Résumé
Objective@#Recently, evidence has suggested that the pathophysiology and risk factors of intracranial atherosclerosis (ICAS) differs from those of extracranial atherosclerosis (ECAS). In addition, novel parameters reflecting metabolic conditions, such as insulin resistance or atherogenic dyslipidemia, based on triglycerides (TG) and other biomarkers, have emerged. In this study, we evaluated the association between TG-related parameters and symptomatic cerebral atherosclerosis in patients with acute ischemic stroke resulting from large artery atherosclerosis (LAA). @*Methods@#We assessed consecutive acute LAA-stroke patients between January 2010 and December 2020. Based on the radiological findings, we classified the relevant symptomatic arteries that caused the index stroke into LAA-ICAS and LAA-ECAS. As TGrelated parameters, the atherogenic index of plasma (AIP) and TG-glucose (TyG) index were calculated according to the following formulas: AIP = log10 (TG Level/High-density Lipoprotein Cholesterol Level), TyG Index = Ln (TG Level × Glucose Level/2). @*Results@#A total of 519 patients with LAA-stroke were evaluated. In multivariable logistic regression analysis to identify predictors of LAA-ICAS, AIP was significantly associated with LAA-ICAS (adjusted odds ratio [aOR], 3.60; 95% confidence interval [CI], 1.60–8.06). TyG index also showed a statistically significant relationship with LAA-ICAS (aOR, 1.60; 95% CI, 1.11–2.32). However, TG per se did not show a statistical association with LAA-ECAS. @*Conclusion@#TG-related parameters were more closely associated with stroke by ICAS than by ECAS. The metabolic conditions reflected by the AIP or TyG index, rather than hypertriglyceridemia itself, may play a greater role in determining the relevant vessel causally involved in a stroke.
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In a unique case of neurocysticercosis in Korea, a 73-year-old woman previously treated with steroids for rheumatoid arthritis exhibited neurological symptoms following steroid cessation. Magnetic resonance imaging findings confirmed vesicular stage neurocysticercosis, and subsequent antiparasitic treatment led to symptom resolution. The immunopathology of neurocysticercosis involves intricate interactions between the cyst’s immune evasion mechanisms and host inflammatory responses. The parasites’ strategy of inducing Th2- mediated anti-inflammatory responses for survival suggests potential therapeutic options for autoimmune disorders.
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Background@#and Purpose: The incidence of ischemic stroke (IS) in young adults is increasing, and the associated large socioeconomic impact makes understanding IS in young adults important. We investigated the causes of and risk factors for IS in young adults, and their impact on outcomes. @*Methods@#The Stroke in Korean Young Adults (SKY) study is a standardized multicenter prospective study involving eight medical centers of the Republic of Korea. First-ever IS patients aged 18 years to 44 years were prospectively included in this study within 7 days of stroke onset.Their outcomes at 3 months were analyzed. @*Results@#This study enrolled 270 patients from April 2014 to December 2018, most (67.8%) of whom were male. About 41.5% of the patients had one or more vascular risk factors from among hypertension, diabetes mellitus, and dyslipidemia. However, only half of them had received regular treatment. Arterial dissection was more common in males, and systemic lupus erythematosus (SLE) and Moyamoya disease were more common in females. The outcome was favorable (modified Rankin Scale score of 0 or 1) in 81.9% of the patients at 3 months after stroke onset. More severe initial symptoms, higher initial glucose level, and SLE as a comorbidity were associated with unfavorable outcomes. @*Conclusions@#Young adult IS patients in Korea exhibit low awareness and poor management of their risk factors. Although the short-term outcome was relatively favorable in those patients, having SLE was associated with unfavorable outcomes. More attention needs to be paid for improving awareness and controlling risk factors in this population.
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No abstract available.
