[Show abstract][Hide abstract] ABSTRACT: Cerebral hemodynamic features of patients with post-stroke dementia (PSD) are still obscure. We compared cerebral vasomotor reactivity (VMR) assessed in the acute phase of ischemic stroke (IS) in patients with and without PSD. VMR was also assessed and compared in demented and non-demented patients in the late phase of IS.
VMR was assessed by transcranial Doppler and the Diamox test (1 g acetazolamide i.v.). PSD was confirmed by the National Institute of Neurological Disorders and Stroke and the Association Internationale pour la Recherche et I'Enseignement en Neurosciences (NINDS-AIREN) and the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. VMR% values were compared to verify correlation with dementia.
Thirty patients with acute IS (AIS) were studied and followed for 3-6 months. An additional group of 37 patients was studied in the late post-stroke period (PIS). VMR% values in the AIS groups with and without PSD were similar (25.3 ± 20.3% and 36.5 ± 22.4%, respectively, NS). The mean VMR% in the PIS groups with and without PSD were similar (32.3 ± 19.5% and 41.2 ± 24.8%, respectively, NS).
VMR cannot predict the development of dementia after AIS and cannot identify patients with dementia in the late phase of stroke.
[Show abstract][Hide abstract] ABSTRACT: Patients with pseudo-dementia are at particular risk of being labeled as Alzheimer dementia. We thus need better diagnostic methods. In this study, we evaluated the cerebral reactivity of the posterior cerebral arteries (PCAs) during visual stimulation by transcranial Doppler ultrasonography.
The study group consisted of 13 and 11 patients suffering from pseudo-dementia and Alzheimer disease (AD), respectively, and 10 healthy controls. Visual reactivity was defined as the differences of cerebral blood flow velocity (CBFv) against the visual stimulus. Mini Mental State Examination and Montgomery-Asberg Depression Rating Scales were used as psychometric tests. The transcranial Doppler ultrasonography device was applied for simultaneous recording of both PCAs. Obtained data were evaluated by Student t test, and 1-way analysis of variance tests, with a priori as P<0.05.
Subjects with AD had a lower CBFv following visual stimuli (P<0.001). Mean CBFv throughout the procedure [P<0.001; right and left sides, in AD and depressive pseudo-dementia (DPD), respectively], velocity at rest (P<0.001 in each side for both groups), and velocity at stimulation (P<0.001; each side for both groups) on both PCAs were significantly lower in patients with AD and DPD than those of the controls. Compared with the controls, the relative (r) CBFvs (%) were found to be significantly lower in AD (P<0.05, P<0.01, for the right and left side, respectively).
We have shown that CBFv decreased in patients with AD and DPD, but vasoneuronal activity was only impaired in patients with AD. On the other hand, although the results do not show significant differences between depressive and demented groups by TCD, further studies will be needed for differentiating these diseases.
The Neurologist 11/2010; 16(6):358-63. · 1.48 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to establish the incidence rate, incidence-related characteristics, and epidemiological profile of epilepsy in Eskisehir, Turkey.
Cases were prospectively recorded by utilizing multiple data sources, including case records obtained through the Hospital Information System, files kept by family physicians, and files kept by private neurologists. Patients diagnosed with epilepsy between July 1, 2007, and June 30, 2008, and above the age of 15 years were included in the study.
219 new cases were diagnosed with epilepsy. The adjusted incidence rate was 33.51/100,000 cases in males and 42.22/ 100,000 cases in females, for a total of 37.59/100,000 persons. The incidence rates according to age were found to be highest in the 15-19-year age group and in the ≥70-year age group. Partial seizures were observed more than generalized seizures after the age of 40. Unknown etiology accounted for 77.2% of the epilepsies. Stroke was the most common etiological cause of epilepsy among the symptomatic group.
The incidence rate of epilepsy in Eskisehir was comparable with the rates reported for developed countries.
