Both cerebrovascular diseases and dementia are important clinical conditions that disrupt daily life and mental abilities. Carotid artery stenosis is the cause of 10-15% of ischemic strokes. Symptomatic and asymptomatic carotid artery stenosis is a little-known, but important risk factor in the etiology of all causes of dementia, including both mild cognitive impairment and Alzheimer's disease. In this review, the effect of asymptomatic carotid artery stenosis on cognition is discussed.

INTRODUCTION: The prognosis for stroke patients that requiring mechanical ventilation is poor with mortality rates up to 80%. Airway management in ischemic stroke patients is of great significance for achieving a better clinical outcome. After endotracheal intubation, tracheostomy is recommended if patients require long-term ventilation. In this study, it is aimed to present the outcomes of percutaneous and surgical tracheostomy in ischemic stroke patients that were monitored in Neurological Intensive Care Unit (NICU).
METHODS: Patients with ischemic stroke admitted to NICU and underwent tracheostomy were reviewed retrospectively. Age, sex, mechanical ventilation time prior to tracheostomy, timing of tracheostomy, complications related to tracheostomy and mortality/discharge state were recorded. Patients were categorized into two groups as percutaneous tracheostomy or surgical tracheostomy groups.
RESULTS: This study presents 76 patients with ischemic stroke that underwent tracheostomy procedure in NICU. Thirty-nine patients were in percutaneous tracheostomy (PT) group and 37 patients were in surgical tracheostomy (ST) group. There was no significant difference between the two groups regarding tracheostomy complications and mortality rates.
DISCUSSION AND CONCLUSION: Based on our seven years of clinical experience, we conclude that PT can be performed at bedside in a short time and is associated with low complication rates. PT can be conveniently applied to indicate patients by neurologists (working in NICU) after proper training.

INTRODUCTION: The cause of approximately 25% of ischemic strokes is unknown. In many studies, paroxysmal atrial fibrillation (PAF) was found in 11-30% of stroke of unknownsource. Compared to the general population, the risk of stroke is twice as high in patients with PAF. CHA2DS2VAS score is used to determine the risk of stroke in patients with AF. In this study, we aimed to investigate the relationship between clinical and demographic data and CHA2DS2VAS score of patients with stroke of unknownsource who had PAF on 24-hour rhythm holter electrocardiography (ECG).

METHODS: Patients who were diagnosed with ischemic stroke in our clinic between 2017-2019 and whose etiology could not be determined and who had PAF on 24-hour rhythm holter ECG were included in the study. Demographic data were recorded, CHA2DS2VAS score, NIHSS (National Institute of Healt Stroke Scale Scores), ASPECT (The Alberta Stroke Program Early CT Score) values, mRS (modified Rankin Scale) were calculated. The relationship between demographic, clinical and imaging data and CHA2DS2VAS score was compared.
RESULTS: The mean age of the 48 patients included in our study was 67.10 ± 12.05. 52.1% (n: 25) of the patients were female and 48.9% (n: 23) were male. The most frequent complaints of the patients were weakness of the arm and leg, impaired speech, and impaired consciousness. Congestive heart failure (CHF) in 6.3% (n: 3), diabetes mellitus (DM) in 29.2% (n: 14), hypertension (HT) in 75% (n: 36), 27.1% (n: 13) had vascular disease. The effect of age on the CHA2DS2VAS score was most prominent (β: 0.676, p <0.01), followed by a high rate of effect on DM and CHF.
DISCUSSION AND CONCLUSION: In our study, age was the most effective factor on CHA2DS2VAS score. This shows that the rate of PAF detection on 24-hour rhythm holter ECG was increases with age.

INTRODUCTION: Malnutrition is vital issue since it is frequently seen among elders with chronic diseases. The aims of this study were to assess the malnutrition of stroke patients whom were 65 years and older, and make a comparison between Mini Nutritional Assessment (MNA) and Short Nutritional Assessment Questionnaire (SNAQ65+).
METHODS: This cross-sectional study was conducted with 130 stroke patients who were followed in Neurology polyclinic of a University Hospital. The data were collected by a structured Questionnaire, MNA and SNAQ65+ Mean±Standard Deviation, percentage, Chi-Square analysises were used in statistical analysis.
RESULTS: The mean age of patients participating were 74.21±6.04 (Min: 65 Max: 88) years, the majority of them were male.Concerning other findings, it was determined that 34.6% of respondents experienced mouth/teeth health problem; and 57.8% of these persons had dental prosthesis problem; 20% had swallowing difficulty; 96.2% were defecating in three days; and 3.1% had chronic diarrhea. According to MNA, 16.9% of the participants and 18.5% of the participants according to SNAQ65+ were found to have malnutrition. According to the SNAQ65+ scale, 24 (18.4%) patients were “malnourished” and 29 (22.3%) patients were “malnourished according to the MNA scale.
DISCUSSION AND CONCLUSION: Compared to MNA, it was determined that the sensitivity of the SNAQ65+ was 68.9%, and its the specificity was %96. According to SNAQ65+, it was determined that 24 patients (18.4%) were "malnourished"; according to MNA, 29 (22.3%) patients had “malnutrition", 9 patients identified as “well fed” by the SNAQ65+ scale were " malnourished". While the use of the MNA scale is recommended as "gold standard" in the screening of malnutrition in the elderly population, also the use of SNAQ65+ scale is suggested that it could be used to screen malnutrition in elderly stroke patients to our results.

