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Öğe Acute-Phase Stroke Outcome and Lipids(Kare Publ, 2021) Tokgoz, Osman Serhat; Guney, Figen; Kaya, Ahmet; Bugrul, Ahmet; Eruyar, Esra; Buyukgol, Huseyin; Seyithanoglu, AbdullahObjectives: The aim of the study is to investigate the relationship of lipid subgroups with short-term mortality in acute stroke (AS). Methods: This retrospective study included 698 patients with AS who presented within 24 h of symptom onset. A hemogram from peripheral venous blood samples was taken at admission. Total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low- density lipoprotein cholesterol (LDL- C), TC/HDL-C rate, and TG/HDL-C rate were recorded. Duration of follow-up was defined as 30 days. Results: 64 out of 698 patients died during the follow-up period. The mean TG, TG/HDL-C, and TC/HDL-C levels were significantly lower in the mortality group than the survival group. In the receiver operating characteristic (ROC) analysis, the cutoff values and area under the curve of the TG, TG/HDL-C, TC, and TC/HDL- C levels for short-term stroke mortality are as follows ([100.2 mg/dL, 0.648]; [2.52, 0.650]; [170.50 mg/dL, 0.598]; and [4.32, 0.640], respectively). In the Cox regression model, only TG and TG/HDL-C, according to their ROC cutoff values, were independent variables as short-term mortality predictors ( TG =100.2 mg/dL, HR:2.413, 95% CI: 1.345-4.327, P:0.004); ( TG/HDL =2.56, HR: 2.720, 95% CI: 1.389-5.359, P:0.003, respectively). Conclusion: Dyslipidemia is a well-known as a risk factor of stroke. However, this study focused on the estimation that lower TG and TG/HDL-C levels at the time of hospital admission might be predictors of short-term mortality within a month of AS attack, which is a different subject from long term risk factors of stroke. Serum TG level may be a better indicator for mortality in the acute hypercatabolic trauma such as stroke.Öğe Acute-Phase Stroke Outcome and Lipids(Kare Publ, 2021) Tokgoz, Osman Serhat; Guney, Figen; Kaya, Ahmet; Bugrul, Ahmet; Eruyar, Esra; Buyukgol, Huseyin; Seyithanoglu, AbdullahObjectives: The aim of the study is to investigate the relationship of lipid subgroups with short-term mortality in acute stroke (AS). Methods: This retrospective study included 698 patients with AS who presented within 24 h of symptom onset. A hemogram from peripheral venous blood samples was taken at admission. Total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low- density lipoprotein cholesterol (LDL- C), TC/HDL-C rate, and TG/HDL-C rate were recorded. Duration of follow-up was defined as 30 days. Results: 64 out of 698 patients died during the follow-up period. The mean TG, TG/HDL-C, and TC/HDL-C levels were significantly lower in the mortality group than the survival group. In the receiver operating characteristic (ROC) analysis, the cutoff values and area under the curve of the TG, TG/HDL-C, TC, and TC/HDL- C levels for short-term stroke mortality are as follows ([100.2 mg/dL, 0.648]; [2.52, 0.650]; [170.50 mg/dL, 0.598]; and [4.32, 0.640], respectively). In the Cox regression model, only TG and TG/HDL-C, according to their ROC cutoff values, were independent variables as short-term mortality predictors ( TG =100.2 mg/dL, HR:2.413, 95% CI: 1.345-4.327, P:0.004); ( TG/HDL =2.56, HR: 2.720, 95% CI: 1.389-5.359, P:0.003, respectively). Conclusion: Dyslipidemia is a well-known as a risk factor of stroke. However, this study focused on the estimation that lower TG and TG/HDL-C levels at the time of hospital admission might be predictors of short-term mortality within a month of AS attack, which is a different subject from long term risk factors of stroke. Serum TG level may be a better indicator for mortality in the acute hypercatabolic trauma such as stroke.