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Öğe Clinical and neuroradiological predictors of mortality in patients with primary pontine hemorrhage(Elsevier Science Bv, 2005) Balci, K; Asil, T; Kerimoglu, M; Celik, Y; Utku, UBackground and purpose: Primary pontine hemorrhage (PPH) accounts aproximately 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. (c) 2005 Elsevier B.V. All rights reserved.Öğe Differentiation of vascular dementia and Alzheimer disease - A functional transcranial Doppler ultrasonographic study(Wiley, 2005) Asil, T; Uzuner, NObjective. in brain perfusion studies, perfusion defects have been reported mainly in the temporal and parietal regions in patients with Alzheimer disease (AD), but it is known that the occipital cortex is partially preserved from metabolic defects in patients with AD, at least in the early stage of the disease. We therefore evaluated the reactivity of the posterior cerebral arteries during visual stimulation with transcranial Doppler ultrasonography (TDU). Methods. Fifteen patients with AD (mean age, 70 years), 12 patients with vascular dementia (VD) (mean age, 61.5 years), and 9 healthy control subjects (mean age, 58 years) were enrolled in the study. The reactivity of both posterior cerebral arteries during visual stimulation was measured with TDU. Reactivity was calculated by the differences in mean relative blood flow velocity (rBFv) between stimulation (vs) and rest (vr) divided by the resting value [rBFv = 100 x (vs - vr)/vr]. Results. Significant increases of vascular reactivity were obtained during visual stimulation for each group (P <.001). There was no significant right or left side difference for vascular reactivity within the groups except in VD,- therefore, values of the right and left sides were pooled for patients with AD and control subjects. Reactivity to visual stimulation was similar for the patients with AD (mean +/- SD, 38% +/- 2.2%) and control subjects (35% +/- 1.8%), but reactivity was found significantly decreased in both sides of patients with VD (25.7% +/- 2.1% for the left side and 24% +/- 2.6% for the right side) compared with the healthy control subjects and the patients with AD (P <.001). Conclusions. These results indicate that the occipital cortex is partially preserved in patients with AD and that functional TDU may be a valuable tool for differentiating VD and AD.Öğe Factors affecting haemorrhagic transformation in middle cerebral artery infarctions(Churchill Livingstone, 2004) Çelik, Y; Utku, U; Asil, T; Balci, KObjective: Haemorrhagic transformation (HT) affects treatment and prognosis in patients with acute ischaemic stroke. The factors affecting haemorrhagic transformation in infarcts due to occlusion of middle cerebral artery (MCA) stem or branch were investigated. Materials and methods: Of 412 patients who were followed in our clinic between January 2001 and December 2001 with acute ischaemic stroke, 86 patients with occlusion in MCA stem or branch were enrolled in this study. These patients were divided into 2 groups, those with HT (n = 35) and without HT (n = 51). Age, sex, systemic arterial hypertension, diabetes mellitus, blood glucose level in the acute period, renal and liver function tests, systolic and diastolic arterial blood pressure in the acute period, previous cerebrovascular disease, leukoaraiosis, modified Rankin Disability Score (mRDS) and stroke subtype were evaluated. Results: High blood glucose level in the acute period and presence of leukoaraiosis on cranial computerized (CCT) tomography were detected as risk factors in development of HT. HT was seen more frequently in MCA stem infarction than branch infarction. mRDS were worse in the group with HT. In multivariate analysis, there were independent relationships between mean blood glucose level on admission, mRDS, presence of diabetes mellitus, and MCA stem infarction and development of haemorrhagic transformation in patients with MCA territorial infarction. (C) 2003 Elsevier Ltd. All rights reserved.Öğe Factors affecting the outcome of decompressive craniectomy for large hemispheric infarctions: a prospective cohort study(Springer Wien, 2005) Kilincer, C; Asil, T; Utku, U; Hamamcioglu, MK; Turgut, N; Hicdonmez, T; Simsek, OBackground. Although surgical decompression of large hemispheric infarction is often a life-saving procedure, many patients remain functionally dependent. The aims of this study were to identify specific factors that can be used to predict functional outcome, thus establish predictive criteria to reduce poor surgical results. Method. In this non-randomized prospective study, we performed decompressive craniectomy in 32 patients (age range, 27 to 77 years) with large hemispheric infarctions. Based on their modified Rankin Score (RS), which was calculated 6 months postoperatively, patients were divided into two functional groups: good (RS 0-3, n = 7) and poor (RS 4-6, n = 25). The characteristics of the two groups were compared using statistical analysis. Findings. One-month mortality was 31%. However, most of the surviving patients were severely disabled (RS 4 or 5), and 6-month total mortality reached 50%. Increased age (>= 60 years) (P = 0.010), preoperative midline shift greater than 10 mm (P = 0.008), low preoperative Glasgow Coma Score (GCS <= 7) (P = 0.002), presence of preoperative anisocoria (P = 0.032), early (within the first three days of the stroke) clinical deterioration (P = 0.032), and an internal carotid artery infarct (P = 0.069) were the positive predictors of a poor outcome. Interpretation. We view decompressive craniectomy for space-occupying large hemispheric infarction as a life-sparing procedure that sometimes yields good functional outcomes. A dominant hemispheric infarction should not be an exclusion criterion when deciding to perform this operation. Early operation and careful patient selection based on the above-mentioned factors may improve the functional outcome of surgical management for large hemispheric infarction.