So-Hyun Kim

Increased Circulating Endothelial Microparticles and Carotid Atherosclerosis in Obstructive Sleep Apnea

Background and Purpose Endothelial impairment is a linking mechanism between obstructive sleep apnea (OSA) and cardiovascular diseases. Profiles of endothelial microparticles (EMPs) and endothelial progenitor cells (EPCs) reflect the degree of endothelial impairment. The aims of this study were to measure the levels of EMPs and progenitor cells in OSA, determine the correlations between these factors and OSA severity and the degree of atherosclerosis, and document any changes in these factors after therapy. Methods Subjects with (n=82) and without (n=22) OSA were recruited prospectively. We measured the number of colony-forming units (CFU) in cell culture as the endothelial progenitor cell index, and the number of EMPs using flow cytometry with CD31 [platelet endothelial cell adhesion molecule (PECAM)], CD42 (platelet glycoprotein), annexin V, and CD62E (E-selectin) antibodies at baseline and after 4-6 weeks of continuous positive airway pressure (CPAP) therapy. Carotid intima-media thickness (IMT) was regarded as a marker of atherosclerosis. Results The levels of PECAM+CD42- (p<0.001), PECAM+annexin V+ (p<0.001), and E-selectin+ microparticles (p=0.001) were higher in OSA subjects than in non-OSA subjects. The number of CFU did not differ between the two groups. OSA severity independently predicted the levels of PECAM+CD42- (p=0.02) and PECAM+annexin V+ (p=0.004). Carotid IMT was correlated with OSA severity (p<0.001), PECAM+CD42- (p=0.03), and PECAM+annexin V+ (p=0.01). Neither OSA severity nor carotid IMT was correlated with either the number of CFU or E-selectin+. CPAP therapy decreased the occurrence of E-selectin+ (p<0.001) in 21 of the OSA subjects, but had no effect on the other microparticles of the number of CFU. Conclusions OSA led to the overproduction of EMPs, which moderately correlated with OSA severity and the degree of atherosclerosis, and partly responded to therapy. The endothelial impairment might contribute to future cardiovascular events.

Spinal subdural hematoma following tissue plasminogen activator treatment for acute ischemic stroke

A 49-year-old woman with an acute ischemic stroke was treated by the intravenous administration of tissue plasminogen activator within 2 h of symptom onset. She complained of severe upper thoracic back pain the following day. Progressive paraparesis was detected on the third admission day. Spinal MRI demonstrated an acute anterior subdural hematoma from the C7 to T2 level. An urgent laminectomy was performed. Neurologists must be aware of the possibility that neck or back pain after thrombolysis for ischemic stroke may be the first presenting symptom of spinal hematoma.

Syndrome of inappropriate antidiuretic hormone secretion associated with pramipexole in a patient with Parkinson's disease.

The syndrome of inappropriate antidiuretic hormone secretion (SIADH) can be caused by a variety of drugs. Dopaminergic drugs might enhance the secretion of the antidiuretic hormone arginine vasopressin by reducing γ-amino butyric acid release through the dopaminergic receptor in supraoptic nucleus. A 75-year-old woman with Parkinson’s disease developed asthenia, delirium, aggravated parkinsonian symptoms, and hypotonic hyponatremia along with the diagnostic criteria for SIADH during dose escalation of pramipexole. After pramipexole withdrawal, these symptoms disappeared, and sodium levels returned to normal values. The serum sodium levels of patients receiving pramipexole should be monitored, especially during dose escalation.

PO15.21 Right-To-Left Shunt Degree by Transcranial Doppler in the Patent Foramen Ovale on the Stroke Mechanism

nystagmus induced by lying down were analyzed. Twenty two patients also underwent bithermal caloric tests before treatment and the followup test was done after treatment in 8 patients. Results: The patients included 18 (60.0%) women and 12 (40.0%) men. Mean age of the patients was 64.4±11.1. Horizontal nystagmus was induced by lying down from sitting to supine position in 26 patients (86.7%), which was ipsilesional in 23 (88.4%). The horizontal nystagmus after head shaking was present in 18 patients (60.0%) and was contralesional in all the patients. The caloric weakness (CP>30%) was present in 7 patients (31.8%, 7/22) before treatment and became normal in every patients after treatment. The caloric paresis was ipsilesional in 6 patients (85.7%, 6/7). Conclusions: In Apo HC-BPV, the direction of head-shaking nystagmus was uniformly contralesional and the caloric paresis was mostly ipsilesional. The head shaking nystagmus and caloric paresis observed in our patients with Apo HC-BPV may be explained by mechanical interference of the endolymphatic flow by the otolithic debris. Head-shaking nystagmus may have lateralizing value in Apo HC-BPV.

