Person: ÖZPAR, RİFAT
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ÖZPAR
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RİFAT
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Publication The relationship between early neurological deterioration, poor clinical outcome, and venous collateral score in cerebral venous sinus thrombosis(Wolters Kluwer Medknow Publications, 2021-07-01) Dinç, Yasemin; Özpar, Rıfat; Hakyemez, Bahattin; Bakar, Mustafa; DİNÇ, YASEMİN; ÖZPAR, RİFAT; HAKYEMEZ, BAHATTİN; BAKAR, HACI MUSTAFA; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı; Bursa Uludağ Üniversitesi/Tıp Fakültesi/ Nöroloji Anabilim Dalı; 0000-0001-6649-9287; 0000-0002-3425-0740; 0000-0003-0342-5939; IWC-9957-2023; AAH-5062-2021; AAI-2318-2021; EKN-8251-2022Background and Purpose: Cerebral venous sinus thrombosis (CVST) is one of the rare causes of cerebrovascular disease and has an extremely heterogeneous prognosis. The aim of this study was to investigate the potential relationship between early neurological deterioration, poor clinical outcome in CVST and the venous collateral score. Materials and Methods: A total of 121 patients diagnosed with CVST between 2010 and 2020 were retrospectively included. The demographic, clinical, and radiological findings related to venous sinus thrombosis and early neurological deterioration were investigated in relation to the clinical outcome. Results: The factors associated with early neurological deterioration were superior sagittal sinus thrombosis (P < 0.001), sinus rectus thrombosis (P = 0.031), parenchymal lesions (P < 0.001), and venous collateral score (P < 0.001). The factors associated with poor clinical outcome were superior sagittal sinus thrombosis (P < 0.001), cortical vein thrombosis (P < 0.001), venous collateral score (P < 0.001), and initial clinical symptoms. Binary logistic regression analyses revealed poor clinical outcome as a significant variable, with a venous collateral scale of 0 or 1 as a risk factor for a poor outcome (significance of the model P < 0.001). Conclusion: Early neurologic deterioration and poor clinical outcome may occur due to poor collateralization in CVST. Identifying the subgroup of CVST patients at risk of clinical deterioration is therefore important. This study highlights the clinical importance of venous collaterals; however, larger prospective multicenter studies are required to confirm the relationship with venous collaterals in patients with CVST.Publication Evaluation of clinical, radiological, and demographic characteristics of juxtacortical hemorrhages in cerebral venous thrombosis(Türk Nöroloji Derneği, 2021-12-01) Dinç, Yasemin; Özpar, Rıfat; Bakar, Mustafa; Hakyemez, Bahattin; DİNÇ, YASEMİN; ÖZPAR, RİFAT; BAKAR, HACI MUSTAFA; HAKYEMEZ, BAHATTİN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Nöroloji Anabilim Dalı; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı; 0000-0001-6649-9287; 0000-0002-3425-0740; IUQ-6999-2023; AAH-5062-2021; EKN-8251-2022; AAI-2318-2021Objective: Cerebral venous thrombosis (CVT) is a rare form of cerebrovascular disease. Intracranial hemorrhage may occur in 40% of the patients with CVT. The morphology of the intracranial hemorrhages ranges from small juxtacortical hemorrhages (JH) to large parenchymal hematomas. Although it has been suggested that JH is a characteristic of CVT, studies examining the relationship between JH and CVT are limited. In this study, it was aimed to determine the clinical, radiological, and demographic characteristics of JH in patients with CVT.Materials and Methods: In this study, a total of 157 patients who were followed up with the diagnosis of CVT between 2015 and 2021 were included retrospectively. Patients were categorized as, those with and without JH. Variables associated with JH were determined by comparing the demographic, clinical, and radiological characteristics, CVT etiologies and clinical