• Title/Summary/Keyword: Ischemic Stroke

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Antithrombotic Therapy for Ischemic Stroke (허혈성 뇌졸중에서의 항혈전 치료)

  • Hah, Jung-Sang;Lee, Jun
    • Journal of Yeungnam Medical Science
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    • v.20 no.1
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    • pp.1-12
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    • 2003
  • Ischemic stroke is among the principal causes of death and disability in the elderly. Although control of blood pressure, decreased cigarette smoking, and modified dietary habits are among important reasons for stroke decline, the use of antithrombotic therapy, rigorously prescribed. Several antiplatelet agents are approved to reduce the risk of recurrent stroke. Aspirin is the best-studied and most widely used antiplatelet agent for stroke prevention; it provides approximately 15% to 25% relatively risk reduction for secondary prevention of stroke or the major vascular death. Combining 2 antiplatelet agents with different mechanism of action was demonstrated to provide a substantial increase in efficacy in several studies. Anticoagulation should be considered first with potential cardiac sources of embolism. Heparin reduces development of erythrocyte-fibrin thrombi that form in regions of vascular stasis especially within the heart, in severely stenosed arteries sometimes engrafted on white thrombi, in acute arterial occlusion. Heparin should not be indiscriminately given to all acute brain ischemia patients, but may contribute to treatment of large artery occlusion and severe stenosis, cardiogenic embolism with a high acute recurrence risk, and dural sinus and cerebral venous thromobosis.

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The Clinical Effect of Drinking Habit in Acute Stroke Patients (급성기 중풍환자에서 음주습관이 중풍의 발생양상에 미치는 임상적 영향)

  • Choi, Dong-Jun;Hyun, Jin-Ho;Shin, Won-Yong;Kim, Yong-Hyung;Kang, A-My;Lee, Won-Chul;Jun, Chan-Yong;Jo, Ki-Ho;Han, Chang-Ho
    • The Journal of Internal Korean Medicine
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    • v.28 no.1
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    • pp.92-96
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    • 2007
  • Objectives : This study investigated the clinical effect of a drinking habit in acute stroke patients. Methods : 409 acute stroke patients were included from October 2005 to October 2006. Patients were hospitalized within 14 days after the onset of stroke at DongGuk University International Hospital, Kyungwon University In-cheon Oriental Medical Hospital, or Department of Cardiovascular and Neurologic Diseases (Stroke Center), Kyung Hee University Oriental Hospital. We investigated general characteristics, drinking habit, and stroke subtype by TOAST classification. Results : Among drinking subjects, hemorrhagic stroke was more frequent than ischemic stroke (odds ratio 3.04), and less in small vessel occlusion than others (odds ratio 1.84). Ischemic stroke was associated with a longer (30 yrs) drinking habit than hemorrhagic stroke. Conclusions : To acquire more concrete conclusions on this theme, we need further and larger scale research.

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Anatomical Correlates of Neuropsychological Deficits Among Patients With the Cerebellar Stroke

  • Shin, Min A;Park, Oak Tae;Shin, Joon-Ho
    • Annals of Rehabilitation Medicine
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    • v.41 no.6
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    • pp.924-934
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    • 2017
  • Objective To investigate the anatomical correlates of the neuropsychological deficits in patients with the cerebellar stroke. Methods We screened patients who were admitted to the National Rehabilitation Center with the cerebellar stroke between October 2012 and November 2016. The patients with the cerebellar stroke who underwent neuropsychological testing for which the Seoul Neuropsychological Screening Battery (SNSB) or the SNSB-II were enrolled. The neuropsychological function capacities were compared in accordance with the stroke type (hemorrhagic vs. ischemic) and the location (right/left anterior, right/left posterior intermediate, right/left posterior lateral lobe, and vermis). Mean z-scores were computed to compare the patient performances with the population averages. Results Twenty-six patients (15 with ischemic stroke and 11 with hemorrhagic stroke) with a mean age of $54.8{\pm}16.6$ years were assessed $8.8{\pm}9.2$ months after the stroke. Differences in the neuropsychological functioning according to the stroke type were not observed. All of the numerical subtests of the stroke patients showed significantly poorer performances compared with the population averages (mean z-score <0), and some of the subtests revealed abnormal performances in attention-, visuospatial function-, memory-, and frontal/executive function-related tasks (mean z-score <-1). The patients with the presence of a lesion in the right posterior intermediate lobe of the cerebellum showed a poorer performance in the subtests evaluating the executive function including the Korean-version Stroop Test (p=0.04), the Digit Symbol Coding Test (p=0.01), and the Korean-version Trail Making Test (p=0.02) compared with the patients without that lesion. Conclusion The present study confirms that the cerebellar stroke affects the neuropsychological functioning which is associated with the anatomical site of stroke.

