Should we use the serum vaspin level for the diagnosis and/or prognosis of subarachnoid hemorrhage?

BACKGROUND: We aimed to investigate whether vaspin, a member of the serine protease family, could be used as a marker for the severity and prognosis of subarachnoid hemorrhage (SAH). METHODS: Fifty-two consecutive patients (mean age, 51.46±3.2 years; 61.5% male) admitted to the emergency service of our hospital and hospitalized at our clinic with the diagnosis of aneurysmal SAH between 2012 and 2014 were included in the study and followed up for six months for outcome. The control group consisted of 52 healthy individuals of similar age and gender. RESULTS: During the 6-month follow-up, 8 of 52 patients died, and 18 (34.6%) patients had poor the Glasgow Outcome Score (GOS) scores. In 20 (38.46%) patients, acute hydrocephalus developed, and external ventricular drainage was performed. In the study group, the mean vaspin level was significantly higher than control group (157.88±33.6 pg/mL and 109.59±45.68 pg/mL, respectively; P<0.01). The mean vaspin level was 215.18±12.36 pg/mL in the non-survival group and 147.47±24.43 pg/mL in the survival group. Furthermore, it was 195.99±21.10 pg/mL in patients with poor outcome in terms of GOS, and 137.71±17.61 pg/mL in those with good outcome. The vaspin levels significantly increased with worsening of GOS, the World Federation of Neurological Surgeons (WFNS) grading system, and Fisher scores and increasing plasma C-reactive protein levels (P<0.01 for all). CONCLUSIONS: In conclusion, vaspin can play a role as a new marker in the diagnosis, severity assessment, and prognosis of SAH.

Correlation with Platelet Parameters and Genetic Markers of Thrombophilia Panel (Factor II g.20210G>A, Factor V Leiden, MTHFR (C677T, A1298C), PAI-1, ß-Fibrinogen, Factor XIIIA (V34L), Glycoprotein IIIa (L33P)) in Ischemic Strokes.

An important type of arterial thrombosis, ischemic stroke is associated with increased mortality risk, severe disability and life quality impairment. In this study, we analyzed mean platelet volume, platelet count values and genetic thrombophilia markers of patients who have ischemic stroke history and searched the relationship with genetic predisposition of ischemic strokes and platelet parameters. A retrospective, clinical trial was performed by reviewing the ischemic stroke history (except cryptogenic events) of 599 patients and 100 controls. The results of the genetic thrombophilia panel were used to classify the study group and control group into low and high risk for thrombophilia groups. The high-risk group included patients homozygous/heterozygous for Factor II g.20210G>A or Factor V Leiden mutations with/without any other polymorphism. The low-risk group included patients heterozygous or homozygous for MTHFR (C677T, A1298C), PAI-1, ß-fibrinogen, Factor XIIIA (V34L) and glycoprotein IIIa (L33P) polymorphisms or negative in terms of both mutations and polymorphisms. The results of study showed us that high-risk group mutations are important risk factors for ischemic stroke but low-risk group polymorphisms are not significant. According to platelet parameters, although there was a significant difference between MPV and PLT values of ischemic stroke and control group, thrombophilia mutations and polymorphisms have not a significant effect on MPV and PLT values in ischemic stroke patients.

Can we distinguish stroke and stroke mimics via red cell distribution width in young patients?

INTRODUCTION: Discrimination of stroke and stroke mimics is problematic in young patients. The aim of the study was to determine whether arterial ischemic stroke and stroke mimics can be differentiated via the red cell distribution width (RDW) value in young patients. MATERIAL AND METHODS: In this retrospective cross-sectional study, a total of 236 patients hospitalized at the neurology ward were investigated. The patients were divided into 3 groups: the 1(st) group included young stroke patients, the 2(nd) group included patients with epilepsy, and the 3rd group included patients with multiple sclerosis (MS). Complete blood count and computed tomographic brain imaging tests were performed in all patients, and magnetic resonance imaging was done when necessary. RESULTS: A total of 236 patients were included in this study. Ninety-five (40%) patients were young stroke patients, 71 (30%) had epilepsy and 70 (30%) had MS. The mean RDW values of young patients with stroke were significantly higher than patients with epilepsy or MS (14.9 ±1.2, 13.3 ±1.2, 13.4 ±0.6, p < 0.0001, respectively). The diagnostic power of RDW in the differentiation of patients with stroke is good (area under the curve (AUC) = 0.89). When an RDW cut-off value of 14.05% is accepted for differentiating young patients with stroke from other disorders, the sensitivity, specificity, positive predictive and negative predictive values were 73.7%, 87.9%, 6.1 and 0.043, respectively. CONCLUSIONS: Red cell distribution width is a promising, rapid, easy and inexpensive parameter to distinguish young stroke from stroke mimics (such as epilepsy and MS) in young patients.