[Show abstract][Hide abstract] ABSTRACT: This study aimed to investigate the prevalence of various cognitive disorders in the older population (age 55 years and above) of Eskisehir, Turkey, by conducting a cluster sampled door-to-door survey. A total of 3100 inhabitants were screened with the Mini-Mental State Examination (MMSE) and a questionnaire concerning demographic, occupational and social data. Individuals (n=320) with MMSE scores of 25 were assessed according to the 10th Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) and were investigated in the more detailed phase 2 study. The overall prevalence of dementia was 8.4%, although it ranged from 2.2% among those aged 55-59 years to 5.3% among those aged 60-64 years, and to 30.4% among those aged 75 or above. Vascular dementia was the most common type (51.1%), followed by Alzheimer's dementia (48.8%). In a very small proportion of individuals (0.1%), dementia was due to other causes such as B12 deficiency, a tumour or hydrocephalus. Significant risk factors for dementia were female sex, low education, age, living in a rural area and a family history of dementia.
Journal of Clinical Neuroscience 09/2009; 16(11):1455-9. · 1.25 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study was carried out to determine if there is any association between plasminogen activator inhibitor type-1 (PAI-1) gene 4G/5G polymorphism and plasma PAI-1 enzyme activity in acute stroke patients.
In this study, 333 genomic DNAs (from 253 acute stroke patients and 80 healthy subjects) were analyzed. Genomic DNAs were prepared from peripheral blood using a saline method. These DNAs were amplified by PCR method using primers specific for 4G and 5G alleles. PCR products were separated by 2% agarose gel electrophoresis and visualized by a charge coupled device (CCD) camera. PAI-1 enzyme activities were measured by ELISA method. The results were evaluated statistically with Student's t-test, chi(2)-test, one-way analysis of variance, and stepwise regression analysis.
In this study, frequency of PAI-1 gene 4G5G genotype was found to be low both in patients and controls. PAI-1 enzyme activities were significantly increased in acute stroke patients compared to controls. Although PAI-1 gene 4G5G genotype frequencies were low, the patients carrying this allele had highest plasma PAI-1 enzyme activity; likewise, although PAI-1 gene 4G4G genotype frequencies were high, the patients carrying this allele had lowest plasma PAI-1 enzyme activities. Homocysteine levels had a positive effect of 65% on plasma PAI-1 enzyme activities.
Consequently, in this study, we may assert that PAI-1 gene, 4G4G and 5G5G genotypes, PAI-1 activity, and homocysteine level determination are significant criteria for identifying patients who are likely to develop stroke; on the other hand, a direct relation does not exist between gene polymorphism and enzyme activity.
[Show abstract][Hide abstract] ABSTRACT: Cerebral hemodynamic features of patients with different types of acute ischemic stroke are still obscure. We compared cerebral vasomotor reactivity (VMR) in acute cortical (CI) and subcortical (SI) brain infarcts.
Acute stroke patients (within 72 h of stroke onset) underwent transcranial Doppler and the Diamox test (1 g acetazolamide IV). The percent difference between blood flow velocities in the middle cerebral arteries before and after acetazolamide was defined as VMR%. CI and SI infarcts were confirmed by computerized tomography and/or magnetic resonance imaging. Clinical status and disability were assessed by means of the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) respectively.VMR% values and stroke severity and disability parameters were compared between CI and SI groups using ANOVA and Pearson's correlation (r) coefficients.
VMR% values of the ipsilateral side to the brain infarct in the CI group were significantly lower as compared with SI group (12.2+/-15.9% and 25.6+/-24.4% respectively, P=0.03). VMR% values in both groups were not correlated with stroke severity and disability (P<0.2).
Our results suggest greater vulnerability of resistance arterioles in the setting of cortical gray matter infarcts. Although gray matter VMR is physiologically higher than white matter VMR, patients with acute CI have impaired cerebral vascular reserve.
