The effects of trunk repositioning errors on trunk and extremity functions in stroke

AIM

The aim of this study was to analyze the TRE in three directions including forward flexion, lateral flexion to the hemiparetic side, and rotation to the hemiparetic side in patients with stroke and to compare the errors with age- and sex-matched healthy subjects. In addition, it was investigated which functional outcomes were explanatory for TRE in patients with stroke.

METHODS

Forty-one patients with subacute/chronic stroke (age 59 ± 14.5 years) and 41 healthy subjects (age 57 ± 12.8 years) were included in the study. Demographic and clinical data were collected. TREs were measured using an inclinometer. The Trunk Impairment Scale (TIS), Fugl-Meyer Assessment (FMA), Wolf Motor Function Test (WMFT), Timed Up and Go Test, and 10-m walk test (10MWT) were also used to assess trunk control, motor impairment, upper extremity function, and lower extremity function, respectively, in patients with stroke.

RESULTS

TRE scores in three directions were higher in patients with stroke than in healthy subjects (p < 0.001). TREs in three directions were significantly strongly correlated with all functional outcomes (ρ > 0.60, r < 0.001). Multiple regression analysis determined 10MWT, WMFT-Performance, TIS, and FMA-Upper Extremity as explanatory factors for TRE.

CONCLUSION

The model presented in this study could help clinicians and researchers to predict the TRE in patients with stroke. Gait speed, upper extremity motor ability, upper extremity motor impairment, and trunk control should be considered for TRE after a stroke.

New Biomarkers (Endocan, Interleukin-17, and Thrombospondin-4) for the Diagnosis, Assessment of Severity, and Follow-Up of Peripheral Arterial Disease

The present study evaluated the use of endocan, interleukin-17 (IL-17), and thrombospondin-4 (TSP-4) blood levels as potential biomarkers for the diagnosis and follow-up of peripheral arterial disease (PAD). Patients with PAD (Rutherford categories I, II, and III) who were admitted between March 2020 and March 2022 for cardiovascular surgery or outpatient clinic follow-up were included. The patients (n = 60) were divided into 2 groups: medical treatment (n = 30) and surgical treatment (n = 30). In addition, a control group (n = 30) was created for comparison. Endocan, IL-17, and TSP-4 blood levels were measured at the time of diagnosis and at the first month after treatment. Endocan and IL-17 values were found to be significantly higher in both groups that underwent medical (259.7 ± 46 pg/mL, 63.7 ± 16.6 pg/mL) and surgical (290.3 ± 84.5 pg/mL, 66.4 ± 19.6 pg/mL) treatment than the control group (187.4 ± 34.5 pg/mL, 56.5 ± 7.2 pg/mL P < .001). Tsp-4 value was found to be significantly higher only in the surgical treatment group (15 ± 4.3 ng/mL) than the control group (12.9 ± 1.4 ng/mL P < .05). The decreases in endocan, IL-17, and TSP-4 levels at the first month of treatment in both groups were also significant (P < .001). A combination of classical and these new biomarkers could be included in PAD screening, early diagnosis, severity determination, and follow-up protocols in order to provide effective assessment in clinical practice.

Is it possible to predict the outcome of endovascular thrombectomy for hyperdense middle cerebral artery sign at the time of first admission?

BACKGROUND

The hyperdense middle cerebral artery sign (HMCAS) on admission non-contrast computed tomography (NCCT) is a well-characterized phenomenon in acute ischemic stroke.

AIM

The purpose of this study is to determine the impact of HMCAS on the outcome of patients who underwent endovascular thrombectomy.

MATERIALS AND METHODS

A retrospective analysis of a prospectively collective database included 136 consecutive patients with anterior circulation acute ischemic stroke who underwent endovascular thrombectomy. We collected the demographics, and clinical and brain imaging as well as functional and imaging outcomes data at baseline. Patients were divided into two groups with hyperdense artery sign and those without the sign. The difference between the two groups in terms of mortality and prognosis was analyzed.

RESULTS

There were 136 patients, 50.7% of them were women. The mean age was 59.1 years. The subgroup with HMCAS present consisted of 93 patients. There were no differences in demographics and clinical characteristics between the two groups; however, tobacco use is more common in patients with HMCAS. No significant difference was observed in clinical outcomes and mortality between the two groups at 3 months. Patients with HMCAS had statistically more new territory emboli during the procedure (9.7%) compared to patients without HMCAS.

CONCLUSION

We showed that the presence of HMCAS in initial CT was not helpful in predicting good clinical outcomes in patients undergoing endovascular therapy patients. However, the presence of HMCAS is related to more new territory embolism during the procedure. Different endovascular strategies may be applied to these patients.

