Table of Content

20 July 2010, Volume 5 Issue 07

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主编手记

Decennium

WANG Yong-Jun

2010, 5(07):  509-511. 

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会议报道

Summary of the European Stroke Conference 2010

2010, 5(07):  512-516. 

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述评

Present Situation of Stroke Medicine in Taiwan

WONG Wen-Jang

2010, 5(07):  517-518. 

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论著

Hypertension Down-Regulates the Expression of Brain-Derived Neurotrophic Factor in the Hippocampus and Cerebral Cortex after Chronic Cerebral Ischemia

LEE Tsong-Hai

2010, 5(07):  519-523. 

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Objective To study whether hypertension may affect the expression of brain-derived neurotrophicfactor in the hippocampus and cerebral cortex after chronic cerebral ischemia.Methods Normotensive Wistar-Kyoto (WKY) rats and spontaneously hypertensive rats (SHR)received permanent occlusion of bilateral common carotid arteries (chronic ischemic animalmodel). In situ hybridization and immunohistochemistry were used to detect the changes ofbrain-derived neurotrophic factor at 1 week and 4 weeks after chronic ischemia. H&E stain wasused to examine the cerebral infarct volume at 4 weeks after ischemia.Results There was a significant reduction of brain-derived neurotrophic factor mRNA andimmunoreactivity in the hippocampal CA1 and cerebral cortex of SHR from 1 week to 4 weeksafter chronic ischemia (P <0.05). Western blot study gave the same result. However, WKY ratshad only transient decrease at 1 week after ischemia (P <0.05). H&E stain showed there was asignificantly larger area of brain infarct in the SHR than WKY rats (12.40±4.26% vs 0.41±0.17%,P =0.026).Conclusion Our study indicates that under chronic ischemia, hypertension may aggravatethe ischemic brain damage and influence the expression of brain-derived neurotrophic factorespecially in ischemia-vulnerable hippocampal CA1 and cerebral cortex.

Experiences of Using Recombinant Tissue Plasminogen Activator for Acute Ischemic Stroke in an University Hospital

HUANG Po-Ying;CHEN Jun-Hong;YANG Yuan-Han;et al.

2010, 5(07):  524-528. 

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Objective To analyze the eligibility for recombinant tissue plasminogen activator (r-tPA) in anuniversity hospital.Methods We developed a protocol for hyperacute stroke in an university teaching hospital.Consecutive patients activated the protocol from June 2004 to October 2005 were prospectivelyregistered. The patients were excluded from r-tPA according to the exclusion criteria developedby the Taiwan Stroke Society.Results A total of 182 patients activated the protocol, only 11 (6.04%) received intravenous (IV)r-tPA and 4 (2.20%) received intra-arterial (IA) thrombolysis. The main reasons for exclusionwere minor or improving stroke (46.15%), hypertension (35.16%), insufficient time to completestudies or onset beyond 3 hours after reconfirmation (24.17%) and intracranial hemorrhage(15.93%).Conclusion Only 11 patients received IV r-tPA and 4 patients received IA thrombolysis at ourhospital over a period of 17 months. The results were probably due to the strict exclusion criteriaand new criteria were developed to maximize the eligibility for r-tPA.

Effects of 17beta-estradiol in Attenuating Experimental Subarachnoid Hemorrhage-Induced Cerebral Vasospasm

LIN Chi-Long;LIU An-Xiang;SU Yu-Feng;et al.

2010, 5(07):  529-535. 

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Objective Although cerebral vasospasm after aneurismal subarachnoid hemorrhage (SAH) hasbeen recognized for over half of a century, it remains a major complication in patients sufferingfrom SAH. As the problem of no effective treatment for cerebral vasospasm still exists, thepathophysiological mechanism contributing to arterial dysfunction needs intensive study. Thepresent study evaluates the effect and possible mechanism of 17β-estradiol (E2) on SAH-inducedvasospasm in a two-hemorrhage rodent model of SAH.Methods A 30-mm Silastic® tube filled with E2 in corn oil (0.3 mg/ml) was subcutaneouslyimplanted in male rats. Serum levels of E2 were measured on day 0, 1, 2, 3, 4, and 7 afterimplantation. The degree of vasospasm was determined by averaging the cross sectional areasof the basilar artery 7 days after the first SAH. Expressions of endothelial nitric oxide synthase(eNOS) and inducible nitric oxide synthase (iNOS) in basilar artery were also evaluated.Results Serum levels of E2 in the E2-treated rats were at physiological levels (56-92 pg/ml) andwere significantly higher than those in the control and vehicle groups. E2-treatment significantly(P <0.01) attenuated SAH-induced vasospasm. Induction of iNOS-mRNA and protein in basilarartery by SAH was significantly diminished by E2-treatment but not by vehicle. The SAHinducedsuppression of eNOS-mRNA and protein was relieved by E2 treatment.Conclusion These results suggest that continuous treatment of E2 at physiological level preventscerebral vasospasm following SAH. The beneficial effect of E2 may be, in part, related to prevent the augmentation of iNOS expression and preserve the normal eNOS expression after SAH. E2-treatment holds therapeutic promise in the treatment of cerebral vasospasm following SAH and ismeritorious of further investigation.

Congenital Vertebral Artery Hypoplasia and Stroke

CHUANG Yu-Min

2010, 5(07):  536-538. 