Journal of the Neurological Sciences 06/2007; 257(1-2):121-5. · 2.24 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Stroke is a multifactorial disease in which genetic factors play an important role. This study was carried out to determine angiotensin-converting enzyme (ACE) gene polymorphism in Turkish acute stroke patients and to establish whether there is an association of angiotensin-converting enzyme gene I/D polymorphism with clinical parameters. In this study 185 patients and 50 controls were recruited. We have investigated the association among the allelic distribution of the insertion/deletion (I/D) polymorphism of the ACE gene identified by polymerase chain reaction. Distribution of ACE gene I/D genotypes and allele frequencies in patients were not significantly different from controls. D allele frequencies were 57.8% in patients versus 53.0% in controls and I allele 42.2% versus 47% respectively. History of hypertension, stroke, renal, heart and vessel diseases incidence and age, gender, systolic-diastolic blood pressures and creatinine levels were significantly high in patients. But these results and ACE activities had no significant differences among the ACE genotypes in patients and controls. Our results suggest that the ACE gene polymorphism is not associated with the pathogenesis of stroke in Turkish stroke patients.
Arquivos de Neuro-Psiquiatria 07/2006; 64(2A):211-6. · 0.83 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Some methylenetetrahydrofolate reductase (MTHFR) gene mutations cause hyperhomocysteinemia and homocystinuria. These may be important risk factors for cardio and cerebrovascular diseases. We investigated whether the MTHFR C677T and A1298C polymorphisms contribute to hyperhomocysteinemia and increase the risk factor for stroke.
A total of 203 acute stroke patients and 55 controls were recruited. Polymorphisms were determined by using polymerase chain reaction-restriction fragment length polymorphism (RFLP) and plasma total homocysteine levels were measured by enzyme-linked immunosorbent assay (ELISA).
There were no significant differences between C677T and A1298C genotypes and allele frequencies in the stroke patients and controls. Total plasma homocysteine level was higher in the 677TT and 1298AA genotypes in stroke patients and especially small-vessel disease patient subgroup. Age, number of males, systolic-diastolic blood pressures, creatinine, vitamin B(12) and homocysteine levels were significantly high among stroke patients. Age, sex, systolic blood pressure and HDL-C were determined as risk factors for homocysteine levels. We also determined that the effect of A1298C polymorphism on homocysteine was not as high as that of C677T polymorphism in acute stroke patients. We conclude that the MTHFR genotype may be a modest risk factor for stroke in Turkish population.
[Show abstract][Hide abstract] ABSTRACT: We assessed the effect of intravenous high-dose methylprednisolone (IVMP) on cerebral reactivity in multiple sclerosis (MS) patients during exacerbations by means of functional transcranial Doppler imaging. Forty-eight clinically defined MS patients were evaluated with visual evoked potentials (VEP) and functional transcranial Doppler sonography (TCD) of both posterior cerebral arteries before and after 5 days of 1000 mg IVMP. After treatment, mean Expanded Disability Status Scale score, mean blood flow velocities and mean blood flow velocities at rest and at stimulation, significantly decreased (p < 0.0001, for each). The change in cerebral blood flow velocity ratio (CBFv) with visual stimulation after treatment increased slightly (p = 0.20). All TCD parameters were not significantly correlated with VEP changes. In conclusion, we observed significant changes in CBFv with a non-significant increase in vascular reactivity after treatment with IVMP in exacerbations of MS. Case-control studies are necessary to draw conclusions regarding the beneficial effects of IVMP treatment.
Journal of Clinical Neuroscience 03/2006; 13(2):214-7. · 1.25 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Radial artery (RA) is now used widely as a conduit of choice in coronary artery bypass grafting. Although RA removal is considered safe in the presence of adequate collateral arterial supply, there is still a considerable suspicion on the functional status of the forearm and hand. However, a neurological dysfunction may occur owing to either surgical trauma or ischemic neuropathy. This study was aimed to investigate the functional outcome of the donor forearm nerves of the patients who underwent coronary artery bypass grafting surgery with RA conduits.
A consecutive series of 50 patients who underwent coronary artery bypass graft surgery with one or two RA grafts were investigated in the study. Motor and sensory functions of donor forearm nerves were measured by ENMG studies, pre- and postoperatively at the third week and sixth month of the operation. The conduction velocities, distal latencies and amplitudes of action potentials for motor and sensorial conductions of radial, ulnar and median nerves were measured in each ENMG examination. Neurologic status of the donor forearm and hand was assessed by the same neurologist who performed a detailed neurologic physical examination and ENMG studies. Results were statistically compared using one-way ANOVA test.
