In Akita Prefecture, there are nine hospitals established by the Akita Prefectural Federation of Agricultural Cooperatives for Health and Welfare (Koseiren). Half of the stroke patients in the prefecture were treated in these Koseiren hospitals, and half of the mass screening projects for the prevention of cardio vascular diseases were undertaken by these hospitals. A retrospective cohort study was done using mass-screening data (age, sex, past history of diabetes mellitus, blood pressure, body mass index, smoking and drinking habits) of 175,033 cases stored at these hospitals from 1988 to 1999, and the prefecture-wide stroke data of 2,520 initial stroke events registered from 1988 to 2003. The number of stroke cases was broken down into 1,428 cases of cerebral infarction (57%, CI), 693 cases of cerebral hemorrhage (27%, CH) and 399 cases of subarachnoid hemorrhage (16%, SAH). The subjects were also divided into five age groups:30-49, 50-59, 60-69, 70-79 and 80-89. Blood pressure (BP) was classified into six categories according to the JNC 6 criteria. Risk factors were determined using the Cox analysis. The hazard ratio for CI and CH was increasing with advancing age. CI showed a higher hazard ratio in men than women (hazard ratio for men was 1.8). The hazard ratio was increasing as BP became higher in any of three stroke subtypes, and especially CH showed the strongest correlation with BP. Uncontrollable risk factors were very closely associated with the attack of CI. On the other hand, BP (controllable risk) was closely linked with the attack of CH. Our results showed the prevention of CI was not easy. Controlling BP may be the most effective strategy for preventing hemorrhagic stroke (CH and SAH).
Cerebrovascular accident ; Cephalic index ; Blood pressure determination ; hazard ; Risk Factors

OBJECTIVES: Recent educational efforts have concentrated on patient's early hospital arrival after symptom onset. The purpose of this study was to evaluate the time interval between symptom onset and hospital arrival and to investigate its relation with clinical outcomes for patients with acute ischemic stroke. METHODS: A prospective registry of patients with signs or symptoms of acute ischemic stroke, admitted to the OO Medical Center through emergency room, was established from September 2003 to December 2004. The interval betwee symptom onset and hospital arrival was recorded for each eligible patient and analyzed together with clinical characteristics, medication type, severity of neurologic deficits, and functional outcomes. RESULTS: Based on the data of 256 patients, the median interval between symptom onset and hospital arrival was 13 hours, and 22% of patients were admitted to the hospital within 3 hours after symptom onset. Patients of not-mild initial severity and functional status showed significant differences between arrival hours of 0-3 and later than 3 in terms of their functional outcomes on discharge. Logistic regression models also showed that arrival within 3 hours was a significant factor influencing functional outcome (OR=5.6; 95% CI=2.1, 15.0), in addition to patient's initial severity, old age, cardioembolism subtype, and referral to another hospital. CONCLUSIONS: The time interval between symptom onset and hospital arrival significantly influenced treatment outcome for patients with acute ischemic stroke, even after controlling for other significant clinical characteristics. The findings provided initiatives for early hospital arrival of patients and improvement of emergency medical system.
Treatment Outcome ; Prospective Studies ; Middle Aged ; Male ; Korea/epidemiology ; Humans ; *Hospitalization ; Female ; Cerebrovascular Accident/epidemiology/*therapy ; Brain Ischemia/physiopathology ; Aged, 80 and over ; Aged ; Adult ; Acute Disease

PURPOSE: We investigated the usefulness of video based, fluoroscopically guided abduction motion analysis of hemiplegic shoulders. PATIENTS AND METHODS: Twenty-two stroke patients with Brunnstrom stages 3-4 (Group 1) or 5-6 (Group 2) were enrolled in this study. Patients with shoulder pain and significant spasticity (MAS 2) were excluded. We recorded motion pictures of the abductions of affected and unaffected shoulder joints under an AP fluoroscopic guide. Lateral scapular slide distances (D1: T2- superior angle, D2: T3- scapular spine, D3: T7-inferior angle) were measured at 30 degrees, 60 degrees, 90 degrees during glenohumeral abduction in a captured photographic image. The angles of scapular rotation and trajectory (stromotion) of the humeral head center, relative to the 3rd thoracic spine in the abduction motion were analyzed. RESULTS: In Group 1, a significant difference was found in the lateral scapular slide distance between the affected and sound sides. However, no significant side to side difference was found in Group 2. Scapular angles in abduction were also increased in Group 1. Patients with a more synergistic movement pattern showed less scapular stabilizing muscle activity and, instead, exhibited a compensatory "shrugging" like motion accomplished by spinal tilting. CONCLUSION: The present findings support the notion that the above parameters of fluoroscopically guided shoulder abduction motion analysis correlate well with clinical findings. These parameters should be useful for evaluations of hemiplegic shoulder biomechanics.
Video Recording ; Shoulder Joint/*physiopathology/radiography ; Movement/*physiology ; Middle Aged ; Humans ; Hemiplegia/etiology/*physiopathology/radiography ; Functional Laterality ; Fluoroscopy ; Cerebrovascular Accident/complications ; Cerebral Infarction/complications ; Aged

