The incidence of ischemic stroke increases with age due to improvements in health care and living conditions. With increasing proportion of old age, the proportion of old age is rapid expansion in acute ischemic stroke patients. Young and old age groups in acute ischemic stroke patients have different risk factors and clinical features. But, many patients of old age are excluded from active treatment like thrombolysis due to hemorrhagic transformation, poorer clinical outcome etc. So we studied clinical features, risk factor, outcome in ≧80 years old patients compared with <80 years. We enrolled 1,445 patients, who diagnosed acute ischemic stroke in Chosun university hospital, from January 2013 to December 2015. Patients were divided into two groups: ≧80 years versus <80 years. We compared with two groups about risk factors, stroke subtypes, thrombolysis, complications in hospital, initial National Institutes of Health Stroke Scale (NIHSS) score, prognosis. Of the total 172 patients, 54(31.4%) patients were 80 years or older. Symptomatic hemorrhage and asymptomatic hemorrhage was not different between both groups [over 79 years patients: 4/54 (7.4%) vs. under 80 years patients: 10/118 (8.5%), p>0.302], [16.7% vs. 17.7%, p>0.701]. There were no difference in mortality and favorable prognosis at 3 months later between both groups [over 79 years patients: 5/54 (9.3%) vs. under 80 years patients: 5/118 (4.2%), p=0.290], [over 79 years patients: 13/ 21 (24.1%) vs. under 80 years patients: 56/86 (47.5%), p=0.803]. There was difference in early neurological improvement rate(improvement > NIHSS 3) and degree of improvement (NIHSS at discharge - NIHSS at admission) were significant[over 79 years patients: 24/54 (44.4%) vs. under 80 years patients: 77/118 (65.8%), p=0.012], [2.69 vs 5.55, p=0.017]. Intracranial hemorrhage(symptomatic and asymptomatic) and favorable prognosis are not different significantly between two groups. Elderly patients is not a absolute contraindication for intravenous thrombolysis. For intravenous thrombolysis in elderly ischemic stroke patients, we need more study to exclude the poor prognostic factors and to consider of gain of patients.

High-resolution magnetic resonance (HR-MR) imaging in intracranial atherosclerotic disease poses a greater challenge in the neurologic fields. Because a high in-plane resolution and a high signal-to-noise ratio are required for vessel wall imaging. HR-MR can depict the morphologies of atherosclerotic plaques, arterial walls, and surrounding structures in the intracranial and cervical carotid arteries. HR-MR also can be observed with traditional luminal evaluation. Differentiating vulnerable from stable plaques and characterizing atherosclerotic plaques are vital parts of the early diagnosis, prevention, and treatment of stroke with atherosclerosis. HR-MR is the most important and popular vessel wall imaging technique for directly evaluating the vascular wall and intracranial artery disease. Intracranial artery atherosclerosis, dissection, moyamoya disease, vasculitis, and reversible cerebral vasoconstriction syndrome also can be diagnosed and differentiated by using HR-MR. Here, we review the radiologic features of intracranial artery disease and vertebral artery dissection on HR-MR.

For patients suffering from acute ischemic stroke from cerebral artery occlusion, reperfusion is necessary to save the ischemic penumbra. Therefore, early and complete recanalization of an occluded artery is the main therapeutic goal of acute ischemic stroke. Among the many advances in management of acute ischemic stroke, thrombolysis with intravenous (IV) tissue plasminogen activator (t-PA) within 4.5 hours after symptom onset has been the only approved pharmacological therapy. However, IV t-PA has many limitations in clinical practice, low eligible patients and low recanalization rates, particularly in cases of larger proximal artery occlusions. In addition, there are many complications, including symptomatic intracranial hemorrhage (approximately 6%). In contrast, higher recanalization rates and an extended therapeutic time window have been reported for intra-arterial (IA) thrombolysis. According to studies until 2013, no studies proving the advantages of IA thrombolysis have been reported. However it was reported that studies in 2015 showed its possibility. Therefore, the purpose of this article is to cast a light on failures of previous studies, and try to assess the differences with studies in 2015. In addition, crucial points for successful IA thrombolysis will be discussed.

Guillain-Barré syndrome can be classified with several subtypes along with the union of each symptom. Autoimmune mechanism is accepted for pathogenesis. It is often difficult to predict the causative antibodies of the various types of Guillain- Barré syndrome, because there are considerable mismatches of causative antibody to clinical phenotype as well as phenotype or antibody heterogeneities. We investigated the clinical characteristics of the patients with positivity of anti-gangliosides antibody in the serum. Nineteen patients were enrolled who showed the positivity of anti-GM1 antibody, anti-GQ1b antibody and anti-GD1b antibody, who had visited the department of neurology of Chosun University Hospital. We classified the three patient groups; 8 patients had positivity for anti-GM1 antibody, 10 patients for anti-GQ1b antibody and 8 patients for GD1b antibody. The result of statistical analysis showed no clinical difference within the groups. Therefore, prediction of causative autoantibody can be risky when we considered only the symptoms and course of disease of Guillain-Barré syndrome.

Proportion of elderly patients is gradually increasing in the republic of Korea. However, intravenous recombinant tissue plasminogen activator (rt-PA) therapy is recently not recommended in elderly acute ischemic stroke patients, although old age is not a proven contraindication to intravenous rt-PA. The purpose of this study was to investigate the safety and prognosis of intravenous thrombolysis in elderly patients.

Spontaneous intracranial hypotension (SIH) causes headache in the absence of tissue injury such as trauma, spinal cord injury, surgery, or epidural anesthesia. Epidural blood patch in the epidural space where CSF leakage occurs is effective for treatment of SIH. However, when the leakage site is unknown, administration of autologous blood into the lumbar epidural space could be effective. Here we report on patients who suffered from headache by SIH and could not confirm the leakage site, however, treatment by lumbar epidural blood patch was administered successfully.