Myasthenia gravis (MG) poses diagnostic challenges due to its diverse clinical presentations. Diagnosing MG remains complex despite advancements, necessitating further understanding of its diverse clinical profiles. We conducted a retrospective analysis of 290 MG cases. Patient demographics, symptomatology, and diagnostic outcomes were reviewed. Patients were categorized into two groups: those displaying classical presentations and those manifesting unusual presentations. The patients with unusual presentations were comprehensively evaluated and the demographic and clinical characteristics of the two groups were compared. In our study of 290 patients with MG, 20 presented with unusual manifestations (6.9%). These included isolated dropped head, bilateral facial weakness, distal limb weakness (e.g., foot and hand drop), weakness of limb-girdle muscles, and isolated ocular findings without ptosis. When patients were categorized into two groups based on their initial symptoms, no significant differences in demographic and clinical features were observed between the classical and unusual groups, except for a higher prevalence of anti-MuSK antibodies and more frequent administration of rituximab in patients with unusual presentations. Recognizing unusual MG presentations is crucial for timely management. Our study underscores the diverse clinical spectrum of MG, emphasizing the need for nuanced diagnostic approaches and prompt intervention.

The postpartum period is a well-defined risk factor for cerebral venous sinus thrombosis (CVST). However, it is unclear which patients are at risk for CVST in the postpartum period. Thus, determining some CVST risk factors in postpartum patients may be useful for preventing the disorder in this population. Previous studies have shown that preeclampsia (PE) is a risk factor for pulmonary thromboembolism and deep vein thrombosis, but whether it is related to postpartum CVST has not yet been evaluated. This study aimed to determine if this relationship exists. This study was a case-control study of retrospectively screened patients diagnosed with CVST between 2018 and 2023 at the Uluda & gbreve; University Faculty of Medicine Department of Neurology, the Eski & scedil;ehir Osmangazi University Faculty of Medicine and the Bursa City Hospital Health Sciences University Department of Neurology. All of the women who delivered between 2018 and 2023 at the Uluda & gbreve; University Faculty of Medicine Department of Obstetrics and Gynaecology were included in the control group. In total, 57 out of 322 cases and 4299 out of 4452 controls were included in this study. A nonsignificant relationship was found between CVST and spinal anesthesia, but a significant relationship was found between PE and stillbirth. Women with PE who had recently delivered were found to be at increased risk of developing CVST. The primary limitation of this study is that it was retrospective, and the control group was hospital-based. We recommend that these findings be confirmed by multicenter prospective international studies.

Limb-shaking transient ischemic attack (TIA); is an uncontrolled rhythmic or dysrhythmic, temporary, and generally coarse tremor movement of the upper or lower extremities. Since Miller Fisher's first report of limb-shaking TIA associated with internal carotid artery (ICA) stenosis in 1962, this condition has been described regularly. These are characterized by brief, arrhythmic, jagged, or jerky movements of the extremities and are generally misdiagnosed as focal seizures or movement disorders. TIA is usually correlated with negative neurological symptoms; thus, the diagnosis of TIA is typically not considered in patients presenting with episodic abnormal movement disorder. We presented three cases, one of these cases was one with ICA stenosis who benefits from revascularization treatment (internal carotid artery stenting), the second case with ICA stenosis and who does not benefit from revascularization treatment (carotid endarterectomy operation), and the last patient without ICA stenosis. The common feature of all three patients was hypotension. These patients are not as rare as thought, and the etiology of cerebral hypoperfusion should be urgently evaluated.

