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Vol. 13 No. 2 December 2020 Eissn 2508-1349 Vol eISSN 2508-1349 Vol. 13 No. 2 December 2020 eISSN 2508-1349 Vol. 13 No. 2 December 2020 pages 69 - 136 I I www.e-jnc.org eISSN 2508-1349 Vol. 13, No. 2, 31 December 2020 Aims and Scope Journal of Neurocritical Care (JNC) aims to improve the quality of diagnoses and management of neurocritically ill patients by sharing practical knowledge and professional experience with our reader. Although JNC publishes papers on a variety of neurological disorders, it focuses on cerebrovascular diseases, epileptic seizures and status epilepticus, infectious and inflammatory diseases of the nervous system, neuromuscular diseases, and neurotrauma. We are also interested in research on neurological manifestations of general medical illnesses as well as general critical care of neurological diseases. Open Access This is an Open Access article distributed under the terms of the Creative Commons Attribution Non- Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non- commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Publisher The Korean Neurocritical Care Society Editor-in-Chief Sang-Beom Jeon Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88 Oylimpic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: +82-2-3010-3440, Fax: +82-2-474-4691, E-mail: [email protected] Correspondence The Korean Neurocritical Care Society Department of Neurology, The Catholic University College of Medicine, 222 Banpo-Daero, Seocho-Gu, Seoul 06591, Korea Tel: +82-2-2258-2816, Fax: +82-2-599-9686, E-mail: [email protected] Website: http://www.neurocriticalcare.or.kr Printing Office M2community Co. 8th FL, DreamTower, 66 Seongsui-ro, Seongdong-gu, Seoul 04784, Korea Tel: +82-2-2190-7300, Fax: +82-2-2190-7333, E-mail: [email protected] Published on December 31, 2020 © 2020 The Korean Neurocritical Care Society This paper meets the requirements of KS X ISO 9706, ISO 9706-1994 and ANSI/NISO Z39. 48-1992 (Permanence of paper). Editorial Board Editor-in-Chief Sang-Beom Jeon Ulsan University, Korea Associate Editor Jun Young Chang Ulsan University, Korea Section Editors Jeong-Ho Hong Keimyung University, Korea Jin-Heon Jeong Dong-A University, Korea Chulho Kim Hallym University, Korea Oh Young Kwon Gyeongsang National University, Korea Editorial Board Sung-Ho Ahn Pusan National University, Korea Huimahn Alex Choi University of Texas Medical School at Houston, USA Moon Ku Han Seoul National University, Korea Raimund Helbok University of Innsbruck, Austria Sang-Bae Ko Seoul National University, Korea Rainer Kollmar University of Erlangen-Nuremberg, Germany Yasuhiro Kuroda Kagawa University, Japan Kiwon Lee Rutger's University, USA Jung-Hwan Oh Jeju National University, Korea Jeong-Am Ryu Sungkyunkwan University, Korea Dong Hoon Shin Gachon University, Korea Fabio Silvio Taccone Université Libre de Bruxelles, Belgium Gene Sung University of Southern California, USA Ethics Editor Ji Man Hong Ajou University, Korea Statistical Editor Seung-Cheol Yun Ulsan University, Korea Ji Sung Lee Ulsan University, Korea © 2020 The Korean Neurocritical Care Society Contents Vol. 13, No. 2, December 2020 REVIEW ARTICLE 69 Blood pressure management in stroke patients Seung Min Kim, Ho Geol Woo, Yeon Jeong Kim, Bum Joon Kim ORIGINAL ARTICLE 80 Minimal-risk traumatic brain injury management without neurosurgical consultation Elizabeth Starbuck Compton, Benjamin Allan Smallheer, Nicholas Russell Thomason, Michael S. Norris, Mina Faye Nordness, Melissa D. Smith, Mayur Bipin Patel 86 The etiologies of altered level of consciousness in the emergency department Suwon Jung, Jae Cheon Jeon, Chang-Gyu Jung, Yong Won Cho, Keun Tae Kim 93 The good genotype for clopidogrel metabolism is associated with decreased blood viscosity in clopidogrel-treated ischemic stroke patients Joong Hyun Park, Sang Won Han, Hyun-Jeung Yu CASE REPORT 101 Cerebral infarction caused by endocarditis in a patient with COVID-19 Doo Hyuk Kwon, Jae-Seok Park, Hyung Jong Park, Sung-Il Sohn, Jeong-Ho Hong 105 Anti-Yo-associated autoimmune encephalitis after colon cancer treatment Na-Yeon Jung, Kyoung-Nam Woo, Jae Wook Cho, Hyun-Woo Kim 109 Bupropion overdose as a clinically significant confounder of the neurological examination Ranier Reyes, Stephen Figueroa 115 Endovascular treatment for pseudoaneurysm after carotid blowout syndrome Chong Hyuk Chung, Young-Nam Roh, Seo Hyeon Lee, Yeong Seok Jeong, Jeong-Ho Hong, Sung-Il Sohn, Hyungjong Park 119 Central skull base osteomyelitis due to nasopharyngeal Klebsiella infection Kyoung-Nam Woo, Jieun Roh, Seung-Kug Baik, Dong-Hyeon