• The Journal of the Society of Stroke on Korean Medicine
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• v.18 no.1
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• pp.55-65
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• 2017

■ Objectives Atrial fibrillation is the most common cause of cardioembolic stroke. Of the 44 ischemic stroke patients with atrial fibrillation who were hospitalized in hospital of Korean Medicine from July 1, 2014 to June 30, 2017, we selected 39 patients who have had Magnetic Resonance Angiography. We divided them into Atrial Fibrillation group with no stenosis or less than 50% stenosis in the ipsilateral artery of the lesion and Artery to Artery Embolism group with more than 50% stenosis or occlusion in the ipsilateral artery of the lesion. ■ Methods Clinical characteristics, examination and evaluation tools were collected from the patient's electronic medical records. CHADS2, Initial National Institutes of Health Stroke Scale, 8-item Stroke Scale and Improved 8-item Stroke Scale Number were checked. ■ Results & Atrial Fibrillation group showed differences in age, brain lesion location, vascular lesion, Conclusion initial National Institutes of Health Stroke Scale, initial 8-item Stroke Scale and progress compared to Artery to Artery Embolism group.

• The Journal of Korean Physical Therapy
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• v.24 no.6
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• pp.423-427
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• 2012

Purpose: The cerebellum is a region of brain structure that plays an important role in calibrating two different information of neural signal from descending motor commands and from ascending sensory inputs. Damage of the cerebellum shows a variety of classic motor symptoms such as postural and locomotor dysfunctions. Therefore, we tried to investigate motor function and skill in stroke patients with cerebellar lesions in sub-acute stage, and compare with these functions of patients with non-cerebellar lesions. Methods: Total twelve stroke patients with cerebellar lesion and 130 stroke patients with non-cerebellar lesions were retrospectively recruited in this study. For evaluation of motor strength, Motricity index (MI) for upper and lower limbs was tested. For measurement of motor skill function, the modified Brunnstrom classification (MBC), Manual function test (MFT), functional ambulatory category (FAC), and Barthel index were adopted. Results: In comparison of motor strength and motor skill function between two groups, statistical differences between the two groups were significantly observed only in upper MI and FAC. Although no significant differences were found in other variables, stroke patients with cerebellar lesion had higher scores in lower and total MI, MBC, and MFT, whereas they had lower scores in FAC and Barthel index. Conclusion: Our results showed that stroke patients with cerebellar lesion had greater impact on movement functions related to hand motor and walking ability in activities of daily life, compared with patients with non-cerebellar lesion, in spite of similar degree of motor function and skill between the two different lesioned-groups.

• Perspectives in Nursing Science
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• v.2 no.1
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• pp.76-91
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• 2005

Stroke patients often develop post stroke sequelae when they survive. Post stroke fatigue and emotional disturbances including depression are common along with motor dysfunction. However, medical personnel have paid relatively little attention to emotional changes and the presence of fatigue following strokes. Post-stroke fatigue was common, occurring in 57% of the patients in our series. The post-stroke fatigue appears to be related to the pre-stroke fatigue, physical disability and post stroke depression (PSD) although the relation to the lesion location remains elusive. The prevalence of post-stroke emotional disturbance has been reported to range from 12% to 64%. The wide variation in the frequency of post stroke depression may be related to methodological heterogeneity in items such as the criteria for depression, the timing of assessment, and the study population. Emotional incontinence, which is characterized by inappropriate or excessive laughing or crying is also common. The incidence of and factor related to this post-stroke emotional incontinence (PSEI) also remains unclear. We reported that out-patients with single, unilateral stroke, 18% had PSD and 34% had PSEI. Although both PSD and PSEI were related to motor dysfunction and location (anterior vs. posterior cortex) of the lesion, the latter was a stronger determinant for PSD. PSEI was more closely associated with subcortical strokes than was PSD. Another manifestation of post stroke patients is the occurrence of post stroke anger proneness (PSAP). They may become easily irritated, impulsive, less generous, and prone to be angry or aggressive at others. We also have reported the PSAP which seems to be closely associated with the presence of PSEI. The lesion distribution appears to be also similar. Both PSEI and PSAP respond well to serotonin reuptake inhibitors suggesting that these symptomsmay be possibly related to the alteration of serotonin after brain injury. Likewise, PSAP also produces a great deal of frustration and embarrassment among patients and caregivers. In summary, emotional disturbances such as depression, emotional incontinence, anger-proneness and fatigue are fairly common but under-recognized sequelae of stroke. These emotional disturbances decrease the quality of life of the patients and caregivers, and may adversely affect the overall prognosis. Therefore, these problems must be appropriately recognized and alleviated. Finding strategies to relieve the symptoms is imperative by understanding the causative factors in individual patient.

