Microangiopathy and m acroangiopathy are induced by increased the tendency of atherosclerosis caused by metabolic impairment. The prerevalance of diabetes mellitus is 15 - 33 % in cases with ischemic stroke. Diabetes mellitus is an independent risk factor especially for stroke an d it can increase the relative risk (RR) 1.8 - 6 times for initial stroke. The risk of ischemic stroke is higher in women with diabetes. Individual adjustment of glycemic targets is performed but treatment regulation as to set ≤ 7.0 % of HbA1C is recommended for decreasing the microvascular and macrovascular complications if the history of stroke or TIA are present. The targeted fasting plasma glucose levels should be ranged from 4.0 to 7.0 mmol/L and the targeted plasma glucose levels at postprandial second hour should be ranged from 5.0 to 10.0 mmol/L. Daily physial activity, weight control, blood pressure control, lipid control and life style changes are recommended to all diabetic patients. Also, medical treatment is commonly needed for targeted HbA1C levels. In diabetic patients, Metformin is an effective first - line pharmacotherapy to decrease the stroke risk. Also, monotherapy with fibrates can be considered. It is proposed to set the blood preassure at < 130/80 mmHg with AC EI or ARB hypertension treatments in diabetic patients. Diabetic adults with additionally risk factors should be treated with statins to decrease the risk of initial stroke. The benefit of antiagregant usage to decrease the stroke risk is not clear yet, ho wever aspirin usage can suitable in diabetic patients with increased cardiovascular event risk.

OBJECTIVE: The aim of this study was to investigate mortality-related factors in ischemic stroke patients 80 years of age and older.
METHODS: We reviewed all ischemic stroke patients admitted to our clinic between January 2010 and January 2012. The patients’ database information was retrospectively analyzed. One hundred and ten patients aged older than 80 years with ischemic stroke were included in the study. The patients were divided into two groups based on survival. Age, gender, recurrent stroke, risk factors, clinical syndrome, etiology, radiographic localization, duration of hospitalization, and presence of systemic complications were accepted as mortality-related prognostic factors. The groups were compared according to these prognostic factors.
RESULTS: In the clinical follow-up, 58 (52.7%) patients died; 65.5% died of neurological causes, and 31% died of systemic complications. No significant differences existed between the two groups in age, gender, risk factors, recurrent stroke, or etiology. The frequency of total anterior circulation infarct syndrome was much higher in deceased than living patients (50% and 36.5% respectively;p<0.05). Deceased patients had a statistically significantly higher incidence of total MCA infarct and systemic complications than did living patients (p<0.05).
CONCLUSION: To date, many variables that affect the early and late prognosis in stroke patients have been reported. Many of these factors cannot be changed, such as oldest age. It is important to determine the changeable and non-changeable factors related to disability and death in the oldest age groups. Starting appropriate treatment and care initiatives as soon as possible is also very necessary in the oldest stroke patients.

OBJECTIVE: Our aim was to present the acute stroke cases carried out decompression surgery and to discuss our results with literature.
METHODS: Decompression surgery was carried out in 8 patients including 4 women and 4 men who followed and clinically progressed despite the medical treatment within 1-11 days in Dokuz Eylül University Hospital Neurology Clinic between August 2010 and February 2012. Extensive hemicraniectomy+duraplasty were performed in 6 patients and suboccipital craniectomy was performed in 2 patients.
RESULTS: One patient with middle cerebral artery infarction died because of widespread posterior system infarction and additionally one patient died due to infection following operation. In remaining patients followed for 35 to 95 days postoperatively, mRS was change 2 points in 2 patients, 4 points in 2 patients, 3 points in 1 patient and 5 points in 1 patient.
CONCLUSION: Although sample size was limited, our results were showed that surgical treatment reduces mortality and helps to provide the functional recovery in some patients.

