Correlation between mossy fiber sprouting, subtype neuronal loss, and clinical characteristics in human medial temporal lobe epilepsy with hippocampal sclerosis

학위논문(박사)--서울대학교 대학원 :의학과 신경과학 전공,2004.Docto

일개 대학병원을 대상으로 한 출혈성 뇌혈관질환과 허혈성 뇌혈관질환 발생 비의 시간적 변동양상에 관한 연구

학위논문(석사)--서울대학교 대학원 :의학과 예방의학전공,1996.Maste

Focused Update of 2009 Korean Clinical Practice Guidelines for the Antiplatelet Therapy in Secondary Prevention of Stroke

The aim of this update of Korean clinical practice guidelines for stroke is to provide timely evidence-based recommendations on the antiplatelet therapy in secondary prevention of stroke. Evidence-based recommendations are included for the use of antiplatelet agents for noncardioembolic stroke. Changes in the guidelines necessitated by new evidence will be continuously reflected in the new guideline.N

Focused Update of Guidelines for Antithrombotic Management of Patients with Atrial Fibrillation and Ischemic Stroke or Transient Ischemic Attack

Cardioembolic stroke related to atrial fibrillation is problematic due to high recurrence, mortality, and morbidity rates. The optimal anticoagulant therapy therefore needs to be applied to prevent the occurrence of a second stroke in patients with nonvalvular atrial fibrillation. The oral anticoagulant warfarin has traditionally been used, but it is limited by its narrow efficacy window, complex pharmacokinetics, and multiple drug interactions, thus requiring frequent blood monitoring. New oral anticoagulants have recently been developed that target a specific coagulation component. Dabigatran (a direct thrombin inhibitor) and rivaroxaban, apixaban, and edoxaban (inhibitors of factor Xa) have advantages of rapid action time, short half-life, stable plasma concentration, and few drug interactions. Large randomized clinical trials and meta-analyses have recently been published on the efficacy and safety of these new oral anticoagulants. Based on the results obtained in recent clinical trials, we have revised the recommendations for selecting optimal anticoagulant therapy in patients with nonvalvular atrial fibrillation.N

Antiplatelet Therapy for Secondary Stroke Prevention: 2012 Focused Update of Korean Clinical Practice Guidelines for Stroke

Writing Committee of Korean clinical practice guidelines for secondary prevention of stroke has reviewed recent randomized controlled trials of cilostazol published after the fi rst edition of Korean clinical practice guidelines that considered evidences published before June 2007. Two clinical trials and 1 meta-analysis which compared cilostazol directly with aspirin in the prevention of stroke in patients with cerebral infarction or transient ischemic attack (TIA) were identifi ed and included for the current guideline update. Review of fi ndings indicates that cilostazol as compared to aspirin achieved a greater reduction of stroke as well as composite vascular events of stroke, myocardial infarction, and vascular death. For safety, cilostazol was associated with fewer major bleeding events than aspirin. Accordingly, new recommendations for cilostazol are made for prevention of stroke in the setting of noncardioembolic stroke or TIA. Changes in the guidelines necessitated by new evidences will be continuously refl ected in future guidelines.N

Update of the Korean Clinical Practice Guidelines for Endovascular Recanalization Therapy in Patients with Acute Ischemic Stroke

Patients with severe stroke due to acute large cerebral artery occlusion are likely to be severely disabled or die if reperfusion is not achieved in a timely manner. Intravenous tissue plasminogen activator (IV-TPA) administered within 4.5 hours after stroke onset was previously the only proven therapy, but IV-TPA alone does not sufficiently improve the outcome of patients with acute large artery occlusion. With the introduction of the advanced endovascular therapy that enables faster and more successful recanalization, recent randomized trials consecutively and consistently demonstrated the benefit of adding endovascular recanalization therapy (ERT) to IV-TPA. Accordingly, to update the recommendations, we assembled members of a writing committee appointed by the Korean Stroke Society, the Korean Society of Interventional Neuroradiology, and the Society of Korean Endovascular Neurosurgeons. The writing committee revised recommendations based on a review of the accumulated evidence, and a formal consensus was achieved by convening a panel of 34 experts from the participating academic societies. The current guideline provides evidence-based recommendations for ERT in patients with acute large cerebral artery occlusion regarding patient selection, treatment modalities, neuroimaging evaluation, and system organization.N

Outcome and Prognostic Factor of Isolated Anterior Cerebral Artery Territory Infarction

