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  • 1
    Online Resource
    Online Resource
    Abstract WMP11: Predictors Of Early Neurological Deterioration After Dual Antiplatelet Therapy In Patients With Cerebral Infarction
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Stroke Vol. 53, No. Suppl_1 ( 2022-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 53, No. Suppl_1 ( 2022-02)
    Abstract: Background: Recent clinical evidence supports the early initiation of aspirin and clopidogrel combination for patients with minor stroke or high-risk transient ischemic attack (TIA) to prevent stroke recurrence. However, some of the patients still experience early neurological deterioration (END) despite optimal antithrombotic treatment. We investigated clinical and laboratory variables related to END after optimal antithrombotic treatment among the patients with non-cardioembolic stroke or TIA. Methods: The patients with minor neurological deficit who received aspirin and clopidogrel within 24 hours after symptom onset were selected from the prospective stroke registries of Seoul National University and Chung-Ang University Hospital, in Seoul, Korea. The END due to ischemic stroke (END_IS) was defined as two or more national institute health stroke scale increase within 5 days after stroke which us due to stroke progression or recurrence. Included patients were divided into two groups according to the presence of END_IS and demographic and laboratory variables were compared between the two groups. Multivariable logistic regression analysis was performed to assess the independent predictors of the END. Results: During the study period from January 2015 to January 2021, 33 (8.7%) out of 380 patients experienced END_IS. In multivariate analysis, independent predictors of END_IS were the presence of intracranial artery stenosis ≥ 50% (odds ratio [OR] 2.922, [95% CI, 1.342-6.364] , p=0.007), higher initial NIHSS score, (OR 1.502 [95% CI 1.120-2.015], p=0.007), previous use of statin (OR 0.282 [95% CI 0.080-0.990] , p=0.007) and higher serum D-dimer level (OR 1.408 [95% CI, 1.074-1.847], p=0.048). Conclusions: Intracranial artery stenosis, stroke severity, previous statin use, and D-dimer level were the independent predictors of END_IS after dual-antiplatelet treatment in patients with minor stroke. Future studies are necessary to develop an additional therapeutic strategy for the at-risk patient group.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.53.suppl_1.WMP11
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 1467823-8
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  • 2
    Online Resource
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    Intracranial Arterial Calcificationes Can Reflect Cerebral Atherosclerosis Burden
    XMLink ; 2019
    In:  Journal of Clinical Neurology Vol. 15, No. 1 ( 2019), p. 38-
    Details
    In: Journal of Clinical Neurology, XMLink, Vol. 15, No. 1 ( 2019), p. 38-
    Type of Medium: Online Resource
    ISSN: 1738-6586 , 2005-5013
    URL: Article
    DOI: 10.3988/jcn.2019.15.1.38
    Language: English
    Publisher: XMLink
    Publication Date: 2019
    detail.hit.zdb_id: 2500489-X
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  • 3
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    Prediction of amyloid PET positivity via machine learning algorithms trained with EDTA-based blood amyloid-β oligomerization data
    Springer Science and Business Media LLC ; 2022
    In:  BMC Medical Informatics and Decision Making Vol. 22, No. 1 ( 2022-11-07)
    Details
    In: BMC Medical Informatics and Decision Making, Springer Science and Business Media LLC, Vol. 22, No. 1 ( 2022-11-07)
    Abstract: The tendency of amyloid-β to form oligomers in the blood as measured with Multimer Detection System-Oligomeric Amyloid-β (MDS-OAβ) is a valuable biomarker for Alzheimer’s disease and has been verified with heparin-based plasma. The objective of this study was to evaluate the performance of ethylenediaminetetraacetic acid (EDTA)-based MDS-OAβ and to develop machine learning algorithms to predict amyloid positron emission tomography (PET) positivity. Methods The performance of EDTA-based MDS-OAβ in predicting PET positivity was evaluated in 312 individuals with various machine learning models. The models with various combinations of features (i.e., MDS-OAβ level, age, apolipoprotein E4 alleles, and Mini-Mental Status Examination [MMSE] score) were tested 50 times on each dataset. Results The random forest model best-predicted amyloid PET positivity based on MDS-OAβ combined with other features with an accuracy of 77.14 ± 4.21% and an F1 of 85.44 ± 3.10%. The order of significance of predictive features was MDS-OAβ, MMSE, Age, and APOE. The Support Vector Machine using the MDS-OAβ value only showed an accuracy of 71.09 ± 3.27% and F−1 value of 80.18 ± 2.70%. Conclusions The Random Forest model using EDTA-based MDS-OAβ combined with the MMSE and apolipoprotein E status can be used to prescreen for amyloid PET positivity.
