Background and Purpose: Stroke risk factors and subtypes were examined for associations with mortality and recurrence rate in Taiwanese patients with first-ever and recurrent stroke. Methods: This study examined patients with initial and recurrent stroke from 2003 to 2005 for risk factors, demographic data, Bamford subtypes and transient ischemic attack. Results: One thousand and twenty-one patients with 1,085 stroke episodes were recruited. Significant factors associated with recurrent stroke were hyperlipidemia, atrial fibrillation and smoking. A significant incidence of lacunar infarction was noted in the patient population (37.82% in all patients; 41.02% in first stroke vs. 35.67% in recurrent stroke patients). Patients with diabetes mellitus were more likely to have lacunar rather than total anterior circulation infarction (TACI) or partial anterior circulation infarction (PACI). Hyperlipidemia was more often attributable to lacunar stroke than PACI. Atrial fibrillation was significantly associated with nonlacunar infarcts, TACI and PACI but not lacunar stroke. Conclusions: The incidence of lacunar infarction was significantly higher in initial rather than recurrent stroke patients. Diabetes mellitus or hyperlipidemia was highly associated with lacunar infarction. Atrial fibrillation was associated with nonlacunar infarction in Taiwan, similar to the result of White and Black populations in the UK.

Perfusion-diffusion mismatch in magnetic resonance imaging (MRI) represents the non-core hypoperfused area in acute ischemic stroke. The mismatch has been used to predict clinical response after thrombolysis in acute ischemic stroke, but its role for predicting early neurological deterioration (END) in acute ischemic stroke without thrombolysis has not been clarified yet. In this study, we prospectively recruited 54 patients with acute non-lacunar ischemic stroke in anterior circulation without thrombolysis. All patients received the first perfusion MRI within 24 hours from stroke onset. Target mismatch profile was defined as a perfusion-diffusion mismatch ratio ≥ 1.2. END was defined as an increase of ≥ 4 points in the National Institute of Health Stroke Scale (NIHSS) score within 72 hours. There were 13 (24.1%) patients developing END, which was associated with larger infarct growth (p = 0.002), worse modified Rankin Scale (p = 0.001) and higher mortality rate at 3 months (p = 0.025). Target mismatch profiles measured by Tmax ≥ 4, 5 and 6 seconds were independent predictors for END after correcting initial NIHSS score. Among the 3 Tmax thresholds, target mismatch measured by Tmax ≥ 6 seconds had the highest odd’s ratio in predicting END (p < 0.01, odd’s ratio = 17), with an 80% sensitivity and a 79.5% specificity. In conclusion, perfusion-diffusion mismatch could identify the patients at high risk of early clinical worsening in acute ischemic stroke without thrombolysis.

Background: The increasing prevalence of type 2 diabetes mellitus (T2DM) poses a major public health challenge throughout the world. It is a major healthcare issue among the elderly. This study was to identify the association between the health promoting behaviors and the diabetic control of type 2 diabetes mellitus (T2DM) patients. Methods: Cross sectional and descriptive research designs were used in this study. Participants were enrolled from three medical centers in northern, central and southern Taiwan during August, 2010 and June, 2011. The instruments encompassed biochemical indicators, and the preliminary developed scale of diabetes mellitus and health promotion (DMHP). Results: A total of 323 participants with T2DM were included in this study. The results showed 1) a high percentage of the participants used cigarette smoking, alcohol drinking and betel nut chewing, which were not conducive to adopting health promoting behaviors; 2) a high percentage of patients showed abnormal blood glucose, dyslipidemia, and elevated blood pressure; 3) few of the participants practiced ideally health promoting behaviors; and 4) practicing health-promoting behavior was positively associated with fasting blood glucose (FBG) and HbA1c levels. Conclusions: Patients with higher health promotion scores had better diabetic control. Less physical activity was found among those addicted to cigarette, alcohol and betel nut consumption. The findings suggest that health care providers should assess health promoting behaviors first for each diabetic patient.

Brain microbleed is a marker of small vessel microhemorrhagic or microaneurysmal lesions, which may induce intracerebral hemorrhage (ICH). This study to prospectively evaluated the association between microbleeds, hematoma and perihematomal edema volume, and various clinical data, as well as patient outcome. Thirty-one patients with ICH and 31 healthy age-matched subjects were enrolled in our study. They were divided into two groups according to the presence or absence of microbleeds detected by MRI. Serial clinical and laboratory data were recorded. Modified Rankin Scale and Barthel Index were estimated three months after hemorrhage. The major location of microbleeds among patients with ICH was the basal ganglia. The volume of perihematomal edema was correlated with the initial hematoma volume on the first, fifth and seventh days after hemorrhage in patients with microbleeds. For patients without microbleeds, this correlation was also significant on the seventh day. Cerebral microbleeds in patients with ICH, especially in the basal ganglia region, represent micro-angiopathy, and are associated with leakage of blood and formation of perihemorrhage edema. Brain microbleeds found in patients with ICH warrant further investigation for evaluation of stroke risk.