RESUMO
BACKGROUND: To evaluate the clinical characteristics of patients with non-amnestic mild cognitive impairment (naMCI) in a memory disorder clinic at a single center. METHODS: A retrospective study was conducted involving 312 patients with naMCI from May 2011 to July 2018. Brain magnetic resonance imaging and detailed neuropsychological tests were performed in all patients. We used the proposed criteria for naMCI to classify the patients into single- and multiple-domain groups. We compared the baseline clinical characteristics, neuroimaging findings, and the rate of progression to dementia between these two groups. RESULTS: The 312 patients comprised 210 in the single-domain group (67.3%) and 102 in the multiple-domain group (32.7%). The mean age was significantly higher in the multiple-domain group than in the single-domain group. The years of education, mean Mini Mental State Examination score, and mean Clinical Dementia Rating Scale Sum of Boxes score were significantly lower in the multiple-domain group than in the single-domain group. The Z-scores of neuropsychological tests in most cognitive domains were significantly lower in the multiple-domain group than in the single-domain group. Compared to the single-domain group, the multiple-domain group showed more-severe medial temporal atrophy and contained a higher proportion of patients with moderate white-matter hyperintensities. Thirteen (8.4%) patients with naMCI progressed to dementia, most of who were diagnosed with Alzheimer's disease. CONCLUSIONS: We present a single-center experience of clinical characteristics in patients with naMCI. Close observation of the clinical profiles of patients with naMCI may help identify individuals at the greatest risk of dementia.
Assuntos
Humanos , Doença de Alzheimer , Atrofia , Encéfalo , Demência , Educação , Imageamento por Ressonância Magnética , Transtornos da Memória , Disfunção Cognitiva , Neuroimagem , Testes Neuropsicológicos , Estudos RetrospectivosRESUMO
BACKGROUND: Sarcopenia causes loss of muscle mass in the elderly and is associated with development of metabolic syndrome in those with obesity. This study evaluated the prevalence of sarcopenic obesity (SO) in healthy Korean elderly women. METHODS: This study was based on data from the Korea National Health and Nutrition Examination Survey IV and V, 2008–2011. Whole body dual energy X-ray absorptiometry and body mass index measurement were performed for all patients. Women aged 65 years or older were included in this study. Total appendicular extremity muscle mass was used to determine the skeletal muscle mass index. RESULTS: Of 2,396 women aged 65 years or older, a total of 1,491 (62.2%) were underweight, normal weight, or overweight, while 905 (37.8%) were obese. The prevalence of sarcopenia using a cut-off value of 5.4 kg/m2 was 64.9% (63/97) in underweight women, 38.2% (320/838) in normal weight women, 17.1% (95/556) in overweight women, and 6.1% (55/905) in obese women. CONCLUSIONS: The prevalence of sarcopenia was different among groups. The prevalence rate in obese women was lower than that in non-obese women. SO is a new category of obesity in older adults with high adiposity coupled with low muscle mass. The prevalence of SO was lower than that in previous studies because of differences in the definition. A consensus definition of SO needs to be established.
Assuntos
Adulto , Idoso , Feminino , Humanos , Absorciometria de Fóton , Adiposidade , Índice de Massa Corporal , Consenso , Estudos Transversais , Extremidades , Coreia (Geográfico) , Músculo Esquelético , Inquéritos Nutricionais , Obesidade , Sobrepeso , Prevalência , Sarcopenia , MagrezaRESUMO
Sarcopenia is an age-related geriatric syndrome which is characterized by the gradual loss of muscle mass, muscle strength, and muscle quality. There are a lot of neurologic insults on sarcopenia at various levels from the brain to the neuromuscular junctions (NMJs) to generate a volitional task. Dopaminergic downregulation, inadequate motor programming and motor coordination impairment lead to decline of supraspinal drive. Motor unit reorganization and inflammatory changes in motor neuron decrease conduction velocity and amplitude of compound muscle action potential. Furthermore, NMJ remodeling and age related neurophysiological alterations may contribute to neuromuscular impairment. Sarcopenia is an age-associated, lifelong process which links to multiple etiological factors. Although not all the causes are completely understood, we suggest that compromised nervous system function may be one of the important contributors to the sarcopenia.
