Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common form of hereditary cerebral small vessel disease. During the last years, our understanding of the disease has substantially changed due to increased availability of the genetic test and high-quality studies. Besides the classical CADASIL phenotype characterized by early onset stroke and premature dementia and death, milder forms with elderly onset have been recognized. On the other hand, atypical NOTCH3 mutations with unknown pathogenicity including cysteine sparing ones, in conjunction with milder forms of the disease make it difficult to ascertain the diagnosis in certain cases. In this paper, I have reviewed the recent data regarding the molecular diagnosis, neuroimaging findings and management of patients with CADASIL.

INTRODUCTION: The aim of the study is to determine the effect of intravenous thrombolytic therapy on mechanical thrombectomy outcomes in stroke patients with basilar occlusion who have a high risk of mortality.
METHODS: The data of acute stroke patients who applied to our hospital between January 2018 and June 2022, who had basilar artery occlusion and underwent mechanical thrombectomy, were retrospectively analysed and included in the study. Patients' demographic characteristics, comorbidities, medications, blood pressure at admission to the emergency room, NIHSS, radiological imaging results, symptom onset time, intravenous recombinant tissue plasminogen activator (IV tPA) treatment and contraindications were examined. The posterior circulation Alberta stroke program early computed tomography score (pc-ASPECT) and the basilar artery on computed tomography angiography (BATMAN) scores were evaluated by examining brain computed tomography (CT) and CT angiography results. The results of the patients who received combined IV tPA and endovascular thrombectomy (EVT) were compared with the patients who underwent EVT alone. Post-procedure recanalization results, EVT complications, functional outcomes at discharge and 3-month outcomes were compared between the two groups. Clinical outcome was determined using the modified Rankin scale (mRS). Those with mRS 0-2 were included in the good clinical outcome group, whereas those with mRS 3-6 were included in the poor clinical outcome group.
RESULTS: The results of the patient group treated with combined IVtPA and EVT were compared with the group treated with EVT alone.The rate of patients who achieved complete recanalization after the procedure was 53.3% in the direct EVT group, compared to 42.9% in the combined group. Intracranial bleeding after EVT was13.3% in the direct EVT group,while it was7.1% in the combined group. After EVT, reocclusion was observed in 3(56.7%)patients in the direct EVT group and in2(14.3%) patients in the combined group. MRS was 31.1%in the0-2 direct EVT group and 35.7%in the combined group.While mRS3-6 was 68.9%in the directEVT group,it was 64.3%in the combined group.There was no statistically significant difference between the groups. Binary logistic analysis showed that advanced age increased the risk of poor outcome.Those with type3 aortic arch increased the risk of poor outcomes 10.5 times compared to those with type1.
DISCUSSION AND CONCLUSION: There was no statistically significant effect of the treatment type on mRS in the patient groups who received direct EVTand IVtPA plusEVT combination.Advanced age was found to be directly associated with poor clinical outcome.

INTRODUCTION: Stroke patients often continue their lives with a long process of rehabilitation and treatment after hospitalization. The adaptation to this process can be challenging for caregivers, particularly during the acute phase. Previous studies about anxiety in stroke have mainly focused on the subacute and chronic phases. Therefore, this study aimed to assess anxiety levels during the acute phase within caregivers of stroke patients in the hospitalization period, along with associated factors.
METHODS: Hospitalized patients for acute stroke and their caregivers were included in the study. Sociodemographic characteristics of patients and their caregivers were recorded. Clinical conditions and disease features of patients were evaluated. Caregivers were administered the State-Trait Anxiety Inventory (STAI) and the Hospital Anxiety and Depression (HAD) scales. The relationships between these variables were assessed.
RESULTS: The study included 100 patients with a mean age of 67.09±11.48 and 100 caregivers with a mean age of 46.19±13.36. Higher anxiety scores were observed in caregivers of patients who were younger than 65, had ischemic stroke, and were treated in the neurology service (p=0.001; p=0.001; p=0.019). A negative correlation was found between the number and satisfaction of physician’s daily information with anxiety scores (p=0.001). In addition, higher anxiety scores were identified in caregivers, particularly female caregivers of patients in the 1st and 2nd degree relatives (p=0.032; p=0.033).
DISCUSSION AND CONCLUSION: Caregivers to stroke patients experience significant levels of anxiety, and depression. This situation is associated with various factors. It is important to provide more frequent and satisfactory information to caregivers, especially in the hospitalization period.

INTRODUCTION: Stroke patients treated with disorders of consciousness in the neurointensive care unit (NICU) can be assessed by evaluating the severity of unconsciousness and get an idea of the prognosis. The aim of this study was to determine the characteristics of stroke patients followed up in the NICU and the predictive power of GCS (Glasgow Coma Scale), FOUR score and NIHSS (National Institutes of Health Stroke Scale) on prognosis.

METHODS: A total of 59 patients admitted with a diagnosis of acute stroke and hospitalised in the NICU were included in the study. GCS and FOUR scores, and NIHSS scores on admission and at 72nd hours were calculated independently by two different neurology speciality students. Demographic information, presence of risk factors and neuroimaging results were recorded. Classification was made by dividing stroke into subtypes. Furthermore, the length of hospitalisation, discharge from the NICU, intubation during hospitalisation and within the first 30 days, and mortality were recorded for all patients, and the prognosis predictive power of GCS and FOUR score were compared using these parameters.
RESULTS: The mean age of the patients was 68.6 ± 13.4 years. 4 patients had haemorrhagic stroke and 55 patients had ischaemic stroke. The mean admission NIHSS was 13.1 and discharge NIHSS was 10. A statistically significant positive correlation (r=989) was found between the investigators in terms of GCS and FOUR score at arrival and 72nd hours. The GCS and FOUR score at 72nd hours of admission and hospitalisation, and the predictive power of mortality during hospitalisation and 30-day mortality were similar.
DISCUSSION AND CONCLUSION: The prognostic value of the FOUR score and its consistency between different investigators were found to be significantly high. We believe that GCS and FOUR score together are effective in the prognostic evaluation of stroke patients during admission and follow-up in the NICUs.

