Chih-ping Chung - Academia.edu (original) (raw)

Papers by Chih-ping Chung

Research paper thumbnail of Statin_after_stroke_Supplementary_appendix_20190627_TAND – Supplemental material for Does statin increase the risk of intracerebral hemorrhage in stroke survivors? A meta-analysis and trial sequential analysis

Supplemental material, Statin_after_stroke_Supplementary_appendix_20190627_TAND for Does statin i... more Supplemental material, Statin_after_stroke_Supplementary_appendix_20190627_TAND for Does statin increase the risk of intracerebral hemorrhage in stroke survivors? A meta-analysis and trial sequential analysis by Ru Jian Jonathan Teoh, Chi-Jung Huang, Chi Peng Chan, Li-Yin Chien, Chih-Ping Chung, Shih-Hsien Sung, Chen-Huan Chen, Chern-En Chiang and Hao-Min Cheng in Therapeutic Advances in Neurological Disorders

Research paper thumbnail of Clinical-CT mismatch defined NIHSS ≥ 8 and CT-ASPECTS ≥ 9 as a reliable marker of candidacy for intravenous thrombolytic therapy in acute ischemic stroke

PLoS ONE, 2021

Background Clinical-diffusion mismatch between stroke severity and diffusion-weighted imaging les... more Background Clinical-diffusion mismatch between stroke severity and diffusion-weighted imaging lesion volume seems to identify stroke patients with penumbra. However, urgent magnetic resonance imaging is sometimes inaccessible or contraindicated. Thus, we hypothesized that using brain computed tomography (CT) to determine a baseline “clinical-CT mismatch” may also predict the responses to thrombolytic therapy. Methods Brain CT lesions were measured using the Alberta Stroke Program Early CT Score (ASPECTS). A total of 104 patients were included: 79 patients with a baseline National Institutes of Health Stroke Scale (NIHSS) score ≥ 8 and a CT-ASPECTS ≥ 9 who were defined as clinical-CT mismatch-positive (P group) and 25 patients with an NIHSS score ≥ 8 and a CT-ASPECTS < 9 who were defined as clinical-CT mismatch-negative (the N group). We compared their clinical outcomes, including early neurological improvement (ENI), early neurological deterioration (END), delta NIHSS score (admi...

Research paper thumbnail of Etiology and risk factors of intracranial hemorrhage and ischemic stroke in young adults

Journal of the Chinese Medical Association, 2021

Background: Young stroke incidence has increased worldwide with lifestyle changes. Etiology and r... more Background: Young stroke incidence has increased worldwide with lifestyle changes. Etiology and risk factors for both ischemic and hemorrhagic stroke in young Asians remain underexplored. Methods: We retrospectively reviewed consecutive acute stroke patients aged 16–45 years admitted to the Taipei Veterans General Hospital between 2009 and 2019 to analyze etiologic subtypes, risk factors, and serial modified Rankin Scale scores for 1 year and compare the age groups of 16–30 and 31–45 years. Results: Among 670 young Taiwanese patients (mean age at onset 37.5 ± 7.0 years; male 65.1%), there were 366 nontraumatic spontaneous hemorrhagic stroke (including 259 intracerebral hemorrhage [ICH] and 107 subarachnoid hemorrhage, SAH), 292 ischemic stroke and 12 cerebral venous thromboses. Notably, ICH was more prevalent in patients aged 16–30 than in those aged 31–45 (54.8% vs 36.8%). Specifically, structural vasculopathy (e.g., arteriovenous malformation, cavernoma) was the most common etiologic subtype in patients aged 16–30 (p < 0.001), whereas hypertensive ICH was the most common subtype in patients aged 31–45 (p < 0.001). On the other hand, the top ischemic subtype for both age groups was other determined diseases (e.g., arterial dissection, autoimmune diseases, moyamoya disease, etc.) rather than large artery atherosclerosis. Hyperlipidemia, diabetes, and cigarette smoking were more common risk factors for infarction than ICH. Familial stroke patients whose first- or second-degree relatives had a stroke by age 80 (n = 104, 15.5%) had more infarctions than those without a familial stroke history. In multivariate analyses, initial stroke severity, and infarction type were important predictors of favorable outcomes after 3 months. At the 1-year follow-up, patients with ICH and SAH had worse functional outcomes and survival rates than those with infarction. Conclusion: An aggressive approach to elucidate the etiology of stroke is indicated because structural vasculopathy-induced ICH and other determined infarction are distinctively prevalent in young adults, particularly those aged 16–30.

Research paper thumbnail of Single-phase computed tomography angiography sufficiently predicts outcomes after mechanical thrombectomy

Journal of the Chinese Medical Association, 2020

Background: Arterial collateral (AC) assessed by single-phase computed tomography angiography (CT... more Background: Arterial collateral (AC) assessed by single-phase computed tomography angiography (CTA) or multiphase CTA has been used to predict clinical outcomes in patients undergoing mechanical thrombectomy (MT). Recently, venous opacification (VO) was proposed as another accurate image marker. This study aimed to compare the efficacy using AC and VO as predictors of MT outcome. Methods: Patients with occlusion of the proximal anterior circulation undergoing MT were included retrospectively. We assessed the AC status respectively according to different methods: modified Tan score, Miteff score in single-phase CTA, and pial arterial filling score in multiphase CTA. VO was assessed according to cortical vein opacification score. Favorable clinical outcome was defined as modified Rankin Scale 0-2 90 days after MT. Logistic regression models were established and receiver operating characteristics curve were used to determine the predictability of favorable outcome in patients with adequate AC and VO. Results: A total of 75 patients were enrolled. Adequate AC identified by modified Tan score (odds ratio, 7.3; p < 0.001), Miteff score (odds ratio, 4.5; p = 0.009), significantly predicted favorable outcome, but not adequate VO. The area under the curve was largest for adequate AC in model of modified Tan score 0.730 (95% CI, 0.60-0.86), while adequate VO showed the least area under the curve: 0.577 (95% CI, 0.43-0.73). Conclusion: We considered adequate AC in single-phase CTA could be reliable enough as an imaging marker rather than adequate VO to predict favorable outcome after MT.

Research paper thumbnail of Epistasis Analysis for Estrogen Metabolic and Signaling Pathway Genes on Young Ischemic Stroke Patients

Research paper thumbnail of Onset Headache Predicts Good Outcome in Patients With First-Ever Ischemic Stroke

Stroke, 2013

Background and Purpose— The study aimed to assess whether onset headache is an ominous sign in pa... more Background and Purpose— The study aimed to assess whether onset headache is an ominous sign in patients with first-ever ischemic stroke. Methods— A large population of ischemic stroke patients was obtained from the Taiwan Stroke Registry. Stroke subtypes were classified by the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria. On the basis of the International Classification of Headache Disorders, second version, onset headache was defined as a new headache that developed at the onset of ischemic stroke. Clinical features and impact on stroke outcomes, including in-hospital stroke in evolution, changes in National Institutes of Health Stroke Scale on discharge, and Barthel index and modified Rankin scale ≤6 months after stroke were compared between those with and without onset headache. Results— Among 11 523 patients with first-ever ischemic stroke, 848 had onset headache (7.4%). Patients with specific cause, large-artery atherosclerosis, or cardioembolism were more like...

