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Öğe A Case of Listeria Rhombencephalitis Mimicking Vertebrobasilar Stroke(Turkish Neurological Soc, 2016) Kilic, Ilay Hilal; Guler, Ayse; Sirin, HadiyeÖğe Chronic inflammatory demyelinating neuropathy associated with Graves disease: A case report(Journal Neurological Sciences, 2008) Guler, Ayse; Gokcay, Figen; Isman, Damla; Diramali, BanuScientific background: Chronic inflammatory demyelinating polyneuropathy ( CIDP) is presumed to occur by autoimmune mechanisms. Its course is multifocal demyelination of the peripheral nerves. If the progress of clinical picture is longer than 2 months, CIDP must be considered. It often presents with symptoms that include weakness of the arms and legs, tingling or numbness, and spontaneous pain. Graves disease or in other words diffuse toxic goiter is one of the most frequent type of thyrotoxicosis in the population. It is an autoimmune disease caused by thyroid stimulating antibodies and immunoglobulins against TSH receptors. Graves disease's triad includes goiter, thyrotoxicosis and ophtalmopathy. In this paper; a case of comorbidity of these two autoimmune conditions is presented with additional referral to the literature. Case: 26 year-old woman presented with the complaints of tingling, numbness, pain and weakness of upper and lower extremities. She stated that tingling, numbness and weakness progressed in 3 months accompanied by mild pain. CIDP is considered according to the neurological examination, EMG findings, albuminocytologic dissociation in CSF, exclusion of the other PNP reasons and the history of clinical progression in 3 months. Conclusion: This case is presented to emphasize that the rare comorbity of these two autoimmune situations, CIDP and Graves might be due to the probable common pathogenesis.Öğe Clinical and video head impulse test in the diagnosis of posterior circulation stroke presenting as acute vestibular syndrome in the emergency department(Ios Press, 2017) Guler, Ayse; Akarca, Funda Karbek; Eraslan, Cenk; Tarhan, Ceyda; Bilgen, Cem; Kirazli, Tayfun; Celebisoy, NeseINTRODUCTION: Head impulse test (HIT) is the critical bedside examination which differentiates vestibular neuritis (VN) from posterior circulation stroke (PCS) in acute vestibular syndrome (AVS). Video-oculography based HIT (vHIT) may have aadditional strength in making the differentiation. METHODS: Patients admitted to the emergency department of a tertiary-care medical center with AVS were studied. An emergency specialist and a neurologist performed HIT. vHIT was conducted by an neuro-otology research fellow. RESULTS: Forty patients 26 male, 14 female with a mean age of 49 years were included in the analyses. Final diagnoses were VN in 24 and PCS in 16 patients. In the VN group, clinical HIT was assessed as abnormal in 19(80%) cases by the emergency specialist and in 20(83%) by the neurologist. In all PCS patients, HIT was recorded as normal both by the emergency specialist and the neurologist (100%). On vHIT, patients with VN had significantly low gain values for both the ipsilesional and contralesional sides when compared with the healthy controls, with significantly lower figures for the ipsilesional side (p < 0.001). All patients in this group had normal DWI-MRI. PCS patients had bilaterally low gain (p < 0.05) on vHIT. However, gain asymmetry was not significant. Subgroup analyses according to presence of brainstem involvement revealed bilateral low gain (p < 0.05) in patients with brainstem infarction (anterior inferior cerebellar artery-posterior inferior cerebellar artery stroke, AICA-PICA stroke) whereas patients with pure cerebellar infarction (posterior inferior cerebellar artery-superior cerebellar artery stroke, PICA-SCA stroke) had gain values similar to healthy controls. With a gain cut-off <= 0.75 and gain asymmetry cut-off >= 17%, as determined by ROC analysis, 100% of PCS patients and 80% of VN patients were correctly diagnosed. CONCLUSIONS: Clinical HIT, either performed by an emergency specialist or neurologist is equivalent to vHIT gain and gain asymmetry analysis as conducted by neuro-otologist in the diagnosis of PCS, albeit mislabeling about 20% of VN patients. vHIT does not appear to yield additional diagnostic information. These findings indicate the strength of clinical HIT. Pure gain-based vHIT analysis seems limited and needs to be incorporated with saccade analysis.