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Chen YH, Wei YC, Weng WC, Chien YY, Wu CL. Steroid-responsive multifocal motor neuropathy with cranial manifestations - a case report. Acta Neurol Taiwan 2024; 33(1):28-35. [PMID: 37848240] [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] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
The typical presentation of multifocal motor neuropathy (MMN) is progressive asymmetric limb weakness. Cranial neuropathy is rare. We report a 28-year-old woman with cranial and bulbar palsies but with typical electrophysiological features of MMN by multifocal motor conduction blocks and serological markers of anti-ganglioside GM1 antibodies. The previous consensus on the treatment of MMN is intravenous immunoglobulins, but our patient responded to oral steroids and had clinical and electrophysiological improvement under continuous low-dose prednisolone treatment. In summary, MMN is a treatable chronic inflammatory disease of peripheral nerves. Cranial neuropathies can be its initial presentations. Electromyography studies are crucial for MMN diagnosis and helpful in monitoring disease activity and treatment responses. Although the previous guideline did not suggest using steroids for MMN, with careful patient selection, low-dose oral steroids can be an effective treatment in patients with relatively minor symptoms. Keywords: Multifocal motor neuropathy, conduction block, bulbar palsy, cranial nerve, cranial neuropathy.
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Affiliation(s)
- Yi-Hsiang Chen
- Department of Neurology, Chang Gung Memorial Hospital, Keelung, 204, Taiwan
| | - Yi-Chia Wei
- Department of Neurology, Chang Gung Memorial Hospital, Keelung, 204, Taiwan; Collage of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Wei-Chieh Weng
- Department of Neurology, Chang Gung Memorial Hospital, Keelung, 204, Taiwan; Collage of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Yu-Yi Chien
- Department of Neurology, Chang Gung Memorial Hospital, Keelung, 204, Taiwan; Collage of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Chia-Lun Wu
- Department of Neurology, Chang Gung Memorial Hospital, Keelung, 204, Taiwan; Collage of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
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Huang KY, Wu CL, Chang YS, Huang WY, Su FC, Lin SW, Chien YY, Weng WC, Wei YC. Elevated plasma neurofilament light chain in immune-mediated neurological disorders (IMND) detected by immunomagnetic reduction (IMR). Brain Res 2023; 1821:148587. [PMID: 37739331 DOI: 10.1016/j.brainres.2023.148587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/10/2023] [Accepted: 09/17/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND In cases of immune-mediated neurological disorders (IMND), different syndromes are associated with antibodies against neuronal surface antigens, intra-neuronal antigens, astrocytic aquaporin, and gangliosides. These autoantibodies can be pathogenic or connected to neuroinflammation and resulting neuronal injuries. This study aims to identify a blood biomarker that can detect neuronal damage in individuals with IMND. To this end, we use immunomagnetic reduction (IMR) nanobead technology to measure plasma neurofilament light chain (NfL). METHODS The patients with IMND were enrolled in the Chang Gung Memorial Hospital at Keelung from 2018 to 2023. Seronegative patients were excluded based on the results of antibody tests. The healthy controls (HC) were community-dwelling adults from the Northeastern Taiwan Community Medicine Research Cohort (NTCMRC) conducted by the Community Medicine Research Center of the Keelung CGMH from 2020 to 2022. IMR technique detects magnetic susceptibility via measuring magnetic signal reduction caused by antigen-antibody immunocomplex formation on magnetic nanobeads. The plasma level of NfL was determined by the magnetic susceptibility changes in IMR. RESULTS The study enrolled 57 IMND patients from the hospital and 73 HC participants from the communities. The plasma NfL was significantly higher in the IMND than in the HC (11.022 ± 2.637 vs. 9.664 ± 2.610 pg/mL, p = 0.004), regardless of age effects on plasma NfL in an analysis of covariance (ANCOVA) (F = 0.720, p = 0.950). In the receiver of operation curve analysis, the area under curve for plasma NfL to discriminate IMND and HC was 0.664 (95% CI = 0.549 to 0.739, p = 0.005). The subgroup analysis of plasma NfL in the IMND patients showed no difference between peripheral immune-mediated neuropathy (IMN) and central immune-mediated encephalomyelitis (IMEM) (11.331 ± 2.895 vs. 10.627 ± 2.260 pg/mL, p = 0.322), nor between tumor and non-tumor IMND (10.784 ± 3.446 vs. 11.093 ± 2.391 pg/mL, p = 0.714). Additionally, the antibody class of ganglioside antibodies in IMN did not have an impact on plasma NfL level (p = 0.857). CONCLUSION Plasma NfL measurement is a reliable indicator of axonal injuries in patients with IMND. It is equally effective in detecting nerve injuries in inflammatory peripheral neuropathies and central neuroinflammation. The IMR nanobead technology offers a feasible method of detecting plasma NfL, which helps identify axonal injuries in IMND.
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Affiliation(s)
- Kuan-Yu Huang
- Department of Neurology, Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Chia-Lun Wu
- Department of Neurology, Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Yueh-Shih Chang
- Department of Hematology and Oncology, Chang Gung Memorial Hospital, Keelung 204, Taiwan; School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Wen-Yi Huang
- Department of Neurology, Chang Gung Memorial Hospital, Keelung 204, Taiwan; School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Feng-Chieh Su
- Department of Neurology, Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Shun-Wen Lin
- Department of Neurology, Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Yu-Yi Chien
- Department of Neurology, Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Wei-Chieh Weng
- Department of Neurology, Chang Gung Memorial Hospital, Keelung 204, Taiwan; School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Yi-Chia Wei
- Department of Neurology, Chang Gung Memorial Hospital, Keelung 204, Taiwan; School of Medicine, Chang Gung University, Taoyuan 333, Taiwan; Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung 204, Taiwan.
