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Bae JH, Ryu JC, Ha SH, Kim BJ, Kang DW, Kwon SU, Kim JS, Chang JY. Association of Left Vertebral Artery Hypoplasia with Posterior Circulation Stroke and the Functional Outcome of Patients with Atrial Fibrillation-Related Cardioembolic Stroke. AJNR Am J Neuroradiol 2023; 44:65-69. [PMID: 36521964 PMCID: PMC9835927 DOI: 10.3174/ajnr.a7738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 11/11/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND PURPOSE A cardiogenic embolus could reach the posterior circulation through the right vertebral artery because of a relatively larger diameter in cases of left vertebral artery hypoplasia. Hence, we investigated whether left vertebral artery hypoplasia is associated with cardiac embolisms with atrial fibrillation in the posterior circulation and its functional outcomes. MATERIALS AND METHODS In this monocentric retrospective study, patients with acute cardioembolic stroke with atrial fibrillation were enrolled and underwent CT or neck MRA, which visualized the aortic arch and subclavian arteries. The laterality and size of vertebral artery hypoplasia were recorded. Posterior circulation stroke, basilar artery occlusion, and the functional outcomes after 3 months were investigated. RESULTS This study included 407 patients; the patients with left vertebral artery hypoplasia experienced a higher rate of posterior circulation stroke (19 versus 73; 42.2% versus 20.2%; P = .001) and basilar artery occlusion (5 versus 10; 11.1% versus 2.8%; P = .005) than the patients without left vertebral artery hypoplasia. Multivariate analysis revealed that left vertebral artery hypoplasia showed an association with lower odds of achieving a good functional outcome 3 months after the stroke (OR = 0.4; 95% CI, 0.2-0.9; P = .027). CONCLUSIONS Patients with cardioembolic stroke and left vertebral artery hypoplasia had posterior circulation stroke, basilar artery occlusion, and poor functional outcomes after 3 months.
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Affiliation(s)
- J-H Bae
- From the Department of Neurology (J.-H.B., J.-C.R., S.H.H., B.J.K., D.-W.K., S.U.K., J.Y.C.), Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - J-C Ryu
- From the Department of Neurology (J.-H.B., J.-C.R., S.H.H., B.J.K., D.-W.K., S.U.K., J.Y.C.), Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - S H Ha
- From the Department of Neurology (J.-H.B., J.-C.R., S.H.H., B.J.K., D.-W.K., S.U.K., J.Y.C.), Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - B J Kim
- From the Department of Neurology (J.-H.B., J.-C.R., S.H.H., B.J.K., D.-W.K., S.U.K., J.Y.C.), Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - D-W Kang
- From the Department of Neurology (J.-H.B., J.-C.R., S.H.H., B.J.K., D.-W.K., S.U.K., J.Y.C.), Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - S U Kwon
- From the Department of Neurology (J.-H.B., J.-C.R., S.H.H., B.J.K., D.-W.K., S.U.K., J.Y.C.), Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - J-S Kim
- Department of Neurology (J.-S.K.), Gangneung Asan Hospital, Gangneung, Korea
| | - J Y Chang
- From the Department of Neurology (J.-H.B., J.-C.R., S.H.H., B.J.K., D.-W.K., S.U.K., J.Y.C.), Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
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Choi SH, Park SD, Lee MJ, Ko YG, Yu CW, Chun WJ, Jang WJ, Kim HJ, Bae JW, Kwon SU, Kim JS, Lee WS, Jeong JO, Lim SH, Yang JH. Prognostic impact of plasma glucose on cardiogenic shock patients with or without diabetes ellitus: smart rescue trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Even though the presence of hyperglycemia has shown to affect the clinical outcome of cardiogenic shock patients, the extent of hyperglycemia and its association with prognosis have not been fully addressed in large population
Purpose
Investigate the clinical relationship between hyperglycemic status and in-hospital mortality in cardiogenic shock patients
Method
A total of 1,177 consecutive cardiogenic shock patients were enrolled from January 2014 to December of 2018 at 12 hospitals in South Korea. The primary outcome was in-hospital mortality. Patients were divided into four groups according to their initial plasma glucose level in each of diabetes patients (n=752) and non-diabetes patients (n=425); group 1 (≤8 mmol/L), group 2 (8–12 mmol/L), group 3 (12–16 mmol/L) and group 4 (≥16 mmol/L).
Results
The groups with higher admission plasma glucose were associated with lower systolic blood pressure and higher lactic acid level in both diabetic and non-diabetic patients. In-hospital mortality increased in groups with higher admission plasma glucose level in non-diabetic patients (group-1:24.2%, group-2: 28.6%, group-3: 38.1%, group-4: 49.0%, p<0.01) whereas in diabetic patients, mortality and admission plasma glucose level showed no significant association (group-1: 45%, group-2: 35.4%, group-3: 33.3%, group-4: 43.1%, p=0.26). Even after Multivariate analysis, high plasma glucose was an independent predictor of in-hospital mortality in non-diabetic patients
Conclusion
In cardiogenic shock patients, plasma glucose obtained at admission was associated with in-hospital mortality in non-diabetic patients
Funding Acknowledgement
Type of funding sources: Private hospital(s). Main funding source(s): Inha University hospital
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Affiliation(s)
- S H Choi
- Inha University Hospital, Cardiology , Incheon , Korea (Republic of)
| | - S D Park
- Inha University Hospital, Cardiology , Incheon , Korea (Republic of)
| | - M J Lee
- Inha University Hospital, Cardiology , Incheon , Korea (Republic of)
| | - Y G Ko
- Severance Cardiovascular Hospital, Yonsei University College of Medicine, Cardiology , Seoul , Korea (Republic of)
| | - C W Yu
- Korea University Anam Hospital, Cardiology , Seoul , Korea (Republic of)
| | - W J Chun
- Samsung Changwon Hospital, Cardiology , Changwon , Korea (Republic of)
| | - W J Jang
- Ewha Womans University Seoul Hospital, Cardiology , Seoul , Korea (Republic of)
| | - H J Kim
- Konkuk University Hospital, Cardiology , Seoul , Korea (Republic of)
| | - J W Bae
- Chungbuk National University College of Medicine, Cardiology , Cheongju , Korea (Republic of)
| | - S U Kwon
- Inje University Ilsan Paik hospital, Cardiology , Goyang , Korea (Republic of)
| | - J S Kim
- Sejong General Hospital, Cardiology , Bucheon , Korea (Republic of)
| | - W S Lee
- Chung-Ang University Hospital, Cardiology , Seoul , Korea (Republic of)
| | - J O Jeong
- Chungnam National University hospital , Daejeon , Korea (Republic of)
| | - S H Lim
- Dankook University, Cardiology , Cheonan-si , Korea (Republic of)
| | - J H Yang
- Samsung Medical Center, Cardiology , Seoul , Korea (Republic of)
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Kwon W, Yang JH, Lee SH, Choi KH, Park TK, Lee JM, Song YB, Hahn JY, Choi SH, Ahn CM, Ko YG, Yu CW, Jang WJ, Kim HJ, Kwon SU. Impact of obesity paradox between genders on in-hospital mortality in cardiogenic shock: a retrospective cohort study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
In a few studies, obesity was associated with better outcomes in patients with cardiogenic shock (CS). Although this phenomenon, the “obesity paradox”, reportedly manifests differently based on sex in other disease entities, it has not yet been investigated in CS patients.
