급성 일산화탄소 중독증 환자의 예후에 미치는 예측인자

방오영,최병옥,최일생,정상혁,노재훈 대한신경과학회 1996 대한신경과학회지 Vol.14 No.1

New Oral Anticoagulants May Be Particularly Useful for Asian Stroke Patients

방오영,홍근식,허지회,Jaseong Koo,권순억,유경호,배희준,이병철,윤병우,김종성 대한뇌졸중학회 2014 Journal of stroke Vol.16 No.2

Atrial fibrillation (AF) is an emerging epidemic in both high-income and low-income countries, mainly because of global population aging. Stroke is a major complication of AF, and AF-related ischemic stroke is more disabling and more fatal than other types of ischemic stroke. However, because of concerns about bleeding complications, particularly intracranial hemorrhage, and the limitations of a narrow therapeutic window, warfarin is underused. Four large phase III randomized controlled trials in patients with non-valvular AF (RE-LY, ROCKET-AF, ARISTOTLE, and ENGAGE-AF-TIMI 48) demonstrated that new oral anticoagulants (NOACs) are superior or non-inferior to warfarin as regards their efficacy in preventing ischemic stroke and systemic embolism, and superior to warfarin in terms of intracranial hemorrhage. Among AF patients receiving warfarin, Asians compared to non-Asians are at higher risk of stroke or systemic embolism and are also more prone to develop major bleeding complications, including intracranial hemorrhage. The extra benefit offered by NOACs over warfarin appears to be greater in Asians than in non-Asians. In addition, Asians are less compliant, partly because of the frequent use of herbal remedies. Therefore, NOACs compared to warfarin may be safer and more useful in Asians than in non-Asians, especially in stroke patients. Although the use of NOACs in AF patients is rapidly increasing, guidelines for the insurance reimbursement of NOACs have not been resolved, partly because of insufficient understanding of the benefit of NOACs and partly because of cost concerns. The cost-effectiveness of NOACs has been well demonstrated in the healthcare settings of developed countries, and its magnitude would vary depending on population characteristics as well as treatment cost. Therefore, academic societies and regulatory authorities should work together to formulate a scientific healthcare policy that will effectively reduce the burden of AF-related stroke in this rapidly aging society.

Multimodal MRI for Ischemic Stroke: From Acute Therapy to Preventive Strategies

방오영 대한신경과학회 2009 Journal of Clinical Neurology Vol.5 No.3

Background and Purpose Conventional therapies for ischemic stroke include thrombolytic therapy, prevention of inappropriate coagulation and thrombosis, and surgery to repair vascular abnormalities. Over 10 years have passed since the US Food and Drug Administration approved intravenous tissue plasminogen activator for use in acute stroke patients, but most major clinical trials have failed during the last 2 decades, including large clinical trials for secondary prevention and neuroprotection. These results suggest the presence of heterogeneity among stroke patients. Neuroimaging techniques now allow changes to be observed in patients from the acute to the recovery phase. The role of MRI in stroke evaluation and treatment is discussed herein. Main Contents Three MRI strategies are discussed with relevant examples. First, the following MRI strategies for acute ischemic stroke are presented: diffusion-perfusion mismatch, deoxygenation (oxygen extraction and cerebral metabolic rate of oxygen), and blood-brain barrier permeability derangement in selected patients for recanalization therapy. Second, multimodal MRI for identifying stroke mechanisms and the specific causes of stroke (i.e., patent foramen ovale, infective endocarditis, and nonbacterial thrombotic endocarditis) are presented, followed by MRI strategies for prevention of recurrent stroke: plaque images and flow dynamics for carotid intervention. Expectations The studies reviewed herein suggest that using MRI to improve the understanding of individual pathophysiologies will further promote the development of rational stroke therapies tailored to the specifics of each case.

