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Background and ObjectivesWhite matter hyperintensities (WMHs) are reportedly increased in moyamoya disease (MMD); however, their clinical importance is not well-established owing to their pathophysiologic heterogeneity by distribution. This study aimed to evaluate the burden and pattern of WMHs and its clinical implications in the MMD trajectory.MethodsAdult patients with MMD without significant structural lesions were 1:1 propensity score-matched with healthy controls for sex and vascular risk factors. The total, periventricular, and subcortical WMH volumes were segmented and quantified fully automatically. WMH volumes were detrended by age and compared between the 2 groups. MMD severity based on Suzuki stage and future ischemic events were assessed for their association with WMH volumes.ResultsA total of 161 pairs of patients with MMD and controls were analyzed. MMD significantly correlated with increased total WMH volume (B [standard error], 0.126 [0.030];p< 0.001), periventricular WMH volume (0.114 [0.027];p< 0.001), and periventricular-to-subcortical ratio (0.090 [0.034];p= 0.009). In the MMD subgroup (n = 187), advanced MMD had an independent association with the total WMH volume (0.120 [0.035];p< 0.001), periventricular WMH volume (0.110 [0.031];p< 0.001), and periventricular-to-subcortical ratio (0.139 [0.038];p< 0.001). Periventricular WMH volume (adjusted hazard ratio [95% confidence interval], 5.12 [1.26–20.79]) and periventricular-to-subcortical ratio (3.80 [1.51–9.56]) were associated with future ischemic events in patients with medically followed up MMD. However, no demonstrable association was found between subcortical WMH volume and MMD, MMD severity, or future ischemic events.DiscussionPeriventricular WMHs, but not subcortical WMHs, may represent the main pathophysiology of MMD. Periventricular WMHs may be used as a marker for ischemic vulnerability in patients with MMD.

We report a case of severe, non-migraine headache accompanied by multifocal cerebral artery stenosis in a 41-year-old man with antiphospholipid syndrome (APS). He visited the emergency department with a headache that had occurred 2 days prior to presentation. He was administered low-dose aspirin (100 mg) daily after being diagnosed with antiphospholipid syndrome. Magnetic resonance angiography revealed severe multifocal cerebral artery stenosis. We assumed that multiple stenoses of the cerebral blood vessels were caused by APS; hence, we initiated pulse intravenous methylprednisolone therapy. Oral anticoagulation with warfarin was continued. After treatment, the symptoms and stenosis of the cerebral arteries gradually improved. Awareness of central nervous system vasculitis (with non-migraine headaches) caused by APS should be created among clinicians.

Introduction: Although the association between vertebral artery or posterior inferior cerebellar artery dissection and lateral medullary infarction (LMI) has been established, the actual prevalence of dissection among patients with LMI may still be underestimated. Methods: Consecutive patients with acute pure LMI admitted between 2010 and 2021 were included. High-resolution vessel wall MRI (VWMRI) and/or transfemoral cerebral angiography (TFCA) were performed in a part of patients and were regarded as gold standard tests for diagnosis of dissection. Factors associated with definite dissection based on VWMRI or TFCA findings were assessed. Risk scoring for dissection was created based on multivariate logistic regression and applied to estimate the number of possible dissection. Results: Eighty-seven LMI patients were eligible and 47 (54.0%) of them underwent VWMRI (n=43) and/or TFCA (n=7). Among these 47 cases, 24 were definite dissection. Three out of 40 patients without gold standard tests were diagnosed with definite dissection based on conventional MRI findings. Preceding headache and normal body weight were independently associated with dissection in LMI patients. A risk scoring which includes age, body mass index, and headache predicted dissection with 91.7% sensitivity and 69.6% specificity (area under the receiver operating characteristic curve, 0.889; 95% confidence intervals, 0.802-0.977) in our population. Additional nine out of 37 patients without gold standard tests nor diagnosis of definite dissection in conventional MRI could be considered as possible dissection based on the scoring. Definite and possible dissections together comprised 41.4% (n=36) of LMI in our study. Conclusions: Arterial dissection may be more prevalent among LMI patients than reported before. Thorough diagnostic effort for dissection is necessary based on scrutinizing risk stratification.