Öğe Fou rire prodromique associated with simultaneous bilateral capsular genu infarction(Elsevier Sci Ltd, 2005) Uzunca, I; Utku, U; Asil, T; Celik, YPathological laughter is exaggerated, uncontrollable, and inappropriate laughter usually unrelated to a true emotion or a congruent mood. Fou rire prodromique is a rare form of prodromal pathological laughter of uncertain pathophysiology that heralds an ischaemic neurologic deficit. We report a case of prodromal pathological laughter marking the onset of bilateral capsular genu infarction. T2-weighted cranial magnetic resonance imaging (MRI) showed bilateral capsular genu infarction. There was also a diffusion defect in the same areas on diffusion-weighted imaging (DWI). Although it is known that bilateral subcortical lesions can cause pathological laughter, this is the first demonstration of simultaneous associated bilateral capsular genu infarction on cranial DWI MRI. (c) 2004 Elsevier Ltd. All rights reserved.Öğe Hepatic myelopathy with spastic paraparesis(Elsevier, 2005) Utku, U; Asil, T; Balci, K; Uzunca, I; Çelik, YProgressive 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 exitability 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. (c) 2004 Elsevier B.V. All rights reserved.Öğe Monitoring of increased intracranial pressure resulting from cerebral edema with transcranial Doppler sonography in patients with middle cerebral artery infarction(Wiley, 2003) Asil, T; Uzunca, I; Utku, U; Berberoglu, UObjective. Cerebral herniation resulting from postischemic brain edema is the most common cause of death in patients with large cerebral infarctions. Early monitoring of intracranial pressure and application of necessary treatment procedures may have life-saving value. In this study, the data obtained by transcranial Doppler sonography were compared with clinical examination and the neuroradiologic findings. Methods. Eighteen patients with first-ever strokes and large middle cerebral artery infarction who were admitted within the first 12 hours after stroke onset were included. Clinical findings were evaluated according to the daily Glasgow Coma Scale and Rankin disability scores on the 10th day. Initial cerebral computed tomography was performed at admission to the hospital. Midline shift and ventricular displacement were evaluated on the third day. Follow-up tomographic scans of some patients were per-formed on subsequent days if necessary. Systolic, diastolic, and mean blood flow velocities and pulsatility indices of all patients were measured by transcranial Doppler sonography daily for 10 days. Results. The pulsatility indices were higher on the third hospital day than on the first day. The increases in the pulsatility indices were correlated with the midline shift measured on the third day. The prognoses of the patients whose maximal pulsatility indices during the first 10 days were higher than 1.5 were poorer than those of the patients whose maximal pulsatility indices were lower than 1.5. Conclusions. Transcranial Doppler sonography enables noninvasive monitoring of raised intracranial pressure in patients with large infarctions. It also provides information for detecting cerebral herniation and deciding on the medical or surgical therapy.Öğe MRI findings of Wernicke encephalopathy revisited due to hunger strike(Elsevier Ireland Ltd, 2006) Unlu, E; Cakir, B; Asil, TBackground and Purpose: The purpose of this study was to determine the characteristic magnetic resonance imaging (MRI) findings among a group of patients who presented with Wernicke encephalopathy (WE) due to the neurological complications of a long-term hunger strike (HS). Methods: MRI studies also including the fluid-attenuated inversion recovery (FLAIR) sequence and diffusion-weighted imaging (DWI) of six male patients with WE aged from 25 to 38 years (mean age 31 years) were evaluated. Results: In all subjects, T2-weighted sequences, FLAIR and DWI revealed a signal hyperintensity within the posteromedial thalami and surrounding the third ventricle. In particular, on coronal images, the hyperintense areas around the third ventricle showed a suggestive double wing configuration. We observed an increased signal on proton-density and T2-weighted images in the mamillary bodies of three patients. Four patients demonstrated additional hyperintensities within the periaqueductal region and/or the tectal plate. At least one lesion area in five of six patients demonstrated contrast enhancement. Conclusion: The consistent imaging findings of our study suggest that MRI is a reliable means of diagnosing WE. Acute WE is sometimes underdiagnosed, yet early diagnosis and treatment of WE is crucial in order to avoid persistent brain damage. MRI, including postcontrast T1-weighted imaging, DWI beneath standardized T2-weighted imaging, and FLAIR sequences may prove to be a valuable adjunct to clinical diagnosis and to provide additional information in acute and/or subacute WE. (c) 2005 Elsevier Ireland Ltd. All rights reserved.Öğe Recovery from aphasia after decompressive surgery in patients with dominant hemispheric infarction(Lippincott Williams & Wilkins, 2005) Asil, T; Utku, U; Balci, K; Kilincer, C[Abstract Not Available]Öğe Reversible MR angiographic findings in a patient with autoimmune Graves disease(Amer Soc Neuroradiology, 2004) Utku, U; Asil, T; Çelik, Y; Tucer, DA 45-year-old woman presented with subacute encephalopathy due to autoimmune Graves disease. MR angiography (MRA) demonstrated stenosis of the major intracerebral arteries. After high-dose methylprednisolone therapy and plasmapheresis, her neurologic status improved dramatically, and the MRA findings resolved after 3 months. The angiographic findings in Graves disease that resemble those in Moyamoya disease are temporary.
