PURPOSE: Patients with superficial middle cerebral artery (MCA) territory infarction may have concomitant lenticulostriate artery (LSA) territory infarction. We investigated the mechanisms thereof and the outcomes of patients with superficial MCA territory infarction according to the presence or absence of LSA involvement. MATERIALS AND METHODS: Consecutive patients with first-ever infarction in the unilateral superficial MCA territory were included in this study. They were divided into the superficial MCA only (SM) group and the superficial MCA plus LSA (SM+L) group. RESULTS: Of the 398 patients, 84 patients (21.1%) had LSA involvement (SM+L group). The SM+L group more frequently had significant stenosis of the proximal MCA or carotid artery and high-risk cardioembolic sources. Stroke severity and outcomes were remarkably different between the groups. The SM+L group showed more severe neurologic deficits (National Institute of Health Stroke Scale score 10.8±7.1 vs. 4.0±5.0, p<0.001) and larger infarct in the superficial MCA territory (40.8±62.6 cm³ vs. 10.8±21.8 cm³, p<0.001) than the SM group. A poor functional outcome (mRS >2) at 3 months was more common in the SM+L group (64.3% vs. 15.9%, p<0.001). During a mean follow-up of 26 months, 67 patients died. All-cause (hazard ratio, 2.246) and stroke (hazard ratio, 9.193) mortalities were higher in the SM+L group than the SM group. In multivariate analyses, LSA involvement was an independent predictor of poor functional outcomes and stroke mortality. CONCLUSION: LSA territory involvement is predictive of poor long-term outcomes in patients with superficial MCA territory infarction.
Carotid Stenosis/mortality/pathology ; Constriction, Pathologic/pathology ; Female ; Humans ; Infarction, Middle Cerebral Artery/mortality/*pathology ; Male ; Middle Cerebral Artery/*pathology ; Multivariate Analysis ; Severity of Illness Index ; Stroke/mortality/pathology

PURPOSE: Short life expectancy influences decision-making when treating very old patients with acute ischemic stroke (AIS). We investigated mortality and survival duration in very old AIS patients (> or =80 years) who received hospital care. PATIENTS AND METHODS: Mortality data were obtained from medical records, structured telephone inquiries, death certificates from the Korean National Statistical Office, and social security data 5+/-1.9 years after stroke onset. Age, gender, vascular risk factors, and functional outcomes from modified Rankin scales (MRS) at discharge were analyzed as predictors of mortality. RESULTS: Among 134 patients, 92 (68.7%) died. On Kaplan- Meier analysis, duration of survival of patients aged 80-84 years was longer than those aged 85-89 or 90-94 (24+/-6.4, 8+/-7.3, 7+/-2.0 months, respectively, p=0.002). Duration of survival of patients discharged in a state of MRS 0-1 was longer than the remaining groups at 47+/-4.8 months (p<0.001). In Cox proportional hazard analysis, age and MRS at discharge were independent predictors of mortality. CONCLUSION: Long-term outcomes of very old patients with AIS are not uniformly grave, therefore predictors of mortality and estimated duration of survival should be considered during decision- making for treatment.
Age Factors ; Aged, 80 and over ; Brain Ischemia/mortality/*pathology ; Female ; Humans ; Kaplan-Meiers Estimate ; Male ; Prognosis ; Stroke/mortality/*pathology ; Survival Rate ; Time Factors