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Objective Vertebral artery (VA) hypoplasia is an uncommon embryonic variation. The frequencyof this congenital variation was reported to be 2%-6% from autopsy and angiograms. Thepurpose of our study was to elucidate the role of VA hypoplasia in acute ischemic stroke.Methods We examined 195 acute ischemic stroke patients (age 57±13 years). Trial of Org10172 in Acute Stroke Treatment (TOAST) subtypes were determined. Magnetic resonanceangiogram(MRA) was performed in every patient. Carotid duplex ultrasound and VA flowvolume measurement need to be completed within 72 h after onset.Results The overall incidence of a unilateral congenital hypoplastic VA was 11.79%, whichwas statistically higher especially in cases of brainstem/cerebellar infarction. Subjects with VAhypoplasia had an etiological preponderance of the ‘large-artery atherosclerosis’ subtype and atopographic preponderance of ipsilateral posterior circulation infarction.Conclusion Based on our results, VA hypoplasia seemed to be a contributing factor of acuteischemic stroke, especially in posterior circulation territories.

Blood Gas Analysis of Venturi Mask Adjuvant Oxygen Therapy in Severe Ischemic Stroke Patients-A Pilot, Randomized Case-control Study

TSAI Ming-Yen;CHANG Ku-Chou;HSU Mao-Chang;et al.

2010, 5(07):  539-544. 

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Objective To investigate the safety and gas analysis after continuous usage of hyperoxygenationin severe ischemic stroke patients.Methods According to the methodology of our prior study, we included 16 severe ischemic strokepatients within 48 hours of onset from August, 2005 to February, 2007; by means of 2:1 (Maskto cannula) randomization. Both groups were allocated to use mask or cannula for 10 days at oneatmosphere. Inclusion criteria were changed to National Institute of Health Stroke Scale(NIHSS)score 17 and more than two-third of middle cerebral artery(MCA) territory infarction. . Overallarterial blood gases were recorded at six o'clock a.m. in the initial, day 1 and day 10 after patientsregistered. Concomitant treatments were as clinical practice.Results During 18 months, 16 severe infarction patients were enrolled in 57 MCA infarctions.There were 11 patients allocated to the venturi mask and 5 to the cannula group randomly. Theywere basically equal. There were no statistical difference at both artery blood gas analysis andAPACHE II scores in survival patients in the initial, day 1 and day 10; NIHSS scores were 22initially and 16 at discharge in both groups. However, confounding factors such as craniectomyand hyperventilation might contribute to the survival outcomes.Conclusion This pilot study sought to find if gas profiles contribute to the survival outcomes.No statistical difference in gas analysis, APACHE II and survival outcomes. Incomplete data collections and confounders might contribute to the survival outcomes which need to be clarifiedin the future large sample size study.

专题论坛

Stroke Prevention--Opinions of Neurologists in Taiwan

2010, 5(07):  545-545. 

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How to Prevent Atrial Fibrillation and Stroke

HSU Hung-Yi

2010, 5(07):  546-547. 

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Angiotensin II Receptor Blockers (ARBs) in Stroke Prevention

LIOU Chia-Wei

2010, 5(07):  548-552. 

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Diabetes Mellitus and Stroke

CHEN Chih-Hung

2010, 5(07):  553-554. 

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病例讨论

Percutaneous Stent Implantation for Angiostenosis due to Takayasu Arteritis

LIN Kuan-Hsiang;CHUNG Chih-Ping;CHANG Feng-Chi;et al

2010, 5(07):  555-557. 

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指南与规范

Guidelines for the Management of Hypertension in Stroke: Guideline from the Taiwan Stroke Society

LO Yuk-Keung;LIN Ching-Huang;WONG Wen-Jang;et al

2010, 5(07):  558-562. 

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Medication Errors in Acute Cardiovascular and Stroke Patients——A Scientific Statement From the American Heart Association (Part 2)

BAI Ying;WANG Chun-Yu

2010, 5(07):  563-572. 

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综述

Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts andLeukoencephalopathy

LEE Yi-Chung;SOONG Bing-Wen;WONG Wen-Jang.

2010, 5(07):  573-578. 

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Cerebral autosomal dominant arteriopathy with subcortical infarcts andleukoencephalopathy (CADASIL) is an adult-onset, dominantly inherited disorder characterizedby recurrent subcortical infarctions, dementia, and less frequently, migraine or psychiatricsymptoms. Its causative gene is NOTCH3. CADASIL is the most common monogenetichereditary cerebral vasculopathy. In this review, we will brief ly introduce the clinicalmanifestations, molecular pathomechanism, diagnostic strategies, and suggestions of themanagement of CADASIL. The characteristic of CADASIL in Taiwan will be also introduced.

Stroke Center at National Taiwan University Hospital

JENG Jiann-Shing

2010, 5(07):  579-582. 

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It has been known that stroke center or stroke unit care can reduce stroke deathrates, enhance functional outcome, and decrease the length of hospital stay for stroke patients.Stroke Center at National Taiwan University Hospital (NTUH) was established in November,2002. The goals of the NTUH stroke center are to provide a multidisciplinary stroke care and anacute stroke team; to enhance reperfusion therapy for acute stroke patients, standards of care andtreatment options for stroke patients, acute rehabilitation, stroke registry, outcome measurementand stroke education for patients and communities; and to enhance stroke systems of care.

Advance of Antithrombotic Therapy in Atrial Fibrillation

HAN Fei;YANG Zhong-Hua.

2010, 5(07):  583-590. 

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Patients with atrial fibrillation have high risk of thromboembolism. In recent years,many progresses have been made in the research of the antithrombotic therapy, especially theprevention of stroke in atrial fibrillation. It mainly reflected in the aspects of anticoagulation andantiplatelet therapy, the use of antiarrhythmic drugs, interventional therapy, etc. Advances ofantithrombotic therapy in atrial fibrillation were reviewed in this paper.