Öğe Clinical and radiologic features and their relationships with neurofunctional scores in patients with acute cerebellar infarct(Medknow Publications & Media Pvt Ltd, 2016) Kozak, Hasan Huseyin; Uca, Ali Ulvi; Poyraz, Necdet; Anliacik, Suleyman Omer; Tokgoz, Osman SerhatBackground: Cerebellar infarct is a rare condition with very nonspecific clinical features. The aim of this study was to assess the full spectrum of the clinical characteristics, neuroimaging findings and neurofunctional analyses of cerebellar infarction, and the relationship between them. Materials and Methods: Data were collected from 59 patients admitted to our department during an 8-year period. We retrospectively analyzed the relationship between demographic characteristics, clinical symptomatology, etiological factors, functional condition, vascular distribution, frequency of subcortical white matter lesions (WMLs), and concomitant lesion outside the cerebellum in patients with acute cerebellar infarct (ACI) at time of admission. Results: The mean age in our series was 65.2 years, with most being male (57.6%). The posterior inferior cerebellar (PICA) artery was the most commonly affected territory at 62.7%. There was concomitant lesion outside the cerebellum in 45.7%. The main etiology in PICA was cardioembolism. While mean National Institutes of Health Stroke Scale on admission was 2.08 +/- 1.67 in study group, modified Rankin Scale (mRS) on admission was detected to be mRS1 (n: 44, 74.5%) and mRS2 (n: 12, 20.3%) most frequently. Fourteen (35%) patients were detected to be in Fazekas stage 0; 11 (27.5%) patients in Fazekas stage 1; 6 (15%) patients in Fazekas stage 2; and 9 (22.5%) patients in Fazekas stage 3. Conclusion: Cerebellar infarct is very heterogeneous. The other cerebral area infarcts which accompany ACI negatively affect neurologic functional scores. Although it is difficult to detect the relationship between WMLs and neurologic functional severity, timely detection of risk factors and their modulation may be associated with prevention and treatability of WMLs, and this may be one of the important points for prevention of stroke-related disability.Öğe A cross-sectional study to assess the association between major depression and inflammatory markers in patients with acute ischemic stroke(Wolters Kluwer Medknow Publications, 2019) Kozak, Hasan Huseyin; Uguz, Faruk; Kilinc, Ibrahim; Uca, Ali Ulvi; Tokgoz, Osman Serhat; Guney, Figen; Ozer, NejlaBackground: Increased interest in the relationship between affective disorder and long-term health consequences has generated recent examinations of depression and stroke. Observations suggest that depressive disorder is associated with abnormal physiological and immunological responses and a resultant increase in inflammatory markers. Given the high prevalence of stroke and associated costs for the community, it is important to understand the mechanisms that may impact on the outcome to achieve the best possible prognosis. Aims: The view that inflammatory factors contribute to depression is predicated on findings that circulating cytokines and other inflammatory factors are increased in depressed patients. Therefore, it has been hypothesized that inflammation could be one of the mechanisms by which depression increases risk for ischemic stroke. Our aim was to determine whether there is any relationship between major depression and tumor necrosis factor-alpha (TNF-alpha), interleukin-1 beta (IL-1 beta), IL-18, brain-derived neurotrophic factor (BDNF), and neuron-specific enolase (NSE) in patients with acute ischemic stroke (AIS). Study Design: This was as a cross-sectional design. Materials and Methods: This study has a cross-sectional design, and it was conducted in Necmettin Erbakan University, the Meram Faculty of Medicine in Konya, Turkey, between 2014 and 2015. Fifty-three AIS patients admitted to the hospital within the first 24 h after stroke onset were recruited. Major depression was ascertained by means of the structured clinical interview for the diagnostic and statistical manual of mental disorders, Fourth Edition/Clinical Version. The enzyme-linked immunosorbent assay was used to measure the serum levels of TNF-alpha, IL-1 beta, IL-18, BDNF, and NSE at admission. Results: A total of 53 patients with a mean age of 65.9 years were recruited. Of these patients, 17 (32.1%) had major depression. Depressive and nondepressive patients had similar demographical and clinical features. There was no significant statistical difference between depressive and nondepressive patients with AIS with respect to levels of TNF-alpha, IL-1 beta, IL-18, BDNF, and NSE. Conclusion: This study suggests that in patients who have experienced AIS, there is no significant relationship between major depression and basal proinflammatory cytokines (TNF-alpha, IL-1 beta, IL-18), BDNF, and NSE.