Assuntos
Potenciais de Ação , Envelhecimento , Ataxia , Encéfalo , Regulação para Baixo , Neurônios Motores , Força Muscular , Sistema Nervoso , Junção Neuromuscular , SarcopeniaRESUMO
BACKGROUND AND PURPOSE: To compare the efficacy and safety of antiplatelet agents for the secondary prevention of ischemic stroke based on cytochrome P450 2C19 (CYP2C19) polymorphisms. METHODS: This study was a prospective, multicenter, randomized, parallel-group, open-label, blind genotype trial. First time non-cardiogenic ischemic stroke patients were enrolled and screened within 30 days. Participants were randomized to receive either triflusal or clopidogrel for secondary stroke prevention. The primary outcome was the time from randomization to first recurrent ischemic stroke or hemorrhagic stroke. RESULTS: The required sample size was 1,080 but only 784 (73%) participants were recruited. In patients with a poor CYP2C19 genotype for clopidogrel metabolism (n=484), the risk of recurrent stroke among those who received triflusal treatment was 2.9% per year, which was not significantly different from those who received clopidogrel treatment (2.2% per year; hazard ratio [HR], 1.23; 95% confidence interval [CI], 0.60–2.53). In the clopidogrel treatment group (n=393), 38% had good genotypes and 62% poor genotypes for clopidogrel metabolism. The risk of recurrent stroke in patients with a good CYP2C19 genotype was 1.6% per year, which was not significantly different from those with a poor genotype (2.2% per year; HR, 0.69; 95% CI, 0.26–1.79). CONCLUSIONS: Whilst there were no significant differences between the treatment groups in the rates of stroke recurrence, major vascular events, or coronary revascularization, the efficacy of antiplatelet agents for the secondary prevention of stroke according to CYP2C19 genotype status remains unclear.
Assuntos
Humanos , Citocromo P-450 CYP2C19 , Sistema Enzimático do Citocromo P-450 , Citocromos , Genótipo , Metabolismo , Inibidores da Agregação Plaquetária , Estudos Prospectivos , Distribuição Aleatória , Recidiva , Tamanho da Amostra , Prevenção Secundária , Acidente Vascular CerebralRESUMO
Restless legs syndrome (RLS) is chronic neurological disorder, in which the primary symptoms is unpleasant and disturbing sensation accompanied by urge to move in multiple body parts especially in legs. RLS may present in distinct phenotypes often described as “primary” vs. “secondary.” Secondary RLS can arise from etiologies such as iron deficiency, pregnancy, peripheral neuropathy, and end-stage renal disease. We report a rare case of RLS associated with neurogenic tumor of the sciatic nerve. A 72-year-old man complained of recurrent and worsening RLS symptoms in his right lower extremity, despite medical treatment. Interestingly, we found a neurogenic tumor at the right greater sciatic notch region on magnetic resonance imaging of the hip.
Assuntos
Idoso , Humanos , Gravidez , Quadril , Corpo Humano , Ferro , Falência Renal Crônica , Perna (Membro) , Extremidade Inferior , Imageamento por Ressonância Magnética , Doenças do Sistema Nervoso , Doenças do Sistema Nervoso Periférico , Fenótipo , Síndrome das Pernas Inquietas , Nervo Isquiático , SensaçãoRESUMO
No abstract available.
Assuntos
Adulto , Feminino , Humanos , Isquemia Encefálica/diagnóstico , Angiografia Cerebral , Evolução Fatal , Hiperventilação/complicações , Doença de Moyamoya/complicações , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Crise Tireóidea/complicaçõesRESUMO
Hemangioblastomas are angioblastic tumors of the central nervous system. Cerebellar hemangioblastomas are traditionally classified into two morphologic types-cystic and solid. Cystic hemangioblastomas are associated with peritumoral edema, but solid hemangioblastomas are not. We report a case of solid cerebellar hemangioblastoma with massive peritumoral edema. An 83-year-old female visited our hospital due to a sudden headache. Five years ago, she had been admitted to our hospital with similar headache and diagnosed with cerebellar hemangioblastoma. Follow-up brain MRI 5 years later showed an increased size of a homogeneous enhancing mass with aggravated peritumoral edema in the left lower cerebellar hemisphere. Cerebral angiography showed a highly vascularized mass in the cerebellum, which was compatible with a solid-type hemangioblastoma.
