Joong Hyun Park

Scoliosis in Patients with Parkinson's Disease

Background and purpose Scoliosis is more common in patients with Parkinsons disease (PD) than in the general elderly population. We compared clinical characteristics between PD patients with and without scoliosis, to identify the relationship between the direction of scoliosis and the laterality of the dominant symptoms of PD. We also studied the associations between dopaminergic pharmacotherapy and scoliosis (defined by a spinal curvature deviation of 10° or larger). Methods The study population comprised 97 patients (42 men and 55 women) with idiopathic PD. All of the patients submitted to a whole-spine scanograph to allow measurement of the degree of scoliosis by Cobbs method. Results True scoliosis was found in 32 of the 97 PD patients, and was observed more frequently in women than in men (28 vs. 4, respectively; p=0.006). The age of patients without scoliosis was significantly lower than that of those with scoliosis (66.5±9.2 years vs. 72.8±7.3 years, respectively, mean±SD, p<0.001). There was no correlation between PD symptom laterality and scoliosis. The rate of occurrence of scoliosis did not differ between de novo and levodopa (L-dopa)-treated patients. Conclusions We suggest that neither L-dopa treatment nor the laterality of the initial symptoms of PD is related to the appearance of scoliosis.

Branch occlusive disease Clinical and magnetic resonance angiography findings

Background: We evaluated the clinicoradiologic characteristics of patients with branch occlusive disease (BOD)–type intracranial atherosclerotic stroke (ICAS) compared with those of patients with non-BOD–type ICAS or with small artery disease (SAD). Methods: We analyzed 201 consecutive patients with acute infarcts within the middle cerebral artery (MCA) distribution but no demonstrable carotid or cardiac embolism sources. According to the diffusion-weighted imaging (DWI) distribution and the presence of ipsilateral MCA stenosis, of any degree, on magnetic resonance angiography (3-T MRI), we divided patients into 3 groups: 1) BOD: subcortical infarcts with MCA stenosis (n = 46); 2) non-BOD: infarcts beyond the subcortical area with MCA stenosis (n = 52); and 3) SAD (n = 103). We compared risk factors, degree of stenoses and distribution, and radiologic features of microangiopathy (leukoaraiosis and cerebral microbleeds) among the groups. Results: Risk factor profiles were similar among the groups, except that hypertension and current smoking were more prevalent in the non-BOD than in the BOD group (p = 0.032 and 0.045). The relevant MCA had more severe and focal stenosis in the non-BOD than in the BOD group (stenosis of ≥70%; 76.9% vs 28.3%; p < 0.001), but the degree of nonrelevant stenosis was similar across the groups. Although clinical features, DWI lesion patterns, and microangiopathy findings were similar between the BOD and SAD groups, nonrelevant stenosis was more prevalent in the BOD than in the SAD group (p < 0.01). Conclusions: BOD is prevalent (47% of ICAS) and shares common characteristics with non-BOD–type ICAS, although its clinicoradiologic features may resemble those of SAD. The morphologic characteristics of stenosis and risk factors may associate with a stroke phenotype in patients with ICAS.

Cilostazol decreases cerebral arterial pulsatility in patients with mild white matter hyperintensities: subgroup analysis from the Effect of Cilostazol in Acute Lacunar Infarction Based on Pulsatility Index of Transcranial Doppler (ECLIPse) study.

Background: The Effect of Cilostazol in Acute Lacunar Infarction Based on Pulsatility Index of the Transcranial Doppler (ECLIPse) study showed a significant decrease in the transcranial Doppler (TCD) pulsatility index (PI) with cilostazol treatment at 90 days after acute lacunar infarction. The aim of the present study was to perform a subgroup analysis of the ECLIPse study in order to explore the effect of cilostazol in acute lacunar infarction based on cerebral white matter hyperintensities (WMH) volume. Methods: The ECLIPse study was a multicenter, randomized, double-blind, placebo-controlled trial that evaluated the difference between the efficacy of cilostazol and a placebo to reduce the PI in patients with acute lacunar infarction using serial TCD examinations. The primary outcome was changes in the PIs of the middle cerebral artery (MCA) and basilar artery at 14 and 90 days from the baseline TCD study. For this subgroup analysis, using semi-automated computerized software, the WMH volume was measured for those subjects for whom fluid-attenuated inversion recovery (FLAIR) images were available. Results: Of the 203 patients in eight hospitals in the ECLIPse study, 130 participants from six hospitals were included in this subgroup analysis. Cilostazol was given to 63 patients (48.5%) and placebo to 67 patients (51.5%). All baseline characteristics were well balanced across the two groups, and there were no significant differences in these characteristics except in the changes of PI from the baseline to the 90-day point. There was a significant decrease of TCD PIs at 90-day study from baseline in the cilostazol group (p = 0.02). The mean WMH volume was 11.57 cm3 (0.13-68.45, median 4.86) and the mean MCA PI was 0.95 (0.62-1.50). The changes in PIs from the baseline to 14 days and to 90 days were 0.09 (-0.21 to 0.33) and 0.10 (-0.22 to 0.36). While there were no significant correlations between WMH volume and the changes in PIs, a trend of inverse correlation was observed between the WMH volume and the changes in PIs from the baseline to the 90-day point. For the subgroup analysis, the WMH volume was dichotomized based on its median value (4.90 cm3). Cilostazol decreased the TCD PIs significantly at the 90-day point in patients with WMH volumes ≤4.9 cm3 (p = 0.002). Significant treatment effects were observed in the cilostazol group. Conclusions: This study showed that cilostazol decreased cerebral arterial pulsatility in patients with WMH. Our findings indicate the unique effect of cilostazol in small vessel disease (SVD), especially in patients with mild WMH changes. Further clinical trials focusing on WMH volume and clinical outcomes are required to assess the unique efficacy of cilostazol in SVD.

