• Journal of Korean Neurosurgical Society
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• v.47 no.4
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• pp.258-264
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• 2010

Objective : The objectives of this study were to analyze the outcome and hemorrhagic risk of intravenous (IV) argatroban in patients with acute ischemic stroke presenting beyond six hours of ischemic symptom onset. Methods : Eighty patients with acute ischemic stroke who were admitted to the hospital beyond six hours from ischemic symptom onset were retrospectively analyzed. We could not perform IV thrombolysis or intra-arterial thrombolysis because of limited time window. So, IV argatroban was performed to prevent recurrent thrombosis and progression of infarcted area. The outcome was assessed by the National Institute of Health Stroke Scale (NIHSS) score and related hemorrhagic risk was analyzed. Also, each outcome was analyzed according to the initial stroke severity, subtype, and location. Results : The median NIHSS was 8.0 at admission, 4.1 upon discharge, and 3.3 after three months. A good outcome was achieved in 81% of patients upon discharge and 88% after three months. Symptomatic hemorrhage occurred in only two patients (3%). IV argatroban was effective regardless of initial stroke severity, subtype, and location. Conclusion : IV argatroban may be an effective and safe treatment modality for acute ischemic stroke presenting beyond six hours of ischemic symptom onset.

• The Journal of the Society of Stroke on Korean Medicine
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• v.9 no.1
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• pp.14-18
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• 2008

Objectives : This study was done to investigate the relationship of differentiation of the patten identification in stroke patients between acute and convalescent stage. Methods : In the time of period Apr. 1st 2007 to Sep. 29th 2008, 903 patients with stroke admitted in the department of Internal Medicine of Kyungwon University Oriental Medical Hospital, Kyunghee University Oriental Medical Hospital, Dongguk University Oriental Medical Hospital were included. Patients were hospitalized within a month after the onset of stroke. Stroke patients were interviewed by doctors who studied standard operation procedures. A questionnaire was completed by a question-and-answer form between patients and doctors after explanation details to patients and the agreement of patients. Results : The frequency of fire-heat patten was the highest in acute stage of stroke and the one of deficiency of Yin group was the highest in convalescent stage of stroke. This result doesn't have statistical significance. (p<0.05) Conclusions : In this study, we found the relationship of differentiation of the patten identification in stroke patients between acute and convalescent stage. Further, we have concluded that this difference should be considered in the management for stroke patients.

• Journal of Neurocritical Care
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• v.11 no.2
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• pp.102-109
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• 2018

Background: A sians were known to have a relatively lower incidence of venous thromboembolism (VTE), and there is insufficient evidence to suggest a specific D-dimer threshold level for screening VTE in patients with acute stroke. Methods: We prospectively enrolled patients with acute ischemic stroke admitted to Jeju National University Hospital. The inclusion criteria were: 1) aged ${\geq}18$ years, 2) admission within seven days of symptom onset, and 3) an initial National Institute of Health Stroke Scale (NIHSS) score >1 for the affected lower limb. Ultrasound scans of the lower limbs and plasma D-dimer assays were performed on days 7-14 and 15-28 after stroke onset. Results: Of 285 patients admitted during the study period, 52 patients met inclusion criteria (mean age 74.5, male 40.4%, median initial NIHSS score 12, and unable to walk unassisted at discharge 76.9%). During 7-14 days, 23 of 52 patients (44.2%) had a D-dimer level above 1.57 mg/L, and 9.6% had a level above 5.50 mg/L. Proximal deep vein thrombosis (DVT) was detected in 3 patients (5.8%, 95% confidence Interval 1.2-16.0%) on ultrasound examination. All DVTs were found in elderly female patients with severe leg weakness. No patient was diagnosed with pulmonary embolism during the study period. Conclusion: The incidence of VTE seems to be very low among Korean patients with acute ischemic stroke. Advanced age, female sex, and severe leg weakness were important risk factors for developing DVT in this study.

