Prediction of Early Recanalization after Intravenous Thrombolysis in Patients with Large-Vessel Occlusion / 대한뇌졸중학회지

Background@#and Purpose We aimed to develop a model predicting early recanalization after intravenous tissue plasminogen activator (t-PA) treatment in large-vessel occlusion. @*Methods@#Using data from two different multicenter prospective cohorts, we determined the factors associated with early recanalization immediately after t-PA in stroke patients with large-vessel occlusion, and developed and validated a prediction model for early recanalization. Clot volume was semiautomatically measured on thin-section computed tomography using software, and the degree of collaterals was determined using the Tan score. Follow-up angiographic studies were performed immediately after t-PA treatment to assess early recanalization. @*Results@#Early recanalization, assessed 61.0±44.7 minutes after t-PA bolus, was achieved in 15.5% (15/97) in the derivation cohort and in 10.5% (8/76) in the validation cohort. Clot volume (odds ratio [OR], 0.979; 95% confidence interval [CI], 0.961 to 0.997; P=0.020) and good collaterals (OR, 6.129; 95% CI, 1.592 to 23.594; P=0.008) were significant factors associated with early recanalization. The area under the curve (AUC) of the model including clot volume was 0.819 (95% CI, 0.720 to 0.917) and 0.842 (95% CI, 0.746 to 0.938) in the derivation and validation cohorts, respectively. The AUC improved when good collaterals were added (derivation cohort: AUC, 0.876; 95% CI, 0.802 to 0.950; P=0.164; validation cohort: AUC, 0.949; 95% CI, 0.886 to 1.000; P=0.036). The integrated discrimination improvement also showed significantly improved prediction (0.097; 95% CI, 0.009 to 0.185; P=0.032). @*Conclusions@#The model using clot volume and collaterals predicted early recanalization after intravenous t-PA and had a high performance. This model may aid in determining the recanalization treatment strategy in stroke patients with large-vessel occlusion.

Prediction of Early Recanalization after Intravenous Thrombolysis in Patients with Large-Vessel Occlusion / 대한뇌졸중학회지

Background@#and Purpose We aimed to develop a model predicting early recanalization after intravenous tissue plasminogen activator (t-PA) treatment in large-vessel occlusion. @*Methods@#Using data from two different multicenter prospective cohorts, we determined the factors associated with early recanalization immediately after t-PA in stroke patients with large-vessel occlusion, and developed and validated a prediction model for early recanalization. Clot volume was semiautomatically measured on thin-section computed tomography using software, and the degree of collaterals was determined using the Tan score. Follow-up angiographic studies were performed immediately after t-PA treatment to assess early recanalization. @*Results@#Early recanalization, assessed 61.0±44.7 minutes after t-PA bolus, was achieved in 15.5% (15/97) in the derivation cohort and in 10.5% (8/76) in the validation cohort. Clot volume (odds ratio [OR], 0.979; 95% confidence interval [CI], 0.961 to 0.997; P=0.020) and good collaterals (OR, 6.129; 95% CI, 1.592 to 23.594; P=0.008) were significant factors associated with early recanalization. The area under the curve (AUC) of the model including clot volume was 0.819 (95% CI, 0.720 to 0.917) and 0.842 (95% CI, 0.746 to 0.938) in the derivation and validation cohorts, respectively. The AUC improved when good collaterals were added (derivation cohort: AUC, 0.876; 95% CI, 0.802 to 0.950; P=0.164; validation cohort: AUC, 0.949; 95% CI, 0.886 to 1.000; P=0.036). The integrated discrimination improvement also showed significantly improved prediction (0.097; 95% CI, 0.009 to 0.185; P=0.032). @*Conclusions@#The model using clot volume and collaterals predicted early recanalization after intravenous t-PA and had a high performance. This model may aid in determining the recanalization treatment strategy in stroke patients with large-vessel occlusion.

Insomnia Symptoms and Mood Disturbances in Shift Workers with Different Chronotypes and Working Schedules

14). Depressive mood and anxiety symptom were significantly worse in 3S compare to EOD. The sleep disturbance by ISI score had significant correlations with depressive mood and anxiety symptoms for both EOD and 3S (EOD: rho=0.57, rho=0.57, 3S: rho=0.37, rho=0.33 respectively). Chronotype type in shift workers had no significant correlation with sleep disturbance, depressive mood, nor anxiety symptom. However, after adjustment, the eveningness chronotype have relationship to the depressive mood in shift workers.CONCLUSIONS: Sleep disturbances are more frequent in shift workers than DW. Depressive mood and anxiety symptoms were frequently reported in 3S, then EOD. Different shift schedules cab be a determinant of depressive mood and anxiety symptom.

