Lacunar infarcts, small deep infarcts that result from occlusion of a penetrating artery, account for about a quarter of all ischemic strokes. Patients with a lacunar infarct usually present with a classical lacunar syndrome (pure motor hemiparesis, pure sensory syndrome, sensorimotor stroke, ataxic hemiparesis or dysarthria–clumsy hand) and, less frequently, an atypical lacunar syndrome. These infarcts have commonly been regarded as benign vascular lesions with a favorable short-term prognosis comparing with other ischemic stroke subtypes. However, there is an increased risk of mortality mainly from
cardiovascular causes, stroke recurrence which is similar to that for most other types of stroke, and patients have an increased risk of developing cognitive decline and dementia in long term. Although hypertension and diabetes mellitus are major risk factors for lacunar stroke, the other potential risk factors should be determined. Risk-factor modifications, antiplatelet and antihypertensive drugs with strict blood pressure are likely to play a major part of therapeutic interventions of lacunar stroke.

Recent technological developments caused new methods of techniques in the treatment of brain ischemia. These methods could be categorized into two types as acute stage interventions and preventive techniques for development of ischemia. In this report, intraarterial thrombolysis, mechanical thrombectomy, intracranial angioplasty and stenting techniques were being described, which were started to be used in the world. These interventions are indirect surgery, subspecialised as neuroendovascular therapy, and require the neurologists, neurosurgeons and radiologists to work as a team. Therefore, it is possible to establish a new hybride branch caring for only stroke patients in the near future.

OBJECTIVE: We aimed to investigate whether there is an association between blood flow parameters of middle cerebral artery measured with transcranial Doppler which is an easy, low-cost, noninvasive, repeatable and bedside applicable examination and prognosis during acute, subacute and chronic periods in patients with acute ischemia on middle cerebral artery territory.
METHODS: Twenty-six patients with acute ischemia on middle cerebral artery territory, applied
within first 12 hours after start of symptom and meet the study criteria were included. The middle cerebral artery blood flow parameters were measured with transcranial Doppler during acute period. Also, stroke severity and prognosis were determined on detailed neurologic examination with GCS, NIHSS and mRANKIN values during acute, subacute and chronic periods. Data of 26 patients were analyzed in this study.
RESULTS: Transcranial Doppler was performed within mean 6.0±2.9 hours during acute period. When we look at blood flow velocity parameters with transcranial Doppler during acute period, pulsatility index on the lesion side was 1.5±0.8. Based on the detailed neurologic examination during acute period, mean arrival GCS was 13.2±2.4 and mean arrival NIHSS was 10.9±6.3. Mean NIHSS and mRS were found 11.5±10.1 and 3.1±2.0 on neurological examination during subacute period, respectively. Mean NIHSS and mRS were found 9.9±12.2 and 2.4±2.4 on neurological examination during chronic period, respectively. There were significantly negative association between pulsatility index measured at the side of lesion during acute period and arrival GCS (p=0.009) and significantly positive association between pulsatility index and arrival NIHSS (p=0.001). In addition, significant positive associations were found between the pulsatility index
on the side of lesion during acute period with NIHSS (p=0,009 ve p=0,013, respectively) and mRANKIN (P=0,035 ve p=0,049, respectively) values measured during subacute and chronic periods.
CONCLUSION: In this study, we concluded that important information about prognosis on acute, subacute and chronic periods can be obtained with pulsatility index measurement which is not affected by measuring fondness among the blood flow parameters measured with transcranial Doppler that as a simple examination method on acute stroke.

