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Yayın Açık Erişim Evaluation of risk factors associated with stroke recurrence in patients with minor ischemic stroke(Türk Nöroloji Derneği, 2022-03-01) Dinç, Yasemin; Akarsu, Emel Oğuz; Hakyemez, Bahattin; Bakar, Mustafa; DİNÇ, YASEMİN; OĞUZ AKARSU, EMEL; HAKYEMEZ, BAHATTİN; Bakar, Mustafa; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Nöroloji Anabilim Dalı; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı; 0000-0002-3425-0740; IUQ-6999-2023; IZQ-0662-2023; IWC-9957-2023; AAI-2318-2021; EKN-8251-2022Objective: Recurrent ischemic stroke (RIS) is a major threat CO patients with IS. The risk of RIS in patients with minor IS (MIS) is 10-13% in the first 3 months. Despite the advanced examination and treatment of the patients, RIS is still common. It is important to know which risk factors cause RIS in order to rake some precautions. The aim of this study is to determine the risky group by determining the demographic, clinical and radiological features associated with RIS in patients with MIS.Materials and Methods: We included 310 patients diagnosed as having acute IS (AIS) by Bursa Uludag University Faculty of Medicine Department of Neurology between 01.01.2019 and 01.01.2020, retrospectively.Results: When clinical, radiological and dermogrophic features were analyzed between patients with and without RIS, there were statistically significant differences between groups in terms of the presence of coronary artery disease (CAD), atherosclerotic vascular disease, anterior circulation stroke, craniocervical atherosclerotic stenosis, atherosclerotic stenosis in the anterior circulation, atherosclerotic stenosis of the symptomatic internal carotid artery (ICA), atherosclerotic stenosis in the asymptomatic ICA and performing carotid artery scenting. When significant variables were analyzed by using binary logistic regression in patients with MIS, it was found that the most significant variables were CAD and asymptomatic ICA stenosis.Conclusion: In our study, the risk factors associated with RIS in patients with MIS were the presence of CAD and asymptomatic ICA stenosis. Atherosclerosis is a systemic disease and therefore craniocervical atherosclerotic stenosis may be multiple. Angiographic evidence has also revealed ethnic and racial differences in patients with AIS. For this reason, more precise information can be obtained with prospective studies to be conducted in our own population.Yayın Açık Erişim Evaluation of ischemic stroke and risk factors of atrial fibrillation in patients with obstructive sleep apnea syndrome(Galenos Yayınevi, 2021-12-01) Dinç, Yasemin; Demir, Aylin Bican; DİNÇ, YASEMİN; BİCAN DEMİR, AYLİN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Nöroloji Anabilim Dalı.; 0000-0001-6739-8605; IWC-9957-2023; KHB-9765-2024Objective: Obstructive sleep apnea syndrome (OSAS), a sleep-related breathing disorder, is characterized by apnea and hypoapnea. In patients with OSAS, ischemic stroke may have various causes such as large-vessel atherosclerosis and cardioembolism. OSAS is one of the risk factors of atherosclerosis, and it is thought to increase the risk of ischemic stroke by triggering atherosclerosis. Many studies have shown the relationship between OSAS and cardioembolic stroke. Ischemic stroke is a heterogeneous group of diseases caused by many complex mechanisms and may show ethnic and racial differences. This study aimed to determine the etiology and risk factors of ischemic stroke in the patient group diagnosed with OSAS in our population.Materials and Methods: A total of 343 patients were retrospectively screened to determine the prevalence and risk factors of ischemic stroke in patients with obstructive sleep apnea in the sleep laboratory of the Department of Neurology, Faculty of Medicine, Uludag University, between 2015 and 2020.Results: The study included 38 (11%) patients who were diagnosed with ischemic stroke. When patients with and without ischemic stroke were compared according to clinical, demographic, radiological, and polysomnographic data, a significant relationship was found in age, atrial fibrillation (AF), heart failure, hypertension, coronary artery disease, diabetes mellitus, smoking, and non-rapid eye movement 1. According to the