    Type of Medium: Online Resource
    ISSN: 1472-6947
    URL: Article
    DOI: 10.1186/s12911-022-02024-z
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2046490-3
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  • 4
    Online Resource
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    P300 latency changes in patients with mild cognitive impairment after taking choline alphoscerate; A preliminary study
    Elsevier BV ; 2018
    In:  eNeurologicalSci Vol. 11 ( 2018-06), p. 5-8
    Details
    In: eNeurologicalSci, Elsevier BV, Vol. 11 ( 2018-06), p. 5-8
    Type of Medium: Online Resource
    ISSN: 2405-6502
    URL: Article
    DOI: 10.1016/j.ensci.2018.04.004
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2018
    detail.hit.zdb_id: 2838045-9
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  • 5
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    The immunologic phenotype of thrombi is associated with future vascular events after cerebral infarction
    BMJ ; 2023
    In:  Journal of NeuroInterventional Surgery
    Details
    In: Journal of NeuroInterventional Surgery, BMJ
    Abstract: Thrombi retrieved from patients with acute ischemic stroke may contain prognostic information. Objective To investigate the relationship between the immunologic phenotype of thrombi and future vascular events in patients with a stroke. Methods This study included patients with acute ischemic stroke who underwent endovascular thrombectomy at Chung-Ang University Hospital in Seoul, Korea, between February 2017 and January 2020. Laboratory and histological variables were compared between patients with and without recurrent vascular events (RVEs). Kaplan–Meier analysis followed by the Cox proportional hazards model was used to identify factors related to RVE. Receiver operating characteristic (ROC) analysis was conducted to evaluate the performance of the immunologic score by combining immunohistochemical phenotypes to predict RVE. Results A total of 46 patients were included in the study with 13 RVEs (mean±SD age, 72.8±11.3 years; 26 (56.5%) men). Thrombi with a lower percentage of programmed death ligand-1 expression (HR=11.64; 95% CI 1.60 to 84.82) and a higher number of citrullinated histone H3 positive cells (HR=4.19; 95% CI 0.81 to 21.75) were associated with RVE. The presence of high-mobility group box 1 positive cell was associated with reduced risk of RVE, but the association was lost after adjustment for stroke severity. The immunologic score, which consists of the three immunohistochemical phenotypes, showed good performance in predicting RVE (area under the ROC curve, 0.858; 95% CI 0.758 to 0.958). Conclusions The immunological phenotype of thrombi could provide prognostic information after stroke.
    Type of Medium: Online Resource
    ISSN: 1759-8478 , 1759-8486
    URL: Article
    DOI: 10.1136/jnis-2023-020155
    Language: English
    Publisher: BMJ
    Publication Date: 2023
    detail.hit.zdb_id: 2506028-4
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  • 6
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    Online Resource
    The uptake pattern of 18F-sodium fluoride radioligand in brain tissue after cerebral infarction
    Springer Science and Business Media LLC ; 2022
    In:  Scientific Reports Vol. 12, No. 1 ( 2022-12-29)
    Details
    In: Scientific Reports, Springer Science and Business Media LLC, Vol. 12, No. 1 ( 2022-12-29)
    Abstract: Positron emission tomography with 18 F-sodium fluoride (NaF) radioligand has been actively investigated in atherosclerosis research because it is known to detect microcalcification activity within atheroma. We studied whether NaF shows any uptake in the brain tissue of patients with acute ischemic stroke. This is a post-hoc analysis of previously reported cerebral atherosclerosis research with positron emission tomography which applied the two radioligands, 18 F-fluorodeoxyglucose and NaF for the detection of culprit atheroma among 20 acute cerebral infarction patients (mean age = 75.1 ± 9.0 years; 10 women). In this study, we measured the maximum and mean standardized uptake value (SUVmax and SUVmean) of NaF uptake level in the cerebral infarct region between lesions with and without diffusion weighted image (DWI) positivity, indicating acute ischemic cell death. Correlation analysis was performed between NaF uptake levels and imaging and clinical variables, including neurological severity. The NaF uptake levels were significantly higher in DWI positive lesions than in negative lesions (SUVmax: 2.0 [0.60–4.2] versus 0.20 [0.10–0.40] , p  = 0.021 by Mann–Whitney U test). The intensity of NaF uptake (SUVmax) was significantly correlated with the initial neurological severity (Spearman's ρ = 0.579, p = 0.007) and white blood cell count (Spearman's ρ = 0.626, p  p  0.003). During ischemic stroke NaF was concentrated in brain tissue undergoing acute cell death and its uptake intensity was correlated with neurological severity, suggesting that NaF could reflect acute ischemic cell death after stroke.