Introduction: White matter hyperintensities (WMH) are reportedly increased in moyamoya disease (MMD); however, their clinical importance is not well-established owing to their pathophysiological heterogeneity by distribution. This study aimed to evaluate the burden and pattern of WMH and its clinical implications in the MMD trajectory. Methods: Adult MMD patients without significant structural lesions were 1:1 propensity score-matched with healthy controls for sex and vascular risk factors. The total, periventricular, and subcortical WMH volumes were segmented and quantified fully automatically. WMH volumes were detrended by age and compared between the two groups. MMD severity based on Suzuki stage and future ischemic events were assessed for their association with WMH volumes. Results: A total of 190 pairs of patients with MMD and controls were analyzed. MMD significantly correlated with increased total (B, 0.086; standard error [SE], 0.027; p=0.002) and periventricular WMH volumes (B, 0.079; SE, 0.025; p=0.002). In the MMD subgroup, advanced MMD had an independent positive association with the total (B, 0.124; SE, 0.034; p Conclusions: Periventricular WMH, but not subcortical WMH, may represent the main pathophysiology of MMD. Periventricular WMH may be used as a marker for ischemic vulnerability in patients with MMD.

Introduction: Alteration of the gastrointestinal (GI) tract by resection or bypass surgery might affect the absorption of both warfarin and direct oral anticoagulants (DOACs). The clinical trials of DOACs excluded individuals with altered GI tract, hence there are limited pharmacokinetic data for them. Only several cases have been reported suggesting atrial fibrillation-related stroke due to reduced absorption of DOACs after GI surgery. We aimed to investigate the efficacy of warfarin and DOACs who underwent GI surgery using nationwide population-based data. Methods: This was a retrospective cohort study using claim-based national data from 2013 to 2020 from Korean Health Insurance Review and Assessment Service (HIRA). Patients with nonvalvular AF (NVAF) taking oral anticoagulants (OACs) were included. The patients taking OACs due to other indications than NVAF were excluded. Cox proportional hazard models with time-varying covariates were used to investigate the impact of GI surgery in patients taking warfarin and DOACs. Results: Of the 311,782 patients (mean age 72, male 56.7%) with NVAF, 3,807 underwent GI surgery. Warfarin and DOACs were prescribed in 14.3% and 85.7% of the patients, respectively. Overall, warfarin was associated with a higher risk of ischemic stroke compared with DOACs (hazard ratio [HR] 1.51, 95% confidence interval [CI] 1.44-1.59). In the GI surgery group, the hazard ratio for ischemic stroke for warfarin compared with DOACs was 2.70 (95% CI, 1.63-4.45, Figure). In the no GI surgery group, warfarin also had a higher risk of ischemic stroke compared with DOACs (HR 1.51, 95% CI 1.44-1.59). Among DOAC-treated patients, GI surgery was not associated with a risk of ischemic stroke (HR 0.87, 95% CI 0.67-1.12). Conclusions: DOACs were more effective for stroke prevention than warfarin in patients with NVAF whose GI tracts were altered due to previous surgery. GI surgery did not affect the risk of stroke in patients with NVAF taking DOAC.

