Murat Sumer

Ischemic stroke subtypes: risk factors, functional outcome and recurrence

The etiology of ischemic stroke affects its prognosis, outcome and management. Our aims were to determine risk factors, clinical and imaging variables and prognostic differences in acute ischemic stroke subtypes. In this study, we prospectively investigated 264 consecutive patients with acute ischemic stroke between 1996 and 2000. All of the patients were categorized to one of four major ischemic stroke subtype based on TOAST (Trial of Org 10172 in Acute Stroke Treatment) criteria. The mean age was greater in patients with stroke of undetermined etiology (SUE). Prevalence of hypertension was higher in patients with lacunar infarct (LAC) than other subtypes. Smoking was less frequent in patients with cardioembolism (CARD). The mean infarct size was largest in patients with large artery atherosclerosis (LAA) while there were no differences in location or conversion of the infarct into hemorrhage. The proportion of the patients with milder neurological deficits at entry was higher in patients with LAC subtype. The rate of independent patients were different between subtypes: 62% in LAC, 43% in CARD, 38% in SUE, 35% in LAA at discharge (p=0.01), and 91% in LAC, 69% in CARD, 59% in SUE, 60% in LAA at 6 months (p<0.001). Recurrence rates were not different between groups. We conclude that risk factors, clinical imaging variables are different among ischemic stroke subtypes and that neurological status on admission and during follow-up strongly favors LAC.

Psychiatric comorbidity in medication overuse headache patients with pre-existing headache type of episodic tension-type headache

Background: Medication overuse headache (MOH) mostly evolves from migraine and episodic tension‐type headache (ETTH). Chronic tension‐type headache (CTTH) is another headache type that evolves over time from ETTH. It is well known that psychiatric comorbidity is high in MOH patients.

Progression in acute ischemic stroke: frequency, risk factors and prognosis.

BACKGROUND AND PURPOSE The aim of this study was to investigate the frequency, possible predictive factors and the prognosis of deteriorating ischemic stroke. METHODS A total of 266 stroke patients who presented within 24h of onset were enrolled. Clinical deterioration was defined as a decrease of > or =1 points in the Canadian Neurological Scale (CNS). Rankin Score (RS) was performed at discharge and at six months. RESULTS Of the 266 patients studied, 26 (9.8%) worsened. Involvement of posterior circulation (odds ratio (OR) 3.16) and noncardioembolic infarction (OR 4.5) were found to be independently associated with neurological worsening. Death occurred in 19.2% of progressive (P) and in 4.16% of nonprogressive (NP) groups. Functional outcome was worse in the P than in NP patients at discharge and at sixth months. CONCLUSIONS Involvement of posterior circulation and noncardioembolic subtypes of infarct independently affect neurological progression in acute ischemic stroke. Clinical deterioration significantly worsens the prognosis.

Low Income and Education Levels May Cause Medication Overuse and Chronicity in Migraine Patients

Background.—Frequent analgesic drug intake, especially in migraine patients, may induce the risk of medication overuse headache (MOH). The various conditions that may affect the development and the features of MOH have not been determined yet.

External ventricular drainage for acute obstructive hydrocephalus developing following spontaneous intracerebral haemorrhages

There is no consensus in the literature on the effects of the development of hydrocephalus on survival and disability after intracerebral haemorrhage (ICH) and the benefits of external ventricular drainage (EVD). In this open, prospective study, we investigated the clinical courses, radiological findings and outcome scores of 47 consecutive patients who were admitted to our clinic with spontaneous ICH. Hydrocephalus developed in 6 (12.8%) of the 47 patients, and EVD was applied in these 6 cases. In one of the 6 patients, the lesion was additionally excised due to the large cerebellar haematoma. Intraventricular haemorrhage was more common in patients developing hydrocephalus (83.3% vs. 29.3% in patients without hydrocephalus; p<0.05) and the lesions of all the patients were in the proximity of the ventricular system. Hospital mortality and functional outcome were not significantly different between patients with and without hydrocephalus. Our results shown that acute obstructive hydrocephalus should be anticipated if haematoma is near the ventricle or if it is opening to the ventricle. EVD is a life-saving and effective procedure that should be performed in patients who develop hydrocephalus following spontaneous intracerebral haemorrhage.

Frontal lobe epilepsy presented as ictal aggression

Aggressive behaviour is rarely observed as an ictal semiology. Ictal aggression can occur in lesions of frontal and limbic structures. In limbic structure lesions, the main mechanism of aggressive behaviour is hyperactivity; whereas frontal lesions may cause aggressive behaviour with an indirect mechanism in which the suppression on limbic system is lost. Here we present a patient with ictal aggression. In this case a right frontoparietal epileptiform focus was detected during the postictal period. Magnetic resonance imaging showed cortical dysplasia on the right inferior frontal gyrus. The seizures disappeared completely after pharmacological treatment.

Sympathetic Skin Response in Migraineurs and Patients With Medication Overuse Headache

Background.—Autonomic dysfunction has been reported in patients with migraine, and it may play a role in promoting attacks.

Spinal granulocytic sarcoma (chloroma) presenting as acute cord compression in a nonleukemic patient

The case of a previously healthy 24-year-old man diagnosed with extradural thoracic granulocytic sarcoma with no evidence of bone marrow or other hematological involvement is described. The tumor was removed totally by microsurgery. The histopathological examination was consistent with granulocytic sarcoma. Granulocytic sarcomas are most commonly found in the context of an acute myelogenous leukemia or in chronic myelogenous leukemia. They rarely have been reported in otherwise healthy patients without any evidence of systemic disease. A review of the literature revealed only 14 more nonleukaemic cases with granulocytic sarcoma causing thoracic spinal cord compression.

Indriven sphenoid wing as a cause of post-traumatic epilepsy.

Abstract.Post-traumatic epilepsy is more frequent after severe head injuries, however the severity of the trauma is not always correlated with the injured brain tissue. We report a patient whose seizures developed 4 years after a face trauma. Upward displacement of the sphenoid wing caused a contusion at the orbital surface of the frontal lobe. Computed tomography, magnetic resonance imaging and electroencephalographic findings are presented. The patient responded well to commonly used antiepileptic drugs.