Sujets)
Syndrome de l'artère spinale antérieure , Hémiplégie , Infarctus , Parésie , Moelle spinaleRésumé
The causes of sudden death after medullary infarction involve arrhythmia, central respiratory failure, and dysautonomia. Sudden cardiac arrest in a medullary infarction is uncommon. Most of these cases experienced sudden cardiopulmonary arrest within 2 weeks from stroke onset as the extent of lesion increased. Here, we report two cases of medullary infarction presenting as sudden cardiac arrest. These cases indicate that medullary infarction could be one of the causes of sudden cardiac arrest.
Sujets)
Troubles du rythme cardiaque , Mort subite , Mort subite cardiaque , Arrêt cardiaque , Infarctus , Moelle allongée , Dysautonomies primitives , Insuffisance respiratoire , Accident vasculaire cérébralRésumé
Mitochondrial encephalomyopathy with lactic acid and stroke-like episodes (MELAS) is a multisystem mitochondrial disorder that typically presents in childhood. We report a case of MELAS syndrome diagnosed in a 45-year-old man presented with chronic kidney disease before a stroke-like episode. Genetic testing revealed a m.3243A>G point mutation in the mtDNA. The original diagnostic criteria for MELAS required the onset of stroke-like episodes prior to 40 years of age but this case demonstrates that disease onset may delay in certain individuals.
Sujets)
Humains , Adulte d'âge moyen , ADN mitochondrial , Dépistage génétique , Acide lactique , Troubles tardifs , Syndrome MELAS , Maladies mitochondriales , Encéphalomyopathies mitochondriales , Mutation ponctuelle , Insuffisance rénale chronique , Accident vasculaire cérébralRésumé
BACKGROUND AND PURPOSE: Many studies have evaluated the association between weather and stroke, with variable conclusions. Herein we determined the relationships between daily meteorological parameters and acute stroke incidence in South Korea. METHODS: Patients with acute stroke (2,894) were identified by standard sampling of a nationwide insurance claims database from January to December 2011. We used multiple Poisson regression analyses of stroke incidence and meteorological parameters (mean temperature, diurnal temperature change, temperature differences over the preceding 24 hours, atmospheric pressure, humidity, wind speed, and physiologically equivalent temperature) to calculate the relative risk of stroke incidence associated with meteorological parameters. RESULTS: There were no seasonal variations in the incidences of ischemic (2,176) or hemorrhagic (718) stroke. Temperature change during the day was positively correlated with ischemic stroke in men (relative risk [RR] 1.027; 95% confidence interval [CI] 1.006–1.05) and older patients (≥65 years) (RR 1.031, 95% CI 1.011–1.052). Temperature differences over the preceding 24 hours had a negative correlation with all strokes (RR 0.968, 95% CI 0.941–0.996), especially among older women. Diurnal variation of atmospheric pressure was also significantly associated with the incidence of ischemic stroke (age < 65 years, RR 1.051, 95% CI 1.011–1.092; age≥65 years, RR 0.966, 95% CI 0.936–0.997). CONCLUSIONS: Diurnal temperature change, temperature differences over the preceding 24 hours, and diurnal variation of atmospheric pressure were associated with daily stroke incidence. These findings may enhance our understanding of the relationship between stroke and weather.
Sujets)
Femelle , Humains , Mâle , Pression atmosphérique , Hémorragie cérébrale , Infarctus cérébral , Humidité , Incidence , Assurance , Assurance maladie , Corée , Saisons , Accident vasculaire cérébral , Temps (météorologie) , VentRésumé
The prognosis of lateral medullary infarction is mostly benign, but unexpected sudden death can occur even when the initial symptoms are benign. An 81-year-old man visited the emergency room with whirling-type dizziness and right-veering tendency. Brain magnatic resonance imaging (MRI) revealed a right lateral medullary infarction accompanied by a right cerebellar infarction. He died suddenly at 1 day after admission with only slight lesion progression on MRI. This case suggests that patients with a lateral medullary infarction should be carefully monitored during the acute period.