Research paper thumbnail of Regional rather than global brain age mediates cognitive function in cerebral small vessel disease

Brain Communications

The factors and mechanisms underlying the heterogeneous cognitive outcomes of cerebral small vess... more The factors and mechanisms underlying the heterogeneous cognitive outcomes of cerebral small vessel disease are largely unknown. Brain biological age can be estimated by machine learning algorithms that use large brain MRI data sets to integrate and compute neuroimaging-derived age-related features. Predicted and chronological ages difference (brain-age gap) reflects advanced or delayed brain aging in an individual. The present study firstly reports the brain aging status of cerebral small vessel disease. In addition, we investigated whether global or certain regional brain age could mediate the cognitive functions in cerebral small vessel disease. Global and regional (400 cortical, 14 subcortical and 28 cerebellum regions of interest) brain-age prediction models were constructed using grey matter features from MRI of 1482 healthy individuals (age: 18–92 years). Predicted and chronological ages differences were obtained and then applied to non-stroke, non-demented individuals, aged ...

Research paper thumbnail of Quantitative CT angiography predicts large artery occlusion types and successful thrombectomy in acute ischemic stroke

Journal of the Chinese Medical Association, 2020

BACKGROUND Clinical and radiological outcomes of endovascular thrombectomy (EVT) are related to e... more BACKGROUND Clinical and radiological outcomes of endovascular thrombectomy (EVT) are related to etiologies of large vessel occlusion (LVO) in acute stroke. However, preprocedural computed tomography angiography (CTA) or CT perfusion imaging can hardly distinguish embolic occlusion from atherosclerotic occlusion. We hypothesized that quantitative multiphase CTA (mCTA) of LVO may predict occlusion types and thrombectomy outcome. METHODS We retrospectively evaluated the consecutive stroke patients who had undergone mCTA and EVT <6 hours of onset at two independent medical centers. The intra-arterial radiodensities of Hounsfield unit (HU) were measured to examine the HUdistal/proximal ratio using receiver operating characteristic curve analysis. The derived cut-off value was re-examined in an independent cohort. RESULTS In the derivation cohort (n=102), 81 patients (79.4%) were embolic occlusion without severe residual intracranial atherosclerotic stenosis (ICAS[-]) and 21 patients were atherosclerosis-related occlusion (ICAS[+]) based on digital subtraction angiography (DSA). The optimal cut-off to predict embolic occlusion was HU ratio <0.6 measured at 2 mm from the occlusion site (maximum area under the curve =0.87; sensitivity 96%; specificity 81%). This cut-off also independently predicted successful recanalization using stent-retrievers and/or contact aspiration (modified Treatment in Cerebral Ischemia score ≥2b; p=0.002) after adjusting for age, atrial fibrillation and collateral circulation score, but not predicted favorable outcome at 3 months post-stroke. Importantly, in the validation cohort (n=95, 80% embolic occlusion), this HU ratio cut-off similarly predicted occlusion types and recanalization outcome, respectively. CONCLUSION The mCTA-based quantitative radiodensities of acute LVO provides preprocedural predictive values of DSA-determined occlusion types and thrombectomy outcomes.

Research paper thumbnail of Classification differentiates clinical and neuroanatomic features of cerebral small vessel disease

Brain Communications, 2021

Age-related cerebral small vessel disease involves heterogeneous pathogenesis, such as arterioscl... more Age-related cerebral small vessel disease involves heterogeneous pathogenesis, such as arteriosclerosis/lipohyalinosis and cerebral amyloid angiopathy. MRI can visualize the brain lesions attributable to small vessel disease pathologies, including white-matter hyperintensities, lacune and cerebral microbleeds. However, these MRI markers usually coexist in small vessel disease of different aetiologies. Currently, there is no available classification integrating these neuroimaging markers for differentiating clinical and neuroanatomic features of small vessel disease yet. In this study, we tested whether our proposed stratification scheme could characterize specific clinical, neuroanatomic and potentially pathogenesis/aetiologies in classified small vessel disease subtypes. Cross-sectional analyses from a community-based non-demented non-stroke cohort consisting of ≥50 years old individuals were conducted. All participants were scanned 3T brain MRI for small vessel disease detection a...

Research paper thumbnail of Cerebellar-limbic neurocircuit is the novel biosignature of physio-cognitive decline syndrome

Aging, 2020

Both physical and cognitive deficits occur in the aging process. We operationally defined the phe... more Both physical and cognitive deficits occur in the aging process. We operationally defined the phenomenon as physio-cognitive decline syndrome (PCDS) and aimed to decipher its corresponding neuroanatomy patterns and neurocircuit. High resolution 3T brain magnetic resonance imaging (MRI) images from a community-dwelling longitudinal aging cohort were analysed. PCDS was defined as weakness (handgrip strength) and/or slowness (gait speed) concomitant with impairment in any cognitive domain (defined by 1.5 standard deviation below age, sex-matched norms), but without dementia or disability. Among 1196 eligible ≥ 50-year-old (62±9 years, 47.6%men) subjects, 15.9% had PCDS. Compared to the other participants, individuals with PCDS had significantly lower gray-matter volume (GMV) in the bilateral amygdala and thalamus, right hippocampus, right temporo-occipital cortex, and left cerebellum VI and V regions. The regions of reduced GMV in people with PCDS were similar between the middle-aged and older adults; whereas larger clusters with more extensive GMV-depleted regions were observed in ≥65-year-olds with PCDS. Diffusion-weighted tractography showed disrupted hippocampus-amygdala-cerebellum connections in subjects with PCDS. The neuroanatomic characteristics revealed by this study provide evidence for pathophysiological processes associated with concomitant physio-cognitive decline in the elderly. This neurocircuit might constitute a target for future preventive interventions.

