Tromboembolizme baðlý iskemik inme veya geçici iskemik nöbet (GÝN) geçiren hastalarda, hemen veya uzun süreli aspirin tedavisi kullanmak, tekrarlayacak olan vasküler olaylarý; örneðin inme, MI ve ölümleri önlemektedir. Oral antikoagülasyon, aspirinden daha etkili deðildir. Uzun süreli clopidogrel tedavisinin, aspirinle karþýlaþtýrýldýðýnda; inme, MI ve vasküler ölümleri relatif olarak %9 oranýnda azalttýðý görülmektedir ( % 0.3 - % 16.5 ). Uzun süreli clopidogrelin aspirinle kombine edildiði durumlarda, yalnýz baþýna aspirin veya clopidogrel kullanýmýna göre kanama riskinin artmasý söz konusu deðildir. Aspirin ile, uzun etkili dipyridamol kombinasyonu, relatif olarak, inme, MI ve vasküler nedenlerden ölümü, yalnýz aspirin tedavisine göre, %18 oranýnda (eþitsizlik oraný 0.82,0.74-0.91), kanama riskini artýrmaksýzýn önler. Cilastozol; inme, MI ve vasküler nedenlerle ölümlerin riskini, plasebo ile karþýlaþtýrýlmalarda % 39 oranýnda azaltýr. 20000’den fazla hasta için aspirin, clopidogrel, dipyridamol karþýlaþtýrýlmasýnýn (120 günden önce oluþan) atherothrombotik iskemik inmelerde koruma saðladýðýnýn 2008 yýlýnda rapor edilmesini beklemekteyiz. Acil atherotromboembolizme baðlý ikincil inmeler için P2Y12 ADP reseptör antagonistleri (prasugrel, cangrelor, AZDF 6140), tromboxan reseptör antagonistleri (S 18886-terutroban) ve trombin reseptör (PAR-1) antogonistleri (eg, SCH530348) halen deðerlendirilmektedir.

OBJECTIVE: The low T3 syndrome is frequently found in hospitalized patients with systemic disease. In several systemic diseases low thyroid hormone levels are predictors of poor prognosis. The objective of this study was to investigate the association between low T3 levels and severity of clinical findings, short term prognosis and etiology in patients with acute ischemic stroke.
METHODS: 154 consecutive patients with acute ischemic stroke who presented within the first 24 hours after the onset of symptoms were included in the study. In the first 24 hour, free T3(fT3), free T4(fT4),thyroid stimulating hormone (TSH) levels of patients were measured.The patients with normal TSH levels were divided into two groups as fT3≤1,8 pq/ml and fT3>1,8 pq/ml. 25(%16,23) patients had fT3 values≤ 1,8 pq/ml and 129(%83,77) patients had fT3 values>1,8 pq/ml.
RESULTS: Coronary heart disease and atrial fibrillation were found more frequently in patients who have fT3 values≤ 1,8 pq/ml(p<0.05). Patients with small vessel disease were accumulated in normal fT3 values(p<0.05). In patients with low T3 values; cardioembolism and large vessel disease were found more frequently than the other group but it wasn’t statistically significant.On admission the NIHSS and mRS scores of patients with fT3 values≤1,8 pq/ml were detected higher than normal T3 group(p<0.001). Results for short term prognosis were similar and discharge mRS scores of low T3 group were higher(p<0.05).
CONCLUSION: Findings of our study suggest that; in patients with acute ischemic stroke, low T3 values on admission could be a predictor of more severe clinical state and worse short term prognosis and also low T3 syndrome in acute ischemic stroke is poorly associated with small vessel disease.

Thalami and midbrain’s arterial supply arises from many perforating blood vessels with a complex distribution for which many variations have been described. Percheron artery is a solitary trunk representing an uncommon anatomic variant that provides bilateral arterial supply to the paramedian thalami and the rostral midbrain. Occlusion of this artery results in bilateral thalamic and mesencephalic infarctions. We presented a patient who had sudden loss of consciousness and bilateral paramedian and upper brianstem infarctions on his brain CT. Early diagnosis of Percheron artery occlusion can be important for determination of the patients’s treatment.

We report a 21-year-old female who was admitted for right-hemiparesis. The first color Doppler ultrasonography (CDU) performed on the second day of admission revealed preocclusive stenosis in the proximal part of the left internal carotid artery (ICA). The magnetic resonance angiography (MRA) that was carried out on the same day couldn’t visualize the left ICA. Magnetic resonance imaging (MRI) on the third day of admission revealed acute parenchymal ischemic lesion in the left hemisphere. Pulse methylprednisolone treatment was administered. On the third day of the treatment a second CDU and MRA showed a normal left ICA. The patient admitted for three more times with very similar clinical and radiological findings. The clinical and radiological findings of the patient confirmed that vasospasms of cervical carotid arteries may be left unrecognized if the imaging studies are not performed promptly, and may cause ischemic stroke in young adults. MRA and CDU are non-invasive and relevant imaging techniques for immediate and follow-up evaluations in such cases.

Medial medullary syndrome is a rare form of the brainstem syndromes that has a triad including ipsilateral weakness of the tongue, contralateral hemiparesis sparing the face, contralateral loss of deep sensation. A Sixty year-old female was admitted to our hospital with the complaints of left hemiparesis and speaking disturbance. On her neurological examination, there were paresis at right tongue, left hemiparesis and impaired deep sensation. On her neuroimaging findings, there was a medial medullary infarction. We reviewed clinical and neuroimaging findings of medial medullary infarctions considering the literature.