급성기 동맥경화성 뇌경색 환자에서 고용량의 클로피도그렐 투여에 의한 혈소판 활성화의 정도 및 임상적 예후의 변화

김욱주,이경미,박경원,김상호,김재우,정민호,임영진,차재관 대한신경과학회 2003 대한신경과학회지 Vol.21 No.2

Effectiveness and Safety of Thrombolysis in Ischemic Stroke Patients Aged 80 Years or Older

김욱주,권오기,오창완,정철규,이지성,이준영,박정현,고영채,장명숙,양미화,한문구,배희준 대한뇌졸중학회 2012 Journal of stroke Vol.14 No.1

Background: Thrombolysis becomes an emerging therapeutic option for acute ischemic stroke. However, few reports exist on its use in the very elderly. We investigated whether there is a difference in the effectiveness and safety of intravenous (IV) and/or intra-arterial (IA) thrombolysis between patients aged ≥80 years and those aged <80 years. Methods: A consecutive series of patients hospitalized within 12 hours from stroke onset were selected. We evaluated the effectiveness of thrombolysis with modifi ed Rankin scale (mRS) at 3 months, and the safety with symptomatic hemorrhagic transformation (sHT). The odds ratio (OR)of thrombolysis on the favorable mRS (0-2) was calculated using multivariable logistic regression analysis with adjustments for potential confounders. Whether the effectiveness of thrombolysis is age-dependent or not was analyzed by introducing an interaction term (thrombolysis×age group) into multivariable models. Results: Among 219 patients ≥80 years, 21% of patients received IV or IA or combined thrombolysis while 23% of 980 patients <80 years received thrombolysis (P =0.51). With respect to the favorable mRS, the adjusted ORs of thrombolysis were 1.70 (95% confi dence interval, 1.08-2.68) in all subjects, 1.61(0.58-4.49) in those ≥80 years, and 1.71 (1.05-2.78) in those <80 years. There was no signifi cant interaction between age group and thrombolysis (P =0.91). With respect to sHT, the adjusted OR was 4.72 (1.94-11.45) in all subjects with no signifi cant interaction (P =0.86). Conclusion: This study suggests that thrombolysis may be equally safe and effective in stroke patients aged ≥80 years versus <80 years.

Can Early Ischemic Lesion Recurrence on Diffusion-Weighted MRI Affect Functional Outcome after Acute Ischemic Stroke?

김욱주,김재형,고영채,박정현,양미화,장명석,한문구,김상윤,박성호,배희준 대한신경과학회 2010 Journal of Clinical Neurology Vol.6 No.1

Background and Purpose Ischemic lesion recurrence on diffusion-weighted imaging (DWI-LR) is a frequently observed phenomenon after acute ischemic stroke. However, no study has elucidated the impact of DWI-LR on functional outcome. Methods Among a consecutive series of patients who presented with focal symptoms or signs compatible with stroke within 48 hours from the onset over a 50-month period, those who had relevant ischemic lesions on initial DWI and underwent follow-up DWI within 14 days after the onset were enrolled in this study. As outcome variables, the scores on the modified Rankin Disability Scale (mRDS) at 3 months and 1 year were measured prospectively and dichotomized into good (0-2) vs. poor (3-6). When calculating odds ratios (ORs), adjustment was performed for age, previous stroke, initial score on the NIH Stroke Scale, stroke subtype, and IV thrombolysis. Results Among those 786 patients finally enrolled in this study, 221 (28.1%) had DWI-LR. For a poor outcome at 3 months, the crude ORs of any, symptomatic, and asymptomatic DWI-LR were 2.70 [95% confidence interval (CI), 1.96 to 3.72], 10.03 (95% CI, 4.39 to 22.96), and 2.04(95% CI, 1.44 to 2.88), respectively. With adjustment, the OR of symptomatic DWI-LR was 6.44(95% CI, 2.50 to 16.57), whereas those of any and asymptomatic DWI-LR lost their statistical significance: 1.44 (95% CI, 0.94 to 2.20) and 1.04 (95% CI, 0.65 to 1.65), respectively. Analyzing with the 1-year outcome produced similar results. Conclusions This study shows that symptomatic early lesion recurrence can affect functional outcome after acute ischemic stroke, whereas an asymptomatic one may not.