Research paper thumbnail of Associations of Blood Pressure and Carotid Flow Velocity with Brain Volume and Cerebral Small Vessel Disease in a Community-Based Population

Translational Stroke Research, 2020

Cerebral small vessel disease (CSVD) is a common finding on brain magnetic resonance imaging (MRI... more Cerebral small vessel disease (CSVD) is a common finding on brain magnetic resonance imaging (MRI). We previously demonstrated that high blood pressure (BP) and low carotid flow velocity were associated with cerebrovascular disease. However, their associations with brain volume and CSVD remain to be determined. A total of 721 adults (≥ 50 years) from the community-based I-Lan Longitudinal Aging Study were included. Flow velocities at the common (CCA) and internal carotid artery (ICA), including peak systolic velocity (PSV) and end-diastolic velocity (EDV), were measured with Doppler ultrasound. We further detected the presence of CSVD including lacune, microbleed, and white matter hyperintensity (WMH) on brain MRI, which were used to construct a combined CSVD score. General linear regression and logistic regression analysis were exploited to evaluate the association between carotid flow velocity, BP, brain volume, and CSVD. The mean of white matter, gray matter, and WMH volume were 422.2 cm 3 , 546.9 cm 3 , and 2.61 cm 3 , respectively. The proportion of lacune and microbleed were 11.1% and 14.2%, respectively. The CSVD score were negatively associated with gray (r = − 0.121, p < .01) and white matter volume (r = 0.058, p = 0.12), but positively associated with systolic BP (beta = 1.02, p = 0.0017). EDV at common carotid artery associated positively with white matter volume (beta = 1.013, p = 0.0064) and negatively predicted the presence CSVD (odds ratio [OR] = 0.93, p = 0.0023). In the ordinal logistic regression analysis adjusting for age, sex, total intracranial volume education, low-density lipoprotein cholesterol, and fasting glucose, compared with hypertensive subjects with low EDV, normotensive subjects with low, middle, and high EDV had an odds ratio of 0.656 (0.327-1.318), 0.429 (0.261-0.705), and 0.272 (0.147-0.502) for CSVD score, respectively. High SBP and low carotid flow velocities were independently associated with brain volume and CSVD. These associations may be involved in the pathophysiology of cognitive function decline.

Research paper thumbnail of Premature Atrial Contractions and Their Association with Stroke Features and Outcome

Journal of Stroke and Cerebrovascular Diseases, 2020

Background: Frequent premature atrial contractions (PACs) are associated with atrial fibrillation... more Background: Frequent premature atrial contractions (PACs) are associated with atrial fibrillation, stroke, and mortality. However, the cutoff value for PAC counts that could identify patients with different stroke features is unclear, and the association of PACs to outcome is not determined. Methods: The study retrospectively included patients with acute ischemic stroke who had underwent both a 24 h Holter recording and a brain MRI in Taipei Veterans General Hospital from January 2015 to May 2016. Patients were categorized into four groups according to their PAC frequencies on 24 h Holter recording. We compared the clinical severity, neuroimage features, stroke subtypes, and functional outcome among the four groups of patients. Results: Among the 278 patients, the lower, middle, and upper quartiles of the PAC counts were 23, 74, and 459.5, respectively. In contrast to the 1 st quartile of patients, the 3 rd (PAC 75-459/24 h) and the 4 th (PAC 460/24 h) quartiles of patients had higher NIH Stroke Scale (NIHSS) at admission (p = 0.014 and p = 0.002, respectively). The frequencies of cryptogenic stroke were not different among the 4 quartiles of the patients, but cryptogenic stroke patients with 75PACs/24hours had higher stroke severity compared to those with PACs < 75counts/24 h (NIHSS 9.1 vs. 5.2, p = 0.043). There was an increased trend in infarcts of multiple vascular territories and in mortality at 1 year among the four groups of patients with increased PAC frequency (p = 0.045 and p = 0.002, respectively). The 4 th PAC quartile was associated with poor functional outcome (modified Rankin Scale 4) at 3 months in univariate analysis (OR: 5.66, CI: 2.69À11.91, p < 0.001), but was not an independent predictor after controlling for initial stroke severity. Conclusions: PACs 75 counts/24 h was associated with higher clinical severity in patients with acute ischemic stroke.

Research paper thumbnail of Large-Scale Structural Covariance Networks Predict Age in Middle-to-Late Adulthood: A Novel Brain Aging Biomarker

Cerebral Cortex, 2020

The aging process is accompanied by changes in the brain’s cortex at many levels. There is growin... more The aging process is accompanied by changes in the brain’s cortex at many levels. There is growing interest in summarizing these complex brain-aging profiles into a single, quantitative index that could serve as a biomarker both for characterizing individual brain health and for identifying neurodegenerative and neuropsychiatric diseases. Using a large-scale structural covariance network (SCN)-based framework with machine learning algorithms, we demonstrate this framework’s ability to predict individual brain age in a large sample of middle-to-late age adults, and highlight its clinical specificity for several disease populations from a network perspective. A proposed estimator with 40 SCNs could predict individual brain age, balancing between model complexity and prediction accuracy. Notably, we found that the most significant SCN for predicting brain age included the caudate nucleus, putamen, hippocampus, amygdala, and cerebellar regions. Furthermore, our data indicate a larger br...

Research paper thumbnail of Better endovascular mechanical thrombectomy outcome in atrial fibrillation patients with acute ischemic stroke: A single-center experience

Journal of the Chinese Medical Association, 2020

Research paper thumbnail of Influence of Vertebrobasilar Stenotic Lesion Rigidity on the Outcome of Angioplasty and Stenting

Scientific Reports, 2020

Stenotic lesion rigidity (SLR) has an unclear influence on the outcome of percutaneous translumin... more Stenotic lesion rigidity (SLR) has an unclear influence on the outcome of percutaneous transluminal angioplasty and stenting (PTAS) for intracranial arterial stenosis. This study evaluated the outcome of PTAS and the relationship of vertebrobasilar SLR to features on vessel wall MRI (VW-MRI) for identifying pathologies of vertebrobasilar stenosis (VBS) and evaluating PTAS outcome. We retrospectively evaluated the results of PTAS in 31 patients with severe VBS. Stenotic lesions were classified as soft (based on predilatation pressure [PP] ≦ 4 atm) in 15 patients or hard (PP >4 atm) in 16 patients. We examined the relationship of SLR to clinical and MR findings. Patients with hard vs soft lesions had atherosclerosis (8/16 [50.0%] vs 2/15 [13.3%]), dissection (0/16 [0.0%] vs 12/15 [80.0%]), and dissection in atherosclerosis (8/16 [50.0%] vs 1/15 [6.7%], P < 0.0001); high intensity signal on the T1WI of VW-MRI (5/16 [31.3%] vs 14/15 [93.3%]) and iso- to low intensity signal (11/16...