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Yang CH, Lin YS, Ou YC, Weng WC, Huang LH, Lu CH, Hsu CY, Tung MC. Short-term stretched penile length analysis for subsequent erectile dysfunction after robotic-assisted radical prostatectomy with bilateral neurovascular bundle preservation. J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.03.360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Wu CL, Chao CH, Lin SW, Chien YY, Huang WY, Weng WC, Su FC, Wei YC. Case Report: Plasma Biomarkers Reflect Immune Mechanisms of Guillain-Barré Syndrome. Front Neurol 2021; 12:720794. [PMID: 34539561 PMCID: PMC8446349 DOI: 10.3389/fneur.2021.720794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 08/02/2021] [Indexed: 11/13/2022] Open
Abstract
This case series reported a group of patients with Guillain–Barré syndrome (GBS) and their plasma cytokine changes before and after immunotherapy. We aimed to understand GBS's pathogenesis and pathophysiology through observing the interval differences of the representative cytokines, which were the thymus and activation regulated chemokine (TARC) for T-cell chemotaxis, CD40 ligand (CD40L) for cosimulation of B and T cells, activated complement component C5/C5a, and brain-derived neurotrophic factor (BDNF) for survival and regenerative responses to nerve injuries. The fluorescence magnetic bead-based multiplexing immunoassay simultaneously quantified the five cytokines in a single sample. From June 2018 to December 2019, we enrolled five GBS patients who had completed before–after blood cytokine measurements. One patient was diagnosed with paraneoplastic GBS and excluded from the following cytokine analysis. The BDNF level decreased consistently in all the patients and made it a potential biomarker for the acute stage of GBS. Interval changes of the other four cytokines were relatively inconsistent and possibly related to interindividual differences in the immune response to GBS triggers, types of GBS variants, and classes of antiganglioside antibodies. In summary, utilizing the multiplexing immunoassay helps in understanding the complex immune mechanisms of GBS and the variation of immune responses in GBS subtypes; this method is feasible for identifying potential biomarkers of GBS.
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Affiliation(s)
- Chia-Lun Wu
- Department of Neurology, Chang Gung Memorial Hospital, Keelung City, Taiwan.,School of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Chung-Hao Chao
- Department of Neurology, Chang Gung Memorial Hospital, Keelung City, Taiwan
| | - Shun-Wen Lin
- Department of Neurology, Chang Gung Memorial Hospital, Keelung City, Taiwan
| | - Yu-Yi Chien
- Department of Neurology, Chang Gung Memorial Hospital, Keelung City, Taiwan.,School of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Wen-Yi Huang
- Department of Neurology, Chang Gung Memorial Hospital, Keelung City, Taiwan.,School of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Wei-Chieh Weng
- Department of Neurology, Chang Gung Memorial Hospital, Keelung City, Taiwan.,School of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Feng-Chieh Su
- Department of Neurology, Chang Gung Memorial Hospital, Keelung City, Taiwan
| | - Yi-Chia Wei
- Department of Neurology, Chang Gung Memorial Hospital, Keelung City, Taiwan.,Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung City, Taiwan
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Abstract
BACKGROUND Cytokines are effective molecules of immune reactions. They work in inflammatory sites as well as circulate in the blood. Cytokines in the cerebrospinal fluid have been suggested to be markers of autoimmune encephalitis and reflect disease progression. However, studies on blood cytokines in autoimmune encephalitis are scarce. We report a case presenting with serial changes in blood cytokine levels in a male patient with anti-contactin-associated protein 2 (Caspr2) encephalitis. CASE PRESENTATION A 61-year-old man without systemic disease presented with ataxia and speech disturbance 1 week. After admission, he further developed visual hallucinations, psychosis, and consciousness deterioration. Brain magnetic resonance imaging and infection and tumor surveillances were negative. 18F-fluorodeoxyglucose positron emission tomography of brain revealed frontal and occipital hypometabolism and anterior cingulate gyrus and mesial temporal hypermetabolism. Autoimmune studies confirmed Caspr2 antibodies in his blood. After receiving a diagnosis of anti-Caspr2 encephalitis, the patient received steroids, plasmapheresis, and zonisamide. He recovered well and was totally independent 6 months after disease onset. A cytokine profiler array kit was used to investigate neuroimmune mechanisms during the disease course. Several cytokines showed significant changes in plasma levels, such as B cell activating factor for B cell proliferation; thymus and activation-regulated chemokine for T cell chemoattraction; soluble CD40 ligand for Th2 cell mediation; C5/C5a for complement activation; brain-derived neurotrophic factor for neuronal survival response; and dipeptidyl peptidase 4, retinol binding protein, dickkopf-related protein, and epidermal growth factor for response to environmental provocation. The concentration of cytokines was verified using Luminex multiplexing assay. CONCLUSIONS Due to their easy accessibility, blood cytokines are potential biomarkers of autoimmune encephalitis. Based on the investigating platform of this single case study, future larger scale studies are warranted.