뇌졸중 환자에게 아스피린과 클로피도그렐 내성

방오영 대한뇌졸중학회 2009 Journal of stroke Vol.11 No.1

Background: An increasing number of anti-platelet agents of various action mechanisms has been tested and used to prevent recurrent ischemic events in patients with ischemic stroke. However, the preventive effects of these anti-platelet agents were still limited. Recently, impaired responses to anti-platelet therapy assessed by laboratory tests have been reported to be associated with an increased risk of recurrent ischemic events after stroke or cardiovascular events. Contents: In this review, 1) the mecha-nisms of anti-platelet failure and anti-platelet resistance, 2) laboratory methods to detect anti-platelet resistance, 3) prevalence and clinical implication of it, and 4) possible management for this situation will be discussed. Conclusion: Although there have been increasing evidences of impact of anti-platelet resistance on the recurrent clinical events, at present there was no solid criteria for anti-platelet resistance or definite evidence to recommend a change anti-platelet medication according to the laboratory results in clinical practice. Hopefully, the further studies on anti-platelet resistance may guide the pharmacologic treatment for stroke prevention in patients with ischemic stroke. (Korean J Stroke 2009;11:1-9)

Considerations When Subtyping Ischemic Stroke in Asian Patients

방오영 대한신경과학회 2016 Journal of Clinical Neurology Vol.12 No.2

Both the incidence and prevalence of stroke in Asia are steadily increasing, and the burden of stroke is particularly high in Asian countries. Although strokes in Asians and Caucasians share many common features, there are some differences that are probably due to differences in lifestyle and genetic background. While there have been advances in the stroke classification system, the assignment of Asian stroke patients to etiological categories has received little attention. The current classification system may not be well suited to Asian patients with ischemic stroke because the proportions and relative importance of stroke subtypes may differ with race and ethnicity. This review addresses concerns about the use of the current stroke classification system in Asian patients with ischemic stroke, and proposes a classification system that is more specific to the Asian population, in conjunction with discussing advances in diagnostic techniques.

Important Link between Dementia Subtype and Apolipoprotein E: a Meta-analysis

방오영,YongTaeKwak,InSooJoo,KyoonHuh 연세대학교의과대학 2003 Yonsei medical journal Vol.44 No.3

자발성 두개내 저압증에서의 척수경막 조영변화

방오영,이필휴,김동익,최일생 대한신경과학회 1997 대한신경과학회지 Vol.15 No.2

베타-아밀로이드에 의한 신경세포 손상에 대한 제니스테인의 신경보호효과

방오영,묵인희,허균 대한신경과학회 2003 대한신경과학회지 Vol.21 No.2

뇌졸중의 바이오마커

방오영 대한뇌졸중학회 2011 Journal of stroke Vol.13 No.2

Background: Most major clinical trials have failed during the last 2 decades, including large clinical trials of secondary prevention and neuroprotection. These results suggest the presence of heterogeneity among stroke patients. Biomarker is defi ned as a biological molecules found in blood, other body fl uids or tissues that is evaluated as an indicator of normal biological processes,pathogenic processes, or pharmacologic responses to a therapeutic intervention. Stroke biomarkers may provide the information on the heterogeneity among patients with ischemic cerebrovascular disease. In addition, stroke biomarkers could be a guiding tool for more effective personalized therapy. Main contents: Three aspects of stroke biomarkers are discussed. First, the role of biomarkers in stroke patients is presented. Second, limitations of current biomarkers (especially protein biomarkers) in the stroke fi eld are discussed with possible reasons. Lastly, types of biomarkers, including protein, genetic and microparticles, are presented with their advantages and disadvantages focusing on the importance of comprehensive approaches using various types of biomarkers. Expectations: Although biomarkers are not recommended as a routine practice in stroke patients, there have been numerous effects to overcome current limitations. The studies reviewed herein suggest that using various biomarkers to improve the understanding of individual pathophysiologies will further promote the development of screening tool of highrisk patients, predicting model of stroke outcome and rational stroke therapy tailored to the specifi cs of each case. (Korean J Stroke 2011;13:57-62)

Stroke Update 2009: Etiologies and Mechanisms of Ischemic Stroke

방오영 대한뇌졸중학회 2009 Journal of stroke Vol.11 No.2

Stroke continues to have a devastating impact on public health. Treatment of option to prevent ischemic stroke is largely depen-dent on their mechanisms. In 2008, there have been numerous reports in the field of the pathophysiologic mechanisms of ischemic stroke and many advances in the techniques for etiologic workups. The recent advance in the understanding of conven-tional stroke mechanisms will be summarized, together with the recent advance in the documentation of stroke mechanism in cryptogenic stroke. (Korean J Stroke 2009;11:47-52)