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Prevalence and Characteristics of Unruptured Cerebral Aneurysms in Ischemic Stroke Patients.

Ji Hwa KIM ; Sang Hyun SUH ; Joonho CHUNG ; Yeo Jin OH ; Sung Jun AHN ; Kyung Yul LEE

Journal of Stroke.2016;18(3):321-327. doi:10.5853/jos.2016.00164

BACKGROUND AND PURPOSE: The prevalence of unruptured cerebral aneurysms (UCAs) in ischemic stroke patients is not clearly defined. This study aimed to measure the prevalence and characteristics of UCAs in patients with acute ischemic stroke (AIS) and to compare our findings with those of the general population. In addition, we investigated the factors associated with cerebral aneurysms in AIS patients. METHODS: We retrospectively reviewed the brain magnetic resonance angiography images of 955 patients with AIS and 2,118 controls who had received a brain magnetic resonance angiography as part of a health check-up. We investigated the prevalence, size, location, and risk factors of the subjects in the context of UCAs. RESULTS: UCAs were found in 74 patients with AIS (7.7%) and in 79 who received a health check-up (3.7%). The prevalence of UCAs was significantly higher in the AIS group than in the health check-up group (odds ratio 2.17, 95% confidence interval 1.56-3.01). The mean aneurysm diameter was larger in the AIS group than in the health check-up group (3.75 mm vs. 3.02 mm, P=0.009). UCAs were primarily located in the internal carotid artery in both groups, and aneurysms in the middle cerebral artery were particularly common in the AIS group. According to multivariate analysis, hypertension alone was associated with an increased prevalence of UCAs in stroke patients. CONCLUSIONS: This study identified a higher prevalence and larger size of UCAs in AIS patients than in the general population. Hypertension was an independent risk factor of UCA in AIS.
Aneurysm ; Brachyura ; Brain ; Carotid Artery, Internal ; Humans ; Hypertension ; Intracranial Aneurysm* ; Magnetic Resonance Angiography ; Middle Cerebral Artery ; Multivariate Analysis ; Prevalence* ; Retrospective Studies ; Risk Factors ; Stroke*

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Association between Aortic Atheroma and Cerebral Small Vessel Disease in Patients with Ischemic Stroke.

Tae Jin SONG ; Young Dae KIM ; Joonsang YOO ; Jinkwon KIM ; Hyuk Jae CHANG ; Geu Ru HONG ; Chi Young SHIM ; Dongbeom SONG ; Ji Hoe HEO ; Hyo Suk NAM

Journal of Stroke.2016;18(3):312-320. doi:10.5853/jos.2016.00171

BACKGROUND AND PURPOSE: Cerebral small vessel disease (SVDs) are related with large artery atherosclerosis. However, the association between aortic atheroma (AA) and cerebral small vessel disease has rarely been reported. This study evaluated the relationship between presence and burden of AAs and those of SVDs in patients with acute ischemic stroke. METHODS: We included 737 consecutive patients who underwent transesophageal echocardiography (TEE) and brain magnetic resonance imaging (MRI) for evaluation of acute stroke. AA subtypes were classified as complex aortic plaque (CAP) and simple aortic plaque (SAP). Presence and burden of SVDs including cerebral microbleeds (CMBs), white matter hyperintensities (WMHs), perivascular spaces (PVSs), asymptomatic lacunar infarctions (ALIs), and total SVD score, were investigated. RESULTS: AA was found by TEE in 360 (48.8%) patients including 11.6% with CAP and 37.2% with SAP. One or more types of SVDs was found in 269 (36.4%) patients. In multivariable analysis, presence of CMBs (odds ratio [OR] 4.68), high-grade WMHs (OR 3.13), high-grade PVSs (OR 3.35), and ALIs (OR 4.24) were frequent in patients with AA than those without AA. Each 1-point increase in total SVD score increased the odds of presence of CAP (OR 1.94, 95% confidence interval (CI) 1.44-1.85) and SAP (OR 1.54, 95% CI 1.35-1.75). CONCLUSIONS: In this study, patients with AA frequently had cerebral SVDs. Larger burden of AA was associated with advanced cerebral SVDs. Our findings give an additional information for positive relationship with systemic atherosclerosis and coexisting cerebral SVDs in acute ischemic stroke patients.
Arteries ; Atherosclerosis ; Brain ; Cerebral Small Vessel Diseases* ; Echocardiography, Transesophageal ; Humans ; Magnetic Resonance Imaging ; Plaque, Atherosclerotic* ; Stroke* ; Stroke, Lacunar ; White Matter

