Relationships between Endogenous Estrogen and the Risk Factors for Vascular Disease / 대한뇌졸중학회지

BACKGROUND: This study evaluated the relationships between endogenous estrogen levels and vascular risk factors in healthy men and women. METHODS: Demographics and laboratory data were collected from normotensive subjects (123 men and 154 women) in their thirties, forties and fifties who had normal laboratory profiles and no cardiovascular risk factors. Initially, estradiol, low-density lipoprotein (LDL)-cholesterol, triglyceride, and high-density lipoprotein (HDL)-cholesterol, systolic and diastolic blood pressure (SBP and DBP), NO2/NO3, homocysteine, and body mass index (BMI) were measured. Then, the relationships between estradiol and the evaluated items were analyzed with comparison of means and correlation, and stepwise multiple regression analysis based on genders and age-groups. RESULTS: Estradiol levels decreased with aging in women. Lower LDL and triglyceride, higher HDL levels, and lower SBP and DBP observed in women were correlated with decreasing age as well as increasing estradiol level. On the multivariate analysis, however, estradiol levels were negatively correlated with the changes in SBP, DBP, and triglyceride among the lipid variables. BMI was positively related with the increase of SBP and DBP and the estradiol levels. Although higher NO2/NO3 and lower homocysteine levels were observed in women than men, the NO2/NO3 and homocysteine levels had no significant correlation with estradiol changes. CONCLUSION: The study observed the beneficial relationships between endogenous estrogen, and blood pressures and lipids in healthy women. The estrogen-related benefits observed in this study were lower TG levels, SBP, and DBP in young women than those in older women or in men.

Intracranial Hemodynamic Changes During Adult Moyamoya Disease Progression

Background and purpose: This study evaluated the changes in blood flow velocity in the anterior and posterior intracranial circulations according to the progression of moyamoya disease in adult patients. Methods: We evaluated Suzuki's angiographic stage and mean blood flow velocity (MBFV) changes in intracranial vessels from both sides in 19 adult moyamoya patients. We then analyzed the linearity of MBFV changes from early to late moyamoya stages in each intracranial vessel using piecewise linear regression models. Results: The MBFV in the middle cerebral artery, terminal internal carotid artery, and anterior cerebral artery increased non linearly until stage III, and then decreased progressively up to stage VI. The ophthalmic artery also showed nonlinear velocity changes, with an increase in MBFV up to stage IV, followed by a decrease in MBFV up to stage VI. The MBFV of the basilar artery increased linearly from a normal velocity at an early moyamoya stage to a stenotic velocity at a late stage. There was no statistically significant regression model for the relationship between the MBFV in the posterior cerebral artery and moyamoya stage. Conclusions: The nonlinear and/or linear MBFV changes associated with variable intracranial vessels might be useful in initial and follow-up evaluations of different stages of moyamoya disease.

Classification and Serial Evolution of PLEDs

BACKGROUND AND PURPOSE: Periodic lateralized epileptiform discharges (PLEDs) are defined as spikes or sharp waves occurring at an approximately regular interval. PLEDs are subdivided into PLEDs proper and PLEDs plus in Reiher's classification, but since this does not sufficiently reflect the pleomorphism of PLEDs, we propose a new subclassification scheme of PLEDs, and discuss the relationship between them and clinical prognoses. METHODS: Thirty-seven patients who had at least two available EEGs were included in this study. Each patient had structural brain lesions identified in brain CT/MRI: 237 EEGs from 37 patients were reviewed and the patterns of PLEDs were classified by electroencephalographic characteristics based on Reiher's classification. PLEDs proper of class 3 were subclassified into four categories: (1) simple, (2) benign, (3) vigorous, and (4) suppressed. RESULTS: Most of the PLEDs that started with the vigorous or suppressed pattern of class 3 evolved into the simple or benign pattern of class 3 and subsequently changed into class 1 or class 2, finally intermingling with the neighboring background waves. PLEDs that started with the benign or simple pattern of class 3 rapidly changed into class 1 or 2. Patients showing the benign or simple pattern of class 3 exhibited a better clinical prognosis. CONCLUSIONS: PLEDs have five distinctive classes, and over time they evolve from malignant PLEDs plus to benign PLEDs proper before finally disappearing. It appears that those of class 3 have more diverse patterns, with the vigorous and suppressed patterns being the more malignant forms of PLEDs in this class.