outcomes of the patients.Results: When the clinical, demographic, and radiological characteristics of the patients with and without JH were compared; female gender (p=0.037), clinical initial symptom (0.003), early superior sagittal sinus (SSS) thrombosis (p<0.001), venous collateral scale (VCS) (p<0.001), being in the postpartum period (p=0.006), development of intracranial herniation (p<0.001), and poor clinical outcome (p<0.001) were significantly related with JH. When the significant variables were evaluated with the binary logistic regression, the most significant and independent variables were found to be SSS thrombosis (p=0.043), cortical vein thrombosis (CoVT) (p=0.010), and seizures after CVT (p=0.004). By contrast, no relationships were found between the groups in terms of VCS in binary logistic regression.Conclusion: Diagnosis of CVT is possible with high clinical suspicion and correct interpretation of radiological imaging. JH could be detected with non-contrast cranial computed tomography, which is the first imaging modality, and may cause the clinician to suspect from SSS thrombosis and CoVT. More precise results could be obtained with the prospective multicenter studies.Publication Statistical shape analysis of putamen in early-onset Parkinson's disease(Elsevier, 2021-10) Sığırlı, Deniz; Özdemir, Senem Turan; Erer, Sevda; Şahin, İbrahim; Ercan, İlker; Özpar, Rifat; Örün, Muhammet Okay; Hakyemez, Bahattin; SIĞIRLI, DENİZ; ERER ÖZBEK, ÇİĞDEM SEVDA; ERCAN, İLKER; ÖZPAR, RİFAT; HAKYEMEZ, BAHATTİN; Özdemir, Senem Turan; Şahin, İbrahim; Bursa Uludağ Üniversitesi/Tıp Fakültesi; 0000-0001-9031-3040; 0000-0002-3425-0740; 0000-0001-6649-9287; AAA-7472-2021; FPU-9468-2022; DVY-9744-2022; HII-7787-2022; ABF-2367-2020; AAH-5062-2021; AAI-2318-2021Objective: To investigate the shape differences in the putamen of early-onset Parkinson's patients compared with healthy controls and to assess and to assess sub-regional brain abnormalities. Methods: This study was conducted using the 3-T MRI scans of 23 early-onset Parkinson's patients and age and gender matched control subjects. Landmark coordinate data obtained and Procrustes analysis was used to compare mean shapes. The relationships between the centroid sizes of the left and right putamen, and the durations of disease examined using growth curve models. Results: While there was a significant difference between the right putamen shape of control and patient groups, there was not found a significant difference in terms of left putamen. Sub-regional analyses showed that for the right putamen, the most prominent deformations were localized in the middle-posterior putamen and minimal deformations were seen in the anterior putamen. Conclusion: Although they were not as pronounced as those in the right putamen, the deformations in the left putamen mimic the deformations in the right putamen which are found mainly in the middle-posterior putamen and at a lesser extend in the anterior putamen.Publication Vertebral artery hypoplasia as an independent risk factor of posterior circulation atherosclerosis and ischemic stroke(Lippincott Williams & Wilkins, 2021-09-24) Dinç, Yasemin; Özpar, Rıfat; Emir, Büsra; Hakyemez, Bahattin; Bakar, Mustafa; DİNÇ, YASEMİN; ÖZPAR, RİFAT; HAKYEMEZ, BAHATTİN; BAKAR, HACI MUSTAFA; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Nöroloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Radyolog Anabilim Dalı.; 0000-0001-6649-9287; 0000-0002-3425-0740; IWC-9957-2023; AAH-5062-2021; AAI-2318-2021; EKN-8251-2022Vertebral artery hypoplasia (VAH) is a frequent anatomical variation of vertebral arteries, with emerging evidence suggesting that it contributes to posterior circulation ischemia. However, the relationship between VAH and ischemic stroke remains unknown. Hence, this study aimed to determine the prevalence of VAH in patients diagnosed with acute ischemic stroke who were followed up in