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Öğe Association between recurrence of stroke and peripheral artery disease after first-ever stroke(Sage Publications Ltd, 2023) Kumral, Emre; Cetin, Fatma Ece; Ozdemir, Huseyin Nezih; Orman, Mehmet[No abstract available]Öğe The Clinical and Cognitive Spectrum of Artery of Percheron Infarction: 1-Year Follow-Up(Cambridge Univ Press, 2022) Cetin, Fatma Ece; Kumral, Emre; Dere, BirgulObjective: Survivors of patients with artery of Percheron infarction (API) often have a prolonged and disabling form of cognitive impairment that remains insufficiently characterized. We aimed to examine the clinical and cognitive features of API in the short and long term after stroke. Methods: We reviewed 6400 patients with a first-ever stroke included in the Stroke Registry between 2011 and 2021. The diagnosis of API was based on clinical diagnosis and imaging confirmation. All patients underwent neuropsychological assessment at hospital stay and 1 year after stroke. A z-score of each patients' cognitive test point was calculated, and a z-score inferior to 2 was considered as pathological. Results: Of the 10 patients enrolled, all had cognitive impairment, consciousness, and behavioral disorders at stroke onset. Six patients had pure bilateral thalamic involvement while four had bilateral thalamic and rostral midbrain involvement. At 12 months, 50% of patients had global mental state scores 2 SD below the population mean (z-score mean +/- SD, -2.17 +/- 0.4). Most of the prefrontal cortex cognitive processes including executive functions such as planning and cognitive control (z-score mean +/- SD, -3.92 +/- 0.3), processing speed (-4.42 +/- 0.5), working memory (-3.97 +/- 0.3) were severely impaired at stroke onset. Especially in patients with thalamic and rostral midbrain involvement, deficiencies in executive function (z-score mean +/- SD, -2.60 +/- 0.4), processing speed (-2.22 +/- 0.5), working (-3.76 +/- 0.4), and episodic memory (-2.23 +/- 0.3) continued 12 months after stroke. Conclusions: The occlusion of the artery of Percheron results in severe behavioral and cognitive disorders in the short and long term after stroke.Öğe The clinical and cognitive spectrum of locked-in syndrome: 1-year follow-up of 100 patients(Springer Heidelberg, 2022) Kumral, Emre; Dorukoglu, Mesut; Uzunoglu, Cansu; Cetin, Fatma EceIn patients with locked-in syndrome (LIS), it is not known exactly to what extent cognitive functions are preserved and it is not known exactly how much it has improved. We aimed to examine the clinical and cognitive features of LIS 1 year after stroke. One hundred patients with locked-in syndrome (LIS) were recruited between January 2008 and May 2019 among 8200 patients with ischemic stroke. Patients were classified into two groups as single pontine infarcts (n = 72), and pontine plus multiple ischemic lesions (PMIL) (n = 28). Since the patients had limited motor and verbal response, the cognitive status of the patients in the early and late stages was evaluated with the Short Neuropsychological Questionnaire for Disabled Patients (SNQDP) test. At the onset of stroke, orientation to time and place was normal in 43% of patients with a single infarct compared with 18% of those with PMIL (OR 3.48; 95% CI 1.10-10.18; P = 0.015). There was no sustained visual fixation or tracking in 53% of patients with a single pontine infarct and 82% of those with PMIL (OR 4.12; 95% CI 1.41-12.02; P = 0.005). After 1-year follow-up, there was significant difference between patients with a single infarct and those with PMIL regarding to perception and execution, especially complex command follow (P = 0.042), attention span and concentration (P = 0.30), intelligible verbalization (P = 0.022). There was relatively high incidence (24%) of patients with a good outcome (mRS = 3) in those with single infarct. Given as in our study that many patients can show significant improvement in LIS, we recommend aggressive supportive measures, intense physical, speech and cognitive therapy to facilitate interaction with others and the environment.Öğe Efficacy of citalopram on stroke recurrence: A randomized clinical trial(Elsevier Sci Ltd, 2022) Cetin, Fatma Ece; Kumral, Emre; Gonul, Ali Saffet; Ozdemir, Hueseyin Nezih; Orman, MehmetPost-stroke depression is one of the main causes of cerebrovascular and cardiovascular diseases. The aim of the present study was to investigate the efficacy of citalopram on stroke recurrence. A 52-week, randomized, double-blind, study involved 440 ischemic stroke patients with depression. Patients with depression who met depression criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV and V) and Hamilton Depression Rating Scale >= 8 (HAM-DRS) were dichotomized into patients receiving citalopram (225 patients), titrated according to clinical response, and patients with placebo (215 patients) for 52 weeks. The primary outcome measure was stroke recurrence and the secondary outcome measures were cardiovascular events and mortality. Stroke recurrence (66% vs 34%; P = 0.001) and cardiovascular events (76% vs. 24%; P = o.oo1) were significantly higher in the placebo group compared to those treated with citalopram. Multivariable analysis showed that hypertension, atrial fibrillation, and large-artery disease were significantly associated with stroke recurrence. Executive processing disorder was more associated with stroke recurrence than other neuropsychological disorders (OR, 1.74; CI95%, 1.04-2.89; P = 0.035). Survival analysis showed that treatment for depression interacted with time to reduce stroke recurrence by nearly half (39% vs. 61%; P = 0.05). The current study supports the importance of depression treatment in protecting the patients from recurrent strokes. This result warrants further studies to demonstrate the efficacy of depression treatment on stroke recurrence.Öğe Presence of Concomitant Depression and its Effect on Clinical Course in Patients Diagnosed with Myasthenia Gravis(Turkish Neurological Soc, 2021) Cetin, Fatma Ece; Karasoy, HaticeObjective: Myasthenia gravis (MG) is a chronic autoimmune disease with fluctuating non-specific symptoms, and symptoms are exacerbated by stress. Many psychiatric disorders, especially depression, may accompany MG. This study aimed to determine the presence of depression accompanying MG and the effect of depression on the clinical course. Materials and Methods: Ninety-eight patients were diagnosed with MG between the ages of 18 and 65 who had a follow-up of at least 1 year at Ege University Faculty of Medicine, Department of Neurology, Muscular Diseases Outpatient Clinic and who did not have any medical or psychiatric illness that prevented communication were included in our study. Instead, of using questionnaire forms to diagnose depression, a one-to-one interview method following Structured Clinical Interview for DSM-IV Criteria (SCID-1) was preferred. The clinical course of patients with and without depression and their responses to standard symptomatic or immunosuppressive therapy was evaluated using the MG treatment response rating scale by the lead investigator, who was blind to the presence of depression in patients. Results: In the SCID-1 evaluation of our patients, depression was detected in 40.8% of the patients. Of our patients, 64.9% identified a stressor factor before the onset of disease symptoms. In the evaluation of treatment response, 19.4% of our patients had remission, and 80.6% had minimal symptoms. In evaluating the change in the clinical situation, improvement was detected in 88.8% of the patients. A statistically significant relationship was found between worse treatment response and depression (p=0.018). Conclusion: It was determined that depression was frequently present in patients with MG and the clinical course was worse in patients with depression. Therefore, it was aimed to draw attention to the importance of detecting depression in patients with MG and that treatment regulation in this direction might positively affect the course of the disease.
