年會壁報論文
前循環大血管阻塞患者電腦斷層灌流
不足指數與電腦斷層血管攝影側枝循
環分數關聯性研究
王淳民
成功大學醫學院附設醫院神經部
The Correlation between the
Hypoperfusion Intensity Ratio and
Pial Artery Collateral Score in Acute
Large Vessel Occlusion in Anterior
Circulation
Chun-Min Wang
Department of Neurology, National Cheng Kung
University Hospital
Background: Evaluating collateral status is
of great importance in predicting evolution
of infarction, predicting the prognosis of
acute ischemic stroke, and selecting eligible
patients of intra-arterial thrombectomy.
Multiphase computed tomography
angiography (mCTA) collateral score is a
reliable indicator of collateral status, yet
with inter-rater difference. Hypoperfusion
intensity ratio (HIR) was reported able
to predict the rate of infarct growth,
functional outcome, and is correlated with
collateral circulation in digital subtraction
angiography. We studied the correlation of
the HIR obtained from CT perfusion and
collateral score from mCTA in patients with
acute large vessel occlusion.
Method: From Feb. 2019 to May 2020, we
retrospectively reviewed patients with acute
ischemic stroke and intracranial cerebral
artery orand proximal middle cerebral artery
occlusion. HIR was defined as the Tmax
> 10 second lesion volume divided by the
Tmax > 6 second lesion volume. The Tmax
lesion volume and core were calculated
b y a u t o m a t i c s o f t w a r e ( S y n g o . Vi a ,
Siemens) through CT perfusion. Collateral
c i r c u l a t i o n w a s a s s e s s e d b y m C TA .
322
Patient’s demographic characteristics and
perfusion data were compared between
good (mCTA score 4-5) and poor (score 1-3)
collaterals. The correlation between HIR
and mCTA score was evaluated by Pearson’s
correlation. The cutoff value predicting
mCTA score was evaluated by receiver
operating characteristic analysis.
Result: There were 94 patients enrolled
into final analysis. The patients with good
collateral had lower stroke severity (median
NIHSS 14 v.s. 25 points, p<0.001), smaller
core volume (37.3±24.7 v.s. 116.5±70 mL,
p<0.001), Tmax 6 (120±64.9 v.s. 203.5±88
seconds, p<0.001), and lower HIR (0.51±0.2
v.s. 0.73±0.13, p<0.001). The higher HIR
was correlated with poorer collateral score
by Pearson’s correlation. (r=-0.64, p<0.001).
The ROC analysis suggests the best HIR
value predicting good collateral score was
0.68 (sensitivity: 0.76; specificity: 0.81; area
under curve: 0.82).
Conclusion: Lower HIR correlates with
good mCTA collaterals core in patients with
acute large artery occlusion. HIR is a good
surrogate of collateral circulation. The best
cutoff value of HIR by Syngo.Via software
to predict good collaterals is 0.68.
從零開始-反覆教育訓練對於推動地區
醫院急性腦中風血栓溶解劑治療之成
效分析－以衛福部桃園醫院新屋分院
為例
江宏基 1, 2
1
衛福部桃園醫院新屋分院醫療部
2
衛福部桃園醫院神經科
Starting from Zero-effectiveness
Analysis of Repetitive Comprehensive
Education for Promoting Intravenous
Thrombolytic Therapy in One District

Hospital- take Sinwu Branch, Taoyuan
General Hospital, Ministry of Health
and Welfare for Example
Hung-Chi Chiang1, 2
1
Sinwu Branch, Taoyuan General Hospital,
Ministry of Health and Welfare
2
Division of Neurology Medicine, Department of
Internal Medicine, Taoyuan General Hospital,
Ministry of Health and Welfare
Background and Purpose: Intravenous
rt-PA therapy within 3 hours is standard
method to treat acute ischemic stroke, early
reperfusion lessens neurological deficits.
Our hospital, Sinwu Branch, Taoyuan
General Hospital, Ministry of Health
and Welfare, one district hospital, which
did not provide acute stroke reperfusion
service until inauguration of neurology
doctor in November 2018. After repetitive
comprehensive education programs and
immediate feedback in each intravenous rt-
PA case, we expect to achieve the goal of
gradual improvement of treatment quality
and close the gap between rural and urban
area. Methods: After introduction of the
rt-PA medicine since December 2018, we
retrospectively analyze the period from
introduction medicine time to September
2020, total one year and ten months.
There were 18 intravenous thrombolytic
cases which were compatible with Taiwan
healthcare payment system. By means of
repetitive comprehensive education program
and immediate feedback of advantage and
disadvantage of each thrombolytic cases
to the acute stroke management staff, we
document all of the interval of ER arrival
to brain CT scanning time and ER arrival to
the intravenous rt-PA loading time(door to
needle time, DTN) to see if any treatment
quality or not. Our repetitive comprehensive
education programs including acute stroke
年會壁報論文
management training course on 5th and 19th
December 2018 at ER and ICU, NIHSS
acute stroke severity assessment certification
training course on 8th October 2019 with
13 nurse practitioners and 11 ER nurses
finally approved by Taiwan Stroke Society
and holding expandly acute ischemic stroke
nursing care and quality monitor training
course on 12th, 16th, 30th June 2020 to
nurse practitioners, ER staff, ICU staff and
general medicine ward staff.
Results: After excluding 2 cases of in-
hospital stroke, there were 16 intravenous
thrombolytic cases. We divide all the 16
cases to 3 intervals by the above-mentioned
training course time, the first interval
(December 2018 to September 2019), the
second interval (October 2019 to April
2020), and the third interval (May 2020 to
September 2020). From first interval to the
third interval, the treatment quality index
(DTN within 60 minutes ratio) gradually
increased. (Table 1.)
