Wos İndeksli Yayınlar Koleksiyonu
Permanent URI for this collectionhttps://hdl.handle.net/11727/4807
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Item Left Atrial Mechanics For Secondary Prevention From Embolic Stroke Of Undetermined Source(2022) Sade, Leyla Elif; Keskin, Suzan; Can, Ufuk; Colak, Ayse; Yuce, Deniz; Ciftci, Orcun; Ozin, Bulent; Muderrisoglu, Haldun; https://orcid.org/0000-0003-3737-8595; 33206942; AAQ-7583-2021Aims Anticoagulation is not justified unless atrial fibrillation (AF) is detected in cryptogenic stroke (CS) patients. We sought to explore whether left atrial (LA) remodelling is associated with embolic stroke of undetermined source (ESUS). Methods and results In this prospective study, we evaluated consecutively 186 patients in sinus rhythm who presented with an acute ischaemic stroke (embolic and non-embolic) and sex- and age-matched controls. We performed continuous electrocardiogram (ECG) monitoring to capture paroxysmal AF episodes as recommended by the guidelines. After 12 months of follow-up, continuous ECG monitoring was repeated in patients with undetected AF episodes. We quantified LA reservoir and contraction strain (LASr and LASct) by speckle-tracking, LA volumes by 3D echocardiography. Out of 186 patients, 149 were enrolled after comprehensive investigation for the source of ischaemic stroke and divided into other cause (OC) (n = 52) and CS (n = 97) groups. CS patients were also subdivided into AF (n = 39) and ESUS (n = 58) groups. Among CS patients, LA strain predicted AF independently from CHARGE-AF score and LA volume indices. ESUS group, despite no captured AF, had significantly worse LA metrics than OC and control groups. AF group had the worst LA metrics. Moreover, LASr predicted both CS (embolic stroke with and without AF) and ESUS (embolic stroke with no detected AF) independently from LAVImax and CHA(2)DS(2)-VASc score. LASr >26% yielded 86% sensitivity, 92% specificity, 92% positive, and 86% negative predictive values for the identification of ESUS (areas under curve: 0.915, P < 0.0001, 95% confidence interval: 0.86-0.97). Conclusion Echocardiographic quantification of LA remodelling has great potential for secondary prevention from ESUS.Item Effects of Bihemispheric Transcranial Direct Current Stimulation on Upper Extremity Function in Stroke Patients: A randomized Double-Blind Sham-Controlled Study(2020) Alisar, Dilek Cetinkaya; Ozen, Selin; Sozay, Seyhan; 0000-0002-8460-7699; 0000-0002-7290-8558; 0000-0002-9610-2153; 31699572; AAJ-2936-2021; ABC-1305-2020Background and Purpose: Transcranial direct current stimulation (tDCS) is a treatment used in the rehabilitation of stroke patients aiming to improve functionality of the plegic upper extremity. Currently, tDCS is not routinely used in post stroke rehabilitation. The aim of this study was to establish the effects of bihemspheric tDCS combined with physical therapy (PT) and occupational therapy (OT) on upper extremity motor function. Methods: Thirty-two stroke inpatients were randomised into 2 groups. All patients received 15 sessions of conventional upper extremity PT and OT over 3 weeks. The tDCS group (n = 16) also received 30 minutes of bihemispheric tDCS and the sham group (n = 16) 30 minutes of sham bihemispheric tDCS simultaneously to OT. Patients were evaluated before and after treatment using the Fug1 Meyer upper extremity (FMUE), functional independence measure (FIM), and Brunnstrom stages of stroke recovery (BSSR) by a physiatrist blind to the treatment group Results: The improvement in FIM was higher in the tDCS group compared to the sham group (P = .001). There was a significant within group improvement in FMUE, FIM and BSSR in those receiving tDCS (P = .001). There was a significant improvement in FIM in the chronic (> 6months) stroke sufferers who received tDCS when compared to those who received sham tDCS and when compared to subacute stroke (3-6 months) sufferers who received tDCS/sham. Conclusions: Upper extremity motor function in hemiplegic stroke patients improves when bihemispheric tDCS is used alongside conventional PT and OT. The improvement in functionality is greater in chronic stroke patients.Item A CASE OF ISCHAEMIC STROKE FOLLOWING CERASTES CERASTES SNAKE BITE IN LIBYA(2020) Ozen, Selin; Guzel, Sukran; 0000-0001-9852-0917; 0000-0002-7290-8558; AAG-3148-2021; ABC-1305-2020Background: Cerastes cerastes is a venomous species of viper native to the deserts of northern Africa and parts of the Middle East. Reported cases of ischaemic stroke following a Cerastes cerastes bite are extremely few. Here we describe a case of ischaemic stroke occurring four days after envenomation by C.cerastes. Case presentation: A 26-year-old male was admitted to our rehabilitation unit with a history of ischaemic stroke and right sided hemiplegia. Four months previously he had been bitten by a C.cerastes viper in Libya. Four days after envenomation the patient developed sudden onset of aphasia and right sided weakness. Brain magnetic resonance imaging (MRI) revealed ischaemia in the territory of the left middle cerebral artery. On admission to our hospital, routine blood tests, coagulopathy and vasculitis screening was normal. Colour doppler ultrasound imaging of the carotid and vertebral arteries, MR angiography, transthoracic and transoesophageal echocardiography and Holter electrocardiogram were normal. A daily dose of aspirin 100 mg and physical therapy program was commenced. Conclusion: Only three cases of ischaemic stroke following C.cerastes bite have been reported in the literature. Hypotension, endothelial injury, hypercoagulability and vasculitis have been suggested as possible mechanisms for its occurrence. This probable case of stroke due to envenomation shows that stroke may occur as late as four days after the snake bit and highlights the importance of early administration of antivenom. Patient education on this subject maybe considered an important public health issue in areas of Africa and Asia in which viper bites occur.Item Does the presence of ideomotor apraxia in stroke patients adversely affect rehabilitation outcomes? A prospective study(2020) Cosar, Sacide Nur Saracgil; Ozen, Selin; Selcuk, Selin Taflan; Yemisci, Oya Umit; 0000-0001-8306-463X; AAF-1085-2021Background and Objectives: Ideomotor apraxia is an inability to perform a gesture following a verbal command despite having intact knowledge of the task. The presence of ideomotor apraxia may negatively affect functional outcome of stroke patients. The aim of this study was to evaluate the effect of ideomotor apraxia on rehabilitation outcomes following first ever stroke. Methods: A cross sectional observational study of 35 stroke patients admitted to a rehabilitation unit for treatment. Patients were evaluated for ideomotor apraxia using the ideomotor apraxia test. Function was assessed before and after treatment using the Functional Independence Measure, motricity index and functional ambulation scale. Cognitive function was evaluated using the Functional Independence Measure and mini mental state examination. Results: Ideomotor apraxia was present in 31.4% of patients. Mean Functional Independence Measure motor and cognitive scores of apraxic patients on admission and at discharge were lower than those of non-apraxic patients, (p<0.05). The cognitive and total Functional Independence Measure scores and motricity scores in the ideomotor apraxia group on discharge had not reached the admission values of the non-ideomotor apraxia group. Conclusion: The presence of ideomotor apraxia following stroke has a negative impact on overall function, both before and after rehabilitation, when compared to stroke patients without ideomotor apraxia. Stroke patients must be assessed for ideomotor apraxia prior to commencement of a rehabilitation program in order to guide treatment and determine realistic treatment goals.