Assuntos
Idoso de 80 Anos ou mais , Feminino , Humanos , Encéfalo , Sistema Nervoso Central , Cerebelo , Angiografia Cerebral , Edema , Seguimentos , Cefaleia , Hemangioblastoma , Imageamento por Ressonância MagnéticaRESUMO
BACKGROUND AND PURPOSE: We examined the characteristics of sleep disturbances and sleep patterns in the caregivers of patients with amnestic mild cognitive impairment (aMCI) and dementia. METHODS: We prospectively studied 132 patients (60 with aMCI and 72 with dementia) and their caregivers, and 52 noncaregiver controls. All caregivers and controls completed several sleep questionnaires, including the Pittsburgh Sleep Quality Index (PSQI). The patients were administered neuropsychological tests and the neuropsychiatric inventory to evaluate their behavioral and neuropsychiatric symptoms of dementia (BPSD). RESULTS: The PSQI global score was 6.25+/-3.88 (mean+/-SD) for the dementia caregivers and 5.47+/-3.53 for the aMCI caregivers. The Insomnia Severity Index (ISI) and short form of the Geriatric Depression Scale (GDS-S) predicted higher PSQI global scores in aMCI caregivers, and higher scores for the ISI, Epworth Sleepiness Scale (ESS), and GDS-S in dementia caregivers. BPSD, including not only agitation, depression, and appetite change in dementia patients, but also depression, apathy, and disinhibition in aMCI patients, was related to impaired sleep quality of caregivers, but nighttime behavior was not. Age and gender were not risk factors for disturbed sleep quality. CONCLUSIONS: Dementia and aMCI caregivers exhibit impaired quality of sleep versus non-caregivers. ISI, GDS-S, and ESS scores are strong indicators of poor sleep in dementia caregivers. In addition, some BPSD and parts of the neuropsychological tests may be predictive factors of sleep disturbance in dementia caregivers.
Assuntos
Humanos , Doença de Alzheimer , Apatia , Apetite , Cuidadores , Demência , Demência Vascular , Depressão , Di-Hidroergotamina , Disfunção Cognitiva , Testes Neuropsicológicos , Estudos Prospectivos , Fatores de Risco , Distúrbios do Início e da Manutenção do Sono , Inquéritos e QuestionáriosRESUMO
Predominant involvement of a particular group of fingers due to a central nervous system lesion has been described as pseudoperipheral palsy. Two patients visited our hospital with isolated weakness of a particular group of fingers due to small cortical infarctions. A 51-year-old woman suddenly developed weakness in her left index and middle fingers. The brain MRI showed a small infarct in the right frontal cortex. A 67-year-old man was sudden difficulty using his chopsticks and had weakness in his right thumb and index finger. The brain MRI showed a small infarct in the left precentral cortex.
Assuntos
Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Encéfalo , Sistema Nervoso Central , Dedos , Infarto , Imageamento por Ressonância Magnética , Paralisia , PolegarRESUMO
No abstract available.
