Various Complications after a Vascular Procedure in Patients with Hemophilia / 임상소아혈액종양

Hemophilia, an inherited bleeding disorder, is caused by a deficiency of coagulation factor VIII or IX. Most of patients with hemophilia need vascular procedure, which can lead to complications. Even though these complications can also occur in normal people, hemophilia and coagulopathy are particular risk factors. We reviewed medical records of patients with hemophilia who underwent vascular procedures and investigated its complications. Vessel-related complications occurred in five patients. Three patients had pseudoaneurysms after radial arterial puncture. All patients underwent coagulation factor replacement or ultrasound-guided compression and showed improvement. Neuropathy developed in one patient due to a hematoma that occurred after blood sampling. The hematoma improved, but motor and sensory deficits remained and neuropathy was confirmed. One patient died of uncontrolled bleeding after angiography. Vascular procedures require more attention in patients with hemophilia. Caution and prevention of complications is essential, even before the patient is diagnosed with hemophilia.

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.

Pre-Procedural Evaluation and Peri-Procedural Management in Carotid Artery Stenting

Carotid-artery stenting (CAS) is as an alternative to surgical endarterectomy for severe carotid-artery stenosis. CAS is advantageous over carotid endarterectomy in that it is less invasive and could shorten the hospital stay. A preprocedural evaluation is necessary to assess the patient's anatomic status or clinical risk factors to determine whether they are a good candidate for CAS. Proper evaluation and management can reduce CAS-associated complications such as embolism and cerebral hyperperfusion syndrome. The frequent use of statins appears to improve the outcome of CAS. Using the appropriate stent type and a protection device could also reduce the complication rate. Given the changes in cerebral hemodynamics following CAS, adequately controlling the blood pressure in individual patients can enhance the efficacy of this treatment. However, there is currently limited data regarding the preprocedural evaluation and periprocedural management for CAS. The evidence and the clinical status related to the preprocedural evaluation and periprocedural management of CAS are presented herein.

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.

Neuroleptic Malignant Syndrome Caused by Long Term Intake of Haloperidol

Neuroleptic malignant syndrome (NMS) is a fatal complication most often caused by an adverse reaction to neuroleptic or antipsychotic drugs, and is mostly brought out in the initial stage of medication. Late onset NMS after long term intake of neuroleptics is uncommon, and the neurochemical mechanism is undiscovered. We report a patient of late onset NMS after a long term intake of haloperidol who was successfully treated with dantrolene and bromocriptine.

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.

Periodic Sharp Wave Complexes observed by Repetitive EEGs in a Patient with Probable Sporadic Creutzfeldt-Jacob Disease

The periodic sharp wave complexes are the most characteristic EEG abnormalities in sCJD. We report the serial EEG findings in a patient with probable sCJD. The initial EEG showed diffuse theta and delta slowings only. However, it changed to the typical periodic sharp wave complexes according to the worsening clinical state. These changes occurred during a short-term interval. The serial EEGs within the short-term interval will be helpful for the earlier diagnosis of sCJD.

Analysis of Ischemic Stroke Patterns Using the Diffusion-Weighted Imaging in Patients with Complicated Aortic Plaques

BACKGROUND: This study aimed at characterizing the lesion patterns in patients with acute ischemic stroke and complicated aortic plaques using the diffusion-weighted magnetic resonance imaging (DWI). METHODS: We retrospectively reviewed 403 consecutive patients with acute ischemic stroke between January 2002 and December 2004, and enrolled patients who had received a trans-esophageal echocardiography (TEE). All the patients should have an acute cerebral infarction within 7 days of the onset of symptoms. We analyzed the ischemic lesion patterns on DWI in the patients who had aortic atheroma protruded into the lumen greater than 4 mm in the aortic arch or ascending aorta (complicated aortic plaques; CAP). Ischemic lesions were classified into subcortical, cortical and multiple infarctions. We investigated the accompanying risk factors for atherosclerosis and stenosis of the relevant major brain artery as well. RESULTS: Of the 403 patients, TEE was performed in 210 (52%) and CAP was found in 25 (12%). Among 25 patients, subcortical infarction was observed in 15 (60%), followed by cortical infarction in 7 (28%), and multiple ischemic lesions in 3 (12%). CAP was frequently associated with hypertension and current smoking, and accompanied with stenosis of the relevant major brain artery as well (68%). CONCLUSIONS: CAP may be a potential source of embolism. However, the high prevalence of the small subcortical lesion in this study questions the mechanisms of ischemic stroke in patients with aortic atheroma. CAP may be an uncomplicated marker of advanced systemic atherosclerosis including the cerebral arteries.