PURPOSE: This study was performed to evaluate the availability of classification of lacunar syndrome and of diffusion weighted MRI as initial diagnostic tools for patients with lacunar syndrome. METHODS: From January 1 to October 31, 2001, we prospectively studied patients presenting with lacunar syndrome. All patients were scanned using diffusion-weighted MRI and were then classified into categories based on the diagnosis pure motor stroke and ataxic hemiparesis, sensory motor stroke, pure sensory stroke, dysarthria-clumsy hand syndrome, and others. RESULTS: The total number of patents was 72 ; 60 cases of lacunar infarcts and 12 cases of lacunar hemorrhage. There were 42 cases of pure motor stroke and ataxic hemiparesis, 17 cases of sensory motor stroke, 8 cases of dysarthria-clumsy hand syndrome, 3 cases of pure sensory stroke, 2 cases of others. Lacunar syndrome can be caused by lesions in a variety of locations, and specific location can cause a variety of lacunar syndromes. With diffusion-weighted MRI, lacunar syndromes were visible in 91.7% of the patients (66/72) and lacunar infarcts were visible in 90% (54/60). The mean size of the lacunar infarcts was 11.90+/-5.04 mm and the mean volume of lacunar hemorrhages was 4.70+/-2.08 ml. CONCLUSION: This study showed that the classification of lacunar syndrome was of little benefit in the diagnosis and treatment of a lacunar infarct. Diffusion-weighted MRI, however, was a good initial diagnostic tool in cases of lacunar infarcts. An additional study of the availability of diffusion weighted MRI for use in cases of hemorrhagic lesions is needed.
Classification* ; Diagnosis ; Diffusion ; Diffusion Magnetic Resonance Imaging ; Hand ; Hemorrhage ; Humans ; Infarction ; Magnetic Resonance Imaging* ; Paresis ; Prospective Studies ; Stroke ; Stroke, Lacunar*

BACKGROUNDDifferentiating intracerebral hemorrhage (ICH) from cerebral infarction as early as possible is vital for the timely initiation of different treatments. This study developed an applicable model for the ambulance system to differentiate stroke subtypes.

METHODSFrom 26,163 patients initially screened over 4 years, this study comprised 1989 consecutive patients with potential first-ever acute stroke with sudden onset of the focal neurological deficit, conscious or not, and given ambulance transport for admission to two county hospitals in Yutian County of Hebei Province. All the patients underwent cranial computed tomography (CT) or magnetic resonance imaging to confirm the final diagnosis based on stroke criteria. Correlation with stroke subtype clinical features was calculated and Bayes' discriminant model was applied to discriminate stroke subtypes.

RESULTSAmong the 1989 patients, 797, 689, 109, and 394 received diagnoses of cerebral infarction, ICH, subarachnoid hemorrhage, and other forms of nonstroke, respectively. A history of atrial fibrillation, vomiting, and diabetes mellitus were associated with cerebral infarction, while vomiting, systolic blood pressure ≥180 mmHg, and age <65 years were more typical of ICH. For noncomatose stroke patients, Bayes' discriminant model for stroke subtype yielded a combination of multiple items that provided 72.3% agreement in the test model and 79.3% in the validation model; for comatose patients, corresponding agreement rates were 75.4% and 73.5%.

CONCLUSIONSThe model herein presented, with multiple parameters, can predict stroke subtypes with acceptable sensitivity and specificity before CT scanning, either in alert or comatose patients. This may facilitate prehospital management for patients with stroke.

