BACKGROUND AND PURPOSE: Current therapy for acute ischemic stroke is highly focused on neuroprotective agents, and many ion channel blockers have been challenged for experimental models. In this study, we tried to reveal the neuroprotective effect of lamotrigine, a voltage-sensitive sodium channel blocker, for transient global ischemia of Mogolian gerbil. METHODS: Lamotrigine (50mg/kg) was administered via gastric tube 30 minutes before and after global ischemia (for 10 min) under body temperature monitoring. Sham-operated and non-treated ischemia group were compared. Seven days after reperfusion, gerbils were killed with perfusion/fixation technique and representative sections were cut through the hippocampus. Hematoxylin-Eosin staining was done for microscopic examination and number of viable neurons in CA1 area was counted. RESULTS: Neuronal density was different between sham-operated (n=11), non-treated ischemic (n=11), and lamotrigine-treated (n=26) group (107.8+13.1/mm vs. 21.5+23.0/mm vs. 82.0+13.1/mm, p<0.01). Both pre-(n=17) and post-treated group (n=9) showed significant neuroprotective effect compared with non-treated group. Neuronal density of pre-treated group was slightly higher than in post-treated group, though statistically not significant (84.6+13.0/mm vs. 77.3+12.7/mm, p=0.13). CONCLUSION: These results show that lamotrigine may have some effects reducing the delayed neuronal death in transient global ischemia. Considering the mechanism of action, we suggest that activation of voltage-sensitive sodium channel and release of glutamate at early phase of ischemia may be related to the delayed neuronal death.
Body Temperature ; Cerebral Infarction ; Gerbillinae ; Glutamic Acid ; Hippocampus ; Ion Channels ; Ischemia* ; Models, Theoretical ; Neurons ; Neuroprotective Agents* ; Reperfusion ; Sodium Channels ; Stroke

Transient ischemic attack (TIA) often precede cerebral infarcts as a warning symptom. But the studies revealing the frequency and the correlation between preceding TIAs and following infarcts are rare. According to the western data, about one-quarter of the patients with cerebral infarct have been supposed to have the previous history of TIAs. We prospectively studied the exact frequency, clinical presentation, and presumed causes of TIAs preceding cerebral infarct. Ninety five patients diagnosed as acute cerebral infarction were interviewed whether they had had previous episodes of TIA. 4 check-list using ordinary language was used, and NINDS diagnostic criteria was applied on the consensus between several neurologists. Seventeen patients (18%) had history of preceding TIAs. Carotid territory was affected in 11 patients (65%), while vertebrobasilar in 4(24%) and undetermined in 2. Duration was less than an hour in 10 patients(59%), and attacks were multiple in about half. Time interval between the last attack and infarction was less than one week in 10 cases(59%). Incidence of recent TIA ((1 month) was 22% in large artery disease(LAD), 11% In cardioembolism(CE), 9% in small-artery disease(SAD), and 7% in mixed etiology. Conclusion, TIAs preceding cerebral infarcts are not rare, but seems to be less common in Koreans than in Caucasians. As expected, atherothrombosis of large artery is supposed to be the leading cause of TIAs.
Arteries ; Cerebral Infarction ; Consensus ; Humans ; Incidence ; Infarction ; Ischemic Attack, Transient* ; National Institute of Neurological Disorders and Stroke ; Prospective Studies