Secondary Degeneration of the Ipsilateral Thalamus and Substantia Nigra Following Cerebral Infarction in the Striatum

Secondary degeneration after ischemic stroke has been demonstrated by computed tomography and magnetic resonance imaging. We report a 77-year-old man with striatal infarction followed by multifocal degeneration that developed in a stepwise manner at the ipsilateral substantia nigra and thalamus on diffusion-weighted images obtained at 4 weeks, 6 weeks and 20 weeks after onset. We also review the underlying pathophysiology and its clinical meanings.

Transcranial Doppler Sonography in Acute Ischemic Stroke

The acute stage of an ischemic stroke shows various hemodynamic changes of the involved intracranial arteries. Transcranial Doppler sonography (TCD) is known to be the only tool that can monitor the hemodynamic changes and microembolic signals in the intracranial artery in real-time after an ischemic stroke. Findings of TCD during systemic thrombolytics could inform us of a recanalization of the occluded vessel and the need for further intervention. It has been accepted that ultrasounds have thrombolytic effect on clots when it is used with systemic thrombolytics although the standard protocol and the evidence for its safety are still lacking until now. In this article, we review current utilities of TCD for the management of acute ischemic strokes.

Horizontal Ocular Tremor after Pontine Hemorrhage with Delayed Olivary Hypertrophy

No abstract available.

Type 1 Chiari Malformation Presenting With Medullary Infarction and Syncope

No abstract available.

Traumatic Dissection of Middle Cerebral Artery with Intimal Flap

No abstract available.

Reversible Pontine MRI Lesion in Acute Thalamic Infarct: Reversible Encephalopathy due to Hypertension?

Posterior reversible encephalopathy syndrome associated with hypertension rarely presents with predominant involvement of the brainstem and is relative sparing of the supratentorial regions. A relative paucity of brainstem signs and symptoms, despite extensive neuroimaging abnormalities therein, support the diagnosis. Although elevation of blood pressure is common in acute cerebral infarction, concomitant brainstem edema has not been reported. We describe here the clinical and neuroimaging features of an unusual brainstem hyperintensity associated with acute ischemic stroke. The neuroimaging abnormalities improved after stabilization of blood pressure, distinguishing this syndrome from brainstem infarction.

Reversible Pontine MRI Lesion in Acute Thalamic Infarct: Reversible Encephalopathy due to Hypertension?

Posterior reversible encephalopathy syndrome associated with hypertension rarely presents with predominant involvement of the brainstem and is relative sparing of the supratentorial regions. A relative paucity of brainstem signs and symptoms, despite extensive neuroimaging abnormalities therein, support the diagnosis. Although elevation of blood pressure is common in acute cerebral infarction, concomitant brainstem edema has not been reported. We describe here the clinical and neuroimaging features of an unusual brainstem hyperintensity associated with acute ischemic stroke. The neuroimaging abnormalities improved after stabilization of blood pressure, distinguishing this syndrome from brainstem infarction.

Encephalitis and Motor Paresis Caused by Herpes Zoster: A case report / 대한통증학회지

Encephalitis is known as a rare complication of varicella zoster virus (VZV) reactivation. It is usually regarded as a complication of a cutaneous infection in patients with impaired cellular immunity. The reported incidence of herpetic motor involvement range between 0.5 and 31%, but is possibly more frequent as the weakness is readily obscured by pain. A 53-years-old woman, who presented with severe shoulder pain, fever, headache and seizure, which developed the day after skin eruptions, also developed motor paresis 7 days after the seizure. Her cerebrospinal fluid (CSF) was VZV-Polymerase chain reaction (PCR) negative, but VZV specific IgG antibody positive, and her brain MRI was found to be normal. With the early diagnosis and proper treatment, such as intravenous administration of acyclovir, stellate ganglion block and Yamamoto New Scalp Stimulation (YNSS), the patient completely recovered, without psychoneurological sequelae. Herein, we present this case, with a discussion of the relevant literature on the incidence, pathophysiology, diagnosis and management of central nervous system VZV involvement.

Aseptic Meningitis in Kikuchi's Disease

The involvement of the nervous system in Kikuchi's disease (KD) is rare. Although some reports of meningeal involvement in KD were described in the literature from Japan, it has rarely been reported in Korea. A 23-year-old man presented with severe headache, fever, and vomiting. Cerebrospinal fluid (CSF) analysis revealed an opening pressure 300 mmH2O, WBC 283/mm3, glucose 44 mg/dl and protein 86 mg/dl. Multiple tender lymph nodes on the left anterior neck were found on the 9th day of his hospital stay. The lymph node biopsy disclosed histopathologic features typical of KD. We report a patient with KD accompanied by aseptic meningitis, emphasizing the importance of recognizing this disorder in diagnosing patients with meningitis.

