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ABSTRACT: Epidural blood patch (EBP) is an effective procedure for the treatment of spontaneous intracranial hypotension (SIH). Neurological compromise following EBP, although rare, is recognized as a serious potential complication. We describe a 33-year-old female patient in whom long-term bladder and bowel dysfunction developed following a small volume (10mL) EBP to treat SIH. We also discuss the possible pathophysiological mechanisms related to this complication in the postprocedure setting.
Journal of Clinical Neuroscience 12/2012; · 1.25 Impact Factor
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ABSTRACT: In this study, we report an efficient and cost-effective method of fabricating polystyrene (PS) nano-featured substrates containing nanopore (NPo) and nanopillar (NPi) arrays based on hot embossing using nickel nano-stamps. We investigate the behavior of adipose-derived stem cells (ASCs), including adhesion, morphology, proliferation and differentiation, on the replicated PS surfaces. Compared to a flat substrate, NPo- and NPi-featured substrates do not alter the morphology of stem cells. However, both NPo- and NPi-featured substrates induce different integrin expression and lower formation of focal adhesion complexes. In addition, ASCs on the NPo-featured substrate exhibit greater adipogenic differentiation, while the NPi-featured substrate induces higher osteogenic differentiation.
Macromolecular Bioscience 10/2012; · 3.89 Impact Factor
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ABSTRACT: Trigeminal neuralgia (TN) is primarily diagnosed by symptoms and patient history. Magnetic resonance (MR) imaging can be helpful in visualizing the neurovascular compression of the trigeminal nerve in TN patients, but the current parameters used as diagnostic markers for TN are less than optimal. The aim of this study is to assess whether the angle between the trigeminal nerve and the pons (the trigeminal-pontine angle) on the affected side of patients with idiopathic TN differs from that of the unaffected side and that found in controls without TN.
A case-control study of 30 clinically diagnosed idiopathic TN patients aged 30 to 79 years and 30 age- and sex-matched controls was conducted. We compared the trigeminal-pontine angle and trigeminal nerve atrophy via fast-imaging employing steady-state acquisition (FIESTA) MR imaging.
A sharp trigeminal-pontine angle was observed in 25 patients (25/30) on the affected side. As such, the mean angle of the trigeminal nerve on the affected side (40.17) was significantly smaller than that on the unaffected side (48.91, p = 0.001) and that in the control group (52.02, p < 0.001).
A sharp trigeminal-pontine angle on the affected side was found in idiopathic TN patients by FIESTA imaging. This suggests that a sharp trigeminal-pontine angle increases the chance of neurovascular compression on the medial side of the trigeminal nerve.
Acta Neurochirurgica 06/2012; 154(9):1627-33. · 1.52 Impact Factor
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ABSTRACT: Kinase insert domain-containing receptor (KDR), vascular endothelial growth factor receptor-2, play a pivotal role in endothelial dysfunction, which may lead to silent brain infarction (SBI). We evaluated whether single nucleotide polymorphisms (SNPs) of KDR genes are associated with increased risk of SBI in a Korean population.
A total of 383 patients with SBI and 387 controls were genotyped for the KDR -604T>C, 1192G>A, and 1719A>T SNPs. We separately analyzed this association according to the age (age≥65 and age<65) and the gender. We also compared haplotype frequencies between SBI patients and controls.
Genotype frequencies for three SNPs did not differ significantly between SBI patients and controls. In addition, haplotype analysis for three SNPs did not show a difference between patients and controls. However, the frequency of genotype of KDR -604T>C was significantly associated with an increased risk of SBI in the age<65 years old group (AOR=1.515, 95% CI, 1.003 to 2.289, p=0.048) and in male group (AOR=1.596, 95% CI, 1.018 to 2.503, p=0.042).
KDR -604T>C SNP may serve as genetic markers for the increased risk of SBI among the younger (<65 years) or male only Korean subpopulations.
