Triglyceride-Related Parameters and Symptomatic Atherosclerotic Lesions in Patients With Ischemic Stroke

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.

Intraparenchymal Neurocysticercosis Unmasked by Cessation of Oral Corticosteroids: Immune Evasion and Therapeutic Approaches

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.

Causes, Risk Factors, and Clinical Outcomes of Stroke in Korean Young Adults: Systemic Lupus Erythematosus is Associated with Unfavorable Outcomes

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.

Thoracic Spinal Cord Infarction Presenting as Isolated Monoplegia

No abstract available.

Medullary Infarction Presenting as Sudden Cardiac Arrest: Report of Two Cases and Review of the Literature

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.

Effects of Temperature and Pressure on Acute Stroke Incidence Assessed Using a Korean Nationwide Insurance Database / 대한뇌졸중학회지

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.

Late-onset MELAS with Chronic Kidney Disease

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.

Multiple Embolic Infarction Due to a Primary Aortic Intimal Sarcoma / 대한뇌졸중학회지

No abstract available.

Sudden Unexpected Death after Lateral Medullary Infarction

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.

Location of Cerebral Microbleeds May Predict Subsequent Stroke after Transient Ischemic Attack / 대한뇌졸중학회지

No abstract available.