전측두엽에서 기원한 잠재성 홍소발작 : 성인에서 발생한 1례 A Case of Young Adulthood Onset

김욱주,천상명,김상호 대한간질학회 2002 대한간질학회지 Vol.6 No.2

급성기 뇌경색환자의 내원시 Troponin-I 수치와 예후와의 연관성

김욱주 대한뇌졸중학회 2003 Journal of stroke Vol.5 No.1

Background : Ischemic stroke and coronary artery disease share the similar pathologic mechanisms. Troponin-I is a specific marker for ischemic heart injury. Previous studies suggested that Troponin-I could predict the clinical outcome of ischemic stroke. In this study, we investigated the clinical significance and prognostic value of plasma level of Troponin-I in patients with acute ischemic stroke. Methods : Eighty-five patients with acute ischemic stroke were included in this study. Plasma Troponin-I level was measured within 24 hrs after stroke onset. We evaluated the clinical characteristics and outcome of the patients wiin acute ischemic stroke with the increased plasma concentration of Troponin-I. Results : Fourteen patient had Troponin-I values at 0.5mg/L or higher, indicating the presence of myocardial injury. Among the 14 patients, 7 patients had large artery atherosclerotic infarction (50%), 2 patients cardioembolism (14%), 4 patients undetermined type (29%) and 1 patient had small vessel disease (7%). Patients with detectable Troponin-I level more often had abnormal values of C-reactive protein and lower functional and neurological scores at admission than those without. Also, patients with increased Troponin-I level had a tendency for poor clinical outcome. Conclusions : These results suggest that the increased level of Troponin-I in patients with acute ischemic stroke may predict the poor outcome.

Adherence to Guidelines for Antithrombotic Terapy in Patients with Atrial Fibrillation According to CHADS2 Score before and afer Stroke: A Multicenter Observational Study from Korea

김욱주,박종무,강규식,조용진,홍근식,이수주,고영채,이경복,박태환,이준,차재관,김대현,유경호,이병철,오미선,이준영,이지성,장명숙,한문구,배희준 대한신경과학회 2016 Journal of Clinical Neurology Vol.12 No.1

Background and Purpose A substantial proportion of patients with atrial fbrillation (AF) are not treated optimally; however, the inappropriateness of drug therapy has never been evaluated before or afer a stroke event. We investigated the adherence to guidelines for therapy in AF patients hospitalized with acute ischemic stroke (AIS) before stroke onset and at discharge, with the aim of identifying the factors associated with inappropriate therapy. Methods AIS patients with AF hospitalized within 7 days of onset were identifed from a prospective nine-center stroke registry database. Two cohorts were defned: patients diagnosed with AF prior to the stroke event (admission cohort) and patients diagnosed with AF at discharge from hospital (discharge cohort). Any of the following conditions were regarded as nonadherence to guidelines in this study: use of anticoagulant or nonuse of antithrombotics with CHADS2 score=0, nonuse of antithrombotics with CHADS2 score=1, or nonuse of anticoagulant with CHADS2 score ≥2. Results Overall, 406 patients were enrolled in the admission cohort and 518 in the discharge cohort. Te rates of nonadherence before a stroke event and at discharge were 77.8% and 33.3%, respectively. Tese rates varied widely for both cohorts, with interhospital diferences being statistically signifcant. Multivariable analysis revealed that old age, stroke history, and congestive heart failure were associated with nonadherence before stroke. At discharge, males, coronary heart disease, inappropriate antithrombotic use before stroke, and functional disability at discharge were associated with nonadherence. Conclusions Tis study shows that antithrombotic use in AIS patients with AF might be not optimal before and afer stroke in Korea.

