Boyoung Kim, J. S. Lee, Hong‐Kyun Park, Youngbok Yung, Ki Chang Oh, Jeong Joo Park, Yong‐Jin Cho, K. Kang, Soo‐Joo Lee, J. Kim, J. Cha, Dae-Hyun Kim, H. Bae, T. Park, Sang-Soon Park, K. Lee, Jun Lee, Byung‐Chul Lee, M. Lee, Joon-Tae Kim, K. Choi, Dong-Eog Kim, J. Choi, Dong-Ick Shin, J. Kwon, Wook-Joo Kim, S. Sohn, Jeong‐Ho Hong, Hyungjong Park, S. Jang, Kwang-Yeol Park, Sang-Hwa Lee, Jong-Moo Park, K. Hong
Background: For acute ischemic stroke (AIS) patients with history of prior stroke (PS) and diabetes mellitus (DM), intravenous recombinant tissue plasminogen activator (IV-tPA) therapy in the 3- to 4.5-hour window is off-label in Korea. This study aimed to assess the safety and efficacy of IV-tPA in these patients.Methods: Using data from a prospective multicenter stroke registry between January 2009 and March 2021, we identified AIS patients who received IV-tPA in the 3- to 4.5-hour window, and compared the outcomes of symptomatic intracranial hemorrhage (SICH), 3-month mortality, 3-month modified Rankin Scale (mRS) score 0-1 and 3-month mRS distribution between patients with both PS and DM (PS/DM, n=56) versus those with neither PS nor DM, or with only one (non-PS/DM, n=927).Results: The PS/DM group versus the non-PS/DM group was more likely to have a prior disability, hypertension, hyperlipidemia, coronary heart disease and less likely to have atrial fibrillation. The PS/DM and the non-PS/DM groups had comparable rates of SICH (0% vs. 1.7%; p>0.999) and 3-month mortality (10.7% vs. 10.2%; p=0.9112). The rate of 3-month mRS 0-1 was non-significantly lower in the PS/DM group than in the non-PS/DM group (30.4% vs. 40.7%; adjusted odds ratio [95% confidence interval], 0.81 [0.41-1.59]).Conclusions: In the 3- to 4.5-hour window, AIS patients with PS/DM, as compared to those with non-PS/DM, might benefit less from IV-tPA. However, given the similar risks of SICH and mortality, IV-tPA in the late time window could be considered in patients with both PS and DM.
背景:在韩国，对于有卒中(PS)和糖尿病(DM)病史的急性缺血性卒中(AIS)患者，在3- 4.5小时内静脉注射重组组织型纤溶酶原激活剂(IV-tPA)治疗属于标签外治疗。本研究旨在评估IV-tPA在这些患者中的安全性和有效性。方法:利用2009年1月至2021年3月期间的前瞻性多中心卒中登记数据，我们确定了在3- 4.5小时窗口内接受IV-tPA治疗的AIS患者，并比较了症状性颅内出血(SICH)、3个月死亡率、3个月修正兰金量表(mRS)评分0-1的结局，以及PS和DM患者(PS/DM, n=56)与既没有PS也没有DM或只有一种(非PS/DM, n=927)之间的3个月mRS分布。结果:与非PS/DM组相比，PS/DM组有残疾、高血压、高脂血症、冠心病的可能性更大，房颤的可能性更小。PS/DM组和非PS/DM组的SICH发生率相当(0% vs. 1.7%;P >0.999)和3个月死亡率(10.7% vs. 10.2%;p = 0.9112)。PS/DM组3个月mRS 0-1发生率低于非PS/DM组(30.4% vs 40.7%;校正优势比[95%可信区间]，0.81[0.41-1.59])。结论:在3- 4.5小时内，与非PS/DM患者相比，伴有PS/DM的AIS患者可能从IV-tPA中获益较少。然而，考虑到SICH和死亡率相似的风险，对于PS和DM患者，可以考虑在晚时间窗使用IV-tPA。
{"title":"Safety and Efficacy of Intravenous Thrombolysis in the 3- to 4.5-hour Window in Acute Ischemic Stroke Patients Who Have Both Diabetes Mellitus and History of Prior Stroke","authors":"Boyoung Kim, J. S. Lee, Hong‐Kyun Park, Youngbok Yung, Ki Chang Oh, Jeong Joo Park, Yong‐Jin Cho, K. Kang, Soo‐Joo Lee, J. Kim, J. Cha, Dae-Hyun Kim, H. Bae, T. Park, Sang-Soon Park, K. Lee, Jun Lee, Byung‐Chul Lee, M. Lee, Joon-Tae Kim, K. Choi, Dong-Eog Kim, J. Choi, Dong-Ick Shin, J. Kwon, Wook-Joo