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Affiliation(s)
- Yi-Chia Wei
- Department of Neurology, Chang Gung Memorial Hospital, No. 222, Maijin Rd., Anle Dist, Keelung City, 204, Taiwan. .,Community Medicine Research Center, Chang Gung Memorial, Hospital, Keelung, Taiwan. .,Collage of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Chia-Lun Wu
- Department of Neurology, Chang Gung Memorial Hospital, No. 222, Maijin Rd., Anle Dist, Keelung City, 204, Taiwan.,Collage of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Chieh Weng
- Department of Neurology, Chang Gung Memorial Hospital, No. 222, Maijin Rd., Anle Dist, Keelung City, 204, Taiwan.,Collage of Medicine, Chang Gung University, Taoyuan, Taiwan
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Wei YC, Tseng JR, Wu CL, Su FC, Weng WC, Hsu CC, Chang KH, Wu CF, Hsiao IT, Lin CP. Different FDG-PET metabolic patterns of anti-AMPAR and anti-NMDAR encephalitis: Case report and literature review. Brain Behav 2020; 10:e01540. [PMID: 31985135 PMCID: PMC7066351 DOI: 10.1002/brb3.1540] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 12/17/2019] [Accepted: 01/04/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION 18 F-fluorodeoxyglucose (FDG)-PET metabolic patterns of brain differ among autoimmune encephalitis with different neuronal surface antigens. In this case report, we compared the topographical relationship of cerebral glucose metabolism and antigen distribution in the patients with anti-NMDAR and anti-AMPAR encephalitis. Literature review summarized the common features of brain metabolism of autoimmune encephalitis. METHODS The cerebral glucose metabolism was evaluated by FDG-PET/CT during acute-to-subacute stage of autoimmune encephalitis and after treatment. The stereo and quantitative analysis of cerebral metabolism used standardized z-score and visualized on three-dimensional stereotactic surface projection. To map NMDAR and AMPAR in human brain, we adopted genetic atlases from the Allen Institute and protein atlases from Zilles's receptor densities. RESULTS The three-dimensional stereotactic surface projection displayed frontal-dominant hypometabolism in a 66-year-old female patient with anti-AMPAR encephalitis and occipital-dominant hypometabolism in a 29-year-old female patient with anti-NMDAR encephalitis. Receptor density maps revealed opposite frontal-occipital gradients of AMPAR and NMDAR, which reflect reduced metabolism in the correspondent encephalitis. FDG-PET hypometabolic areas possibly represent receptor hypofunction with spatial correspondence to receptor distributions of the autoimmune encephalitis. The reversibility of hypometabolism was in line with patients' cognitive improvement. The literature review summarized six features of metabolic anomalies of autoimmune encephalitis: (a) temporal hypermetabolism, (b) frontal hypermetabolism and (c) occipital hypometabolism in anti-NMDAR encephalitis, (d) hypometabolism in association cortices, (e) sparing of unimodal primary motor cortex, and (e) reversibility in recovery. CONCLUSIONS The distinct cerebral hypometabolic patterns of autoimmune encephalitis were representative for receptor hypofunction and topographical distribution of antigenic receptors. The reversibility of hypometabolism marked the clinical recovery of autoimmune encephalitis and made FDG-PET of brain a valuable diagnostic tool.
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Affiliation(s)
- Yi-Chia Wei
- Department of Neurology, Chang Gung Memorial Hospital, Keelung, Taiwan.,Institute of Neuroscience, National Yang Ming University, Taipei, Taiwan.,Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan.,Collage of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jing-Ren Tseng
- Collage of Medicine, Chang Gung University, Taoyuan, Taiwan.,Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Lun Wu
- Department of Neurology, Chang Gung Memorial Hospital, Keelung, Taiwan.,Collage of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Feng-Chieh Su
- Department of Neurology, Chang Gung Memorial Hospital, Keelung, Taiwan.,Collage of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Chieh Weng
- Department of Neurology, Chang Gung Memorial Hospital, Keelung, Taiwan.,Collage of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Chin Hsu
- Institute of Neuroscience, National Yang Ming University, Taipei, Taiwan
| | - Kai-Hsiang Chang
- Department of Neurology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chun-Feng Wu
- Collage of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Hematology and Oncology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Ing-Tsung Hsiao
- Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Po Lin
- Institute of Neuroscience, National Yang Ming University, Taipei, Taiwan
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Weng WC, Huang WY, Tang HY, Cheng ML, Chen KH. The Differences of Serum Metabolites Between Patients With Early-Stage Alzheimer's Disease and Mild Cognitive Impairment. Front Neurol 2019; 10:1223. [PMID: 31824405 PMCID: PMC6884031 DOI: 10.3389/fneur.2019.01223] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 11/04/2019] [Indexed: 01/25/2023] Open
Abstract
Background: Mild cognitive impairment (MCI) is regarded as a transition phase between normal aging and Alzheimer's disease (AD). Identification of novel and non-invasive biomarkers that can distinguish AD at an early stage from MCI is warranted for therapeutic and support planning. The goal of this study was to identify the differences of serum metabolomic profiles between MCI and early-stage AD, which could be potential non-invasive biomarkers for early diagnosis of AD. Methods: The subjects enrolled in the study were classified into two diagnostic groups: MCI (n = 40) and early-stage AD (n = 40). Targeted metabolomics analysis of serum samples was performed using the Biocrates Absolute-IDQ P180 kit. Targeted metabolic data were analyzed by TargetLynx, and MetIDQ software was applied to integrate the metabolites by automated calculation of metabolite concentrations. Results: The datasets of targeted metabolite analysis were analyzed by the orthogonal-projection-to-latent-structure–discriminant-analysis (OPLS-DA) model. The OPLS-DA score plots demonstrated considerable separation between the MCI and early-stage AD patients. The levels of pimelylcarnitine, putrescine, SM (OH) C24:1, and SM C24:0 were significantly lower, whereas the levels of acetylornithine, methionine sulfoxide, and PC ae C44:3 were significantly higher in early-stage AD patients as compared with MCI patients. Receiver operating characteristic curve analysis of a combination of three lipid metabolites [SM (OH) C24:1, SM C24:0, and PC ae C44:3] showed an acceptable discrimination between the early-stage AD and MCI patients (area under the curve = 0.788). Conclusions: Our results characterized the differences of serum metabolic profiles between MCI and early-stage AD patients. The positive findings from this study indicate that the minimally invasive method of blood sampling may help to identify patients with AD at an early stage from those with MCI.