Carotid Intima-Media Thickness in Patients with Idiopathic Restless Legs Syndrome

Background: There have been no studies of carotid intima-media thickness (IMT) in idiopathic restless legs syndrome (iRLS) patients. The aims of this study were to evaluate the future risk of stroke in iRLS patients using computer software-assisted automated IMT measurement systems. Methods: We measured the carotid IMT by high-resolution B-mode ultrasound with Intimascope software in 38 iRLS patients and 64 controls. Results: The mean value of the maximum IMT in iRLS patients was significantly lower than that in controls (p < 0.05). In multiple linear regression analysis, younger age and the presence of iRLS remained statistically significant. Younger age or the presence of iRLS was highly correlated with a lower value of the maximum IMT (p < 0.001, p < 0.05). Conclusion: We suggest that iRLS patients may have a lower risk of progression of atherosclerosis.

Central Aortic Pressure and Pulsatility Index in Acute Ischemic Stroke

We investigated the relationship between transcranial Doppler (TCD) pulsatility index (PI) and central aortic pressure by measurement of the aortic augmentation index (AIx).

Carotid Intima-Media Thickness in Patients With Carpal Tunnel Syndrome

We measured the carotid intima‐media thickness, a surrogate marker of early atherosclerosis, in patients with carpal tunnel syndrome compared to a control group to evaluate the risk of atherosclerotic disease.

Bilateral cerebellar infarction caused by dominant medial posterior inferior cerebellar artery

With the advances made in imaging techniques, ischemic strokes affecting the bilateral cerebellum have been reported with increasing frequency. However, simultaneous infarctions in the bilateral medial regions of the cerebellum, territories of the medial branches of the posterior inferior cerebellar artery (mPICA), are rare. This rare type of infarction shows a good prognosis without accompanying acute hydrocephalus. A 71-year-old man with a history of hypertension presented with an abrupt gait disturbance. On neurologic examination, he could stand but not walk due to gait ataxia. He did not have tremor or dysdiadochokinesia. Brain MRI revealed an acute infarction in the vermis and adjacent areas on the bilateral cerebellar hemispheres, which were consistent with the involvement of the territories of the bilateral mPICA (figure, A).1 A selective …

Carotid Intima-Media Thickness is Inversely Related to Bone Density in Female but not in Male Patients with Acute Stroke

Atherosclerosis and osteoporosis are two major public health problems. It is still uncertain whether an abnormal carotid ultrasonography, either increased intima‐media thickness (IMT) or plaque thickness, is associated with osteoporosis in acute ischemic stroke patients. To investigate the possible relationships between osteoporosis and carotid atherosclerosis, we evaluated the correlation between carotid IMT/plaque thickness and bone mineral density (BMD) in acute ischemic stroke patients.

Septic cavernous sinus thrombosis with infectious arteritis of the internal carotid artery

Septic cavernous sinus thrombosis (CST) is thrombophlebitis in the cavernous sinus. It is an unusual complication of paranasal sinusitis, otitis media and, less often, pharyngitis and dental infection, affecting the anatomic structures running in the cavernous sinus.1–3 Ophthalmoplaegia may be the presenting symptom of cavernous sinus thrombosis. Impaired extraocular muscle motility is seen, usually starting with a lateral gaze.3 Contrary to nervous system structures, however, the internal carotid artery (ICA) is rarely involved. A 53-year-old woman without contributory medical history was admitted to our hospital with a high fever, left-sided headache …

A Comparative Study of Central Hemodynamics in Parkinson’s Disease

Objective To explore the central aortic pressure in patients with Parkinson’s disease (PD). Methods We investigated central arterial stiffness by measurement of the augmentation index (AIx) in PD patients. Patients were eligible for the study if they were de novo PD and 45 years of age or older. The patients’ demographics, vascular risk factors, and neurologic examinations were collected at baseline. The AIx was measured by applanation tonometry. Results A total of 147 subjects (77 in control and 70 in PD groups) were enrolled in the study. While there was no significant difference in peripheral systolic blood pressure (SBP), diastolic blood pressure (DBP), or mean arterial pressure between groups, peripheral pulse pressure (PP) was significantly lower in the PD group than in the control group (p = 0.012). Regarding central pressure, aortic DBP was significantly higher and PP was significantly lower in the PD group (p = 0.001, < 0.0001). Although there was no significant difference in the AIx between the groups, a trend toward a lower AIx was observed in the PD group (31.2% vs. 28.1%, p = 0.074). Conclusion This study showed that peripheral and central PP was significantly lower in the PD group than in the control group. Our study suggests that PD patients may have a low risk of a cardiovascular event by reason of a lower PP.