No abstract available.
Orbit* ; Vascular Malformations ; Visual Acuity*

Coagulopathies are a relatively common cause of young-age stroke. We present herein a 15-year-old male who was admitted for acute cerebral infarction with dysarthria and weakness of the right side. He had previously been diagnosed with autosomal dominant protein-S deficiency. His left internal carotid artery was totally occluded. Emergency mechanical thrombolysis resulted in recanalization of that occluded artery and consequent improvement in symptoms. The patient was discharged with an oral anticoagulant.
Adolescent ; Arteries ; Carotid Artery, Internal ; Cerebral Infarction* ; Dysarthria ; Emergencies ; Humans ; Male ; Mechanical Thrombolysis ; Protein S Deficiency* ; Stroke

OBJECTIVES: Retinal vein occlusion (RVO) is associated with an increased risk of future cardiovascular events. Statin therapy is a key cornerstone in prevention for patients at high cardiovascular risk. However, little is known about the role of statin therapy for patients with RVO. This study evaluated whether statin treatment in patients with RVO was associated with a lower risk of cardiovascular events. METHODS: A population-based, nested case-control study was conducted with a cohort of newly diagnosed RVO patients without prior cardiovascular disease between 2008 and 2020 using a nationwide health claims database in Korea. From this cohort of RVO patients, we identified cases of cardiovascular events (stroke or myocardial infarction) after RVO and matched controls based on sex, age, insurance type, antiplatelet use, and underlying comorbidities using 1:2 incidence density sampling. RESULTS: Using a cohort of 142,759 patients with newly diagnosed RVO, we selected 6,810 cases and 13,620 matched controls. A significantly lower risk of cardiovascular events (adjusted odds ratio, 0.604; 95% confidence interval, 0.557 to 0.655) was observed in RVO patients with statin treatment than in those without statin treatment. Statin treatment was associated with a reduced risk for both stroke and myocardial infarction after RVO. Longer statin treatment after RVO was associated with a lower risk for cardiovascular events. CONCLUSIONS Statin treatment was associated with a lower risk for future cardiovascular events in patients with newly diagnosed RVO. Further studies are warranted to clarify the potential cardiovascular preventive role of statins in patients with RVO.

Sudden bilateral hearing loss is mainly caused by peripheral otologic disorders or psychogenic origins. Bilateral temporal lobe infarcts can be one of the rare causes. We report a 50-year-old man presented with cortical deafness due to bilateral temporal lobe infarctions. He was admitted at hospital because he did not respond to any verbal questions or environmental sounds, although he understood written commands partially and spoke fluently. Brain MRI demonstrated ischemic infarcts in both temporal lobes involving primary auditory cortex.
Auditory Cortex ; Brain ; Cerebral Infarction ; Hearing Loss, Bilateral ; Hearing Loss, Central ; Hearing Loss, Sudden ; Humans ; Infarction ; Middle Aged ; Middle Cerebral Artery ; Temporal Lobe

BACKGROUND AND PURPOSE: Interarm differences in the systolic and diastolic blood pressures (IASBD and IADBD, respectively) are found in various populations, including stroke patients, but their significance for stroke outcomes has rarely been reported. We aimed to determine the associations of IASBD and IADBD with early neurological deterioration (END), functional outcome, and mortality. METHODS: This study included 1,008 consecutive noncardioembolic cerebral infarction patients who were admitted within 24 hours of onset and had automatic measurements of blood pressures in the bilateral arms. END was assessed within 72 hours of stroke onset according to predefined criteria. A poor functional outcome was defined as a score on the modified Rankin Scale ≥3 at 3 months after the index stroke. All-cause mortality was also investigated during a median follow-up of 24 months. The absolute difference of blood pressure measurements in both arms were used to define IASBD and IADBD. RESULTS: END occurred in 15.3% (155/1,008) of the patients. A multivariate analysis including sex, age, and variables for which the p value was < 0.1 in a univariate analysis revealed that IASBD ≥10 mm Hg was significantly associated with END [odds ratio (OR)=1.75, 95% CI=1.02–3.01]. IADBD ≥10 mm Hg was also related to END (OR=3.11, 95% CI=1.61–5.99). Moreover, having both IASBD ≥10 mm Hg and IADBD ≥10 mm Hg was related to a poor functional outcome (OR=2.67, 95% CI=1.36–5.35) and mortality (hazard ratio=7.67, 95% CI=3.76–12.83) even after adjusting for END. CONCLUSIONS: This study suggests that an interarm blood pressure difference of ≥10 mm Hg could be a useful indicator for the risks of END, poor functional outcome, and mortality.
Ankle Brachial Index ; Arm ; Blood Pressure* ; Cerebral Infarction ; Follow-Up Studies ; Humans ; Mortality* ; Multivariate Analysis ; Stroke*

