Background: Delayed arrival at hospital is one of the major obstacles in enhancing the rate of thrombolysis therapy in patients with acute ischemic stroke. Our study aimed to investigate factors associated with prehospital delay after acute ischemic stroke in Korea. Methods: A prospective, multicenter study was conducted at 14 tertiary hospitals in Korea from March 2009 to July 2009. We interviewed 500 consecutive patients with acute ischemic stroke who arrived within 48 hours. Univariate and multivariate analyses were performed to evaluate factors influencing prehospital delay. Results: Among the 500 patients (median 67 years, 62% men), the median time interval from symptom onset to arrival was 474 minutes (interquartile range, 170-1313). Early arrival within 3 hours of symptom onset was significantly associated with the following factors: high National Institutes of Health Stroke Scale (NIHSS) score, previous stroke, atrial fibrillation, use of ambulance, knowledge about thrombolysis and awareness of the patient/bystander that the initial symptom was a stroke. Multivariable logistic regression analysis indicated that awareness of the patient/bystander that the initial symptom was a stroke (OR 4.438, 95% CI 2.669-7.381), knowledge about thrombolysis (OR 2.002, 95% CI 1.104-3.633) and use of ambulance (OR 1.961, 95% CI 1.176-3.270) were significantly associated with early arrival. Conclusions: In Korea, stroke awareness not only on the part of patients, but also of bystanders, had a great impact on early arrival at hospital. To increase the rate of thrombolysis therapy and the incidence of favorable outcomes, extensive general public education including how to recognize stroke symptoms would be important.

Cho AH, et al. J Stroke. 2015 Jan;17(1):60-66. http://dx.doi.org/10.5853/jos.2015.17.1.60

Objective: Parkinson's disease (PD) is a neurodegenerative disease involving multiple systems that can affect mortality. This study aimed to compare all-cause and cause-specific mortality between people with PD and without PD.Methods: This population-based prospective cohort study is based on Korean National Health Insurance Service data. The primary outcome was the hazard ratio (HR) of all-cause and cause-specific mortality for PD from 2010 to 2019. Cox proportional hazards regression was applied to calculate HRs under crude and three adjusted models with epidemiologic variables.Results: A total of 8,220 PD patients and 41,100 age- and sex-matched controls without PD were registered. Ten-year mortality was 47.9% in PD patients and 20.3% in non-PD controls. The mortality rate was higher among older and male participants. The leading cause of death in PD was nervous system diseases (38.73%), and 97.1% of those were extrapyramidal and movement disorders, followed by circulatory diseases (15.33%), respiratory diseases (12.56%), and neoplasms (9.7%). PD contributed to an increased risk of all-cause death with an HR of 2.96 (95% CI = 2.84–3.08). HRs of death for PD were 3.07 (95% CI = 2.74–3.45) from respiratory diseases, 1.93 (95% CI = 1.75–2.13) from circulatory diseases, 2.35 (95% CI = 2.00–2.77) from external causes, and 2.69 (95% CI = 2.10–3.43) from infectious diseases.Conclusion: These results showed that PD was related to a higher risk of mortality in all ages and sexes. The leading causes of death in PD were nervous, circulatory, respiratory, infectious diseases, and external causes.

Jung KW, et al. J Clin Neurol. 2012 Jun;8(2):104-108. http://dx.doi.org/10.3988/jcn.2012.8.2.104

The ideal therapy of acute ischemic stroke is achieved by early recanalization that finally leads to good clinical outcome. The recombinant intravenous tissue plasminogen activator (rtPA) within 4.5 hours was approved as an important thrombolytic treatment. However, the recanalization rate was low in patients with a large artery occlusion. The efficacy of intravenous rtPA regarding recanalization of a large artery occlusion was limited. In several clinical trials, pharmacological and mechanical intra-arterial thrombolytic therapy showed improved recanalization rates, but the favorable outcome had not been achieved. Through those trials and errors, researchers have learned that speed of treatment initiation, patient selection by documentation of large artery occlusion and the use of effective devices could be crucial for good clinical outcomes. Finally, five recent randomized controlled trials of endovascular therapy compared to standard medical care have been published. The superiority of endovascular thrombolysis to standard medical care was proved. In this article, we reviewed previous and recent clinical evidence about endovascular thrombolytic therapy of acute ischemic stroke.

We investigated the prevalence of amyloid positivity and cerebral microbleeds (CMBs) in subjects with cognitive complaints with the aim of identifying differences in clinical parameters and cognitive function according to the pattern of coexistence. We retrospectively enrolled 200 subjects with memory impairment and applied both standardized ¹⁸F-florbetaben PET and brain MRI, including susceptibility-weighted imaging. The amyloid burden was visually classified as positive or negative, and the number and location of CMBs were also analyzed visually. Descriptive analysis was performed for the prevalence of amyloid positivity and CMBs. The relationship between the coexisting pattern of those two findings and clinical parameters including the results of neuropsychiatric tests was analyzed. Positive amyloid PET scans were exhibited by 102 (51.5%) of the 200 patients, and 51 (25.5%) of them had CMBs, which were mostly located in lobar areas in the patients with positive amyloid scans. The patients with CMBs were older and had a higher burden of white-matter hyperintensities than the patients without CMBs. The patients with CMBs also performed worse in confrontation naming and frontal/executive function. When classified by topographical region, parietal CMBs (odds ratio=3.739, p=0.024) were significantly associated with amyloid positivity. The prevalence of CMBs was higher in patients with cognitive decline than in the general population. CMBs play distinctive roles in affecting clinical parameters and neuropsychological profiles according to the coexistence of amyloid pathology.