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*

No abstract available.
Leukodystrophy, Metachromatic*

No abstract available.
Information Management* ; Occupational Health*

OBJECTIVE: To retrospectively compare the imaging characteristics of retropharyngeal density and associated findings for Kawasaki disease with those for non-Kawasaki disease, and identify the distinguishing features which aid the CT diagnosis of Kawasaki disease with retropharyngeal low density. MATERIALS AND METHODS: Among the enhanced neck CT performed in children less than 8-years old with clinical presentation of fever and cervical lymphadenopathy over a 6-year period, only cases with retropharyngeal low density (RLD) were included in this study. The 56 cases of RLD were divided into two groups; group A included cases diagnosed as Kawasaki disease (n = 34) and group B included cases diagnosed as non-Kawasaki disease (n = 22). We evaluated the CT features including the thickness of RLD and its extent into the deep neck spaces, as well as soft tissue change in the adjacent structure. We also scored the extent of RLD into the deep neck spaces and the soft tissue changes in the adjacent structure. RESULTS: The thickness of RLD was greater in group A than in group B (group A, 6.0 +/- 2.1; group B, 4.6 +/- 1.5, p = 0.01). The score of the RLD extent into the deep neck spaces was significantly greater in group A than in group B (group A, 2.3 +/- 1.3; group B, 0.8 +/- 1.0, p < 0.01). Also, the score of the adjacent soft tissue changes was greater in group A than in group B (group A, 2.0 +/- 1.1; group B, 1.0 +/- 1.0, p < 0.01). CONCLUSION: If children present with fever and cervical lymphadenopathy that display retropharyngeal low density with extension into more deep neck spaces as well as changes in more adjacent soft tissue, the possibility of Kawasaki disease should be considered.
Child ; Child, Preschool ; Female ; Humans ; Lymphatic Diseases/complications/radiography ; Male ; Mucocutaneous Lymph Node Syndrome/complications/*radiography ; Neck/*radiography ; Pharyngeal Diseases/complications/*radiography ; Pharynx/*radiography ; *Tomography, X-Ray Computed

BACKGROUND: Coronary artery bypass graft (CABG) surgery is performed more frequently than before in Korea. Central nervous system (CNS) complications are often the major prognostic determinants following the surgery. We carried out a prospective study to clarify the incidence and risk factors of neurologic complications after CABG surgery. METHODS: A consecutive series of 150 patients undergoing 152 CABG operations from March 1995 to July 1997 by one cardiac surgeon was evaluated by a team of neurologists before and after the surgery. The patients received extensive preoperative examinations including the evaluation of intracranial & extracranial cerebral artery disease. RESULTS: In 44 operations (28.9%), we detected various neurologic complications, including encephalopathy (36 operations, 23.7%), cerebral infarction (5 operations, 3.3%), and seizure (7 operations, 4.6%). Eight patients died postoperatively including one due to neurologic complication. On univariate analysis, age, degree of intracranial artery disease (ICAD), duration of bypass time, hypotension index, duration of ventricular assistant device (VAD), intraoperative event, intra- or postoperative arrhythmia, reoperation, and postoperative bleeding were statistically significant risk factors of CNS complications (p< 0.05). After multivariate analysis, however, age alone remained significant (p=0.02). The degree of ICAD showed marginal significance (p=0.06). CONCLUSIONS: The incidence of CNS complication in the patients undergoing CABG surgery was 28.9%. Our results showed that age was an independent risk factor of CNS complications. And the possibility of ICAD as a risk factor was suggested. Further study with a large number of patients would be necessary to prove the above suggestion.
Arrhythmias, Cardiac ; Arteries ; Central Nervous System* ; Cerebral Arterial Diseases ; Cerebral Infarction ; Coronary Artery Bypass* ; Coronary Vessels* ; Hemorrhage ; Humans ; Hypotension ; Incidence ; Korea ; Multivariate Analysis ; Prospective Studies ; Reoperation ; Risk Factors ; Seizures ; Transplants

No abstract available.
Hemorrhage*

OBJECTIVES: This study was performed to survey worker's demands for worksite medical care and agency's intention for offering worksite medical care in Group Health Service Agency. METHODS: One study subjects were employers, workers and office personnels in 167 factories. They were asked for medical care utilization behavior and worksite medical care demand. 121 employers(72.5%), 145 office personnels(86.8%) and 816 workers(60.5%) answered the questionnaire. The other subjects were doctors, nurses and administrators in 66 Group Health Service Agencies nationwide. They were asked for intention of offering worksite medical care in Group Health Service Agency through the mail survey. 31 doctors(47.0%), 38 nurses(57.6%) and 34 administrators answered the questionnaire. RESULTS: 87 percentage of doctors and 94 percentage of nurses had experiences of being requested to prescribe and laboratory examination. All nurses, 94 percentage of administrators and 76 percentage of doctors thought that it was necessary to give medical treatment at worksite. Also in worksite 85 percentage of employers, 86 percentage of office personnels and 81 percentage of workers answered that they accepted the worksite medical care when it would be given. CONCLUSIONS: Worksite medical care should be permitted because almost of all workers and employers requested worksite medical care, and doctors and nurses in Group Health Service Agency were willing to give worksite medical care and there was necessity to prevent occupational cerebrovascular disease.
Administrative Personnel ; Health Services* ; Humans ; Intention* ; Postal Service ; Questionnaires ; Workplace*

Both vein and arterial involvements with various manifestations in Beh et's disease is defined as vasculo-Beh et's disease. Venous lesions such as thrombosis or varices are more common than arterial lesions. Aneurysms or arterial steno-occlusion involving large intracranial arteries are very rare. We report two cases of vasculo-Beh et's disease involving intracranial arteries. The one case presented with carotid-cavernous sinus fistula due to internal carotid aneurysm, and the other case was accompanied by cerebral infarct due to intracranial arterial stenosis.
Aneurysm ; Arteries* ; Carotid-Cavernous Sinus Fistula ; Constriction, Pathologic ; Intracranial Aneurysm ; Thrombosis ; Varicose Veins ; Veins

Leber's hereditary optic neuropathy (LHON) is an important cause of bilateral optic neuropathy in youth and occasionally associated with other neurological abnormalities (Leber's plus). The authors recently found out one family of LHON and another patient of Leber's plus with mitochondrial DNA (mtDNA) 11778 mutation. The presence of a point mutation of mtDNA was investigated by restriction length fragment polymorphism. Among 14 patients who had mtDNA 11778 mutation in the family, only two men had bilateral optic neuropathy. The other was a man of optic neuropathy with myelopathy. The age at onset of visual loss ranged from 14 to 25 (average 19.7). The time delay between involvement of the two eyes was I to 3 months Central visual field defect was observed in each of all affected eyes and worse in the earlier affected. The brain MRI and CSF studies revealed no abnormality. This study showed that the clinical manifestations and genealogical features of LHON in our patients are similar to those of previously reported cases in other countries.
Adolescent ; Brain ; DNA, Mitochondrial* ; Humans ; Magnetic Resonance Imaging ; Male ; Optic Atrophy, Hereditary, Leber ; Optic Nerve Diseases ; Point Mutation ; Spinal Cord Diseases ; Visual Fields

No abstract available.
Capsid Proteins* ; Capsid*