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腦血管疾病學 the Tingling Sensation and Limbs Weakness Recurred and She Was Referred 1 to Our Hospital for Further Survey

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腦血管疾病學 the Tingling Sensation and Limbs Weakness Recurred and She Was Referred 1 to Our Hospital for Further Survey Poster Session performed one hour later was negative. 壁報論文 Her symptoms recovered gradually after 8 hours of staying in hospital. Nevertheless, five hours after discharge, 腦血管疾病學 the tingling sensation and limbs weakness recurred and she was referred 1 to our hospital for further survey. 個案研究:以急性全身刺痛與無力表現 Neurological examination revealed the 的雙內側延髓中風 muscle power was 3/5 in all four limbs 朱海瑞 湯頌君 鄭建興 with bilateral extensor type of plantar 國立臺灣大學醫學院附設醫院 神經部 response. The gag reflex was trance Bilateral medial medullary infarction and tongue could not be protruded. Ten presenting as acute fluctuating tingling hours after arriving in our emergency sensation and weakness over all limbs room, the muscle strength deteriorated and trunk: a case report Hai-Jui Chu, Sung-Chun Tang, Jiann-Shing Jeng to 2/5 in upper limbs and 1/5 in lower Department of Neurology, National Taiwan University Hospital ones. Magnetic resonance imaging revealed bilateral MMI infarction with Background Bilateral medial heart shape sign. Digital subtraction medullary infarction (MMI) is extremely angiography showed normal rare among patients with acute ischemic appearance of bilateral vertebral stroke. Here we reported a case of arteries but suspected an azygos bilateral MMI presenting as an unusual anterior spinal artery mainly derived course of acute fluctuating tingling from the left vertebral artery. For the sensation and weakness in all limbs and consequently respiratory distress, she trunk for 2 days. was intubated. Heparinization was given for 2 days and was shifted to Case Report A 41-year-old female had Clopidogrel 1 tablet per day. Three newly diagnosed hypertension but did not months later, her muscle strength take regular medication for several improved significantly and she could months. The day before the symptom walk with a quadricane well. onset, she went to bed as usual. Around midnight, she was awakened by Conclusion Although rare, bilateral generalized tingling and burning MMI needs to be considered in the sensation. It first started from tips of all differential diagnosis for patients with fingers and soon ascended to both arms, acute motor and sensory symptoms of head, neck and whole body. She also all limbs and trunk plus bulbar complained four limbs weakness symptoms. although she could elevate her four limbs symmetrically. Head CT which was 1 2 size. Carotid stenosis was associated 腦出血病人頸動脈內膜厚度與再中風 positively with old age, hypertension, 的關聯性 and inversely with hemorrhage size. 江宜蓁 陳怡君 林口長庚紀念醫院 神經內科 Total cholesterol was the only independent predictor (OR 1.03 and Carotid intima-media thickness and 95% CI 1.00-1.06, P = 0.04) of incidence of recurrent stroke in significant stenosis. The follow-up patients with first-ever spontaneous intracerebral hemorrhage (ICH) time was 4.30 ± 2.61 years for Yi-Chen Chiang, Yi-Chun Chen first-ever ICH patients with CCD, with Department of Neurology, Chang Gung Memorial Hospital, Lin-Kou Medical Center time to recurrent stroke 2.41 ± 2.02 years. Recurrent stroke was 15.1 %, Objectives Increase in carotid with 12.6 % for infarction and 2.5% intima-media thickness (IMT) and for ICH. Multivariable Cox stenosis are shown to be independent proportional hazards models did not predictors of primary ICH, but their find any association of carotid association with recurrent stroke after thickness or stenosis with recurrent primary ICH is less clear. This study stroke. Increasing carotid IMT was examined the correlation of carotid associated with a hazard ratio of ultrasonographic findings with first-ever recurrent ICH of 0.49 (95% CI, ICH and its role in recurrence of ICH and 0.08-3.0) and a hazard ratio of infarction. recurrent infarct of 1.01 (95% CI, 0.63-1.64). Increasing carotid stenosis Methods This retrospective study was associated with a hazard ratio of included 508 patients with first-ever recurrent ICH of 0.99 (95% CI, spontaneous ICH. Among them, 166 0.90-1.08) and a hazard ratio of patients had examination of carotid recurrent infarct of 1.00 (95% CI, color-coded duplex sonography (CCD). 0.97-1.03). Results CCD was performed more Conclusion The clinical impact of frequently in those with hypertension, carotid IMT and stenosis on recurrent higher Glasgow Coma Scale and smaller stroke in primary ICH cases remains ICH size due to better prognosis. insignificant. This conclusion can be Ultrasonographic findings were further applied for the population of patient divided into 3 subtypes: carotid thickness, with higher Glasgow Coma Scale and carotid stenosis, and significant stenosis smaller ICH size. (>50%). Carotid thickness was correlated positively with old age, hypertension, and DM, and inversely with hemorrhage 2 3 The results of attitudes showed tending 探討花蓮地區緊急救護技術員之急性 to "agree". The results of prehospital 腦中風到院前救護行為意圖 care intention of acute stroke showed 江俊宜 1 胡益進 2 李明憲 3 陳俊安 4 李俊泰 4 1 國軍花蓮總醫院內科部 2 國立台灣師範大學健 "possible to do it ". 