It has been known that CT scan shows only a few abnormalities within the first hours of acute ischemic stroke. We investigated the frequency and the predictive value of early CT scan signs of ischemia for late infarct locations In acute middle cerebral artery (MCA) territory stroke. Precontrast CT (PCT) scans were performed in the 35 consecutive patients with cerebral anterior circulation infarction within 6 hours after the onset of stroke. We confirmed MCA territory infarction on follow-up PCT or MRI within 3 to 7 days. The locations of infarction were classified deep, superficial, and total (deep and superficial) infarction on follow-up PCT or MRI. The initial PCT was abnormal in 74.3% (26/3s). The locations of infarction were deep in 10, superficial in 8, and total in 14. Abnormal findings of the initial PCT were attenuation of lentiform nucleus (ALN) in 18 patients, loss of insular ribbon (LIR) in 11, hemispheric sulcus effacement (HSE) in 10, hyperdense MCA sign (HMCAS) in 2, and small subcortical low attenuation in 2. Of 24 patients with late infarction in basal ganglia 18 (75%) had ALN on initial PCT. Of 17 patients with late infarction in insular cortex 11 (65%) had LIR. Of IS patients with late infarction in cerebral cortex 10 (67%) had HSE. Early PCT signs were correlated with late locations of MCA territory infarction : ALN - deep infarct, HSE - superficial infarct, LIR - superficial infarct, HMCAS - total infarction. Our findings suggest that PCT frequently discloses abnormalities during the first hours of ischemic stroke. Early signs of ischemia on the initial PCT scan may predict the late infarct locations on follow-up study.
Basal Ganglia ; Cerebral Cortex ; Corpus Striatum ; Follow-Up Studies ; Humans ; Infarction ; Ischemia ; Magnetic Resonance Imaging ; Middle Cerebral Artery* ; Stroke* ; Tomography, X-Ray Computed*

The North American Symptomatic Carotid Endarterectomy Trial (NASCET) demonstrated the superiority of endarterectomy over medical management for symptomatic carotid stenosis of 70-99%. More recently, the Asymptomatic Carotid Atherosclerosis Study (ACAS) showed a statistically significant reduction in stroke incidence after carotid endarterectomy (CEA) in asymptomatic carotid stenosis of 60-99%. But CEA has not been frequently performed in Korea. We reviewed the 38 CEA cases which were performed from November 1994 to September 1996 in respect to clinical presentations, findings of brain and neurovascular imaging, and complications. The risk factors were hypertension in 25 patients, hyperlipidemia in 23, smoking in 20, transient ischemic attack (TIA) in 20, minor stroke in 12, heart disease in 17 (coronary artery disease in 16 and sick sinus syndrome in 1), and DM in 13. The clinical presentations of 28 symptomatic carotid stenosis included hemispheric TIA in 17 patients, retinal TIA in 2, and minor stroke in 9. Of 10 asymptomatic carotid stenosis included coronary heart disease in 7 patients, asymptomatic carotid bruit in 3, posterior cerebral artery territory infarction in 4, and vascular claudication in 1. The degrees of carotid artery stenosis were measured by use of the linear-based methods of NASCET on the selected carotid angiography. The locations of carotid artery stenosis were near the bifurcation area in 28 cases, proximal ICA in 9, and common carotid artery in 1. Four out of 9 cases with proximal ICA stenosis at above 2 cm distal to bifurcation had long segmental stenosis more than 3 cm in length. Among them 3 cases had separated multi-segmental stenosis of proximal ICA. CEA was performed unilaterally in 28 patients and bilaterally in 5. Thirty0eight CEAs had carotid artery stenosis of 70-99% in 25 cases (4 had ulceration), 50-69% in 7 (2 had ulceration), 30-49% in 3 (all had ulceration), and 0-29% in 3 (all had ulceration). Of 38 CEAs 7 cases had stenosis (>50%) and/or occlusion of intracranial arteries and 15 had stenosis and/or occlusion of contralateral carotid artery. Peri-operative complications included minor ischemic stroke in 1 case, death in 1, and frontal lobe syndrome in 1.
Angiography ; Arteries ; Brain ; Carotid Arteries ; Carotid Artery Diseases ; Carotid Artery, Common ; Carotid Stenosis ; Constriction, Pathologic ; Coronary Disease ; Endarterectomy ; Endarterectomy, Carotid* ; Frontal Lobe ; Heart Diseases ; Humans ; Hyperlipidemias ; Hypertension ; Incidence ; Infarction ; Ischemic Attack, Transient ; Korea ; Posterior Cerebral Artery ; Retinaldehyde ; Risk Factors ; Sick Sinus Syndrome ; Smoke ; Smoking ; Stroke

