• 제목/요약/키워드: acute stroke

검색결과 537건 처리시간 0.026초

Left Atrial Strain Derived From Cardiac Magnetic Resonance Imaging Can Predict Outcomes of Patients With Acute Myocarditis

  • Jimin Lee;Ki Seok Choo;Yeon Joo Jeong;Geewon Lee;Minhee Hwang;Maria Roselle Abraham;Ji Won Lee
    • Korean Journal of Radiology
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    • 제24권6호
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    • pp.512-521
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    • 2023
  • Objective: There is increasing recognition that left atrial (LA) strain can be a prognostic marker of various cardiac diseases. However, its prognostic value in acute myocarditis remains unclear. Therefore, this study aimed to evaluate whether cardiovascular magnetic resonance (CMR)-derived parameters of LA strain can predict outcomes in patients with acute myocarditis. Materials and Methods: We retrospectively analyzed the data of 47 consecutive patients (44.2 ± 18.3 years; 29 males) with acute myocarditis who underwent CMR in 13.5 ± 9.7 days (range, 0-31 days) of symptom onset. Various parameters, including feature-tracked CMR-derived LA strain, were measured using CMR. The composite endpoints included cardiac death, heart transplantation, implantable cardioverter-defibrillator or pacemaker implantation, rehospitalization following a cardiac event, atrial fibrillation, or embolic stroke. The Cox regression analysis was performed to identify associations between the variables derived from CMR and the composite endpoints. Results: After a median follow-up of 37 months, 20 of the 47 (42.6%) patients experienced the composite events. In the multivariable Cox regression analysis, LA reservoir and conduit strains were independent predictors of the composite endpoints, with an adjusted hazard ratio per 1% increase of 0.90 (95% confidence interval [CI], 0.84-0.96; P = 0.002) and 0.91 (95% CI, 0.84-0.98; P = 0.013), respectively. Conclusion: LA reservoir and conduit strains derived from CMR are independent predictors of adverse clinical outcomes in patients with acute myocarditis.

Diffusion-Weighted MR Imaging of Intracerebral Hemorrhage

  • Bo Kiung Kang;Dong Gyu Na;Jae Wook Ryoo;Hong Sik Byun;Hong Gee Roh;Yong Seon Pyeun
    • Korean Journal of Radiology
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    • 제2권4호
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    • pp.183-191
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    • 2001
  • Objective: To document the signal characteristics of intracerebral hemorrhage (ICH) at evolving stages on diffusion-weighted images (DWI) by comparison with conventional MR images. Materials and Methods: In our retrospective study, 38 patients with ICH underwent a set of imaging sequences that included DWI, T1-and T2-weighted imaging, and fluid-attenuated inversion recovery (FLAIR). In 33 and 10 patients, respectively, conventional and echo-planar T2* gradient-echo images were also obtained. According to the time interval between symptom onset and initial MRI, five stages were categorized: hyperacute (n=6); acute (n=7); early subacute (n=7); late subacute (n=10); and chronic (n=8). We investigated the signal intensity and apparent diffusion coefficient (ADC) of ICH and compared the signal intensities of hematomas at DWI and on conventional MR images. Results: DWI showed that hematomas were hyperintense at the hyperacute and late subacute stages, and hypointense at the acute, early subacute and chronic stages. Invariably, focal hypointensity was observed within a hyperacute hematoma. At the hyperacute, acute and early subacute stages, hyperintense rims that corresponded with edema surrounding the hematoma were present. The mean ADC ratio was 0.73 at the hyperacute stage, 0.72 at the acute stage, 0.70 at the early subacute stage, 0.72 at the late subacute stage, and 2.56 at the chronic stage. Conclusion: DWI showed that the signal intensity of an ICH may be related to both its ADC value and the magnetic susceptibility effect. In patients with acute stroke, an understanding of the characteristic features of ICH seen at DWI can be helpful in both the characterization of intracranial hemorrhagic lesions and the differentiation of hemorrhage from ischemia.

