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.

Transient ischemic attack (TIA) often precede cerebral infarcts as a warning symptom. But the studies revealing the frequency and the correlation between preceding TIAs and following infarcts are rare. According to the western data, about one-quarter of the patients with cerebral infarct have been supposed to have the previous history of TIAs. We prospectively studied the exact frequency, clinical presentation, and presumed causes of TIAs preceding cerebral infarct. Ninety five patients diagnosed as acute cerebral infarction were interviewed whether they had had previous episodes of TIA. 4 check-list using ordinary language was used, and NINDS diagnostic criteria was applied on the consensus between several neurologists. Seventeen patients (18%) had history of preceding TIAs. Carotid territory was affected in 11 patients (65%), while vertebrobasilar in 4(24%) and undetermined in 2. Duration was less than an hour in 10 patients(59%), and attacks were multiple in about half. Time interval between the last attack and infarction was less than one week in 10 cases(59%). Incidence of recent TIA ((1 month) was 22% in large artery disease(LAD), 11% In cardioembolism(CE), 9% in small-artery disease(SAD), and 7% in mixed etiology. Conclusion, TIAs preceding cerebral infarcts are not rare, but seems to be less common in Koreans than in Caucasians. As expected, atherothrombosis of large artery is supposed to be the leading cause of TIAs.
Arteries ; Cerebral Infarction ; Consensus ; Humans ; Incidence ; Infarction ; Ischemic Attack, Transient* ; National Institute of Neurological Disorders and Stroke ; Prospective Studies

BACKGROUND & OBJECTIVE: Recent studies suggest that anticoagulation, or antiplatelet therapy is safe and effective for the prevention of cardiogenic embolic stroke. However it has not been studied in Korea how the patients with cardioembolic source were managed in practice for the prevention of stroke. This study was done to assess the current status of primary and secondary prevention of cardioembolic stroke. METHODS: Retrospective study was undertaken in 124 patients with cardiogenic embolic stroke, following items were examined, previous anticoagulation or antiplatelet therapy, previous stroke, Insight of the heart disease, and International Normalize Ratio(INR) value on arrival at the hospital. RESULTS: In 124 patients cardioembolic sources were constituted of non-valvular atrial fibrillation (NVAF) in 54, rheumatic heart disease In 40, prosthetic cardiac valve In 14, dilated cardiomyopathy(D-CMP) in 6, left ventricular akinetic segment in 7(including 3 cases of LV thrombi), recent myocardial infarction in 3. In 93 patients with no previous stroke, 44 patients had regular medical follow-up because of his/her cardiac problems and primary prevention of stroke was made only in 12 (27%) patients (8 on anticoagulation and 4 on antiplatelet therapy). The rate of primary prevention varied according to the type of cardioembolic source; 100% with mechanical prosthetic valve, 33.3% with valvular atrial fibrillation, 6.7% with NVAF, and none with D-CMP and bioprosthetic valve. Previous stroke was found in 31 patients, among whom 24 had been followed regularly. Twenty patients(83%) were under secondary prevention of cardioembolic stroke (anticoagulation in 11 and antiplatelet agents in 9). Among 19 patients who developed stroke in spite of anticoagulation, INR values were lower than 1.5 in 12(63%), between 1.5 and 2.0 in 5(26%), and above 2.0 in 2(11%). CONCLUSION: Our results suggest that cardioembolic strokes have not been prevented properly. Many physicians seem to be reluctant to anticoagulate their patients with cardioembolic source, and even with anticoaguation the dosage is frequently insufficient to prevent stroke.
Atrial Fibrillation ; Follow-Up Studies ; Heart Diseases ; Heart Valves ; Humans ; International Normalized Ratio ; Korea ; Myocardial Infarction ; Platelet Aggregation Inhibitors ; Primary Prevention ; Retrospective Studies ; Rheumatic Heart Disease ; Secondary Prevention ; Stroke*

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

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

85 cases of neurosyphilis were observed in Seoul National University Hospital over 6-year period (1979-1984). They were analyzed with respect to clinical symptoms and signs in individual types, serological data in both blood and CSF, changes of cytochemical compositions in CSF, and other significant findings. And some coparisons with other reports were made. They ranged from 22 to 66 years in age with the peak incidence in the forties (41%). Ratio of male to female was observed to be 4.3:1. There were 27 cases of asymptomatic neurosyphilis (NS) (32%), 14 cases of tabes dorsalis (16%), 18 cases of general paresis (21%), 2 cases of taboparesis (2%), 7cases of vascular NS (8%), 6 cases of meningeal NS (7%), 4 cases of syphilitic eight nerve involvement (5%), 4 cases of late syphilitic ocular involvement including optic atrophy (5%), and 3 cases of spinal form (4%). Except in 4 self-referral cases, alimentary system symptoms or illnesses were the main prolbems in asymptomatic neurosyphilitics (48%). Most symptomatic cases had the similar clinical pictures as described in the previous reports but some cases appeared to be combined with symptoms and signs of different types. In tabes dorsalis, patients presented paresthesia and hypoactive DTRs in lower limbs as the most frequent features. According to predominant manifestations, there were 4 cases of dementic form and 14 cases of psychotic form in general paresis but in most cases both features overlapped each other. In 8 cases of general paresis brain CT scans were performed, which revealed diffuse cerebral atrophy in five. Focal abnormalities of vascular NS were most frequently found in temporal areas (4 in 7 cases). Meningeal irritation signs were observed only in one among 6 cases 6 meningeal NS. All cases of eighth nerve involvement showed sensorineural hearing loss at high-tone level. Compared with TPHA, which was used as a criterion for the patient selection, VDRL reactivity was 98% in serum and 49% in CSF. It is notable that as for general paresis and meningeal NS, higher reactivity and elevated titers of CSF VDRL were associated with increase of cells and total protein in CSF, suggesting higher disease activity in both types. Unlike those from other countries, the domestic studies including this report show that general paresis occupies a relatively higher proportion than tabes dorsalis in Korea.
Atrophy ; Brain ; Digestive System ; Female ; Hearing Loss, Sensorineural ; Humans ; Incidence ; Korea ; Lower Extremity ; Male ; Neurosyphilis* ; Optic Atrophy ; Paresthesia ; Patient Selection ; Seoul ; Tabes Dorsalis ; Tomography, X-Ray Computed

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*