Öğe Delirium in patients with acute ischemic stroke admitted to the non-intensive stroke unit: Incidence and association between clinical features and inflammatory markers(Termedia Publishing House Ltd, 2017) Kozak, Hasan Huseyin; Uguz, Faruk; Kilinc, Ibrahim; Uca, Ali Ulvi; Tokgoz, Osman Serhat; Akpinar, Zehra; Ozer, NejlaBackground: Stroke patients with development of delirium have unfavorable outcomes, higher mortality, longer hospitalizations, and a greater degree of dependence after discharge. Studies suggest that delirium is associated with abnormal immunological responses and a resultant increase in inflammatory markers. Objective: Our aim was to determine whether there is an entity relationship between delirium, inflammation and acute ischemic stroke (AIS). Methods: Sixty AIS patients admitted to the hospital were consecutively recruited. Delirium was diagnosed with the clinical assessment according to the Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria. Enzyme-linked immunosorbent assay (ELISA) was used to measure serum levels of Interleukin-1 beta (IL-1 beta), Interleukin 18 (IL-18), Tumor Necrosis Factor-alpha (TNF-alpha), Brain-Derived Neurotrophic Factor (BDNF), and Neuron Specific Enolase (NSE) at admission. Results: Eleven (18.3%) of 60 patients were diagnosed with delirium, and the majority (n = 8, 72.7%) was the hypoactive type. Delirious and non-delirious patients had similar demographic and clinical features. Delirious patients had significantly higher lengths of hospital stay, National Institutes of Health Stroke Scale (NIHSS) at admission and discharge compared to non-delirious patients. In addition, there was no significant statistical difference between delirious and non-delirious patients with AIS in respect of levels of TNF-alpha, IL-1 beta, IL-18, BDNF and NSE. This study suggests that delirium is not scarce in patients with AIS admitted to the non-intensive stroke unit, and that delirium developing after AIS seems not to be associated with serum TNF-alpha, IL-1 beta, IL-18, BDNF and NSE but is associated with length of hospital stay and stroke severity. (C) 2016 Published by Elsevier Sp. z o.o. on behalf of Polish Neurological Society.Öğe The Effect of Blood Glucose Value on the Short-term Mortality of Acute Ischemic Stroke(Galenos Publ House, 2021) Tokgoz, Osman Serhat; Karakurt, Feridun; Bugrul, AhmetAim: This study aimed to examine the relationship between short-term mortality and blood glucose values (BGV) obtained during the first week of ischemic stroke, when neurological causes, such as increased intracranial pressure, are mainly predominant in mortality prediction. Materials and Methods: This is a retrospective study that includes 417 patients with acute ischemic stroke (AIS), who were admitted to our hospital within the first 24 hours of the stroke. Data were recorded using the International Classification of Diseases Code. On the first, third, fifth, and seventh days of the stroke, the effect of BGV on the patient's functional outcome was evaluated. Results: Of 417 patients, 90 (21.58%) died within a one-month follow-up period. There was no difference between the mortality and survival groups in terms of diabetes mellitus (DM) history (chi 2=0.783; p=0.224). On the first, third, fifth, and seventh day of the stroke, BGV were significantly higher in the mortality group (130.5 mg/dL, 124.5 mg/dL, 133.5 mg/dL, and 132.5 mg/dL, respectively, according to the receiver operating characteristic analysis) than in the survival group (p<0.05). BGV of the fifth day (133.5 mg/dL) was an independent predictor for mortality (hazard ratio: 3.001; 95% confidence interval (1.43-6.3); p=0.004), while BGV of the other days were dependent on a coma scale. Conclusion: Hyperglycemia predicting short-term AIS mortality might be a DM-independent stress hyperglycemia. Although hyperglycemia is predominantly a coma-scale-dependent [modified Rankin Scale (mRS)] predictor during the first week of blood glucose monitoring, BGV of the fifth day may be an independent predictor of short-term mortality.