Hemichorea is caused by various diseases but stroke is the most common cause. The usual lesions of the stroke related hemichorea are the contralateral subthalamus or basal ganglia. Few cases with cortical lesion have been reported. But hemichorea with primary somatosensory cortical lesion has not yet been reported. We report a case with hemichorea after acute infarction of the contralateral primary somatosensory cortex.
Basal Ganglia ; Cerebral Infarction ; Chorea ; Infarction ; Somatosensory Cortex ; Stroke ; Subthalamus

The accessory middle cerebral artery (MCA) is an anomalous vessel which arises from the anterior cerebral artery (ACA) and runs through the Sylvian fissure along with the normal MCA. Here we present a case of acute cerebral infarction in a patient with stenosis of the accessory MCA. The accessory MCA, which originated from the proximal A1 segment of the ACA, had severe focal stenosis in its proximal part and the ischemic lesions were in the frontal subcortical white matter. This case illustrates the anomalous vessel and its territory, the atheromatous vascular change, and the related ischemic insults.
Anterior Cerebral Artery ; Cerebral Infarction ; Constriction, Pathologic ; Glycosaminoglycans ; Humans ; Middle Cerebral Artery

BACKGROUND: Aspirin resistance (AR) in platelet function assays showed substantial variation depending on the methods used to evaluate it. METHODS: In this study, we prospectively compared the results of Multiplate impedance platelet aggregometry (IPA) with those of light transmission aggregometry (LTA) and VerifyNow(R) system in determination of the prevalence of aspirin resistance (AR) and investigated the correlation between its presence and poor outcome (modified Rankin scale >2) in 105 patients with aspirin after acute ischemic stroke (AIS). RESULTS: After 5 days of using aspirin, 15 patients (14.3%) were classified as aspirin-resistance with the use of IPA, 24 patients (22.9%) by the LTA, and 14 patients (13.3%) by VerifyNow. Good agreement between the results of IPA and VerifyNow, was found (R=0.674, P<0.01). The concordance rate of AR detection was high between VerifyNow and IPA (k=0.72, P<0.01), albeit quite low between LTA and IPA. Regarding on its influence on clinical outcome after AIS, there wasn't any significant relationship between occurrence of poor outcome and the presence of AR in three platelet function assays. CONCLUSION: This study reveals that the incidence of AR in AIS might be highly test-specific. IPA seems to be similar to VerifyNow as a platelet function test.
Aspirin ; Blood Platelets ; Electric Impedance ; Humans ; Incidence ; Light ; Platelet Function Tests ; Prevalence ; Prospective Studies ; Stroke

BACKGROUND: Atrial fibrillation (AF) and patent foramen ovale (PFO) are established sources of cardioembolism. We investigated differences in stroke outcome and patterns between PFO and AF. METHODS: We performed a retrospective review of the medical records and brain MR images of patients with AF or PFO from the prospective acute stroke and transient ischemic attack registry. Infarct pattern and volume on diffusion-weighted imaging, and the national institutes of health stroke scale (NIHSS) on admission were compared between patients with AF and PFO. RESULTS: From June 2005 to July 2008, a total of 289 subjects were enrolled (AF group, n=156; PFO group, n=133). Infarct pattern analyzed with MR images revealed that multiple vascular territorial infarction was more prevalent in AF group than in PFO group (26.9% vs. 8.3%, P<0.01). A probable cardiac embolism, radiologically defined as territorial infarction without symptomatic steno-occlusion of the corresponding artery, was more frequently documented in AF group than in PFO group (71.8% vs. 41.4%, P<0.01) The infarct volume of PFO was smaller than that of AF. Compared to AF, PFO was associated with the mild neurologic deficit (NIHSS< or =3) after adjusting age, sex and previous stroke history. CONCLUSION: These results suggested that AF and PFO had different characteristics such as infarct patterns and initial clinical severity although both are classified as cardioembolism.
Arteries ; Atrial Fibrillation ; Brain ; Embolism ; Foramen Ovale, Patent ; Humans ; Infarction ; Ischemic Attack, Transient ; Medical Records ; National Institutes of Health (U.S.) ; Neurologic Manifestations ; Prospective Studies ; Retrospective Studies ; Stroke

BACKGROUND: Thrombolysis becomes an emerging therapeutic option for acute ischemic stroke. However, few reports exist on its use in the very elderly. We investigated whether there is a difference in the effectiveness and safety of intravenous (IV) and/or intra-arterial (IA) thrombolysis between patients aged > or =80 years and those aged <80 years. METHODS: A consecutive series of patients hospitalized within 12 hours from stroke onset were selected. We evaluated the effectiveness of thrombolysis with modified Rankin scale (mRS) at 3 months, and the safety with symptomatic hemorrhagic transformation (sHT). The odds ratio (OR) of thrombolysis on the favorable mRS (0-2) was calculated using multivariable logistic regression analysis with adjustments for potential confounders. Whether the effectiveness of thrombolysis is age-dependent or not was analyzed by introducing an interaction term (thrombolysisxage group) into multivariable models. RESULTS: Among 219 patients > or =80 years, 21% of patients received IV or IA or combined thrombolysis while 23% of 980 patients <80 years received thrombolysis (P=0.51). With respect to the favorable mRS, the adjusted ORs of thrombolysis were 1.70 (95% confidence interval, 1.08-2.68) in all subjects, 1.61 (0.58-4.49) in those > or =80 years, and 1.71 (1.05-2.78) in those <80 years. There was no significant interaction between age group and thrombolysis (P=0.91). With respect to sHT, the adjusted OR was 4.72 (1.94-11.45) in all subjects with no significant interaction (P=0.86). CONCLUSION: This study suggests that thrombolysis may be equally safe and effective in stroke patients aged > or =80 years versus <80 years.
Aged ; Electrolytes ; Humans ; Logistic Models ; Odds Ratio ; Stroke ; Treatment Outcome

