OBJECTIVE: The purpose of this study is to investigate the incidence of aneurysmal subarachnoid hemorrhage (SAH) in Youngdong district for 10 years. METHODS: From Jan. 1997 to Dec. 2006, 732 patients (327 males, 405 females, mean age: 54.8+/-13.1 years) with spontaneous SAH were admitted to our hospital. We reviewed the medical records and radiological findings regarding to the ictus of SAH, location and size of the ruptured aneurysms, Hunt-Hess grade and Fisher grade on admission, personal details such as address, age, and sex, and previous history of medical diseases. RESULTS: In these 732 patients, 672 cases were confirmed as aneurysmal SAH. Among them, 611 patients (262 males, 349 females, mean age: 54.9+/-13.2 years) came from Youngdong district. The average crude annual incidence of aneurysmal SAH for men, women, and both sexes combined in Youngdong district was 7.8+/-1.7, 10.5+/-2.7, and 9.1+/-2.1 per 100,000 population, respectively. Because of the problems related to the observation period and geographical confinement, it was suspected that the representative incidence of aneurysmal SAH in Youngdong district should be made during the later eight years in six coastal regions. Therefore, the average age-adjusted annual incidence for men, women, and both sexes combined was 8.8+/-1.4, 11.2+/-1.3 and 10.0+/-1.0, respectively in the coastal regions of Youngdong district from 1999 to 2006. CONCLUSION: In overall, our results on the incidence of aneurysmal SAH was not very different from previous observations from other studies.
Aneurysm* ; Aneurysm, Ruptured ; Epidemiology ; Female ; Humans ; Incidence* ; Korea* ; Male ; Medical Records ; Subarachnoid Hemorrhage*

BACKGROUND: Various rat models have been used to study subarachnoid hemorrhage related to a stress ulcer. However, these models have many problems such as high mortality, low success rates, and a bias due to a long procedure time. The purpose of this study was to develope a more reliable rat model for the study of subarachnoid hemorrhage related to a stress ulcer. METHODS: Sprague-Dawley rats were anesthetized, and various volume of autologous blood were injected into the basal cistern by percutaneous injection. Mild stress consisting of restraint plus 4degreesC cold water immersion, 20degreesC cold water immersion, or 4degreesC cold water immersion with 40degreesC water rewarming were used to produce a stress ulcer. Thirty minutes after water immersion, rats were euthenized and the relative ulcer length (RUL) was measured. RESULTS: Experimental subarachnoid hemorrhage by an injection of 0.2 ml autologous blood and three cycles of restraint plus 4degreesC cold water immersion with 40degreesC water rewarming produced a marked ulceration without mortality and a significant neurologic deficit. CONCLUSIONS: An injection of 0.2 ml autologous blood combined with three cycle of restraint plus 4degreesC cold water immersion with 40degreesC water rewarming is an ideal model to study subarachnoid hemorrhage related to a stress ulcer.
Animals ; Bias (Epidemiology) ; Immersion ; Models, Animal* ; Mortality ; Neurologic Manifestations ; Rats* ; Rats, Sprague-Dawley ; Rewarming ; Subarachnoid Hemorrhage* ; Ulcer* ; Water