BACKGROUND & OBJECTIVE: Recent studies suggest that anticoagulation, or antiplatelet therapy is safe and effective for the prevention of cardiogenic embolic stroke. However it has not been studied in Korea how the patients with cardioembolic source were managed in practice for the prevention of stroke. This study was done to assess the current status of primary and secondary prevention of cardioembolic stroke. METHODS: Retrospective study was undertaken in 124 patients with cardiogenic embolic stroke, following items were examined, previous anticoagulation or antiplatelet therapy, previous stroke, Insight of the heart disease, and International Normalize Ratio(INR) value on arrival at the hospital. RESULTS: In 124 patients cardioembolic sources were constituted of non-valvular atrial fibrillation (NVAF) in 54, rheumatic heart disease In 40, prosthetic cardiac valve In 14, dilated cardiomyopathy(D-CMP) in 6, left ventricular akinetic segment in 7(including 3 cases of LV thrombi), recent myocardial infarction in 3. In 93 patients with no previous stroke, 44 patients had regular medical follow-up because of his/her cardiac problems and primary prevention of stroke was made only in 12 (27%) patients (8 on anticoagulation and 4 on antiplatelet therapy). The rate of primary prevention varied according to the type of cardioembolic source; 100% with mechanical prosthetic valve, 33.3% with valvular atrial fibrillation, 6.7% with NVAF, and none with D-CMP and bioprosthetic valve. Previous stroke was found in 31 patients, among whom 24 had been followed regularly. Twenty patients(83%) were under secondary prevention of cardioembolic stroke (anticoagulation in 11 and antiplatelet agents in 9). Among 19 patients who developed stroke in spite of anticoagulation, INR values were lower than 1.5 in 12(63%), between 1.5 and 2.0 in 5(26%), and above 2.0 in 2(11%). CONCLUSION: Our results suggest that cardioembolic strokes have not been prevented properly. Many physicians seem to be reluctant to anticoagulate their patients with cardioembolic source, and even with anticoaguation the dosage is frequently insufficient to prevent stroke.
Atrial Fibrillation ; Follow-Up Studies ; Heart Diseases ; Heart Valves ; Humans ; International Normalized Ratio ; Korea ; Myocardial Infarction ; Platelet Aggregation Inhibitors ; Primary Prevention ; Retrospective Studies ; Rheumatic Heart Disease ; Secondary Prevention ; Stroke*

BACKGROUND: Cardiogenic embolic infarction is the most preventable type of ischemic stroke. This study was under-taken to compare the infarct size, prognosis, and risk factors between cardiogenic embolic infarction (CE) and large artery atherosclerotic infarction (LAA). METHODS:We reviewed the medical records and brain computed tomography/magnetic resonance image (CT/MRI) scans of patients with CE or LAA during the period between January 1996 and May 1998. Patients with lacunar and posterior circulation infarctions were excluded. A slice of brain CT/MRI scan showing the largest lesion was selected in each patient and the area of infarction was then measured. Prognosis was determined by the Modified Rankin Disability Scale (MRDS) and was grouped as either good (MDRS 0, 1, 2) or poor (MDRS 3, 4, 5). RESULTS: The study included 103 patients : 50 with CE (NVAF in 23, VHD with or without AF in 13, prosthetic valve in 6, and others in 8) and 53 with LAA (large artery thrombosis in 29, and artery to artery embolism in 24). The infarct size of CE (23.2+/-14.7 cm2) was significantly larger than that of LAA (11.4+/-10.5 cm2) (p<0.001). The infarct size of NVAF (29.0+/-19.1 cm2) was significantly larger than that of VHD with or without AF (19.2+/-11.5 cm2) (p<0.05). Patients with CE had a worse prognosis (poor in 46%) than those with LAA (poor in 23%) (p<0.05). CONCLUSIONS Our results showed that CE led to larger lesions and worse outcomes. Therefore, we emphasize the importance of primary and secondary preventions of stroke in patients with cardiogenic embolic sources.
Arteries* ; Brain ; Embolism ; Heart Valve Diseases ; Humans ; Infarction* ; Medical Records ; Prognosis* ; Risk Factors ; Secondary Prevention ; Stroke ; Thrombosis

No abstract available.
Gait* ; Humans ; Spinal Cord Diseases*

We retrospectively analyzed 29 patients with caudate hemorrhage, and evaluated the prognosis and the predictors of short-term and long-term outcomes. P With caudate hemorrhage showed better short-term outcome compared to those with intracerebral hemorrhages in general. However, the ciance re -ing was Rebleedmg, which had interval of less than 1 year in most cases, occurred mainly in patients with previous stroke. And this worsened the patients' outcome. Management of risk factors is critical. The prognostic factor influencing on the short-term outcome was the initial consciousness level and the long-term outcome could be anticipated through the evaluation of the neurologic status on the 30th day; subsequent improvement was expected in patients with mild abnormality, but not in those with moderate to severe disability.
Cerebral Hemorrhage ; Consciousness ; Hemorrhage* ; Humans ; Prognosis* ; Retrospective Studies ; Risk Factors ; Stroke