Background and Aims: Although insufficient physical activity (PA) and sedentary behavior (SB) are established independent risk factors for stroke, stroke survivors may ultimately be at a higher risk of physical inactivity. Thus, we investigated the factors associated with PA and SB in stroke survivors in a community setting. Methods: A cross-sectional study was performed using representative data from the Korea National Health and Nutrition Surveys from 2016 to 2020. We compared the level of moderate to vigorous aerobic PA, resistance exercise, and sedentary time between stroke survivors and controls. Then we performed a multivariate analysis to investigate the factors associated with physical inactivity and long sedentary time. The recommended level of aerobic PA was at least 150 min of moderate-intensity activity or at least 75 min of vigorous-intensity activity or an equivalent combination of moderate and vigorous-intensity activity throughout the week. The sufficient level of resistance exercise was defined as ≥2 days/week. Long sedentary time was defined as spending ≥8 h/day on SB. Results: Physical inactivity was significantly more prevalent among stroke survivors. The older age (odds ratio [OR]=5.448, p=0.001), and living in rural areas (OR=1.911, p=0.020) were associated with low levels of aerobic PA. Female sex (OR=0.427, p=0.007) was associated with a low degree of resistance exercise. Finally, Living without economic activity (OR=2.224, p=0.001), subjective unhealthy (OR=1.458, p=0.027), a single life (OR=1.611, p=0.049), and old age (OR=1.231, p=0.046) were independent predictors of long sedentary time. Conclusions: Based on these results, further research and policy studies are needed to increase the physical activity of stroke survivors.

Introduction: Clonal hematopoiesis of indeterminate potential (CHIP) has been linked with incident cardiovascular disease and its outcome. However, the association between CHIP and acute ischemic stroke is not yet fully elucidated. Methods: This retrospective, observational cohort study included 366 acute ischemic stroke patients from a single center prospective stroke registry and 4,628 general population control (age over 40 years old). We compared the prevalence of CHIP between stroke patients and control groups. A multivariable linear or logistic regression model was used to assess the association between CHIP and initial stroke severity, hemorrhagic transformation and functional disability at 90-day (modified Rankin scale score >1) after stroke. The contribution of individual CHIP driving genes was also evaluated. Results: When comparing the acute ischemic stroke patients (N=366) and the general population (N=4,628), the prevalence of CHIP was significantly higher in stroke patients than in the general population (32.0% vs. 13.9% with variant allele frequencies of 1.5%, p Conclusion: CHIP was obviously increased in ischemic stroke patients. Furthermore, CHIP was significantly associated with stroke severity, hemorrhagic transformation, and functional disability at 90 days.

Nilotinib is a Bcr-Abl tyrosine kinase inhibitor used to treat chronic myelogenous leukemia. There have been case reports of nilotinib-related vasculopathy. However, most cases present peripheral artery disease, whilst reports of nilotinib-related cerebrovascular disease are quite uncommon. Herein, we report a case of nilotinib-induced intracranial stenosis in a patient with recurrent transient ischemic attacks and discuss the results of serial vessel wall magnetic resonance imaging.

Although it is not recognized as essential to test for antiphospholipid antibody (aPL) in stroke of unknown cause, aPL-related stroke may account for a considerable number of cryptogenic strokes. We aimed to assess the current status and diagnostic value of aPL testing in cryptogenic stroke patients.Consecutive patients admitted with acute ischemic stroke were examined to confirm the factors associated with performing aPL testing and with positive aPL test results in real-world practice. Cryptogenic stroke patients were separately examined in the same manner. The antibody profiles of cryptogenic stroke patients with aPL positivity were compared by age.Among 2947 patients, 606 (20.6%) were tested for aPLs and 129 (21.3%) were positive. Physicians tended to perform aPL testing in patients aged50 years and in cryptogenic stroke patients. Cryptogenic stroke was a strong predictor of positive aPL results (adjusted odds ratio 3.70, 95% confidence interval 2.38-5.76). However, aPL positivity did not differ by age in stroke patients. Among 283 cryptogenic stroke patients, 136 (48.1%) were tested for aPLs and 56 (41.2%) were positive. aPL tests were performed predominantly in patients aged50 years rather than in older patients, even among cryptogenic stroke patients. The two age groups had similar positivity rates of40% (50 years: 43.2%; ≥50 years: 40.4%; p = 0.92) and their antibody profiles were similar.A significant number of patients with cryptogenic stroke had positive aPL results regardless of age. aPL testing may offer additional diagnostic opportunities in cryptogenic stroke patients, and thus may reduce the incidence of cryptogenic stroke.

