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    Öğe
    Exploring Cognitive Impairment in Patients With Bilateral Capsular Genu Lesions
    (Amer Psychiatric Publishing, Inc, 2022) Kumral, Emre; Cetin, Fatma Ece; Ozdemir, Huseyin Nezih; Cankaya, Seyda; Schabitz, Wolf-Rudiger; Yulug, Burak
    Objective: The authors investigated for presence of cognitive impairment after occurrence of bilateral lesions of the genu of the internal capsule (GIC). Clinical and neuropsychological features of unilateral GIC lesions have previously been studied, but the cognitive profile of bilateral lesions of the GIC has not been fully explored. Methods: An investigation was conducted of neurocognitive deficits and computerized tomography MRI findings among 4,200 stroke patients with bilateral GIC involvement who were admitted to the hospital between January 2010 and October 2018. Results: Eight patients with bilateral lesions of the capsular genu were identified and their data analyzed. Overall, behavioral and cognitive dysfunction were characterized by impairment of frontal, memory, and executive functions. Attention and abstraction were present among all eight patients (100%); apathy, abulia, and executive dysfunctions, among seven (87.5%); global mental dysfunction and planning deficits, among six (75.0%); short-term verbal memory deficits and language dysfunctions, among five (62.5%); long-term verbal memory deficits, among four (50.0%); and spatial memory deficits, reading, writing, counting dysfunctions, and anarthria, among two (25.0%). Four of the patients (50.0%) without a history of cognitive disorder showed severe mental deterioration compatible with the clinical picture of dementia. A clinical picture of dementia was still present in these patients 6 months after stroke. Conclusions: Bilateral lesions of the capsular genu appearing either simultaneously or at different times were significantly associated with executive dysfunctions.
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    Öğe
    Mezensefalik Kanamalı Hastalarda Fonksiyonel Sonuçlara Yönelik Prognostik Faktörler
    (2023) Oktem, Ece Ozdemir; Kumral, Emre; Çetin, Fatma Ece; Özşimşek, Ahmet; Dorukoğlu, Mehmet Mesut; Cankaya, Seyda; Yuluğ, Burak
    Amaç: Mezensefalik kanama (MH), spontan intraparankimal kanamanın nadir görülen bir prezentasyonudur. Bu çalışma, mezensefalik kanamalardaki prognostik parametreleri değerlendirmeyi amaçlamaktadır. Yöntem: Çalışmamızda; izole mezensefalik kanamalı olgular PRISMA (Sistematik İncelemeler ve Meta-Analizler için Tercih Edilen Raporlama Öğeleri) beyanına göre kapsamlı şekilde taranmıştır. Literatürde yer alan BT veya MRG ile kanıtlanmış 62 uygun vaka ve bunlara MRG ile doğrulanmış altı vaka olmak üzere 68 hasta çalışmaya dâhil edildi. Hastalar modifiye Rankin Skalasına göre (mRS), iyi sonlanım (0–2 puan) ve kötü sonlanım (3–6 puan) olarak iki gruba ayrılarak, prognostik parametreler istatistiksel olarak karşılaştırıldı. Bulgular: Çalışılan 68 hastanın 26’sının (%38) bilinci açık, 22’si (%32) letarjik, 20’si (%29) stupor veya koma ile başvurdu. İyi prognoz gösteren olguların 26’sında (%65), kötü prognoz gösterenlerin 12’sinde (%43) idiopatik kanama gözlendi (p=0,059). Tek değişkenli analizlerde, arteriyovenöz malformasyonlar (p=0,33) ve kavernomlar (p=0,19) prognoz ile ilişkili bulunmadı. Çoklu lojistik regresyon analizlerinde; hipertansiyon (OR, 51,22; CI%95, 1,92–1370,24; P=0,019, bilinç durumu (OR, 133,54; CI%95, 1,61–1113,3; p=0,03), başvuru anındaki NIHSS (OR, 57,23; CI%95, 2,87–1141,2; p=0,008) ve ventrodorsal kanama boyutu (?1 cm) (OR, 61,83; CI%95, 2,15–1779,2; p=0,016), kötü prognoz ile ilişkili bulundu. Mezensefalik kanamadan üç ay sonra, 40 hastanın (%59) klinik olarak iyi durumda, 28 (%41) hastanın klinik olarak kötü durumda olduğu, sekiz hastanın ise (%12) kaybedildiği gözlendi. Sonuç: Bu bulgular, hemorajinin ventrodorsal boyutunun ve inme başlangıcındaki klinik şiddetin mezensefalik kanama sonrası fonksiyonel sonuç açısından olası belirleyicileri olduğunu göstermektedir.
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    Öğe
    Prognostic Factors For Functional Outcome in Patients with Mesencephalic Hemorrhage
    (Turkish Neuropsychiatry Assoc-Turk Noropsikiyatri Dernegi, 2023) Oktem, Ece Ozdemir; Kumral, Emre; Bayam, Fatma Ece; Ozsimsek, Ahmet; Dorukoglu, Mehmet Mesut; Cankaya, Seyda; Yulug, Burak
    Introduction: Mesencephalic hemorrhage (MH) is a rare presentation of spontaneous intraparenchymal hemorrhage. This study aims to evaluate prognostic parameters of the MH outcome. Methods: We conducted an extensive search in the literature for cases with spontaneous, isolated mesencephalic hemorrhage. The study was conducted according to the statement of Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Sixty-two eligible cases have been reported in the literature as proven by CT or MRI, and to these, we added six cases confirmed by MRI. The modified Rankin Scale (mRS) was dichotomized into two groups as the favorable outcome (FO; score, 0-2) and unfavorable outcome (UO; score, 3-6). Results: Of the 68 patients studied, 26 (38%) presented with normal consciousness, 22 (32%) with lethargy, and 20 (29%) with stupor or coma. There was no cause of hemorrhage in 26 (65%) patients with FO and 12 (43%) with UO (p=0.059). In univariate analyses, neither arteriovenous malformations (p=0.33) nor cavernomas (p=0.19) were associated with outcome. Multiple logistic regression analysis revealed that hypertension (OR, 51.22; CI95%, 1.92-1370.24; P=0.019), consciousness (OR, 133.54; CI95%, 1.61-1113.3; P=0.03), NIHSS at admission (OR, 57.23; CI95%, 2.87-1141.2; p=0.008), and ventrodorsal hemorrhage size (=1 cm) (OR, 61.83; CI95%, 2.15-1779.2; p=0.016) were significantly associated with UO. Three months after stroke, 40 patients (59%) had FO, 28 (41%) had UO, and 8 (12%) died. Conclusion: These results suggest that ventrodorsal size of hemorrhage and clinical severity at stroke onset are possible predictors of functional outcome after mesencephalic hemorrhage.