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ABSTRACT: The vertebral artery (VA) is important for the development of the transverse foramen (TF). Most studies of these structures have focused on anatomical anomalies. Therefore, we investigated quantitatively the association between the relative sizes of the TF and VA.
We recruited a consecutive series of subjects who underwent CT angiography to estimate the relative sizes of the VA and TF in axial source images. Two neurologists independently reviewed the axial CT images of 208 patients who had no history of transient ischemic attack or stroke. Averaged areas of the VA and TF were defined by the sum of the areas at each level from C3 to C6, divided by 4. Correlation analyses were adjusted for age, sex, and vascular risk factors.
The mean age of the subjects was 53 years. The interobserver and intraobserver reliabilities of TF size were good. There was a linear relationship between the sizes of the VA and TF on each side (right side: r(2)=0.58, p<0.001; left side: r(2)=0.62, p<0.001). The area of the VA was significantly associated with that of the TF after adjusting for vascular risk factors.
The size of the VA is strongly and linearly correlated with the size of the TF. These findings suggest that measurement of the TF and VA with CT angiography is a reliable method for evaluating VA diseases, and may provide new insight into the differentiation between VA hypoplasia and atherosclerosis of the VA.
Journal of Clinical Neurology 12/2012; 8(4):259-64. · 1.69 Impact Factor
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ABSTRACT: To date, no large study has been conducted to investigate baseline stroke awareness within a nationally representative sample of the Korean population.
A total of 1000 residents were randomly sampled according to regional demographic characteristics and were interviewed in person by trained interviewers. Structured, open-ended and close-ended questions were asked to assess stroke awareness.
Among the respondents, 62% reported at least 1 stroke symptom and 56% reported at least 1 risk factor for stroke in open-ended questioning. Multivariate analysis revealed that completion of ≥12 years of education was independently associated with knowledge of symptoms (OR, 1.527; 95% CI, 1.146-2.034) and risk factors (OR, 1.577; 95% CI, 1.175-2.115). Approximately 31% and 33% of respondents, respectively, had some knowledge of thrombolysis and the proper action (call emergency medical services). Compared with subjects aged 20 to 39 years, those aged 40 to 59 years were more knowledgeable about thrombolysis (OR, 1.433; 95% CI, 1.045-1.964) and proper action (OR, 2.291; 95% CI, 1.646-3.188). The major source of information about stroke was television (59%), and the most reliable source was the respondents' physicians (55%). Among respondents 20 to 39 years of age, the Internet (37%) was the second greatest source of information.
Stroke awareness was suboptimal in Korea, especially among younger citizens and those with less education. To improve their knowledge, physicians should exert greater efforts to educate the public about stroke using mass media and the Internet.
Stroke 12/2011; 43(4):1146-9. · 5.73 Impact Factor
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Young Seo Kim, Sang-Soon Park,
Hee-Joon Bae,
A-Hyun Cho,
Yong-Jin Cho,
Moon-Ku Han,
Ji Hoe Heo,
Kyusik Kang,
Dong-Eog Kim,
Hahn Young Kim, [......],
Kyung Bok Lee,
Seung-Hoon Lee,
Su-Ho Lee,
Yong-Seok Lee,
Hyo Suk Nam,
Mi-Sun Oh,
Jong-Moo Park,
Joung-Ho Rha,
Kyung-Ho Yu,
Byung-Woo Yoon
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ABSTRACT: Delayed arrival at hospital is one of the major obstacles in enhancing the rate of thrombolysis therapy in patients with acute ischemic stroke. Our study aimed to investigate factors associated with prehospital delay after acute ischemic stroke in Korea.
A prospective, multicenter study was conducted at 14 tertiary hospitals in Korea from March 2009 to July 2009. We interviewed 500 consecutive patients with acute ischemic stroke who arrived within 48 hours. Univariate and multivariate analyses were performed to evaluate factors influencing prehospital delay.
Among the 500 patients (median 67 years, 62% men), the median time interval from symptom onset to arrival was 474 minutes (interquartile range, 170-1313). Early arrival within 3 hours of symptom onset was significantly associated with the following factors: high National Institutes of Health Stroke Scale (NIHSS) score, previous stroke, atrial fibrillation, use of ambulance, knowledge about thrombolysis and awareness of the patient/bystander that the initial symptom was a stroke. Multivariable logistic regression analysis indicated that awareness of the patient/bystander that the initial symptom was a stroke (OR 4.438, 95% CI 2.669-7.381), knowledge about thrombolysis (OR 2.002, 95% CI 1.104-3.633) and use of ambulance (OR 1.961, 95% CI 1.176-3.270) were significantly associated with early arrival.
