Background: The prognostic value of the neutrophil–lymphocyte ratio (NLR) in ischemic stroke remains debated due to cohort variability and treatment heterogeneity across studies. This study evaluates the relationship between admission NLR, stroke severity and 90-day outcomes in patients with anterior circulation large vessel occlusion (LVO) undergoing early, successful revascularization. Methods: A retrospective multicenter study was conducted with 1082 patients treated with mechanical thrombectomy for acute ischemic stroke. The relationship between admission NLR, baseline National Institutes of Health Stroke Scale (NIHSS), 24 h NIHSS and 90-day modified Rankin Scale (mRS) outcomes was analyzed using logistic regression. Results: Admission NLR correlated weakly but significantly with both baseline (p = 0.018) and 24 h (p = 0.005) NIHSS scores, reflecting stroke severity. However, multivariate analysis showed that higher 24 h NIHSS scores (OR 0.831, p = 0.000) and prolonged puncture-to-recanalization times (OR 0.981, p = 0.000) were independent predictors of poor 90-day outcomes, whereas NLR was not (p = 0.557). Conclusions: Admission NLR is associated with stroke severity but does not independently predict clinical outcomes at 90 days in patients achieving early and successful revascularization. These findings underscore the critical role of inflammation in the acute phase of stroke but suggest that its prognostic value for long-term outcomes is limited in this context.

Background Peripheral nerve block (PNB) is usually performed in patients with migraine who are resistant to treatment with medications.Objective To compare the efficacy of PNB alone and PNB combined with prophylactic medications in migraine patients.Method The data on migraine patients who underwent PNB in our clinic between November 2019 and January 2022 were retrospectively reviewed. Blocks of the greater occipital nerve (GON), lesser occipital nerve (LON) and supraorbital nerve (SON) were performed upon admission and in the second week.Results The study included 116 patients. While 21 out of 39 episodic migraine (EM) patients continued to use prophylactic medications, 18 were followed up with PNB alone. While 49 out of 77 chronic migraine (CM) patients continued to use prophylactic medications, 28 were followed up with PNB alone. Comparison of the admission and second-month data of the patients who only underwent PNB and those who continued the drug treatment together with PNB in both the EM and the CM group showed that the number of days with pain, number of analgesics taken and scores on the Visual Analog Scale (VAS) and the Migraine Disability Assessment (MIDAS) were significantly reduced in both groups (p < 0.01). Comparison of the second-month data of the patients followed up with PNB alone and those followed up with PNB together with prophylactic medications showed that there was no significant difference between the EM and CM patients (p > 0.05).Conclusion Bilateral GON, LON and SON block with lidocaine injection seems to be an effective treatment on its own, without the need for prophylactic medications, in both EM and CM patients during a two-month follow-up.

Zonulin regulates permeability in blood–brain and intestinal barriers. The pathophysiology of migraine is based on the effect of neurogenic inflammation. The aim of the current investigation was to examine the serum zonulin level in individuals suffering from migraine. The sample comprised 40 individuals who had migraine and 40 controls. Disease duration, attack duration, attack frequency, Visual Analog Scale (VAS) scores, and comorbidities were available for the migraine group. Serum zonulin levels were evaluated by using the ELISA method. There were no statistically significant differences between the two groups concerning age or gender (p > 0.05). The zonulin value of patients with migraine was higher when compared to the controls, indicating a significant difference (p = 0.037; p < 0.05). The zonulin level did not correlate with disease duration, attack duration, VAS score, or attack frequency (p > 0.05). The receiver operating characteristic curve analysis of zonulin revealed a cut-off value of 30.58 and above, at which it had 52.50% sensitivity, 77.5% specificity, 70% positive predictive value, and 62% a negative predictive value. The area under the curve was 63.6%, and the standard error value was 6.3%. The analysis also showed a statistically significant correlation between migraine diagnosis and a zonulin level of 30.58 (p = 0.006; p < 0.01). Elevated zonulin levels in patients with migraine support the disruption of the intestinal barrier and neuroinflammation in these patients. The zonulin level may be a predictive biomarker of migraine. Multicenter, randomized trials are needed to evaluate treatments for intestinal permeability and zonulin levels in migraine patients.

