OBJECTIVE: We aimed to investigate the relationship between adipokines and antioxidation enzyme and the risk of progression of symptomatic intracranial atherosclerotic stenosis (ICAS). METHODS: Of 409 patients who participated in the TOSS-2 (trial of cilostazol in symptomatic intracranial stenosis-2) study, 52 patients showed progression of symptomatic ICAS on magnetic resonance angiography at seven months after an index stroke. We randomly selected 20 patients with progression and 20 age- and sex-matched control patients. We serially collected blood sample initially, one month, and seven months after an index stroke. Then, multiplex analysis of biomarkers was performed for adiponectin, resistin, leptin, and superoxide dismutase-1, 2, 3. RESULTS: Demographic features and risk factors such as hypertension, diabetes, and smoking history were comparable between the two groups. Control group showed higher adiponectin levels at 7 months than progression group (P=0.05) and a significant in-creasing trend (P for trend=0.01). Resistin, leptin, and superoxide dismutase-1, 2, 3 levels were not different between the progression and control group initially, one month, and seven months after an index stroke. CONCLUSION: Increase of adiponectin level showed protective effect in the progression of ICAS. Resistin, leptin, and superoxide dismutase-1, 2, 3 levels are not different between the groups. Further large numbers of patients with longer follow-up studies are needed.
Adipokines* ; Adiponectin ; Biomarkers ; Constriction, Pathologic* ; Follow-Up Studies ; Humans ; Hypertension ; Leptin ; Magnetic Resonance Angiography ; Resistin ; Risk Factors ; Smoke ; Smoking ; Stroke ; Superoxide Dismutase ; Superoxides*

Background: and PurposeThe impact of fluid-attenuated inversion recovery hyperintense vessels (FHVs) on outcomes in patients ineligible for recanalization therapy with large-vessel occlusion (LVO) is unclear. We investigated the impact of FHVs determined using the FHV– Alberta Stroke Program Early CT Score (ASPECTS) on clinical outcomes in patients with LVO stroke of mild-to-moderate severity ineligible for recanalization therapy. Methods: Sixty-eight consecutive patients with M1-middle cerebral artery occlusion who underwent magnetic resonance imaging within 24 hours of symptom onset and were ineligible for recanalization were included. Patients were dichotomized into a severe-FHV group (FHV-ASPECTS ≤4; n=33) and a mild-FHV group (FHV-ASPECTS >4; n=35), and multiple logistic regression analysis was used to examine the relationships of FHV scores with early neurological deterioration (END) and an unfavorable 3-month outcome (modified Rankin Scale score ≥3). Results: Mean age was 66.2±13.5 years (mean±SD), and 30 (44%) were female. The severe-FHV group had a larger infarct volume (median, 5.5 mL vs. 3 mL) and more frequently exhibited the susceptibility vessel sign (30% vs. 3%) than the mild-FHV group. Ipsilateral old nonlacunar infarct was more frequent in the mild-FHV group than in the severe-FHV group (37% vs. 15%). The severe-FHV group had a fivefold higher risk of END (odds ratio [OR] 5.02, 95% confidence interval [CI] 1.36–18.45) and unfavorable outcome (OR 5.97, 95% CI 1.18–33.31, p=0.03) compared with the mild-FHV group. Conclusions Greater FHV extent was associated with higher risk of END and unfavorable outcome in patients with LVO stroke of mild-to-moderate severity.

Background: and PurposeThe impact of fluid-attenuated inversion recovery hyperintense vessels (FHVs) on outcomes in patients ineligible for recanalization therapy with large-vessel occlusion (LVO) is unclear. We investigated the impact of FHVs determined using the FHV– Alberta Stroke Program Early CT Score (ASPECTS) on clinical outcomes in patients with LVO stroke of mild-to-moderate severity ineligible for recanalization therapy. Methods: Sixty-eight consecutive patients with M1-middle cerebral artery occlusion who underwent magnetic resonance imaging within 24 hours of symptom onset and were ineligible for recanalization were included. Patients were dichotomized into a severe-FHV group (FHV-ASPECTS ≤4; n=33) and a mild-FHV group (FHV-ASPECTS >4; n=35), and multiple logistic regression analysis was used to examine the relationships of FHV scores with early neurological deterioration (END) and an unfavorable 3-month outcome (modified Rankin Scale score ≥3). Results: Mean age was 66.2±13.5 years (mean±SD), and 30 (44%) were female. The severe-FHV group had a larger infarct volume (median, 5.5 mL vs. 3 mL) and more frequently exhibited the susceptibility vessel sign (30% vs. 3%) than the mild-FHV group. Ipsilateral old nonlacunar infarct was more frequent in the mild-FHV group than in the severe-FHV group (37% vs. 15%). The severe-FHV group had a fivefold higher risk of END (odds ratio [OR] 5.02, 95% confidence interval [CI] 1.36–18.45) and unfavorable outcome (OR 5.97, 95% CI 1.18–33.31, p=0.03) compared with the mild-FHV group. Conclusions Greater FHV extent was associated with higher risk of END and unfavorable outcome in patients with LVO stroke of mild-to-moderate severity.