BACKGROUND AND PURPOSE: MicroRNA (miRNA) expression has been examined in multiple conditions, including various cancers, neurological diseases, and cerebrovascular diseases, particularly stroke. Existing evidence indicates that miRNA biosynthesis and function play crucial roles in ischemic stroke physiology and pathology. In this study, we selected six known polymorphisms in miRNA-biogenesis genes; DICER rs13078A>T, rs3742330A>G; DROSHA rs10719T>C, rs6877842G>C; Ran GTPase (RAN) rs14035C>T; exportin 5 (XPO5) rs11077A>C. METHODS: We analyzed the associations between these polymorphisms and disease status and clinical factors in 585 ischemic stroke patients and 403 controls. Genotyping was performed with the polymerase chain reaction-restriction fragment length polymorphism method. RESULTS: The DICER rs3742330A>G (AA vs. AG+GG: adjusted odds ratio [AOR], 1.360; 95% confidence interval [CI], 1.024 to 1.807; P=0.034) and DROSHA rs10719T>C polymorphisms (TT vs. CC: AOR, 2.038; 95% CI, 1.113 to 3.730; P=0.021) were associated with ischemic stroke prevalence. During a mean follow-up of 4.80±2.11 years, 99 (5.91%) of the stroke patients died. In multivariate Cox proportional hazard regression models, a significant association was found between RAN rs14035 and survival of large artery disease patients with ischemic stroke (CC vs. TT: adjusted hazard ratio, 5.978; P=0.015). CONCLUSIONS: An association was identified between the DICER and DROSHA polymorphisms and ischemic stroke. Specifically, polymorphisms (rs3742330 and rs10719) were more common in stroke patients, suggesting that they may be associated with an increased risk of ischemic stroke.
Arteries ; Cerebrovascular Disorders ; Follow-Up Studies ; GTP Phosphohydrolases ; Humans ; Methods ; MicroRNAs ; Mortality ; Odds Ratio ; Pathology ; Physiology ; Polymorphism, Genetic ; Prevalence ; Stroke

BACKGROUNDLocal hypothermia induced by intravascular infusion of cold saline solution effectively reduces brain damage in stroke. We further determined the optimal temperature of local hypothermia in our study.

METHODSSeventy-eight adult male Sprague Dawley rats (260 - 300 g) were randomly divided into 3 groups: group A, ischemia/reperfusion without cold saline infusion (n = 26) (control group); group B, infusion with 20 degrees C saline before reperfusion (n = 26); group C: infusion with 10 degrees C saline before reperfusion (n = 26). In each group, we chose 15 rats for monitoring physical indexes and the temperature of the brain (cortex and striatum) and body (anus), measurement of brain infarction volume, assessment of neurological deficits and the survival rate of reperfusion at 48 hours. Another 8 rats from each group was chosen for examining brain edema, another 3 from each group for histological observation by electron microscopy (EM) and light microscopy (LM) at 48 hours after reperfusion.

RESULTSThere was no significant difference among the 3 groups for physical indexes during the examination (F((2, 45)) = 0.577, P = 0.568; F((2, 45)) = 0.42, P = 0.78 for blood pressure and blood gas analysis, respectively). The brain temperature was significantly reduced in the group C compared to the other groups (F((2, 45)) = 37.074, P = 0.000; F((2, 45)) = 32.983, P = 0.000, for cortex and striatum temperature respectively), while the difference in rectal temperature between group A and B or C after reperfusion was not significant (F((2, 45)) = 0.17115, P = 0.637). And the brain infarct volume was significantly reduced in group C (from 40% +/- 10% in group A, 26% +/- 8% in group B, to 12% +/- 6% in group C, F((2, 45)) = 43.465, P = 0.000) with the neurological deficits improving in group C (chi(2) = 27.626, P = 0.000). The survival rate at 48 hours after 10 degrees C and 20 degrees C saline reperfusion was increased by 132.5% and 150%, respectively, as compared to the control group (chi(2) = 10.489, P = 0.005). The extent of the brain edema showed no significant difference (F((2, 21)) = 0.547, P = 0.587) after cold saline infusion compared to the control group. No obvious vascular injury was found by electron or light microscopy in either infusion group.

CONCLUSIONSRegional hypothermia with 10 degrees C cold saline infusion can significantly decrease the infarction volume, improve the neurological deficits, and 10 degrees C seems to be the optimal temperature in inducing a cerebral protection effect during stroke. This procedure could be adopted as a further treatment for acute stroke patients.