뇌졸중홍보캠페인에 사용된 대표적인 다섯 가지 대표적 뇌졸중 증상의 타당도조사

김욱주,고영채,박정현,반별님,한문구,조용진,배희준 대한신경과학회 2013 대한신경과학회지 Vol.31 No.1

Background: For the improvement in stroke care, we have campaigned for stroke warning signs and its symptoms. However, few reports on the validation of symptom selection in the campaign have been published till now. Methods: Based on the prospective stroke registry, patients were identified, who were hospitalized with stroke within 7days from the stroke onset and had relevant lesions on their brain images. One presenting symptom was selected in each patient through review of electronic medical records by an investigator, and those collected symptoms were classified into 5 symptom categories or the unclassified. Those 5 symptom categories were developed and are being used in the stroke awareness campaign in 2009 by the Korean Stroke Society (KSS). Results: A total of 3027 patients (age, 66.57±12.6 years; male, 58.2%) were enrolled in our study. The rate of frequency of each categorized symptom was 54.9% for unilateral numbness or weakness, 27.5% for confusion or speech disturbance,2.8% for visual disturbance, 10.5% for dizziness or gait disturbance, 2.3% for severe headache, and 2.0% for the unclassified. Ninety-eight percent of stroke patients were classified into one of the 5 symptom categories. Confusion or speech disturbance was associated with the shorter pre-hospital delay, whereas dizziness or gait disturbance with the longer delay. Dizziness was the most frequent symptom in TIA, and so was severe headache in hemorrhagic stroke. Conclusions: Our study shows that the 5 stroke warning symptoms of the KSS campaign represent well the presenting symptoms of Korean patients with acute stroke or TIA.

의미 치매 1예 : 신경심리 및 뇌영상 검사의 연속적인 추적 관찰 소견 Serial Follow-up Study of Neuropsychological and Neuroimaging Findings

박경원,김욱주,전진민,강도영,김재우 대한치매학회 2003 Dementia and Neurocognitive Disorders Vol.2 No.1

Semantic dementia (SD) is a very rare, distinct form of dementia which is characterized by impairment of naming and comprehension, prosopagnosia, visual agnosia for objects and relative preservation of other aspects of cognition, such as episodic memory, nonverbal problem-solving and visuospatial functions. A 68-year-old man visited our clinic for progressive speech disturbance since 1997. His main speech problems were word finding difficulty and loss of word meaning for objects. Language assessment demonstrated profound semantic memory loss for words with preserved fluency, corresponding to anomic aphasia. There were marked impairments in verbal and visual memory functions and word fluency tasks, but no grammatical or phonologic errors in speech. Also were remarkable anosognosia and object visual agnosia with preserved visuospatial function and calculation in neuropsychological tests. Serial follow-up study of language test showed more deterioration in comprehension and repetition, consistent with Wernicke's aphasia. Initial brain MR imaging and brain perfusion SPECT showed prominent focal atrophy in the left temporal lobe, and marked hypoperfusion in the left temporal and both frontal areas. Follow-up brain MR imaging and perfusion SPECT revealed more atrophy in both temporal lobes and showed more extensive hypoperfusion areas compared to the previous study.