OBJECTIVE: The circadian pattern of the onset time of aneurysmal subarachnoid hemorrhage (aSAH) has been reported by various authors. However, the effect of the degree of physical exertion on the circadian pattern has not been studied in detail. Therefore, we conducted this study to investigate the effect of physical exertion on the circadian pattern of aSAH.METHODS: Of the 335 patients presenting with aSAH from January 2012 to December 2017, 234 patients with identifiable onset time and metabolic equivalent (MET) values were enrolled. The onset time of aSAH was divided into 4-hour intervals. The patient’s physical exertion was then assessed on a scale between 1 and 8 METs using generally accepted MET values, and categorized into two groups—light exertion (1 to 4 METs) and moderate to heavy exertion (5 to 8 METs)—to determine the effect of the degree of physical exertion on the onset time distribution of aSAH. Multivariate analysis was used to calculate the odds ratio (OR) between the two groups to determine the effect of the degree of physical exertion on each set of time periods.RESULTS: There was a definite bimodal onset pattern that peaked at 08:00–12:00 hours followed by 16:00–20:00 hours (p <0.001). MET values at all time intervals were found to be significantly higher than the night time (00:00–04:00 hours) values (p<0.031). The MET value distribution showed a unimodal pattern that slightly differed from the bimodal distribution of the onset time of aSAH. There were no significant differences in the ORs of each time interval according to the degree of the MET value.CONCLUSION: This study reaffirmed that aSAH occurs in a bimodal pattern, especially showing the highest prevalence in the morning. Although aSAH could be related to daily activity, there were no significant changes in diurnal variations affected by the degree of physical exertion.
Aneurysm ; Epidemiology ; Humans ; Metabolic Equivalent ; Motor Activity ; Multivariate Analysis ; Odds Ratio ; Physical Exertion ; Prevalence ; Risk Factors ; Subarachnoid Hemorrhage

PURPOSE: The aim of this study was to determine whether there are monthly and seasonal variations of incidence of subarachnoid hemorrhage (SAH) in Seoul. METHODS: We conducted a cross-sectional, retrospective study on the incidence of SAH using the National Emergency Department Information System (NEDIS) of Korea, a nationwide electronic emergency medical care database. Meteorological data (daily and monthly mean sea level air pressure, daily and monthly mean air temperature, daily temperature range) between January 2010 and December 2010 in Seoul were acquired from the Korea Meteorological Administration. The incidence of SAH in patients visiting the ED was defined as those assigned the following codes of the Korea Standard Classification of Disease, 6th Revision (KCD-6codes): I600-I609. RESULTS: The diurnal variation of the onset of SAH showed two broad peak times from 10 a.m. to 2 p.m. and from 4 p.m. to 7 p.m. There was a clear seasonal variation in the occurrence rate of SAH, which was higher in winter than in any other season. Daily temperature (mean, maximum, and minimum) and mean sea-level barometric pressure were not associated with the occurrence rates of SAH. Univariate analysis showed no significant difference between bleeding days and non-bleeding days for the number of SAH patients. In multivariate analysis, the monthly mean temperature showed significant correlation with the occurrence of SAH. CONCLUSION: This study showed seasonal variation in the onset of SAH. Conduct of further population-based study would be required in order to obtain more precise and valuable information.
Air Pressure ; Classification ; Climate* ; Emergencies ; Emergency Service, Hospital ; Epidemiology ; Hemorrhage ; Humans ; Incidence ; Information Systems ; Korea ; Multivariate Analysis ; Retrospective Studies ; Seasons* ; Seoul ; Subarachnoid Hemorrhage*

BACKGROUNDNontraumatic spontaneous subarachnoid hemorrhage (SAH) is associated with a high mortality. This study was conducted to investigate the epidemiological features of nontraumatic spontaneous SAH in China.

METHODSFrom January 2006 to December 2008, the clinical data of patients with nontraumatic SAH from 32 major neurosurgical centers of China were evaluated. Emergent digital subtraction angiography (DSA) was performed for the diagnosis of SAH sources in the acute stage of SAH (≤3 days). The results and complications of emergent DSA were analyzed. Repeated DSA or computed tomography angiography (CTA) was suggested 2 weeks later if initial angiographic result was negative.