a neurology clinic and to determine if it can potentially be a risk factor for atherosclerotic stenosis in vertebrobasilar circulation. This retrospective study included 609 patients diagnosed with acute ischemic stroke between January 1, 2019 and January 1, 2020. Demographic of patients, risk factors, radiological and clinical characteristics were evaluated. Posterior circulation was very common in patients with VAH, and the most common locations of atherosclerotic stenosis were V1 and V4 segments of the vertebral artery and the middle segment of basilar artery. Analysis of the risk factors for atherosclerotic stenosis in patients with posterior circulation acute ischemic stroke suggested that VAH was an independent risk factor. Findings of the study suggest that VAH pre-disposes atherosclerotic stenosis in vertebrobasilar circulation, although its mechanism remains unknown. Hemodynamic parameters associated with atherosclerosis could not be measured in vivo. Thus, to better understand the underlying mechanism, conducting studies that examine blood flow parameters with high-resolution magnetic resonance angiography in patients diagnosed with acute cerebral ischemia patients with VAH is warranted.Publication Non-contrast magnetic resonance venography with inhance 3D Velocity: Diagnostic performance for intracranial venous thrombosis(Springer, 2021-04-06) Özpar, Rifat; Tonkaz, Mehmet; Erkal, Duygu; Öngen, Gökhan; Hakyemez, Bahattin; ÖZPAR, RİFAT; TONKAZ, MEHMET; ERKAL TONKAZ, DUYGU; ÖNGEN, GÖKHAN; HAKYEMEZ, BAHATTİN; 0000-0001-6649-9287; 0000-0002-8201-1568; 0000-0002-3425-0740; AAH-5062-2021; DZJ-5260-2022; EUK-9600-2022; FQR-8472-2022; AAI-2318-2021Purpose The aim of this study was to evaluate the diagnostic performance of Inhance 3D Velocity (I3DV) in intracranial venous thrombosis and investigate the possible impact of venous sinus hypoplasia/aplasia on false thrombosis diagnosis made with I3DV. Methods This study included 540 patients. Contrast-enhanced magnetic resonance venography combined with conventional sequences was considered the gold standard test (GST), while I3DV was considered as diagnostic test. We accessed the diagnostic success of I3DV for intracranial venous thrombosis detection, thrombosed vessel identification, and total/partial thrombus distinction. The possible relationship between false-positive thrombus diagnosed by I3DV and venous sinus hypoplasia or aplasia diagnosed by GST was investigated. Results The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of I3DV in the detection of intracranial venous thrombosis were 95.7%, 92.1%, 64.1%, 99.3%, and 92.6%, respectively. A significant association was observed between I3DV and GST in terms of thrombosis detection and total/partial thrombus distinction (p < 0.001). A significant relationship was observed between false-positive thrombosis diagnosis in I3DV and hypoplasia in the left transverse sinus (p < 0.001). Conclusion Intracranial venous thrombosis may be diagnosed faster and more accurately than traditional phase contrast magnetic resonance angiography in I3DV. This technique can be used in situations where contrast medium application is contraindicated. As in other non-contrast magnetic resonance venography techniques, left transverse sinus hypoplasia can be diagnosed as a thrombosed vessel in I3DV.Publication Identifying the risk factors of early neurological deterioration after thrombolysis in patients with acute ischemic stroke(Galenos Yayıncılık, 2022-09-01) Dinç, Yasemin; Özpar, Rıfat; Hakyemez, Bahattin; Bakar, Hacı Mustafa; DİNÇ, YASEMİN; ÖZPAR, RİFAT; HAKYEMEZ, BAHATTİN; BAKAR, HACI MUSTAFA; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Nöroloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı.; 0000-0001-6649-9287; 0000-0003-0342-5939; 0000-0002-3425-0740; 0000-0001-5229-0001; IUQ-6999-2023; AAH-5062-2021; AAI-2318-2021; EKN-8251-2022Objective: The efficacy of