Assuntos
Blefaroptose , Miosite , Miosite Orbital , Pseudotumor OrbitárioRESUMO
BACKGROUND: Intravenous thrombolysis with alteplase is the most effective therapy for acute ischemic stroke, but hemorrhagic transformation (HT) is a potentially dangerous complication of such thrombolysis. Few studies have investigated the predictors of HT after thrombolysis in Korean stroke patients. METHODS: From 2003 to 2009, acute ischemic stroke patients who received intravenous alteplase were included from the prospective stroke registry of Kyung Hee University Hospital. Patients submitted to CT or MRI scans with gradient echo sequences within 12-36 hours of thrombolysis. The Hemorrhage After Thrombolysis (HAT) score [ranging from 0 (minimum risk) to 5 (maximum risk)] was calculated retrospectively for each patient. The predictive ability of the HAT score for HT and symptomatic intracranial hemorrhage (sICH) was calculated using C statistics. RESULTS: Among 151 consecutive patients, HT was confirmed in 35 on follow-up brain imaging. Atrial fibrillation (OR=2.709, 95%CI=1.118-6.567) and low one-third CT scan (OR=3.419, 95%CI=1.281-9.121) increased the risk of HT after intravenous thrombolysis in multivariate logistic regression analysis. HT, sICH (based on the National Institute of Neurological Disorders and Stroke and the Safe Implementation of Treatment in Stroke-Monitoring Study definitions), unfavorable [modified Rankin Scale (mRS) score of 2-6] and poor (mRS score of 3-6) outcomes at 3 months, and mortality at 3 months were increased with higher HAT scores (C statistic=0.632, 0.637, 0.843, 0.670, 0.689, and 0.659, respectively; p=0.018, 0.036, 0.042, 0.002, 0.015, and <0.001). CONCLUSIONS: The HAT score can be used to predict the risk of sICH following intravenous thrombolysis and the long-term clinical outcome.
Assuntos
Humanos , Fibrilação Atrial , Seguimentos , Hemorragia , Hemorragias Intracranianas , Modelos Logísticos , Imageamento por Ressonância Magnética , National Institute of Neurological Disorders and Stroke (USA) , Neuroimagem , Estudos Prospectivos , Estudos Retrospectivos , Acidente Vascular Cerebral , Terapia Trombolítica , Ativador de Plasminogênio TecidualRESUMO
Stroke is a major health problem in Korea. It is the second leading cause of death, and many stroke survivors are permanently disabled. Despite the high economic and social burden of stroke, little is known about utilization of health care services for sufficiently long follow-up periods. This study assessed nationwide patterns of hospitalization for inpatients with stroke from 2000 to 2010, using national health insurance claim data. Overall, during these 10 years, the number of stroke hospitalizations grew by a compound annual growth rate of 6.4%, and health care expenditures showed continued growth at a faster rate of 13.2%. These growth trends were also consistent in different types of hospitals as well as different stroke subtypes. However, the utilization patterns of inpatient services were different across hospital types, especially in lengths of hospital stay (LOS), health care expenditures, and proportions of stroke subtypes. Concerning the proportion of patients in different types of hospitals, there were sharp increases in the use of long-term care hospitals from 5% to 20% of all stroke patients while the proportion has decreased from 49% to 39% in general hospitals. The LOS was also different across hospital types: The longest average LOS of 49 days was shown in long-term care hospitals, while the tertiary hospitals showed the shortest LOS of 15. In conclusion, despite a continuing decline in stroke mortality due to improved survival, the burden of disease due to stroke is increasing. To manage this issue, monitoring the trends of health care expenditures in detail, as well as the incidence and mortality rates, would be useful. These efforts will result in understanding the factors contributing to the increasing burden and in identifying the efficient and effective utilization of limited health care resources.
Assuntos
Humanos , Causas de Morte , Atenção à Saúde , Gastos em Saúde , Hospitalização , Hospitais Gerais , Incidência , Pacientes Internados , Coreia (Geográfico) , Tempo de Internação , Assistência de Longa Duração , Programas Nacionais de Saúde , Acidente Vascular Cerebral , Sobreviventes , Centros de Atenção TerciáriaRESUMO
The accessory middle cerebral artery (MCA) is an anomalous vessel which arises from the anterior cerebral artery (ACA) and runs through the Sylvian fissure along with the normal MCA. Here we present a case of acute cerebral infarction in a patient with stenosis of the accessory MCA. The accessory MCA, which originated from the proximal A1 segment of the ACA, had severe focal stenosis in its proximal part and the ischemic lesions were in the frontal subcortical white matter. This case illustrates the anomalous vessel and its territory, the atheromatous vascular change, and the related ischemic insults.
