• Investigative Magnetic Resonance Imaging
• /
• 제22권2호
• /
• pp.131-134
• /
• 2018

Susceptibility-weighted imaging (SWI) is well known for detecting the presence of hemorrhagic transformation, microbleeds and the susceptibility of vessel signs in acute ischemic stroke. But in some cases, it can provide the tissue perfusion state as well. We describe a case of a patient with hyperacute ischemic infarction that had a slightly hypodense, patchy lesion at the left thalamus on the initial SWI, with a left proximal posterior cerebral artery occlusion on a magnetic resonance (MR) angiography and delayed time-to-peak on an MR perfusion performed two hours after symptom onset. No obvious abnormal signals at any intensity were found on the initial diffusion-weighted imaging (DWI). On a follow-up MR image (MRI), an acute ischemic infarction was seen on DWI, which is the same location as the lesion on SWI. The hypointensity on the initial SWI reflects the susceptibility artifact caused by an increased deoxyhemoglobin in the affected tissue and vessels, which reflects the hypoperfusion state due to decreasing arterial flow. It precedes the signal change on DWI that reflects a cytotoxic edema. This case highlights that, in some hyperacute stages of ischemic stroke, hypointensity on an SWI may be a finding before the hyperintensity is seen on a DWI.

• Annals of Clinical Neurophysiology
• /
• 제7권2호
• /
• pp.75-79
• /
• 2005

Vestibular evoked myogenic potentials (VEMP) have been known to useful in documenting abnormality in patients with various vestibular disorders but the studies of VEMP in stroke patients are rare. We recorded VEMP in 17 consecutive patients with acute ischemic stroke in the brainstem lesions. All patients underwent magnetic resonance imaging and we compare VEMP results with the lesion documented by brain imaging. VEMP were defined to be abnormal when they were very asymmetrical (one is 2 times of more as large as the other), or absent in one side. VEMP abnormalities were found in 71%(12/17) of acute infarction patients with brainstem lesions. Most abnormalities found in the ipsilateral side of the lesion(9/12) but abnormalities in contralateral side of lesion were found in 25%(3/12) of patients.VEMP would be considered a useful complementary neurophysiological tool for the evaluation of brainstem dysfunction in acute stroke patients.

• 방사선산업학회지
• /
• 제10권4호
• /
• pp.193-198
• /
• 2016

Perfusion magnetic resonance image of biological mechanism are independent of magnetic field strength in hyper acute ischemic stroke. 3.0 T magnetic field, however, does affect the SNRs (signal to noise ratio) and artifacts of PMRI (perfusion magnetic resonance image), which basically will influence the quantitative of PMRI. In this study, the effects of field strength on PMRI are analyzed. The effects of the diseases also are discussed. PMRI in WM(white matter), GM (gray matter), hyper acute ischemic stroke were companied with 1.5 T and 3.0 T on SNR. PMRI also was compared to the SI difference after setting ROI(region of interest) in left and right side of the brain. In conclusion, the SNRs and SI of the 3.0 T PMRI showed higher than those at 1.5 T. In summary, PMRI studies at 3.0 T is provided significantly improved perfusion evaluation when comparing with 1.5 T.

• 대한간호학회지
• /
• 제26권1호
• /
• pp.138-147
• /
• 1996

Although sensory deficits caused by stroke have been occasionally reported, dysfunctions of discriminative sensation have seldom been studied in patients with strokes. With the use of specifically designed methods, discriminative sensations including texture discrimination and position sense were tested in 67 patients with acute unilateral stroke. Thirty-two age and sex-matched healthy subjects were used as controls. Impaired discriminative sensation was common in patients with unilateral stroke (detected in 57 out of the 67 patients) regardless of the lesion location except for patients with lateral medullary stroke. Proprioceptive discriminative sensation remained intact in all except for three out of 25 patients who were initially diagnosed as having pure motor stroke on the bases of conventional sensory tests. However, tactile discriminative sensation remained intact in only 17 out of 25 patients. Discriminative sensory disturbances are common in patients with unilateral stroke even in those with intact sensory function on routine examination. The subtle disturbances of this sensation may explain, at least in part, the clumsiness of the patients that is not readily explained by conventional neurological tests.

• Journal of Korean Neurosurgical Society
• /
• 제60권3호
• /
• pp.335-347
• /
• 2017

Intravenous recombinant tissue plasminogen activator had been the only approved treatment for acute ischemic stroke since its approval in 1995. However, the restrictive time window, numerous contraindications, and its low recanalization rate were all limitations of this modality. Under those circumstances, endovascular stroke therapy went through a great evolution during the past two decades of intravenous thrombolysis. The results of the 2013 randomized trials for endovascular stroke therapy were neutral, although they were limited by insufficient imaging screening at enrollment, early-generation devices with less efficacy, and treatment delays. Huge progress was made in 2015, as there were five randomized clinical trials which all demonstrated the safety and efficacy of endovascular stroke treatment. Despite differences in detail patient enrollment criteria, all 5 trials employed key factors for good functional recovery; (1) screening with non-invasive imaging to identify the proximal occlusion and exclude a large infarct core, (2) using highly effective modern thrombectomy devices mainly with stent retriever, and (3) establishment of a fast workflow to achieve effective reperfusion. The results of those trials indicate that modern thrombectomy devices can allow for faster and more effective reperfusion, which can lead to improved clinical outcomes compared to intravenous thrombolysis alone. These advances in mechanical thrombectomy are promising in the global fight against ischemic stroke-related disability and mortality. Two current mainstreams among such mechanical thrombectomy techniques, "stent retriever thrombectomy" and "direct clot aspiration", are the topic of this review. Stent retriever thrombectomy using Solitaire and Trevo retriever will be firstly discussed. And, the commonalities and the differences between two major clot aspiration thrombectomy techniques; a direct aspiration first pass technique (ADAPT) and forced arterial suction thrombectomy (FAST), will be additionally explained. Finally, details regarding the combination of direct clot aspiration and stent retriever thrombectomy, the switching strategy and the Solumbra technique, will be described.