Research paper thumbnail of Similar thrombolysis outcomes in acute stroke patients with and without atrial fibrillation if pre-stroke CHA2DS2-VASc score is low

Medicine, 2020

The prognosis of acute ischemic stroke patients treated with intravenous (IV) recombinant tissue ... more The prognosis of acute ischemic stroke patients treated with intravenous (IV) recombinant tissue plasminogen activator (rtPA) is poorer in patients with atrial fibrillation (AF) than patients without AF, which might be related to the greater stroke severity in AF patients. Higher pre-stroke CHA 2 DS 2-VASc scores are associated with greater stroke severity and poorer outcomes. AF Patients tend to have higher CHA 2 DS 2-VASc scores than the non-AF patients. We thus hypothesized that pre-stroke CHA 2 DS 2-VASc scores can be used to improve outcome stratification of IV thrombolysis therapy in acute stroke patients with and without AF. We retrospectively enrolled ischemic stroke patients who received IV-rtPA and categorized them into 2 groups: low-risk (CHA 2 DS 2-VASc scores 2) and high-risk (CHA 2 DS 2-VASc scores ≥ 3) groups. We compared the outcomes between AF and non-AF patients and the interactive effects of the levels of CHA 2 DS 2-VASc scores on this outcome difference. In the low-risk group, there was no difference in outcomes between the AF and non-AF patients. In the high-risk group, the AF patients had worse outcomes at 3 and 6 months. Our results suggest that pre-stroke CHA 2 DS 2-VASc scores are a useful outcome predictor of IV thrombolytic therapy in acute stroke patients with AF.

Research paper thumbnail of Cerebral Small Vessel Disease Is Associated with Dysregulation in the Ubiquitin Proteasome System and Other Major Cellular Pathways in Specific Brain Regions

Neurodegenerative Diseases, 2017

Background/Aims: Cerebral small vessel disease (SVD) is characterized by periventricular white ma... more Background/Aims: Cerebral small vessel disease (SVD) is characterized by periventricular white matter (WM) changes and can lead to vascular dementia, the second most common form of age-dependent dementia. The pathogenesis of the disease remains poorly understood, and studies of its molecular basis are limited. By profiling gene expression of dissected postmortem brain tissue in SVD patients and comparisons with tissue of nonneurological controls, we aimed to identify genes and processes that are involved in the pathogenesis of SVD to gain new pathogenetic insights. Methods: We performed genome-wide expression analyses in postmortem brain tissue samples dissected from frontal, temporal, and occipital lobes as well as basal nuclei comprising thalamus, basal ganglia, and hippocampus from 5 SVD cases and 5 nonaffected control cases. Cellular pathways associated with differently expressed genes were identified in each brain region individually. Results: This analysis disclosed regional d...

Research paper thumbnail of Enhanced Performance of Single Poly-Silicon EEPROM Cell With a Tungsten Finger Coupling Structure by Full CMOS Process

IEEE Transactions on Electron Devices, 2014

A single poly-silicon electrically erasable programmable read only memory cell with a tungsten fi... more A single poly-silicon electrically erasable programmable read only memory cell with a tungsten finger coupling structure by fully compatible 0.13-μm CMOS process is proposed for the first time in this paper and its performances are compared with the conventional poly-silicon finger coupling cell. Results show that the tungsten finger coupling cell has smaller drain-induced barrier lowering effect, higher coupling ratio, and higher cell current and programming/erasing (P/E) speeds due to its metallic control gate and incremental capacitance from control gate structure. Furthermore, the reliability characteristics in this proposed tungsten finger coupling cell are comparable with poly-silicon finger coupling cell, and its P/E windows are wider during reliability tests.

Research paper thumbnail of Diagnosis of Transverse Sinus Hypoplasia in Magnetic Resonance Venography

Medicine, 2016

In previous studies of transverse sinus (TS) hypoplasia, discrepancies between TS diameter measur... more In previous studies of transverse sinus (TS) hypoplasia, discrepancies between TS diameter measured by magnetic resonance venography (MRV) and contrast T1-weighted magnetic resonance (contrast T1) were observed. To investigate these discrepancies, and considering that TS hypoplasia is associated with neurological disorders, we performed a post hoc analysis of prospectively collected data from 3 case-control studies on transient global amnesia (TGA), transient monocular blindness (TMB), and panic disorders while retaining the original inclusion and exclusion criteria. Magnetic resonance (MR) imaging of 131 subjects was reviewed to evaluate TS diameter and the location and degree of venous flow stenosis and obstruction. MRV without contrast revealed that TS hypoplasia was observed in 69 subjects, whom we classified into 2 subgroups according to the concordance with contrast T1 observations: concordance indicated anatomically small TS (30 subjects), and discrepancy indicated that the MRV diagnosis is in fact flow-related and that TS is not anatomically small (39 subjects). The latter subgroup was associated with at least 1 site of venous compression/stenosis in the internal jugular vein (IJV) or the left brachiocephalic vein (BCV) (P < 0.001), which was significantly larger in patients than controls. Compensatory dilatation of contralateral TS diameter was only observed with MRV, not with contrast T1 imaging. The clinical implication of these results is that using MRV only, IJV/ BCV compression/stenosis may be misdiagnosed as TS hypoplasia. And contralateral TS have no compensatory dilatation in its diameter in contrast T1 imaging, just compensatory increased flow volume. (Medicine 95(10):e2862) Abbreviations: BCV = brachiocephalic vein, contrast T1 = contrast T1-weighted magnetic resonance imaging, FA = flip angle, FOV = field of view, IJV = internal jugular vein, IQR = interquartile range, MR = magnetic resonance, MRV = magnetic resonance venography, SPGR = spoiled gradient recalled, TE = echo time, TGA = transient global amnesia, TMB = transient monocular blindness, TR = repetition time, TRICKS = time-resolved imaging of contrast kinetics, TS = transverse sinus, VV = vertebral vein.

Research paper thumbnail of Posterior Circulation Ischemic Stroke Caused by Arterial Dissection: Characteristics and Predictors of Poor Outcomes

Cerebrovascular Diseases, 2015

Background: Posterior circulation ischemic stroke (PCS) caused by arterial dissection (AD-PCS) wa... more Background: Posterior circulation ischemic stroke (PCS) caused by arterial dissection (AD-PCS) was rarely discussed. The present study aimed to evaluate the clinical characteristics and predictors of poor outcomes in AD-PCS patients. Methods: A total of 286 PCS patients were recruited from Taipei Veterans General Hospital Stroke Registry (between January 1, 2012 and February 28, 2014). Clinical/image data of recruited PCS patients were reviewed by stroke specialists who reached a consensus on the stroke etiologies. Data of AD-PCS patients were analyzed. Results: Seventy-four patients (65.8 ± 15.6 years, 56 (75.7%) men) were determined as AD-PCS. Headache and neck pain at admission were only presented in 18.9 and 6.8% of patients, respectively. The location of AD was initiated in the vertebral artery (66.2%), basilar artery (27.0%), posterior inferior cerebellar artery (5.4%) and posterior cerebral artery (1.4%). The involvement of intracranial arteries was present in the majority of...