Conclusion: Starting from zero to establish
smooth acute stroke management team rely
on cooperation in each member. Repetitive
comprehensive education programs and
immediate feedback of each thrombolytic
case to staff show benefits of treatment
quality in one district hospital. We expect
these efforts could improve stroke treatment
quality in rural area.
人工智慧之ASPECTS系統之初步研究
呂勇陞 1、陳龍 2、林緯翔 1、蘇振隆 1
1
中原大學生物醫學工程學系
2
臺北醫學大學-部立雙和醫院神經科
AI Based ASPECTS System: A
Preliminary Study
Yung-Sheng Lu1, Lung Chan2, Wei-Siang Lin1,
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 年會壁報論文
Jenn-Lung Su1
1
Department of Biomedical Engineering, Chung
Yuan Christian University
2
Department of Neurology, Taipei Medical
University-Shuang Ho Hospital
Background and Purpose: In recent
years, ischemic stroke ranks fourth among
the top ten causes of death in Taiwan,
and its prognosis is highly related to the
implementation time of reperfusion therapy.
Due to the rapidity and low cost of brain
computed tomography (CT), the ASPECTS
scoring system based on non-contrast brain
CT images in clinical diagnosis has become
an important pre-reperfusion evaluation. In
this study, we propose a diagnostic method
to assist the clinical in the rapid calculation
of ASPECT scores based AI method.
Methods: This study uses image processing
and neural network technology to construct.
The input images were filtered to remove CT
image noise, and the contrast was improved
by adaptive histogram equalization, and
the sample size was increased by image
augmentation for AI training. 240 brain CT
images and 200 images containing ischemic
lesions were used and augmented to 12,000
and 16000 images to train U- shaped full
convolution network (FCN) coupled dense
conditional random field (CRF) model.
Based on the location of the lesion on
corresponding 100 DWI-MRI images, the
correlation of the Dice coefficient and the
surface distance between the AI system
and the doctor's circle selection on the non-
contrast CT image are compared. Moreover,
the ASPECT score are calculated and
compared to the ASPECTS scores evaluated
by the physicians are used for system
evaluation and validation.
Results: Preliminary results showed that
this developed system can segment the brain
324
tissue and circle ROI correctly with Dice
coefficient, average surface distance (ASD),
and maximum surface distance (MSD) are
99.78%, 0.994, 0.029 (pixel), and 5.578
(pixel), and are 99.6%, 0.8, 0.65 (pixel)
and 12.1 (pixel) respectively compared
with the results of the expert. Moreover,
in the calculation of ASPECTS scores,
the accuracy of forebrain circulation and
posterior cerebral circulation reached 93%
and 86%, respectively, and the correlation
between the circle selection and the accuracy
of ASPECTS score evaluation were better
than the judgment results of clinicians. The
similarity of the ischemic and old ischemic
zones to the cerebral ventricles can lead to a
systemic error in judgment. The calculation
time has been shortened to 34 seconds
in average, which is better for clinical
diagnosis. However, this system is more
limited in the use of existing ischemic areas
in the past.
Conclusion: The results show that this
developed AI system can provide faster
and more accurate clinical judgment. In
the ischemic lesion model, it is expected to
realize the automatic segmentation of acute
and super acute lesions and improve the
usefulness of the system through more data.
下頦抗阻力訓練對於中風吞嚥障礙的
療效探討：一篇統合分析及系統性回
顧
李雨璇、魏雅瑩、許耀宗
國軍高雄總醫院復健科
The Effect of Chin Tuck Against
Resistance Exercise for Dysphagia
Following Stroke: A Systematic Review
And Meta-analysis

Yu-Hsuan Li, Ya-Ying Wei, Yao-Tsung Hsu
Department of Physical Medicine and
Rehabilitation, Kaohsiung Armed Forces
General Hospital, Kaohsiung City, Taiwan
Background: Chin Tuck Against Resistance
Exercise(CTAR) is an therapy modified from
Shaker exercise. This exercise can improve
the swallow function and reduce the risk
of choking in stroke patients. The primary
purpose of this study is to investigate the
effects of CTAR for dysphagia following
stroke by a systematic review and meta-
analysis.
Methods: A comprehensive database
search of the literature up to August 2020
was performed via MEDLINE, EMBASE,
CINAHL, PubMed. Keywords were: (1)
Stroke or CVA, (2) Dysphagia or Swallowing
Disorders, (3) Chin Tuck Against Resistance
Exercise. Randomized clinical trials that
included CTAR for improving swallowing
function of stroke patients were located.The
primary outcome was clinical assessments
of Penetration Aspiration Scale. Three
reviewer (Li, Wei, and Hsu) independently
assessed the risk of bias and trial quality
via using the Cochrane risk of bias tool
and the Physiotherapy Evidence Database
scale (PEDro) and then synthesized the
study results. The swallowing function
i m p r o v e m e n t o f t h e C TA R a n d t h e
traditional dysphagia treatment groups was
compared by calculating standardized mean
differences to derive a summary effect size.
Results: Three studies were included in the
meta-analysis. All of the results show that
CTAR could improved swallowing function.
A random-effects model of meta-analysis
showed a significant overall effect: Z = 3.36
(P < 0.01), heterogeneity: Tau² = 0.13; Chi² =
3.64, df = 2 (P = 0.16); I² = 45%. Summary
Hedge’s g was statistically significant in
年會壁報論文
favor of the CTAR group (Hedge’s g = -1.02,
p < 0.01), which suggested a large effect.
Jing GAO, 2017 also shows that CTAR and
Shaker exercise have similar effects, and
better than traditional dysphagia treatment.