Red cell distribution width identifies cerebral venous sinus thrombosis in patients with headache.

BACKGROUND: Diagnosing cerebral venous sinus thrombosis (CVST) in patients referring to emergency service or neurology outpatient unit with complaints of headache is a challenging task. Magnetic resonance (MR) venography is the gold standard, but there are limitations regarding its use. AIM: To evaluate the validity of red cell distribution width (RDW) in CVST diagnosis in patients presenting with headache. METHODS: A total of 138 patients comprising 37 patients with CVST and 101 control primer headache cases were included in this retrospective cross-sectional study. Control group consists of hospitalized patients with primary headache. Venous blood hemoglobin (Hb), platelet, mean corpuscular volume (MCV), RDW, fibrinogen, and vitamin B12 levels of the patients were recorded at the first referral. Diagnosis of CVST was established by MR venography. RESULTS: The RDW ratio of patients with a diagnosis of CVST was significantly higher than that in patients with primary headache (15.3 ± 1.4 vs 13.3 ± 0.5; P <.0001). Fibrinogen and vitamin B12 levels were not significantly different between the 2 groups. In a total of 11 patients, there was more than 1 thrombosis. In 21 of the patients with CVST, gene mutation was detected. There was no significant difference between the patients with and without mutations regarding RDW values. Diagnostic validity of RDW was found to be excellent in differentiating patients with CVST and primary headache (area under the curve = 0.996; 95% CI: 0.990-1.000). Optimum RDW cutoff value was determined as 14.1% (sensitivity: 91.9%, specificity: 99%, positive predictive value: 92.8, negative predictive value: 0.082). CONCLUSION: We suppose that among patients presenting with the complaint of headache, RDW value may lead to diagnose CVST.

Migraine prevalence, disability, and sociodemographic properties in the eastern region of Turkey: a population-based door-to-door survey.

BACKGROUND/AIM: To determine the frequency of migraine in the eastern part of Turkey and its sociodemographic characteristics, impact on disability, and clinical aspects. MATERIALS AND METHODS: The study was conducted door-to-door in the eastern part of Turkey. Those who suffered from headaches were diagnosed with migraine as per the 2004 diagnosis criteria of the International Headache Society and its frequency was determined. Demographic data and Migraine Disability Assessment Scale (MIDAS) scores were recorded. RESULTS: Of the individuals evaluated, 60.4% (883) suffered from headaches, of which 43.6% (637) were evaluated as nonmigraine and 16.8% (246) as migraine headaches. Migraine prevalence was detected to be 10.3% (75) in men and 23.1% (171) in women. When the MIDAS scale was considered, 7.3% of the patients were classified with mild pain, 36.9% with mild to moderate pain, 41% with moderate pain, and 14.6% with severe pain. CONCLUSION: Migraine headache has a wide and complex range of symptoms and is frequently observed in women and young adults. The prevalence of migraine among the general population of eastern Turkey was found to be similar to the averages in the rest of the country, as well to the averages of studies in Europe.

Prevalence of Tension-Type Headache in Individuals Aged between 18-65 Years in the Eastern Parts of Turkey.