Animals ; Body Temperature ; Brain ; pathology ; Cerebral Infarction ; pathology ; Hypothermia, Induced ; Male ; Rats ; Rats, Sprague-Dawley ; Stroke ; mortality ; pathology ; physiopathology ; therapy ; Survival Rate ; Temperature

OBJECTIVES: Diabetes and obesity each increases mortality, but recent papers have shown that lean Asian persons were at greater risk for mortality than were obese persons. The objective of this study is to determine whether an interaction exists between body mass index (BMI) and diabetes, which can modify the risk of death by cardiovascular disease (CVD). METHODS: Subjects who were over 20 years of age, and who had information regarding BMI, past history of diabetes, and fasting blood glucose levels (n=16 048), were selected from the Korea Multi-center Cancer Cohort study participants. By 2008, a total of 1290 participants had died; 251 and 155 had died of CVD and stroke, respectively. The hazard for deaths was calculated with hazard ratio (HR) and 95% confidence interval (95% CI) by Cox proportional hazard model. RESULTS: Compared with the normal population, patients with diabetes were at higher risk for CVD and stroke deaths (HR, 1.84; 95% CI, 1.33 to 2.56; HR, 1.82; 95% CI, 1.20 to 2.76; respectively). Relative to subjects with no diabetes and normal BMI (21 to 22.9 kg/m2), lean subjects with diabetes (BMI <21 kg/m2) had a greater risk for CVD and stroke deaths (HR, 2.83; 95% CI, 1.57 to 5.09; HR, 3.27; 95% CI, 1.58 to 6.76; respectively), while obese subjects with diabetes (BMI > or =25 kg/m2) had no increased death risk (p-interaction <0.05). This pattern was consistent in sub-populations with no incidence of hypertension. CONCLUSIONS: This study suggests that diabetes in lean people is more critical to CVD deaths than it is in obese people.
Aged ; Blood Glucose/analysis ; *Body Mass Index ; Cardiovascular Diseases/etiology/*mortality ; Cohort Studies ; Diabetes Complications ; Diabetes Mellitus/*pathology ; Female ; Humans ; Male ; Middle Aged ; Proportional Hazards Models ; Risk Factors ; Stroke/etiology/mortality

Although unilateral antegrade selective cerebral perfusion (UASCP) is considered a safe cerebral protection strategy during aortic surgery, an optimum temperature remains to be defined. This study compared outcomes in patients undergoing UASCP at either <24degrees C or > or =24degrees C. Between 2000 and 2007, 104 consecutive patients underwent aortic surgery using UASCP. Patients were divided into two groups according to systemic temperature: group A comprised 64 patients undergoing deep hypothermia (<24degrees C); and group B comprised 40 patients undergoing moderate hypothermia (> or =24degrees C). Both groups were similar in terms of the extent of aortic replacement and mean UASCP time. The total cardiopulmonary bypass time and aortic cross clamp time were longer in group A. Both groups were similar in terms of 30-day mortality rate (9.4% group A, 10.0% group B), and in terms of temporary (6.7% group A, 7.7% group B) and permanent (11.3% group A, 2.6% group B) neurological deficits. Multivariate analysis showed preoperative shock status was a risk factor for in-hospital mortality, and a preoperative history of a cerebral incident was a risk factor for permanent neurological deficit. UASCP under moderate hypothermia is a relatively safe and effective cerebral protective strategy during aortic surgery.
Aged ; Aorta, Thoracic/surgery ; Aortic Diseases/mortality/pathology/*surgery ; Body Temperature ; Cardiopulmonary Bypass/methods ; *Cerebrovascular Circulation ; Female ; Hospital Mortality ; Humans ; *Hypothermia, Induced ; Magnetic Resonance Angiography ; Male ; Middle Aged ; Reperfusion/methods ; Risk Factors ; Shock/complications ; Stroke/complications ; Treatment Outcome

