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Multiple Cerebral Infarcts Following Acute Plasmodium vivax Infection.

Young Kyoung JANG ; Yang Ki MINN ; Soo Jin CHO ; Ki Han KWON

Korean Journal of Stroke.2012;14(3):149-151.

Cerebral malaria is a severe neurological complication of Plasmodium falciparum infection. Cerebral malaria can lead to cerebral infarction by several mechanisms including systemic inflammatory response. The systemic inflammatory response is known to rarely occur in Plasmodium vivax infection. We report a patient who developed multiple cerebral infarctions following Plasmodium vivax infection.
Cerebral Infarction ; Humans ; Malaria, Cerebral ; Plasmodium ; Plasmodium falciparum ; Plasmodium vivax

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Patterns of Collateral Pathway on Transfemoral Cerebral Angiography in Patients with Internal Carotid Artery Stenosis.

Min Ki SON ; Jae Myung KIM ; Hee Young HWANG ; Dong Jin SHIN

Korean Journal of Stroke.2012;14(3):142-148.

BACKGROUND: In recent studies, by utilizing single photon emission computed tomography (SPECT) and magnetic resonance angiography (MRA), anatomical and functional evaluation became possible. Although MRA is increasingly being used to evaluate vascular status, conventional angiography is still gold standard for investigating anatomical structures. We studied the correlation between internal carotid artery (ICA) stenosis, patterns of collateral pathway, and cerebrovascular reserve using transfemoral cerebral angiography (TFCA) and SPECT. METHODS: We studied 54 patients with symptomatic ICA stenosis who were visit to our hospital between Sep 2009 and May 2011. Forms of collateral pathway were classified into primary and secondary pathway group. Severity of ICA stenosis was divided into 4 stages. Vascular reserve on SPECT was classified into favorable and poor groups. RESULTS: As a result of TFCA, collateral pathways were observed in 44 of 54 patients. Collateral flow via anterior communicating artery (AcoA) pattern occupied the highest proportion and other major patterns were collaterals via posterior cerebral artery-middle cerebral artery (PCA-MCA) and via posterior communicating artery (PCoA) pattern. Twenty-eight patients were primary pathway group and 16 patients were secondary pathway group. In both groups, most patients had moderate or severe ICA stenosis. As a result of SPECT, favorable vascular reserves were observed in 17 of 54 patients. Most of them had mild ICA stenosis and/or primary collateral pathway. Contrarily, most of secondary pathway group had poor vascular reserve even if their ICA stenosis severity was mild. CONCLUSION: In patients with symptomatic ICA stenosis with collateral pathways, rate of primary collateral pathways was higher than secondary collateral pathways. Secondary collateral pathways had insufficient compensatory effect about reduced cerebral blood perfusion.
Angiography ; Arteries ; Carotid Artery, Internal ; Carotid Stenosis ; Cerebral Angiography ; Cerebral Arteries ; Collateral Circulation ; Constriction, Pathologic ; Humans ; Magnetic Resonance Angiography ; Perfusion ; Tomography, Emission-Computed, Single-Photon

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Relation of Stroke Risk Factors to Severity and Disability after Ischemic Stroke.

Kwangsoo KIM

Korean Journal of Stroke.2012;14(3):136-141.

BACKGROUND: The role of stroke risk factors as a determinant of clinical outcome is not well established. This study aimed to evaluate the prognostic value of stroke risk factors in patients with ischemic stroke by determining whether or not they contribute to stroke severity and disability after ischemic stroke. METHODS: Subjects were 433 patients with ischemic stroke. National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) were used to assess the severity of neurological deficit and clinical disability respectively. Multiple linear regression analysis was performed to evaluate the relation of stroke risk factors to stroke severity and disability. RESULTS: Among stroke risk factors, atrial fibrillation was significantly correlated with NIHSS (P<0.001) and mRS scores (P=0.006). Hypertension and age were significantly correlated with mRS scores (P=0.010, P=0.018, respectively). CONCLUSION: Atrial fibrillation was an independent factor associated with severe stroke and disability. Hypertension, and older age were independently correlated with serious disability after ischemic stroke.
Atrial Fibrillation ; Humans ; Hypertension ; Linear Models ; National Institutes of Health (U.S.) ; Risk Factors ; Stroke

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The rCBV Ratio Is a Predictive Factor for Developing Malignant Middle Cerebral Artery Infarction within 6 Hours of Symptom Onset.

