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1.
Journal of Stroke ; : 42-59, 2019.
Article in English | WPRIM | ID: wpr-740619

ABSTRACT

Despite the great socioeconomic burden of stroke, there have been few reports of stroke statistics in Korea. In this scenario, the Epidemiologic Research Council of the Korean Stroke Society launched the “Stroke Statistics in Korea” project, aimed at writing a contemporary, comprehensive, and representative report on stroke epidemiology in Korea. This report contains general statistics of stroke, prevalence of behavioral and vascular risk factors, stroke characteristics, pre-hospital system of care, hospital management, quality of stroke care, and outcomes. In this report, we analyzed the most up-to-date and nationally representative databases, rather than performing a systematic review of existing evidence. In summary, one in 40 adults are patients with stroke and 232 subjects per 100,000 experience a stroke event every year. Among the 100 patients with stroke in 2014, 76 had ischemic stroke, 15 had intracerebral hemorrhage, and nine had subarachnoid hemorrhage. Stroke mortality is gradually declining, but it remains as high as 30 deaths per 100,000 individuals, with regional disparities. As for stroke risk factors, the prevalence of smoking is decreasing in men but not in women, and the prevalence of alcohol drinking is increasing in women but not in men. Population-attributable risk factors vary with age. Smoking plays a role in young-aged individuals, hypertension and diabetes in middle-aged individuals, and atrial fibrillation in the elderly. About four out of 10 hospitalized patients with stroke are visiting an emergency room within 3 hours of symptom onset, and only half use an ambulance. Regarding acute management, the proportion of patients with ischemic stroke receiving intravenous thrombolysis and endovascular treatment was 10.7% and 3.6%, respectively. Decompressive surgery was performed in 1.4% of patients with ischemic stroke and in 28.1% of those with intracerebral hemorrhage. The cumulative incidence of bleeding and fracture at 1 year after stroke was 8.9% and 4.7%, respectively. The direct costs of stroke were about ₩1.68 trillion (KRW), of which ₩1.11 trillion were for ischemic stroke and ₩540 billion for hemorrhagic stroke. The great burden of stroke in Korea can be reduced through more concentrated efforts to control major attributable risk factors for age and sex, reorganize emergency medical service systems to give patients with stroke more opportunities for reperfusion therapy, disseminate stroke unit care, and reduce regional disparities. We hope that this report can contribute to achieving these tasks.


Subject(s)
Adult , Aged , Alcohol Drinking , Ambulances , Atrial Fibrillation , Cerebral Hemorrhage , Emergency Medical Services , Emergency Service, Hospital , Epidemiology , Female , Hemorrhage , Hope , Humans , Hypertension , Incidence , Korea , Male , Mortality , Prevalence , Reperfusion , Risk Factors , Smoke , Smoking , Stroke , Subarachnoid Hemorrhage , Writing
2.
Article in English | WPRIM | ID: wpr-765899

ABSTRACT

BACKGROUND: A subanalysis study of the ENGAGE AF-TIMI 48 trial showed that cardiac troponin I, N-terminal proB-type natriuretic peptide, and D-dimer, were powerful predictors of cerebrovascular adverse events. We aimed to evaluate D-dimer and cardiac troponin I levels during the acute period of ischemic stroke in anticoagulation-naïve patients with non-valvular atrial fibrillation (NVAF) and also studied the association between these biomarkers and stroke severity. METHODS: Consecutive anticoagulation-naïve patients with acute ischemic stroke due to NVAF were enrolled within two days after each stroke event, and all patients were stratified into either moderate-to-severe or mild neurologic deficit groups using the National Institutes of Health Stroke Scale (NIHSS) at admission. RESULTS: A total of 98 patients were enrolled in this study. The median value for the D-dimer was above the upper limit of the normal reference range, but the troponin I value was within the normal range for all patients. After adjusting for CHA2DS2-VASc risk factors, the log-transformed values for D-dimer were positively correlated with an increasing NIHSS score (r=0.233; P=0.051). In the multivariate logistic analysis, the log-transformed D-dimer was positively associated with more severe strokes (odds ratio, 30.1; 95% confidence interval [CI], 1.9–486.2 and 29.7; 95% CI, 2.0–430.8 in the upper two quartiles respectively). The log-transformed values for troponin I did not correlate with the NIHSS score. CONCLUSION: D-dimer levels were higher and an independent risk factor for severe stroke in anticoagulation-naïve patients with NVAF related stroke. In contrast, troponin I levels were normal and were not associated with stroke severity.