Various physiological parameters like blood pressure, temperature, blood sugar after onset of stroke have been proposed as possible marker of stroke prognosis to study the glycaemic status after acute stroke and assess the role of glycaemic status along with other clinical parameters in influencing stroke outcome. Forty-two confirmed stroke patients attending hospital within 6 hours of onset of stroke onset were included in the study. The time lag for hospitalization, blood pressure, blood sugar, HbA1c, stroke severity according to Toronto Scale, demographic factors, stroke onset type, type of stroke, past history of stroke, diabetes, and hypertension were recorded. The outcome was whether patient survived at the end of forth week. Twenty-one percent of patients who were not known diabetic found to be hyperglycemic though their HBA1C level was normal. Eighty-nine percent of such patients died. This rate was significantly higher than patients known to be diabetic with raised sugar and HBA1c level (26% patients, 12% mortality). There was strong and significant association between stroke severity and poor outcome. Strong and significant association was also found between stroke severity and blood sugar level. Modeling of stroke outcome using decision tree analysis (QUEST) found stroke severity as most important and significant predictor especially for severe stroke cases. In mild and moderately severe stroke, high sugar level was found to be a predictor, though not statistically significant.This study suggests that stroke severity is the most important predictor of stroke outcome, with high sugar level as a marker of stroke severity.
Cerebrovascular accident ; Biological Markers ; Sugars ; prognostic ; Blood Glucose

Stroke is the third leading cause of death, a major cause of disability in adults, and is frequently more disabling than fatal. With a decline in mortality from initial cerebral infarction and an increase in the life expectancy of the population, the number of patients with recurrent stroke and ensuing cardiovascular events will become greater. Thus it is important to find out those patients at high risk of stroke recurrence. This case report illustrates the process of recurrent stroke and the resulting disabilities and morbidities in a 42-year- old man. The role of integrated stroke rehabilitation programme is described.
Cerebrovascular accident ; Recurrent ; Cardiovascular ; Disability, NOS ; Role

Procoagulant or impaired fibrinolytic states as well as inflammatory reactions mediated by cytokines are likely involved in the pathogenesis of acute ischemic stroke. We examined the potential relationship between interleukin 6 (IL-6) and hemostatic markers. The procoagulant and fibrinolytic states were assessed in 46 patients with acute stroke by measuring plasma levels of plasminogen activator inhibitor-1 (PAI-1), thrombin-antithrombin complex (TAT), and plasminogen-antiplasmin complex (PAP). Circulating IL-6 levels were measured using ELISA (Quantikine, R and D systems, MN, USA). Circulating IL-6 (mean, 26.5 pg/mL) and PAI-1 (mean, 19.9 ng/mL) levels were higher in patients with acute stroke than in healthy subjects (mean, 3.0 pg/mL, 10.4 ng/mL, respectively). TAT levels were statistically different according to the etiologic subtypes of stroke (atherogenic, 2.5 ng/mL; lacunar 3.2 ng/mL; cardiogenic 9.9 ng/mL, p = 0.021). Neither procoagulant levels nor fibrinolytic markers significantly correlated with circulating IL-6 levels. Our findings suggest that elevated proinflammatory cytokines during the initial hours of ischemic stroke may be an independent pathogenic factor or a consequence of the thrombotic event with no relationship to the procoagulant or fibrinolytic states.
Thrombosis ; Thrombolytic Therapy ; Thrombin/chemistry ; Plasminogen Activator Inhibitor 1/blood ; Phospholipids/chemistry ; Models, Statistical ; Middle Aged ; Male ; Ischemia/*blood/*pathology ; Interleukin-6/*blood/metabolism ; Humans ; Hemostasis ; *Fibrinolysis ; Female ; Enzyme-Linked Immunosorbent Assay ; Cytokines/metabolism ; Coagulants/*metabolism ; Cerebrovascular Accident/*blood/*pathology ; Blood Coagulation Factors/metabolism ; Antithrombins/chemistry ; Aged ; Acute Disease