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배뇨중재 프로그램이 뇌졸중 재활대상자의 잔뇨량, 도뇨횟수, 배뇨불편감, 요로감염에 미치는 효과 (The Effect of Urinary Elimination Facilitation Program for Stroke Patients During Rehabilitation: Residual Urine, the Number of Urinary Catheterization, Urinary Discomfort, and Urinary Tract Infections)

  • 송영애;이정희;정지영;김난지;양이은;신채원;조문숙
    • 임상간호연구
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    • 제22권2호
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    • pp.132-141
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    • 2016
  • Purpose: The aims of this study were to develop and apply the urinary elimination facilitation program for stroke patients with urinary disorders and evaluate the effectiveness of the program. Methods: This study was conducted using the non-equivalent control group pre- posttest design. The participants included 23 patients in the control group and 22 in the experimental group. Data were collected from Nov. 25, 2013 to Nov. 25, 2014 in acute rehabilitation inpatient wards. For the final analysis, 35 patients' data were utilized 17 in the control group and 18 in the experimental group. The developed urinary elimination facilitation program was continued for 7 days and the program consisted of logging urination, monitoring timely voiding, assisting urinary elimination, and stimulating urination using sound. The data were analyized using the SPSS-win (version 21). Results: The number of urinary catheterization and the urinary discomfort were significantly improved in the experimental group compared to the control group. However residual urine and the occurrence of urinary tract infections were not significantly different between the experimental and control groups. Conclusion: The results of this study indicated that the urinary elimination intervention program for stroke patients with urination disorder could be useful in decreasing the number of urinary catheterization and the urinary discomfort.

한의 중풍변증표준안-III에 대한 보고 (Report on the Korean Standard Pattern Identifications for Stroke-III)

  • 이주아;이정섭;강병갑;고미미;문태웅;조기호;방옥선
    • 대한한방내과학회지
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    • 제32권2호
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    • pp.232-242
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    • 2011
  • Objectives : The purpose of this study was to develop the Korean standard pattern identifications for stroke-III (KSPIS-III). KSPIS-III includes 4 major pattern identifications (PIs) and clinical indicators for each. Methods : To extract the indicators for 4 major PIs, we analyzed 1548 clinical data from 15 traditional Korean medicine hospitals. Patients got acute stroke within 30 days from onset. Two physicians independently checked 65 indicators and performed pattern diagnosis. If the PI were diagnosed the same, PI would be confirmed. First we built an assumption model that set up the relationship among pattern identifications. Second, we extracted the indicators for fire-heat pattern and qi deficiency pattern by comparison between excessive and deficiency group, heat and non-heat group. By comparing yin deficiency pattern and 3 other patterns respectively, we extracted the indicators for yin deficiency pattern. Dampness-phlegm pattern indicators were extracted by the same method. Results : After cross tabulation with 65 indicators on the basis of our assumption model, we finally extracted 19 indicators for fire-heat pattern, 11 for qi deficiency pattern, 7 for yin deficiency pattern, and 7 for dampness-phlegm pattern. Conclusions : KSPIS-III was more improved than KSPIS-II because it was based on more clinical data. Further study to establish the PI diagnostic model would be required for practical use in the clinical field.

뇌졸중후 요저류에 대한 침치료 임상진료지침 (Clinical Practice Guideline for acupuncture in Post-stroke urinary retention)

  • 이지원;이의주;신병철;이명수;임성민;조충식;문상관
    • 대한한의학회지
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    • 제37권1호
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    • pp.1-9
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    • 2016
  • Objectives: Objectives : This study is aimed to develop a Clinical Practice Guideline (CPG) on acupuncture treatment for the patients with Post-stroke Urinary Retention; PSUR. Methods: Experts committee, consisting of stroke or methodology specialists, searched Medline, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and 19 Korean medicine journals. The search terms were selected to screen the randomized controlled trials (RCTs) or systematic reviews for the effectiveness of acupuncture on PSUR compared with placebo or conventional group. Levels of evidence and grades of recommendations were appraised based on Recommendations for Development of Clinical Practice Guideline in Korean Medicine. Results & Conclusions: 4 RCT were included to build the CPG. There was a strong evidence to support the effectiveness of acupuncture treatment for PSUR. The moderate evidence was presented that over 3 times a week of the acupuncture should be performed over 4 weeks on the acupoints, such as SP6, CV3, CV6, CV4, SP9, BL28, BL23, BL22, KI3 or BL67, for 15-30 minutes. 20-140Hz frequency and 10-20 minutes of treatment is suggested if electro-acupuncture treatment is performed with. It was also suggested that the procedure should begin at the acute stage just after the vital signs of the patients are stabilized. Finally, there was a moderate evidence to support safety of acupuncture treatment for PSUR.