intravenous (IV) recombinant tissue plasminogen activator (rt-PA) therapy in the treatment of acute ischemic stroke (AIS) has been demonstrated in many studies and IV rt-PA therapy has been increasingly used all over the world. Early neurological deterioration (END) in AIS is common and potentially associated with a poor clinical outcome. The prevalence of END in AIS ranges from 13% to 37% in studies. The aim of this study is to determine the prevalence and risk factors of END in patients with AIS receiving IV rt-PA therapy. Materials and Methods: One hundred fifty seven patients who were given IV rt-PA treatment by Bursa Uludag University Faculty of Medicine, Department of Neurology between 01.01.2020 and 01.01.2021 were retrospectively included in this study. It was planned to determine the risk group by comparing patients with END with those without. Results: Age (p=0.023), serum glucose level (p=0.045), The National Institutes of Health Stroke score at discharge (p<0.01), Alberta Stroke Program Early CT (ASPECT) score (p<0.01) when clinical, radiological and demographic data associated with END were evaluated and, statistically significant correlation was found with the presence of major vessel occlusion (p=0.012), ischemic stroke due to cardioembolism (p=0.002), clinical outcome (p<0.001) and symptomatic intracerebral hemorrhage (p<0.001). When the significant variables associated with END were evaluated with binary logistic regression, the most significant variables were found to be age (p=0.006) and ASPECT score (p<0.001). Conclusion: The causes of END are multifactorial. The most associated risk factors were found to be advanced age and low ASPECT score. It was understood that the most common cause of END was the inability to perform mechanical thrombectomy for major vessel occlusion. Contrary to popular belief, the most common cause of END in patients with AIS who received IV rt-PA treatment was not considered to be symptomatic intracranial hemorrhage but to inadequate recanalization or late recanalization.Publication Reliability of CT angiography scoring systems used for brain death and the effect of cranial interventions on the results(Elsevier Science, 2021-04-19) Özpar, Rıfat; Tonkaz, Mehmet; Girgin, Nermin Kelebek; Bodur, Muhittin; Dinç, Yasemin; Kocaeli, Hasan; Hakyemez, Bahattin; ÖZPAR, RİFAT; TONKAZ, MEHMET; KELEBEK GİRGİN, NERMİN; BODUR, MUHİTTİN; DİNÇ, YASEMİN; KOCAELİ, HASAN; HAKYEMEZ, BAHATTİN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Reanimasyon Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Nörolojisi Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Nöroloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Beyin Cerrahi Anabilim Dalı.; 0000-0001-6649-9287; 0000-0002-5882-1632; 0000-0002-2588-8195; 0000-0002-3425-0740; IUQ-6999-2023; JAN-9435-2023; AAH-5062-2021; AAH-2684-2021; DZJ-5260-2022; DTU-3148-2022; FDK-3229-2022; AAI-2318-2021Objective: To assess vascular opacifications, the efficiency, and interobserver agreement (IOA) of five different computed tomography angiography (CTA) brain death (BD) scoring systems in patients with and without cranial interventions, for determining alternative findings correctly supporting BD diagnosis by CTA even in cranial intervention presence. Methods: 45 patients clinically identified with BD and evaluated with CTA were included. IOA of five different scoring systems used for CTA BD diagnosis, the effect of intracranial interventions on scoring systems, and vascular opacification were evaluated. Results: IOA was almost perfect (Kappa = 0.843-0.911, p < 0.05) and substantial (Kappa = 0.771-0.776, p < 0.05) in all scoring systems. Significant relationships were observed between craniectomy presence and middle cerebral artery M4 segment and internal cerebral vein (ICV) opacification. No opacification was observed in straight sinus (SS) by observers in any of the craniectomized patients. Conclusion: IOA of CTA scoring systems is adequate. But a significant degree of false-negative results is observed due to ICV filling in craniectomy cases. Opacification presence in SS can give an idea of BD in these cases.Publication Reply: "Spinal nerve pathology in Guillain-Barre syndrome associated withCOVID-19 infection"(Wiley, 2020-08-10) Oğuz-Akarsu, Emel; Özpar, Rıfat; Hakyemez, Bahattin; Karlı, Necdet; OĞUZ AKARSU, EMEL; ÖZPAR, RİFAT; HAKYEMEZ, BAHATTİN; KARLI, HAMDİ NECDET; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Nöroloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı.; 0000-0001-6649-9287; 0000-0001-6649-9287; 0000-0002-3425-0740; AAI-2318-2021; AAA-8936-2021; AAN-4912-2021; AAH-5062-2021; IZQ-0662-2023Publication Normal or elevated prolactin is a good indicator to show pituitary stalk interruption syndrome in patients with multiple pituitary hormone deficiency(Walter De Gruyter Gmbh, 2022-09-23) Eren, Erdal; Öngen, Yasemin Denkboy; Özgür, Taner; Özpar, Rıfat; Demirbaş, Özgecan; Yazıcı, Zeynep; Tarım, Ömer; EREN, ERDAL; DENKBOY ÖNGEN, YASEMİN; ÖZGÜR, TANER; ÖZPAR, RİFAT; DEMİRBAŞ, ÖZGECAN; YAZICI, ZEYNEP; TARIM, ÖMER FARUK; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Endokrinolojisi Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Pediatri Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Radyolojisi Anabilim Dalı.; 0000-0002-1684-1053; 0000-0001-6649-9287; 0000-0002-6922-5203; 0000-0002-5322-5508; KHZ-1491-2024; JPK-3909-2023; AAH-5062-2021; AAI-2303-2021; FPE-9941-2022; GQX-9760-2022; CCU-8073-2022Objectives To determine the importance of serum prolactin (PRL) in the detection of pituitary stalk interruption syndrome (PSIS) in children with multiple pituitary hormone deficiency (MPHD). We hypothesized that PRL elevation might be a diagnostic indicator of pituitary stalk pathologies. Methods Clinical, radiological, and laboratory features of the 50 cases of MPHD were studied. Results The median age at presentation of the 50 cases (52%, n=26 were female) was 6.61 (0.02-18.9) years. PSIS was detected in 60% (n=30), pituitary hypoplasia in 32% (n=16), partial empty sella in 6% (n=3), and only 2% (n=1) was reported as normal. Out of 50 patients, 21.3% (n=10) were hypoprolactinemic, 44.7% (n=19) were normoprolactinemic, and 34% (n=16) were hyperprolactinemic. The median PRL value was 27.85 (4.21-130) ng/mL in patients with PSIS and 5.57 (0-41.8) ng/mL in patients without PSIS. Additional hormone deficiencies, especially ACTH and LH were detected in follow-up. Conclusions Patients with normal or high prolactin levels deserve special attention regarding the possibility of PSIS. Furthermore, we emphasize the importance of regular follow-up and monitoring for multiple pituitary hormone deficiencies in all patients with a single pituitary hormone deficiency.Publication Pituitary involvement as a primary manifestation of granulomatosis with polyangiitis(Wolters Kluwer Medknow Publications, 2022-05-01) Koç, Emine R.; KOÇ, EMİNE RABİA; Güllü, Gizem; GÜLLÜ, GİZEM; Güner, Altuğ; GÜNER, ALTUĞ; Tolunay, Şahsine; TOLUNAY, ŞAHSİNE; Özpar, Rifat; ÖZPAR, RİFAT; Dalkılıç, Hüseyin E.; DALKILIÇ, HÜSEYİN EDİZ; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Nöroloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Romatoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı.; 0000-0002-0264-7284; 0000-0001-6649-9287; A-7083-2015Granulomatosis with polyangiitis is a systemic necrotizing granulomatous vasculitis that can predominantly affect systemic small- and medium-sized vessels. Isolated pituitary gland involvement at the onset of the disease is extremely rare in granulomatosis with polyangiitis and usually associated with other organ involvement, especially upper and lower respiratory tract and kidneys. This report highlights granulomatosis with polyangiitis -related pituitary dysfunction with clinical, radiological, and laboratory findings.