年會壁報論文
虛引實戰腦部手術
湯其暾
國防醫學中心三軍總醫院神經外科部
Virtual Neuro-Navigation in Reality
Surgery
Chi-Tun Tang
Department of Neurosurgery, Tri-Service
General Hospital, National Defense Medical
Center, Taipei
Objectives: The 3D virtual image system
is prevailing at current modern surgeries.
With improvement in computational power
and advances in visual and haptic display
technologies, virtual surgical environments
can now offer potential benefits for surgical
training, planning, and rehearsal in a safe,
simulated setting. It is readily compensated
by provide depth perception and stereotactic
visualization to the operator. Neural tract
is invisible under the microscope except
visualized by virtual tractography by
computing methodology. Diffuse tensor
images (DTI) are the source to make the
tensor neural tract being able to see after
combination of current navigation system –
we named “Virtual Neuro-navigation”. Even
though the innovative development, the
surgeon still needs to overcome the learning
cascade.
Methods: Between 2015 and 2017, 120
patients were selected and underwent VR
Neuro-navigation Surgery (VRNAS). We
performed VRNAS by aids of virtual 3D
conversion simulator (SHINKO, Tokyo,
Japan) with head-mounted display (HMD,
SONY-HMZ, Tokyo, Japan) visualization.
The perioperative maneuverability (score
0-4) was compared to the other standard
surgeries purely by standard navigation
system with no VR assistance. The
operator’s discomfort (cybersickness) in
this adaptation to the new approach was
also analyzed. The flow of procedure and
complications were recorded at outpatient
follow-up.
Results: All patients experienced neurologic
improvement after the operations. 79
patients had no recurrence and hormonal
balance at serial follow-ups, 23 patients
underwent postoperative stereotactic
r a d i o s u rg e r y o n a c c o u n t o f r e s i d u a l
tumor. There was no catastrophic vascular
conflict and major complications (CSF
leaks, bacterial meningitis, stroke, etc.) in
our cohort. The mean operation time and
maneuverability were comparable with our
controlled group (p=0.01). With regard to
the wearing limitation, repeated training can
vanish the cybersickness and it is associated
with the individual tolerance.
Conclusion: The use of the VRNAS
integrated the VR and real-time navigation
technology showed the comparative benefit
in accuracy and patients’ outcome. We
believed there is great promising potential
to mature this novel technology to guarantee
the patient’s safety.
一份PRISMA系統性回顧和統合分析
探討經顱直流電刺激對慢性腦中風患
者上肢功能性恢復的影響
魏雅瑩 1、許耀宗 2、楊忠育 3
1, 2
高雄國軍總醫院醫療部復健科
3
美國紐約大學物理治療臨床博士班
A PRISMA Systematic Review and Meta-
Analysis of the Effects of Transcranial
Direct Current Stimulation on Upper
Extremity Functional Recovery in
Patients with Chronic Stroke
Ya-Ying Wei1, Ya-Ying Wei2, Chung-Yu Yang3
1, 2
Department of Physical Medicine and
223
 年會壁報論文
Rehabilitation, Kaohsiung Armed Forces
General Hospital, Kaohsiung City, Taiwan;
3
Doctor of Physical Therapy for Practicing
Physical Therapists, New York University, New
York City, USA
Background: In the chronic phase of stroke,
an imbalance of interhemispheric excitability
could hinder the motor recovery of the upper
extremity (UE). Transcranial direct current
stimulation (tDCS) is a promising treatment
that could promote the interhemispheric
balance and motor recovery by modulating
neuronal excitability in a polarity-specific
manner. However, there is a lack of current
systematic studies investigating UE
functional recovery after receiving the tDCS
intervention. Therefore, the primary purpose
of this study is to investigate the effects of
tDCS on UE functional recovery in chronic
stroke patients by a systematic review and
meta-analysis.
Methods: A comprehensive database
search of the literature up to June
2019 was performed via MEDLINE,
EMBASE, CINAHL, AMED, PubMed,
PEDro. keywords were: (1) stroke, (2)
cerebrovascular accident, (3) tDCS and
(4) upper/arm/hand. Randomized clinical
trials that included tDCS intervention for
improving UE function of chronic stroke
patients were located. The primary outcome
was clinical assessments of UE functional,
based on the activity categories of
International Classification of Functioning,
Disability and Health (ICF), which included:
(1) Action Research Arm Test (ARAT),
(2) Wolf motor function test (WMFT), (3)
Jebsen-Taylor Hand Function Test (JHFT),
(4) Motor assessment scale (MAS) and
Box and Block Test of Manual Dexterity
(BBT). Two review authors independently
assessed the risk of bias and trial quality
224
via using the Cochrane risk of bias tool and
the Physiotherapy Evidence Database scale
(PEDro) and then synthesized the study
results. The UE functional recovery of the
real-tDCS and sham-tDCS groups was
compared by calculating standardized mean
differences (Hedge’s g) to derive a summary
effect size.
Results: Thirteen studies (295 participants
with chronic stroke) were included. These
studies yielded a positive effect in favor of
UE functional recovery, and among these
studies, six studies showed that tDCS could
promote recovery of UE function over 40%
(106 chronic stroke patients). The percentage
of improvement is calculated thus: (post-
tDCS - pre-tDCS) /pre-tDCS scores*100%.
Ten of high-quality (PEDro >7) and low-
bias studies were included in the meta-
analysis. A random-effects model of meta-
analysis showed a significant overall effect:
Z = 2.66 (p = 0.008), heterogeneity: Tau² =
0.06; Chi² = 11.79, df = 9 (p = 0.23); I² =
24%. Summary Hedge’s g was statistically
significant in favor of the real-tDCS group
(Hedge’s g = 0.44, p = 0.008), which
suggested a moderate effect.
Conclusion: In conclusion, all tDCS studies
support the validity of the interhemispheric
balance theory. This meta-analysis study
reveals a superior UE functional recovery
on patients of chronic stroke in the real-
tDCS group compared to patients in the
sham group. As a result, the tDCS could
be a viable intervention for chronic stroke
patients because it is safe, cost-effective, and
clinically convenient to be combined with
other therapies.

機械取栓術後早期再發缺血性腦中風
的臨床探討
薛頌儒 1、陳志昊 1、林彥亨 2、蔡力凱 1、李崇
維 2、湯頌君 1、鄭建興 1
1
台大醫院神經部、 2台大醫院影像醫學部
Early Recurrent Stroke in Patients
Receiving Mechanical Thrombectomy
Sung-Ju Hsueh 1, Chih-Hao Chen 1, Yen-Heng
Lin2, Li-Kai Tsai1, Chung-Wei Lee2, Sung-Chun
Tang1, Jiann-Shing Jeng1
1
Department of Neurology, 2 Department of
Medical Imaging, National Taiwan University
Hospital, Taipei, Taiwan
Background: Mechanical thrombectomy
(MT) for acute ischemic stroke is a proven
technique effective in selective patients. This
study described the incidence and clinical
characteristics of early recurrent stroke
(ERS) in patients receiving MT from a
single center in Taiwan.
Methods: We retrospectively reviewed
patients who had acute ischemic stroke
and received MT from January 2015 to
September 2018 at one medical center. ERS
was defined as newly developed neurological
deficit localized a different vascular territory
and not caused by hemorrhage within the 21
days after the onset of index stroke. Good
functional outcome was defined as modified
Rankin Scale (mRS) ≤ 2 at 3 months after
stroke.
Results: During the period, 200 patients
(mean age 71.6 ± 12.3 years, male 49.0%)
received MT. Seventeen patients (mean age
65.0 ± 15.5 years, male 35.3%) developed
ERS (8.5%, 95% confidence interval 5.4%-
13.4%). The stroke etiologies of those with
ERS were cardioembolism in 10 (58.8%)
patients, active cancer with positive
disseminated intravascular coagulation
profiles in 4 patients (23.5%), catastrophic
年會壁報論文
antiphospholipid syndrome in 1 (5.9%)
patient, and large artery atherosclerosis
in 2 (11.8%) patients. Ten (58.8%) of
them received repeated MT, all achieving
successful revascularization and none
developed symptomatic hemorrhage.
The patients with and without ERS had
comparable good functional outcome (29.4%
versus 41.0%, p = 0.31).
Conclusion: ESR in stroke patients with
MT was not rare, and repeated MT could be
effective and feasible in subjects with ERS.
Rivaroxaban與apixaban於亞洲心房纖
維顫動族群之濃度分析
林欣儀 1, 2、郭錦樺 2、葉馨喬 3、蔡力凱 3、劉
言彬 4、黃織芬 1, 2、湯頌君 3、鄭建興 3
1
台大醫院藥劑部、 2台灣大學藥學專業學院藥
學系、 3台大醫院神經部、 4台大醫院內科部心
血管中心
Real World Rivaroxaban and Apixaban
Levels in Asian Patients with Atrial
Fibrillation
Shin-Yi Lin1, 2, Ching-Hua Kuo2, Shin-Joe Yeh3,
Li-Kai Tsai3, Yen-Bin Liu4, Chih-Fen Huang1, 2,
Sung-Chun Tang3, Jiann-Shing Jeng3
1
Department of Pharmacy, 3Stroke Center and
Department of Neurology, 4 Department of
Internal Medicine, National Taiwan University
Hospital, Taipei, Taiwan
2
School of Pharmacy, College of Medicine,
National Taiwan University, Taipei, Taiwan
Introduction: Although the therapeutic
index for non-vitamin K antagonist oral
anticoagulants (NOAC) is wide, measuring
NOAC level remains the most arbitrary
method for evaluating the pharmacologic
effect. The study aims to measure the plasma
225
 年會壁報論文
levels of rivaroxaban and apixaban among
Asian atrial fibrillation (AF) patients and
compare the results with expected drug
levels from clinical studies.
