Too bad to treat? Predicting clinical outcome after mechanical thrombectomy in octogenarians.

OBJECTIVES: We aimed to reveal the effect of the totaled health risk in vascular events (THRIVE) score and the radiological parameters of the Alberta stroke program early computed tomography score (ASPECTS), the Van Swieten Scale (VSS) score, and the Evans Index on clinical outcomes in patients over 80 years of age who underwent endovascular thrombectomy (EVT). MATERIALS AND METHODS: We retrospectively analyzed anterior ischemic stroke (AIS) patients over 80 years of age who underwent EVT between May 2017 and April 2022. Good functional outcome was accepted as a 90-day modified Rankin Scale (mRS) score of 0-2. We constructed three models to compare to the mRS (model 1: THRIVE, CTA-ASPECT; model 2: THRIVE, CTA-ASPECT, Evans Index; model 3: THRIVE, CTA-ASPECT, Evans Index, VSS). RESULTS: A total of 39 octogenarian patients with thrombolysis in cerebral infarction (TICI) 2c-3 recanalization were selected, and their 90-day mRS scores were compared. Of these, 19 patients (48%) showed good outcomes. In multivariable receiver operating characteristic (ROC) analyses, the AUC of model 1 was 0.797 (95% confidence interval [CI], 0.638-0.909), the AUC of model 2 was 0.862 (95% CI, 0.714-0.951), and the AUC of model 3 was 0.905 (95% CI, 0.768-0.975). CONCLUSIONS: Evaluation of the THRIVE score, which measures vascular disease burden and stroke severity, together with the radiological parameters of ASPECTS score, VSS score, and the Evans Index, provides useful guidance in predicting the clinical outcomes of elderly AIS patients after EVT.

Progression rates of medulla oblongata infarcts in clinical follow-up: A retrospective study.

OBJECTIVE: To determine clinical progression rates in patients with medulla oblongata infarction (MOI). MATERIALS AND METHODS: The data of patients diagnosed with MOI were analysed retrospectively. Dermographic characteristics of the patients; Age, gender, history and stroke etiology were evaluated. Radiological imagings were reviewed retrospectively. Intensive care unit (ICU) requirement, number of intubation days, failed extubation and death rates, good clinical outcome at discharge and 3 months [modified Rankin Scale (mRS 0-2)] and poor clinical outcome (mRS 3-6) rates were evaluated. In addition, the clinical results of patients with medial medullary infarction (MMI) and lateral medullary infarction (LMI) were compared. RESULTS: 33 patients were included in the study, 22 (66.7 %) were male. The mean age of the patients was 72.0 (43.0-85.0). The characteristics of the patients (dermographic features, comorbidities, clinical symptoms, infarct localization, etc.) were evaluated. The results of MMI and LMI patients were compared. The intubation rate was 4 (44.4 %) in the MME group, while it was 8 (33.3 %) in the LME group. There was no statistically significant difference between the two groups in terms of failed extubation, tracheostomy, hospitalization and mortality rates. However, while discharge mRS was statistically significant between the two groups, the mRS at 3 months was not statistically significant. Twelve (36.4 %) of all patients were intubated due to severe clinical progression. In the clinical follow-up, 6 (50.0 %) of the intubated patients died, 3rd month mRS of 6 (50.0 %) patients who survived was 5. In all patients 3-month good clinical outcome rate was % 48,5. CONCLUSION: It should not be forgotten that life-threatening clinical progressions may develop at a considerable rate during the early treatment process of patients diagnosed with MOI.

Evaluation of temporomandibular joint disorder in headache patients.

OBJECTIVE: The present study is aimed at determining the percentage of temporomandibular joint disorder (TMD) in patients admitted to the neurology outpatient clinic with a headache complaint and to evaluate the association of TMD with the presence of bruxism and headache traits. MATERIALS AND METHODS: A total of 349 headache patients were included in the study. The headache type, characteristics of the headache (incidence, duration, and severity of attacks), and the scores of the migraine disability scale (MIDAS) and Allodynia Symptom Scale (ASC-12T) were examined considering the presence of sleep bruxism. The International Classification of Headache Disorders (ICHD-3 Beta) criteria were used for diagnosing headaches. The presence of TMD was evaluated by using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). All patients diagnosed with TMD and/or bruxism were evaluated by a dentist. RESULTS: A total of 349 patients, 259 females and 90 males, were included in the study. The mean age of the patients was 36 years. Primary and secondary headaches were diagnosed in 317 (90.80%) and 32 (9.20%) patients, respectively. In the primary headache group, there were 227 migraines (182 females, 45 males), 74 tension-type headaches (TTH) (48 females, 26 males), and 15 trigeminal autonomic cephalalgias (TACs) (7 females, 8 males) patients. The remaining patients were diagnosed with other types of diagnoses. The rate of patients with chronic headache was 86.50%. TMD was detected in 89 (25.50%) of the patients while sleep bruxism was present in 80 (23.30%) patients. TMD was detected in 68 (30.0%) migraine patients and 13 (17.60%) TTH patients. The rate of TMD was statistically significantly higher in migraine patients compared to the TTH patients (p=0.037). CONCLUSION: Our cross-sectional outpatient-based study determined the incidence of TMD in headache patients as 25%. Among the primary headaches, the incidence of TMD was higher in migraine patients compared to the other diagnoses. Considering these data, the presence of TMD is a clinical condition that should be considered in the pathophysiology of headache, primarily migraine, and especially in cases of non-response to treatment.