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Infarct Core Expansion on Computed Tomography before and after Intravenous Thrombolysis
송동범,유준상,백장현,김진권,이혜선,김영대,남효석,허지회 연세대학교의과대학 2018 Yonsei medical journal Vol.59 No.2
Purpose: Infarct core can expand rapidly in acute stroke patients receiving intravenous tissue plasminogen activator (IV t-PA). We investigated changes in the extent of infarct core during IV t-PA treatment, and explored the associative factors of this infarct core expansion in patients with proximal artery occlusion. Materials and Methods: We included patients who were considered for sequential intra-arterial therapy (IAT) due to occlusion of intracranial proximal artery after IV t-PA. Patients who had a baseline Alberta Stroke Program Early Computed Tomography (CT) Score (ASPECTS) ≥6 and who underwent two consecutive CT scans before and shortly after IV t-PA infusion were enrolled. Patientswere classified into no, moderate, and marked expansion groups based on decreases in ASPECTS (0-1, 2-3, and ≥4, respectively)on follow-up CT. Collateral status was graded using CT angiography. Results: Of the 104 patients, 16 (15.4%) patients showed moderate and 13 (12.5%) patients showed marked infarct core expansion on follow-up CT scans obtained at 71.1±19.1 min after baseline CT scan. Sixteen (15.4%) patients had an ASPECTS value <6 on the follow-up CT. None of the patients with marked expansion were independent at 3 months. Univariate analysis and ordinal logisticregression analysis demonstrated that the infarct core expansion was significantly associated with collateral status (p<0.001). Conclusion: Among patients who were considered for IAT after IV t-PA treatment, one out of every seven patients exhibited marked expansion of infarct core on follow-up CT before IAT. These patients tend to have poor collaterals and poor outcomes despiterescue IAT.
송동범,예병석,허지회,조현지 대한신경과학회 2008 대한신경과학회지 Vol.26 No.2
Cerebral air embolism, the entry of air into the cerebral artery, is an iatrogenic clinical problem in most cases, which may result in seizure, severe neurologic deficits and even death. Although cerebral air embolism may result from almost all procedures that are performed in clinical specialties, occurrence following a gastroscopy is very rare. We report a patient who developed cerebral air embolism following a gastroscopy.
송동범,박은철,서다혜,박현빈,안성귀,선승민,이후연 대한가정의학회 2006 Korean Journal of Family Medicine Vol.27 No.1
The Relationship between Stress and Eating Habits of University StudentsDong Beom Song, M.D., Da Hea Seo, M.D., Hyun Bin Park, M.D., Sung Gwee Ahn, M.D., Seung Min Sun, M.D., Eun Choel Park, M.D.*, Hoo Yeon Lee, M.D.** †College of Medicine, Yonsei University, Seoul, *National Cancer Center, Division of Cancer Policy and Management, Ilsan, **Graduate School of Public Health, Yonsei University, Seoul, Korea 최근 대학생들은 취업을 비롯한 여러 가지 원인으로 스트레스를 많이 받고 있다. 따라서 이들의 건강에 중요한 영향을 미치는 스트레스 수준과 식습관을 살펴보고, 이들의 관계를 알아보고자 하였다.
