Acute cerebral infarction following aconitine ingestion

Aconitine is a main component of Aconitum carmichaeli, a Chinese herb known to be effective for arthritis and neuralgia. Many senior citizens consume the herb as a folk remedy. Aconitine-associated cardiogenic toxicity has been observed but aconitine-induced cerebrovascular event has not been reported so far. We report two elderly patients who became unconscious and showed neurological dysfunction soon after ingesting aconitine for pain control. We speculate that the aconitine induced cardiac arrhythmia. This resulted in cardiogenic emboli formation with subsequent large territory cerebral infarction.

Effects of in-Person, in-Hospital Education for Stroke Patients by an Education-Specialized Nurse

BACKGROUND: We assessed the effects of customized in-hospital, in-person education provided by an education-specialized nurse in ischemic stroke patients. METHODS: All ischemic stroke patients who were hospitalized between April 2015 and December 2015 were included. They were provided with education about stroke by an education-specialized nurse during their hospital stay. The knowledge of stroke warning signs and appropriate responses was examined both before the in-hospital education and 3 months after discharge in 127 patients. RESULTS: The awareness of the following stroke warning signs increased significantly at 3 months after discharge compared to before receiving the education (all p values <0.001): sudden difficulty in speaking or in understanding speech (74.0→93.7%), sudden numbness or weakness (72.4→92.1%), sudden dizziness (71.7→89.8%), sudden severe headache (44.9→82.7%), and sudden visual impairment (38.6→69.3%). The proportion of patients with a good knowledge of stroke warning signs (defined as providing at least five correct answers) increased significantly, from 38.6% to 81.9%. Almost half of them (46.5%) correctly answered that they should call an ambulance first when someone shows stroke symptoms before receiving the education, with this proportion increasing to 68.5% at 3 months after discharge (p<0.001). The proportions of patients who understood the need for prompt treatment of stroke and the golden time window increased from 80.3% to 96.9% and from 66.1% to 86.6%, respectively (both p<0.001). The proportion of patients with knowledge of thrombolytic therapy for stroke also increased significantly after the in-hospital education, from 11.0% to 76.4% (p<0.001). CONCLUSIONS: In-hospital, in-person education was effective at increasing the understanding that patients have of stroke, even at 3 months after discharge. In-hospital education provided by an education-specialized nurse would be an effective intervention for increasing the likelihood of stroke patients reacting appropriately to stroke recurrence.

Vascular risk factors for stroke among urban community dwelling adults in Ansan city, Korea

Background & Objective: The number of ischemic stroke is increasing steadily. The recent stroke prevention strategies have targeted risk factors for preventing ischemic stroke. Community-based data that quantify the prevalence of these risk factors are needed to develop effective stroke prevention strategies. This study was performed aiming to establish customized prevention strategies by investigating vascular risk factors of ischemic stroke among the healthy adults in an urban population in Korea. Methods: The Prevention of Stroke and Dementia (PRESENT) survey collected data associated with stroke risk factors between 2007 and 2009 in Ansan city, Korea. Of 46,537 people, 2,843 were selected by random sampling, and final population included 358 men and 422 women over 50 years old. We checked modifiable risk factors, such as hypertension, diabetes mellitus, smoking, hyperlipidemia, atrial fibrillation, cardiovascular disease, obesity, and physical inactivity. Results: The mean age of study subjects was 60.1±8.2 years; 55.5% had hypertension, 18.6% had diabetes mellitus, 17.7% were current smoker, 44.9% had hyperlipidemia, 1.7% had atrial fibrillation, and 4.5% had cardiovascular disease. Men had more risk factors for stroke, and higher rates of diabetes mellitus and current smoking. However, women had higher cholesterol and obesity rates and lower physical activity. The proportion of individuals with >1 risk factor for stroke increased with age. Hypertension, diabetes mellitus, and cardiovascular diseases also increased with age, but low-density lipoprotein levels and current smoking decreased. Conclusions: This study provides valuable information to develop customized strategic policies for primary and secondary stroke prevention.

Mobile Thrombus within Carotid Artery Stent

No abstract available.

Effects of Community-based Stroke Education and Advocacy on the Time from Stroke Onset to Hospital Arrival in Ischemic Stroke Patients

BACKGROUND: We assessed the effects of stroke community-based education and advocacy on the time from stroke onset to hospital arrival in ischemic stroke patients. METHODS: Stroke community-based education and advocacy were implemented between May 2014 and December 2014 in Iksan, Jeollabukdo. The extent of ambulance utilization, time from stroke onset to hospital arrival, and proportions of arrivals within certain golden-time windows were compared with those of patients admitted from May to December 2013 (before vs. after intervention). RESULTS: The demographic and clinical characteristics did not differ significantly between the patients admitted in 2013 and 2014, nor did the proportion of ambulance utilization (33.6% and 39.4%, respectively; p=0.195). The median time from stroke onset to hospital arrival changed from 582 min in 2013 to 367 min in 2014, although not statistically significant (p=0.062). The proportion of hospital arrivals within 3 hours from stroke onset increased significantly from 28.5% in 2013 to 42.3% in 2014 (p=0.002). CONCLUSIONS: A comprehensive community-based stroke intervention may increase the probability of hospital arrival within the golden-time window, thereby leading to a better prognosis.