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Association of Left Atrial Enlargement with Cortical Infarction in Subjects with Patent Foramen Ovale.

Mi Ji LEE ; Sung Ji PARK ; Chang Hyo YOON ; Ji Won HWANG ; Sookyung RYOO ; Suk Jae KIM ; Gyeong Moon KIM ; Chin Sang CHUNG ; Kwang Ho LEE ; Oh Young BANG

Journal of Stroke.2016;18(3):304-311. doi:10.5853/jos.2016.00290

BACKGROUND AND PURPOSE: Left atrial dysfunction has been reported in patients with patent foramen ovale (PFO). Here we investigated the role of left atrial dysfunction in the development of embolic stroke in patients with PFO. METHODS: We identified consecutive patients with embolic stroke of undetermined sources except for PFO (PFO+ESUS). Healthy subjects with PFO served as controls (PFO+control). A stratified analysis by 10-year age group and an age- and sex- matching analysis were performed to compare echocardiographic markers between groups. In the PFO+ESUS group, infarct patterns of PFO-related stroke were determined (cortical vs. cortico-subcortical) and analyzed in correlation with left atrial function parameters. RESULTS: A total of 118 patients and 231 controls were included. The left atrial volume indices (LAVIs) of the PFO+ESUS patients were higher than those of the PFO+controls in age groups of 40–49, 50–59, and 60–69 years (P<0.001, P=0.003, and P=0.027, respectively), and in the age- and sex-matched analysis (P=0.001). In the PFO+ESUS patients, a higher (>28 mL/m2) LAVI was more associated with the cortical infarct pattern (P=0.043 for an acute infarction and P=0.024 for a chronic infarction, both adjusted for age and shunt amount). The degree of right-to-left shunting was not associated with infarct patterns, but with the posterior location of acute infarcts (P=0.028). CONCLUSIONS: Left atrial enlargement was associated with embolic stroke in subjects with PFO. Left atrial physiology might contribute to the development of PFO-related stroke and need to be taken into consideration for optimal prevention of PFO-related stroke.
Atrial Function, Left ; Echocardiography ; Embolism ; Embolism, Paradoxical ; Foramen Ovale, Patent* ; Healthy Volunteers ; Heart Atria ; Humans ; Infarction* ; Physiology ; Stroke

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Difference in the Location and Risk Factors of Cerebral Microbleeds According to Ischemic Stroke Subtypes.

Bum Joon KIM ; Youngshin YOON ; Hoyon SOHN ; Dong Wha KANG ; Jong S KIM ; Sun U KWON

