Combined quality of life and survival for estimation of long-term health outcome of patients with stroke.

Background: Advanced medical technologies can prolong life of stroke survivors. Dynamic change of health outcomes provides essential information to manage stroke. Mathematical models, to extrapolate health status over a lifetime from cross-sectional data, can be used to investigate long term health outcomes among stroke survivors.

Comparison of Computerized and Standard Cognitive Test in Thai Memory Clinic.

Background: Computer-based Thai Cognitive Test or Computer-based Thai Mental State Examination (cTMSE) was developed aiming to help doctors to easily get the accurate results of TMSE in a routine, busy outpatient clinics. The purpose of this study was to compare the evaluation process in terms of feasibility, duration of the test, participants/administrator preference, and the results of cognitive test between cTMSE and the standard Thai Mental State Examination (sTMSE).

Methods: Twenty-two elderly participants (>60 years old) who were not demented and 22 patients with mild-to-moderate dementia were included in the study.

The curative effect comparison of two kinds of therapeutic regimens on decreasing the relative intensity of microembolic signal in CLAIR trial.

Background: Microembolic signals (MESs) are direct markers of unstable large artery atherosclerotic plaques. In a previous study, we found that the number of MESs is associated with stroke recurrence and that clopidogrel plus aspirin more effectively reduce the number of MESs than does aspirin alone. Stroke recurrence is associated with not only the number of MESs but also the size of the MES, which can theoretically be estimated by monitoring the MES intensity via transcranial doppler (TCD).

Arcanobacterium pyogenes endocarditis: a case report and literature review.

We report the case of a 64-year-old man with Arcanobacterium pyogenes endocarditis. The patient presented with dyspnea and asymmetrical progressive quadriparesis. A transthoracic echocardiogram revealed mobile vegetations on both leaflets of his mitral valve measuring 0.

The effect of cilostazol on carotid intima-media thickness progression in patients with symptomatic intracranial atherosclerotic stenosis.

Background: The progression of carotid intima-media thickness (CIMT) is closely associated with ischemic stroke recurrence. However, the efficacy of cilostazol on preventing CIMT progression in stroke patients has never been investigated properly by a prospective trial.

Methods: This study is a part of "Trial of Cilostazol in Symptomatic Intracranial Arterial Stenosis-2.

Atrial fibrillation and paroxysmal atrial fibrillation detection in patients with acute ischemic stroke.

Background: Studies about continuous electrocardiographic (ECG) monitoring in detection of paroxysmal atrial fibrillation (PAF) in Asian patients with acute ischemic stroke are very limited. We looked for the prevalence and associated factors of atrial fibrillation (AF) and PAF in Thai patients with acute ischemic stroke.

Methods: In all, 204 patients with acute ischemic stroke were prospectively included.

Blood pressure control among stroke patients in Thailand--the i-STROKE study.

Background: Direct correlation between stroke mortality and hypertension calls for a tight blood pressure (BP) control. Our study determined the prevalence of the BP control and evaluated current clinical practices on hypertension management in stroke patients in Thailand.

Methods: This multicenter, cross-sectional, retrospective, observational study was carried out between February 2010 and January 2011 and enrolled stroke patients aged 45 years or older with ictus incidence 12,030 days before the enrollment.

Dual antiplatelets reduce microembolic signals in patients with transient ischemic attack and minor stroke: subgroup analysis of CLAIR study.

Background: Short course of dual antiplatelet therapy for early secondary prevention is a promising treatment for patients with minor stroke or transient ischemic attack at high risk of recurrence.

Methods: We examined the efficacy and safety of dual antiplatelets in patients with transient ischemic attack or minor stroke, defined as National Institute of Health Stroke Scale scores 0-3, in a subgroup analysis of Clopidogrel plus aspirin versus Aspirin alone for Reducing embolization in patients with acute symptomatic cerebral or carotid artery stenosis (CLAIR) study. Microembolic signals on transcranial Doppler monitoring was used as surrogate marker for recurrent stroke risk.

Prevalence and predictors of carotid stenosis in Thai patients with ocular disorders.

There are limited data on prevalence and predictors of carotid stenosis (CS) in Thai and Asian patients with ocular disorders. A total of 135 of 2849 patients enrolled in the Neurosonology Registry had an ocular indication (OI). Demographics, the nature of the OI, risk factors (RF), presence of CS >50% and non-stenotic carotid plaque (NSCP) were analyzed.

Coexistent extra- and intracranial stenosis, cervical atherosclerosis, and abnormal ankle brachial index in acute ischemic stroke.

Background: There are limited data regarding abnormal ankle brachial index (ABI) with coexistent extracranial carotid stenosis (ECS), intracranial stenosis (ICS), and nonstenotic cervical atherosclerosis (CAS) in stroke, especially in Asia.

Methods: We studied the prevalence of ECS, ICS, CAS, and combined ECS and ICS in 756 Thai patients with acute ischemic stroke and correlated sites of atherosclerosis with stroke risk factors and abnormal ABI.

Results: The prevalence of ECS was 8.

Prevalence and association between risk factors, stroke subtypes, and abnormal ankle brachial index in acute ischemic stroke.

Background: Abnormal ankle brachial index (ABI) identifies a stroke subgroup with high risk of subsequent stroke and other vascular events. There are few data regarding the prevalence of abnormal ABI in ischemic stroke in Asian countries.