OBJECTIVE: Hematoma volume is the most important predictor of outcome following intracerebral hemorrhage (ICH). A number of predictive models have been developed to identify patients with unfavorable prognosis after ICH. It is not known whether they are superior to predictions based solely on hematoma volume. In this study we assessed the predictive accuracy of hematoma volume and two widely used prognostic models - ICH scale and ICH grading scale (ICH-GS) – in determining in-hospital mortality in patients with ICH.
METHODS: A consecutive series of patients with ICH and cranial computed tomography imaging within 24 hours of symptom onset were included into the study. Hematoma volume was calculated by using the ABC/2 method. ICH scale and ICH-GS scores of each patient were determined. The outcome variable was in-hospital mortality. The overall predictive
ability of hematoma volume, ICH scale and ICH-GS were assessed by computing the area under the receiver-operating characteristic curves (AUC).
RESULTS: Among a total of 193 (116 male, 77 female, mean age 66±13 years) patients included in the study, 75 (39%) died during hospitalization. The AUC was 0.761 (95%CI: 0.694-0.819) for hematoma volume, 0.797 (95%CI: 0.733-0.852) for ICH score and 0.784 (95%CI: 0.719-0.840) for ICH-GS (p>0.05). On the other hand the smallest hematoma volume at which the positive predictive value for mortality was 100% was 130 mL.
CONCLUSION: Hematoma volume, by itself, is not inferior to other prognostic models in predicting in-hospital mortality in patients with ICH.

Subclavian steal syndrome is a clinical feature displayed because of decrease or reversion of blood flow in ipsilateral vertebral artery due to severe stenosis or occlusion of proximal subclavian artery. We reported a subclavian steal syndrome which blood flow is spontaneously supplied from external carotid artery. Since collateral circulation was
supplied, it was not associated with patient’s present neurological condition. Evidence regarding steal phenomenon should be expected when there is high grade stenosis or occlusion in main carotid artery. Conventional surgery which is applied for the treatment of symptomatic patients is a by-pass application between carotid and subclavian artery as
well as cleanse of thrombus in subclavian artery. Our case was evaluated as a rarely seen variation that not required such treatment because of the spontaneous presence of by-pass.

Intracerebral hematomas are % 10 of all strokes.Although there are many risc factors causing cerebral hematomas in young population, hypertension is still the major risc factor of all. The incidance of recurrent hemorrhagic stroke is % 2.4 per year in patients with intracerebral hematomas. There are no studies about the types of following hemorrhagic strokes and unruptured cerebral aneurisms are found in these patients.
44 years old hypertensive woman was admitted to our emergency department with speech disturbance. She had a history of left thalamic hematoma 6 mounths ago. In her neurological examination, she had dysarthria, vertical gaze disturbance and left hemihypoestesia. There was acute Grade 2B thalamic hematoma in her cranial tomography. She had uncontrolled renal hypertension for about 19 years. In her control tomographies there was a suspicious hypodensity in right cavernous sinuse, so cranial MRI and DSA were performed and an unruptured ICA aneurism was seen. In conclusion, hypertension is still the major risc factor for intracerebral hematomas in young population. Cerebral angiography is not routinely performed in primary intracerebral hematomas but in these patients not rarely unruptured aneurisms were found. Especially in literature, they were seen in young females.By our presentation we aimed to remember that although there are huge unruptured aneurisms are present, hypertension is still the major risc factor of intracerebral hematomas and vascular malformations can also exist in primary cerebral hematomas especially in young female patients.

Causing serious morbidities and having so many different clinic formes are the clinical importances of brucellosis, which is a zoonotic infections. Neurobrucellosis, can appear with cranial nerve pathologies, optic stasis, menengitis, myelitis, radiculopathy, periferic neuropathy etc. The case is the woman who is 69 years old. Her complaints began as
lumbar pain 3 years ago. She has not been able to stand unaided for a year. In the periventricular white matter chronic ischemic lessions, and in the right serebellar hemisfer an encephalomalasia were determined in the kranial MRI. Brucella
tube agglitunation was 1/160(+). Clinic remission observed after neurobrucellosis treatment. The neurobrucellosis is a manifestation that can appear in a lot of different clinic formes; and it requires attention in the differential diagnoastics of several diseases.