• Journal of the Korea Convergence Society
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• v.3 no.4
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• pp.23-28
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• 2012

The aim of this study is to reveal the right approach and prognosis of cerebrovascular accident (CVA) by reviewing the various researches on CVAs. The reviews were done by BNBI PubMed, KMBase, RISS, and KoreaMed. Based on the articles, prevalence rate of CVA, prehospital CVA patients assessment and emergency care, and in-hospital care were analyzed. The most important scales are Cincinnati prehospital stroke scale(CPSS) and Los Angeles prehospital stroke screen(LAPSS). These two scales are the basic assessment tools for CVAs and it is necessary to perform the emergency care by way of these scales.

• Journal of the Korean neurological association
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• v.36 no.4
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• pp.350-353
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• 2018

Ischemic stroke caused by the cerebral vasculopathy is a rare complication of polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome. We present a case of recurrent ischemic strokes caused by cerebral vasculopathy in a patient with POEMS syndrome. A 34-year-old man presented with gait disturbance and dizziness. Brain magnetic resonance imaging demonstrated acute ischemic stroke in the middle cerebral artery-anterior cerebral artery (MCA-ACA) border zones of bilateral hemispheres. Repeated angiographic studies showed progressive worsening of the left distal internal carotid artery, ACA, and MCA stenoses, along with sustained steno-occlusion of right MCA.

• Journal of Neurocritical Care
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• v.11 no.2
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• pp.129-133
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• 2018

Background: A few cases of moyamoya syndrome associated with thyrotoxicosis have been reported. However, studies on the association of hyperthyroidism with moyamoya syndrome are insufficient. Case Report: Here we report a case of hyperthyroidism associated with moyamoya syndrome in a 41-year-old woman with aphasia and right side weakness. Brain imaging revealed acute cerebral infarction of left middle cerebral artery territory and occlusion of bilateral distal internal carotid arteries. Conclusion: Antithyroid medication stabilized the patient's neurologic deterioration, suggesting that thyrotoxicosis could aggravate acute cerebral infarction caused by moyamoya syndrome.

• Investigative Magnetic Resonance Imaging
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• v.6 no.1
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• pp.55-63
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• 2002

Purpose : We investigated the predictive values of relative CBV measured with perfusion MR imaging, and relative CBF measured with SPECT for tissue outcome in acute ischemic stroke. Material and Methods : Thirteen patients, who had acute unilateral middle cerebral artery occlusion, underwent perfusion MR imaging, and $^{99m}Tc-HMPAO$ SPECT within 6 hours after the onset of symptoms. Lesion-to-contralateral ratios of perfusion parameters were measured, and best cut-off values of both parameter ratios with their accuracy to discriminate between regions with and without evolving infarction were calculated. Results : Mean relative CBV ratios in regions with evolving infarction and without evolving infarction were $0.58{\pm}0.27$ and $0.9{\pm}0.17$ (p < 0.001), and mean relative CBF ratios in those regions were $0.41{\pm}0.22$ and $0.71{\pm}0.14$ (p < 0.001). The best cutoff values to discriminate between regions with and without evolving infarction were estimated to be 0.80 for relative CBV ratio and 0.56 for relative CBF ratio. The sensitivity, specificity and efficiency of each cutoff value were 80.6, 87.5, 82.7% for relative CBV ratio, and 72.2, 75.0, 73.0% for relative CBF ratio (p > 0.05 between two parameters). Conclusion Measurement of relative CBV and relative CBE may be useful in predicting tissue outcome in acute ischemic stroke.

• The Journal of Internal Korean Medicine
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• v.19 no.2
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• pp.28-36
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• 1998

Background : Yang-do-rack is frequently used in diagnosing syndromes in oriental medical hospital, but there has been few clinical report on Yang-do-rack. So we intended to find out the relationship among Yang-do-rack, general characteristics and the differentiaion of syndromes in acute stroke patients. Materials and Methods : In this study we selected the subjects who were hospitalized from March 1, 1998 to July 31. 1998 at the department of circulatory internal medicine at college of oriental medicine, in Kyung-Hee University, diagnosed acute cerebral infarction or hemorrhage within 7 days after onset time. We checked Yang-do-rack scores with Autonomic Nervous System YORAK (Sord Medicom co. Ltd, Korea) and calculated the scores of each diffentiation of syndroms. Resuts : 1. In left leg meridian, there was more numerical value male than female on LF1, LF2, LF4, LF6. The value of LF1, LF3, LF4, LF5 was getting lower as the score of heat-transformation syndrom(火熱證) increased. 2. In left arm meridian, there was more numerical value male than female on LH2, LH5. The value of LH1, LH3, LH5 was getting lower as the score of exuberance of Yang due to deficiency of Yin syndrom(陰虛陽亢證) increased. 3. In right leg meridian, there was more numerical value male than female on RF1, RF2, RF4, RF6. The value of RF3, RF5 was getting lower as the score of heat-transformation syndrom(火熱證) increased and RF4 as the score of exuberance of Yang due to deficiency of Yin syndrom(陰虛陽亢證) increased. 4. In right arm meridian, the value of RH1 was getting lower as the score of exuberance of Yang due to deficiency of Yin syndrom(陰虛陽亢證) increased. These results show that the Yang-do-rack diagnosis could offer supplemental help for diffrentiation of syndroms in acute stroke patient.