인지훈련 프로그램이 급성 허혈성 뇌졸중 환자의 인지기능과 일상생활 수행능력에 미치는 효과 (Effects of a Cognitive Training Program on Cognitive Function and Activities of Daily Living in Patients with Acute Ischemic Stroke)

  • 오은영;정미숙
    • 대한간호학회지
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    • 제47권1호
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    • pp.1-13
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    • 2017
  • Purpose: The purpose of this study was to examine the effects of a cognitive training program on neurocognitive task performance and activities of daily living (ADL) in patients who had a stroke. Methods: The research design for this study was a nonequivalent control group non-synchronized design. Patients were assigned to the experimental (n=21) or control group (n=21). The experimental group received a 4-week cognitive training program and usual care (i.e., rehabilitation service), while the control was received usual care only. Cognitive function was measured with a standardized neurocognitive test battery and ADL was assessed at baseline and one and two months after completion of the intervention. Repeated measures ANOVA was used to determine changes in cognitive function and ADL over 2 months. Results: The interaction of group and time was significant indicating that the experimental group showed improvement in attention, visuospatial function, verbal memory, and executive function compared to the control group which had a sustained or gradual decrease in test performance. A significant group by time interaction in instrumental ADL was also found between the experimental group with gradual improvement and the control group showing no noticeable change. Conclusion: Findings show that the cognitive training program developed in this study is beneficial in restoring cognitive function and improving ADL in patients following a stroke. Further study is needed to investigate the long-term relationship between cognitive training participation and cognitive improvement and effective functioning in daily living.

뇌졸중의 약침 치료에 대한 메타분석의 통합적 고찰 (Pharmacopuncture for Stroke: An Overview of Meta-Analyses)

  • 김미경;한창호
    • 대한한방내과학회지
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    • 제40권6호
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    • pp.1081-1100
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    • 2019
  • Objectives: This study is an overview of the meta-analysis and systematic review of randomized controlled trials investigating the clinical effectiveness and safety of pharmacopuncture for patients with stroke. Methods: Core electronic databases were searched from their inception to 21 May 2019. A measurement tool to assess systematic reviews (AMSTAR 2) was applied to screen high-quality studies. The results of these studies were summarized, and additional meta-analysis was conducted. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to evaluate the certainty of evidence. Results: Sixteen studies met eligibility criteria. Four were excluded owing to insufficiency of AMSTAR 2 or low data reliability. The finally selected 12 studies were about pharmacopuncture using either a single herb extract, such as Dengzhan xixin, Sanch, Ginkgo biloba, or Acanthopanax, or a mixture of herbs, such as Compound danshen, Shenxiong, Xingnaojing, or Mailuoning. Most of the patients were from China, with acute ischemic stroke. All the studies using a pharmacopuncture versus a non-pharmacopuncture design reported the significant superiority of pharmacopuncture on every outcome measure. On the other hand, in a few studies, pharmacopuncture was inferior to active control in improving neurological deficit. Few studies reported adverse events. Conclusions: It is difficult to apply the results of this study directly to Korea, because the level of evidence is generally low and the clinical settings and social acceptance of pharmacopuncture therapy differ in Korea and China. Further studies are warranted to confirm the domestic applicability of evidence generated in China and to create evidence that supports the domestic situation.

뇌졸중환자의 낮 병동 재활간호프로그램의 적용평가를 위한 예비연구 (The Preliminary Study for the evaluation of the Rehabilitation Nursing Program integrated with Day Care Program of Stroke Survivors)

  • 서문자;강현숙;이명화
    • 재활간호학회지
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    • 제3권1호
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    • pp.98-107
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    • 2000
  • A Preliminary study for the evaluation of the Rehabilitation Nursing Program(RNP) implemented to the 25 stroke survivors at the Day Care Program Center of National Rehabilitation Hospital in Seoul was done at 1999. The purposes of this study was to assess the psychological effects as outcome-variables such as depression, powerlessness and self efficacy of the stroke survivors who were discharged from acute care hospitals. The Rehabilitation Nursing Program (RNP) integrated with the Day Care Program for rehabilitation was implemented and the psychological outcome variables were measured by 3 psychologic instruments of Zung Depression Scale, Millers's powerlessness and the Bandura's self efficacy scale. These instruments were translated into Korean and the contents validity and the reliability were tested. The subjects were 17 males and 8 females and 52% were aged over 51 years old and 24% were from 31 to 50 years old. Most of them (72%) had been educated more than high school level. The contents of RNP were 8 sessions composing of self-introduction, individualized assessment, health contract and feedback, management of depression, shaving experiences, effective communication, self efficacy teaching, health information, and daily care activities. This study found that the level of depression and the powerlessness were within average level and had not been changed the level of self efficacy after RNP were somewhat higher than before, but it was not changed significantly. According to the results, the psychological state of the subjects were not changed significantly. Only the level of self efficacy was a little improved after having the RNP. Based on theses results, the RNP should be focussed on the psychological nursing care and the psychological outcome variables were retested strictly with the enough sample size.