PURPOSE: The benefits of thrombolytic treatment are time-dependent. We developed a smartphone application that aids stroke patient self-screening and hospital selection, and may also decrease hospital arrival time. MATERIALS AND METHODS: The application was developed for iPhone and Android smartphones. Map data for the application were adopted from the open map. For hospital registration, a web page (http://stroke119.org) was developed using PHP and MySQL. RESULTS: The Stroke 119 application includes a stroke screening tool and real-time information on nearby hospitals that provide thrombolytic treatment. It also provides information on stroke symptoms, thrombolytic treatment, and prescribed actions when stroke is suspected. The stroke screening tool was adopted from the Cincinnati Prehospital Stroke Scale and is displayed in a cartoon format. If the user taps a cartoon image that represents abnormal findings, a pop-up window shows that the user may be having a stroke, informs the user what to do, and directs the user to call emergency services. Information on nearby hospitals is provided in map and list views, incorporating proximity to the user's location using a Global Positioning System (a built-in function of smartphones). Users can search for a hospital according to specialty and treatment levels. We also developed a web page for hospitals to register in the system. Neurology training hospitals and hospitals that provide acute stroke care in Korea were invited to register. Seventy-seven hospitals had completed registration. CONCLUSION: This application may be useful for reducing hospital arrival times for thrombolytic candidates.
*Cellular Phone ; Geographic Information Systems ; Hospitals ; Humans ; Republic of Korea ; Stroke/*diagnosis

We report a 72-year-old man suffering from recurrent attacks of transient drowsy mentality during meal or on orthostatic body position. Markedly disturbed collateral blood flow to right hemisphere was observed on conventional cerebral angiography. Acute and old ischemic lesions in the right internal borderzone area were also noticed on magnetic resonance image. Postprandial and orthostatic hypotension in the present case could be the cause of the recurrent neurological deficit developed in the primarily disturbed collaterals in the right middle cerebral territory.
Aged ; Carotid Artery, Internal* ; Cerebral Angiography ; Humans ; Hypotension* ; Hypotension, Orthostatic ; Ischemic Attack, Transient* ; Meals

A recently developed machine learning algorithm referred to as Extreme Learning Machine (ELM) was used to classify machine control commands out of time series of spike trains of ensembles of CA1 hippocampus neurons (n=34) of a rat, which was performing a target-to-goal task on a two-dimensional space through a brain-machine interface system. Performance of ELM was analyzed in terms of training time and classification accuracy. The results showed that some processes such as class code prefix, redundancy code suffix and smoothing effect of the classifiers' outputs could improve the accuracy of classification of robot control commands for a brain-machine interface system.
Aniline Compounds ; Animals ; Brain-Computer Interfaces ; Hippocampus ; Learning ; Neural Prostheses ; Neurons ; Rats ; Machine Learning

A 30-year-old woman in her first pregnancy was admitted with headache and horizontal diplopia indicating left abducens nerve palsy. Brain magnetic resonance imaging revealed a cerebral venous thrombosis. She had thrombocytosis in the peripheral blood, and a genetic test for thrombocytosis revealed the presence of the valine-to-phenylalanine (V617F) mutation of the Janus kinase 2 (JAK2) gene. Treatment with low-molecular-weight heparin resolved her symptoms of headache and diplopia. The presence of genetic disorders such as the JAK2-V617F gene mutation should be assessed in patients with cerebral venous thrombosis and coexisting thrombocytosis.
Abducens Nerve Diseases ; Adult ; Brain ; Diplopia ; Female ; Headache ; Heparin, Low-Molecular-Weight ; Humans ; Janus Kinase 2 ; Magnetic Resonance Imaging ; Pregnancy ; Thrombocytosis ; Venous Thrombosis

Background: Cancer patients have an increased risk of cardiovascular outcomes and are susceptible to coronavirus disease 2019 (COVID-19) infection. We aimed to assess the cardiovascular safety of COVID-19 vaccination for cancer patients in South Korea. Methods: We conducted a self-controlled case series study using the K-COV-N cohort (2018– 2021). Patients with cancer aged 12 years or older who experienced cardiovascular outcomes were identified. Cardiovascular outcomes were defined as myocardial infarction, stroke, venous thromboembolism (VTE), myocarditis, or pericarditis, and the risk period was 0–28 days after receiving each dose of COVID-19 vaccines. A conditional Poisson regression model was used to calculate the incidence rate ratio (IRR) with 95% confidence interval (CI). Results: Among 318,105 patients with cancer, 4,754 patients with cardiovascular outcomes were included. The overall cardiovascular risk was not increased (adjusted IRR, 0.99 [95% CI, 0.90–1.08]) during the whole risk period. The adjusted IRRs of total cardiovascular outcomes during the whole risk period according to the vaccine type were 1.07 (95% CI, 0.95–1.21) in the mRNA vaccine subgroup, 0.99 (95% CI, 0.83–1.19) in the ChAdOx1 nCoV-19 vaccine subgroup, and 0.86 (95% CI, 0.68–1.10) in the mix-matched vaccination subgroup. However, in the analysis of individual outcome, the adjusted IRR of myocarditis was increased to 11.71 (95% CI, 5.88–23.35) during the whole risk period. In contrast, no increased risk was observed for other outcomes, such as myocardial infarction, stroke, VTE, and pericarditis. Conclusion For cancer patients, COVID-19 vaccination demonstrated an overall safe profile in terms of cardiovascular outcomes. However, caution is required as an increased risk of myocarditis following COVID-19 vaccination was observed in this study.