Sujets)
Sujet âgé de 80 ans ou plus , Humains , Encéphale , Mort subite , Sensation vertigineuse , Service hospitalier d'urgences , Infarctus , Imagerie par résonance magnétique , Moelle allongée , Pronostic , Accident vasculaire cérébralRésumé
No abstract available.
Sujets)
Accident ischémique transitoire , Accident vasculaire cérébralRésumé
BACKGROUND: Small vessel disease is an important cause of cerebrovascular diseases and cognitive impairment in the elderly. There have been conflicting results regarding the relationship between Helicobacter pylori infection and ischemic stroke. This study aimed to examine the association between H. pylori infection and cerebral small vessel disease. METHODS: The study included 1,117 patients who underwent brain magnetic resonance imaging and H. pylori identification between 2005 and 2013 at Health Promotion Center, Seoul National University Hospital. Multivariable logistic regression analysis was used to assess the association between H. pylori infection and small vessel disease with adjustment for age, sex, hypertension, diabetes mellitus, dyslipidemia, body mass index, smoking status, problem drinking, and antiplatelet use. RESULTS: The adjusted odds ratios (aORs) for the association between H. pylori infection and silent brain infarction and cerebral microbleeds were 1.03 (95% confidence interval [CI], 0.66-1.61) and 0.70 (95% CI, 0.38-1.28), respectively. The aORs for silent brain infarction and cerebral microbleeds were 0.81 (95% CI, 0.44-1.44) and 0.59 (95% CI, 0.30-1.18) in patients aged 65 years, respectively. Moreover, the aORs for silent brain infarction and cerebral microbleeds were 0.96 (95% CI, 0.54-1.71) and 0.74 (95% CI, 0.33-1.69) in H. pylori-infected patients without atrophic gastritis and 0.89 (95% CI, 0.48-1.62) and 0.99 (95% CI, 0.43-2.27) in those with atrophic gastritis, respectively. CONCLUSION: No association between H. pylori infection and small vessel disease was observed. H. pylori-induced inflammation may not be a risk factor for microcirculatory damage in the brain.
Sujets)
Sujet âgé , Humains , Indice de masse corporelle , Encéphale , Infarctus encéphalique , Maladies des petits vaisseaux cérébraux , Diabète , Consommation de boisson , Dyslipidémies , Gastrite atrophique , Promotion de la santé , Helicobacter pylori , Helicobacter , Hypertension artérielle , Inflammation , Modèles logistiques , Imagerie par résonance magnétique , Odds ratio , Facteurs de risque , Séoul , Fumée , Fumer , Accident vasculaire cérébralRésumé
BACKGROUND AND PURPOSE: Clinical practice guidelines (CPGs) are regarded as an essential guidance tool for practicing physicians. We surveyed physicians in Korea in order to evaluate their attitudes toward the Korean CPGs for stroke. METHODS: We obtained participation agreement for our survey from 27 centers of the 33 most actively contributing to the Korean Stroke Registry. A total of 174 neurologists participated in a questionnaire interview regarding their attitudes toward CPGs for stroke. RESULTS: Of 174 participating neurologists, 65 (37.4%) were stroke neurologists. The average age was 33.6+/-7.1 and 49 (28.2%) were female. Most of the respondents held positive attitudes and opinions regarding the use of the guidelines, whereas only a small percentage (14.9%) responded negatively. More than 60% of the physicians in the survey reported adherence to the Korean CPGs in dyslipidemia management for the secondary prevention of stroke. CONCLUSIONS: The positive attitudes and opinions toward the guidelines imply that physicians' attitudes should not be regarded as a potential barrier to the implementation of Korean CPGs for stroke practiced by general physicians.