Öğe Effects of Gluteus Maximus Muscle Strength on Ataxia, Gait, and Equilibrium in Multiple Sclerosis(Pera Yayincilik Hizmetleri, 2023) Erdeo, Fatma; Uca, Ali Ulvi; Tokgoz, Osman Serhat; Salci, Yeliz; Balkan, Ayla FilObjective: Multiple sclerosis (MS) is an autoimmune disease that causes scar tissue in the nervous system and seriously affects the quality of life of people. Muscle weakness, spasticity and coordination problems are seen primarily in the lower extremities. Strengthening exercises improve muscle strength in people with multiple sclerosis, but there is no consensus on their effect on walking capacity. Methods: To determine the relationship between gluteus maximus muscle strength, ataxia, balance and walking capacity in Multiple Sclerosis. An experimental study design was applied. Gluteus maximus muscle strength was measured using a dynamometer. Walking capacity was determined by the 6-minute walk test (6MWT) and dynamic gait index (DGI). Balance was evaluated with the one-leg standing test (SLS). The severity of ataxia was measured with the International Ataxia Rating Scale (ICARS). Fatigue was evaluated with VAS and quality of life of all patients with SF36 short form. Results: EDSS mean of the study = 3.39 +/- 1.4; 2 men and 16 women with mean age = 37.17 +/- 9.16 years were included. 6MWT, DGI, ALS, ICARS, VAS were different before and after treatment (p<0.05). There was no significant difference other than physical function and general health among the sub-parameters of SF36 (p>0.05). Correlation of muscle strength with ataxia, gait and balance was not significant (p>0.05) Conclusion: In individuals with MS, the fact that the treatment program consists of modalities that include balance and sensory exercises as well as muscle strengthening exercises increases the success of rehabilitation.Öğe A Neuro-Behcet's Case Operated with the Intracranial Mass Misdiagnosis(Korean Neurosurgical Soc, 2012) Tokgoz, Osman Serhat; Akpinar, Zehra; Guney, Figen; Seyithanoglu, AbdullahBehcet's disease (BD) is an inflammatory systemic disorder with oral and genital ulcers, as well as ophthalmologic and cutaneous symptoms. Neurological manifestations in BD represent between 2.2% to 50% of the cases. The 25-year-old male patient, diagnosed with BD three years earlier, was admitted to our clinic with complaints of recurrent headaches. Tumor-like-parenchimal involvement was detected on a cranial magnetic resonance imaging. The lesion was removed surgically and then he suffered from right hemiparesis and epilepsy. Pathological examination of the lesion noted a demyelinating non-tumoural etiology. A neuro-Behcet's case with parenchymal involvement has been examined in light of the literature, in terms of a tumor and a demyelinating disease differential diagnosis.Öğe Possible roles of sestrin2 in multiple sclerosis and its relationships with clinical outcomes(Assoc Arquivos Neuro- Psiquiatria, 2022) Odabas, Faruk Omer; Uca, Ali Ulvi; Akdag, Turan; Demirdogen, Filiz; Altas, Mustafa; Tokgoz, Osman SerhatBackground: Characterized by demyelination, inflammation and axonal damage, multiple sclerosis (MS) is one of the most common disorders of central nervous system led by the immune system. There is an urgent and obvious need for biomarkers for the diagnosis and follow-up of MS. Objective: To investigate serum levels of sestrin2 (SESN2), a protein that responds to acute stress, in MS patients. Methods: A total of 85 participants, 40 patients diagnosed previously with relapsing-remitting MS and 45 healthy controls, were included. Serum SESN2 parameters were investigated in blood samples drawn