Exploring PGE2 and LXA4 Levels in Migraine Patients: The Potential of LXA4-Based Therapies.

Neurogenic inflammation plays a significant role in the pathogenesis of migraines. This study aimed to investigate the serum levels of prostaglandin E2 (PGE2), lipoxin A4 (LXA4), and other inflammatory biomarkers (C-reactive protein, fibrinogen) in migraine patients. In total, 53 migraine patients and 53 healthy controls were evaluated. Blood serum samples were collected during both attack and interictal periods and compared with the control group. In both the attack and interictal periods, PGE2 and LXA4 values were significantly lower in migraine patients compared to the control group (p < 0.001). Additionally, PGE2 values during the attack period were significantly higher than those during the interictal period (p = 0.016). Patients experiencing migraine attacks lasting ≥ 12 h had significantly lower serum PGE2 and LXA4 levels compared to those with attacks lasting < 12 h (p = 0.028 and p = 0.009, respectively). In ROC analysis, cut-off values of 332.7 pg/mL for PGE2 and 27.2 ng/mL for LXA4 were determined with 70-80% sensitivity and specificity. In conclusion, PGE2 and LXA4 levels are significantly lower in migraine patients during both interictal and attack periods. Additionally, the levels of LXA4 and PGE2 decrease more with the prolongation of migraine attack duration. Our findings provide a basis for future treatment planning.

Evaluation of aspiration risk by relatives of inpatients in the neurology service: A metaphor analysis.

BACKGROUND: The risk of aspiration is high in stroke patients due to dysphagia/loss of swallowing. This problem can cause problems affecting the nutrition of patients. Due to the possible risk of aspiration during feeding, patient relatives are hesitant to feed their patients. Because of this fear, malnutrition and hospital readmissions may increase. It is important to evaluate the fear of aspiration risk of relatives of patients hospitalized in the neurology service. The aim of this study is to determine the views of the relatives of patients treated in the neurology service about the risk of aspiration through metaphors. METHOD: This article analyzed metaphors of patients' relatives' about the risk of aspiration. The analysis uses metaphor identification and analysis. The research sample consisted of 31 patients. First of all, in the study, evaluation of the data was conducted by performing content analysis, as a result of which it was divided into metaphors and conceptual categories, and the relevant field was associated with the text (event, thought, feelings, related in speech or writing). In the reporting of research, the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used. RESULTS: It was seen that the patients' relatives produced 31 different metaphors in response to the statement 'Aspiration risk is like …, because it is …' The patients' relatives mostly compared the concept of 'fear of aspiration' to the concept of 'fear' (n: 24). CONCLUSIONS: In this study, relatives mostly described the concept of fear related to the risk of aspiration. According to this result, patients' relatives have a great fear of aspiration increasing the risk of readmission to hospital and of malnutrition. This result shows that informing patients' relatives will increase awareness and will allow them to provide informed care. PATIENT AND PUBLIC CONTRIBUTION: Collaborated with patients and their relatives regarding the risk of aspiration and contributed to the planning of care for the risk of aspiration.

Endovascular treatment for anterior cerebral artery occlusions.

BACKGROUND: We sought to examine the feasibility, safety and preliminary efficacy of anterior cerebral artery (ACA) occlusions in patients undergoing endovascular treatment. METHODS: Four hundred five consecutive patients with large-vessel occlusion treated with endovascular treatment were analysed to identify all patients with acute ACA occlusion who underwent endovascular treatment. RESULTS: Twenty had ACA occlusion (primary ACA occlusion: 9, rescue ACA occlusion: 11), 395 patients had other occlusions (internal carotid artery and MCA). The median [IQR] mRS score in the third month was significantly higher in the ACA-rescue occlusion group versus the ACA-primary occlusion group. The rate of haematoma in patients with ACA-occlusions was significantly higher compared with the ACA-primary occlusion group. Moreover, the three-month mortality rate was higher in patients with ACA-rescue than the patients with ACA-primary. CONCLUSIONS: Although endovascular treatment can be considered in patients with primary ACA occlusions, our data suggest that future clinical trials are needed to determine the efficacy of endovascular treatment for ACA occlusions. Unfavourable outcomes in our study were considered to occur in the rescue ACA occlusions.