Sujets)
Femelle , Humains , Enquêtes et questionnaires , Dyslipidémies , Corée , Prévention secondaire , Accident vasculaire cérébralRésumé
BACKGROUND AND PURPOSE: Secondary stroke prevention guidelines recommend statins for the management of dyslipidemia in ischemic stroke and transient ischemic attack (TIA). This study assessed the guideline-based statin prescription (GBSP) rate in Korea and the associated physician and patient factors. METHODS: A survey was conducted to assess Korean neurologists' knowledge of and attitude toward the current dyslipidemia management guidelines. The characteristics and discharge statin prescription for all consecutive patients with acute ischemic stroke or TIA treated by participating neurologists during the 6 months prior to the survey were abstracted. Using algorithms to determine GBSP, we assessed the rate and independent factors of GBSP. RESULTS: Of the 174 participating neurologists, 79 (45.4%) were categorized as a higher-level knowledge group. For the 4407 patients (mean age, 66.4 years; female, 42.5%; 90.6% with ischemic stroke and 9.4% with TIA) enrolled in this study, the GBSP rate at discharge was 78.6%. The GBSP rate increased significantly with increasing physician knowledge level (test for trend, p<0.0001), and was higher among patients treated by the higher-level knowledge group than for those treated by the lower-level knowledge group (81.6% vs. 74.7%; unadjusted p<0.0001 and adjusted p=0.045). Other independent factors associated with a higher GBSP rate were hypercholesterolemia and higher low-density lipoprotein cholesterol level, while those associated with a lower GBSP rate were cardioembolism, undetermined etiology due to negative or incomplete work-up, other determined etiology, and TIA presentation. CONCLUSIONS: More than three-quarters of acute ischemic stroke survivors and TIA patients receive a GBSP at discharge, and this proportion would be further improved by improving the knowledge of dyslipidemia management guidelines among neurologists.
Sujets)
Femelle , Humains , Cholestérol , Dyslipidémies , Inhibiteurs de l'hydroxyméthylglutaryl-CoA réductase , Hypercholestérolémie , Accident ischémique transitoire , Corée , Lipoprotéines , Ordonnances , Accident vasculaire cérébral , SurvivantsRésumé
Right-sided neglect after an acute, left subcortical brain injury is a rare phenomenon for several reasons including its rapid resolution and decreased clinical suspicion. Here we present a case of a 72-year-old right-handed man who presented with right auditory and sensory extinction following a left thalamic intracerebral hemorrhage without visual extinction, sensory or corticosensory deficits, and discuss the mechanisms involved in this infrequently encountered stroke syndrome.
Sujets)
Sujet âgé , Humains , Lésions encéphaliques , Hémorragie cérébrale , Hémorragie , Accident vasculaire cérébral , ThalamusRésumé
BACKGROUND: Small proportions of all the elderly stroke patients receive recombinant tissue plasminogen activator (r-tPA) therapy, although old age is not a proven contraindication to intravenous thrombolytic therapy for acute ischemic stroke. The purpose of this study was to identify reasons for exclusion from r-tPA therapy and factors associated with the decision of r-tPA use in elderly patients with acute ischemic stroke. METHODS: From the acute stroke registries of 22 domestic university hospitals taking the r-tPA therapy from January 2007 to May 2010, we extracted data of all acute ischemic stroke patients who were aged 80 or over and arrived within onset 3 hours. For all patients, we assessed the eligibility of r-tPA therapy using National Institute of Neurological Disorders and Stroke (NINDS) r-tPA trial criteria. For eligible patients, we compared all clinical variables between patients who were treated with r-tPA and those who were not, and analyzed potential factors related to the decision of r-tPA use. RESULTS: A total of 494 patients were included in this study. 255 patients (51.6%) were excluded by NINDS r-tPA trial criteria and the major reasons for exclusion were minor neurological deficit (53.7%) and clinical improvement (17.3%). Among 239 patients who were eligible for r-tPA, 162 (32.8%) patients received r-tPA and 77 (15.6%) did not. Multivariable analysis showed that younger age, shorter time-delay from onset to admission, non-smoker, no history of prior stroke, good pre-stroke functional status and severe initial neurological deficit were independently associated with the decision of r-tPA use in the elderly stroke patients predictors for r-tPA treatment. CONCLUSION: In very elderly patients, mild neurological deficit on arrival and rapid clinical improvement in neurological symptoms were the main reasons for exclusion from thrombolytic therapy.