The incidence of any neurologic symptoms was 32% in early postoperative period. All reported neurologic complaints were associated with sensory conduction deceleration in ENMG investigations of related nerves. In postoperative assessment, median nerve sensory-motor, and ulnar nerve motor conduction records were slightly lower than the preoperative values, but no statistical difference was observed. Pre- and postoperative radial nerve motor and sensory conduction records were statistically similar (P>0.05).
We advocate that removal of RA does not lead to any major neurologic hand complications in the presence of adequate collateral arterial blood supply. ENMG studies confirmed minimal conduction alterations with no statistical significance, even if neurologic symptoms were stated.
European Journal of Cardio-Thoracic Surgery 10/2005; 28(3):420-4. · 2.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The effects of age and hematocrit on transcranial Doppler (TCD) velocities have not been evaluated in a large patient group with recent ischemic stroke.
This study assessed the effects of age and hematocrit on TCD measurements in patients with recent ischemic stroke compared to patients with non-vascular diseases.
University Hospital, retrospective study.
TCD records and data files of 862 consecutive patients (mean age, 57+/-16 years) with various neurological diagnoses were reviewed retrospectively. The peak systolic, end diastolic and mean flow velocities (FV), systolic/diastolic ratios and pulsatility indices (PI) in the middle cerebral arteries were averaged and the effect of age and hematocrit values on these TCD values was studied. Independent samples t test, Pearson's coefficients of correlation, and linear regression test were used for statistical analysis.
Among 862 patients, 413 were women (mean age, 53+/-17 years) and 449 were men (mean age, 60+/-13 years). Peak systolic and mean FV were higher and hematocrit concentration was lower in women compared to men (P< 0.001). The relation of TCD velocities with age and hematocrit was more remarkable in the group of patients with non-vascular neurological disorders. PI values demonstrated a significant correlation to age (r=+0.47) (P< 0.001), but did not change significantly with hematocrit level.
It should be remembered that blood FV measured by TCD may be significantly affected by age and hematocrit level. However, there seems to be no significant association between TCD velocities and hematocrit in patients with a recent ischemic stroke.
Neurology India 03/2005; 53(1):51-4; discussion 54. · 1.04 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to measure the effects of electromagnetic waves (EMW) at 900 MHz. EMW were produced by a signal generator and were administered to mice via an antenna. The frequency of the waves was tested by a spectrum analyser and a frequency-meter. The emitted power was 0.25 mW. A total of 117 mice (59 prepubertal and 58 adult) was used. Mice were exposed to EMW or sham radiation for 2 h and 20 h before an injection of pentylenetetrazole (PTZ). A statistically significant difference was found between the latency measurements within 20 h for prepubertal mice in stages 1 and 2 ( p<0.05). The effects on prepubertal mice of long-term 900 MHz EMW in a PTZ model may be an indication of possible problems in developing brains.
[Show abstract][Hide abstract] ABSTRACT: Electrical cardioversion (ECV) in patients with atrial fibrillation (AF) is known to be associated with an increased peri-procedural risk for thromboembolic events. ECV of AF for at least 3 weeks of effective oral anticoagulation was recently determined to be disassociated with occurrence of cerebral circulating microemboli (ME). Nonetheless, whether ECV in patients undergoing short-term anticoagulation with heparin is concomitant with cerebral ME still remains obscure. The objective of this study was to determine whether or not short-term anticoagulation with heparin helps avoid microemboli before and immediately after cardioversion of AF in patients undergoing transesophageal echocardiography (TEE)-guided ECV.
A total of 34 patients (21 women, aged 61+/-12 years) who underwent TEE-guided ECV were enrolled into the study. All the patients underwent treatment with heparin for 3 days for anticoagulation before ECV. Transcranial Doppler ultrasonography (TCD) of the right middle cerebral artery and left middle cerebral artery was simultaneously performed through the temporal skull with a two-channel 2-MHz probe in all patients lasting for 30 min before ECV and 30 min immediately after successive ECV.