INTRODUCTION: The success and quality of transcranial color Doppler insonation of the middle cerebral artery (MCA) can be determined by visualization of craniocerebral sonoanatomical markers defined by transcranial B-mode sonography. This strategy can bring practical gains to the neurosonology examination.
METHODS: Transcranial B-mode sonography and transcranial color Doppler ultrasonography were performed in 375 healthy control patients (Female: 217, age: 64 ± 9 years) over 50 years of age with no apparent neurological disease. The quality of sonic imaging of the contralateral temporal bone (CTB), mesencephalon (MB) and ipsilateral sphenoid bone small wing (LSW) was determined by the Suzuki classification, and their diagnostic properties were determined in terms of recordability of the MCA Doppler signal.
RESULTS: Failure to record the MCA Doppler signal on at least one side is 4.6% (95% CI: 3.2 -6.4%) and is significantly higher in women (11.1% vs. 0.6%). For failure to receive MCA doppler signal, lower limit of 95% confidence interval of the sensitivity of MB total nonvisualisation in B-mode was 87%, along with specificity of 99%; the sensitivity of LSW sonic absence was 80% and specificity was 93%; sensitivity and specificity of non-sufficient insonation of CTB were 29% and 99.5%; sensitivity and specificity of suboptimal (visualization of less than half of the border of CTB) insonation of CTB were 89.5% and 99.5%, respectively.
DISCUSSION AND CONCLUSION: B mode sonography can easily identify the inadequacy of the transtemporal acoustic window for MCA Doppler examination. Failure of imaging of the contralateral temporal bone may be more guiding than mesencephalon and ipsilateral sphenoid bone.

INTRODUCTION: Trombectomy is commonly used in acute middle cerebral artery,especially in M1 and M2 segment, occlusions. The decision of iv tPA or thrombectomy in M2-M3 segment occlusions is still controversial. In our study, we aimed to assess good clinical outcomes, mortality and hemorrhage rates in acute ischemic stroke patients with MCA M2-M3 occlusion who were treated with iv tPA.
METHODS: In our study, we analyzed data from 38 patients admitted to the emergency department between April 2015- March 2019, whose CT-angiographies showed M2-M3 occlusion. Age, gender, NIHSS and ASPECT scores at admission and iv tpa time period data were collected. Intracerebral hemorrhage and mortality rates, Mrs score at third month after iv rtpa treatment were also assessed
RESULTS: There was no statistically significant relationship between NIHSS score at admission, ASPECT score or t-PA time period; but multivariate analysis showed that NIHSS score at admission was the most relevant variable with good clinical outcome. Among all variables, age is found to be the most relevant and statistically significant variable with good clinical outcome.
Symptomatic intracranial hemorrhage was not observed in any of the 38 patients. At third month assessment, 18 patients’ mRS score was 0-1 (excellent outcome), 2 patients’ mRS score was 2 (good outcome) and 18 patients’ mRS score was 3-6 (poor outcome); %47,3, %5,2 and %47,3 respectively.

DISCUSSION AND CONCLUSION: Results from our study is found to be better than other studies with iv. trombolysis and similar to those with endovascular treatment in MCA M2-M3 occlusions in literature. Therefore we conclude that trombolytic treatment must be considered in a patient with acute MCA M2-M3 occlusion before thrombectomy plan.

The report illustrates a case with innumerable disseminated cerebral microbleeds (CMBs) and posterior reversible encephalopathy syndrome (PRES) in a patient with hypertension and sepsis. Both sepsis and uncontrolled hypertension, if severe enough, might lead to PRES and CMBs via multiple mechanisms including endothelial dysfunction, vasoconstriction and coagulopathy. This case highlights their effect might be additive in milder cases.

With the increasing number of diagnostic and interventional vascular procedures in recent years, there has also been an increase in complication numbers due to these. Because the femoral artery is most common used for catheterization, femoral nerve, that is closely related to it, can be damaged. A 70- year- old woman presented with right leg weakness and numbness in the second week after digital substraction angiography, cardiac stenting and right and left carotid stenting. Single leg numbness and weakness after angiography and catheterization, may be related to femoral nerve injury.