Aged ; Cerebral Hemorrhage ; classification ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Stroke ; classification ; diagnosis ; Tomography, X-Ray Computed

OBJECTIVE: Arterial stiffness is a common change associated with aging and can be evaluated by measuring pulse wave velocity (PWV) between sites in the arterial tree, with the stiffer artery having the higher PWV. Arterial stiffness is associated with the risk of stroke in the general population and of fatal stroke in hypertensive patients. This study is to clarify whether PWV value predicts functional outcome of acute ischemic stroke. METHODS: One hundred patients were enrolled with a diagnosis of acute ischemic stroke and categorized into two groups: large-artery atherosclerosis (LAAS) or small vessel disease (SVD) subtype of Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification. Each group was divided into two sub-groups based on the functional outcome of acute ischemic stroke, indicated by modified Rankin Scale (mRS) at discharge. Poor functional outcome group was defined as a mRS > or = 3 at discharge. Student's t-test or Mann-Whitney U-test were used to compare maximal brachial-ankle PWV (baPWV) values. RESULTS: Twenty-four patients whose state was inadequate to assess baPWV or mRS were excluded. There were 38 patients with good functional outcome (mRS < 3) and 38 patients with poor functional outcome (mRS > or = 3). The baPWV values were significantly higher in patients with poor outcome (2,070.05 +/- 518.37 cm/s) compared with those with good outcome (1,838.63 +/- 436.65) (p = 0.039). In patients with SVD subtype, there was a significant difference of baPWV values between groups (2,163.18 +/- 412.71 vs. 1,789.80 +/- 421.91, p = 0.022), while there was no significant difference of baPWV among patients with LAAS subtype (2,071.76 +/- 618.42 vs. 1,878.00 +/- 365.35, p = 0.579). CONCLUSIONS: Arterial stiffness indicated by baPWV is associated with the functional outcome of acute ischemic stroke. This finding suggests that measurement of baPWV predicts functional outcome in patients with stroke especially those whose TOAST classification was confirmed as SVD subtype.
Aging ; Arteries ; Atherosclerosis ; Classification ; Diagnosis ; Humans ; Pulse Wave Analysis ; Stroke* ; Vascular Stiffness*

Careful history taking, clinical course of the disease, and neurological examination are mandatory to differentiate cerebrovascular disease from other neurological diseases or even from non-neurological diseases. Cerebrovascular diseases can be classified as ischemic stroke and hemorrhagic stroke. More specified classification of ischemic stroke according to the presumptive ischemic mechanism may be helpful to the treatment and secondary prevention. The unique clinical characteristics of ischemic stroke of different subtypes and diagnostic tests are described.
Cerebrovascular Disorders* ; Classification ; Diagnosis* ; Diagnostic Tests, Routine ; Neurologic Examination ; Secondary Prevention ; Stroke

BACKGROUND AND PURPOSE: In order to improve inter-rater reliability and minimize diagnosis of undetermined etiology for stroke subtype classification, using a stroke registry, we developed and implemented a magnetic resonance imaging (MRI)-based algorithm for acute ischemic stroke subtype classification (MAGIC). METHODS: We enrolled patients who experienced an acute ischemic stroke, were hospitalized in the 14 participating centers within 7 days of onset, and had relevant lesions on MR-diffusion weighted imaging (DWI). MAGIC was designed to reflect recent advances in stroke imaging and thrombolytic therapy. The inter-rater reliability was compared with and without MAGIC to classify the Trial of Org 10172 in Acute Stroke Treatment (TOAST) of each stroke patient. MAGIC was then applied to all stroke patients hospitalized since July 2011, and information about stroke subtypes, other clinical characteristics, and stroke recurrence was collected via a web-based registry database. RESULTS: The overall intra-class correlation coefficient (ICC) value was 0.43 (95% CI, 0.31-0.57) for MAGIC and 0.28 (95% CI, 0.18-0.42) for TOAST. Large artery atherosclerosis (LAA) was the most common cause of acute ischemic stroke (38.3%), followed by cardioembolism (CE, 22.8%), undetermined cause (UD, 22.2%), and small-vessel occlusion (SVO, 14.6%). One-year stroke recurrence rates were the highest for two or more UDs (11.80%), followed by LAA (7.30%), CE (5.60%), and SVO (2.50%). CONCLUSIONS: Despite several limitations, this study shows that the MAGIC system is feasible and may be helpful to classify stroke subtype in the clinic.
Arteries ; Atherosclerosis ; Classification* ; Diagnosis ; Humans ; Magic ; Magnetic Resonance Imaging ; Recurrence ; Stroke* ; Thrombolytic Therapy

