8] with complete data were included in this sub-study. Results: Gastrostomy was inserted in 10.7% of the patients with ischemic stroke, 10.1% of the patients with ICH and in 50% of the patients with PRE. Independent predictors of percutaneous endoscopic gastrostomy (PEG) administration were The National Institutes of Health Stroke Scale score at admission [exp (ss): 1.09 95% confidence interval (CI): 1.05-1.14, per point] in ischemic stroke; and mechanical ventilation in ischemic [exp (ss): 6.18 (95% CI: 3.16-12.09)] and hemorrhagic strokes [exp (ss): 26.48 (95% CI: 1.36-515.8)]. PEG was found to be a significant negative indicator of favorable (modified Rankin's scale score 0-2) functional outcome [exp (ss): 0.032 (95% CI: 0.004-0.251)] but not of in-hospital mortality [exp (ss): 1.731 (95% CI: 0.785-3.829)]. Nutritional and swallowing assessments were performed in approximately two-thirds of patients. Of the nutritional assessments 69% and 76% of dysphagia assessments were completed within the first 2 days. Tube feeding was performed in 39% of the patients. In 83.5% of them, tube was inserted in the first 2 days; 28% of the patients with feeding tube had PEG later. Conclusion: The NoroTek study provided the first reliable and large-scale data on key quality metrics of nutrition practice in acute stroke in Turkey. In terms of being economical and accurate it makes sense to use the point prevalence method.

Purpose: This study aims to determine the clinical significance of epileptic nystagmus in patients with acute neurological symptoms.Method: The clinical findings of patients with documented epileptic nystagmus, their original video and EEG data, and cranial imaging and laboratory tests were analyzed retrospectively.Results: 20 patients were included in the study and 21 epileptic nystagmus attacks were determined from pa-tients' clinical and video-EEG recordings. All recorded seizures with epileptic nystagmus were focal onset in nature. The ictal discharge pattern was rhythmic fast activity with a mean frequency of 15 Hz. The ictal dis-charges originated from the parieto-occipital (n = 8), temporo-occipital (n = 7), parieto-occipito-temporal (n = 3), temporal (n = 2), occipital (n = 1), and centroparietal (n = 1) areas. In the fast phase, the nystagmus was beating away from the side of ictal discharges. The origin of the ictal discharges on EEG images was compatible with the lesion localization at cranial MRI in all patients. Etiologies were epilepsy in seven patients, non-ketotic hyperglycemia in four, ketotic hyperglycemia in one, PRES in three, acute stroke in three, HSV encephalitis in one, and MELAS in one.Conclusions: Epileptic nystagmus represents a guide to the lateralization and localization of the lesion in cases presenting with acute neurological symptoms. In these patients, the lesion is frequently in the posterior regions of the hemispheres. Although various diseases affect these regions in terms of etiology, such cases should be evaluated in terms of the presence of hyperglycemia.

Infective endocarditis (IE) is the infection of the endocardial surfaces of the heart and intracardiac foreign bodies, and is caused by various microorganisms such as bacteria, fungus and viruses. Most common findings of IE include cardiac murmur, splenomegaly, Osler nodes, splinter hemorrhages, and Janeway lesions. Here, we aimed to present a IE case which was misdiagnosed as thromboembolic stroke, treated with intravenous (IV) thrombolytic treatment and developed multiple cerebral and cerebellar hemorrhages. A 35-year-old man with a history of diabetes mellitus (DM) and hypertension (HT) was admitted to our clinic with multiple cerebral and cerebellar hemorrhages. It was found out that the patient was given an antibiotic treatment due to high fever (39-40 oC) and pharyngitis two weeks before admission to our clinic, and a week later he developed right side weakness. As computerised tomography (CT) and diffusion-weighted magnetic resonance imaging (MRI) were normal at the clinic the patient applied with right sided weakness, he was diagnosed with acute ischemic stroke and was given intravenous thrombolytic treatment-alteplase (IV rTPA). Patient was referred to our clinic due to persistent fever, clinical worsening and multiple cerebral and cerebellar hemorrhages in follow-up CT scan. The patient was referred to the Cardiology clinic with the preliminary diagnosis of infective endocarditis. Echocardiography (ECO) showed a thrombotic vegetation measuring 1.1 x 0.7 centimeters (cm) on the anterior mitral valve, and transoesophageal ECO showed a thrombotic vegetation measuring 1.9 x 0.9 on the mitral valve. The patient was referred to Infctious Diseases clinic for initiation of antibiotherapy, and Cardiovascular Surgery clinic regarding the need for surgery. Yet, as the surgery required high-dose heparin application, an operation was not performed. After the treatment, hemorrhage areas were seen to be regressed in follow-up brain CT scan. While evaluating patients who admit to the emergency with high fever and neurological deficits, septic embolism should also be kept in mind at the first visit and imaging methods should be used for further evaluation.