The prognostic value of the left ventricle ejection fraction (LVEF) after acute myocardial infarction (AMI) has been questioned even though it is an accurate marker of left ventricle (LV) systolic dysfunction. This study aimed to examine the prognostic impact of LVEF in patients with AMI with or without high-grade mitral regurgitation (MR). A total of 15,097 patients with AMI who received echocardiography were registered in the Korean Acute Myocardial Infarction Registry (KAMIR) between January 2005 and July 2011. Patients with low-grade MR (grades 0-2) and high-grade MR (grades 3-4) were divided into the following two sub-groups according to LVEF: LVEF < or = 40% (n = 2,422 and 197, respectively) and LVEF > 40% (n = 12,252 and 226, respectively). The primary endpoints were major adverse cardiac events (MACE), cardiac death, and all-cause death during the first year after registration. Independent predictors of mortality in the multivariate analysis in AMI patients with low-grade MR were age > or = 75 yr, Killip class > or = III, N-terminal pro-B-type natriuretic peptide > 4,000 pg/mL, high-sensitivity C-reactive protein > or = 2.59 mg/L, LVEF < or = 40%, estimated glomerular filtration rate (eGFR), and percutaneous coronary intervention (PCI). However, PCI was an independent predictor in AMI patients with high-grade MR. No differences in primary endpoints between AMI patients with high-grade MR (grades 3-4) and EF < or = 40% or EF > 40% were noted. MR is a predictor of a poor outcome regardless of ejection fraction. LVEF is an inadequate method to evaluate contractile function of the ischemic heart in the face of significant MR.
Aged ; Coronary Angiography ; Coronary Artery Disease/mortality/*pathology/surgery ; Echocardiography ; Female ; Heart/radiography ; Humans ; Male ; Middle Aged ; Mitral Valve Insufficiency/*pathology ; Myocardial Infarction/mortality/*pathology/surgery ; Myocardium/pathology ; Percutaneous Coronary Intervention ; Prospective Studies ; Stroke Volume/*physiology ; Treatment Outcome ; Ventricular Dysfunction, Left/*surgery ; Ventricular Function, Left/physiology

BACKGROUND: We aimed to evaluate the incidence, predictive factors, and impact of acute kidney injury (AKI) after thoracic endovascular aortic repair (TEVAR). METHODS: A total of 53 patients who underwent 57 TEVAR operations between 2008 and 2015 were reviewed for the incidence of AKI as defined by the RIFLE (risk, injury, failure, loss, and end-stage kidney disease risk) consensus criteria. The estimated glomerular filtration rate was determined in the perioperative period. Comorbidities and postoperative outcomes were retrospectively reviewed. RESULTS: Underlying aortic pathologies included 21 degenerative aortic aneurysms, 20 blunt traumatic aortic injuries, six type B aortic dissections, five type B intramural hematomas, three endoleaks and two miscellaneous diseases. The mean age of the patients was 61.2+/-17.5 years (range, 15 to 85 years). AKI was identified in 13 (22.8%) of 57 patients. There was an association of preoperative stroke and postoperative paraparesis and paraplegia with AKI. The average intensive care unit (ICU) stay in patients with AKI was significantly longer than in patients without AKI (5.3 vs. 12.7 days, p=0.017). The 30-day mortality rate in patients with AKI was significantly higher than patients without AKI (23.1% vs. 4.5%, p=0.038); however, AKI did not impact long-term survival. CONCLUSION: Preoperative stroke and postoperative paraparesis and paraplegia were identified as predictors for AKI. Patients with AKI experienced longer average ICU stays and greater 30-day mortality than those without AKI. Perioperative identification of high-risk patients, as well as nephroprotective strategies to reduce the incidence of AKI, should be considered as important aspects of a successful TEVAR procedure.
Acute Kidney Injury* ; Aortic Aneurysm ; Comorbidity ; Consensus ; Endoleak ; Glomerular Filtration Rate ; Hematoma ; Humans ; Incidence ; Intensive Care Units ; Kidney Failure, Chronic ; Mortality ; Paraparesis ; Paraplegia ; Pathology ; Perioperative Period ; Retrospective Studies ; Risk Factors* ; Stroke