    Type of Medium: Online Resource
    ISSN: 2045-2322
    URL: Article
    DOI: 10.1038/s41598-022-26992-4
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2615211-3
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  • 7
    Online Resource
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    Impact of onset-to-door time on outcomes and factors associated with late hospital arrival in patients with acute ischemic stroke
    Public Library of Science (PLoS) ; 2021
    In:  PLOS ONE Vol. 16, No. 3 ( 2021-3-25), p. e0247829-
    Details
    In: PLOS ONE, Public Library of Science (PLoS), Vol. 16, No. 3 ( 2021-3-25), p. e0247829-
    Abstract: Previous studies have reported that early hospital arrival improves clinical outcomes in patients with acute ischemic stroke; however, whether early arrival is associated with favorable outcomes regardless of reperfusion therapy and the type of stroke onset time is unclear. Thus, we investigated the impact of onset-to-door time on outcomes and evaluated the predictors of pre-hospital delay after ischemic stroke. Methods Consecutive acute ischemic stroke patients who arrived at the hospital within five days of onset from September 2019 to May 2020 were selected from the prospective stroke registries of Seoul National University Hospital and Chung-Ang University Hospital of Seoul, Korea. Patients were divided into early (onset-to-door time, ≤4.5 h) and late ( 〉 4.5 h) arrivers. Multivariate analyses were performed to assess the effect of early arrival on clinical outcomes and predictors of late arrival. Results Among the 539 patients, 28.4% arrived early and 71.6% arrived late. Early hospital arrival was significantly associated with favorable outcomes (three-month modified Rankin Scale [mRS] : 0−2, adjusted odds ratio [aOR]: 2.03, 95% confidence interval: [CI] 1.04–3.96) regardless of various confounders, including receiving reperfusion therapy and type of stroke onset time. Furthermore, a lower initial National Institute of Health Stroke Scale (NIHSS) score (aOR: 0.94, 95% CI: 0.90–0.97), greater pre-stroke mRS score (aOR: 1.58, 95% CI: 1.18–2.13), female sex (aOR: 1.71, 95% CI: 1.14–2.58), unclear onset time, and ≤6 years of schooling (aOR: 1.76, 95% CI: 1.03–3.00 compared to 〉 12 years of schooling) were independent predictors of late arrival. Conclusions Thus, the onset-to-door time of≤4.5 h is crucial for better clinical outcome, and lower NIHSS score, greater pre-stroke mRS score, female sex, unclear onset times, and ≤6 years of schooling were independent predictors of late arrival. Therefore, educating about the importance of early hospital arrival after acute ischemic stroke should be emphasized. More strategic efforts are needed to reduce the prehospital delay by understanding the predictors of late arrival.