Methods and results
1,227 patients with CS from The REtrospective and prospective observational Study to investigate Clinical oUtcomes and Efficacy of left ventricular assist device for Korean patients with cardiogenic shock (RESCUE) registry in Korea were analyzed. The study population was classified into obese and non-obese groups according to Asian-Pacific criteria (BMI >25.0 kg/m2 for obese). Clinical impact of obesity on in-hospital mortality according to sex was analyzed using logistic regression analysis and restricted cubic spline curves. In-hospital mortality rate was significantly lower in obese men than non-obese men (34.2% vs. 24.1%, p=0.004) while the difference was not significant in women (37.3% vs. 35.8%, p=0.884). As a continuous variable, higher BMI showed a protective effect in men conversely, BMI was not associated with clinical outcomes in women. Comparing to normal-weight patients, obesity was associated with a decreased risk of in-hospital death in men (multivariable-adjusted OR 0.63, CI 0.43–0.92, p=0.016), not in women (multivariable-adjusted OR 0.94, 95% CI 0.55–1.61, p=0.828). Interaction P value for the association between BMI and sex was 0.023.
Conclusions
Obesity paradox exists and apparently occurs in men among CS patients. The differential effect of BMI on in-hospital mortality was observed according to sex.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- W Kwon
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - J H Yang
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - S H Lee
- Chonnam National University Hospital , Gwangju , Korea (Republic of)
| | - K H Choi
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - T K Park
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - J M Lee
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - Y B Song
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - J Y Hahn
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - S H Choi
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - C M Ahn
- Yonsei Cardiovascular Center , Seoul , Korea (Republic of)
| | - Y G Ko
- Yonsei Cardiovascular Center , Seoul , Korea (Republic of)
| | - C W Yu
- Korea University Anam Hospital , Seoul , Korea (Republic of)
| | - W J Jang
- Ewha Womans University Seoul Hospital , Seoul , Korea (Republic of)
| | - H J Kim
- Konkuk University Hospital , Seoul , Korea (Republic of)
| | - S U Kwon
- Inje University Sanggye Paik Hospital , Seoul , Korea (Republic of)
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Choi E, Byun E, Kwon SU, Kim N, Suh CH, Kwon H, Han Y, Kwon TW, Cho YP. Carotid Plaque Composition Assessed by CT Predicts Subsequent Cardiovascular Events among Subjects with Carotid Stenosis. AJNR Am J Neuroradiol 2021; 42:2199-2206. [PMID: 34711554 DOI: 10.3174/ajnr.a7338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 07/28/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Currently, the characteristics of carotid plaques are considered important factors for identifying subjects at high risk of stroke. This study aimed to test the hypothesis that carotid plaque composition assessed by CTA is associated with an increased risk of future major adverse cardiovascular events among asymptomatic subjects with moderate-to-severe carotid artery stenosis. MATERIALS AND METHODS This single-center, retrospective cohort study included 194 carotid plaques from 176 asymptomatic subjects with moderate-to-severe carotid artery stenosis. The association of CTA-determined plaque composition with the risk of subsequent adverse cardiovascular events was analyzed. RESULTS During a median follow-up of 41 months, the adverse cardiovascular event incidence among 194 carotid plaques was 19.6%. There were significant differences in plaque Hounsfield units (P < .001) and spotty calcium presence (P < .001) between carotid plaques from subjects with and without subsequent adverse cardiovascular events. Multivariable analysis revealed carotid plaque Hounsfield unit density (P < .001) and spotty calcium (P < .001) as independent predictors of subsequent adverse cardiovascular events. In association with moderate carotid artery stenosis, the plaque Hounsfield unit values were significantly lower among carotid plaques from subjects who experienced subsequent adverse cardiovascular events (P = .002), strokes (P = .01), and cardiovascular deaths (P = .04); the presence of spotty calcium was significantly associated with the occurrence of adverse cardiovascular events (P = .001), acute coronary syndrome (P = .01), and cardiovascular death (P = .04). CONCLUSIONS Carotid plaque Hounsfield unit density and spotty calcium were independent predictors of a greater risk of adverse cardiovascular event occurrence.
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Affiliation(s)
- E Choi
- From the Departments of Surgery (E.C., E.B., H.K., Y.H., T.-W.K., Y.-P.C.)
| | - E Byun
- From the Departments of Surgery (E.C., E.B., H.K., Y.H., T.-W.K., Y.-P.C.)
| | | | - N Kim
- Clinical Epidemiology and Biostatistics (N.K.)
| | - C H Suh
- Radiology and Research Institute of Radiology (C.H.S.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - H Kwon
- From the Departments of Surgery (E.C., E.B., H.K., Y.H., T.-W.K., Y.-P.C.)
| | - Y Han
- From the Departments of Surgery (E.C., E.B., H.K., Y.H., T.-W.K., Y.-P.C.)
| | - T-W Kwon
- From the Departments of Surgery (E.C., E.B., H.K., Y.H., T.-W.K., Y.-P.C.)
| | - Y-P Cho
- From the Departments of Surgery (E.C., E.B., H.K., Y.H., T.-W.K., Y.-P.C.)
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Park JH, Heo SH, Lee MH, Kwon HS, Kwon SU, Lee JS. White matter hyperintensities and recurrent stroke risk in patients with stroke with small-vessel disease. Eur J Neurol 2019; 26:911-918. [PMID: 30637882 DOI: 10.1111/ene.13908] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 01/08/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE White matter hyperintensities (WMH) are a predictor of stroke among elderly individuals. This study aimed to evaluate the association between WMH severity and the risk of recurrent vascular events among Asian patients with ischaemic stroke with small-vessel disease (SVD) including micro/macrobleeds and lacunes. METHODS Data from participants (n = 1454) in the PICASSO (PreventIon of CArdiovascular Events in iSchemic Stroke Patients with High Risk of Cerebral HemOrrhage) trial were reviewed. The severity of WMH in baseline brain magnetic resonance imaging scans was assessed using the Fazekas scale. The association between WMH severity and stroke (ischaemic or hemorrhagic) and major vascular events (MVEs) (a composite of stroke/myocardial infarction/vascular death) was assessed. RESULTS Study patients had a significant burden of SVD: Fazekas score 0 (n = 2), 1 (n = 426), 2 (n = 650) and 3 (n = 376) [median Fazekas score 2 (mean follow-up, 1.9 ± 1.3 years)]. The stroke incidence rate per 100 personyears was 2.6 in the Fazekas 0-1 group, 3.6 in the Fazekas 2 group and 7.0 in the Fazekas 3 group, and the rates for MVEs were 3.3, 4.3 and 7.6, respectively. Compared with the Fazekas 0-1 group, the Fazekas 3 group was associated with a higher risk of stroke [adjusted hazard ratio (HR), 2.15; 95% confidence interval (CI), 1.19-3.88; P = 0.011], ischaemic stroke (adjusted HR, 2.11; 95% CI, 1.07-4.15; P = 0.031), hemorrhagic stroke (adjusted HR, 3.72; 95% CI, 1.09-12.70; P = 0.036) and MVEs (adjusted HR, 2.09; 95% CI, 1.20-3.66; P = 0.010). CONCLUSION Advanced WMH in Asian patients with ischaemic stroke with SVD burden was associated with an increased risk of recurrent vascular events. It may exert an effect as a prognostic indicator in high risk of recurrent vascular events.