• Journal of Korean Neurosurgical Society
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• v.67 no.1
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• pp.73-83
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• 2024

Objective : The Act on Life-Sustaining Treatment (LST) decisions for end-of-life patients has been effective since February 2018. An increasing number of patients and their families want to withhold or withdraw from LST when medical futility is expected. This study aimed to investigate the status of the Act on LST decisions for patients with acute cerebrovascular disease at a single hospital. Methods : Between January 2017 and December 2021, 227 patients with acute cerebrovascular diseases, including hemorrhagic stroke (n=184) and ischemic stroke (n=43), died at the hospital. The study period was divided into the periods before and after the Act. Results : The duration of hospitalization decreased after the Act was implemented compared to before (15.9±16.1 vs. 11.2±18.6 days, p=0.127). The rate of obtaining consent for the LST plan tended to increase after the Act (139/183 [76.0%] vs. 27/44 [61.4%], p=0.077). Notably, none of the patients made an LST decision independently. Ventilator withdrawal was more frequently performed after the Act than before (52/183 [28.4%] vs. 0/44 [0%], p<0.001). Conversely, the rate of organ donation decreased after the Act was implemented (5/183 [2.7%] vs. 6/44 [13.6%], p=0.008). Refusal to undergo surgery was more common after the Act was implemented than before (87/149 [58.4%] vs. 15/41 [36.6%], p=0.021) among the 190 patients who required surgery. Conclusion : After the Act on LST decisions was implemented, the rate of LST withdrawal increased in patients with acute cerebrovascular disease. However, the decision to withdraw LST was made by the patient's family rather than the patient themselves. After the execution of the Act, we also observed an increased rate of refusal to undergo surgery and a decreased rate of organ donation. The Act on LST decisions may reduce unnecessary treatments that prolong end-of-life processes without a curative effect. However, the widespread application of this law may also reduce beneficial treatments and contribute to a decline in organ donation.

• Quality Improvement in Health Care
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• v.15 no.2
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• pp.73-81
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• 2009

문제: 뇌졸중 환자를 돌보는 간호현장에서는 급성기 뇌졸중 환자의 증상악화에 대한 조기사정과 적절한 대처가 매우 중요한 문제이다. 그러나 임상현장에서는 이를 객관화하고 수치화하여 모든 의료진이 의사소통할 수 있는 유용한 도구를 사용하고 있지는 못하는 실정이다. 이러한 문제를 해결하기위해 NIHSS(National Institute of Health Stroke Scale)를 신경과 진료의사를 중심으로 활용하고 있지만 아직 간호현장에서는 보편적으로 사용하지 않고 있다. 이에 뇌졸중 환자 간호에 NIHSS를 활용하여 뇌졸중 증상악화의 조기사정과 빠른 대처로 궁극적으로는 뇌졸중 환자 간호의 질을 보다 향상시키기 위하여 본 활동이 시도되었다. 목적: 첫째, 간호사의 NIHSS 측정 신뢰도의 현수준을 점검하고 이를 향상시키기 위한 프로그램을 개발 적용한다. 둘째, 간호사가 급성기 뇌졸중환자에게 NIHSS 측정을 통하여 뇌졸중 악화를 얼마나 예측할 수 있는지 분석하고 이를 향상시킬 수 있는 방법을 모색한다. 셋째, 궁극적으로 급성기 뇌졸중 환자의 증상악화의 조기 발견과 치료를 위한 의료진의 올바른 대처지침을 마련하여 이를 적용한다. 의료기관: 경기도에 소재한 대학병원의 뇌졸중 집중치료실. 질 향상 활동: 첫째, 간호사의 NIHSS 측정 신뢰도 향상을 위해 "NIHSS 간호사 교육 프로그램"을 마련하였다. 둘째, NIHSS 측정을 통한 뇌졸중 악화 예측율 향상을 위하여 "뇌졸중 악화 발생 시 의사, 간호사 대처 활동 프로토콜"을 개발하고 추적 관찰하였다. 개선효과: NIHSS 측정 신뢰도는 질 향상 활동 전 89%에서 92%로 향상되었다. 그리고 간호사의 뇌졸중 악화 양성 예측율은 58.7%에서 87.1%로 향상되었다(참고 : 간호사의 뇌졸중 악화 음성 예측율 100% 유지). 즉 "NIHSS 간호사 교육 프로그램 활용", "뇌졸중 악화 발생 시 의사, 간호사 대처 활동 프로토콜"의 적용으로 뇌졸중의 조기 발견 및 치료가 가능하였고, 향후 환자 예후에 긍정적인 영향을 줄 수 있을 것이라 기대된다.

