ABSTRACT
Cardioembolic stroke related to atrial fibrillation is problematic due to high recurrence, mortality, and morbidity rates. The optimal anticoagulant therapy therefore needs to be applied to prevent the occurrence of a second stroke in patients with nonvalvular atrial fibrillation. The oral anticoagulant warfarin has traditionally been used, but it is limited by its narrow efficacy window, complex pharmacokinetics, and multiple drug interactions, thus requiring frequent blood monitoring. New oral anticoagulants have recently been developed that target a specific coagulation component. Dabigatran (a direct thrombin inhibitor) and rivaroxaban, apixaban, and edoxaban (inhibitors of factor Xa) have advantages of rapid action time, short half-life, stable plasma concentration, and few drug interactions. Large randomized clinical trials and meta-analyses have recently been published on the efficacy and safety of these new oral anticoagulants. Based on the results obtained in recent clinical trials, we have revised the recommendations for selecting optimal anticoagulant therapy in patients with nonvalvular atrial fibrillation.
Subject(s)
Humans , Anticoagulants , Atrial Fibrillation , Dabigatran , Drug Interactions , Half-Life , Ischemic Attack, Transient , Mortality , Pharmacokinetics , Plasma , Recurrence , Rivaroxaban , Secondary Prevention , Stroke , Thrombin , WarfarinABSTRACT
Intracranial aneurysmal rupture causes subarachnoid hemorrhage which usually leads to fatality or severe disability. Treatment of unruptured intracranial aneurysms (UIAs) can substantially reduce the risk of rupture and prevent the grave consequences, but the risk of prophylactic treatment cannot be ignored. UIAs have diverse characteristics and management strategy needs to be tailored according to their location, size and clinical status. In the absence of level I evidence, the treatment guidance often relied on expert's opinions and experience. Knowledge of the natural course and management risks of individual aneurysms can help to guide treatment decision, but the natural history is still controversial and risks are not clearly defined. The Korean Society of Cerebrovascular Surgeons (KSCVS) decided to issue a Korean version of UIA management guideline as a framework for the treatment decision and as a basis for future studies, following 'Guideline Development Manual' of the Clinical Research Center for Stroke (CRCS). The organized committee systematically reviewed relevant literature and major guidelines published between January 2000 and July 2010 and took a developmental strategy of adaptation rather than de novo methods. On the basis of interpretation of the published evidences, recommendations were synthesized, and the level of evidence and the grade of recommendation were determined using the methods adapted from those of the US Agency for Healthcare Policy and Research and CRCS. The current guideline focuses on three domains of natural history, diagnosis and treatment of UIAs. The hierarchy of evidence and the recommendation grading indicate the current level by the literature and do not indicate the necessity or the prohibition of a certain clinical practice. Accordingly, this guideline cannot provide the answer for every clinical situation and should not take precedence over the clinical judgment of responsible physicians for individual patients. The final judgment regarding the care of a particular patient must be made by the physician and patient in light of circumstances specific to that patient. This is the first version of the UIA management guideline in Korea and new evidences will be timely and continuously updated in the future guidelines.
Subject(s)
Humans , Aneurysm , Calcium Hydroxide , Delivery of Health Care , Intracranial Aneurysm , Judgment , Korea , Light , Natural History , Risk Management , Rupture , Stroke , Subarachnoid Hemorrhage , Zinc OxideABSTRACT
The publisher wishes to apologise for incorrectly displaying the fourth author's name. We correct the fourth author's name from Ha Seob Song, M.D. to Ha-Sup Song, MD.
ABSTRACT
A small localized infarction in the dorsal pontine area can cause various eye-movement disturbances, such as abducens palsy, horizontal conjugate gaze palsy, internuclear ophthalmoplegia, and one-and-a-half syndrome. However, complete loss of vertical saccades and pursuit with horizontal gaze palsy has not been reported previously in a patient with a small pontine lesion. We report a 67-year-old man with a small dorsal caudal pontine infarct who exhibited total horizontal gaze palsy as well as loss of vertical saccades and pursuit.
Subject(s)
Aged , Humans , Infarction , Ocular Motility Disorders , Ophthalmoplegia , Paralysis , SaccadesABSTRACT
The purpose of this study was to investigate dietary habits and food compliance in stroke patients. One-hundred sixty eight elderly stroke patients and 97 young patients with first -ever stroke admitted to Asan Medical Center between 1994 and 1998 were studied. Using a structured interview, we assessed food intake. food consumption frequency and compliance to low salt, low meat hight fish and high fruit and vegetable diets. These results were analyzed with chi2, t-tests, and analysis of variance (ANOVA) using the SAS package program. Salted food intake and cholesterol-containing food frequency were increased whereas frequency of fruits and vegetables intake was decreased in young stroke patients compared to the elderly. Meat intake and cholesterol-containing food frequency were increased in the males compared to the females in elderly stroke patients. and fish intake and cholesterol-containing food frequency were higher in the males than the females in the young. In patients with high economic status, frequency of fruits and vegetables was elevated. Also compliance the low meat and high fruit and vegetable diet in young patients was lower than that in the elderly. When the life-style risk factors influencing the food intake of frequency of fruits and vegetables was affected by education in young stroke patients. In elderly stroke patients, meat intake frequency of cholesterol-containing foods and fruits and vegetables were influenced by sex and /or income. Our results suggest that dietary intake of salt meat, cholesterol-containing foods. fruits and vegetables in stroke patients may vary with age, sex the presence of risk factors or economic status therefore guidelines and nutrition education should by formulated to prevent stroke recurrence based on dietary habits and risk factors of individual patients.