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We report a case of delayed rupture of an anterior communicating artery (Acom) pseudoaneurysm following mechanical thrombectomy (MT) of a distal artery occlusion using a stent retriever. An elderly patient with right hemiparesis showed left proximal internal cerebral artery and middle cerebral artery occlusions. During MT, a fragmented thrombus moved to the anterior cerebral artery (ACA). A stent retriever was deployed to the occluded ACA, and the Acom and proximal ACA segment were significantly straightened. Additionally, we attempted a blind exchange mini-pinning (BEMP) technique, but a subarachnoid hemorrhage (SAH) occurred. Bleeding was almost entirely absorbed 9 days after the procedure, but the SAH recurred at 20 days, and computed tomography angiography revealed a new pseudoaneurysm formation in the Acom. We suggest that the proposed mechanism of pseudoaneurysm formation was likely due to the dislocation and avulsion of the Acom perforators when the ipsilateral ACA was pushed and pulled during MT.

Background: Although many electrocardiography wearable devices have been released recently for the detection of atrial fibrillation (AF), there are few studies reporting prospective data for wearable devices compared to the strategy of the existing guidelines in the detection of atrial fibrillation (AF) after cryptogenic stroke. A tiny single-patch monitor is more convenient than a conventional Holter monitor recording device and, therefore, longer duration of monitoring may be acceptable., Methods and Design: The CANDLE-AF study is a multicenter, prospective, randomized controlled trial. Patients with transient ischemic attack or ischemic stroke without any history of AF will be enrolled. The superiority of the 72-h single-patch monitor to standard strategy and non-inferiority of the 72-h single-patch monitor to an event-recorder-type device will be investigated. Single-patch monitor arm will repeat monitoring at 1, 3, 6, and 12 months, event-recorder-type arm will repeat monitoring twice daily for 12 months. The enrollment goal is a total of 600 patients, and the primary outcome is the detection of AF which continues at least 30 s during study period. The secondary outcome is the rate of changes from antiplatelet to anticoagulant and major adverse cardiac and cerebrovascular events within 1 year., Conclusions: The results of CANDLE-AF will clarify the role of a single-lead patch ECG for the early detection of AF in patients with acute ischemic stroke. In addition, the secondary outcome will be analyzed to determine whether more sensitive AF detection can affect the prognosis and if further device development is meaningful. (cris.nih.go.kr KCT0005592)., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Jung, Lee, Kang, Shin, Chang, Woo Shin, Park, Kim, Nam, Heo, Kim, Yu, Lee, Heo, Woo, Park, Roh, Kim, Lee, Do, Kim, Song, Park and CANDLE-AF Trial Investigators.)

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has led to changes in stroke patients' healthcare use. This study evaluated changes in Korean stroke patients' health-seeking behaviors and stroke care services using data from the Korean Stroke Registry (KSR)., Methods: We reviewed data from patients with acute stroke and transient ischemic attack (TIA) during 2019 (before COVID-19 period) and 2020 (COVID-19 period). Outcomes included patient characteristics, time from stroke onset to hospital arrival, and in-hospital stroke pathways. Subgroup analyses were performed for an epidemic region (Daegu city and Gyeongsangbuk-do region, the D-G region)., Results: The study included 1,792 patients from the pre-COVID-19 period and 1,555 patients from the COVID-19 period who visited hospitals that contribute to the KSR. During the COVID-19 period, the D-G region had two-thirds the number of cases (vs. the pre-CO-VID-19 period) and a significant decrease in the proportion of patients with TIA (9.97%-2.91%). Unlike other regions, the median onset-to-door time increased significantly in the D-G region (361 min vs. 526.5 min, p = 0.016), and longer onset-to-door times were common for patients with mild symptoms and who were in their 60s or 70s. The number of patients who underwent intravenous thrombolysis also decreased during the COVID-19 period, although the treatment times were not significantly different between the 2 periods., Discussion/conclusion: Korean stroke patients in a CO-VID-19 epidemic region exhibited distinct changes in health-seeking behaviors. Appropriate triage system and public education regarding the importance of early treatment are needed during the COVID-19 pandemic., (© 2021 The Author(s) Published by S. Karger AG, Basel.)