Predictors of Symptomatic Hemorrhage After Endovascular Treatment for Anterior Circulation Occlusions: Turkish Endovascular Stroke Registry

We evaluated the predictive factors of symptomatic intracranial hemorrhage (SICH) in endovascular treatment of stroke. We included 975 ischemic stroke patients with anterior circulation occlusion. Patients that had hemorrhage and an increase of ≥4 points in their National Institutes of Health Stroke Scale (NIHSS) after the treatment were considered as SICH. The mean age of patients was 65.2±13.1 years and 469 (48.1%) were women. The median NIHSS was 16 (13-18) and Alberta Stroke Program Early CT 9 (8-10). In 420 patients (43.1%), modified Rankin Scale was favorable (0-2) and mortality was observed in 234 (24%) patients at the end of the third month. Patients with high diastolic blood pressure (P<.05) had significantly higher SICH. SICH was significantly higher in those with high NIHSS scores (P<.001), high blood glucose (P<.001), and leukocyte count at admission (P<.05). Diabetes mellitus (DM) (OR 1.90; P<.001), NIHSS (OR 1.07; P<.05), adjuvant intra-arterial thrombolytic therapy (IA-rtPA) (OR, 1.60; P<.05), and puncture-recanalization time (OR 1.01; P<.05) were independent factors of SICH. Higher baseline NIHSS score, longer procedure time, multiple thrombectomy maneuvers, administration of IA-rtPA, and the history of DM are independent predictors of SICH in anterior circulation occlusion.

Treatment-refractory paraneoplastic opsoclonus-myoclonus syndrome in a patient with small-cell carcinoma of the lung

Opsoclonus-myoclonus syndrome is a rare disease and traditionally described as "dancing eyes, dancing feet syndrome." It is characterized by opsoclonus (oscillations of the eyes in either horizontally or vertically) and myoclonus (spontaneous jerky movements of the limbs and trunk). There are numerous etiological factors defined such as paraneoplastic, para-infectious, toxic-metabolic, and idiopathic causes. The experience of opsoclonus-myoclonus syndrome in adults is very limited. Here, we present a case of treatment-refractory paraneoplastic opsoclonus-myoclonus syndrome associated with small-cell carcinoma of the lung.

Effect of hyperglycemia on conduction parameters of tibial nerve's fibers to different muscles: A rat model

Introduction:

Routine conduction studies reflect the summation of all nerve fibers in a peripheral nerve. Nerve fiber groups to distal, small muscles have smaller diameters than the ones to large proximal muscles. There may be minimal differences between the diameters of nerve fiber groups innervating different muscles; even they are all same type of fibers. So, in neuropathic processes some nerve fiber groups may be more seriously affected.

Materials and Methods:

14 rats ( 7 diabetic, 7 control) were studied. Tibial nerve was stimulated from two points and while recorded from a distal (foot intrinsic muscles) and a proximal (gastrocnemius) muscle.

Results:

There was a significant difference between the proximal and distal recorded conduction velocities. Both proximal and distal recorded conduction velocities decreased during the hyperglycemic process.

Discussion:

Our method successfully demonstrated different nerve fiber groups; but, the neuropathic process seemed to be homogeneous in both fiber groups.

Association between cholesterols, homocysteine and silent brain infarcts

BACKGROUND

The aim of this study was to assess the relationship between total plasma homocysteine, cholesterol levels, vitamin B(12), folate, thyroid hormones, urea, ferritin, uric acid, C-reactive protein, cardiovascular risk factors and silent brain infarct (SBI) in patients without any neurological disorder. Whether the factors of interest were associated with SBI is investigated.

METHODS

One hundred and forty-two subjects with a mean age of 52.1 +/- 13.1 years (21-87 years) without any history of stroke, transient ischaemic attack and neurological abnormality were enrolled in this cross-sectional study. The subjects underwent brain magnetic resonance imaging and blood chemistry determinations. Student's t-test was used to compare differences in means of laboratory results between the groups with and without SBI. The chi(2)-test was used for categorized variables. Multiple logistic regression analysis was used to determine the independent predictors of SBI.

RESULTS

The group comprised 56 men and 86 women. SBI were found in 40 patients (28%). The low-density lipoprotein levels were significantly higher in the infarct group (P = 0.019), homocysteine concentrations were significantly higher in the men-infarct group (P = 0,029) and total cholesterol levels were significantly higher in the women-infarct group than the women non-infarct group (P = 0.006).

CONCLUSION

Serum low-density lipoprotein, total cholesterol and homocysteine levels were associated with SBI.

Acute transverse myelitis at the conus medullaris level after rabies vaccination in a patient with Behçet's disease

CASE REPORT

A 25-year-old man with Behçet's disease was admitted because of weakness of the lower limbs and difficulty in urination. He had received a rabies vaccination 2 months previous because he had been bitten by a dog.

FINDINGS

Clinical and laboratory findings supported acute transverse myelitis. A hyperintense lesion and expansion at the level of conus medullaris was detected on spinal magnetic resonance imaging.

CONCLUSION

Although neurologic involvement is one of the main causes of mortality and morbidity in Behçet's disease, the factors that aggravate the involvement of the nervous system are still unclear. Vaccination may have been the factor that had activated autoimmune mechanisms in this case. To our knowledge, involvement of the conus medullaris in Behçet's disease after rabies vaccination has not been reported.