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Akut İskemik İnme Vakalarında Radyolojik Görüntüleme ve Laboratuvar Değerlerinin Analizi

Yıl 2024, Cilt: 34 Sayı: 2, 171 - 180, 30.04.2024

Mustafa Alpaslan Necmi Baykan

https://doi.org/10.54005/geneltip.1315349

Öz

Giriş: Akut iskemik inmeye bağlı ölüm ve sakatlık oranı dünyada ikinci sırada yer almaktadır. Bu çalışmada, iskemik inme geçiren hastalarda demografik özellikler ve etiyolojide yer alan ek hastalıklar ile yapılan radyolojik görüntüleme ve laboratuvar değerlerinin analizinin yapılması planlandı.
Gereç ve Yöntem: Bu çalışma retrospektif olarak 01.01.2022-31.12.2022 tarihleri arasında acil servisten iskemik inme teşhisi ile hastaneye yatırılan hastaların analizi ile yapılmıştır. Hastalarda rutin laboratuvar değerleri, lipitler, vitamin düzeyleri, radyolojik görüntülemeler ve etiyolojiye yönelik testler analiz edilmiştir.
Bulgular: Çalışmada 177 hasta analiz edildi. Hastaların %53,1’i erkekti. Yaş ortalaması 75±12,75 oldu. Ek hastalık olarak en sık hipertansiyon, diyabet ve hiperlipidemi olduğu görüldü. İskemik infarkt olarak en sık orta serebral arterin beslediği alanlarda tutulum görüldü. Hastalarda yapılan karotis ve/veya vertebral doppler ultrasonografide damarlarda %83,1 oranında plak olduğu görüldü. Transtorasik ekokardiyografi bulgularına göre hastaların %79,3’ünde kalp kapak patolojisi olduğu saptandı. Hastalarda patolojik olarak çoğunlukta hiperglisemi, D vitamini eksikliği ve HDL kolesterol seviyesinde düşüklük olduğu gözlendi. Altı hastada trombolitik tedavi uygulandı ve üç hasta fayda görürken bir hasta kanama gelişerek öldü. Hastaların %13,6’sı yoğun bakımda tedavi edildi.
Sonuç: İskemik inme görülme riski ileri yaşlarda artmaktadır. Hipertansiyon ve diyabet en önemli risk faktörlerindendir. Vitamin D ve vitamin B12 eksikliği ile folik asit eksikliği ateroskleroz açısından risk arz etmektedir. Aynı zamanda düşük HDL kolesterol düzeyi de inme riskini artırmaktadır. Etiyolojide önlenebilir nedenler olarak değerlendirilen bu faktörler tedavi ile kontrol altına alınmalıdır.

