• The Journal of the Society of Stroke on Korean Medicine
• /
• v.13 no.1
• /
• pp.43-51
• /
• 2012

Object : The purpose of this study was to evaluate the relationship between pattern identification (PI) and stroke risk factors, such as hypertension, diabetes mellitus, dyslipidemia, stroke history, obesity, abdominal obesity and metabolic syndrome. Methods : 46 patients with acute ischemic stroke were recruited from May 2012 to November, 2012. We analyzed the data of 32 patients, and pattern identification was identified by resident and specialist of Korean medicine. We analized patient's PI and risk factor by Fisher's exact test. Results : We found that Dampness-phlegm group was more related with patient's metabolic syndrome than non Dampness-Phlegm group. And Yin deficiency group had less relationship with patient's metabolic syndrome, obesity, abdominal obesity and dyslipidemia than non Yin deficiency group. Conclusions : According to the analysis, these results provide evidence for relationship between the Dampness-phlegm group, Yin deficiency and metabolic syndrome.

• Journal of Korean Neurosurgical Society
• /
• v.30 no.3
• /
• pp.284-294
• /
• 2001

Objective : Stroke is leading cause of death and more importantly it is cause of serious disability. The effective treatment of acute ischemic stroke still remains a challenge to modern medicine. Recent clinical trials have shown that carotid endareterctomy(CEA) provide overwhelming benefits compared with medical therapy in preventing subsequent stroke for symptomatic carotid stenosis. For the asymptomatic ones, the data are less compelling, but highly suggestive that CEA do have benefits in properly selected patients. Materials and Methods : To investigate the clinical manifestations of carotid stenosis and results of CEAs, authors analyzed retrospectively 19 CEAs in 16 patients from June 1986 to June 1999. Age of patients ranged from 55 to 76 years(median, 66) and male to female ratio was 14 to 2. The duration of follow-up was 1 to 144 months (median, 26). All of CEAs were done on the side of stenosis more than 80% and bilateral CEAs were done in three. Six CEAs were performed in asymptomatic patients. Results : Seventeen of 19 CEAs showed excellent results and complication rate was low although ipsilateral ischemic stroke occurred in two. Conclusion : CEA may be a valuable surgical treatment for ischemic stroke caused by carotid stenosis and also for prevention of stroke of asymptomatic patients with carotid stenosis.

• Journal of Biomedical and Translational Research
• /
• v.19 no.4
• /
• pp.110-115
• /
• 2018

Transient ischemic attack (TIA) indicates high risk for major stroke and is considered a medical emergency. Diffusion-weighted imaging (DWI) enables detection of acute ischemic lesions. The clinical significance of DWI positive lesions in TIA is obscure and its prevalence, clinical features are not established. Therefore, we performed a clinical, etiological and prognostic analysis through a cross-sectional analysis of 235 TIA patients, grouped according to presence of DWI lesion. Clinical features, underlying risk factors for stroke, outcome and rate of recurrence were analyzed. 3 months follow-up of modified Rankin Scales (mRS) were done with telephone survey. DWI positive lesions were present in 14.0% of patients. Etiological factors significantly associated with DWI lesions in TIA patients were male sex (p = 0.038), stroke history (p = 0.012) and atrial fibrillation (p < 0.001). Presence of at least one medium or high risk of cardioembolism from TOAST classification were not associated with lesions when excluding association to atrial fibrillation (p = 0.108). Clinical features showed no significant difference. Whether the patients had lesion-positive DWI was not related to an increase in mRS score during the hospital stay or at the 3-month follow-up after discharge. Future studies should include multi-center samples with large numbers, considering each unique medical environment. Routine acquisition of follow-up DWI for proper evaluation of the tissue-based definition of TIA should also be considered.

• Annals of Clinical Neurophysiology
• /
• v.2 no.2
• /
• pp.101-106
• /
• 2000

Background and Purpose : Brainstem auditory evoked potentials(BAEPs) are responses of the brainstem by auditory stimulation. Vertebrobasilar transient ischemic attacks is the disease that occurs by insufficient circulation in the region of brainstem. The purpose of this study is to know the factors influencing the changes of BAEPs in vertebrobasilar transient ischemic attacks. Methods : The subject of study was 96 patients diagnosed as vertebrobasilar transient ischemic attacks. Patients were divided into two groups according to the BAEPs findings. Their age, sex, presence of hypertension, diabetes, hyperlipidemia, heart disease, neurologic findings, previous stroke, previous vertebrobasilar transient ischemic attacks, smoking and alcohol drinking, and time period between symptom onset and testing were compared. Results : There were no significant differences in age, sex, and presence of hypertension, diabetes, hyperlipidemia, heart disease, previous stroke history, previous vertebrobasilar transient ischemic attack, smoking, and alcohol drinking between two groups. The presence of abnormal neurologic findings in the first examination and time period between symptom onset and testing were significantly different between normal BAEPs group and abnormal BAEPs one(P<0.05). Conclusions : The factors influencing the changes of BAEPs were presence of abnormal neurologic findings and time period between symptom onset and testing. These findings suggest that BAEPs test should be performed in acute stage of ischemic attack.