There is not a unique registry program about the CVM patients in Korea, even in the World. During the business meeting of International Society for the Study of Vascular Anomalies (ISSVA) 1996 in Rome, a sincere discussion took place about the 1988 Hamburg classification of CVM. This was followed by introduction of registry form that could be used universally throughout the world. We developed a CVM registry program calling CVM for world-wide sharing and analysis. This program is a typical database program application system based on Borland's Delphi 1.0 and the database is managed with dBase III+ . It became clear incoporating the Hamburg classification would be natural while expanding the diagnosis and treatment sections. This is a user-friendly, self-explanatory program that hardly needs any tutorial or instruction. Nonthless, for the foolhardy, it comes with manual that explains every aspect of it. Every panel comes with friendly buttons at your service at the stroke of the mouse or the pad. It can be used either on Windows 3.1 or 95, switching back and forth depending on your computer's capability. The program may obtained by diskettes, compact disc or downloaded from the Internet hompage. We will endeavor to upgrade periodcally as necessity arises.
Animals ; Classification ; Commerce ; Compact Disks ; Diagnosis ; Humans ; Internet ; Korea ; Mice ; Stroke

The authors tried to do the setup of a database management system of congenital heart diseases. We used a personal computer (IBM PC compatible, 486DX2, 50MHz, 256 Cache memory, 250 MB Hard disk) and developed database program by using Foxpro for Windows(version 2.6, Microsoft, USA). For classification and compatibility of terms in congenital heart diseases, we used code system which was modified from Boston Children's Hospital's codes. The program's menu consisted of input, retrieval, statistic and other utility menus. Used data were summary report, echo-cardiographic report, catheterization laboratory report, surgery report, fetal echo-cardiographic report, electrophyiologic study report and reply report. These all data was related each other. The essential code number of each datum was transferred to summary data automatically and simultaneously on entry of data. Because many portions of input fields of each data were to be selected by menu and popup style, special education for use this program was not necessary. All stored data could be retrieved by example-showing method rapidly and easily. Statistics of diagnosis and surgical results could be gotten by several key strokes, simply. On networking, multiple users could use this program without difficulty. We could consummate the database program which was very effective in data management for congenital heart diseases.
Catheterization ; Catheters ; Classification ; Database Management Systems* ; Diagnosis ; Education, Special ; Heart Diseases* ; Heart* ; Humans ; Memory ; Microcomputers* ; Research Report ; Stroke

Systemic lupus erythematosus(SLE) is a disease of unknown etiology in which multiple organs are damaged by pathogenic autoantibodies and immune complexes. Neuropsychiatric manifestations in SLE were first described by Kaposi in 1872. These are so diverse that they include psychosis, depression, stroke, seizure and cognitive dysfunction etc. These patients are frequently consulted for psychiatric evaluation. Neuropsychiatric manifestations in SLE are also among the leading causes of morbidity and mortality and associated with poor long-term outcome. So it is essential to recognize and intervene these symptoms early. But the clear diagnostic criteria for CNS involvement in SLE have not been formulated, and diversity and fluctuation of illness make it difficult to confirm it. The authors reported three cases of SLE with severe neuropsychiatric manifestations. These patients showed symptoms such as disorientation, auditory and visual hallucibation, delusion and mood instability. They became frequently impulsive and violent and had risks to injure themselves or others. Although CNS involvement in SLE is not well known, we reviewed the pathogenesis, classification, diagnosis, clinical manifestation and treatment of them.
Antigen-Antibody Complex ; Autoantibodies ; Classification ; Delusions ; Depression ; Diagnosis ; Humans ; Lupus Erythematosus, Systemic* ; Mortality ; Psychotic Disorders ; Seizures ; Stroke