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Left Ventricular Ejection Fraction Predicts Poststroke Cardiovascular Events and Mortality in Patients without Atrial Fibrillation and Coronary Heart Disease

  • Lee, Jeong-Yoon;Sunwoo, Jun-Sang;Kwon, Kyum-Yil;Roh, Hakjae;Ahn, Moo-Young;Lee, Min-Ho;Park, Byoung-Won;Hyon, Min Su;Lee, Kyung Bok
    • Korean Circulation Journal
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    • 제48권12호
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    • pp.1148-1156
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    • 2018
  • Background and Objectives: It is controversial that decreased left ventricular function could predict poststroke outcomes. The purpose of this study is to elucidate whether left ventricular ejection fraction (LVEF) can predict cardiovascular events and mortality in acute ischemic stroke (AIS) without atrial fibrillation (AF) and coronary heart disease (CHD). Methods: Transthoracic echocardiography was conducted consecutively in patients with AIS or transient ischemic attack at Soonchunhyang University Hospital between January 2008 and July 2016. The clinical data and echocardiographic LVEF of 1,465 patients were reviewed after excluding AF and CHD. Poststroke disability, major adverse cardiac events (MACE; nonfatal stroke, nonfatal myocardial infarction, and cardiovascular death) and all-cause mortality during 1 year after index stroke were prospectively captured. Cox proportional hazards regressions analysis were applied adjusting traditional risk factors and potential determinants. Results: The mean follow-up time was $259.9{\pm}148.8days$ with a total of 29 non-fatal strokes, 3 myocardial infarctions, 33 cardiovascular deaths, and 53 all-cause mortality. The cumulative incidence of MACE and all-cause mortality were significantly higher in the lowest LVEF (<55) group compared with the others (p=0.022 and 0.009). In prediction models, LVEF (per 10%) had hazards ratios of 0.54 (95% confidence interval [CI], 0.36-0.80, p=0.002) for MACE and 0.61 (95% CI, 0.39-0.97, p=0.037) for all-cause mortality. Conclusions: LVEF could be an independent predictor of cardiovascular events and mortality after AIS in the absence of AF and CHD.

Efficacy and Safety of Endovascular Treatment in Patients with Internal Carotid Artery Occlusion and Collateral Middle Cerebral Artery Flow

  • Kim, Yong-Won;Kang, Dong-Hun;Kim, Yong-Sun;Hwang, Yang-Ha
    • Journal of Korean Neurosurgical Society
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    • 제62권2호
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    • pp.201-208
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    • 2019
  • Objective : In patients with internal carotid artery (ICA) occlusion, collateral middle cerebral artery (MCA) flow has a protective role against ischemia. However, some of these patients may experience initial major neurological deficits and major worsening on following days. Thus, we investigated the safety and efficacy of endovascular treatment (EVT) for ICA occlusion with collateral MCA flow by comparing clinical outcomes of medical treatment versus EVT. Methods : The inclusion criteria were as follows : 1) acute ischemic stroke with ICA occlusion and presence of collateral MCA flow on transfemoral cerebral angiography (TFCA) and 2) hospital arrival within 12 hours from symptom onset. The treatment strategy was made by the attending physician based on the patient's clinical status and results of TFCA. Results : Eighty-one patients were included (30 medical treatment, 51 EVT). The EVT group revealed a high incidence of intracranial ICA occlusion, longer ipsilesional MCA contrast filling time, and a similar rate of favorable clinical outcome despite a higher mean baseline the National Institutes of Health Stroke Scale (NIHSS) score. By binary logistic regression analysis, intravenous recombinant tissue plasminogen activator and EVT were independent predictors of favorable clinical outcome. In subgroup analysis based on stroke etiology, the non-atherosclerotic group showed a higher baseline NIHSS score, higher incidence of EVT, and a higher rate of distal embolization during EVT in comparison with the atherosclerotic group. Conclusion : In patients with ICA occlusion and collateral MCA flow, decisions regarding treatment strategy based on TFCA can help achieve favorable clinical outcomes. EVT strategy with respect to etiology of ICA occlusion might help achieve better angiographic outcomes.