康促進與衛生教育學系 3 國立東華大學課程設 2. The relationship between 4 計與潛能開發學系 三軍總醫院神經科部 knowledge, attitudes, self-efficacy, Prehospital care intention of acute cues to action and health behavior stroke related factors among showed positive correlations. emergency medical technicians in the 3. Among the background variables Hualien area Chun-I Chiang1, Yih-Jin Hu 2, Ming-Shinn Lee3, “experience of acute stroke care”, Chun-An Chen4, Jiunn-Tay Lee4 "cues to action”, “self-efficacy” on 1 Department of Internal Medicine, Hualien “prehospital care of acute stroke" could Armed Force General Hospital 2 Department of Health Education, National effectively predict health behavior. The Taiwan Normal University most effective variable was 3 Department of Curriculum Design and Human Potentials Development Graduate Institute of “self-efficacy”. However, “having Compulsory Education, National Dong Hwa advanced cardiovascular life support University, Hualien, 4 Department of Neurology, Tri-Service General training” became a negative effect. Hospital Conclusion Case-based learning for EMS stroke education may be an Background Emergency medical effective method under the positive services (EMS) transport and hospital variables “experience of acute stroke prenotification are not been strengthened care”, “cues to action”, and in Taiwan. The main purpose of this “self-efficacy”. study is to understand the status of the knowledge, cues to action, attitudes, 4 self-efficacy and intention and related 經動脈血管栓塞術改善顱內動靜脈 factors of prehospital care of acute stroke 廔管引起之癲癇重積症 among emergency medical technicians in 江星逸 1 劉濟弘 1 廖洺鋒 1 林秀娜 1 黃浩輝 2 林口長庚紀念醫院 1 神經內科 2 放射診斷科 the Hualien area. Transarterial Embolization Methods The target group for this Improves Refractory Status study focused on first line technicians Epilepticus in a Patient with Intracranial Dural Arteriovenous working in the Hualien area. Fistula 1 Hsing-I Chiang , Chi-Hung Liu1, Ming-Feng 1 1 2 Results The research tool was based on Liao , Siew-Na Lim , Ho-Fai Wong 1Department of Neurology and 2Department of a structured questionnaire among a total Medical Imaging and Intervention, Chang Gung of 109 valid questionnaires. Memorial Hospital, Linkou Medical Center 1. The results of knowledge on acute Background Status epilepticus (SE) stroke showed an upper middle level. 3 is an infrequent manifestation of Conclusion The treatments of this intracranial dural arteriovenous fistula patient suggest the TAE with Onyx (DAVF). Endovascular treatment is an may effectively alleviate the refractory option when aggressive symptoms SE by means of improvement of develop. We report our experience using vasogenic edema and venous endovascular embolization in the hypertension. treatment of DAVF with SE refractory to medications. 5 平板電腦與智慧型手機於急性缺血 Case Report An 82-year-old woman 性腦中風處置之臨床運用 何旭華 was admitted due to SE with seizure 虎尾天主教若瑟醫院 神經內科 focus at left temporal area. Brain magnetic resonance imaging (MRI) The Applications of Tablet Computer and Smart Phone in Acute showed venous hypertension and Ischemic Stroke vasogenic edema at left occipital and Hsu-Hua Ho Department of Neurology, Saint Joseph's temporal lobes. Digital subtraction Hospital angiography confirmed Cognard type II a + b DAVF at left lateral sinus supplied by 背景 以往，我們對於急性缺血性中 middle meningeal artery with reflux into 風期的處置治療，大多是書面記錄於 left posterior cortical veins and left 紙本上，再輸入於電腦，進行後置的 transverse sinus stenosis. Midazolam 人工作業。這種處置與記錄的過程， continuous infusion (0.21mg/kg/hr) and 不僅延長了急性處置的時效，並且增 oral antiepileptic drugs (AED) including 加了後續統計與分析工作的複雜性。 levetiracetam (3000 mg/day), 隨著智慧型手機與平板電腦的普及 oxcarbazepine (1200 mg/day), topiramate 化和軟體程式的革新和進步。我們藉 (400 mg/day), and valproic acid (1600 此發展急性缺血性中風處置流程的 mg/day) failed to control the SE but led 關鍵軟體程式，自動將所得檢驗數據 to unstable vital signs. We arranged 進行符合條件比對、透過數位化記錄 transarterial embolization (TAE) with 各項臨床神經學檢查量表、計算所需 Onyx through middle meningeal artery 施打藥物劑量、同時也追蹤和立即反 and the feeding artery was obliterated. 映出處置進行的時間與流程準確性。 The SE subsided and the electroencephalogram showed burst 方法 我們使用 Android 手機作業系 suppression after TAE. Follow-up MRI 統，它是一個以 Linux 為基礎的半開 showed improvement of vasogenic 放原始碼作業系統，由於它支援多工 edema. Meanwhile, we successfully 與多重語言，並且內置 SQLite 小型 discontinued midazolam infusion and 關聯式資料庫管理系統來負責存儲 tapered the total doses of AED. 數據；同時也支援所有的雲端和無線 4 網路服務器訊息；因此非常適合用來開 6 發小型的醫療影像與數據的儲傳資料 鑑別診斷洗腎病人之人工血管造成 庫。所使用開發應用程式的編程語言為 之鎖骨下動脈竊血症候群 吳令治 J AVA 和 XML。藉由無線網路系統， 財團法人台灣基督教門諾會醫院 神經內科 將病人基本資料與各項檢驗數據由系 統帶入，並進行是否符合條件之判斷。 Can we use carotid duplex to differentiate subclavian steal caused 各項臨床評估量表( NIHSS、巴氏量 by vascular access for hemodialysis
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