Journal of the neurological sciences 04/2012; 318(1-2):85-9. · 2.32 Impact Factor
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ABSTRACT: Stem cell therapy has been developing rapidly as a potential cure for repairing or regenerating the functions of diseased organs and tissues. Adipose-derived stromal cells (ASCs) are an attractive cell source for stem cell therapy because they can be isolated easily from fat tissue in significant numbers and exhibit multiple differentiation potential under appropriate in vitro culture conditions. However, ASCs derived from individual donors can show wide variations in differentiation potential. In addition, the regulatory mechanisms underlying stem cell differentiation remain unclear. Transforming growth factor β (TGFβ) is a well-known ASC chondrogenic differentiation factor that stimulates ASC signaling pathways by activating transmembrane type I and type II receptors. We hypothesized that the chondrogenic differentiation potential of ASCs is dependent upon the expression of TGFβ receptors and could be improved by the co-delivery of type I (TGFβRI) and type II (TGFβRII) TGFβ receptors. To prove this, heterogeneity within the chondrogenic potential of ASCs isolated from 10 donors was examined and their susceptibility to TGFβ during the process of chondrogenic differentiation investigated. In addition, the results showed that co-delivery of the TGFβRI and TGFβRII genes increased the expression of TGFβ receptor signaling in ASCs with low chondrogenic potential, resulting in increased chondrogenic differentiation. Monitoring and delivering TGFβRI and TGFβRII may, therefore, be a powerful tool for predicting the differentiation potential of stem cells and for enhancing their differentiation capacity prior to stem cell transplantation.
Journal of Controlled Release 04/2012; 160(3):577-82. · 5.73 Impact Factor
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Young Seok Park,
Young Joo Jeon,
Hyun Seok Kim,
Kyu Young Chae,
Seung-Hun Oh, In Bo Han,
Hyun Sook Kim,
Won-Chan Kim,
Ok-Joon Kim,
Tae Gon Kim,
Joong-Uhn Choi,
Dong-Seok Kim,
Nam Keun Kim
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ABSTRACT: We conducted a case-control study to investigate whether vascular endothelial growth factor (VEGF -2578, -1154, -634, and 936) and kinase insert domain containing receptor (KDR -604, 1192, and 1719) polymorphisms are associated with moyamoya disease. Korean patients with moyamoya disease (n = 107, mean age, 20.9±15.9 years; 66.4% female) and 243 healthy control subjects (mean age, 23.0±16.1 years; 56.8% female) were included. The subjects were divided into pediatric and adult groups. Among the 64 surgical patients, we evaluated collateral vessel formation after 2 years and divided patients into good (collateral grade A) or poor (collateral grade B and C) groups. The frequencies and distributions of four VEGF (-2578, -1154, -634, and 936) and KDR (-604, 1192, and 1719) polymorphisms were assessed from patients with moyamoya disease and compared to the control group. No differences were observed in VEGF -2578, -1154, -634, and 936 or KDR -604, 1192, and 1719 polymorphisms between the control group and moyamoya disease group. However, we found the -634CC genotype occurred less frequently in the pediatric moyamoya group (p = 0.040) whereas the KDR -604C/1192A/1719T haplotype increased the risk of pediatric moyamoya (p = 0.024). Patients with the CC genotype of VEGF -634 had better collateral vessel formation after surgery. Our results suggest that the VEGF -634G allele is associated with pediatric moyamoya disease and poor collateral vessel formation.
PLoS ONE 01/2012; 7(10):e47158. · 4.09 Impact Factor
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ABSTRACT: OBJECTIVE: To analyze the interspinous distance and the height, length, and thickness of the lumbar spinous process for interspinous device implantation in Korean patients. METHODS: Morphometric data obtained from plain radiographs of the lumbar and sacral spine were analyzed. The study included 60 matched subjects who visited an outpatient clinic for back pain. Exclusion criteria included collapsed intervertebral disc, lumbarization, and sacralization. There were 34 men and 26 women; age range was the 20s to 70s, with 10 subjects in each decade. The interspinous distance and height, length, and thickness of the lumbar spinous process were obtained on lateral radiographs using an image analysis program (M-view 5.4; Marotech). RESULTS: The largest interspinous distance was at L2-3, with a mean of 12 mm (range 6-22 mm), and the smallest distance was at L5-S1, with a mean of 8 mm (range 3-16 mm). The interspinous distance became shorter from L1-2 to L5-S1. A negative correlation was noted between age and interspinous distance in the L1-5 levels (L1-2, y = -0.11x + 17.27, r(2) = 0.34, P < 0.0001; L2-3, y = -0.07x + 15.68, r(2) = 0.12, P = 0.0058; L3-4, y = -0.08x + 14.39, r(2) = 0.27, P < 0.0001; L4-5, y = -0.05x + 11.65,r(2) = 0.096, P = 0.0158; L5-S1, y = -0.02x + 9.25, r(2) = 0.028, P = 0.1982). CONCLUSIONS: There is a decreasing trend in the interspinous distance in the L1-5 levels with advancing years. Taking progressive collapse of the interspinous distance with the aging process into consideration, interspinous implants should be carefully selected in younger patients.