PO4.1 Cardiovascular Autonomic Dysfunction in Dementia

Background: There is a need to identify cardiovascular autonomic dysfunction in patients with dementia in order to ensure appropriate management and reduce risk of falls. The objective of this study is to assess cardiovascular autonomic function in patients with Alzheimer’s disease (AD), subcortical ischemic vascular dementia (SIVD), or dementia with Lewy body (DLB). Methods: Twenty-three patients with AD, seven with SIVD, nine with DLB and twenty-four age matched healthy controls were recruited for the study. Heart rate responses to standing and deep breathing, Valsalva ratio, change of blood pressure to standing and isometric exercise, and overshoot of blood pressure in phase IV of Valsalva maneuver were assessed with continuous monitor, Finapres. Results: The prevalence of orthostatic hypotension was significantly high in patients with DLB in comparison with elderly controls (55.6% vs. 4.2%, p = 0.007). Overshoot of blood pressure of phase IV in Valsalva maneuver was significantly small in patient with DLB and VaD in comparison with controls (11.0±14.9 mmHg vs. 5.9±34.1 mmHg 30.7±19.9 mmHg, p < 0.05). Patients with DLB and SIVD had impaired heart rate responses to standing in comparison with controls and patients with AD. The prevalence of cardiovascular dysautonomia by Ewing’s classification was significantly high in patients with DLB in comparison with controls (89% vs. 42%). Atypical dysautonomia with absent or one of the three heart rate tests abnormal and one or both of the blood pressure tests abnormal were frequent in patient with DLB (55.6%, p = 0.015). Conclusions: Cardiovascular autonomic dysfunction is prominent in DLB and SIVD. Cardiovascular sympathetic dysfunction is more severe in DLB in comparison with SIVD.

PO15.5 Effect of Antiplatelet Agent on the Progression of Leukoaraiosis

Background: Leukoaraiosis is bilateral patchy or diffuse hyperintensity lesion in the cerebral white matter on T2-weighted or FLAIR imaging. It is thought to be caused by ischemia, but clinical relevance is uncertain. Asymptomatic elderly commonly show the incidental leukoaraiosis on MRI. However, there is no consensus on the treatment of these patients, including the usage of antiplatelet. We performed this study to assess the effects of antiplatelet treatment on the progression of asymptomatic leukoaraiosis. Methods: We recruited subjects who were more than 50 years-old and had two MRI scans separated by at least three years interval. The patients with brain lesion such as stroke, brain tumor, systemic malignancy, and infection were excluded. Subjects were categorized into antiplatelet and non-antiplatelet group, which were decided by the attending physician’s preference. White matter change was assessed in FLAIR image based on the Schelten’s scale without clinical information of the subjects, and the progression of scale was compared between the two groups. Wilcoxon signed rank sum test was used for the statistical comparison. Results: From 2002 to 2008 in Inha University Hospital, 34 patients were followed up and analyzed. Fifteen subjects were included in antiplatelet group and nineteen in non-antiplatelet group. Median Schelten scale of initial MRI were 6.9±2.5 in the antiplatelet group and 4.8±2.9 in the nonantiplatelet group (p = 0.04). The scale of follow-up MRI were 7.1±2.6 and 4.9±2.9 (p = 0.029), respectively. Worsening of scale more than 1 grade was evident in eight subjects (23.5%). There was no significant difference in the change of white matter grade between the antiplatelet group and the non-antiplatelet group (0.20±0.41, p = 0.082 vs. 0.05±0.02, p = 0.33). Conclusions: Subjects with higher white matter grade on MRI were more likely to take antiplatelet, but there was no effect on the progression of leukoaraiosis.

PO15.2 Comparison of Lacunar Infarct with Branch Atheromatous Occlusion

Background: Increasing efficiency of intensive care of preeclampsia. Methods: We examined 100 pregnant women with preeclampsia. In the main group, we assessed preeclampsia severity, taking into account changes in hemodynamics system and in vegetative tonus following the method of aminazine test, developed by the author. We also determined plasma osmolality, considering growth in fluid volume during application of infusion solutions. The control group received conventional complex preeclampsia therapy. Aminazine test consisted of intravenous titrated administration of up to 12.5 mg of aminazine with control of arterial blood pressure, hands skin temperature, and blood-filling of nail beds. Results: We diagnosed compensated preeclampsia stage in case of positive aminazine test (decrease in systolic blood pressure by 20 25 mm Hg, in diastolic blood pressure by 10 15 mm Hg, temperature increase by 1oC comparing with the primary improvement in blood-filling of nail beds. In the absence of the described reaction, we diagnosed decompensated stage. After aminazine test we introduced 5 mg of aminazine every 4 hours for both stages, which produced decrease in the amount of prescribed medications. The effect of developed method induced the shortening of treatment period, decrease in the number of surgical operations during delivery. It also pushed up the number of independent deliveries. Conclusions: For differentiated diagnostics of preeclampsia’s stage severity, and for creation of the background for correction of pathophysiological disturbances, it is necessary to include into complex intensive care aminazine test.

