We report a case of hypereosinophilia causing multiple areas of cerebral infarcts. A 52-year-old Korean man presented with dysarthria and weakness in both arms. A brain MRI revealed multiple acute infarcts in the distal border zone with focal intracerebral hemorrhage, whereas a cerebral angiogram was not remarkable. The eosinophil count was 5,500/microLiter and was accompanied by elevated cardiac enzyme levels. The pattern of cerebral infarcts and laboratory results suggest a thromboembolic infarction associated with hypereosinophilia.
Cerebral Hemorrhage/diagnosis/*etiology ; Cerebral Infarction/diagnosis/*etiology ; Diagnosis, Differential ; Eosinophilia/*complications/drug therapy ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged

OBJECTIVETo evaluate the thrombus length on CT perfusion imaging and to assess its predictive value for recanalization and clinical outcome after intravenous thrombolysis therapy (IVT).

METHODSFifty-six consecutive acute ischemic stroke patients with proximal middle cerebral artery (M1 segment) occlusion underwent CT perfusion imaging examination before IVT between June 2009 and May 2015. The onset-to needle time was (214.3 ± 82.0) min, and the pretreatment NIHSS score of patients was 13 (IQR 8-17). The thrombus length was determined as the distance between the proximal and distal thrombus end delineated on dynamic angiography, which was reconstructed from CT perfusion source images. Recanalization was evaluated according to Arterial Occlusive Lesion (AOL) scale, and functional outcome was based on modified Rankin scale (mRS) 3 months after IVT. Logistic regression model was used to investigate the relationship between thrombus length and recanalization, and the optimal cut-off points were determined by receiver operating characteristic curve (ROC).

RESULTSAmong 56 patients, 42 (75%) achieved recanalization 24 h after IVT with mean thrombus length of (9.0 ± 4.7) mm; and 14 (25%) patients remained occlusion with mean thrombus length of (10.0 ± 5.4) mm. Logistic regression analysis demonstrated that thrombus length was an independent predictor for both recanalization (OR=0.869; 95% CI:0.764-0.987; P=0.031) and unfavorable outcome (OR=1.180;95% CI:1.023-1.362; P=0.023). Thrombus length of 11.3 mm was identified as the optimal cut-off value for recanalization (AUC=0.697, sensitivity 71.4%, specificity 76.2%), while thrombus length of 9.9 mm was the optimal cut-off value for unfavorable functional outcome (AUC=0.689, sensitivity 64.7%, specificity 71.4%).

CONCLUSIONThe thrombus length evaluated on CT perfusion imaging is an effective predictor for recanalization and unfavorable outcome after IVT in acute ischemic stroke patients with middle cerebral artery occlusion.

Angiography ; Humans ; Infarction, Middle Cerebral Artery ; pathology ; Logistic Models ; Perfusion Imaging ; Sensitivity and Specificity ; Stroke ; diagnosis ; drug therapy ; Thrombolytic Therapy ; Thrombosis ; diagnosis ; drug therapy ; Tomography, X-Ray Computed

OBJECTIVE: The purpose of the study was to review the current status of intra-arterial (IA) thrombolysis in Korea by conducting a retrospective analysis of the data from multiple domestic centers. MATERIALS AND METHODS: The radiologists at each participating institution were asked to fill out case report forms on all patients who had undergone IA recanalization due to acute anterior circulation ischemia. These forms included clinical, imaging and procedure-related information. A central reader analyzed the CT/MR and angiographic results. The rates of successful recanalization, hemorrhagic transformation and functional outcome were obtained. The univariate analyses were performed together with the multivariate analysis. RESULTS: We analyzed the data from 163 patients, and they had been treated at seven institutes. The initial imaging modalities were CT for 46 patients (28%), MR for 63 (39%), and both for 54 (33%). Various mechanical treatment methods were applied together in 50% of the patients. Radiologically significant hemorrhage was noted in 20/155 patients (13%). We found various factors that influenced the recanalization rate and the occurrence of significant hemorrhagic transformations. The favorable outcome rate, reported as modified Rankin Scale < or = 2, was 40%, and the mortality rate was 11%. The factors that predicted a poor functional outcome were old age (p = 0.01), initially severe neurological symptoms (p < 0.0001), MR findings of a wide distribution of lesions (p = 0.001), involvement of the basal ganglia (p = 0.01), performance of procedures after working hours (p = 0.01), failure of recanalization (p = 0.003), contrast extravasation after the procedure (p = 0.007) and significant hemorrhagic transformation (p = 0.002). The subsequent multivariate analysis failed to show any statistically significant variable. CONCLUSION: There was a trend toward increased dependency on MR imaging during the initial evaluation and increased usage of combined pharmacologic/mechanical thrombolysis. The imaging and clinical outcome results of this study were comparable to those of the previous major thrombolytic trials.
Acute Disease ; Cerebral Angiography ; Cerebral Infarction/diagnosis/*drug therapy ; Female ; Fibrinolytic Agents/*administration & dosage ; Humans ; Injections, Intra-Arterial ; Logistic Models ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Retrospective Studies ; Thrombolytic Therapy/*methods/standards ; Tomography, X-Ray Computed ; Treatment Outcome