Hyo Jin BAE ; Eun Hwan JEONG ; Dae Hyun KIM ; Jae Kwan CHA

Korean Journal of Stroke.2012;14(3):128-135.

BACKGROUND: Malignant middle cerebral artery (MCA) infarction is one of the leading cause of death for patients with acute MCA infarction. We investigated the predicting factors for developing malignant MCA infarction (MMI) using multi-parametric magnetic resonance imaging (MRI). METHODS: We included 159 MCA infarction patients who visited Dong-A University Stroke Center from January 2007 to December 2010 and were diagnosed MCA occlusion within 6 hours after symptom onset. All patients underwent brain MRI including diffusion and perfusion-weighted image. The definition of the malignant MCA infarction is as follows: 1) deterioration of neurological symptoms and consciousness with clinical signs of uncal herniation, and 2) at least two-thirds of the MCA territory with compression of ventricles or midline shifting. The neurological deterioration was observed for 7 days. The severity of neurological symptom and clinical outcome were assessed by using National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS). RESULTS: Among 159 patients, 49 patients (30.8%) developed MMI. In a multivariate analysis, a larger diffusion volume on diffusion-weighted image, a lower regional cerebral blood volume (rCBV) ratio on perfusion-weighted image, and a higher NIHSS score on admission were identified as the predictive factors of MMI. The cut-off values of diffusion volume, NIHSS on admission and rCBV ratio were 69 mL, 15 points and 0.78. CONCLUSION: A large diffusion volume, a high NIHSS score and particularly a low rCBV ratio can predict a malignant course in MCA infarction within 6 hours of symptom onset in MCA occlusion.
Blood Volume ; Brain ; Cause of Death ; Consciousness ; Diffusion ; Humans ; Infarction ; Infarction, Middle Cerebral Artery ; Magnetic Resonance Imaging ; Middle Cerebral Artery ; Multivariate Analysis ; National Institutes of Health (U.S.) ; Stroke

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Ischemic Stroke in Patients with Renal Transplantation.

Tae Jin SONG ; Myoung Jin CHA ; Jinkwon KIM ; Dong Hyun LEE ; Hye Sun LEE ; Chung Mo NAM ; Young Dae KIM ; Hyo Suk NAM ; Ji Hoe HEO

Korean Journal of Stroke.2012;14(3):122-127.

BACKGROUND: Impaired renal function may contribute to development of stroke and small vessel pathology in the brain. We investigated whether stroke subtype, initial stroke severity, early neurologic outcomes, time to cerebral infarction occurrence, and the presence of small vessel pathology in the brain are different between patients with end stage renal disease (ESRD) and those with renal transplantation (RT). METHODS: A total of 57 consecutive de novo RT patients (RT group) and 120 patients undergoing dialysis due to ESRD (ESRD group) who developed a first-ever acute cerebral infarction were enrolled. We compared stroke subtypes based on the Trial of Org 10172 in Acute Stroke Treatment classification, the presence of small vessel pathology (cerebral microbleed, leukoaraiosis and silent lacunar infarction) on MRI, stroke severity based on the National Institutes of Health Stroke Scale (NIHSS) and in-hospital mortality between the groups. RESULTS: The stroke subtypes, NIHSS scores at admission and in-hospital mortality were not different between the two groups. On multivariate analysis, the presence of high grade periventricular white matter changes tended to be more frequently detected in the ESRD group than the RT (P=0.078). The time from starting dialysis to stroke was longer in the RT group (129.9+/-60.9 months) than in the ESRD group (51.1+/-46.1 months). CONCLUSIONS: The stroke patterns, severity and short term outcomes were not different between RT and ESRD. The risk of cerebral infarction and high grade periventricular white matter changes may be reduced after RT in patients with ESRD.
Brain ; Cerebral Infarction ; Chondroitin Sulfates ; Dermatan Sulfate ; Dialysis ; Glycosaminoglycans ; Heparitin Sulfate ; Hospital Mortality ; Humans ; Kidney Failure, Chronic ; Kidney Transplantation ; Leukoaraiosis ; Multivariate Analysis ; National Institutes of Health (U.S.) ; Stroke

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Stroke Update 2012: Etiology and Mechanism of Stroke.

Seung Hoon LEE

Korean Journal of Stroke.2012;14(3):116-121.