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Affiliation(s)
- Wei-Chieh Weng
- Department of Neurology, College of Medicine, Keelung Chang Gung Memorial Hospital, Chang Gung University, Keelung, Taiwan
| | - Wen-Yi Huang
- Department of Neurology, College of Medicine, Keelung Chang Gung Memorial Hospital, Chang Gung University, Keelung, Taiwan
| | - Hsiang-Yu Tang
- Department of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.,Metabolomics Core Laboratory, Chang Gung University, Taoyuan, Taiwan.,Clinical Metabolomics Core Laboratory, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Kidney Research Center, College of Medicine, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Mei-Ling Cheng
- Department of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.,Metabolomics Core Laboratory, Chang Gung University, Taoyuan, Taiwan.,Clinical Metabolomics Core Laboratory, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Kidney Research Center, College of Medicine, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Kuan-Hsing Chen
- Kidney Research Center, College of Medicine, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
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Lung YJ, Weng WC, Wu CL, Huang WY. Association Between Total Cholesterol and 5 year Mortality in Patients with Carotid Artery Stenosis and Poststroke Functional Dependence. J Stroke Cerebrovasc Dis 2019; 28:1040-1047. [PMID: 30642665 DOI: 10.1016/j.jstrokecerebrovasdis.2018.12.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 10/22/2018] [Revised: 12/03/2018] [Accepted: 12/22/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Aggressive lipid-lowering treatment reduces the risk of cardiovascular events, but remains controversial in stroke patients. We investigate the influence of total cholesterol level on 5-year outcomes of ischemic stroke patients with high-grade internal carotid artery (ICA) stenosis and poststroke functional dependence. METHODS One-hundred and ninety-six acute ischemic stroke patients with high-grade ICA stenosis and modified Rankin Scale score ≥ 3 upon discharge were enrolled and prospectively observed for 5 years. Patients were divided into 2 groups according to total cholesterol level at admission: ≥200 mg/dL or <200 mg/dL. Demographic features, vascular risk factors, co-morbidities, and outcomes were compared between the 2 groups. RESULTS 117 (59.7%) patients had higher and 79 (40.3%) patients had lower total cholesterol levels. The prevalence of older age and atrial fibrillation was significantly higher in patients with lower total cholesterol; the prevalence of diabetes mellitus was higher in patients with higher total cholesterol. After adjusting for the established clinical predictors of adverse outcomes, the multivariate Cox regression revealed that lower total cholesterol level is a significant predictor of 5-year mortality (HR (hazard ratio) = 1.88, 95% CI (confidence interval) = 1.09-3.23, P = .023). CONCLUSIONS Lower total cholesterol level is associated with increased risk of 5-year mortality in ischemic stroke patients with high-grade ICA stenosis and post-stroke functional dependence. Aggressive treatment of hyperlipidemia should be carefully considered in these patients although it could reduce the risk of atherosclerotic cardiovascular diseases and stroke recurrence in some stroke patients.
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Affiliation(s)
- Yen-Ju Lung
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung branch, Keelung, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Wei-Chieh Weng
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung branch, Keelung, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Chia-Lun Wu
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung branch, Keelung, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Wen-Yi Huang
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung branch, Keelung, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
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Chou YF, Weng WC, Huang WY. Association between gastrointestinal bleeding and 3-year mortality in patients with acute, first-ever ischemic stroke. J Clin Neurosci 2017; 44:289-293. [DOI: 10.1016/j.jocn.2017.06.068] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 06/19/2017] [Accepted: 06/21/2017] [Indexed: 11/28/2022]
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Weng WC, Wei YC, Huang WY, Chien YY, Peng TI, Wu CL. Risk factor analysis for meralgia paresthetica: A hospital-based study in Taiwan. J Clin Neurosci 2017; 43:192-195. [DOI: 10.1016/j.jocn.2017.04.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 02/22/2017] [Accepted: 04/22/2017] [Indexed: 11/29/2022]
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Chu CH, Weng WC, Su FC, Peng TI, Chien YY, Wu CL, Lee KY, Wei YC, Lin SW, Yu YJ, Huang WY. Association between Atrial Fibrillation and Three-Year Mortality in Nondiabetic Patients with Acute First-Ever Ischemic Stroke. J Stroke Cerebrovasc Dis 2016; 25:2660-2667. [PMID: 27480821 DOI: 10.1016/j.jstrokecerebrovasdis.2016.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/06/2016] [Accepted: 07/02/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM) is a risk factor for atrial fibrillation (AF) and is known to be an important risk factor for death from stroke. The influence of AF on long-term outcomes in patients with ischemic stroke remains controversial. To clarify the exact influence of AF on stroke outcome and exclude the effect from DM, we investigated the influence of AF on the 3-year outcomes of nondiabetic patients with acute first-ever ischemic stroke. METHODS Five-hundred seventy-four nondiabetic patients with acute first-ever ischemic stroke were enrolled and had been followed for 3 years. Patients were divided into 2 groups according to whether AF was diagnosed or not. Clinical presentations, risk factors for stroke, laboratory data, comorbidities, and outcomes were recorded. RESULTS A total of 107 patients (18.6%) had AF. The age was significantly older in patients with AF. Total anterior circulation syndrome occurred more frequently among patients with AF (P < .001). The mean length of stay in the acute ward was significantly higher in patients with AF (P < .001). Furthermore, dependent functional status following discharge was higher in patients with AF (P < .001). Multivariate Cox regression revealed that AF is a significant predictor of 3-year all-cause mortality (hazard ratio = 1.98, 95% confidence interval = 1.07-3.67, P = .022). CONCLUSIONS AF is associated with increased risk of 3-year mortality in nondiabetic patients with acute first-ever ischemic stroke. Careful cardiac evaluation and treatment are essential in patients with AF and stroke.
