No abstract available.
Nicotine*

BACKGROUND: Great efforts have been devoted to developing a mechanism-oriented classification of ischemic stroke. Information on the subtype of recurrent stroke may tell us whether the classification using the index stroke mechanism is appropriate. Data on the mechanism of recurrence in each stroke subtype are lacking for Asian patients. METHODS: Using the clinical syndrome, diffusion-weighted imaging, and vascular studies, we divided the patients into five groups [large artery atherosclerosis (LAA), cardioembolism (CE), small artery disease (SAD), parent artery disease occluding the deep perforators (PAD), and no determined cause (NC)], and registered recurrent strokes for up to three years. The LAA patients were subdivided into two groups: intracranial (IC-LAA) and extracranial (EC-LAA) LAA. RESULTS: Seventy-six recurrent vascular events (73 strokes and 3 coronary heart diseases) were evaluated in 73 patients. The pattern of recurrent stroke differed for the IC-LAA and EC-LAA groups; unlike the patients with IC-LAA, recurrent strokes in EC-LAA were often unpredictable with respect to the site of recurrence and degree of pre-existing stenosis. None of the patients in the IC-LAA group recurred as EC-LAA, or vice versa. Patients with SAD and NC recurred most frequently as their index stroke subtype, but intracranial stenosis was often found at the time of recurrence. CONCLUSIONS: From a prognostic and therapeutic perspective, patients with atherosclerosis should be divided into IC-LAA and EC-LAA. In addition, intracranial atherosclerosis may be more important in the development of SAD and NC in Asians than in Westerners, due to the high prevalence of intracranial atherosclerosis.
Arteries ; Asian Continental Ancestry Group ; Atherosclerosis ; Classification ; Constriction, Pathologic ; Follow-Up Studies* ; Heart ; Humans ; Intracranial Arteriosclerosis ; Parents ; Prevalence ; Recurrence* ; Stroke*

No abstract available.
Dyspnea* ; Hypothyroidism*

BACKGROUND AND PURPOSE: Conventional therapies for ischemic stroke include thrombolytic therapy, prevention of inappropriate coagulation and thrombosis, and surgery to repair vascular abnormalities. Over 10 years have passed since the US Food and Drug Administration approved intravenous tissue plasminogen activator for use in acute stroke patients, but most major clinical trials have failed during the last 2 decades, including large clinical trials for secondary prevention and neuroprotection. These results suggest the presence of heterogeneity among stroke patients. Neuroimaging techniques now allow changes to be observed in patients from the acute to the recovery phase. The role of MRI in stroke evaluation and treatment is discussed herein. MAIN CONTENTS: Three MRI strategies are discussed with relevant examples. First, the following MRI strategies for acute ischemic stroke are presented: diffusion-perfusion mismatch, deoxygenation (oxygen extraction and cerebral metabolic rate of oxygen), and blood-brain barrier permeability derangement in selected patients for recanalization therapy. Second, multimodal MRI for identifying stroke mechanisms and the specific causes of stroke (i.e., patent foramen ovale, infective endocarditis, and nonbacterial thrombotic endocarditis) are presented, followed by MRI strategies for prevention of recurrent stroke: plaque images and flow dynamics for carotid intervention. EXPECTATIONS: The studies reviewed herein suggest that using MRI to improve the understanding of individual pathophysiologies will further promote the development of rational stroke therapies tailored to the specifics of each case.
Atherosclerosis ; Blood-Brain Barrier ; Endocarditis ; Foramen Ovale, Patent ; Humans ; Neuroimaging ; Perfusion ; Permeability ; Population Characteristics ; Secondary Prevention ; Stroke ; Thrombolytic Therapy ; Thrombosis ; Tissue Plasminogen Activator ; United States Food and Drug Administration

Stem cell therapy is considered a potential regenerative strategy for patients with neurologic deficits. Studies involving animal models of ischemic stroke have shown that stem cells transplanted into the brain can lead to functional improvement. With current advances in the understanding regarding the effects of introducing stem cells and their mechanisms of action, several clinical trials of stem cell therapy have been conducted in patients with stroke since 2005, including studies using mesenchymal stem cells, bone marrow mononuclear cells, and neural stem/progenitor cells. In addition, several clinical trials of the use of adult stem cells to treat ischemic stroke are ongoing. This review presents the status of our understanding of adult stem cells and results from clinical trials, and introduces ongoing clinical studies of adult stem cell therapy in the field of stroke.
Adult Stem Cells* ; Adult* ; Bone Marrow ; Brain ; Humans ; Mesenchymal Stromal Cells ; Models, Animal ; Neurologic Manifestations ; Stem Cells ; Stroke*

