The treatment of patients with cerebrovascular events due to patent foramen ovale is either medical or invasive including surgery and percutaneous closure. Among these, medical therapy and percutaneous closure are most commonly selected for the treatment of PFO. Currently we do not have convincing evidence regarding the management of PFO . However randomized trials that compares the medical treatment versus percutaneous closure currently ongoing. Therefore we do need to initiate individual based therapy. Patient’s age, occupation, morphology and the diameter of patent foramen ovale, underlying venous thrombosis, the presence of paradoxical embolism and the experience of medical centers in percutaneous closure may influence our treatment strategy. Exclusion of other causes of cerebrovascular diseases rather than PFO is crucial in the management of stroke or TIA due to presumed paradoxical embolism.

In this study, the cases of 273 patients who came to our clinic between December 2002 – December 2006 seeking treatment for spontaneous subarachnoid hemorrhage have been examined retrospectively. The female/male ratio was 1,2. Age ranged from 7 to 86 years with a mean of 53,5. The neurological status of the patients were evaluated using Glasgow Coma Scale (GCS) and criteria by Yasargil, and Computed Tomography (CT) examinations were done according to the grading criteria by Fisher. Most common aneurysm location was found to be anterior communicant artery. Neurological outcomes of patients were favorable (good recovery, moderate or severe disability) in % 75,5, and unfavorable (persistent vegetative state or death) in % 24,5 according to Glasgow Outcome Scale (GOS). Cases were determined according to symptoms, findings of clinical and radyological, therapy and out¬come and were discussed comparing with literature findings.

Indroduction: Cerebral Vascular Disease (CVD) causing death or disability, has gained promising advancement in terms of treatment. However the new treatment has limited application on patients. In order to prevent adverse affects of CVD in both individual and society risk factors associated and preventive measures should be determined. Determination of the effect of risk factors and routine laboratory findings may give clue on treatment process and prognosis. In fact that this study determination of known risk factors and routine laboratory findings on mortality in CVD. Materials and Methods: The study involved 358 CVD patients. Patients were examined using computerised brain tomography, Glasgow coma score and routine laboratory test. Risk factors investigated were age, gender, family history, smoking, hypertension, diabetes mellitus, hypercholesterolemia, heart and peripheral vascular diseases. Types of CVD were Transient Ischemic Attack (TÝA), ischemic infarct and intra cerebral haemorrhage. According to vascular localisation, total anterior circulation infarct (TACÝ), partial anterior circulation (PACI), posterior circulation infarct (POCÝ), and lacunars infarct. Patient information’s were collected either at routine policlinics following or by telephone. Results: Of 358 patients, 168 were male 190 were female. The mean age was 67.5 years. According to CVD types, 11 cases had TÝA, 158 had ischemic and 89 had intra cerebral haemorrhage. Of the cases 78% had hypertension, 20,2% had hypercholesterolemia, 27,7% had diabetes, and 40% had heart diseases. A total 79 (22%) of patients was died in the first 10 day in the hospital. The number patient died in first month 3rd, 6th, and 12th months of onset were 15, 18, 12 and 8 respectively, accounting for total of 123(34,3%) deaths in the first year. The majority of deaths occurred in first month of clinical onset. The average age of those died was 70,6 years. The mortality rate was high in elderly patients. Of the patients died 51(41, 4%) were male, 72(%58, 6) were female. Numbers of deaths were high in female patients but this was not statistically significant. When deaths were evaluated according to types, 78 had ischemia, 43 had haemorrhages and 2 had TÝA. Death rate was high in haemorrhagic CVD cases (p<0, 05). According to vascular localisation, number of deaths were higher in total anterior circulation infarct cases (p<0, 05). Mortality was higher in those with Glasgow coma scores above 9 (p<0,05).Laboratory findings of death patients revealed in increased C-reactive protein(CRP) leukocyte court and sedimentation rate (p<0,05). Conclusion: Factors associated with CVD were older ages, intra cerebral haemorrhage, and ischemic affecting large vessels. Those died of CVD had higher leukocyte count, CRP and sedimentation rate.

