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1.
Article in English | WPRIM | ID: wpr-915429

ABSTRACT

Background@#Acute ischemic stroke is a time-sensitive disease. Emergency medical service (EMS) prehospital notification of potential patients with stroke could play an important role in improving the in-hospital medical response and timely treatment of patients with acute ischemic stroke. We analyzed the effects of FASTroke, a mobile app that EMS can use to notify hospitals of patients with suspected acute ischemic stroke at the prehospital stage. @*Methods@#We conducted a retrospective observational study of patients diagnosed with acute ischemic stroke at 5 major hospitals in metropolitan Daegu City, Korea, from February 2020 to January 2021. The clinical conditions and time required for managing patients were compared according to whether the EMS employed FASTroke app and further compared the factors by dividing the patients into subgroups according to the preregistration received by the hospitals when using FASTroke app. @*Results@#Of the 563 patients diagnosed with acute ischemic stroke, FASTroke was activated for 200; of these, 93 were preregistered. The FASTroke prenotification showed faster door-tocomputed-tomography times (19 minutes vs. 25 minutes, P < 0.001), faster door-to-intravenousthrombolysis times (37 minutes vs. 48 minutes, P < 0.001), and faster door-to-endovascularthrombectomy times (82 minutes vs. 119 minutes, P < 0.001). The time was further shortened when the preregistration was conducted simultaneously by the receiving hospital. @*Conclusion@#The FASTroke app is an easy and useful tool for prenotification as a regional stroke care system in the metropolitan area, leading to reduced transport and acute ischemic stroke management time and more reperfusion treatment. The effect was more significant when the preregistration was performed jointly.

2.
Article | WPRIM | ID: wpr-831717

ABSTRACT

Coronavirus disease 2019 (COVID-19) is an ongoing pandemic infection associated with high morbidity and mortality. The Korean city of Daegu endured the first large COVID-19 outbreak outside of China. Since the report of the first confirmed case in Daegu on February 18, 2020, a total of 6,880 patients have been reported until May 29, 2020. We experienced five patients with ischemic stroke and COVID-19 during this period in four tertiary hospitals in Daegu. The D-dimer levels were high in all three patients in whom D-dimer blood testing was performed.Multiple embolic infarctions were observed in three patients and suspected in one. The mean time from stroke symptom onset to emergency room arrival was 22 hours. As a result, acute treatment for ischemic stroke was delayed. The present case series report raises the possibility that the coronavirus responsible for COVID-19 causes or worsens stroke, perhaps by inducing inflammation. The control of COVID-19 is very important; however, early and proper management of stroke should not be neglected during the epidemic.

3.
Article in Korean | WPRIM | ID: wpr-766444

ABSTRACT

Although dizziness is common, it is one of the most challenging symptoms in clinical medicine. Defining the type of dizziness has been considered the first step when approaching patients with dizziness. This approach was based on the belief that each type of dizziness reflects a specific underlying mechanism. A more recent approach involves grouping patients into 4 major categories: 1) acute prolonged spontaneous dizziness, 2) recurrent spontaneous dizziness, 3) recurrent positional dizziness, and 4) chronic persistent dizziness and imbalance. Vestibular neuritis and strokes are the most common causes of acute prolonged spontaneous dizziness, and neuro-otologic examination findings play a key role in the differential diagnosis. Careful history-taking is extremely important in diagnosing the disorders that cause recurrent spontaneous dizziness since the findings of the clinical examination and laboratory evaluations are often negative without a confirmatory diagnostic tool. Benign paroxysmal positional vertigo is a predominant cause of recurrent positional vertigo and can easily be treated with canalith-repositioning maneuvers. Chronic persistent dizziness and imbalance occur in various degenerative or psychiatric disorders that frequently require a referral to a specialist. This new approach may be more practical for managing patients with dizziness.


Subject(s)
Benign Paroxysmal Positional Vertigo , Clinical Medicine , Diagnosis, Differential , Dizziness , Humans , Referral and Consultation , Specialization , Stroke , Vertigo , Vestibular Neuronitis
4.
Article in Korean | WPRIM | ID: wpr-916109

ABSTRACT

Although dizziness is common, it is one of the most challenging symptoms in clinical medicine. Defining the type of dizziness has been considered the first step when approaching patients with dizziness. This approach was based on the belief that each type of dizziness reflects a specific underlying mechanism. A more recent approach involves grouping patients into 4 major categories: 1) acute prolonged spontaneous dizziness, 2) recurrent spontaneous dizziness, 3) recurrent positional dizziness, and 4) chronic persistent dizziness and imbalance. Vestibular neuritis and strokes are the most common causes of acute prolonged spontaneous dizziness, and neuro-otologic examination findings play a key role in the differential diagnosis. Careful history-taking is extremely important in diagnosing the disorders that cause recurrent spontaneous dizziness since the findings of the clinical examination and laboratory evaluations are often negative without a confirmatory diagnostic tool. Benign paroxysmal positional vertigo is a predominant cause of recurrent positional vertigo and can easily be treated with canalith-repositioning maneuvers. Chronic persistent dizziness and imbalance occur in various degenerative or psychiatric disorders that frequently require a referral to a specialist. This new approach may be more practical for managing patients with dizziness.