Subject(s)
Atrial Fibrillation , Biomarkers , Humans , Neurologic Manifestations , Reference Values , Risk Factors , Stroke , Troponin I
3.
Journal of Stroke ; : 131-139, 2018.
Article in English | WPRIM | ID: wpr-740602

ABSTRACT

BACKGROUND AND PURPOSE: Following the positive results from recent trials on endovascular therapy (EVT), bridging therapy (intravenous alteplase plus EVT) is increasingly being used for the treatment of acute ischemic stroke. However, the optimal dose of intravenous alteplase remains unknown in centers where bridging therapy is actively performed. The optimal dose for eventual recanalization and positive clinical outcomes in patients receiving bridging therapy also remains unknown. METHODS: In this prospective Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED) sub-study, we explored the outcomes following treatment with two different doses (low- [0.6 mg/kg] or standard-dose [0.9 mg/kg]) of intravenous alteplase across 12 Korean centers where EVT is actively performed. The primary endpoint was a favorable outcome at 90 days (modified Rankin Scale scores 0 to 1). Secondary endpoints included symptomatic intracerebral hemorrhage (ICH) in all patients, and the recanalization rate and favorable outcome in patients who underwent cerebral angiography for EVT (ClinicalTrials.gov, number NCT01422616). RESULTS: Of 351 patients, the primary outcome occurred in 46% of patients in both the standard-(80/173) and low-dose (81/178) groups (odds ratio [OR], 1.14; 95% confidence interval [CI], 0.72 to 1.81; P=0.582), although ICHs tended to occur more frequently in the standard-dose group (8% vs. 3%, P=0.056). Of the 67 patients who underwent cerebral angiography, there was no significant difference in favorable functional outcome between the standard- and low-dose groups (39% vs. 21%; OR, 2.39; 95% CI, 0.73 to 7.78; P=0.149). CONCLUSIONS: There was no difference in functional outcome between the patients receiving different doses of alteplase in centers actively performing bridging therapy.


Subject(s)
Cerebral Angiography , Cerebral Hemorrhage , Cerebral Infarction , Humans , Hypertension , Intracranial Hemorrhages , Prospective Studies , Stroke , Thrombectomy , Tissue Plasminogen Activator
4.
Article in English | WPRIM | ID: wpr-36759

ABSTRACT

OBJECTIVE: The purpose of this study was to compare the histogram analysis and visual scores in 3T MRI assessment of middle cerebral arterial wall enhancement in patients with acute stroke, for the differentiation of parent artery disease (PAD) from small artery disease (SAD). MATERIALS AND METHODS: Among the 82 consecutive patients in a tertiary hospital for one year, 25 patients with acute infarcts in middle cerebral artery (MCA) territory were included in this study including 15 patients with PAD and 10 patients with SAD. Three-dimensional contrast-enhanced T1-weighted turbo spin echo MR images with black-blood preparation at 3T were analyzed both qualitatively and quantitatively. The degree of MCA stenosis, and visual and histogram assessments on MCA wall enhancement were evaluated. A statistical analysis was performed to compare diagnostic accuracy between qualitative and quantitative metrics. RESULTS: The degree of stenosis, visual enhancement score, geometric mean (GM), and the 90th percentile (90P) value from the histogram analysis were significantly higher in PAD than in SAD (p = 0.006 for stenosis, < 0.001 for others). The receiver operating characteristic curve area of GM and 90P were 1 (95% confidence interval [CI], 0.86–1.00). CONCLUSION: A histogram analysis of a relevant arterial wall enhancement allows differentiation between PAD and SAD in patients with acute stroke within the MCA territory.


