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Öğe Acute Onset Myositis Associated with Brucellosis, Quite a Rare Diagnosis(Japan Soc Internal Medicine, 2008) Celik, Aygul Dogan; Celik, Yahya; Yulugkural, Zerrin; Balci, Kemal; Utku, UfukBrucellosis is a zoonosis that is transmissible to humans. It is a disease with multi-systemic involvement caused by the genus Brucella. Neurological complications, including meningitis, meningo-encephalitis, myelitis-radiculoneuritis, brain abscess, epidural abscess and meningo-vascular syndromes, are rarely encountered. We present a patient presenting with acute onset myositis. This kind of presentation has not previously been reported in the English language literature. We conclude that the diagnosis of neuro-brucellosis should be considered in patients presenting with muscle weakness.Öğe Bilateral basal ganglionic lesions due to transdermal methanol intoxication(Elsevier Sci Ltd, 2009) Karaduman, Fatih; Asil, Talip; Balci, Kemal; Temizoz, Osman; Unlu, Ercument; Yilmaz, Arif; Utku, UfukMethanol is a clear, colorless, and highly toxic liquid with a similar smell and taste to ethanol, and is found in many commercial products such as solvents and cleaning fluids. Severe methanol intoxication occurs after suicidal or accidental oral ingestion of solvents. A few patients with methanol intoxication via the transdermal route have been reported. We present a 47-year-old woman with acute transdermal methanol intoxication admitted to the emergency department with weakness, blurred vision, bilateral areactive mydriasis, and deterioration of consciousness. (C) 2009 Elsevier Ltd. All rights reserved.Öğe Cerebral infarction due to traumatic carotid artery dissection(Turkish Assoc Trauma Emergency Surgery, 2008) Kilincer, Cumhur; Tiryaki, Mehmet; Celik, Yahya; Turgut, Nilda; Balci, Kemal; Utku, Ufuk; Cobanglu, SebahattinWith the advent of improved neuroradiological methods, it has been determined that frequency of traumatic carotid artery dissections is higher than previously observed. Since delayed neurological deficits may develop in some asymptomatic undiagnosed cases, it is essential to consider the possibility of the carotid artery dissection and evaluate it properly in suspicious cases. In this article, a case of internal carotid artery dissection and subsequent cerebral infarction following a motor vehicle accident is presented. Pathogenesis, clinical features, diagnostic method choices and treatments in this rare but severe condition are discussed in light of the relevant literature in order to convey current knowledge.Öğe Changing cerebral blood flow velocity by transcranial Doppler during head up tilt in patients with diabetes mellitus(Elsevier, 2007) Asil, Talip; Utku, Ufuk; Balci, Kemal; Uzunca, IlkayObjective: Diabetes mellitus is an independent risk factor for poor prognosis in patients with ischemic stroke. It is known that diabetes mellitus directly affects cerebral vasculature as a secondary, long-term complication of cerebral circulation, and causes cerebral blood flow abnormalities. The abnormalities of cerebral autoregulation also poorly affects the prognosis of ischemic stroke. In this study, we aimed to show the cerebral autoregulation with transcranial Doppler (TCD) ultrasound in diabetic patients with autonomic nervous system abnormalities, determined with electrophysiological studies. Material and method: Twenty healthy controls and 39 patients, who had at least 2 years of diabetes mellitus, were evaluated (age ranges: 42-75 years). The patients were divided into two groups according to sympathetic skin response and R-R interval variation studies: (1) patients with autonomic neuropathy; (2) patients without autonomic neuropathy. Blood flow velocities were measured during supine position and after the patients were raised upright position on head up tilt table. Arterial blood pressures and heart rates were also evaluated. Results: Mean blood flow velocities of diabetic patients with autonomic neuropathy were found more decreased at 90 s after the patients were raised upright position. Discussion: Autonomic neuropathy due to diabetes mellitus affects cerebral autoregulation, and by this way cerebral perfusion loses protection against hemodynamical changes. (c) 2006 Elsevier B.V. All rights reserved.