5.
Article in English | WPRIM | ID: wpr-765887

ABSTRACT

BACKGROUND: Carotid revascularization is frequently complicated by hemodynamic depression (HD), which can increase the risk of stroke or vascular death. However, no studies yet exist describing the correlation between the timing of carotid revascularization and HD. The present study investigated whether carotid revascularization in the early phase of a stroke had an impact on the incidence of HD. METHODS: A retrospective study of consecutive ischemic stroke patients who underwent carotid revascularization was designed to compare the incidence of HD between early and late carotid revascularization. Early carotid revascularization was defined as carotid artery stenting or endarterectomy within two weeks of stroke onset. HD was defined as hypotension or bradycardia within five days of carotid revascularization. RESULTS: Of 69 carotid revascularizations, HD occurred in 29 (42.0%). The incidence of HD did not differ significantly between the early and late phase groups (48.0% vs. 38.6%, respectively, P =0.449). Patients with HD had undergone more carotid artery stenting than those without HD (79.3% vs. 35%, respectively, P < 0.001). Age, sex, hypertension, diabetes, heart disease, antihypertensive medication, and severity of carotid stenosis did not differ between patients with and without HD. CONCLUSION: The present research suggests that early carotid revascularization is as safe as late carotid revascularization with regard to HD.


Subject(s)
Bradycardia , Carotid Arteries , Carotid Stenosis , Depression , Endarterectomy , Endarterectomy, Carotid , Heart Diseases , Hemodynamics , Humans , Hypertension , Hypotension , Incidence , Retrospective Studies , Stents , Stroke
6.
Article in Korean | WPRIM | ID: wpr-182775

ABSTRACT

BACKGROUND: The ankle brachial index (ABI) is a useful screening tool for peripheral arterial disease. It has been documented that the cerebral atherosclerosis is more frequent in stroke patients with abnormal ABI than in those with normal ABI. The present study compared the different calculation methods of ABI for coexistent intracranial and extracranial arterial stenosis (IECAS) in ischemic stroke. METHODS: We reviewed the data of patients admitted for acute ischemic stroke or transient ischemic attack. The following four distinct ABIs were calculated: the ratio of the higher (ABI-H), lower (ABI-L), or either of the systolic blood pressures (SBPs) of the posterior tibial (ABI-PT) and dorsalis pedis (ABI-DP) arteries relative to the higher of the brachial SBP. We compared the values of these four ABI measures relative to the presence of any IECAS using receiver operating characteristic (ROC) curve analysis. RESULTS: ABI-H, ABI-L, ABI-PT, and ABI-DP were abnormal (≤ 0.9) in 19 (13.1%), 36 (24.8%), 29 (20%), and 30 (20.7%) of 145 patients, respectively. The area under the ROC curve was significantly larger for ABI-H, ABI-L, and ABI-DP than for ABI-PT for any type of IECAS. The extracranial stenosis was more frequent when any of the four ABIs was abnormal, while intracranial stenosis was not correlated with the four ABIs. The IECAS was more frequent for abnormal ABI-H and ABI-DP than for normal ABIs. CONCLUSIONS: Our studies suggested that ABIs based on a higher SBP of the PT or DP (i.e., ABI-H) are more strongly associated with the presence of IECAS than are those using the SBP of the PT (ABI-PT). Extracranial artery stenosis seems to be more strongly associated with ABI than is intracranial stenosis.


Subject(s)
Ankle Brachial Index , Ankle , Arteries , Atherosclerosis , Constriction, Pathologic , Humans , Intracranial Arteriosclerosis , Ischemic Attack, Transient , Mass Screening , Methods , Peripheral Arterial Disease , ROC Curve , Stroke
7.
Article in Korean | WPRIM | ID: wpr-75281

ABSTRACT

Guillain-Barre syndrome (GBS) is an autoimmune polyneuropathy that presents with acute onset and rapid progression of ascending quadriparesis and hyporeflexia, which can be triggered by various conditions. However, GBS following cerebral infarction is very rare. We describe herein a patient with facial diplegia, ophthalmoplegia, and areflexia that occurred during acute cerebral infarction. The symptoms were improved after intravenous immunoglobulin treatment. The details of this case suggest that GBS is triggered by immune dysregulation after acute cerebral infarction.