Background and Purpose: Results from the studies questioning the importance of stroke units in the treatment of acute stroke patients are increasing. In this manuscript, we aimed to share our stroke unit experience Materials and methods: We evaluated the records of 229 patients who had been treated in our stroke unit between May 2007 and May 2008. Clinical findings of these patients are presented in this manuscript. Results: In our stroke unit 229 patients (94 female (41.1%), 135 male (58.9%)) whom ages were between 24 – 94 years (mean 67.77±13.33 years) had been treated between May 2007- May 2008. Most of the ischemic stroke patients had largeartery atherosclerosis (63 patients 29%) and 52 patients (24%) had cardioembolic stroke. 38 patients (17%) were admitted to hospital within 3 hours of stroke onset. I.v. rtPA was given to15 of them (39.5%). 22 patients (10%), 11 patients (5%), 30 patients (14%) and 67 patients (31%) were admitted to hospital within 3-6 hours, 6-12 hours, 12-24 hours and more than 24 hours of stroke onset, respectively. Also, 39 patients (18%) were admitted to hospital with unknown time of stroke onset and 11 patients (5%) with stroke during sleep. National Institute of Health and Stroke Scale Scores of the patients were 8,07±6,59 before treatment and 6,48±6,72 after treatment. Number of days of the patients spent in stroke unit were changing from 2 to 39 with a mean of 5,63±4,03 days. 111 patients (50.9%) were discharged from stroke unit to home, 100 patients (45.8%) to Neurology service and 4 patients (1.8%) to Intensive Care Unit. 3 patients (1.5%) died. Conclusion: Studies about management of a stroke patient have been done for more than 10 years . Management of a stroke patient has 3 steps; pre-hospital period, hospital period and period after discharge. The most fascinating improvement is in hospital period; stroke units are the corner-stones of this period. In May 2007,specially designated 4- bed Stroke Unit was introduced in Dokuz Eylül University Neurology Service. We tried to share our one year stroke unit experience in this manuscript. The importance of stroke units will be more clear when the experience about this subject in our country is increased.

Bilateral thalamic infarction is a rare condition. It can appear with acute coma. Awakening disability and loss of motivation is seen after coma and it causes permanent cognitive deficiency. Usually ocular signs accompany. Vertical gaze paresis of which the mechanism is not completely figured out, is often seen. In some cases corticospinal tractus is not affected so loss of strength in the extremities doesn’t occur. Infarct is bilateral at paramedian thalamus and generally extends to mesencephalon. In this article 4 cases with bilateral thalamus infarcts are discussed by clinical course and neurological and radiological findings.

Scientific background: Takayasu’s Arteritis is a chronic inflammatory disease that affects the aorta and its major branchs. And also it is proposed that it was a cell mediated autoimmune disease. Organ ischemia may be seen in the disease progress. In the latest stage of disease, resulting from cerebral ischemia neurological manifestations occur. Neurological features are major causes of increasing mortality and morbidity. Case: A 38 years old woman admitted to hospital with the complaint of weakness at leftside of her body. Blood pressure from right arm was lower than that of left arm and Brachial artery pulse was found weakened at right arm. She was disartric, had left central facial palcy and motor strength of 4/5 from left upper and lower limbs. Babinski sign was positive on the left side. With findings of computerized brain tomography, diagnosis of ischemic stroke was made. Digital substracting angiography showed extremely narrowed right internal carotid artery. We thought takayasu’s arteritis as the aetiology of ischemic stroke with the findings of physical and neurological examination and imaging studies. Conclusion: Ischemic stroke is one of the most serious symptom of TA and is an important contributor to patient mortality. The reported frequency is from 8 % to 35 %. Rarely TA may be presented with ischemic stroke. In the case of young woman with acute ischemic stroke and no aetiological explanation, we should remind vasculitis especially Takayasu’s arteritis

Scientific background: Factor V Leiden and prothrombin G20210A gene mutations, are considered to be the most common hereditary prothrombotic conditions. Case: A 38-year-old female with acute multiple ischemic stroke concomitant heterozygous for factor V Leiden and homozygous prothrombin G20210A gene mutation is described. Neurologic examination revealed a left central facial paralysis, dysarthria and right monoparesis. Prothrombotic study was normal except for a heterozygous mutation for factor V Leiden and for homozygous prothrombin G20210A gene mutation. Cardiac exams (electrocardiogram and transesophageal echocardiography) were normal. Cervical and transcranial duplex ultrasound and magnetic resonance angiography (MRA) were normal. Brain magnetic resonance imaging revealed multiple cortical and subcortical cerebral infarcts. Antiplatelet and anticoagulant therapy was given to the patient. Concluion: Prothrombotic states as factor V leiden and prothrombin G20210A should be investigated in especially young stroke cases with multiple lesions.