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우호걸,양광익,송태진 대한수면연구학회 2021 Journal of sleep medicine Vol.18 No.3
Obstructive sleep apnea (OSA), a common comorbidity in patients with stroke, has shown increasing prevalence over the past few decades. OSA is an important risk factor for stroke in addition to other well-known contributors, including hypertension, hyperlipidemia, atrial fibrillation, and diabetes mellitus. Moreover, OSA is an independent predictor of neurological outcomes and mortality. The pathological mechanisms underlying the association between OSA and stroke include autonomic dysfunction, hypertension, cardiac arrhythmia, dyslipidemia, impaired glucose tolerance, hypoxia, and inflammation. Continuous positive airway pressure (CPAP) therapy has proven clinical utility in improvement of neurological symptoms in patients with stroke. Findings from a CPAP withdrawal model have shown increased sympathetic activity in OSA with a consequent significant elevation in blood pressure, relevant cerebral hypoxia, and disturbed cardiac repolarization. In this review, we present an overview of the literature that describes an association between OSA and stroke in addition to the vascular risk factors, including hypertension, hyperlipidemia, atrial fibrillation, and diabetes mellitus. This study highlights the importance of early and accurate diagnosis and management of OSA for stroke prevention and care and will benefit physicians in clinical practice.
우호걸,이혜아,류동열,송태진 연세대학교의과대학 2021 Yonsei medical journal Vol.62 No.1
Purpose: Antiplatelet drugs are essential in patients with cardiovascular disease who undergo stent placement. We hypothesizedthat risks of mortality would differ according to adherence to antiplatelet agents, number of antiplatelet agents, and antiplateletregimens in patients undergoing stent placement or angioplasty. Materials and Methods: Between 2002 and 2013, we initially enrolled 8671 subjects who underwent stent placement or angioplastyin the National Health Insurance Service-National Sample Cohort in Korea. Using the International Classification of Diseases,10th revision, the incidence of all-cause death, including cardiovascular disease, cerebrovascular disease, and cancer, wasdefined. Using a nested case-control study design, controls were matched to cases at a ratio of 4:1, and a total of 5415 subjects wereeligible for this study. Results: During a median follow-up period of 3.51 years, the incidence rate of all-cause death was 40 per 1000 person-years. Wefound that adherence to antiplatelet monotherapy significantly decreased risk of death by cerebro-cardiovascular disease, comparedwith discontinuation of antiplatelets [adjusted odds ratio (OR) 0.62, 95% confidence interval (CI) (0.41–0.96)]. Comparedwith dual antiplatelet therapy (DAPT), aspirin and clopidogrel monotherapy significantly reduced death by cerebro-cardiovasculardisease [adjusted OR 0.65, 95% CI (0.44–0.95) and adjusted OR 0.58, 95% CI (0.35–0.96), respectively]. There was no significantdifference of mortality between aspirin monotherapy and clopidogrel monotherapy. Conclusion: Our study demonstrated that adherence to antiplatelet therapy and antiplatelet monotherapy, compared with DAPT,in patients with stent placement or angioplasty may have a beneficial effect on mortality in cerebro-cardiovascular disease.
Central Sleep Apnea without Cheyne-Stokes Breathing Following an Acute Cerebral Infarction
오혜정,우호걸,석진명,양광익 대한수면연구학회 2019 Journal of sleep medicine Vol.16 No.1
Central sleep apnea (CSA) is attributed to medical or neurological conditions including stroke. The association of lesion location and CSA in patients with ischemic stroke has not been well elucidated. A 69-year-old man with a history of hypertension and diabetes mellitus was admitted due to stroke. The brain magnetic resonance imaging showed an acute ischemic stroke in the right ventral thalamus and adjacent hypothalamus. During hospitalization, polysomnography (PSG) was performed because repetitive cessation of respiration during sleep was observed by chance. PSG showed severe CSA; the apnea-hypopnea index (AHI) was 73.5 with a minimum oxygen saturation of 89% and central apnea index (CAI) was 63.0. Two years later, follow-up PSG showed that AHI was 7.2 with a minimum oxygen saturation of 91% and CAI was 1.0. We report the patient with CSA after ischemic stroke with right thalamus and adjacent hypothalamus, which resolved spontaneously with time.