Conclusion: High-quality studies show
that CTAR and Shaker exercise have
similar effects and better than traditional
therapy. As a result, CTAR could be a viable
intervention for stroke patients because
it requires less space, cost-effective, and
clinically convenient to be combined with
other therapies.
Future research: Since only three studies,
the sample is not enough. It is recommended
to continue to follow the effect of CTAR on
dysphagia after stroke in the future, so that
it can be included in home exercise in the
future to improve the swallowing function of
patients and reduce the risk of choking and
pneumonia.
靜脈竇栓塞一病例報告
阮圓真、何宗翰、周中興、李俊泰
三軍總醫院神經科部
Cerebral Venous Sinus Thrombosis: A
Case Report
Yuan-Zhen Ruan, Tsung-Han Ho, Chung-Hsing
Chou, Jiunn-Tay Lee
Department of Neurology, Tri-Service General
Hospital, National Defense Medical Center,
Taipei, Taiwan
Background: CVST is a special type of
cerebrovascular disease that present with
focal cerebral edema, venous cerebral
infarction, seizures, and intracranial
hypertension as its most prominent clinical
features. The disease often affects young
adults, women of childbearing age and
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 年會壁報論文
children. One study reported that 50%
of CVST patients had a poor prognosis.
However, if an early correct identification of
CVST is achieved, the majority of patients
who are diagnosed and treated early have a
generally good prognosis.
Case report: A 36 year-old male with a
history of migraine for 20 years and silence
for 10 years, present with severe headache
(VAS 8). Brain CT and MRI showed cerebral
venous thrombosis, and used low-molecular
weight heparin and warfarin as treatment.
An episode of generalized tonic-clonic
seizure attack took place and anti-epileptic
drug (Depakine) was started. Brain CT
image was performed again after admitted
to our hospital, which revealed suspected
filling defect over superior sagittal sinus in
CTV films. Brain MRI showed no flow-void
signal at left sigmoid sinus, the superior
sagittal sinus and bilateral superior cortical
veins is seen with contrast filling defect. C/
W venous thrombosis and symmetrical mild
subdural effusions over bilateral cerebral
convexities. Due to family history of protein
S deficiency, we rechecked blood test
showed low levels of protein S and protein
C, with suspected protein S deficiency. EEG
showed paroxysmal disorder thus we kept
AEDs. Headache was still complained then
anticoagulant was shifted from Warfarin
and Clexane to Xarelto. Analgesics and
antimetics was prescribed. Extremely
severe headache with photophobia without
neurologic deficits was complained
accompanied with mild IICP sign including
slow HR and elevated blood pressure.
Emergency CT was indicated and revealed
acute SDH at bilateral frontal convexity,
suspicious SDH along left tentorium.
Anticoagulant was postponed and vitamin C,
K1 for hemostasis was used. Depakine 400
mg Q8H was added for seizure prevention.
326
On the same day, follow up CT showed no
interval change. Headache improved and the
patient discharged under anti-epileptic drug
and analgesics. EEG was normal without
Topamax and no seizure episode or headache
noted afterward. NOAC was consider if no
hemorrhage transformation in follow up
brain CT images.
Conclusion: When patients have an acute
onset of a severe headache, progressive
aggravation of a chronic intermittent
headache, or a new chronic headache with
seizures or focal neurological deficits, with
or without visual edema, cerebral venous
sinus thrombosis should be considered.
腦中風病人的ABI數據分析與年紀性
別危險因子比較
周兆亮 1, 3、黃俊肇 2, 3、孫芳如 4、林雅如 1, 3、
傅維仁 1
1
臺北馬偕醫院神經科
2
臺北馬偕醫院放射科
3
馬偕醫學院醫學系
4
臺北馬偕醫院醫研部
Age, Gender, and Risk Factors Analysis
of Ankle-Brachial Index Value in
Cerebral Infarction Patients
Chao-Liang Chou 1, 3, Chun-Chao Huang 2, 3,
Fang-Ju Sun4, Ya-Ju Lin1, 3, Helen L. Po1
1
Department of Neurology, Mackay Memorial
Hospital, Taipei, Taiwan
2
Department of Radiology, Mackay Memorial
Hospital, Taipei, Taiwan
3
Department of Medicine, Mackay Medical
College, New Taipei City, Taiwan
4
Department of Medical Research, MacKay
Memorial Hospital, Taipei, Taiwan
Background: Peripheral artery disease
(PAD) and cerebral infarction are often

categorized as atherosclerotic disease.
Ankle-Brachial Index (ABI) is a simple non-
invasive tool in evaluation PAD. However,
actual prevalence of PAD in cerebral
infarction patients is few discussed before.
Age, gender, and side preference of ABI
value in infarction patients is also limited
studied.
Method: Patients visiting our neurological
outpatient clinic with history of cerebral
infarction were enrolled in study between
Jan. to Dec. 2015. Baseline physiological
data and systemic comorbidity history were
recorded. ABI≤0.9 was defined as abnormal.
Results : Totally 2208 patients were
enrolled. Abnormal ABI value prevalence
was 13.5% (n=298) in ever stroke patients.
We found ABI values was significant lower
in elderly (P trend<0.001). Compared with
<60 years old group, the odds ratio having
abnormal ABI value were 2.32 and 5.76
in groups of age 60-74 and >75 years old,
respectively. In gender and side preference,
female and left side have borderline higher
rate for abnormal ABI value. In risk factors
analysis, diabetes, hypertension, and atrial
fibrillation are significant (Odd ratio: 1.47,
1.74, 2.28 respectively). Smoking, body
mass index (BMI) and dyslipidemia have no
significance.
