Yoonjae Choi

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.

Is antiplatelet treatment effective at attenuating the progression of white matter hyperintensities

Objective We performed this study to assess the effect of an antiplatelet agent on the progression of white matter hyperintensities (WMH). Methods From August 2003 to May 2005, we consecutively enrolled patients who underwent brain magnetic resonance imaging (MRI) for health check-up purposes and showed no significant findings other than WMH of any degree. Patients were divided into two groups based on whether or not they received antiplatelet therapy. All patients had a follow-up brain MRI after 5 years and WMH volume change was measured using imaging analysis software. To minimize selection bias potentially arising from antiplatelet treatment assignment, analyses were inverse probability weighted. Results Among the 93 patients who met the inclusion criteria, 54 patients (58.1%) were grouped as the antiplatelet group (AG), and the remaining 39 patients (41.9%) as the non-antiplatelet group (NAG). After inverse propensity weighting, all baseline characteristics were similar between the two groups, and antiplatelet treatment did not show any significant effect on the total WMH volume change (p = 0.957). Conclusion Antiplatelet medication may not alter the progression of WMH.

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.