PO15.3 Intima-Media Thickness According to TOAST Classificaton and Risk Factors in Ischemic Stroke

Background: Increasing efficiency of intensive care of preeclampsia. Methods: We examined 100 pregnant women with preeclampsia. In the main group, we assessed preeclampsia severity, taking into account changes in hemodynamics system and in vegetative tonus following the method of aminazine test, developed by the author. We also determined plasma osmolality, considering growth in fluid volume during application of infusion solutions. The control group received conventional complex preeclampsia therapy. Aminazine test consisted of intravenous titrated administration of up to 12.5 mg of aminazine with control of arterial blood pressure, hands skin temperature, and blood-filling of nail beds. Results: We diagnosed compensated preeclampsia stage in case of positive aminazine test (decrease in systolic blood pressure by 20 25 mm Hg, in diastolic blood pressure by 10 15 mm Hg, temperature increase by 1oC comparing with the primary improvement in blood-filling of nail beds. In the absence of the described reaction, we diagnosed decompensated stage. After aminazine test we introduced 5 mg of aminazine every 4 hours for both stages, which produced decrease in the amount of prescribed medications. The effect of developed method induced the shortening of treatment period, decrease in the number of surgical operations during delivery. It also pushed up the number of independent deliveries. Conclusions: For differentiated diagnostics of preeclampsia’s stage severity, and for creation of the background for correction of pathophysiological disturbances, it is necessary to include into complex intensive care aminazine test.

Cardiovascular autonomic dysfunction in dementia

Background: Learning digital instruments is to democratize access to daily technology, include elder people in the information society and preserve independence, autonomy and citizenship. Methods: Forty workshops (130 hours) with 46 communities elder people above 60 years using digital instruments in Local Area Network Houses, between 2004 and 2006, in São Paulo city and Florianópolis city, Brazil. Sociodemographic, health, cognitive and functional variables were measured and compared to learning time of: mouse, electronic games, browser and e-mail. Kaplan-Meier curves were plotted to analyze learning time. Statistical differences between the covariates were evaluated by log-rank test. The impact of covariates on learning time was analyzed by Cox proportional risk model, in SPSS software. Results: The average age was 73 years with 4,2 pathologies per person, 9,1 years of scholarship, 26% presented falls in the last 6 months. The mean learning time (in hours) for ‘‘basic use of the mouse’’ was 8,5 (CI95%:6,610,5), for ‘‘game use’’ was 10,0 (CI95%:6,8-13,2), for ‘‘browser use’’ was 16,0 (CI95%:11,8-20,2) and for ‘‘e-mail use’’ was 27,0 (CI95%:24,629,4). Hypertension, diabetes and falls in the last 6 months were not significant variables even in the bivariate analysis. More than 3 pathologies, more than 3 continuous medications, dislipidemia, hypotiroidism, activities of the daily living losses and low scholarship had no independent significance for the outcomes studied. The cognitive status was an independent factor related to learning time of mouse, games and browser. Age above 75 years and cognitive status were independent factors related to e-mail use. Conclusions: Modifiable factors that influence learning time of elder people must be screened and treated to promote access to the information society by elder people. The ability to conquer new proficiencies is a characteristic of healthy elder people.

Typical Kleine-Levin syndrome

각삽화사이에는정상적인수면및행동양상을보이는것이 특징이다 삽화 시 환각 정신착란 . (hallucination), (confu등 인지장애와 과식증 과다성욕증 sion) (hyperphagia), 과민성 등 행동장애도 동 (hypersexuality), (irritability) 반될 수 있다. 1-3 현재 원인과 병리는 확실히 밝혀지지 않았 지만 뇌 단일광자방출단층촬영술 , (brain single photon 이하 에서 양측 emission computed tomography, SPECT) 측두엽 및 비우성 전두엽 특히 시상하부에서관류 감소를 , 보였다는 검사 결과들이 보고된바 있고, 1-4 뇌척수액 내의 이 감소를 보인다는 결과가 보고 되었 hypocretin-1 다. 1-3,5 저자들은 환시와 과식증을 동반한 반복적 수면과다 증 을 보인 환자를 예로 반복적인 수면과다 (hypersomnia) , 증과 동반될 수 있는 증상들 임상적인 접근 및 감별 진단 , 에 대하여 알아보고자 한다.