• The Journal of Internal Korean Medicine
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• v.28 no.4
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• pp.808-815
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• 2007

Objectives : This study investigated stroke lesions and their relationship with warning signs and risk factors in stroke patients. Methods : Three hundred fifty-three stroke patients were recruited at the Department of Cardiovascular and Neurologic Diseases (stroke center) of Kyung Hee University Oriental hospital from October 2005 to July 2007. We evaluated their stroke lesions with brain MRI, their warning signs, and risk factors. Results : 353 subjects were included in the final analysis. The frequency of diabetes was found more in presence of brain stem lesion than without. The cortex lesion showed a close relationship with smoking, drinking and the frequency of one side paralysis or weakness. These were more common in males than in females. Conclusions : We observed stroke lesions and their characteristics in stroke patients. The subjects' brain lesions seemed affectedby the risk factors. A concrete conclusion can hardly be drawn from this study; additional research is necessary.

• Journal of Korean Biological Nursing Science
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• v.11 no.1
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• pp.23-31
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• 2009

Purpose: The purpose of the present study was to investigate the prevalence and related factors of sleep-wake disturbance (SWD) in Korean post-stroke patients. This study was the first to address post-stroke SWD in Korea using a structured questionnaire. Method: We investigated the prevalence of SWD and related factors including lesion location, stroke severity, presence of depression and fatigue. We assessed sleep-wake pattern including quality of sleep, sleep latency, wake episodes, wake time after sleep onset, daytime sleep episode and sleep time at daytime. Ninety stroke patients admitted to a university affiliated hospital in Seoul between the period September 2008 and January 2009 were included in the study. Result: Thirty five patients (38.9%) complained insomnia and 32 (35.6%) complained excessive daytime sleepiness (EDS). Quality of sleep (p=.000), sleep latency (p=.000) and total sleep time (p=.001) were significantly poorer in 16 patients with both insomnia and EDS than in the others. The related factors to insomnia were level of education (p=.030), depression (p=.007) and fatigue (p=.034), though related factors to EDS were stroke onset time (p=.049), stroke severity (p=.005), motor dysfunction (p=.035), dysphasia (p=.018), fatigue (p=.001) and lesion location (p=.019). Conclusion: Sleep-wake disturbance is a common problem in Korean stroke patients. Strategies to improve quality of sleep are urgently needed in the post-stroke patients.

• The Journal of Korean Medicine
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• v.23 no.2
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• pp.180-189
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• 2002

Background and Purpose : The hemiplegic upper extremity is affected in many stroke patients, and recovery is often poor. The purpose of this study was to assess the efficacy of electroacupuncture (EA) in enhancing the upper extremity motor and functional recovery of ischemic stroke patients. Subjects and Methods : Forty ischemic stroke patients (the upper extremity Fugl-Meyer motor scale (FM) score lower than 46, lesion location within middle cerebral artery territory) within 2 weeks of stroke onset were randomly allocated to either an EA group that received EA treatment or a control group that received only routine ward care. The EA was applied at Quchi-Shousanli (LI11-LI10), Waiguan-Hegu (TE5-LI4) points on the hemiparetic side six times per week for 4 weeks. The frequency of stimulation was 25-50Hz and the intensity was set at a level sufficient to induce muscle contraction. EA treatment was given for 30 minutes and all patients of both groups received standard rehabilitation program. Outcomes were assessed, in a blind manner, before treatment began and at 4 weeks after treatment, with the FM, the Motor Power score (MP) for shoulder/elbow, and the subsection of the Modified Barthel Index (MBI) for drinking/feeding/dressing upper body/grooming. Results : These 2 groups had comparable clinical characteristics, lesion location, lesion size, and pretreatment impairment scores. By the end of treatment, the EA group showed significantly more improvement than the control group in the subsection of the FM for shoulder/elbow/coordination (6.4 vs. 3.7; P=0.047) and the MP for shoulder/elbow (5.3 vs. 3.3; P=0.008). The subsection scores of the MBI for drinking/feeding/dressing upper body/grooming were not significantly different between two groups. No adverse effects due to treatment were found Conclusion : These results suggest that EA enhances the upper extremity motor recovery of acute stroke patients. However, this study failed to demonstrate any significant functional benefit related with upper extremity. Future study should be carried out in a larger sample size and use the functional outcome measure that is more specific and sensitive to the upper extremity.

