Identifying Atrial Fibrillation With Sinus Rhythm Electrocardiogram in Embolic Stroke of Undetermined Source: A Validation Study With Insertable Cardiac Monitors

Background and Objectives@#Paroxysmal atrial fibrillation (AF) is a major potential cause of embolic stroke of undetermined source (ESUS). However, identifying AF remains challenging because it occurs sporadically. Deep learning could be used to identify hidden AF based on the sinus rhythm (SR) electrocardiogram (ECG). We combined known AF risk factors and developed a deep learning algorithm (DLA) for predicting AF to optimize diagnostic performance in ESUS patients. @*Methods@#A DLA was developed to identify AF using SR 12-lead ECG with the database consisting of AF patients and non-AF patients. The accuracy of the DLA was validated in 221 ESUS patients who underwent insertable cardiac monitor (ICM) insertion to identify AF. @*Results@#A total of 44,085 ECGs from 12,666 patient were used for developing the DLA. The internal validation of the DLA revealed 0.862 (95% confidence interval, 0.850–0.873) area under the curve (AUC) in the receiver operating curve analysis. In external validation data from 221 ESUS patients, the diagnostic accuracy of DLA and AUC were 0.811 and 0.827, respectively, and DLA outperformed conventional predictive models, including CHARGE-AF,C2HEST, and HATCH. The combined model, comprising atrial ectopic burden, left atrial diameter and the DLA, showed excellent performance in AF prediction with AUC of 0.906. @*Conclusions@#The DLA accurately identified paroxysmal AF using 12-lead SR ECG in patients with ESUS and outperformed the conventional models. The DLA model along with the traditional AF risk factors could be a useful tool to identify paroxysmal AF in ESUS patients.

Incomplete Oculomotor Nerve Palsy Caused by Internal Carotid Artery Giant Aneurysm with Fibromuscular Dysplasia

No abstract available.

Dizziness after Traumatic Brain Injury: Neurological Aspects / 대한평형의학회지

Vertigo, dizziness, and disequilibrium are common symptoms following concussion or traumatic brain injury. Dizziness and vertigo may be the result of trauma to the peripheral vestibular system or the central nervous system, or, in some cases, may be due to anxiety, depression, or posttraumatic stress disorder; these mechanisms are not mutually exclusive. While most peripheral vestibular disorders can be identified by testing and examination, those without inner ear causes that have persisting complaints of dizziness and motion sickness are more difficult to understand and to manage. Some of these patients exhibit features compatible with vestibular migraine and may be treated successfully with migraine preventative medications. This paper reviews the neurological causes of persisting dizziness, the possible mechanisms, and the pathophysiology, as a framework for patient management and for future research.

Benign Paroxysmal Positional Vertigo after Yoga Practice / 대한평형의학회지

A 57-year-old woman presented with sudden onset of whirling vertigo associated with nausea and vomiting. The neurological examination showed left-beating horizontal nystagmus on the lying-down test and right-beating horizontal nystagmus on the head bending test. Geotropic direction-changing horizontal nystagmus was demonstrated on both sides during the supine roll test. Benign paroxysmal positional vertigo (BPPV) was the most common vestibular disorder in patients after head trauma. The authors experienced a case of right horizontal canal BPPV occurred after a yoga practice, thereby we report the case with a review of the related literatures.

Cranial Polyneuropathy in Ramsay Hunt Syndrome Manifesting Severe Pharyngeal Dysphagia: a Case Report and Literature Review

Ramsay Hunt syndrome (RHS) is characterized by herpes zoster oticus, facial nerve palsy, and vestibulocochlear symptoms. Dysphagia caused by the involvement of multiple cranial nerves (CNs) in RHS is very rare. We encountered a rare case presented with severe dysphagia due to cranial polyneuropathy involving trigeminal nerve (CN V), facial nerve (CN VII), vestibulocochlear nerve (CN VIII), glossopharyngeal nerve (CN IX), vagus nerve (CN X), and hypoglossal nerve (CN XII) in RHS. This case report suggested that the prognosis for dysphagia in RHS seems favorable, and swallowing rehabilitation therapy could be beneficial in expediting tube removal.