Assuntos
Humanos , Artéria Cerebral Anterior , Infarto Cerebral , Constrição Patológica , Glicosaminoglicanos , Artéria Cerebral MédiaRESUMO
BACKGROUND AND PURPOSE: Stroke imposes a major burden on patients, their families, and the national healthcare system. The purpose of this study was to determine the itemized hospital charges in acute ischemic stroke patients according to their severity by partitioning the charges in detail and then examining whether stroke severity was a significant contributor to these charges. METHODS: This study analyzed data of first-time acute ischemic stroke patients who had been admitted to an academic medical center between September 2003 and April 2009. The patients' demographic and clinical characteristics were analyzed descriptively, and then eight categorized hospital charges as well as the total charge were compared among patients grouped according to stroke severity, using analysis of variance. Multiple regression analyses were conducted to test the influence of stroke severity on itemized hospital charges as well as the total charge, while controlling for other related factors. RESULTS: More-severe strokes were associated with a higher total charge. Significantly higher charges were associated with patients with more-severe strokes regarding all charged items except imaging studies. The charges for imaging studies were similar across all severities of stroke. While controlling for other factors, a significant impact of stroke severity was found in both the total hospital charge and most itemized charges. CONCLUSIONS: Itemized hospital charges for inpatients with acute ischemic stroke varied according to stroke severity. Stroke severity was a significant factor influencing the itemized charges of acute hospitalization of ischemic stroke patients.
Assuntos
Humanos , Centros Médicos Acadêmicos , Infarto Cerebral , Atenção à Saúde , Honorários e Preços , Preços Hospitalares , Hospitalização , Pacientes Internados , Coreia (Geográfico) , Acidente Vascular CerebralRESUMO
BACKGROUND: Herpes zoster ophthalmicus (HZO) can involve the oculomotor nerve; however, isolated trochlear nerve palsy has rarely been reported. CASE REPORT: An 83-year-old man who suffered from HZO in the right frontal area and scalp subsequently developed vertical diplopia and severe pain. Cerebrospinal fluid examination and brain MRI revealed no abnormalities. Isolated right trochlear nerve palsy was diagnosed based on the findings of neuro-ophthalmological tests. CONCLUSIONS: Isolated trochlear nerve involvement associated with HZO is very rare and may be easily overlooked. Physicians should carefully examine oculomotor involvement in HZO.
Assuntos
Idoso de 80 Anos ou mais , Humanos , Encéfalo , Diplopia , Herpes Zoster , Herpes Zoster Oftálmico , Couro Cabeludo , Nervo Troclear , Doenças do Nervo TroclearRESUMO
We describe a patient with isolated inferior rectus palsy due to midbrain infarction. A 68-year-old-man developed vertical diplopia of sudden onset which was maximal with a right lower side gaze. Neurological examination revealed weakness of the right inferior rectus muscle. Magnetic resonance imaging of the brain showed a focal infarction in the dorsomedial portion of the right midbrain tegmentum. The sole involvement of fascicular fibers of the inferior rectus muscle in the midbrain was accountable as the cause of this isolated inferior rectus palsy. We think that this is a case supporting the three-dimensional model of somatotopic fascicular arrangement of oculomotor nerve in the midbrain.
Assuntos
Humanos , Encéfalo , Diplopia , Infarto , Imageamento por Ressonância Magnética , Mesencéfalo , Músculos , Exame Neurológico , Nervo Oculomotor , ParalisiaRESUMO
BACKGROUND AND PURPOSE: Unstable carotid atherosclerotic plaques are characterized by cap rupture, leading to thromboembolism and stroke. Matrix metalloproteinases (MMPs) have been implicated in the progression of atherosclerosis and plaque rupture. The aim of this study was to assess the relationship between the expressions of MMP-2 and MMP-9 and carotid plaque instability. METHODS: Eighty atherosclerotic plaques were collected from 74 patients undergoing carotid endarterectomy. Clinical information was obtained from each patient, and plaque morphology was examined at the macroscopic and microscopic levels. The immunohistochemical expressions of MMPs were graded using semiquantitative scales. RESULTS: Macroscopic ulceration (84.6% versus 63.4%, p=0.042) and microscopic cap rupture (79.5% versus 51.2%, p=0.010) were more common in symptomatic than in asymptomatic patients. Immunoreactivities of MMP-2 and MMP-9 were increased in 40 and 36 atheromatous plaques, respectively. Macroscopic ulceration was strongly correlated with the expressions of MMP-2 (p<0.001) and MMP-9 (p=0.001). There were significant correlations between increased MMP-2 expression and cap rupture (p=0.002), intraplaque hemorrhage (p=0.039), and a thin fibrous cap (p=0.002), and between increased MMP-9 expression and cap rupture (p=0.010) and a large lipid core (p=0.013). CONCLUSIONS: Plaque rupture was significantly associated with the development of vascular events in carotid atherosclerotic disease. MMP-2 and MMP-9 are strongly correlated with plaque instability.