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-CO­VID-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 CO­VID-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.

Background The research about the influence of triglyceride-glucose index on early prognosis in stroke is lacking. Aims In this study, we evaluated the association between triglyceride-glucose index and early neurological deterioration in patients with single subcortical infarctions. Methods Consecutive patients with single subcortical infarctions within 72 h of symptom onset between 2011 and 2015. Early neurological deterioration was defined as an increase of ≥2 in the total NIHSS score or ≥1 in the motor NIHSS score. The triglyceride-glucose index was calculated using the log scale of fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2. Results A total of 305 patients with single subcortical infarctions were evaluated. In multivariable analysis, the triglyceride-glucose index (adjusted odds ratio [aOR] = 2.94, 95% confidence interval [CI] = 1.58–5.45) and age (aOR = 1.05, 95% CI = 1.01–1.09) were associated with early neurological deterioration. In subgroup analysis according to the type of single subcortical infarctions, only patients with proximal single subcortical infarctions showed a significant association between the triglyceride-glucose index and early neurological deterioration (aOR = 2.92, 95% CI = 1.35–6.29). On the other hand, there was no statistical significance in patients with distal single subcortical infarctions. Patients with untreated diabetes also showed the close association between the triglyceride-glucose index and early neurological deterioration (aOR = 3.94, 95% CI = 1.47–10.52). Conclusions The triglyceride-glucose index was associated with early neurological deterioration in single subcortical infarctions. This association differed depending on the location of lesion and the presence of untreated diabetes.

Background and Purpose: Renal dysfunction is known to affect vasculature and lead to systemic arterial stiffness. It also independently increases the risk of cerebral small vessel disease (cSVD) and stroke. We aimed to examine the effect of renal dysfunction on cerebral hemodynamics and the burden of cSVD. Methods: Of the 412 patients admitted to Seoul National University Hospital, between May 2015 and 2019, with lacunar infarction and no major intracranial arterial stenosis observed on magnetic resonance angiography, we included 283 patients who had undergone a transcranial Doppler (TCD) ultrasound after 72 h of stroke onset. The patients were divided into renal dysfunction (estimated glomerular filtration rate [eGFR] 2 at admission) and control (eGFR ≥60 mL/min/1.73 m2) groups. We investigated the correlations between renal function, the pulsatility index (PI), and the total MRI burden of cSVD. Furthermore, multivariate analysis was performed to assess the association between renal dysfunction and the PI of the middle cerebral artery (MCA) measured through TCD ultrasound. Results: Among the total patients, 74 (26.1%) had renal dysfunction (eGFR 2 at admission). Patients with renal dysfunction were significantly older, showed higher pulse pressure, and had a higher prevalence of hypertension, diabetes mellitus, and coronary artery disease. Renal dysfunction was significantly associated with higher distal cerebrovascular flow resistance (median PI 1.12, interquartile range [IQR]: 0.85–1.57 vs. controls 0.84, IQR: 0.54–1.22; p < 0.001). Also, patients with renal dysfunction had a significantly higher total MRI burden of cSVD (median cSVD score 2, IQR: 1–3 vs. controls median score 1, IQR: 0–2; p < 0.001). There was an inverse proportional relationship between the PI and eGFR. Finally, multivariate analysis showed renal dysfunction (adjusted odds ratio: 4.516, 95% confidence interval: 1.051–20.292) and older age (adjusted odds ratio: 1.076, 95% confidence interval: 1.038–1.114) as independent predictors of a high PI. Conclusions: Renal dysfunction is independently associated with a high PI of MCA. Renal dysfunction leads to systemic arterial stiffness including stiffness in cerebral arteries, thus increasing the burden of cSVD. Therefore, noninvasive screening for high PI by TCD in kidney failure patients might be helpful.

