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Öğe Circle of Willis anomalies in stroke patients related with symptomatic carotid artery disease(Turkish Society of Cerebrovascular Diseases, 2012) Kamis?i S.; Kamişli Ö.; Teker U.; Kablan Y.; Saraç K.; Oz?can C.PURPOSE: Carotid artery disease, strokes due to hypoperfusion and embolism is composed of two mechanisms, the brain collateral circulation has an important role in the prevention of stroke. We investigated the Circle of Willis anomalies in the anterior circulation ischemic stroke related with carotid artery disease who had transient ischemic attack or ischemic stroke. MATERIAL AND METHODS: The patients whose circle of Willis anomalies in the digital subtraction angiographies fully evaluated in the first week of neurological symptoms included to this study. The relationship between the severity of symptomatic carotid artery stenosis was evaluated with variety of anomalies. Patients with stenosis and posterior cerebral artery first divison hypoplasia or aplasia in the same side had statistical lower stenosis percentages with patients those without this anomaly (p <0.013). CONCLUSION: The existence of Circle of Willis anomalies are as important as the degree of stenosis in symptomatic carotid artery disease. This situation can be considered when treatment decisions.Öğe Epileptic seizures in patients with a posterior circulation infarct(Turkish Society of Cerebrovascular Diseases, 2014) Kaplan Y.; Kamişli Ö.; Kamişli S.; Özcan C.OBJECTIVE: The aim of this study was to investigate the frequency of seizures and the clinical features of patients with seizures related to a posterior circulation infarct (POCI). MATERIAL and METHODS: We reviewed all ischemic stroke patients admitted to our clinic between January 2011 and January 2012. The patients' database information was retrospectively analyzed. Fifty-five patients with a POCI were included in the study. We reviewed all patients with epileptic seizures related to a POCI. Age, gender, recurrent stroke, risk factors, etiology, radiographic localization, the seizure type and onset time, and the electroencephalographic findings of patients were evaluated. We excluded all patients who had precipitating conditions during seizures such as taking drugs, acid-base disturbances, electrolyte imbalance, and history of epilepsy. RESULTS: Seizures were observed in four patients (3 male, 1 female) with a POCI related epileptic seizures (7.2%). The etiology of strokes was cardiac-embolic in 3 patients and vertebral artery dissection in 1 patient. Seizures occurred in 2 patients as presenting finding, in 1 patient within 7 days, and 1 patient within 28 days. Primary generalized tonic-clonic seizures occurred in 3 patients and simple partial seizures with secondary generalization in 1 patient. Three patients had cerebellum infarction at the left hemisphere. One patient had lateral medullary infarction at the right side. The electroencephalographic findings of patients were normal. CONCLUSION: Studies involving patients with seizures related to a POCI are novel and few in number. Three patients with seizure had cerebellum infarction. The cerebellum in these patients may contribute via different mechanisms over seizure activity.Öğe The evaluation of serum uric acid levels in the ischemic stroke subtypes(Turkish Society of Cerebrovascular Diseases, 2013) Kamişli Ö.; Gönüllü S.; Kamişli S.; Kaplan Y.; Özcan C.OBJECTIVE: Uric acid is a water-soluble antioxidant which is the end-product of purine metabolism. Several studies indicated that high levels of serum uric acid increased the risk of cerebrovascular events and some of them reported poor prognosis with increased serum uric acid levels in stroke patients. Our aim was to analyse serum uric acid levels in the early phase of ischemic stroke and determine whether increased levels of uric acid are associated with ischemic stroke subtypes. MATERIAL and METHODS: 237 patients with ischemic stroke admitted to the study between January 2011 and December 2011. Ischemic stroke subtypes were classified according to Bamford classification. Patients admitted in the the beginning of the first 24 hour of disease were included the study. We compare the serum uric acid levels between stroke subgroups and controls. RESULTS: We found increased serum uric acid levels in all stroke patients but the most increased levels were in the posterior circulation infarct group. However this elevation was not statistically significant. CONCLUSION: Future researches should be focus on the pathogenetic mechanism of hyperuricemia as well as examining the role in stroke subtypes especially posterior circulation infarcts.