Öğe Cost Analysis of Nosocomial Infections in a Tertiary Care Referral Hospital's Neurology Intensive Care Unit: A Case-Control Study(Journal Neurological Sciences, 2015) Taner, Safak; Guler, Ayse; Sirin, Hadiye; Pullukcu, Husnu; Arda, BilginAim: The purpose of this study is to overview nosocomial infections (NI), to determine risk factors and to evaluate the clinical and financial impact of NI on direct hospital cost among neurology intensive care unit (NICU) patients in a tertiary-care referral hospital. Material and Methods: A retrospective case control study was performed. The sample size was calculated to be at least 51 per group. A list of the last 55 patients who acquired an infection in NICU was obtained from infection control committee. These patients were matched with uninfected patients according to age, sex, diagnosis. The data were collected from patient files, accounting records. Results: A total of 79 NI occurred in 55 cases. The most common NI were pneumonia (48%), catheter related urinary tract infection (39%). Acinetobacter baumannii (25%) is most commonly responsible for NI. NI were detected less in patients who were conscious, non-intubated, without blood transfusion, tracheostomy, urinary catheter or mechanical ventilation. The mortality ratio was 53.1% in cases and 30.8% in controls. The excess costs of NI were $7121.15 and extra length of stay was 26.9 days. Although reimbursement took longer than six months, the Social Security Institution paid back the total billing amount. Conclusion: Given the impact on monetary and health costs of NI, measures to prevent NI in the hospital are strongly recommended for patient safety and for hospital reputation. NICUs in tertiary care referral facilities do not cause financial burden; on the contrary, they provide an opportunity to balance the budget.Öğe Determinants of in-hospital muscle loss in acute ischemic stroke- Results of the Muscle Assessment in Stroke Study (MASS)(Churchill Livingstone, 2023) Gungor, Levent; Arsava, Ethem Murat; Guler, Ayse; Isikay, Canan Togay; Aykac, Ozlem; Caglayan, Hale Zeynep Batur; Kozak, Hasan HuseyinBackground & aims: There is a change in the mass and composition of paretic and non-paretic skeletal muscles in the chronic phase of stroke. The multi-center, prospective, and observational Muscle Assessment in Stroke Study (MASS) was performed to evaluate the degree of muscle loss during the in-hospital acute stroke setting and determine factors contributing to this loss.Methods: Acute dysphagic ischemic stroke patients (n = 107) admitted to neuro-intensive care units were evaluated by computed tomography on days 1 and 14 after admission to determine the cross-sectional muscle area (CSMA) at the level of the mid-humerus, mid-thigh, and third lumbar vertebra. The percentage change in CSMA and variables associated with this change were evaluated by univariate and multivariate analyses.Results: There were significant reductions in CSMA in all the muscle groups analyzed; the most prom-inent change was observed in the arms (both: 14.2 +/- 10.7%; paretic: 17.7 +/- 11.6%; non-paretic: 10.1 +/- 12.5%), followed by the muscles in the legs (both: 12.4 +/- 8.7%; paretic: 12.9 +/- 9.9%; non-paretic: 12.0 +/- 9.3%) and L3-vertebra level (5.6 +/- 9.8%) (P < 0.001 for all). Higher calorie (r =-0.378, P < 0.001) or protein (r =-0.352, P < 0.001) intake was negatively associated with the decrease in CSMA of upper extremities. A substantial protein (>= 0.4 g/kg/d) or calorie (>= 5 kcal/kg/d) gap between targeted or actual intake was related to a larger decrease in CSMA in all the anatomic regions (P < 0.05 for all). Other significant predictors of muscle loss included history of diabetes mellitus, male sex, higher BMI, in-hospital infections, and the necessity for invasive mechanical ventilation.Conclusions: There is a considerable degree of loss in the global muscle mass in acute ischemic stroke patients over a two-week period. Along with several factors, falling significantly behind the daily protein or calorie targets was related to the decrease in the muscle area. Trial registration information: clinicaltrials.gov identifier NCT03825419.