OBJECTIVETo observe the curative effect of integrated Chinese and Western medicine on acute cerebral infarction (ACI).

METHODSTwo hundred and seventy-nine ACI patients were assigned to two groups. The control group (140 cases) was treated with Western medicine by staging and the treated group (139 cases) was given TCM therapy according to syndrome differentiation on the basis of Western medicine. The end point was set at the 90th day of the administration. The curative effect was assessed by Chinese stroke scale (CSS), National Institutes of health stroke scale score (NIHSS), Rankin scale and Barthel index (BI).

RESULTSAt the end point of the trial, the total effective rate was 73.38% in the treated group and 61.43% in the control group, the former was superior to the latter (P<0.05). There were 66 cases (47.14%) in the control group and 80 cases (57.55%) in the treated group with improvement rate of NIHSS > or =40%, 65 cases (46.43%) with their Rankin scale within 0-2 grade in the control group and 78 cases (56.12%) in the treated group, 60 cases (42.86%) in the control group and 71 cases (51.08%) in the treated group with BI > or =85, 61 cases (43.57%) in the control group and 72 cases (51.80%) in the treated group with improvement rate of CSS > or = 46%, comparison between them showed significant differences (P < 0.05).

CONCLUSIONTCM therapy accord-ing to syndrome differentiation combined with Western medicine by staging shows better curative efficacy on ACI.

Acute Disease ; Adult ; Aged ; Anticoagulants ; therapeutic use ; Cerebral Infarction ; diagnosis ; drug therapy ; Diagnosis, Differential ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Phytotherapy ; Syndrome ; Treatment Outcome

No abstract available.
Aneurysm, Dissecting/diagnosis/*etiology/physiopathology/therapy ; Anticoagulants/therapeutic use ; Aortic Aneurysm/diagnosis/*etiology/physiopathology/therapy ; Behcet Syndrome/*complications/diagnosis/drug therapy ; Cerebral Infarction/diagnosis/etiology ; Diffusion Magnetic Resonance Imaging ; Echocardiography, Doppler, Color ; Electrocardiography ; Hemodynamics ; Humans ; Immunosuppressive Agents/therapeutic use ; Male ; Middle Aged ; *Sinus of Valsalva/physiopathology/ultrasonography ; Thrombosis/diagnosis/drug therapy/*etiology/physiopathology ; Ventricular Septal Rupture/diagnosis/*etiology/physiopathology/therapy

OBJECTIVETo observe the effects of therapeutic method of expelling wind, eliminating phlegm and promoting blood circulation (EWEPPB) in treating acute cerebral infarction (ACI) depending on the clinical and data platform of stroke clinical unit.

METHODSACI patients were randomly assigned to the control group (36 cases) treated by routine Western therapy alone and the treatment group (32 cases) with routine therapy plus Chinese medicinal compound for EWEPPB. The treatment course was 14 days. The scores of TCM symptom, the NIH stroke scale (NIHSS), and Barthel index (BI) were used for evaluating the effect of treatment.

RESULTSThe scores of TCM symptom and NIHSS decreased, and that of BI increased after treatment in both groups, and the treatment in the treatment group showed a effect significantly better than that in the control group (P < 0.05).

CONCLUSIONEWEPPB is effective method in treating ACI, traditional Chinese compounds for EWEPPB could play a positive role in the stroke unit.