OBJECTIVE: Aim of this experiment study was the erythropoietin (Epo) testing, on rat model and particularly on ischemia reperfusion protocol. The benefit or the non effect of that molecule was studied hematologically on platelet distribution width (PDW).
METHODS: 40 rats were used of mean weight 247,7 gr. PDW was measured on these time points: on 60 min after reperfusion (groups A and C), and on 120 min after reperfusion (groups B and D), A and B without but C and D with Epo administration.
RESULTS: Epo administration increased significantly the PDW levels by 0.22 % [0.034374 % - 0.4056259 %] (P= 0.0214), in accordance also with paired t-test (P= 0.0196), 2) reperfusion time decreased significantly the PDW levels by 0.27 % [-0.4483669 % - 0.0916332 %] (P= 0.0040), in accordance also with paired t-test (P= 0.0012), and 3) interaction of Epo administration and reperfusion time increased non significantly the PDW levels by 0.06 % [-0.054648 % - 0.1819207 %] (P= 0.0615).
CONCLUSION: Epo administration has significant increasing short-term effects on PDW levels. However, reperfusion time attenuates significantly this effect. Their interaction seems to resemble the action of Epo administration. The following question is whether these PDW levels alterations are the cause or the result of diseases process modification.

While hypertension is the most common cause of primer ýntracerebral hemorrhage, various rare causes can be cited including hematologic diseases. In this report, a case with recurrent intracerebral hemorrhage due to a rare coagulation defect, factor XIII deficiency is presented. Thirty six year old female patient was admitted to the neurology clinic with sudden onset nausea, vomiting, unconsciousness and right hemiplegia. A large hematoma was seen at the left frontoparietal region on computed brain tomography (CT). CT angiography was normal. All the laboratory tests were normal, except factor XIII clot solubility test being positive. Antiedema and fresh frozen plasma therapy (FFP) were given for several days. After stabilization of the clinical picture, the patient was discharged with motor aphasia and slight right hemiparesis. One month later the patient was seen with normal neurological examination. However, three months later she was admitted to the hospital again with severe headache. CT was repeated and in the parietal lobe, a new hematoma was seen. She was treated with FFP in the same way and discharged 2 weeks later with nominal aphasia. In spontaneous and recurrent ICH cases, hematologic causes must be kept in mind albeit very rare, especially in the young. Ýt is important to identify coagulation disorders among hematologic causes as their therapy is possible and life saving.

Aneurysmal subarachnoid haemorrhage which has a serious mortality and morbitity ratio, occurs approximately 10/100 000 population per year and it is usally caused by rupture of a cerebral artery aneurysm. Aneurysms are classified sacculer, fusiform or dissecan by morphlogical description. Vascular congenital anomalies of the cerebral vessels contribute to saccular aneurysm formation by increasing hemodynamic stress on the vessel wall. Although anterior communicating artery (ACoA) is the most seen site of vascular anomalies associated with aneurysmal formation, the agenesis of the anterior commmunicating artery is very rare. Here, we present unusual anatomical variations of ACoA detected by three-dimensional CT angiography after subarachnoid hemorrhage.

BACKGROUND AND PURPOSE: Bilateral anterior cerebral artery (ACA) territory infarction is rare localization in stroke which should always prompt a search for an anterior communicating artery (ACoA) aneurysm. The common neurological manifestations are contralateral weakness predominate in the lower extremite, behavior disturbance, motor inertia, muteness, incontinence, grasp reflex, diffuse rigidity, akinetic mutism.
CASE DESCRIPTION: We describe a 38-year-old woman presented with a left sided hemiparesia and decrease of speech for last days. She was a smoker and morbide obese. She had no any diagnosed disease. Her neurological examination had weakness of left extremites affected leg more than the arm and akinetic mutism like as no spontaneously speech and move and grasp reflex. CT showed bilateral ACA infarction which included cingulate gyrus, the right side more than left and subarachnoid hemorrhage in the interhemispheric fissure. MRI angiography showed the appearance of AcoA aneurysm.
CONCLUSION: We report a patient with bilateral infarction in the ACA which a rare localization and clinicians must be alert to exist AcoA aneurysm which may bleed, different symptoms and signs like as akinetic mutism, primitive reflexes.

A widely under-recognized brain-death confirming transcranial ultrasonography pattern resembling the red-blue beacon signal was demonstrated. Familiarity to this distinct and characteristic ultrasonic pattern seems to be important in the perspective of point-of-care neurological ultrasound use and knobology.

Lateral sinus thrombophlebitis (LST) is a rarely seen intracranial complication of chronic otitis media. Even single case report may guide in this entity given the lack of larger series. In the present manuscript, we will discuss removal of infected thrombus localized in transverse sinus via Foley catheter in a 46-years old man with sickle cell anemia underwent surgery due to LST.