• Journal of Korean Neurosurgical Society
• /
• v.58 no.4
• /
• pp.321-327
• /
• 2015

Objective : To determine whether the use of contrast enhancement (especially its extent) predicts malignant brain edema after intra-arterial thrombectomy (IAT) in patients with acute ischemic stroke. Methods : We reviewed the records of patients with acute ischemic stroke who underwent IAT for occlusion of the internal carotid artery or the middle cerebral artery between January 2012 and March 2015. To estimate the extent of contrast enhancement (CE), we used the contrast enhancement area ratio (CEAR)-i.e., the ratio of the CE to the area of the hemisphere, as noted on immediate non-enhanced brain computed tomography (NECT) post-IAT. Patients were categorized into two groups based on the CEAR values being either greater than or less than 0.2. Results : A total of 39 patients were included. Contrast enhancement was found in 26 patients (66.7%). In this subgroup, the CEAR was greater than 0.2 in 7 patients (18%) and less than 0.2 in the other 19 patients (48.7%). On univariate analysis, both CEAR ${\geq}0.2$ and the presence of subarachnoid hemorrhage were significantly associated with progression to malignant brain edema (p<0.001 and p=0.004), but on multivariate analysis, only CEAR ${\geq}0.2$ showed a statistically significant association (p=0.019). In the group with CEAR ${\geq}0.2$, the time to malignant brain edema was shorter (p=0.039) than in the group with CEAR <0.2. Clinical functional outcomes, based on the modified Rankin scale, were also significantly worse in patients with CEAR ${\geq}0.2$ (p=0.003) Conclusion : The extent of contrast enhancement as noted on NECT scans obtained immediately after IAT could be predictive of malignant brain edema and a poor clinical outcome.

• Annals of Clinical Neurophysiology
• /
• v.19 no.1
• /
• pp.46-49
• /
• 2017

Carotidynia is characterized by unilateral neck pain around the carotid artery. We describe a 50-year-old woman who presented with transient left-side weakness and right-side neck pain. She frequently massaged the uncomfortable neck area during the symptomatic course of the condition. Magnetic resonance imaging revealed multifocal cerebral infarctions and a carotid intramural thrombus ipsilateral to the carotidynia.Long-term carotidynia might result in the involvement of an intramural thrombus and intimal disruption, and ischemic stroke after carotidynia may be provoked by carotid sinus massage.

• Journal of Korean Neurosurgical Society
• /
• v.61 no.5
• /
• pp.548-558
• /
• 2018

Objective : Diagnosing acute cerebral infarction is crucial in determining prognosis of stroke patients. Although many serologic tests for prompt diagnosis are available, the clinical application of serologic tests is currently limited. We investigated whether $S100{\beta}$, matrix metalloproteinase-9 (MMP-9), D-dimer, and heat shock protein 70 (HSP70) can be used as biomarkers for acute cerebral infarction. Methods : Focal cerebral ischemia was induced using the modified intraluminal filament technique. Mice were randomly assigned to 30-minute occlusion (n=10), 60-minute occlusion (n=10), or sham (n=5) groups. Four hours later, neurological deficits were evaluated and blood samples were obtained. Infarction volumes were calculated and plasma $S100{\beta}$, MMP-9, D-dimer, and HSP70 levels were measured using enzyme-linked immunosorbent assay. Results : The average infarction volume was $12.32{\pm}2.31mm^3$ and $46.9{\pm}7.43mm^3$ in the 30- and 60-minute groups, respectively. The mean neurological score in the two ischemic groups was $1.6{\pm}0.55$ and $3.2{\pm}0.70$, respectively. $S100{\beta}$, MMP-9, and HSP70 expressions significantly increased after 4 hours of ischemia (p=0.001). Furthermore, $S100{\beta}$ and MMP-9 expressions correlated with infarction volumes (p<0.001) and neurological deficits (p<0.001). There was no significant difference in D-dimer expression between groups (p=0.843). The area under the receiver operating characteristic curve (AUC) showed high sensitivity and specificity for MMP-9, HSP70 (AUC=1), and $S100{\beta}$ (AUC=0.98). Conclusion : $S100{\beta}$, MMP-9, and HSP70 can complement current diagnostic tools to assess cerebral infarction, suggesting their use as potential biomarkers for acute cerebral infarction.