No abstract available.
Ixodes* ; Tick Bites* ; Ticks*

The importance of intracranial atherosclerotic disease (ICAD) as a cause of stroke is underscored as compared to that of extracranial carotid stenosis and nonvalvular atrial fibrillation. Recent large clinical trials of ICAD, which evaluated the effectiveness of anticoagulation and stenting to prevent thromboembolism and restore hemodynamic compromise, failed to reduce major vascular events in patients with ICAD. These trials showed the importance of optimal control of risk factors to reduce major vascular events in these patients. Recent advances in risk factors for ICAD are summarized, together with possible reasons for race-ethnic differences in the prevalence of ICAD. In addition, the failure of the major clinical trials of ICAD may be caused by limitations in the understanding of ICAD. Unlike in patients with extracranial carotid stenosis or atrial fibrillation, stroke associated with ICAD occurs in association with various stroke mechanisms such as in situ thrombotic occlusion, artery-to-artery embolism, hemodynamic insufficiency, and branch occlusion. In clinical trials of ICAD, patients with all these types of ICAD were included. However, treatment effects may differ among the different types of ICAD. Treatment strategies might be selected based on clinical features (including the time after onset) and serologic and neuroimaging biomarkers (including diffusion-weighted image pattern and plaque images). Additional clinical trials considering these features are needed.
Atherosclerosis ; Atrial Fibrillation ; Biomarkers ; Carotid Stenosis ; Embolism ; Hemodynamics ; Humans ; Intracranial Arteriosclerosis* ; Neuroimaging ; Prevalence ; Risk Factors ; Stents ; Stroke ; Thromboembolism

Both the incidence and prevalence of stroke in Asia are steadily increasing, and the burden of stroke is particularly high in Asian countries. Although strokes in Asians and Caucasians share many common features, there are some differences that are probably due to differences in lifestyle and genetic background. While there have been advances in the stroke classification system, the assignment of Asian stroke patients to etiological categories has received little attention. The current classification system may not be well suited to Asian patients with ischemic stroke because the proportions and relative importance of stroke subtypes may differ with race and ethnicity. This review addresses concerns about the use of the current stroke classification system in Asian patients with ischemic stroke, and proposes a classification system that is more specific to the Asian population, in conjunction with discussing advances in diagnostic techniques.
Asia ; Asian Continental Ancestry Group* ; Classification ; Continental Population Groups ; Humans ; Incidence ; Life Style ; Prevalence ; Stroke*

BACKGROUND: Though symptomatic improvements after treatment of donepezil is well documented in Alzheimer's disease (AD), the electrophysiological change have not yet been elucidated. Among the parameters of quantitative electroen-cephalography (q-EEG), high frequency activity, especially gamma rhythm, may play a role in normal cognitive function including the integration of sensory processing, association, coupling or selective attention, which are characteristically impaired in AD. METHODS: In order to define the profile of q-EEG changes including gamma rhythm after donepezil treatment, we followed 17 AD patients for 12 weeks. We analyzed the spectra power taken from 16 derivations by averaging twenty-2-sec epoch in normal controls and AD patients. After logarithmic transformation of spectra power, statistical test was done and the effect of donepezil treatment on q-EEG profile was analyzed during follow up period. RESULTS: Before medication of donepezil, AD patients had a significantly lower alpha spectra power as well as a significant higher delta spectra power, compared with normal control. After medication of donepezil in AD patients, compared to base-line q-EEG, gamma spectra power was significantly increased, whereas delta spectra power was significantly reduced. Compared to absolute power, relative power was more sensitive in detecting change of EEG after donepezil treatment. CONCLUSIONS: This study suggests that donepezil significantly change delta and gamma spectra power in q-EEG, and the increase in gamma rhythm may be correlated with the clinical improvements after donepezil treatment. (J Korean Neurol Assoc 19(3):245~250, 2001)
Alzheimer Disease* ; Electroencephalography* ; Follow-Up Studies ; Humans

BACKGROUND: There is a growing interest in the use of genetic markers in predicting the various types of dementia such as Alzheimer's disease (AD) and vascular dementia (VD). It is important to differentiate AD from other causes of dementia because the early diagnosis of AD or VD could lead to early therapeutic intervention. This study is to confirm the association of the apolipoprotein E (Apo E) epsilon 4 allele with AD and, to confirm the differential diagnostic values of Apo E4 in the various causes of dementia. METHODS: One hundred seventy-seven patients participated in the study. Fifty-one had a diagnosis of AD, 68 with VD, 18 with mixed dementia, 17 with other dementia, and 23 controls with no diagnoses of dementia. Patients with AD and VD met the criteria of NINCDS-ADRDA and NINDS-AIREN respectively. The genomic DNA was isolated from whole blood and the Apo E allele was determined by polymerase chain reactions. RESULTS: The Apo E4 allele frequency in the AD group was 21.6% and was significantly different (p<0.05) from those of non-demented controls (4.3%) or VD (8.1%). The age of onset of AD was delayed by the presence of the Apo E2 allele and by the absence of Apo E4 allele, although was not statistically significant. The severities of dementia assessed by MMSE were not different among groups with different Apo E genotypes, implying that factors other than Apo E might be involved in the progression of AD. CONCLUSIONS: The Apo E genotypes can be a valuable genetic marker for predicting the risk for AD in Korea and also for differentiating AD from VD cases.
Age of Onset ; Alleles ; Alzheimer Disease* ; Apolipoprotein E2 ; Apolipoprotein E4 ; Apolipoproteins E ; Apolipoproteins* ; Dementia ; Dementia, Vascular ; Diagnosis* ; Diagnosis, Differential* ; DNA ; Early Diagnosis ; Gene Frequency ; Genetic Markers ; Genotype ; Humans ; Korea ; Polymerase Chain Reaction