2021 Taiwan Stroke Society Guidelines of blood pressure control for ischemic stroke prevention.

Background: Since the publication of the 2015 Taiwan Stroke Society Blood Pressure for Treatment and Prevention of Stroke Guideline (2015 TSS BP Guideline), several new clinical studies have addressed whether a stricter blood pressure (BP) target would be effective for stroke prevention.

Methods: TSS guideline consensus group provides recommendations on BP targets for stroke prevention based on updated evidences.

Results: The present guideline covers five topics: (1) diagnosis of hypertension; (2) BP control and primary prevention of ischemic stroke; (3) BP control and secondary prevention of ischemic stroke; (4) BP control and secondary prevention of large artery atherosclerosis ischemic stroke; and (5) BP control and secondary prevention of small vessel occlusion ischemic stroke.

Effectiveness of Standard-Dose vs. Low-Dose Alteplase for Acute Ischemic Stroke Within 3-4.5 h.

Background: The efficacy and safety of intravenous alteplase administered 3-4.5 h after acute ischemic stroke have been demonstrated. However, whether responses differ between low-dose and standard-dose alteplase during this time window and whether certain subgroups benefit more remain unknown.

Diagnosis and Treatment for embolic stroke of undetermined source: Consensus statement from the Taiwan stroke society and Taiwan society of cardiology.

Cryptogenic stroke comprises about one-quarter of ischemic strokes with high recurrence rate; however, studies specifically investigating the features and treatment of this stroke subtype are rare. The concept of 'embolic stroke of undetermined source' (ESUS) may facilitate the development of a standardized approach to diagnose cryptogenic stroke and improve clinical trials. Since recent large randomized control trials failed to demonstrate a reduction in stroke recurrence with anticoagulants, anti-platelet agents remain the first-line treatment for ESUS patients.

Intravenous Thrombolysis Administration 3-4.5 h After Acute Ischemic Stroke: A Retrospective, Multicenter Study.

Intravenous recombinant tissue plasminogen activator (rt-PA) has been approved for acute ischemic stroke (AIS) within 3 h after onset and the treatment was then extended to 4.5 h. However, the Food and Drug Administration did not approve the indication in the expanded time window.

The Relationship among Carotid Artery Remodeling, Cardiac Geometry, and Serum N-Terminal Pro-B-Type Natriuretic Peptide Level in Asymptomatic Asians: Sex-Differences and Longitudinal GEE Study.

Background: Carotid artery remodeling is known to be associated with a variety of cardiovascular diseases. However, there is limited information regarding gender differences in carotid remodeling. We sought to investigate the associations among blood pressure (BP), carotid artery remodeling and cardiac geometries, and further explore gender differences.

Association of Serum Uric Acid with Cardiovascular Disease in Taiwanese Patients with Primary Hypertension.

Background: Hyperuricemia is closely linked to hypertension and may be a marker of susceptibility or an intermediate step in the development of metabolic syndrome. However, recently, there have been conflicting conclusions regarding the independent role of uric acid as a risk factor of cardiovascular disease (CVD). The specific role of serum uric acid (SUA) in relation to CVD remains controversial, and there are limited reports utilizing Asian data available on this issue.

The efficacy and safety of cilostazol in ischemic stroke patients with peripheral arterial disease (SPAD): protocol of a randomized, double-blind, placebo-controlled multicenter trial.

Rationale: It is not uncommon for patients with ischemic stroke to have peripheral arterial disease (PAD). Patients with polyvascular diseases carry greater burden of atherosclerosis and higher risks of developing vascular events and death. More effective regimens, such as dual antiplatelet agents, may be more effective for controlling progression of atherosclerosis in secondary prevention.

Relation of carotid artery diameter with cardiac geometry and mechanics in heart failure with preserved ejection fraction.

Background: Central artery dilation and remodeling are associated with higher heart failure and cardiovascular risks. However, data regarding carotid artery diameter from hypertension to heart failure have remained elusive. We sought to investigate this issue by examining the association between carotid artery diameter and surrogates of ventricular dysfunction.