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Affiliation(s)
- J-H Park
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Goyang
| | - S H Heo
- Department of Neurology, Kyung Hee University Hospital, Seoul
| | - M H Lee
- Department of Neurology, Myongji St Mary's Hospital, Seoul
| | - H S Kwon
- Department of Neurology, Hanyang University College of Medicine, Seoul
| | - S U Kwon
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - J S Lee
- Clinical Research Center, Asan Medical Center, Seoul, South Korea
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Lee NJ, Chung MS, Jung SC, Kim HS, Choi CG, Kim SJ, Lee DH, Suh DC, Kwon SU, Kang DW, Kim JS. Comparison of High-Resolution MR Imaging and Digital Subtraction Angiography for the Characterization and Diagnosis of Intracranial Artery Disease. AJNR Am J Neuroradiol 2016; 37:2245-2250. [PMID: 27659192 DOI: 10.3174/ajnr.a4950] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 07/22/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE High-resolution MR imaging has recently been introduced as a promising diagnostic modality in intracranial artery disease. Our aim was to compare high-resolution MR imaging with digital subtraction angiography for the characterization and diagnosis of various intracranial artery diseases. MATERIALS AND METHODS Thirty-seven patients who had undergone both high-resolution MR imaging and DSA for intracranial artery disease were enrolled in our study (August 2011 to April 2014). The time interval between the high-resolution MR imaging and DSA was within 1 month. The degree of stenosis and the minimal luminal diameter were independently measured by 2 observers in both DSA and high-resolution MR imaging, and the results were compared. Two observers independently diagnosed intracranial artery diseases on DSA and high-resolution MR imaging. The time interval between the diagnoses on DSA and high-resolution MR imaging was 2 weeks. Interobserver diagnostic agreement for each technique and intermodality diagnostic agreement for each observer were acquired. RESULTS High-resolution MR imaging showed moderate-to-excellent agreement (interclass correlation coefficient = 0.892-0.949; κ = 0.548-0.614) and significant correlations (R = 0.766-892) with DSA on the degree of stenosis and minimal luminal diameter. The interobserver diagnostic agreement was good for DSA (κ = 0.643) and excellent for high-resolution MR imaging (κ = 0.818). The intermodality diagnostic agreement was good (κ = 0.704) for observer 1 and moderate (κ = 0.579) for observer 2, respectively. CONCLUSIONS High-resolution MR imaging may be an imaging method comparable with DSA for the characterization and diagnosis of various intracranial artery diseases.
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Affiliation(s)
- N J Lee
- From the Department of Radiology and Research Institute of Radiology (N.J.L., M.S.C., S.C.J., H.S.K., C.-G.C., S.J.K., D.H.L., D.C.S.)
| | - M S Chung
- From the Department of Radiology and Research Institute of Radiology (N.J.L., M.S.C., S.C.J., H.S.K., C.-G.C., S.J.K., D.H.L., D.C.S.)
| | - S C Jung
- From the Department of Radiology and Research Institute of Radiology (N.J.L., M.S.C., S.C.J., H.S.K., C.-G.C., S.J.K., D.H.L., D.C.S.)
| | - H S Kim
- From the Department of Radiology and Research Institute of Radiology (N.J.L., M.S.C., S.C.J., H.S.K., C.-G.C., S.J.K., D.H.L., D.C.S.)
| | - C-G Choi
- From the Department of Radiology and Research Institute of Radiology (N.J.L., M.S.C., S.C.J., H.S.K., C.-G.C., S.J.K., D.H.L., D.C.S.)
| | - S J Kim
- From the Department of Radiology and Research Institute of Radiology (N.J.L., M.S.C., S.C.J., H.S.K., C.-G.C., S.J.K., D.H.L., D.C.S.)
| | - D H Lee
- From the Department of Radiology and Research Institute of Radiology (N.J.L., M.S.C., S.C.J., H.S.K., C.-G.C., S.J.K., D.H.L., D.C.S.)
| | - D C Suh
- From the Department of Radiology and Research Institute of Radiology (N.J.L., M.S.C., S.C.J., H.S.K., C.-G.C., S.J.K., D.H.L., D.C.S.)
| | - S U Kwon
- Department of Neurology (S.U.K., D.-W.K., J.S.K.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - D-W Kang
- Department of Neurology (S.U.K., D.-W.K., J.S.K.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - J S Kim
- Department of Neurology (S.U.K., D.-W.K., J.S.K.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Kim YJ, Lee DH, Kwon JY, Kang DW, Suh DC, Kim JS, Kwon SU. High resolution MRI difference between moyamoya disease and intracranial atherosclerosis. Eur J Neurol 2013; 20:1311-8. [PMID: 23789981 DOI: 10.1111/ene.12202] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 04/30/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Along with intracranial atherosclerotic disease (ICAD), moyamoya disease (MMD) is the most common cause of middle cerebral artery (MCA) occlusion in Asians. Although they have differing vascular wall pathologies, conventional angiographic evaluation methods cannot easily differentiate MMD from ICAD in certain situations, such as in young patients with atherosclerotic risk factors. High resolution magnetic resonance imaging (HR-MRI) findings for the diseased segments of MCAs in MMD and symptomatic ICAD were compared to further elucidate differences in arterial wall changes. METHODS Angiographically confirmed patients, 12 MMD and 20 ICAD, who suffered a stroke due to MCA occlusion were recruited and underwent HR-MRI. The size of the outer diameter and other stenotic vessel wall characteristics revealed by HR-MRI, including enhancement, eccentricity and other lesion patterns, were analyzed by two independent reviewers in a blind fashion. RESULTS MMD patients were younger than ICAD patients (32.92 ± 11.08 years vs. 51.85 ± 11.97 years; mean ± SD) and displayed a smaller outer diameter in the stenotic portion (1.61 ± 0.43 mm for MMD vs. 3.03 ± 0.53 mm for ICAD, P < 0.0001). Eccentric lesions (three of 12 in MMD vs. 19 of 20 in ICAD, P < 0.0001) and focal enhancements in diseased areas (two of seven in MMD vs. 13 of 17 in ICAD, P = 0.061) were less common in MMD cases. CONCLUSIONS Our HR-MRI findings show that MMD is associated with smaller, concentric occlusive lesions which are rarely enhanced compared with symptomatic ICAD, consistent with the results of previous pathological reports. HR-MRI may therefore have utility in differentiating MMD from ICAD.
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Affiliation(s)
- Y J Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Yoon Y, Lee DH, Kang DW, Kwon SU, Suh DC, Bang OY, Kim JS. Stroke recurrence patterns are predicted by the subtypes and mechanisms of the past, non-cardiogenic stroke. Eur J Neurol 2013; 20:928-34. [PMID: 23398300 DOI: 10.1111/ene.12101] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Accepted: 12/12/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE The association between past stroke subtypes and recurrent stroke subtypes in non-cardiogenic stroke remains unknown. METHODS Patients with ischaemic stroke who had a past history of large-artery disease (LAD) or small-artery disease (SAD) subtypes were assessed. LAD was subdivided into intracranial atherosclerosis (ICAS) and extracranial atherosclerosis (ECAS). LAD stroke mechanisms were categorized as artery-to-artery embolism, in situ thrombotic occlusion and local branch occlusion, while SAD was subdivided into lacunar infarction (LI) and branch atheromatous disease (BAD) on the basis of magnetic resonance imaging findings. The relationship between past and current strokes was analyzed. RESULTS Among the 202 patients enrolled, the LAD group (n = 111) had 64 and 47 patients with ICAS and ECAS, and the SAD group (n = 91) had 63 and 28 patients with LI and BAD, respectively, at the time of past stroke. Patients with LAD developed LAD-associated strokes most often (n = 99, 89.2%), and patients with SAD developed SAD most often (n = 69, 75.8%; P < 0.001). Patients with ICAS were more likely to develop ICAS later (n = 46, 79.3%), whereas those with ECAS developed ECAS more often (n = 31, 75.6%; P < 0.001). Patients with ICAS presenting with artery-to-artery embolism more often developed artery-to-artery embolism later (n = 26, 72.2%), whereas those with local branch occlusion developed recurrent local branch occlusion most often (n = 10, 66.7%, P = 0.005). In the SAD group, patients with BAD developed LAD more frequently than the LI group (n = 11, 39.3% vs. n = 9, 14.3%, P = 0.022). CONCLUSIONS The subtypes and mechanisms of recurrent stroke are significantly influenced by those of the past stroke.