• Journal of Korean Neurosurgical Society
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• v.45 no.6
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• pp.360-368
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• 2009

Objective : The objectives of this study were to analyze the recanalization rates and outcomes of multimodal therapy that consisted of sequential intravenous (IV)/intra-arterial (IA) thrombolysis, mechanical thrombolysis including mechanical clot disruption using microcatheters and microwires, balloon angioplasty, and stenting for acute ischemic stroke, and to evaluate the prognostic factors related to the outcome. Methods : Fifty patients who were admitted to the hospital within 8 hours from ischemic symptom onset were retrospectively analyzed. Initial IV thrombolysis and subsequent cerebral angiography were performed in all patients. If successful recanalization was not achieved by IV thrombolysis, additional IA thrombolysis with mechanical thrombolysis, including balloon angioplasty and stenting, were performed. The outcomes were assessed by the National Institute of Health Stroke Scale (NIHSS) change and modified Rankin scale (mRS) and prognostic factors were analyzed. Results : Successful recanalization was achieved in 42 (84%) of 50 patients, which consisted of 8 patients after IV thrombolysis, 19 patients after IA thrombolysis with mechanical clot disruption, and 15 patients after balloon angioplasty or stenting. Symptomatic hemorrhage occurred in 4 (8%) patients. Good outcomes were achieved in 76% and 70% of patients upon discharge, and 93% and 84% of patients after 3 months according to the NIHSS change and mRS. The initial clinical status, recanalization achievement, and presence of symptomatic hemorrhage were statistically related to the outcomes. Conclusion : Multimodal therapy may be an effective and safe treatment modality for acute ischemic stroke. Balloon angioplasty and stenting is effective for acute thrombolysis, and produce higher recanalization rates with better outcomes.

• Journal of Korean Physical Therapy Science
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• v.29 no.3
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• pp.1-11
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• 2022

Background: The aim of this randomized controlled pilot study was to determine the effect of trunk training in wheelchair on fall efficacy, fall risk and activities of daily living in acute stroke patients. Design: Randomized controlled pilot trial. Methods: The study included 18 patients with acute stroke who were randomly allocated to an experimental group (EG) (n=9) and a control group (CG) (n=9). Patients in the EG group received general rehabilitation therapy combined with trunk training in wheelchair for 20min, whereas CG group received general rehabilitation therapy combined with bicycle training for 20min. Both groups performed the exercise 5 times a week for 3 weeks. Outcomes were assessed using Korean-Fall Efficacy Scale (K-FES), Fullerton Advanced Balance Scale (FAB) and Korean-Modified Barthel Index (K-MBI). Results: After 3 weeks of training, both groups showed significantly improved K-FES, FAB and K-MBI (p<.05 in both groups). However, the K-FES, FAB and K-MBI in the experimental group was significantly improving than in the control group (p<.05). Conclusion: These findings indicate that trunk training in wheelchair may be effective at decreasing fall risk and improving activities of daily living in acute stroke patients. Therefore, trunk training in wheelchair may be recommended as an intervention in reducing the incidence of fall risk in acute stroke patient.

• Journal of muscle and joint health
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• v.20 no.1
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• pp.22-30
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• 2013

Purpose: The International Classification of Functioning, Disability and Health (ICF) model was proposed by the World Health Organization for enhancing interdisciplinary communication. The purpose of this study was to examine the functional status of acute stroke patients using ICF core sets-short form. Methods: A set of 15 ICF items on functional status was used by nurses for their daily nursing assessment on functional status in 44 acute stroke patients in a university hospital. Results: The highest level of function was "consciousness", while the lowest was "defecation". Compared with functional status on the first day, consciousness, ingestion, language (mental), and defecation functions were significantly improved on the 14th day. However, there was no significant changes in items on activity and participation or environmental functions. Conclusion: These findings suggest that the function-specific nursing interventions for acute stroke patients need to be developed. Future research needs to test the usefulness of ICF items as an measurement tool.