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Affiliation(s)
- Chun-Hsueh Chu
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Wei-Chieh Weng
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Feng-Chieh Su
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Tsung-I Peng
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Yu-Yi Chien
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Chia-Lun Wu
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Kuang-Yung Lee
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Yi-Chia Wei
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Shun-Wen Lin
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Yi-Jing Yu
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Wen-Yi Huang
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
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Yu YJ, Weng WC, Su FC, Peng TI, Chien YY, Wu CL, Lee KY, Wei YC, Lin SW, Zhu JX, Huang WY. Association between pneumonia in acute stroke stage and 3-year mortality in patients with acute first-ever ischemic stroke. J Clin Neurosci 2016; 33:124-128. [PMID: 27436765 DOI: 10.1016/j.jocn.2016.02.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 01/26/2016] [Revised: 02/17/2016] [Accepted: 02/22/2016] [Indexed: 11/16/2022]
Abstract
The influence of pneumonia in acute stroke stage on the clinical presentation and long-term outcomes of patients with acute ischemic stroke is still controversial. We investigate the influence of pneumonia in acute stroke stage on the 3-year outcomes of patients with acute first-ever ischemic stroke. Nine-hundred and thirty-four patients with acute first-ever ischemic stroke were enrolled and had been followed for 3years. Patients were divided into two groups according to whether pneumonia occurred during acute stroke stage or not. Clinical presentations, risk factors for stroke, laboratory data, co-morbidities, and outcomes were recorded. The result showed that a total of 100 patients (10.7%) had pneumonia in acute stroke stage. The prevalence of older age, atrial fibrillation was significantly higher in patients with pneumonia in acute stroke stage. Total anterior circulation syndrome and posterior circulation syndrome occurred more frequently among patients with pneumonia in acute stroke stage (P<0.001 and P=0.009, respectively). Multivariate Cox regression revealed that pneumonia in acute stroke stage is a significant predictor of 3-year mortality (hazard ratio=6.39, 95% confidence interval=4.03-10.11, P<0.001). In conclusion, pneumonia during the acute stroke stage is associated with increased risk of 3-year mortality. Interventions to prevent pneumonia in acute stroke stage might improve ischemic stroke outcome.
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Affiliation(s)
- Yi-Jing Yu
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Jin Road, Keelung, Zip. 204, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan, Zip. 333, Taiwan
| | - Wei-Chieh Weng
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Jin Road, Keelung, Zip. 204, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan, Zip. 333, Taiwan
| | - Feng-Chieh Su
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Jin Road, Keelung, Zip. 204, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan, Zip. 333, Taiwan
| | - Tsung-I Peng
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Jin Road, Keelung, Zip. 204, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan, Zip. 333, Taiwan
| | - Yu-Yi Chien
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Jin Road, Keelung, Zip. 204, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan, Zip. 333, Taiwan
| | - Chia-Lun Wu
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Jin Road, Keelung, Zip. 204, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan, Zip. 333, Taiwan
| | - Kuang-Yung Lee
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Jin Road, Keelung, Zip. 204, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan, Zip. 333, Taiwan
| | - Yi-Chia Wei
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Jin Road, Keelung, Zip. 204, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan, Zip. 333, Taiwan
| | - Shun-Wen Lin
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Jin Road, Keelung, Zip. 204, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan, Zip. 333, Taiwan
| | - Jun-Xiao Zhu
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Jin Road, Keelung, Zip. 204, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan, Zip. 333, Taiwan
| | - Wen-Yi Huang
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Jin Road, Keelung, Zip. 204, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan, Zip. 333, Taiwan.
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Lin SW, Weng WC, Huang YH, Su FC, Peng TI, Chien YY, Wu CL, Lee KY, Yu YJ, Zhu JX, Huang WY. Association between renal dysfunction and 3-year mortality in patients with acute first-ever ischemic stroke. Clin Neurol Neurosurg 2015; 137:15-21. [PMID: 26117593 DOI: 10.1016/j.clineuro.2015.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 06/01/2015] [Revised: 06/10/2015] [Accepted: 06/12/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The influence of renal dysfunction on the clinical presentation and outcomes of patients with acute ischemic stroke is still controversial. We investigate the influence of renal dysfunction on the outcomes of patients with acute first-ever ischemic stroke. METHODS Nine-hundred thirty-four patients with acute first-ever ischemic stroke were enrolled and followed for 3 years. Renal function was assessed using the equation of the Modification Diet for Renal Disease for estimated glomerular filtration rate (eGFR). Serum creatinine levels were obtained within 3 days of acute stroke onset. Reduced eGFR was defined as eGFR<60ml/min/1.73m(2). Clinical presentation, risk factors for stroke, laboratory data, co-morbidities, and outcomes were recorded. RESULTS Total 264 patients (28.3%) had a reduced eGFR. The prevalence of older age, hypertension, and atrial fibrillation was significantly higher in patients with a reduced eGFR. Total anterior circulation syndrome occurred more frequently among patients with a reduced eGFR (P=0.010). Multivariate Cox regression revealed that a reduced eGFR is a significant predictor of 3-year mortality (HR=1.67, 95% CI=1.06-2.62, P=0.026). CONCLUSION Reduced eGFR during the acute stroke stage is associated with increased risk of 3-year mortality. Furthermore, risk of acute complications and poor functional outcomes following discharge was significantly higher in patients with a reduced eGFR.
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Affiliation(s)
- Shun-Wen Lin
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Jin Road, Keelung Zip. 204, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan Zip. 333, Taiwan
| | - Wei-Chieh Weng
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Jin Road, Keelung Zip. 204, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan Zip. 333, Taiwan
| | - Yu-Hua Huang
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Jin Road, Keelung Zip. 204, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan Zip. 333, Taiwan
| | - Feng-Chieh Su
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Jin Road, Keelung Zip. 204, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan Zip. 333, Taiwan
| | - Tsung-I Peng
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Jin Road, Keelung Zip. 204, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan Zip. 333, Taiwan
| | - Yu-Yi Chien
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Jin Road, Keelung Zip. 204, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan Zip. 333, Taiwan
| | - Chia-Lun Wu
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Jin Road, Keelung Zip. 204, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan Zip. 333, Taiwan
| | - Kuang-Yung Lee
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Jin Road, Keelung Zip. 204, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan Zip. 333, Taiwan
| | - Yi-Jing Yu
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Jin Road, Keelung Zip. 204, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan Zip. 333, Taiwan
| | - Jun-Xue Zhu
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Jin Road, Keelung Zip. 204, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan Zip. 333, Taiwan
| | - Wen-Yi Huang
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Jin Road, Keelung Zip. 204, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan Zip. 333, Taiwan.