Kim, S. Sohn, Jeong‐Ho Hong, Hyungjong Park, S. Jang, Kwang-Yeol Park, Sang-Hwa Lee, Jong-Moo Park, K. Hong","doi":"10.17340/jkna.2023.2.2","DOIUrl":"https://doi.org/10.17340/jkna.2023.2.2","url":null,"abstract":"Background: For acute ischemic stroke (AIS) patients with history of prior stroke (PS) and diabetes mellitus (DM), intravenous recombinant tissue plasminogen activator (IV-tPA) therapy in the 3- to 4.5-hour window is off-label in Korea. This study aimed to assess the safety and efficacy of IV-tPA in these patients.Methods: Using data from a prospective multicenter stroke registry between January 2009 and March 2021, we identified AIS patients who received IV-tPA in the 3- to 4.5-hour window, and compared the outcomes of symptomatic intracranial hemorrhage (SICH), 3-month mortality, 3-month modified Rankin Scale (mRS) score 0-1 and 3-month mRS distribution between patients with both PS and DM (PS/DM, n=56) versus those with neither PS nor DM, or with only one (non-PS/DM, n=927).Results: The PS/DM group versus the non-PS/DM group was more likely to have a prior disability, hypertension, hyperlipidemia, coronary heart disease and less likely to have atrial fibrillation. The PS/DM and the non-PS/DM groups had comparable rates of SICH (0% vs. 1.7%; p>0.999) and 3-month mortality (10.7% vs. 10.2%; p=0.9112). The rate of 3-month mRS 0-1 was non-significantly lower in the PS/DM group than in the non-PS/DM group (30.4% vs. 40.7%; adjusted odds ratio [95% confidence interval], 0.81 [0.41-1.59]).Conclusions: In the 3- to 4.5-hour window, AIS patients with PS/DM, as compared to those with non-PS/DM, might benefit less from IV-tPA. However, given the similar risks of SICH and mortality, IV-tPA in the late time window could be considered in patients with both PS and DM.","PeriodicalId":437080,"journal":{"name":"Journal of the Korean Neurological Association","volume":"124 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134310724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Palatal Tremor and Central Sleep Apnea Accompanied by Bilateral Hypertrophic Olivary Degeneration after Brainstem Hemorrhage","authors":"K. Ji","doi":"10.17340/jkna.2023.2.12","DOIUrl":"https://doi.org/10.17340/jkna.2023.2.12","url":null,"abstract":"","PeriodicalId":437080,"journal":{"name":"Journal of the Korean Neurological Association","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131213800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Seung Won Seo, Jae-Wook Lee, Jin-Hyung Lee, M. Kim, B. Yoo, Hee-Young Kim
Intravascular large B-cell lymphoma (IVLBCL) is a rare form of non-Hodgkin’s lymphoma that selectively involves the lumina of vessels, and may present as ischemic stroke. A 62-year-old man presented with progressive aphasia, dementia, seizure and stroke-like symptom. Brain magnetic resonance imaging revealed dynamic progressive fluid attenuated inversion recovery lesions and multiple punctate microbleeds in the bilateral subcortical region. A kidney biopsy revealed IVLBCL. We report a patient with IVLBCL presenting as rapidly progressive encephalopathy.