Research paper thumbnail of Statin_after_stroke_Supplementary_appendix_20190627_TAND – Supplemental material for Does statin increase the risk of intracerebral hemorrhage in stroke survivors? A meta-analysis and trial sequential analysis

Supplemental material, Statin_after_stroke_Supplementary_appendix_20190627_TAND for Does statin i... more Supplemental material, Statin_after_stroke_Supplementary_appendix_20190627_TAND for Does statin increase the risk of intracerebral hemorrhage in stroke survivors? A meta-analysis and trial sequential analysis by Ru Jian Jonathan Teoh, Chi-Jung Huang, Chi Peng Chan, Li-Yin Chien, Chih-Ping Chung, Shih-Hsien Sung, Chen-Huan Chen, Chern-En Chiang and Hao-Min Cheng in Therapeutic Advances in Neurological Disorders

Research paper thumbnail of Clinical-CT mismatch defined NIHSS ≥ 8 and CT-ASPECTS ≥ 9 as a reliable marker of candidacy for intravenous thrombolytic therapy in acute ischemic stroke

PLoS ONE, 2021

Background Clinical-diffusion mismatch between stroke severity and diffusion-weighted imaging les... more Background Clinical-diffusion mismatch between stroke severity and diffusion-weighted imaging lesion volume seems to identify stroke patients with penumbra. However, urgent magnetic resonance imaging is sometimes inaccessible or contraindicated. Thus, we hypothesized that using brain computed tomography (CT) to determine a baseline “clinical-CT mismatch” may also predict the responses to thrombolytic therapy. Methods Brain CT lesions were measured using the Alberta Stroke Program Early CT Score (ASPECTS). A total of 104 patients were included: 79 patients with a baseline National Institutes of Health Stroke Scale (NIHSS) score ≥ 8 and a CT-ASPECTS ≥ 9 who were defined as clinical-CT mismatch-positive (P group) and 25 patients with an NIHSS score ≥ 8 and a CT-ASPECTS < 9 who were defined as clinical-CT mismatch-negative (the N group). We compared their clinical outcomes, including early neurological improvement (ENI), early neurological deterioration (END), delta NIHSS score (admi...

Research paper thumbnail of Etiology and risk factors of intracranial hemorrhage and ischemic stroke in young adults

Journal of the Chinese Medical Association, 2021

Background: Young stroke incidence has increased worldwide with lifestyle changes. Etiology and r... more Background: Young stroke incidence has increased worldwide with lifestyle changes. Etiology and risk factors for both ischemic and hemorrhagic stroke in young Asians remain underexplored. Methods: We retrospectively reviewed consecutive acute stroke patients aged 16–45 years admitted to the Taipei Veterans General Hospital between 2009 and 2019 to analyze etiologic subtypes, risk factors, and serial modified Rankin Scale scores for 1 year and compare the age groups of 16–30 and 31–45 years. Results: Among 670 young Taiwanese patients (mean age at onset 37.5 ± 7.0 years; male 65.1%), there were 366 nontraumatic spontaneous hemorrhagic stroke (including 259 intracerebral hemorrhage [ICH] and 107 subarachnoid hemorrhage, SAH), 292 ischemic stroke and 12 cerebral venous thromboses. Notably, ICH was more prevalent in patients aged 16–30 than in those aged 31–45 (54.8% vs 36.8%). Specifically, structural vasculopathy (e.g., arteriovenous malformation, cavernoma) was the most common etiologic subtype in patients aged 16–30 (p < 0.001), whereas hypertensive ICH was the most common subtype in patients aged 31–45 (p < 0.001). On the other hand, the top ischemic subtype for both age groups was other determined diseases (e.g., arterial dissection, autoimmune diseases, moyamoya disease, etc.) rather than large artery atherosclerosis. Hyperlipidemia, diabetes, and cigarette smoking were more common risk factors for infarction than ICH. Familial stroke patients whose first- or second-degree relatives had a stroke by age 80 (n = 104, 15.5%) had more infarctions than those without a familial stroke history. In multivariate analyses, initial stroke severity, and infarction type were important predictors of favorable outcomes after 3 months. At the 1-year follow-up, patients with ICH and SAH had worse functional outcomes and survival rates than those with infarction. Conclusion: An aggressive approach to elucidate the etiology of stroke is indicated because structural vasculopathy-induced ICH and other determined infarction are distinctively prevalent in young adults, particularly those aged 16–30.

Research paper thumbnail of Single-phase computed tomography angiography sufficiently predicts outcomes after mechanical thrombectomy

Journal of the Chinese Medical Association, 2020

Background: Arterial collateral (AC) assessed by single-phase computed tomography angiography (CT... more Background: Arterial collateral (AC) assessed by single-phase computed tomography angiography (CTA) or multiphase CTA has been used to predict clinical outcomes in patients undergoing mechanical thrombectomy (MT). Recently, venous opacification (VO) was proposed as another accurate image marker. This study aimed to compare the efficacy using AC and VO as predictors of MT outcome. Methods: Patients with occlusion of the proximal anterior circulation undergoing MT were included retrospectively. We assessed the AC status respectively according to different methods: modified Tan score, Miteff score in single-phase CTA, and pial arterial filling score in multiphase CTA. VO was assessed according to cortical vein opacification score. Favorable clinical outcome was defined as modified Rankin Scale 0-2 90 days after MT. Logistic regression models were established and receiver operating characteristics curve were used to determine the predictability of favorable outcome in patients with adequate AC and VO. Results: A total of 75 patients were enrolled. Adequate AC identified by modified Tan score (odds ratio, 7.3; p < 0.001), Miteff score (odds ratio, 4.5; p = 0.009), significantly predicted favorable outcome, but not adequate VO. The area under the curve was largest for adequate AC in model of modified Tan score 0.730 (95% CI, 0.60-0.86), while adequate VO showed the least area under the curve: 0.577 (95% CI, 0.43-0.73). Conclusion: We considered adequate AC in single-phase CTA could be reliable enough as an imaging marker rather than adequate VO to predict favorable outcome after MT.

Research paper thumbnail of Epistasis Analysis for Estrogen Metabolic and Signaling Pathway Genes on Young Ischemic Stroke Patients

Research paper thumbnail of Onset Headache Predicts Good Outcome in Patients With First-Ever Ischemic Stroke

Stroke, 2013

Background and Purpose— The study aimed to assess whether onset headache is an ominous sign in pa... more Background and Purpose— The study aimed to assess whether onset headache is an ominous sign in patients with first-ever ischemic stroke. Methods— A large population of ischemic stroke patients was obtained from the Taiwan Stroke Registry. Stroke subtypes were classified by the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria. On the basis of the International Classification of Headache Disorders, second version, onset headache was defined as a new headache that developed at the onset of ischemic stroke. Clinical features and impact on stroke outcomes, including in-hospital stroke in evolution, changes in National Institutes of Health Stroke Scale on discharge, and Barthel index and modified Rankin scale ≤6 months after stroke were compared between those with and without onset headache. Results— Among 11 523 patients with first-ever ischemic stroke, 848 had onset headache (7.4%). Patients with specific cause, large-artery atherosclerosis, or cardioembolism were more like...