Öğe Comparative neurophysiological study for the diagnosis of mild polyneuropathy in patients with diabetes mellitus and glucose intolerance(Taylor & Francis Ltd, 2006) Turgut, Nilda; Guldiken, Sibel; Balci, Kemal; Tugrul, Armagan; Berberoglu, Ufuk; Altun, Betul UgurThis article evaluates diagnostic sensitivity of minimal F-wave latency, sural/radial amplitude ratio ( SRAR), dorsal sural/radial amplitude ratio ( DSRAR), sympathetic skin response ( SSR), and R-R interval variability ( RRIV) for detecting early polyneuropathy in patients with glucose intolerance and diabetic patients. F-wave latencies were more prolonged in diabetic patients with normal and abnormal nerve conduction studies than control subjects ( p < .001). SRAR was lower, SSR latency was more prolonged, and RRIV was lower in diabetic patients with abnormal nerve conduction studies than healty controls ( p < .001). SSR latency was more prolonged and RRIV was lower in diabetic patients with normal nerve conduction studies than healty controls ( p < .01, p < .05, respectively). DSRAR was lower in diabetic patients with normal and abnormal nerve conduction studies than control subjects ( p < .001). DSRAR was also lower in patients with glucose intolerance than control subjects ( p < .01). DSRAR was the most sensitive and specific test in either of diabetic patients with normal nerve conduction studies ( sensitivity 66%, specificity 90%) and diabetic patients with abnormal nerve conduction studies ( sensitivity 100%, specificity 90%). DSRAR is the most reliable method for detection of early nerve pathology. Patients with glucose intolerance might have subclinical neuropathy that can be demonstrated with DSRAR analysis.Öğe Cost of acute ischemic and hemorrhagic stroke in Turkey(Elsevier, 2011) Asi, Talip; Celik, Yahya; Sut, Necdet; Celik, Aygul Dogan; Balci, Kemal; Yilmaz, Arif; Karaduman, FatihObjective: 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$ 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$ 2108 and US$ 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. (C) 2010 Elsevier B.V. All rights reserved.Öğe Decompression craniotomy(Amer Assoc Neurological Surgeons, 2007) Kilincer, Cumhur; Asil, Talip; Utku, Ufuk; Balci, Kemal; Hamacioglu, Mustafa KemalObject. Middle cerebral artery infarction often occurs at a younger age than other strokes and is associated with significant rates of mortality and morbidity. After a period of pessimism regarding decompressive hemicraniectomy in the management of acute stroke, the method has reemerged in the past decade. The present study was undertaken to assess the immediate and long-term outcome of this intervention and to help better define the selection criteria for surgery. Methods. The authors conducted a nonrandomized prospective study using decompressive hemicraniectomy with duraplasty in patients at various stages of clinical deterioration due to a space-occupying middle cerebral artery infarct. Patients were assessed at 6 and 12 months postinfarction by using functional scales. Subjective reconsideration was assessed using a questionnaire. Twenty-six patients were included in the study. The mean age was 48.4 +/- 11.2 years, and the mean preoperative Glasgow Coma Scale score was 9.9 +/- 3.2. The median time from ictus to surgery was 54 hours (range 13-288 hours). The rate of survival at 1 year postsurgery was 73%. Among survivors, 33.3% were independent (Barthel Index [BI] > 95) and 55.6% were partially dependent (BI 60-95) at 1 year postsurgery, with 72% attaining the ability to walk independently by 1 year postsurgery. No patient remained in a vegetative state. The 1-year BI score was inversely related to patient age(r = -0.47, p = 0.048). Conclusions. Survival after decompressive hemicraniectomy was better than previously reported using medical management alone. A vegetative state was avoided and functional independence was possible, especially in younger patients. Increasing age was a statistically significant predictor of disability and long-term functional dependence.