The aim of this article is to review the results of recent researches with regard to risk factors or primary prevention of stroke. We have discussed the contribution of various risk factors to the burden of stroke, variability in blood pressure, intensive glycemic control, lipid management, management of asymptomatic carotid stenosis, vitamin B supplements lowing homocysteine, lifestyle factors, and aspirin efficacy for primary prevention of stroke.
Aspirin ; Blood Pressure ; Carotid Stenosis ; Homocysteine ; Life Style ; Primary Prevention ; Risk Factors ; Stroke ; Vitamins

Inflammatory and infectious conditions can involve the cerebral vasculature and cause stroke. Vasculitis involving central nervous system (CNS) is a heterogeneous entity of disorders characterized by inflammation and necrosis of blood vessel walls. It can be caused by noninfectious and infectious diseases. Noninfectious cause includes primary angiitis of CNS, giant cell arteritis, Takayasu's disease and Behcet's disease. Hepatitis C, human immunodeficiency and varicella-zoster viruses as well as bacterial and fungal organisms have been reported to be associated with infectious vasculitis. Inflammatory biomarkers and infectious index are in a portion regarded as risk factors of stroke. However, there is still controversy and further prospective evaluation should be performed. In the current article, the author concisely reviewed contemporary studies about inflammatory and infectious conditions associated with stroke.
Biomarkers ; Blood Vessels ; Central Nervous System ; Communicable Diseases ; Giant Cell Arteritis ; Glycosaminoglycans ; Hepatitis C ; Herpesvirus 3, Human ; Humans ; Inflammation ; Necrosis ; Risk Factors ; Stroke ; Vasculitis

Writing Committee of Korean clinical practice guidelines for secondary prevention of stroke has reviewed recent randomized controlled trials of cilostazol published after the first edition of Korean clinical practice guidelines that considered evidences published before June 2007. Two clinical trials and 1 meta-analysis which compared cilostazol directly with aspirin in the prevention of stroke in patients with cerebral infarction or transient ischemic attack (TIA) were identified and included for the current guideline update. Review of findings indicates that cilostazol as compared to aspirin achieved a greater reduction of stroke as well as composite vascular events of stroke, myocardial infarction, and vascular death. For safety, cilostazol was associated with fewer major bleeding events than aspirin. Accordingly, new recommendations for cilostazol are made for prevention of stroke in the setting of noncardioembolic stroke or TIA. Changes in the guidelines necessitated by new evidences will be continuously reflected in future guidelines.
Aspirin ; Cerebral Infarction ; Hemorrhage ; Humans ; Ischemic Attack, Transient ; Myocardial Infarction ; Secondary Prevention ; Stroke ; Tetrazoles ; Writing

Cerebral venous sinus thrombosis (CVST) may be complicated with various intracranial hemorrhage such as petechial hemorrhage, hemorrhagic infarction, parenchymal hemorrhage, subarachnoid hemorrhage (SAH), and subdural hematoma (SDH). However, combination of these types of intracranial hemorrhages supervening on CVST is seldom reported. A 55-year-old female with rectal cancer presented with severe headache, nausea, vomiting and diplopia. She was diagnosed as having CVST in the superior sagittal sinus with left frontal parenchymal hemorrhage and was treated with anticoagulants. The CVST were extended to inferior sagittal and straight sinuses. Moreover, SDH along the left cerebral convexity and SAH in the left sylvian fissure were simultaneously observed. Our present case shows that combination of various types of hemorrhages is rare but may occur in advanced CVST.
Anticoagulants ; Diplopia ; Female ; Headache ; Hematoma ; Hematoma, Subdural ; Hemorrhage ; Humans ; Infarction ; Intracranial Hemorrhages ; Nausea ; Rectal Neoplasms ; Sinus Thrombosis, Intracranial ; Subarachnoid Hemorrhage ; Superior Sagittal Sinus ; Vomiting

Cilostazol is a phosphodiesterase inhibitor that has been shown to have similar efficacy in stroke prevention but fewer hemorrhagic events compared with aspirin. We report a case of spontaneous spinal epidural hematoma (SSEH) in a 67-year-old woman who has been treated with cilostazol for cerebral infarction. The patient was presented with sudden neck pain and right hemiparesis. Thirteen days after the onset, she recovered completely. Even cilostazol, which is a relatively safer drug in terms of bleeding risk compared to other antiplatelet agents, may cause SSEH. Therefore, physicians should keep in mind rare, but potentially fatal, bleeding complications such as SSEH when prescribing antiplatelet agents.
Aspirin ; Cerebral Infarction ; Female ; Hematoma, Epidural, Spinal ; Hemorrhage ; Humans ; Neck Pain ; Paresis ; Platelet Aggregation Inhibitors ; Stroke ; Tetrazoles