(c) 2023 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.Öğe The effects of the cerebral, cerebellar and vestibular systems on the head stabilization reflex(Springer-Verlag Italia Srl, 2016) Bademkiran, Fikret; Uludag, Burhanettin; Guler, Ayse; Celebisoy, NeseThe head stabilization reflex (HSR) is a brain stem reflex which appears in the neck muscles in response to sudden head position changes and brings the head to its previous position. The reflex mechanism has not been understood. The afferent fibers come from cervical muscle spindles, vestibular structures, and the accessory nerve, the efferents from the accessory nerve. In this study, we aim to investigate the roles of supraspinal neural structures and the vestibular system on the HSR. The patient group consisted of 86 patients (33 cerebral cortical lesion, 14 cerebellar syndrome and 39 vestibular inexcitability or hypoexcitability); the control group was composed of 32 healthy volunteers. Concentric needle electrodes were inserted into the sternocleidomastoid muscle (SCM) and the accessory nerves were stimulated with the electrical stimulator. A reflex response of about 45-55 ms was obtained from the contralateral SCM muscle. 50 % of cases had bilateral loss whereas 37 % of cases with unilateral cerebellar lesions had an ipsilateral reflex loss. Bilateral HSR loss was detected in 84 % of cases with bilateral cerebellar lesions. Bilateral reflex loss was observed in 70 % of patients with unilateral cortical lesions and 94 % of those with bilateral vestibular dysfunction. Ipsilateral HSR loss was observed in 55 % of cases with unilateral vestibular dysfunction. It was discovered that supraspinal structures and the vestibular system may have an excitatory effect on HSR. This effect may be lost in supra-segmental and vestibular dysfunctions. The localization value of HSR was found to be rather poor in our study.Öğe The Ege Agraphia Test Battery for Identifying the Writing Disorders in Cases with Mild Cognitive Impairment and Alzheimer's Disease(Turkiye Sinir Ve Ruh Sagligi Dernegi, 2016) Evyapan Akkus, Dilek; Guler, AyseObjective: The purpose of this study is to create an agraphia test battery specific to Turkish language, to obtain normative data for the performance and error types of this test and to demonstrate its success in detecting cognitive disorders in mild cognitive impairment (MCI) cases that can't be diagnosed by formal neuropsychological tests due to the fact that writing is a complex function. Method: For this purpose, 20 healthy control (HC) subjects, 20 MCI cases and 20 Alzheimer's disease (AD) patients with Clinical Dementia Rating (CDR) of 1 were evaluated with Ege Agraphia Test Battery. Results: Significant differences between the performance points and the error types of HC subjects, MCI cases and AD patients were obtained. As the cognitive impairment of the subjects in the study got worse, the writing skills also became worse revealing lower test points. Besides, some statistically significant differences between the error types of MCI cases and AD patients were found. Conclusion: Ege Agraphia Test Battery is not only a practical test, but also is the first defined agraphia test specific for Turkish language. Writing disorders in cases with MCI support the view that MCI is a transition period for AD. Further studies are required to increase the test data and proper rearrangements of the test battery.Öğe Epileptic nystagmus with different localization of lesions in magnetic resonance imaging in a patient with MELAS(Ege Univ, 2018) Tabakoglu, Aycin Yildiz; Ciftci, Seyma; Ekinci, Aysen Suzen; Guler, Ayse; Bademkiran, Fikret; Karasoy, Hatice; Aydogdu, IbrahimMitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) is a syndrome which is characterized as mitochondrial myopathy, encephalopathy, lactic acidosis and recurrent stroke-like episodes. Recurrent attacks of prolonged migrainous headache, different types of epileptic seizures and repeated cerebral lesions are the main clinical features of the disease. Cerebral lesions can cause different seizure types in this syndrome according to affected brain areas. Herein, we are reporting a case of MELAS who experienced recurrent neurologic deficits, confusional states and epileptic seizures with ictal epileptic nystagmus. Ictal electroencephalogram (EEG) recordings and magnetic resonance imaging (MRI) lesions also supported to the ictal focus of epileptic nystagmus. With this case, we would like to take attention to this rare ictal event.