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    Assessment of patients with intracerebral hemorrhage or hemorrhagic transformation in the VENOST study
    (Karger, 2021) Duman, Taşkın; Yayla, Vildan; Uludüz, Derya; Göksu, Eylem Özaydin; Yürekli, Vedat Ali; Genç, Hamit; Utku, Uygar; Çınar, Nilgün; Tekeli, Hakan; Sungur, Mehmet Ali; Tokuç, Firdevs Ezgi; Uzuner, Nevzat; Şenol, Mehmet Güney; Yılmaz, Arda; Gökçe, Mustafa; Demirci, Seden; Küsbeci, Özge Yılmaz; Uzuner, Gülnur Tekgöl; Şahin, Şevki; Çağlayan, Hale Zeynep Batur; Açıkgöz, Mustafa; Özdağ, Fatih; Baybaş, Sevim; Ekmekçi, Hakan; Çabalar, Murat; Yaman, Mehmet; Bektaş, Hesna; Kaplan, Yüksel; Göksel, Başak Karakurum; Milanlıoğlu, Aysel; Örken, Dilek Necioğlu; Aluçlu, Mehmet Ufuk; Çolakoğlu, Senalu; Tüfekçi, Ahmet; Bakar, Mustafa; Nazlıel, Bijen; Taşçılar, Nida; Göksan, Baki; Kozak, Hasan Hüseyin; Mısırlı, Handan; Küçükoğlu, Hayriye; Midi, İpek; Mengüllüoğlu, Necdet; Aytaç, Emrah; Yeşilot, Nilüfer; İnce, Birsen; Yalın, Osman Özgür; Güneş, Taşkın; Oruç, Serdar; Domaç, Füsun Mayda; Öztürk, Şerefnur; Karahan, Ali; Erdoğan, Hacı Ali; Afşar, Nazire
    Introduction: Cerebral venous and sinus thrombosis (CVST) may lead to cerebral edema and increased intracranial pressure; besides, ischemic or hemorrhagic lesions may develop. Intracerebral hemorrhages occur in approximately one-third of CVST patients. We assessed and compared the findings of the cerebral hemorrhage (CH) group and the CVST group. Materials and Methods: In the VENOST study, medical records of 1,193 patients with CVST, aged over 18 years, were obtained from 35 national stroke centers. Demographic characteristics, clinical symptoms, signs at the admission, radiological findings, etiologic factors, acute and maintenance treatment, and outcome results were reported. The number of involved sinuses or veins, localizations of thrombus, and lesions on CT and MRI scans were recorded. Results: CH was detected in the brain imaging of 241 (21.1%) patients, as hemorrhagic infarction in 198 patients and intracerebral hemorrhage in 43 patients. Gynecologic causes comprised the largest percentage (41.7%) of etiology and risk factors in the CVST group. In the CH group, headache associated with other neurological symptoms was more frequent. These neurological symptoms were epileptic seizures (46.9%), nausea and/or vomiting (36.5%), altered consciousness (36.5%), and focal neurological deficits (33.6%). mRS was >= 3 in 23.1% of the patients in the CH group. Discussion and Conclusion: CVST, an important cause of stroke in the young, should be monitored closely if the patients have additional symptoms of headache, multiple sinus involvement, and CH. Older age and parenchymal lesion, either hemorrhagic infarction or intracerebral hemorrhage, imply poor outcome.