BACKGROUND: There are many rating scales for assessment of geriatrics. But each of these scales were not sufficient to evaluate comprehensive geriatric assessment, physical and psychologic efforts for care. METHODS: We developed new scales to comprehensive geriatric assessment for care of geriatric patients. The Geriatrics Physical Support Scale(GPSS) evaluates physical effort consists of 10 areas and the Geriatrics Global Support Scale(GGSS) evaluates general condition of patients consist of 6 areas. Eighty probable and possible AD patients received the Clinical Dementia Rating Rating Scale(CDR), Korearn version of Mini-Mental State Examination(K-MMSE), Barthel Activity of Daily Living Index(B-ADL) GPSS, GGSS. We tested internal consistency, correlation among dementia rating scales. RESULTS: The GPSS correlated to CDR -0.63(p<0.01), B-ADL -0.90(p<0.01) and the GGSS correlated to CDR -0.60(p<0.01), B-ADL -0.75(p<0.01). The internal consistency were 0.69(GGSS), 0.92(GPSS). CONCLUSION: The Geriatrics Global Support Scale evaluate general condition of patients and the Geriatrics Physical Support Scale evaluate physical efforts needed for care of geriatric patients. These scales an also brief and easy rating scales to grade degree of caregiver`s burden.
Dementia ; Geriatric Assessment ; Geriatrics* ; Humans ; Physical Exertion ; Reproducibility of Results* ; Weights and Measures

Background: Hypertension results from an impaired baroreceptor reflex and enhanced sympathetic activity. The prevalence of hypertension differs among ethnicities and is more frequent in South Asians than in Caucasians, suggesting that baseline autonomic nervous system functions and their regulation may also differ among ethnic groups. In most studies, the reference values for clinical autonomic function tests are obtained from heterogeneous ethnic populations, or ethnic factors are not considered in the study design. Obtaining reference data in a homogenous ethnic group and comparing them within various ethnic groups could be helpful to detect ethnic differences in autonomic functions. The aim of this study was to identify normative reference values for standard autonomic reflex measurements in a homogeneous Korean population. Methods: A total of 181 healthy Korean volunteers (age, 20–74 years) underwent standard autonomic function tests: heart rate difference during deep breathing, Valsalva maneuver, and the quantitative sudomotor axon-reflex test. Mean and 5th and 95th percentile values were obtained for each age group. We also analyzed factors (age, sex, and body mass index) that can influence autonomic functions. Results: The heart rate difference during deep breathing and expiratory-inspiratory ratio were higher in males than in females and were inversely related to age. The Valsalva ratio was inversely related to age. Males had higher sweat volumes at all body areas evaluated than those of females, and only forearm sweat volume was significantly different between the age groups. Conclusions: Cardiovagal function was affected by age and sex in Koreans. Sudomotor function was affected by sex, and only forearm sweat volume was affected by age and sex. These results represent preliminary normative clinical autonomic data in a Korean population comprised of a single ethnicity
Hypertension