Effects of in-Person, in-Hospital Education for Stroke Patients by an Education-Specialized Nurse

BACKGROUND: We assessed the effects of customized in-hospital, in-person education provided by an education-specialized nurse in ischemic stroke patients. METHODS: All ischemic stroke patients who were hospitalized between April 2015 and December 2015 were included. They were provided with education about stroke by an education-specialized nurse during their hospital stay. The knowledge of stroke warning signs and appropriate responses was examined both before the in-hospital education and 3 months after discharge in 127 patients. RESULTS: The awareness of the following stroke warning signs increased significantly at 3 months after discharge compared to before receiving the education (all p values <0.001): sudden difficulty in speaking or in understanding speech (74.0→93.7%), sudden numbness or weakness (72.4→92.1%), sudden dizziness (71.7→89.8%), sudden severe headache (44.9→82.7%), and sudden visual impairment (38.6→69.3%). The proportion of patients with a good knowledge of stroke warning signs (defined as providing at least five correct answers) increased significantly, from 38.6% to 81.9%. Almost half of them (46.5%) correctly answered that they should call an ambulance first when someone shows stroke symptoms before receiving the education, with this proportion increasing to 68.5% at 3 months after discharge (p<0.001). The proportions of patients who understood the need for prompt treatment of stroke and the golden time window increased from 80.3% to 96.9% and from 66.1% to 86.6%, respectively (both p<0.001). The proportion of patients with knowledge of thrombolytic therapy for stroke also increased significantly after the in-hospital education, from 11.0% to 76.4% (p<0.001). CONCLUSIONS: In-hospital, in-person education was effective at increasing the understanding that patients have of stroke, even at 3 months after discharge. In-hospital education provided by an education-specialized nurse would be an effective intervention for increasing the likelihood of stroke patients reacting appropriately to stroke recurrence.

Idiopathic Hypertrophic Cranial Pachymeningitis Masquerading as Tolosa-Hunt Syndrome / 대한임상신경생리학회지

Idiopathic hypertrophic cranial pachymeningitis (ICHP) is diffuse inflammatory process of the dura mater. ICHP can produce similar presentation with Tolosa-Hunt syndrome (THS) if it involves cavernous sinus. A-29-year old male with persistent headache and no definite neurologic dysfunction was noted. Two weeks later, he complained of ophthalmoplegia, and his symptoms were thought to be manifestations of THS. Brain magnetic resonance images revealed diffuse thickened, enhanced pachymeninges in left tentorium. The patient was diagnosed with IHCP. We report a IHCP patient who showed very similar presentation as THS.

Transient Blood-Brain Barrier Disruption Induced by Cerebral Concussion

No abstract available.

Transient Blood-Brain Barrier Disruption Induced by Cerebral Concussion

No abstract available.

A Case of Polycythemia Vera Presenting as an ST-Elevation Myocardial Infarction / 대한내과학회지

Traditional risk factors for acute myocardial infarction are hypertension, diabetes, dyslipidemia, smoking, and a family history of coronary heart disease. Most acute myocardial infarction patients have at least one of these risk factors. Polycythemia vera is a rare etiological factor for acute myocardial infarction. Polycythemia vera leads to hyperviscous milieu of the blood and increased platelet activity, which increases the chance of thrombotic occlusion of coronary arteries. In this article we report a rare case of polycythemia vera presenting as an ST-elevation myocardial infarction without any traditional risk factors for cardiovascular disease.

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.

Anterior Spinal Artery Infarction Presenting with Hemiparesis

No abstract available.

Spinal Epidural Hematoma and Intracranial Subarachnoid Hemorrhage Aggravated with Lumbar Puncture in a Patient with Polycythemia Vera / 대한임상신경생리학회지

No abstract available.

Neuro-Behcet Syndrome Presented with Diplopia

No abstract available.

Prevalence and risk factors of cerebral white matter changes and silent infarcts on brain computed tomography scans among community-dwelling healthy adults: The PRESENT project

Cerebral white matter changes (WMCs) and silent brain infarcts (SBIs) are common radiologic findings in neurologically asymptomatic elderly people, but are associated with an increased risk of subsequent stroke. We investigated the prevalence and risk factors for these cerebral changes on brain computed tomography (CT) in 480 community-dwelling healthy Korean adults without stroke or dementia, who were recruited for an early health program. Cerebral WMCs were defined as the presence of approximately 5 mm wide ill-defined and moderately hypodense lesions, and SBIs were defined as the presence of >2 mm wide well-defined hypodense lesions. Of the 480 patients, 49 (10.2%) had cerebral WMCs and SBIs findings on brain CT. The prevalence of WMCs and SBIs increased with age: the prevalence was 2.4%, 9%, and 32% for subjects in their 50, 60s, and 70s, respectively. In addition, hypertension, abdominal obesity, increased levels of homocysteine and high sensitivity C-reactive protein were significantly associated with cerebral WMCs and SBIs. Our study suggests that regular monitoring of risk factors is required to prevent cerebral WMCs and SBIs and decrease the incidence of stroke and dementia in healthy individuals.