Investigation on Warning Signs of the patients with Acute Ischemic Stroke (급성기 뇌경색 환자의 전조증상 유무에 따른 특성 비교)

  • Jung, Jae-han;Sun, Jong-joo;Jung, Woo-sang;Moon, Sang-kwan;Cho, Ki-ho;Ko, Seong-gyu;Chen, Chan-yong;Han, Chang-ho
    • The Journal of the Society of Stroke on Korean Medicine
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    • v.7 no.1
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    • pp.59-64
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    • 2006
  • Objective : This study was aimed to investigated the warning signs and its relationship with the other characteristics in acute stroke patients. Methods : Three-hundred sixty three acute stroke patients were recuited in the oriental medical hospitals of 3 universities located in metropolitan region from October in 2005 to October in 2006. We evaluated their stroke type with brain MRI, their waring signs, and general characteristics such as age, sex, past history, risk factor, etc. Result : Of the 363 patient, 138(38%) patients were experience of warning signs. The frequency of Stress were found more in experience of warning signs than none of them. Warning signs were more common in Large Artery Atherosclerosis than in the other etiology. Conclusion : Although a concrete conclusion can hardly be drawn from this study, it reminds physicians of the importance of warning signs which their patients appeal. For the further investigation, it seems to be necessary to construct fundamental databases for stroke by increasing the number of patients and by examination into the etiology and location.

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Factors Influencing the Changes of BAEPs in Vertebrobasilar Transient Ischemic Attacks (추골기저동맥 일과성 허혈발작에서 뇌간청각유발전위변화에 영향을 미치는 인자)

  • Park, Young Hyuk;Yoo, Bong Goo;Kim, Kwang Soo;Yoo, Kyung Moo
    • Annals of Clinical Neurophysiology
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    • v.2 no.2
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    • pp.101-106
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    • 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.

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Cellular and Molecular Pathways of Ischemic Neuronal Death

  • Won, Seok-Joon;Kim, Doo-Yeon;Gwag, Byoung-Joo
    • BMB Reports
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    • v.35 no.1
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    • pp.67-86
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    • 2002
  • Three routes have been identified triggering neuronal death under physiological and pathological conditions. Excess activation of ionotropic glutamate receptors cause influx and accumulation of $Ca^{2+}$ and $Na^+$ that result in rapid swelling and subsequent neuronal death within a few hours. The second route is caused by oxidative stress due to accumulation of reactive oxygen and nitrogen species. Apoptosis or programmed cell death that often occurs during developmental process has been coined as additional route to pathological neuronal death in the mature nervous system. Evidence is being accumulated that excitotoxicity, oxidative stress, and apoptosis propagate through distinctive and mutually exclusive signal transduction pathway and contribute to neuronal loss following hypoxic-ischemic brain injury. Thus, the therapeutic intervention of hypoxic-ischemic neuronal injury should be aimed to prevent excitotoxicity, oxidative stress, and apoptosis in a concerted way.