Anahtar Kelimeler

acil servis Akut iskemik inme serebrovasküler hastalık

Kaynakça

  • Roger VL, Go AS, Llyod Jones DM, Adams RJ, Berry JD, Brown TM, et al. Heart disease and stroke statistics 2011 update: a report from the American Heart Association. Circulation 2011; 123: 18-209.
  • GBD 2016 Stroke Collaborators. Global, regional, and national burden of stroke, 1990-2016: a sys¬tematic analysis for the Global Burden of Disea¬se Study 2016. Lancet Neurol 2019; 18:439-58.
  • Feigin VL. Stroke epidemiology in the developing world, Lancet, 2005; 365:2160-61.
  • Dhamija, RK, Arora, S, Jais PG, Kaintura A, Kumar M, Bhattacharjee J. Study of genetic, metabolic and inflammatory risk factors in patients of acute ischemic stroke, Indian Journal of Clinical Biochemistry 2008; 23: 136-43.
  • Rowland, LP, Pedley TA. Pathogenesis, classification and epidemiology of cerebrovascular disease, East O (Translation Ed.). Merritt's Neurology Turkish 12th ed. Istanbul: Güneş Medicine Publishing House. 2012. p. 250-263.
  • Amarenco P, Bogousslavsky J, Caplan LR, Donnan GA, Hennerici MG. Classification of stroke subty¬pes. Cerebrovasc Dis 2009; 27: 493-501.
  • Adams Jr HP, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. Classification of su¬btype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993; 24:35-41.
  • Alberts MJ. Diagnosis and treatment of ischemic stroke. Am J Med 1999; 106:211–21.
  • Oguzhan C. Definitions, classification, epidemiology and risk factors in cerebrovascular diseases. In: Ö g e AE, editor. Neurology. Istanbul: Nobel Medicine Bookstores. 2004. p. 193-4.
  • Soyudoğru S, Akdeniz YS, İpekci A, İkizceli İ. Evaluation of Ischemic Stroke and Transient Ischemic Attack Patients Admitted to the Emergency Department. Phnx Med J. 2020;2(1):16-24.
  • Gül M, Cander B, Girgin S, Tokgöz S, Koçak S, Bircan M et al. The relationship between acute ischemic stroke and acute phase reactants, JAEM 2011:161-4.
  • Hakbilir O, Gang Y, Göksu E, Akyol C, Kılıçaslan İ. Demographic characteristics of the stroke population and the effect of late emergency department admissions on new treatment approaches. Turk J Emerg Med 2006; 6(3):132-38.
  • Aksoy D, Inanir A, Ayan M, Cevik B, Kurt S, Unaldi HK. Mortality and morbidity markers in acute ischemic stroke, Neuropsychiatry archive 2013; 50: 40-4.
  • Ozturk B, Ozön AO. Ischemic stroke and gender. Akd Med J. 2020; 6(1):59-65.
  • Kiyan S, Özsaraç M, Ersel M, Aksay E, Yuruktümen A, Musalar E et al. A one-year retrospective review of 124 patients with acute ischemic stroke admitted to the emergency department. JAEM 2009; 8:3.
  • Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M et al. Heart disease and stroke statistics 2016 Update: a report from the american heart association. circulation 2016; 133: 38.
  • Inan RA, Ozer D, Ozen Barut B. Etiological investigation in young ischemic stroke patients in a tertiary care center. KSU Faculty of Medicine 2021; 16(1): 46-52.
  • Morkavuk G, Işık K, Koç G, Sayın R, Leventoğlu A. Relationship between ıschemic stroke risk factors and vitamin D. Van Medical Journal 2021; 28(4):595:602.
  • Heuschmann PU, Wiedmann S, Wellwood I, Rudd A, Di Carlo A, Bejot Y et al. Registers of Stroke. Three month stroke outcome: The European Registers of Stroke (EROS) Investigators. Neurology 2011; 76: 159-65.
  • Kostulas N, Markaki I, Cansu H, Masterman T, Kostulas V. Hyperglycaemia in acute ischaemic stroke is associated with an increased five year mortality. Age and ageing 2009; 38: 590-4.
  • İyigün İ, Bakırcı Y. Plasma concentrations of C-reactive protein and fibrinogen in ischemic stroke. J Int Med Res 2002; 30: 591-6.
  • Vila N, Filella X, Deulofeu R, Ascaso C, Abellana R, Chamorro A. Cytokine induced inflammation and longterm stroke functional outcome. J NeurolSci1999; 162:185-8.
  • Canova CR, Courtin C, Reinhart WH. C-reactive protein in cerebrovascular events. Aterosclerosis1999; 147: 49-53.
  • Taşkıran E, Tekeşin A, Yağız O, Manga F, Saak Ş. Fibrinogen and CRP levels in patients with ischemic stroke. Istanbul medical journal 2010; 2: 62-64.
