BACKGROUND: Common carotid artery intima-media thickness (IMT) is an accepted sonographic marker of early atherosclerosis, and increased IMT represents a risk of ischemic stroke. The purpose of this study was to evaluate the correlation between common carotid artery IMT and stroke risk factors in patients with ischemic stroke. METHODS: Subjects were 381 patients with acute ischemic stroke. High resolution B-mode ultrasonography was performed to measure IMT at common carotid artery. Multivariate regression analysis was performed to determine the independent factors related to common carotid artery IMT. RESULTS: The variables that strongly predicted an increase in the common carotid artery IMT were age (P <0.001) and diabetes mellitus (P <0.001). CONCLUSION: Increased common carotid artery IMT is independently associated with age and diabetes mellitus in patients with ischemic stroke.
Atherosclerosis ; Carotid Arteries ; Carotid Artery, Common ; Diabetes Mellitus ; Humans ; Risk Factors ; Stroke

BACKGROUND: Although current guidelines do not recommend immediate anticoagulation therapy (IAC) for acute ischemic stroke, judicious debates are still lingering on whether it might be done for acute cardioembolic stroke (ACES). We surveyed current practice patterns of anticoagulation therapy for ACES in Korea, and analyzed their related factors. METHODS: Using a web-based system, all neurology staffs of training hospitals in Korea surveyed about when and how they commenced anticoagulation therapy in the hypothetical cases with ACES. RESULTS: Of the 359 subjects invited, 281 responded to the e-mail, of whom 76 abstained from participating. The number of participants was therefore 205 (57.1%). Although a few physicians (4.4%) always performed IAC and some (10.7%) never did, most physicians made different decisions according to infarct size and presence of hemorrhagic transformation (HTr): IAC was performed more often in cases with medium-sized or small infarct than large one (68.2% vs. 35.9%, P<0.001), and in cases without HTr (68.6% vs. 34.9%, P<0.001). The most common method of administration was 'heparin followed by warfarin' (68.2%), and then 'warfarin alone' or 'warfarin with aspirin'. If IAC was not commenced, it resumed most commonly between 1 and 2 weeks after the onset (44.0%). CONCLUSION: Quite many neurologists in Korea did IAC in selective ACES, e.g. small sized infarction without HTr. Further studies are needed to prove the efficacy of IAC therapy in this selective population.
Atrial Fibrillation ; Electronic Mail ; Heparin ; Infarction ; Korea ; Neurology ; Stroke ; Taurine

BACKGROUND: There are many causes for the failure of aspirin therapy in patients with acute ischemic stroke. Laboratory aspirin resistance (AR) might be involved in clinical aspirin non-response. The PFA-100 is a laboratory method to evaluate AR in the clinical setting. However, there has been limited data regarding concordance with optical platelet aggregometry, which is considered the gold standard for detecting AR. We retrospectively analyzed platelet function tests using the PFA-100 and an optical platelet aggregometer in 86 patients with acute ischemic stroke. METHODS: Eighty six patients were enrolled in the study and were evaluated the platelet function test by optical aggregometer and a PFA-100. We determined the variability in the prevalence of AR and the kappa value between the two tests in patients with acute ischemic stroke. RESULTS: Among 86 patients, 27 (31.4%) were detected as AR by the optical aggregometer and 31 (36.0%) by the PFA-100. There were 13 cases of AR (15.1%) in both laboratory methods. The optical platelet aggregometer results showed that female gender (P=0.03), aspirin monotherapy (P =0.05), and NIHSS at baseline (P=0.04) were related with AR in acute ischemic stroke. Multiple logistic regression analysis showed that NIHSS was independently associated with AR of the optical platelet aggregometer (OR=1.12 95%, CI: 1.00-1.25, P=0.05). CONCLUSION: The prevalence of AR was similar between the PFA-100 and the optical platelet aggregometer in patients with acute ischemic stroke. However, the concordance rate of these two tools is low.
Aspirin ; Blood Platelets ; Female ; Humans ; Logistic Models ; Platelet Aggregation ; Platelet Function Tests ; Prevalence ; Retrospective Studies ; Stroke

Highly reproducible and consistent ischemic stroke models are critical for obtaining more confident data. To date, the infarct variation of several ischemic rat models is considerable. Therefore, many factors related to outcome variation and infarct growth must be controlled. Among various infarct models of rodents, intraluminal filament model is common by virtue of its consistency of the success rate and the outcomes. Recently more long-term evaluation of functional and imaging outcomes is considered in terms of clinical practice. Concise and subsequent outcome assessment could result in the improvement of translational stroke research. We recommend that the researchers should remember the guidelines addressed by the Stroke Therapy Academic Industry Roundtable (STAIR) and the Good Laboratory Practice (GLP).
Animals ; Rats ; Rodentia ; Stroke ; Virtues

Since the publication of the first edition of Korean clinical practice guidelines of secondary stroke prevention, encouraging data from recent large clinical trials and meta-analysis have led us to consider many therapeutic options in the treatment of symptomatic extracranial carotid stenosis. Accordingly, the writing group of Clinical Research Center for Stroke decided to provide recent views on the therapeutic revascularization of extracranial carotid stenosis, and timely evidence-based recommendations. In this updated version, new evidences about carotid angioplasty/stenting, treatment timing, and perioperative preparation are given, and qualifying conditions for operator are elucidated. This refinement was based on current consensus between Korean Society of Intravascular Neurosurgery, Korean Society of Interventional Neuroradiology, and Korean Society of Cerebrovascular Surgery and approved by Korean Stroke Society, Korean Neurological Association, and Korean Society of Geriatric Neurology. These recommendations are subject to future correction based on new evidences from ongoing and future studies.
Carotid Arteries ; Carotid Stenosis ; Consensus ; Endarterectomy, Carotid ; Neurology ; Neurosurgery ; Publications ; Secondary Prevention ; Stroke ; Writing

