Endovascular treatment modalities that directly retrieve the clot have become standard strategies in the care of acute ischemic stroke with major vessel occlusion in selected patient groups. The anesthetic strategy applied in the perioperative stage of endovascular treatment should be well determined in order to minimize loss of time and to maintain hemodynamic stability. Most retrospective studies in previous years have shown that conscious sedation may be more advantageous. However, in recent randomized controlled trials, it has not been shown that general anesthesia leads to worse neurological outcomes when compared to conscious sedation. In this review, the effect of anesthetic strategy selection on patient outcome will be presented in the context of recent publications.

INTRODUCTION: Anatomic variations of cerebral arteries may influence the development of aneurysms. In this study our aim was to determine vascular anatomical variations of the anterior circulation of the brain in patients with and without cerebral aneurysms and also the relationship between vascular variations.
METHODS: The cerebral digital subtraction angiography data of 438 patients were investigated retrospectively. Anatomical vascular variations of MCA and ACA-AcomA complex were investigated separately in patients with and without aneurysm.
RESULTS: Most of our patients with cerebral aneurysms had SAH (n: 68, 80%). Although normal ACA AcomA complex and MCA vascular anatomy was less frequently seen in SAH, there was no statistical significance. ACA AcomA vascular anatomy was not significantly different between patients with and without cerebral aneurysm, however patients with cerebral aneurysm had statistically higher MCA vascular anatomical variations (p: 0.03).
DISCUSSION AND CONCLUSION: ACA-AcomA vascular anatomy was not significantly different between patients with and without cerebral aneurysm. However MCA vascular anatomical variations were more commonly seen in patients with cerebral aneurysm. Variations of MCA may increase the risk of aneurysm formation and therefore have an important role in the planning of aneurysm treatment.

INTRODUCTION: In the protection of both primary and secondary ischemic stroke, the effectiveness and reliability of the placement of carotid artery stent (CAS) has been demonstrated. Our aim in this study is to demonstrate the reliability of the CAM procedure performed in the tertiary care neurology clinic and the clinical and radiological to evaluation the two-year results.
METHODS: Twenty-seven patients who applied to our hospital between July 2015 and July 2016, were evaluated by our neurology clinic, decided on CAS and stenting were studied (average age 71.6 [58-85]). Patients with symptomatic onset of the carotid artery stenosis over 50% angiographically, asymptomatic and over 70% stenosis in the carotid artery were included.
RESULTS: The operation success rate was 96.3% (a thrombus developed in the stent 2 hours after the operation in a single patient). No deaths or myocardial infarction occurred in any of these patients with CAS. No ischemic cerebrovascular event or transient ischemic attack occurred in any of the patients at 6 months follow-up. No restenosis was observed in any of the carotid doppler follow-ups performed in our clinic.
DISCUSSION AND CONCLUSION: We believe that carotid artery stent placement performed by neurologists trained in endovascular surgery can be safely performed with low complication and high success rates in symptomatic or asymptomatic patients and that patients will be monitored in a more healthy manner.

INTRODUCTION: Inflammation is associated with the pathogenesis of subarachnoid hemorrhage (SAH) which is a serious disease with high mortality. NLR and PLR as novel inflammatory markers may serve as predictors of clinical severity and mortality in patients with SAH.
METHODS: Medical records of adult SAH patients who were admitted to our Neurology and Neurosurgery Departments were investigated. Clinical, neuroradiological, laboratory, and follow-up data were collected from electronic database. Admission complete blood count values including hemoglobin, leukocyte, neutrophil, platelet and mean platelet volume, neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were also studied. Fisher score and mortality rates were also evaluated.
RESULTS: : A total of 152 patients with a mean age of 52.94±17.04 (20-104) years, (94 (%61.8) females and 58 (38.2%) males) with SAH were included in the study. The patients were divided into two groups: aneurysmal (group 1, n: 99) and nonaneurysmal SAH (group 2, n: 53). In comparison of complete blood count parameters we found lower lymphocyte and higher neutrophil, NLR and PLR values in aneurysmal SAH patients who had also higher Fisher scores and mortality rate. There were also correlations between Fisher score and leukocyte, neutrophil, lymphocyte, NLR and PLR values. We also found that advanced age and higher NLR, PLR values are significantly related to mortality rates independent of presence of aneurysm.
DISCUSSION AND CONCLUSION: Aneurysmal SAH patients had lower lymphocyte and higher neutrophil, NLR, PLR values with higher mortality rates and disease severity. Additionally advanced age and higher NLR, PLR values were significantly related to mortality rates independent of presence of aneurysm. We believe that NLR and PLR can be used as simple parameters to evaluate severity of SAH and short term mortality in clinical practice.

INTRODUCTION: The cause of ischemic stroke is thought to be undetermined in around a quarter of patients. Paroxysmal atrial fibrillation could be responsible for a significant number of cryptogenic stroke events. In recent studies, mean platelet volume (MPV) has been found to be increased during paroxysmal atrial fibrillation (PAF) attacks. In this study, we aimed to assess whether increased MPV in cryptogenic stroke patients could be prognostic of atrial fibrillation.
METHODS: We analyzed cryptogenic ischemic stroke patients who were admitted to neurology clinic between July 2014-December 2015. Demographic features, blood tests, neuroimagings, standard electrocardiogram (EKG), 24 hours holter EKG, transthoracic echocardiography were all evaluated.
RESULTS: 133 patients were included to the study. Atrial fibrillation (AF) was detected in 30 patients (22,6 %). MPV was not found to be increased statistically in patients with AF.
DISCUSSION AND CONCLUSION: Although MPV has been found to be increased during paroxysmal atrial fibrillation (PAF) attacks in recent studies, we could not find any evidence that MPV could be prognostic of atrial fibrillation in cryptogenic ischemic stroke patients.

Capsular warning syndrome is an important clinical entity because of its typical story, presentation and increased risk of symptom recurrence recurrence. Since the pathophysiology of this syndrome has not be fully understood, there is no consensus on the treatment approach. Furthermore, clinical deterioration may occur despite antiplatelet, anticoagulant or trombolytic treatments. We aimed to present three cases with capsular warning syndrome to discuss their clinical presentations, radiological findings and to underline that prevention of its progression to a completed stroke may be difficult.

Medial medullary syndrome (MMS) consists of ipsilateral lingual paresis, contralateral hemiparesis and lemniscal sensory loss. Hemiplegia cruciata (HC) consists of ipsilateral arm paresis and contralateral leg paresis. Both syndromes develop as a result of pathologies affecting V4 segment of the vertebral artery and anterior spinal artery. A 54-year-old man was admitted with left sided weakness. Neurological examination revealed left hemiparesis and right lingual paresis. Acute diffusion defect of anterior part of medulla oblongata was observed on Diffusion Weighted Imaging (DWI) and the patient was diagnosed with medial medullary syndrome. A month later, he developed another stroke causing a newly-emerging right arm paresis and progression of left leg paresis. DWI examination was repeated, which revealed an acute diffusion defect of craniocervical junction extending till third cervical vertebra. The patient was diagnosed with HC following MMS. We presented these two extremely rare syndromes which developed consecutively in a patient with stroke recurrence.