Öğe Evaluation of posterior reversible encephalopathy syndrome from different aspects: What is the role of serum LDH and albumin level in pathogenesis?(Asean Neurological Assoc, 2016) Guler, Ayse; Ciftci, Seyma; Eraslan, Cenk; Celebisoy, Nese; Sirin, HadiyeBackground: Posterior reversible encephalopathy syndrome (PRES), is characterized by headache, lethargy, visual complaints and epileptic seizures. Brain imaging findings include abnormalities of the white matter and the grey matter. The diagnosis currently relies on clinical manifestations and typical neuroimaging findings. Different pathophysiological factors can play role in the disease process. The purpose of this study is to review causes, clinical aspects, imaging-laboratory findings and prognosis in patients diagnosed with PRES. Method: Patients who showed clinical and magnetic resonance imaging (MRI) findings consistent with PRES between January 2011 and December 2014 were included in the study. Patient data were collected retrospectively from hospital records. Results: Total number of patients was 22 (18 female, 4 male). Median age was 28 years (range 18-84). Comorbid conditions included eclampsia (n=10, 45%), pre-eclampsia (n=1, 4.5%), HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome (n=1), primary kidney disease (n=3, 13%). Acute elevation of blood pressure was found in 9 patients (40%). Five patients (22%) were using steroids or immunosupressive drugs. Typical PRES imaging pattern with bilateral parieto-occipital involvement was present in 15/22 patients (68%) and occipital involvement was present in 3/22 patients (14%). Atypical neuroimaging features included frontal involvement in 10 patients (45%), basal ganglia gray matter lesion in 1 patient (4%) and the cerebellum was involved in 3 patients (14%). Serum LDH level was high in 13 patients (59%). Hypoalbuminemia was detected in 12 patients (54%). Conclusion: Although hypertension is thoughtto be the main pathologic factor in the disease process, endothelial dysfunction seems to be equally important.Öğe Four novel and two recurrent NHLRC1 (EPM2B) and EPM2A gene mutations leading to Lafora disease in six Turkish families(Elsevier Science Bv, 2012) Salar, Seda; Yeni, Naz; Gunduz, Aysegul; Guler, Ayse; Gokcay, Ahmet; Velioglu, Sibel; Gundogdu, Asli; Caglayan, S. HandeLafora disease (LD) is a type of autosomal recessive, progressive myoclonus epilepsy resulting mostly from mutations in the EPM2A and NHLRC1 genes. Mutational analysis in both genes was initiated with the aim of establishing LD DNA diagnosis in Turkey. Four novel NHLRC1 (p.G131X, p.P69S and p.D82H) and EPM2A (p.V7A) and two recurrent NHLRC1 (p.D146N) and EPM2A (p.R241X) mutations were identified in six families. The delineation of causative mutations in patients provided early disease diagnosis for other family members and contributed to the knowledge of LD pathogenesis. (C) 2011 Elsevier B.V. All rights reserved.Öğe Genotyping and Molecular Identification of Acanthamoeba Genotype T4 and Naegleria fowleri from Cerebrospinal Fluid Samples of Patients in Turkey: Is it the Pathogens of Unknown Causes of Death?(Springer Int Publ Ag, 2022) Aykur, Mehmet; Erdogan, Derya Dirim; Gunel, Nur Selvi; Guler, Ayse; Avci, Cigir Biray; Celebisoy, Nese; Gunduz, CumhurPurpose 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.Öğe Glasgow coma scale and APACHE-II scores affect the liver transplantation outcomes in patients with acute liver failure(Zhejiang Univ Sch Medicine, 2013) Guler, Necdet; Unalp, Omer; Guler, Ayse; Yaprak, Onur; Dayangac, Murat; Sozbilen, Murat; Akyildiz, Murat; Tokat, YamanBACKGROUND: The timing and selection of patients for liver transplantation in acute liver failure are great challenges. This study aimed to investigate the effect of Glasgow coma scale (GCS) and APACHE-II scores on liver transplantation outcomes in patients with acute liver failure. METHOD: A total of 25 patients with acute liver failure were retrospectively analyzed according to age, etiology, time to transplantation, coma scores, complications and mortality. RESULTS: Eighteen patients received