Objectives: The study aimed to determine the clinical relevance of cortical vein thrombosis (CVT) accompanying cerebral venous sinus thrombosis (CVST) and to investigate the risk factors. Patients and methods: This retrospective study included 176 patients (52 males, 124 females; mean age: 41.8±14.5 years; range, 16 to 72 years) with CVST between January 2015 and January 2021. The radiological, demographic, and clinical features and risk factors of patients with and without CVT were com-pared. Results: When the clinical demographic and radiological features associated with CVT were evaluated; there was a significant relationship between age, clinical onset symptom, connective tissue disease, post-partum period, presence of hypercoagulopathy, superior sagittal sinus (SSS) thrombosis, transverse sinus thrombosis, sigmoid sinus thrombosis, non-hemorrhagic venous infarct, small juxtacortical hemorrhage and large parenchymal hematomas, time to diagnosis (days), and poor clinical outcome. When significant risk factors for CVT were analyzed by binary logistic regression, the post-partum period and SSS thrombosis were independent risk factors. Conclusion: In this study, the rate of CVT accompanying CVST was 30.7%, which is higher than the studies in the literature. Cortical vein thrombosis accompanying CVST is associated with parenchymal lesions and poor clinical outcome; SSS thrombosis and the postpartum period are independent risk factors. Multicenter prospective studies are recommended for more precise information.

Seizure semiology and electroencephalograph (EEG) are very important for determining seizure type, hemisphere lateralization, or localization. Clinical symptoms of focal seizures, as well as findings at the onset or end of a focal to bilateral tonic–clonic seizure (FBTCS), are highly informative for lateralization. This study aimed to investigate the relationship of asymmetric last clonic jerk in patients with temporal or extratemporal lobe epilepsy with pathologies, localization, lateralization, or other semiological findings detected in neuroimaging or neuro psychometric tests and its positive predictive value for the detection of hemisphere lateralization based on seizure onset ictal EEG activation. 44 patients with asymmetric last clonic jerks (aLCJ) who were followed up in our VEM unit were randomized 1:1 with epilepsy patients without. In patients with ipsilateral automatism and contralateral posture or gustatory and olfactory hallucinations aLCJ was less or absent. In patients with unilateral tonic activity, aLCJ was more common. The positive predictive value of aLCJ for ictal EEG activation lateralization was 86.36%. In conclusion, asymmetric last clonic beat is valuable for lateralization of FBTCS and should be considered. Its presence strongly and reliably lateralizes to the side of seizure onset.

OBJECTIVES:Cerebral venous sinus thrombosis (CVST) is a cerebrovascular disease characterized by thrombosis of the cerebral venous or dural sinuses. Autoimmune diseases (AD) are important causes of CVST. This study aims to reveal the differences between CVST associated with autoimmune diseases compared with other causes (OCs) and Behcet's syndrome (BS) compared with other ADs.METHODS:This is a single-center retrospective study in which the medical records of 187 patients we followed with a diagnosis of CVST between 2008 and 2023 were collected retrospectively. Four neurologists collected data on initial symptoms, neurological examinations, and laboratory findings. Findings on magnetic resonance imaging and magnetic resonance venography performed on all patients (thrombosis localizations, hemorrhagic or ischemic complications, and collateralization) were re-evaluated by 2 radiologists. The results were compared with AD, other ADs, and OCs groups.RESULTS:There were 28 cases of CVST associated with AD. Of these, 18 were BS, and 10 were other AD. Subacute-chronic onset, headache, and transverse sinus involvement were more common in AD-related patients than in OCs. However, collateralization, venous infarction, hemorrhagic transformation, and bleeding were less common. BS-related patients had earlier age, more frequent transverse sinus, less frequent cortical vein thrombosis, and better collateralization than other ADs.CONCLUSION:CVST is one of the rare complications in autoimmune diseases. It has a more subacute-chronic onset. Since headaches are more common, it is essential to make a differential diagnosis of CVST in autoimmune diseases with chronic headaches. Transverse sinus thrombosis is more common. Collateralization, venous infarction, and hemorrhagic transformation are less.