  • Şengül Y, Bilge S, Hız F, Kökeş Ü, Çınar M, Karagöl T. C-reactive protein and internal carotid artery intima-media thickness in acute ischemic stroke. Kartal Training and Research Hospital Medical Journal. 2008; 3: 138-43.
  • Cao JJ, Thach C, Manolio TA, Psaty BM, Kuller LH, Chaves PH, et al. C-reactive protein, carotid intima media thickness and incidence of ischemic stroke in theelderly: the Cardiovascular Health Study. Circulation 2003;108(2):166-70.
  • Luo Fan, LiGui, Chai EQ, Wei CJ. Routine hematological parameters areas sociated with short and long term prognosis of patients with ischemic stroke. J Clin Lab Anal. 2018;32:e22244.
  • Kaşıkcı MT, Yıldırım S. The relationship between hospital mortality and hematological parameters in patients with acute ischemic stroke. MMJ. 2020;7(1):45-9.
  • Dermirkiran MK. Homocysteine and cerebralvascular diseases. Kocatepe Medical Journal. 2003;1: 08-13.
  • Genç MF, Karda S, Özer F, Öventaş Y, Koldaş M. Plasma Homocysteine, Folate, Vitamin B12, Protein C and Protein S Levels in the Acute Period in the Stroke Population. Turkish Journal of Neurology 2003; 9(1):23-33.
  • Muscogiuri G, Annweiler C, Duval G, Karras S, Tirabassi G, Salvio G, et al. Vitamin D and cardiovascular disease: from atherosclerosis to myocardial infarction and stroke. IntJCardiol 2017; 230:577-84.
  • Borgi L, McMullan C, Wohlhueter A, Curhan GC, Fisher ND, Forman JP. Effect of
  • Vitamin D on endothelial function: a randomized, double blind, placebo controlled trial. Am J Hypertens 2017;30(2):124-9.
  • Manouchehri N, Vakil Asadollahi M, Zandifar A, Rasmani F, Saadatnia M. Vitamin D status in small vessel and large vessel ıschemic stroke patients: a case control study Adv Biomed Res 2017; 6:146.
  • Beheshti S, Madsen, CM, Varbo, A, Benn, M, Nordestgaard BG. Relationship of familial hypercholesterolemia and high LDL Cholesterol to ischemic stroke: the Copenhagen general population study, Circulation, 2018, 138; 578-89.
  • Yılmaz F, Demircan A, Bildik F. The role of homocysteine in ischemic cerebrovascular disease. JAEM 2010:9(3); 134-42.
  • Yücel K, Eren F. The relationship between blood lipid parameters and the development of intracerebral hemorrhage in patients with ischemic stroke. CBU-SBED: Celal Bayar University Health Sciences Institute Journal. 2021; 8(2):197-304.
  • Uzar E, Cevik MU, Yücel Y, Cansever S, Arıkanoğlu A, Ekici F, et al. Demographic, etiological and risk factors of young patients with ischemic stroke. Duzce Med J. 2012; 14(3):32-6.
  • Naess H, Nyland HI, Thomassen L, Aarseth J, Nykand G, Myhr KM. Incidence and shortterm outcome of cerebral infarction in young adults in Western Norway. Stroke. 2002; 33: 2105-08.
  • Damar Ö, Avnca Ö, Kaçmaz Ö, Karakoç Y, Cansever S, Taş M. Determining the risk factors affecting mortality in ischemic stroke patients admitted to the emergency department. Anadolu J Emerg Med. 2020; 3(1):9-13.
  • Uncu G, Aydın E, Güler A, Şirin H, Sağduyu KA, Çallı MC. acute ischemic stroke; etiopathogenetic classification, neuroradiological, clinical, prognostic correlation. Turkish Journal of Cerebrovascular Diseases, 2020; 26(1):95-106.
  • Kim YH, Roh SY. The mechanism of and preventive therapy for stroke in patients with atrial fibrillation. J Stroke2016;18:129-137.
  • Diker S, Tanburoğlu A. The relationship between recurrent ischemic stroke and transient ischemic attack and atrial fibrillation. Dicle Medical Journal. 2022; 49(1):187-92.
  • Marti Fabregas J, Bravo Y, Cocho D, MartiVilalta JL, Diaz Manera J, Roman LS et al. Frequency and predictors of symptomatic intracerebral hemorrhage in pa¬tients with ischemic stroke treated with recombinant tissue plasminogen activator outside clinical trials. Cerebrovasc¬Dis2007; 23:85-90.
  • Eren F, Öngün G, Yıldoğan AT, Işık M, Öztürk Ş. Intravenous thrombolytic therapy in acute ischemic stroke: clinical evaluation. Journal of General Medicine. 2019; 29(4):169-74.

