허혈성 뇌졸중의 아형 및 병변 위치에 따른 NIH Stroke Scale과 개량형 NIH Stroke Scale의 비교

부선희,윤성상,장혜정,권영대,박기정,안태범,장대일,정경천 대한신경과학회 2006 대한신경과학회지 Vol.24 No.2

Background: The National Institutes of Health Stroke Scale (NIHSS) is regarded as a valid and reliable tool to measure the severity of neurological deficits in acute stroke, but has been criticized for its complexity and variability. Therefore, the modified NIHSS (mNIHSS) was developed, eliminating redundant and less reliable items from the full version of the NIHSS. The aim of the present study was to evaluate the validity of the mNIHSS according to the subtypes of stroke and the location of affected arterial territories. Methods: The severity of stroke in 155 patients with acute cerebral infarction was measured. Each patient was evaluated by two neurologists using both the NIHSS and mNIHSS, and the stroke subtype was determined according to the TOAST classification. The vascular territory of lesion was classified into an anterior and posterior circulation. The criterion-related validity was evaluated by the Pearson Correlation Coefficient between the NIHSS and mNIHSS scores. Results: When considering the NIHSS scores as the gold criteria, the Pearson correlation coefficients of the mNIHSS were 0.96 in the subtype of large artery atherosclerosis, 0.91 in small vessel occlusion, 0.98 in cardioembolism, and 0.99 in undetermined etiology. On the other hand, the correlation coefficient was 0.98 in patients with an anterior circulation infarction, and was 0.94 in patients with a posterior circulation infarction. Conclusions: The criterion-related validity of the mNIHSS scoring system was very high in general. However, the correlations were relatively low in patients with the TOAST subtype of small vessel occlusion and also a posterior circulation infarction.

비행기의 하강과 관련되어 발생한 두통

이학영,부선희,김상범,신원철 대한신경과학회 2008 대한신경과학회지 Vol.26 No.4

Headache may develop in flight passengers without underlying pathology even though this type of headache is not included in “The International Classification of Headache Disorders”. We report on a case of headache which had developed during airplane landing. A rapid change in the ambient pressure may give rise to headache.

NIH Stroke Scale을 이용한 초기 뇌졸중 중증도에 대한 후향적 평가의 타당성

윤성상,부선희,박기정,장혜정,권영대 대한신경과학회 2006 대한신경과학회지 Vol.24 No.1

Background: The retrospective severity scoring system of NIHSS for acute stroke patients was found to be valid and reliable by using patients' medical records in studies abroad. However, in Korea, medical records are often summarized and contain missing information which makes it difficult to conduct a restropective outcome study. The purpose of this research was to evaluate the validity and reliability of the retrospective NIHSS scoring system according to patients' medical records with written clinical histories and physical admission notes. Methods: An algorithm for the retrospective NIHSS scoring system was developed and applied to 75 patients with acute ischemic stroke. Missing data on physical examination results were scored as normal. One neurologist who was blinded to this study measured the NIHSS score prospectively on the initial patient examination. After the patient's discharge, two other neurologists, blinded to the patient's clinical condition, evaluated the NIHSS score independently based on the information collected from the patient's physical admission notes. The criterion-related validity was evaluated by the Pearson Correlation Coefficient, and the measure of agreement between two raters was evaluated by the Kappa Statistic. Results: The criterion-related validities of the retrospective NIHSS scoring system were high in the total and each itemized scores, except for the items of LOC command, limb ataxia, dysarthria, and neglect. The interrater reliabilities were also high except for the items of LOC command, limb ataxia, and dysarthria. Conclusions: The retrospective NIHSS scoring algorithm was found to be a reliable and unbiased tool even when some physical examination elements are missing from the written medical records.

반무도병의 신경영상연구

이상훈,안태범,부선희,김덕윤 대한신경과학회 2007 대한신경과학회지 Vol.25 No.3

Background: Hemichorea-Hemiballism (HCHB) can be caused by various diseases such as cerebrovascular disease, hyperglycemia, tumor, and inflammatory diseases. However, there are a few case studies using functional imaging such as single photon emission computed tomography (SPECT). Methods: In this study, we included patients with HCHB. The patients with hyperglycemia over 250 mg/dl or high signal intensity on T1 weighted imaging were excluded. Clinical and neuroimaging characteristics of the patients were obtained and analyzed. Results: We included 20 patients (M:F=12:8, mean age=67.1±15.3). Sixteen patients were presented with hemiballism and four with hemichorea. Six patients had no structural lesions causing HCHB. Subthalamic nucleus was the causative lesion in 6 patients. Other lesions associated with HCHB were basal ganglia, thalamus, and cortices. In a patient without structural lesion, anti-double stranded DNA antibody was detected. Brain SPECT showed not only perfusion abnormalities in the cases without structural lesions but also additional abnormalities in those with definite lesions. Conclusions: Various mechanisms were related to the development of HCHB. Functional imaging such as SPECT and immunological work-up is needed to investigate the underlying pathomechanism of HCHB.