노경철,최혜연,우호걸,장준영,허성혁,장대일,김범준 대한신경과학회 2022 Journal of Clinical Neurology Vol.18 No.4
Background and Purpose Ischemic stroke recurs despite the use of antiplatelet agents. Various mechanisms are involved in recurrence due to intracranial atherosclerosis (ICAS) and extracranial atherosclerosis (ECAS). High-on-aspirin platelet reactivity (HAPR) may differ between recurrent stroke due to ICAS and ECAS. Methods Patients with recurrent ischemic stroke as a result of large-artery atherosclerosis despite taking aspirin were enrolled consecutively. Ischemic stroke was classified as stroke due to ICAS or ECAS according to the location of the culprit stenosis. An aspirin reaction units (ARU) value of >550 IU was defined as HAPR. HAPR and its associated factors were compared between the two groups and also considering the mechanism of stroke. Results Among the 190 patients with recurrent stroke (111 with ICAS and 79 with ECAS), 36 (18.3%) showed HAPR. The ARU value was higher in the ECAS than the ICAS group (492± 83 vs. 465±78, mean±standard deviation; p=0.028), as was the proportion of patients with HAPR (27.8% vs. 12.6%, p=0.008). Being male and having stroke due to ECAS (reference = stroke due to ICAS: odds ratio=5.760; 95% confidence interval=2.154–15.403; p<0.001) was independently associated with HAPR. The ARU value differed according to the stroke mechanism, and was highest in those with artery-to-artery embolism. Artery-to-artery embolism was independently associated with HAPR in both the ICAS and ECAS groups. Conclusions Recurrent stroke due to ECAS was more strongly associated with HAPR and insufficient antiplatelet inhibition than was that due to ICAS. Artery-to-artery embolism was associated with HAPR in recurrent ischemic stroke as a result of ICAS or ECAS.
장윤경,김진권,우호걸,류동열,오형중,송태진 대한신경과학회 2020 Journal of Clinical Neurology Vol.16 No.1
Background and Purpose Fibroblast growth factor 23 (FGF23) is associated with atherosclerosis via nitric-oxide-associated endothelial dysfunction and calcium-phosphate-related bone mineralization. This study aimed to determine the association of the plasma FGF23 concentration with intracranial cerebral atherosclerosis (ICAS) and extracranial cerebral atherosclerosis (ECAS). Methods We prospectively enrolled 262 first-ever ischemic stroke patients in whom brain magnetic resonance was performed and a blood sample acquired within 24 h after admission. Plasma FGF23 concentrations were measured using an enzyme-linked immunosorbent assay. The presence of ICAS or ECAS was defined as a ≥50% decrease in arterial diameter in magnetic resonance angiography. The burden of cerebral atherosclerosis was calculated by adding the total number of vessels defined as ICAS or ECAS. Results Our study population included 152 (58.0%) males. The mean age was 64.7 years, and the plasma FGF23 concentration was 347.5±549.6 pg/mL (mean±SD). ICAS only, ECAS only, and both ICAS and ECAS were present in 31.2% (n=82), 4.9% (n=13), and 6.8% (n=18) of the subjects, respectively. In multivariate binary and ordinal logistic analyses, after adjusting for sex, age, and variables for which p<0.1 in the univariate analysis, the plasma FGF23 concentration (per 100 pg/mL) was positively correlated with the presence of ICAS [odds ratio (OR)=1.07, 95% CI=1.00–1.15, p=0.039], burden of ICAS (OR=1.09, 95% CI=1.04–1.15, p=0.001), and burden of ECAS (OR=1.06, 95% CI=1.00–1.12, p=0.038), but it was not significantly related to the presence of ECAS (OR=1.05, 95% CI=0.99–1.12, p=0.073). Conclusions The plasma FGF23 may be a potential biomarker for cerebral atherosclerosis, particularly the presence and burden of ICAS in stroke patients.
조수현,이지훈,우호걸,정유진,김상범,신원철 대한임상신경생리학회 2014 Annals of Clinical Neurophysiology Vol.16 No.2
Foot drop is usually derived from peroneal nerve injury. Traumatic causes of peroneal nerve injury are more commonthan insidious causes including metabolic syndromes and mass lesions. We present a case with common peronealneuropathy due to schwannoma, which is extremely rare. Complete excision of the mass lead to a gradual improvementof the symptoms. Schwannoma should be considered as a cause of common peroneal neuropathy.(Korean J Clin Neurophysiol 2014;16:74-76)