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    Epileptic seizures in cerebral venous sinus thrombosis: Subgroup analysis of VENOST study
    (W B Saunders Co Ltd, 2020) Uluduz, Derya; Midi, Ipek; Duman, Taskin; Yayla, Vildan; Karahan, Ali Yavuz; Afsar, Nazire; Goksu, Eylem Ozaydin
    Purpose: The aim of this study is to evaluate the presence and prognostic impact of early seizures in cerebral venous sinus thrombosis patients (CVST). Method: VENOST is a retrospective and prospective national multicenter observational study. CVST patients with or without epileptic seizures (ES) were analyzed and compared in terms of demographic and imaging data, causative factors, clinical variables, and prognosis in a total of 1126 patients. Results: The mean age of the patients in the ES group was 39.73 +/- 12.64 and 40.17 +/- 14.02 years in the non-ES group (p > 0.05). Epileptic seizures were more common (76.6 %) in females (p < 0.001). Early ES occurred in 269 of 1126 patients (23.9 %). Epileptic seizures mainly presented in the acute phase (71.4 %) of the disease (p < 0.001). Majority of these (60.5 %) were in the first 24 h of the CVST. The most common neurological signs were focal neurologic deficits (29.9 %) and altered consciousness (31.4 %) in the ES group. Superior sagittal sinus (SSS) and cortical veins (CV) involvement were the most common sites of thrombosis and the mostly related etiology were found puerperium in seizure group (30.3 % vs 13.9 %). Patients with seizures had worse outcome in the first month of the disease (p < 0.001) but these did not have any influence thereafter. Conclusions: In this largest CVST cohort (VENOST) reported female sex, presence of focal neurological deficits and altered consciousness, thrombosis of the SSS and CVs, hemorrhagic infarction were risk factors for ES occurrence in patients with CVST.
  • Küçük Resim
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    Headache as the sole presenting symptom of cerebral venous sinuses thrombosis: Subgroup analysis of data from the VENOST study
    (Kare Publ., 2021) Duman, Taşkın; Çınar, Nilgün; Uludüz, Derya; Domaç, Füsun Mayda; Öztürk, Şerefnur; Yayla, Vildan; Karahan, Ali Yavuz; Afşar, Nazire; Sungur, Mehmet Ali; Göksu, Eylem Özaydın; Yürekli, Vedat Ali; Genç, Hamit; Utku, Uygar; Şahin, Şevki; Tekeli, Hakan; Tokuç, Firdevs Ezgi; Uzuner, Nevzat; Şenol, Mehmet Güney; Yılmaz, Arda; Gökçe, Mustafa; Demirci, Seden; Küsbeci, Özge Yılmaz; Uzuner, Gülnur Tekgöl; Çağlayan, Hale Zeynep Batur; Açıkgöz, Mustafa; Kurucu, Hatice; Özdağ, Mehmet Fatih; Baybas, Sevim; Ekmekçi, Hakan; Çabalar, Murat; Yaman, Mehmet; Bektaş, Hesna; Kaplan, Yüksel; Göksel, Başak Karakurum; Milanlıoğlu, Aysel; Örken, Dilek Necioğlu; Aluçlu, Mehmet Ufuk; Çolakoğlu, Sena; Tüfekçi, Ahmet; Bakar, Mustafa; Nazliel, Bijen; Taşçılar, Nida; Göksan, Baki; Kozak, Hasan Hüseyin; Mısırlı, Cemile Handan; Küçükoğlu, Hayriye; Midi, Ipek; Mengüllüoğlu, Necdet; Aytaç, Emrah; Yeşilot, Nilüfer; İnce, Birsen; Yalın, Osman Özgür; Güneş, Taşkın; Oruç, Serdar; Demir, Serkan
    Objectives: Headache is the most common complaint in cerebral venous sinus thrombosis (CVST) and it may sometimes be the only symptom in these patients. This retrospective and prospective study was an investigation of any differences in terms of clinical risk factors, radiological findings, or prognosis in patients with CVST who presented with isolated headache (IH) and cases with other concomitant findings (non-isolated headache [NIH]). Methods: A total of 1144 patients from a multicenter study of cerebral venous sinus thrombosis ( VENOST study) were enrolled in this research. The demographic, biochemical, clinical, and radiological aspects of 287 IH cases and 857 NIH cases were compared. Results: There were twice as many women as men in the study group. In the IH group, when gender distribution was evaluated by age group, no statistically significant difference was found. The onset of headache was frequently subacute and chronic in the IH group, but an acute onset was more common in the NIH group. Other neurological findings were observed in 29% of the IH group during follow-up. A previous history of deep, cerebral, or other venous thromboembolism was less common in the IH group than in the NIH group. Transverse sinus involvement was greater in the IH group, whereas sagittal sinus involvement was greater in the NIH group. The presence of a plasminogen activator inhibitor (PAI) mutation was significantly greater in the IH group. Conclusion: IH and CVST should be kept in mind if a patient has subacute or chronic headache. PAI, which has an important role in thrombolytic events, may be a risk factor in CVST. Detailed hematological investigations should be considered. Additional studies are needed.