Öğe Deep cerebral vein thrombosis associated with iron deficiency anaemia in adults(Elsevier Sci Ltd, 2007) Balci, Kemal; Utku, Ufuk; Asil, Talip; Buyukkoyuncu, NiluferCerebral venous thrombosis (CVT) is rare and has a wide spectrum of symptoms, therefore it is difficult to diagnose. Thrombosis of the deep cerebral veins occurs very rarely: it has been reported that approximately 6% of patients with CVT have deep CVT, and the prognosis for patients with this condition is poor. CVT has been reported in association with dehydration, a hypercoagulable state, mastoiditis, tumour invasion of a venous sinus, use of oral contraceptives, pregnancy, puerperium, head trauma, vasculitis, and intracranial and systemic infections. However, in the literature, there are few reported cases of CVT in association with iron deficiency anaemia, especially in adults. We present here two patients with bilateral thalamic and basal ganglionic lesions due to thrombosis of the deep cerebral veins. Both of our patients had severe hypochromic microcytic anaemia due to iron deficiency, and both had a good prognosis after 2 months. (c) 2006 Elsevier Ltd. All rights reserved.Öğe Does Cervical Radiculopathy Have an Effect on Peripheral Nerve Conduction Studies? An Electrophysiological Evaluation(Karger, 2011) Balci, Kemal; Asil, Talip; Tekinaslan, Ilkay; Ir, NasifBackground: Peripheral nerve neuropathies are more common in patients with cervical radiculopathy (CR) and a proximal lesion along an axon might predispose that nerve to injury at distal sites. To evaluate this hypothesis, the frequency of median nerve neuropathy at the wrist and the frequency of ulnar nerve neuropathy at the elbow were investigated in 80 patients with one-sided CR. Methods: The symptomatic and asymptomatic extremities were compared for the electrophysiological parameters of ulnar and median nerve conduction studies. The patients were divided into three diagnostic subgroups (C5/C6 radiculopathy, C7 radiculopathy and C8/Th1 radiculopathy), and ulnar nerve conduction studies were compared between symptomatic and asymptomatic extremities in each subgroup. Results: Although, the median and ulnar nerves are mainly derived from C8/Th1 roots, we did not observe an increased frequency of ulnar nerve involvement at the elbow (3.7% in symptomatic, 2.5% in asymptomatic extremities) while increased median nerve involvement was present at the wrist (27.5% in symptomatic, 12.5% in asymptomatic extremities). Conclusion: The electrophysiological data and the frequency of ulnar and median nerve neuropathy did not support an etiological association between CR and distal neuropathy. Significance: the association between CR and peripheral neuropathy is associational rather than causative. Copyright (C) 2011 S. Karger AG, BaselÖğe Dorsal sural nerve conduction study in vitamin B12 deficiency with megaloblastic anemia(Blackwell Publishing, 2006) Turgut, Burhan; Turgut, Nilda; Akpinar, Seval; Balci, Kemal; Pamuk, Guelsuem E.; Tekguenduez, Emre; Demir, MuzafferPeripheral neuropathy is frequently observed in B-12 deficiency. In spite of this, there is little knowledge about peripheral neuropathy in B-12 deficiency because the severity of clinical involvement of the central nervous system clearly outweighs signs and symptoms due to peripheral nervous system involvement. We primarily investigated peripheral neuropathy with dorsal sural conduction study, which is a new method for detection of early peripheral neuropathy, in B-12 deficiency with megaloblastic anemia. Conventional nerve conduction studies and tibial sensory-evoked potential (SEP) recording were also performed. Twenty-eight B-12-deficient patients (15 male, 13 female, mean age 65.8 years) with megaloblastic anemia and 18 age- and sex-matched controls were included in the study. Although dorsal sural sensory nerve action potentials (SNAPs) were not recorded in 15 (54%) of 28 patients, only 9 (32%) of them were found to have polyneuropathy by conventional conduction studies. Furthermore, patients with dorsal sural SNAP had mean lower amplitude, mean longer latency, and slower velocity response when compared with controls. Twenty patients (71%) were diagnosed as having myelopathy by the combination of tibial SEP and neurological findings. Two patients whose dorsal sural SNAPs were not recorded had normal tibial SEP responses; therefore, these patients were considered to have isolated peripheral neuropathy. As a result, we conclude that dorsal sural nerve conduction study is a reliable method for detection of early peripheral neuropathy in B-12 deficiency.