Methods: We evaluated the prevalence of abnormal ABI in 747 Thai patients with ischemic stroke or transient ischemic attack and assessed the correlation of abnormal ABI with stroke risk factors and stroke subtypes.

Stroke fast track reduces time delay to neuroimaging and increases use of thrombolysis in an academic medical center in Thailand.

Delays between hospital arrival and neuroimaging prevented patients from receiving thrombolysis. We report impact of Stroke Fast Track (SFT) on time to imaging, and rates of recombinant tissue plasminogen activator (rt-PA) in eligible patients. Characteristics, time intervals, and rates of rt-PA were evaluated in 464 patients with suspected acute stroke within 7 days (2005-2006).

Clopidogrel plus aspirin versus aspirin alone for reducing embolisation in patients with acute symptomatic cerebral or carotid artery stenosis (CLAIR study): a randomised, open-label, blinded-endpoint trial.

Background: Few randomised clinical trials have investigated the use of antithrombotic drugs for early secondary prevention of stroke or transient ischaemic attack in patients with intracranial atherosclerotic stenosis. Microembolic signals, detected by transcranial doppler, are a surrogate marker of future stroke risk and have been used to show treatment efficacy in patients with extracranial carotid stenosis. We aimed to investigate whether treatment with clopidogrel plus aspirin reduced the number of microembolic signals detected with transcranial doppler ultrasound compared with aspirin alone in patients with recent stroke.

Thai venous stroke prognostic score: TV-SPSS.

Background And Objective: Prognosis of cerebral venous sinus thrombosis (CVST) has never been studied in Thailand. A simple prognostic score to predict poor prognosis of CVST has also never been reported. The authors are aiming to establish a simple and reliable prognostic score for this condition.

Detection of air microbubbles in the internal jugular vein after intravenous injection of contrast agent for the diagnosis of patent foramen ovale.

The use of agitated air and saline, injected intravenously, combined with monitoring of the middle cerebral artery using transcranial Doppler sonography, is an effective method for detecting paradoxic cerebral embolism caused by right-to-left intracardiac shunting. This technique is particularly useful in patients with a patent foramen ovale. In patients without temporal acoustic windows, the method can be modified by using sonographic monitoring of the common carotid artery.

Long-term follow-up of myasthenia gravis patients with hyperthyroidism.

Objective: To access clinical characteristics and treatment outcome of myasthenia gravis (MG) patients with hyperthyroidism (HT).

Materials And Methods: The clinical characteristics of 51 MG patients with HT were studied. The treatment outcome was analysed in 34 patients, comparing high-dosage prednisolone (HDP) (group IS), HDP and/or immunosuppressants with antithyroid drugs (group IS + antiHThyr), antithyroid drugs (group antiHThyr), and thymectomy.

Noninvasive ultrasound evaluation of the vertebral artery in hypertension.

Background And Purpose: Surgical decompression of the vascular loop of the vertebral artery (VA) at the left lateral medulla can reduce blood pressure (BP) in hypertension, and a larger diameter of the left VA has been found in hypertensive patients. Noninvasive evaluation of the VA in hypertension may assist selecting patients for more appropriate diagnosis and treatment. Duplex ultrasonography is used to study the relationship between VA diameter and BP.

Pitfall of electron beam computed tomography angiography in diagnosis of subclavian steal syndrome.

A patient presented with vertebrobasilar insufficiency during exertion. Vertebral duplex and transcranial Doppler ultrasonography showed reversal of flow in both intracranial and extracranial vertebral and basilar arteries, suggesting bilateral subclavian and vertebrobasilar steal. Electron beam computed tomography angiography (CTA) showed no evidence of subclavian artery stenosis including normal vertebral artery origin on both sides.

Middle cerebral artery flow velocity correlates with common carotid artery volume flow rate after CO2 inhalation.

Cerebral vasoreactivity can be studied with transcranial Doppler (TCD) by monitoring CO2-induced middle cerebral artery (MCA) velocity changes. Expected MCA mean velocity (Vm) changes due to changes in end-expiratory CO2 (EE-CO2) are established, but reactivity of common carotid artery (CCA) volume flow rate (VFR) has not been extensively reported. The authors assess the relationship between MCA Vm, CCA VFR, and EE-CO2.

A new dynamic method for detection of internal jugular valve incompetence using air contrast ultrasonography.

The internal jugular (IJ) valve is the only valve between the heart and the brain, preventing venous reflux into the IJ vein. Internal jugular valve competence has been tested by IJ venography. Doppler ultrasonography of the IJ vein and M-mode ultrasonography of the IJ valve, and color flow imaging (CFI) of the IJ vein.

Mirror-image artifact can affect transcranial Doppler interpretation.

Transcranial Doppler ultrasonography (TCD) allows evaluation of blood-flow velocity in intracranial arteries detection and monitoring of vasospasm in patients with subarachnoid hemorrhage. Spectral Doppler artifacts can affect TCD data. A 1-month series of TCD findings showed marked fluctuation in blood-flow velocity values in both the middle and anterior cerebral arteries of a patient with subarachnoid hemorrhage.

Single oral loading dose of phenytoin: a pharmacokinetics study.

In order to determine the optimal single oral loading dose of phenytoin in patients with seizures, a two part study of phenytoin pharmacokinetics was conducted. In the first part, 15 mg/kg of phenytoin was given orally as a single dose to 19 normal medical volunteers with informed consent. Serum concentrations of phenytoin reached the therapeutic level (10 micrograms/ml) with an average of 2.