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Affiliation(s)
- Y Yoon
- Department of Neurology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
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Yoo SH, Kwon SU, Jo MW, Kang DW, Kim JS. Age- and weight-adjusted warfarin initiation nomogram for ischaemic stroke patients. Eur J Neurol 2012; 19:1547-53. [PMID: 22672718 DOI: 10.1111/j.1468-1331.2012.03772.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 04/24/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Specific guidelines for initial dosing of warfarin in ischaemic stroke patients have not been developed. Therefore, we have developed an age- and weight-adjusted warfarin initiation nomogram (AW-WIN) for ischaemic stroke patients and then evaluated the efficacy and safety of AW-WIN compared with physician-determined warfarin dosing (PDWD). METHODS The age- and weight-adjusted warfarin initiation nomogram was administered to 104 acute ischaemic stroke patients between January 2008 and February 2009. A historical control group (PDWD) of 96 patients was selected from comparable patients who were discharged with warfarin during the previous year. Time-to-therapeutic international normalized ratios (INRs) and the incidence of excessive anticoagulation were compared in the AW-WIN and PDWD groups. RESULTS The general characteristics, risk factors, and stroke mechanism of the AW-WIN and PDWD groups did not differ significantly. The mean time to INR ≥ 2.0 was significantly shorter in the AW-WIN than in the PDWD group (4.9 ± 0.7 vs. 6.2 ± 0.8 days, P = 0.0008). After adjustment for potential confounding variables, the AW-WIN group reached target INR faster than the PDWD group (hazard ratio, 1.76; 95% confidence interval, 1.26-2.45; P = 0.001). The time-to-therapeutic INR ≥1.7 was shorter (P = 0.0002), the proportion of patients with therapeutic INR (2-3) at 5 days was higher (P = 0.002), and the rate of excessive anticoagulation of ≥3.5 INR during hospitalization was lower (P = 0.024) in the AW-WIN than in the PDWD group. CONCLUSIONS AW-WIN reduces the time to target INR and the risk of excessive anticoagulation. AW-WIN may be an efficient and safe method of anticoagulation during the acute phase of ischaemic stroke.
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Affiliation(s)
- S-H Yoo
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Choi-Kwon S, Han K, Choi S, Suh M, Kim YJ, Song H, Cho KH, Nah HW, Kwon SU, Kang DW, Kim JS. Poststroke depression and emotional incontinence: factors related to acute and subacute stages. Neurology 2012; 78:1130-7. [PMID: 22459674 DOI: 10.1212/wnl.0b013e31824f8090] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES To investigate the characteristics and prevalence of poststroke depression (PSD) and poststroke emotional incontinence (PSEI) and the factors related to these conditions at admission and 3 months after stroke. METHODS We evaluated 508 consecutive patients with acute ischemic stroke for PSD and PSEI at admission and 3 months later. PSD was evaluated using the Beck Depression Inventory, and PSEI was evaluated using Kim's criteria. Blood samples were collected and genotyped for the promoter region of the serotonin transporter protein (5-HTTLPR) and the number of tandem repeats within intron 2 (STin2 VNTR). Perceived social support (the ENRICHD Social Support Inventory) was also measured. RESULTS PSD and PSEI were present in 13.7% and 9.4% of patients, respectively, at admission and in 17.7% and 11.7%, respectively, at 3 months after stroke. Multivariate analyses showed that PSD at admission was associated with the NIH Stroke Scale score at admission (p < 0.001), whereas PSD at 3 months was associated with the presence of microbleeds (p < 0.01) and perceived low social support (p < 0.001). In contrast, only lesion location (p = 0.022) was associated with PSEI at admission, whereas modified Rankin Scale score (p = 0.019), STin2 VNTR (p = 0.040), and low social support (p = 0.042) were related to PSEI 3 months after stroke. CONCLUSIONS Diverse factors such as neurologic dysfunction, lesion location, microbleeds, genetic traits, and social support are differently related to acute and subacute emotional disturbances. Strategies to prevent or manage these problems should consider these differences.
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Affiliation(s)
- S Choi-Kwon
- College of Nursing, Seoul National University, Seoul, Korea
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Topakian R, King A, Kwon SU, Schaafsma A, Shipley M, Markus HS. Ultrasonic plaque echolucency and emboli signals predict stroke in asymptomatic carotid stenosis. Neurology 2011; 77:751-8. [PMID: 21849657 DOI: 10.1212/wnl.0b013e31822b00a6] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Better methods are required to identify patients with asymptomatic carotid stenosis (ACS) at risk of future stroke. Two potential markers of high risk are echolucent plaque morphology on carotid ultrasound and embolic signals (ES) in the ipsilateral middle cerebral artery on transcranial Doppler ultrasound (TCD). We explored the predictive value of a score based on these 2 measures in the prospective, observational, international multicenter Asymptomatic Carotid Emboli Study. METHODS A total of 435 recruited subjects with ACS ≥70% had baseline ultrasound images and TCD data available. Subjects were prospectively followed up for 2 years. RESULTS A total of 164 (37.7%) plaques were graded as echolucent. Plaque echolucency at baseline was associated with an increased risk of ipsilateral stroke alone (hazard ratio [HR] 6.43, 95% confidence interval [CI] 1.36-30.44, p = 0.019). A combined variable of plaque echolucency and ES positivity at baseline was associated with a markedly increased risk of ipsilateral stroke alone (HR 10.61, 95% CI 2.98-37.82, p = 0.0003). This association remained significant after controlling for risk factors, degree of carotid stenosis, and antiplatelet medication. CONCLUSIONS Plaque morphology assessed using a simple, and clinically applicable, visual rating scale predicts ipsilateral stroke risk in ACS. The combination of ES detection and plaque morphology allows a greater prediction than either measure alone and identifies a high-risk group with an annual stroke risk of 8%, and a low-risk group with a risk of <1% per annum. This risk stratification may prove useful in the selection of patients with ACS for endarterectomy.
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Affiliation(s)
- R Topakian
- Clinical Neuroscience, St. Georges University of London, London, UK.