A male patient aged 54 came to the neurology department complaining of weakness and tingling sensation in the left lower extremity during squatting exercises for the previous four days. A neurological examination revealed left proximal leg weakness and hypesthesia on the medial side of the left lower leg. In eight hours after onset, he took brain and lumbar MRIs at a local clinic and the results were normal. In order to identify possible causes, we performed a follow-up lumbar MRI, femoral angiography, electromyography, and nerve conduction study but failed to obtain any abnormal findings. Finally, a recent infarction of right corona radiata was observed by a follow-up brain MRI which was taken 16 days after onset of the symptom. Leg monoparesis caused by cerebral infarction is known to be rare and in particular combines motor and sensory deficits limited to one extremity.
Aged ; Angiography ; Brain ; Cerebral Infarction ; Electromyography ; Exercise ; Extremities ; Follow-Up Studies ; Humans ; Hypesthesia ; Infarction ; Leg ; Lower Extremity ; Male ; Neural Conduction ; Neurologic Examination ; Neurology ; Paresis ; Porphyrins ; Sensation

As thrombolysis for acute ischemic stroke is a double-edged sword, so could be the hemostatic treatment for thrombolysis-induced intracerebral hemorrhage. An 88-year-old woman with acute ischemic stroke presented with severe dysarthria and right hemiparesis. Her neurological symptoms rapidly improved after intravenous tissue plasminogen activator (t-PA) treatment. However, she became drowsy one hour after the intravenous t-PA treatment. Brain CT revealed a small right thalamic hemorrhage which was contralateral to the initial ischemic lesion. To prevent expansion of the hematoma, vitamine K was infused intravenously. Three hours after the infusion, conjugate eyeball deviation to the left side and right hemiplegia developed, which were likely to be resulted from reocclusion. Hemostatic therapy, such as vitamine K infusion, might be related to the worsening of cerebral ischemia after recanalization with t-PA.
Aged, 80 and over ; Brain ; Brain Ischemia ; Cerebral Hemorrhage ; Dysarthria ; Female ; Hematoma ; Hemiplegia ; Hemorrhage ; Humans ; Infarction ; Paresis ; Stroke ; Tissue Plasminogen Activator ; Vitamin K ; Vitamins

The most common etiology of spontaneous, non-traumatic intracerebral hemorrhage is hypertension. One of the most decisive factors for the determination of etiology is location of the hemorrhage. Here, we report on a 53-year-old female patient who was admitted with left putaminal hemorrhage. She did not have prominent vascular risk factors other than fundoscopic signs of hypertensive retinopathy. Magnetic resonance imaging and angiography revealed arteriovenous malformation (AVM) in the basal ganglia, which was fed by the lateral lenticulostriate artery. This case suggests that we should consider an AVM-related hemorrhage in relatively young stroke patients, regardless of hematoma location or presence of accompanying hypertension.
Angiography ; Arteries ; Arteriovenous Malformations ; Basal Ganglia ; Cerebral Hemorrhage ; Female ; Hematoma ; Hemorrhage ; Humans ; Hypertension ; Hypertensive Retinopathy ; Magnetic Resonance Imaging ; Middle Aged ; Putaminal Hemorrhage ; Risk Factors ; Stroke

Acute ischemic stroke is often the first manifestation of essential thrombocythemia (ET). We report two cases of acute ischemic stroke in patients with ET who suffered acute thrombus formation in a large cerebral artery with related cortical infarction. We suggest that platelet aggregation and its distal embolization may occur in large intracranial arteries in patients with ET.
Arteries ; Blood Platelets ; Cerebral Arteries ; Humans ; Infarction ; Platelet Aggregation ; Stroke ; Thrombocythemia, Essential ; Thrombosis

Syphilis is a rare cause of aortic inflammatory lesion and stroke. A 65-year-old woman presented with sudden onset of right hemiplegia and hemianopsia. Magnetic Resonance (MR) imaging of the brain revealed bihemispheric cerebral infarctions. Echocardiography demonstrated aortic regurgitation, pericardial effusion, and dilatation of the aortic root. MR aortography showed intramural hematoma in dilated ascending and descending aorta. The serum Venereal Disease Research Laboratory and Treponema Pallidum Haemagglutination test were positive. The level of protein in cerebrospinal fluid was increased. After treatment with penicillin for three weeks, her neurological status progressively improved. As syphilis can lead to aortitis and aortic dissection, it should be considered as a treatable cause of stroke.
Aged ; Aorta, Thoracic ; Aortic Valve Insufficiency ; Aortitis ; Aortography ; Brain ; Cerebral Infarction ; Dilatation ; Echocardiography ; Female ; Hematoma ; Hemianopsia ; Hemiplegia ; Humans ; Magnetic Resonance Spectroscopy ; Penicillins ; Pericardial Effusion ; Sexually Transmitted Diseases ; Stroke ; Syphilis ; Syphilis, Cardiovascular ; Treponema pallidum