Conclusion: In cerebral infarction patients,
older age was strong correlated to abnormal
ABI value. Diabetes, hypertension, and atrial
fibrillation were main risk factors.
中年人的頸動脈粥樣硬化可預測認
知：一項10年的追蹤研究
林秀芬 1、黃玲鈞 2、卓夙航 3、陳正生 4
1
高醫附院神經科
2
高雄市立大同醫院神經科
3
中國醫藥大學附設醫院醫學研究部
年會壁報論文
4
高醫附院精神科
C a ro t i d A t h e ro s c l e ro s i s A m o n g
Middle-aged Individuals Predicts
Cognition: A 10-year Follow-up Study
Hsiu-Fen Lin1, Ling-Chun Huang2, Suh-Hang
Juo3, Cheng-Sheng Chen4
1
Department of Neurology, Kaohsiung Medical
University Hospital
2
Department of Neurology,Kaohsiung Municipal
Da-Tung Hospital
3
D epartment of Medical Research, China
Medical University Hospital
4
Department of Psychiatry, Kaohsiung Medical
University Hospital
Background and Aims: Lack of studies
simultaneously evaluate the impact of
structural and functional atherosclerosis
on cognition. We investigated the long-
term predictive and interaction effects
of structural and functional carotid
atherosclerosis markers on future cognitive
decline.
Methods: Five hundred and twenty-eight
middle-aged participants enrolled in the
carotid atherosclerosis examination in
Kaohsiung Atherosclerosis Longitudinal
Study (KALS) between 2006-2009 were
tested for cognition between 2016-2019. The
Montreal Cognitive Assessment (MoCA)
was used for the cognitive test. Baseline
structural atherosclerosis was assessed by
carotid intima–media thickness (cIMT) and
plaque, whereas functional atherosclerosis
was evaluated by carotid stiffness (β, Ep,
and pulse wave velocity). Participants in the
top quartile of cIMT and those with plaques
were considered to have advanced structural
atherosclerosis, whereas participants with all
three stiffness parameters in the top quartile
were defined to have advanced functional
atherosclerosis.
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 年會壁報論文
Results: The mean participant age at
baseline was 53.88±8.37 years. Each case
of advanced structural atherosclerosis and
advanced functional atherosclerosis was
associated with low 10-year MoCA scores
with p<0.001 and p=0.03, respectively. An
interaction effect was observed between
structural and functional atherosclerosis on
the MoCA score 10 years later (p=0.02).
Participants with both advanced structural
and functional markers showed a marked
impact on future cognitive function,
especially executive and language domains.
Conclusion: Carotid atherosclerosis in
middle-aged individuals can predict their
cognitive function in 10 years. Integrated
information regarding both arterial wall and
stiffness could help improve the predictive
power for cognitive decline.
心房纖維顫動病人使用apixaban濃度
與預後之關聯性
林欣儀 1、郭錦樺 2、劉言彬 3、黃織芬 1、湯頌
君 4、鄭建興 4
1
臺大醫院藥劑部
2
臺灣大學藥學系
3
臺大醫院內科部心血管中心
4
臺大醫院神經部腦中風中心
Real-world Apixaban Concentration
and Outcomes Among Asian Patients
with Atrial Fibrillation
Shin-Yi Lin1, Ching-Hua Kuo2, Yen-Bing Liu3,
Chih-Fen Huang 1, Sung-Chun Tang 4, Jiann-
Shing Jeng4
1
Department of Pharmacy, National Taiwan
University Hospital, Taipei, Taiwan
2
School of Pharmacy, College of Medicine,
National Taiwan University, Taipei, Taiwan
3
Division of Cardiology and Cardiovascular
Center, Department of Internal Medicine,
328
National Taiwan University Hospital, Taipei,
Taiwan
4
Stroke Center, Department of Neurology,
National Taiwan University Hospital, Taipei,
Taiwan
Introduction: Apixaban is a factor Xa
inhibitor widely used in preventing
thromboembolism among patients with
atrial fibrillation (AF). The purpose of our
investigation is to analyze the association
between apixaban concentration and
outcome events, and further investigate
risk factors associated with out-of-expected
range apixaban concentrations.
Material and Methods: This is a prospective
observational study. Patients who were older
than 20 years, had AF and took apixaban
were enrolled into this study. All participants
were followed until the end of the study to
record ischemic stroke (IS), major bleeding
(MB) and any other bleeding outcomes.
Plasma apixaban concentration was
compared to the results reported in clinical
trials to define higher, within, or lower-than-
expected range. Cox proportional hazard
model and multivariate logistic regression
were used to investigate risk factors
associated with occurrence of outcome
events and out-of-expected range apixaban
concentrations.
Results: A total of 202 participants (115
male, 56.9%) were enrolled into this study,
and contributed 198 peak and 202 trough
levels. Their mean age was 77.1±9.9 years,
and mean CHADS2-VASc score was 4.3±1.6
points. As compared to clinical trials,
20.2% of peak concentration were higher-
than-expected range, and 8.9% of trough
concentration were lower-than-expected
range. The median follow-up duration was
3.09 years. During study period, a total of
7 IS, 12 MB and 17 other bleeding events

happened. IS events were significantly
associated with lower creatinine clearance
(hazard ratio [HR] and 95% confidence
interval, 0.93 [0.88 to 1.00], p=0.04), and
lower-than-expected trough level (HR=7.69
[1.04 to 57.03], p=0.05). MB events were
associated with higher CHADS2-VASc
score (HR=1.81 [1.18 to 2.76], p=0.01), and
concurrent use of aspirin (HR=17.15 [1.46
to 200.08], p=0.02). We then investigated
factors associated with out-of-expected
range apixaban concentrations and found
that inappropriately reduced apixaban dose
was related to lower-than-expected trough
concentrations. Among participants ordered
appropriate apixaban dose, lower estimated
glomerular filtration rate was associated
with higher-than-expected range peak
concentration (odds ratio [OR] 0.97 [0.95 to
1.00], p=0.05).