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Song HS, Kang CK, Kim JS, Park CA, Kim YB, Lee DH, Kang DW, Kwon SU, Cho ZH. Assessment of pial branches using 7-tesla MRI in cerebral arterial disease. Cerebrovasc Dis 2010; 29:410. [PMID: 20185908 DOI: 10.1159/000288056] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- H-S Song
- Department of Neurology, College of Medicine, Kyung Hee University, Seoul, Korea
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Hong KS, Kang DW, Bae HJ, Kim YK, Han MK, Park JM, Rha JH, Lee YS, Koo JS, Cho YJ, Kwon SU, Kim SE, Park SH. Effect of cilnidipine vs losartan on cerebral blood flow in hypertensive patients with a history of ischemic stroke: a randomized controlled trial. Acta Neurol Scand 2010; 121:51-7. [PMID: 19925528 DOI: 10.1111/j.1600-0404.2009.01299.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this study was to compare the effects of antihypertensive agents on cerebral blood flow (CBF) in hypertensive patients with previous ischemic stroke. MATERIALS AND METHODS In this double-blind, multi-center, non-inferiority trial, 196 patients were randomized to cilnidipine 10-20 mg or losartan 50-100 mg once daily for 4 weeks. Baseline and follow-up CBF as measured by single photon emission computed tomography were obtained in 167. The primary endpoint was the global CBF change. The secondary endpoints were the CBF change in the hemisphere ipsilateral to the index stroke, non-impairment of global CBF and blood pressure (BP) reduction. RESULTS Global CBF increased significantly in the cilnidipine arm (9.0 +/- 29.6%, P = 0.0071) and the losartan arm (11.4 +/- 31.4%, P = 0.0012), and these changes were not different between the two groups (P = 0.607). However, the estimated difference in percentage global CBF change between the two groups was -2.43% (97.5% CI, -13.06% to 8.21%), which crossed the predetermined non-inferiority margin of -8.6%. Ipsilesional hemispheric CBF change, non-impairment of global CBF and BP reduction were similar in the two groups. CONCLUSIONS This trial failed to prove the non-inferiority of cilnidipine to losartan regarding global CBF change. Both the treatments, however, increase the global CBF despite BP lowering.
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Affiliation(s)
- K-S Hong
- Department of Neurology, Clinical Research Center, Ilsan Paik Hospital, Inje University, Goyang, Korea
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Lee JH, Cha JK, Lee SJ, Ha SW, Kwon SU. Addition of cilostazol reduces biological aspirin resistance in aspirin users with ischaemic stroke: a double-blind randomized clinical trial. Eur J Neurol 2009; 17:434-42. [DOI: 10.1111/j.1468-1331.2009.02837.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Yoo SH, Nah HW, Jo MW, Kang DW, Kim JS, Koh JY, Kwon SU. Age and body weight adjusted warfarin initiation program for ischaemic stroke patients. Eur J Neurol 2009; 16:1100-5. [DOI: 10.1111/j.1468-1331.2009.02745.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
BACKGROUND It is unknown whether the development of cerebral microbleeds (MBs), small areas of signal loss on T2*-weighted gradient-echo imaging (GRE), follows a slow or a rapid process. We hypothesized that MBs may develop rapidly after certain critical events, such as strokes, and investigated the frequency, location, and factors associated with the formation of new MBs after acute ischemic stroke. METHODS We retrospectively examined 237 consecutive acute ischemic stroke patients who underwent MRI within 24 hours and follow-up MRI during the week after symptom onset. We defined new MBs as MBs that newly appeared on follow-up GRE outside the infarcted area. We examined the association of new MBs with demographics, risk factors, laboratory data, baseline MBs, and small vessel disease (SVD; leukoaraiosis and lacunar infarctions). RESULTS Seventy-five patients (31.6%) had baseline MBs, and 30 (12.7%) developed new MBs. Multiple logistic regression analysis indicated that the presence of baseline MBs (odds ratio [OR] 5.72, 95% confidence interval [CI] 2.12-15.42, p = 0.001) and severe SVD (OR 2.94, 95% CI 1.12-7.77, p = 0.03) independently predicted the development of new MBs. Of the 56 new MBs, 29 (51.8%) appeared in the lobar location, 17 (30.4%) appeared in the deep location, and 10 (17.9%) appeared in the infratentorial location. CONCLUSIONS This study suggests that new microbleeds (MBs) can develop rapidly after acute ischemic stroke. Baseline MBs and severe small vessel disease are predictors for the development of new MBs. Further studies will be needed to investigate the clinical implications and mechanisms of these findings.
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Affiliation(s)
- S-B Jeon
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea
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Kim JS, Cho KH, Kang DW, Kwon SU, Suh DC. Basilar artery atherosclerotic disease is related to subacute lesion volume increase in pontine base infarction. Acta Neurol Scand 2009; 120:88-93. [PMID: 19630153 DOI: 10.1111/j.1600-0404.2008.01124.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although basilar artery atherosclerotic disease (BAD) is frequent in patients with pontine base infarction, it remains unknown whether BAD is related to the lesion size or clinical outcome. METHODS We studied 56 patients with unilateral pontine base infarction who underwent (i) diffusion-weighted MRI within 48 h after stroke onset and (ii) follow-up MRI and MR angiography in the subacute stage. Neurologic progression was defined as increased National Institutes of Health Stroke Scale score by > or = 2 during admission. Clinical outcome was dichotomized as good and poor (> or = 3) according to the modified Rankin Scale at 1 month after stroke onset. RESULTS Twenty-two patients (39%) had BAD and 15 patients (27%) had neurologic progression. Follow-up MRI performed at median 3.5 +/- 1.1 days after the initial MRI showed the lesion volume significantly increased (P < 0.001). The BAD was not significantly related to demographic characteristics, risk factors, initial and follow-up lesion volume, neurologic progression and clinical outcome, but was closely related to the subacute increase in lesion volume (P = 0.004 for 20% increase, P = 0.029 for 50% increase). CONCLUSIONS BAD is related to subacute increase in lesion volume, but not to ultimate poor clinical outcome in patients with pontine base infarction.
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Affiliation(s)
- J S Kim
- Stroke Center and Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Korea.
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Cho AH, Suh DC, Kim GE, Kim JS, Lee DH, Kwon SU, Park SM, Kang DW. MRI evidence of reperfusion injury associated with neurological deficits after carotid revascularization procedures. Eur J Neurol 2009; 16:1066-9. [PMID: 19486141 DOI: 10.1111/j.1468-1331.2009.02650.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Some patients develop major neurological complications after carotid revascularization procedures, despite the lack of new infarcts or classical hyperperfusion syndrome. METHODS In four patients who developed major neurological deficits after carotid revascularization procedures, but without evidence of new ischemic infarcts or hyperperfusion, we performed post-procedural MRI [diffusion-weighted image (DWI), perfusion-weighted image (PWI), pre-and post-contrast fluid-attenuated inversion recovery (FLAIR) image] immediately after and 1 day after the procedure. RESULTS Post-gadolinium FLAIR images on 1 day after the procedures showed prominent leptomeningeal enhancements in the revascularized hemispheres. These radiological findings disappeared on follow-up FLAIR images accompanied by the clinical improvement over the following several days after the procedures. CONCLUSION Reperfusion syndrome may be associated with transient severe neurological deficits after carotid revascularization in patients without new ischemic events or classical hyperperfusion syndrome.
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Affiliation(s)
- A-H Cho
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Cho AH, Kwon SU, Kim TW, Lee SJ, Shon YM, Kim BS, Yang DW. High prevalence of unrecognized cerebral infarcts in first-ever stroke patients with cardioembolic sources. Eur J Neurol 2009; 16:838-42. [DOI: 10.1111/j.1468-1331.2009.02604.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cho KH, Kang DW, Kwon SU, Kim JS. Location of single subcortical infarction due to middle cerebral artery atherosclerosis: proximal versus distal arterial stenosis. J Neurol Neurosurg Psychiatry 2009; 80:48-52. [PMID: 18931013 DOI: 10.1136/jnnp.2007.143354] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Atherosclerotic middle cerebral artery (MCA) disease may produce subcortical infarction either in the upper part (corona radiata, CR) or in the lower area (internal capsule, IC) of the pyramidal tract. The study aimed to see whether the location of MCA stenosis (proximal vs distal) determines the location of subcortical infarction. METHODS 62 consecutive patients who developed an acute (<72 h) infarction either on the CR or IC confirmed by diffusion-weighted MRI due to corresponding focal MCA M1 stenosis assessed by MR angiography were studied. The distance between the MCA origin and the centre of stenotic portion (S) and that between the MCA origin and its bifurcation site (M) were measured. Based on the S/M ratio, stenotic lesions were divided into "proximal' and "distal'. The relationship between the location of arterial stenosis and the location of infarcts was analysed. RESULTS Thirteen of 31 patients (41.9%) with proximal M1 stenosis had IC lesions, while 26 (83.9%) of 31 patients with distal stenosis had CR lesions (p = 0.025). The S/M ratio in patients with the CR infarcts (mean (SD) 0.65 (0.21) was significantly greater than in those with the IC infarcts (0.48 (0.23)) (p = 0.007). In addition, the National Institutes of Health Stroke Scale score at admission was higher in patients with proximal M1 stenosis than in those with distal stenosis (6 vs 3.5; p = 0.04). CONCLUSIONS The results suggest that perforating arteries arising from the distal M1 segment are related to infarcts involving the upper part of pyramidal tract, while those from proximal segment are related to lower lesions.
