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후기발병 양측성 의미변이원발진행실어증 환자에서 보인 비대칭 아밀로이드 국소침착 소견의 해석 및 진단 접근
오기창,박정주,용영복,김보영,김지은 대한신경과학회 2023 대한신경과학회지 Vol.41 No.2
Semantic variant primary progressive aphasia (svPPA), a well-known subtype of the frontotemporal dementia often shows peculiar clinical features and structural neuroimage findings. To strengthen the accuracy of a clinical diagnosis, amyloid positron emission tomography-computed tomography (PET-CT) might be helpful. However, in patients with late-onset svPPA, an admixture of the various neuropathology would interfere with diagnostic approach. Herein, we report a case of late-onset bilateral svPPA showing a regional amyloid deposition on PET-CT scan.
당뇨병과 뇌졸중 병력을 모두 가진 급성 뇌경색 환자에서 증상 발생 3-4.5시간대 정맥내혈전용해술의 안전성 및 효과
김보영,이지성,박홍균,용영복,오기창,박정주,조용진,강규식,이수주,김재국,차재관,김대현,배희준,박태환,박상순,이경복,이준,이병철,이민우,김준태,최강호,김동억,최재철,신동익,권지현,김욱주,손성일,홍정호,박형종,장성화,박광열,이상화,박종무,홍근식 대한신경과학회 2023 대한신경과학회지 Vol.41 No.2
Background: For acute ischemic stroke (AIS) patients with history of prior stroke (PS) and diabetes mellitus (DM), intravenous recombinant tissue plasminogen activator (IV-tPA) therapy in the 3- to 4.5-hour window is off-label in Korea. This study aimed to assess the safety and efficacy of IV-tPA in these patients. Methods: Using data from a prospective multicenter stroke registry between January 2009 and March 2021, we identified AIS patients who received IV-tPA in the 3- to 4.5-hour window, and compared the outcomes of symptomatic intracranial hemorrhage (SICH), 3-month mortality, 3-month modified Rankin Scale (mRS) score 0-1 and 3-month mRS distribution between patients with both PS and DM (PS/DM, n=56) versus those with neither PS nor DM, or with only one (non-PS/DM, n=927). Results: The PS/DM group versus the non-PS/DM group was more likely to have a prior disability, hypertension, hyperlipidemia, coronary heart disease and less likely to have atrial fibrillation. The PS/DM and the non-PS/DM groups had comparable rates of SICH (0% vs. 1.7%; p>0.999) and 3-month mortality (10.7% vs. 10.2%; p=0.9112). The rate of 3-month mRS 0-1 was non-significantly lower in the PS/DM group than in the non-PS/DM group (30.4% vs. 40.7%; adjusted odds ratio [95% confidence interval], 0.81 [0.41-1.59]). Conclusions: In the 3- to 4.5-hour window, AIS patients with PS/DM, as compared to those with non-PS/DM, might benefit less from IV-tPA. However, given the similar risks of SICH and mortality, IV-tPA in the late time window could be considered in patients with both PS and DM.