    Type of Medium: Online Resource
    ISSN: 1932-6203
    URL: Article
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    DOI: 10.1371/journal.pone.0247829
    DOI: 10.1371/journal.pone.0247829.g001
    DOI: 10.1371/journal.pone.0247829.t001
    DOI: 10.1371/journal.pone.0247829.t002
    DOI: 10.1371/journal.pone.0247829.t003
    DOI: 10.1371/journal.pone.0247829.s001
    DOI: 10.1371/journal.pone.0247829.r001
    DOI: 10.1371/journal.pone.0247829.r002
    DOI: 10.1371/journal.pone.0247829.r003
    DOI: 10.1371/journal.pone.0247829.r004
    Language: English
    Publisher: Public Library of Science (PLoS)
    Publication Date: 2021
    detail.hit.zdb_id: 2267670-3
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  • 8
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    Online Resource
    Impact of Metabolic Activity of Vertebra and Amygdala on Stroke Recurrence: A Prospective Cohort Study
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Circulation: Cardiovascular Imaging Vol. 16, No. 1 ( 2023-01)
    Details
    In: Circulation: Cardiovascular Imaging, Ovid Technologies (Wolters Kluwer Health), Vol. 16, No. 1 ( 2023-01)
    Abstract: Elevated metabolic activity of amygdala is known to be related to atherosclerotic cardiovascular event by increasing inflammatory cell production from bone marrow. We tried to identify the factors of metabolic activity in the amygdala, vertebrae, liver, spleen, and internal carotid artery related to the future vascular events after stroke. Methods: A total of 110 patients with acute stroke were included (72±10 years of age, 39% women) and underwent whole-body 18 F-fluorodeoxyglucose (FDG) positron emission tomography between August 1, 2015 and February 28, 2020. We compared the FDG uptake in the amygdala, vertebrae, liver, spleen, and internal carotid artery between patients with and without recurrent vascular event. Cox proportional hazards model was used to identify factors related to recurrent stroke and vascular event. Results: During the median follow-up period of 18 months, 22 patients experienced vascular events, including 15 stroke recurrence. Patients with recurred vascular event had a significantly higher FDG uptake in the amygdala and vertebrae than those without. The Cox proportional hazard model including diabetes, renal function, and carotid stenosis showed that a higher FDG uptake in the amygdala was independently associated with total vascular events (hazard ratio, 3.11 [95% CI, 1.11–8.70]) and higher FDG uptake in the vertebrae with stroke recurrence (hazard ratio, 4.94 [95% CI, 1.29–18.9] ). Conclusions: The increased metabolic activities of the vertebrae and amygdala are related to future vascular event among stroke survivors.
    Type of Medium: Online Resource
    ISSN: 1941-9651 , 1942-0080
    URL: Article
    DOI: 10.1161/CIRCIMAGING.122.014544
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 2440475-5
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  • 9
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    Cerebral paragonimiasis: Clinicoradiological features and serodiagnosis using recombinant yolk ferritin
    Public Library of Science (PLoS) ; 2022
    In:  PLOS Neglected Tropical Diseases Vol. 16, No. 3 ( 2022-3-16), p. e0010240-
    Details
    In: PLOS Neglected Tropical Diseases, Public Library of Science (PLoS), Vol. 16, No. 3 ( 2022-3-16), p. e0010240-
    Abstract: Cerebral paragonimiasis (CP), caused by aberrant migration of Paragonimus worms, frequently invokes serious illness. The causal relationship between the lesion characteristics and patients’ symptoms has poorly been understood. CP serodiagnosis has not been properly evaluated to date. A total of 111 CP cases were diagnosed in our laboratory between 1982 and 2003. This study retrospectively assessed the clinical and imaging characteristics of the 105 patients along with the evaluation of diagnostic potentials of recombinant P . westermani yolk ferritin (rPwYF) by enzyme-linked immunosorbent assay (ELISA) employing patients’ sera and cerebrospinal fluids (CSFs). We analyzed 60 male and 45 female patients; 50 early-stage patients with non-calcified enhancing nodule(s) (median age, 38 years; interquartile range [IQR], 24.75–52; median symptom duration, 0.75 years; IQR, 0.2–2) and 54 chronic cases having calcified lesion(s) (median age, 33 years; IQR, 25–41; median symptom duration, 10 years; IQR, 5–20). One patient showed a normal neuroimage. The patients were largely diagnosed in their 30s. The parietal lobe was most commonly affected, followed by occipital, frontal, and temporal lobes. Twenty-six patients had lesions encompassing ≥ two lobes. The patients complained mainly of seizures, headaches, hemiparesis, and focal neurologic deficits ( P 〈 0.001). Seizures and visual defects were predominant in patients with calcified lesion(s) ( P 〈 0.001). The diagnostic sensitivity and specificity of rPwYF against serum/CSF were 100%/97% and 97.2%/92.5%, respectively. The specific IgG antibody levels against rPwYF in sera and CSFs showed a positive correlation (r = 0.59). The clinical manifestations of the early-stage patients might be associated with cortical lesions or meningeal irritation, while those in the chronic stage were caused by conglomerated space-occupying lesions. rPwYF would be useful for the serodiagnosis of both early and chronic CP cases.