Öğe The Effect of Admission Blood Pressure on the Prognosis of Patients with Intracerebral Hemorrhage That Occurred during Treatment with Aspirin, Warfarin, or No Drugs(Informa Healthcare, 2012) Balci, Kemal; Utku, Ufuk; Asil, Talip; Celik, Yahya; Tekinaslan, Ilkay; Ir, Nasif; Unlu, ErcumentBackground. Hypertension is the most important modifiable risk factor for intracerebral hemorrhage (ICH), but blood pressure (BP) management during the acute phase of ICH is still controversial. Approximately one-fourth of ICHs occur during treatment with warfarin or aspirin. Aim. This study was designed to determine the effect of admission BP on the early prognosis of ICH patients by dividing them into three groups (warfarin, aspirin, and no drugs). Methods. Three hundred and sixty-nine patients with supratentorial ICH were divided into three groups according to medication. Each group was evaluated in terms of prognosis and the risk for mortality based on the modified Rankin Scale (mRS) score at discharge (good prognosis: mRS <= 3; poor prognosis: mRS > 3). The effect of admission BP on prognosis was evaluated for each group. Results. The inhospital mortality rate was 72% for ICH patients treated with warfarin, 41.6% for ICH patients treated with aspirin, and 35% for ICH patients treated with no drugs. Admission mean arterial blood pressure (MABP) values were higher in patients with poor prognosis compared with patients with good prognosis for the aspirin (P = .002) and no-drug (P = .001) groups, but not in the warfarin (P = .067) group. Conclusion. A high MABP at admission was found to be an independent predictor of poor prognosis for ICH patients treated with aspirin or with no drugs, but not for ICH patients treated with warfarin.Öğe The Effects of Pulsed Electromagnetic Field Treatment in Pain Due to Diabetic Polyneuropathy(Aves Yayincilik, Ibrahim Kara, 2010) Fezyioglu, Pervin; Ozdemir, Ferda; Guldiken, Sibel; Balci, Kemal; Sut, NecdetObjectives: Diabetic polyneuropathy is the most common and disabled complication of diabetes mellitus. Pharmacological treatment of diabetic neuropathy is limited because of the side efects of the drugs, used in the treatment of diabetic neuropthy. Alternative treatments are also used in diabetic neuropathy. Systemic side effects of non-pharmacological treatment modalities are rare. We evaluated the value of pulsed electromagnetic field treatment in patients with pain due to diabetic polyneuropathy. Patients and Methods: Symptomatic 95 patients were included in the study, and from these patients, 25 patients were randomized in pulsed electromagnetic field treatment group and 25 patients were randomized in placebo group. Pulsed electromagnetic field device was applied over both feet of the patients for one hour a day (during 10 days). Visual analog scale and neuropathic pain scale of all patients were performed before and after treatment and 6th week. Electroneuromyography was also performed before treatment and 6th week. Results: Improvement of pain determined by visual analog scale was 53% after treatment and 67% six weeks later. The improvement of visual analog scale scores were statistically significant in study group when compared with control subjects. Conclusion: The pulsed electromagnetic field may be an alternative treatment modality in diabetic patients with neuropathic pain.Öğe An epidemiologic investigation of amyotrophic lateral sclerosis in Thrace, Turkey, 2006-2010*(Taylor & Francis Ltd, 2019) Turgut, Nilda; Saracoglu, Gamze Varol; Kat, Selahattin; Balci, Kemal; Guldiken, Baburhan; Birgili, Ozlem; Kabayel, LeventObjective: The aim of the study was to investigate the incidence and prevalence of amyotrophic lateral sclerosis (ALS) in Thrace, Turkey in a five-year time period (2006-2010). Methods: Study population included residents of three provinces (Edirne, Tekirdag, Kirklareli) in the Thrace region. Cases were ascertained from all of the neurologic centers and hospitals of these provinces. Demographic and clinical information was collected for each patient. Newly diagnosed ALS patients who are fulfilling the El Escorial revised diagnostic criteria were enrolled into the study. Results: We identified a total of 145 patients (93 males, 52 females). The mean age at diagnosis was 57.0 +/- 13.6. According to El Escorial criteria, 60.0% of the cases were definite ALS, 24.8% were probable, and 15.2% were possible ALS. Thirty-two cases were bulbar (22.1%), 113 cases (77.9%) were spinal onset. Mean time delay from onset to diagnosis was 12.0 +/- 11.2 months. Age-gender standardized incidence rates with reference to Turkey, USA 2008 census were 1.9 (95% confidence interval (CI), 1.8-2.1), 1.9 (95%CI, 1.8-2.2) for overall. There were 112 living ALS patients at the end of the study. Crude point prevalence was calculated as 7.3 per 100,000 population (95%CI, 5.9-8.7). Conclusions: This is the first study to provide fundamental data about demographic and clinical characteristics about ALS in Thrace region of Turkey. Incidence and prevalence of ALS in Thrace region of Turkey appear to be comparable with European countries.