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    Behcet's disease as a causative factor of cerebral venous sinus thrombosis: subgroup analysis of data from the VENOST study
    (OXFORD UNIV PRESS, 2019) Uluduz, Derya; Midi, Ipek; Duman, Taskin; Colakoglu, Sena; Tufekci, Ahmet; Bakar, Mustafa; Nazliel, Bijen; Tascilar, Nida; Goksan, Baki; Sungur, Mehmet Ali; Kozak, Hasan Huseyin; Demir, Serkan; Misirli, Cemile Handan; Kucukoglu, Hayriye; Cinar, Nilgun; Domac, Fusun Mayda; Ozturk, Serefnur; Yayla, Vildan; Karahan, Ali Yavuz; Afsar, Nazire; Goksu, Eylem Ozaydin; Mengulluoglu, Necdet; Aytac, Emrah; Yesilot, Nilufer; Ince, Birsen; Yalin, Ozgur Osman; Oruc, Serdar; Demirci, Seden; Senol, Mehmet Guney; Yilmaz, Arda; Gokce, Mustafa; Kusbeci, Ozge Yilmaz; Uzuner, Gulnur; Caglayan, Hale Zeynep Batur; Acikgoz, Mustafa; Zeydan, Burcu; Ozdag, Fatih; Baybas, Sevim; Ekmekci, Hakan; Cabalar, Murat; Yaman, Mehmet; Yurekli, Vedat Ali; Tekeli, Hakan; Genc, Hamit; Utku, Uygar; Tokuc, Firdevs Ezgi Ucan; Uzuner, Nevzat; Bektas, Hesna; Kablan, Yuksel; Goksel, Basak K.; Milanlioglu, Aysel; Orken, Dilek Necioglu; Aluclu, Ufuk
    Objective This study was performed to determine the rate of cerebral venous sinus thrombosis (CVST) among cases of Behcet's disease (BD) included in a multicentre study of cerebral venous sinus thrombosis (VENOST). Methods VENOST was a retrospective and prospective national multicentre observational study that included 1144 patients with CVST. The patients were classified according to aetiologic factors, time of CVST symptom onset, sinus involvement, treatment approach and prognosis. Results BD was shown to be a causative factor of CVST in 108 (9.4%) of 1144 patients. The mean age of patients in the BD group was 35.27 years and 68.5% were men, whereas in the non-BD CVST group, the mean age was 40.57 years and 28.3% were men (P < 0.001). Among the aetiologic factors for patients aged 18-36 years, BD was predominant for men, and puerperium was predominant for women. The onset of symptoms in the BD group was consistent with the subacute form. The transverse sinuses were the most common sites of thrombosis, followed by the superior sagittal sinuses. The most common symptom was headache (96.2%), followed by visual field defects (38%). Conclusions BD was found in 9.4% of patients in our VENOST series. Patients with BD were younger and showed a male predominance. The functional outcome of CVST in patients with BD was good; only 12% of patients presenting with cranial nerve involvement and altered consciousness at the beginning had a poor outcome (modified Rankin Score 2).
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    Cerebral Venous Sinus Thrombosis in Women: Subgroup Analysis of the VENOST Study
    (Hindawi, 2020) Uluduz, Derya; Sahin, Sevki; Duman, Taskin; Ozturk, Serefnur; Yayla, Vildan; Afsar, Nazire; Uzuner, Nevzat; Midi, Ipek; Cinar, Nilgun; Sungur, Mehmet Ali; Domac, Fusun Mayda; Ince, Birsen; Goksan, Baki; Misirli, Cemile Handan; Bakar, Mustafa; Kozak, Hasan Huseyin; Colakoglu, Sena; Karahan, Ali Yavuz; Goksu, Eylem Ozaydin; Ozdag, Fatih; Senol, Mehmet Guney; Yurekli, Vedat Ali; Aluclu, Ufuk; Demir, Serkan; Kucukoglu, Hayriye; Oruc, Serdar; Yesilot, Nilufer; Nazliel, Bijen; Tokuc, Firdevs Ezgi Ucan; Bektas, Hesna; Aytac, Emrah; Gokce, Mustafa; Caglayan, Hale Zeynep Batur; Tufekci, Ahmet; Uzuner, Gulnur; Orken, Dilek Necioglu; Yalin, Osman Ozgur; Utku, Uygar; Yılmaz, Arda; Genc, Hamit; Cabalar, Murat; Milanlioglu, Aysel; Ekmekci, Hakan; Zeydan, Burcu; Baybas, Sevim; Kablan, Yuksel; Goksel, Basak Karakurum; Acikgoz, Mustafa; Kurucu, Hatice; Demirci, Seden; Gunes, Taskin
    Background. Early diagnosis of cerebral venous sinus thrombosis (CVST) associated with reproductive health-related risk factors (RHRF) including pregnancy, puerperium, and oral contraceptive (OC) use can prevent severe neurological sequelae; thus, the symptoms must be documented in detail for each group.Methods. Out of 1144 patients with CVST, a total of 777 women were enrolled from a multicenter for the study of cerebral venous sinus thrombosis (VENOST). Demographic, biochemical, clinical, and radiological aspects were compared for 324 cases with RHRF and 453 cases without RHRF.Results. The mean age of the RHRF (-) group (43.2 +/- 13 years) was significantly higher than of the RHRF (+) group (34 +/- 9years). A previous history of deep venous thrombosis (3%), isolated cavernous sinus involvement (1%), cranial neuropathy (13%), comorbid malignancy (7%), and its disability scores after 12 months (9%) were significantly higher in the RHRF (-) group. The RHRF (+) group consisted of 44% cases of puerperium, 33% cases of OC users and 23% of pregnant women. The mean age was found to be higher in OC users (38 +/- 9years). A previous history of deep venous thrombosis was slightly higher in the pregnancy subgroup (4%). Epileptic seizures were more common in the puerperium group (44%).Conclusion. The results of our study indicate that the risk of CSVT increases parallel to age, OC use, and puerperium period. In addition, when considering the frequency of findings and symptoms, epileptic seizures in the puerperium subgroup of the RHRF (+) group and malignancies in the RHRF (-) group may accompany the CSVT. In daily practice, predicting these risks for the CSVT and early recognition of the symptoms will provide significant benefits to patients.
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    Cerebrovascular reactivity in multiple sclerosis patients
    (Sage Publications, 2007) Uzuner, Nevzat; Özkan, Sezai; Çınar, Nilgün
    A close relationship between multiple sclerosis (MS) lesions and the cerebral vasculature has long been recognised. Some studies have suggested that vascular endothelial cell activation might be an early event in the evolution of MS, and demyelisation may have an ischemic basis in this condition. Hypoxia caused by breath holding (BH) results in autoregulatory vasodilatation, and an increase in CBF to the cortex. The increased CBF can be evaluated by transcranial Doppler (TCD), and can provide information about the vascular integrity. In this study, we aimed to examine the vascular integrity and assess the vasomotor reactivity of MS patients in response to BH in different activation phases of the disease by means of TCD. We studied 12 patients with clinically diagnosed relapsing remitting (RR) MS, according to the Poser criteria. The initial TCD examination was performed in the first two days of an acute exacerbation of disease and prior to any treatment. The second test was performed just after iv methylprednisolone (IVMP) treatment, and the third examination occurred one month later, when the patient was in the remission phase. A group of 11 healthy subjects was also examined by TCD as control. Blood flow velocities were recorded during 30 seconds of normal breathing and 15 seconds BH. Vasomotor reactivity was calculated as a ratio of difference of cerebral flow velocities during BH. There were no significant vasomotor reactivity differences between the controls (55.7%) and the patients during attacks (46.5%), as well as after treatment (48.3%) and during attack free periods (50.9%). There were also no significant changes amongst the patients groups throughout the study. In this study, in different disease activity stages, we observed non-significant cerebrovascular vasomotor reactivity difference between the RRMS patients and the healthy controls, although it was slightly lower in the MS patients. This observation suggests that cerebrovascular reactivity is normal in different disease activity levels.
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    Epileptic seizures in cerebral venous sinus thrombosis: Subgroup analysis of VENOST study
    (W B SAUNDERS CO LTD, 2020) Uluduz, Derya; Midi, Ipek; Duman, Taskin; Yayla, Vildan; Karahan, Ali Yavuz; Afsar, Nazire; Goksu, Eylem Ozaydin; Mengulluoglu, Necdet; Aytac, Emrah; Sungur, Mehmet Al; Yesilot, Nilufer; Ince, Birsen; Yalin, Osman Ozgur; Oruc, Serdar; Senol, Mehmet Guney; Yilmaz, Arda; Gokce, Mustafa; Demirci, Seden; Kusbeci, Ozge Yilmaz; Uzuner, Gulnur; Caglayan, Hale Zeynep Batur; Acikgoz, Mustafa; Kurucu, Hatice; Ozdag, Fatih; Baybas, Sevim; Ekmekci, Hakan; Cabala, Murat; Yaman, Mehmet; Yurekli, Vedat Ali; Tekeli, Hakan; Genc, Hamit; Utku, Uygar; Sahin, Sevki; Tokuc, Firdevs Ezgi Ucan; Uzuner, Nevzat; Bektas, Hesna; Kablan, Yuksel; Goksel, Basak Karakurum; Milanlioglu, Aysel; Orken, Dilek Necioglu; Aluclu, Ufuk; Colakoglu, Sena; Tufekci, Ahmet; Bakar, Mustafa; Nazliel, Bijen