Cerebrovascular accident (CVA) is the most common cause of neurologic disorder accompanying grave prognosisand its mortality above 50%. Prior to introduction of the CT, the diagnosis have been depended on clinicalfindings and spinal puncture. Radiologic diagnostic methods, such as angiography, ventriculography andradioisotope scanning are invasive and less sentitive in diagnosis of CVA than CT. The size, location andextension of the intracranial pathology and ventricular penetration are accureately and rapidly portrayed by CT.Consequently, CT plays impotant role in effective tratement and evaluation of prognosis in CVA. Authors analyzed63 cases of diagnosed CVA who were performed CT scan in Korea General Hospital from November 1981 to April 1982.The results were as follows. 1. The most prevalent age group of CVA was 6th decade, and then 7th and 5th decadesin decreasing order. The sex ration between male and female was 1.2:1. 2. The causes of CVA were hypertensivehemorrhage (50.8%), vascular occlusive disease(22.2%), anurysm ruture (4.8%), arteriovenous malformation (3.2%)and hemorrhage of unknown etiology (19.0%). 3. The most common site of hemorrhage was basal ganglia (34.6%) andthen thalamus(21.8%) and cerebral lobes(20.5%). In infarction, the common sites were the lobes(64.7%) and thebasal ganglia (35.3%) 4. Round or oval shaped hematomas of high density (85.9%) were frequent findings ofhemorrhage and mass effect occured in 75.6%. 5. All infarctions were low in density ; Most of the lesion wasinhomogeneous(70.6%) and the rests were homogeneous. Mass effects were seen in 29.4%.
Angiography ; Arteriovenous Malformations ; Basal Ganglia ; Diagnosis ; Female ; Ganglia ; Hematoma ; Hemorrhage ; Hospitals, General ; Humans ; Infarction ; Korea ; Male ; Mortality ; Nervous System Diseases ; Pathology ; Prognosis ; Spinal Puncture ; Stroke ; Tomography, X-Ray Computed

BACKGROUND: Cheiro-oral-pedal syndrome is characterized by a unilateral or bilateral sensory disturbance in mouth corner and hand and/or foot, and associated with central nervous system disease. Causative diseases are cerebral infarction, intracranial hemorrhage, brain tumor, migraine, etc. When related with cerebral infarction, it is known to have lacunar type pathology and favorable prognosis. But other pathogenic mechanism and poor prognosis is suggested. METHODS: We retrospectively studied 12 patients presented with cheiro-oral-pedal syndrome, who visited the department of neurology in Chosun University Hospital from September 2000 to August 2002. Cheiro-oral-pedal syndrome was diagnosed according to the clinical manifestations and brain MRI findings. We assessed neurological findings, brain MRI and MRA findings, duplex sonographic findings, risk factors of stroke and outcome of the patients. Followup period was 3-20 (mean 8) months. RESULTS: There were 12 patients (10 men, 2 women) with the age ranged from 45 to 80 (mean 57.8) years. Sensory loss on cheiro-oral area was present in 8 (66.7%) and on cheiro-oral-pedal area in 4 (33.3%). Responsible lesions were found in thalamus, capsulo-striatum, corona radiata, pons, and fronto-parietal cortex. Three patients had a major cerebral vascular abnormality on MRA. One had MCA stenosis, the other PCA stenosis and another distal ICA stenosis. Sensory symptoms had remained in all patient except one. In-hospital mortality and other neurological deficit at discharge were absent in all. CONCLUSIONS: Cheiro-oral syndrome has mixed pathogenic mechanism of small vessel disease and large vessel atherosclerosis and involves various sites. Paresthesia itself has bad prognosis but overall clinical course is benign.
Atherosclerosis ; Brain ; Brain Neoplasms ; Central Nervous System ; Cerebral Infarction ; Constriction, Pathologic ; Follow-Up Studies ; Foot ; Hand ; Hospital Mortality ; Humans ; Intracranial Hemorrhages ; Magnetic Resonance Imaging* ; Male ; Migraine Disorders ; Mouth ; Neurology ; Paresthesia ; Passive Cutaneous Anaphylaxis ; Pathology ; Pons ; Prognosis ; Retrospective Studies ; Risk Factors ; Stroke ; Thalamus ; Ultrasonography