Long COVID, characterized by persistent symptoms post-acute COVID-19, remains a subject of intense investigation. This study focuses on pain, a common and notable symptom reported by long COVID patients. A cohort of 191 individuals, initially diagnosed with mild-to-moderate COVID-19, was followed up 1.5 years later to assess the frequency, clinical characteristics, and factors associated with pain persistence. Our study revealed that 31.9

OBJECTIVES:Basilar artery atherosclerotic plaque is the predominant cause of stroke in the posterior circulation. İscheamic stroke caused basilar artery atherosclerosis faces a high risk of recurrence despite optimal medical treatment, which might lie in the less than ideal recognition of underlying stroke mechanism and lack of individualized treatment for strokes of different mechanisms. We aim in this study to investigate the effect on stroke mechanism, stroke recurrence and clinical outcome in stroke patients with basilar artery atherosclerosis. METHODS:In this study, 107 ischaemic stroke patients with atherosclerotic stenosis in the BA who were followed up in Uludag University Faculty of Medicine between 1 January 2019 and 1 January 2022. The study was conducted retrospectively and observationally. RESULTS:According to the results of our study, the degree of stenosis in atherosclerotic stenosis of the symptomatic basilar artery was found to be an independent risk factor for stroke recurrence. Independent risk factors for unfavourable clinical outcomes in these patients were determined as female gender, stenosis being in the proximal segment, stroke mechanism being from artery to artery embolism, and congestive heart failure. CONCLUSION:The most striking result of our study is that clinical outcome was found to be closely related to the female gender, the stroke mechanism being artery-to-artery embolism, and the stenosis is in the proximal segment. If stroke mechanisms were evaluated more clearly, it would likely help provide individualised treatments.

Abstract İntroduction: Posterior circulation stroke differs from anterior circulation stroke in etiopathogenesis. Studies have shown that the most common stroke aetiology in posterior circulation stroke is ischemic stroke due to large vessel atherosclerosis. However, even under aggressive medical treatment, the risk of recurrent ischemic stroke in ischemic stroke due to intracranial atherosclerotic stenosis remains high. This study aims to obtain the rate of atherosclerotic disease of the BA in our ischemic stroke population, to determine its symptomatology, and to determine the factors affecting clinical outcome and ischaemic stroke recurrence in the symptomatic group. Material method: we included 107 patients who were diagnosed with acute ischemic stroke with basilar artery stenosis. Results According to the results of our study, the degree of stenosis in atherosclerotic stenosis of the symptomatic BA was found to be an independent risk factor for stroke recurrence. Independent risk factors for unfavourable clinical outcomes in these patients were determined as female gender, stenosis being in the proximal segment, stroke mechanism being from artery to artery embolism, and congestive heart failure. Discussion The most striking result of our study is that clinical outcome was found to be closely related to the female gender, the stroke mechanism being artery-to-artery embolism, and the stenosis is in the proximal segment. If stroke mechanisms were evaluated more clearly, it would likely help provide individualized treatments.

Background & Objective: Intracranial atherosclerotic disease (ICAD) is a prevalent cause of ischemic stroke and is related to recurrent strokes. In this study, we aim to identify the ICAD rate and establish the risk factors in patients with acute ischemic stroke (AIS) in our population in Turkey. Methods: Eight hundred sixty-two patients diagnosed with AIS in our tertiary centre between 01-01.2019 and 01.01.2021 were retrospectively included in this study. Results: We detected ICAD in 172 (20%) patients. While the independent risk factors of anterior ICAD were hypertension and diabetes mellitus, the risk factors of posterior ICAD were advanced age, diabetes mellitus, hyperlipidaemia and vertebral artery hypoplasia. There were more frequent posterior ICAD. Conclusion: There was difference in the risk factors for anterior ICAD and posterior ICAD in this Turkish study.

