Stroke is a common cause of death in South Korea. The etiology of stroke affects prognosis, outcome, and management. Trials of therapies for patients with acute stroke should include measurement of responses as influenced by the subtypes of stroke. Stroke can be classified into ischemic and hemorrhagic stroke. Ischemic stroke classification denotes five subtypes of ischemic stroke : ① large-artery atheromatous disease, ② cardioembolism, ③ lacunes, ④ stroke of other causes, and ⑤ transient ischemic attack. Hemorrhagic stroke can be classified into ① intracerebral hemorrhage, ② subarachnoid hemorrhage, and ③ other hemorrhages. Stroke is a syndrome with various etiologies, and proper classification is important for the treatment and prognosis. Risk factors for stroke such as hypertension, heart disease, smoking, diabetes, and hypercholesterolemia should be controlled properly. Clinical trials testing new treatment for acute stroke are on-going worldwide, and it is appropriate to standardize the classification of stroke.
Cause of Death ; Cerebral Hemorrhage ; Cerebrovascular Disorders* ; Classification* ; Heart Diseases ; Hemorrhage ; Humans ; Hypercholesterolemia ; Hypertension ; Ischemic Attack, Transient ; Korea ; Prognosis ; Risk Factors ; Smoke ; Smoking ; Stroke ; Subarachnoid Hemorrhage

No abstract available.
Gait*

Reviewing of each parameters of MRI and PET scan in thirteen acute ischemic stroke patients according to their ROIs based on the lesion in MRI, lesion-cores and lesion-peris in MRI are relatively well correlated with infarction and ischemia of the PET criteria respectively. Among the parameters of PET scan, CMRO2 values seem to be bst correlated with T1 and T2 changes of the lesions in MRI of acute ischemic stroke. As those parameters of both imaging techniques are more related with the pathologic site than the type of the stroke, the changes of the parameters in stroke are greater when the lesion is located in cerebral cortex than in white matter. It is assumed that T2 change occurs in the early stage of the ischemic insult followed by more prominet T1 change with increase of water content which leads to the infarction of the tissue, but further confirmation is needed.
Cerebral Cortex ; Humans ; Infarction ; Ischemia ; Magnetic Resonance Imaging* ; Positron-Emission Tomography ; Statistics as Topic* ; Stroke*

Persistent trigeminal artery is an embryonic remnant of the anastomotic channel linking the internal carotid artery and the basilar artery. Cases of vertebrobasilar insufficiency caused by the persistent trigeminal artery with internal carotid artery stenosis has been described previously, but vertebrobasilar insufficiency entirely due to in situ stenosis of the persistent trigeminal artery has not been reported. A 71-year-old man presented with frequent dizzy episodes. The brain MRI showed no parenchymal lesions. MR angiography showed poor visualization of vertebrobasilar system. He was diagnosed as having vertebrobasilar insufficiency. Cerebral angiography revealed that there was complete occlusion at the vertebrobasilar junction, and the basilar artery was supplied by the persistent trigeminal artery which had severe stenosis at its origin. There was no stenosis of the internal carotid artery of both sides. We believe that this is the first report of vertebrobasilar insufficiency due to stenosed persistent trigeminal artery, without internal carotid artery stenosis.

85 cases of neurosyphilis were observed in Seoul National University Hospital over 6-year period (1979-1984). They were analyzed with respect to clinical symptoms and signs in individual types, serological data in both blood and CSF, changes of cytochemical compositions in CSF, and other significant findings. And some coparisons with other reports were made. They ranged from 22 to 66 years in age with the peak incidence in the forties (41%). Ratio of male to female was observed to be 4.3:1. There were 27 cases of asymptomatic neurosyphilis (NS) (32%), 14 cases of tabes dorsalis (16%), 18 cases of general paresis (21%), 2 cases of taboparesis (2%), 7cases of vascular NS (8%), 6 cases of meningeal NS (7%), 4 cases of syphilitic eight nerve involvement (5%), 4 cases of late syphilitic ocular involvement including optic atrophy (5%), and 3 cases of spinal form (4%). Except in 4 self-referral cases, alimentary system symptoms or illnesses were the main prolbems in asymptomatic neurosyphilitics (48%). Most symptomatic cases had the similar clinical pictures as described in the previous reports but some cases appeared to be combined with symptoms and signs of different types. In tabes dorsalis, patients presented paresthesia and hypoactive DTRs in lower limbs as the most frequent features. According to predominant manifestations, there were 4 cases of dementic form and 14 cases of psychotic form in general paresis but in most cases both features overlapped each other. In 8 cases of general paresis brain CT scans were performed, which revealed diffuse cerebral atrophy in five. Focal abnormalities of vascular NS were most frequently found in temporal areas (4 in 7 cases). Meningeal irritation signs were observed only in one among 6 cases 6 meningeal NS. All cases of eighth nerve involvement showed sensorineural hearing loss at high-tone level. Compared with TPHA, which was used as a criterion for the patient selection, VDRL reactivity was 98% in serum and 49% in CSF. It is notable that as for general paresis and meningeal NS, higher reactivity and elevated titers of CSF VDRL were associated with increase of cells and total protein in CSF, suggesting higher disease activity in both types. Unlike those from other countries, the domestic studies including this report show that general paresis occupies a relatively higher proportion than tabes dorsalis in Korea.
Atrophy ; Brain ; Digestive System ; Female ; Hearing Loss, Sensorineural ; Humans ; Incidence ; Korea ; Lower Extremity ; Male ; Neurosyphilis* ; Optic Atrophy ; Paresthesia ; Patient Selection ; Seoul ; Tabes Dorsalis ; Tomography, X-Ray Computed