The first-line imaging modality used to detect subarachnoid hemorrhage (SAH) is a non-contrast computed tomography (CT) scan. Although a CT scan shows great sensitivity for diagnosis of SAH, especially in the hyper-acute and acute stages, it sometimes shows negative results despite typical symptoms. It is thought that the small amount of blood causing the hemorrage and the delay time of the CT scans were the causes of the negative results. Two patients presented to us with SAH, but initial CT scans were negative. We diagnosed the SAH of these patients using magnetic resonance images.
Humans ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Subarachnoid Hemorrhage

Giant pigmented nevus is a variety of congenital melanocytic nevi, and may be associated with various abnormalities, such as skeletal malformation, lipoma, vascular nevi, melanosis in the meninges, meningocele, and intracranial arteriovenous malformation. We report a case with congenital giant pigmented nevus and porencephaly. This association should be considered as the spectrum of neurocutaneous syndromes related to congenital giant pigmented nevus.
Intracranial Arteriovenous Malformations ; Lipoma ; Melanosis* ; Meninges ; Meningocele ; Neurocutaneous Syndromes ; Nevus ; Nevus, Pigmented*

Objectives: White matter hyperintensities are known to influence dementia in Alzheimer’s disease. Genetic components are suggested as putative risk factors for vascular pathology and cognitive decline. This study aimed to determine whether there is an association between candidate genetic polymorphisms and the severity of white matter hyperintensities in patients with Alzheimer’s disease. Methods: Seventy-five patients diagnosed with Alzheimer’s disease underwent genetic tests for specific alleles of apolipoprotein E, angiotensin-converting enzyme, and methylenetetrahydrofolate reductase. All patients underwent brain magnetic resonance imaging scans and neuropsychological tests. The severity of white matter hyperintensities was semiquantified using the CREDOS rating scale, and patients were divided into three groups according to their rating. Results:The severity of white matter hyperintensities was related to age and hypertension. However, none of the gene polymorphisms we tested was found to be associated with the severity of white matter hyperintensities. Conclusion:The genetic polymorphisms found in apolipoprotein E, angiotensin-converting enzyme and methylenetetrahydrofolate reductase did not contribute to white matter hyperintensities in Alzheimer’s disease.Only age and hypertension factors were found to be contributory to white matter hyperintensities.
Alzheimer Disease ; Dementia

A lesion that is hyperintense on diffusion-weighted imaging (DWI) and hypointense on the apparent diffusion coefficient (ADC) map is a characteristic magnetic resonance imaging (MRI) finding in acute ischemic infarction. In some cases, however, these findings can persist for a few months after infarct onset. It is thought that these finding reflect the different evolution speeds of the infarcted tissue. We report a patient with a right middle cerebral artery territory infarction with persistent hyperintensity on DWI and hypointensity on the ADC map for over 8 months. To our knowledge, this is the most persistent case of hyperintensity lesion on DWI and the serial MRI images of this patient provide important information on the evolution of infarcted tissue.
Cerebral Infarction ; Diffusion ; Humans ; Infarction ; Infarction, Middle Cerebral Artery ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Middle Cerebral Artery

No abstract available.
Ventriculoperitoneal Shunt

We present a case report of a 45-year-old woman with spontaneous pneumocephalus accompanied by pneumorrhachis of the thoracic spine, which is a very rare condition generally associated with trauma and thoracic or spinal surgery. The patient had undergone an operation about 10 years earlier to treat a giant cell tumor of the thoracic spine. During the operation, a metallic device was installed, which destroyed the bronchus and caused the formation of a broncho-paraspinal fistula. This is the suspected cause of her pneumocephalus and pneumorrhachis. To our knowledge, this is a very rare case of pneumocephalus accompanied by pneumorrhachis induced by metallic device, and when considering the length of time after surgery these complications presented are also exceptional.
Bronchi ; Female ; Fistula ; Giant Cell Tumors ; Humans ; Middle Aged ; Pneumocephalus ; Pneumorrhachis ; Spine