Methods: AF patients aged more than 20
years who took rivaroxaban or apixaban for
more than 7 days were enrolled. Peak and
trough levels were collected at 1–4 hours
after medication ingestion and right before
the next dose, respectively. Samples were
measured using ultra-high performance
liquid chromatography with tandem mass
spectrometry.
Results: A total of 178 patients were
enrolled, 73 who took rivaroxaban (15
mg daily, 34 patients; 10 mg daily, 39
patients) and 105 who took apixaban (5
mg twice daily, 44 patients; 2.5 mg twice
daily, 61 patients). Patients in the apixaban
group were more likely to be ordered an
inappropriately-adjusted dose compared
to those in the rivaroxaban group (37.5%
versus 22.5%, p = 0.046). The percentage of
those with drug levels within the expected
range reported in clinical studies was
significantly higher in the apixaban group
than in the rivaroxaban group, both for
trough (84.8% versus 64.4%, p = 0.002) and
peak level (76.9% versus 33.8%, p < 0.001).
After adjusting for age, sex, kidney function,
appropriate dose and adherence, patients in
the rivaroxaban group were still less likely
to have peak and trough levels within the
expected drug levels (odds ratio [OR] for
trough 0.279, 95% confidence interval [CI]
= 0.13–0.62, P = 0.002; for peak, OR = 0.172,
95% CI = 0.08–0.35, P < 0.001).
Conclusion: Our real world data suggests
that Asian patients taking rivaroxaban are
more likely to have out-of-expected drug
levels than those taking apixaban.
226
經顱直流電刺激對於腦中風倖存者的
影響：一份統合分析研究
魏雅瑩 1、許耀宗 2、陳麒方 3
1, 2
高雄國軍總醫院醫療部復健科
3
美國紐約大學物理治療臨床博士班
The Effect of Transcranial Direct
Current Stimulation on Activities of
Daily Living in Stroke Survivor: A
Systematic Review
Ya-Ying Wei1, Yao-Tsung Hsu2, Qi-Fang Chen3
1, 2
Department of Physical Medicine and
Rehabilitation, Kaohsiung Armed Forces
General Hospital, Kaohsiung, Taiwan;
3
Department of Physical Therapy, College of
Health Sciences, Kaohsiung Medical University,
Kaohsiung, Taiwan
Background: Changes in interhemispheric
activation balance after the occurrence
of a stroke have been postulated to
impede recovery of activities of daily
living (ADL) among stroke patients. As
a promising technique, transcranial direct
current stimulation (tDCS) has gained
much attention for its potential effects
regarding restoration of motor function and
ADL following cases of stroke. However,
individual studies have yielded inconsistent
or conflicting results. The current systematic
review investigates the effects of tDCS on
ADL in stroke patients.
Methods: Our literature search focused
on tDCS studies that have investigated
the effects on stroke patients’ ADL. An
initial search was carried out using the
databases MEDLINE, EMBASE, CINAHL,
AMED, PUBMED, PEDro, and airiti
library from May 2000 until June 2019.
Four keywords were used: (1) stroke, (2)
cerebrovascular accident, (3) tDCS, (4)
daily living. Meanwhile, search outcomes
were limited to full text of articles reviewed

that were either in the Chinese or English
language. Studies were selected if they met
the following inclusion criteria: (1) studies
on stroke patients, (2) multiple sessions
of tDCS intervention, (3) assessment of
the ADL before and after the intervention,
(4) placebo-controlled study-design. The
primary outcome measure for clinical
assessments of ADL includes: (1) Barthel
index, (2) Functional independence measure,
(3) Frenchay activities index, (4) Modified
Rankin scale, (5) Stroke specific quality
of life scale. Two reviewers independently
assessed the chosen body of works for bias
and quality using a validated, reliable tool,
the Cochrane Risk of Bias Tool and the
Physiotherapy Evidence Database scale
(PEDro) scale, respectively.
Results: There were 37 articles found via the
listed search databases. However, only six
works of research literature (which included
180 participants in total) were included
based on meeting our inclusion criteria for
review. Study subjects were of the mean age
of 55.8 (ranging from 47 to 62) years old.
Additionally, studies included cases with the
period from stroke onset to a range of from
4.9 weeks to 33.5 months. The PEDro scores
are from 8 to 11, and the bias was deemed of
low risk by the independent reviewers. These
studies show a positive effect in regard to
ADL recovery: subjects receiving tDCS (78
stroke patients) showed improvements in
ADL ranging between 1.9% and 81.3% from
baseline (with an average of 39.4%), while
those “receiving” the placebo-tDCS showed
improvements in ADL ranging between 0%
and 55.6% (on average 20.7%).
Conclusion: In conclusion, all tDCS studies
support the validity of the interhemispheric
balance theory. These studies show a
positive effect on ADL recovery for stroke
patients in the real-tDCS group far greater
年會壁報論文
than the effect on patients in the control
group. However, the results have been
differentiated regarding the passage of time
since stroke onset, which is known to be a
crucial parameter of the focal changes of
interhemispheric plasticity. The time of the
intervention after stroke onset likely has a
very significant impact on the efficacy of
tDCS intervention; however, these results
need to be confirmed by future clinical
studies.
血中NfL與GFAP可預測CADASIL之
疾病嚴重度及中風復發
陳志昊、湯頌君、鄭建興
台大醫院神經部暨腦中風中心
Blood Neurofilament Light-Chain and
Glial Fibrillary Acidic Protein Can
Reflect CADASIL Disease Severity
and Predict Recurrent Stroke
Chih-Hao Chen, Sung-Chun Tang, Jiann-Shing
Jeng
Stroke Center & Department of Neurology,
National Taiwan University Hospital, Taipei
Objective: To investigate whether plasma
biomarkers can reflect the disease severity
and predict stroke recurrence in patients
with CADASIL.
Methods: Sixty-three patients with
CADASIL (mean age 58.9±9.3 years old,
male 63%) and 17 controls were recruited.
Patients with CADASIL were divided into
those without stroke (n=16), with ischemic
stroke (IS, n=26) only, and ever intracerebral
hemorrhage (ICH, n=21) based on their
history upon recruitment. Plasma biomarkers
including neurofilament light chain (NfL),
glial fibrillary acidic protein (GFAP), tau,
and ubiquitin carboxy-terminal hydrolase L1
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 年會壁報論文
(UCHL1) were measured by ultra-sensitive
single molecule array. MRI markers included
Fazekas scale of white matter hyperintensity,
numbers of lacunes and cerebral microbleeds
(CMBs).
Results: The four serum biomarkers were
significantly elevated in patients with
CADASIL than control. Among patients
with CADASIL, those with ICH had highest
serum GFAP compared with no stroke or IS
groups. Higher NfL and GFAP correlated
with lower MMSE (s=-0.44 and -0.52,
respectively), higher Fazekas scale (s=0.26
and 0.50, respectively), and CMBs count
(s=0.38 and 0.42, respectively; all P<0.05).
Within a median follow-up of 3.1±2.1 years,
9 patients (14.3%) had at least one recurrent
stroke. A cox regression analysis showed
that higher NfL (HR=1.89, 95% CI=1.15–
3.82) or GFAP (HR=1.90, 95% CI=1.14–
3.16) at baseline were associated with stroke
recurrence.
Conclusions: Serum NfL and GFAP can
be promising biomarkers in reflecting
the disease burden and monitoring stroke
occurrence in patients with CADASIL.
顱血管超音波對於頸動脈-海綿竇廔管
的診斷陷阱：一病例報告
陳柏安 1、林暐婷 2
1
台北市立聯合醫院仁愛院區
2
台北馬偕紀念醫院
High Resistance Index in the Feeding
Arteries of Indirect Carotid-Cavernous
Fistula: A Diagnostic Pitfall
Bo-An Cheni1, Wei-Ting Lin2
1
Taipei City Hospital, Renai Branch, Taipei;
2
Mackay Memorial Hospital, Taipei
Carotid-cavernous fistulae (CCFs) are
228
classified into the direct and indirect
types, which can be attributed to trauma,
atherosclerosis, hypertension (HTN),
diabetes mellitus (DM), pregnancy or
postmenopausal status. Carotid Doppler
ultrasonography (CDU) typically reveals
increased blood flow velocity and decreased
resistance index (RI) in the feeding arteries,
which can assist in the diagnosis. We herein
report a case of indirect CCF presenting
with high RI in the feeding arteries, which
was mainly attributed to the generalized
atherosclerotic change, and was regarded as
diagnostic pitfall of CCF.
腦幹中風病患呈現內側蹄系症候群擬
似頸椎神經根病變：一病例報告
鍾紀培
信義醫療財團法人高雄基督教醫院
Medial Lemniscus Syndrome
Masquerading Cervical Radiculopathy
in a Brain Stem Stroke Patient: A Case
Report
Chi-Pei Chung
Department of Neurology, Lutheran Medical
Foundation Kaohsiung Christian Hospital,
Kaohsiung, Taiwan
Background and Purpose: Two main
somatosensory tracts exist: The medial
lemniscus responsible for light touch,
proprioception and vibration and the
spinothalamic tract responsible for sensing
pain and body temperature, disturbance of
deep and discriminative sensory perception.
Infarction of medial lemniscus could present
symptom mimic cervical radiculopathy.
Case Report: A 52-year-old man presented
with sudden onset of sensory disturbance
and numbness over right hand, forearm, arm

(ventral and dorsal parts). Initially, cervical
multiple radiculopathy was suspected,
then sensory disturbance migrating to right
flank and knee. His past history included
hypertension without regular control,
hyperlipidemia without control, and heavy
smoker. On neurological assessment and
examination, there was only paresthesia
and reduced perception of right upper
limb to light touch as well as vibratory
and proprioceptive stimuli over left C5678
dermatome, other neurological examination
were within normal limits including cranial
nerve ,motor systems and cerebellar systems.
