Kürşad Kutluk

Basilar artery blood flow velocity changes in patients with panic disorder following 35% carbon dioxide challenge ☆

PURPOSE We compared the mean basilar artery blood flow velocity (BABFV) between patients with panic disorder and healthy subjects both at rest and immediately following carbon dioxide (CO(2)) challenge, and examined the effects of treatment on BABFV. METHODS Twenty four patients with panic disorder with or without agoraphobia and 12 healthy comparison subjects were studied. Visual Analog Anxiety Scale was used to evaluate the anxiogenic effect of 35% CO(2) inhalation. Mean BABFV was monitored using transcranial Doppler ultrasonography at rest and 10, 20, 30, 60, 90, 120 s after 35% CO(2) challenge both before and after four weeks treatment with paroxetine. RESULTS The hemodynamic response pattern of basilar artery to CO(2) inhalation was significantly different between two groups. CO(2) rapidly triggered blood flow velocity in basilar artery amongst panic patients but not in healthy comparisons. The mean time to normalization of BABFV was significantly longer in panic patients. Four weeks of treatment with paroxetine led to a significantly reduced mean BABFV after 35% CO(2) inhalation in comparison with pretreatment. CONCLUSIONS Patients with panic disorder had impaired cerebral regulatory mechanisms observed as a change in response characteristics in BABFV in response to CO(2) inhalation. Treatment with paroxetine reduced the increase of BABFV seen in patients after the CO(2) challenge.

Intravenous thrombolytic treatment in a patient with transient ischemic attack associated with mural carotid thrombi.

A 77-year old man experiencing frequent transient ischemic attacks for five days was admitted to our hospital. Radiological examinations including brain computed tomography, supraaortic computed tomography angiography were performed. Supraaortic computed tomography angiography revealed two thrombi in common carotid artery. Thrombi were located proximally, one of which was elongated and adhared to the arterial wall and the other one was located below bifurcation of left carotid artery. Since the case has been categorized as a high risk patient for ischemic stroke despite the normal neurological status, intravenous recombinant tissue plasminogen activator was given. Ischemic attacks completely ceased soon after thrombolysis. Control computed tomography angiography revealed normal findings with patent carotid artery, without any clot. To our knowledge this is the only case of transient ischemic attack treated with intravenous recombinant tissue plasminogen activator in the literature with the score of 0 on the National Institutes of Health Stroke Scale.

Ability of Emergency Physicians to Detect Early Ischemic Changes of Acute Ischemic Stroke on Cranial Computed Tomography

Objective: The objective of this study was to evaluate the ability of emergency physicians (EPs) to diagnose early ischemic changes due acute ischemic stroke on cranial computed tomography (CT). Subjects and Methods: Three EPs interpreted CT scans obtained within 3 h of symptom onset in 50 patients with acute stroke. The CT scans were interpreted by the EPs and compared to official neuroradiologist reports as a gold standard. ĸ statistics were calculated to determine agreement among the three readers. Sensitivities and specificities were analyzed for each reader. Results: The EPs’ sensitivities were 50, 45.5, and 45.5%, and specificities were 64.3, 82.1, and 64.3%, respectively. Focal parenchymal hypodensity was the criterion for which the EPs were the most sensitive (77.3%). The ability of EPs to recognize early ischemic changes on CT scans in acute ischemic stroke was moderate based on sensitivities. Conclusion: Based on this study, EPs must be trained especially for recognizing early ischemic changes in acute ischemic stroke to improve their accuracy of interpretation.

Benedikt and "plus-minus lid" syndromes arising from posterior cerebral artery branch occlusion.

A 53-year-old man was admitted with diplopia, right ptosis, left lid retraction, mild left sided weakness and involuntary movements. Neurological examination revealed plus-minus lid and Benedikts syndromes together. Magnetic resonance imaging (MRI) showed two distinct mesencephalic infarctions in territories of paramedian and pedincular perforating arteries. Magnetic resonance angiography (MRA) showed severe stenosis of proximal segment of the right posterior cerebral artery (PCA). Rare clinical presentations such as Benedikt and plus-minus syndromes can be seen together and be due to stenosis of the posterior cerebral artery with specific regional infarctions.