RESULTSA total of 2562 patients were enrolled, including 81.4% of aneurysmal SAH and 18.6% of nonaneurysmal SAH. The total complication rate of emergent DSA was 3.9% without any mortality. Among the patients with aneurysmal SAH, 321 cases (15.4%) had multiple aneurysms, and a total of 2435 aneurysms were detected. The aneurysms mostly originated from the anterior communicating artery (30.1%), posterior communicating artery (28.7%), and middle cerebral artery (15.9%). Among the nonaneurysmal SAH cases, 76.5% (n = 365) had negative initial DSA, including 62 cases with peri-mesencephalic nonaneurysmal SAH (PNSAH). Repeated DSA or CTA was performed in 252 patients with negative initial DSA, including 45 PNSAH cases. Among them, the repeated angiographic results remained negative in 45 PNSAH cases, but 28 (13.5%) intracranial aneurysms were detected in the remaining 207 cases. In addition, brain arteriovenous malformation (AVM, 7.5%), Moyamoya disease (7.3%), stenosis or sclerosis of the cerebral artery (2.7%), and dural arteriovenous fistula or carotid cavernous fistula (2.3%) were the major causes of nonaneurysmal SAH.

CONCLUSIONSDSA can be performed safely for pathological diagnosis in the acute stage of SAH. Ruptured intracranial aneurysms, AVM, and Moyamoya disease are the major causes of SAH detected by emergent DSA in China.

Angiography, Digital Subtraction ; Arteriovenous Malformations ; epidemiology ; mortality ; Cerebral Angiography ; China ; epidemiology ; Hospitals ; statistics & numerical data ; Humans ; Intracranial Aneurysm ; epidemiology ; mortality ; Moyamoya Disease ; epidemiology ; mortality ; Subarachnoid Hemorrhage ; epidemiology ; mortality ; Tomography, X-Ray Computed

OBJECTIVE: To evaluate the epidemiological data of stroke patients admitted to Dong-Eui Hospital. METHOD: We performed a prospective study on 1370 cases of stroke consecutively admitted to the hospital from June, 2001 to May, 2002 during hospitalization by medical records and questionaire. RESULT: The highest incidence of the stroke was noted in the group of 60 years of age. The proportion of stroke subtypes were infarct (75.2%), intracranial hemorrhage (21.2%), and subarachnoid hemorrhage (3.6%). Sixteen percents of patients arrived over 24 hours after onset of stroke. The seasonal incidence was in order of frequency of spring, winter, autumn, and summer. The highest occurrence of the stroke was noted in May. The onset time of stroke was highest between 7: 00 am and 8: 00 am. Risk factors in stroke by the order of frequency were hypertension (61.1%), abnormal EKG at admission (45.5%), hyperlipidemia (38.3%), smoking (36.6%), previous stroke history (24.7%), and diabetes mellitus (24.7%). The common complications during hospitalization were pneumonia (7.6%), gastritis (5.6%), depression (4.8%), and hepatitis (4.6%). CONCLUSION: Although the results of this study obtained from one local hospital in Korea, they are valuable as basic epidemiologic data of stroke for the rospective community- based study in the future.
Depression ; Diabetes Mellitus ; Electrocardiography ; Epidemiology ; Gastritis ; Hepatitis ; Hospitalization ; Humans ; Hyperlipidemias ; Hypertension ; Incidence ; Intracranial Hemorrhages ; Korea ; Medical Records ; Pneumonia ; Prospective Studies ; Risk Factors ; Seasons ; Smoke ; Smoking ; Stroke* ; Subarachnoid Hemorrhage