Brain Magnetic resonance image showed
hypointensity lacune signal in tegmentum
part of left mid-pons level in T2. Lab data
also revealed hyperlipidemia as TG 661,
Cholesterol 301, LDL 144.
Conclusion: MRI confirmed an acute
infarction of a paramedian branch of the
basilar artery in the left medial lemniscus
in a patient presenting as mimic cervical
radiculopathy. Sensory projections from
the face, arm, and leg are somatotopically
arranged medially to laterally within the
medial lemniscus in the posterior column
pathway. It is possible that the infarction of
medial meniscus mimic polyneuropathy or
cervical or lumbar radiculopathy. Although
strokes classically present with numbness,
medial lemniscal infarcts can presents
as acute paresthesia as radicular sensory
symptoms without dermatome distributions.
急性缺血性腦中風取栓試驗之非劣性
臨界值之探討
林浚仁 1、 Jeffrey L. Saver2
1
臺北榮民總醫院神經內科
2
Comprehensive Stroke Center and Department
of Neurology, David Geffen School of Medicine,
年會壁報論文
University of California, Los Angeles, USA
Non-Inferiority Margins in Trials of
Thrombectomy Devices for Acute
Ischemic Stroke: Is the Bar Being Set
Too Low?
Chun-Jen Lin1, Jeffrey L. Saver2
1
Division of Cerebrovascular Diseases,
Neurological Institute, Taipei Veterans General
Hospital, Taiwan
2
Comprehensive Stroke Center and Department
of Neurology, David Geffen School of Medicine,
University of California, Los Angeles, USA
Background and Purpose: Novel
endovascular mechanical therapy (EVT)
devices for acute ischemic stroke (AIS) are
often cleared by regulatory agencies on the
basis of non-inferiority trials. The relation
between the non-inferiority margins used in
trials and the minimal clinically important
differences (MCIDs) determined by experts
has not been systematically investigated.
Methods: Systematic searches were
performed to identify: 1) all non-inferiority
design or non-inferiority-presented stroke-
EVT trials for AIS, 2) all studies determining
the MCIDs for the same outcomes, and 3)
all non-inferiority coronary revascularization
trials. Stroke-EVT trial results were re-
analyzed using the broad non-inferiority
margins originally employed and narrower
non-inferiority margins derived from formal
MCID studies.
Results: We identified 7 non-inferiority
designed or non-inferiority interpreted
stroke-EVT controlled trials, enrolling
1,766 patients, variously comparing coil
retrievers, 1st and 2nd generation stent
retrievers, and aspiration devices. In 6 trials,
the primary outcome was achievement of
reperfusion, using non-inferiority margins
of 15% (3 trials), 10% (2 trials), and 8%
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 年會壁報論文
(1 trial). In contrast, a stroke expert survey
identified the MCID for reperfusion as 3.1-
5%, and cardiac trials used non-inferiority
margins of 3.5-4.4%. In one stroke-EVT
trial, the primary outcome was functional
independence, employing a non-inferiority
margin of 15%. However, two stroke
expert survey studies identified MCIDs for
functional independence as having lower
values, 5% and 1-1.5%. For both reperfusion
and functional independence outcomes, all
7 trials demonstrated non-inferiority with
the broadest non-inferiority margin, but only
4 and 3 trials demonstrated non-inferiority
with actual expert-derived margins for
reperfusion and functional independence,
respectively.
Conclusion: Non-inferiority margins
employed in EVT device trials have
regularly exceeded the MCIDs determined
by stroke experts, as well as margins used
for cardiac devices. New approaches, such as
the use of reasonably adequate performance
margins, rather than non-inferiority margins,
are needed to optimize stroke-EVT trial
design integrity and trial performance
feasibility.
神經科和整合科聯合照護對於中風病
人的影響
林高章 1, 2、林慧娟 2、李瑞琦 1、許建清 3、楊
浚銘 2
1
奇美醫院全人醫療科、 2奇美醫院神經內科、
3
奇美醫院急診部
Impacts to Stroke Patients Under
Hospitalist and Neurologist Combined
Care Model
Kao-Chang Lin1, 2, Huey-Juan Lin2, Jei-Chi Li1,
Chien-Chin Hsu3, Chun-Ming Yang2
1
Department of Holistic Care, 2 Neurology,
230
3
Emergent Medicine, Chi-Mei Medical Center,
Tainan, Taiwan
Introduction: In 2012-18, we set a specific
care model (hospitalist care model-HCM)
with 8 medical sub-specialists at emergency
department(ED) to care all pre-hospitalized
patientswith 3 shifting-duty works within
24 hours. The mortality rate, waiting time,
6- and 24-hour deterioration after admission
were declined, and patient satisfaction was
higher over 90% by the collaboration with
ED physicians.
Purpose: To understand weather this HCM
improved the efficiency and efficacy of care
in stroke patients.
Methods: One qualified hospitalist,
certified by Taiwan Neurology Society,
participated in the care of stroke patients
referred by emergency physicians at ED for
admission since 2012, with a duty consultant
neurologist. Both hospitalist and neurologist
shared decisions making for copy strategy
and specific tests including lipid profile,
c a r o t i d D o p p l e r, a n d n e u r o i m a g i n g
study (exp., magnetic resonance image-
MRI),which were supposed to be performed
after hospitalization in most hospitals in
Taiwan. We compared several parameters
before and after setting this HCM to realize
the impacts to stroke patients the efficacy
and efficiency.
Results: Three time period was divided
before and after setting HCM (2010-
8~2012-7; 2012-8~2015-7; 2015-8~2018-
7) by excluding patients died at ED (n =
23), and direct admission without stopover
(n = 1149). Totally, 6299 were analyzed
for demographics. Sex (M : F = 1.5 : 1),
NIHSS at admission was 3 (1-7 of inter-
quartile range-IQR), length of stay at
wards 2 was 5 (3-9 of IQR), and modified
ranking scale at discharge was 2 (1-4 of

IQR) without statistically significant. The
over-waiting time (24~48 hours) in pre-
hospitalized period at ED declined, and the
complete necessary studies increased, both
was statistically significant (p < 0.05). The
increase rate of specific tests at ED saved
much time of delaying decision to perform
further procedures in next steps.
Conclusion: Our study, setting a new HCM
at ED, saved pre-hospitalized boarding time
especially on long waiting period over 24
hours for stroke patients. The efficiency of
Doppler study, lipid profile, and MRI was
earlier performed at ED by the collaboration
between hospitalist and neurologist to
make earlier decision for precise treatment
compared to not setting this model. Although
the mortality, disease severity, and length
of stay at wards of stroke patients did not
reduce in our analysis may due to variable
etiologies, the impacts to stroke patients for
fast diagnosis and better decision making in
treatment are mandatory importance.
動脈內血栓移除術後發生症狀性腦出
血之風險評估
傅傳修 1、陳志昊 1、林君賢 2、李孟 2、湯頌君
1
、鄭建興 1
1
台大醫院腦中風中心
2
嘉義長庚醫院神經內科
Risk-scoring Systems in Predicting
Symptomatic Intracranial
Hemorrhage after Endovascular
Thrombectomy
Chuan-Hsiu Fu1, Chih-Hao Chen1, Chun-Hsien
Lin2, Meng Lee2, Sung-Chun Tang1, Jiann-Shing
Jeng1
1
Stroke Center and Department of Neurology,
National Taiwan University Hospital, Taipei,
Taiwan
年會壁報論文
2
Department of Neurology, Chiayi Chang Gung
Memorial Hospital, Chiayi, Taiwan
Background: Several risk score models
were developed to predict symptomatic
intracranial hemorrhage (SICH) after
intravenous thrombolysis, while the
risk models for predicting SICH after
endovascular thrombectomy (EVT) were
limited. The study aimed to use previously
established risk scores for intravenous
thrombolysis to predict SICH after EVT.
Methods: Patients with anterior circulation
large vessel occlusion who received EVT
in two medical centers were recruited.
Two definition of SICH, the European
Collaborative Acute Stroke Study II
(ECASS II) and the Safe Implementation
of Thrombolysis in Stroke-Monitoring
Study (SITS-MOST), were used.
Previously developed risk scores including
the Hemorrhage After Thrombolysis
(HAT) score, the Safe Implementation
of Thrombolysis in stroke (SITS) SICH
risk score, and the SEDAN score, were
calculated. Logistic regression and area
under a receiver operating characteristic
curve (AUC-ROC) were used to evaluate the
effectiveness and performance of each risk
model.
Results: A total of 243 patients (mean
age 71.8 ± 12.6 years; men: 47.4%) were
included in this study. The observed rate of
SICH by ECASS II definition was 11.5% (28
cases), which was higher than the predicted
rates by the HAT score (10.5%) and SITS-
SICH risk score (6.5%), while lower than
predicted rate by the SEDAN score (11.6%).
The observed rates of SICH by SITS-MOST
definition was 4.9%, which was higher
than the predicted rates by the SITS-SICH
risk score (2.3%). The SEDAN score was a
significant predictor for SICH by ECASSII
231
 年會壁報論文
and SITS-MOST definitions (OR = 1.54 and
1.96 per score increase, respectively; both P
< 0.05), while the HAT score only predicted
SICH by ECASSII definition (OR = 1.45,
P = 0.04) and the SITS-SICH risk score
by SITS-MOST definition (OR = 1.37, P
= 0.05). The AUC-ROC was highest when
using the SEDAN score to predict SICH by
SITS-MOST definition (0.71, 95% CI 0.56-
0.86). In multivariate logistic regression
analysis, atrial fibrillation, procedure time
and presence of CT hypodensity were
independent risk factors for SICH after
EVT by ECASSII definition, while age,
serum glucose level and presence of CT
hypodensity predicted SICH by SITS-MOST
definition.
