Yahya Çelik

Migraine Prevalence and Some Related Factors in Turkey

Objectives.—The aim of our study is to determine the prevalence of migraine in Provincial Center of Edirne.

CADASIL syndrome in a large Turkish kindred caused by the R90C mutation in the Notch3 receptor

Mutations in the Notch3 gene are the cause of the autosomal dominant disorder CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy). The CADASIL is an adult‐onset neurologic disorder (average age of onset is 45 years) characterized by recurrent strokes and dementia. Clinical features combined with cerebral magnetic resonance imaging (MRI), showing a diffuse leukoencephalopathy with subcortical infarcts in the basal ganglia and white matter, are highly contributive to the diagnosis. We present a Turkish family with CADASIL, in which 12 individuals in four generations were affected showing the typical clinical features of recurrent strokes. Mutation analysis of the Notch3 receptor gene identified the recently described R90C mutation in the N‐terminal part of the gene in affected individuals. Interestingly, migraine without aura was found as an initial symptom of the disease in two young mutation carriers (22 and 25 years, respectively), who did not show any additional clinical features or any MRI abnormalities. This indicates that migraine without aura in the absence of MRI abnormalities may represent an early initial symptom of CADASIL, which is difficult to diagnose in the absence of molecular diagnosis. Therefore, the used molecular screening method for Notch3 mutations provides a rapid and accurate diagnostic tool in addition to the standard diagnostic procedures.

Hepatic myelopathy with spastic paraparesis

Progressive myelopathy is a rare neurological complication of chronic liver disease with portal hypertension and there is no special diagnostic tool for hepatic myelopathy. Neuropathological studies of the patients with hepatic myelopathy have demonstrated demyelination of the lateral corticospinal tracts with various degree of axonal loss. Transcranial magnetic stimulation (TMS) is widely utilized as an indicator of changes in excitability and conductivity of the motor pathways. TMS studies are also used for the diagnosis of hereditary spastic paraparesis in the literature. In this study, we described two patients who presented with spastic paraparesis; TMS studies suggested that they had myelopathy and diagnosed as hepatic myelopathy when all the other possible diagnoses were ruled out.

Ischemic stroke in young adults: risk factors, subtypes, and prognosis.

BackgroundIschemic strokes occurring in patients younger than 47 years is a relatively rare event and accounts for less than 5% of all ischemic strokes in western countries. ObjectiveThe etiologic spectrum in younger patients and older patients differs considerably. MethodsIn this hospital case series study, we enrolled 192 patients with ischemic stroke, aged 18 to 47 years, all of whom were submitted to a diagnostic protocol. The risk factors for stroke and the distribution of stroke subtype and prognosis were studied. Modified diagnostic criteria adopted from the Trial of ORG 10172 in Acute Stroke Treatment and the Baltimore-Washington Cooperative Young Stroke Study, were used for etiologic classification. ResultsHypertension was found to be the main risk factor (45%) followed by cigarette smoking (37%), hyperlipidemia (35.4%), diabetes mellitus (17%), and family history of stroke (18%). Hypertension, diabetes mellitus, hypercholesterolemia, and smoking were present either alone or in combination in the majority of our patients. Oral contraceptives were being taken by 25% of the women. The etiology of stroke was as follows: atherothrombosis 26.5%, cardioembolism 20%, nonatherosclerotic vasculopathies 13%, other determined causes 10%, lacunar stroke 6%, migraine 3.6%, and undetermined causes 21%. ConclusionsHypertension, diabetes mellitus, hypercholesterolemia, and smoking were the most common risk factors in our ischemic stroke patients between 18-47 years of age. Health care programs targeting the prevention and treatment of these factors will reduce the associated morbidity and mortality of stroke among this socioeconomically active age group.

Clinical and neuroradiological predictors of mortality in patients with primary pontine hemorrhage

BACKGROUND AND PURPOSE Primary pontine hemorrhage (PPH) accounts approximately for about 5-10% of intracranial hemorrhages, and PPHs are known to have a much less uniform prognosis. We aimed to evaluate the clinical and radiological predictors affecting the mortality in 32 patients with PPH. MATERIAL AND METHODS We retrospectively evaluated the data of 32 patients with PPH admitted to our clinic between 1994 and 2004. We divided the patients into two groups: (1) patients who survived (14 patients), and (2) patients who died (18 patients). The two groups were compared for age, gender, diabetes mellitus, hypertension, initial clinical status, initial GCS, pupillary abnormalities, ophthalmoparesis, volume and localisation of hemorrhage, intraventricular and extrapontine extension, necessity of mechanical ventilation and hydrocephalus. The hematoma volumes were measured with the formulation described by Broderick. RESULTS Eighteen patients (56%) died and 14 patients (44%) survived. The patients who died (61.3 +/- 8.8) were older than the survivors (56.4 +/- 11.0), but the difference was not statistically significant. The mean GCS was 4.4 +/- 0.2, the mean hematoma volume was 9.9 +/- 3.3 ml for patients who died and the mean GCS was 10.1 +/- 3.3, the mean hematoma volume was 3.3 +/- 1.2 ml for survivors (p < 0.001). Coma on admission (p = 0.001), extrapontine extension (p = 0.001), intraventricular extension (p = 0.019), necessity of mechanical ventilation (p = 0.007), hydrocephalus (p = 0.024), massive and bilateral tegmental localisation (p = 0.006) were found statistically significant predictors for mortality with univariate comparison, and coma on admission (p = 0.038) was the only significant predictor with multivariate regression analysis. CONCLUSION In patients with PPH, it is important to know the prognostic factors for mortality for planning the treatment protocol, and coma and bad clinical status on admission was found the only significant prognostic predictor for mortality with multivariate regression analysis.

Cost of acute ischemic and hemorrhagic stroke in Turkey

OBJECTIVE The aim of this study is to examine the direct medical costs and outcomes of patients with stroke. MATERIAL AND METHODS The records of the patients admitted with ischemic and hemorrhagic stroke to the University of Trakya, School of Medicine, Department of Neurology were reviewed retrospectively in year 2007. Direct medical costs (total costs, radiological, laboratory, medicine, and other) were calculated, additionally cost per life saved and per life-year saved were calculated for stroke patients. RESULTS The study group consisted of 328 patients (169 male/159 female) and mean age was 66.5 ± 12.4 years. Length of hospital stay was 10.7 ± 7.5 days. Mortality rate was 20.4% and the mRS score of the patients was 3.2 ± 2.1. The average cost of stroke was US

A non-alcoholic patient with acute Marchiafava-Bignami disease associated with gynecologic malignancy: paraneoplastic Marchiafava-Bignami disease?

1677 ± 2964 (29.9% medicine, 19.9% laboratory, 12.8% neuroimaging, and 38% beds and staff). Cost per life saved and per life-year saved were US

Risk factors of status epilepticus in children.

2108 and US

Post‐stroke mania in late life due to right temporoparietal infarction

1070, respectively. CONCLUSION This is the first study in order to determine direct medical cost of stroke in Turkey, therefore, it may be guideline for disease-cost management of stroke.

Stroke due to Bee Sting

We report a 45-year-old, non-alcoholic woman with ovarian cancer who presented with acute impairment of consciousness. Cranial MRI revealed symmetrical and bilateral increased signal intensities of the corpus callosum and the dentate nucleus, without contrast enhancement. The findings are comparable with Marchiafava-Bignami disease (MBD), although pathological confirmation was not possible. Most of the reported cases of MBD are related to chronic ingestion of red wine and/or related with a nutritional cause. We suggest that this patient may suffer a MBD possible related to the ovarian cancer.