Subject(s)
Arteries , Constriction, Pathologic , Humans , Magnetic Resonance Imaging , Middle Cerebral Artery , Parents , ROC Curve , Stroke , Tertiary Care Centers
5.
Journal of Stroke ; : 73-80, 2014.
Article in English | WPRIM | ID: wpr-59976

ABSTRACT

Atrial fibrillation (AF) is an emerging epidemic in both high-income and low-income countries, mainly because of global population aging. Stroke is a major complication of AF, and AF-related ischemic stroke is more disabling and more fatal than other types of ischemic stroke. However, because of concerns about bleeding complications, particularly intracranial hemorrhage, and the limitations of a narrow therapeutic window, warfarin is underused. Four large phase III randomized controlled trials in patients with non-valvular AF (RE-LY, ROCKET-AF, ARISTOTLE, and ENGAGE-AF-TIMI 48) demonstrated that new oral anticoagulants (NOACs) are superior or non-inferior to warfarin as regards their efficacy in preventing ischemic stroke and systemic embolism, and superior to warfarin in terms of intracranial hemorrhage. Among AF patients receiving warfarin, Asians compared to non-Asians are at higher risk of stroke or systemic embolism and are also more prone to develop major bleeding complications, including intracranial hemorrhage. The extra benefit offered by NOACs over warfarin appears to be greater in Asians than in non-Asians. In addition, Asians are less compliant, partly because of the frequent use of herbal remedies. Therefore, NOACs compared to warfarin may be safer and more useful in Asians than in non-Asians, especially in stroke patients. Although the use of NOACs in AF patients is rapidly increasing, guidelines for the insurance reimbursement of NOACs have not been resolved, partly because of insufficient understanding of the benefit of NOACs and partly because of cost concerns. The cost-effectiveness of NOACs has been well demonstrated in the healthcare settings of developed countries, and its magnitude would vary depending on population characteristics as well as treatment cost. Therefore, academic societies and regulatory authorities should work together to formulate a scientific healthcare policy that will effectively reduce the burden of AF-related stroke in this rapidly aging society.


Subject(s)
Aging , Anticoagulants , Asian Continental Ancestry Group , Atrial Fibrillation , Delivery of Health Care , Developed Countries , Embolism , Health Care Costs , Hemorrhage , Humans , Insurance , Intracranial Hemorrhages , Population Characteristics , Stroke , Warfarin
6.
Article in Korean | WPRIM | ID: wpr-85109

ABSTRACT

The first edition of Korean Clinical Practice Guidelines for Stroke, which was published in 2009, reflected evidence published prior to June 2007. Since then, many clinical trials and well-designed observational studies provided new evidence that may be pertinent to clinical practice. Accordingly, investigators of the Clinical Research Center for Stroke have timely updated the guidelines. This article summarizes the recent evidence and updated guidelines regarding the use of aspirin for primary stroke prevention, the management of asymptomatic carotid stenosis, the use of antithrombotics in atrial fibrillation for stroke prevention, the diagnosis and management of unruptured aneurysm, intravenous and intra-arterial thrombolysis in acute ischemic stroke, antiplatelet therapy for secondary stroke prevention in patients with non-cardioembolic stroke or transient ischemic attack, and the management of symptomatic carotid stenosis for secondary stroke prevention.


Subject(s)
Aneurysm , Aspirin , Atrial Fibrillation , Carotid Stenosis , Humans , Ischemic Attack, Transient , Research Personnel , Stroke
7.
Article in Korean | WPRIM | ID: wpr-38035

ABSTRACT

BACKGROUND: This scientific statement is intended to provide a systematic review of new evidences in dyslipidemia and inflammation for primary stroke prevention. METHODS: Using a structured literature search, we identified major observational studies, clinical trials, meta-analyses, and updated major guidelines published between July 2007 and November 2010. In addition to the brief summary of earlier evidences employed in the first edition of Korean clinical practice guideline for primary prevention of stroke, we summarized the newly identified evidences. RESULTS: For dyslipidemia, observational studies further support a strong association between ischemic stroke and high total and low-density lipoprotein cholesterol and low high-density lipoprotein cholesterol. Two clinical trials and 6 meta-analyses confirm statin efficacy for primary prevention of stroke in high risk patients. Efficacy of other lipid-lowering agents is not established. For inflammation, inflammatory markers might help to identify patients having high risk for stroke or cardiovascular event and to decide whether statin therapy is indicated, but its usefulness for broad population needs to be confirmed. CONCLUSIONS: Writing committee will continue to keep an eye on upcoming evidences to timely update the guideline for primary stroke prevention in dyslipidemia and inflammation.


