No abstract

No abstract

We aimed to assess the Addenbrooke's Cognitive Examination Revised (ACE-R) and three questions (3Qs, European Aids Clinical Society Guidelines) as potential screening tools for HIV-associated neurocognitive disorder (HAND). In addition, we tried to determine the prevalence and associated factors for HAND among people living with HIV (PLWH) in Turkey. Methods Persons living with HIV were enrolled from two teaching hospitals between March 2018 and September 2018. Participants underwent screening tools, a neuropsychological test battery (NTB) and an assessment of activities of daily living. HAND was diagnosed according to Frascati's criteria and applying the Global Deficit Score (GDS) approach. A receiver operating characteristic (ROC) curve analysis was performed to compare the predictive accuracy of ACE-R to that of the NP test battery. Factors associated with HAND were evaluated using multivariate logistic regression analysis. Results The study sample included 162 participants (94% male). The HAND prevalence was 45.7% [asymptomatic neurocognitive impairment (ANI), 37.7%; mild neurocognitive disorder (MND), 7.4%; HIV-associated dementia (HAD), 0.6%] according to the Frascati criteria and 31.5% (ANI, 25.9%; MND, 4.9%; HAD, 0.6%) using the GDS. In the ROC analysis, the ACE-R showed an area under the curve of 0.68 at a cutoff score of 89. The sensitivity, specificity and correct classification rate of screening tests for HAND diagnosis were as follows: ACE-R (62.2%, 67%, 64.8%) and 3Qs (10.8%, 88.6%, 53%). In multivariate analysis, only education level (adjusted odds ratio [aOR] = 0.84, 95% CI: 0.76-0.92, P ≤ 0.001) was an independent risk factor for HAND. Conclusions HAND is a common comorbidity in PLWH in Turkey. The sensitivities and specificities of 3Qs and the ACE-R as screening tools are lower than desired.

ÖZETGenç yaş serebrovasküler hastalıkların sebepleri arasında vertebral arter diseksiyonu son yıllarda daha sık bildirilmektedir. Spontan olabileceği gibi boyun manipulasyonlarını veya travmayı takiben de ortaya çıkabilir. Olguların 3'ü kadın (ortalama yaş: 35±265 yıl), 7'si erkek (ortalama yaş: 37.71±4.96 yıl) idi. İki olguda boyun bölgesine uygulanan travma öyküsü vardı. Nörolojik muayenede tüm olgularda serebellar bulgular ön planda idi. Radyolojik incelemelerde 2 olguda bilateral, 5 olguda sağ ve 3 olguda sol vertebral artere ait vasküler değişiklikler izlendi. Hastaların tümüne antikoagülan tedavi verildi. Dokuz olguda tam iyilik hali görülürken bir olgu sekel olarak iyileşti. Vertebral arter diseksiyonunda hızlı tanı ve uygun tedavi ile prognoz genellikle iyidir. Dijital substraksiyon arteriografi disseksiyon tanısında altın standarttır. Bu yazıda vertebral arter diseksiyonunda klinik ve radyolojik özellikler gözden geçirildi. Anahtar Sözcükler: İnme, vertebral arter, diseksiyon. CLINICAL AND RADIOLOGICAL EVALUATION IN VERTEBRAL ARTERY DISSECTIONS ABSTRACTIn recent years, vertebral artery dissection (VAD) is reported more frequently as a cause of young cerebrovascular accidents. It can occur spontaneously or following a neck manipulation and trauma. The patients were 3 females (mean age: 35±26 years) and 7 males (mean age: 37.71±4.96 years). Only 2 patients described neck trauma. Cerebellar findings were prominent in all cases. On radiological investigation, vascular changes of vertebral arteries were detected bilaterally in 2 cases, right in 5 and left in 3 cases. All the cases were treated with anticoagulant therapy and cured but 1 with sequela. Prognosis of vertebral artery dissection is generally good by early diagnosis and treatment. In this article, we reported clinical and radiological properties of 10 vertebral artery dissection cases.