Association of Aortic Knob Calcification with Intracranial Stenosis in Ischemic Stroke Patients / 대한뇌졸중학회지

BACKGROUND AND PURPOSE: Aortic knob calcification (AC) is associated with increased risks of cardiovascular and cerebrovascular events. We evaluated the clinical importance of AC in ischemic stroke patients with intracranial (IC) stenosis using simple, non-invasive and routine chest radiography. METHODS: The presence of AC was assessed in a chest posteroanterior view in 307 acute ischemic stroke patients admitted from May 2009 to April 2010, and who underwent magnetic resonance angiography or distal subtraction angiography. The association of AC with IC stenosis was analyzed. RESULTS: Patient age (68.3+/-8.7 vs. 65.9+/-8.27 years, P=0.04), and the prevalence of IC stenosis (70.7 vs. 41.3%, P<0.01) were higher in patients with AC than in patients without calcification. After adjusting for age, gender and vascular risk factors, logistic regression analysis showed that AC (Odds ratio, 3.54; 95% confidence interval, 1.90 to 6.61, P<0.01) and age (Odds ratio, 1.79; 95% confidence interval, 1.01 to 3.19; P=0.04) were independent factors affecting IC stenosis. CONCLUSIONS: AC appears to be a reliable predictor for IC stenosis, an important mechanism of ischemic stroke.

Tooth Loss Is Associated with Brain White Matter Change and Silent Infarction among Adults without Dementia and Stroke

Periodontal disease is a predictor of stroke and cognitive impairment. The association between the number of lost teeth (an indicator of periodontal disease) and silent infarcts and cerebral white matter changes on brain CT was investigated in community-dwelling adults without dementia or stroke. Dental examination and CT were performed in 438 stroke- and dementia-free subjects older than 50 yr (mean age, 63 +/- 7.9 yr), who were recruited for an early health check-up program as part of the Prevention of Stroke and Dementia (PRESENT) project between 2009 and 2010. In unadjusted analyses, the odds ratio (OR) for silent cerebral infarcts and cerebral white matter changes for subjects with 6-10 and > 10 lost teeth was 2.3 (95% CI, 1.38-4.39; P = 0.006) and 4.2 (95% CI, 1.57-5.64; P < 0.001), respectively, as compared to subjects with 0-5 lost teeth. After adjustment for age, education, hypertension, diabetes mellitus, hyperlipidemia, and smoking, the ORs were 1.7 (95% CI, 1.08-3.69; P = 0.12) and 3.9 (95% CI, 1.27-5.02; P < 0.001), respectively. These findings suggest that severe tooth loss may be a predictor of silent cerebral infarcts and cerebral white matter changes in community-dwelling, stroke- and dementia-free adults.

Tooth Loss May Predict Poor Cognitive Function in Community-Dwelling Adults without Dementia or Stroke: The PRESENT Project

Periodontal disease is a potential predictor of stroke and cognitive impairment. However, this association is unclear in adults aged 50 yr and above without a history of stroke or dementia. We evaluated the association between the number of teeth lost, indicating periodontal disease, and cognitive impairment in community-dwelling adults without any history of dementia or stroke. Dental examinations were performed on 438 adults older than 50 yr (315 females, mean age 63+/-7.8 yr; 123 males, mean age 61.5+/-8.5 yr) between January 2009 and December 2010. In the unadjusted analysis, odds ratios (OR) of cognitive impairment based on MMSE score were 2.46 (95% CI, 1.38-4.39) and 2.7 (95% CI, 1.57-4.64) for subjects who had lost 6-10 teeth and those who had lost more than 10 teeth, respectively, when compared with subjects who had lost 0-5 teeth. After adjusting for age, education level, hypertension, diabetes, hyperlipidemia, and smoking, the relationship remained significant (OR, 2.0; 95% CI, 1.08-3.69, P=0.027 for those with 6-10 teeth lost; OR, 2.26; 95% CI, 1.27-4.02, P=0.006 for those with more than 10 teeth lost). The number of teeth lost is correlated with cognitive impairment among community-dwelling adults aged 50 and above without any medical history of stroke or dementia.

Acute Cerebral Infarction, Deep Vein Thrombosis and Pulmonary Embolism in Kimura's Disease / 대한뇌졸중학회지

Kimura's disease is a chronic inflammatory disease producing subcutaneous tumor-like nodules chiefly in the head and neck region. It is characterized histologically by lymphoid follicles, intense aggregations of eosinophils, vascular proliferation and fibrosis combined with peripheral blood eosinophilia. We report a 56-year-old man who presented with dysarthria and right hemiparesis. On physical examination, a non-ender mass 5 x 6 cm was identified in the right submandibular area. He was diagnosed with Kimura's disease by biopsy. One month after admission, he complained of paresthesia in the left lower extremity. CT angiography revealed thromobosis in the left femoral vein and bilateral pulmonary embolism. To our knowledge, the concomitant occurrence of acute cerebral infarction, deep vein thrombosis and pulmonary embolism in patients with Kimura's disease has never been reported. Eosinophil-derived cytotoxic proteins are presumed to be fundamental to the pathogenesis of these disorders in Kimura's disease.

Tuberculous Abscess of the Psoas Muscle in a Patient with Acute Lumbar Burst Fracture: A Missed Diagnosis

The authors present a rare case of tuberculous spondylitis and a large abscess in the left psoas muscle that occurred after spinal surgery for an acute traumatic burst fracture of the L2 vertebral body. We retrospectively reviewed the patient's first magnetic resonance imaging (MRI) we found that some unusual findings, indicative of psoas abscess had been overlooked. As a result, diagnosis and treatment of tuberculous psoas abscess and spondylitis were considerably delayed. Despite the critical condition of patients in a similar emergency, surgeons should always pay close attention to the radiological findings and clinical symptoms of the patient before considering a surgical intervention or biopsy.

Horizontal Ocular Tremor after Pontine Hemorrhage with Delayed Olivary Hypertrophy

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.