BACKGROUND & PURPOSE: The aim of our study is to evaluate the stroke pattern, the correlation of collateralization with cerebral perfusion and stroke severity, and the utility of transcranial Doppler(TCD) to detect collateral pathways in patients with internal carotid artery(ICA) occlusion in the neck. METHODS: Thirty-six patients(28 men and 8 women, mean age of 59.6 ? 12.9 years) with ICA occlusion confirmed by transfemoral cerebral angiography(25 patients) or magnetic resonance angiography(MRA, 11 patients) were studied retrospectively. They had no potential cardiac source of stroke. We evaluated the pattern of cerebral infarcts by magnetic resonance imaging, and the number and the patency of collateral vessels, and the degree of perfusion through collaterals by cerebral angiography. The collateral vessels detected by TCD and MRA were compared with those by cerebral angiography. RESULTS: We found territorial infarcts in 23 patients(64%) and borderzone infarcts in 15(42%). Territorial infarcts(p<0.0001) and borderzone infarcts(p=0.02) occurred more in the ipsilateral hemisphere to the occluded ICA. The prevalence of small subcortical infarcts did not differ between hemispheres. Collateralizations through leptomeningeal anastomosis(p<0.01) and ophthalmic artery(OA, p<0.05) were associated with angiographically reduced cerebral perfusion. Collateralization through OA was also associated with severe symptomatic group(p<0.05); and collateralization through anterior or posterior communicating artery was associated with mild symptomatic group with marginal statistical significance(p=0.097). The number of collateral vessels was associated with neither the degree of perfusion nor the stroke severity. The sensitivity and specificity of TCD to detect collateralization through anterior communicating artery were 100% and 78%, through posterior communicating artery, 67% and 75%, and through OA, 67% and 63%, respectively. CONCLUSION: Cerebral infarcts related to a proximal ICA occlusion are more likely to be ipsilateral territorial or borderzone. The type of collateralization is more important factor for cerebral perfusion and stroke severity than the number of collateral vessels. TCD is a reliable tool for the evaluation of the collateral vessels in the patients with ICA occlusion.
Arteries ; Carotid Artery, Internal* ; Cerebral Angiography ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Neck* ; Perfusion ; Prevalence ; Retrospective Studies ; Sensitivity and Specificity ; Stroke*

Infarct limited to the pial branch territory of the middle cerebral artery(IPBMCA) is a common entity of cerebrovascular diseases. Atherothrombosis of middle cerebral (MCA) or internal carotid artery (ICA), and cardiogenic embolism are presumed causes of this type of cerebral infarct. Thirty-three patients with acute IPBMCA were systematically studied with brain CT, MRI, electrocardiography, blood tests, echocardiography, and in selected cases with angiography or MRA. Hypertension(58%) and heart disease(37%) were common risk factors, and previous episodes of TIA were present in 27%. Half of the patients undergoing angiography revealed stenosis or occlusion of MCA, and evidence of carotid disease was found in 39% of patients with large-artery disease(LAD). Presumed causes of infarct were LAD in half and cardioembolism in one-fourth. Multiple combinations of motor weakness, hypesthesia, visual field defect and aphasia or hemineglect were the clinical presentation. Motor weakness was frequent(91%), and involvement of the f ace, arm and leg was the most common pattern. In our study, atherothrombosis of MCA itself is presumed to be the leading cause of IPBMCA in Korea, but cardioembolism, artery-to-artery embolism from proximal ICA, and occlusion of ICA are also supposed to contribute to the pathogenesis of IPBMCA.
Angiography ; Aphasia ; Arm ; Brain ; Carotid Artery, Internal ; Constriction, Pathologic ; Echocardiography ; Electrocardiography ; Embolism ; Heart ; Hematologic Tests ; Humans ; Hypesthesia ; Korea ; Leg ; Magnetic Resonance Imaging ; Middle Cerebral Artery* ; Risk Factors ; Visual Fields