Intracranial Atherosclerotic Disease; Current Options for Surgical or Medical Treatment

  • Huh, Pil-Woo;Yoo, Do-Sung
    • Journal of Korean Neurosurgical Society
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    • v.42 no.6
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    • pp.427-435
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    • 2007
  • Recently, intracranial atherosclerosis has become a major cause of ischemic stroke, appearing more frequently in Koreans than Caucasians. Symptomatic or asymptomatic intracranial atherosclerosis is a disease that could recur readily even during the treatment with anti-platelet agents. When the symptoms develop, ischemic stroke can not be recovered readily. Therefore, aggressive treatments such as endovascular therapy and bypass surgery are required in addition to medical treatment for the intracranial artery stenosis. Recent intracranial stenting and drug eluting stenting have shown as very advanced effective therapeutic modalities. Nevertheless, until now, a randomized controlled study has not been conducted. Regarding bypass surgery, since the failed EC-IC bypass surgery study performed 20 years ago, extensive studies on its efficacy has not been conducted yet, and thus it has to be performed strictly only in hemodynamically compromised patients. Unless breakthrough drugs that suppress the progression of intracranial atherosclerosis and the formation of thrombi, and facilitate the regression of the arterial stenosis, the treatment concept of the recovery of the blood flow of stenotic arterial territory by mechanical recanalization or bypass surgery would be remained for the prevention as well as treatment of ischemic stroke caused by intracranial atherosclerosis.

Image-Centric Integrated Data Model of Medical Information by Diseases: Two Case Studies for AMI and Ischemic Stroke

  • Lee, Meeyeon;Park, Ye-Seul;Lee, Jung-Won
    • Journal of Information Processing Systems
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    • v.12 no.4
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    • pp.741-753
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    • 2016
  • In the medical fields, many efforts have been made to develop and improve Hospital Information System (HIS) including Electronic Medical Record (EMR), Order Communication System (OCS), and Picture Archiving and Communication System (PACS). However, materials generated and used in medical fields have various types and forms. The current HISs separately store and manage them by different systems, even though they relate to each other and contain redundant data. These systems are not helpful particularly in emergency where medical experts cannot check all of clinical materials in the golden time. Therefore, in this paper, we propose a process to build an integrated data model for medical information currently stored in various HISs. The proposed data model integrates vast information by focusing on medical images since they are most important materials for the diagnosis and treatment. Moreover, the model is disease-specific to consider that medical information and clinical materials including images are different by diseases. Two case studies show the feasibility and the usefulness of our proposed data model by building models about two diseases, acute myocardial infarction (AMI) and ischemic stroke.

Determinants of the Brachial-ankle Pulse Wave Velocity in Patients with Metabolic Syndrome and Ischemic Stroke (대사증후군을 동반한 허혈성 뇌혈관 질환 환자의 맥파속도에 관한 연구)

  • Kim, Dong-Woung;Park, Bo-Ra
    • Journal of Physiology & Pathology in Korean Medicine
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    • v.25 no.3
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    • pp.551-557
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    • 2011
  • The purpose of this study is to investigate the relation between brachial-ankle pulse wave velocity and the features of metabolic syndrome, and differences according to sex in patients diagnosed cerebral infarction. The study group comprised 61 patients over age 30 who were diagnosed cerebral infarction, accompanied with metabolic syndrome. The brachial-ankle pulse wave velocity, blood pressure, lipid profiles, fasting blood glucose, body mass index were measured. Also we checked past history of patients. Then we analyzed the association between brachial-ankle pulse wave velocity and the features of metabolic syndrome. Pearson correlation analysis reflected the variables affecting the brachial-ankle pulse wave velocity as follows : Age, SBP(systolic blood pressure), DBP(diastolic blood pressure), FBS(fasting blood glucose) were positively correlated. As a result of regression analysis, in patients with cerebral infarction accompanied with metabolic syndrome, the brachial-ankle pulse wave velocity is affected by age to men, SBP, FBS, DBP to women. The brachial-ankle pulse wave velocity is not affected by the components of metabolic syndrome, except blood pressure, FBS, in patients with ischemic stroke.