from each participant in the patient and control groups. Results: SESN2 levels were significantly lower in MS patients than in controls (z:-3.06; p=0.002). In the ROC analysis of SESN2, the predictive level for MS was 2.36 ng/mL [sensitivity, 72.50%; specificity, 55.56%; p=0.002; area under the curve (AUC)=0.693]. For the cut-off value in both groups, SESN2 was an independent predictor for MS [Exp (B)=3.977, 95% confidence interval (95%CI) 1.507-10.494 and p=0.013]. Conclusions: The decreased expression of SESN2 may play a role in MS pathogenesis, and SESN2 could be used as a biomarker for MS and as immunotherapeutic agent to treat MS.Öğe Possible roles of sestrin2 in multiple sclerosis and its relationships with clinical outcomes(Assoc Arquivos Neuro- Psiquiatria, 2022) Odabas, Faruk Omer; Uca, Ali Ulvi; Akdag, Turan; Demirdogen, Filiz; Altas, Mustafa; Tokgoz, Osman SerhatBackground: Characterized by demyelination, inflammation and axonal damage, multiple sclerosis (MS) is one of the most common disorders of central nervous system led by the immune system. There is an urgent and obvious need for biomarkers for the diagnosis and follow-up of MS. Objective: To investigate serum levels of sestrin2 (SESN2), a protein that responds to acute stress, in MS patients. Methods: A total of 85 participants, 40 patients diagnosed previously with relapsing-remitting MS and 45 healthy controls, were included. Serum SESN2 parameters were investigated in blood samples drawn from each participant in the patient and control groups. Results: SESN2 levels were significantly lower in MS patients than in controls (z:-3.06; p=0.002). In the ROC analysis of SESN2, the predictive level for MS was 2.36 ng/mL [sensitivity, 72.50%; specificity, 55.56%; p=0.002; area under the curve (AUC)=0.693]. For the cut-off value in both groups, SESN2 was an independent predictor for MS [Exp (B)=3.977, 95% confidence interval (95%CI) 1.507-10.494 and p=0.013]. Conclusions: The decreased expression of SESN2 may play a role in MS pathogenesis, and SESN2 could be used as a biomarker for MS and as immunotherapeutic agent to treat MS.Öğe The Relationship Between Pain and Clinical Features in Multiple Sclerosis(Turkish Neurological Soc, 2014) Akpinar, Zehra; Tokgoz, Osman Serhat; Gumus, HalukObjective: Multiple sclerosis (MS) is an autoimmune-neurodegenerative disease of the central nervous system. The prevalence of pain is between 29% and 86% and besides neuropathic pain, somatic pain types may also emerge together or separately. In this study we aimed to analyze the relationship between pain and other clinical features in MS. Materials and Methods: One-hundred cases who were followed in MS clinic and who have complaints of pain, were included in this study. We evaluated pain type and localization during patients were filling in the forms. We applied Visual Pain Scale (VPS), Ashworth Spasticity Scale (ASS) and Beck Depression Scale (BDS). Results: When female and male patients were compared, there were no statistical differences between age, disease duration and EDDS scores. Seventy seven percent of cases complained of neuropathic pain, 21% of cases had Lhermitte symptoms. Trigeminal neuralgia has been observed in 1% of cases and 55% of neuropathic extremity pain. In 60% of the cases nociceptive pains, in 12% of the cases joint-extremity-muscle pain, in 47% headache and in 1% painful tonic spasms were present. Pain depending on the treatment was observed only in 2% of the cases. The pain score was high in patients with spasticity and depression. Although there was reasonable positive correlation between age, EDDS score and VPS, poor correlation was obtained between disease period and number of attacks. Conclusion: These findings indicate that MS pain is related with spasticity, disability and depression and these clinical findings should be taken into account during pain treatment.