In 2011, a number of studies shed further light on the understanding of stroke etiologies and mechanism. Regarding eating habit and a risk of stroke, three studies from Swedish cohort showed independent relations of chocolate, red meat, and coffee consumption with a risk of stroke. In relation to biomarkers, plasma tissue Kallikrein and resistin levels have been shown to be associated with a risk of stroke. In addition, with regard to infection and stroke, one study reported an increasing incidence of HIV infection in stroke patients and another study demonstrated that new-onset atrial fibrillation among patients with severe sepsis is associated with an increased risk of stroke. Finally, European consortium of cervical artery dissection reported risk factors for cervical artery dissection and differences between carotid and verterbral artery dissections.
Arteries ; Atrial Fibrillation ; Biomarkers ; Cacao ; Coffee ; Cohort Studies ; Eating ; HIV Infections ; Humans ; Incidence ; Light ; Meat ; Plasma ; Resistin ; Risk Factors ; Sepsis ; Stroke ; Tissue Kallikreins

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Focused Update on Primary Stroke Prevention in Patients with Atrial Fibrillation in Korean Clinical Practice Guidelines for Stroke.

Jong Moo PARK ; Keun Sik HONG ; Sang Won HAN ; Hahn Young KIM ; Yong Jin CHO ; Kyusik KANG ; Kyung Ho YU ; Joung Ho RHA ; Ji Hoe HEO ; Sun Uck KWON ; Chang Wan OH ; Hee Joon BAE ; Byung Chul LEE ; Byung Woo YOON ; Jaseong KOO

Korean Journal of Stroke.2012;14(3):106-115.

Pivotal clinical trials testing the efficacy of new antithrombotics for the prevention of stroke and systemic embolism in patients with atrial fibrillation have been published since the release of the first edition of Korean clinical practice guidelines for primary stroke prevention. From July 2007 to August 2012, 5 clinical studies and update of guidelines in Europe and North America were identified through systematic search. In patients with atrial fibrillation who were unsuitable for warfarin, the combination of clopidogrel and aspirin reduced the risk of stroke at the cost of increased major bleedings as compared to aspirin. In patients with nonvalvular atrial fibrillation and risk factors for stroke, new oral anticoagulants, dabigatran, rivaroxaban and apixaban, were as effective as or more effective than warfarin in preventing stroke or systemic embolism. The risks of major bleeding with novel anticoagulants were similar to or lower than that of warfarin. Particularly, the risk of intracranial bleeding was significantly lower with novel anticoagulants than with warfarin. In this report, we summarized the new evidences and updated our recommendations for primary stroke prevention in patients with atrial fibrillation.
Anticoagulants ; Aspirin ; Atrial Fibrillation ; Benzimidazoles ; beta-Alanine ; Embolism ; Europe ; Hemorrhage ; Humans ; Morpholines ; North America ; Primary Prevention ; Pyrazoles ; Pyridones ; Risk Factors ; Stroke ; Thiophenes ; Ticlopidine ; Warfarin ; Dabigatran ; Rivaroxaban

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Focused Update of Korean Clinical Practice Guidelines for the Thrombolysis in Acute Stroke Management.

Kyung Hee CHO ; Sang Bae KO ; Dae Hyun KIM ; Hee Kwon PARK ; A Hyun CHO ; Keun Sik HONG ; Kyung Ho YU ; Ji Hoe HEO ; Sun Uck KWON ; Hee Joon BAE ; Chang Wan OH ; O Ki KWON ; Byung Chul LEE ; Byung Woo YOON ; Joung Ho RHA

Korean Journal of Stroke.2012;14(3):95-105.

Since the release of first Korean Clinical Practice Guideline of Stroke in 2009, many important new evidences have emerged in the field of thrombolytic therapy. Among the recent developments are the extended therapeutic time window of intravenous (IV) tissue plasminogen activator (tPA) up to 4.5 hours after onset, and the efforts for the wider application of IV thrombolysis to patients with minor stroke and elderly patients over 80 years old. Debates about the optimal dose of IV tPA according to the ethnic population is still ongoing. Further evidences for the efficacy of intra-arterial thrombolysis have also accumulated, including the application of various novel mechanical devices with promising results. Thus update of guideline became necessary and we revise the acute stroke management guideline, focusing on the thrombolytic therapy.
Aged ; Humans ; Stroke ; Thrombolytic Therapy ; Tissue Plasminogen Activator

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Critical Appraisal of SAMMPRIS Study.

Kwang Yeol PARK

Korean Journal of Stroke.2012;14(1):55-56.

No abstract available.

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Critical Appraisal of SCAST Study.

Hahn Young KIM

Korean Journal of Stroke.2012;14(1):52-54.

No abstract available.
Benzimidazoles ; Blood Pressure ; Stroke ; Tetrazoles

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