Conclusion: Ischemic stroke during
apixaban therapy was associated with
low trough concentration. In addition,
inappropriately reduced apixaban dose
leaded to low trough concentration. Among
patients correctly ordered apixaban dose
as per package insert, worse renal function
predicted higher apixaban peak level.
經總頸動脈之動脈機械取栓術－案例
分享
林蔚 1、林健群 1、李俊泰 1、李喬華 2、蔡佳光 1
1
臺北三軍總醫院神經科部
2
臺北三軍總醫院放射診斷部
A Successful Case of Endovascular
Thrombectomy Via Common Carotid
Artery Puncture
Wei Lin 1 , Jiann-Chyn Lin 1 , Jiunn-Tay Lee 1 ,
Chiao-Hua Lee2, Chia-Kuang Tsai1
1
Department of Neurology, Tri-Service General
年會壁報論文
Hospital, Taipei, Taiwan
2
Department of Radiology, Tri-Service General
Hospital, Taipei, Taiwan
While facing ischemic stroke caused by
large arteries occlusion, endovascular
thrombectomy alone or combination with
intravenous thrombolysis provide a safe and
effective treatment for reducing disabilities
in selected patients. Devices of stent
retrievers and catheter aspiration devices
are used for mechanical thrombectomy.
Catheter is sent to the internal carotid artery
and beyond the site of the intracranial
large artery occlusion via femoral artery
puncture. Here we presented a successful
case of ischemic stroke patient who received
mechanical thrombectomy via direct
common carotid artery puncture.
兒童中大腦動脈剝離伴急性腦梗塞續
發帕金森氏症候群：病例報告
洪碩隆、陳冠廷、宋岳峰、李俊泰
臺北三軍總醫院神經科部
Middle Cerebral Artery Dissection
Pres en t in g wit h Acu t e Ce reb r al
Infarction and Following Parkinsonism
in Children: A Case Report
Shou-Lung Hung, Guan-Ting Chen, Yueh-Fung
Sung, Jiunn-Tay Lee
Department of Neurology, Tri-Service General
Hospital, Taipei, Taiwan
Background: Spontaneous cervicocephalic
arterial dissection is an uncommon cause
of stroke. Segments of the middle cerebral
artery (MCA) are rarely involved. This time,
we report the case of a young patient with
acute stroke due to middle cerebral artery
dissection, complicated with parkinsonism
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 年會壁報論文
one and half year after stroke onset.
Case report: A 12-year-old Taiwanese girl,
without any systemic diseases in the past,
suffered from sudden onset of headache
followed by dizziness after rope skipping.
About one hour later, she had weakness
of left upper limb and fell down from
the seat at the classroom. She was sent
to our emergency room, where GCS was
E4M6V5, muscle power over left upper
limb was MRC grade 0, and left side central
facial palsy also noted. The non-contrast
computed tomography of brain revealed
no abnormalities. However, brain magnetic
resonance imaging showed high signal
intensity at right basal ganglion on diffusion-
weighted imaging, indicative of acute
cerebral infarction. MR angiography showed
a focal stenosis at right middle cerebral
artery (MCA), M1 segment, suggestive of
dissection. A series of examinations for
young stroke surveys showed no remarkable
findings. Anti-platelet agent with aspirin
was administrated. Her muscle power of
left upper limb improved from MRC grade
0 to grade 4+. About one and half year after
discharge, mild bradykinesia and rigidity of
left limbs were noted. 99mTc-TRODAT-1
study revealed decreased tracer uptake
at right caudate and putamen. Based on
the result, post-stroke Parkinsonism was
confirmed. No anti-PD medications were
given because no obvious impairment of
daily activities was reported. The patient
was regularly followed up at our outpatient
department.
Conclusion: Ischemic stroke in childhood
is rare. Physicians should take arterial
dissection into consideration in the
differential diagnosis of acute stroke,
when patients have a history of trauma or
exercise. Parkinsonism rarely complicates
the recovery from stroke. However, an
330
infarction (usually a lacunar type) involving
basal ganglia can present with a clinical
picture indistinguishable from Parkinson’s
disease.
中風病患周邊動脈硬化指數與顱內外
粥狀動脈硬化與顱內小血管疾病之關
聯性
張育銘、李宗霖、宋碧姍
成大醫院神經部
Association of Ankle-Brachial Index
and Pulse-Wave Velocity with Cerebral
Atherosclerosis and Small Vessel
Disease in Stroke Patients
Yu-Ming Chang, Tsung-Lin Lee, Pi-Shan Sung
Department of Neurology, National Cheng Kung
University Hospital, Tainan, Taiwan
Background and Purpose: Ankle-brachial
index (ABI) and pulse wave velocity (PWV)
are widely used noninvasive modalities to
evaluate atherosclerosis and arterial stiffness
of peripheral vessels. Recent evidences
suggested ABI and baPWV may be novel
markers of cerebrovascular risk but whether
its risk reflects a large arterial disease
mechanism (extracranial or intracranial large
artery stenosis) or a small vessel disease
mechanism (leukoaraiosis and lacunar
infarction) is still undetermined. Through
this study, we aim at investigating the
association between ABI, baPWV and the
presence and severity of large artery disease
and small vessel disease in patients with
acute ischemic stroke.