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Weng WC, Huang WY, Su FC, Chien YY, Wu CL, Lee TH, Peng TI. Less favorable neurological recovery after acute stroke in patients with hypercholesterolemia. Clin Neurol Neurosurg 2013; 115:1446-50. [DOI: 10.1016/j.clineuro.2013.01.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 01/15/2013] [Accepted: 01/23/2013] [Indexed: 11/24/2022]
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Kuo SF, Chuang WY, Ng S, Chen CH, Chang CN, Chou CH, Weng WC, Yeh CH, Lin JD. Pituitary gigantism presenting with depressive mood disorder and diabetic ketoacidosis in an Asian adolescent. J Pediatr Endocrinol Metab 2013; 26:945-8. [PMID: 23729615 DOI: 10.1515/jpem-2013-0136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Accepted: 04/18/2013] [Indexed: 11/15/2022]
Abstract
Hyperglycemia is seldom described in young patients with pituitary gigantism. Here, we describe the case of a 17-year-old Taiwanese boy who developed depressive mood disorder and diabetic ketoacidosis (DKA) at the presentation of pituitary gigantism. The boy complained of lethargy and dysphoric mood in June 2008. He presented at the emergency department with epigastralgia and dyspnea in January 2009. Results of laboratory tests suggested type 1 diabetes mellitus with DKA. However, serum C-peptide level was normal on follow-up. Although he had no obvious features of acral enlargement, a high level of insulin-like growth factor 1 was detected, and a 75 g oral glucose suppression test showed no suppression of serum growth hormone levels. A pituitary macroadenoma was found on subsequent magnetic resonance imaging. The pituitary adenoma was surgically removed, followed by gamma-knife radiosurgery, and Sandostatin long-acting release treatment. He was then administered metformin, 500 mg twice daily, and to date, his serum glycohemoglobin has been <7%.
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Huang WY, Weng WC, Peng TI, Chien YY, Wu CL, Lee M, Hung CC, Chen KH. Association of hyponatremia in acute stroke stage with three-year mortality in patients with first-ever ischemic stroke. Cerebrovasc Dis 2012; 34:55-62. [PMID: 22759703 DOI: 10.1159/000338906] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Accepted: 04/16/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hyponatremia is the most common electrolyte disorder in hospitalized patients, and is frequently a marker of a significant underlying disease. The prognostic value of hyponatremia in patients with acute first-ever ischemic stroke is not known. We aimed to analyze whether hyponatremia in the acute stroke stage contributed to the risk of mortality or recurrent stroke in these patients. METHODS We studied 925 patients presenting with acute first-ever ischemic stroke between 2002 and 2004. Sodium levels were obtained on arrival at the emergency room within 3 days of acute stroke onset. Hyponatremia was defined as a serum sodium concentration of 134 mmol/l or less. Clinical presentation, stroke risk factors, associated medical disease, and outcome were recorded. All patients were followed for 3 years for survival analysis. A multivariate Cox proportional hazards model was used to identify risk factors for 3-year mortality in these patients. We also constructed Kaplan-Meier survival curves, and compared groups with hyponatremia and normonatremia by means of log rank tests for significant differences. RESULTS Among the patients with acute first-ever ischemic stroke, 107 (11.6%) were hyponatremic. Among stroke risk factors, the prevalence of diabetes mellitus was significantly higher among hyponatremic patients (p < 0.001). Prevalence of chronic renal insufficiency was also higher in the hyponatremic group (p = 0.002). Clinical presentations, such as the length of acute ward stay, initial impaired consciousness, and clinical course in acute stroke were similar among normo- and hyponatremic patients. Among the complications, pneumonia and urinary tract infection were significantly higher in hyponatremic than in normonatremic patients. After multivariate logistic regression analysis, diabetes mellitus and chronic renal insufficiency were associated with hyponatremia in these patients. Kaplan-Meier analysis indicated that the survival rate was significantly lower in hyponatremic patients than in normonatremic patients (log rank test; p value <0.001). After multivariate Cox proportional hazards model analysis, hyponatremia was a significant predictor of 3-year mortality in these patients after adjustment for related variables (p value = 0.003, hazard ratio = 2.23, 95% confidence interval: 1.30-3.82). CONCLUSION Hyponatremia in the acute stroke stage is a predictor of 3-year mortality in patients with acute first-ever ischemic stroke that is independent of other clinical predictors of adverse outcome.