Öğe Mortality-related factors in ischemic stroke patients 80 years of age and older(Turkish Society of Cerebrovascular Diseases, 2014) Kaplan Y.; Kamişli Ö.; Kamişli S.; Özcan C.OBJECTIVE: The aim of this study was to investigate mortality-related factors in ischemic stroke patients 80 years of age and older. MATERIAL and METHODS: We reviewed all ischemic stroke patients admitted to our clinic between January 2010 and January 2012. The patients' database information was retrospectively analyzed. One hundred and ten patients aged older than 80 years with ischemic stroke were included in the study. The patients were divided into two groups based on survival. Age, gender, recurrent stroke, risk factors, clinical syndrome, etiology, radiographic localization, duration of hospitalization, and presence of systemic complications were accepted as mortality-related prognostic factors. The groups were compared according to these prognostic factors. RESULTS: In the clinical follow-up, 58 (52.7%) patients died; 65.5% died of neurological causes, and 31% died of systemic complications. No significant differences existed between the two groups in age, gender, risk factors, recurrent stroke, or etiology. The frequency of total anterior circulation infarct syndrome was much higher in deceased than living patients (50% and 36.5% respectively;p<0.05). Deceased patients had a statistically significantly higher incidence of total MCA infarct and systemic complications than did living patients (p<0.05). CONCLUSION: To date, many variables that affect the early and late prognosis in stroke patients have been reported. Many of these factors cannot be changed, such as oldest age. It is important to determine the changeable and non-changeable factors related to disability and death in the oldest age groups. Starting appropriate treatment and care initiatives as soon as possible is also very necessary in the oldest stroke patients.Öğe Pregnancy in women with epilepsy and monitoring: Review(2010) Özişik Karaman H.I.; Canbaz Kabay S.; Kamişli Ö.; Erdinç O.O.The prevalence of epilepsy is about 05-1.0%, and slightly less than half of those affected are women. Epilepsy is more frequent neurologocical disorder during pregnancy. Women with epilepsy that plan to become pregnant can in general look forward to uneventful pregnancies and to giving birth to normal children. Women with epilepsy do have an increased risk of certain obstetrical complications. There is an increased risk of vaginal bleeding, anemia, hyperemesis gravidarum, vitamine D and K deficiency, megaloblastic anemia, preeclampsia, eclampsia,premature labor, and postpartum bleeding. The effect of pregnancy on seizure frequency is variable and unpredictable between patients. Approximately 25% of patients have an increase in their seizures. Pregnancy is associated with several physiologic and psychologic changes that can alter seizure frequency, including changes in sex hormone concentrations, changes in antiepileptic drug metabolism, sleep deprivation, and new stresses. The risk for congenital malformations is higher in women on antiepileptic drug regimens.These risks can be reduced with appropriate prepregnancy counseling. During pregnancy, important considerations include; therapeutic drug monitoring, surveillance for obstetric complications and vigilance for seizures during the intrapartum and postpartum period. The care of pregnant women with epilepsy requires attention and close cooperation between neurologist and gynecologist is recommended. In this article we answer the questions commonly asked by epileptic patients regarding pregnancy. Copyright © 2010 by Türkiye Klinikleri.Öğe Sinus thrombosis: Clinical assessment(Turkish Society of Cerebrovascular Diseases, 2009) Kamişli Ö.; Arslan D.; Altinayar S.; Kamişli S.; Kablan Y.; Özcan C.Cerebral venous sinus thrombosis is a challenging condition because of its variability of clinical symptoms and signs. Diagnosis is not easy at initial presentation. All age groups can be affected. Large sinuses such as the superior sagittal sinus are most frequently involved. Systemic inflammatory diseases, inherited and acquired coagulation disorders are frequent causes, although in up to 30% of cases no underlying cause can be identified. The oral contraceptive pills appears to be an important additional risk factor. The spectrum of clinical presentations ranges from headache with papil oedema to focal deficit, seizures and coma. Magnetic resonance imaging with venography is the investigation of choice; computed tomography alone will miss a significant number of cases. Intravenous heparin is the first-line treatment for cerebral venous sinus thrombosis.