transplants from live donors and 7 had cadaveric whole liver transplants. The mean duration of follow-up after liver transplantation was 39.86 +/- 40.23 months. Seven patients died within the perioperative period and the 1-, 3-, 5-year survival rates of the patients were 72%, 72% and 60%, respectively. The parameters evaluated for the perioperative deaths versus alive were as follows: the mean age of the patients was 33.71 vs 28 years, MELD score was 40 vs 32.66, GCS was 5.57 vs 10.16, APACHE-II score was 23 vs 18.11, serum sodium level was 138.57 vs 138.44 mmol/L, mean waiting time before the operation was 12 vs 5.16 days. Low GCS, high APACHE-II score and longer waiting time before the operation (P<0.01) were found as statistically significant factors for perioperative mortality. CONCLUSION: Lower GCS and higher APACHE-II scores are related to poor outcomes in patients with acute liver failure after liver transplantation.Öğe Investigation of the efficacy of colorimetric capnometry method used to verify the correct placement of the nasogastric tube(Elsevier Sci Ltd, 2017) Erzincanli, Saadet; Zaybak, Ayten; Guler, AyseObjectives: This present study was designed to determine the efficacy of the colorimetric capnometry method used to verify the correct placement of the nasogastric tube. Methods: The present study comprised forty patients who had a nasogastric tube inserted and were being monitored in the adult intensive care unit. After the insertion of the nasogastric tube, 40 colorimetric capnometry and 40 auscultation measurements were performed. Auscultation and colorimetric capnometry results were compared with tube placement results confirmed radiologically. Results: In the confirmation of the placement of the nasogastric tube, the consistency was 97.5% (p < 0.05) between the colorimetric capnometry method and the radiological method, and 82.5% (p > 0.05) between the auscultatory method and the radiological method. The oesophageal placement of the nasogastric tube was detected with the colorimetric capnometry method, but the gastric and duodenal insertions were not determined. White the sensitivity and specificity of the colorimetric capnometry method in determining the correct placement of the nasogastric tube were 1.00 and 0.667 respectively, those of the auscultatory method were 0.89 and 0.0 respectively. Conclusion: As a result, for the confirmation of the NGT placement, the colorimetric capnometry method is considered more reliable than the auscultatory method and is compatible with the radiological method. However, the colorimetric capnometry method is inadequate to distinguish between the gastric or duodenal insertion. (C) 2016 Elsevier Ltd. All rights reserved.Öğe Is there an association between migraine and atopic disorders? The results of multicenter migraine attack study(Journal Neurological Sciences, 2008) Ozge, Aynur; Ozturk, Candan; Dora, Babuer; Inan, Levent; Saip, Sebahattin; Ozturk, Musa; Vanli, Ebru Nur; Gokcay, Figen; Ozturk, Vesile; Erdemoglu, Ali Kemal; Tasmertek, Fazilet; Yilmaz, Nurguel; Ozer, Gokhan; Siva, Aksel; Demir, Nurhak; Baykan, Betuel; Guler, Ayse; Poyraz, Turan; Doner, Hatice; Sirin, HadiyeWe designed this multicenter study to evaluate the abnormalities related to the mast cell activation during attacks in a large group of migraineurs and to compare the findings both with episodic tension type headache (ETTH) and matched healthy control subjects. After the evaluation of diagnostic criteria, 213 subjects were included in this study after giving consent. Of all 146 subjects (67.8%) were migraineurs, 38 (19.4%) were ETTH patients and 29 others were healthy controls matched according to age and sex. Immunological screening showed significantly high ratios of IL-beta, IL-2, IL-6 and TNF-alpha in the migraine group compared to ETTH (16.6% vs 10.5%, 20.0% vs 5.3%, 13.8% vs 2.6% and 15.9% vs 5.3%, respectively) and to the healthy controls. Logistic regression analysis showed that only duration of headache has an important effect on having IL-2 abnormality (Exp-B: 0.322, 95% CI: 0.151-0.688, p=0.003) in patients with migraine. There was no important effect of clinical variables on serological abnormalitites or each other. In conclusion, our multicenter clinical and laboratory based study suggests that primary headache disorders (migraine and ETTH) are associated with atopic changes and they might share the inflammatory mechanism (pro-inflammatory as well as anti-inflammatory cytokine abnormalities) during headache attacks.