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Affiliation(s)
- Wen-Yi Huang
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung Branch, Taipei, Taiwan, ROC
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Huang WY, Peng TI, Weng WC, Chien YY, Wu CL, Lee M, Chen KH. Higher leukocyte count is associated with higher risk of 3-year mortality in non-diabetic patients with first-ever ischemic stroke. J Neurol Sci 2012; 316:93-8. [PMID: 22336697 DOI: 10.1016/j.jns.2012.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 01/13/2012] [Accepted: 01/19/2012] [Indexed: 12/01/2022]
Abstract
Leukocyte count predicted the risk of first-time myocardial infarction and ischemic stroke. The aim of this study was to determine the role of elevated leukocyte count in non-diabetic patients admitted for acute first-ever ischemic stroke on clinical presentation and 3-year mortality. We studied 462 patients with acute first-ever ischemic stroke without diabetes mellitus or active infection at admission. Patients were classified into 2 groups according to their leukocyte count. A white blood cell (WBC) count ≥ 10,000/μL was defined as an elevated leukocyte count, otherwise as normal. Clinical presentation, risk factors for stroke, laboratory data, co-morbidities, and outcomes were recorded. 64 patients (13.9%) had elevated leukocytes. Multivariate logistic regression showed that an elevated platelet count was positively associated with the elevated leukocyte count, while a low serum sodium level was negatively associated with an elevated leukocyte count (P=0.008, P=0.003, respectively). An elevated leukocyte count was associated with a higher risk of a stroke in evolution (P=0.021). Multivariate Cox regression analysis revealed that an elevated leukocyte count is a significant predictor of 3-year mortality [P=0.010, HR=3.26 (1.33-7.98)]. In conclusion, higher leukocyte counts during the acute stroke stage are associated with increased risk of 3-year mortality in patients with acute, first-ever ischemic stroke.
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Affiliation(s)
- Wen-Yi Huang
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung branch, Taiwan, School of Medicine, Chang-Gung University, Taiwan
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Weng WC, Huang WY, Chien YY, Wu CL, Su FC, Hsu HJ, Lee TH, Peng TI. The impact of smoking on the severity of acute ischemic stroke. J Neurol Sci 2011; 308:94-7. [PMID: 21665225 DOI: 10.1016/j.jns.2011.05.046] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 05/25/2011] [Accepted: 05/26/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study investigated the impact of smoking on the initial severity of acute ischemic stroke and examined its subsequent outcome. METHODS Patient data was collected from the Stroke Registry in the Chang Gung Healthcare System (SRICHS). A total of 2650 patients admitted for acute ischemic stroke from January to December 2009 were included. Baseline characteristics were compared between smokers and non-smokers. Factors affecting the initial severity and the recovery from neurological deficit were examined by logistic regression analysis. The patients were further divided according to stroke mechanism for subgroup analysis. RESULTS The total number of smokers and non-smokers was 817 (31.9%) and 1833 (69.1%), respectively. Univariate analysis showed that smokers had lower NIHSS scores on admission than did non-smokers (P<0.001). In subgroup analysis, smokers with small-vessel occlusions frequently had higher NIHSS scores on admission than did non-smokers (P=0.001). However, smokers with cardioembolic stroke had lower NIHSS scores on admission as compared to non-smokers (P=0.024). No subgroup had smoking as a significant factor for neurological recovery during hospitalization. CONCLUSIONS Smoking correlated with higher NIHSS scores on admission for small-vessel occlusion. Conversely, it was associated with lower NIHSS scores on admission for cardioembolism.
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Affiliation(s)
- Wei-Chieh Weng
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung branch, Taiwan
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Huang WY, Chien YY, Wu CL, Weng WC, Peng TI, Chen HC. Pituitary adenoma apoplexy with initial presentation mimicking bacterial meningoencephalitis: a case report. Am J Emerg Med 2009; 27:517.e1-4. [PMID: 19555639 DOI: 10.1016/j.ajem.2008.08.004] [Citation(s) in RCA: 11] [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] [Subscribe] [Scholar Register] [Received: 08/01/2008] [Accepted: 08/03/2008] [Indexed: 11/16/2022] Open
Abstract
Pituitary apoplexy is a rare but life-threatening disorder. Clinical presentation of this condition includes severe headache, impaired consciousness, fever, visual disturbance, and variable ocular paresis. Signs of meningeal irritation are very rare. However, if present and associated with headache, fever, and pleocytosis, meningeal irritation may lead to misinterpretation as infectious meningoencephalitis. To the best of our knowledge, pituitary apoplexy with an initial presentation mimicking infectious meningoencephalitis had rarely been reported in the literature. Here, we report a 57-year-old man who had acute severe headache, high fever, neck stiffness, disturbance in consciousness, and left ocular paresis. Laboratory data showed leukocytosis, an elevated C-reactive protein level, and neutrophilic pleocytosis in the cerebrospinal fluid. Because bacterial meningoencephalitis was suspected, empiric antibiotic therapy was administered but in vain. Further examinations indicated a diagnosis of pituitary adenoma with apoplexy. After the immediate administration of intravenous corticosteroid supplement and surgical decompression, the patient recovered.
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Affiliation(s)
- Wen-Yi Huang
- Department of Neurology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan 204, Republic of China.
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Huang WY, Weng WC, Peng TI, Ro LS, Yang CW, Chen KH. Central Pontine and Extrapontine Myelinolysis after Rapid Correction of Hyponatremia by Hemodialysis in a Uremic Patient. Ren Fail 2009; 29:635-8. [PMID: 17654329 DOI: 10.1080/08860220701392314] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Osmotic demyelination syndrome, a well-known entity, is characterized by demyelination in the pons and extrapontine areas. Rapid correction of chronic hyponatremia is its most important cause. This report presents a 52-year-old man with uremia and hyponatremia. Demyelination syndrome developed after the first hemodialysis session. Brain images showed central pontine myelinolysis and extrapontine myelinolysis. This case emphasizes the fact that demyelination syndrome can occur when hyponatremia is corrected too rapidly, even in uremic patients. Lowering dialysate sodium with multiple, short durations of hemodialysis at a low blood flow rate should be prescribed during hemodialysis in select hyponatremic patients.