    Purpose: The aim of this study is to evaluate the presence and prognostic impact of early seizures in cerebral venous sinus thrombosis patients (CVST). Method: VENOST is a retrospective and prospective national multicenter observational study. CVST patients with or without epileptic seizures (ES) were analyzed and compared in terms of demographic and imaging data, causative factors, clinical variables, and prognosis in a total of 1126 patients. Results: The mean age of the patients in the ES group was 39.73 +/- 12.64 and 40.17 +/- 14.02 years in the non-ES group (p > 0.05). Epileptic seizures were more common (76.6 %) in females (p < 0.001). Early ES occurred in 269 of 1126 patients (23.9 %). Epileptic seizures mainly presented in the acute phase (71.4 %) of the disease (p < 0.001). Majority of these (60.5 %) were in the first 24 h of the CVST. The most common neurological signs were focal neurologic deficits (29.9 %) and altered consciousness (31.4 %) in the ES group. Superior sagittal sinus (SSS) and cortical veins (CV) involvement were the most common sites of thrombosis and the mostly related etiology were found puerperium in seizure group (30.3 % vs 13.9 %). Patients with seizures had worse outcome in the first month of the disease (p < 0.001) but these did not have any influence thereafter. Conclusions: In this largest CVST cohort (VENOST) reported female sex, presence of focal neurological deficits and altered consciousness, thrombosis of the SSS and CVs, hemorrhagic infarction were risk factors for ES occurrence in patients with CVST.
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    A Multicenter Study of 1144 Patients with Cerebral Venous Thrombosis: The VENOST Study
    (ELSEVIER SCIENCE BV, 2017) Duman, Taskin; Uluduz, Derya; Midi, Ipek; Bektas, Hesna; Kablan, Yuksel; Goksel, Basak K.; Milanlioglu, Aysel; Orken, Dilek Necioglu; Aluclu, Ufuk; Colakoglu, Sena; Tufekci, Ahmet; Bakar, Mustafa; Nazliel, Bijen; Tascilar, Nida; Goksan, Baki; Kozak, Hasan Huseyin; Demir, Serkan; Misirli, Cemile Handan; Kucukoglu, Hayriye; Cinar, Nilgun; Domac, Fusun Mayda; Ozturk, Serefnur; Yayla, Vildan; Karahan, Ali Yavuz; Afsar, Nazire; Goksu, Eylem Ozaydin; Mengulluoglu, Necdet; Aytac, Emrah; Yesilot, Nilufer; Ince, Birsen; Yalin, Ozgur Osman; Oruc, Serdar; Demirci, Seden; Senol, Mehmet Guney; Yilmaz, Arda; Gokce, Mustafa; Kuspeci, Ozge Yilmaz; Uzuner, Gulnur; Caglayan, Hale Zeynep Batur; Acikgoz, Mustafa; Zeydan, Burcu; Ozdag, Fatih; Baybas, Sevim; Ekmekci, Hakan; Cabalar, Murat; Yaman, Mehmet; Yurekli, Vedat Ali; Tekeli, Hakan; Genc, Hamit; Utku, Uygar; Tokuc, Firdevs Ezgi Ucan; Uzuner, Nevzat
    Background: Based on a number of small observational studies, cerebral venous sinus thrombosis has diverse clinical and imaging features, risk factors, and variable outcome. In a large, multicenter cerebral venous thrombosis (VENOST) study, we sought to more precisely characterize the clinical characteristics of Caucasian patients. Methods: All data for the VENOST study were collected between the years 2000 and 2015 from the clinical follow-up files. Clinical and radiological characteristics, risk factors, and outcomes were compared in terms of age and sex distribution. Results: Among 1144 patients 68% were women, and in older age group (>50 years) male patients were more prevalent (16.6% versus 27.8%). The most frequent symptoms were headache (89.4%) and visual field defects (28.9%) in men, and headache (86.1%) and epileptic seizures (26.8%) in women. Gynecological factors comprised the largest group in women, in particular puerperium (18.3%). Prothrombotic conditions (26.4%), mainly methylenetetrahydrofolate reductase mutation (6.3%) and Factor V Leiden mutation (5.1%), were the most common etiologies in both genders. 8.1% of patients had infection-associated and 5.2% had malignancy-related etiology that was significantly higher in men and older age group. Parenchymal involvement constitutively hemorrhagic infarcts, malignancy, and older age was associated with higher Rankin score. Epileptic seizures had no effect on prognosis. Conclusions: Clinical and radiological findings were consistent with previous larger studies but predisposing factors were different with a higher incidence of puerperium. Oral contraceptive use was not a prevalent risk factor in our cohort. Malignancy, older age, and hemorrhagic infarcts had worse outcome. (c) 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.