INTRODUCTION: It is known that local vascular anatomy and related hemodynamic factors are effective in aneurysm formation. The Willis polygon that forms the cerebral artery network is asymmetric in upto 54% of population. However, this is not the only determinant of aneurysm formation. It is suggested that A1 segment hypoplasia/aplasia and hemodynamic changes in the anterior communicating artery have an effect on the formation of anterior communicating artery aneurysm. The aim of this study is to investigate any possible effect of anterior cerebral artery-A1 segment hypoplasia on the formation of anterior communicating artery aneurysm.
METHODS: In this study, digital subtraction angiography images of 535 patients, performed in our clinic, were evaluated. The patients were divided into in three groups as those having anterior communicating artery aneurysm (Group-1, 100 patients), patients with aneurysm in the anterior circulation without accompanying anterior communicating artery aneurysm (Group-2, 166 patients), and those who underwent digital subtraction angiography (DSA) due to subarachnoid hemorrhage but no aneurysm was detected (Group-3, 269 patients).
RESULTS: The frequency of hypoplasia/aplasia observed in Group-1 (45.0%) is significantly higher than Group-2 (13.3%) and Group-3 (16.4%) (p<0.001).
DISCUSSION AND CONCLUSION: This result suggests that A1 segment hypoplasia/aplasia can play a role in the formation of anterior communicating artery aneurysm.

INTRODUCTION: Optic nerve sheath diameter (ONSD) is seen to increase in patients with spontaneous intracerebral hemorrhage (ICH) due to increased intracranial pressure. The prognostic value of increased ONSD in ICH patients is uncertain. In this study, we aimed to reveal the predictive power of ONSD about the prognosis of ICH patients.
METHODS: Patients diagnosed with ICH between January 2020 and April 2022 were examined by retrospectively scanning their files. 39 patients with ICH detected on the first cranial computed tomography (CT) scan within 6 hours after the onset of symptoms were included in the study. In the first cranial CT of the patients, bleeding localization, volume, presence of intraventricular hemorrhage (IVH), ONSD, optic nerve sheath area (ONSA) were examined. Final outcome at discharge: The good prognosis group was divided into patients with 0-3 points according to the modified Rankin scale (MRS), and the poor prognosis group was divided into 4-6 points. Student's t-test was used for continuous variables, chi-square test for categorical variables, Pearson correlation coefficient was used to determine the correlation of OCSD measurement with various parameters, and Spearman correlation coefficient was used to determine the correlation with volume.
RESULTS: The ONSD of the poor outcome group was significantly higher than positive outcome group (6.67 ± 0.85 vs. 5.97 ± 0.61 mm, p<0.001). A significant positive correlation was found between hematoma volume and ONSD measurements (r = 0.529, p<0.001). The hematoma volumes of the bad group were significantly higher than good group (p=0.012). The presence of IVH was significantly higher in bad group (p=0.026).
In addition, the cut-off value for ONSD was found to be 6.60 mm, with a specificity of %90.9 and sensitivity of %64.7.
DISCUSSION AND CONCLUSION: Increased ONSD measured on initial CT predicted poor outcome. Therefore, it can be used as a prognostic scale and alert the physician for timely appropriate intervention.

Fetal posterior cerebral artery (fPCA) is a common variant in the posterior cerebral circulation, in which the posterior cerebral artery perfuses this region as a branch of the internal carotid artery (ICA). The importance of fPCA in the risk of acute ischemic stroke is not clear. In this article, we aimed to present a case with ipsilateral fPCA detected in the acute infarction of the posterior circulation and stent applied to the ipsilateral carotid artery. A 55-year-old female patient was admitted to the emergency service with complaints of inability to see her right side and numbness in her right hand, which started after chemotherapy and continued for three days. In the angiogram, it was observed that there was a filling defect compatible with 99% stenosis in the left ICA cervical segment with injection from the left common carotid artery, and only fPCA filling in its distal, and the left subclavian artery was occluded from the proximal with injection from the aortic arch. Using the distal embolism-retaining filter, first balloon angioplasty and then carotid artery stenting were performed. In the post-procedure image, the stent was intact there was no residual stenosis, and there was clear filling of the left MCA and both PCAs (left fPCA) in the distal. The presence of carotid stenosis and fPCA may not always be considered in posterior circulation strokes. The connection between PCA and ICA is provided by the posterior communicating artery (PCoA). fPCA is an anatomical variant of ICA. In the presence of fPCA, especially in cases with stenosis or occlusion in the ipsilateral hemodynamically significant ICA, adequate collateral circulation may be lacking, and when cerebral perfusion is impaired (e.g. due to hypotension), watershed infarcts may occur in PCA-perfused areas.

Relapsing polychondritis is a multisystemic autoimmune disease with a predilection for cartilaginous structures, causing recurrent episodes of chondritis. The most common presentations are auricular and nasal chondritis and arthritis; however, the disease may affect almost every part of body including heart, vessels, tracheobronchial tree and nervous system. Stroke has rarely been reported in patients with relapsing polychondritis. We present a case with stroke, probably due to vasculitis and other typical manifestations of relapsing polychondritis including auricular perichondritis, sensorineural hearing loss and ocular inflammation.