Öğe Location of the contrast extravasation is important in predicting outcome of anterior circulation stroke patients(Asean Neurological Assoc, 2024) Ozdemir, Huseyin Nezih; Karaman, Bedriye; Guler, Ayse; Dere, Birgul; Cinar, Celal; Kumral, Dursun Emre; Sirin, HadiyeObjectives: 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.Öğe Magnetic Resonance Imaging Characteristics of Persistent Vegetative State Due to Prolonged Hypoglycemia(Premchand Shantidevi Research Foundation, 2015) Guler, Ayse; Kumral, Emre; Sirin, Tuba Cerrahoglu; Sirin, Hadiye; Kitis, OmerHypoglycemia is the sudden decrease in serum glucose level <50mg/dL. Neurological manifestations complicating profound and prolonged hypoglycemia range from reversible focal deficits and transient encephalopathy to irreversible coma. Here, we report magnetic resonance imaging characteristics of a patient with prolonged hypoglylicemia. A 47-year-old woman with a history of insulin dependent diabetes mellitus has been brought to the emergency room by her relatives. She used mistakenly overdose insulin injection and probably stayed 11 hours with low level blood glucose. The initial blood sugar level was 39.6 mg/dL at the emergency department visit, which was recovered urgently by 50% dextrose. MR imaging revealed high intensities at the bilateral posterior parietal cortices, corona radiata and hippocampus, but not in the basal ganglia. Seventy-two hour after admission, confluent lesions in the posterior parietal, temporal, frontal cortices and splenium of corpus callosum were more prominent on DWI and FLAIR, and did not match typical arterial territories. None of the lesions were enhanced on contrast-enhanced T1-weighted images. The prognosis or neurologic sequelae of hypoglycemic encephalopathy may depend on the severity and duration of hypoglycemia and persistent, diffuse involvement of the cerebral cortex, basal ganglia, or hippocampus on the following MR imaging. MR imaging findings in hypoglycemic vegetative state can be helpful in the differential diagnosis distinguishing from other neurologic conditions.Öğe Mechanical Thrombectomy With Solitaire Stent in Acute Ischemic Stroke Patients: Our First Experiences(Journal Neurological Sciences, 2014) Guler, Ayse; Cinar, Celal; Oran, Ismail; Sirin, Hadiye; Celebisoy, Nese; Akarca, Funda Karbek; Kiyan, Guclu SelahattinIntroduction: Intravenous thrombolysis or endovascular treatment for occluded vessel in acute ischemic stroke patients reduces mortality and effects prognosis. Mechanical thrombectomy shows better results than intravenous thrombolytic treatment on proximal vessel occlusions. In this study, we aimed to evaluate efficiency of Solitaire stent based mechanical thrombectomy for acute ischemic stroke patients who has proximal vessel occlusion, and its impact on prognosis of these patients. Material and Method: Data of eleven patients, who applied to Ege University Medical School Emergency Department between March 2012 -May 2013 with acute ischemic stroke diagnosis due to proximal vessel occlusion and treated with mechanical thrombectomy collected retrospectively. Inclusion criterias were: 1) Age between 18-80, 2) NIHSS >= 10 at admission, 3) ICA or ASM occlusion found on cranial and neck CT angio, 4) symptom duration <= 6 hours, 5) no contrindication for reperfusion theraphy. Results: Eleven patients treated with mechanical thrombectomy(8female/3male), and mean age of these patients were 59(min34, max 75). The mean symptom to door time was 98 minutes(30-180 minutes). Demographic data, application time, time to treatment, additional treatments, complications, NIHSS at 0 and 24 hour and mRS at discharge were evaluated. Conclusion: The main aim of acute stroke treatment is revascularizaion of occluded vessel as quickly as possible. Intravenous thrombolytic treatment is the standard treatment procedure for acute ischemic stroke. Intraarterial treatment options must be inside of our treatment strategies for the patients with acute ischemic stroke diagnosis and who had proximal vessel occlusion.