World Neurosurgery 11/2011; · 0.68 Impact Factor
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ABSTRACT: We fabricated polystyrene substrates with lotus leaf surface structure (LLSS) and investigated cell behaviors, including attachment, morphology, proliferation, and differentiation of adipose-derived stem cells (ASCs) on them. Compared to the flat substrate, the LLSS substrate induced higher cell attachment rate, but did not significantly change the cell proliferation rate. In addition, ASCs on the LLSS substrate exhibited relatively narrower spreading morphology and less organized cytoskeleton, there by resulting in smaller sizes of cells than those on the flat substrate. According to histochemical staining and RT-PCR analysis, the LLSS substrate induced higher adipogenic differentiation of ASCs than the flat substrate, while chondrogenic and osteogenic differentiation were decreased.
Macromolecular Bioscience 07/2011; 11(10):1357-63. · 3.89 Impact Factor
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ABSTRACT: In this study, adipose-derived stem cells (ASCs) were cocultured with nucleus pulposus (NP) cells using a porous membrane to investigate the effect of NP cell phenotype on ASC chondrogenic differentiation. Human NP cells were collected from 14 patients and classified into two groups (normal vs. degenerative) depending on the level of type II collagen, aggrecan (AGG), type I collagen, and bax gene expression. Human ASCs were then cocultured with each group of NP cells on porous membranes in the absence of chondrogenic supplements. After 2 weeks, real-time-polymerase chain reaction results showed that ASCs cocultured with normal NP cells had much higher type II collagen and AGG gene expression than ASCs cocultured with degenerative NP cells. The production of AGG was also observed only in the group cocultured with normal NP cells. Additionally, coculture of ASC pellets with normal NP cells promoted the production of AGG as compared to coculture of ASC monolayer with normal NP cells. These data demonstrate that a coculture system using porous membranes can induce ASC differentiation into NP cells without chondrogenic supplements. Further, the phenotype of cocultured NP cells significantly influences the extent of ASC differentiation.
Tissue Engineering Part A 05/2011; 17(19-20):2445-51. · 4.64 Impact Factor
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ABSTRACT: Degenerative disorders of the intervertebral discs (IVDs) are generally characterized by enhanced matrix degradation, angiogenesis, innervation, and increased expression of catabolic cytokines. In this study, we investigated the effects of inflammatory cytokines, IL-1β, and TNF-α, on the expression of an angiogenic factor, vascular endothelial growth factor (VEGF), and neurotrophic factors, nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF), in human IVD degeneration. IL-1β and TNF-α stimulated the gene expression of VEGF, NGF, and BDNF in nucleus pulposus (NP) cells isolated from patient tissues. Immunohistochemical results demonstrated a positive correlation between IL-1β and VEGF/NGF/BDNF expression in human IVD tissues. RNA expression analysis of patient tissues also identified positive correlations between VEGF and platelet endothelial cell adhesion molecule-1 (PECAM-1) and between NGF/BDNF and protein gene product 9.5 (PGP9.5). Our findings suggest that IL-1β is generated during IVD degeneration, which stimulates the expression of VEGF, NGF, and BDNF, resulting in angiogenesis and innervation.
Journal of Orthopaedic Research 02/2011; 29(2):265-9. · 2.81 Impact Factor
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ABSTRACT: Intervertebral disc degeneration is now considered to be genetically determined in large part, with environmental factors also playing an important role. The human is known to uniquely exhibit variable numbers of tandem repeat polymorphism within the aggrecan CS1 domain. To date, the analysis of aggrecan's variable numbers of tandem repeat polymorphism has given inconsistent results with respect to the correlation between the allele's size and intervertebral disc degeneration. We wanted to investigate the patterns of the variable numbers of tandem repeat polymorphism in the aggrecan CS1 domain of Koreans, and we analyzed the association between the polymorphism and intervertebral disc degeneration.
A total of 66 males and 38 females participated in this study. Their ages ranged from 13 to 73 years. Genomic deoxyribonucleic acid was extracted from blood samples and PCR was carried out to detect the alleles of the aggrecan gene. The subjects were evaluated on MRI and they were classified by the number, severity, and morphology of disc degeneration.