Conclusion: The SICH after EVT in our
study occurred at a rate of 11.5% and 4.9%
by ECASSII and SITS-MOST definition.
The SEDAN score could be a practical tool
to predict SICH after EVT.
台美中風登錄中施打血栓溶解劑病患
之比較
陳志昊 1、陳玉菁 2、鄭建興 1、許重義 3、范揚
政4
1
台大醫院神經部
2
亞洲大學生物資訊與醫學工程學系
3
中國醫藥大學臨床醫學研究所
4
美國國家衛生院
Comparison of Intravenous Thrombolysis
Treated Patients Between Stroke Registry
in Taiwan and the United States
Chih-Hao Chen1, Yu-Ching Chen2, Jiann-Shing
Jeng1, Chung Y. Hsu3, Yang C. Fann4
1
Department of Neurology, National Taiwan
University Hospital, Taipei, Taiwan
2
Department of Bioinformatics and Medical
Engineering, Asia University, Taichung, Taiwan
232
3
Graduate Institute of Clinical Medical Science,
China Medical University, Taichung, Taiwan
4
National Institute of Neurological Disorders
and Stroke, National Institutes of Health, USA
Introduction: Registry-based stroke research
has provided real-world evidence on the
performance and quality of clinical care
among different regions in the world.
We aimed to compare the outcome of
intravenous thrombolysis treated patients
from two stroke registries in Taiwan and the
United States.
Methods: There were 122,191 stroke cases
from Taiwan Stroke Registry (TSR) and
10,981 from National Institute of Health-
funded SPOTRIAS network. Among them,
we analyzed 3302 patients in TSR and 3002
in SPOTRIAS treated with intravenous
thrombolysis with available clinical
information.
Results: The mean age of patients (68.2±12.5
vs 67.8±12.5 years) and initial NIHSS score
(13.0±7.3 vs 13.0±7.5) were comparable
between the two registries, while the
prevalence vascular risk factors were higher
in TSR. The door-to-needle time was
significantly faster in the TSR (median 55
min, IQR 42 to 77) than SPOTRIAS (65 min,
IQR 45 to 90; P < 0.001). The proportion of
patients with favorable outcome (modified
Rankin scale 0 and 1) at discharge were
higher in TSR than SPOTRIAS (29.7% vs
22.5%, P < 0.001). Combining age, NIHSS,
door-to-needle time can have good accuracy
in predicting favorable outcome in TSR (area
under the curve [AUC] 0.72), SPOTRIAS
(AUC 0.79) and overall patients (AUC 0.74).
Conclusion: We found certain degree of
differences in clinical features and practice
of intravenous thrombolysis between Taiwan
and the United States, while the predictors for
clinical outcome were universally similar.

散在性偏癱偏頭痛之發作期與不發作
期的正子斷層造影比較
林柏佐 1、彭徐鈞 2、尤香玉 1
1
台北榮民總醫院神經內科
2
台北醫學大學
Ictal-Interical Comparison of FDG-
PET Findings in Sporadic Hemiplegic
Migraine
Po-Tso Lin1, Syu-Jyun Peng2, Hsiang-Yu Yu1
1
Department of Neurology, Neurological
Institute, Taipei Veterans General Hospital,
Taipei, Taiwan
2
Professional Master Program in Artificial
Intelligence in Medicine, Taipei Medical
University, Taipei, Taiwan
Background: Sporadic hemiplegic migraine
(SHM) is regarded as prolonged motor aura
when migraine attack and its underlying
pathophysiology remained unclear. It is
among one kind of stroke mimics.
Case report: We report an 18-fluorodeoxyglucose
positron emission tomography (FDG-PET)
finding in a 15-year-old female of sporadic
hemiplegic migraine. She presented with
recurrent right distal arm weakness twice
a week that each time lasted for around 3
hours to 3 days. The hemiplegic migraine
attack started with right limb weakness
followed by right upper limb pain and
shoulder pain. Throbbing headache at
right temporal region soon evolved. It was
moderate to severe in intensity, aggravated
by physical activity and was accompanied
by nausea, vomiting, photophobia and
phonophobia. The headache disappeared
before weakness recovered. It was regarded
as transient ischemic attack or epilepsy first.
Brain magnetic resonance imaging (MRI)
was normal and without evidence of acute
infarction. Video electroencephalogram
showed no evidence of epilepsy in nature
年會壁報論文
during the events. As a result, according to
the criteria of the International Classification
of Headache Disorder III (ICHD-
III), sporadic hemiplegic migraine was
diagnosed. We further did brain subtraction
of ictal-interictal FDG-PET co-registered to
MRI for image analysis to demonstrate its
underlying pathophysiology. Activation level
threshold was set to 1.5 standard deviations.
In comparison with interictal state, the FDG-
PET image showed decreased brain glucose
metabolism in the bilateral dorsal lateral
frontal cortices and the bilateral occipital
cortices, whereas increased metabolism was
observed in the left precentral motor cortex
and right premotor cortex.
Conclusion: These findings reveal an
increase in metabolism in the contralateral
motor and ipsilateral premotor cortex during
general cortical dysfunction in the frontal
and occipital cortex in SHM.
年輕男性合併法布瑞氏症、高胱胺酸
血症及葉酸缺乏發生反覆中風：一案
例報告
林伯昱、林典佑
成大醫院神經部
Recurrent Ischemic Stroke in A Young
Male with Concurrent Fabry Disease,
Hyperhomocysteinemia and Folic Acid
Deficiency: A Case Report
Po-Yu Lin, Tien-Yu Lin
Department of Neurology, National Cheng Kung
University Hospital, Tainan, Taiwan
Background: Fabry disease is a
risk factor of ischemic stroke, as are
hyperhomocysteinemia and folic acid
deficiency. Here we reported a case
of recurrent ischemic stroke who had
233
 年會壁報論文
concurrent Fabry disease, elevated serum
homocysteine and folic acid deficiency.
Case Report: A 44-year-old male patient
had history of ischemic stroke in brainstem
years ago. He presented with acute onset
occipital headache, blurred vision and
transient vertigo. Acute ischemic stroke
in bilateral occipital lobes was diagnosed
through brain MRI. Stroke risk factor survey
revealed hypertension, tobacco use, Fabry
disease (GLA gene mutation, c.658C>T),
high serum homocysteine (19.41 μmol/L),
and low serum folic acid (3.2 ng/mL). The
underlying pathophysiology of cerebral
vascular involvement in Fabry disease is not
yet fully understood. In previous reports,
serum homocysteine was higher in patients
with Fabry disease comparing to normal
control. Serum folic acid was also found to
be decreased in patients with Fabry disease.
Conclusion: We reported this case to
highlight the possible correlation between
Fabry disease, hyperhomocysteinemia and
folic acid deficiency, and emphasis the
proactivity in searching these modifiable risk
factor in patient with ischemic stroke.
靜脈血栓溶解劑使用於一位急性缺血
性中風合併剝離性主動動脈瘤之病人
謝鎮陽
台南新樓醫院神經科
Intravenous Thrombolysis in a Patient
with Acute Ischemic Stroke and
Dissecting Aortic Aneurysm
Cheng-Yang Hsieh
Department of Neurology, Tainan Sin Lau
Hospital, Tainan, Taiwan
Background and purpose: Aneurysm is a
contraindicated condition for intravenous
234
thrombolysis, because of the high potentials
of massive bleeding. We present a case of
dissecting aneurysm presenting with acute
ischemic stroke and receiving intravenous
thrombolysis.
Case Report: An 86-year-old hypertensive
man presented to our emergency room due
to acute left hemiparesis for 2 hours. The
initial National Institutes of Health Stroke
Scale (NIHSS) score was 5, and non-
contrast computed tomography (CT) of brain
did not show intracerebral hemorrhage.
However, routine chest x-ray showed a
suspicious aortic aneurysm. After a thorough
discussion with the patient and his family
about the benefit and risk of thrombolysis,
intravenous alteplase was still administered.
After 24 hours, his NIHSS score improved
to 2. Magnetic resonance images of brain
showed acute infarct at right pre-central
gyrus without hemorrhagic transformation.
Contrast CT of chest showed a thrombosed
dissecting aneurysm at the aortic arch
without evidences of bleeding. He was
discharged to post-acute ward about 1 week
after stroke onset. At 1 month, the functional
status was almost back to his baseline.
Conclusion: Despite the high risk of bleeding,
intravenous thrombolysis was effective
and without bleeding complications in this
elderly stroke patients with dissecting aortic
aneurysm. Further study may be warranted
to determine the safety and efficacy of
intravenous thrombolysis in such patients.
急性缺血中風動脈內血栓移除術後之
顯影劑腦病變
朱永載 1、陳志昊 1、李崇維 2、蔡力凱 1、湯頌
君 1、鄭建興 1
1
台大醫院神經部暨腦中風中心、 2影像醫學部

Contrast-Induced Encephalopathy
after Endovascular Thrombectomy for
Acute Ischemic Stroke
Yung-Tsai Chu1, Chih-Hao Chen1, Chung-Wei
Lee 2, Li-Kai Tsai 1, Sung-Chun Tang 1, Jiann-
Shing Jeng1
1
Department of Neurology and Stroke Center,
2
Department of Radiology, National Taiwan
University Hospital, Taipei, Taiwan
Background: Contrast-induced encephalopathy
(CIE) is a rare complication of endovascular
thrombectomy (EVT). This study aimed to
investigate the incidence and risk factors of
CIE in patients undergoing EVT for acute
ischemic strokes (AIS).