Background Cerebral venous sinus thrombosis (CVST) is not as well understood as an ischemic stroke of arterial origin. Although the prognosis of CVST is usually good, parenchymal lesions may occur in some patients, and the development of intracranial herniation may result in death. For this reason, recognizing the risk factors for intracranial herniation and accurately determining those patients who should undergo decompressive craniectomy is important. Objective This study aims to determine the risk factors for intracranial herniation in patients with CVST. Methods A total of 177 patients diagnosed with CVST between 2015 and 2021 in our tertiary center were retrospectively included in this study. Results Of the 177 patients, 124 were female and 53 were male with mean ages of 40.65 +/- 13.23 and 44.13 +/- 17.09, respectively. Among those, 18 patients had developed intracranial herniation. A significant statistical relationship was observed between superior sagittal sinus thrombosis, sinus rectus thrombosis, venous collateral score, nonhemorrhagic venous infarct, presence of malignancy, small juxtacortical hemorrhage, and cortical vein thrombosis. The binary logistic regression analysis results showed that the most significant variables were the venous collateral score of 0, malignancy, and small juxtacortical hemorrhages. Conclusion This study identified small juxtacortical hemorrhages, the presence of malignancy, and a venous collateral score of 0 to be independent risk factors for intracranial herniation in CVST patients. Drawing on these results, we recommend close clinical observation of CVST patients, as they may be candidates for decompressive craniectomy.

İskemik inme, dünya çapında sakatlık ve mortalitenin yaygın nedenlerinden biridir ve gelişmekte olan ülkelerde görülme sıklığı artmaktadır. Tip 2 diyabet, akut iskemik inme için iyi tanımlanmış bir risk faktörüdür. Diyabetin iskemik inme sonrası mortalite ve kötü klinik sonuçla ilişkili olduğu tahmin edilmektedir. Diyabet ve iskemik inme halk sağlığı sorunlarıdır. Bu çalışmanın amacı toplumumuzdaki diyabetli akut iskemik inme hastalarının demografik klinik ve radyolojik özelliklerini belirlemek ve diyabetli hastalarda iskemik inme rekürrensini etkileyen faktörleri belirlemektir. Bu çalışmada 2019-2021yılları arasında Bursa Uludağ Üniversitesi Tıp Fakültesi Nöroloji bölümünde iskemik inme tanısı alan 862 hasta değerlendirildi. Hastaların demografik, klinik ve radyolojik özellikleri kaydedildi. Diyabetik olan ve olmayan hastaların iskemik inme rekürrensine etki eden faktörler sorgulandı. Bu çalışmada diyabetli akut iskemik inme hastalarında koroner arter hastalığı (p

Background Seizures after stroke can negatively affect the prognosis of ischemic stroke and cause a decrease in quality of life. The efficacy of intravenous (IV) recombinant tissue plasminogen activator (rt-PA) treatment in acute ischemic stroke has been demonstrated in many studies, and IV rt-PA treatment has been increasingly used around the world. The SeLECT score is a useful score for the prediction of late seizures after stroke and includes the severity of stroke (Se), large artery atherosclerosis (L), early seizure (E), cortical involvement (C), and the territory of the middle cerebral artery (T). However, the specificity and sensitivity of the SeLECTscore have not been studied in acute ischemic stroke patients that received IV rt-PA treatment. Objective In the present study, we aimed to validate and develop the SeLECT score in acute ischemic stroke patients receiving IV rt-PA treatment. Methods The present study included 157 patients who received IV thrombolytic treatment in our third-stage hospital. The 1-year seizure rates of the patients were detected. SeLECT scores were calculated. Results In our study, we found that the SeLECT score had low sensitivity but high specificity for predicting the likelihood of late seizure after stroke in patients administered IV rt-PA therapy. In addition to the SeLECT score, we found that the specificity and sensitivity were higher when we evaluated diabetes mellitus (DM) and leukoaraiosis. Conclusion We found that DM was an independent risk factor for late seizures after stroke in a patient group receiving thrombolytic therapy, and late seizures after stroke were less frequent in patients with leukoaraiosis.