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    TÜRKİYE’DE HASTANEDE NÖROVASKÜLER HASTALIK YÖNETİMİ: MANTIK, HİPOTEZ, YÖNTEMLER VE TANIMLAYICI KARAKTERİSTİKLER (NÖROTEK: TÜRKİYE NÖROLOJİ TEK GÜN ÇALIŞMASI)
    (2021) Yayla, Vildan; Işıkay, Canan Togay; Ongun, Nedim; Güven, Bülent; Aluçlu, Mehmet Ufuk; Değirmenci, Bahar; Çetiner, Mustafa
    GİRİŞ ve AMAÇ: Türkiye'de yatarak tedavi gören akut inme hastalarının profiline ilişkin nesnel veriler sınırlıdır. Ancak bu, bölgesel akut inme yönetimi de dâhil olmak üzere ilgili sağlık sisteminin optimize edilmesi için gereklidir. NöroTek çalışması, temel hastane içi kalite ölçütleri perspektifinde iskemik inme, intraserebral kanama ve kardiyopulmoner arrest vakalarının özelliklerini toplamayı amaçladı. YÖNTEM ve GEREÇLER: NöroTek, 10 Mayıs 2018 Dünya İnme Farkındalık gününde Türkiyede’ki 30 sağlık hizmet bölgesini temsil eden 87 merkezin (16 Hastane, 26 inme ünitesi ve 45 inme merkezi) dahli ile gerçekleştirilmiş olan nokta prevalans çalışmasıdır. Toplam 1802 yatan hasta (Kadın %50,4; yaş: 61,4±18,4 yıl) çalışmaya dâhil edildi. Hastane süreçleri, akut inme kliniği, görüntüleme, tedavi ve prognoz ile ilgili soruları içeren bir form (başvuru gününde 6 kategoride 49 soru ve taburculuk anında 7 kategoride 52 soru) araştırmacılar tarafından dolduruldu. BULGULAR: Belirlenen tarihte toplam 1070 nörovasküler hastalık (TIA %3,7, iskemik inme %48,4, intraserebral kanama %7, kardiyopulmoner arrest %0,4 ve vegetatif durum %0,1) ve 732 (%40,4) nörolojik hastalık kaydedildi. Nörovasküler hastalık nedeniyle izlenmekte olan hastaların üçteikisinde bilinen hipertansiyon mevcuttu. İskemik inme ve TIA’da diabet üçteiki, dislipidemi üçtebir ve rekürren olay üçtebir oranında olup hepsi intraserebral kanamalardan daha sık idi. Derin ven trombozu tanısı iskemik inmede %3,9 ve intraserebral kanamalarda %2,9 oranında iken hastane enfeksiyonları iskemik inmede intraserebral kanamalardan daha az idi (Pnömoni %30,8'e %40,6, idrar yolu enfeksiyonu %10,9'a %13,9). Ortalama hastane yatışı süresi nörovasküler hastalıklarda diğerlerinden uzundur (22'ye 17 gün). Hastane içi mortalite iskemik inmede %10,3 ve intraserebral kanamalarda %15,5 olup %60'ının nedeni enfeksiyonu idi. TARTIŞMA ve SONUÇ: İnme klinik literatüründe “ilk” “nokta prevalans çalışması” olan NöroTek Türkiye hastanelerde yatan inme hastalarının başlıca kalite metriklerinin profilini ortaya koymuştur. Elde ettiğimiz veri pandemi sonrası akut inme yöntemi strateji belirleniminde anahtar olma potansiyeline sahiptir