Methods: Patients who experienced AIS
and received endovascular thrombectomy
during the period of September 2014 to
August 2019 at National Taiwan University
Hospital were included. Contrast leakage
(CL) was defined as the presence of contrast
medium after EVT on follow-up computed
tomography (CT) within 24 hours. CIE was
defined clinico-radiologically. Clinically,
the patients experienced neurological
deterioration which cannot be explained by
the infarct or hemorrhagic transformation.
Radiologically, the image showed CL plus
edematous changes possibly extending
beyond the infarct core. The incidence and
possible risk factors of CL and CIE were
analyzed.
Results: Of 270 patients who received EVT,
four (1.5%) patients developed CIE and
additional seven patients (2.6%) had CL on
follow-up images after ET. The manifestation
of CIE included seizures, altered mental
status and prolonged neurological recovery.
The risk factors of CIE were prior history
of stroke, renal dysfunction, heart diseases
and posterior circulation strokes. One index
patient was a 61-year-old man with history
年會壁報論文
of old right middle cerebral artery (MCA)
infarct attributed to infective endocarditis,
who developed sudden onset of aphasia.
Perfusion CT showed left MCA posterior
M2 territory infarct, and he underwent ET
with successful recanalization (TICI 3).
However, he was semi-comatose after the
procedure and later developed generalized
tonic-clonic seizure. Emergent CT showed
diffuse swelling of the whole left hemisphere
with CL. Magnetic resonance imaging
(MRI) on the next day showed infarct core
only in posterior M2 territory with gyral T2
hyperintensity in the left hemisphere. He
gradually regained his consciousness and CT
after one week revealed total resolution of
cerebral edema.
Conclusion: This study described the
incidence and risk factors of CIE after EVT.
CIE should be suspected in patients with
clinical worsening and evident CL after
EVT.
腦靜脈栓塞併出血性中風之凝血酶原基
因新突變F2 p.F382L案例報告
林詠萱 1、張力鑫 2、鍾芷萍 1, 3、李怡慧 1, 2
1
台北榮民總醫院神經內科
2
國立陽明大學腦科學研究所
3
國立陽明大學醫學系
Hemorrhagic Stroke and Cerebral
Venous Thrombosis with a Novel
Prothrombin Gene Variant F2 p.F382L
Yung-Shuan Lin1, Li-Hsin Chang2, Chih-Ping
Chung1, 3, I-Hui Lee1, 2
1
Department of Neurology, Neurological
Institute, Taipei Veterans General Hospital,
Taipei, Taiwan
2
Institute of Brain Science, Brain Research
Center, National Yang-Ming University, Taipei,
Taiwan
235
 年會壁報論文
3
Faculty of Medicine, National Yang-Ming
University School of Medicine, Taipei, Taiwan
Acute intracranial hemorrhage with cerebral
venous thrombosis (CVT) is sometimes
under-diagnosed and life-threatening, which
presents with a wide spectrum of clinical
symptoms. We present a young 21-year-
old woman having hereditary hemorrhagic
stroke and CVT with a novel prothrombin
F2 gene variant. She presented with febrile
episode followed by a week of posterior
headache, blurred vision and increased
somnolence. She rapidly developed
clustered generalized tonic-clonic seizures
and became comatose, and was intubated
for airway protection. The neurological
examination showed skew eye deviation,
flaccid four limbs, generalized hyperreflexia
and presence of bilateral Babinski sign. Her
brain magnetic resonance imaging revealed
acute intracranial hemorrhage in bilateral
frontal and parietal lobe with superior
sagittal sinus thrombosis and marked
vasogenic edema, which led to midline
shifting and impending uncal herniation.
She was given subcutaneous low molecular
weight heparin with bridging to Warfarin.
The patient recovered well and walked
without aids on day 30 (modified Rankin
Scale of 3) and functionally normalized at 6
months. There was a strong family history
of venous thromboembolism. Her mother
had four episodes of deep vein thrombosis
and her maternal uncle died of extensive
pulmonary embolism in his twenties. The
laboratory tests disclosed abnormally
low circulating coagulation factor II
(prothrombin). Whole exome sequencing
revealed a novel F2 p.F382L (c.C1146A)
variant, which was highly evolutionary
conserved and possibly pathogenic
by in silico prediction tools. This case
236
demonstrates a familial young hemorrhagic
stroke with CVT and thrombophilia. Early
identification of the underlying etiology and
timely anticoagulation therapy are important
for preventing neurological deterioration and
good functional recovery.
經肱動脈進行缺血性腦中風動脈血取
移除術：病例系列報告
朱海瑞 1、林彥亨 2、湯頌君 1、李崇維 2
1
台大醫院神經部暨腦中風中心、 2影像醫學部
A C a s e S e r i e s o f Tr a n s b r a c h i a l
Artery Approach for Endovascular
Thrombectomy in Acute Ischemic Stroke
Hai-Jui Chu1, Yen-Heng Lin2, Sung-Chun Tang1,
Chung-Wei Lee2
1
Department of Neurology and Stroke Center,
2
Department of Medical Imaging, National
Taiwan University Hospital, Taipei, Taiwan
Background and Purpose: Endovascular
thrombectomy (EVT) has become the
standard of care for selected patients
with acute ischemic stroke. Although the
transfemoral arterial approach (TFA) has
been the conventional approach for EVT,
transbrachial artery approach (TBA) could
be alternative, but rarely described before.
In this study, we reported a case series of
stroke patients receiving EVT via TBA and
compared their clinical parameters with
those via TFA.
Methods: The prospective registry for
patients who received EVT for acute
i s c h e m i c s t r o k e a t N a t i o n a l Ta i w a n
University Hospital between September
2014 and September 2019 were reviewed.
The demographic features, reasons for TBA,
techniques used and outcomes including
modified Rankin Scale at 90 days were

collected.
Results: Seventeen patients (mean age: 79.4
± 9.3 years; men: 47.1%) out of 284 (5.9%)
underwent suction-based thrombectomy
via TBA. The median (IQR) NIHSS were
18(14-22). Thirteen (76.5%) patients were
through right TBA including 8 (7.1%)
right anterior circulation, 3 (17.6%) left
anterior circulation and 2 (11.8%) posterior
circulation. Four (23.5%) patients received
left TBA, 2 (11.8%) for posterior circulation,
and 2 (11.8%) for left anterior circulation
after aortic arch surgery with left subclavian-
carotid bypasses. Twelve (70.6%) patients
received primary TBA while the others
received TBA following failed TFA. The
major reasons for TBA were unfavorable
aortic arch anatomy for TFA and vessel
tortuosity. Successful recanalization (mTICI
2b-3) were achieved in 13(76.5%) with
a median puncture to recanalization time
as 15(11-21) min in primary TBA and
50(39-166) min in switching from TFA.
One had pseudoaneurysm formation by
manual compression and the other one had
brachial artery occlusion by closure device
at puncture sites. Comparing to those with
TFA, patients with TBA were older, more
prior stroke and less intravenous rt-PA
use. The rates of successful recanalization,
symptomatic hemorrhage and mortality
were similar but the percentage of functional
independence was significantly lower in
patients via TBA comparing to those via
TFA.
Conclusion: TBA could be an alternative
route for EVT with good recanalization and
acceptable complication rates, especially for
those with failure of EVT via TFA.
年會壁報論文
使用氟-18胸腺嘧啶核苷偵測缺血性腦
中風後之內生性神經幹細胞
蔡欣熹 1、蔡力凱 2
1
台大醫院北護分院神經科
2
台大醫院神經部暨腦中風中心
Detecting Endogenous Neurogenesis
after Ischemic Stroke: F-18-
fluorothymidine PET Study
Hsin-Hsi Tsai1, Li-Kai Tsai2
1
Neurology Department, National Taiwan
University Hospital Beihu Branch, Taipei,
Taiwan
2
Neurology Department, National Taiwan
University Hospital, Taipei, Taiwan
Background and Purpose: Adult neural
stem cells (NSCs) can be activated after
stroke, but currently noninvasive imaging
technique to visualize cerebral neurogenesis
is lacking. F-18-fluorothymidine (FLT) has
been used as a PET tracer to image cell
proliferation and could detect endogenous
NSCs in vivo. In this study, we assessed the
change in cerebral FLT uptake in a rat model
of ischemic stroke.
Methods: Cerebral FLT PET was performed
in rats subjected to transient middle
cerebral artery occlusion (MCAO). PET
data were semiquantitatively analyzed and
expressed as average mean standardized
uptake value ratios (SUVRs) of regions
of interest using cerebellar cortex as the
reference region. Neurological function
was assessed via modified Neurological
Severity Score (mNSS) 1 day after MCAO,
and infarct volume was analyzed by
2,3,5-Triphenyltetrazolium chloride staining
method 7 days after MCAO.
Results: Seven days after MCAO, rats
exhibited a higher number of Ki67
immunoreactive cells at the subventricular
zone, striatum, frontal and temporal
237
 年會壁報論文
cortices in the infarcted brain, indicating
promotion of neurogenesis. The FLT PET
showed higher SUVR in the infarcted brain
compared to the unaffected side (Striatum:
1.03 ± 0.36 vs 0.74 ± 0.16, p = 0.001;
Frontal: 1.14 ± 0.27 vs 0.96 ± 0.13, p =
0.004; Temporal: 1.16 ± 0.26 vs 1.00 ± 0.15,
p = 0.01). The cerebral FLT binding activity
gradually declined from post MCAO day
7 to day 28 in the infarcted brain. The FLT
binding ratio (global SUVR in the infarcted
brain divided by that in the contralateral
side) was positively correlated to the
severity of stroke, including mNSS (r = 0.70,
p < 0.001) and infarct volume (r = 0.90, p <
0.001).
Conclusion: In vivo FLT PET can detect
NSCs in a rat model of ischemic stroke. The
promising results of FLT PET suggest that it
can be potentially applied in clinical studies
as noninvasive longitudinal monitoring and
quantification of endogenous NSC activation
in the human brain.