The Effect of Topiramate and Lamotrigine on Cerebral Glucose Metabolism in Idiopathic Generalized Epilepsy Patients / 대한간질학회지

BACKGROUND: To investigate the effects of topiramate (TPM) or lamotrigine (LTG) on cerebral glucose metabolism, we performed 18F-fluorodeoxy glucose positron emission tomography (FDG-PET) before and after medication in patients with drug naive idiopathic generalized epilepsy. METHODS: Thiry-three patients with newly diagnosed as idiopathic generalized epilepsy (IGE) or IGE without antiepileptic drugs after diagnosis were included. Pre- and post-antiepileptic drug FDG-PET were performed (before and after TPM or LTG administration) in 33 subjects treated with TPM or LTG who had been seizure free for at least 8 weeks. Sixteen of patients received TPM (M/F=8/8, aged 29.2+/-12.3 years) and 17 LTG (M/F=8/9, 26.8+/-9.3 years). For statistical paramateric (SPM) analysis, all PET images were spatially normalized to the standard PET template and then smoothed using a 12-mm full width at half-maximum Gaussian kernel. The paired t-test was used to compare pre- and post-medication FDG-PET images. RESULTS: SPM analysis of post- and pre-medication FDG-PETs showed TPM reduced glucose metabolism markedly in the thalamus, corpus callosum, and white matters, whereas LTG decreased glucose metabolism in cortico-striato-entorhinal areas with a false discovery rate corrected p<0.05. No brain region showed post-medication hypermetabolism in either group. CONCLUSION: Our study demonstrates that both TPM and LTG affect the cerebral glucose metabolism in drug naive idiopathic generalized epilepsy patients.

A Case of Cerebral Toxoplasmosis in a Patient with Acquired Immune Defeciency Syndrome / 감염과화학요법

Toxoplasmosis is one of the most common opportunistic infection of the central nervous system in patients with acquired immunodeficiency syndrome(AIDS). There have been few reports of cerebral toxoplasmosis in patients with AIDS in Korea. In most cases, the diagnosis was assisted by serology and neuroradiologic findings. Making a reliable diagnosis of acute cerebral toxoplasmosis is difficult in patients with AIDS because of the lack of specificity of serologic data and neuroradiological findings. We report a case of 32-year-old man who presented with decreased mentality and fever. Brain MRI showed multiple ill-defined mass-like lesions in both basal ganglia and right thalamus. Stereotatic brain biopsy revealed small parasitic cysts which were filled with toxoplasmic bradyzoites in inflammatory brain tissue.

A Case of Cerebral Toxoplasmosis in a Patient with Acquired Immune Defeciency Syndrome / 감염과화학요법

Toxoplasmosis is one of the most common opportunistic infection of the central nervous system in patients with acquired immunodeficiency syndrome(AIDS). There have been few reports of cerebral toxoplasmosis in patients with AIDS in Korea. In most cases, the diagnosis was assisted by serology and neuroradiologic findings. Making a reliable diagnosis of acute cerebral toxoplasmosis is difficult in patients with AIDS because of the lack of specificity of serologic data and neuroradiological findings. We report a case of 32-year-old man who presented with decreased mentality and fever. Brain MRI showed multiple ill-defined mass-like lesions in both basal ganglia and right thalamus. Stereotatic brain biopsy revealed small parasitic cysts which were filled with toxoplasmic bradyzoites in inflammatory brain tissue.

The Influence of Acute Cerebral Infarction on the Circadian Rhythm of Melatonin Secretion

BACKGROUND: The circadian rhythm of circulating melatonin is regulated by the endogenous oscillators, the suprachi-asmatic nuclei, and entrained by the light-dark cycle of the environment, but it seems that the rhythm can be affected by variable lesions outside the retina-pineal pathway. We intended to know how acute cerebral infarction affects on the cir-cadian rhythm of plasma melatonin secretion. METHODS: Plasma melatonin level was measured from 64 patients with acute cerebral infarction. On admission, blood samples were collected by venipuncture at 2AM, 4AM, 10AM, and 2PM and melatonin level was measured by radioimmunoassay. The state of consciousness of each patient was assessed clini-cally and the infarction site and size were evaluated clinically and radiographically. RESULTS: Among 64 patients with acute cerebral infarction, dramatic blunting or obliteration of nocturnal melatonin surge in the blood was found in 29 patients. The circadian rhythm of melatonin secretion was absent in 12 of 35 alert patients, in 10 of 20 drowsy patients, and in 5 of 7 stuporous patients. Melatonin secretion into plasma was markedly decreased in all 2 comatose patients. Of 14 patients with brainstem lesions, 8 patients showed decreased melatonin levels with the absence of a nocturnal rise, although most of them were alert. CONCLUSIONS: This study suggests that brainstem and the initial mental state might contribute to the regulation of the circadian rhythm of plasma melatonin even though the lesion does not involve the retina-pineal pathway, but further extensive study is required to elucidate it. (J Korean Neurol Assoc 19(4):359~363, 2001)

Spontaneous Resolution of Pituitary Apoplexy: Report of 4 Cases

Pituitary apoplexy refers to a clinical syndrome characterized by sudden headache, visual impairmentm and ophthalmoplegia, which are caused by infarction or hemorrhage of the pituitary tumor. There is disagreement regarding the role of early surgery. All the patients may not require surgical decompression because spontaneous recovery is possible. We report 4 cases of pituitary tumor showing spontaneous resolution after pituitary apoplexy treated only by hormonalreplacement therapy.