Methods: We prospectively enrolled
patients from July 2016 to December 2017
who presented to the hospital within 10
days after stroke onset and received brain
CT and MRI for the index stroke. ABI

screen test was applied to all of the stroke
patients within this period. We use “total
SVD score” representing the severity
of small vessel disease. The presence of
intracranial or extracranial artery stenosis is
evaluated by MRA and carotid duplex. We
use sum of each vessel’s stenotic score as
severity of large vessels stenosis, including
both extracranial and intracranial vessels.
Multivariable logistic regression analysis
of variables was used to determine the
correlation.
Results: A total of 820 patients were
enrolled for further images analysis. Patients
with abnormal ABI (defined as either one
side of value ≤0.9) had significant higher
grade of extracranial stenosis (mean scores:
7.0 vs. 5.0, p<0.001) and higher grade of
intracranial stenosis (mean scores: 12.0 vs.
11.0, p=0.002) in comparison of patients
group of normal ABI. Abnormal baPWV
(defined as either one side of value ³14)
was also correlated with higher grade of
extracranial stenosis (mean scores: 5.0 vs.
4.0, p=0.004) in comparison of normal
baPWV. SCVD scores demonstrated no
significant correlation with either ABI
or baPWV values. Multinominal logistic
regression showed that ABI values, older age
and diabetes mellitus predicted extracranial
stenosis severity and ABI values, older age
and hypertension predicted the presence of
intracranial stenosis severity.
Conclusion: Abnormal ABI was associated
with both extracranial and intracranial
stenosis, but not the presence of severe SVD
burden in acute stroke patients.
中型醫院如何維持全日全時中風取栓
運作能量：安南醫院一年經驗分享
張哲肇
年會壁報論文
臺南市立安南醫院-委託中國醫藥大學興建經
營 神經外科
How to Maintain A Full-time Operating
Endovascular Treatment Center
in A Mid-size Hospital: One Year
Experience from Tainan Municipal An-
Nan Hospital
Che-Chao Chang
Division of Neurosurgery, Department of
Surgery, Tainan Municipal An-NaN Hospital -
China Medical University, Tainan, Taiwan
With limited resource, it's difficult to maintain
the availability of endovascular treatment
(EVT) for acute ischemic stroke (AIS) in
mid-sized hospital. We share the experience
from Tainan Municipal An-Nan Hospital
(TMANH) about the basic requirements
of facilities, instruments, and members to
maintain a full-time operating EVT center.
Currently, in TMANH, there is only 1
neurosurgeon/neuro-interventionist. From
Oct. 2019 to Sep. 2020 in TMANH, we had
maintained a full-time operating EVT center
for AIS with more than 80 consultations of
stroke patients from emergency room, ward,
or intensive care unit with high NIHSS score,
which were suspected to have large vessel
occlusion. There were also some patient
who were transferred from other hospitals in
Tainan where EVT was not available. The
results revealed 21 cases were feasible for
EVT, and the percentage of TICI 2b or 3 is
76.2% (16/21). There was no intracerebral
hemorrhage which was life-threatening or
needing craniotomy.
腦部海綿狀血管畸形合併腦出血：一
病例報告
梁宏瑋、徐昌鴻
331
 年會壁報論文
三軍總醫院神經科部
Cerebral Cavernous Malformations
with Symptomatic Bleeding: A Case
Report
Hung-Wei Liang, Chang-Hung Hsu
Department of Neurology, Tri-Service General
Hospital, National Defense Medical Center,
Taipei, Taiwan
Background: Cerebral cavernous
malformations (CCM) or cavernomas are
collections of structurally abnormal slow-
flow capillaries predominantly in the central
nervous system. However, 20%–50%
of CA patients have no symptoms, and
their disease is identified incidentally
due to the widespread accessibility and
utilization of brain MRI. We present a case
of an individual with multiple cerebral
cavernous malformations with symptomatic
hemorrhage and recurrent seizures.
Case report: A 80-year-old woman was
admitted to our facility with sudden onset
of incoherent speech, jerk-like movements
of her right upper limb and dizziness. Her
past medical history was significant for
multiple CCM in bilateral hemispheres and
cavernoma of cervical spinal cord(C5-C6),
complicated with partial seizure and right
hemiparesis. Serial imaging over the ensuing
16 days revealed recent hemorrhagic CCM
of right frontal lobe, with multiple new small
cavernomas in bilateral cerebrum, brain
stem and cerebellum. Valproic acid(VPA)
was used initially to control seizure, but she
developed VPA-induced hyperammonemia.
We shifting VPA to Levetiracetam, she
experienced resolution of incoherent speech,
conscious disturbance and seizures.
Conclusion: Few studies have reported
on the potential of hemodynamic changes,
and the dramatically increased episode of
332
bleeding once a symptomatic hemorrhage
has occurred, contributing to cerebral
cavernous malformation rupture. Aiming at
stabilizing and preventing rebleeding is the
first priority when it comes to therapeutic
development of CCM with systemic
hemorrhage.