Radiological Imaging and Analysis of Laboratory Values in Case of Acute Ischemic Stroke

Yıl 2024, Cilt: 34 Sayı: 2, 171 - 180, 30.04.2024

Mustafa Alpaslan Necmi Baykan

https://doi.org/10.54005/geneltip.1315349

Öz

Background: The rate of death and disability due to acute ischemic stroke ranks second in the world. In this study it was planned to analyze the demographic characteristics and additional diseases in the etiology as well as radiological imaging and laboratory values in patients with ischemic stroke.
Materials and Methods: This study was conducted retrospectively by analyzing the patients hospitalized with the diagnosis of ischemic stroke from the emergency department between 01.01.2022 and 31.12.2022. Routine laboratory values, lipids, vitamin levels, radiological imaging and tests for etiology were analyzed in the patients.
Results: One hundred seventy seven patients were analyzed in the study. 53.1% of the patients were male. The mean age was 75±12.75 years. The most common comorbidities were hypertension, diabetes and hyperlipidemia. As ischemic infarction, involvement was most common in the areas fed by the middle cerebral artery. In the carotid and/or vertebral doppler ultrasonography performed in the patients, plaque was observed in the vessels at a rate of 83.1%. According to the transthoracic echocardiographic findings, 79.3% of the patients were found to have heart valve pathology. Pathologically the majority of patients had hyperglycemia, vitamin D deficiency and low HDL cholesterol levels. Thrombolytic therapy was applied in six patients and three patients benefited and one patient died due to bleeding. 13.6% of the patients were treated in the intensive care unit.
Conclusion: The risk of ischemic stroke increases in advanced age. Hypertension and diabetes are among the most important risk factors. Vitamin D and vitamin B12 deficiency and folic acid deficiency pose a risk in terms of atherosclerosis. At the same time, low HDL cholesterol levels increase the risk of stroke. These factors which are considered as preventable causes in etiology should be controlled with treatment.