Subject(s)
Cholesterol , Dyslipidemias , Eye , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Inflammation , Lipoproteins , Meta-Analysis as Topic , Practice Guidelines as Topic , Primary Prevention , Stroke , Writing
8.
Article in Korean | WPRIM | ID: wpr-36057

ABSTRACT

Extracranial carotid stenosis is a well-established, modifiable risk factor for stroke. Asymptomatic extracranial carotid stenosis is increasingly being detected due to the introduction of less-invasive and more-sensitive advanced diagnostic technologies. For severe asymptomatic stenosis, earlier pivotal clinical trials demonstrated the benefit of carotid endarterectomy over the best medical therapy. Since then, great advances have been made in interventional and medical therapies as well as surgical techniques. The first edition of the Korean Stroke Clinical Practice Guidelines for primary stroke prevention for the management of asymptomatic carotid stenosis reflected evidences published before June 2007. After the publication of the first edition, several major clinical trials and observational studies have been published, and major guidelines updated their recommendation. Accordingly, the writing group of Korean Stroke Clinical Practice Guidelines (CPG) decided to provide timely updated evidence-based recommendations. The Korean Stroke CPG writing committee has searched and reviewed literatures related to the management of asymptomatic carotid stenosis including published guidelines, meta-analyses, randomized clinical trials, and nonrandomized studies published between June 2007 and Feb 2011. We summarized the new evidences and revised our recommendations. Key changes in the updated guidelines are the benefit of intensive medical therapy and further evidence of carotid artery stenting as an alternative to carotid endarterectomy. The current updated guidelines underwent extensive peer review by experts from the Korean Stroke Society, Korean Society of Intravascular Neurosurgery, Korean Society of Interventional Neuroradiology, Korean Society of Cerebrovascular Surgery, and Korean Neurological Association. New evidences will be continuously reflected in future updated guidelines.


Subject(s)
Carotid Arteries , Carotid Stenosis , Constriction, Pathologic , Endarterectomy, Carotid , Neurosurgery , Peer Review , Primary Prevention , Publications , Risk Factors , Stents , Stroke , Writing
9.
Korean Journal of Stroke ; : 106-115, 2012.
Article in Korean | WPRIM | ID: wpr-109665

ABSTRACT

Pivotal clinical trials testing the efficacy of new antithrombotics for the prevention of stroke and systemic embolism in patients with atrial fibrillation have been published since the release of the first edition of Korean clinical practice guidelines for primary stroke prevention. From July 2007 to August 2012, 5 clinical studies and update of guidelines in Europe and North America were identified through systematic search. In patients with atrial fibrillation who were unsuitable for warfarin, the combination of clopidogrel and aspirin reduced the risk of stroke at the cost of increased major bleedings as compared to aspirin. In patients with nonvalvular atrial fibrillation and risk factors for stroke, new oral anticoagulants, dabigatran, rivaroxaban and apixaban, were as effective as or more effective than warfarin in preventing stroke or systemic embolism. The risks of major bleeding with novel anticoagulants were similar to or lower than that of warfarin. Particularly, the risk of intracranial bleeding was significantly lower with novel anticoagulants than with warfarin. In this report, we summarized the new evidences and updated our recommendations for primary stroke prevention in patients with atrial fibrillation.


Subject(s)
Anticoagulants , Aspirin , Atrial Fibrillation , Benzimidazoles , beta-Alanine , Embolism , Europe , Hemorrhage , Humans , Morpholines , North America , Primary Prevention , Pyrazoles , Pyridones , Risk Factors , Stroke , Thiophenes , Ticlopidine , Warfarin , Dabigatran , Rivaroxaban
10.
Article in English | WPRIM | ID: wpr-211523