OBJECTIVE: To define the incidence, the prognosis, and the risk factors of neurologic complications of open heart surgery. Background. Open heart surgery poses many hemodynamic, embolic, and metabolic threats to the brain with multiple factors relating to neurologic complications. Despite the progress in surgical technique, neurologic complications remain major causes of morbidity and occasional mortality. METHODS: Data were obtained from the charts of 297 patients submitted to open heart surgery at SNUH in 1993. We analysed the risk factors for CNS complications and identified the incidence, the type, and the results of the complications. RESULTS: Among 297 patients, CNS complications occurred in 34 patients(11.4%). The incidences of each complication were as follows. ; 6 anoxic encephalopathies(17.7%), 12 encephalopathies of uncertain etiology(35.3%), 7 seizures (20.6%), 6 TIAs or. Infarctions(17.7%), and 3 other complications(8.8%). Of the 34 patients, there were 6 deaths (17.7%), 1 vegetative state(2.9%), 1 major neurologic deficit(2.9%), 3 minor neurologic deficits(8.8%), and full recovery in 23 patients(67.7%). The risk factors such as age, presence of thrombi, type of operation, duration of bypass, duration of aortic clamping time, use of total circulatory arrest, re-operation, and use of ventricular assist device were statistically significant. CONCLUSION: The CNS complications of open heart surgery are infrequent but still remain important causes of morbidity and mortality. Evaluating the risk factors could be of help to prevent the CNS complications.
Brain ; Constriction ; Heart* ; Heart-Assist Devices ; Hemodynamics ; Humans ; Incidence ; Mortality ; Prognosis ; Risk Factors ; Seizures ; Thoracic Surgery*

BACKGROUND: In experimental cerebral ischemia, hypothermia protects the brain, while hyperglycemia aggravates ischemic damage. Clinical studies have also reported worse outcomes in ischemic stroke patients with hyperglycemia or fever and improved outcomes with hypothermic therapy. However, it is not well known what will happen if these opposite effects exist together. METHODS: Sixty male Sprague-Dawley rats were used. Focal cerebral ischemia was induced for 2 hours by an intraluminal thread followed by reperfusion for 4 hours. Rats were divided into 4 groups; 1) normo-glycemic normothermic (NGNT), 2) normoglycemic hypothermic (low temperature) (NGLT), 3) hyperglycemic normothermic (HGNT), and 4) hyperglycemic hypothermic (HGLT) groups (n=15 for each group). Hyperglycemia wasmade by intraperitoneal injection of streptozotocin (60 mg/kg) 3 days before ischemia. The body temperature was maintained at 37+/-1 degrees C in normothermic animals, while lowered at 32+/-1 degrees C in hypothermic animals during the ischemic period. Following reperfusion, 2-mm thick coronal slices were obtained and stained by triphenyltetrazolium chloride. The infarct volume was measured using an image analyzer. RESULTS: Mean glucose levels (mean+/-SD in mg/dl) were 77.9+/-9.3 in NGNT, 77.7+/-11.5 in NGLT, 311.0+/-69.2 in HGNT, and 355.3+/-57.7 in HGLT. Mean infarct volumes (mean+/-SD in mm 3) were 168.2+/-44.2 in NGNT, 66.2+/-24.2 in NGLT, 417.6+/-123.2 in HGNT, and 337.2+/-89.3 in HGLT. The protective effect of hypothermia was less evident in hyperglycemic rats and the aggravating effect of hyper-glycemia was more evident in hypothermic rats. Infarct volume of HGLT was 2-fold bigger than that of NGNT (p<0.05). CONCLUSIONS: Our results suggest that the detrimental effect of hyperglycemia may override the protective effect of hypothermia in transient focal cerebral ischemia.
Animals ; Body Temperature ; Brain ; Brain Ischemia* ; Fever ; Glucose ; Humans ; Hyperglycemia* ; Hypothermia* ; Injections, Intraperitoneal ; Ischemia ; Male ; Rats* ; Rats, Sprague-Dawley ; Reperfusion ; Streptozocin ; Stroke