Follow-up Analysis of Serum TNF-Related Apoptosis-Inducing Ligand Protein and mRNA Expression in Peripheral Blood Mononuclear Cells from Patients with Ischemic Stroke

Tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL), which is TNF receptor superfamily member, contributes to several diseases pathogenesis. The aim of this research was to investigate the relevance of serum TRAIL protein levels and mRNA expression in peripheral blood mononuclear cells (PBMC) of patients with stroke through 6 months follow-up. We enrolled patients with first-ever acute ischemic stroke (n = 95) and healthy controls (n = 95) in this study. Follow-up blood samples were collected from patients at day 7, 28, and 180 after the onset. The stroke severity was evaluated by National Institutes of Health Stroke Scale score. TRAIL protein levels were quantified by using ELISA kits and TRAIL mRNA expression by quantitative real-time PCR. Our study showed that stroke patients have statistically significant lower levels of serum TRAIL protein (p < 0.0001) and elevated TRAIL mRNA expression (p < 0.0001) in PBMC at the disease onset. Our follow-up study revealed that TRAIL protein levels were increased while mRNA expression levels were downregulated in later periods. Overall, our findings suggest that serum TRAIL levels and mRNA expression in PBMC could reliably serve as a predictor of stroke outcome. Additionally, our study supports that TRAIL plays a role in pathogenesis and progression of ischemic stroke.

Safety Concerns With the Clinical Use of Erythropoietin in Acute Ischemic Stroke

To the Editor: In their study published in Stroke , Ehrenreich et al report serious side effects after erythropoietin (EPO) therapy in acute ischemic stroke. These results call attention to the importance of meta-analysis of preclinical studies as a potential guidance of clinical stroke trials.1 Actually, 2 recent meta-analysis studies evaluating the efficacy of EPO in animal stroke models have concluded that preclinical safety studies for the combination of EPO with thrombolytic …

Neuroophthalmological findings in multiple sclerosis: Analysis of 354 patients

Symptoms and signs due to demyelination of visual snd oculomotor systenrs in multiple tclerosla (MS) W. common and well k-. However, the al= which Investigate the frequency end va!w of these various Rndings hl Crtiolqfkal diagnosis are few end did nc4 consls( 01 large populations. Thh shtdy pressnls the results of 354 MS patients (137 malo, 217 fwle) evalrphd in our neurwphthalm&gy untl and outpatknt chic of rnuiiiple sclerorb. Neurwphthalmdoglcal findings were m In 260 (73.44%) cam. Involvement of aftwent vhual system was W with logalher ,fundoseqpk and biomlcroscoplc slgrn such Is uv&ls-reUnlUr (1 .I2 U). papi(2.54 %) optic abophy and lempor~l pallor ( 52.25 )o. In &Rbn kr amaurosls (056 %), decreased vlslan (6 49 %). vhtml fiekt defer& (1.08 %) On ths dha hand. there worn nculnr motor dlsturbsnws in many pall&s md tha meal Imp&ant complnlnl due to oculomdor sys@m Invdvrm& wm dipk@t (18.35 W) .&ubmdor nerve parnlysls 13 muuliva factor hr been soan in 11 U d cam. la addltion. IN0 ma de&ted In a ratlo of 18.3 % tforlzontal and vwtial m p&e6 ( 10.4 U) woe found as a resuti 01 brainstem gaze contr, lwbns. Involunb~ ocular movements included horizontal (31 .B W). vertical ( 18 % ) r&tory ( 2.8 %) and othst types of nystagmus. DECREASED IL-3 PRODUCTION BY PERIPHERAL BLOOD MONONUCLEAR CELLS IN PATIENTS WITH M.S.