Research paper thumbnail of Regional rather than global brain age mediates cognitive function in cerebral small vessel disease

Brain Communications

The factors and mechanisms underlying the heterogeneous cognitive outcomes of cerebral small vess... more The factors and mechanisms underlying the heterogeneous cognitive outcomes of cerebral small vessel disease are largely unknown. Brain biological age can be estimated by machine learning algorithms that use large brain MRI data sets to integrate and compute neuroimaging-derived age-related features. Predicted and chronological ages difference (brain-age gap) reflects advanced or delayed brain aging in an individual. The present study firstly reports the brain aging status of cerebral small vessel disease. In addition, we investigated whether global or certain regional brain age could mediate the cognitive functions in cerebral small vessel disease. Global and regional (400 cortical, 14 subcortical and 28 cerebellum regions of interest) brain-age prediction models were constructed using grey matter features from MRI of 1482 healthy individuals (age: 18–92 years). Predicted and chronological ages differences were obtained and then applied to non-stroke, non-demented individuals, aged ...

Research paper thumbnail of Quantitative CT angiography predicts large artery occlusion types and successful thrombectomy in acute ischemic stroke

Journal of the Chinese Medical Association, 2020

BACKGROUND Clinical and radiological outcomes of endovascular thrombectomy (EVT) are related to e... more BACKGROUND Clinical and radiological outcomes of endovascular thrombectomy (EVT) are related to etiologies of large vessel occlusion (LVO) in acute stroke. However, preprocedural computed tomography angiography (CTA) or CT perfusion imaging can hardly distinguish embolic occlusion from atherosclerotic occlusion. We hypothesized that quantitative multiphase CTA (mCTA) of LVO may predict occlusion types and thrombectomy outcome. METHODS We retrospectively evaluated the consecutive stroke patients who had undergone mCTA and EVT <6 hours of onset at two independent medical centers. The intra-arterial radiodensities of Hounsfield unit (HU) were measured to examine the HUdistal/proximal ratio using receiver operating characteristic curve analysis. The derived cut-off value was re-examined in an independent cohort. RESULTS In the derivation cohort (n=102), 81 patients (79.4%) were embolic occlusion without severe residual intracranial atherosclerotic stenosis (ICAS[-]) and 21 patients were atherosclerosis-related occlusion (ICAS[+]) based on digital subtraction angiography (DSA). The optimal cut-off to predict embolic occlusion was HU ratio <0.6 measured at 2 mm from the occlusion site (maximum area under the curve =0.87; sensitivity 96%; specificity 81%). This cut-off also independently predicted successful recanalization using stent-retrievers and/or contact aspiration (modified Treatment in Cerebral Ischemia score ≥2b; p=0.002) after adjusting for age, atrial fibrillation and collateral circulation score, but not predicted favorable outcome at 3 months post-stroke. Importantly, in the validation cohort (n=95, 80% embolic occlusion), this HU ratio cut-off similarly predicted occlusion types and recanalization outcome, respectively. CONCLUSION The mCTA-based quantitative radiodensities of acute LVO provides preprocedural predictive values of DSA-determined occlusion types and thrombectomy outcomes.

Research paper thumbnail of Classification differentiates clinical and neuroanatomic features of cerebral small vessel disease

Brain Communications, 2021

Age-related cerebral small vessel disease involves heterogeneous pathogenesis, such as arterioscl... more Age-related cerebral small vessel disease involves heterogeneous pathogenesis, such as arteriosclerosis/lipohyalinosis and cerebral amyloid angiopathy. MRI can visualize the brain lesions attributable to small vessel disease pathologies, including white-matter hyperintensities, lacune and cerebral microbleeds. However, these MRI markers usually coexist in small vessel disease of different aetiologies. Currently, there is no available classification integrating these neuroimaging markers for differentiating clinical and neuroanatomic features of small vessel disease yet. In this study, we tested whether our proposed stratification scheme could characterize specific clinical, neuroanatomic and potentially pathogenesis/aetiologies in classified small vessel disease subtypes. Cross-sectional analyses from a community-based non-demented non-stroke cohort consisting of ≥50 years old individuals were conducted. All participants were scanned 3T brain MRI for small vessel disease detection a...

Research paper thumbnail of Cerebellar-limbic neurocircuit is the novel biosignature of physio-cognitive decline syndrome

Aging, 2020

Both physical and cognitive deficits occur in the aging process. We operationally defined the phe... more Both physical and cognitive deficits occur in the aging process. We operationally defined the phenomenon as physio-cognitive decline syndrome (PCDS) and aimed to decipher its corresponding neuroanatomy patterns and neurocircuit. High resolution 3T brain magnetic resonance imaging (MRI) images from a community-dwelling longitudinal aging cohort were analysed. PCDS was defined as weakness (handgrip strength) and/or slowness (gait speed) concomitant with impairment in any cognitive domain (defined by 1.5 standard deviation below age, sex-matched norms), but without dementia or disability. Among 1196 eligible ≥ 50-year-old (62±9 years, 47.6%men) subjects, 15.9% had PCDS. Compared to the other participants, individuals with PCDS had significantly lower gray-matter volume (GMV) in the bilateral amygdala and thalamus, right hippocampus, right temporo-occipital cortex, and left cerebellum VI and V regions. The regions of reduced GMV in people with PCDS were similar between the middle-aged and older adults; whereas larger clusters with more extensive GMV-depleted regions were observed in ≥65-year-olds with PCDS. Diffusion-weighted tractography showed disrupted hippocampus-amygdala-cerebellum connections in subjects with PCDS. The neuroanatomic characteristics revealed by this study provide evidence for pathophysiological processes associated with concomitant physio-cognitive decline in the elderly. This neurocircuit might constitute a target for future preventive interventions.