Assuntos
Humanos , Aterosclerose , Artérias Carótidas , Doenças das Artérias Carótidas , Endarterectomia das Carótidas , Hemorragia , Metaloproteinases da Matriz , Placa Aterosclerótica , Ruptura , Acidente Vascular Cerebral , Tromboembolia , ÚlceraRESUMO
BACKGROUND: Previous research has revealed that the type of health insurance significant impacts health-care utilization and patient health. The aim of this study was to describe and compare hospital service utilization and charges of inpatients with acute cerebral infarction among patients using two types of health insurance: National Health Insurance (NHI) and Medical Aid (MA). METHODS: The demographic, clinical, health-service utilization, and payment data of 1600 patients were analyzed. The patients were admitted within 7 days after the onset of stroke symptoms. Two insurance groups were compared in terms of patient characteristics and hospital charges using the chi-square test or the t-test. The significance of the impact of the health-insurance type on health-care utilization was tested after controlling for other related factors, using regression models. RESULTS: At the time of admission, the patients' gender, age, and stroke subtype differed significantly between the two insurance groups, whereas there were no differences in risk factors, admission route, referral status, or severity. There were no significant differences in treatments, length of stay, and referral status during their hospital stay. The total hospital charges and daily charges were significantly higher for patients with NHI than for patients with MA. In particular, significant differences were found in the categories of room and board, injection, laboratory tests, and imaging studies. CONCLUSIONS: There were significant differences between NHI and MA in terms of patient demographic characteristics, health-care utilization, and inpatient charges. Patients with NHI had higher hospital charges, especially in the categories of room and board and imaging tests.
Assuntos
Humanos , Infarto Cerebral , Atenção à Saúde , Honorários e Preços , Preços Hospitalares , Pacientes Internados , Seguro , Seguro Saúde , Tempo de Internação , Programas Nacionais de Saúde , Encaminhamento e Consulta , Fatores de Risco , Acidente Vascular CerebralRESUMO
BACKGROUND: The role of uric acid in cerebrovascular disease is controversial. Uric acid may be an independent risk factor for cerebrovascular diseases but its neuroprotective role as an antioxidant has also been suggested. We studied the effects of uric acid on the early prognosis in acute ischemic stroke. METHODS: The subjects were 721 patients with moderate-to-severe acute stroke who arrived at hospital within 48 hours from the onset of symptoms. Patients were divided into quartiles based on serum uric acid levels at admission. In-hospital stroke outcome were calculated on the National Institutes of Health Stroke Scale (NIHSS) and analyzed by multivariate logistic regression. RESULTS: Differences in NIHSS scores between baseline and discharge in the patients were not significantly related to serum uric acid levels. However, in large artery atherosclerosis group, the proportion of patients with neurological improvement and differences in NIHSS score between baseline and discharge differed between the quartile uric acid groups (p<0.01 and p=0.04, respectively). A multivariate analysis adjusting for known vascular risk factors showed that a higher uric acid level was associated with a higher probability of a good in-hospital outcome (odds ratio, 1.31 per additional 1 mg/dL; 95% confidence interval, 1.07-1.60 per additional 1 mg/dL), but only in those with large-artery atherosclerosis. CONCLUSIONS: Uric acid level is independently correlated with the neurological improvement in patients with acute ischemic stroke caused by large-artery atherosclerosis.
Assuntos
Humanos , Artérias , Aterosclerose , Hiperuricemia , Modelos Logísticos , Análise Multivariada , Prognóstico , Fatores de Risco , Acidente Vascular Cerebral , Ácido ÚricoRESUMO
No abstract available.