BACKGROUND: The aim of this study is to compare the diagnostic power of transorbital Doppler (TOD) and magnetic resonance angiography (MRA) in detecting carotid siphon disease (CSD) confirmed by conventional angiography (CA) and elucidate the diagnostic role of TOD in CSD. METHODS: We recruited the patients who underwent TOD, MRA and CA within 2 months. TOD velocities above 75cm/sec or no flow was defined as abnormal. Carotid siphon on MRA and CA was divided into C2 & C4 segments; stenosis more than 50% or occlusion on the segment corresponding to the flow direction of TOD was defined abnormal. RESULTS: Sixty patients (44 males and 16 females, mean age: 55.4+/-12.2 years) were recruited. In 117 available carotid siphons 16 vessels (13.7%) were detected as abnormal by CA, 23 vessels (19.7%) by TOD, and 29 vessels (24.8%) by MRA. When CA was used as a gold-standard, the sensitivity and specificity of TOD were 75.0% and 89.1% while those of MRA were 87.5% and 85.1%, respectively. Positive predictive value was about half (52.2% in TOD and 48.3% in MRA) and negative predictive value was over 95% (95.7% in TOD and 97.7% in MRA). The diagnostic accuracy was 87.2% in TOD and 85.5% in MRA. When TOD and MRA were normal, CA was also normal in 98.7% and when both tests were abnormal, CA was abnormal in 78.6%. But when one of two tests was abnormal, CA was abnormal only in 16.7%. Diagnostic consistency of TOD & MRA was acceptable (kappa value = 0.409). Among 23 carotid siphons, which were abnormal on TOD, 11 vessels were normal on CA; false positive rate was 47.8%. But we could find the presumed causes of false positive results in most of cases, such as contralateral proximal ICA occlusion, ipsilateral ICA stenosis just proximal to carotid siphon, etc. CONCLUSIONS: Transorbital Doppler is as good as MRA in noninvasive detection of carotid siphon disease. Despite of the relatively low positive predictive value of TOD and MRA, the combination of their results increases the diagnostic accuracy in carotid siphon disease and may reduce the need of conventional angiography.
Angiography* ; Constriction, Pathologic ; Female ; Humans ; Magnetic Resonance Angiography ; Male ; Sensitivity and Specificity

BACKGROUND: Hyperthermia is known to be one of the important poor prognostic factors of ischemic stroke. However, the prognostic role of fever in hemorrhagic stroke is not clear. We investigated whether the prognostic role of fever is influenced by the type of stroke. METHODS: We analyzed the linical data of patients who were admitted to our hospital within three days after the onset of stroke during 28 months. We divided the patients into three groups according to the degree of maximum temperature recorded during the first seven days; no fever (< OR=37.2 degrees C), low grade (37.3~38.0 degrees C) or high grade (> OR=38.1degrees C) fever. Using the modified Rankin disability scale (MRDS) at discharge, clinical outcome was dichotomized into favorable (MRDS 0~2) and unfavorable (MRDS 3~5) categories. The size of lesion, age, sex, alcohol, diabetes, hypertension, initial glucose level, hypercholesterolemia, heart disease, smoking, previous stroke, and initial National Institutes of Health Stroke Scale (NIHSS) were investigated. RESULTS: Of 217 patients, 46.1% had no fever, 36.9% had low grade fever, and 17.1% had high grade fever. Fever was strongly correlated with outcome in patients with stroke of any type (p<0.05). The size of lesion was also significantly correlated with the degree of fever in patients with ischemic stroke (p=0.01). Multivariate analysis in the logistic model revealed that fever and NIHSS were independent predictors for a poor prognosis. CONCLUSIONS: Fever in patients with acute stroke is an independent poor prognostic factor regardless of stroke type.
Body Temperature* ; Fever ; Glucose ; Heart Diseases ; Humans ; Hypercholesterolemia ; Hypertension ; Logistic Models ; Multivariate Analysis ; National Institutes of Health (U.S.) ; Prognosis ; Smoke ; Smoking ; Stroke*