허혈성 뇌졸중 환자에서 난원공개증의 빈도: 경두개초음파 연구

장대일,이미숙,조상희,부선희,정세희,허성혁,윤강욱,안태범,윤성상,정경천 대한신경과학회 2005 대한신경과학회지 Vol.23 No.3

Background: Patent foramen ovale (PFO) is increasingly being recognized in stroke patients. The capability of transcranial Doppler (TCD) to detect a PFO has been established. We studied the frequency of PFO in patients with ischemic stroke. Methods: Eighty-nine patients with ischemic stroke (62 men, mean age: 56.5) consecutively underwent a contrast-enhanced TCD with monitoring of the bilateral middle cerebral arteries (MCA). The contrast solution, which consisted of 8 ml of normal saline, 1 ml of air, and 0.2 ml of patient’s blood, was injected twice during normal breathing and the Valsalva maneuver. High intensity transient signals (HITS) were counted for 30 seconds after the injection. Results: Patent foramen ovale was detected in 19 patients (21%). The mean age was similar in those with (55 years) and those without (57 years) PFO. Patent foramen ovale was more frequent among men (26%) than women (11%). There were no differences in the frequency of PFO among stroke subtypes (large artery atherosclerosis, 18%; small artery occlusion, 27%; cardioembolic, 27%; undetermined cause, 11%). Conclusions: Patent foramen ovale is common in patients with ischemic stroke of all subtypes.

90대 뇌졸중 환자의 임상적 특성

허성혁,장대일,서경화,부선희,강명찬,이상범,박기정,안태범,윤성상,정경천 대한신경과학회 2007 대한신경과학회지 Vol.25 No.2

Background: As the elderly population is fast growing, the incidence of stroke is also increasing. We studied the clinical characteristics of nonagenarian stroke compared to a population of patients under the age of ninety. Methods: Subjects included 44 nonagenarian stroke patients and 22,227 control patients aged under ninety. Clinical characteristics including age, sex, risk factors, stroke subtype, and outcome (one-year prognosis, evaluated by a modified Rankin scale) were analyzed. Results: The proportion of nonagenarian stroke accounted for 0.2% of all cases of stroke. Ischemic stroke was more common than hemorrhagic stroke in the nonagenarian group. In addition, the female gender was more frequent (p<0.01). As the patients were older, their admission period was shorter, the discharge against medical advice was increased, and the mortality was higher. Hypertension and atrial fibrillation were significantly higher (p<0.05, p<0.001, respectively) in the nonagenarian ischemic stroke patients. Conclusions: Nonagenarian stroke patients have unique clinical characteristics compared with stroke patients under the age of ninety. Background: As the elderly population is fast growing, the incidence of stroke is also increasing. We studied the clinical characteristics of nonagenarian stroke compared to a population of patients under the age of ninety. Methods: Subjects included 44 nonagenarian stroke patients and 22,227 control patients aged under ninety. Clinical characteristics including age, sex, risk factors, stroke subtype, and outcome (one-year prognosis, evaluated by a modified Rankin scale) were analyzed. Results: The proportion of nonagenarian stroke accounted for 0.2% of all cases of stroke. Ischemic stroke was more common than hemorrhagic stroke in the nonagenarian group. In addition, the female gender was more frequent (p<0.01). As the patients were older, their admission period was shorter, the discharge against medical advice was increased, and the mortality was higher. Hypertension and atrial fibrillation were significantly higher (p<0.05, p<0.001, respectively) in the nonagenarian ischemic stroke patients. Conclusions: Nonagenarian stroke patients have unique clinical characteristics compared with stroke patients under the age of ninety.

Clinical Usefulness of 18F-FC119S Positron-Emission Tomography as an Auxiliary Diagnostic Method for Dementia: An Open-Label, Single-Dose, Evaluator-Blind Clinical Trial

이인기,나해리,변병현,임일한,김병일,최창운,고인옥,이교철,김경민,박수연,김유경,이준영,부선희,김정화,길희섭,박찬수,지대윤,하정호,임상무 대한신경과학회 2020 Journal of Clinical Neurology Vol.16 No.1

Background and Purpose The aim of this study was to determine the diagnostic performance and safety of a new 18F-labeled amyloid tracer, 18F-FC119S. Methods This study prospectively recruited 105 participants, comprising 53 with Alzheimer’s disease (AD) patients, 16 patients with dementia other than AD (non-AD), and 36 healthy controls (HCs). In the first screening visit, the Seoul Neuropsychological Screening Battery cognitive function test was given to the dementia group, while HC subjects completed the Korean version of the Mini Mental State Examination. Individuals underwent 18F-FC119S PET, 18F-fluorodeoxyglucose (FDG) PET, and brain MRI. The diagnostic performance of 18F-FC119S PET for AD was compared to a historical control (comprising previously reported and currently used amyloid-beta PET agents), 18F-FDG PET, and MRI. The standardized uptake value (SUV) ratio (ratio of the cerebral cortical SUV to the cerebellar SUV) was measured for each PET data set to provide semiquantitative analysis. All adverse effects during the clinical trial periods were monitored. Results Visual assessments of the 18F-FC119S PET data revealed a sensitivity of 92% and a specificity of 84% in detecting AD. 18F-FC119S PET demonstrated equivalent or better diagnostic performance for AD detection than the historical control, 18F-FDG PET (sensitivity of 80.0% and specificity of 76.0%), and MRI (sensitivity of 98.0% and specificity of 50.0%). The SUV ratios differed significantly between AD patients and the other groups, at 1.44±0.17 (mean±SD) for AD, 1.24±0.09 for non-AD, and 1.21±0.08 for HC. No clinically significant adverse effects occurred during the trial periods. Conclusions 18F-FC119S PET provides high sensitivity and specificity in detecting AD and therefore may be considered a useful diagnostic tool for AD.