The genotyping identified 11 alleles ranging from 21 to 36 repeats. Alleles 13, 18, 19, and 20 were not found in this study. Of the 104 subjects, 29 (28%) were homozygotes and 75 (72%) were heterozygotes. Allele 27 (39%) was the most common form together with alleles 26 (26%) and 28 (14%). The allele 36 is the longest among the alleles ever discovered. For the case that the analysis was limited to subjects with the fourth decades or less, the 21 allele was significantly overrepresented among the persons with multilevel disc degeneration (p < 0.006).
Carrying a copy of the allele with 21 repeats might increase the risk of multiple disc degeneration in the subjects below the age of 40 years.
Acta Neurochirurgica 10/2010; 153(1):129-33. · 1.52 Impact Factor
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ABSTRACT: Degenerative disorders of the intervertebral discs (IVDs) are generally characterized by enhanced matrix degradation, angiogenesis, innervation, and increased expression of catabolic cytokines. In this study, we investigated the effects of inflammatory cytokines, IL-1β, and TNF-α, on the expression of an angiogenic factor, vascular endothelial growth factor (VEGF), and neurotrophic factors, nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF), in human IVD degeneration. IL-1β and TNF-α stimulated the gene expression of VEGF, NGF, and BDNF in nucleus pulposus (NP) cells isolated from patient tissues. Immunohistochemical results demonstrated a positive correlation between IL-1β and VEGF/NGF/BDNF expression in human IVD tissues. RNA expression analysis of patient tissues also identified positive correlations between VEGF and platelet endothelial cell adhesion molecule-1 (PECAM-1) and between NGF/BDNF and protein gene product 9.5 (PGP9.5). Our findings suggest that IL-1β is generated during IVD degeneration, which stimulates the expression of VEGF, NGF, and BDNF, resulting in angiogenesis and innervation. © 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 29:265–269, 2011
Journal of Orthopaedic Research 08/2010; 29(2):265 - 269. · 2.81 Impact Factor
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ABSTRACT: Cervical dystonia (CD) is the most common form of focal dystonia. The treatment options for CD include medical therapy and surgery. The 3 basic types of CD are tonic, phasic and tremulous. Selective peripheral denervation (SPD) and globus pallidus internus (GPi) deep brain stimulation (DBS) have been developed as therapeutic options for the treatment of CD.
Between 1997 and 2009, 24 patients with CD underwent operations: either SPD (n = 16) or DBS (n = 8). The mean follow-up period was 29.5 months (range = 2-59). The mean age at onset of symptoms was 46.6 years (range = 27-65). The patients were evaluated with the subjective scores and the Toronto Western Spasmodic Torticollis Scale scores.
All patients showed gradual improvement after SPD and DBS. No statistically significant differences were seen between the SPD group and the DBS group. However, there was a trend toward greater pain reduction in the DBS group (p = 0.094).
Both the SPD group and the DBS group showed successful improvement in their Toronto Western Spasmodic Torticollis Scale scores as well as subjective scores. The GPi DBS group showed a remarkable improvement on the pain scale and there was a trend toward greater pain reduction in the DBS group.
Stereotactic and Functional Neurosurgery 05/2010; 88(4):234-8. · 1.85 Impact Factor
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ABSTRACT: Methylenetetrahydrofolate reductase (MTHFR) is the main regulatory enzyme for homocysteine metabolism. In the present study, we evaluated whether the MTHFR 677C>T and 1298A>C gene polymorphisms are associated with SBI and plasma homocysteine concentration in a Korean population.
We enrolled 264 patients with SBI and 234 healthy controls in South Korea. Fasting plasma total homocysteine (tHcy) concentrations were measured, and genotype analysis of the MTHFR gene was carried out.
The plasma tHcy levels were significantly higher in patients with SBI than in healthy controls. Despite a significant association between the MTHFR 677TT genotype and hyperhomocysteinemia, the MTHFR 677C>T genotypes did not appear to influence susceptibility to SBI. However, odds ratios of the 1298AC and 1298AC + CC genotypes for the 1298AA genotype were significantly different between SBI patients and normal controls. The frequencies of 677C-1298A and 677C-1298C haplotypes were significantly higher in the SBI group than in the control group.
