일과성 전뇌허혈의 모래쥐 모델에서 저 용량 Riluzole의 신경보호효과에 관한 연구

학위논문(석사)--서울대학교 대학원 :의학과 신경과학전공,2000.Maste

Etiology and Mechanism of Posterior Circulation Stroke

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경두개 초음파의 다양한 임상적 응용

1982년 cerebral vasospasm의 진단에 활용하기위해 처음 임상에 도입된 이후[1] TCD는 그 우수한 단순성과 재현성 덕분에 빠른 속도로 폭 넓게 임상에서 활용되게 되었다.그리고 여러 단점에도 불구하고 타 검사에 비해 TCD가 가지고 있는 탁월한 장점(시간적 해상도,비교적 저가의 장비,검사의 비침습성 및 안전성)은 그 활용의 폭을 각종 neuroscience research 영역에 까지 확장케 하고 있다.Medline에 transcranial Doppler라는 key word를 넣고 검색을 해보면 도입 이후 10년 동안(1991년까지)모두 522편의 논문이 수록되었는데 반하여 199년 이후 지금까지는 2779건의 논문이 검색되며 작년 한해에만 모두 352건이 발표되었다.국내에서 TCD의 보급속도 역시 매우 빨라 국내 몇몇 대규모 종합병원에서는 2대 이상의 장비를 활용하고 있다.덕분에 신경과 전공의나 전문의,심지어는 타과 의사 및 한의사들까지 TCD에 관심을 가지게 되었고 대한뇌졸중학회지에 종설로 TCD 및 duplexsono에 대한 특집을 다루게 된 것도 이러한 경향을 반영한다고 할 것이다.일차적인 TCD의 활용은 물론 뇌졸중,특히 주요 뇌대동맥의 폐색 및 협착의 진단 및 추적검사이다.그러나 앞으로 소개할 각종 기법들에 대한 연구가 매우 활발히 진행되면서 임상에서도 실제 진료에 적극적으로 활용하는 추세이므로 이들에 대한 관심을 소홀히 해서는 안된다는 점을 필자는 강조하고 싶다. 국내 대부분의 병원에서 TCD의 활용을 주요 뇌대동맥의 폐색 및 협착의 진단 및 추적검사에 국한하고 있는 실정이므로 더욱 그러하다.단지 소개할 기법들 중 몇가지는 개인적으로 경험도 가지고 있고 관련된 연구도 진행 중이지만 또한 일부는 필자 역시 시도해 보지 않았거나 시도하였으나 임상적으로 활용하는데 실패한 분야 (특히 microemboli monitoring이 그러하다)이여서 설명에 한계가 있을 것이 걱정되며 미리 사과 드리는 바이다. (Korean Journal of Stroke 2001;3(1): 21~30)N

Epidemiology of Stroke: 2006 Update

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Risk Factors For Intracerebral Hemorrhage

서 론 역학에서 위험인자(risk factor)라는 용어는 각 개인에게서 특정 질병이 발병할 가능성에 관련되는 변수를 가리킬 때 사용된다. 이제까지 뇌졸중의 위험인자에 대해 매우 광범위한 연구가 이루어져 왔으나 개별적인 위험인자를 정의하는 방식이나 이를 활용하여 위험인자와 특정 질병의 발병 가능성의 상관성을 결정하는 방법론의 차이로 아직은 이견이 많은 처지이다. 일반적으로 특정 요인이 특정 질병의 위험인자라고 이야기 하려면 다음 세가지 조건을 만족하여야 한다[1]. 첫째, 특정 요인과 질병의 발병사이에 통계적으로 유의한 상관성이 있어야 한다. 둘째,요인이 질병의 발생보다 선행되어야 한다. 셋째, 관찰되는 상관성이 오류에 의한 것이 아니어야 한다. 오류에는우연에 의한 것과 다른 제3의 요인의 간여에 의한 것, 연구 설계나 분석과정에서의 오류에 의한 것이 있다. 위험인자의 개념 또한 연구자의 목적이 질병의 원인을 찾는데 있는지 또는 질병의 예방 수단을 찾는데 있는지에 따라차이가 날 수 있다. 최근 유전학의 발전은 위험인자에 대한 인식에 변화를 주고 있다. 본 종설에서는 뇌출혈(출혈 성 뇌졸중), 그 중에서도 뇌실질내 출혈을 중심으로 위험인자에 대해 이제까지 연구된 내용을 개괄적으로 살펴 보고 최근 뇌출혈의 위험인자와 관련되어 흥미를 끄는 몇몇소주제에 대해 좀 더 자세히 공부해 보는 기회를 갖고자 한다.N

One-Year Health Related Quality of Life and Its Comparison With Various Clinical and Functional Scale in Hospitalized Patients With Acute Ischemic Stroke: Seoul National University Bundang Stroke Registry Study