The utilization of carotid artery imaging beyond metabolic scores and high-sensitivity CRP in screening intermediate-to-high Framingham risk of asymptomatic Taiwanese population.

To compare the diagnostic accuracy of various cardiovascular screening tools in asymptomatic subjects with intermediate-to-high risk Framingham risk score (FRS). In addition, we also investigated whether carotid artery study could further add incremental value beyond metabolic abnormality and inflammatory marker in this issue. 1,200 asymptomatic subjects who underwent health evaluation were recruited in our study.

Leukoencephalopathy after levamisole for the treatment of verrucae.

Purpose: Levamisole is an antihelmintic and immunomodulator used as a dewormer and in combination with other forms of chemotherapy to treat colon cancer, melanoma, and head and neck cancer. It has also been used for treating dermatologic disorders such as verrucae. However, its benefits remain controversial and serious side effects such as central nervous system toxicity are unexpected.

Body composition, C-reactive protein, carotid artery remodeling and subclinical atherosclerosis in a general Taiwanese population.

Obesity, an escalating problem worldwide, increases the risk of serious disease, particularly atherosclerosis. A community-based cross-sectional study was designed to screen for undetected atherosclerosis. High-sensitivity C-reactive protein (hs-CRP), the presence of the metabolic syndrome (MetS), and ultrasound studies to detect fatty liver and measure carotid intimal-medial thickness were performed.

Transcranial Doppler studies on cerebral autoregulation suggest prolonged cerebral vasoconstriction in a subgroup of patients with orthostatic intolerance.

We studied the cerebral autoregulation in a subgroup of patients with orthostatic intolerance, who exhibited excessively decreased middle cerebral artery flow velocity (MCAFV) on transcranial Doppler sonography (TCD) during head-up tilt (HUT) test but without orthostatic hypotension or postural tachycardia. Twenty patients and 20 age- and sex-matched controls underwent Valsalva maneuver (VM) and HUT test with simultaneous monitoring of MCAFV by TCD and blood pressure, heart rate recordings. The pulsatility index (PI), cerebrovascular resistance (CVR) and autoregulatory indices were calculated.

The prescribing patterns of antithrombotic agents for prevention of recurrent ischemic stroke.

Objectives: Antithrombotic agents are effective in the secondary prevention of ischemic strokes. In the present study, we sought to determine the antithrombotic prescribing patterns of neurologists in patients with first-ever ischemic stroke and also to identify the factors influencing the choice of a specific agent and what changes are made when a recurrent stroke occurs in these patients.

Methods: We retrospectively reviewed the medical records of neurology patients who were diagnosed with first-ever ischemic stroke and were antithrombotic naive from January 1, 2000 to December 31, 2000.

Extrapontine myelinolysis after correction of hyponatremia presenting as generalized tonic seizures.

Central pontine myelinolysis and extrapontine myelinolysis are rare complications of rapid correction of chronic hyponatremia. Central pontine myelinolysis is more common and more predictable in presentation. Extrapontine myelinolysis' presenting symptoms vary and may be as general as lethargy or altered mood.

Acute neurological deficits caused by cefipime: a case report and review of literature.

Cefepime (Maxipime) is a fourth-generation cephalosporin commonly used to treat a variety of infections. Its controversial side effect profile is not well appreciated by first-line practitioners. We report a case of urinary tract infection treated with cefepime in a 91-year-old woman.

A case of bow hunter's stroke caused by non-dominant vertebral artery.

Rotational movements in the territory of vertebrobasilar artery of the head and neck can induce vertebrobasilar insufficiency (VBI) or infarction. The term "bow hunter's stroke" or "rotational VBI" has been used to describe this clinical syndrome. In most cases, symptoms were provoked because of involvement of a dominant vertebral artery (VA) with hypoplasia or occlusion of the contralateral VA.

Low back pain in a pregnant woman.

Low back pain is very common and often considered a part of normal pregnancy. Because the pain is always attributed to pregnancy, referral to a specialist is often delayed. We describe a young woman who developed low back pain and signs of progressive spinal cord compression at 33 weeks' gestation of her second pregnancy.