Öğe Erdheim-Chester Disease Presented with Bilateral Carotid Artery Occlusion: Case Report(Turkish Neurological Soc, 2010) Celik, Yahya; Balci, Kemal; Asil, Talip; Tuzun, Erdem; Hamamcioglu, Mustafa Kemal; Temizoz, Osman; Albayram, SaitErdheim-Chester disease is a rare, non-Langerhans form of systemic histiocytosis of unknown etiology. The disease affects multiple organ systems, including musculoskeletal, cardiac, pulmonary, gastrointestinal, and central nervous systems, producing protean manifestations. Neurological manifestations are less frequent. We present a 44-year-old patient with Erdheim-Chester disease who had bilateral carotid artery occlusion and cavernous sinus infiltration.Öğe Evaluation of vasomotor reactivity by transcranial Doppler sonography in patients with acute stroke who have symptomatic intracranial and extracranial stenosis(Wiley, 2007) Uzunca, Ilkay; Asil, Talip; Balci, Kemal; Utku, UfukObjective. In patients with large artery disease, determining the cerebral hemodynamic state and following its alterations may be a good marker for predicting long-term outcome. The aim of our study was to compare the changes in vasomotor reactivity (VMR) of patients with symptomatic intracranial and extracranial artery stenosis. We also examined whether VMR after stroke influences the long-term prognosis for these patients. Methods. Forty-one patients were included in the study. To determine the cerebral hemodynamic state, transcranial Doppler ultrasound examinations and acetazolamide tests were performed after acute stroke and repeated after 6 months. We compared the VMR on admission and at 6 months, together with changes in VMR, of the patients with symptomatic intracranial and extracranial artery stenosis. By calculating the Barthel index at 6 months, We examined whether VMR had an effect on an improvement in their quality of life. Results. We observed a significantly higher initial VMR of the ipsilateral hemisphere in patients with intracranial stenosis (22.4 +/- 9.1 versus 13.4 +/- 12.8; P = .013). At 6 months, the VMR obtained from the ipsilateral hemisphere was better in patients with extracranial stenosis than in the patients with intracranial stenosis (P = .01). The ipsilateral VMR measured on admission showed a positive correlation with the Barthel index at 6 months (P = .007; r = 0.434). Conclusions. Our study showed that VMR in patients with acute stroke who have extracranial and intracranial artery stenosis measured by using a transcranial Doppler examination may have value in predicting long-term outcome.Öğe Hepatic Encephalopathy and Atypical Cortical Involvement in Cranial MRI: case report(Aves Yayincilik, Ibrahim Kara, 2009) Celik, Yahya; Ozbek, Bahar; Balci, Kemal; Unlu, Ercuement; Utku, UfukHepatic encephalopathy is characterized by neuropsychiatric abnormalities occurring in patients with liver dysfunction. It most commonly occurs in association with cirrhosis, portal hypertension, portal-systemic shunts and acute liver failure. Clinical features of hepatic encephalopathy varies between mild cognitive impairment to deep coma. Several neuroimaging techniques, especially magnetic resonance imaging (MRI), may eventually be useful for the diagnosis of hepatic encephalopathy. Cranial MRI may demonstrate high signal intensity in the bilateral globus pallidum on T1-weighted images. Cortical involvement due to hepatic encephalopathy is rarely reported in the literature. We presented here a case of hepatic encephalopathy with cortical and subcortical involvement.