Pioglitazone與PPAR-γ調控治療在糖
尿病併缺血性中風患者的長期療效
劉濟弘
林口長庚醫院神經內科暨腦中風中心
Pioglitazone and PPAR-γ Modulating
Treatment in Type 2 Diabetic Patients
after Ischemic Stroke: a national
cohort study
Chi-Hung Liu
Stroke Center and Department of Neurology,
Linkou Chang Gung Memorial Hospital,
Taoyuan, Taiwan
Background and purpose: Peroxisome
proliferator-activated receptor-γ
(PPAR-γ) modulating treatment may have
238
cardiovascular benefits in type 2 diabetic
(T2DM) patients after ischemic stroke
(IS). However, whether there are additional
benefits from intensive PPAR-γ modulating
treatments in Asian patients with T2DM
after IS remains unknown.
Methods: Between 2001 and 2013, patients
admitted due to IS were identified from
the National Health Insurance Research
Database of Taiwan. Patients with T2DM
and hypertension using angiotensin receptor
blockers were further included. Eligible
patients were divided into 2 groups: (1)
pioglitazone and (2) non-pioglitazone oral
antidiabetic agents groups. Propensity
score matching (1 : 2) was used to balance
the distribution of baseline characteristics,
stroke severity and medications. The primary
outcome was recurrent IS. Subgroup analysis
for recurrent IS in pioglitazone and/or
telmisartan users, the trend of IS risks across
different PPAR-γ intensity treatments, and
dose-dependent outcomes across different
pioglitazone possession ratios were further
studied. Statistical significance was set at
p < 0.05 and p < 0.1 for clinical outcomes
and interaction of subgroup analyses,
respectively.
Results: Patients of the pioglitazone
group had a lower risk of recurrent IS
(subdistribution hazard ratio, 0.91; 95%
confidence interval, 0.84-0.99). Pioglitazone
was also associated with reduced recurrent
IS in patients who also used telmisartan (p
for interaction = 0.071). A graded correlation
was found a borderline significant trend
between the intensity of PPAR-γ therapy
and following IS (p = 0.076). The dose-
dependent outcome also showed a borderline
significant trend that higher pioglitazone
possession ratio was associated with a lower
risk of recurrent IS (p = 0.068).
Conclusions: This study suggests that

pioglitazone use in diabetic IS patients is
associated with fewer recurrent IS events in
Asian population. Patients with concurrent
telmisartan use or a higher pioglitazone
possession ratio may have a trend of
increased pleiotropic effects due to the
higher PPAR-γ modulating effect.
雙線與單線抗血小板藥物在嚴重大血
管粥狀硬化所致之缺血性中風二級預
防之長期結果比較與分析：回溯性研
究
曾子芸 1、李怡慧 1, 2、林浚仁 1, 3
1
台北榮總神經內科
2
國立陽明大學腦科學研究所
3
國立陽明大學醫學系
Long-Term Outcomes of Dual Versus
Single Antiplatelet Therapy For
Secondary Stroke Prevention in
Patients with Severe Large Artery
Atherosclerosis: A Retrospective Study
Tzu-Yun Tseng1, I-Hui Lee1, 2, Chun-Jen Lin1, 3
1
Department of Neurology, Neurological
Institute, Taipei Veterans General Hospital,
Taipei, Taiwan
2
Institute of Brain Science, Brain Research
Center, National Yang-Ming University, Taipei,
Taiwan
3
School of Medicine, National Yang-Ming
University, Taipei, Taiwan
Background and Purpose: Dual antiplatelet
therapy (DAPT), such as aspirin plus
clopidogrel, for months is generally a
cornerstone of the medical therapy for
patients with symptomatic ≥50% large
artery atherosclerosis. A recent study
showed that long-term (>12 months) use of
aspirin plus cilostazol significantly reduced
年會壁報論文
stroke recurrence without increasing major
bleeding in patients with ≥50% stenosis of
intra- or extracranial large arteries. However,
it has been challenging to determine a
benefit-harm balance of long-term DAPT for
stroke patients with severe cervico-cerebral
large artery stenosis. The purpose of this
study was to compare the clinical outcomes
of DAPT or mono antiplatelet therapy (MT)
in our ischemic stroke patients with cervico-
cerebral large artery atherosclerosis.
Methods: We conducted a preliminary
retrospective study for ischemic stroke
patients with cervico-cerebral large artery
≥50% stenosis based on the Stroke Registry
a t Ta i p e i Ve t e r a n s G e n e r a l H o s p i t a l
between January 1, 2017 and April 30,
2017. We analyzed vascular risk factors
(including hypertension, diabetes mellitus,
hyperlipidemia, coronary artery disease
and smoking), anti-thrombotic regimens
and clinical outcomes. Patients using any
combination of 2 antiplatelet agents for ≥ 3
months were defined as the DAPT group.
Those treated with single antiplatelet or
DAPT for less than 3 months were defined as
the MT group. The outcome measurements
included functional independence (modified
Rankin Scale, mRS 0-2) at 3 months and
1 year after stroke, recurrent ischemic
stroke, hemorrhagic stroke and major
gastrointestinal (GI) bleeding.
Results: During the study period, 106 out
of 381 ischemic stroke patients (27.8%)
fulfilled our criteria. 57 (53.8%) were in
the MT group and 32 (30.2%) were in the
DAPT group, 17 (16%) were no treatment
or using only anti-coagulants. The basic
characteristics including vascular risk
factors did not differ between groups.
There was no significant difference in the
proportion of functional independence at
3-month and 1-year follow-up (p = 0.084
239
 年會壁報論文
and p = 0.471, respectively). The 1-year
risk of recurrent ischemic stroke was 6.5%
in the MT group and 7.1% in the DAPT
group (p = 0.464), and the risk of major GI
bleeding was 10.9% in the MT group and
3.6% in the DAPT group (p = 0.399). There
was no hemorrhagic stroke during the 1-year
follow-up in both groups.
Conclusions: In this preliminary retrospective
study, there was no significant difference
in the functional outcomes at 3 months and
1 year, nor in recurrent ischemic stroke
between two groups. Interestingly, there was
no significant difference in adverse effects
of hemorrhagic stroke and GI bleeding
either. Further analysis with a larger sample
size and a longer follow-up is undergoing.
A randomized controlled trial to validate
the optimal antithrombotic regimens in
ischemic stroke patients with large artery
atherosclerosis is warranted.
新竹地區區域醫院治療腦部大血管阻
塞病患的困境
蔡坤璋
台大醫院新竹分院神經部
The Trouble of Treating Patients with
Large Vessel Occlusion at Regional
Hospital in Hsinchu
Kun-Chang Tsai
Department of Neurology, National Taiwan
University Hospital Hsin-chu Branch, Hsinchu,
Taiwan
Background: Acute ischemic stroke (AIS)
with large vessel occlusion (LVO) is
critical. In regional hospitals, endovascular
thrombectomy (EVT) is not always available
with limitation in advanced neuroimage
study and resources of manpower, most
240
patients with LVO are transferred to primary
stroke center. We reported the results in
transferred/non-transferred patients with
LVO in Hsinchu regional hospital.
Method: The AIS patients within 3~4.5
hours were given intravenous thrombolysis
in the emergency room setting under the
qualified neurologist’s evaluation. The
advanced image study is CTA and CTP. If
the LVO is suspected, the transfer-protocol
would be initiated , either radiographer for
CTA and CTP or no neuro-interventionist
is in the hospital. The patients were mostly
transferred to primary stroke center which
located in 80km far from our hospital. The
interventionist in our hospital includes
cardiologist, neurosurgeon, neurologist.
Results: Since 2016~2019/08, 36 LVO-
patients were suspected. 14 LVO-patients
were transferred to primary stroke center
without confirmation of CTA. 9 of 14
patients (64%) were definite LVO after
CTA. 4 of 9 patients (44%) underwent
EVT. 22 LVO-patients underwent CTA in
our hospital, and 18 patients (81%) were
confirmed LVO. 5 of 18 patients were
transferred to primary stroke center for
EVT because lack of interventionists. 1 of 5
patients underwent EVT after transfer. 6 of
13 patients underwent EVT in our hospital.
Conclusion: Time is brain. The median time
of door to groin puncture was longer among
transferred patients than not transferred
patients (228 minutes vs 205 minutes). The
futile inter-hospital transfer rate for EVT
was 56%. The positive predictive rate of
LVO was lower among transferred patients
than non-transferred patients (64% vs 81%)
The distance between regional hospitals in
Hsinchu and primary stroke centers is more
far than other counties in Taiwan. Therefore
the time-saving for inter-hospital transfer
is very limited. The full-time coverage of

interventionist for EVT is a major solution
for these LVO patients.
影像學小血管病變或海馬迴萎縮對第
一次缺血性中風病患中風後一年之認
知曲線之影響
李剛伯、林伯昱、蘇慧真、陳志弘、宋碧姍
成大醫院神經部
The Impact of Small Vessel Disease
Burden and Hippocampal Atrophy on
Cognitive Trajectory over One Year
in Patients with First-Ever Ischemic
Stroke
Kang-Po Lee, Po-Yu Lin, Hui-Chen Su, Chih-
Hung Chen, Pi-Shan Sung
Department of Neurology, National Cheng-Kung
University Hospital, Tainan, Taiwan
Background: The aim of this study is
to investigate the impact of small-vessel
disease burden and hippocampal atrophy
on post-stroke cognitive trajectory over one
year after first-ever ischemic stroke.