Despite the great socioeconomic burden of stroke, there have been few reports of stroke statistics in Korea. In this scenario, the Epidemiologic Research Council of the Korean Stroke Society launched the “Stroke Statistics in Korea” project, aimed at writing a contemporary, comprehensive, and representative report on stroke epidemiology in Korea. This report contains general statistics of stroke, prevalence of behavioral and vascular risk factors, stroke characteristics, pre-hospital system of care, hospital management, quality of stroke care, and outcomes. In this report, we analyzed the most up-to-date and nationally representative databases, rather than performing a systematic review of existing evidence. In summary, one in 40 adults are patients with stroke and 232 subjects per 100,000 experience a stroke event every year. Among the 100 patients with stroke in 2014, 76 had ischemic stroke, 15 had intracerebral hemorrhage, and nine had subarachnoid hemorrhage. Stroke mortality is gradually declining, but it remains as high as 30 deaths per 100,000 individuals, with regional disparities. As for stroke risk factors, the prevalence of smoking is decreasing in men but not in women, and the prevalence of alcohol drinking is increasing in women but not in men. Population-attributable risk factors vary with age. Smoking plays a role in young-aged individuals, hypertension and diabetes in middle-aged individuals, and atrial fibrillation in the elderly. About four out of 10 hospitalized patients with stroke are visiting an emergency room within 3 hours of symptom onset, and only half use an ambulance. Regarding acute management, the proportion of patients with ischemic stroke receiving intravenous thrombolysis and endovascular treatment was 10.7% and 3.6%, respectively. Decompressive surgery was performed in 1.4% of patients with ischemic stroke and in 28.1% of those with intracerebral hemorrhage. The cumulative incidence of bleeding and fracture at 1 year after stroke was 8.9% and 4.7%, respectively. The direct costs of stroke were about ₩1.68 trillion (KRW), of which ₩1.11 trillion were for ischemic stroke and ₩540 billion for hemorrhagic stroke. The great burden of stroke in Korea can be reduced through more concentrated efforts to control major attributable risk factors for age and sex, reorganize emergency medical service systems to give patients with stroke more opportunities for reperfusion therapy, disseminate stroke unit care, and reduce regional disparities. We hope that this report can contribute to achieving these tasks.
Adult ; Aged ; Alcohol Drinking ; Ambulances ; Atrial Fibrillation ; Cerebral Hemorrhage ; Emergency Medical Services ; Emergency Service, Hospital ; Epidemiology ; Female ; Hemorrhage ; Hope ; Humans ; Hypertension ; Incidence ; Korea ; Male ; Mortality ; Prevalence ; Reperfusion ; Risk Factors ; Smoke ; Smoking ; Stroke ; Subarachnoid Hemorrhage ; Writing

OBJECTIVE: The purpose of this study is to present the epidemiological data on patients with a stroke admitted to the severance hospital, Yonsei University College of Medicine (YUMC) and to investigate the significant risk factors of stroke. METHODS: We reviewed medical records of 532 patients with a stroke admitted to the hospital of from 1992 to 1996 retrospectively. RESULTS: The incidence was highest in the sixth decade. Ischemic stroke (64.3%) was more common than a hemorrhagic stroke (35.7%) and the thrombotic infarction was the leading type (28.3%) of all kinds of stroke. Middle cerebral arterial territory was the most commonly involved site for the thrombotic and embolic stroke. Of the intracerebral hemorrhages, basal ganglia (48.4%) was the most commonly involved site with was followed by the thalamus (24.2%), lobar (19.3%), and cerebellum (6.5%). In subarachnoid hemorrhages, the aneurysm was most frequently located in the middle cerebral artery (34.4%). The possible contributing factors of stroke were hypertension, hypercholesterolemia, cigarette smoking and diabetes mellitus. The common complications during hospitalization were the frozen shoulders, depression, pneumonia, reflex sympathetic dystrophy (RSD), and hydrocephalus. CONCLUSION: This study showed the changing trends of stroke in its distribution of subtypes. Multicenter prospective study using stroke registry would be required for the determination of national epidemiologic trends.
Aneurysm ; Basal Ganglia ; Cerebellum ; Cerebral Hemorrhage ; Depression ; Diabetes Mellitus ; Epidemiology ; Hospitalization ; Humans ; Hydrocephalus ; Hypercholesterolemia ; Hypertension ; Incidence ; Infarction ; Medical Records ; Middle Cerebral Artery ; Pneumonia ; Reflex Sympathetic Dystrophy ; Retrospective Studies ; Risk Factors ; Shoulder ; Smoking ; Stroke* ; Subarachnoid Hemorrhage ; Thalamus