Journal of Stroke.2016;18(3):297-303. doi:10.5853/jos.2016.00360

BACKGROUND AND PURPOSE: The location of cerebral microbleeds (CMBs) may differ according to ischemic stroke subtype, and the underlying pathomechanism may differ by their location. Here, we investigated the characteristics of CMBs according to various ischemic stroke subtypes to verify this issue. METHODS: Patients with acute ischemic stroke were consecutively included. The presence of CMBs was determined by gradient echo image sequence. The distribution of CMBs was classified as deep, lobar, or diffuse (both deep and lobar). The prevalence, risk factors, and distribution of CMBs were compared among patients with different stroke subtypes. Factors associated with the distribution of CMBs were investigated. RESULTS: Among the 1033 patients included in this study, ischemic stroke subtypes were classified as large artery atherosclerosis (LAA; n=432), small vessel occlusion (SVO; n=304), and cardioembolism (CE; n=297). The prevalence of CMBs was highest in patients with SVO (40.5%), followed by CE (33.0%) and LAA (24.8%; P<0.001). The locations of CMBs was different according to subtype (P=0.004). CE [odds ratio (OR)=1.85 (1.02-3.34); P=0.042] and the use of antithrombotics [OR=1.80 (1.10-2.94); P=0.019] were associated with lobar CMBs, and old age [OR=1.02 (1.00-1.04); P=0.015] and hypertension [OR=1.61 (1.08-2.40); P=0.020] were associated with deep CMBs. CONCLUSIONS: CMBs were frequently located in the lobar area in patients with CE. Previous use of antithrombotic agents is associated with lobar CMBs. The pathogenic mechanism of CMB may differ according to ischemic stroke subtype and location.
Arteries ; Atherosclerosis ; Classification ; Fibrinolytic Agents ; Humans ; Hypertension ; Prevalence ; Risk Factors* ; Stroke*

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Direct Thrombus Imaging in Stroke.

Jongseong KIM ; Jung E PARK ; Matthias NAHRENDORF ; Dong Eog KIM

Journal of Stroke.2016;18(3):286-296. doi:10.5853/jos.2016.00906

There is an emergent need for imaging methods to better triage patients with acute stroke for tissue-plasminogen activator (tPA)-mediated thrombolysis or endovascular clot retrieval by directly visualizing the size and distribution of cerebral thromboemboli. Currently, magnetic resonance (MR) or computed tomography (CT) angiography visualizes the obstruction of blood flow within the vessel lumen rather than the thrombus itself. The present visualization method, which relies on observation of the dense artery sign (the appearance of cerebral thrombi on a non-enhanced CT), suffers from low sensitivity. When translated into the clinical setting, direct thrombus imaging is likely to enable individualized acute stroke therapy by allowing clinicians to detect the thrombus with high sensitivity, assess the size and nature of the thrombus more precisely, serially monitor the therapeutic effects of thrombolysis, and detect post-treatment recurrence. This review is intended to provide recent updates on stroke-related direct thrombus imaging using MR imaging, positron emission tomography, or CT.
Angiography ; Arteries ; Humans ; Magnetic Resonance Imaging ; Methods ; Positron-Emission Tomography ; Recurrence ; Stroke* ; Therapeutic Uses ; Thrombosis* ; Tomography, X-Ray Computed ; Triage

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Traditional Risk Factors for Stroke in East Asia.

Young Dae KIM ; Yo Han JUNG ; Gustavo SAPOSNIK

Journal of Stroke.2016;18(3):273-285. doi:10.5853/jos.2016.00885

Stroke is one of the leading causes of death and morbidity worldwide. The occurrence of stroke is strongly dependent on well-known vascular risk factors. After rapid modernization, urbanization, and mechanization, East Asian countries have experienced growth in their aged populations, as well as changes in lifestyle and diet. This phenomenon has increased the prevalence of vascular risk factors among Asian populations, which are susceptible to developing cardiovascular risk factors. However, differing patterns of stroke risk factor profiles have been noted in East Asian countries over the past decades. Even though the prevalence of vascular risk factors has changed, hypertension is still prevalent and the burden of diabetes and hypercholesterolemia will continue to increase. Asia remains a high tobacco-consuming area. Although indicators of awareness and management of vascular risk factors have increased in many East Asian countries, their rates still remain low. Here we review the burdens of traditional risk factors, such as hypertension, diabetes, hypercholesterolemia, and smoking in East Asia. We will also discuss the different associations between these vascular risk factors and stroke in Asian and non-Asian populations.
Asia ; Asian Continental Ancestry Group ; Cause of Death ; Diet ; Epidemiology ; Far East* ; Humans ; Hypercholesterolemia ; Hypertension ; Life Style ; Prevalence ; Risk Factors* ; Smoke ; Smoking ; Social Change ; Stroke* ; Urbanization

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Neural Stem Cells and Ischemic Brain.