比較急性缺血中風3至4.5小時使永彪
諄劑量或低劑量Alteplase治療
陳志昊1、陳右緯1, 2、陳志弘3、湯頌君1、蔡力
凱 1、宋昇峰 4、林慧娟 5、黃虹瑜 6、傅維仁 7、
孫瑜 8、陳柏霖 9、陳龍 10、魏誠佑 11、李俊泰
12
、謝鎮楊13、林永煬14、連立明15、鄭建興1
1
台大醫院神經部、 2成大醫院神經部、 3嘉義
基督教醫院神經科、 4奇美醫院神經內科、 5中
國醫藥大學附設醫院神經科、 6馬偕醫院神經
內科、 7恩主公醫院神經科、 8台中榮總神經內
科、 9雙和醫院神經內科、 10彰濱秀傳神經內
科、 11三軍總醫院神經科部、 12台南新樓醫院
神經內科、 13台北榮總神經醫學中心神經內
科、 14新光醫院神經科
Effectiveness of Standard- Versus
Low-Dose Alteplase for Acute Ischemic
Stroke Within 3 to 4.5 Hours
Chih-Hao Chen1, Yu-Wei Chen1, 2, Chih-Hung
Chen3, Sung-Chun Tang1, Li-Kai Tsai1, Sheng-
Feng Sung4, Huey-Juan Lin5, Hung-Yu Huang6,
Helen L. Po 7, Yu Sun 8, Po-Lin Chen 9, Lung
Chan10, Cheng-Yu Wei11, Jiunn-Tay Lee12, Cheng-
Yang Hsieh13, Yung-Yang Lin14, Li-Ming Lien15,
Jiann-Shing Jeng1
1
Stroke Center and Department of Neurology,
National Taiwan University Hospital, Taipei, Taiwan
2
D e p a r t m e n t o f N e u r o l o g y, L a n d s e e d
International Hospital, Taoyuan, Taiwan
3
Department of Neurology, National Cheng
Kung University Hospital, Tainan, Taiwan
4
Division of Neurology, Department of Internal
Medicine, Ditmanson Medical Foundation
Chiayi Christian Hospital, Chiayi, Taiwan

5
Department of Neurology, Chi Mei Medical
Center, Tainan, Taiwan
6
Department of Neurology, China Medical
University Hospital, Taichung, Taiwan
7
Department of Neurology, Mackay Memorial
Hospital, Taipei, Taiwan
8
Department of Neurology, En Chu Kong
Hospital, New Taipei City, Taiwan
9
Department of Neurology, Taichung Veterans
General Hospital, Taichung, Taiwan
10
Department of Neurology and Stroke Center,
Taipei Medical University–Shuang Ho
Hospital, New Taipei City, Taiwan
11
Department of Neurology, Chang Bing Show
Chwan Memorial Hospital, Changhwa, Taiwan
12
Department of Neurology, Tri Service General
Hospital, Taipei, Taiwan
13
Department of Neurology, Sin-Lau Hospital,
Tainan, Taiwan
14
Department of Neurology and Department
of Critical Care Medicine, Taipei Veterans
General Hospital, Taipei, Taiwan
15
Department of Neurology, Shin Kong WHS
Memorial Hospital, Taipei, Taiwan
Background: The effectiveness and safety
of intravenous alteplase at 3–4.5 hours
after acute ischemic stroke onset was
already demonstrated by clinical trials and
meta-analysis. However, whether certain
subgroup benefit more from the responses
differ between low- versus standard-dose
of alteplase in this time window were
unknown.
Methods: The current analysis was based
on a retrospective, matched cohort study in
Taiwan. The treatment group comprised of
378 patients receiving intravenous alteplase
at 3–4.5 hours after onset, and 192 of them
had standard-dose (0.6 mg/kg) while 182
had low-dose (0.9 mg/kg) alteplase. The
control group included 378 age- and sex-
matched patients from the same registry
presenting in similar time window without
receiving alteplase. Favorable outcome was
defined as a modified Rankin Scale (mRS) 0
or 1 at 90 days.
Results: Overall, patients receiving alteplase
年會壁報論文
had more favorable outcome than the
controls (34.0% vs 22.7%, odds ratio [OR]
1.75, 95% confidence intervals [CI] 1.27
to 1.42), and the effectiveness was also
demonstrated in both the low-dose (OR
1.39, 95% CI 1.15-1.69) and standard-
dose group (OR 1.58, 95% CI 1.07-2.34).
The subgroup analysis showed that patients
without diabetes mellitus, without smoking,
or having cardioembolism were more likely
to benefit from the treatment. The standard-
dose was more effective in patients younger
than 70 years old (OR 1.65, 95% CI 1.04-
2.63) or having cardioembolism (OR 3.04,
95% CI 1.47-6.29), while the low-dose
performed better in patients older than 70
years old (OR 2.05, 95% CI 1.13-3.71) or
without atrial fibrillation (OR 1.86, 95% CI
1.17-2.93). Direct comparison between two
treatment groups suggested that standard-
dose was more effectiveness in patients with
atrial fibrillation (OR 2.80, 95% CI 1.24-
6.32) and hypercholesterolemia (OR 2.23,
95% CI 1.17-4.26).
Conclusions: At 3–4.5 hour time window,
the effectiveness of low-dose alteplase is
comparable with standard-dose. Standard
dose may be chosen for patients with
hypercholesterolemia or atrial fibrillation.
小腦中風
陳彥秀、何宗翰、李俊泰、宋岳峰、楊富吉
臺北三軍總醫院神經科部
A Case of Cerebellum Infarction
Yen-Hsiu Chen, Tsung-Han Ho, Jiunn-Tay Lee,
Yueh-Feng Sung, Fu-Chi Yang
Department of Radiology, Tri-Service General
Hospital, National Defense Medical Center,
Taipei, Taiwan
333
 年會壁報論文
Brain infarction is very common to seen in the
world wide, but people always miss diagnosed
cerebellum infarction compared to cerebral.
Ischemic stroke in cerebellum is less frequent
seen. More frequent in younger individuals
and those with less comorbidities. Majority of
arterial infarctions cause specific symptoms,
such as vomit, walking abnormalities and
vertigo. Dysarthria, ataxia and nystagmus may
be confused with other benign disorders of
peripheral vestibular system.