ABSTRACT

BACKGROUND AND PURPOSE: Disability-adjusted life years (DALY), incorporating both disability and mortality, has been widely employed to measure regional and global burdens of stroke. Thus far, the DALY lost to stroke in a population has been estimated using only the crude population-level data; no previous study has incorporated refined data from stroke registries. The aim of this study was to integrate the stroke registry data and the population-level incidence data to project the nationwide DALY lost to ischemic stroke. METHODS: From the data of two large ischemic stroke registries, we derived an average DALY lost due to ischemic stroke for each of the following age groups: or =85 years. The nationwide ischemic stroke incidence for each age group was extracted from a cardiovascular and cerebrovascular surveillance study that analyzed the 2004 Korean Health Insurance database. RESULTS: The average DALY lost due to ischemic stroke for the age groups or =85 years was 5.07, 4.63, 4.35, 3.88, 2.88, and 1.73, respectively. By multiplying the incidence and the average DALY lost, the nationwide DALY lost was determined to be 9,952 for those or =85 years, respectively. The projected nationwide DALY lost due to 64,688 ischemic strokes in 2004 was 234,399 (121,482 for men and 113,244 for women), and the DALY lost per 100,000 person-years was 483 (500 for men and 469 for women). CONCLUSIONS: Incidence data from a population study and DALY values derived from stroke registries can be integrated to provide a more refined projection of the nationwide burden of ischemic stroke. In Korea, more than 230,000 years of healthy life are being lost annually due to ischemic stroke, and hence prompt action is imperative.


Subject(s)
Humans , Incidence , Insurance, Health , Korea , Male , Registries , Stroke
11.
Article in Korean | WPRIM | ID: wpr-109604

ABSTRACT

The first edition of the Korean clinical practice guidelines for primary stroke prevention reflects evidence published before June 2007. Since then, several clinical studies and meta-analyses have been conducted to determine the efficacy of aspirin for the primary prevention of cardiovascular disease including stroke. The aim of this guideline update is to provide timely recommendations taking into consideration the new evidence. Three clinical studies and four meta-analyses performed between July 2007 and November 2010 were identified and included for updating the guidelines. The main finding was a lack of aspirin efficacy for primary stroke prevention in patients with diabetes or peripheral arterial disease. We have summarized the new evidence and revised our recommendations for aspirin for primary stroke prevention. New evidence will need to be reflected continuously in future guideline updates.


Subject(s)
Aspirin , Cardiovascular Diseases , Humans , Peripheral Arterial Disease , Primary Prevention , Stroke
12.
Article in Korean | WPRIM | ID: wpr-111880

ABSTRACT

BACKGROUND: Prehospital delay is a major obstacle for successful treatment of acute stroke. We investigated the annual change of prehospital delay and related factors in patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA). METHODS: From prospective patient registry, demographic and clinical characteristics of patients who presented within 48 hours of symptom onset after AIS or TIA from 2005 to 2008 were analyzed. We compared the annual change of prehospital delay (time from symptom onset to hospital arrival) and the proportion of early arrival (EA-3, prehospital delay<3 h; EA-6, prehospital delay<6 h). We also investigated factors associated with prehospital delay and early arrival. RESULTS: Of 612 patients, 623 events of AIS or TIA were analyzed. The adjusted geometric mean (95% CI) of prehospital delay (hours) was 7.42 (6.07-9.06) in 2005, 8.18 (6.76-9.89) in 2006, 4.39 (3.50-5.51) in 2007, and 4.02 (3.10-5.22) in 2008 (p<0.01). The proportion of early arrival (year) was 23.6% (2005), 31% (2006), 58% (2007), 54% (2008) for EA-3 (p<0.001) and 38.8% (2005), 32.5% (2006), 51.6% (2007), 75% (2008) for EA-6 (p<0.001). Compared with 2006, the adjusted odds (95% CI) for early arrival were 1.54 (0.87-2.71) in 2005, 1.91 (1.11-3.30) in 2007, 2.29 (1.31-4.01) in 2008 for EA-3 and 1.37 (0.84-2.25) in 2005, 1.73 (1.06-2.81) in 2007, 2.03 (1.23-3.36) in 2008 for EA-6. Younger age, severe neurologic deficit, admission through emergency department, cardioembolic stroke, and TIA were also independently associated with early arrival. CONCLUSIONS: From 2005 to 2008, prehospital delay decreased and potential candidates for thrombolytic therapy increased significantly.