No ME were detected in 34 patients during the 30-min period during AF before ECV. Similarly, after ECV no ME were observed during 30-min monitoring in 27 patients who were converted to sinus rhythm. None of the patients presented with clinical signs or symptoms suggestive of manifest cerebral embolism either before or after ECV.
TCD monitoring did not disclose any evidence of microemboli in short-term anticoagulated patients with heparin before and immediately after TEE-guided ECV.
International Journal of Cardiology 04/2003; 88(1):107-12. · 6.18 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The frequency of complications resulting from angiograms reported in the literature vary between 0.2-5 percent. This study was planned to determine the changes in cerebral blood flow velocity before and after angiography, using transcranial doppler in patients of subarachnoid hemorrhage (SAH) undergoing angiographies. Thirty patients with subarachnoid hemorrhage underwent transcranial doppler ultrasonography immediately before and after angiography. Nonionic water-soluble agents were used during the angiograms. The mean flow velocity (MFV) and pulsatility index (PI) at the M1 segment of both middle cerebral arteries was simultaneously measured. When the patients (11 male, 19 female, mean age+SD; 52.45+12.06) were compared according to changes in MFV and PI, pre and post-angiography, there was no statistical difference in MFV (p=0.51 and p=0.99, left and right side respectively), and in PI (p=0.48 and p=0.66) pre and post angiography. Although angiogram can be used to detect vasospasm in SAH, it can also be cause of vasospasm, partially due to the effect of the contrast agent on the cerebral arteries. This study proposes that the angiographic method is still safe and TCD can be used to follow up any possible changes in diameter of cerebral arteries before and after angiography.
Neurology India 01/2003; 50(4):459-61. · 1.04 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To assess whether a correlation between perfusion changes to visual stimulus on the bilateral occipital areas and blood flow velocity changes to visual stimulus in both posterior cerebral arteries is present.
Nine right-handed healthy subjects (4 women and 5 men; mean +/- SD age, 58.0 +/- 5.6 years) were included in the study. Visual stimulation was performed in room light with the subject's eyes open and looking around versus eyes closed as the stimulus-off condition. The blood flow velocities were recorded using transcranial Doppler sonography, and the regional cerebral blood flow measurements were recorded with the use of technetium Tc 99m exametazime and a single photon emission computed tomographic gamma camera system. Individual reactivity was defined as a relative increase of blood flow velocity and perfusion, which were calculated as percentage changes of baseline values.
Visual stimuli produced a marked increase of blood flow velocity in both posterior cerebral arteries (35.2 +/- 2.3 cm/s; P < .001) without a significant side-to-side difference in all subjects as well as a marked increase of perfusion on both occipital areas (24.9 +/- 4.8 cm/s; P < .01). Moreover, there was a positive correlation between blood flow velocity changes and perfusion changes on both sides (r = 0.833; P < .01).
The use of bilateral simultaneous Doppler recordings by means of a flow velocity averaging algorithm to a specific stimulus allows quantitative assessment of blood flow responses, and simple visual stimuli can be applied for different disorders to assess the vasomotor regulation that may result in measurable abnormal cerebral flow regulation even when clinically stabilized.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 10/2002; 21(9):955-9. · 1.40 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We assessed the blood flow velocity (BFv) changes to visual stimuli using transcranial Doppler (TCD) in patients with multiple sclerosis (MS) during an exacerbation period by means of vasoneuronal coupling. Eighty-four patients (19 men, 75 women) and 45 healthy subjects (14 men, 31 women) were studied. Both posterior cerebral arteries (PCAs) were simultaneously monitored by TCD sonography during 10 cycles of 20 s eyes open observing complex moving visual images, and 20 s eyes closed at the end of every cycle. TCD sonography was performed at least at the first 2 days of exacerbation. Mean cerebral BFv throughout the procedure (p=0.003, p=0.001; right and left sides, respectively), velocity at rest (p=0.001, p<0.001), and velocity at stimulation (p=0.021, p=0.01) on both PCAs were significantly lower in patients than controls. However, BFv changes to visual stimulation on both sides were significantly higher in patients (p=0.01, p=0.031) compared to controls. There were negative correlations between P100 latencies and relative blood flow changes on both sides, but it was not significant on the left side. These results may suggest that patients with MS during exacerbation have more reactive vessels in the posterior circulation and! or more reactive neurons in the occipital cortex.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to evaluate the occurrence of micro embolic signals (MES) in patients with a cerebral ischaemia using transcranial doppler monitoring and to find out its diagnostic relevance. We prospectively performed bilateral multigated transcranial doppler monitoring from both middle cerebral arteries in 359 patients with an acute or recent (<4 weeks) cerebral ischaemic event, and in 182 control subjects without a cerebral ischaemic event. MES were analysed according to the standardised protocol. Patients with cerebral ischaemic events had a significantly higher (p<0.00001) rate of MES occurrence (31.8%) than control subjects (5.5%). MES were detected significantly higher in patients with partial or total anterior circulation infarcts (39.1%) than in those with lacunar infarcts (26.0%) or transient ischaemic attacks (27.3%). A correlation of MES and neuroimaging finding was also tried. TCD was found to have a predictive role in microemboli monitoring, predominantly in patients with large vessel territory infarction.
