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Öğe Changing cerebral blood flow velocity by transcranial Doppler during head up tilt in patients with diabetes mellitus(Elsevier, 2007) Asil, Talip; Utku, Ufuk; Balci, Kemal; Uzunca, IlkayObjective: Diabetes mellitus is an independent risk factor for poor prognosis in patients with ischemic stroke. It is known that diabetes mellitus directly affects cerebral vasculature as a secondary, long-term complication of cerebral circulation, and causes cerebral blood flow abnormalities. The abnormalities of cerebral autoregulation also poorly affects the prognosis of ischemic stroke. In this study, we aimed to show the cerebral autoregulation with transcranial Doppler (TCD) ultrasound in diabetic patients with autonomic nervous system abnormalities, determined with electrophysiological studies. Material and method: Twenty healthy controls and 39 patients, who had at least 2 years of diabetes mellitus, were evaluated (age ranges: 42-75 years). The patients were divided into two groups according to sympathetic skin response and R-R interval variation studies: (1) patients with autonomic neuropathy; (2) patients without autonomic neuropathy. Blood flow velocities were measured during supine position and after the patients were raised upright position on head up tilt table. Arterial blood pressures and heart rates were also evaluated. Results: Mean blood flow velocities of diabetic patients with autonomic neuropathy were found more decreased at 90 s after the patients were raised upright position. Discussion: Autonomic neuropathy due to diabetes mellitus affects cerebral autoregulation, and by this way cerebral perfusion loses protection against hemodynamical changes. (c) 2006 Elsevier B.V. All rights reserved.Öğe Evaluation of vasomotor reactivity by transcranial Doppler sonography in patients with acute stroke who have symptomatic intracranial and extracranial stenosis(Wiley, 2007) Uzunca, Ilkay; Asil, Talip; Balci, Kemal; Utku, UfukObjective. In patients with large artery disease, determining the cerebral hemodynamic state and following its alterations may be a good marker for predicting long-term outcome. The aim of our study was to compare the changes in vasomotor reactivity (VMR) of patients with symptomatic intracranial and extracranial artery stenosis. We also examined whether VMR after stroke influences the long-term prognosis for these patients. Methods. Forty-one patients were included in the study. To determine the cerebral hemodynamic state, transcranial Doppler ultrasound examinations and acetazolamide tests were performed after acute stroke and repeated after 6 months. We compared the VMR on admission and at 6 months, together with changes in VMR, of the patients with symptomatic intracranial and extracranial artery stenosis. By calculating the Barthel index at 6 months, We examined whether VMR had an effect on an improvement in their quality of life. Results. We observed a significantly higher initial VMR of the ipsilateral hemisphere in patients with intracranial stenosis (22.4 +/- 9.1 versus 13.4 +/- 12.8; P = .013). At 6 months, the VMR obtained from the ipsilateral hemisphere was better in patients with extracranial stenosis than in the patients with intracranial stenosis (P = .01). The ipsilateral VMR measured on admission showed a positive correlation with the Barthel index at 6 months (P = .007; r = 0.434). Conclusions. Our study showed that VMR in patients with acute stroke who have extracranial and intracranial artery stenosis measured by using a transcranial Doppler examination may have value in predicting long-term outcome.Öğe A patient with brucellar cervical spondylodiscitis complicated by epidural abscess(Elsevier Sci Ltd, 2011) Eker, Alper; Uzunca, Ilkay; Tansel, Ozlem; Birtane, MuratBrucellar cervical spondylodiscitis and epidural abscess are serious medical conditions that can cause permanent neurological deficits. Fortunately, they are rare. We report a 34-year-old male patient, complaining of fever and neck pain and stiffness, with increased deep tendon reflexes. A lumbar puncture was normal. Brucella species organisms were isolated from blood cultures, and the Rose-Bengal test and the standard tube agglutination (STA) test were positive. The diagnosis was made on MRI. The patient was treated with doxycycline and rifampin daily for 16 weeks. On day 51 of treatment, the patient had no symptoms and his physical and neurological examinations were normal. His repeat cervical MRI was almost normal. The STA test was negative at week 20. It is important to consider brucellar cervical spondylodiscitis with epidural abscess in endemic regions. (C) 2010 Elsevier Ltd. All rights reserved.Öğe Six-month follow-up study in patients with symptomatic intracranial arterial stenosis(Churchill Livingstone, 2006) Asil, Talip; Balci, Kemal; Uzunca, Ilkay; Kerimoglu, Mahmut; Utku, UfukIschaemic stroke due to intracranial atherosclerosis is estimated to comprise 8-12% of all ischaemic strokes. It is known that the risk of recurrence is extremely high in patients with ischaemic stroke caused by intracranial stenosis. In the present study we aimed to evaluate the clinical and radiological findings over a 6-month follow-up period in patients with intracranial atherosclerosis. Prospective data for the ischaemic stroke patients admitted to our clinic between 2001 and 2004 were collected. The localization of stenosis/occlusion detected by magnetic resonance angiography (MRA) was recorded and patients were divided into two groups according to the presence of one or more arterial stenoses on MRA. The patients were followed up for 6 months at regular intervals and stroke recurrence and deaths were noted. Of the 47 patients, 11 had posterior circulation stenosis and 36 had anterior circulation stenosis. Thirty-three patients had only one intracranial artery stenosis, whereas 14 had more than one intracranial artery stenosis. Of the 38 patients who completed the 6-month follow-up period, 13 had recurrent stroke, and 10 died. The rate of stroke recurrence in patients with intracranial artery stenosis may be higher than in patients with stroke due to other aetiologies, and stenosis of multiple intracranial arteries increases the rate of recurrence. (C) 2006 Elsevier Ltd. All rights reserved.