Adult ; Aged ; Aged, 80 and over ; Cerebral Infarction ; diagnosis ; drug therapy ; therapy ; Diagnosis, Differential ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Phytotherapy ; Treatment Outcome

We report a case of delayed cerebral infarction due to stent longitudinal folding deformation following carotid artery stenting using a self-expandable stent with an open-cell design. The stented segment of the left common carotid artery was divided into two different lumens by this folding deformation, and the separated lumens became restricted with in-stent thrombosis. Although no established method of managing this rare complication exists, a conservative approach was taken with administration of anticoagulant and dual antiplatelet therapy. No neurological symptoms were observed during several months of clinical follow-up after discharge.
Aged ; Anticoagulants/therapeutic use ; Carotid Arteries/radiography ; Cerebral Infarction/*diagnosis/therapy ; Humans ; Male ; Platelet Aggregation Inhibitors/therapeutic use ; Stents/*adverse effects ; Thrombosis/drug therapy/*etiology ; Ticlopidine/analogs & derivatives/therapeutic use ; Tomography, X-Ray Computed

Aspirin ; administration & dosage ; therapeutic use ; Brain ; diagnostic imaging ; pathology ; Cerebral Infarction ; diagnosis ; drug therapy ; etiology ; Epilepsy ; diagnosis ; drug therapy ; etiology ; Humans ; Immunoglobulins, Intravenous ; administration & dosage ; therapeutic use ; Infant ; Male ; Mucocutaneous Lymph Node Syndrome ; complications ; diagnosis ; drug therapy ; Tomography, X-Ray Computed

We report here the case of a suprasellar cystic germ cell tumor (GCT) initially diagnosed as an arachnoid cyst. A 10-year-old boy experienced headache, dizziness, and diplopia, and was shown to have an approximately 2 cm suprasellar cyst. Two months after endoscopic third ventriculostomy was performed, a 5-6 cm cystic mass with an internal enhancing component was observed in the suprasellar cistern. Serum human chorionic gonadotropin levels were slightly increased in the serum and cerebrospinal fluid (55 and 162 IU/L, respectively) but were strikingly elevated in the cystic fluid (14,040 IU/L). The patient showed complete remission, with only a very small cystic lesion remaining after surgery, chemotherapy, and radiation treatment for a suprasellar mixed GCT. However, follow-up after treatment was complicated by moyamoya syndrome and cerebral infarction. GCT can be considered as a rare differential diagnosis in the case of a suprasellar cystic mass. Evaluation of tumor markers and close follow-up will be necessary.
Arachnoid* ; Central Nervous System Cysts* ; Cerebral Infarction ; Cerebrospinal Fluid ; Child ; Chorionic Gonadotropin ; Diagnosis, Differential ; Diplopia ; Dizziness ; Drug Therapy ; Follow-Up Studies ; Germ Cells* ; Headache ; Humans ; Male ; Moyamoya Disease ; Neoplasms, Germ Cell and Embryonal* ; Biomarkers, Tumor ; Ventriculostomy

OBJECTIVETo observe the effect of Huatan Tongluo Granule (HTG) on the expression of suppressors of cytokine signaling-3 (SOCS-3) and tumor necrosis factor-alpha (TNF-alpha) in patients with acute cerebral infarction (ACI) of phlegm-wind-stasis obstruction (PWSO) syndrome type.

METHODSSixty-six ACI patients of PWSO type admitted within 72 h were randomized into the treatment group (34 cases) and the control group (32 cases), they were treated with foundational therapeutics, but HTG was given additionally to patients in the treatment group. SOCS-3 expression was detected by ELISA before treatment (d0) and on the 3rd (d3) and 7th day (d7) of treatment; TNF-alpha expression was detected by chemiluminescence at dO and d7. Data were compared with the respective parameters obtained from 20 healthy persons as normal control. Meantime, the degree of neuro-deficit in the two groups was evaluated by NIH Stroke scale and Barthel index on d0, d7, d14 and d21.

RESULTSSOCS-3 expression at d0, d3, d7; and TNF-alpha expression at d0, d7 were higher in the two patients' groups significantly than in normal controls (P < 0.05). As compared with the control group, on d7, SOCS-3 expression was higher (360.98 +/- 123.31 ng/L vs. 281.87 +/- 133.66 ng/L) and TNF-alpha expression was lower (35.72 +/- 19.94 ng/L vs. 49.86 +/- 34.79 ng/L), while the NIHSS score on d7 and d14, as well as the Barthel index on d14 and d21 were lower in the treatment group (all P < 0.05).

CONCLUSIONSThe acting mechanism of HTG for promoting nerve function recovery of ACI patients is possibly and closely related with the up-regulation of the inflammation suppressive factor SOCS-3, the down-regulation of the inflammation promoting factor TNF-alpha, and the elimination of secondary inflammatory injury after cerebral ischemia.

Adult ; Aged ; Aged, 80 and over ; Cerebral Infarction ; drug therapy ; metabolism ; Diagnosis, Differential ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Phytotherapy ; Suppressor of Cytokine Signaling 3 Protein ; Suppressor of Cytokine Signaling Proteins ; metabolism ; Tumor Necrosis Factor-alpha ; metabolism