• The Journal of Korean Physical Therapy
• /
• 제27권4호
• /
• pp.175-182
• /
• 2015

Purpose: The purposes of this study were to develop the Korean version of the trunk impairment scale (K-TIS) and to examine reliability and responsiveness of the K-TIS in patients with stroke. Methods Subjects of the study were 51 stroke patients (mean age: 57.78 years) recruited from two stroke clinics. For the interrater and test-retest reliability, two raters measured the K-TIS two times using video clips with an interval of 2 weeks. For the responsiveness, intensive physical therapy training was provided to all participants 2 times a day for one month or three months depending on the onset of the stroke and the admission rules of the two clinics. Inter-rater reliability and test-retest reliability of the K-TIS three subscales (static sitting balance, dynamic sitting balance, and coordination) scores and total scores were examined using intra-correlation coefficient ($ICC_{3,1}$) and Pearson's correlation coefficient (r). To examine responsiveness, the minimally important difference (MID) was calculated with effect size. Results: Inter-rater reliability of the K-TIS subscales and total scores were all high (ICC3,1=0.920-0.983 and r=0.924-0.984). For the test-retest reliability, $ICC_{3,1}$=0.805-0.901 and r=0.806-0.903, and the MID for acute and post-acute as well as chronic stroke patients remained in the mean change range. Conclusion: It is suggested that the K-TIS might be used for clinical and research purposes as a standardized tool for stroke patients. In addition, it can also be useful in establishment of treatment goal(s) and planning treatment program(s) for patients with stroke.

• 대한중풍순환신경학회지
• /
• 제13권1호
• /
• pp.1-12
• /
• 2012

Object : This is a study of ischemic stroke patients designed for comparison Combination therapy of western medical treatment and oriental medical treatment. and western medical treatments alone. Methods : 45 patients were diagnosed by Br-MRI scan as having suffered ischemic stroke. They had entered Kyung-Hee Medical hospital within ten days of attack, between March 2011 and October 2012. Patients were divided into two groups; a group treated with Combination therapy of western medical treatment and oriental medical treatment and other group treated with Western medical treatments. Scandinavian stroke scale and Motricity Index score was checked at admission, 2 weeks or 3 weeks later to assess neurologic improvement and motor function recovery. Results : Comparing the Scandinavian stroke scale and Motricity Index score between baseline and 2 or 3 weeks later, the combination therapy group and western medical treatment group had improved but there was no significance. Conclusions : Combination therapy have more beneficial effect on acute stage of stroke.

• 수면정신생리
• /
• 제9권1호
• /
• pp.5-8
• /
• 2002

Stroke is a leading cause of death in most developed countries and some developing countries including South Korea. It is well known that stroke has is related in some way with several sleep disorders. At first, the onset time of stroke varies according to circadian rhythm. Early morning is the most prevalent time and late evening the least. The changes of blood pressure, catecholamine level, plasminogen activity and aggregation of platelet during sleep have been suggested as possible mechanisms. Sleep apnea (SA), a representative disorder in the field of sleep medicine, is found in more than 70% of acute stroke patients compared to 2-5% of the general population. Various sleep related breathing disorders occur after stroke and snoring is a distinct risk factor for stroke. So the relationship between stroke and SA is obvious, but the cause and effect are still not clearly known. Also, stroke may cause many sleep related problems such as insomnia, hypersomnia, parasomnia and changes in sleep architecture. Patients, family members and even medical personnel often ignore stroke-related sleep problems, being concerned only about the stroke itself. The clinical impacts of sleep problems in stroke patients may be significant not only in terms of quality of life but also as a risk factor or prognostic factor for stroke. More attention should be paid to the sleep problems of stroke patients.

• 대한신경과학회지
• /
• 제36권4호
• /
• pp.408-410
• /
• 2018

• 대한중풍순환신경학회지
• /
• 제9권1호
• /
• pp.1-7
• /
• 2008

Objectives : We questioned whether the tongue diagnosis is effective for judging seriousness of cerebrovascular accidents. This study is about the relationship between tongue diagnosis and National Institute of Health Stroke Scale(NIHSS) in acute stroke patients. Methods : 738 subjects were recruited from the patients admitted to the department of internal medicine at Kyung-Hee University oriental medical center, Kyung-Hee University East-West Neo Medical Center, Kyungwon university Incheon oriental medical center, Kyungwon university Songpa oriental medical center and DongGuk university Ilsan oriental medical center from April 2007 to August 2008. We looked at the tongue as in three dimensions of tongue color, tongue fur color and tongue body. And, we calculated NIHSS means according to the subtypes of three dimensions. Results : 1. In the Tongue color, from the most commom to least common colors were pale red, red, pale, bluish purple, and ect. The NIHSS mean score of red is significantly higher than pale and pale red. 2. In the Tongue fur color, white fur was the most common, and then yellow fur, etc. There is no significant difference among three subtypes in the NIHSS mean score. 3. In the Tongue body, etc. is the most common, followed by teeth-marked tongue, enlarged tongue, blood patchy tongue, and mirror tongue. The NIHSS mean score of teeth-marked tongue is significantly lower than blood patchy tongue and mirror tongue. Conclusions : The tongue color and the tongue body are useful indexes for judging seriousness of cerebrovascular accidents presented by NIHSS. But in our study, the tongue fur color was not useful. Further study is necessary on the tongue fur.