OBJECTIVE: Although tension-type headache (TTHA) is one of the most frequently encountered diseases in the general population, relatively few studies have been conducted on this health condition. The published data are limited on the frequency of TTHA in Turkey, and no studies to date have been initiated on the prevalence of TTHA in the city of Erzurum or the Eastern Anatolian Region. MATERIALS AND METHODS: The study was conducted using in-depth interviews from 1972 individuals from city of Erzurum. TTHA was queried in patients with a history of headache, according to the International Classification of Headache Disorders diagnostic criteria, and the frequency of TTHA was investigated. RESULTS: A total of 1972 patients were enrolled in this study. The frequency reached a peak between the ages of 40-49 years (35%), and it significantly declined after the age of 49. During an examination (palpation), cranial muscle sensitivity was detected in 33% of the patients. CONCLUSION: The frequency of TTHA has been identified as 22.3% in patients between the ages of 18-65. The frequency of tension type headache in the city of Erzurum was lower than that in the general population of Turkey.

Investigation of the prevalence of essential tremor in individuals aged 18-60 in Erzurum.

Essential tremor (ET) is one of the common neurological diseases and it is the most common movement disorder in adults. The main clinical finding in patients with ET is kinetic tremor in the arms. There is no adequate study investigating the prevalence of ET in Turkey. Therefore, this study was planned in the center of the city of Erzurum in order to determine the prevalence of essential tremor in our region. This study was performed door to door in the center of the city of Erzurum. ET screening questionnaires were administered to all participants between the ages of 18-60 at first stage. Those who answer yes to any of the first five questions of the questionnaire were evaluated. Patients without a clear differential diagnosis were called for examination to the neurology department and they were re-evaluated by a faculty member specializing in movement disorders. Patients were classified by using Washington Heights-Inwood Genetic Study of Essential Tremor diagnostic and clinical evaluation scale. The prevalence of ET was calculated as 1.60 % (64 out of 4,024 participants). 30 of the cases were male and 34 were female. First-degree relatives of 30 patients with ET had a history of tremor. While 52 patients had tremor only in their hands, 11 patients had in various organs including hands. There was isolated head tremor in one patient. ET prevalence was increasing with age. The prevalence of ET in people between the ages of 18 and 60 was calculated as 1.60 %. This value is compatible with other measurements of the prevalence of ET.

Relationship between plasma metalloproteinase-9 levels and volume and severity of infarct in patients with acute ischemic stroke.

Matrix metalloproteinases (MMP) constitute an endopeptidase family involved in various physiological and pathological processes. It was demonstrated that plasma MMP-9 level was increased in patients with acute ischemic stroke. In this study, it was investigated whether there was a relationship between the levels of plasma MMP-9 and the severity of stroke and infarct volume in patients with acute ischemic stroke. A total of 32 patients with acute ischemic stroke, (16 males and 16 females) and 30 healthy controls were included in the study. Plasma MMP-9 levels were measured using ELISA method. Computed tomography was performed at 48th hour and infarct volume was calculated using the Cavalieri method. The National Institute of Health Stroke Scale (NIHSS) was checked at baseline, 12, 24, and 48th hour. Plasma MMP-9 levels of the patient group at baseline, 12, 24, and 48th hour were found significantly higher compared to the control group (p < 0.05). An important correlation between MMP-9 levels and the infarct volume was observed at baseline, 12, 24, and 48th hour (p < 0.001). Furthermore, a positive correlation was recorded between plasma MMP-9 levels and NIHSS scores at baseline, 12, 24, and 48th hour (p < 0.001). Plasma MMP-9 levels of those of suffering medium and heavy damages were found significantly higher when compared to those of having slight damage (p < 0.05). A significant relationship was also observed between infarct volumes and neurological deficits (p < 0.05). Plasma MMP-9 levels of the patients at 48th hour were found to be significantly lower in recovered patients compared to those who did not improved or worsened (p < 0.05). A positive correlation was recorded between the infarct volume and infarct progression (p < 0.05). In conclusion, this study showed that plasma MMP-9 level substantially increased during the acute period of ischemic cerebrovascular disease and correlated with the severity of the disease and infarct volume. The definition of the exact role of plasma MMP-9 after ischemic stroke will have important diagnostic implications for stroke and for the development of therapeutic strategies aimed at modulating plasma MMP-9.