INTRODUCTION: We evaluated the effect of Cinkgo biloba extract alone and in combination with nicardipine on ultrastructural changes in a rat model of transient forebrain ischemia by using electron microscope. The appearence of neural elements was fairly normal in theanimalswhich received Ginkgo biloba in combination withnicardipine in both pre- and post-ischemic periods. Non-treated control groups and the groups which Cingko bil oba was given alone or combined with nicardipine only in pre-ischemic period showed vaýious degrees of ultrastructural ischemic chýýnges. It can be suggested that Ginkgo biloba is effective against ischemic cerebral damage, particularly in post-ischemic period, and this effect might be supported by pre-ischemic co-administration of nicardipine.
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INTRODUCTION: To analyse the value in estimation of the ou tcome of comatose state due to stroke, Glasgow Coma Score (GCS), oculocepha lic (OSR), vestibuloocular (VOR), light reflexes and laboratory findings such as CT scan and brainstem auditory evoked pa. tentials (BAEP) were investigated on 87 patients. Fourty-seven male and 40 female patients with a mean age 57.7 years (range 20-78) were followed for an average of 8.2 (range 1-40) days. GCS, OSR, VOR, light reflexes and CT-scan findings were significant predictors of prognosis. There is a limited relationship between BAEP results and prognosis. Age, sex and hy· perýension did not influence clinical outcome in coma due to stroke.
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Aphasia tests were performed on twelve stroke patients with language disturbances including the types of Broca (two patients), Wemid:e (two patients), Transcortical sensoýy (two patients), anomic (two patients) and global (four patients). CT and/or MRI were done to detect the lesion location. Ali patients were also evaluated by SPECT for the measurement of regional cerebral blood. flow and Quantitative EEC for background abnormalities. SPECT and Quantitative EEG revealed greater functional defects than structural lesions assessed by CT or MRI. The wide homolog cortical hypoperfusion areas were suggested to contribute to the aphasic syndromes, especially in deep small lesions.

The aim of this study to evaluate the effects of the nimodipine ,which is .:ý cerebroselective calcium channel bloker, on the systemic blood pressure and the pulse rate. The patients admitted within first 24 hours due to acute cerebrovascular events, have been randomised to nimodipine (50 patients) or control (50 patients) groups. Their cranial CT were performed. In nimodipine group, if subarachnoid hemorrhage or intracerebral hemorrhage has been displayed by CT, the nimodipine would have been given 2 mg/hour intrýývenously with perfusion pomp if available. ýf ischemic lesion has been displayed by cranial CT, the nimodipine would hýýve been given orally at 180 mg in day. In control group, whether or not the cranial CT displýýyed hemorrhage, nimodipine were not given. After admission ýo the hospital, ali patient's sysýemic blood pressures and pulse r.ýtes have b.een recorded asa basa] point. After then, 5th, 15th, 30th and 60th minutes in the first hour, and after than every hours within the 23 hours, and every two hours in the second 24 hours their blood pressures and pulse rates were also recorded. Ten patients ( 2 patients in nimodipine group and 8 patients in control group) excluded because they has been treatment with antihypertensive agents due to malign hypertension. Two directed variance analysis, TUKEY W tests and student's t tests were used far statistical analysis. Either patients or records showed heterojenite in nimodipine group, as well as in control group. Systolic and diastolic blood pressures were significantly decreased in the group using nimodipine per orally, while only systolic blood pressure was significantly decreased in the group using nimodipine intravenously. Furthermore the hypotensive and bradycardic effects of the nimodipine were not significant in the groups which patients has Clasgow coma scale 011, and patients with previously hypertensive or heart failure.

in this study, vascular distribution pattem of infarct has been investigated tomographically in ischemic cerebrovascular accidents (CVA) in which artery-to-artery emboly hils been estilblished as an etiologic filctor. In diagnosing artery-ýo-artery embolic CVA, following criteria were used: 1. Advanced stenosis (%70 or above) and/or deep ulcerilled plaque must be found in extracranial carotis arteria by duplex scanning and color doppler ultrasonography. 2. A cardiac emboly source has to be excluded by physical examinýýtion, ECC ý:ýnd transthoracic echocardiography. Of the 638 patients who were followed up by our hospital's stroke polyclinic in 1993-1994, 516 cases that were diagnosed as ischemic CVA were included in the study. in 56 cases (averageage: 64.11±11.13 yrs, F/M: 30/26) artery-to-artery emboly has been established as the etiologic factor. in "f,, 60 of lhe cases unilaternl advanced stenosis, in 34.5 % bilateral advanced stenosis, in 5.4 o/,,u\cerated plaque ha ve been found. When considering ali of our cases, it is found that infarcts of piýýl artery territory especially in MCA area were most frequent in both unilateral and bilateral advanced stenosis. MCA cortical branches were influenced more than the deep branches.

