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.

No abstract available.
Diagnosis* ; Encephalitis, Herpes Simplex* ; Herpes Simplex*

We reviewed forty five cases of intracranial arteriovenous malformation (AVM) who were admitted in Seoul National University Hospital within recent 7 years; thirty one patients revealed intracerebral hemorrhage and fourteen patients showed seizure or progressived focal neurologic deficit as an initial presentation. To evaluate the natural history of AVM after initial hemorrhage, out of these 45 cases, we selected 22 cases who were, operated or not, observed naturally for at least 1 year. To know the post operative course, we also selected 18 cases who were operated on. Thses two groups were compared with respect to the mortality, morbidity, frequency of rebleeding or seizure, which were 9%, 27%, 55%, 27%, in the former, and 0%, 17%, 0%, and 28% in the latter. Among the 14 patients whose initial presentation was not intracranial bleeding, 9 had seizure, 5 had progressive focal neurologic deficit, and 4 had both. During the follow-up period (average 5 years), only one patient had intracranial bleeding. Seizures in this group were relatively well controlled by regular antiepileptic regimen. Out of the 2 cases who were operated for seizure control, one had considerable degree of neurologic deficit after operation. From above evidences, we tentatively conclude that the AVM with initial bleeding should be better operated on if accessible, whereas the AVM without initial bleeding should be best managed conservatively. For a more definite conclusion, large, radomized controlled studies should be done again which, however, may meet ethical problems.
Cerebral Hemorrhage ; Follow-Up Studies ; Hemorrhage ; Humans ; Intracranial Arteriovenous Malformations* ; Mortality ; Natural History ; Neurologic Manifestations ; Seizures ; Seoul

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

BACKGROUND: Involuntary movement is a rare symptom of stroke. The pathophysiologic mechanism is poorly understood. METHODS: We retrospectively evaluated the medical records of 1547 stroke patients who have been admitted to the Seoul National University Hospital from March, 1988 to March, 1997. RESULTS: We found 18 patients with involuntary movements. Dystonia was observed in 10 patients, ballism or chorea in 8 patients and tremor in 5 patients. Anatomical structures responsible for dystonia were thalamus, lenticular nucleus, caudate nucleus and midbrain. Ballism-chorea was associated with lesions of subthalamic nucleus, thalamus, and lenticular nucleus. Tremor was associtated with lesions of thalamus, lenticular nucleus and midbrain. Ballism-chorea was present in the onset of stroke in 6 cases, 2 months after stroke in 1 case, and 21 months after in 1 case. But only 1 case of dystonia was present in the onset of stroke, 2 cases within 7 days, 5 cases in one week to one month, and 2 cases after one month. The involuntary movements subsided in 5 cases of hemiballism-chorea and in 3 cases of dystonia In most of the improved cases, the symptoms subsided in a month. CONCLUSIONS: Basal ganglia and thalamus were the main areas involved where lesions associated with involuntary movements were reported. The nature of involuntary movements was variable. However, lesions in subthalamic nucleus resulted only in ballism-chorea. The presence of only ballism chorea, but not any other involuntary movements, due to subthalamic nucleus lesions indicates that an indirect pathway may play a role in the pathogenesis of ballism-chorea. The latency between the onset of stroke and involuntary movements was longer in dystonia than ballism-chorea. The course of ballism-chorea was generally better than dystona.
Basal Ganglia ; Caudate Nucleus ; Chorea ; Corpus Striatum ; Dyskinesias* ; Dystonia ; Humans ; Medical Records ; Mesencephalon ; Retrospective Studies ; Seoul ; Stroke* ; Subthalamic Nucleus ; Thalamus ; Tremor

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

BACKGROUND AND PURPOSE: Current therapy for acute ischemic stroke is highly focused on neuroprotective agents, and many ion channel blockers have been challenged for experimental models. In this study, we tried to reveal the neuroprotective effect of lamotrigine, a voltage-sensitive sodium channel blocker, for transient global ischemia of Mogolian gerbil. METHODS: Lamotrigine (50mg/kg) was administered via gastric tube 30 minutes before and after global ischemia (for 10 min) under body temperature monitoring. Sham-operated and non-treated ischemia group were compared. Seven days after reperfusion, gerbils were killed with perfusion/fixation technique and representative sections were cut through the hippocampus. Hematoxylin-Eosin staining was done for microscopic examination and number of viable neurons in CA1 area was counted. RESULTS: Neuronal density was different between sham-operated (n=11), non-treated ischemic (n=11), and lamotrigine-treated (n=26) group (107.8+13.1/mm vs. 21.5+23.0/mm vs. 82.0+13.1/mm, p<0.01). Both pre-(n=17) and post-treated group (n=9) showed significant neuroprotective effect compared with non-treated group. Neuronal density of pre-treated group was slightly higher than in post-treated group, though statistically not significant (84.6+13.0/mm vs. 77.3+12.7/mm, p=0.13). CONCLUSION: These results show that lamotrigine may have some effects reducing the delayed neuronal death in transient global ischemia. Considering the mechanism of action, we suggest that activation of voltage-sensitive sodium channel and release of glutamate at early phase of ischemia may be related to the delayed neuronal death.
Body Temperature ; Cerebral Infarction ; Gerbillinae ; Glutamic Acid ; Hippocampus ; Ion Channels ; Ischemia* ; Models, Theoretical ; Neurons ; Neuroprotective Agents* ; Reperfusion ; Sodium Channels ; Stroke