{"title":"Intravascular Large B-cell Lymphoma Presenting as Rapidly Progressive Encephalopathy","authors":"Seung Won Seo, Jae-Wook Lee, Jin-Hyung Lee, M. Kim, B. Yoo, Hee-Young Kim","doi":"10.17340/jkna.2023.2.4","DOIUrl":"https://doi.org/10.17340/jkna.2023.2.4","url":null,"abstract":"Intravascular large B-cell lymphoma (IVLBCL) is a rare form of non-Hodgkin’s lymphoma that selectively involves the lumina of vessels, and may present as ischemic stroke. A 62-year-old man presented with progressive aphasia, dementia, seizure and stroke-like symptom. Brain magnetic resonance imaging revealed dynamic progressive fluid attenuated inversion recovery lesions and multiple punctate microbleeds in the bilateral subcortical region. A kidney biopsy revealed IVLBCL. We report a patient with IVLBCL presenting as rapidly progressive encephalopathy.","PeriodicalId":437080,"journal":{"name":"Journal of the Korean Neurological Association","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125958066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Y. Jeong, Sung‐Jo Bang, G. Kim, Jae Ho Jeon, Gi Ryeong Oh, C. Chung, Hyung-Kuk Park
The coronavirus disease-19 (COVID-19) pandemic leaded to inevitable expeditious vaccine rollout without sufficient safety profile. Especially, severe acute respiratory syndrome coronavirus 2 infection has known to induce overreacted immune responses such as releasing of proteinase-3 and myeloperoxidase (MPO) by neutrophil. This overreacted immune response leads to the concern of the development of autoimmune diseases after COVID-19 vaccination. We report the case of de novo MPO-associated systemic vasculitis involving central nervous system following heterogeneous mRNA1273 COVID-19 booster vaccination.
{"title":"A Case of de novo MPO-associated Central Nervous System Vasculitis Following Heterogeneous mRNA1273 COVID-19 Booster Vaccination","authors":"Y. Jeong, Sung‐Jo Bang, G. Kim, Jae Ho Jeon, Gi Ryeong Oh, C. Chung, Hyung-Kuk Park","doi":"10.17340/jkna.2023.2.8","DOIUrl":"https://doi.org/10.17340/jkna.2023.2.8","url":null,"abstract":"The coronavirus disease-19 (COVID-19) pandemic leaded to inevitable expeditious vaccine rollout without sufficient safety profile. Especially, severe acute respiratory syndrome coronavirus 2 infection has known to induce overreacted immune responses such as releasing of proteinase-3 and myeloperoxidase (MPO) by neutrophil. This overreacted immune response leads to the concern of the development of autoimmune diseases after COVID-19 vaccination. We report the case of de novo MPO-associated systemic vasculitis involving central nervous system following heterogeneous mRNA1273 COVID-19 booster vaccination.","PeriodicalId":437080,"journal":{"name":"Journal of the Korean Neurological Association","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130021786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jee-Min Rhyu, Sang Yeon Kim, Hyunhyung Kang, Byoung-Soo Shin
{"title":"Treatment of Iatrogenic Pseudoanerysm of Femoral Artery: Ultrasound Guided Thrombin Injection","authors":"Jee-Min Rhyu, Sang Yeon Kim, Hyunhyung Kang, Byoung-Soo Shin","doi":"10.17340/jkna.2023.2.9","DOIUrl":"https://doi.org/10.17340/jkna.2023.2.9","url":null,"abstract":"","PeriodicalId":437080,"journal":{"name":"Journal of the Korean Neurological Association","volume":"64 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121524496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Endovascular Treatment of Acute Basilar Artery Occlusion through the Hidden True Lumen of Vertebral Artery Dissection","authors":"Yeook Son, Joong-Goo Kim","doi":"10.17340/jkna.2023.2.11","DOIUrl":"https://doi.org/10.17340/jkna.2023.2.11","url":null,"abstract":"","PeriodicalId":437080,"journal":{"name":"Journal of the Korean Neurological Association","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127078895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Su Min Park, Jung-Ju Lee, Byung-Kun Kim, K. Kang, Woong-Woo Lee
Isolated unilateral hypoglossal nerve palsy (IUHNP) is rare because of its complex course and close adjacent structures. Prostate cancer is a very rare cause of hypoglossal nerve palsy and reported scarcely. We herein report the first case of metastatic prostate cancer presented with IUHNP in Korea, which shows good clinico-radiological correlation.