Jt has bcen recorded that the arýticarcliolipin antibodics Which known !hat rise in some autoimmune, infectious and cardiovascular diseases take role on strokc elhiopathogencsis. The ACA 's cause lo ischemk stroke invcstigating il ýýonvasculitic thrombotic lesi on in cerebral veins and arteries in lhis studt 43 stroke cascs have been taken for investlgution, containing 24 males end 19 femalcs who are 25-85 years old (Avr,and 50:58,42±14,02) 34 ofpatientswere isclýemic and 9 of them were homomagicstroke. ACA highness has been detemýined on 8 of the total cases, 4 of them were lgG and 4 of them lgM group antibodies.. The average age has beeýý found significianly smalL in thc group who have high ACA, in comparison with the group who have nomýal ACA (A ve. arýd SD:57 25±1 J ,59), (t=12A 1 ;P

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Poststroke hyperglycemia and involved factors arestill a discussion field in cerebrovascular accidents. There are few studies which note a relationship between poststroke hyperg\ycemiil and lesion localiuýtion. in this study, hyperglycemia was investigated in the piltients with thatamic hemiltoma. 53 patients who were admitted to ourdepartment betweerý January 1993 and June 1994 with thediagnosis of thalamic hem atoma were evaluated for admission blood sugar. On stroke onset, increased blood g\ucose wus found in 35 patients of 53 patienls with thalamic hematoma. This ratio issignifýcilntlyhigher thiln results which were reported as related to the incidenceofhyperglycemia in acute stroke. in occurrence of hyperglycemia in ýhalamic lesions, behind the mechanisms which explaln hyperglycemia acute stroke, hypothalilmic disfunclion and irritation of the regulatoir center seems also involved. it was ronsidered that, hemiltomas which effect thillamic region ha ve higher risk for poststroke hyperglycemia.

We assessed the blood viscosity of 25 patients with acute ischemic cerebrovascular disease (CVD) and investigated foran association between the blood viscosity and risk factors of CVD, other hemorheological alterations, size of the in fa ret and prognosis. The blood visrositywas found significantly increased in pntients group (Mann-Whitney test; z= 0.897, p= 0.0038) when compared to the age- and sex-matched control group consisting of 18 normal people. lncreased viscosity was associated with elevated hematocrit, hemoglobin, reci blood cell count and decreased plnsma albumin, alfal and alfa 2 globulin levels. No correlation was found related with fibrinogen, blood lipids, size of the lesion and prognosis of CVD.

Evidences of genetic studies in molecular level showed that stroke maý be genetic transmission disease, this may be receive risk factor in occlusive cerebrovascular diseases. in this study, for the purpose of research possibility of clýromosomal malformations in ischemic stroke, chromosomal anayýsis made in 9 patients and 17 persons fýrst level relalives of those patients, which not demonstrated aný risk factor for stroke. And the end in chromosomal analysis of 26 persons not found any numerical and morphological malformation.

This experimental vasospasm model was made by giving aotologous blood into the cistema magna in rats. When giving 300 mg/kg twicedaily mýýgnesium sulfate on chronic vasospasm (7 days) on býýsilarartery, both morphologicmeasurements and histopathological changes were not seen than plasebo groups.

Airn: This study was designed tu determine etiological nnd clinical fetures of ischemic strokes under age 45. Methods: one hundred consecutive patients under age 45 among 1034 ischemic strokes hosbitalized. in the Neurology Service of Hacettepe University Hosbital during the period of 1990-1994 were enrolled. A detailed etiological analysis according to our standart protocol was performed in ali subjects. We evaulated patient ýs in 2 groups as 17-30 years and 31-45 years. etiologic factors responsible for the stroke were classifýed according tý TOAST criteria. The groups were compilred in respect to the Jesion size, localization and topography. Results: Ischemic strokes under age 45 constituted 9.7o/., of all palients. Cnrdioembolism was found to be the leading cause of stroke (62%). Other common causes reported in the literature (dissection, migrane, patent foramen ovale) were not observed in our study group. Wecouid not find any etiology in 4o/., of patients. Conclusion: The high frequency of cardioembolism emphasizes the importances of performing transthoracic ECHO to ali patients under age 45. The difference in underlying etiologies between our study population and literature indicates the immeediatenecessityof multicenter trials in Turkey.

Prevention ofstrokeisa healýcare problem as stroke is the third causeof death after myocard in fa ret and cancer, in developed countries. Among various drugs for the prophylaxis of stroke aspirin is the most widely used agent with its relative risk reduction far stroke of about 30 o/o. Ticlopidine a new antipi.atelet agent, has been shown to be more effective than aspirin in preventing stroke and death in patients with TýA and stroke. The purpose of this study was to determine the efficacy of tiklopidine in a groupof patient with ischemic cerebrovasculardiseasewho had not success with aspirin therapy or who could not tolerateaspirin. During the total follow-upperiod ofmean 6,9 months (4-11 monthýý), 26 patients with TýAor stroke ( RýND, Minor or majör stroke) were treated with tiklopidine SOOmg/day. Prophylactic efficacy of the drug has been definetely shown at the and of the trial in 24 patients (efficacy of 92,4 %) without any sex differences. Among thesepatients percentage of adverse effects seen as skin rash was 7,6 o/o. ýn conclusion tiklopidine in preventing TýA and stroke is more effective than aspirin and can be prescribed in patients who are unable to tolerate aspirin.

Sentral nervous system has complex role in the functional regulation of the cardiovasculer system by autonomic nervous system balanceand neuroendocrinal effects. There is a reciprocal afeects between the heart and brain during thephysiologic and pathologic changes. The essential risc factors for embolic stroke are atrial fibrillation, prostetic valves, mitral stenosis and new myocard infarction, cerebral lesions in the initial period of stroke may lead to rhytmic disturbances of the heart.

in acute ischemic stroke, nine multi-centre, placebo controlled oral nimodipine studies included 3632 patients and two studies with iV nimodipine against placebo were carried on 392 patients. A favorable functional outcome was assessed by Barthel score and by Mathew disability scale. The patients treated with oral nimodipine within 12 h had benefits but those treated between 13 and 24 h had no effect and those treated after 24 h had a worse clinical outcome. The effect was moreevidentwhen the initial neurologic scores showed moderate to sev ere impairments. The studies with IV nimoclipine showed no benefit in acute ischemic stroke. Nicardipine would require further studies for to eva)uate the effect in acute ischemic stroke.