Two Cases of Histiocytic Necrotizing Lymphadenitis Accompanied by Aseptic Meningitis

Histiocytic necrotizing lymphadenitis is a benign disorder of the lymph node which should be differentiated from other types of lymphadenitis or malignant lymphoma. The most common presentation includes fever and cervical lym-phadenopathy .The course is invariably benign and spontaneous resolution usually occurs within 4 to 6 months. The diagnosis is confirmed by characteristic pathological findings of the involved lymph node. The involvement of the ner-vous system is known to be rare. We report two patients with histiocytic necrotizing lymphadenitis accompanied by aseptic meningitis. In one patient, both diseases developed simultaneously and in the other patient, histiocytic necrotiz-ing lymphadenitis was followed by aseptic meningitis 2 months later.

Effect of Continuous Infusion of Low Concentrations of Ketamine on the Bispectral Index and Recovery from Propofol-N2O-O2 Anesthesia / 대한마취과학회지

BACKGROUND: Ketamine as an analgesic adjunct in propofol-based anesthesia has the benefit of potent analgesic action and more stable vital signs due to sympathetic stimulation. However, its impact on the bispectral index and speed of recovery is still controvertial. The aim of this study was to evaluate the effects of continuous infusion of low concentrations of ketamine (0.1 microgram/ml) on the bispectral index and speed of recovery from propofol-N2O-O2 anesthesia. METHODS: Forty ASA I or II adult patients scheduled for elective orthopedic surgery were randomly allocated to one of two groups according to intraoperative ketamine use. In group P, anesthesia was induced and maintained with propofol (Ct: 3 - 6 microgram/ml), 67% nitrous oxide and 33% oxygen and the target concentration of propofol was kept at 4 microgram/ml at least 20 min before the end of propofol infusion. In group P + K, the method of anesthesia was same as in group P, but the low concentration (0.1 microgram/ml) of ketamine was continuously infused until discontinuation of propofol using computer-assisted continuous infusion. Bispectral index, recovery time from anesthesia, current/effect concentration of drugs, vital signs before and at induction, end of drug infusion, eye opening time on verbal command, and orientation time were checked. RESULTS: Changes in vital signs showed no differences between the groups. For bispectral index, there was no difference between groups initially, but it was higher (4 - 8) after the end of drug infusion in group P K than in group P. Also, recovery from anesthesia was delayed significantly in group P + K (P < 0.05). CONCLUSIONS: From these observations, we concluded that the use of low concentrations of ketamine during propofol-N2O-O2 anesthesia increased BIS, delayed eye opening and recovery from anesthesia without any benefit to vital sign stability.

Cerebrovascular Diseases in Cancer Patients

BACKGROUND: The association of vascular thrombosis with cancer has been known since Trousseau's description of venous thrombophlebitis in patients with carcinoma. Previous studies, mainly autopsy-based, have suggested that the stroke spectrum in cancer patients differ from that of the general population. However, no studies that address this question in the adult oncological population from a clinical perspective are available in Korea. We therefore assessed the clinical features of cerebrovascular diseases in cancer patients. METHODS: We retrospectively analyzed 44 cases of symptomatic cerebrovascular disease in cancer patients who were admitted to the Wonju Christian Hospital from January 1993 to June 1998 by reviewing their charts and brain CT or MRI; primary cancer, the interval from a cancer diagnosis to the occurrence of stroke, the incidence of hypercoagulability as an infarction cause, the location and size of the infarction, the type of hemorrhage, and the prognosis. RESULTS: The mean age was 62.3 years. Twenty eight cases (63.6%) were ischemic stroke and sixteen cases (36.4%) were hemorrhagic stroke. The most common primary cancer of infarction and hemorrhage was stomach cancer. In ischemic patients, the most common cell type of cancer was ade-nocarcinoma and six cases (21.4%) were considered to have hypercoagulability as a cause. In hemorrhagic patients, seventy percent of patients with coagulopathy died in the hospital or were discharged moribundly. CONCLUSIONS: Although hypercoagulability is present to a greater extent in the patient population than in the general population, it appears that conventional stroke risk factors account for the majority of cerebral ischemic events in the adult cancer population. Cancer patients with intracranial hemorrhage owing to coagulopathy reveal poor prognosis.