Background: Isolated anterior cerebral artery (ACA) territory infarction is uncommon and there have been no prospective out-come studies in Korea. Methods: From September 2004 to August 2005, patients with isolated ACA territory infarction ad-mitted within 7 days of symptom onset from 4 university hospitals were collected prospectively. We analyzed clinical and lab-oratory characteristics, stroke subtypes, stroke severity, and medical complications by a predetermined protocol. The out-come was measured by the modified Rankin Scale (mRS) at 3-months after stroke onset and classified as good (mRS score of 0 to 3) or poor (mRS score of 4 to 6) outcome. Results: Thirty-seven (2.9%) patients were identified to have isolated ACA ter-ritory infarction among 1,254 patients with acute ischemic stroke. Mean age was 67 years (range 45 to 83) and female were 22 (59%). Stroke subtypes were large-artery atherosclerosis in 57%, cardioembolism in 22%, undetermined in 19%, and small-vessel occlusion in 3%. The median National Institutes of Health Stroke Scale (NIHSS) score at admission was 4 (range 0 to 28). Neurological progression was developed in 9 patients (24%) and medical complications in 13 patients (35%). At 3 months after the stroke onset, 27 patients (72%) showed good outcome and 10 patients (27%) showed poor outcome. On univariate a-nalysis, medical complication, and NIHSS scores at admission were significantly associated with good outcome. Multivar-iate analysis revealed NIHSS scores at admission was independent predictor of functional outcome at 3 months. Conclusion: The overall prognosis of isolated ACA infarction was favorable and NIHSS scores at admission were important prognostic factor. (Korean J Stroke 2009;11:19-24)N

Korean J Intern Med. 2021 Jul;36(4):906-913.

Background/aims: Atrial fibrillation (AF)-related stroke accounts for 20% of ischemic strokes. Rivaroxaban use in AF patients for preventing stroke and systemic embolism was approved in 2013 in Korea. This study was to investigate the safety and effectiveness of rivaroxaban use in Korean patients with non-valvular AF in a real-world setting. Methods: This was an analysis of the Korean patients in Xarelto for Prevention of Stroke in Patients with Atrial Fibrillation in Asia-Pacific (XANAP), which was a prospective, observational cohort study including patients with non-valvular AF starting rivaroxaban treatment to prevent stroke or non-central nervous system systemic embolism (non-CNS SE), conducted in 10 Asian countries. Results: A total of 844 patients were enrolled in the Korean portion of the XANAP study. In XANAP Korea, the mean age was 70.1 years and 62.6% were males. The mean CHADS2 score was 2.5 and the mean CHA2DS2-VASc score was 3.8. 47% of the patients had experienced prior stroke or non-CNS SE or transient ischemic attack. 73.6% of the patients had CHADS2 score ≥ 2. Incidence proportions of 0.8% of the patients (1.1 per 100 patient-years) developed adjudicated treatment-emergent major bleeding. Death was observed in 1.2% of the patients. The incidence of non-major bleeding as well as thromboembolic event were 8.4% (11.6 per 100 patient-years) and 1.5% (2.0 per 100 patient-years), respectively. Conclusion: This study reaffirmed the consistent safety profile of rivaroxaban. We found consistent results with overall XANAP population for rivaroxaban in terms of safety in non-valvular AF patients for the prevention of stroke and non-CNS SE. Keywords: Atrial fibrillation; Korea; Rivaroxaban; Stroke

2019 Update of the Korean Clinical Practice Guidelines of Stroke for Endovascular Recanalization Therapy in Patients with Acute Ischemic Stroke

Endovascular recanalization therapy (ERT) has been a standard of care for patients with acute ischemic stroke due to large artery occlusion (LAO) within 6 hours after onset since the five landmark ERT trials up to 2015 demonstrated its clinical benefit. Recently, two randomized clinical trials demonstrated that ERT, even in the late time window up to 16 hours or 24 hours after last known normal time, improved the outcome of patients who had a target mismatch defined as either clinical-core mismatch or perfusion-core mismatch, which prompted the update of national guidelines in several countries. Accordingly, to provide evidence-based and up-to-date recommendations for ERT in patients with acute LAO in Korea, the Clinical Practice Guidelines Committee of the Korean Stroke Society decided to revise the previous Korean Clinical Practice Guidelines of Stroke for ERT. For this update, the members of the writing group were appointed by the Korean Stroke Society and the Korean Society of Interventional Neuroradiology. After thorough reviewing the updated evidence from two recent trials and relevant literature, the writing members revised recommendations, for which formal consensus was achieved by convening an expert panel composed of 45 experts from the participating academic societies. The current guidelines are intended to help healthcare providers, patients, and their caregivers make their well-informed decisions and to improve the quality of care regarding ERT. The ultimate decision for ERT in a particular patient must be made in light of circumstances specific to that patient. J Korean Neurol Assoc 38(2N