Methods: This is a prospective cohort study
with serial monitoring of cognitive function
for 3 times over 1-year period after first-
ever ischemic stroke. The time to monitor
cognitive function included acute phase
(4-7 days post stroke), subacute (3 months
post stroke) and chronic state (1 year post
stroke). We enrolled patients with first-
ever ischemic stroke admitted to our stroke
ward from 2015/02 to 2018/01. The enrolled
criteria included normal consciousness
level without delirium, subjective memory
impairment or language disturbance as the
chief complaints of index stroke. Cognitive
function was assessed by Montreal
Cognitive Assessment (MoCA). Brain MRI
were performed in acute phase to determine
年會壁報論文
the stroke lesion and the baseline brain
condition. Small-vessel disease burden was
decided by modified cerebral small vessel
disease burden (mCSVD) and the degree
of hippocampal atrophy was evaluated by
mesial temporal atrophy score (mTA). Both
scales were evaluated by the committee of
3 independent readers blinded to cognitive
results and the final scores of the mCSVD
and mTA was given to each patient after
decision-making committee. The serial data
of cognitive results were analyzed using
group-based trajectory model and the impact
of vascular burden and hippocampal atrophy
was analyzed by multiple logistic regression.
Results: A total of 132 patients were
enrolled and we analyzed the data from 112
patients who completed cognitive monitoring
for at least 2 times. Mean age was 64.9 ±
10.2 years. The median values of education
level was 9 (IQR:6-12) years. The median
of NIHSS at admission was 3 (IQR1.5-5)
points. The post-stroke cognitive trajectory
was grouped into low/intermediate/high
(group I/II/III) cognitive performance by
trajectory modelling. Both improvement in
post-stroke cognitive function was noted
over 1-year period in the intermediate and
high cognitive performance group, but not
noted in the low cognitive performance
group. Higher dementia occurrence rate
was found during follow-up in the low
performance group. The baseline vascular
burden, instead of hippocampal atrophy, was
independently associated with higher risk
of low cognitive performance group after
stroke (mCVSD: adjusted OR 2.74 (95% CI
1.09-6.86) p = 0.032; mTA: adjusted OR 1.53
(95% CI 0.56-4.21) p = 0.405), but the risk
was even higher in those patients combined
with concomitant high vascular burden and
hippocampal atrophy (Adjusted OR 6.29
(95% CI1.90-20.83), p = 0.003). However,
241
 年會壁報論文
the stroke location, stroke etiology or stroke
severity exhibited no association with the
post-stroke cognitive trajectory.
Conclusion: In our studies, cognitive
improvement after stroke was noted in
patient with intermediate or high cognitive
performance, but not in low performance
group, which also gave higher occurrence
rate of dementia over 1-year follow-up.
Stroke severity, etiology or location might
exert less impact in this group with small
strokes (median NIHSS at admission:
3 points). The impact of small-vessel
disease burden may somehow outweigh the
detrimental effect of hippocampal atrophy in
post-stroke cognitive transition.
施德丁類藥物可減少心房顫動病人發
生急性缺血性中風後顱內出血發生率
和1年死亡率：台灣流行病學研究
林惠甄 1、蔡宛蓁 1、林志榮 2、張文能 1、盧成
憲 1、蔡乃文 1
1
高雄長庚紀念醫院神經內科
2
臨床資訊與醫學統計研究中心
Adjunctive Statin Therapy Reduces
Intracranial Hemorrhage and 1-Year
Mortality in Patients with Atrial
Fibrillation after Acute Ischemic Stroke:
A Population-Based Epidemiological
Study From Taiwan
Hui-Chen Lin 1 , Wan-Chen Tsai 1 , Jr-Rung
Lin2,,Wen-Neng Chang1, Cheng-Hsien Lu1, Nai-
Wen Tsai1
1
Department of Neurology, Chang Gung
Memorial Hospital-Kaohsiung Medical Center,
Taoyuan, Taiwan
2
Clinical Informatics and Medical Statistics
Research Center, Chang Gung University,
Taoyuan, Taiwan
242
Background: Atrial fibrillation (AF)-
related stroke causes severe disability and
poor prognosis. Adjunctive statin therapy
has been recommended for atherosclerotic-
related stroke but not AF-related stroke. This
study investigated the effects of statin in AF
patients who experienced acute ischemic
stroke.
Methods: Data from patients with AF
experiencing first-ever ischemic stroke
between 2001 and 2010 were collected
from the Taiwan National Health Insurance
Research Database and categorized into non-
statin and statin groups. The statin group was
further divided into pre-stroke statin (those
who began statin therapy before stroke) and
post-stroke statin (those who began statin
therapy after stroke) groups. The risks for
recurrent ischemic stroke, coronary artery
disease (CAD), intracranial hemorrhage
(ICH), and 1-year mortality were compared
among the groups.
Results: A total of 43,242 patients were
in the non-statin, 2858 in the pre-stroke
statin and 4640 in poststroke statin groups.
Comparing the risk for recurrent stroke and
CAD among the three groups, the prestrike
statin and post-stroke statin groups did not
exhibit a significant difference compared
with the non-statin group. In terms of
ICH risk, the statin group had a lower
risk for ICH (odds ratio [OR] 0.79, 95%
confidence interval [CI] 0.68–0.90; p =
0.0007) compared with the non-statin group.
The overall 1-year mortality in both statin
subgroups was lower than that in the non-
statin group (pre-stroke statin, OR 0.55 [95%
CI 0.49–0.61]; p < 0.0001 versus post-stroke
statin, OR 0.53 [95% CI 0.48–0.58]; p <
0.0001).
Conclusions: Statin therapy reduced the risk
of ICH and 1-year mortality in AF patients
who experienced acute ischemic stroke.

意識障礙的創傷性頸動脈海綿竇瘻管顯
明於傳統腦血管造影罕見案例報告
黃玉晴、李志明
衛生福利部桃園醫院神經內科
Traumatic Carotid Cavernous Fistula
Discovered Incidentally on Conventional
Cerebral Angiography
Huang Yu-Ching, Lee Chi-Ming
Department of Neurology, Taoyuan Hospital,
Ministry of Health and Welfare, Taoyuan,
Taiwan
Carotid cavernous fistula (CCF) involves
an abnormal communication between the
cavernous sinus and the carotid arteries
presenting with clinical features. According
to literature, CCF is not an uncommon
occurrence in patients involved in road
traffic accident. Its pathogenesis could be
traumatic or spontaneous. Our patient is
a 32-year-old woman involved in a road
traffic accident and developing head injury.
Emergency cranial CT scan revealed
subarachnoid hemorrhage and suspected
aneurysm of the left internal carotid
artery. Subsequent computed tomographic
angiography and magnetic resonance
angiography were negative for aneurysm or
CCF but a latter digital subtraction cerebral
angiography showed florid signs of CCF
(dilated cavernous sinus and left ophthalmic
vein). Though, no clinical feature of
CCF was seen in this patient. Patient was
subsequently referred to another hospital,
under the condition of persistent impaired
consciousness but lack of clinical signs, with
a neuro-interventional radiologist for further
intervention and management. In conclusion,
this case indicates that the absence of
clinical features and negative non-invasive
investigation does not exclude the diagnosis
of carotid cavernous fistula.
年會壁報論文
中風後中樞神經痛的病生理機制：運
動皮質的去抑制及其與臨床及感覺症
狀的相關性
湯頌君 1、李俊賢 1, 2、鄭建興 1、謝松蒼 1、江
明彰 3、葉馨喬 1、薛學文 1、趙啟超 1
1
台大醫院神經部
2
國家衛生研究院
3
陽明大學醫工所
Pathophysiology of Central Poststroke
Pain: Motor Cortex Disinhibition and
Its Clinical and Sensory Correlates
Sung-Chun Tang1, Lukas Jyuhn-Hsiarn Lee1, 2,
Jiann-Shing Jeng1, Sung-Tsang Hsieh1,
Ming-Chang Chiang3, Shin-Joe Yeh1, Hsueh-Wen
Hsueh1, Chi-Chao Chao1
1
Department of Neurology, National Taiwan
University Hospital, Taipei, Taiwan
2
National Institute of Environmental Medicine
Sciences, National Health Research Institutes,
Taiwan
3
Department of Biomedical Engineering,
National Yang-Ming University, Taipei, Taiwan
Background and Purpose: Central poststroke
pain (CPSP) is a disabling condition in
stroke patients, and evidence suggests that
altered corticospinal and motor intracortical
excitability occurs in neuropathic pain. The
objective of this study was to investigate
changes in motor cortex excitability and
sensorimotor interaction and their correlates
with clinical manifestations and alterations
in somatosensory systems in CPSP patients.
Methods: Fourteen patients with CPSP but
no motor weakness were compared with
age- and sex-matched healthy controls for
motor cortex excitability and sensorimotor
interaction assessed by transcranial
magnetic stimulation to measure resting
motor thresholds, short-interval intracortical
inhibition, intracortical facilitation, and
afferent inhibitions. The sensory pathway
243
 年會壁報論文
was evaluated by quantitative sensory
testing, contact heat evoked potential, and
somatosensory evoked potentials. Clinical
pain and quality of life were assessed with
validated tools.
Results: The duration of CPSP was 3.3
± 3.0 years (ranging 0.5-10 years), and
pain significantly impaired quality of life.
Compared with the unaffected hemisphere,
the stroke hemisphere had higher thermal
thresholds, lower contact heat evoked
potential amplitudes, and prolonged cortical
somatosensory evoked potential latencies.
There was no difference in resting motor
thresholds between the stroke and unaffected
h e m i sp h e re or betw een patients a nd
controls. CPSP patients had a reduction in
short-interval intracortical inhibition in the
stroke hemisphere compared with that in
the unaffected hemispheres of patients and
controls. No changes were noted in afferent
inhibitions between the stroke and unaffected
hemispheres. The short-interval intracortical
inhibition of the stroke hemisphere was
negatively correlated with self-rated health
on a visual analog scale and positively
correlated with cortical somatosensory
evoked potential latencies.