Research paper thumbnail of Associations of Blood Pressure and Carotid Flow Velocity with Brain Volume and Cerebral Small Vessel Disease in a Community-Based Population

Translational Stroke Research, 2020

Cerebral small vessel disease (CSVD) is a common finding on brain magnetic resonance imaging (MRI... more Cerebral small vessel disease (CSVD) is a common finding on brain magnetic resonance imaging (MRI). We previously demonstrated that high blood pressure (BP) and low carotid flow velocity were associated with cerebrovascular disease. However, their associations with brain volume and CSVD remain to be determined. A total of 721 adults (≥ 50 years) from the community-based I-Lan Longitudinal Aging Study were included. Flow velocities at the common (CCA) and internal carotid artery (ICA), including peak systolic velocity (PSV) and end-diastolic velocity (EDV), were measured with Doppler ultrasound. We further detected the presence of CSVD including lacune, microbleed, and white matter hyperintensity (WMH) on brain MRI, which were used to construct a combined CSVD score. General linear regression and logistic regression analysis were exploited to evaluate the association between carotid flow velocity, BP, brain volume, and CSVD. The mean of white matter, gray matter, and WMH volume were 422.2 cm 3 , 546.9 cm 3 , and 2.61 cm 3 , respectively. The proportion of lacune and microbleed were 11.1% and 14.2%, respectively. The CSVD score were negatively associated with gray (r = − 0.121, p < .01) and white matter volume (r = 0.058, p = 0.12), but positively associated with systolic BP (beta = 1.02, p = 0.0017). EDV at common carotid artery associated positively with white matter volume (beta = 1.013, p = 0.0064) and negatively predicted the presence CSVD (odds ratio [OR] = 0.93, p = 0.0023). In the ordinal logistic regression analysis adjusting for age, sex, total intracranial volume education, low-density lipoprotein cholesterol, and fasting glucose, compared with hypertensive subjects with low EDV, normotensive subjects with low, middle, and high EDV had an odds ratio of 0.656 (0.327-1.318), 0.429 (0.261-0.705), and 0.272 (0.147-0.502) for CSVD score, respectively. High SBP and low carotid flow velocities were independently associated with brain volume and CSVD. These associations may be involved in the pathophysiology of cognitive function decline.

Research paper thumbnail of Premature Atrial Contractions and Their Association with Stroke Features and Outcome

Journal of Stroke and Cerebrovascular Diseases, 2020

Background: Frequent premature atrial contractions (PACs) are associated with atrial fibrillation... more Background: Frequent premature atrial contractions (PACs) are associated with atrial fibrillation, stroke, and mortality. However, the cutoff value for PAC counts that could identify patients with different stroke features is unclear, and the association of PACs to outcome is not determined. Methods: The study retrospectively included patients with acute ischemic stroke who had underwent both a 24 h Holter recording and a brain MRI in Taipei Veterans General Hospital from January 2015 to May 2016. Patients were categorized into four groups according to their PAC frequencies on 24 h Holter recording. We compared the clinical severity, neuroimage features, stroke subtypes, and functional outcome among the four groups of patients. Results: Among the 278 patients, the lower, middle, and upper quartiles of the PAC counts were 23, 74, and 459.5, respectively. In contrast to the 1 st quartile of patients, the 3 rd (PAC 75-459/24 h) and the 4 th (PAC 460/24 h) quartiles of patients had higher NIH Stroke Scale (NIHSS) at admission (p = 0.014 and p = 0.002, respectively). The frequencies of cryptogenic stroke were not different among the 4 quartiles of the patients, but cryptogenic stroke patients with 75PACs/24hours had higher stroke severity compared to those with PACs < 75counts/24 h (NIHSS 9.1 vs. 5.2, p = 0.043). There was an increased trend in infarcts of multiple vascular territories and in mortality at 1 year among the four groups of patients with increased PAC frequency (p = 0.045 and p = 0.002, respectively). The 4 th PAC quartile was associated with poor functional outcome (modified Rankin Scale 4) at 3 months in univariate analysis (OR: 5.66, CI: 2.69À11.91, p < 0.001), but was not an independent predictor after controlling for initial stroke severity. Conclusions: PACs 75 counts/24 h was associated with higher clinical severity in patients with acute ischemic stroke.

Research paper thumbnail of Large-Scale Structural Covariance Networks Predict Age in Middle-to-Late Adulthood: A Novel Brain Aging Biomarker

Cerebral Cortex, 2020

The aging process is accompanied by changes in the brain’s cortex at many levels. There is growin... more The aging process is accompanied by changes in the brain’s cortex at many levels. There is growing interest in summarizing these complex brain-aging profiles into a single, quantitative index that could serve as a biomarker both for characterizing individual brain health and for identifying neurodegenerative and neuropsychiatric diseases. Using a large-scale structural covariance network (SCN)-based framework with machine learning algorithms, we demonstrate this framework’s ability to predict individual brain age in a large sample of middle-to-late age adults, and highlight its clinical specificity for several disease populations from a network perspective. A proposed estimator with 40 SCNs could predict individual brain age, balancing between model complexity and prediction accuracy. Notably, we found that the most significant SCN for predicting brain age included the caudate nucleus, putamen, hippocampus, amygdala, and cerebellar regions. Furthermore, our data indicate a larger br...

Research paper thumbnail of Better endovascular mechanical thrombectomy outcome in atrial fibrillation patients with acute ischemic stroke: A single-center experience

Journal of the Chinese Medical Association, 2020

Research paper thumbnail of Influence of Vertebrobasilar Stenotic Lesion Rigidity on the Outcome of Angioplasty and Stenting

Scientific Reports, 2020

Stenotic lesion rigidity (SLR) has an unclear influence on the outcome of percutaneous translumin... more Stenotic lesion rigidity (SLR) has an unclear influence on the outcome of percutaneous transluminal angioplasty and stenting (PTAS) for intracranial arterial stenosis. This study evaluated the outcome of PTAS and the relationship of vertebrobasilar SLR to features on vessel wall MRI (VW-MRI) for identifying pathologies of vertebrobasilar stenosis (VBS) and evaluating PTAS outcome. We retrospectively evaluated the results of PTAS in 31 patients with severe VBS. Stenotic lesions were classified as soft (based on predilatation pressure [PP] ≦ 4 atm) in 15 patients or hard (PP >4 atm) in 16 patients. We examined the relationship of SLR to clinical and MR findings. Patients with hard vs soft lesions had atherosclerosis (8/16 [50.0%] vs 2/15 [13.3%]), dissection (0/16 [0.0%] vs 12/15 [80.0%]), and dissection in atherosclerosis (8/16 [50.0%] vs 1/15 [6.7%], P < 0.0001); high intensity signal on the T1WI of VW-MRI (5/16 [31.3%] vs 14/15 [93.3%]) and iso- to low intensity signal (11/16...

