Introduction: The aim of this study was to assess whether we could distinguish stroke subtype by analyzing the size, weight, shape, color and imaging characteristics of the retrieved thrombus. Methods: From October 2013 to January 2016, 28 thrombi were classified as cardioembolism (CE) and 16 were large artery atherosclerosis (LAD). The size, shape, and color characteristics of the thrombus were analyzed. The weight of total thrombi of each case was measured. The weight, length, and sectional area of the largest thrombus of each case was measured again. We compared the degree of circularity, roundness, aspect ratio, and solidity of the largest thrombus. The color image of the largest thrombus was analyzed by using RGB histograms. Retrieved thrombus was subjected to post-MRI under ex vivo conditions. Results: The probability of stroke due to CE increases as the RBC composition of thrombus increases, and the probability of stroke due to LAD increases as the fibrin composition of thrombus increases (p=0.018). The size of the cross-sectional area of the largest thrombus (22.38 ±21.48mm2 vs. 12.15±10.86mm2, p=0.043) is larger in the CE group. Also, the weight of total thrombi (140.00±231.39mg vs. 37.50± 30.31mg, p=0.049) and the weight of the largest thrombus (46.14±47.34mg vs. 17.94±16.89mg, p=0.013) is heavier in the CE group. Higher RGB values in the LAD group mean that the thrombus of the LAD group is brighter than the thrombus of the CE group. In multivariate logistic regression analysis, the mean Green value of RGB (OR 1.488, 95% CI 1.032-2.146; p= 0.033) was independently associated with LAD. Blooming artifacts of the post-MRI under ex vivo conditions well correlate with that of the pre-MRI (p=0.016), and blooming artifacts of the post-MRI under ex vivo conditions was associated with red blood cell composition of thrombus (p=0.005). Conclusions: The shape of the thrombus did not help to determine the stroke subtype. The weight, cross-sectional area, and color difference of the thrombus helped to distinguish CE and LAD, and the mean Green value of RGB was found to be the most significant predictor. And blooming artifacts of the post-MRI under ex vivo conditions was well correlated with that of the pre-MRI and red blood cell composition of thrombus.
Introduction Sarcopenia, characterized by reduced skeletal muscle mass (RMM), is increasingly recognized as a significant factor influencing outcomes in various health conditions, including stroke. Although most studies focus on sarcopenia developing during stroke rehabilitation, the impact of sarcopenia present at the onset of acute ischemic stroke remains underexplored. This study aims to evaluate the effect of RMM at stroke onset on 3-month functional outcomes in acute ischemic stroke patients. Materials and methods We prospectively enrolled acute ischemic stroke patients admitted between May 2019 and December 2019. Muscle mass was accessed early during hospitalization using whole-body dual-energy X-ray absorptiometry (DXA), and patients were categorized into RMM and normal muscle mass (NMM) groups based on the Asian Working Group for Sarcopenia (AWGS) criteria. Functional outcomes at 3 months were assessed using the modified Rankin Scale (mRS), with unfavorable outcomes defined as mRS scores 2–5. Multivariable logistic regression and SHAP (Shapley Additive exPlanations) analyses were used to evaluate the independent impact of RMM on 3-months functional outcomes. Results A total of 99 patients were analyzed. The RMM group had a significantly higher prevalence of unfavorable outcomes at 3 months compared to the NMM group (p < 0.001). Patients with RMM were older and presented with more severe strokes. Multivariable analysis confirmed RMM as an independent predictor of unfavorable outcomes (adjusted OR: 8.07, 95% CI: 1.603–40.66, p = 0.011), even after adjusting for age and initial stroke severity. SHAP analysis ranked RMM as the second most influential predictor of unfavorable outcomes, following NIHSS on admission. These findings indicate that RMM not only worsens initial stroke severity but also independently hinders post-stroke recovery. Conclusions Reduced muscle mass at the onset of acute ischemic stroke is a significant, independent predictor of unfavorable outcomes at 3 months. In addition to its impact on recovery, RMM is linked to older age and more severe strokes, worsening prognosis. Maintaining muscle mass is also crucial for stroke prevention, as it supports cardiovascular health and resilience. Early identification and intervention for sarcopenia can improve recovery and reduce future stroke risk.