Infective Endocarditis Associated with Transcatheter Aortic Valve Replacement: Potential Importance of Local Trauma for a Deadly Nidus

Recently, transcatheter aortic valve replacement (TAVR) has emerged as an alternative for the treatment of severe symptomatic aortic stenosis patients. Although experience with TAVR is increasing exponentially, few cases of post-TAVR endocarditis are reported. We present a case of 76-year-old man with infective endocarditis after TAVR who was definitely diagnosed by echocardiography.

Nonbacterial Thrombotic Endocarditis in a Patient with Bowel Infarction due to Mesenteric Vein Thrombosis

Ante mortem cases of venous thrombosis in patients with nonbacterial thrombotic endocarditis (NBTE) have not yet been reported. We describe a rare case of NBTE in a patient with mesenteric vein thrombosis. A healthy 37-year-old man with abdominal pain and fever underwent emergency small bowel resection due to bowel ischemia resulting from mesenteric vein thrombosis. Transthoracic echocardiography revealed multiple mobile masses attached to the anterior leaflet of the mitral valves and their chordae tendineae. On suspicion of infective endocarditis, the cardiac masses were excised through open-heart surgery. However, pathologic reviews were compatible with NBTE. The patient was stable after the cardiac surgery and was treated with warfarin. Laboratory and imaging findings regarding his hypercoagulable condition were all negative.

A Case of Prosthetic Valve Endocarditis with Pseudoaneurysm Formation Caused by Haemophilus parainfluenzae / 대한내과학회지

Prosthetic valve endocarditis (PVE) caused by Haemophilus parainfluenzae (H. parainfluenzae) is very rare. Here, we report a case of H. parainfluenzae PVE that developed following the Bentall procedure complicated by a pseudoaneurysm and cerebral emboli. A diagnosis was delayed in this case because of the slow-growing nature of the organism and the unusual clinical presentation.

A Case of Prosthetic Valve Endocarditis with Pseudoaneurysm Formation Caused by Haemophilus parainfluenzae / 대한내과학회지

Prosthetic valve endocarditis (PVE) caused by Haemophilus parainfluenzae (H. parainfluenzae) is very rare. Here, we report a case of H. parainfluenzae PVE that developed following the Bentall procedure complicated by a pseudoaneurysm and cerebral emboli. A diagnosis was delayed in this case because of the slow-growing nature of the organism and the unusual clinical presentation.

Tooth Loss May Predict Poor Cognitive Function in Community-Dwelling Adults without Dementia or Stroke: The PRESENT Project

Periodontal disease is a potential predictor of stroke and cognitive impairment. However, this association is unclear in adults aged 50 yr and above without a history of stroke or dementia. We evaluated the association between the number of teeth lost, indicating periodontal disease, and cognitive impairment in community-dwelling adults without any history of dementia or stroke. Dental examinations were performed on 438 adults older than 50 yr (315 females, mean age 63+/-7.8 yr; 123 males, mean age 61.5+/-8.5 yr) between January 2009 and December 2010. In the unadjusted analysis, odds ratios (OR) of cognitive impairment based on MMSE score were 2.46 (95% CI, 1.38-4.39) and 2.7 (95% CI, 1.57-4.64) for subjects who had lost 6-10 teeth and those who had lost more than 10 teeth, respectively, when compared with subjects who had lost 0-5 teeth. After adjusting for age, education level, hypertension, diabetes, hyperlipidemia, and smoking, the relationship remained significant (OR, 2.0; 95% CI, 1.08-3.69, P=0.027 for those with 6-10 teeth lost; OR, 2.26; 95% CI, 1.27-4.02, P=0.006 for those with more than 10 teeth lost). The number of teeth lost is correlated with cognitive impairment among community-dwelling adults aged 50 and above without any medical history of stroke or dementia.