Research paper thumbnail of Similar thrombolysis outcomes in acute stroke patients with and without atrial fibrillation if pre-stroke CHA2DS2-VASc score is low

Medicine, 2020

The prognosis of acute ischemic stroke patients treated with intravenous (IV) recombinant tissue ... more The prognosis of acute ischemic stroke patients treated with intravenous (IV) recombinant tissue plasminogen activator (rtPA) is poorer in patients with atrial fibrillation (AF) than patients without AF, which might be related to the greater stroke severity in AF patients. Higher pre-stroke CHA 2 DS 2-VASc scores are associated with greater stroke severity and poorer outcomes. AF Patients tend to have higher CHA 2 DS 2-VASc scores than the non-AF patients. We thus hypothesized that pre-stroke CHA 2 DS 2-VASc scores can be used to improve outcome stratification of IV thrombolysis therapy in acute stroke patients with and without AF. We retrospectively enrolled ischemic stroke patients who received IV-rtPA and categorized them into 2 groups: low-risk (CHA 2 DS 2-VASc scores 2) and high-risk (CHA 2 DS 2-VASc scores ≥ 3) groups. We compared the outcomes between AF and non-AF patients and the interactive effects of the levels of CHA 2 DS 2-VASc scores on this outcome difference. In the low-risk group, there was no difference in outcomes between the AF and non-AF patients. In the high-risk group, the AF patients had worse outcomes at 3 and 6 months. Our results suggest that pre-stroke CHA 2 DS 2-VASc scores are a useful outcome predictor of IV thrombolytic therapy in acute stroke patients with AF.

Research paper thumbnail of Cerebral Small Vessel Disease Is Associated with Dysregulation in the Ubiquitin Proteasome System and Other Major Cellular Pathways in Specific Brain Regions

Neurodegenerative Diseases, 2017

Background/Aims: Cerebral small vessel disease (SVD) is characterized by periventricular white ma... more Background/Aims: Cerebral small vessel disease (SVD) is characterized by periventricular white matter (WM) changes and can lead to vascular dementia, the second most common form of age-dependent dementia. The pathogenesis of the disease remains poorly understood, and studies of its molecular basis are limited. By profiling gene expression of dissected postmortem brain tissue in SVD patients and comparisons with tissue of nonneurological controls, we aimed to identify genes and processes that are involved in the pathogenesis of SVD to gain new pathogenetic insights. Methods: We performed genome-wide expression analyses in postmortem brain tissue samples dissected from frontal, temporal, and occipital lobes as well as basal nuclei comprising thalamus, basal ganglia, and hippocampus from 5 SVD cases and 5 nonaffected control cases. Cellular pathways associated with differently expressed genes were identified in each brain region individually. Results: This analysis disclosed regional d...

Research paper thumbnail of Enhanced Performance of Single Poly-Silicon EEPROM Cell With a Tungsten Finger Coupling Structure by Full CMOS Process

IEEE Transactions on Electron Devices, 2014

A single poly-silicon electrically erasable programmable read only memory cell with a tungsten fi... more A single poly-silicon electrically erasable programmable read only memory cell with a tungsten finger coupling structure by fully compatible 0.13-μm CMOS process is proposed for the first time in this paper and its performances are compared with the conventional poly-silicon finger coupling cell. Results show that the tungsten finger coupling cell has smaller drain-induced barrier lowering effect, higher coupling ratio, and higher cell current and programming/erasing (P/E) speeds due to its metallic control gate and incremental capacitance from control gate structure. Furthermore, the reliability characteristics in this proposed tungsten finger coupling cell are comparable with poly-silicon finger coupling cell, and its P/E windows are wider during reliability tests.

Research paper thumbnail of Diagnosis of Transverse Sinus Hypoplasia in Magnetic Resonance Venography

Medicine, 2016

In previous studies of transverse sinus (TS) hypoplasia, discrepancies between TS diameter measur... more In previous studies of transverse sinus (TS) hypoplasia, discrepancies between TS diameter measured by magnetic resonance venography (MRV) and contrast T1-weighted magnetic resonance (contrast T1) were observed. To investigate these discrepancies, and considering that TS hypoplasia is associated with neurological disorders, we performed a post hoc analysis of prospectively collected data from 3 case-control studies on transient global amnesia (TGA), transient monocular blindness (TMB), and panic disorders while retaining the original inclusion and exclusion criteria. Magnetic resonance (MR) imaging of 131 subjects was reviewed to evaluate TS diameter and the location and degree of venous flow stenosis and obstruction. MRV without contrast revealed that TS hypoplasia was observed in 69 subjects, whom we classified into 2 subgroups according to the concordance with contrast T1 observations: concordance indicated anatomically small TS (30 subjects), and discrepancy indicated that the MRV diagnosis is in fact flow-related and that TS is not anatomically small (39 subjects). The latter subgroup was associated with at least 1 site of venous compression/stenosis in the internal jugular vein (IJV) or the left brachiocephalic vein (BCV) (P < 0.001), which was significantly larger in patients than controls. Compensatory dilatation of contralateral TS diameter was only observed with MRV, not with contrast T1 imaging. The clinical implication of these results is that using MRV only, IJV/ BCV compression/stenosis may be misdiagnosed as TS hypoplasia. And contralateral TS have no compensatory dilatation in its diameter in contrast T1 imaging, just compensatory increased flow volume. (Medicine 95(10):e2862) Abbreviations: BCV = brachiocephalic vein, contrast T1 = contrast T1-weighted magnetic resonance imaging, FA = flip angle, FOV = field of view, IJV = internal jugular vein, IQR = interquartile range, MR = magnetic resonance, MRV = magnetic resonance venography, SPGR = spoiled gradient recalled, TE = echo time, TGA = transient global amnesia, TMB = transient monocular blindness, TR = repetition time, TRICKS = time-resolved imaging of contrast kinetics, TS = transverse sinus, VV = vertebral vein.

Research paper thumbnail of Posterior Circulation Ischemic Stroke Caused by Arterial Dissection: Characteristics and Predictors of Poor Outcomes

Cerebrovascular Diseases, 2015

Background: Posterior circulation ischemic stroke (PCS) caused by arterial dissection (AD-PCS) wa... more Background: Posterior circulation ischemic stroke (PCS) caused by arterial dissection (AD-PCS) was rarely discussed. The present study aimed to evaluate the clinical characteristics and predictors of poor outcomes in AD-PCS patients. Methods: A total of 286 PCS patients were recruited from Taipei Veterans General Hospital Stroke Registry (between January 1, 2012 and February 28, 2014). Clinical/image data of recruited PCS patients were reviewed by stroke specialists who reached a consensus on the stroke etiologies. Data of AD-PCS patients were analyzed. Results: Seventy-four patients (65.8 ± 15.6 years, 56 (75.7%) men) were determined as AD-PCS. Headache and neck pain at admission were only presented in 18.9 and 6.8% of patients, respectively. The location of AD was initiated in the vertebral artery (66.2%), basilar artery (27.0%), posterior inferior cerebellar artery (5.4%) and posterior cerebral artery (1.4%). The involvement of intracranial arteries was present in the majority of...