Background: Chronic kidney disease (CKD) increases risk of cardiovascular diseases, which might be mediated by facilitation of atherosclerosis. However, impact of CKD on progression of atherosclerosis has not been fully evaluated, and we sought to investigate associations between CKD and extent of carotid atherosclerosis. Methods: Between January 2009 and February 2013, we enrolled a consecutive series of 147 CKD patients and compared the same number of age, sex and vascular risk factor-matched 147 control subjects who visited our hospital during the same period. Carotid atherosclerosis was examined with MR angiography of internal carotid artery (ICA). The degree of stenosis of the internal carotid artery (ICA) in each patient was classified into 5 grades; (1) normal; (2) mild (<50%); (3) moderate (50-69%) ;(4) severe (70-99%); (5) occlusion. Results: Mean age of the subjects was 72.2±8.7 years, and 208 were male (70.7%) among the total of 294 subjects. Significant stenosis of ICA (stenosis more than 50%) was more prevalent in CKD patients [odds ratio (OR) 6.7; 95% confidence interval (CI) 2.2-20.4, p=0.001). The presence of CKD was an independently risk factor for increasing the severity of stenosis of ICA (mild, OR 4.5, 95% CI 2.0-10.2; moderate, OR 3.9, 95% CI 1.3-22.4; severe, OR 12.0, 95% CI 4.3-34.6; occlusion, 14.1, 95% CI 2.1-92.2). Conclusion: In the current case-control study, we found that CKD is associated with incidence of significant carotid stenosis and increases the severity of carotid stenosis. Our results indicate that CKD should be treated as a new risk factor for carotid atherosclerosis.
Background Choriocarcinoma is a subtype of gestational trophoblastic disease (GTD) that can spread to multiple organs, including the central nervous system. Most cases of GTD affecting the central nervous system can cause intra- or extra-axial hemorrhages. Herein, we describe a rare case of multiple embolic infarctions and intracranial hemorrhages in a patient with GDT. Case Report A 36-year-old woman with sudden headache and right homonymous hemianopsia was admitted to our hospital 19 hours from symptom onset. Brain magnetic resonance imaging revealed small acute infarctions in the territories of the left posterior cerebral artery and both middle cerebral arteries. Furthermore, intracerebral hemorrhage in the left occipital lobe, small amounts of intraventricular hemorrhage, and subarachnoid hemorrhage were observed. In the past, she gave birth to her child through cesarean section 6 months ago. D-dimer level was elevated with a value of 1.61 µg/mL (reference range <0.5 µg/mL). Her urine beta-human chorionic gonadotropin (hCG) was positive, and her serum beta-hCG level was >1,000 IU/mL. She was diagnosed with GTD and underwent chemotherapy. Conclusion The precise pathogenesis of the coexistence of multiple embolic infarctions and intracranial hemorrhage remains unclear. Cancer-related coagulopathy, micro-tumor emboli, or both could be involved in the pathogenesis of the rare presentation of this patient. Key Words: Gestational trophoblastic disease; Stroke; Intracranial hemorrhage
Background and purpose: Warfarin is one of the most important prevention drugs against ischemic stroke. Factors influencing on warfarin adherence in patients with atrial fibrillation have been investigated. However, few studies have elaborated on the significance and related factors of warfarin adherence in patients with ischemic stroke or transient ischemic attack (TIA). Methods: A total of 46,219 patients with ischemic stroke or TIA were enrolled from October 2007 through December 2011 in Clinical Research Center for Stroke as a nationwide project in Korea. The morality information of all patients was based on computerized searches of death certificate data from the “Statistics Korea” of the Korean National Statistical Office, and the whole drug information was obtained from the Health Insurance Review Assessment and Review Service in Korea. Among them, warfarin was prescribed for 5,660 patients over 6 months. Warfarin adherence was defined as % adherence = (n of days’ supply) / (actual n of days to refill) х 100. Nonadherence was defined as < 80% adherence. We censored the mortality data on 31 December 2012. Results: From 5,660 patients using warfarin over 6 months, 801 patients (14.2%) were included in nonadherence group. The factors related to nonadherence for warfarin ware theses: old age, increased stroke severity, and the presence of diabetes or hyperlipidemia. Based on Cox regression analysis, compared with good adherence group, the adjusted hazard ratio (HR) of the nonadherence group for all-cause of mortality were 1.46 (95% confidence interval, 1.24 – 1.72) after controlling old age, stroke severity, and the presence of diabetes, hypertension, hyperlipidemia, and smoking. The presence of diabetes also predicted all-cause death after stroke independently in patients using warfarin over 6 months (adjusted HR, 1.28 ; 95% confidence interval, 1.10 – 1.49). Conclusion: Our study demonstrated that nonadherence for warfarin is independent predictor of all-cause death after ischemic stroke or TIA from nationwide multicenter follow-up study. The related factors to nonadherence for warfarin were old age, increased stroke severity, and the presence of diabetes or hyperlipidemia.