송동범,이기정,Eun Hye Kim,김영대,이혜선,김진권,송태진,안성수,남효석,허지회 대한뇌졸중학회 2016 Journal of stroke Vol.18 No.1
Background and Purpose We developed a novel method named Gray-matter Volume Estimate Score (GRAVES), measuring early ischemic changes on Computed Tomography (CT) semi-automatically by computer software. This study aimed to compare GRAVES and Alberta Stroke Program Early CT Score (ASPECTS) with regards to outcome prediction and inter-rater agreement. Methods This was a retrospective cohort study. Among consecutive patients with ischemic stroke in the anterior circulation who received intra-arterial therapy (IAT), those with a readable pretreatment CT were included. Two stroke neurologists independently measured both the GRAVES and ASPECTS. GRAVES was defined as the percentage of estimated hypodense lesion in the gray matter of the ipsilateral hemisphere. Spearman correlation analysis, receiver operating characteristic (ROC) comparison test, and intra-class correlation coefficient (ICC) comparison tests were performed between GRAVES and ASPECTS. Results Ninety-four subjects (age: 68.7±10.3; male: 54 [54.9%]) were enrolled. The mean GRAVES was 9.0±8.9 and the median ASPECTS was 8 (interquartile range, 6-9). Correlation between ASPECTS and GRAVES was good (Spearman’s rank correlation coefficient, 0.642; P<0.001). ROC comparison analysis showed that the predictive value of GRAVES for favorable outcome was not significantly different from that of ASPECTS (area under curve, 0.765 vs. 0.717; P=0.308). ICC comparison analysis revealed that inter-rater agreement of GRAVES was significantly better than that of ASPECTS (0.978 vs. 0.895; P<0.001). Conclusions GRAVES had a good correlation with ASPECTS. GRAVES was as good as ASPECTS in predicting a favorable clinical outcome, but was better than ASPECTS regarding inter-rater agreement. GRAVES may be used to predict the outcome of IAT.
허혈뇌졸중 환자의 관상동맥질환 선별검사에 관한 과학적 진술
송동범,김영대,홍근식,윤병우,이병철,나정호,권순억,배희준,유경호,박종무,박광열,고상배,오창완,김정은,허지회 대한신경과학회 2016 대한신경과학회지 Vol.34 No.2
Ischemic stroke and myocardial infarction share common risk factors and pathophysiologic mechanisms. Unrecognized coronary artery disease typically occurs in 20-30% of patients with ischemic stroke, and its presence helps to predict the outcome. Coronary artery disease is also an important cause of morbidity and mortality in patients with ischemic stroke. Therefore, applying a screening test for asymptomatic coronary artery disease may be considered in ischemic stroke patients who have a high cardiovascular risk profile. Coronary computed tomography (CT) angiography, myocardial perfusion imaging, or stress echocardiography can be used as a screening test. Coronary CT angiography is recommended in the absence of allergy to contrast media and renal insufficiency.
Effect and Safety of Rosuvastatin in Acute Ischemic Stroke
허지회,송동범,남효석,김응엽,김영대,이경열,이기정,유준상,김윤남,이병철,윤병우,Jong S. Kim 대한뇌졸중학회 2016 Journal of stroke Vol.18 No.1
Background and Purpose The benefit of statins in acute stroke remains uncertain. Statins may prevent stroke recurrence during the acute stage of stroke via pleiotropic effects. However, statins may increase the risk of intracerebral hemorrhage. We investigated the effect and safety of rosuvastatin in acute stroke patients. Methods This randomized, double-blind, multi-center trial compared rosuvastatin 20 mg and placebo in statin-naïve stroke patients who underwent diffusion-weighted imaging (DWI) within 48 hours after symptom onset. The primary outcome was occurrence of new ischemic lesions on DWI at 5 or 14 days. Results This trial was stopped early after randomization of 316 patients due to slow enrollment. Among 289 patients with at least one follow-up imaging, the frequency of new ischemic lesions on DWI was not different between groups (rosuvastatin: 27/137, 19.7% vs. placebo: 36/152, 23.6%) (relative risk 0.83, 95% confidence interval 0.53–1.30). Infarct volume growth at 5 days (log-transformed volume change, rosuvastatin: 0.2±1.0 mm3 vs. placebo: 0.3±1.3 mm3; P=0.784) was not different, either. However, hemorrhagic infarction or parenchymal/subarachnoid hemorrhage on gradient-recalled echo magnetic resonance imaging occurred less frequently in the rosuvastatin group (6/137, 4.4%) than the placebo group (22/152, 14.5%, P=0.007). Among 314 patients with at least one dose of study medication, progression or clinical recurrence of stroke tended to occur less frequently in the rosuvastatin group (1/155, 0.6% vs. 7/159, 4.4%, P=0.067). Adverse events did not differ between groups. Conclusions The efficacy of rosuvastatin in reducing recurrence in acute stroke was inconclusive. However, statin use was safe and reduced hemorrhagic transformation.