Objective: To investigate the therapeutic effect of cranial microcurrent stimulation (CMS) in patients with tension-type headaches (TTH)., Methods: This study was designed as a prospective, randomised, double-blinded and sham-controlled trial. A total of 22 patients with tension-type headache were selected as our study participants and randomly assigned into two groups: CMS group (n = 11) and Sham group (n = 11). To each of the participants, a sham or a true portable CMS stimulation device (CMS; intensity, 25 μA; frequency, 8 Hz) to wear was distributed, and 20-minute daily treatment was provided using the device for 2 weeks. In CMS group, treatment was given by means of electrodes clipped to the ear, whereas, in Sham group, sham treatment was provided by CMS without current. The measurements of Visual Analogue Scale (VAS), Headache Impact Test-6 (HIT6), Patient Health Questionnaire-9 (PHQ9), Generalised Anxiety Disorder 7-item (GAD7) and Hospital Anxiety and Depression Scale (HADS) were performed at pre-treatment (baseline), week 1 and 2 of treatment and two weeks post-treatment., Results: In CMS group, VAS of maximal headache and VAS of current headache, HIT6, PHQ9 and GAD7 significantly decreased by two weeks post-CMS therapy, but not in Sham group (P < .05). Scores of HADS-A (anxiety), HADS-D (depression) and HADS-T (total) significantly decreased by 2 weeks post-CMS therapy in CMS group, but not in Sham group (P < .05). Changes in scores of PHQ9 and GAD7, HADS-A, HADS-D and HADS-T in CMS group were significantly greater than in Sham group by 2 weeks post-CMS therapy (P < .05)., Conclusion: The results indicate that CMS, as an adjunctive treatment for patients with TTH, is safe and analgesic as well as reducing depression or anxiety., (© 2021 John Wiley & Sons Ltd.)

Background: Myalgic encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a poorly understood disease. Amongst others symptoms, the disease is associated with profound fatigue, cognitive dysfunction, sleep abnormalities, and other symptoms that are made worse by physical or mental exertion. While the etiology of the disease is still debated, evidence suggests oxidative damage to immune and hematological systems as one of the pathophysiological mechanisms of the disease. Since red blood cells (RBCs) are well-known scavengers of oxidative stress, and are critical in microvascular perfusion and tissue oxygenation, we hypothesized that RBC deformability is adversely affected in ME/CFS., Methods: We used a custom microfluidic platform and high-speed microscopy to assess the difference in deformability of RBCs obtained from ME/CFS patients and age-matched healthy controls., Results and Conclusion: We observed from various measures of deformability that the RBCs isolated from ME/CFS patients were significantly stiffer than those from healthy controls. Our observations suggest that RBC transport through microcapillaries may explain, at least in part, the ME/CFS phenotype, and promises to be a novel first-pass diagnostic test.

Although statins are established therapy for the secondary prevention of ischemic stroke, factors associated with adherence to statin treatment following ischemic stroke are not well known. To address this, we assessed the 6-month statin adherence using 8-item Morisky Medication Adherence Scale-8 in patients with acute ischemic stroke. Of 991 patients, 65.6% were adherent to statin at 6-month after discharge. Multiple logistic regression analysis showed that patients' awareness of hyperlipidemia (OR 1.62; 95% CI 1.07-2.43), large artery stroke subtype (versus non-large artery stroke, OR 1.79; 95% CI 1.19-2.68), and alcohol drinking habits (OR 1.64; 95% CI 1.06-2.53) were positively associated, while high statin dose (versus low dose, OR 0.6; 95% CI 0.40-0.90) and higher daily number of medication pills (OR 0.93; 95% CI 0.88-0.97) were found to have a negative association with self-reported good adherence to statin medication after acute ischemic stroke. However, stroke severity and diagnosis of hyperlipidemia were not associated with adherence. These results suggest that educational and motivational interventions may enhance statin adherence because modifiable factors were associated with statin adherence., (© 2018 S. Karger AG, Basel.)

Objectives: Direct assessment of the patient perspective is necessary to thoroughly understand patients' experiences of disease. We aimed to examine information from children with short stature on their perceived HrQoL within 5 European countries., Methods: Patients, identified through clinical databases, were approached by their clinicians according to the inclusion criteria regarding a diagnosis of growth hormone deficiency or idiopathic short stature and age requirements. A focus group methodology was applied in 84 children and 112 parents. Based on a category system, individual statements were allocated to domains. To evaluate the emerging topics, qualitative content analysis was conducted. Domains and respective coding frequencies per category were compared across countries and respondents., Results: The highest number of statements produced by the children and parents were related to social (29%) and emotional needs and concerns (28%). In particular, children stressed their experience of social exclusion but also their perception of social support. Regarding emotional needs, they stated mainly the desire to be taller in order to be less teased by peers. National differences were identified, for example, Swedish (22%) and British (16%) children and their parents (Sweden 26%; Britain 23%) stressed physical HrQoL aspects, whereas German children (21%) strongly focused on treatment aspects, mainly the benefit of treatment., Conclusion: Comprehensive knowledge of the impact of a chronic condition such as short stature on wellbeing is an important precondition of effective treatment. Because socioemotional topics were rated in all the countries to be most important, interventions aimed at improving HrQoL should target social and emotional responses to short stature., (Copyright © 2017 John Wiley & Sons, Ltd.)