In Korea, stroke awareness not only on the part of patients, but also of bystanders, had a great impact on early arrival at hospital. To increase the rate of thrombolysis therapy and the incidence of favorable outcomes, extensive general public education including how to recognize stroke symptoms would be important.
BMC Neurology 01/2011; 11:2. · 2.17 Impact Factor
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Young Kim, Sang-Soon Park,
Hee-Joon Bae,
A-Hyun Cho,
Yong-Jin Cho,
Moon-Ku Han,
Ji Heo,
Kyusik Kang,
Dong-Eog Kim,
Hahn Kim, [......],
Kyung Lee,
Seung-Hoon Lee,
Su-Ho Lee,
Yong-Seok Lee,
Hyo Nam,
Mi-Sun Oh,
Jong-Moo Park,
Joung-Ho Rha,
Kyung-Ho Yu,
Byung-Woo Yoon
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ABSTRACT: Abstract Background Delayed arrival at hospital is one of the major obstacles in enhancing the rate of thrombolysis therapy in patients with acute ischemic stroke. Our study aimed to investigate factors associated with prehospital delay after acute ischemic stroke in Korea. Methods A prospective, multicenter study was conducted at 14 tertiary hospitals in Korea from March 2009 to July 2009. We interviewed 500 consecutive patients with acute ischemic stroke who arrived within 48 hours. Univariate and multivariate analyses were performed to evaluate factors influencing prehospital delay. Results Among the 500 patients (median 67 years, 62% men), the median time interval from symptom onset to arrival was 474 minutes (interquartile range, 170-1313). Early arrival within 3 hours of symptom onset was significantly associated with the following factors: high National Institutes of Health Stroke Scale (NIHSS) score, previous stroke, atrial fibrillation, use of ambulance, knowledge about thrombolysis and awareness of the patient/bystander that the initial symptom was a stroke. Multivariable logistic regression analysis indicated that awareness of the patient/bystander that the initial symptom was a stroke (OR 4.438, 95% CI 2.669-7.381), knowledge about thrombolysis (OR 2.002, 95% CI 1.104-3.633) and use of ambulance (OR 1.961, 95% CI 1.176-3.270) were significantly associated with early arrival. Conclusions In Korea, stroke awareness not only on the part of patients, but also of bystanders, had a great impact on early arrival at hospital. To increase the rate of thrombolysis therapy and the incidence of favorable outcomes, extensive general public education including how to recognize stroke symptoms would be important.
BMC Neurology. 01/2011;
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ABSTRACT: Transcranial Doppler sonography (TCD) is commonly used for the diagnosis of middle cerebral artery (MCA) stenosis. However, TCD indices to predict distal MCA (M2) stenosis have not yet been established. We compared TCD and magnetic resonance angiography (MRA) to validate a new index for the diagnosis of M2 stenosis.
Consecutive patients who underwent TCD and MRA were included. Based on MRA, M2 stenosis was defined as >50% narrowing beyond the bifurcation area. TCD index of the M2/M1 ratio was defined as the ratio between the mean flow velocity (MFV) obtained at a depth of 30-44 mm (M2) and a depth of 45-65 mm (M1). Sensitivity and specificity of the M2/M1 ratio were calculated from the receiver operating characteristic curve. The diagnostic yield of elevated MFV (>80 cm/s) and asymmetry index of >30% for M2 stenosis were also investigated.
Among the consecutive patients, 105 with M2 stenosis were compared with 123 without MCA stenosis. The M2/M1 ratio was significantly higher in the M2 stenosis group (1.10 versus 0.86, p < 0.001). Sensitivity and specificity for M2 stenosis were most satisfying when the M2/M1 ratio of 0.97 was adopted as the cutoff value. Diagnostic yield of the M2/M1 ratio was better than MFV or asymmetry index.
The M2/M1 ratio may be a highly specific parameter for assessing M2 stenosis with TCD.
Journal of Clinical Ultrasound 10/2010; 38(8):420-5. · 0.81 Impact Factor