• Health Policy and Management
• /
• v.26 no.4
• /
• pp.359-372
• /
• 2016

Background: The purpose of this study was to develop risk-adjustment models for acute stroke mortality that were based on data from Health Insurance Review and Assessment Service (HIRA) dataset and to evaluate the validity of these models for comparing hospital performance. Methods: We identified prognostic factors of acute stroke mortality through literature review. On the basis of the avaliable data, the following factors was included in risk adjustment models: age, sex, stroke subtype, stroke severity, and comorbid conditions. Survey data in 2014 was used for development and 2012 dataset was analysed for validation. Prediction models of acute stroke mortality by stroke type were developed using logistic regression. Model performance was evaluated using C-statistics, $R^2$ values, and Hosmer-Lemeshow goodness-of-fit statistics. Results: We excluded some of the clinical factors such as mental status, vital sign, and lab finding from risk adjustment model because there is no avaliable data. The ischemic stroke model with age, sex, and stroke severity (categorical) showed good performance (C-statistic=0.881, Hosmer-Lemeshow test p=0.371). The hemorrhagic stroke model with age, sex, stroke subtype, and stroke severity (categorical) also showed good performance (C-statistic=0.867, Hosmer-Lemeshow test p=0.850). Conclusion: Among risk adjustment models we recommend the model including age, sex, stroke severity, and stroke subtype for HIRA assessment. However, this model may be inappropriate for comparing hospital performance due to several methodological weaknesses such as lack of clinical information, variations across hospitals in the coding of comorbidities, inability to discriminate between comorbidity and complication, missing of stroke severity, and small case number of hospitals. Therefore, further studies are needed to enhance the validity of the risk adjustment model of acute stroke mortality.

• The Journal of Korean Medicine
• /
• v.16 no.2 s.30
• /
• pp.100-114
• /
• 1995

This bibliographic study was designed to research indications of the Moschus which was representatively used for resuscitation in acute stage of stroke throughout successive books of oriental medicine. Especially, in this study, severe cases with disturbance of consciousness and acute stage of stroke were investigated. The results were summarized as the followings: 1. The Moschus was dried material which secreted from aromatic vescicle of Moschus moschiferus L.. which was pungent in flavor, warm in nature, nontoxic and strongly aromatic. The Moschus removed the obstruction in the channels and used to early stage of stroke. 2. The Moschus was aromatic resuscitatable medicine, which recovered disturbance of consciousness due to stroke. 3. The Moschus had excitatory actions of respirtory center and vascular motor center, heart stimulating action, inhibitatory action of the platelet aggregation and anti thrombin action and recovered cerebral ischemic change. According to these actions, the Moschus could be used cerebral infarction. 4. Prescriptions included the Moschus was used to symptoms of unconsciousness, secretion, stuporous mental state, dysarthria, facial palsy and hemiplegia. That was Angungwoohwangh wan(安宮牛黃丸), Woohwangchungshimwon(牛黃淸心元), Sahyangsohaphangwon(麝香蘇合香元), etc. According to the above mentioned results, the Moschus was aromatic resuscitatable medicine which was used for symptoms of conscius disturbance, convulsion, sudden fainting etc., promoted cerebral blood flow and had good effect on acute stage of stroke and severe cases with conscious disturbance. Therefore, it is considered that the Moschus must be studied for effect of cerebral infarction and hemorrhage in clinic with animal's and pharmacological experimental results.

• Journal of Sasang Constitutional Medicine
• /
• v.13 no.3
• /
• pp.23-30
• /
• 2001

Objective : Stroke is the most frequent cause of death in Korea. Because it remains severe disablities disturbing normal life, it is important to carry out intervention preventing from progression of condition in patients with acute ischemic stroke within therapeutic time window. Thus early western intervention is necessary and beneficial for patients with acute stroke. However its therapeutic efficacy is not known in combination with Sasang Constitutional medical therapy. In this study, we investigated the clinical effect of East(Sasang Constitutional Medicine)-West integrated therapy. Methods : Among 54 patients with acute onset of stroke no later than seven days, 34 patients received East(Sasang Constitutional Medicine)-West integrated therapy and 20 pateints received West medical therapy. We estimated the subjects's status with Sasang Constitutional Symptomatic Scale (SCSS) prior to therapy and at 1 week, 2 weeks, 3 weeks after the starting each therapy. Results : There is no significant difference in SCSS between two group from admission to 1 week. But significant difference was observed after 2 weaks. Conclusion : The results of these investment suggest that East(Sasang Constitutional medicine)-West integrated therapy is more effective in Sasang Constitutional Pathology.