Huzursuz bacaklar sendromu (HBS) en sık görülen uyku ile ilişkili hareket bozukluğudur. HBS, yaşam kalitesini bozan önemli uyku sonuçları olan sensorimotor bir hastalık olup özellikle dinlenme sırasında ortaya çıkar. HBS semptomlarının sistemik inflamasyona sekonder oluşabileceği ya da kötüleşebileceği bilinmektedir. Covid 19 enfeksiyonu da sistemik inflamasyon yanıtına yol açabilen bir durumdur. Covid-19 enfeksiyonunun uyku bozuklukları ile ilişkisine ilişkin yapılmış birçok çalışma vardır. Ancak HBS ve covid-19 birlikteliğine ilişkin çalışmalar sınırlı olup bu araştırma ile literatüre katkıda bulunulmak istenmiştir.

Purpose: To investigate possible relationships between the presence and location of arterial transit artifacts (ATA) and clinical symptoms, digital subtraction angiography (DSA), and dynamic susceptibility contrast (DSC) perfusion imaging abnormalities in patients with carotid artery stenosis (CAS).Methods: Forty-seven patients who underwent arterial spin labeling (ASL) and DSC perfusion imaging in the same period diagnosed with > 50% unilateral internal carotid artery (ICA) stenosis by DSA performed 24 h after perfusion imaging were included. The presence of ATA, localization and hypoperfusion were evaluated using ASL interpretation. Maps derived from DSC perfusion, symptomatology, stenosis rates, and collateralization findings observed in DSA were investigated. Probable relationships were evaluated.Results: ATA on ASL were detected in 68.1% (32/47); 40.6% (13/32) of ATAs were observed in the distal middle cerebral artery (MCA) trace, 50% (16/32) in the intracranial ICA and MCA traces, and 9.4% (3/32) in the intracranial ICA trace. When classifications based on the ATA presence and localization was made, qualitative and quantitative CBF, MTT, and TTP abnormalities, symptomatology, stenosis rates, and collateralization findings significantly differed between groups (p < 0.05).Conclusion: The presence and localization of ATA in patients with CAS may provide essential insights into cerebral hemodynamics and the CAS severity. ATAs observed only in the distal MCA trace may represent early-stage perfusion abnormalities and a moderate level of stenosis. ATA in the ICA trace may related to a more advanced level of perfusion abnormalities, critical stenosis rates, symptom or collateralization presence. & COPY; 2022 Elsevier Masson SAS. All rights reserved.

Coronavirus is a pathogen that caused fatal pneumonia cases in Wuhan province of China in December 2019 [1]. It was declared as a pandemic in March 2020 by the World Health Organization [2]. The disease is a severe acute respiratory syndrome with multi-organ involvement, including the cardiovascular system, musculoskeletal system, gastrointestinal and neurological system. Neurological manifestations may be common in COVID-19 patients [3]. Among these, several autoimmunity-affecting syndromes that may result in encephalitis and new-onset refractory status epilepticus (NORSE) have been described. New-onset refractory status epilepticus (NORSE) is an uncommon clinical entity with a mortality rate of 16-27% in adults and significant long-term neurological sequelae. Approximately 50% of patients with NORSE have an unknown aetiology. There is a lack of consensus regarding the best treatment options available for managing patients with NORSE. However, immediate cessation of seizure activity, early institution of continuous infusion of anaesthetic agents, and immunotherapies can play an important role in reducing morbidity and mortality in NORSE.

Amaç: İskemik inme gelişen akut ve koruyucu tedavilere rağmen, iskemik inmenin tekrarlaması nedeniyle de yüksek ölüm ve morbidite nedeni olarak kalmaya devam etmektedir. Genellikle kabul edilen görüş, ilk inmeye neden olan risk faktörlerinin, iskemik inme tekrarında da önemli olduğudur. Bizim çalışmamız erken dönem iskemik inme tekrarında yer alan risk faktörlerini belirlemek amacıyla yapılmıştır. Yöntem: İskemik inme hastalarını kendi inme veri tabanımızdan seçtik ve bu çalışmaya alınan hastalar içinde ilk inmeden sonraki dönemde 3 ay takip edilebilen ve incelemeleri eksiksiz olan 521 hasta analize dahil edilmişlerdir Sonuçlar Yetmiş bir hasta (%14) ilk inmeden sonraki 3 ay içerisinde tekrar inme geçirmişlerdir. Erken inme tekrarı için geçen ortalama süre 21 gündür. Erken inme için belirgin risk faktörleri koroner arter hastalığı (%43, p

