Prediction of Hemorrhagic Transformation and Functional Outcome Using HAT Score in Acute Ischemic Stroke Patients Treated with Intravenous Alteplase

BACKGROUND: Intravenous thrombolysis with alteplase is the most effective therapy for acute ischemic stroke, but hemorrhagic transformation (HT) is a potentially dangerous complication of such thrombolysis. Few studies have investigated the predictors of HT after thrombolysis in Korean stroke patients. METHODS: From 2003 to 2009, acute ischemic stroke patients who received intravenous alteplase were included from the prospective stroke registry of Kyung Hee University Hospital. Patients submitted to CT or MRI scans with gradient echo sequences within 12-36 hours of thrombolysis. The Hemorrhage After Thrombolysis (HAT) score [ranging from 0 (minimum risk) to 5 (maximum risk)] was calculated retrospectively for each patient. The predictive ability of the HAT score for HT and symptomatic intracranial hemorrhage (sICH) was calculated using C statistics. RESULTS: Among 151 consecutive patients, HT was confirmed in 35 on follow-up brain imaging. Atrial fibrillation (OR=2.709, 95%CI=1.118-6.567) and low one-third CT scan (OR=3.419, 95%CI=1.281-9.121) increased the risk of HT after intravenous thrombolysis in multivariate logistic regression analysis. HT, sICH (based on the National Institute of Neurological Disorders and Stroke and the Safe Implementation of Treatment in Stroke-Monitoring Study definitions), unfavorable [modified Rankin Scale (mRS) score of 2-6] and poor (mRS score of 3-6) outcomes at 3 months, and mortality at 3 months were increased with higher HAT scores (C statistic=0.632, 0.637, 0.843, 0.670, 0.689, and 0.659, respectively; p=0.018, 0.036, 0.042, 0.002, 0.015, and <0.001). CONCLUSIONS: The HAT score can be used to predict the risk of sICH following intravenous thrombolysis and the long-term clinical outcome.

Neuroimaging of Hemichorea-Hemiballism

BACKGROUND: Hemichorea-Hemiballism (HCHB) can be caused by various diseases such as cerebrovascular disease, hyperglycemia, tumor, and inflammatory diseases. However, there are a few case studies using functional imaging such as single photon emission computed tomography (SPECT). METHODS: In this study, we included patients with HCHB. The patients with hyperglycemia over 250 mg/dl or high signal intensity on T1 weighted imaging were excluded. Clinical and neuroimaging characteristics of the patients were obtained and analyzed. RESULTS: We included 20 patients (M:F=12:8, mean age=67.1+/-15.3). Sixteen patients were presented with hemiballism and four with hemichorea. Six patients had no structural lesions causing HCHB. Subthalamic nucleus was the causative lesion in 6 patients. Other lesions associated with HCHB were basal ganglia, thalamus, and cortices. In a patient without structural lesion, anti-double stranded DNA antibody was detected. Brain SPECT showed not only perfusion abnormalities in the cases without structural lesions but also additional abnormalities in those with definite lesions. CONCLUSIONS: Various mechanisms were related to the development of HCHB. Functional imaging such as SPECT and immunological work-up is needed to investigate the underlying pathomechanism of HCHB.

A Case of Isolated Traumatic Caudate Lesion with Marked Improvement in Visuospatial Function by Donepezil

Visuospatial dysfunction after isolated caudate lesion and improvement by donepezil has not been reported. Herein we report a 46-year old woman with visuospatial dysfunction after an isolated traumatic caudate lesion. Memory impairment and visuospatial dysfunction with normal frontal executive functioning was found in the first neuropsychological test. Her brain MRI showed an isolated right caudate lesion in the dorsal portion. Donepezil was prescribed. On follow-up neuropsychological testing, memory and visuospatial function increased by more than 100% from the base line.