binary logistic regression analysis, the variable most significantly related with ischemic stroke was AF. A significant relationship was found between OSAS severity and AF.Conclusion: OSAS is a treatable sleep disorder that causes cardiovascular morbidity. OSAS is an important risk factor for the development and recurrence of AF. In this study, AF is the most important variable related to ischemic stroke in patients with OSAS, and it is associated with the severity of OSAS. Thus, patients with OSAS must be evaluated for AF to prevent ischemic stroke.Yayın Açık Erişim Identifying the risk factors of early neurological deterioration after thrombolysis in patients with acute ischemic stroke(Galenos Yayıncılık, 2022-09-01) Dinç, Yasemin; Özpar, Rıfat; Hakyemez, Bahattin; Bakar, Hacı Mustafa; DİNÇ, YASEMİN; ÖZPAR, RİFAT; HAKYEMEZ, BAHATTİN; BAKAR, HACI MUSTAFA; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Nöroloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı.; 0000-0001-6649-9287; 0000-0003-0342-5939; 0000-0002-3425-0740; 0000-0001-5229-0001; IUQ-6999-2023; AAH-5062-2021; AAI-2318-2021; EKN-8251-2022Objective: The efficacy of intravenous (IV) recombinant tissue plasminogen activator (rt-PA) therapy in the treatment of acute ischemic stroke (AIS) has been demonstrated in many studies and IV rt-PA therapy has been increasingly used all over the world. Early neurological deterioration (END) in AIS is common and potentially associated with a poor clinical outcome. The prevalence of END in AIS ranges from 13% to 37% in studies. The aim of this study is to determine the prevalence and risk factors of END in patients with AIS receiving IV rt-PA therapy. Materials and Methods: One hundred fifty seven patients who were given IV rt-PA treatment by Bursa Uludag University Faculty of Medicine, Department of Neurology between 01.01.2020 and 01.01.2021 were retrospectively included in this study. It was planned to determine the risk group by comparing patients with END with those without. Results: Age (p=0.023), serum glucose level (p=0.045), The National Institutes of Health Stroke score at discharge (p<0.01), Alberta Stroke Program Early CT (ASPECT) score (p<0.01) when clinical, radiological and demographic data associated with END were evaluated and, statistically significant correlation was found with the presence of major vessel occlusion (p=0.012), ischemic stroke due to cardioembolism (p=0.002), clinical outcome (p<0.001) and symptomatic intracerebral hemorrhage (p<0.001). When the significant variables associated with END were evaluated with binary logistic regression, the most significant variables were found to be age (p=0.006) and ASPECT score (p<0.001). Conclusion: The causes of END are multifactorial. The most associated risk factors were found to be advanced age and low ASPECT score. It was understood that the most common cause of END was the inability to perform mechanical thrombectomy for major vessel occlusion. Contrary to popular belief, the most common cause of END in patients with AIS who received IV rt-PA treatment was not considered to be symptomatic intracranial hemorrhage but to inadequate recanalization or late recanalization.Yayın Açık Erişim Causes of ischemic stroke in patients with atrial fibrillation(Türk Nöroloji Derneği, 2020-12-01) Dinc, Yasemin; Bakar, Mustafa; Hakyemez, Bahattin; Dinç, Yasemin; DİNÇ, YASEMİN; Bakar, Mustafa; BAKAR, HACI MUSTAFA; Hakyemez, Bahattin; HAKYEMEZ, BAHATTİN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı.; AAI-2318-2021; IUQ-6999-2023Objective: Atrial fibrillation (AF) is the most common cardiac arrhythmia affecting 1% of the adult population. However, ischemic strokes in patients with AF can be triggered by alternative mechanisms, especially in high-risk patients with additional vascular risk factors. In some patients, atherothrombotic mechanisms may cause stroke, and AF may be incidental or a symptom of atherosclerotic disease. In this case, it may be difficult to distinguish cardioembolic stroke from stroke due to large artery atherosclerosis. The aim of this study was to determine the causes of non-cardioembolic ischemic stroke in patients with non-valvular AF and to determine the risk factors for craniocervical atherosclerotic stenosis.Materials and Methods: This study