OBJECTIVES: Stroke has become the leading cause of death and disability among adults in China. This study aims to analyze the disease burden based on gender and age and the risk factors for stroke subtypes in China 2019, and to provide reference for targeted stroke prevention and control. METHODS: Based on 2019 data of the Global Burden of Disease (GBD), the gender and age in patients with different stroke subtypes (ischemic stroke, intracranial hemorrhage, subarachnoid hemorrhage) in China 2019 was described by using disability-adjusted life years (DALY), and attributable burden of related risk factors was analyzed. RESULTS: In 2019, the burden of intracranial hemorrhage was the heaviest one in China, resulting in 22.210 6 million person years of DALY, following by ischemic stroke and subarachnoid hemorrhage, resulting in 21.393 9 and 2.344 7 million person years of DALY, respectively. Among them, except the 0-14 age group, the disease burden of different subtypes of stroke in men was higher than that in women. The disease burden of ischemic stroke was increased with age in both men and women, with the heaviest disease burden in ≥70 years group. The disease burden of intracranial hemorrhage and subarachnoid hemorrhage was the heaviest in males aged 50-69 years old, and in females aged ≥70 years and 50-69 years, respectively. Metabolic factors were the main risk factors in all ages of different stroke subtypes, and the most important risk factor was high systolic blood pressure. Other risk factors were different between men and women. Smoking, high body mass index, high low-density lipoprotein, and outdoor particulate matter pollution were the main risk factors for stroke in men, while high body mass index, outdoor particulate matter pollution, and high fasting blood glucose were the main risk factors of stroke in women. The main risk were different among different age groups. CONCLUSIONS The burden and attributable risk factors for different stroke subtypes are discrepancy in different gender and age groups. Targeted interventions should be conducted in the future to reduce the burden of stroke.
Male ; Adult ; Humans ; Female ; Infant, Newborn ; Infant ; Child, Preschool ; Child ; Adolescent ; Middle Aged ; Aged ; Subarachnoid Hemorrhage/epidemiology* ; Quality-Adjusted Life Years ; Cost of Illness ; Stroke/etiology* ; Risk Factors ; China/epidemiology* ; Particulate Matter ; Ischemic Stroke ; Intracranial Hemorrhages/etiology*

Asia, which holds 60% of the world’s population, comprises some developing countries which are in economic transition. This paper reviews the epidemiology of stroke in South, East and South-East Asia. Data on the epidemiology of stroke in South, East, and South-East Asia were derived from the Global Burden of Disease study (mortality, disability-adjusted life-years [DALYs] lost because of stroke), World Health Organization (vascular risk factors in the community), and publications in PubMed (incidence, prevalence, subtypes, vascular risk factors among hospitalized stroke patients). Age- and sex-standardized mortality is the lowest in Japan, and highest in Mongolia. Community-based incidence data of only a few countries are available, with the lowest rates being observed in Malaysia, and the highest in Japan and Taiwan. The availability of prevalence data is higher than incidence data, but different study methods were used for case-finding, with different age bands. For DALYs, Japan has the lowest rates, and Mongolia the highest. For community, a high prevalence of hypertension is seen in Mongolia and Pakistan; diabetes mellitus in Papua New Guinea, Pakistan, and Mongolia; hypercholesterolemia in Japan, Singapore, and Brunei; inactivity in Malaysia; obesity in Brunei, Papua New Guinea, and Mongolia; tobacco smoking in Indonesia. Hypertension is the most frequent risk factor, followed by diabetes mellitus and smoking. Ischemic stroke occurs more frequently than hemorrhagic stroke, and subarachnoid hemorrhages are uncommon. There are variations in the stroke epidemiology between countries in South, East, and South-East Asia. Further research on stroke burden is required.
Asia* ; Brunei ; Cerebrovascular Disorders ; Developing Countries ; Diabetes Mellitus ; Epidemiology* ; Hypercholesterolemia ; Hypertension ; Incidence ; Indonesia ; Japan ; Malaysia ; Mongolia ; Mortality ; Obesity ; Pakistan ; Papua New Guinea ; Prevalence ; Risk Factors ; Singapore ; Smoke ; Smoking ; Stroke* ; Subarachnoid Hemorrhage ; Taiwan ; World Health Organization