An analytical observation was carried out on clinical features manifested by 435 patients admitted to Sacred Heart Hospital under a diagnosis of hypertension for a period of June 1968 to August 1972. The following results were obtained: 1. The occurence rate of hypertension was like to be higher in males than in females, showing a ratio of 3:2. The group of the 6th decade of age showed the densest distribution followed the groups in the 5th and the 7th decades, in either sex. 2. The average measurement of blood pressure in patients with hypertension for less than 2 years of duration was 174.8+/-25.14/114.0+/-18.72 mmHg. One who had suffered for over 10 years showed 189.7+/-32.02/126.6+/-23.95mmHg. The value had a tendency to increase as the ailment duration prolonged. 3. In eye fundus findings,hypertensive retinopathy of K-W stage II was the most frequent, observed in 39.0% of all. The appearing rate of hypertensive retinopathy increased and the change in the eye ground was accentuated as the ailment lingered longer. There was no noticeable correlative evidence between serum cholesterol and retinopathy by K-W classification, while the appearing rate of arteriosclerosis in the eye ground by Scheie's classification somewhat increased as serum cholesterol elevated. 4. Albuminuria was observed in 62.9% of all cases, a tendency of a higher appearing rate in parallel with the protraction of illness and a higher measurement of blood pressure. 5. The appearing rate of albuminuria increased as the change of eye fundus deepened. 6. The mean value of serum cholesterol was 192.0mg%, and there was no difference in cholesterol determination by age. 7. The ECG revealed an abnormal tracing in 78.0% of all cases, of which LVH was the most common abnormality appearing in 62.3%. The abnormalities in ECG were found more frequently as the illness protracted longer and blood pressure measured higher. 8. The chest X-ray showed abnormal findings in 55.6% of all cases, of which cardiomegaly was the most common change evidenced in 43.9%. 9. The cerebrovascular accident(22.9%), cardiac failure(8.6%) and renal insufficiency(7.9%) were the major complications of hypertension. The cerebrovascular accident was also found in higher occurence in the cases of longer duration of ailment with hypertension.
Albuminuria ; Arteriosclerosis ; Blood Pressure ; Cardiomegaly ; Cholesterol ; Classification ; Diagnosis ; Electrocardiography ; Female ; Heart ; Humans ; Hypertension* ; Hypertensive Retinopathy ; Korea* ; Male ; Stroke ; Thorax

PURPOSE: The BNP (B-type natriuretic peptide) test is a widely used diagnostic tool to differentiate congestive heart failure (CHF) from other diseases in patients with acute dyspnea in the emergency department. However, limited data exist regarding the effects of the left ventricular ejection fraction (LVEF) on NT-proBNP and BNP levels in acute CHF. We compared NT-proBNP with BNP in relation to the LVEF and correlated these levels to the CHF severity. METHODS: We assessed 113 patients who underwent BNP testing and echocardiography (Echo) during April 2005 and 127 patients who underwent NT-proBNP testing and Echo during May 2005. There were minimal differences with regard to epidemiologic data, past histories, clinical symptoms, New York Heart Association (NYHA) classifications, and final diagnoses between the two groups. We compared the sensitivity between BNP and NT-(pro)BNP in the diagnosis of heart failure, the change in BNP levels according to severity of CHF, and the optimal cutoff values of BNP and NT-proBNP. RESULTS: NT-(pro)BNP (AUC 95% confidence interval 0.875 - 0.965) was found to be superior to BNP (AUC 95% CI 0.675 - 0.851) in predicting CHF, it trended to be statistically significant. The BNP value correlated both with the severity of CHF (classified by NYHA) and LVEF gradings. The cutoff values for BNP and NT-(pro)BNP were 129 pg/mL and 451 pg/mL respectively. CONCLUSION : NT-proBNP is a more powerful predictor of acute CHF in patients presenting to the emergency department with acute dyspnea. Furthermore, NT-(pro)BNP tests may be useful in diagnosing and evaluating the severity of CHF.
Classification ; Diagnosis ; Dyspnea ; Echocardiography ; Emergency Service, Hospital ; Estrogens, Conjugated (USP)* ; Heart ; Heart Failure* ; Humans ; Natriuretic Peptide, Brain ; Stroke Volume