일개 병원기반 코호트에서 관찰한 장기간의 뇌졸중 재발률

고영채,김욱주,양미화,오창완,백남종,한문구,배희준,박정현,정철규,권오기 대한신경과학회 2009 대한신경과학회지 Vol.27 No.2

Background: Recurrent stroke is a major cause of morbidity and mortality among stroke survivors. However, studies of the long-term prognosis after acute stroke are very rare, especially in Asia. This study aimed to provide estimates of recurrent stroke rates by age, gender, and subtype of stroke in an unselected cohort of patients hospitalized to a community-based general hospital due to acute stroke. Methods: Based on a prospective stroke registry, acute stroke patients were enrolled within 7 days of symptom onset and followed retrospectively or prospectively for up to 3 years. Information was gathered about stroke recurrence and other vascular events. The cumulative risk of recurrent stroke was calculated using the Kaplan-Meier method. Results: Two-thousand and sixty-eight patients were enrolled in this study. The cumulative risks of stroke recurrence were 2.3%, 5.5%, 8.6%, and 10.0% at 90 days and 1, 2, and 3 years, respectively. The prevalence of stroke recurrence increased with age and the presence of previous stroke history (p<0.001), but not with gender or stroke subtype. Conclusions: To the best of our knowledge, this is the first cohort study of stroke recurrence in Korea. Its limitation of being a single hospital-based study warrants community- or multicenter-based cohort studies to identify high-risk groups for stroke recurrence. Background: Recurrent stroke is a major cause of morbidity and mortality among stroke survivors. However, studies of the long-term prognosis after acute stroke are very rare, especially in Asia. This study aimed to provide estimates of recurrent stroke rates by age, gender, and subtype of stroke in an unselected cohort of patients hospitalized to a community-based general hospital due to acute stroke. Methods: Based on a prospective stroke registry, acute stroke patients were enrolled within 7 days of symptom onset and followed retrospectively or prospectively for up to 3 years. Information was gathered about stroke recurrence and other vascular events. The cumulative risk of recurrent stroke was calculated using the Kaplan-Meier method. Results: Two-thousand and sixty-eight patients were enrolled in this study. The cumulative risks of stroke recurrence were 2.3%, 5.5%, 8.6%, and 10.0% at 90 days and 1, 2, and 3 years, respectively. The prevalence of stroke recurrence increased with age and the presence of previous stroke history (p<0.001), but not with gender or stroke subtype. Conclusions: To the best of our knowledge, this is the first cohort study of stroke recurrence in Korea. Its limitation of being a single hospital-based study warrants community- or multicenter-based cohort studies to identify high-risk groups for stroke recurrence.

급성기 중증 뇌졸중 환자의 치료 의사결정

김도경,김욱주 한국의료윤리학회 2023 한국의료윤리학회지 Vol.26 No.2

This article discusses the case of an elderly patient with a severe stroke for whom hemicraniectomy was proposed to lower intracranial pressure. Although patients in this situation can increase their chances of survival with hemicraniectomy, expected quality of life following the procedure remains uncertain. This case is analyzed using the four topics chart, which consists of medical indication, patient preference, quality of life, and contextual features. In relation to contextual features, the conflict of interest experienced by the family as caregivers and the influence of the Life-Sustaining Treatment Decision-making Act are discussed. It is argued that in order to make medical decisions that are in the patient’s best interest, shared decision-making between physicians and family members should be based on information obtained through the four topics chart. 고령의 중증 뇌졸중 환자에서 뇌압을 낮추기 위해 반두개졀개술이 제안된 환자의 사례를 의학적 적 응증, 환자의 선호, 삶의 질, 맥락적 특성으로 구성된 4분면 접근법(the four topics chart)를 활용하여 분석하였다. 환자는 급성의 위중한 상황으로 반두개절제술로 생존 가능성을 높일 수는 있으나 위급한 상황을 넘겨 안정적이 되었을 때 일상생활의 전부, 혹은 상당 부분을 타인에게 의존해야 하며, 인지저 하가 예상된다. 환자의 삶의 질이 매우 낮을 것으로 예상되는 상황에서 가족과 의사는 의사결정능력이 없는 환자를 대신하여 의학적 근거, 예상되는 삶의 질, 환자라면 선택하였을 법한 환자에게 최선의 이 익이 되는 결정을 내려야 한다. 또한 맥락적 특성을 고려해야 하는데, 여기에서는 가족이 겪는 이해상 충에 대한 인지, 제도의 측면에서 연명의료결정법의 영향에 대해 논하였다. 의사와 가족은 함께하는 의 사결정(shared decision-making)을 통해 4분면 접근법의 분석 내용을 논의하고 환자의 최선의 이익 에 부합하는 선택을 할 수 있을 것이다.