Neurology India 09/2001; 49(3):225-30. · 1.04 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To identify the risk factors for falling after stroke, to establish the relation with lesion localisation, and to evaluate the incidence of falling.
The falling history and the mood of 293 patients with stroke were investigated by a standard questionnaire. Other information (time since stroke, risk factors, and CT) about patients was obtained from their hospital records.
Increasing age, depression, and heart disease were significant risk factors for falling (heart disease had a negative influence). A right hemispheric infarct was significantly more common among the falling group.
This study suggests clues for possible modifications of the management of patients with stroke during the recovery period.
[Show abstract][Hide abstract] ABSTRACT: The changes of regional cerebral blood flow (rCBF) related to metabolic demand depend on both integrity of neuronal function and vascular blood flow. Therefore, we assessed the motor stimulus to blood flow velocity (BFv) changes of bilateral middle cerebral arteries (MCA) by transcranial Doppler (TCD) sonography in normal subjects. Eighteen subjects (nine female, aged 48.0+/-3.8 years; nine male, aged 54.4+/-4.8 years) were investigated. Bilateral TCD sonography from both MCA were monitored during ten cycles of 20 s when subjects were performing bilateral hand gripping with a frequency of one per second, and subsequently 20 s when they were rest. Bilateral hand gripping showed a significant BFv increase on both MCA (P<0.001). These values were (19+/-2)% on both sides. There was no significant side to side difference between the absolute BFv values both at rest and during bilateral hand gripping. Additionally, the absolute BFvs and BFv increases were not significantly different between male and female subjects. This study was based on a small sample size, and the method requires the subject cooperation. Our results suggest that bilateral hand gripping may affect blood flow in both MCA without side to side differences. Finally, our suggestion is that test might be useful to assess the neurovascular integrity.
European Journal of Ultrasound 06/2000; 11(2):147-50.
[Show abstract][Hide abstract] ABSTRACT: Amblyopia represents the most common form of visual impairment in children, affecting approximately 2% of the population. To determine the efficacy of the dopamine agonist levodopa for childhood amblyopia, a double-masked, placebo-controlled randomised study was performed on 32 amblyopic children with central fixation between 4 and 17 years. Subjects received 2 mg/kg levodopa benzeraside or placebo 3 times per day over a 1 week period. Estimates of visual acuity for each eye (Snellen visual acuity) were obtained, and pattern-shift visually evoked potentials (VEP) were examined by an opthalmologist and a neurologist. At the end of dosing regimens, the levodopa group was significantly improved in visual acuity by 1.4 lines and pattern VEP amplitudes. No changes could be detected after placebo administration. One week after the termination of the treatment, Snellen line acuity and pattern VEP amplitude were decreased to pretreatment levels. The transient effect of levodopa points to a long-term treatment with the substance. Our results should therefore encourage further long-term clinical trials investigating the therapeutic potential of levodopa in amblyopia.