Öğe Hereditary neuropathy with liability to pressure palsies in a Turkish patient (HNPP)(Turkish Neurosurgical Soc, 2008) Celik, Yahya; Kilincer, Cumhur; Hamamcioglu, M. Kemal; Balci, Kemal; Birgili, Baris; Cobanoglu, Sebahattin; Utku, UfukHereditary neuropathy with liability to pressure palsies (HNPP) is an autosomal dominant nerve disease usually caused by 1,5 Mb deletion on chromosome 17p11.2.2-p12, the region where the PMP-22 gene is located. The patients with HNPP usually have relapsing and remitting entrapment neuropathies due to compression. We present a 14-year-old male who had acute onset, right-sided ulnar nerve entrapment at the elbow. He had electrophysiological findings of bilateral ulnar nerve entrapments (more severe at the right side) at the elbow and bilateral median nerve entrapment at the wrist. Genetic tests of the patient demonstrated deletions in the 17p11.2 region. The patient underwent decompressive surgery for ulnar nerve entrapment at the elbow and completely recovered two months after the event. Although HNPP is extremely rare, it should be taken into consideration in young adults with entrapment neuropathies.Öğe Herpes Zoster Ophthalmicus With Sixth Cranial Nerve Palsy: A Case Report(Turkish Neurological Soc, 2008) Balci, Kemal; Utku, Ufuk; Ozbek, BaharScientific background: Herpes zoster ophthalmicus represents aproximately 25% of all zoster infections. However extraocular gaze palsy in association with herpes zoster infection is extremely rare. Objective: We presented here a patient who had herpes zoster ophthalmicus with sixth cranial nerve palsy. Case: The sixty year old patient had suffered from left retroorbital pain, conjunctival congestion and rashes on the left forehead and the nose and developed ipsilateral sixth cranial nerve palsy. Result: Herpes zoster virus infection should be taken into consideration in patients with extraocular paralysis and early treatment may prevent such complications.Öğe Intravenous tPA Administration in Patients With Acute Ischemic Stroke: Edirne Experience(Journal Neurological Sciences, 2011) Asil, Talip; Balci, Kemal; Utku, Ufuk; Ir, NasifObjective: Intravenous (IV) thrombolytic therapy is the only approved effective treatment used in patients with acute ischemic stroke. In this study, we aimed at establishing the clinical outcomes of the IV tissue plasminogen activator (tPA) therapy and the main factors affecting the success rate of the treatment. Patients and Methods: Demographic data, radiological and clinical findings of the patients with acute ischemic stroke who were administered IV tPA therapy in our clinic were recorded. During the first 90 days, symptomatic intracranial hemorrhage and death events were reported. On day 90, patients were divided into two groups; patients with 0-2 MRS scores were deemed to have a good prognosis, while patients with 0-1 MRS score were deemed to have an excellent prognosis. The next step was to analyze the factors which affected disease prognosis. Results: The study included 48 patients with acute ischemic stroke. Patients were administered IV tPA therapy between November 2006 and January 2010. The mean age was 64,8 +/- 12,8 and the mean NIH score was 16,8 +/- 5,2. In addition, the mean ASPECT score was 6,7 +/- 2,5 based on the baseline CT scan. A total of 9 (18%) of the patients died within the first 90 days, including 2 (4%) patients with symptomatic intracranial hemorrhage. On day 90, 11 patients (23%) had an excellent prognosis, whereas 22 (46%) had a good prognosis. In the study, baseline NIH scores and ASPECT scores were associated with a good prognosis. Conclusion: Intravenous tPA therapy is an approved therapeutic modality in patients with acute ischemic patients, which prevents disability, although it does not decrease mortality. Our study results suggesting that IV tPA therapy was an effective treatment in patients with acute ischemic disease were also consistent with previous significant study findings.Öğe Ischemic Stroke in Young Adults Risk Factors, Subtypes, and Prognosis(Lippincott Williams & Wilkins, 2011) Balci, Kemal; Utku, Ufuk; Asil, Talip; Celik, YahyaBackground: Ischemic 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. Objective: The etiologic spectrum in younger patients and older patients differs considerably. Methods: In 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. Results: Hypertension 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%. Conclusions: Hypertension, 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.