Introduction: There are few studies on cognitive impairment in neuromyelitis optica (NMO). The purpose of this study is to assess the factors that may be related with the frequency and level of cognitive impairment in Turkish NMO patients. Methods: 22 patients with the diagnosis of NMO are evaluated retrospectively. Cognitive function was evaluated with Brief Repeatable Battery of Neuropsychological tests (BRB-N), Beck Depression Inventory (BDI) and Addenbrooke Cognitive Evaluation (ACE-R). The groups with and without cognitive impairment were compared according to age, sex, level of education, pathologic findings on cranial MRI, NMO Ig existence and EDSS score. The relation of the clinical, radiological and demographic values and patients' depression level was evaluated. The specificity and sensitivity of ACE-R test on detecting cognitive impairment were assessed through ACE-R test results. Results: The mean age of the patients was 42.8 +/- 10.9.45.5% (n=10) of the patients had cognitive impairment and 50% (n=11) had depression. The group with cognitive impairment had significantly older age, lower educational status, higher EDSS and BDI scores (p<0.05). The mostly affected cognitive domains were memory impairment, attention and processing dysfunction. When the specificity and sensitivity of ACE-R test on NMO patients were evaluated, diagnostic level of the test was found to be statistically good since it could detect cognitive impairment with a sensitivity of 88% and specificity of 75% on a cut off level of 82.5. Conclusion: In our study, cognitive impairment and depression were detected in approximately half of the patients with BRB-N and BDI tests. It can be concluded that ACE-R test can be used to detect cognitive impairment in NMO patients. Since cognitive impairment and depression are frequent in NMO patients, it is important to assess the patients' cognitive functions and arrange the treatments to improve their quality of life,

This study was conducted to evaluate the correlation between serum oxidative stress parameters and clinical characteristics of patients with migraine by measuring total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI), ischemia- modified albumin (IMA), and thiol/disulfide homeostasis levels. The study included a total of 152 individuals, of whom 76 were diagnosed with migraine and 76 were controls. Disease duration, attack duration, attack frequency, Visual Analog Scale scores, comorbidities, were recorded in the migraine group. Using the serum samples of the patient and control groups, oxidative stress parameters were analyzed by colorimetric methods and evaluated together with clinical findings. In the patient group, the measured total thiol, native thiol, IMA, TOS, and OSI levels were statistically significantly higher than those in the control group (for each group; p < 0.01). The mean TAS level of the patient group was significantly lower than that of the control group (p < 0.01). A significant positive correlation was found between the frequency of attacks and the measured IMA levels (r: 0.244; p = 0.034; p < 0.05). This study found that TAS levels decreased, while TOS, OSI, and IMA levels increased during the interictal period in patients with migraine. These parameters shifting toward an oxidant balance may indicate that oxidative stress also plays a role in the pathogenesis of migraine. In addition, the significant positive correlation between the frequency of attacks and IMA levels are likely to indicate that secondary ischemic mechanisms may play a role in the pathophysiology of this condition.

OBJECTIVE: Peripheral nerve blockage treatments reduce central sensitization and are effective in patients with migraine. We wanted to evaluate the efficacy of peripheral nerve blockage in patients with fibromyalgia and migraine whose etiology may be responsible for central sensitization, and their associations are common. METHODS: The files of patients with chronic migraine who had peripheral nerve blockage treatment in our clinic and had fibromyalgia were scanned. The patients underwent bilateral great occipital nerve, lesser occipital nerve, and supraorbital nerve blockage at baseline and in the second week. The revised Fibromyalgia Impact Questionnaire, Migraine Disability Assessment Scale, Visual Analog Scale scores, the number of days in pain, and the number of analgesics taken in the last month were recorded. RESULTS: In the third month, Fibromyalgia Impact Questionnaire, Migraine Disability Assessment Scale, and Visual Analog Scale scores were significantly lower from baseline. While Fibromyalgia Impact Questionnaire scores in the third month were significantly lower than in the first month, no significant difference was observed between Visual Analog Scale scores. In the third month, the number of days in pain and the number of analgesics taken in the last month was significantly lower than the baseline but higher than the first month. CONCLUSION: Peripheral nerve blockage has been found to be an effective treatment for the symptoms of both diseases in patients with migraine and fibromyalgia coexistence.