Objective: Obstructive sleep apnea syndrome (OSAS) is a common disorder that results from the collapse of the upper airways during sleep and causes temporary hypoxia. OSAS and hypertension are common and multifactorial diseases. aim This study aimed to determine the clinical, demographic, polysomnographic and prognostic features of OSAS patients with hypertension. Materials and Methods: In this study, 364 patients diagnosed with OSAS in the sleep laboratory of the Department of Neurology, Bursa Uludag University Faculty of Medicine between 2016 and 2021 were retrospectively scanned and included. The patients were analyzed by comparing them with and without hypertension. Results: When patients with and without hypertension were compared according to clinical, demographic and polysomnography data, age (p<0.001), sex (p=0.009), presence of diabetes mellitus (DM) (p<0.001), presence of coronary artery disease (p<0.001), presence of heart failure (p=0.020), presence of atrial fibrillation (p=0.004), ischemic stroke (p<0.001), minimum oxygen saturation (p=0.015), oxygen desaturation index (p=0.034) and body mass index (BMI) (p<0.001) were statistically significantly correlated. When the significant variables were analyzed with binary logistic regression, the most significant variables were age [p<0.001, odds ratio (OR): 1.07], DM (p<0.001, OR: 7.58), coronary artery disease (p=0.003, OR: 4.92), heart failure (p=0.041, OR: 5.53), ischemic stroke (p=0.042, OR: 3.38) and BMI (p<0.001, OR: 1.28). Conclusion: In this study, we found that cardiovascular diseases such as coronary artery disease, heart failure and ischemic stroke are more common in OSAS patients with hypertension, and this is independent of risk factors such as age, DM and BMI. OSAS and cardiovascular diseases may show ethnic and racial differences. For this reason, we suggest conducting multicenter prospective studies examining the effects on blood pressure regulation and cardiovascular diseases in our own population.

Objective: The efficacy of intravenous (IV) recombinant tissue plasminogen activator (rt-PA) therapy in the treatment of acute ischemic stroke (AIS) has been demonstrated in many studies and IV rt-PA therapy has been increasingly used all over the world. Early neurological deterioration (END) in AIS is common and potentially associated with a poor clinical outcome. The prevalence of END in AIS ranges from 13% to 37% in studies. The aim of this study is to determine the prevalence and risk factors of END in patients with AIS receiving IV rt-PA therapy. Materials and Methods: One hundred fifty seven patients who were given IV rt-PA treatment by Bursa Uludag University Faculty of Medicine, Department of Neurology between 01.01.2020 and 01.01.2021 were retrospectively included in this study. It was planned to determine the risk group by comparing patients with END with those without. Results: Age (p=0.023), serum glucose level (p=0.045), The National Institutes of Health Stroke score at discharge (p<0.01), Alberta Stroke Program Early CT (ASPECT) score (p<0.01) when clinical, radiological and demographic data associated with END were evaluated and, statistically significant correlation was found with the presence of major vessel occlusion (p=0.012), ischemic stroke due to cardioembolism (p=0.002), clinical outcome (p<0.001) and symptomatic intracerebral hemorrhage (p<0.001). When the significant variables associated with END were evaluated with binary logistic regression, the most significant variables were found to be age (p=0.006) and ASPECT score (p<0.001). Conclusion: The causes of END are multifactorial. The most associated risk factors were found to be advanced age and low ASPECT score. It was understood that the most common cause of END was the inability to perform mechanical thrombectomy for major vessel occlusion. Contrary to popular belief, the most common cause of END in patients with AIS who received IV rt-PA treatment was not considered to be symptomatic intracranial hemorrhage but to inadequate recanalization or late recanalization.