Endovascular treatment for M3 occlusions.

INTRODUCTION: Endovascular treatment (ET) is a beneficial treatment for M1-2 occlusions of the middle cerebral artery. Mortality and disability rates are high if large vessel occlusions are not treated. While these rates are lower in M3 occlusions, important branch blockages can lead to disability. Endovascular treatment of small vessel occlusions is difficult, and there are no studies on the effectiveness of endovascular treatment for M3 occlusions. Accordingly, in this study, our aim was to assess the feasibility, safety, and preliminary efficacy of endovascular therapy for M3 occlusions. METHODS: This study involved a retrospective analysis of a prospectively collected from two centres for acute ischemic stroke of the anterior system between July 2015 and April 2020. Demographic, radiologic, procedural and outcome variables were collected for patients who underwent endovascular therapy for acute ischemic stroke of the anterior system. RESULTS: Complete or near complete reperfusion (mTICI 2b-3) of the M3 occlusion was achieved in 15 cases (38.5%). Complete (mTICI 3) reperfusion was achieved in 24 cases (61.5%). Twenty-six patients were treated for primary M3 occlusion, while 13 patients with M3 occlusion were treated as a rescue strategy after successful treatment of a proximal greater vascular occlusion. Complete or near complete reperfusion (mTICI 2b-3) of primary occlusion was achieved in eight cases (30.8%), and complete (mTICI 3) reperfusion was achieved in 18 cases (69.2%). In addition, complete or near complete reperfusion (mTICI 2b-3) of rescue M3 occlusion was achieved in seven cases (%53.8), while complete (mTICI 3) reperfusion was achieved in six cases (46.2%). Only one patient with primary M3 occlusion had ICH due to extravasation. The patient's neurological examination one month later was normal. CONCLUSIONS: This retrospective study demonstrates that endovascular treatment of M3 occlusions is safe, effective and reliable.

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.

Cortical and cerebellar atrophy, but no lesion in a patient with neuro-Behçet's disease.

Neuro-Behçet's disease (NBD) is a rare clinical entity. There are no reports about cortical atrophy in NBD. We report a patient with NBD exhibiting only cortical and cerebellar atrophy without any lesions. A 38-year-old male was hospitalized due to gait disorder. He had experienced forgetfulness, irritability, sexual and behavioral dyscontrol, and incontinence for 5 years. Magnetic resonance imaging (MRI) showed cortical and cerebellar atrophy, but there were no lesions. In the differential diagnosis of NBD, physicians should take into account the presence of both brainstem and cerebellar and cortical atrophy even in the absence of typical lesions for NBD, particularly in the presence of cognitive dysfunctions.

Prothrombin G20210A mutation, hypogonadotropic hypogonadism, and generalized vitiligo-related ischemic stroke in a young adult.

PURPOSE: Cerebral infarction is a rare neurological situation in young adults, usually caused by genetic factors. We report here a case of multiple cerebral infarctions with prothrombin G20210A mutation, hypogonadotropic hypogonadism, and generalized vitiligo as a first case report. CASE REPORT: A 17-year-old female adolescent was admitted to our clinic due to a change in mental status. The patient's neurological examination revealed loss of consciousness and the presence of tetraparesia. Generalized vitiligo was also detected. Magnetic resonance imaging (MRI) and diffusion-weighted investigations (DWIs) showed acute ischemic stroke in the bilateral cerebellum, pons and left occipital regions. Heterozygote prothrombin G20210A mutation was found upon genetic examination. She had never had a menstrual cycle. Laboratory data revealed that the level of luteinizing hormone (LH) was 0.5 mIU/mL (1.1-11.6) and follicle-stimulating hormone (FSH) was 1.7 mIU/mL (2.8-11.3). Therefore, she was diagnosed with hypogonadotropic hypogonadism. The causes of ischemic stroke are heterozygote prothrombin G20210A mutation, generalized vitiligo, and hypogonadotropic hypogonadism. After treatment, the patient's neurological deficit partially improved and she was discharged. CONCLUSION: In order to identify the etiology of ischemic stroke, we suggest physicians take into account heterozygote prothrombin G20210A mutation and endocrine abnormalities, especially hypogonadotropic hypogonadism and generalized vitiligo.