• Korean Journal of Clinical Laboratory Science
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• v.46 no.4
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• pp.143-149
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• 2014

Pulse wave velocity (PWV) is used to non-invasively estimate the severity of arteriosclerosis by measuring the patient's arterial stiffness comparing with each normal reference range according to their ages. Increased arterial stiffness is closely related to both atherosclerosis and arteriosclerosis, which have been known for causes of cardiovascular disease and stroke, also negatively affects the prognosis and the re-occurrence in patients with stroke. The study is focused on how brachial-ankle pulse wave velocity (baPWV) is related to cardiovascular disease risk factors in patients with acute stroke. There were 114 subjects, 69 males and 45 females, all in their 60's and had PWV test for acute stroke. The results are as follows: the group with increased arterial stiffness showed significant increase in HbAlc, total cholesterol, RSBP (resting systolic blood pressure), CSBP (central systolic blood pressure) and CDBP (central diastolic blood pressure). Cross tabulation test showed that there was a significant relationship only between the group with increased arterial stiffness and diabetes mellitus (DM). Therefore, it might be useful for preventing re-occurrence and making a favorable prognosis to promptly adjust DM and hypertension-related risk factors in patients with acute stroke.

• The Journal of the Convergence on Culture Technology
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• v.5 no.1
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• pp.417-428
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• 2019

The aims of this study were to evaluate the prevalence of dysphagia in patients hospitalized with acute stroke and to identify factors associated with dysphagia. The study was conducted in a tertiary hospital and a total of 131 patients hospitalized with acute stroke (aged 34-92 years old, 58.0% male) were enrolled. The prevalence of dysphagia was 24.4% out of 131 participants and risk factors associated with dysphagia were age, neurological severity, oral health status, and dependence in activity of daily living of participants. Considering the long-term rehabilitation trajectory, it is necessary to apply the early screening and preventive nursing intervention for dysphagia during acute stage of stroke patient.

• Journal of Neurocritical Care
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• v.11 no.2
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• pp.86-92
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• 2018

Background: A delay of transfer for patients with acute stroke needing emergent revascularization is a huge hurdle for efficacy of revascularization. The objective of this study was to investigate changes of transportation time calculated by image to door (ITD) time (from checking brain images at first contact hospital to arriving at our emergency center) before and after 2015. Methods: This study was performed in a retrospective manner from 2013 into 2017. Acute ischemic stroke (AIS) patients having intravenous thrombolysis and/or mechanical thrombectomy during the observation period were enrolled. Among them, those who had revascularization under 'Drip-and-Ship' or 'Ship-and-Drip' paradigm were selected. Results: During the observation period, 225 patients were treated under 'Drip-and-Ship' or 'Ship-and-Drip' paradigm. Twenty-three were excluded due the lack of detailed data. Among 202 patients, 73 and 129 were treated under Drip-and-Ship and Ship-and-Drip paradigms, respectively. In 2013, 35 patients from 18 hospitals (median distance, 25 km) were transferred to our regional stroke center and their median ITD time was 116 minutes. It was gradually decreased after 2015. In 2017, ITD time was significantly (P<0.01) shortened to 85 minutes without significant changes in transfer distance. The median onset to puncture time was also significantly (P=0.03) decreased from 365 minutes in 2013 to 270 minutes in 2017. Conclusion: Our results implicate that many hospitals in our stroke region might have recognized the importance of rapid transportation for AIS after 2015.

• Journal of Korean Neurosurgical Society
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• v.64 no.5
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• pp.763-775
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• 2021

Objective : Hemorrhagic transformation (HT) can be occurred after acute cerebral infarction. HT can worse symptoms in severe cases and adversely affect long-term prognosis. As bone and vascular smooth muscle are composed of type 1 collagen, we aimed to identify a potential relationship between bone mineral density (BMD) and HT after acute cardioembolic stroke. Methods : As an indicator of BMD, we used mean frontal skull Hounsfield unit (HU) values on brain computed tomography (CT). Multivariative hazard ratios were calculated using Cox regression analysis to identify whether the osteoporotic condition was an independent predictor of HT after acute cardioembolic stroke. Results : This 11-year analysis enrolled 506 patients who diagnosed as acute cardioembolic infarction. The first tertile of skull HU value was an independent predictor of HT development compared to the third tertile (hazard ratio, 2.12; 95% confidence interval, 1.13-3.98; p=0.020). We observed no interactions between age and skull HU with respect to HT statistically. Conclusion : The results of this study revealed an association between osteoporotic conditions and HT development after acute cardioembolic stroke. A convenient method to measure the cancellous bone HU value of the frontal skull using brain CT images may be useful for predicting HT in patients with acute cerebral infarction.