identified risk factors for craniocervical atherosclerotic stenosis in patients followed up at the Uludag University Faculty of Medicine Department of Neurology with a diagnosis of ischemic stroke and non-valvular AF. In this study, 180 patients who were followed up with a diagnosis of non-valvular AF and acute ischemic stroke between January 1st, 2019 - March 1st 2020, in Uludag University Faculty of Medicine Department of Neurology, were retrospectively included.Results: In this study, the non-cardiac stroke rate was 20% in patients with non-valvular AF who had acute ischemic stroke. Ischemic stroke due to large vessel atherosclerosis was found in 14.4% of these patients, and 9.5% of all patients with AF were stented. When dermographic features, clinical features, and risk factors were analyzed for craniocervical atherosclerotic stenosis, a significant statistical result was obtained with male sex (p=0.020) and smoking (p<0.001).Conclusion: Stroke is a heterogeneous group of diseases caused by many complex mechanisms. Prevention of stroke recurrence is possible by starting effective treatment early. The presence of critical artery stenosis in a patient with acute ischemic stroke with AF causes stroke recurrence and this relapse cannot be prevented by anticoagulant treatment. Angiographic evidence also revealed ethnic and racial differences in patients with acute ischemic stroke. Therefore, more precise information can be obtained through prospective studies in our population.Yayın Açık Erişim The relationship between early neurological deterioration, poor clinical outcome, and venous collateral score in cerebral venous sinus thrombosis(Wolters Kluwer Medknow Publications, 2021-07-01) Dinç, Yasemin; Özpar, Rıfat; Hakyemez, Bahattin; Bakar, Mustafa; DİNÇ, YASEMİN; ÖZPAR, RİFAT; HAKYEMEZ, BAHATTİN; BAKAR, HACI MUSTAFA; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı; Bursa Uludağ Üniversitesi/Tıp Fakültesi/ Nöroloji Anabilim Dalı; 0000-0001-6649-9287; 0000-0002-3425-0740; 0000-0003-0342-5939; IWC-9957-2023; AAH-5062-2021; AAI-2318-2021; EKN-8251-2022Background and Purpose: Cerebral venous sinus thrombosis (CVST) is one of the rare causes of cerebrovascular disease and has an extremely heterogeneous prognosis. The aim of this study was to investigate the potential relationship between early neurological deterioration, poor clinical outcome in CVST and the venous collateral score. Materials and Methods: A total of 121 patients diagnosed with CVST between 2010 and 2020 were retrospectively included. The demographic, clinical, and radiological findings related to venous sinus thrombosis and early neurological deterioration were investigated in relation to the clinical outcome. Results: The factors associated with early neurological deterioration were superior sagittal sinus thrombosis (P < 0.001), sinus rectus thrombosis (P = 0.031), parenchymal lesions (P < 0.001), and venous collateral score (P < 0.001). The factors associated with poor clinical outcome were superior sagittal sinus thrombosis (P < 0.001), cortical vein thrombosis (P < 0.001), venous collateral score (P < 0.001), and initial clinical symptoms. Binary logistic regression analyses revealed poor clinical outcome as a significant variable, with a venous collateral scale of 0 or 1 as a risk factor for a poor outcome (significance of the model P < 0.001). Conclusion: Early neurologic deterioration and poor clinical outcome may occur due to poor collateralization in CVST. Identifying the subgroup of CVST patients at risk of clinical deterioration is therefore important. This study highlights the clinical importance of venous collaterals; however, larger prospective multicenter studies are required to confirm the relationship with venous collaterals in patients with CVST.Yayın Açık Erişim Vertebral artery hypoplasia as an independent risk factor of posterior circulation atherosclerosis and ischemic stroke(Lippincott Williams & Wilkins, 2021-09-24) Dinç, Yasemin; Özpar, Rıfat; Emir, Büsra; Hakyemez, Bahattin; Bakar, Mustafa; DİNÇ, YASEMİN; ÖZPAR, RİFAT; HAKYEMEZ, BAHATTİN; BAKAR, HACI MUSTAFA; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Nöroloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Radyolog Anabilim Dalı.; 0000-0001-6649-9287; 