• Speech Sciences
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• v.12 no.2
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• pp.101-108
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• 2005

Apraxia of phonation (AOP) has often been described as a feature of apraxia of speech or of severe non-fluent type of aphasia. Pure AOP is rare and, to our knowledge, only two cases have been reported. Brain lesion sites of the reported cases were not those sites known to be responsible for apraxia of speech. This study presents a case of AOP which resulted from the secondary stroke in the left corona radiata immediately following the first stroke in the left temporoparietal lobe. A 61-year old right-handed man shwoed a global type of aphasia after the first cerebral infarction, but was able to generate spontaneously some short fragments of speech. On the day after the first infarction, he suffered from the secondary infarction, leaving him a complete loss of voluntary phonation. He did not showed any significant change in language functions. Several occurrences of involuntary phonation were observed upon laughing or crying. He was also able to cough unintentionally. A vidoe-stroboscopic examination failed to reveal any evidence of structural and functional impairment in larynx. Although this case is not of pure form of AOP, AOP appeared after the secondary stroke without significant changes of language impairment since the first stroke. Therefore, AOP may be a consequence of the brain lesion from the secondary stroke even though we cannot rule out the possibility of an additive effect of the secondary to the first stroke.

• The Journal of Internal Korean Medicine
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• v.26 no.2
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• pp.353-359
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• 2005

Objectives: Dysphagia is a common in stroke patients. Dysphagia often affects the rehabilitation of stroke patients by increasing the risk of nutritional deficits and aspiration pneumonia. Despite the proliferation of physical therapies including swallowing training, much controversy remains regarding the application and benefit of them. Therefore, in this study, the clinical effect of moxibustion at Chonjung(CV17, Shanzhong) on post-stroke dysphagia were assessed using Swallowing Provocation Test(SPT). Methods: Dysphagia subjects were selected by Dysphagia Screening Test. Swallowing function was tested by Swallowing Provocation Test(sec). Direct moxibustion was applied to the acupoint, Chonjung, five times and Swallowing Provocation Test was performed before and after 30 minute. The Latency Time of Swallowing Reflex (LTSR) was checked by SPT. To find factors related with improving swallowing function, Cold-Heat and Excess-Deficiency Diagnosis were considered. Results: A total of 42 patient were included, but two of them were excluded due to severe coughing. Overall, the swallowing reflex improved significantly. In subgroup analysis on brain lesion, non-brain stem lesion patients significantly improved. Moxibustion was more effective in the cold group than in the heat group, but there were no differences between the Excess and the Deficiency groups. Conclusions: The result of this clinical study suggest that moxibustion at Chonjung(CV17, Shanzhong) is an effective treatment for the dysphagia patients after stroke, especially in non-brain stem lesion and the cold diagnosed patients.

• Annals of Rehabilitation Medicine
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• v.41 no.6
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• pp.924-934
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• 2017

Objective To investigate the anatomical correlates of the neuropsychological deficits in patients with the cerebellar stroke. Methods We screened patients who were admitted to the National Rehabilitation Center with the cerebellar stroke between October 2012 and November 2016. The patients with the cerebellar stroke who underwent neuropsychological testing for which the Seoul Neuropsychological Screening Battery (SNSB) or the SNSB-II were enrolled. The neuropsychological function capacities were compared in accordance with the stroke type (hemorrhagic vs. ischemic) and the location (right/left anterior, right/left posterior intermediate, right/left posterior lateral lobe, and vermis). Mean z-scores were computed to compare the patient performances with the population averages. Results Twenty-six patients (15 with ischemic stroke and 11 with hemorrhagic stroke) with a mean age of $54.8{\pm}16.6$ years were assessed $8.8{\pm}9.2$ months after the stroke. Differences in the neuropsychological functioning according to the stroke type were not observed. All of the numerical subtests of the stroke patients showed significantly poorer performances compared with the population averages (mean z-score <0), and some of the subtests revealed abnormal performances in attention-, visuospatial function-, memory-, and frontal/executive function-related tasks (mean z-score <-1). The patients with the presence of a lesion in the right posterior intermediate lobe of the cerebellum showed a poorer performance in the subtests evaluating the executive function including the Korean-version Stroop Test (p=0.04), the Digit Symbol Coding Test (p=0.01), and the Korean-version Trail Making Test (p=0.02) compared with the patients without that lesion. Conclusion The present study confirms that the cerebellar stroke affects the neuropsychological functioning which is associated with the anatomical site of stroke.

• Annals of Clinical Neurophysiology
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• v.7 no.2
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• pp.75-79
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• 2005

Vestibular evoked myogenic potentials (VEMP) have been known to useful in documenting abnormality in patients with various vestibular disorders but the studies of VEMP in stroke patients are rare. We recorded VEMP in 17 consecutive patients with acute ischemic stroke in the brainstem lesions. All patients underwent magnetic resonance imaging and we compare VEMP results with the lesion documented by brain imaging. VEMP were defined to be abnormal when they were very asymmetrical (one is 2 times of more as large as the other), or absent in one side. VEMP abnormalities were found in 71%(12/17) of acute infarction patients with brainstem lesions. Most abnormalities found in the ipsilateral side of the lesion(9/12) but abnormalities in contralateral side of lesion were found in 25%(3/12) of patients.VEMP would be considered a useful complementary neurophysiological tool for the evaluation of brainstem dysfunction in acute stroke patients.