Korean J Stroke

뇌졸중 이차예방을 위한 항혈소판제의 사용: 2012년 한국 뇌졸중 이차 ...

Tai Hwan Park1 — 2012-05-04T15:21:46+09:00

Writing Committee of Korean clinical practice guidelines for secondary prevention of stroke has reviewed recent randomized controlled trials of cilostazol published after the fi rst edition of Korean clinical practice guidelines that considered evidences published before June 2007. Two clinical trials and 1 meta-analysis which compared cilostazol directly with aspirin in the prevention of stroke in patients with cerebral infarction or transient ischemic attack (TIA) were identifi ed and included for the current guideline update. Review of fi ndings indicates that cilostazol as compared to aspirin achieved a greater reduction of stroke as well as composite vascular events of stroke, myocardial infarction, and vascular death. For safety, cilostazol was associated with fewer major bleeding events than aspirin. Accordingly, new recommendations for cilostazol are made for prevention of stroke in the setting of noncardioembolic stroke or TIA. Changes in the guidelines necessitated by new evidences will be continuously refl ected in future guidelines. (Korean J Stroke 2012;14:1-5) KEY WORDS: Practice guideline, Stroke, Secondary prevention, Cilostazol, Aspirin

뇌졸중과 관련된 염증 및 감염

Tai Hwan Park — 2012-05-04T15:41:02+09:00

Infl ammatory and infectious conditions can involve the cerebral vasculature and cause stroke. Vasculitis involving central nervous system (CNS) is a heterogeneous entity of disorders characterized by infl ammation and necrosis of blood vessel walls. It can be caused by noninfectious and infectious diseases. Noninfectious cause includes primary angiitis of CNS, giant cell arteritis, Takayasu’s disease and Behcet’s disease. Hepatitis C, human immunodefi ciency and varicella-zoster viruses as well as bacterial and fungal organisms have been reported to be associated with infectious vasculitis. Infl ammatory biomarkers and infectious index are in a portion regarded as risk factors of stroke. However, there is still controversy and further prospective evaluation should be performed. In the current article, the author concisely reviewed contemporary studies about infl ammatory and infectious conditions associated with stroke. (Korean J Stroke 2012;14:6-11) KEY WORDS: Infl ammation, Vasculitis, Stroke

Stroke Update: 위험인자 및 일차예방

Jae Guk Kim — 2012-05-04T15:51:24+09:00

The aim of this article is to review the results of recent researches with regard to risk factors or primary prevention of stroke. We have discussed the contribution of various risk factors to the burden of stroke, variability in blood pressure, intensive glycemic control, lipid management, management of asymptomatic carotid stenosis, vitamin B supplements lowing homocysteine, lifestyle factors, and aspirin effi cacy for primary prevention of stroke. (Korean J Stroke 2012;14:12-18) KEY WORDS: Stroke, Risk Factors, Primary Prevention

Effectiveness and Safety of Thrombolysis in Ischemic Stroke Patients Aged 80 Years or Older

Wook-Joo Kim1 — 2012-05-04T15:58:33+09:00

Background: Thrombolysis becomes an emerging therapeutic option for acute ischemic stroke. However, few reports exist on its use in the very elderly. We investigated whether there is a difference in the effectiveness and safety of intravenous (IV) and/or intra-arterial (IA) thrombolysis between patients aged ≥80 years and those aged <80 years. Methods: A consecutive series of patients hospitalized within 12 hours from stroke onset were selected. We evaluated the effectiveness of thrombolysis with modified Rankin scale (mRS) at 3 months, and the safety with symptomatic hemorrhagic transformation (sHT). The odds ratio (OR)of thrombolysis on the favorable mRS (0-2) was calculated using multivariable logistic regression analysis with adjustments for potential confounders. Whether the effectiveness of thrombolysis is age-dependent or not was analyzed by introducing an interaction term (thrombolysis×age group) into multivariable models. Results: Among 219 patients ≥80 years, 21% of patients received IV or IA or combined thrombolysis while 23% of 980 patients <80 years received thrombolysis (P =0.51). With respect to the favorable mRS, the adjusted ORs of thrombolysis were 1.70 (95% confi dence interval, 1.08-2.68) in all subjects, 1.61 (0.58-4.49) in those ≥80 years, and 1.71 (1.05-2.78) in those <80 years. There was no signifi cant interaction between age group and thrombolysis (P =0.91). With respect to sHT, the adjusted OR was 4.72 (1.94-11.45) in all subjects with no signifi cant interaction(P =0.86). Conclusion: This study suggests that thrombolysis may be equally safe and effective in stroke patients aged≥80 years versus <80 years. (Korean J Stroke 2012;14:19-28) KEY WORDS: Thrombolysis, Treatment outcome, Aged 80 and over