Öğe Multidisciplinary clinical management of paroxysmal nocturnal hemoglobinuria(E-Century Publishing Corp, 2015) Sahin, Fahri; Ozkan, Melda Comert; Mete, Nihal Gokmen; Yilmaz, Mumtaz; Oruc, Nevin; Gurgun, Alev; Kayikcioglu, Meral; Guler, Ayse; Gokcay, Figen; Bilgir, Ferda; Ceylan, Cengiz; Bilgir, Oktay; Sari, Ismail Hakan; Saydam, GürayParoxysmal nocturnal hemoglobinuria (PNH) is a rare, acquired disease caused by clonal expansion of one or more hematopoietic stem cell (HSC) lines due to a somatic mutation of the phosphatidylinositol glycan anchor (PIG-A) gene located on Xp22.1. PNH incidence is 1.5-2 cases per million of the population per year. PNH can affect multiple systems in the body and requires multidisciplinary clinical management. Patients can manifest with severe pancytopenia, life-threatening thrombosis affecting the hepatic, abdominal, cerebral, and subdermal veins, and high requirements for blood transfusion due to haemolytic anemia. PNH can also be associated with bone marrow failure. Advances in diagnostic techniques and a targeted therapeutic approach for PNH have emerged in the last two decades. Eculizumab, a promising humanized monoclonal antibody against C5, is the first approved therapy for PNH.Öğe Ophthalmoplegia due to Invasive Fungal Sinusitis: A Report of Three Cases(Turkish Neurological Soc, 2017) Colak, Ayse Yagmur; Gokcay, Figen; Celebisoy, Nese; Gokcay, Ahmet; Guler, Ayse; Pullukcu, Husnu; Midilli, Rasit; Gode, SercanInvasive fungal sinusitis is an infection of the paranasal sinuses that should be diagnosed early due to its high mortality and morbidity rates. Mucormycosis and aspergillus are the two most important agents of invasive fungal sinusitis. Although usually seen in patients who are immunocompromised, they are rarely seen in immunocompetent patients. In this article, we present three patients with ophthalmoplegia; one patient with hematologic malignancy, and two patients with uncontrolled diabetes. By presenting these three patients with invasive fungal sinusitis, we aimed to emphasize the possible role of fungal sinusitis in the development of ophthalmoplegia in patients with diabetes or immunosuppression due to any reason, and the importance of early treatment.Öğe Post-stroke lower urinary system dysfunction and its relation with functional and mental status: a multicenter cross-sectional study(Taylor & Francis Ltd, 2019) Akkoc, Yesim; Bardak, Ayse Nur; Ersoz, Murat; Yilmaz, Bilge; Yildiz, Necmettin; Erhan, Belgin; Tunc, Hakan; Koklu, Kurtulus; Alemdaroglu, Ebru; Dogan, Asuman; Ozisler, Zuhal; Koyuncu, Engin; Atalay, Nilgun Simsir; Gunduz, Berrin; Isik, Ridvan; Guler, Ayse; Sekizkardes, Merve; Demir, Yasin; Yasar, Evren; Sasmaz, Ezgi; Satir, OzlemBackground: Review of the literature clearly reveals that little is known about the association between functional and mental status, and Lower Urinary Tract Dysfunction (LUTD) in patients with stroke. Objective: The aim of this study was to assess functional and mental status in stroke patients and to identify possible associations with the prevalence, severity and bother of LUTD. Material and methods: This study was designed as a cross-sectional study and included 260 stroke patients enrolled from six different hospitals in Turkey. The patients were questioned using the Danish Prostatic Symptom Score (DAN-PSS) Questionnaire to evaluate LUTD, and evaluated using the Modified Barthel Index (MBI), Incontinence Quality of Life Questionnaire (I-QoL), and the Mini Mental State Examination (MMSE). Results: At least one LUTD finding was reported in 243 (93.5%) patients; the most commonly encountered complaint in these patients was nocturia (75.8%). The mean MBI, MMSE, and I-QoL scores were found to be significantly lower in LUTD (+) patients compared to LUTD (-) patients (p = 0.000, p = 0.005, and p < 0.01, respectively). Similarly all parameters (MBI, MMSE, and I-QoL scores) assessed were found to be significantly lower for patients with urinary incontinence than those without incontinence (p = 0.000, p = 0.000, and p < 0.01, respectively). Conclusion: LUTD is a common problem in patients with stroke. LUTD is associated with poorer cognitive and functional status and the quality of life in these patients. We, therefore, suggest that bladder dysfunction should not be overlooked during rehabilitation of stroke patients.
