Effect of Steroid on the Development of Cerebral Edema in Experimental Intracerebral Hemorrhage

BACKGROUND: Although steroid is one of the most widely used therapeutic measures for brain edema, its effect on brain edema after intracerebral hemorrhage (ICH) remains to be clarified. We performed this study to evaluate the efficacy of high dose methylprednisolone and conventional dose dexamethasone on the development of brain edema after experimental ICH. METHODS: Fifty-four male Sprague-Dawley rats, weighing 350-450 g, were used. ICH was made by stereotaxic injection of autologous arterial blood (0.13ml) into the right caudatoputamen. The animals were divided into three groups (n = 18 each). Group A received intraperitoneal(IP) injection of normal saline at 8-hour interval. Group B received dexamethasone (0.2mg/kg IP 30minutes after blood injection and 0.1mg/kg IP every 8h thereafter). Group C received methylprednisolone (30 mg/kg IP 30 minutes after ICH, 15mg/kg IP at 2 h after initial dose, and every 8h thereafter). We sacrificed the rat after 3 days and the development of brain edema was determined by measuring brain water content. We compared brain water content in each group. RESULTS: Water content of the right hemisphere was slightly lower in the methylprednisolone-treated rats than other groups; mean + S.D. in group A, B, and C was 80.94 + 0.66%, 80.56 + 0.70%, and 80.42 + 0.91%, respectively. However, there was no statistical significance ( p > 0.1) by the ANOVA test. The difference of the mean water contents between the two hemispheres was slightly higher in the saline-treated group than other groups, but without statistical significance ( p > 0.1). CONCLUSION: We could not find any significant reduction of the brain water content in the groups treated with steroid regardless of the doses. Our results do not warrant the popular steroid therapy in patients with ICH.

Ictal PET Findings of Complex Partial Status Epilepticus

We performed an 18F-fluorodeoxyglucose (FDG) position emission tomography (PET) in two patients with complex partial status epilepticus (CPSE). Ictal FDG studies usually occur by chance, because of the unpredictable nature of seizures and the short half-life of flourine-18. In addition to that, ictal PET studies are often contaminated by postictal hypometabolism due to the relatively long FDG uptake period. We experienced two patients with prolonged states of mental confusion. During the confused state, eletrophysiologic and neuroimaging studies were done to confirm the diag-nosis of CPSE. Ictal PET studies showed hypermetabolism during status epilepticus compared with interictal PET. There has been no case report about ictal PET in Korea. We present two cases of ictal PET with a review of the literature

Ictal PET Findings of Complex Partial Status Epilepticus

We performed an 18F-fluorodeoxyglucose (FDG) position emission tomography (PET) in two patients with complex partial status epilepticus (CPSE). Ictal FDG studies usually occur by chance, because of the unpredictable nature of seizures and the short half-life of flourine-18. In addition to that, ictal PET studies are often contaminated by postictal hypometabolism due to the relatively long FDG uptake period. We experienced two patients with prolonged states of mental confusion. During the confused state, eletrophysiologic and neuroimaging studies were done to confirm the diag-nosis of CPSE. Ictal PET studies showed hypermetabolism during status epilepticus compared with interictal PET. There has been no case report about ictal PET in Korea. We present two cases of ictal PET with a review of the literature

How well Do We Prevent Cardioembolic Stroke?

BACKGROUND & OBJECTIVE: Recent studies suggest that anticoagulation, or antiplatelet therapy is safe and effective for the prevention of cardiogenic embolic stroke. However it has not been studied in Korea how the patients with cardioembolic source were managed in practice for the prevention of stroke. This study was done to assess the current status of primary and secondary prevention of cardioembolic stroke. METHODS: Retrospective study was undertaken in 124 patients with cardiogenic embolic stroke, following items were examined, previous anticoagulation or antiplatelet therapy, previous stroke, Insight of the heart disease, and International Normalize Ratio(INR) value on arrival at the hospital. RESULTS: In 124 patients cardioembolic sources were constituted of non-valvular atrial fibrillation (NVAF) in 54, rheumatic heart disease In 40, prosthetic cardiac valve In 14, dilated cardiomyopathy(D-CMP) in 6, left ventricular akinetic segment in 7(including 3 cases of LV thrombi), recent myocardial infarction in 3. In 93 patients with no previous stroke, 44 patients had regular medical follow-up because of his/her cardiac problems and primary prevention of stroke was made only in 12 (27%) patients (8 on anticoagulation and 4 on antiplatelet therapy). The rate of primary prevention varied according to the type of cardioembolic source; 100% with mechanical prosthetic valve, 33.3% with valvular atrial fibrillation, 6.7% with NVAF, and none with D-CMP and bioprosthetic valve. Previous stroke was found in 31 patients, among whom 24 had been followed regularly. Twenty patients(83%) were under secondary prevention of cardioembolic stroke (anticoagulation in 11 and antiplatelet agents in 9). Among 19 patients who developed stroke in spite of anticoagulation, INR values were lower than 1.5 in 12(63%), between 1.5 and 2.0 in 5(26%), and above 2.0 in 2(11%). CONCLUSION: Our results suggest that cardioembolic strokes have not been prevented properly. Many physicians seem to be reluctant to anticoagulate their patients with cardioembolic source, and even with anticoaguation the dosage is frequently insufficient to prevent stroke.