• Annals of Clinical Neurophysiology
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• v.3 no.2
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• pp.128-135
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• 2001

Background : Tremor is uncommon manifestation of stroke. Therefore a few cases have been reported until now. There is still uncertainty about the characteristics of post-stroke tremor. Furthermore the pathogenesis and responsible structures of post-stroke tremor are not precisely known. We have recently experienced 34 cases of post-stroke tremor for the past 6 years. We analysed the clinical features and electrophysiologic findings of post-stroke tremor to evaluate the general characteristics and to analogize the possible pathogenetic mechanisms of post-stroke tremor. Methods : The clinical characteristics of post-stroke tremor were summarized in according to the onset time, involved body parts, types, tremor frequencies, neuroradiologic findings, and associated symptoms. The tremor frequencies were recorded by using a gyroscope. The spectral analysis of tremor frequencies were done automatically with Motus I soft ware. Results : Tremor onset were remarkably varied. Some patients showed a tremor appearing at the onset of a stroke and other patients showed delayed-onset tremor 10 years after a stroke. Tremor frequencies were also much varied. The range of hand tremor frequencies were from 1.5 to 12 Hz. Lesions were found in 31 cases(infarction 27, hemorrhage 4) on neuroimaging. In the cases of cerebral infarctions, 7 cases showed multiple small vessel diseases and 20 cases showed cerebral vessel lesions. The most commonly involved cerebral vessel lesion was the middle cerebral artery territory Several different clinical patterns of post-stroke tremor were identified. Conclusions : There are some evidences from the data summarized here to suggest that several pathogenetic mechanisms including central oscillators could be involved for the development of tremors and that tremor generating neural circuits could be more complex than previously suggested neural circuits.

• Korean Journal of Clinical Laboratory Science
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• v.50 no.4
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• pp.477-483
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• 2018

Transcranial doppler is a non-invasive method that measures the blood flow velocity and the direction of cerebral blood vessels through the doppler principle. The pulsatility index is an index for measuring the transcranial doppler that reflects the distal vascular resistance and is used as an index for the presence and diffusion of cerebral small vessel diseases. The purpose of this study was to evaluate the risk factors affecting the basilar artery pulsatility index in ischemic stroke patients. From January 2014 to May 2015, 422 patients were selected by measuring the transcranial doppler pulsatility index, considering their basilar artery pulsatility index. Univariate analysis was performed using the basilar artery pulsatility index as a dependent variable. Multiple regression analysis was performed considering the factors affecting the pulsatility index as variables. Univariate analysis revealed age, presence of hypertension, presence of diabetes mellitus, presence of hyperlipidemia, and hematocrit (P<0.1) as factors. Multiple regression analysis showed statistically significant results with age (P<0.001), presence of diabetes (P=0.004), and presence of hyperlipidemia (P=0.041). The risk factors affecting the basilar artery pulsatility index of transcranial doppler were age, diabetes, and hyperlipidemia. Further research will be needed to increase the cerebral pulsatility index as a surrogate marker of the elderly, diabetes, and hyperlipidemia.

• Journal of the Korean Society of Radiology
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• v.84 no.4
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• pp.855-865
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• 2023

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary small artery vasculopathy caused by mutations in the NOTCH3 gene on chromosome 19. Jeju Island has the highest reported prevalence of CADASIL patients in the world. Even though most studies on the neuroimaging characteristics of CADASIL have focused on Western populations, there are notable differences in Korean CADASIL patients compared to those in Western countries, which may impact their clinical manifestations and prognosis. Herein, this pictorial essay presents the neuroimaging patterns of CADASIL in patients in Korea, with an emphasis on the differences observed from previous reports based on a Western patient population.

• Journal of the Korean Society of Radiology
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• v.81 no.3
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• pp.488-500
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• 2020

Accumulating evidence suggests that Alzheimer's disease (AD) is not only caused by accumulation of abnormal proteins, including amyloid and tau, but is also closely associated with abnormalities in the microvascular environment including the blood-brain barrier (BBB), both of which lead to neuroinflammation and neurodegeneration. Application of in vivo magnetic resonance imaging (MRI) has recently increased to assess BBB permeability in AD and related diseases. Here, we provide a narrative review of BBB permeability-related pathology in Alzheimer dementia and recent MRI research on BBB permeability changes in AD and related diseases. Furthermore, we briefly introduce the measurement of BBB permeability using MRI and its methodological issues.

• The Journal of Internal Korean Medicine
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• v.28 no.1
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• pp.47-67
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• 2007