Background: Knowing the magnitude of a problem is the first step to improving it, and quantifying the healthrelated quality of life (HRQOL) allows us to do it with respect to stroke. To identify the HRQOL in patients with ischemic stroke and its affecting factors, and compare it with other clinical and functional scales. Methods: A consecutive series of patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA) was recruited. Their HRQOL and utilities were assessed using the EQ-5Dindex－which evaluates the health profile of an individual in five dimensions (mobility, self-care, usual activity, pain/discomfort, and anxiety/depression) and three levels (no problem, some/moderate problems, and extreme problems)－at 1 year after stroke. The Modified Rankin Scale (MRS), Barthel Index (BI), and NIH Stroke Scale (NIHSS) were used to measure clinical and functional statuses. The EQ-5Dindex and the clinical and functional statuses were compared by clinical parameters, and the relationships among those scales were examined. Additionally, the EQ-5Dindex in the patients was compared with that in age- and sex-matched healthy controls. Results: Among 538 patients with AIS or TIA, 465 patients (males, 59.8%; age, 65.3±11.8 [mean±SD]; TIA, 7.7%; and initial NIHSS, 4.5±5.1) were evaluated. The EQ-5Dindex and the clinical and functional statuses were clearly aggravated by age, but did not differ with most of the risk factors. The EQ-5Dindex was strongly and significantly correlated with scores on the MRS, BI, and NIHSS. The EQ-5Dindex was lower in patients (especially older ones) than in healthy controls. Conclusions: This study shows that the EQ-5D is a feasible and valid tool for measuring HRQOL in patients with AIS or TIA.N

Utilization of Health Care Resources and Costs of Stroke Patients: Patients' Perspective

Background: Policy-makers are required to know the current patterns of resource use and the costs of stroke. However, the scientific evidence, on which health policy-making can be based, is not sufficient. Our study aimed to investigate resource utilization and costs during the one year after stroke. Methods: Among patients with acute ischemic stroke (7 days from onset) who were admitted from July of 2001 to July of 2002, 223 were interviewed one year after the onset of stroke through a home visit by an experienced research nurse. Resource utilization and related costs were investigated. Results: The average length of stay was 25 days. The average first inpatients costs was ￦2,230,000. After discharge, the average outpatient visit was 22 days. The average expenditure per patient during the one year from onset of stroke was ￦5,235,000. The hospital charge was 59% of the total cost, the cost for hiring a care-giver was 14%, and the fee for the outpatient clinic was 13%. Thirty-nine percent (￦2,051,000) of the total expenditure was consumed in the first month, 12% was in the second, 8% was in the third, and around 5% monthly was after 3 months. Conclusions: Our study is the first one to investigate the resource utilization and the related costs in stroke patients in Korea. The results of this study should not be generalized to all Korean stroke patients, but this study may serve as a reference for inferring the real status in Korea and may be a starting point for further nationwide resource utilization and costs studies.N

Factors Related to Temporal Window Failure in Korean

Background : Although transcranial doppler sonography (TCD) is a useful technique evaluating cerebral blood flow velocity, temporal acoustic window failure (TWF) limits its wide application in stroke patients. However, factors related to TWF remain unknown. The purpose of this study was to investigate the factors effecting TWF. Methods : We performed TCD in 104 consecutive patients (62 males and 42 females, aged 38 - 84 years) with ischemic stroke. We assessed the bone mineral density (g/cm2) of the L2, femur and the skull using bone mineral densitometry and measured the thickness of temporal bone shown in the CT scan with the use of PACS system. Results : Blood flow signals were recorded in 136(65.4%) of the 208 middle cerebral arteries. TWF was more common in women than men - 59.5%(50/84) vs. 17.7%(22/124) (p<0.001). Patients with TWF was significantly older than those without - 70.2¡¾8.4 years vs. 63.1¡¾7.2 years in women(p<0.005) and 67.4¡¾10.7 years vs. 60.9 ¡¾8.5years in men(p<0.001). TWF was not related with bone mineral density after adjusting the age and sex. However, the thickness of temporal bone was significantly greater in patients with TWF (3.3¡¾0.7 mm) than those without (2.3¡¾0.4 mm) (p<0.001). Besides, temporal bone was thicker in women than in men - 3.0¡¾0.8 mm vs. 2.4¡¾0.6 mm (p<0.001). Inhomogeneity in temporal bone was more common in patients with TWF than those without - 89.1% (41/46) vs. 15.4%(4/26) in women and 68.2%(15/22) vs. 18.6%(19/102) in men (p<0.001, each). Conclusions : TWF in Korean patients is related with advanced age, female sex and temporal bone thickness and inhomogeneity, but not with the mineral density of the temporal bone.N

Follow-up study on mortality in Korean stroke patients

Stroke is the most common cause of death as single-diseases in South Korea. And it generates additional medical cost through high incidence of related disabilities and complications, which would become more important with the rapid aging process in Korean society. This study was preformed to identify stroke patients' mortality and its associated factors. Patients diagnosed as stroke (ICD-10 code 160-163) in 2003 were identified. Their follow-up mortality rate in 5 years and related factors (stroke type, sex, age, type of first admission hospital, comorbidity score) were analyzed using national health insurance claim data and national cause of death statistics. The mortality rate peaked in early days after attack, and decreased subsequently as the survive time gets longer. The mortality rate was higher in hemorrhagic stroke than ischemic stroke, in female than male, with the older age, and with the higher comorbidity score. It is recommended that the early intervention at general hospital or tertiary referral hospital should be promoted to decrease the mortality rate in stroke patients, and related quality assurance programs have to be enforced.N

(A Case of Poliomyelitis-like Syndrome with Typical Abnormalities in MRI)

A 28-year-old man presented with headache, fever, and myalgia. Subsequently, rapidly progressive quadriplegia with areflexia developed. CSF examination revealed moderate pleocytosis and protein elevation. MRI of brain and spinal cord showed hyperintense lesions on T2-weighted image at midbrain and ventral horns along the whole spinal cord. Serial serologic examinations of CSF for Epstein-Barr virus and cytomegalovirus were negative. Culture and neutralization tests of stool and CSF for enterovirus were negative. Although the etiologic pathogen was not identified, we diagnosed him as poliomyelitis-like syndrome by clinical features and findings of MRI.N