Radiological markers for cerebral small vessel disease (SVD) may have different biological underpinnings in their development. We attempted to categorize SVD burden by integrating white matter signal abnormalities (WMSA) features and secondary presence of lacunes, microbleeds, and enlarged perivascular spaces.Data were acquired from 610 older adults (aged40 years) who underwent brain magnetic resonance imaging exam as part of a health checkup. The WMSA were classified individually by the number and size of non-contiguous lesions, distribution, and contrast. Age-detrended lacunes, microbleeds, and enlarged perivascular space were quantified to further categorize individuals. Clinical and laboratory values were compared across the individual classes.Class I was characterized by multiple, small, deep WMSA but a low burden of lacunes and microbleeds; class II had large periventricular WMSA and a high burden of lacunes and microbleeds; and class III had limited juxtaventricular WMSA and lacked lacunes and microbleeds. Class II was associated with older age, diabetes, and a relatively higher neutrophil-to-lymphocyte ratio. Smoking and higher uric acid levels were associated with an increased risk of class I.The heterogeneity of SVD was categorized into three classes with distinct clinical correlates. This categorization will improve our understanding of SVD pathophysiology, risk stratification, and outcome prediction.• Classification of white matter signal abnormality (WMSA) features was associated with different characteristic of lacunes, microbleeds, and enlarged perivascular space and clinical variability. • Class I was characterized by multiple, small, deep WMSA but a low burden of lacunes and microbleeds. Class II had large periventricular WMSA and a high burden of lacunes and microbleeds. Class III had limited juxtaventricular WMSA and lacked lacunes and microbleeds. • Class II was associated with older age, diabetes, and higher neutrophil-to-lymphocyte ratio. Smoking and higher uric acid levels were associated with an increased risk of class I.

Purpose: There are many differences between in hospital ischemic stroke(IHS) and community onset ischemic stroke(COS), and there are several comparative studies. Although the importance of mechanical thrombectomy(MT) in the treatment of acute ischemic stroke is becoming increasingly important, there are not many studies on the effectiveness of MT in IHS. We aimed to compare the clinical features and outcomes between IHS and COS patients who received MT. Methods: We analyzed cases of mechanical thrombectomy performed at Seoul National University Hospital from January 2012 to June 2020. We selected patients with previous mRS(modified Rankin Scale) 0-1 and then divided them into two groups: IHS and COS, and compared successful recanalization, discharge mRS, 3month mRS, and 3month functional independence (mRS 0-2). Results: A total of 41 patients with IHS and 213 patients with COS were included. The baseline characteristics(age, sex, underlying disease, occlusion site) of the two groups were similar, but malignancy tended to be more common in IHS than COS(19.5% vs 7.5%). The median/mean LNT(last normal time)-to-puncture time was 341min/399min in IHS and 370min/461min in COS. The percentages of successful recanalization (92% vs 89%), discharge mRS (mean, 2.19 vs 2.97), 3 month mRS (mean, 2.05 vs 2.56), 3 month functional independence (61% vs 49%) were comparable between the two groups. In the multivariable analysis of the 3 month functional independence, initial NIHSS and successful recanalization were the most important predictors. In addition, a multivariable analysis was performed on successful recanalization, and LNT to puncture time was the most important predictor. Conclusions: The importance of MT is still high even in the in hospital stroke. In addition, IHS has more factors that can reduce the onset to puncture time compared to COS such as well designed on-call system and patient transfer system, well arrangement of nursing manpower. Therefore, more attention is needed for MT in IHS.