OBJECT: To analyze clinical'data about the patients presenting with altered consciousness in the emergency room and to plan adequate evaluations and managements. BACKGROLTND. Clinical analysis of comatose patients is necessary. We have a few reports but they don't give enough clues to evaluate the patients rapidly and systematically. METHOD: We included the patients with altered consciousness on the base of the daily reports of emergency room, and reviewed the medical records of the patients. We analyzed the age, sex, visiting date, the patterns of discharge of emergency room, underlying causes, and consequences of the patients. The validity of the contents of daily reports was tested by pilot study. In pilot study, we examined all patients entering emergency room for a week, and compared contents of daily reports with the data acquired from direct examination. RESULTS: The pilot study revealed that the method of patient selection had no problem statistically. The nwnber of patients with altered consciousness entering emergency room, was 594 for one year. The causes of altered consciousness consisted of metabolic problem (35.4%), hemorrhagic stroke (21.2%), malignancy (9.26%), nonhemorrhagic stroke (8. 1%), and others. The causes of metabolic coma werehepatic encephalopathy (69.5%), glucose and electrolyte problem (12.9/o), drug intoxication (6.67%), uremic encephalopathy (6.19%) and alcohol related illness (4.76%). Metabolic coma patients showed better prognosis than others, and hemorrhagic stroke and malignancy showed poor prognosis. The ischemic stroke patients were older than others. Considering the age of the patients, the younger men had better clinical courses than elderly. Significant seasonal variation was notfound. CONCLUSION: The patients visitmg emergency room with altered consciousness had various causes. The most common cause was metabolic origin followed by hemorrhagic stroke. Under the influence of the improvement of socioeconomic status and longevity, the distributions of the underlying disease have changed. The prognosis and consequence of them relied on underlying diseases and age.
Aged ; Coma ; Consciousness* ; Emergencies* ; Emergency Service, Hospital* ; Glucose ; Humans ; Longevity ; Male ; Medical Records ; Patient Selection ; Pilot Projects ; Prognosis ; Seasons ; Social Class ; Stroke

BACKGROUND: Cardiogenic embolic infarction is the most preventable type of ischemic stroke. This study was under-taken to compare the infarct size, prognosis, and risk factors between cardiogenic embolic infarction (CE) and large artery atherosclerotic infarction (LAA). METHODS:We reviewed the medical records and brain computed tomography/magnetic resonance image (CT/MRI) scans of patients with CE or LAA during the period between January 1996 and May 1998. Patients with lacunar and posterior circulation infarctions were excluded. A slice of brain CT/MRI scan showing the largest lesion was selected in each patient and the area of infarction was then measured. Prognosis was determined by the Modified Rankin Disability Scale (MRDS) and was grouped as either good (MDRS 0, 1, 2) or poor (MDRS 3, 4, 5). RESULTS: The study included 103 patients : 50 with CE (NVAF in 23, VHD with or without AF in 13, prosthetic valve in 6, and others in 8) and 53 with LAA (large artery thrombosis in 29, and artery to artery embolism in 24). The infarct size of CE (23.2+/-14.7 cm2) was significantly larger than that of LAA (11.4+/-10.5 cm2) (p<0.001). The infarct size of NVAF (29.0+/-19.1 cm2) was significantly larger than that of VHD with or without AF (19.2+/-11.5 cm2) (p<0.05). Patients with CE had a worse prognosis (poor in 46%) than those with LAA (poor in 23%) (p<0.05). CONCLUSIONS Our results showed that CE led to larger lesions and worse outcomes. Therefore, we emphasize the importance of primary and secondary preventions of stroke in patients with cardiogenic embolic sources.
Arteries* ; Brain ; Embolism ; Heart Valve Diseases ; Humans ; Infarction* ; Medical Records ; Prognosis* ; Risk Factors ; Secondary Prevention ; Stroke ; Thrombosis

Medial medullary infarction is usually manifested as hypoglossal palsy, limb weakness, impairment of proprioception, and oculomotor disturbance. We report a case with the unusual presentation of sensory ataxia. A 71 year-old male presented with ataxia and disequilibrium. Bilateral dysmetria, truncal ataxia, Upbeat nystagmus, and impaired vibration and position sense were the clinical features. However, weakness of the limbs, tongue, or face was not definite. MRI revealed bilateral lesion in the medullary tegmentum, and cortical potentials of somatosensory evoked response were absent. Recovery was fair after treatment. According to the literature, motor weakness is a cardinal manifestation in medial medullary infarction, and there has been no reported case presented as sensory ataxia preserving motor power. Current development of diagnostic tools would contribute to define a variety of clinical manifestations, topography, vascular concomitants, and prognosis in medial medullary infarction.
Aged ; Ataxia/*etiology ; Cardiovascular Diseases/diagnosis ; Case Report ; Cerebral Infarction/*complications/*diagnosis ; Diagnosis, Differential ; Human ; Magnetic Resonance Imaging ; Male ; Medulla Oblongata/*blood supply ; Syndrome