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Affiliation(s)
- K-H Cho
- Department of Neurology, Keimyung University School of Medicine, Dogsan Medical Center, Dagu, Korea
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Choi-Kwon S, Choi J, Kwon SU, Kang DW, Kim JS. Fluoxetine improves the quality of life in patients with poststroke emotional disturbances. Cerebrovasc Dis 2008; 26:266-71. [PMID: 18648199 DOI: 10.1159/000147454] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2007] [Accepted: 03/17/2008] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Fluoxetine may improve the poststroke emotional disturbances. The purpose of the present study was to evaluate the efficacy of fluoxetine on quality of life (QOL) over time in stroke patients with emotional disturbances. METHODS We studied 152 consecutive stroke patients (mean age, 58 years) who had either poststroke depression (PSD), emotional incontinence (PSEI) or anger proneness (PSAP) at an average of 14 months (range = 3-28) after the onset of stroke. The Korean version of SF-36 was used to assess the QOL. The presence of PSD, PSEI and PSAP was also determined with a standardized questionnaire. The subjects were given either 20 mg/day of fluoxetine (n = 76) or placebo (n = 76) for 3 months. Follow-up evaluations were done at 3, 6 and 12 months after the beginning of the treatment. RESULTS The score in the mental health domain was significantly higher in the fluoxetine group than in the placebo group at the 3-, 6- and 12-month follow-ups. The scores in the general health (p < 0.05) and social functioning (p < 0.05) domains were also significantly higher in the fluoxetine than in the placebo group at 12 months of follow up even if there was no definitive improvement in PSD, PSEI and PSAP at this time. CONCLUSIONS Fluoxetine is effective in improving QOL, particularly so in the mental health subdomain. Our results suggest that fluoxetine may be used to improve the QOL of stroke patients with emotional disturbances.
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Affiliation(s)
- S Choi-Kwon
- College of Nursing, Seoul National University, Seoul, Korea
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Suh DC, Kim JK, Choi CG, Kim SJ, Pyun HW, Ahn C, Yang DH, Lim KS, Leem JG, Hahm KD, Lee JH, Kwon SU, Kim JS. Prognostic factors for neurologic outcome after endovascular revascularization of acute symptomatic occlusion of the internal carotid artery. AJNR Am J Neuroradiol 2007; 28:1167-71. [PMID: 17569981 PMCID: PMC8134168 DOI: 10.3174/ajnr.a0492] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Management of acute symptomatic internal carotid artery (ICA) occlusion remains controversial. We evaluated outcome predictors of a good recovery in patients with acute symptomatic ICA occlusion. MATERIALS AND METHODS We retrospectively evaluated 33 consecutive patients (men/women, 23/10; mean age, 66 years) with: 1) acute symptomatic ICA occlusion within 6 hours of symptom onset or with mismatch of symptoms and an early infarct area, 2) National Institutes of Health Stroke Scale (NIHSS) score of 6 or more, and 3) attempted endovascular revascularization of the occluded ICA. Various single and multiple variable analyses were conducted to assess the association of 14 predictors with short-term (1-month NIHSS) and long-term (1-year modified Rankin Scale [mRS]) outcomes. RESULTS Successful recanalization (at or more than grade 2 distal residual occlusion) was obtained in 14 (42%) of 33 and good recovery (mRS <or=2) after 1 year in 11 (33%) of 33. Distal residual occlusion (DRO; P=.005), initial NIHSS score (P=.023), and postprocedural thrombolysis in cerebral infarction (P=.027), retrograde ICA filling (P=.036), and ophthalmic collaterals (P=.046) were significant predictors of short-term outcome. DRO (P=.018) and initial NIHSS (P=.033) were significant predictors of long-term outcome on univariable analysis. DRO was the only significant predictor for short-term (P=.026) and long-term outcome (P=.033) on multivariable logistic regression. CONCLUSIONS Active revascularization of acute symptomatic ICA occlusion resulted in good recovery in one third of patients after 1 year. DRO is an independent predictor of a favorable clinical outcome.
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Affiliation(s)
- D C Suh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea.
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Choi CG, Lee DH, Lee JH, Pyun HW, Kang DW, Kwon SU, Kim JK, Kim SJ, Suh DC. Detection of intracranial atherosclerotic steno-occlusive disease with 3D time-of-flight magnetic resonance angiography with sensitivity encoding at 3T. AJNR Am J Neuroradiol 2007; 28:439-46. [PMID: 17353309 PMCID: PMC7977826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND AND PURPOSE The spatial resolution of 3D time-of-flight MR angiography (TOF-MRA) can be improved within a reasonable examination time by combining 3T and sensitivity encoding technique. We evaluated the diagnostic performance of high-resolution 3D TOF-MRA at 3T in patients with suspected atherosclerotic steno-occlusive disease of the intracranial arteries. MATERIALS AND METHODS We assessed 160 arteries in 39 patients: 68 distal internal carotid arteries, 68 middle cerebral arteries, and 24 vertebrobasilar arteries. The measured voxel size of 3D TOF-MRA was 0.28 x 0.56 x 1.2 mm(3). Steno-occlusive disease was assessed independently by 2 observers using conventional angiography as the reference standard. RESULTS According to observers 1 and 2, respectively, 3D TOF-MRA at 3T had a sensitivity of 78%/85% (21/27, 23/27), a specificity of 95%/95% (126/133, 127/133), a positive predictive value of 75%/79% (21/28, 23/29), and a negative predictive value of 95%/97% (126/132, 127/131), using a 50%-99% threshold of diameter stenosis. For detection of complete occlusion, according to observers 1 and 2, respectively, 3D TOF-MRA at 3T had a sensitivity of 100% (13/13), a specificity of 99% (145/147), a positive predictive value of 87% (13/15), and a negative predictive value of 100% (145/145). Interobserver agreement of 3D TOF-MRA was excellent (kappa = 0.81). CONCLUSION High-resolution 3D TOF-MRA with sensitivity encoding at 3T can be used as a reliable diagnostic tool for the detection of clinically significant steno-occlusive disease of major intracranial arteries.
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Affiliation(s)
- C G Choi
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Pyun HW, Lee DH, Kwon SU, Lee JH, Choi CG, Kim SJ, Suh DC. Internal carotid artery stenosis with ipsilateral persistent hypoglossal artery presenting as a multiterritorial embolic infarction: a case report. Acta Radiol 2007; 48:116-8. [PMID: 17325936 DOI: 10.1080/02841850601026443] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Persistent hypoglossal artery (PHA) is a relatively rare vascular anomaly of persistent carotid-basilar anastomosis. We have treated a patient with stenosis of the internal carotid artery which was combined with PHA and who presented with multiple small embolic infarcts in multiple vascular territories. It is important to know that a persistent carotid-basilar anastomosis could be one of the causes bringing about acute infarction in both the anterior and posterior vascular territories, mimicking cardioembolism.