Subject(s)
Cerebral Infarction , Guillain-Barre Syndrome , Humans , Immunoglobulins , Ophthalmoplegia , Polyneuropathies , Quadriplegia , Reflex, Abnormal
8.
Article in Korean | WPRIM | ID: wpr-219532

ABSTRACT

Restless legs syndrome (RLS) is a common neurological condition characterized by uncomfortable and unpleasant sensations experienced primarily in the legs. Several clinical reports have indicated that many patients with RLS also have the same symptoms in their arms. We report contralateral arm and leg restlessness on resting after acute internal capsular infarction, which resulted in sleep-onset insomnia and disappeared after administering a dopamine receptor agonist. These observations could provide clues to the mechanism underlying the pathophysiology of RLS.


Subject(s)
Arm , Dopamine Agonists , Humans , Infarction , Leg , Psychomotor Agitation , Restless Legs Syndrome , Sensation , Sleep Initiation and Maintenance Disorders
9.
Article in Korean | WPRIM | ID: wpr-171307

ABSTRACT

Hemichorea is caused by various diseases but stroke is the most common cause. The usual lesions of the stroke related hemichorea are the contralateral subthalamus or basal ganglia. Few cases with cortical lesion have been reported. But hemichorea with primary somatosensory cortical lesion has not yet been reported. We report a case with hemichorea after acute infarction of the contralateral primary somatosensory cortex.


Subject(s)
Basal Ganglia , Cerebral Infarction , Chorea , Infarction , Somatosensory Cortex , Stroke , Subthalamus
10.
Article in Korean | WPRIM | ID: wpr-218529

ABSTRACT

No abstract available.


Subject(s)
Calcinosis
11.
Article in English | WPRIM | ID: wpr-194086

ABSTRACT

Polychlorinated biphenyls (PCBs) are accumulated in our body through food chain and cause a variety of adverse health effects including neurotoxicities such as cognitive deficits and motor dysfunction. In particular, neonates are considered as a high risk group for the neurotoxicity of PCBs exposure. The present study attempted to analyze the structure-activity relationship among PCB congeners and the mechanism of PCBs-induced neurotoxicity. We measured total protein kinase C (PKC) activities, PKC isoforms, reactive oxygen species (ROS), and induction of neurogranin (RC-3) and growth associated protein-43 (GAP-43) mRNA in cerebellar granule cells of neonatal rats with phorbol 12, 13-dibutyrate ([3H]PDBu) binding assay, western blot, ROS assay, and reverse transcription PCR (RT-PCR) analysis respectively following the different structural PCBs exposure. Only non-coplanar PCBs showed a significant increase of total PKC-alpha and betaII activity as measured with [3H]PDBu binding assay. ROS were more increased with non-coplanar PCBs than coplanar PCBs. The mRNA levels of RC-3 and GAP-43 were more induced with non-coplanar PCBs than coplanar PCBs, indicating that these factors may be useful biomarkers for differentiating non-coplanar PCBs from coplanar PCBs. Non-coplanar PCBs may be more potent neurotoxic congeners than coplanar PCBs. This study provides evidences that non-coplanar PCBs, which have been neglected in the risk assessment processes, should be added in the future to improve the quality and accuracy of risk assessment on the neuroendocrinal adverse effects of PCBs exposures.


Subject(s)
Animals , Blotting, Western , Food Chain , GAP-43 Protein , Humans , Infant, Newborn , Nerve Growth Factor , Neurogranin , Neurons , Neurotoxicity Syndromes , Phorbols , Polychlorinated Biphenyls , Polymerase Chain Reaction , Protein Isoforms , Protein Kinase C , Rats , Reactive Oxygen Species , Reverse Transcription , Risk Assessment , RNA, Messenger , Structure-Activity Relationship , Biomarkers
12.
Article in Korean | WPRIM | ID: wpr-14868

ABSTRACT

Cryptococcosis is a global invasive mycosis associated with significant morbidity and mortality. Fever, headache and vomiting are common clinical presentations of the cryptococcal meningitis. But ischemic stroke and cranial nerve impairment are rare neurologic complications. We report a case of cryptococcal meningoencephalitis presenting as cerebral infarction and multiple cranial nerve palsies.


Subject(s)
Cerebral Infarction , Cranial Nerve Diseases , Cranial Nerves , Cryptococcosis , Fever , Headache , Meningitis, Cryptococcal , Meningoencephalitis , Stroke , Vomiting
13.
Article in Korean | WPRIM | ID: wpr-145206

ABSTRACT

The carotid stump is a known source of cerebral embolisms. Direct ultrasound sonographic visualization of a thrombus in the common carotid stump after development of a cerebral infarction is rare. We report a case of a 69-year-old man who presented with acute ipsilateral ischemic stroke with occlusion of the left common carotid artery, forming a stump proximal to the carotid bifurcation. Carotid duplex sonography revealed a mobile thrombus in the stump. An ipsilateral microembolic signal was observed by transcranial Doppler imaging.


Subject(s)
Aged , Carotid Artery, Common , Cerebral Infarction , Embolism , Humans , Intracranial Embolism , Stroke , Thromboembolism , Thrombosis , Ultrasonography, Doppler
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