    Type of Medium: Online Resource
    ISSN: 1935-2735
    URL: Article
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    DOI: 10.1371/journal.pntd.0010240
    DOI: 10.1371/journal.pntd.0010240.g001
    DOI: 10.1371/journal.pntd.0010240.g002
    DOI: 10.1371/journal.pntd.0010240.g003
    DOI: 10.1371/journal.pntd.0010240.g004
    DOI: 10.1371/journal.pntd.0010240.t001
    DOI: 10.1371/journal.pntd.0010240.t002
    DOI: 10.1371/journal.pntd.0010240.t003
    DOI: 10.1371/journal.pntd.0010240.t004
    DOI: 10.1371/journal.pntd.0010240.s001
    DOI: 10.1371/journal.pntd.0010240.s002
    DOI: 10.1371/journal.pntd.0010240.s003
    Language: English
    Publisher: Public Library of Science (PLoS)
    Publication Date: 2022
    detail.hit.zdb_id: 2429704-5
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  • 10
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    Intravenous Thrombolysis in Patients With Ischemic Stroke and Recent Ingestion of Direct Oral Anticoagulants
    American Medical Association (AMA) ; 2023
    In:  JAMA Neurology Vol. 80, No. 3 ( 2023-03-01), p. 233-
    Details
    In: JAMA Neurology, American Medical Association (AMA), Vol. 80, No. 3 ( 2023-03-01), p. 233-
    Abstract: International guidelines recommend avoiding intravenous thrombolysis (IVT) in patients with ischemic stroke who have a recent intake of a direct oral anticoagulant (DOAC). Objective To determine the risk of symptomatic intracranial hemorrhage (sICH) associated with use of IVT in patients with recent DOAC ingestion. Design, Setting, and Participants This international, multicenter, retrospective cohort study included 64 primary and comprehensive stroke centers across Europe, Asia, Australia, and New Zealand. Consecutive adult patients with ischemic stroke who received IVT (both with and without thrombectomy) were included. Patients whose last known DOAC ingestion was more than 48 hours before stroke onset were excluded. A total of 832 patients with recent DOAC use were compared with 32 375 controls without recent DOAC use. Data were collected from January 2008 to December 2021. Exposures Prior DOAC therapy (confirmed last ingestion within 48 hours prior to IVT) compared with no prior oral anticoagulation. Main Outcomes and Measures The main outcome was sICH within 36 hours after IVT, defined as worsening of at least 4 points on the National Institutes of Health Stroke Scale and attributed to radiologically evident intracranial hemorrhage. Outcomes were compared according to different selection strategies (DOAC-level measurements, DOAC reversal treatment, IVT with neither DOAC-level measurement nor idarucizumab). The association of sICH with DOAC plasma levels and very recent ingestions was explored in sensitivity analyses. Results Of 33 207 included patients, 14 458 (43.5%) were female, and the median (IQR) age was 73 (62-80) years. The median (IQR) National Institutes of Health Stroke Scale score was 9 (5-16). Of the 832 patients taking DOAC, 252 (30.3%) received DOAC reversal before IVT (all idarucizumab), 225 (27.0%) had DOAC-level measurements, and 355 (42.7%) received IVT without measuring DOAC plasma levels or reversal treatment. The unadjusted rate of sICH was 2.5% (95% CI, 1.6-3.8) in patients taking DOACs compared with 4.1% (95% CI, 3.9-4.4) in control patients using no anticoagulants. Recent DOAC ingestion was associated with lower odds of sICH after IVT compared with no anticoagulation (adjusted odds ratio, 0.57; 95% CI, 0.36-0.92). This finding was consistent among the different selection strategies and in sensitivity analyses of patients with detectable plasma levels or very recent ingestion. Conclusions and Relevance In this study, there was insufficient evidence of excess harm associated with off-label IVT in selected patients after ischemic stroke with recent DOAC ingestion.
    Type of Medium: Online Resource
    ISSN: 2168-6149
    URL: Article
    DOI: 10.1001/jamaneurol.2022.4782
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2023
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