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Affiliation(s)
- H W Pyun
- Department of Radiology and Research Institute of Radiology, and Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Park KC, Lee BH, Kim EJ, Shin MH, Choi KM, Yoon SS, Kwon SU, Chung CS, Lee KH, Heilman KM, Na DL. Deafferentation-disconnection neglect induced by posterior cerebral artery infarction. Neurology 2006; 66:56-61. [PMID: 16401846 DOI: 10.1212/01.wnl.0000191306.67582.7a] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate patients with posterior cerebral artery (PCA) infarctions to learn whether hemispatial neglect is more frequent and severe after right than left PCA infarction; whether visual field defects (VFDs) influence the presence or severity of hemispatial neglect; and the anatomic loci of lesions that are associated with hemispatial neglect. METHODS The authors recruited 45 patients with PCA infarction that involved only the occipital lobe or the occipital lobe plus other areas served by the PCA. All subjects received seven neglect tests within 2 months after onset. RESULTS Overall, the frequency of hemispatial neglect was 42.2%. The frequency did not significantly differ between the right (48.0%) and left (35.0%) PCA groups, but the severity of hemispatial neglect was significantly greater in the right group. VFD alone did not influence the frequency or severity of neglect after controlling other variables. Isolated occipital lesions were rarely associated with hemispatial neglect, and it was only the occipital plus splenial lesion that significantly influenced the frequency and severity of neglect. CONCLUSIONS This study suggests that after excluding such confounding factors as aphasia or hemiplegia, neglect frequency does not differ between the right and left posterior cerebral artery (PCA) groups, but the severity of neglect is greater after right PCA infarctions; even in the acute stage of PCA infarction; visual field defect from an isolated occipital lesion does not cause hemispatial neglect; and the injury to both the occipital lobe and the splenium of the corpus callosum is important for producing hemispatial neglect with PCA infarction.
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Affiliation(s)
- K C Park
- Department of Neurology, Kyung Hee University, School of Medicine, Korea
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Choi-Kwon S, Lee SK, Park HA, Kwon SU, Ahn JS, Kim JS. What stroke patients want to know and what medical professionals think they should know about stroke: Korean perspectives. Patient Educ Couns 2005; 56:85-92. [PMID: 15590227 DOI: 10.1016/j.pec.2003.12.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2003] [Revised: 12/16/2003] [Accepted: 12/24/2003] [Indexed: 05/24/2023]
Abstract
BACKGROUND AND PURPOSE Patients and medical professionals are likely to have different perspectives of stroke, making what patients want to know about stroke different from what medical professionals think they should know. We wished to determine these differences for patients and medical professionals in South Korea, as well as to identify patients' characteristics associated with perceptions of stroke education. METHODS Fifty consecutive patients with acute stroke admitted to Asan Medical Center, Seoul, Korea, and 88 medical professionals (31 doctors and 57 nurses) working in the Departments of Neurology or Neurosurgery were administered a structured questionnaire regarding various aspects of patient education concerning stroke. RESULTS The average ranking of total items for stroke education was higher in nurses than in doctors or patients (P < 0.01 for each). Patients gave higher rankings than doctors for 'possibility to cure with drug treatment' (P < 0.01), 'stress management' (P < 0.01), and most items concerning 'general medical knowledge' and 'post-stroke diet management,' whereas doctors gave higher rankings than patients for most items concerning risk factor management and treatment with surgery. Items concerning 'post-stroke diet management' were ranked lower by male patients than females patients (P < 0.005), and were ranked lower by doctors than by patients or nurses (P < 0.001). Younger patients gave higher rankings than older patients for items concerning 'medical knowledge regarding stroke,' 'exercise,' and 'post-stroke sexual activities' (P < 0.001 for each). CONCLUSIONS Perspectives on stroke education differ among doctors, nurses and patients. They also differ according to the situation of the patient. Education of stroke patients should be based on an understanding of these differences.
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Affiliation(s)
- S Choi-Kwon
- College of Nursing, Seoul National University, Seoul 110-744, South Korea
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Chung SJ, Kwon SU, Kim JS. Headache Caused by Alternating Intracranial Hypertension and Intracranial Hypotension: A Case Report. Cephalalgia 2004; 24:235-7. [PMID: 15009019 DOI: 10.1111/j.1468-2982.2004.00637.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Using the 10-item Spielberger Trait Anger Scale, the authors interviewed 145 patients with stroke regarding inability to control anger or aggression (ICAA). Poststroke depression and emotional incontinence were also assessed. ICAA was present in 47 patients (32%) and was closely related to motor dysfunction, dysarthria, emotional incontinence, and lesions affecting frontal-lenticulocapsular-pontine base areas. ICAA seems to be one of the major behavioral symptoms in patients with stroke.
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Affiliation(s)
- J S Kim
- Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Korea.
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Lee WH, Hwang TH, Oh GT, Kwon SU, Choi YH, Park JE. Genetic factors associated with endothelial dysfunction affect the early onset of coronary artery disease in Korean males. Vasc Med 2002; 6:103-8. [PMID: 11530961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
The maintenance of balance between nitric oxide (NO) and the superoxide anion is required for proper functioning of the endothelium. To investigate the relationship between genetic factors associated with endothelial function and the development of coronary artery disease (CAD), endothelial nitric oxide synthase (ecNOS) gene a/b polymorphism and NADH/NADPH oxidase p22 phox gene C242T polymorphism were examined in 305 Korean male CAD patients and 215 healthy male control subjects. The beta-fibrinogen gene H1/H2 polymorphism was also analyzed. Both ecNOS a/b and p22 phox C242T polymorphisms were found to be associated with the development of CAD in the study population (p=0.020 and 0.011, respectively). When the association was analyzed by age, statistical significance was retained only in those <51 years (p=0.021 and 0.025 for the a/b and the C242T polymorphism, respectively) and not in those >51 years of age (p=0.155 and 0.278 respectively). However, the distribution of the beta-fibrinogen H1/H2 genotypes was not found to be associated with the development of CAD in either the < or =50 (p = 0.611) or >50 groups (p = 0.188). The ecNOS gene a/b polymorphism and the NADH/NADPH oxidase p22 phox gene C242T polymorphism were found to be significantly associated with the development of CAD in Korean male patients less than 51 years old.
