This study was conducted to integrate the results of previous studies which evaluated hypertension as a risk factor for cerebrovascular disorders (CVD) in Koreans. We retrieved the Korean literature using a manual search and the English literature using the MEDLINE database concerning the relationship between hypertension and CVD in Koreans from 1980 to 1997. The overall effect size of hypertension as a risk factor of CVD was represented by common odds ratio (OR). Before the integration of each effect size, a heterogeneity test and a sensitivity test was conducted. The materials were nine published epidemiologic studies with a total of 2,271 cases of CVD. The common ORs (95% confidence interval) of overall CVD, hemorrhagic CVD and ischemic CVD associated with hypertension were 4.10 (3.56-4.71), 6.56 (4.92-8.80) and 3.28 (2.77-3.90), respectively. Thus, the common OR of hemorrhagic CVD associated with hypertension was significantly higher than that of overall or ischemic CVD. This suggests that hypertension is an important risk factor for overall CVD and its subtypes in Koreans. Due to the lack of reliable prospective studies, however, longitudinal study is required in this area.
Cerebrovascular Accident/etiology* ; Human ; Hypertension/complications* ; Randomized Controlled Trials ; Risk Factors

PURPOSE: We investigated the usefulness of video based, fluoroscopically guided abduction motion analysis of hemiplegic shoulders. PATIENTS AND METHODS: Twenty-two stroke patients with Brunnstrom stages 3-4 (Group 1) or 5-6 (Group 2) were enrolled in this study. Patients with shoulder pain and significant spasticity (MAS 2) were excluded. We recorded motion pictures of the abductions of affected and unaffected shoulder joints under an AP fluoroscopic guide. Lateral scapular slide distances (D1: T2- superior angle, D2: T3- scapular spine, D3: T7-inferior angle) were measured at 30 degrees, 60 degrees, 90 degrees during glenohumeral abduction in a captured photographic image. The angles of scapular rotation and trajectory (stromotion) of the humeral head center, relative to the 3rd thoracic spine in the abduction motion were analyzed. RESULTS: In Group 1, a significant difference was found in the lateral scapular slide distance between the affected and sound sides. However, no significant side to side difference was found in Group 2. Scapular angles in abduction were also increased in Group 1. Patients with a more synergistic movement pattern showed less scapular stabilizing muscle activity and, instead, exhibited a compensatory "shrugging" like motion accomplished by spinal tilting. CONCLUSION: The present findings support the notion that the above parameters of fluoroscopically guided shoulder abduction motion analysis correlate well with clinical findings. These parameters should be useful for evaluations of hemiplegic shoulder biomechanics.
Video Recording ; Shoulder Joint/*physiopathology/radiography ; Movement/*physiology ; Middle Aged ; Humans ; Hemiplegia/etiology/*physiopathology/radiography ; Functional Laterality ; Fluoroscopy ; Cerebrovascular Accident/complications ; Cerebral Infarction/complications ; Aged

Although early natural menopause has been postulated to increase stroke risk, studies have not produced convincing results. We examined the associations between stroke risks and age at natural menopause or time since natural menopause. 5,731 naturally postmenopausal women more than 65 yr of age were followed from 1993 to 1998. Information on age at menopause and risk factors were obtained using mailed questionnaires. 186 cases of stroke occurred over a total 27,936 person years. After adjusting for age, hypertension, and physical activity, age at menopause was not found to be significantly associated with stroke or cerebral infarction. However, adjusted relative risks (aRRs) showed a significant increasing tendency of hemorrhagic stroke versus age at menopause (aRRs, 0.66, 0.48, 1.00 and 2.33 for the following age groups at menopause; 40-44, 45-49, 50-54 [reference group], and > or =55 yr). Time since menopause (11-20, 21-30, and > or =31 yr) was not found to be significantly associated with cerebral infarction, or hemorrhagic stroke. Late menopause (menopause age > or =55 yr) showed a tendency of a lower risk of cerebral infarction (aRR, 0.79) and a higher risk of hemorrhagic stroke (aRR, 2.33). Further study is warranted to determine stroke risk in women during the decade following menopause.
Adult ; Age Factors ; Aged ; Aged, 80 and over ; Cerebral Hemorrhage/etiology ; Cerebral Infarction/etiology ; Cerebrovascular Accident/*etiology ; Cohort Studies ; Female ; Humans ; Korea ; *Menopause ; Middle Aged ; Prospective Studies ; Questionnaires ; Research Support, Non-U.S. Gov't ; Time Factors

99mTc-ECD SPECT is valuable for the evaluation of cell viability and function. The purpose of the present study was to evaluate the significance of 99mTc-ECD brain SPECT in ischemic stroke. We compared 99mTc-ECD brain SPECT with perfusion and diffusion weighted images (PWI, DWI). Ten patients with acute and early subacute ischemic stroke were included in this prospective study. T2-weighted images (T2WI), DWI, PWI and 99mTc-ECD SPECT were obtained during both the acute/early subacute and late subacute stages. In the case of PWI, time to peak (TTP) and regional cerebral blood volume (rCBV) maps were obtained. The rCBV map and 99mTc-ECD SPECT images were compared in 8 lesions using delta AI. The asymmetry index (AI) was calculated as (Ci - Cc) X 200 / (Ci + Cc); where Ci is the mean number of pixel counts of an ipsilateral lesion and Cc is the mean number of pixel counts of the normal contralateral hemisphere. delta AI was defined as AIacute - AIsubacute in the ischemic core and periphery. PWI and 99mTc-ECD SPECT detected new lesions of the hyperacute stage or of evolving stroke more accurately than T2WI and DWI. 99mTc-ECD SPECT was able to localize the infarct core and peri-infarct ischemia in all lesions in both the acute and the subacute stages. delta AI was higher in the rCBV map than in the 99mTc-ECD SPECT images in the ischemic core (p = 0.063) and in the periphery (p = 0.091). In the 99mTc-ECD SPECT images, delta AI was higher in the ischemic core than in the periphery (p = 0.028). During the subacute stage, 99mTc-ECD SPECT detected all the lesions without the pseudonormalization seen in the MR images of 5/11 lesions. Based on this study, 99mTc-ECD SPECT is comparable to PWI in terms of its ability to detect acute stroke and is more useful than PWI in the case of subacute infarction.
Acute Disease ; Adult ; Aged ; Brain Ischemia/*complications ; Cerebrovascular Accident/*diagnosis/*etiology ; Comparative Study ; Cysteine/*analogs & derivatives/*diagnostic use ; Diffusion ; Female ; Human ; Magnetic Resonance Imaging/methods ; Male ; Middle Age ; Organotechnetium Compounds/*diagnostic use ; Perfusion ; Radiopharmaceuticals/*diagnostic use ; *Tomography, Emission-Computed, Single-Photon