Cerebrovascular diseases associated with neurofibromatosis type 1 (NF-1) are not frequent. Ischemic stroke have been reported quite well in the literature, but cerebral hemorrhage associated with intracranial steno-occlusion were very rare and has not been reported in Korea. We report a 28-year-old woman with NF-1, who presented with cerebral hemorrhage. She had the history of multiple episodes of transient left hemiparesis. Sudden right occipital headache and left hemiparesis, followed by loss of consciousness, brought her to our emergency room and right thalamic hemorrhage with intraventricular extension was detected. Angiogram showed occlusion of the right supraclinoid internal carotid artery (ICA) and the left anterior cerebral artery, focal narrowing of the right petrous and the left supraclinoid ICA, and diffuse narrowing of the basilar artery. We discussed the genetic aspect and the pathophysiology of vascular occlusive disease in patients with NF-1.
Adult ; Anterior Cerebral Artery ; Basilar Artery ; Carotid Artery, Internal ; Cerebral Hemorrhage* ; Emergency Service, Hospital ; Female ; Headache ; Hemorrhage ; Humans ; Korea ; Moyamoya Disease ; Neurofibromatoses* ; Neurofibromatosis 1* ; Paresis ; Stroke ; Unconsciousness

Data accumulated over the past four decades have dispelled the long-held dogma that the adult mammalian brain cannot generate new neurons. Although neurogenesis, the birth of new neurons, is confined largely to the embryonic period, accumulating evidence indicates that certain germinative zones persist throughout life and continue to generate neurons and glia in specific brain regions. Although limited knowledge exists regarding the normal function of neurogenesis in the adult and its alteration by brain injury, the persistence of neurogenesis suggests that the mature brain maintains an even greater potential for plasticity after injury than previously recognized. Underlining the idea are recent reports that seizures induced by various experimental manipulations increase neurogenesis in the adult rodent brain. Studies of dentate gyrus neurogenesis in the adult rodent epilepsy models suggest that seizure-induced neurogenesis involves aberrant neuroblast migration and integration that may contribute to abnormal hyperexcitability. The presence of endogenous neural progenitors in other proliferative regions, however, may offer potential strategies for the development of antiepileptogenic or neuronal replacement therapies. The effects of seizure-induced neurogenesis in the epileptic brain, in terms of either a pathological or reparative role, are only beginning to be investigated.
Adult ; Brain ; Brain Injuries ; Dentate Gyrus ; Epilepsy* ; Humans ; Neurogenesis* ; Neuroglia ; Neuronal Plasticity ; Neurons ; Parturition ; Plastics ; Rodentia ; Seizures

Atherosclerosis is characterized by progressive accumulation of lipids and inflammatory cells within the artery wall. It is a diffuse systemic disease; however, some atherosclerotic plaques are more prone to rupture causing sudden thromboembolic vascular occlusions, while others are clinically silent. Therefore, to prevent such devastating vascular events as stroke or myocardial infarction, clinicians need to have smart tools to localize high-risk vulnerable plaques, which have been a huge challenge to date. Molecular imaging, which visualizes biologic processes at the cellular and molecular level, has a potential to assess plaque vulnerability and consequently identify high-risk patients prior to the development of the clinical events. In this review, we summarize important updates on the molecular imaging of atherosclerosis in the field of optical imaging, magnetic resonance imaging, positron emission tomography, and computerized tomography imaging.
Arteries ; Atherosclerosis ; Humans ; Magnetic Resonance Imaging ; Molecular Imaging ; Myocardial Infarction ; Optical Imaging ; Plaque, Atherosclerotic ; Positron-Emission Tomography ; Rupture ; Stroke

Atherosclerosis is characterized by progressive accumulation of lipids and inflammatory cells within the artery wall. It is a diffuse systemic disease; however, some atherosclerotic plaques are more prone to rupture causing sudden thromboembolic vascular occlusions, while others are clinically silent. Therefore, to prevent such devastating vascular events as stroke or myocardial infarction, clinicians need to have smart tools to localize high-risk vulnerable plaques, which have been a huge challenge to date. Molecular imaging, which visualizes biologic processes at the cellular and molecular level, has a potential to assess plaque vulnerability and consequently identify high-risk patients prior to the development of the clinical events. In this review, we summarize important updates on the molecular imaging of atherosclerosis in the field of optical imaging, magnetic resonance imaging, positron emission tomography, and computerized tomography imaging.
Arteries ; Atherosclerosis ; Humans ; Magnetic Resonance Imaging ; Molecular Imaging ; Myocardial Infarction ; Optical Imaging ; Plaque, Atherosclerotic ; Positron-Emission Tomography ; Rupture ; Stroke