Background and Purpose: Chronic kidney disease (CKD) is known to have affected the systemic vasculature and its remodeling, which eventually led to the systemic arterial stiffness. However, the relationship between cerebral circulation and impaired renal function is poorly understood. To evaluate the effect of renal dysfunction to increase systemic and intracranial arterial stiffness, we assessed the relation between renal resistive index (RRI) and pulsatility index (PI) of the middle cerebral artery (MCA). Methods: We included patients with acute lacunar infarction. Demographic and clinical data were collected by retrospective chart review. Bilateral transcranial Doppler ultrasound (TCD) examination of the MCAs was performed using the ST3 Ultrasound system (Spencer Technologies) and PI were calculated. RRI was obtained through kidney Doppler sonography. Subjects with occlusion or significant stenosis of MCA, atrial fibrillation, bilaterally absent transtemporal sonographic windows were excluded. Results: Of the 283 included subjects (mean age 67.8 ± 10.2), 74 patients had renal dysfunction (glomerular filtration rate < 60ml/min/1.73m2 at admission) and 49 patients underwent kidney Doppler ultrasound within 1 year since their acute stroke. Renal dysfunction was significantly associated with higher arterial stiffness (median PI 1.12, IQR 0.85 to 1.57 vs. controls PI 0.84, IQR 0.54 to 1.22 [pr =0.65, p Conclusions: In patients with lacunar infarction, renal impairment is an independent determinant of increased arterial stiffness in cerebral circulations. In addition, PI is significantly associated with RRI.

Supplemental material, sj-pdf-1-wso-10.1177_1747493020984069 for Triglyceride-glucose index is associated with early neurological deterioration in single subcortical infarction: Early prognosis in single subcortical infarctions by Ki-Woong Nam, Min K Kang, Han-Yeong Jeong, Tae J Kim, Eung-Joon Lee, Jeonghoon Bae, Kipyoung Jeon, Keun-Hwa Jung, Sang-Bae Ko and Byung-Woo Yoon in International Journal of Stroke

BackgroundFamily history (FH) is one of important risk factors for cardiovascular disease (CVD). However, little is known about its impact on dyslipidemia prevalence and management status. Thus, we aimed to investigate the impact of FH of CVD on dyslipidemia prevalence, awareness, treatment, control, and healthy behaviors in Korean adults.MethodsWe conducted a cross-sectional study using representative data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2014–2018. A total of 22,024 participants aged ≥ 19 years without histories of CVDs were classified into two groups according to the presence of FH of CVD (with FH, n = 3,778; without FH, n = 18,246). FH of CVD was defined as having a first-degree relative with ischemic heart disease or stroke. Multivariate logistic regression analyses were performed to evaluate the association between FH of CVD and dyslipidemia prevalence, awareness, treatment, control, and healthy behaviors (weight control, non-smoking, non-risky drinking, sufficient physical activity, and undergoing health screening).ResultsFH of CVD was significantly associated with a higher dyslipidemia prevalence (adjusted odds ratio [aOR] 1.34, 95% confidence interval [CI] 1.18–1.51), better awareness (aOR 1.54, 95%CI 1.19–2.00), and treatment rates (aOR 1.34, 95%CI 1.12–1.60), but not control. Having an FH of CVD was not predictive of any healthy behaviors in dyslipidemia patients. For non-dyslipidemia patients, FH of CVD even showed significant association with smoking (aOR 1.18, 95%CI 1.02–1.36), and risky drinking (aOR 1.20, 95%CI 1.03–1.40) while it was predictive of receiving health screening (aOR 1.14, 95% CI 1.02–1.27).ConclusionsHaving an FH of CVD might positively trigger dyslipidemia patients to start pharmacological intervention, but not non-pharmacological interventions. Therefore, physicians should make more efforts to educate and promote the importance of non-pharmacological behavioral modification in dyslipidemia patients with an FH of CVD.

We report a case of acute middle cerebral territory ischemic infarction caused by left ventricular thrombus (LVT) in a doxorubicin cardiomyopathy patient. A major adverse effect of doxorubicin is cardiotoxicity. In doxorubicin cardiomyopathy, as the ventricular contractility decreases, LVT can occur and lead to systemic embolic events such as stroke.

