Ki-Han Kwon

Stroke after Burn

Background: Stroke is regarded as a possible complication of burn. Some author reported that stroke developed in 22% of burned patients. However, the true incidence and the clinical characteristics of stroke occurring after burn injury are unknown. Methods: We reviewed the medical records of patients who had been admitted to the Burn Center at the Hangang Sacred Heart Hospital between January 1997 and May 2005. Patients with mild burns who did not require admission to the hospital were excluded from the study. Stroke patients were selected. Results: A total of 13,468 patients were admitted due to burn injury during the above-mentioned period. Nine (0.07%) patients (5 men, 4 women; mean age, 55 years) developed stroke while being under treatment for their burn injuries. The median duration between the burn injury and stroke onset was 33 days (range, 2–307). The mean surface area of the burn wound was 21% (range, 3–50). Ischemic infarction was observed in 4 patients, intracerebral hemorrhage in 3 others, and multiple hemorrhagic infarction and subdural hematoma in 1 patient each. Seven out of the 9 patients revealed the presence of septic conditions that occurred subsequent to the burn. Conclusion: Stroke is a rare complication of a burn injury in the clinical setting. It develops in moderate burns (10–50% of the total body surface area) after some time. Prevention of infection/sepsis is important to alleviate the occurrence of a stroke in these patients.

Significance of Silent Infarcts in Acute Ischemic Stroke Patients Aged 80 Years and Older

Background: The significance of silent infarcts (SIs) is unknown in very elderly patients with first-ever acute ischemic stroke. Methods: Fifty patients aged 80 years and older with first-ever acute ischemic stroke were studied. The conventional risk factors for stroke, the scores of age-related white matter changes, and the findings on echocardiography were compared between patients with and without SIs. Results: Thirty-eight patients (76%) had one or more SIs. The patients without SIs frequently had atrial fibrillation (50% vs. 13.2%, p = 0.014) or spontaneous echo contrast or thrombi on echocardiography (57.1% vs. 0%, p = 0.026) and showed lower scores on age-related white matter changes (0.5 ± 0.67 vs. 1.13 ± 0.58, p = 0.002) than did patients with SIs. There were no differences in other risk factors for stroke between the two groups. Conclusion: In patients aged 80 years and older, the absence of SIs with a first-ever acute ischemic stroke may suggest the presence of cardiac embolic sources or atrial fibrillation.

Atypical Anterior Spinal Artery Infarction due to Left Vertebral Artery Occlusion Presenting with Bilateral Hand Weakness

Background Infarct of the anterior spinal artery is the most common subtype of spinal cord infarct, and is characterized by bilateral motor deficits with spinothalamic sensory deficits. We experienced a case with atypical anterior-spinal-artery infarct that presented with bilateral hand weakness but without sensory deficits. Case Report A 29-year-old man presented with sudden neck pain and bilateral weakness of the hands. Magnetic resonance imaging (MRI) of the brain did not reveal any lesion. His motor symptoms improved rapidly except for mild weakness in his left wrist and fingers. Magnetic resonance angiography showed proximal occlusion of the left vertebral artery; a spine MRI revealed left cervical cord infarction. Conclusions Bilateral or unilateral hand weakness can be the sole symptom of a cervical cord infarct.

Lateral temporal atrophy in mild cognitive impairment

decline is a hallmark of Alzheimer’s disease (AD), describing both risks and benefits in terms of changes in function is a logical choice for such an exercise and requires understanding the temporal relationship of changes in cognition and function. The objective of this study was to co-vary the individual items with Disability Assessment in Dementia (DAD) with measures of cognition and time to identify the temporal order associated with disease progression. Methods: 337 subjects (196 AD, 70 mild cognitive impairment, 71 cognitively healthy volunteers) were enrolled at 40 study sites across the US and Europe during 2006 and 2007 for an 18-month non-interventional study (ELN-AIP-901), sponsored by Elan Pharmaceuticals and Wyeth Research. Recruitment criteria were similar to those used in the ADNI study. DAD was performed at baseline and at 6-months intervals. DAD item scale scores were co-varied with Mini-Mental State Examination (MMSE) score using survival analysis. Results: Using median MMSE survival, patients were unable to perform activities for all items of the sub-domains for finance, medication, and outings at higher scores than for items in other sub-domains. The specific activities ‘‘organize finance’’ and ‘‘adequately organize correspondence’’ exhibited the shortest MMSE survival, ie, ‘‘lost’’ earlier in the course of the disease. The inability to perform items in the sub-domains of personal hygiene, dressing, eating, and continence occurred at lowest MMSE survivals, ie, ‘‘lost’’ at the later stages of AD progression. Seven items ‘‘lost’’ late in the course of the disease, lowest median MMSE survival, were from 3 of the 10 sub-domains, specifically dressing (4 items), eating (2 items), and continence (1 item). Conclusions: Inability to perform instrumental functional activities occurred earlier in the course of the disease, as measured by MMSE score, than basic functional activities. DAD items exhibit a hierarchical loss progression associated with cognitive decline, by MMSE. These findings support the use of DAD items that correlate with AD progression as a method for characterizing benefit and risk.