Shin, Ki-Seok Park, Min-Gyu Park, Kyung-Pil Park, Sung-Ho Ahn 123 Multiple embolic infarctions and intracranial hemorrhage in a patient with gestational trophoblastic disease Kyong Young Kim, Seunguk Jung, Changhyo Yoon, Heejeong Jeong, Eun Bin Cho, Tae-Won Yang, Seung Joo Kim, Sean Hwang, Ki-Jong Park 128 Normal pressure hydrocephalus after gamma knife radiosurgery in a patient with vestibular schwannoma Yoonah Park, Bong-Goo Yoo, Seonghun Jeong, Won Gu Lee, Meyung Kug Kim, So-Young Huh, Jin-Hyung Lee 133 Radiculopathy caused by lumbar epidural varix Jiyong Shin, Nawon Oh, Jisoon Huh, Chang Lim Hyun, Joong-Goo Kim, Sa-Yoon Kang, Jung-Hwan Oh © 2020 The Korean Neurocritical Care Society eISSN 2508-1349 J Neurocrit Care 2020;13(2):69-79 https://doi.org/10.18700/jnc.200028 Blood pressure management in stroke patients REVIEW ARTICLE Seung Min Kim, MD, PhD1; Ho Geol Woo, MD, PhD2; Yeon Jeong Kim, MD, PhD3; Bum Joon Kim, MD, PhD3 Received: October 15, 2020 Revised: November 14, 2020 1Department of Neurology, VHS Medical Center, Seoul, Republic of Korea Accepted: November 26, 2020 2Department of Neurology, Kyung Hee University School of Medicine, Seoul, Republic of Korea 3Department of Neurology, Asan Medical Center, Seoul, Republic of Korea Corresponding Author: Bum Joon Kim, MD, PhD Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43- gil, Songpa-gu, Seoul 05505, Korea Tel: +82-2-3010-3981 Fax: +82-2-474-4691 E-mail: [email protected] Hypertension is a major, yet manageable, risk factor for stroke, and the benefits of well-controlled blood pressure are well established. However, the strategy for managing blood pressure can differ based on the pathomechanism (subtype), stage, and treatment of stroke patients. In the present review, we focused on the management of blood pressure during the acute stage of intracerebral hemorrhage, subarachnoid hemorrhage, and cerebral infarction. In patients with cerebral infarction, the target blood pressure was discussed both before and after thrombolysis or other endovascular treatment, which may be an important issue. When and how to start antihyper- tensive medications during the acute ischemic stroke period were also discussed. In regards to the secondary prevention of ischemic stroke, the target blood pressure may differ based on the mechanism of ischemic stroke. We have reviewed previous studies and guidelines to summarize blood pressure management in various situations involving stroke patients. Keywords: Stroke; Hypertension; Cerebral infarction; Intracranial hemorrhage INTRODUCTION has a high mortality rate during the acute phase [2]. The mecha- nism of ischemic stroke is more heterogeneous, compared to Stroke is a disease with a heterogeneous pathomechanism, and is hemorrhagic stroke. Embolisms caused by large artery atheroscle- primarily considered to be hemorrhagic or ischemic. Hemorrhag- rosis in the proximal vessels can cause infarction. The heart cham- ic stroke is the result of ruptured blood vessels in the brain, result- bers may be one such source of embolism (cardioembolism). An- ing in intracerebral hemorrhage (ICH). This includes ruptured other example of this is lacunar infarction, which results from the perforator vessels in the deep structures of the brain, including the occlusion of small perforators due to lipohyalinosis, which subse- basal ganglia, thalamus, pons, and cerebellum [1]. In cases of lo- quently causes small infarctions [3]. bar hemorrhage, two potential causes are underlying cerebral am- Hypertension is one of the most important risk factors for yloid antipathy or cancer metastases. The rupture of an intracrani- stroke, and is the risk factor with the highest population-attribut- al aneurysm may lead to subarachnoid hemorrhage (SAH), which able risk [4]. High blood pressure (BP) may lead to endothelial © 2020 The Korean Neurocritical Care Society This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited. www.e-jnc.org 69 Seung Min Kim, et al. • Blood pressure in stroke patients dysfunction, resulting in the development of atherosclerosis [5]. divided into two groups, with targeted SBPs of < 150 mmHg and Hypertension also affects the heart directly and increases the risk < 180 mmHg. Perfusion computed tomography (CT) imaging of cardioembolic stroke [6]. was used to compare the CBF around the hematomas. It was Additionally, small perforators originating from the intracranial found that the degree of BP reduction did not affect the CBF artery are affected by hypertension. In contrast to capillary vessels, around the hematoma, and thus, it the reduction
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