Background The effectiveness of mechanical thrombectomy (MT) in cancer-related stroke (CRS) is largely unknown. This study aims to investigate the clinical and radiological outcomes of MT in CRS patients. We also explored the factors that independently affect functional outcomes of patients with CRS after MT. Methods We retrospectively reviewed 341 patients who underwent MT after acute ischemic stroke onset between May 2014 and May 2020. We classified the patients into CRS (n = 34) and control (n = 307) groups and compared their clinical details. Among CRS patients, we analyzed the groups with and without good outcomes (3-months modified Rankin scale [mRS] score 0, 1, 2). Multivariate analysis was performed to investigate the independent predictors of unfavorable outcomes in patients with CRS after MT. Results A total of 341 acute ischemic stroke patients received MT, of whom 34 (9.9%) had CRS. Although the baseline National institute of health stroke scale (NIHSS) score and the rate of successful recanalization was not significantly different between CRS patients and control group, CRS patients showed more any cerebral hemorrhage after MT (41.2% vs. controls 23.8%, p = 0.037) and unfavorable functional outcome at 3 months (CRS patients median 3-month mRS score 4, interquartile range [IQR] 2 to 5.25 vs. controls median 3-month mRS score 3, IQR 1 to 4, [p = 0.026]). In the patients with CRS, elevated serum D-dimer level and higher baseline NIHSS score were independently associated with unfavorable functional outcome at 3 months (adjusted odds ratio [aOR]: 1.524, 95% confidence interval [CI]: 1.043–2.226; aOR: 1.264, 95% CI: 1.010–1.582, respectively). Conclusions MT is an appropriate therapeutic treatment for revascularization in CRS patients. However, elevated serum D-dimer levels and higher baseline NIHSS scores were independent predictors of unfavorable outcome. Further research is warranted to evaluate the significance of these predictors.

We introduce a process for optically reconstructing full-color holographic images recorded by optical scanning holography. A complex RGB-color hologram was recorded and converted into a binary hologram using a direct binary search (DBS) algorithm. The generated binary hologram was then optically reconstructed using a spatial light modulator. The discrepancies between the reconstructed object sizes and colors due to chromatic aberration were corrected by adjusting the reconstruction parameters in the DBS algorithm. To the best of our knowledge, this represents the first optical reconstruction of a full-color hologram recorded by optical scanning holography.

Background: There is evidence that smoking increases stroke risk. However, the impact of smoking status on age at onset of ischemic stroke has not been studied. The aim of this study is to explore the effect of smoking status on the age at onset of first-ever ischemic stroke using the Korean Stroke Registry(KSR), the nation-wide, multicenter, hospital-based stroke registry in Republic of Korea. Methods: This study used individual data of first-ever ischemic stroke patients from the KSR, between 2014 and 2018. We divided the patients into four groups according to their smoking status; current smokers, past-smokers - quit in recent 5 years, past smokers - quit over than 5 years, and never-smokers. Results: A total of 27,942 patients were included in the analysis. The mean age at onset of the first-ever stroke were 60.0±11.9 in current smokers, 65.9±11.9 past-smokers - quit in recent 5 years, 70.1±10.8 in past smoker - quit over than 5 years, and 70.5±12.8 in never-smokers (p Conclusions: The smoking status of patients was associated with an earlier onset age of the first-ever stroke. The onset age tends to be delayed with the longer duration of cessation period.