Subject(s)
Emergencies , Humans , Ischemic Attack, Transient , Neurologic Manifestations , Stroke , Thrombolytic Therapy
13.
Korean Journal of Stroke ; : 147-151, 2011.
Article in Korean | WPRIM | ID: wpr-24630

ABSTRACT

Previous studies have shown that patients with tandem occlusions involving extracranial internal carotid artery (ICA) and middle cerebral artery (MCA) have lower likelihood of recanalization by standard intravenous thrombolytic therapy. A 70-years-old man with a history of hypertension was admitted because of left hemiplegia and drowsiness which developed 47 minutes ago. On neurologic examination, he was drowsy and showed neglect syndrome as well as left hemiplegia. Brain CT angiography showed tandem occlusions at right extracranial ICA and proximal MCA. The administration of intravenous (IV) tissue plasminogen activator (tPA) did not improve his symptoms. We performed angioplasty and stenting for proximal ICA occlusion followed by mechanical thrombolysis for MCA occlusion. After the endovascular treatment, the MCA was recanalized and the patient recovered to show only mild left side weakness. This case shows successful treatment of hyperacute ischemic infarction from tendem occlusion of right MCA and proximal ICA with endovascular treatment following IV tPA thrombolysis.


Subject(s)
Angiography , Angioplasty , Brain , Carotid Artery, Internal , Cerebral Infarction , Hemiplegia , Humans , Hypertension , Infarction , Mechanical Thrombolysis , Middle Cerebral Artery , Neurologic Examination , Sleep Stages , Stents , Thrombolytic Therapy , Tissue Plasminogen Activator
14.
Article in Korean | WPRIM | ID: wpr-10206

ABSTRACT

For the past 20 years, it has been suggested that B vitamins (vitamin B6, folate, vitamin B12) and antioxidant vitamins (vitamin A, vitamin C, vitamin E) can prevent cardiovascular disease. Many observational studies reported a consistent dose-related association between homocysteine levels and cardiovascular morbidity and mortality. Homocysteine can be easily lowered by supplementation of vitamin B6, folate, and vitamin B12. Because the vitamins are inexpensive and relatively safe, such therapy would be highly cost effective. However randomized clinical studies using vitamin B6, folate or vitamin B12 supplementation failed to show benefit in preventing cardiovascular disease despite adequate lowering of homocysteine. Similarly, the role of anti-oxidant vitamins was linked to prevention of cardiovascular disease by limiting oxidation of low density lipoprotein cholesterol. In large observational studies, higher intake of anti-oxidant vitamins from diet or supplement was associated with decreased risk of coronary artery disease in men and women. However, a series of large randomized trials demonstrated no benefit from these anti-oxidant vitamins. Instead, several meta-analyses showed that supplementation of carotene, vitamin C or vitamin E increased cardiovascular mortality or all cause mortality. Considering currently available evidences, vitamins taken in excess of the dose required to prevent deficiency states are not beneficial in preventing cardiovascular disease and may harm people.


Subject(s)
Ascorbic Acid , Cardiovascular Diseases , Carotenoids , Cholesterol , Cholesterol, LDL , Coronary Artery Disease , Diet , Female , Folic Acid , Homocysteine , Humans , Lipoproteins , Male , Stroke , Vitamin B 12 , Vitamin B 6 , Vitamin B Complex , Vitamin E , Vitamins
15.
Article in Korean | WPRIM | ID: wpr-87691

ABSTRACT

BACKGROUND: Neurological syndromes often complicate the management of infective endocarditis. METHODS: We reviewed the neurological complications in 100 patients with infective endocarditis in a tertiary care hospital. RESULTS: Neurological complications occurred in 25 patients (25%). Ischemic infarctions occurred in 15 patients, hemorrhagic infarctions in 5, intracerebral hemorrhages in 12, subarachnoid hemorrhages in 4, and subdural hemorrhages in 2. Brain abscess was detected in 4 and seizures in 2 patients. Staphylococcus aureus endocarditis (p=0.01) and mitral valvular heart disease (p=0.015) correlated statistically with the development of neurological complications. The mortality rate was significantly higher in patients with neurological complications than those without neurological complications (p=0.00). Age, sex, and type of valve (native versus prosthetic) were not related to the complication rate. CONCLUSIONS: We concluded that (1) hemorrhagic complications occurred at a higher rate in this study than previous reports; (2) S.aureus infection and mitral valvular disease predicted the occurrence of neurological complications; and (3) neurological complications were related to mortality rates. (J Korean Neurol Assoc 19(3):202~206, 2001)


