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이미지,장혜민,정우교,방오영 대한신경과학회 2015 Journal of Clinical Neurology Vol.11 No.4
Background Dabigatran etexilate, a new oral anticoagulant, was recently approved as an efcacious alternative to warfarin for the prevention of frst and recurrent stroke in patients with nonvalvular atrial fbrillation. Limited data are available for dabigatran use in patients with a creatinine clearance rate (CrCL) of 15–30 mL/min. Furthermore, current guidelines do not recommend frequent blood monitoring afer dabigatran use. We report herein a patient with severe renal dysfunction who exhibited profound coagulopathy afer 2 days of dabigatran use. Case Report An 87-year-old woman was admitted for altered mental status and lef-side weakness. She was diagnosed with right middle cerebral artery infarction. Te baseline assessment revealed a serum creatinine concentration of 1.29 mg/dL and a CrCL of 27.2 mL/ min. Dabigatran therapy was started 5 weeks afer admission at a dosage of 110 mg twice daily. Afer 2 days of dabigatran use, the patient developed multiple bruises and evidence of upper-gastrointestinal bleeding. Laboratory tests demonstrated a severe coagulopathy, with a prothrombin time of 85.9 sec, an international normalized ratio of 11.36, an activated partial thromboplastin time of 119.2 sec, and a thrombin time of 230.8 sec. Serial assessment of the patient’s renal function revealed substantial fuctuation of the CrCL (range, 17.9–26.5 mL/ min). Conclusions Te present case emphasizes the need for frequent checking of renal function and assessment using coagulation assays afer commencing dabigatran therapy in patients with moderate-to-severe renal impairment.
Ring finger protein 213 유전자검사와 영상추적검사를 통해 확인한 성인 모야모야병
권순욱,박윤경,문준규,정우교,김동엽,신종화,차지훈,기창석,방오영,김석재 대한신경과학회 2014 대한신경과학회지 Vol.32 No.2
A 63-year-old female complained of transient dysarthria. MRA was conducted to evaluate this symptom, revealing distalinternal carotid artery occlusion with collateral vessel development, suggesting Moyamoya disease, which had not beendetected in MRA performed 5 years previously. Vascular risk factors and laboratory findings suggested no cardiac orautoimmune diseases. The diameter of stenosis of the middle cerebral artery on high-resolution MRI was 2.11 mm, andgenetic evaluation revealed mutation of the gene encoding ring finger protein 213 (RNF213). High-resolution MRI andgene studies are useful for distinguishing between Moyamoya disease and atherosclerosis.