Öğe Serum levels of irisin and nesfatin-1 in multiple sclerosis(Assoc Arquivos Neuro- Psiquiatria, 2022) Altas, Mustafa; Uca, Ali Ulvi; Akdag, Turan; Odabas, Faruk Omer; Tokgoz, Osman SerhatBackground: Multiple sclerosis (MS) is an inflammatory and neurodegenerative autoimmune chronic neurological disease. Currently, there are no effective serum biomarkers to verify MS diagnosis, to assess disease prognosis, and evaluate response to MS treatment. Objective: The present study is a preliminary assessment of irisin and nesfatin-1 serum levels in patients with relapsing-remitting MS (RRMS). Methods:A total of 86 participants, 42 patients with RRMS diagnosis and 44 healthy controls were included in the study. The serum irisin and nesfatin-1 parameters of the patients and control group members were analyzed.Results:Irisin and nesfatin-1 levels of the RRMS patients were significantly lower than the controls (z:-3.82, p<0.001; z:-4.79, p<0.001, respectively) The cut-off level of irisin is 10.390 (ng/mL) (sensitivity: 84.1%, specificity: 71.4%, AUC: 0.800), and the cut-off level of nestatin-1 is 7.155 (ng/mL) (sensitivity: 68.2%, specificity: 64.3%, AUC: 0.739) in the ROC analysis. For these cut-off levels in the case-control groups, the lower irisin and nesfatin-1 levels are the independent variables for MS patients (OR 9.723, 95%CI 2.884-32.785, p<0.001; OR 3.992, 95%CI 1.336-11.928, p<0.001) respectively. Conclusion: The present study revealed lower irisin and nesfatin-1 levels in patients with RRMS. These findings suggest that the decreased levels of irisin and nesfatin-1 peptides may contribute to MS pathogenesis such as inflammation, oxidative stress, and apoptosis in MS, leading to demyelination, axonal damage with neuronal loss, and gliosis.Öğe Serum levels of irisin and nesfatin-1 in multiple sclerosis(Assoc Arquivos Neuro- Psiquiatria, 2022) Altas, Mustafa; Uca, Ali Ulvi; Akdag, Turan; Odabas, Faruk Omer; Tokgoz, Osman SerhatBackground: Multiple sclerosis (MS) is an inflammatory and neurodegenerative autoimmune chronic neurological disease. Currently, there are no effective serum biomarkers to verify MS diagnosis, to assess disease prognosis, and evaluate response to MS treatment. Objective: The present study is a preliminary assessment of irisin and nesfatin-1 serum levels in patients with relapsing-remitting MS (RRMS). Methods:A total of 86 participants, 42 patients with RRMS diagnosis and 44 healthy controls were included in the study. The serum irisin and nesfatin-1 parameters of the patients and control group members were analyzed.Results:Irisin and nesfatin-1 levels of the RRMS patients were significantly lower than the controls (z:-3.82, p<0.001; z:-4.79, p<0.001, respectively) The cut-off level of irisin is 10.390 (ng/mL) (sensitivity: 84.1%, specificity: 71.4%, AUC: 0.800), and the cut-off level of nestatin-1 is 7.155 (ng/mL) (sensitivity: 68.2%, specificity: 64.3%, AUC: 0.739) in the ROC analysis. For these cut-off levels in the case-control groups, the lower irisin and nesfatin-1 levels are the independent variables for MS patients (OR 9.723, 95%CI 2.884-32.785, p<0.001; OR 3.992, 95%CI 1.336-11.928, p<0.001) respectively. Conclusion: The present study revealed lower irisin and nesfatin-1 levels in patients with RRMS. These findings suggest that the decreased levels of irisin and nesfatin-1 peptides may contribute to MS pathogenesis such as inflammation, oxidative stress, and apoptosis in MS, leading to demyelination, axonal damage with neuronal loss, and gliosis.Öğe UNILATERAL HYPOGLOSSAL NERVE PALSY FOLLOWING RHINOPLASTY(Medknow Publications & Media Pvt Ltd, 2014) Gundeslioglu, Ozlem; Toksoz, Mustafa Rasid; Tokgoz, Osman Serhat; Yasar, ErayIn this case we presented isolated unilateral hypoglossal nerve palsy after an uneventful rhinoplasty operation. After rhinoplasty numbness of tongue, difficulty in speaking, chewing and swallowing occurred in the first day of surgery. Left side deviation of the tongue was present when the patient put her tongue out. Neurological assessments were compatible with hypoglossal nerve palsy. There was no other pathology detected in differential diagnosis. We followed the patient with oral vitamin B complex and steroids. Complete recovery was obtained ten months after surgery.