OBJECTIVE: Hyperdense lesions can frequently be observed on the CT obtained immediately after intra-arterial (IA) thrombolysis, and it is sometimes difficult to differentiate contrast extravasation from the hemorrhagic lesions. The purposes of this study are to classify the hyperdense lesions according to their morphologic features and to track the outcome of those lesions. MATERIALS AND METHODS: Among the 94 patients who suffered with anterior circulation ischemic stroke and who were treated with IA thrombolysis, 31 patients revealed hyperdense lesions on the CT obtained immediately after the procedure. The lesions were categorized into four types according to their volume, shape, location and density: cortical high density (HD), soft HD, metallic HD and diffuse HD. The follow-up images were obtained 3-5 days later in order to visualize the morphologic changes and hemorrhagic transformation of the lesions. RESULTS: Among the 31 patients with HD lesions, 18 (58%) showed hemorrhagic transformation of their lesion, and six of them were significant. All the cortical HD lesions (n = 4) revealed spontaneous resolution. Seven of the soft HD lesions (n = 13) showed spontaneous resolution, while the rest of the group showed hemorrhagic transformation. Among them the hemorrhage was significant in only two patients (2/6) who did not achieve successful recanalization. All the metallic HD lesions (n = 10) resulted in hemorrhagic transformation; among them, three cases (30%) with a maximum CT value more than 150 HU (Hounsfield unit) subsequently showed significant hemorrhagic transformation on the follow-up CT. There were four diffuse HD lesions, and two of them showed hemorrhagic transformation. CONCLUSION: The parenchymal hyperdense lesions observed on the CT obtained immediately after IA thrombolysis in ischemic stroke patients exhibited varying features and they were not always hemorrhagic. Most of the soft HD lesions were benign, and although all of the metallic HD lesions were hemorrhagic, some of them were ultimately found to be benign.
Treatment Outcome ; *Tomography, X-Ray Computed ; Thrombolytic Therapy/*methods ; Statistics, Nonparametric ; Retrospective Studies ; Middle Aged ; Male ; Magnetic Resonance Imaging ; Infusions, Intra-Arterial ; Humans ; Fibrinolytic Agents/therapeutic use ; Female ; Cerebrovascular Accident/*drug therapy/pathology/*radiography ; Brain Ischemia/*drug therapy/pathology/*radiography ; Aged ; Acute Disease

Objective: The objective of this study is to investigate the outcome-determining factors of stroke patients treated in our hospital which is the largest hospital in Ibaraki Prefecture with more than 1,000 beds.Methods: Ninety two patients (62 with cerebral infarction and 30 with hemorrhage) who were hospitalized for stroke for the first time between January and June in 2004, and underwent rehabilitation. The patients were classified into two groups according to their outcomes: Group 1 patients who were directly discharged to home and Group 2 patients who were transferred to other hospitals or nursing homes. We investigated the severity of paresis, high cortical functional disorder as complication, functional outcome, and family background of these patients, and analyzed the outcome-determining factors.Result: Among the patients, 65.2% were directly discharged to home. Their paresis was not severe in most cases, and 70% of them could walk independently (with or without canes and devices). There were no significant differences in age or family size between the two groups. Fifteen patients did not choose to go home, even though they were physically able to do so. They all had higher brain dysfunction or difficulty in accepting their disability. For such patients, the shortage of caregivers was not necessarily considered as a factor in their decision not to go home.Conclusion: The severity of paresis and walking ability (locomotion) are the key factors in determining of whether the patients can be discharged to home or not.
Cerebrovascular accident ; Paresis ; Impaired health ; Hospitals ; agreement

We report on three elderly patients with stroke-like onset of atypical Miller Fisher syndrome (MFS). The serum titer of anti-GQ1b IgG was markedly elevated in these patients. Their prognoses were sufficiently good with immunoadsorption therapy with or without intravenous immune globulin (IVIg) therapy. However, some neurological findings were not characteristic of typical MFS. Patient 1 suffered from prolonged dysesthesia in her left extremities, and Patients 2 and 3 showed no ataxia. Moreover, complete bilateral gaze limitation is rare in MFS. The sudden stroke-like onset along with the gaze limitation of these patients suggests that the unexpected elevation in the serum titer of anti-GQ1b IgG due to unknown immune dysregulation might have severely affected the third, fourth, and sixth nerves and this potent antibody rapidly attacked these nerves and induced stroke-like clinical features and complete ophthalmoplegia.
Cerebrovascular accident ; Miller Fisher Syndrome ; Right and left ; Serum ; Atypical

This research analyzes the prevalence of metabolic syndrome (MS) in Korea and examines how the presence of a familial history of diseases related to MS, such as hypertension/stroke, cardiovascular disease, and diabetes, affect the development of MS in Koreans. The prevalence of MS and its components, as defined by the Nation-al Cholesterol Education Program Adult Treatment Panel guidelines, were evalu-ated in nationally representative samples of non-institutionalized civilian Koreans. This analysis is based on the 2001 Korea National Health and Nutrition Examina-tion Survey, which used a stratified multistage probability sampling design. The final study included 5, 742 adults who had completed the necessary health examinations and met the diagnosis of MS. The prevalence of MS was 25.5% in men and 28.7% in women. Odds ratio for MS among men with a familial history of hypertension/stroke was higher than that among men who did not have this history. The OR for MS among women with a familial history of hypertension/stroke or diabetes was higher than that among women who had no familial history of these diseases. These results show that familial history of hypertension/stroke and diabetes was significantly related to the presence of MS in both young men and women.
Sex Factors ; Prevalence ; Odds Ratio ; Middle Aged ; Metabolic Syndrome X/epidemiology/*genetics ; Male ; Korea/epidemiology ; Hypertension/*genetics ; Humans ; Genetic Predisposition to Disease/*genetics ; Female ; Family Health ; Diabetes Mellitus/*genetics ; Cerebrovascular Accident/*genetics ; Cardiovascular Diseases/*genetics ; Aged ; Age Factors ; Age Distribution ; Adult