RESUMEN
BACKGROUND: Platelet aggregation plays an important role in the pathogenesis of thromboembolic cerebrovascular disease. Platelet aggregation ratio (PAR) and its derivates have been used successfully to identify the effectiveness of antiplatelet agents and their optimum dosage in patients suffering from stroke. However, we failed to find any study using PAR as a predictive factor in differential diagnosis of ischemic cerebrovascular diseases. In this study, we aimed to investigate PAR in patients with acute ischemic stroke and transient ischemic attack (TIA), comparing their neuroradiological features, and whether PAR values could be an indicator for differential diagnosis of TIA and cerebral ischemic stroke. METHODS: The study consisted of 75 adult patients who were admitted with suspected stroke and 25 control healthy individuals. All patients were diagnosed with acute ischemic stroke or TIA and the diagnoses were confirmed by clinical examination and computed tomography (CT). The stroke group consisted of 45, and the TIA group of 30 consecutive patients. The patients included in this study had noncardioembolic stroke. PAR values were measured on admission in all groups, according to the modified method of Wu and Hoak. The statistical significance of differences was evaluated using one-way ANOVA, the unpaired Student t test and the Bonferroni and Tamhane post hoc tests. RESULTS: Differences in PARs between the control and TIA groups, control and stroke groups and stroke and TIA groups were significant (p < 0.001). Nevertheless, in each group, differences between genders were not statistically significant. Initial CT scan demonstrated early infarction sign in 26 stroke patients (57%); however, in 19 stroke patients, it was not detected. Differences in PARs between TIA and stroke patients, whose initial CT scan findings were negative, were found to be significant. However, differences in PARs between CT negative stroke patients and positive stroke patients were not significant. CONCLUSION: We believe that the use of PAR values in the assessment of acute ischemic stroke and TIA could open up a new perspective in the management of such patients. In differential diagnosis, PAR values have to combine with neurological examination and CT scan signs. The current test is not able to differentiate vascular occlusive diseases in other organs from vascular occlusive problems in the brain. Further study is needed to determine the sensitivity and specificity of this test in all patients and to confirm the prognostic value in stroke patients.
Asunto(s)
Isquemia Encefálica/diagnóstico , Ataque Isquémico Transitorio/diagnóstico , Agregación Plaquetaria , Accidente Cerebrovascular/diagnóstico , Análisis de Varianza , Isquemia Encefálica/sangre , Isquemia Encefálica/diagnóstico por imagen , Angiografía Cerebral , Diagnóstico Diferencial , Femenino , Humanos , Ataque Isquémico Transitorio/sangre , Ataque Isquémico Transitorio/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Examen Neurológico , Valor Predictivo de las Pruebas , Pronóstico , Sensibilidad y Especificidad , Accidente Cerebrovascular/sangre , Accidente Cerebrovascular/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
The aim of this study was to examine dissociative experiences, childhood abuse and anxiety in epileptic and pseudoseizure female patients. Thirty-three patients with pseudoseizures and thirty patients with epilepsy were recruited from Cumhuriyet University Hospital Psychiatry and Neurology Units. We assessed each participant using the Dissociative Experiences Scale, the Clinician-Administered Dissociative States Scale and the Childhood Abuse and Neglect Questionnaire. The female patients with pseudoseizures showed significantly higher levels of dissociative experiences and childhood trauma. Epileptic female patients showed higher levels of anxiety. The significantly higher incidence of dissociative experiences and childhood trauma in the patients with pseudoseizures makes a case for dissociation in the pathogenesis of these seizures.
Asunto(s)
Abuso Sexual Infantil/psicología , Trastornos Disociativos/psicología , Epilepsia/psicología , Convulsiones/psicología , Adolescente , Adulto , Ansiedad/complicaciones , Ansiedad/diagnóstico , Ansiedad/psicología , Niño , Abuso Sexual Infantil/diagnóstico , Trastornos Disociativos/complicaciones , Trastornos Disociativos/diagnóstico , Educación , Epilepsia/complicaciones , Epilepsia/diagnóstico , Femenino , Humanos , Escalas de Valoración Psiquiátrica , Convulsiones/complicaciones , Convulsiones/diagnóstico , Factores Socioeconómicos , Encuestas y Cuestionarios , TurquíaRESUMEN
Sneddon's syndrome is characterized by livedo reticularis and cerebrovascular lesions. We report the cases of women (mean age, 36.2 +/- 8.1 years) diagnosed with Sneddon's syndrome based on the presence of livedo reticularis and characteristic cerebrovascular findings. Seven of these patients had cerebral infarcts on cranial computed tomography scan. Antiphospholipid antibodies were positive in 6 of these cases. Three cases had abnormal levels of antithrombin III. Analyses of chromosome 6 revealed no abnormalities. In 3 of the cases, investigation of the pedigrees revealed autosomal dominant traits. Two cases had epilepsy, and 3 had migraine. One case with migraine also had myasthenia gravis. In addition, we detected inferior altudinal hemianopia in 2 cases, cognitive functional disorder in 3 and depression in 2. Based on these findings, the entire vascular, haematologic, neurologic, and dermatologic systems should be evaluated in patients diagnosed with Sneddon's syndrome.