BACKGROUND: Until recently lateralization or localization of language area was possible only by electrical stimulation or Wada test. We describe here a convenient and noninvasive method of language localization with functional magnetic resonance image (MRI). METHOD: Twelve healthy right-handed Korean young volunteers (M:F=9:3, mean age: 24 years) were recruited for this study. We collected brain activation image of 6 slice using gradient echo EPI (Echo-planar imaging) during 8 sets of resting and activation periods. During resting periods, each of 10 Korean nouns composed of two to four syllables was shown continuously every 3 seconds and the subjects were required to simply read the words. The activation task was to generate words as many as possible beginning with the same initial syllable seen on screen without any movement. The data were analyzed using SPM (statistical parametric mapping) and the activated signals were overlayed on a T1-weighed image. RESULT: The activated areas were observed in the perisylvian areas including inferior frontal gyrus and middle superior temporal gyri in 9 subjects. (left in 7, right in 2) Another one subject showed nonsignificant activation in left pre-& postcentral gyrus. The remaining two subjects showed only motion artifacts. Therefore, except motion artifact we localized motor speech areas in 9 of 10 subjects. CONCLUSION: Activation of motor speech area is observed by functional MRI using EPI technique efficiently, quickly and noninvasively. Such functional mapping may have value for the neurosurgical planning.
Artifacts ; Brain ; Electric Stimulation ; Magnetic Resonance Imaging* ; Volunteers

BACKGROUND: The etiology of transient global amnesia (TGA) is uncertain. Recent studies have demonstrated a high signal intensity on diffusion MRI in TGA patients. In this study we reviewed and compared the use of electroencephalography (EEG) and diffusion-weighted imaging (DWI) in TGA in order to determine their sensitivity and to reveal clues about the etiology of this condition. METHODS: Twenty patients (7 males and 13 females; aged 58.0+/-12.1 years, mean+/-SD) who had been diagnosed with TGA at Dongguk University International Hospital within a 2-year period (2007 and 2008) were included in the study. All patients underwent EEG and DWI. RESULTS: The EEG of 12 of the 20 patients (60.0%) exhibited abnormalities; all 12 exhibited slowing on either the left side (n=6) or bilaterally (n=6). Spikes or sharp waves were detected in two patients. DWI revealed unilateral high signal intensities in the hippocampus of eight patients; five of these patients had left hippocampal lesions, and the other three had right hippocampal lesions. Four patients with a unilateral DWI lesion exhibited bilateral EEG abnormalities, and six patients exhibited only EEG abnormalities (without DWI abnormalities). Three patients had a high-signal-intensity lesion on DWI without EEG abnormalities. Five patients had normal EEG and DWI results. Interestingly, no patient had EEG abnormalities confined to the right temporal area. CONCLUSIONS: These findings suggest that left temporal dysfunction is important for the development of TGA. EEG might be complementary to DWI in TGA investigations, and may be superior at illustrating the associated memory dysfunction.
Aged ; Amnesia, Transient Global ; Diffusion Magnetic Resonance Imaging ; Electroencephalography ; Hippocampus ; Humans ; Male ; Memory

BACKGROUND: Intracerebral hemorrhage (ICH) is associated with a considerable proportion of stroke and head injuries, but except for supportive care, there is no medical therapy available. Transplantation of human neural stem cells (NSCs) can be used to reduce behavioral deficit in experimental ischemic infarct model. However, effect of stem cell transplantation in experimental intracerebral hemorrhage (ICH) is unknown. We hypothesized that NSCs could migrate and differentiate into neurons or glial cells, and improve functional outcome in ICH. METHODS: Experimental ICH was made by intrastriatal administration of bacterial collagenase in adult rats. Animals were randomized to receive intravenously either immortalized Lac-Z positive human NSCs (5x1 06 in 500microL, n=15) or same volume of saline (n=12) on the following day. Animals were evaluated for 8 weeks after surgery with behavioral test battery. After 8 weeks, animals were sacrificed and the brains were sectioned. Transplanted NSCs were detected by X-gal histochemistry or beta-gal immunohistochemistry, and differentiation of grafted NSCs were evaluated by double labeling of GFAP, NeuN, or neurofilament. RESULTS: Transplanted NSCs migrated to the side of peri-hematomal areas, and differentiated into neurons and astrocytes. NSCs injection group showed improved performances on rotarod test after 2 weeks and on limb placing test after 5 weeks compared with control group (p<0.05) and these effect persisted up to 8 weeks. CONCLUSIONS: Intravenously injected NSCs enter rat brain with ICH, and differentiate into astrocytes or neuronal cell, which lead to functional recovery. These findings show the possibility that NSCs can be used to reduce neurological deficits in the experimental ICH.
Adult ; Animals ; Astrocytes ; Brain ; Cerebral Hemorrhage* ; Collagenases ; Craniocerebral Trauma ; Extremities ; Humans* ; Immunohistochemistry ; Neural Stem Cells* ; Neuroglia ; Neurons ; Rats ; Rotarod Performance Test ; Stem Cell Transplantation ; Stroke ; Transplants