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Affiliation(s)
- Wen-Yi Huang
- Department of Neurology, Keelung Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
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Huang WY, Weng WC, Chien YY, Wu CL, Peng TI, Chen KH. Predictive factors of outcome and stroke recurrence in patients with unilateral atherosclerosis-related internal carotid artery occlusion. Neurol India 2009; 56:173-8. [PMID: 18688143 DOI: 10.4103/0028-3886.41996] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Clinical outcome of internal carotid artery (ICA) occlusion is highly variable and the reason is uncertain. AIM To study the predictive factors of clinical outcome and stroke recurrence in patients with ischemic stroke associated with unilateral atherosclerosis-related ICA occlusion. SETTINGS AND DESIGN Prospective study in neurology department of a single hospital. MATERIALS AND METHODS We prospectively studied 66 patients who suffered from first-ever ischemic stroke associated with unilateral atherosclerosis-related ICA occlusion over a period of two years. The end point was death or stroke recurrence. STATISTICAL ANALYSIS Chi-square or Fisher's exact test was used to analyze predictors of early functional outcome. Multivariate analysis was used to analyze predictors of death or stroke recurrence within two years. RESULT Higher age (>or=70 years) predicted a worse functional outcome (P=0.049). Total anterior circulation syndrome (TACS) was associated with a poor functional outcome (P<0.001), but lacunar syndrome had a better outcome (P=0.001). Stroke in evolution predicted a poor outcome (P=0.001), while those with symptom improvement had a better outcome (P=0.016). Pneumonia predicted a poor outcome (P=0.021). Five patients expired and 22 patients suffered from recurrent stroke in the following 24 months. Previous transient ischemic attack (TIA) and anemia were associated with a higher risk of death or recurrent stroke within two years (P=0.036, P=0.012). CONCLUSION High age, TACS, stroke in evolution and pneumonia were predictors for poor functional outcome. Previous TIA and anemia were predictors for death and recurrent stroke within two years.
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Affiliation(s)
- Wen-Yi Huang
- Department of Neurology, Keelung Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
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Huang WY, Chen IC, Meng L, Weng WC, Peng TI. The influence of anemia on clinical presentation and outcome of patients with first-ever atherosclerosis-related ischemic stroke. J Clin Neurosci 2009; 16:645-9. [PMID: 19285409 DOI: 10.1016/j.jocn.2008.08.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Revised: 08/18/2008] [Accepted: 08/21/2008] [Indexed: 11/16/2022]
Abstract
There is considerable debate regarding whether anemia qualifies as a prognostic factor for stroke. The purpose of this study was twofold: first, to assess the influence of anemia on vascular risk factors and clinical presentations in patients with first-ever atherosclerosis-related ischemic stroke and, second, to evaluate whether anemia may be of prognostic importance. A total of 774 consecutive patients with first-ever atherosclerosis-related ischemic stroke were prospectively investigated. Vascular risk factors, clinical presentations and outcomes were recorded and compared between those patients with and without anemia. Stroke recurrence and mortality were recorded at the 3-year follow-up. Of the study population, 168 (21.7%) were anemic. Multivariate analysis revealed that patients with anemia were more likely to be older than 70 years (p<0.001) and have chronic renal insufficiency (p<0.001). After a mean follow-up period of 958 days, 21 (12.5%) and 24 (4.0%) of the patients in the anemic and control groups, respectively, died. Within 3 years of initial onset, the mortality rate was significantly higher in patients with anemia (p=0.021). The Kaplan-Meier analysis for patients with and without anemia showed different survival curves (Log-rank test p<0.001). Within 3 years of the onset of first-ever atherosclerosis-related ischemic stroke, patients who had anemia at the time of the initial admission had an associated higher mortality rate. The stroke risk factors of being older than 70 years and having chronic renal insufficiency were more frequently observed in those patients with anemia.
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Affiliation(s)
- Wen-Yi Huang
- Department of Neurology, Keelung Chang-Gung Memorial Hospital, 222, Maijin Road, Anle Chiu, Keelung 204, Taiwan.
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Weng WC, Huang WY, Ryu SJ, Chang KH, Lin SK, Peng TI. Very early hemorrhagic transformation of a subcortical infarction. Acta Neurol Taiwan 2008; 17:263-266. [PMID: 19280872] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Hemorrhagic transformation (HT) of an ischemic stroke within 6 hours has never been documented. We reported a case of 65-year-old female experiencing sudden onset of slurred speech and right side weakness. Her past history disclosed rheumatic heart disease and atrial fibrillation. The National Institutes of Health stroke scale (NIHSS) score was 20. The brain computed tomography one hour after symptom onset revealed a faint hypodense lesion in the left striatum. The lesion, however, was transformed spontaneously into a large hematoma within 3 hours of symptom onset. This case thus developed a very early HT of a subcortical infarct of possible cardioembolic origin and high initial NIHSS score. Though rare, very early spontaneous HT does happen.
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Affiliation(s)
- Wei-Chieh Weng
- Department of Neurology, Kee-Lung Medical Center, Chang-Gung Memorial Hospital, Taiwan
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Abstract
Two capillary electrophoretic methods, a micellar electrokinetic electrophoretic (MEKC) one and a capillary zone electrophoretic (CZE) one, were developed for the separation of 12 constituents in Artemisiae Capillaris Herba. Detection at 254 nm with 20 mM sodium dodecyl sulfate and 20 mM sodium borate buffer (pH 9.82) in MEKC or with 25 mM sodium borate and 6.75 mg/ml 2,3,6-tri-O-methyl-beta-cyclodextrin buffer in CZE was found to be the most suitable approach for this analysis. Within 42 min, the MEKC method could successfully separate 12 authentic constituents, whereof chlorogenic acid, however, appeared as a broad and split peak, and capillarisin and chlorogenic acid overlapped partially with other coexisting substances in crude extract of the herb. The CZE method could completely overcome these problems and was used to determine the amounts of capillarisin, chlorogenic acid, scopoletin and caffeic acid in the extract. The effect of buffers on the constituent separation and the validation of the two methods were discussed.
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Affiliation(s)
- S J Sheu
- Department of Chemistry, National Taiwan Normal University, Taipei.
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