• 재활복지
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• v.21 no.2
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• pp.247-259
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• 2017

We investigated the improvement of cognitive functions, activity of daily living (ADL), and quality of life (QoL) after hemorrhagic stroke and identified associated factors. For this research, twenty-five patients with a hemorrhagic stroke were enrolled. We measured cognitive function, activity of daily living (ADL), and quality of life (QoL) from 7 days to 12 months after onset of stroke. Then we analyzed the correlation between cognitive function and other risk factors. According to results, cognitive functions improved during 12 months with statistically significant differences. Other functions were similar to cognitive functions. Improvement of cognitive functions were correlated with age, the type of hemorrhagic stroke and Glasgow coma scale at 7 days after stroke. Overall, cognitive function in patients with hemorrhagic stroke recovered from acute to 12 months after onset of stroke. And, improvement of cognitive function at this phase were associated with age, the type of hemorrhagic stroke and GCS score at 7 days. These results would provide us an information to plan cognitive rehabilitation in patients with hemorrhagic stroke.

• Journal of The Korean Society of Emergency Medicine
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• v.29 no.5
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• pp.500-508
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• 2018

Objective: The aim of this study was to evaluate the clinical characteristics of heat stroke in a bath facility and investigate predictive factors of multiple major complications in heat stroke patients. Methods: This was a retrospective study on heat stroke patients who visited an urban emergency center from January 2010 to March 2018. We compared clinical characteristics, complication, and outcomes of heat stroke patients in bath and non-bath facilities. Multivariate logistic regression analysis were performed to identify independent predictors of multiple major complications in heat stroke patients. Results: A total of 67 heat stroke patients with heat stroke were enrolled, of which 42 (62.6%) were in a bath facility and 25 (37.3%) were in a non-bath facility. Patients with heat stroke in the bath facility were characterized by old age, past medical history of hypertension and diabetes mellitus, and high incidence of hypotension compared with those in the non-bath facility but also low incidence of acute renal failure, seizure, and multiple major complications. In the multivariate analysis, predictive factors of multiple major complications in heat stroke patients were non-bath facility (odds ratio [OR], 5.4; 95% confidence interval [CI], 1.2-29.9), Glasgow Coma Scale (GCS)${\leq}8$ (OR, 8.2; 95% CI, 1.3-49.4), and mean arterial pressure (MAP), body temperature above $40.5^{\circ}C$ (OR, 8.1; 95% CI, 1.1-58.8) <60 mmHg (OR, 14.8; 95% CI, 1.8-122.9). Conclusion: Heat stroke in the bath facility resulted in less major complications, and high body temperature, GCS ${\leq}8$, and MAP <60 mmHg were independent predictive factors of multiple major complications in heat stroke patients.

• The Journal of Internal Korean Medicine
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• v.43 no.4
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• pp.656-679
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• 2022

Objectives: The aims of this study were to evaluate the fidelity of stroke stage reporting, the timeliness of the outcome measures, and the use of the core outcome set. Methods: We searched the literature using 6 domestic databases. We selected studies that used Korean medicine interventions and targeted stroke patients with motor sequelae. We examined whether the included studies reported the stroke stage and whether they used the outcome measures in the appropriate period based on the recommendations of the "Stroke Evidence Database to Guide Effectiveness". We also confirmed the use of the essential assessment tools suggested by the core outcome set. Results: Overall, 77 studies were finally selected, with 16 (21%), 55 (71%), and 6 (8%) published on the acute, subacute, and chronic phases, respectively. Only 11 of the studies directly mentioned the stroke stage. The most commonly used assessments were the National Institutes of Health Stroke Scale, Modified Barthel Index, and Manual Muscle Testing. Only 5 studies failed to apply the stage-related outcome measures at the recommended period. The outcome variables used inadequately were the National Institutes of Health Stroke Scale, Functional Ambulation Categories, 36-Item Short Form Health Survey, and Mini-Mental State Examination. Among the core outcome set items, some studies used liver and renal function tests, but no herbal medicine safety reporting was conducted. Conclusions: In future studies, we propose to ensure accurate reporting of the stroke stage with reliable outcome measures to deliver better clinical and research outcomes. Furthermore, in future clinical studies on stroke, a standard protocol that reflects the core outcome set should be developed.