The presence of primary intraventricular hemorrhage (IVH) without vascular lesion is very rare. We experienced solitary IVH without subarachnoid hemorrhage due to aneurysmal rupture in a 58-year-old man treated with coil embolization, which contributed to his good prognosis. After 33 days of hospitalization, he had mild right hemiplegic symptoms remaining, and he was transferred to a rehabilitation institute for further treatment. In cases of primary IVH, computed tomography angiography seems worthwhile for making a differential diagnosis, although the possibility of IVH due to cerebral aneurysmal rupture is very low. Endovascular intervention is a good option for diagnosis and treatment. Keywords: Cerebral angiography, Intraventricular hemorrhage, Intracranial aneurysm, Endovascular procedures, Subarachnoid hemorrhage
Background Intracranial artery dissection (IAD) may be an underdiagnosed cause of large vessel occlusion. The safety and efficacy of intra-arterial therapy (IAT) in patients with IAD are largely unknown. We report the case of a patient with IAD who was successfully treated with IAT. Case Report A 27-year-old man with a sudden-onset sensory dominant aphasia was admitted to our hospital around 16 hours after disease onset. Brain magnetic resonance angiography revealed an occlusion in the left distal middle cerebral artery (MCA). On the susceptibility-weighted imaging, bead-shaped dark signals were observed in the left MCA bifurcation, and intramural hematoma was suspected. We performed thrombectomy and permanent stenting for the dissecting MCA occlusion and achieved complete recanalization. Conclusion The IMH on susceptibility-weighted imaging led us to suspect that the large vessel occlusion was due to the IAD. Further research is needed to address the efficacy and safety of IAT in patients with IAD. Key Words: Middle cerebral artery; Blood vessel dissection; Thrombectomy
Background and purpose The occurrence of stroke in cancer patients is caused by conventional vascular risk factors and cancer‐specific mechanisms. However, cryptogenic stroke in patients with cancer was considered to be more related to cancer‐specific hypercoagulability. In this study, we investigated the potential of the D‐dimer level to serve as a predictor of early neurologic deterioration ( END ) in cryptogenic stroke patients with active cancer. Methods We recruited 109 cryptogenic stroke patients with active cancer within 72 h of symptom onset. We defined END as an increase of ≥1 point in the motor National Institutes of Health Stroke Scale ( NIHSS) score or ≥2 points in the total NIHSS score within 72 h of admission. After adjusting for potential confounding factors in the multivariate analysis, we calculated the odds ratios ( OR s) and confidence intervals ( CI s) of D‐dimer in the prediction of END . Results Among 109 patients, END events were identified in 34 (31%) patients within 72 h. END was significantly associated with systemic metastasis, multiple vascular territory lesions on the initial magnetic resonance imaging ( MRI) , initial NIHSS score and D‐dimer levels. In the multivariate analysis, the D‐dimer level (adjusted OR , 1.11; 95% CI , 1.04–1.17; P < 0.01) and initial NIHSS score (adjusted OR , 1.08; 95% CI , 1.01–1.15; P = 0.03) predicted END after adjusting for potential confounding factors. In the subgroup analysis of 72 follow‐up MRI s, D‐dimer level was also correlated with new territory lesions on the follow‐up MRI in a dose‐dependent manner. Conclusion Ischemic stroke patients with active cancer and elevated D‐dimer levels appear to be at increased risk for END recurrent thromboembolic stroke.
'%3e%3cg id='b'%3e%3cpath id='a' stroke='%23000' stroke-width='2' d='M-6-25H6m-12 3H6m-12 3H6'/%3e%3cuse xlink:href='%23a' y='44'/%3e%3c/g%3e%3cpath stroke='%23fff' d='M0 17v10'/%3e%3ccircle r='12' fill='%23cd2e3a'/%3e%3cpath fill='%230047a0' d='M0-12A6 6 0 0 0 0 0a6 6 0 0 1 0 12 12 12 0 0 1 0-24z'/%3e%3c/g%3e%3cg transform='rotate(-123.69)'%3e%3cuse xlink:href='%23b'/%3e%3cpath stroke='%23fff' d='M0-23.5v3M0 17v3.5m0 3v3'/%3e%3c/g%3e%3c/svg%3e)
'%3e%3ccircle r='120' fill='%230f47af'/%3e%3cg id='a'%3e%3cpath fill='%23fcdd09' d='m0-96-4.206 12.944 17.348 53.39h-23.13l-2.599 8h74.163l11.011-8H21.553z'/%3e%3cpath stroke='%23fcdd09' stroke-width='4' d='m25.863-35.597 30.564-42.069'/%3e%3c/g%3e%3cuse xlink:href='%23a' transform='rotate(72)'/%3e%3cuse xlink:href='%23a' transform='rotate(144)'/%3e%3cuse xlink:href='%23a' transform='rotate(216)'/%3e%3cuse xlink:href='%23a' transform='rotate(288)'/%3e%3c/g%3e%3c/svg%3e)