0000-0002-3425-0740; IWC-9957-2023; AAH-5062-2021; AAI-2318-2021; EKN-8251-2022Vertebral artery hypoplasia (VAH) is a frequent anatomical variation of vertebral arteries, with emerging evidence suggesting that it contributes to posterior circulation ischemia. However, the relationship between VAH and ischemic stroke remains unknown. Hence, this study aimed to determine the prevalence of VAH in patients diagnosed with acute ischemic stroke who were followed up in a neurology clinic and to determine if it can potentially be a risk factor for atherosclerotic stenosis in vertebrobasilar circulation. This retrospective study included 609 patients diagnosed with acute ischemic stroke between January 1, 2019 and January 1, 2020. Demographic of patients, risk factors, radiological and clinical characteristics were evaluated. Posterior circulation was very common in patients with VAH, and the most common locations of atherosclerotic stenosis were V1 and V4 segments of the vertebral artery and the middle segment of basilar artery. Analysis of the risk factors for atherosclerotic stenosis in patients with posterior circulation acute ischemic stroke suggested that VAH was an independent risk factor. Findings of the study suggest that VAH pre-disposes atherosclerotic stenosis in vertebrobasilar circulation, although its mechanism remains unknown. Hemodynamic parameters associated with atherosclerosis could not be measured in vivo. Thus, to better understand the underlying mechanism, conducting studies that examine blood flow parameters with high-resolution magnetic resonance angiography in patients diagnosed with acute cerebral ischemia patients with VAH is warranted.Yayın Açık Erişim Evaluation of clinical, radiological, and demographic characteristics of juxtacortical hemorrhages in cerebral venous thrombosis(Türk Nöroloji Derneği, 2021-12-01) Dinç, Yasemin; Özpar, Rıfat; Bakar, Mustafa; Hakyemez, Bahattin; DİNÇ, YASEMİN; ÖZPAR, RİFAT; BAKAR, HACI MUSTAFA; HAKYEMEZ, BAHATTİN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Nöroloji Anabilim Dalı; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı; 0000-0001-6649-9287; 0000-0002-3425-0740; IUQ-6999-2023; AAH-5062-2021; EKN-8251-2022; AAI-2318-2021Objective: Cerebral venous thrombosis (CVT) is a rare form of cerebrovascular disease. Intracranial hemorrhage may occur in 40% of the patients with CVT. The morphology of the intracranial hemorrhages ranges from small juxtacortical hemorrhages (JH) to large parenchymal hematomas. Although it has been suggested that JH is a characteristic of CVT, studies examining the relationship between JH and CVT are limited. In this study, it was aimed to determine the clinical, radiological, and demographic characteristics of JH in patients with CVT.Materials and Methods: In this study, a total of 157 patients who were followed up with the diagnosis of CVT between 2015 and 2021 were included retrospectively. Patients were categorized as, those with and without JH. Variables associated with JH were determined by comparing the demographic, clinical, and radiological characteristics, CVT etiologies and clinical outcomes of the patients.Results: When the clinical, demographic, and radiological characteristics of the patients with and without JH were compared; female gender (p=0.037), clinical initial symptom (0.003), early superior sagittal sinus (SSS) thrombosis (p<0.001), venous collateral scale (VCS) (p<0.001), being in the postpartum period (p=0.006), development of intracranial herniation (p<0.001), and poor clinical outcome (p<0.001) were significantly related with JH. When the significant variables were evaluated with the binary logistic regression, the most significant and independent variables were found to be SSS thrombosis (p=0.043), cortical vein thrombosis (CoVT) (p=0.010), and seizures after CVT (p=0.004). By contrast, no relationships were found between the groups in terms of VCS in binary logistic regression.Conclusion: Diagnosis of CVT is possible with high clinical suspicion and correct interpretation of radiological imaging. JH could be detected with non-contrast cranial computed tomography, which is the first imaging modality, and may cause the clinician to suspect from SSS thrombosis and CoVT. More precise results could be obtained with the prospective multicenter studies.