PURPOSE:This study was aimed to investigate the presence of pathogenic free-living amoebae (FLA) in suspected cases of meningoencephalitis with unknown causes of death in Turkey.METHOD:A total of 92 patients, who were diagnosed as meningoencephalitis, were enrolled. All cerebrospinal fluid (CSF) samples were directly microscopically examined and cultured. Acanthamoeba, N. fowleri and B. mandrillaris were further investigated using molecular diagnostic tools including real-time PCR, sequencing, and phylogenetic analyses.RESULTS:The examined CSF samples were not found positive for the presence of FLA by microscopic examination and culture method. However, two CSF samples were detected positive by real-time PCR assay. Of the positive CSF samples, one was identified as Acanthamoeba genotype T4 and the second positive sample was identified as N. fowleri belonging to genotype II. Furthermore, the pathogens diagnoses was verified through Sanger sequencing.CONCLUSION:This study was significant to report the presence of Acanthamoeba genotype T4 and N. fowleri genotype II in CSF samples by real-time PCR assay. The present study shows the significance of primary amoebic meningoencephalitis (PAM) and granulomatous amoebic encephalitis (GAE) as one of the differential diagnoses to be considered by clinicians during the evaluation of suspected meningoencephalitis or cases of unknown cause in Turkey. Using real-time PCR, this has made the rapid detection, in a short time-frame, of Acanthamoeba and N. fowleri in CSF samples from patients. The problems with qPCR is that it is not available in every laboratory, reagents are expensive, and it requires skilled and expert personnel to set up these assays.

Serebral venöz tromboz, morbidite ve mortaliteye yol açabilen nadir bir hastalıktır. En sık 30-40 yaş arası olmak üzere tüm yaş gruplarında görülebilir. Serebral venöz tromboz hastaları sıklıkla baş ağrısı, bulantı, papilödem daha nadir olarak nöbet, ensefalopati, intrakraniyal kanama, multipl kranial sinir tutulumlarını içeren çeşitli klinik bulgularla başvurabilir. Serebral venöz tromboz hastalarının değişken prezentasyonu tanıda zorluklar ortaya çıkarmaktadır. Bu yazıda 10 gündür baş ağrısı şikâyeti olan ve MR görüntülemelerinde ilk olarak alamik kitle olduğu düşünülen ancak ayrıntılı radyolojik incelemeler sonucu internal serebral venlerde tromboz saptanan bir olgu sunulmuştur.

Background - Decompressive surgery (hemicraniectomy) for large hemispheric stroke reduces the risk of death and increases the chance of a favorable outcome. We aim to evaluate the outcome in patien...

Objectives: Patients with left ventricular assist devices (LVADs) frequently experience cerebrovascular complications. We investigated the complications, including intracra-nial hemorrhage (ICH) and ischemic stroke (IS), in patients with LVADs. Methods: A historical cohort study was performed at an emergency clinic including patients who underwent LVAD placement between February 16, 2015, and April 1, 2020. Of the 295 patients with LVADs, 71 (24.1%) were admitted to the emergency service between the study dates because of IS and ICH. Electronic medical files were reviewed, and patients were categorized as ICH or IS. Results: Of the included patients, 245 (83.0%) were male. The most common postoperative complications were pump thrombosis (26.8%, n = 79), blood culture positivity (19.3%, n = 57), and surgical bleeding (5.8%, n = 17). The most frequent LVAD indication was ischemic dilated cardiomyopathy (71.5%, n = 211). The mean age was 49.6 ± 16.7 and 51.3 ± 14.8 years for patients with and without neurological complications, respectively (P = 0.415). Neurological complications were seen in 65 (31.3%) patients with and in 6 (6.9%) patients without coronary ischemia (P < 0.001). Neurological complications were found in 39 (30.5%) patients with an implantable cardioverter defibrillator (ICD) and in 32 (19.2%) patients without an ICD (P = 0.024). Neurological complications were found in 19 (61.3%) patients with and in 52 (19.7%) patients without a history of stroke (P < 0.001). Logistic regression analysis revealed that age and Glasgow coma scale (GCS) were the only significant variables independently affecting mortality status. While a younger age was a protective factor, a one-unit increase in the GCS was associated with a 4.1-fold (95% CI: 1.308-13.071) increase in mortality. Conclusions: Coronary ischemia, ICD, cerebrovascular disease, and smoking significantly affected the presence of complications. Moreover, patients with combined IS and ICH had a lower chance of recovering. Interventional procedures should be performed as early as possible, especially in elderly patients with a low GCS.