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Affiliation(s)
- W H Lee
- Cardiology Division, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Kim JS, Yoon SS, Kwon SU, Ha JH, Suh EJ, Chi HS. Treatment of acute cerebral infarction with arginine esterase: a controlled study with heparin. Cerebrovasc Dis 2001; 11:251-6. [PMID: 11306776 DOI: 10.1159/000047647] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE [corrected] There is no treatment proven to be of definitive benefit for ischemic stroke. Arginine esterase, a natural product from a snake venom, has been shown to reduce the serum fibrinogen level in human beings and may be useful in the treatment of ischemic stroke. In the present study, we compared the therapeutic effect of arginine esterase with that of heparin. SUBJECTS AND METHODS We studied 50 consecutive patients with acute ischemic stroke who were admitted to the Asan Medical Center. We randomly administered either arginine esterase 0.005 unit/kg x 2 times/day or heparin (activated partial thromboplastin time 2-3 times of baseline value) intravenously for 7 days. Antiplatelets were administered afterwards in both groups. Blood fibrinogen, fibrinogen degradation product (FDP) and D-dimer levels were measured at 0, 6, 12, 18 h and 1, 2, 3, 7 and 30 days after the onset of stroke. NIH stroke scale was measured daily by 2 neurologists while Barthel index and Rankin scale were assessed at 7 days and 1 month after the onset of stroke by a research nurse. All these investigators were blinded to the therapeutic regimen each patient received. RESULTS There were no significant differences in the mean age, gender proportion, stroke subtypes and baseline neurological severity between the two groups. One patient in the arginine esterase group died in an acute stage due to massive herniation and 1 in the heparin group underwent surgery for herniation. One (arginine esterase group) died of massive gastrointestinal bleeding due to previously unrecognized stomach cancer. Otherwise, no significant clinical and laboratory side effects were observed in both groups. In the arginine-esterase treated group, D-dimer and FDP levels were significantly (p < 0.05) elevated, and fibrinogen level significantly (p < 0.05) decreased at 2-7 days after the onset of stroke compared to the heparin-treated group. However, there was no significant difference in the neurological improvement reflected by NIH stroke scale, Barthel index and Rankin scale. CONCLUSION Arginine esterase seems to be safe and has significant fibrinolytic effects when administered in the patients with acute ischemic stroke. However, in this preliminary study, it was not superior to heparin in terms of the improvement of neurological deficits. Further studies with larger doses and a larger number of subjects are required.
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Affiliation(s)
- J S Kim
- Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Korea.
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Abstract
Hypereosiophilia-induced encephalopathy (HE) is a rare but well-described clinical syndrome. However, serial magnetic resonance imaging (MRI) findings of HE have rarely been reported. We describe serial MRI findings of three patients with HE. The patients presented with acute confusion, focal neurological deficits and/or seizures. Eosinophils in repeated blood tests were more than 3000/mm3 in all the patients. Echocardiography in two patients showed findings consistent with eosinophilic endomyocardial fibrosis or global hypokinesia. The initial MRI revealed multiple high-signal lesions on T2-weighted images with gadolinium-DTPA enhancement on T1-weighted images, which were predominantly distributed in the border zone of the middle-anterior cerebral arteries and the middle-posterior cerebral arteries. The second MRIs taken prior to the initiation of steroid therapy showed that the lesions increased in size and number in the same area. The third MRIs performed long after the therapy showed that the lesions were shrunken. A brain biopsy specimen in one patient showed reactive gliosis following infarction with abundant intravascular eosinophils. The MRI-identified lesions in the patients with HE thus develop mainly in the border zone. The lesions occasionally increase in size and number and shrink if the eosinophilia is adequately treated. Although the nature of the MRI-identified lesions remains unclear, their pathogenesis may be related to multiple embolisms associated with concomitant cardiac abnormality and hypercoagulable state.
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Affiliation(s)
- S U Kwon
- Department of Neurology, Asan Medical Centre, University of Ulsan, 388-1 Pungnap-dong, Songpa-gu, Seoul
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Abstract
We report CT, MRI and angiographic findings of an arachnoid granulation in the straight sinus in a young man. Its density and signal intensity were isodense and isointense with cerebrospinal fluid on CT and MRI, respectively. The lesion appeared as a filling defect on MR venography and conventional angiography.
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Affiliation(s)
- J H Shin
- Department of Diagnostic Radiology, Asan Medical Centre, University of Ulsan College of Medicine, South Korea
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Abstract
OBJECTIVES To evaluate the characteristics of ischemic stroke in Korean young adults. MATERIAL AND METHODS We prospectively studied 149 consecutive patients with acute ischemic stroke aged between 15 to 44 years who were admitted to Asan Medical Center. All patients underwent brain CT/MRI and the majority of them underwent cerebral anglogram, echocardiography and laboratory studies for coagulopathy and vasculitis. Stroke subtypes were classified according to TOAST criteria. RESULTS In our study, men (75.2%) significantly outnumbered women. Stroke subtypes were: large artery atherosclerosis 20.8%), small artery occlusive disease 17.4%), cardioembolism 18.1%, undetermined causes 16.8%, and other determined etiologies 26.8%. The prevalence of hypertension, cigarette smoking and habitual alcohol consumption was significantly higher in men than in women. CONCLUSIONS Compared to the western studies, the deviation of sex ratio and the relative proportion of large artery atherosclerosis/small artery occlusion was higher. Heavy exposure to risk factors such as hypertension and cigarette smoking in Korean young men may explain these differences.
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Affiliation(s)
- S U Kwon
- Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Korea
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Affiliation(s)
- S K Lee
- Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, South Korea
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Abstract
Cerebral infarction is a well-documented complication of systemic lupus erythematosus (SLE), that usually occurs several years after the diagnosis of SLE. To our knowledge, however, strokes associated with vertebrobasilar artery involvement were not reported to present as an initial manifestation of SLE. We report two patients, who presented with vertebrobasilar territory infarction as an initial manifestation of SLE. Patient 1 was a 16-year-old girl, who developed dysarthria and ataxia. MRI showed multiple infarcts in the pons, cerebellum and thalamus. Four-vessel cerebral angiography showed multifocal stenoses in the vertebral and basilar arteries with beaded appearance. Patient 2 was a 26-year-old woman, who developed headache associated with dysarthria, dizziness and ataxia. MRI showed multiple infarcts in the cerebellum, medulla, pons, midbrain and thalamus. Cerebral angiography revealed occlusion of both vertebral arteries at the first cervical vertebral level with non-visualization of the basilar artery. Both patients were diagnosed as having SLE supported by laboratory results. Although rare, posterior circulation stroke can present as an initial manifestation of SLE, which may be attributed to vasculitis or dissection in the vertebral/basilar artery.
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Affiliation(s)
- S U Kwon
- Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, South Korea
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Abstract
A patient with left thalamo-mesencephalic infarction presented with micrographia in the right hand as the only motor sign. Brain MRI and 99mTc ethyl cysteinate dimer (ECD) perfusion SPECT revealed ischemic lesions in the left midbrain and the anterior thalamus, but not in the basal ganglia, whereas [123I]-IPT SPECT demonstrated decreased activity of the [123I]-IPT in the left striatum. The patient's micrographia may be related to a dysfunctional nigrostriatal dopaminergic system secondary to ischemic damage to the substantia nigra.
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Affiliation(s)
- J S Kim
- Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Korea
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Bygdeman M, Kwon SU, Mukherjee T, Roth-Brandel U, Wiqvist N. The effect of the prostaglandin F compounds on the contractility of the pregnant human uterus. Am J Obstet Gynecol 1970; 106:567-72. [PMID: 5412850 DOI: 10.1016/0002-9378(70)90042-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Wiqvist N, Bygdeman M, Kwon SU, Mukherjee T, Roth-Brandel U. Effect of prostaglandin E1 on the midpregnant human uterus. Intravenous, intramuscular, intra-amniotic, and vaginal administration. Am J Obstet Gynecol 1968; 102:327-32. [PMID: 5675883 DOI: 10.1016/0002-9378(68)90002-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Bygdeman M, Kwon SU, Mukherjee T, Wiqvist N. Effect of intravenous infusion of prostaglandin E1 and E2 on motility of the pregnant human uterus. Prostaglandins and related factors 65. Am J Obstet Gynecol 1968; 102:317-26. [PMID: 5675882 DOI: 10.1016/0002-9378(68)90001-x] [Citation(s) in RCA: 76] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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