Introduction: Temperature affects human health. It is widely known that mean ambient temperature with both short-term and cumulative lagged effect, is the exposure measure for ischemic stroke. Recently, not only mean temperature, larger diurnal temperature range (DTR, difference between high- and low-daily temperature) was associated with coronary heart disease mortality and ischemic stroke hospitalizations. We hypothesized that a larger DTR results in environmental stress to the human cardiovascular system, thereby increasing the risk for acute ischemic stroke severity. Methods: We used both time-series and case-crossover approaches to assess the relation between DTR and ischemic stroke severity between summer of 2016 and 2018 in Korea. Data were obtained from Korean Stroke Registry and Korean Meteorological Administration. We used exposures averaged over periods varying from 1 to 14 days to assess the effects of DTR on stroke severity. We estimated the relation between DTR and ischemic stroke severity after adjustment for classical stroke risk factor and weather conditions of stroke index day. Results: A 9,249 patients were included in both time-series and case-crossover analyses. The results showed that DTR was significantly associated with stroke severity. The lag effect of DTR was stabilized at about 3-4 days. A 5 °C increase of three-day moving average of DTR corresponded to a 1.67 (95% Confidential Interval, CI 1.64-1.70, p Discussion: The current study supported our hypothesis that diurnal temperature variation could be a new severity factor for acute ischemic stroke. Moreover, the two different methods we used provided relatively similar results, suggesting that the association between DTR and stroke severity was reasonably robust. Our data added additional evidence that exposure to large DTR was associated with increased burden of stroke. This findings would contribute public health program to prevent unstable thermal environments.

Background and Objectives: Atrial fibrillation (AF) is well-established risk factor for cardioembolic stroke. Epidemiological evidence indicates that there is increased risk of AF with chronic kidney disease (CKD) and impaired renal function. Cystatin C (Cys-C) is now considered as a specific marker for detection of renal impairment. However, there are no data about the potential association of Cys-C with AF and cardioembolic stroke in the subjects without evident CKD. We investigated whether serum Cys-C level is associated with development of cardioembolic stroke in patients with AF. Methods: Consecutive data were collected retrospectively at the Seoul National University Hospital (SNUH). Patients with ischemic stroke with subtypes of large artery atherosclerosis, small vessel occlusion and cardioembolism who admitted at the SNUH between November 2014 and November 2017 were screened. We excluded the patient who have a history of secondary hypertension, CKD (estimated glomerular filtration rate < 60 mL/min/1.73 m 2 ), valvular heart disease, congenital heart disease, dilated or hypertrophy cardiomyopathy and thyroid disease. Results: Among the total 627 patients, 61.8% were male, with a mean age of 67.9 years. Compared to the other stroke mechanisms, a stepwise logistic regression analysis showed that AF was independently associated with size of left atrium (OR, 1.196, 95% CI: 1.160-1.266), initial stroke severity (NIH Stroke Scale) (OR, 1.126, 95% CI: 1.083-1.189), and Cys-C (OR, 2.472, 95% CI: 1.255-15.129), but not with eGFR (OR 0.993, 95% CI: 0.977-1.009). Conclusion: Cys-C is a superior predictor for cardioembolic stroke due to AF in patients without evident CKD.

We propose binocular full-color complex holograms with lines of sight matching for a binocular display. In which, we record the holograms for binocular display and match the lines of sight using feature matching.

Patients with hereditary hemorrhagic telangiectasia (HHT) are at risk of developing pulmonary arteriovenous malformations (pAVMs). Paradoxical embolism may occur through pAVMs or patent foramen ovale (PFO) and lead to cerebral infarction. We present a case of cerebral infarction with both pAVM associated with HHT and PFO. Evidence of a right-to-left shunt can suggest other treatment options for stroke prevention, and patients without evidence of conventional stroke etiologies require a thorough evaluation. J Korean Neurol Assoc 33(3):217-220, 2015

We propose a numerical technique that analyses the imaging properties of optical scanning holography (OSH) constructed using real optical components in a real optical alignment situation. Using the proposing technique, we analyze the aberrations and the vulnerability of the OSH about the optical alignment. After that, we propose a digital filter that compensates the aberrations of the OSH. Finally, we show that the digital filter removes the aberrations of an experimentally recorded OSH.