난원공개존증과 심방 세동 환자의 뇌경색 용적과 초기 신경학적 결손 비교

Chang-Gi Hong — 2012-05-04T16:03:27+09:00

Background: Atrial fi brillation (AF) and patent foramen ovale (PFO) are established sources of cardioembolism. We investigated differences in stroke outcome and patterns between PFO and AF. Methods: We performed a retrospective review of the medical records and brain MR images of patients with AF or PFO from the prospective acute stroke and transient ischemic attack registry. Infarct pattern and volume on diffusion-weighted imaging, and the national institutes of health stroke scale (NIHSS)on admission were compared between patients with AF and PFO. Results: From June 2005 to July 2008, a total of 289 subjects were enrolled (AF group, n=156; PFO group, n=133). Infarct pattern analyzed with MR images revealed that multiple vascular territorial infarction was more prevalent in AF group than in PFO group (26.9% vs. 8.3%, P <0.01). A probable cardiac embolism, radiologically defi ned as territorial infarction without symptomatic steno-occlusion of the corresponding artery, was more frequently documented in AF group than in PFO group (71.8% vs. 41.4%, P <0.01) The infarct volume of PFO was smaller than that of AF. Compared to AF, PFO was associated with the mild neurologic defi cit (NIHSS≤3) after adjusting age, sex an previous stroke history. Conclusion: These results suggested that AF and PFO had different characteristics such as infarct patterns and initial clinical severity although both are classifi ed as cardioembolism. (Korean J Stroke 2012;14:29-34) KEY WORDS: Atrial fi brillation, Patent foramen ovale, Stroke

Aspirin Resistance May Not Be Associated with Clinical Outcome after Acute Ischemic Stroke: ...

Nam-Tae Yoo1 — 2012-05-04T16:09:39+09:00

Background: Aspirin resistance (AR) in platelet function assays showed substantial variation depending on the methods used to evaluate it. Methods: In this study, we prospectively compared the results of Multiplate impedance platelet aggregometry(IPA) with those of light transmission aggregometry (LTA) and VerifyNow® system in determination of the prevalence of aspirin resistance (AR) and investigated the correlation between its presence and poor outcome (modifi ed Rankin scale >2) in 105 patients with aspirin after acute ischemic stroke (AIS). Results: After 5 days of using aspirin, 15 patients (14.3%) were classified as aspirin-resistance with the use of IPA, 24 patients (22.9%) by the LTA, and 14 patients (13.3%) by VerifyNow. Good agreement between the results of IPA and VerifyNow, was found (R=0.674, P <0.01). The concordance rate of AR detection was high between VerifyNow and IPA (k=0.72, P <0.01), albeit quite low between LTA and IPA. Regarding on its infl uence on clinical outcome after AIS, there wasn’t any signifi cant relationship between occurrence of poor outcome and the presence of AR in three platelet function assays. Conclusion: This study reveals that the incidence of AR in AIS might be highly test-specifi c. IPA seems to be similar to VerifyNow as a platelet function test. (Korean J Stroke 2012;14:35-42) KEY WORDS: Aspirin resistance, Acute ischemic stroke, Platelet function test

Acute Cerebral Infarction Related to Stenosis of Accessory Middle Cerebral Artery

Sang-Hyeon Son1 — 2012-05-04T16:13:30+09:00

The accessory middle cerebral artery (MCA) is an anomalous vessel which arises from the anterior cerebral artery (ACA) and runs through the Sylvian fi ssure 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. (Korean J Stroke 2012;14:43-45) KEY WORDS: Accessory middle cerebral artery; Cerebral infarction; Atherosclerotic stenosis

일차 체성감각피질 경색에 의한 반무도병 1예

Youn Ho Kim — 2012-05-04T16:16:33+09:00

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. (Korean J Stroke 2012;14:46-48) KEY WORDS: Chorea, Somatosensory cortex, Cerebral infarction

외상환자에서 비타민 K의 정맥주사 후 발생한 다발성 뇌경색

Se-Hoon Lee — 2012-05-04T16:19:26+09:00

Vitamin K, a cofactor of coagulation cascade, is used for hemostasis in patients with abnormal coagulation status. However, it is uncertain whether administration of vitamin K elevates the risk of thrombotic events. We present a patient with trauma who developed acute multiple cerebral infarctions after receiving intravenous vitamin K for several days. We presume that vitamin K can be a contributing factor for embolism in a patient with trauma. (Korean J Stroke 2012;14:49-51) KEY WORDS: Trauma, Surgery, Vitamin K, Cerebral infarction

SCAST Study에 대한 비판적 분석

Hahn Young Kim — 2012-05-04T17:34:17+09:00

KEY WORDS: Acute stroke, Blood pressure, Angiotensin receptor blocker, Candesartan

SAMMPRIS Study에 대한 비판적 분석

Kwang-Yeol Park — 2012-05-04T17:36:11+09:00

KEY WORDS: Intracranial arterial stenosis, Stenting