This study demonstrates that the MTHFR 1298A>C polymorphism is a risk factor for SBI in a Korean population. The genotypes of 677C>T and 1298A>C polymorphisms interact additively, and increase the risk of SBI in Korean subjects.
Yonsei medical journal 03/2010; 51(2):253-60. · 0.77 Impact Factor
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ABSTRACT: In vitro laboratory study.
The aim of this study was to evaluate the effects of injection speed, contrast viscosity, and needle profile on manometric pressures during discography.
As the degree of the response in a provocation test depends on the intensity of the stimulus, the precise measurement of intradiscal pressure during discography is crucial. Although manometric pressure measurement is safe and easy, manometric pressures may be affected by potential confounding factors, including injection speed, contrast viscosity, and needle profile.
Pressure-controlled discography was performed using an automated pressure-controlled discography system in a total of 60 intervertebral discs in 2 porcine cadavers. Dynamic pressures were measured while changing the following parameters: injection speed (0.01 mL/s vs. 0.08 mL/s), media viscosity (Visipaque vs. normal saline), needle diameter (18G vs. 22G), and needle length (7 inch vs. 3.5 inch). The unit change in manometric pressure per fractional change in injected volume (dP/dV) was used for statistical analysis.
The mean dP/dV increased from 137.9 +/- 11.3 at 0.08 mL/s to 160.3 +/- 12.5 at 0.01 mL/s. Visipaque injection resulted in a higher mean dP/dV than the normal saline injection (160.3 +/- 12.5 vs. 97.8 +/- 34.1). A 7.5 inch needle had a higher mean dP/dV than a 3.5 inch needle (137.9 +/- 11.3 vs. 92.5 +/- 48.6). The mean dP/dV of the 22G needle was higher than the 18G needle (137.9 +/- 11.3 vs. 84.7 +/- 28.3).
High injection speed, high viscosity, small diameter, and a long needle increase the dynamic pressure. To minimize the differences among examiners, we recommend standardization of injection speed, the viscosity of the injected material, and the diameter and length of the needle.
Spine 10/2009; 34(22):E790-3. · 2.08 Impact Factor
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ABSTRACT: To evaluate unusual possible causes and clinical presentations of hemifacial spasm (HFS).
The authors reviewed 1642 cases of HFS. Assessments were based on clinical features, 3-dimensional time-of-flight magnetic resonance angiography, and surgical findings. Causes other than neurovascular compression at the root exit zone of the facial nerve were investigated and unusual clinical presentations were noted.
Nine (0.5%) patients had a secondary causative structural lesion, 7 patients had a tumor, and the remaining 2 had a vascular malformation. Direct compression by dolichoectatic vertebrobasilar artery was noted in 12 (0.7%) patients. In 7 (0.4%) patients, only the distal portion of the facial nerve was compressed, and five (0.3%) had only venous compression. Bilateral HFS and tic convulsif were encountered in 7 (0.4%) and 6 (0.37%) patients, respectively. Fifty-six (3.4%) patients were younger than 30 years old at the time of microvascular decompression.
HFS can result from tumor, vascular malformation, and dolichoectatic artery. Therefore, appropriate preoperative radiological investigations are crucial to achieve a correct diagnosis. The authors emphasize that distal compression or only venous compression can be responsible for persistent or recurrent symptoms postoperatively. In cases of bilateral HFS, a definite differential diagnosis is necessary for appropriate therapy. MVD is recommended as the treatment of choice in patients younger than 30 years old or patients with painful tic convulsif.
Neurosurgery 08/2009; 65(1):130-7; discussion 137. · 2.79 Impact Factor
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ABSTRACT: Although prompt diagnosis and emergent surgical intervention are important in acute spinal subdural hematoma (SSDH), some cases with spontaneous remission of symptom and hematoma without surgery have been reported. We present a case of acute nontraumatic SSDH presenting with transient left hemiplegia for 4 hours. A magnetic resonance imaging study of cervical spine confirmed SSDH with C3-6 cervical cord compression at the left side. The patient had conservative management without recurrence. Although hemiplegia is an unusual clinical manifestation of SSDH, it should be differentiated from that of cerebrovascular origin promptly. Conservative management may be an alternative therapeutic option for selective cases with transient neurological deficits.