Anahtar Kelimeler

Emergency department Acute ischemic stroke Cerebrovascular disease

Kaynakça

  • Roger VL, Go AS, Llyod Jones DM, Adams RJ, Berry JD, Brown TM, et al. Heart disease and stroke statistics 2011 update: a report from the American Heart Association. Circulation 2011; 123: 18-209.
  • GBD 2016 Stroke Collaborators. Global, regional, and national burden of stroke, 1990-2016: a sys¬tematic analysis for the Global Burden of Disea¬se Study 2016. Lancet Neurol 2019; 18:439-58.
  • Feigin VL. Stroke epidemiology in the developing world, Lancet, 2005; 365:2160-61.
  • Dhamija, RK, Arora, S, Jais PG, Kaintura A, Kumar M, Bhattacharjee J. Study of genetic, metabolic and inflammatory risk factors in patients of acute ischemic stroke, Indian Journal of Clinical Biochemistry 2008; 23: 136-43.
  • Rowland, LP, Pedley TA. Pathogenesis, classification and epidemiology of cerebrovascular disease, East O (Translation Ed.). Merritt's Neurology Turkish 12th ed. Istanbul: Güneş Medicine Publishing House. 2012. p. 250-263.
  • Amarenco P, Bogousslavsky J, Caplan LR, Donnan GA, Hennerici MG. Classification of stroke subty¬pes. Cerebrovasc Dis 2009; 27: 493-501.
  • Adams Jr HP, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. Classification of su¬btype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993; 24:35-41.
  • Alberts MJ. Diagnosis and treatment of ischemic stroke. Am J Med 1999; 106:211–21.
  • Oguzhan C. Definitions, classification, epidemiology and risk factors in cerebrovascular diseases. In: Ö g e AE, editor. Neurology. Istanbul: Nobel Medicine Bookstores. 2004. p. 193-4.
  • Soyudoğru S, Akdeniz YS, İpekci A, İkizceli İ. Evaluation of Ischemic Stroke and Transient Ischemic Attack Patients Admitted to the Emergency Department. Phnx Med J. 2020;2(1):16-24.
  • Gül M, Cander B, Girgin S, Tokgöz S, Koçak S, Bircan M et al. The relationship between acute ischemic stroke and acute phase reactants, JAEM 2011:161-4.
  • Hakbilir O, Gang Y, Göksu E, Akyol C, Kılıçaslan İ. Demographic characteristics of the stroke population and the effect of late emergency department admissions on new treatment approaches. Turk J Emerg Med 2006; 6(3):132-38.
  • Aksoy D, Inanir A, Ayan M, Cevik B, Kurt S, Unaldi HK. Mortality and morbidity markers in acute ischemic stroke, Neuropsychiatry archive 2013; 50: 40-4.
  • Ozturk B, Ozön AO. Ischemic stroke and gender. Akd Med J. 2020; 6(1):59-65.
  • Kiyan S, Özsaraç M, Ersel M, Aksay E, Yuruktümen A, Musalar E et al. A one-year retrospective review of 124 patients with acute ischemic stroke admitted to the emergency department. JAEM 2009; 8:3.
  • Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M et al. Heart disease and stroke statistics 2016 Update: a report from the american heart association. circulation 2016; 133: 38.
  • Inan RA, Ozer D, Ozen Barut B. Etiological investigation in young ischemic stroke patients in a tertiary care center. KSU Faculty of Medicine 2021; 16(1): 46-52.
  • Morkavuk G, Işık K, Koç G, Sayın R, Leventoğlu A. Relationship between ıschemic stroke risk factors and vitamin D. Van Medical Journal 2021; 28(4):595:602.
  • Heuschmann PU, Wiedmann S, Wellwood I, Rudd A, Di Carlo A, Bejot Y et al. Registers of Stroke. Three month stroke outcome: The European Registers of Stroke (EROS) Investigators. Neurology 2011; 76: 159-65.
  • Kostulas N, Markaki I, Cansu H, Masterman T, Kostulas V. Hyperglycaemia in acute ischaemic stroke is associated with an increased five year mortality. Age and ageing 2009; 38: 590-4.
  • İyigün İ, Bakırcı Y. Plasma concentrations of C-reactive protein and fibrinogen in ischemic stroke. J Int Med Res 2002; 30: 591-6.
  • Vila N, Filella X, Deulofeu R, Ascaso C, Abellana R, Chamorro A. Cytokine induced inflammation and longterm stroke functional outcome. J NeurolSci1999; 162:185-8.
  • Canova CR, Courtin C, Reinhart WH. C-reactive protein in cerebrovascular events. Aterosclerosis1999; 147: 49-53.
  • Taşkıran E, Tekeşin A, Yağız O, Manga F, Saak Ş. Fibrinogen and CRP levels in patients with ischemic stroke. Istanbul medical journal 2010; 2: 62-64.
  • Şengül Y, Bilge S, Hız F, Kökeş Ü, Çınar M, Karagöl T. C-reactive protein and internal carotid artery intima-media thickness in acute ischemic stroke. Kartal Training and Research Hospital Medical Journal. 2008; 3: 138-43.