Phase-contrast synchrotron X-ray microtomography (pcSyncX) based on the highly coherent X-ray beam has previously been used to visualize the microstructures of biologic specimens, but it has never been used to evaluate embolic debris adherent on a cerebral protection device (CPD). The purpose of this study was to demonstrate the feasibility of pcSyncX for evaluating embolic debris during carotid artery stenting (CAS). Five patients (four males, age range 67-77 years) with severe carotid artery stenosis underwent CAS. The retrieved CPD was exposed to synchrotron radiation and 1000 pcSyncX projection images were obtained by rotating the CPD through 180°. An X-ray shadow of a CPD was converted into a visual image by the scintillator. After microtomographic reconstruction, the three-dimensionally reconstructed images were further segmented into the embolic debris and CPD. The total volume of emboli was calculated by summing the volume at each scanning level. The number of membrane pores covered by emboli as seen from the outer surface was counted and the percentage of covered area was calculated. Embolic debris was clearly demonstrated not only on the inner surface and within pores but also on the outer surface of the CPD. The mean total volume of embolic debris was 0.538 × 10(-6) mm(3) (range 0.225-0.965 × 10(-6) mm(3)). Most (61.5%) of the debris was located at the apical one-third of the CPD and 20.8% of the pore area was covered by debris.

Objectives: This study was conducted to evaluate the effect of revascularisation, whether revascularisation improves total cerebral blood flow volume (FVTCBF), and how cerebral veins would respond to altered FVTCBF., Methods: The 39 carotid artery stenoses in 37 patients who underwent revascularisation including 32 stentings and 7 endarterectomies were included in this prospective study. From the two-dimensional phase-contrast (2D-PC) MRI acquired before and after revascularisation, the flow volumes (FVs) of the arteries and veins were compared using paired t-test. The relationships between these parameters were correlated using Pearson's correlation coefficient., Results: The mean FV in the treated carotid artery (proportion of treated artery among total FV) increased from 162.06 ml/min (25.80 %) to 267.71 ml/min (37.21 %; P < 0.001). Revascularisation increased the FVTCBF of patients from 638.66 ml/min to 716.72 ml/min (P < 0.001). The FV of the internal jugular veins, superior sagittal and straight sinuses (FVSS + SSS), and transverse sinuses increased after revascularisation (P < 0.05). Positive relationships were shown between the FVTCBF and the FVSS + SSS (r = 0.584-0.741, P < 0.001)., Conclusions: Revascularisation improves the FVTCBF by increasing the FV in the treated carotid artery. The venous drainages are closely linked to FVTCBF. 2D-PC-MRI is a feasible method for evaluating comprehensively the haemodynamic improvement after revascularisation., Key Points: • Revascularisation may be beneficial in ischaemic strokes due to carotid artery stenosis. • Revascularisation of the affected artery increases total cerebral blood flow volume ( FV TCBF). • Cerebral venous drainage, closely linked to FV TCBF, is also improved. • Two-dimensional phase-contrast MRI can comprehensively assess these haemodynamic improvements after carotid revascularisation.

Background and Purpose: Frovatriptan is a selective 5-HT(1B/1D) agonist with a long duration of action and a low incidence of side effects. Although several placebo-controlled trials have documented the clinical efficacy and safety of frovatriptan in adults with migraine, this drug has not previously been studied in Asian including Korean patients., Methods: In this double-blind multicenter trial, 229 patients with migraine were randomized to receive frovatriptan 2.5 mg or placebo upon the occurrence of a moderate-to-severe migraine. The primary outcome was the 2-hour headache response rate., Results: Frovatriptan significantly increased the 2-hour headache response rate compared with placebo (52.9% vs. 34.0%, p=0.004). The headache response rates at 4, 6, and 12 hours were significantly higher in the frovatriptan group than in the placebo group, as was the pain-free rate at 2 hours (19.0% vs. 5.7%, p=0.004), 4 hours (40.7% vs. 23.0%, p=0.006), and 6 hours (56.1% vs. 34.0%, p=0.002). The median time to a headache response was significantly shorter in the frovatriptan group than in the placebo group (2.00 hours vs. 3.50 hours, p<0.001). The use of rescue medications was more common in the placebo group (p=0.005). Chest tightness associated with triptan was infrequent (2.5%), mild, and transient., Conclusions: These results demonstrate that 2.5-mg frovatriptan is effective and well tolerated in Korean migraineurs for acute treatment of migraine attacks.

We reported a 43-year-old woman who showed a Guillain-Barré like syndrome associated with acute renal failure (ARF) and thrombocytopenia following acute viral hepatitis A(HA). The clinical feature was acute progressive and of ascending symmetric paraparesis which developed 5 days after gastrointestinal infection. Neurologic examination showed flaccid paraparesis, areflexia in all extremities and limitation on the straight leg raising test. Laboratory examinations showed the evidences of ARF, thrombocytopenia and HA. EMG findings suggested a polyradiculopathy. Renal biopsy showed the findings of acute interstitial nephritis, acute tubular necrosis and IgA deposition nephropathy. She was treated by plasmapheresis and platelet transfusion, then showed a rapid improvement, and has been well without further complication after discharge.