Objectives : This study was aimed to investigated the warning signs and its relationship with the other characteristics in acute stroke patients. Methods : 225 acute stroke patients were recruited at the Department of Cardiovascular and Neurologic Diseases (Stroke Center) of Kyung Hee University Oriental Hospital from October 2005 to September 2006. We evaluated their stroke type with brain MRI, their warning signs, and general characteristics such as age, sex, past history, risk factors, etc. Results : 225 subjects were included in the final analysis. In the subjects' general characteristics, the most common etiology of stroke was small vessel occlusion. In the assessment of the subjects' warning signs, the frequency of tension felt at the cervical area was highest followed by blepharospasm, sensory dysfunction (one side of numbness, tingling sensation, dead sensation), one side paralysis or weakness, etc. After analyzing etiology, cerebral hemorrhage had more facial spasm sign and hypertension than cerebral infarction. On the other hand, cerebral infarction had more diabetes and sensory dysfunction (one side of numbness, tingling sensation, dead sensation) than cerebral hemorrhage. Among stroke locations, subjects with their brain lesion in the cortex had more warning sings of motor dysfunction such as one side paralysis, or weakness. Multiple lesions showed a close relationship with smoking habit and were more common in males than in females. The under 65 years old group were more commonly associated with alcohol consumption, accidental mental stress and blepharospam than the over 65 years old group. In the group of under 65 years old, males more commonly had lesions in occipital lobe, alcohol consumption and smoking habit than females. Otherwise, females more commonly had vision dysfunction and blepharospasm than males. In the group of over 65 years old, males more commonly had cortex lesion than females. On the other hand, Females more commonly had accidental mental stress than males. Conclusions : We observed various warning signs and their distribution in acute stroke patients. The subjects' brainlesions and their etiology seemed to affect the features of the warning signs. Hypertension, diabetes and hyperlipidemia were also related to etiology of stroke and some habitual problems such as smoking and drinking seemed to reduce the age of stroke ictus. Although a concrete conclusion can hardly be drawn from this study, it reminds physicians of the importance of warning signs which appear among their patients.

• Investigative Magnetic Resonance Imaging
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• v.2 no.1
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• pp.104-112
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• 1998

Purpose : To evaluate the clinical utility of diffusion-weighted imaging by analyzing the signal intersity of lesions in patients with various intracranial diseases. Materials and Methods : difusion-weighted MR imaging was prospectively perormed in randomly selected 70 patients with various intracranial idseases. They consisted of 20 patients with acute infarct, 21 patients with chronic infarct of small vessel disease, 14 patients with primary intracranial tumor, three patients with brain metastasis, five patient with brain abscess, five patients with brain abscess, five patients with cerebral hemorrhage, one patient with neurocysticercosis, and one patient with epidermoid cyst. the diffusion-weighted images were obtained immediately after routine T2-weighted imaging on a 1.5T MR unit using single shot spin echo EPI technique with 6500 ms TR, 107ms TE, $128{\times}128$ matrix, 1 number of excitation, $24{\times}24$ field of view, 5-7 mm slice thickness, 2-3 mm inter-slice gap. The diffusion-gradients (b value of ($1000s{\;}/{\;}textrm{mm}^2$)) were applied along three directions(x, y, z). On visual inspection of diffusion-weighted images, the signal intersity of lesions was arbitrarily graded as one of 5 grades. In quantitative assessment, we measured the signal intensity of all the lesions and the contralateral corresponding normal area using round region of interest(ROI), and then calculated the signal intensity ratio of the lesion to the normal brain parenchyma. Results : On visual inspection, markedly hyperintense signals were seen in all cases of acute infarct, brain abscess, epidermoid cyst, and neurocysticercosis in degenerating stage. In all cases of cerebral hematoma, the very high signal internsity was intermingled with low signal intensity. focal very high signal intersity was also seen in a solid portion of the tumor in a patient. the mean signal intensity ratios of all those lesions to the normal brain parenchyma were above 2.5. Gliosis, solid component of brain tumor, brain metastasis, and vasogenic dedma appeared isointense to the normal brain parenchyma in 71%, 64%, 100%, and 67%, respectively ; the mean signal intensity ratios of those lesions to the normal brain parenchyma ranged 1.15 to 1.28 and there was no significant difference among these(p>0.1). Cystic cerebromalacia and necrotic or cystic portions in tumor were markedly or slightly hypointense, and the mean signal intensity ratios were 0.45 and 0.42, respectively. Conclusion : Very high signal intensity of acute infarct, brain abscess, epidermoid cyst, and cystic neurocysticercosis in degenerating stage on diffusion-weighted images may be helpful in differentiating from other diseases that are hypointense or isointense to the normal brain parenchyma. It may be especially useful differentiation of brain abscess from brain tumor with necrotic or cystic portion.

• Korean Journal of Clinical Laboratory Science
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• v.50 no.3
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• pp.267-274
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• 2018

Posterior canal benign paroxysmal positional vertigo (PCBPPV) is the most common disease among patients who visited the st. Carollo hospital dizziness center with the head suddenly feeling rolling or rotational dizziness caused by head and body movements. Most patients showed improvements in symptoms after a single treatment. On the other hand, there are more causes requiring multiple treatments. This study examined the factors affecting the canalithiasis repositioning maneuver for symptom recovery of dizziness, which is posterior BPPV. Dizziness patients who visited the dizziness center of PCBPPV were classified. From March 2008 to November 2010, the cure rate of 165 posterior BPPVs patients was investigated. The success rate after the first, second, third, and further treatments was 57.6%, 17.6%, 10.3%, and 14.5%, respectively. The factors affecting treatment of PCBPPVs included traumatic, medical disease, cerebral infarction, small vessel disease, vestbro basilar artery insufficiency (VBI), cerebrovascular disease, brain disease, and vestibuloplasty (P<0.05). Vomiting, nausea, and syncope can be treated easily by considering the factors affecting these treatments. If the related diseases are combined with the treatment of the canalithiasis repositioning maneuver for symptom recovery of dizziness, the results will show an improvement in daily life that is free from painful dizziness.