  • Cao JJ, Thach C, Manolio TA, Psaty BM, Kuller LH, Chaves PH, et al. C-reactive protein, carotid intima media thickness and incidence of ischemic stroke in theelderly: the Cardiovascular Health Study. Circulation 2003;108(2):166-70.
  • Luo Fan, LiGui, Chai EQ, Wei CJ. Routine hematological parameters areas sociated with short and long term prognosis of patients with ischemic stroke. J Clin Lab Anal. 2018;32:e22244.
  • Kaşıkcı MT, Yıldırım S. The relationship between hospital mortality and hematological parameters in patients with acute ischemic stroke. MMJ. 2020;7(1):45-9.
  • Dermirkiran MK. Homocysteine and cerebralvascular diseases. Kocatepe Medical Journal. 2003;1: 08-13.
  • Genç MF, Karda S, Özer F, Öventaş Y, Koldaş M. Plasma Homocysteine, Folate, Vitamin B12, Protein C and Protein S Levels in the Acute Period in the Stroke Population. Turkish Journal of Neurology 2003; 9(1):23-33.
  • Muscogiuri G, Annweiler C, Duval G, Karras S, Tirabassi G, Salvio G, et al. Vitamin D and cardiovascular disease: from atherosclerosis to myocardial infarction and stroke. IntJCardiol 2017; 230:577-84.
  • Borgi L, McMullan C, Wohlhueter A, Curhan GC, Fisher ND, Forman JP. Effect of
  • Vitamin D on endothelial function: a randomized, double blind, placebo controlled trial. Am J Hypertens 2017;30(2):124-9.
  • Manouchehri N, Vakil Asadollahi M, Zandifar A, Rasmani F, Saadatnia M. Vitamin D status in small vessel and large vessel ıschemic stroke patients: a case control study Adv Biomed Res 2017; 6:146.
  • Beheshti S, Madsen, CM, Varbo, A, Benn, M, Nordestgaard BG. Relationship of familial hypercholesterolemia and high LDL Cholesterol to ischemic stroke: the Copenhagen general population study, Circulation, 2018, 138; 578-89.
  • Yılmaz F, Demircan A, Bildik F. The role of homocysteine in ischemic cerebrovascular disease. JAEM 2010:9(3); 134-42.
  • Yücel K, Eren F. The relationship between blood lipid parameters and the development of intracerebral hemorrhage in patients with ischemic stroke. CBU-SBED: Celal Bayar University Health Sciences Institute Journal. 2021; 8(2):197-304.
  • Uzar E, Cevik MU, Yücel Y, Cansever S, Arıkanoğlu A, Ekici F, et al. Demographic, etiological and risk factors of young patients with ischemic stroke. Duzce Med J. 2012; 14(3):32-6.
  • Naess H, Nyland HI, Thomassen L, Aarseth J, Nykand G, Myhr KM. Incidence and shortterm outcome of cerebral infarction in young adults in Western Norway. Stroke. 2002; 33: 2105-08.
  • Damar Ö, Avnca Ö, Kaçmaz Ö, Karakoç Y, Cansever S, Taş M. Determining the risk factors affecting mortality in ischemic stroke patients admitted to the emergency department. Anadolu J Emerg Med. 2020; 3(1):9-13.
  • Uncu G, Aydın E, Güler A, Şirin H, Sağduyu KA, Çallı MC. acute ischemic stroke; etiopathogenetic classification, neuroradiological, clinical, prognostic correlation. Turkish Journal of Cerebrovascular Diseases, 2020; 26(1):95-106.
  • Kim YH, Roh SY. The mechanism of and preventive therapy for stroke in patients with atrial fibrillation. J Stroke2016;18:129-137.
  • Diker S, Tanburoğlu A. The relationship between recurrent ischemic stroke and transient ischemic attack and atrial fibrillation. Dicle Medical Journal. 2022; 49(1):187-92.
  • Marti Fabregas J, Bravo Y, Cocho D, MartiVilalta JL, Diaz Manera J, Roman LS et al. Frequency and predictors of symptomatic intracerebral hemorrhage in pa¬tients with ischemic stroke treated with recombinant tissue plasminogen activator outside clinical trials. Cerebrovasc¬Dis2007; 23:85-90.
  • Eren F, Öngün G, Yıldoğan AT, Işık M, Öztürk Ş. Intravenous thrombolytic therapy in acute ischemic stroke: clinical evaluation. Journal of General Medicine. 2019; 29(4):169-74.
Toplam 45 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Acil Tıp, Radyoloji ve Organ Görüntüleme, Tanı Radyografisi, Klinik Tıp Bilimleri (Diğer)
Bölüm Original Article
Yazarlar

Mustafa Alpaslan 0000-0003-3170-0125

Necmi Baykan 0000-0002-6845-9550

Erken Görünüm Tarihi 27 Nisan 2024
Yayımlanma Tarihi 30 Nisan 2024
Gönderilme Tarihi 15 Haziran 2023
Yayımlandığı Sayı Yıl 2024 Cilt: 34 Sayı: 2

Kaynak Göster

Vancouver Alpaslan M, Baykan N. Radiological Imaging and Analysis of Laboratory Values in Case of Acute Ischemic Stroke. Genel Tıp Derg. 2024;34(2):171-80.

Genel Tıp Dergisi Creative Commons Atıf-GayriTicari 4.0 Uluslararası Lisansı (CC BY NC) ile lisanslanmıştır.