Zhenggang ZHANG ; Michael CHOPP

Journal of Stroke.2016;18(3):267-272. doi:10.5853/jos.2016.00206

Stroke activates neural stem cells in the ventricular-subventricular zone (V/SVZ) of the lateral ventricle, which increases neuroblasts and oligodendrocyte progenitor cells (OPCs). Within the ischemic brain, neural stem cells, neuroblasts and OPCs appear to actively communicate with cerebral endothelial cells and other brain parenchymal cells to mediate ischemic brain repair; however, stroke-induced neurogenesis unlikely plays any significant roles in neuronal replacement. In this mini-review, we will discuss recent findings how intercellular communications between stroke-induced neurogenesis and oligodendrogenesis and brain parenchymal cells could potentially facilitate brain repair processes.
Brain* ; Endothelial Cells ; Lateral Ventricles ; Neural Stem Cells* ; Neurogenesis ; Neurons ; Oligodendroglia ; Stem Cells ; Stroke

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Adult Stem Cell Therapy for Stroke: Challenges and Progress.

Oh Young BANG ; Eun Hee KIM ; Jae Min CHA ; Gyeong Joon MOON

Journal of Stroke.2016;18(3):256-266. doi:10.5853/jos.2016.01263

Stroke is one of the leading causes of death and physical disability among adults. It has been 15 years since clinical trials of stem cell therapy in patients with stroke have been conducted using adult stem cells like mesenchymal stem cells and bone marrow mononuclear cells. Results of randomized controlled trials showed that adult stem cell therapy was safe but its efficacy was modest, underscoring the need for new stem cell therapy strategies. The primary limitations of current stem cell therapies include (a) the limited source of engraftable stem cells, (b) the presence of optimal time window for stem cell therapies, (c) inherited limitation of stem cells in terms of growth, trophic support, and differentiation potential, and (d) possible transplanted cell-mediated adverse effects, such as tumor formation. Here, we discuss recent advances that overcome these hurdles in adult stem cell therapy for stroke.
Adult Stem Cells* ; Adult* ; Biocompatible Materials ; Bone Marrow ; Cause of Death ; Humans ; Mesenchymal Stromal Cells ; Stem Cells ; Stroke*

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Post-stroke Mood and Emotional Disturbances: Pharmacological Therapy Based on Mechanisms.

Jong S KIM

Journal of Stroke.2016;18(3):244-255. doi:10.5853/jos.2016.01144

Post-stroke mood and emotional disturbances are frequent and diverse in their manifestations. Out of the many post-stroke disturbances, post-stroke depression, post-stroke anxiety, post-stroke emotional incontinence, post-stroke anger proneness, and post-stroke fatigue are frequent and important symptoms. These symptoms are distressing for both the patients and their caregivers, and negatively influence the patient’s quality of life. Unfortunately, these emotional disturbances are not apparent and are therefore often unnoticed by busy clinicians. Their phenomenology, predicting factors, and pathophysiology have been under-studied, and are under-recognized. In addition, well-designed clinical trials regarding these symptoms are rare. Fortunately, these mood and emotional disturbances may be treated or prevented by various methods, including pharmacological therapy. To administer the appropriate therapy, we have to understand the phenomenology and the similarities and differences in the pathophysiological mechanisms associated with these emotional symptoms. This narrative review will describe some of the most common or relevant post-stroke mood and emotional disturbances. The phenomenology, factors or predictors, and relevant lesion locations will be described, and pharmacological treatment of these emotional disturbances will be discussed based on presumable pathophysiological mechanisms.
Affective Symptoms* ; Anger ; Anxiety ; Caregivers ; Depression ; Fatigue ; Humans ; Quality of Life ; Serotonin ; Stroke

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Journal of Stroke (JoS) Receives High Impact Factor.

Jong S KIM

Journal of Stroke.2016;18(3):243-243. doi:10.5853/jos.2016.01284

No abstract available.
Stroke*

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