Conclusions: CPSP patients with intact
corticospinal tracts showed reduced motor
intracortical inhibition in the stroke
hemisphere, suggesting defective gamma-
aminobutyric acid-ergic inhibition. This
disinhibition was associated with impaired
quality of life and was related to dorsal
column-medial lemniscus pathway
dysfunction.
取栓術後病人之護理
林靜薇、何淑媛、黃蕙琦、蔡瑞窈、
劉子菁、梁穎
244
臺北榮民總醫院護理部
C a re o f t h e P o s t I n t r a - A r t e r i a l
Thrombectomy Patient
Ching-Wei Lin, Shu-Yuan Ho, Hui-Chi Huang,
Jui-Yao Tsai, Tzu-Ching Liu, Ying Liang
Department of Nursing, Taipei Veterans General
Hospital, Taipei, Taiwan
Background and Purpose: In the past 20
years, active treatment of acute infarction
has only administered intravenous
thrombolytic agents within 3–4.5 hours of
gold. However, in very short time windows,
patients who are able to receive treatment in
a timely manner are still a minority (about
2–5% of all strokes). However, if the stroke
is a major vascular occlusion from a larger
diameter, until the success of the new intra-
arterial mechanical thrombectomy trial in
2015, the acute stroke treatment time will be
extended again.
Results: We retrospectively retrieved
patients’ data from Stroke Registry of a
Northern medical center. Patients admitted
between 2017 and 2018 were screened.
The current study recruited 129 patients.
Demographics of patients are presented in
Table 2. The results showed that baseline
characteristics were similar. At 3-months
after stroke, 44.2% of patients had better
functional recovery .Our results showed that
about half of the stroke patients improved
their functional status at 3-months after
stroke.
Conclusions: Intravenous recombinant
tissue plasminogen activator (IV -rtPA)
remains the only approved systemic
reperfusion therapy suitable for most
patients presenting timely with acute
ischemic stroke. In recent years, intra-arterial
thrombectomy (mechanical thrombectomy)
has emerged, and the results of randomized

control trials have also proved its efficacy.
This article provides an overview of
thrombectomy, the management of patients
with an acute ischemic stroke eligible for
this procedure and the implications for
nursing practice in Taipei Veterans General
Hospital. A new treatment has started to
redefine acute stroke care in countries
all over the world –thrombectomy. Early
treatment is critical to rescue potentially
salvageable tissue. Safe, rapid and effective
arterial recanalization to restore blood flow
and improve a functional outcome remains
the primary goal of hyperacute ischemic
stroke management. Post-thrombectomy
management of the emergent large vessel
occlusions patient is complex. Vital aspects
of patient care that require monitoring
and treatment include optimization of
reperfusion, post-reperfusion hemorrhage,
cerebral edema, access site complications,
and rehabilitation efforts. Careful attention
to these aspects is vital to outcome
optimization. Nurses must keep up with the
times and be active. Take the initiative to
learn new guidelines, update concepts in
real time, challenge higher standards, and
dynamically masterstrokes. New progress in
diagnosis and treatment, providing evidence-
based support for nursing decision-making
and implementation of ischemic stroke.
Reducing the complications and length of
stays of stroke patients, and improving the
quality of life of stroke.
基於深度學習之梗塞性中風磁振造影
辨識
蔡孟宗 1、彭徐鈞 2、陳右緯 3、王國偉 3、
郭葉璘 3、蔡章仁 1
1
國立中央大學、 2台北醫學大學、 3聯新國際
醫院
年會壁報論文
Identification of Ischemic Stroke in
MRI Using Convolutional Neural
Network with Deep Learning
Meng- Zong Tsai1, Syu-Jyun Peng2, Yu-Wei
Chen3, Kuo-Wei Wang3, Ye-Lin Guo3, Jang-Zern
Tsai1
1
National Central University,
2
Taipei Medical University,
3
Landseed International Hospital
Background and Purpose: Infarct detection
on cerebral MRI have been hindered by
the histographic overlapping of image
artifacts and infarct lesions. This study
aimed at improving the detection accuracy
by utilizing convolutional neural network
trained by deep learning algorithm.
Methods: The preprocess included the
flowing 7 steps: First, image centralization;
Second, registration of DWI to T1W; Third,
registration of ADC to DWI; Fourth, z-axis
registration of ADC to DWI; Fifth, skull
masking; Sixth, intensity normalization of
the cerebellar portion of excessive intensity;
Seventh, removing DWI/ADC pixels with
below-/above-threshold intensity.
The CNN structure contained four
convolutional layers that had 16, 32, 64 and
64 filters of size 4 × 4. A convolutional layer
was followed by a batch normalization layer,
a ReLU layer, max pooling 2d layer. The
output layer is a classification layer preceded
by a fully connected layer and a softmax
layer.
The network model was trained with deep
learning using the stochastic gradient
descent algorithm. The activation function
ReLU was used for faster convergence and
computational efficiency. The initial network
weights were initialized randomly.
An experiment to evaluate the developed
CNN involed 15 stroke patients and 15
healthy persons. The cerebral infarcts and
245
 年會壁報論文
artifacts of the patients had been segmented
by an experienced neurologist. Patches of
16 × 16 pixels were generated from all the
subject MRIs. The training set consisted of
90% of the patches and the rest were used as
the test set.
Results: The experimental result shows
a similarity index of the developed CNN
infarct detector exceeds 90%. Moreover,
the required detection time to finish the
detection is just one third of that of the
conventional automated method.
Conclusion: Our deep learning algorithm
incorporates location information, whole
brain intensity, slice intensity, and slice order
to better exploit the infarct features. The
performance of this new design is better than
conventional infarct detection algorithm.
經動脈治療顱外內頸動脈阻塞之急性
缺血性腦中風
嚴寶勝 1、黃虹瑜 2
1
中國醫藥大學附設醫院放射部、 2中國醫藥大
學附設醫院神經部
Endovascular Treatment of Extracranial
Internal Carotid Artery Occlusions in
Acute Ischemic Stroke
Pao-Sheng Yen1, Hung-Yu Huang2
1
Radiology Department, 2Neurology Department,
China Medical University Hospital, Taichung,
Taiwan
Purpose: Acute ischemic stroke (AIS) due
to acute occlusion of the extracranial internal
carotid artery (ICA) is associated with a
significant level of morbidity and mortality.
The purpose of this study is to demonstrate
the technical success of endovascular
treatment as well as the benefit in clinical
outcome in this unique stroke population.
246
Methods: We performed a single center
retrospective analysis of consecutive
patients with AIS due to acute occlusion
of extracranial ICA, who underwent
thrombectomy with or without carotid stent
placement. The outcomes were evaluated
based on rate of angiographic recanalization
(modified TICI scale), rate of improvement
of NIHSS score, modified Rankin Scale
(mRS) at discharge and after 3 months,
and symptomatic cerebral hemorrhagic
complications.
Results: From October 2014 to Feb. 2019,
43 consecutive thrombectomy procedure
with extracranial artery stenosis. Nine (21%)
cases was failed to access the occluded
lesion due to complete proximal occlusion.
In the rest of 34 cases with complete
endovascular procedures, 76% are men,
with median age 65 years (IQR 59-74).
The median NIHSS at presentation was 19
(IQR 59-74). In 21 patients, there was an
additional intracranial occlusion (tandem
lesions) at distal ICA and M1. Intracranial
occlusions were either treated mainly
with combined stentreiver and aspiration
technique. 82% cases achieved successful
revascularization (TICI>= 2b). Among the
cases (n = 14) with carotid stent deployment
in hyperacute phase, 3 (21%) patients had
mRS<3 at day 90. Symptomatic intracranial
hemorrhage (sICH) was found in 6 patients
(18%). The mortality rate was 6% at 90
days.
Conclusion: Endovascular treatment of
acute ICA occlusion appears to have a high-
recanalization rate in our cohort of patients
with acute ICA occlusion. Future prospective
studies are necessary to determine which
patients are most likely to benefit from this
form of therapy.

中風對生活品質及出院安置的影響
1 2
沈秀祝 、林慧娟
1
高雄榮民總醫院
2
奇美醫學中心
The Influence of Quality of Life and
Discharge
Hsiu-Chu Shen1, Huey-Juan Lin2
1
Kaohsiung Veterans General Hospital
2
Chi-Mei Medical Center
Background & Purpose: While diagnostic
tools and medical treatment have advanced
considerably, stroke is widely considered a
catastrophic event with long-term physical,
psychological, and social consequences. The
burden of stroke is likely to increase, as a
consequence of the rapidly aging population
and a better survival rate of stroke. However,
the provision of chronically continuing
services for patients is typically limited by
the lack of robust estimates of long-term
needs after the stroke event. Specifically,
less attention has been paid to the long-term
burden and related needs for health care. Our
study would contribute to extant research
by proposing various strategies for clinical
management, accessing specialized care, and
organizing in-hospital stroke care. Moreover,
our proprietary data would provide useful
年會壁報論文
information for enhancing the quality of
health care and for managing the secondary
health problems faced by stroke survivors.
These prospective domestic data would be
particularly valuable for inter-regional and
international comparisons, as well as for
state-level policy making.
Methods: We will conduct a one-year
prospective cohort study by enrolling
consecutive patients with first-ever ischemic
stroke in the Chi-Mei Medical Center.
Participants will be evaluated via assessment
survey questionnaires by face-to-face or
telephone interviews at acute ward, and 1, 3,
6 months after stroke.
Goals: We expect to assess the short-term
and long-term needs and newly developing
secondary health problems in stroke
survivors. These prospective domestic
data will be of great value for setting up a
comprehensive multidisciplinary team care
model to evaluate the influence of potential
interventions on the long-term consequences
of stroke, as well as for providing
implications for health policy makers.
Keywords: ischemic stroke, prognosis,
quality of life, needs assessment, subacute
care, long-term care.
247