Sujets)
Sujet âgé , Humains , Hôpitaux universitaires , National Institute of Neurological Disorders and Stroke (USA) , Enregistrements , Accident vasculaire cérébral , Traitement thrombolytique , Activateur tissulaire du plasminogèneRésumé
The aim of this update of Korean clinical practice guidelines for stroke is to provide timely evidence-based recommendations on the antiplatelet therapy in secondary prevention of stroke. Evidence-based recommendations are included for the use of antiplatelet agents for noncardioembolic stroke. Changes in the guidelines necessitated by new evidence will be continuously reflected in the new guideline.
Sujets)
Acide acétylsalicylique , Antiagrégants plaquettaires , Prévention secondaire , Accident vasculaire cérébral , TiclopidineRésumé
BACKGROUND: Restless-legs syndrome (RLS) is known to be caused by dopaminergic hypofunction in the brain. We investigated whether antipsychotics that act as antidopaminergics increase the risk of RLS. METHODS: We prospectively recruited 72 schizophrenic patients who had been medicated with antipsychotic drugs in a psychiatry clinic. We evaluated RLS diagnostic criteria and basic sleep habits using the Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index by face-to-face interviews using a structured questionnaire. We also applied the Unified Parkinson's Disease Rating Scale to evaluate extrapyramidal symptoms. RESULTS: Three of the 72 patients (4.2%) met RLS criteria, which is similar to the previously reported RLS incidence among the general population in Korea. CONCLUSIONS: There is no evidence that antipsychotics increase the risk of RLS. We believe that the mild antidopaminergic effect of antipsychotics does not overwhelm their prominent antipsychotic effect.
Sujets)
Humains , Neuroleptiques , Encéphale , Incidence , Maladie de Parkinson , Études prospectives , Enquêtes et questionnaires , Syndrome des jambes sans repos , Facteurs de risque , SchizophrénieRésumé
BACKGROUND AND PURPOSE: Restless legs syndrome (RLS) is a sleep disorder that frequently occurs in dialysis patients, which disturbs the sleep and reduces the quality of life. The aim of this study was to determine the risk factors for RLS in dialysis patients. METHODS: Patients who visited any of four outpatient dialysis clinics between September 2005 and May 2006 were included in this study. The diagnosis of RLS and the severity assessment were made using the criteria described by the International Restless Legs Syndrome Study Group. We collected basic demographic data, clinical information, and laboratory findings, and then analyzed their association with various aspects of RLS using univariate and multivariate analyses. RESULTS: RLS was present in 46 (28.0%) of 164 dialysis patients. We found no significant risk factor for inducing RLS. The predialysis serum blood urea nitrogen (BUN) level in the dialysis patients with RLS was significantly correlated with RLS symptom severity. CONCLUSIONS: Predialysis BUN is related to RLS symptom severity. Further studies on the underlying mechanism are needed.
Sujets)
Humains , Azote uréique sanguin , Dialyse , Analyse multifactorielle , Patients en consultation externe , Qualité de vie , Dialyse rénale , Syndrome des jambes sans repos , Facteurs de risqueRésumé
The dorsolateral medullary syndrome (Wallenberg's syndrome) is produced by infarction of a wedge of lateral medulla posterior to the inferior olivary nucleus, and is usually caused by vertebral artery occlusion. Ipsilateral axial lateropulsion as an initial symptom of vertebral artery occlusion is rare, and the responsible anatomical structure is still uncertain. Here we describe a patient presenting with ipsilateral axial lateropulsion as an initial symptom of vertebral artery occlusion.