Journal of Korean Neurosurgical Society 07/2009; 45(6):390-3. · 0.60 Impact Factor
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ABSTRACT: Microvascular decompression is the most reliable treatment for HFS, but it may cause complications. The aim was to identify factors affecting the prognosis after MVD and to establish appropriate means to reduce complications.
We retrospectively reviewed 1524 patients with HFS who underwent MVD and were followed for more than 6 months since January 1987. The mean follow-up duration was 30.9 months (6-197 months).
The effect of MVD was satisfying (excellent or good) in 94.6% (n = 1442). The failure and recurrence rates were 2.1% (n = 32) and 0.4% (n = 6), respectively. Postoperative complications were noted in 545 (35.8%) patients. Among them, facial palsy, hearing deficit, and low cranial nerve palsies were found in 18.6% (n = 283), 7.2% (n = 109), and 2.8% (n = 43), respectively. However, permanent facial weakness, hearing deficit, and lower cranial nerve palsies such as hoarseness and dysphagia were encountered in 1.2% (n = 18), 2.1% (n = 32), and 0.1% (n = 2), respectively. The more immediate and severe the facial palsy was, the more permanent it remained, with statistical significance (P < .05). There was a trend that the more immediate and severe the hearing deficit was, the more permanent the deficit remained, without statistical significance (P = .673).
Early (occurrence within 24 hours after operation) and severe cranial nerve deficits, including facial, hearing, and lower cranial nerve deficits after MVD, entail the risk to stay permanent.
Surgical Neurology 02/2008; 69(2):153-7; discussion 157. · 1.67 Impact Factor
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ABSTRACT: Traumatic vertebral artery injuries pose difficulty in early diagnosis and management because of concomitant neurologic dysfunction and limitations in direct surgical access. The purpose of this report is to review endovascular therapy in patients with traumatic vertebral artery injuries for preservation of the parent artery, and to determine the safety and efficacy of such endovascular therapy.
Six patients with traumatic vertebral artery lesions were treated using therapeutic endovascular methods. Endovascular therapy was accomplished by stent insertion or coil embolization or both.
Except one patient who underwent coil embolization of a transected vertebral artery, all dissections and pseudoaneurysms were successfully treated by stent placement or stent-assisted coiling with preservation of parent arteries. No additional surgical procedures for vascular lesions were required. There were no delayed neurologic or vascular complications and no lesions recurred during the follow-up period (mean, 36.7 months).
The author's experience demonstrates that endovascular therapy using stents and coils is both feasible and safe in the treatment of traumatic vertebral artery injuries. Endovascular therapy selectively eliminated the vascular abnormality while maintaining the normal patency of the cerebral arteries. Long-term follow-up review of these repairs will be necessary to provide a full evaluation of the safety and efficacy of these devices.
The Journal of trauma 04/2007; 62(4):886-91. · 2.48 Impact Factor
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ABSTRACT: Intra-arterial thrombolysis and percutaneous angioplasty is feasible in patients with acute middle cerebral artery (MCA) occlusion limited to 6 hours post-ictus, but there are some limitations such as reocclusion or hemorrhagic complications. In this report, we describe a stent placement in the treatment of a refractory artherothrombotic MCA occlusion beyond 6 hours of symptom onset. A 57-year-old man presented with a progressive left-sided weakness and verbal disturbance resulting from an acute thrombotic occlusion of the right MCA superimposed on severe proximal atheromatous stenosis. Diffusion-perfusion magnetic resonance imaging (MRI) demonstrated the significant diffusion-perfusion mismatch. After chemical and mechanical thrombolysis of the clot, balloon angioplasty of the underlying MCA stenosis was performed 2 days post-attack, without significant angiographic improvement. Percutaneous endovascular deployment of a stent (Driver 2.5 x 12 mm, MTI, Irvine, CA) was subsequently performed, with excellent angiographic results. Follow-up diffusion-perfusion MRI showed improved perfusion in the hypoperfused area. The patient's National Institutes of Health Stroke Scale (NIHSS) score was increased from 12 to 3. Clot thrombolysis and subsequent stenting in patients with refractory proximal MCA occlusion is feasible and allows for a significant reduction in the amount of thrombolytic drug required. In selective patients with acute MCA occlusion, the therapeutic window for recanalization procedures can be safely and effectively extended beyond the 'traditional 6 hours'. Diffusion-perfusion MRI in acute MCA occlusion is important for indication of therapy.
Neurological Research 01/2007; 28(8):881-5. · 1.52 Impact Factor