{"title":"Metastatic Prostate Cancer Presented with Isolated Unilateral Hypoglossal Nerve Palsy: Demonstration of Clinico-radiological Correlation","authors":"Su Min Park, Jung-Ju Lee, Byung-Kun Kim, K. Kang, Woong-Woo Lee","doi":"10.17340/jkna.2023.2.5","DOIUrl":"https://doi.org/10.17340/jkna.2023.2.5","url":null,"abstract":"Isolated unilateral hypoglossal nerve palsy (IUHNP) is rare because of its complex course and close adjacent structures. Prostate cancer is a very rare cause of hypoglossal nerve palsy and reported scarcely. We herein report the first case of metastatic prostate cancer presented with IUHNP in Korea, which shows good clinico-radiological correlation.","PeriodicalId":437080,"journal":{"name":"Journal of the Korean Neurological Association","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117026644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
King Oh, Jeong Ju Park, Youngbok Yung, B. Kim, Ji Eun Kim
Semantic variant primary progressive aphasia (svPPA), a well-known subtype of the frontotemporal dementia often shows peculiar clinical features and structural neuroimage findings. To strengthen the accuracy of a clinical diagnosis, amyloid positron emission tomography-computed tomography (PET-CT) might be helpful. However, in patients with late-onset svPPA, an admixture of the various neuropathology would interfere with diagnostic approach. Herein, we report a case of late-onset bilateral svPPA showing a regional amyloid deposition on PET-CT scan.
{"title":"Decision-making Approach in Late-onset Bilateral Semantic Variant Primary Progressive Aphasia with Coexisting Asymmetric Regional Amyloid Deposition","authors":"King Oh, Jeong Ju Park, Youngbok Yung, B. Kim, Ji Eun Kim","doi":"10.17340/jkna.2023.2.3","DOIUrl":"https://doi.org/10.17340/jkna.2023.2.3","url":null,"abstract":"Semantic variant primary progressive aphasia (svPPA), a well-known subtype of the frontotemporal dementia often shows peculiar clinical features and structural neuroimage findings. To strengthen the accuracy of a clinical diagnosis, amyloid positron emission tomography-computed tomography (PET-CT) might be helpful. However, in patients with late-onset svPPA, an admixture of the various neuropathology would interfere with diagnostic approach. Herein, we report a case of late-onset bilateral svPPA showing a regional amyloid deposition on PET-CT scan.","PeriodicalId":437080,"journal":{"name":"Journal of the Korean Neurological Association","volume":"142 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123197802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Headache is a frequent complaint in coronavirus disease-19 (COVID-19) patients. Nevertheless, no detailed information on the pathophysiology of headache in COVID-19 infection is currently limited. We encountered a patient developing headache, diplopia, and intracranial hypertension after COVID-19 infection. The patient no more complained of headache and diplopia after the intracranial pressure was normalized. Our case suggests that intracranial hypertension is a mechanism of headache in COVID-19 infection. We report herein a case of transient intracranial hypertension after COCVID-19 infection.
{"title":"Intracranial Hypertension after COVID-19 Infection","authors":"W. Park, S. Song, D. Jung, Jung hyun Lee, M. Chu","doi":"10.17340/jkna.2023.2.7","DOIUrl":"https://doi.org/10.17340/jkna.2023.2.7","url":null,"abstract":"Headache is a frequent complaint in coronavirus disease-19 (COVID-19) patients. Nevertheless, no detailed information on the pathophysiology of headache in COVID-19 infection is currently limited. We encountered a patient developing headache, diplopia, and intracranial hypertension after COVID-19 infection. The patient no more complained of headache and diplopia after the intracranial pressure was normalized. Our case suggests that intracranial hypertension is a mechanism of headache in COVID-19 infection. We report herein a case of transient intracranial hypertension after COCVID-19 infection.","PeriodicalId":437080,"journal":{"name":"Journal of the Korean Neurological Association","volume":"57 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127866745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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