Subject(s)
Brain Abscess , Cerebral Hemorrhage , Endocarditis , Heart Diseases , Heart Valve Diseases , Hematoma, Subdural , Humans , Infarction , Mortality , Seizures , Staphylococcus aureus , Subarachnoid Hemorrhage , Tertiary Healthcare
16.
Article in Korean | WPRIM | ID: wpr-133270

ABSTRACT

Homocystinuria is an inborn error of methionine metabolism and has several causes. Among the causes, cystathionine-b-synthase deficiency is the most common. The major clinical manifestations are ectopia lectis skeletal deformities, mental retardation and occlusive vascular disease A 16 year old girl was admitted with generalized seizure. She had a history of bilateral lens dislocation and thoracic scoliosis. Her brain MRI and MRA showed mass-like lesions at both frontal area and diffuses, stenosis of the right internal carotid artery She underwent a stereotaxic brain biopsy and cerebral angiography. Two days, after angiography, she was suddenly aggravated to show stuporous mentality and quadriplegia. FoIlow-up brain MRI showed newly developed acute ischemic lesions at both parietal area MR venography confirmed superior sagittal sinus thrombosis. Methionine and homocystine were markedly elevated in plasma and 24 hour urine. She recovered with anticoagulation and vitamin supplementation(folate and pyridoxine). Homocystinuria should be suspected in stroke patients of young age, especially if thy have nontraumatic lens dislocation or marfanoid features. We report a patient with homocystinuria complicated by cerebral venous sinus thrombosis which was aggrevated after cerebral angiography.


Subject(s)
Adolescent , Angiography , Biopsy , Brain , Carotid Artery, Internal , Cerebral Angiography , Congenital Abnormalities , Constriction, Pathologic , Female , Homocystine , Homocystinuria , Humans , Intellectual Disability , Lens Subluxation , Magnetic Resonance Imaging , Metabolism , Methionine , Phlebography , Plasma , Quadriplegia , Rabeprazole , Scoliosis , Seizures , Sinus Thrombosis, Intracranial , Stroke , Stupor , Superior Sagittal Sinus , Thrombosis , Vascular Diseases , Vitamins
17.
Article in Korean | WPRIM | ID: wpr-133268

ABSTRACT

Homocystinuria is an inborn error of methionine metabolism and has several causes. Among the causes, cystathionine-b-synthase deficiency is the most common. The major clinical manifestations are ectopia lectis skeletal deformities, mental retardation and occlusive vascular disease A 16 year old girl was admitted with generalized seizure. She had a history of bilateral lens dislocation and thoracic scoliosis. Her brain MRI and MRA showed mass-like lesions at both frontal area and diffuses, stenosis of the right internal carotid artery She underwent a stereotaxic brain biopsy and cerebral angiography. Two days, after angiography, she was suddenly aggravated to show stuporous mentality and quadriplegia. FoIlow-up brain MRI showed newly developed acute ischemic lesions at both parietal area MR venography confirmed superior sagittal sinus thrombosis. Methionine and homocystine were markedly elevated in plasma and 24 hour urine. She recovered with anticoagulation and vitamin supplementation(folate and pyridoxine). Homocystinuria should be suspected in stroke patients of young age, especially if thy have nontraumatic lens dislocation or marfanoid features. We report a patient with homocystinuria complicated by cerebral venous sinus thrombosis which was aggrevated after cerebral angiography.


Subject(s)
Adolescent , Angiography , Biopsy , Brain , Carotid Artery, Internal , Cerebral Angiography , Congenital Abnormalities , Constriction, Pathologic , Female , Homocystine , Homocystinuria , Humans , Intellectual Disability , Lens Subluxation , Magnetic Resonance Imaging , Metabolism , Methionine , Phlebography , Plasma , Quadriplegia , Rabeprazole , Scoliosis , Seizures , Sinus Thrombosis, Intracranial , Stroke , Stupor , Superior Sagittal Sinus , Thrombosis , Vascular Diseases , Vitamins
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