急性腦梗塞併急性心肌梗塞
陳晉誼、翁興裕
台北醫學大學 萬芳醫院 神經內科
Simultaneous Acute Myocardial and
Cerebral Infarction
Chin-I Chen, Hsing-Yu Weng
Department of Neurology, Taipei Municipal
Wanfang Hospital, Taipei Medical University,
Taipei, Taiwan
Background and Purpose: Acute myocardial
and cerebral infarctions are medical
emergencies which require immediate diagnosis
and management. However, simultaneous
acute ischemic stroke accompanied with acute
myocardial infarction has been rarely reported.
Since there is no guideline to follow, the
management of these patients is challenging.
Clinical presentation: A 61-year-old male
patient presented with sudden onset of
conscious disturbance and right hemiparesis
while waiting for our neurosugeon
outpatient department. He was sent to our
emergency room immediately. At ER, his
National Institute of Health Stroke Scale
(NIHSS) was 21. Since the onset time was
within 3 hours, intravenous TPA followed
by endovascular thrombectomy was
334
administered. Without complaining of chest
pain, his serum level of cardiac enzyme was
elevated and ECG showed sinus tachycardia
with RBBB. Cardiologist was consulted
and non S-T segment elevation myocardial
infarction (NSTEMI) was diagnosed.
Cardiac catheterization and LAD stent were
performed three days after admission. He
was discharged with NIHSS of 18.
Conclusion: We present a case having acute
infarction of left middle cerebral artery
territories and NSTEMI simultaneously. He
was successfully treated with intravenous rt-
PA plus endovascular thrombectomy for his
ischemic stroke and coronary stenting for his
myocardial infarction. Future clinical trial, in
spite of the scarcity of the cases, is necessary
to find the optimal treatment protocol.
腦中風合併顱外狹窄之介入治療
陳國瑋 1、林彥亨 2、李崇維 2
1
臺大醫院新竹分院神經外科
2
臺大醫院影像醫學部
Balloon Angioplasty Followed by
Aspiration of Large Vessel Occlusion
(BAFALO) ‒ An Efficient and Safe
Technique to Treat Tandem Occlusions
Kuo-Wei Chen1, Yen-Hung Lin2, Chung-Wei Lee2
1
D e p a r t m e n t o f S u r g e r y, D i v i s i o n o f
Neurosurgery, National Taiwan University
Hospital HsinChu Branch, Taiwan
2
Department of Medical Imaging, National
Taiwan University Hospital, Taipei, Taiwan
Background: Endovascular thrombectomy
(EVT) for acute ischemic stroke associated
with tandem occlusions is challenging. The
concurrent extracranial steno-occlusive
disease limits the intracranial access
and prolongs the revascularization time.

Thromboembolism is of concern while
crossing the proximal lesion and during
carotid stent deployment. We utilized a
technique of Balloon Angioplasty Followed
by Aspiration of Large vessel Occlusion
(BAFALO) to deal with this clinical issue.
The technical details, neurological and
radiographic outcomes were presented.
Material and Methods: A review of a
prospectively maintained stroke registry
from January 2015 to April 2020 was
performed. The patients presented with acute
ischemic stroke with concurrent extracranial
tandem steno-occlusive disease underwent
EVT were identified. The extracranial
lesions included ipsilateral carotid, vertebral
artery, and any anatomical locations that
came in the way of intracranial access.
Those treated with BAFALO technique were
included.
Results: Twelve patients were enrolled.
Eleven were anterior and one was posterior
circulation stroke. The extracranial lesions
were ipsilateral ICA stenosis/occlusion
(10), left CCA to subclavian artery bypass
stenosis (1), and VA orifice stenosis (1). The
median NIHSS was 16 (interquartile range:
14-16). mTICI 2b or more revascularization
was achieved in 11 (92%) patients. The
median puncture-to-revascularization time
was 25 (IQR: 19.5–31) minutes. Acute stent
implantation was performed in 5 (42%)
patients. Eight (67%) proximal stenotic
vessels remained patent. No symptomatic
intracranial hemorrhage occurred. Eight
(67%) patients had favorable clinical
outcomes (modified Rankin Score 0-2 at 90
days).
C o n c l u s i o n : B A FA L O t e c h n i q u e i s
applicable for various kinds of tandem lesions,
and could achieve fast revascularization, and
possibly fair clinical outcome.
年會壁報論文
富含纖維蛋白及血小板之取出血栓作
為腦中風合併癌症之標記
傅傳修 1、陳志昊 1、林彥亨 2、李崇維 2、蔡力
凱 1、湯頌君 1
1
臺大醫院神經部、 2影像醫學部
Fibrin and Platelet-rich Composition
in Retrieved Thrombi Hallmarks
Stroke with Active Cancer
Chuan-Hsiu Fu 1, Chih-Hao Chen 1, Yen-Heng
Lin2, Chung-Wei Lee2, Li-Kai Tsai1, Sung-Chun
Tang1
1
Department of Neurology and 2Department of
Medical Imaging, National Taiwan University
Hospital, Taipei, Taiwan
Background: We aim to investigate whether
histopathologic examination of thrombi
retrieved from acute ischemic stroke patients
undergoing endovascular treatment (EVT)
could distinguish cancer-related stroke from
other etiologies.
Methods: Thrombi from patients undergoing
EVT were analyzed. The etiology of stroke
was divided into cardioembolism (CE), large
artery atherosclerosis (LAA), and active
cancer groups. All selected thrombi were
subjected to hematoxylin and eosin staining.
The percentages of fibrin/platelets, red
blood cells, and white blood cells within a
thrombus were quantified.
Results: One-hundred fifty-two patients
(active cancer, 19; CE, 107; LAA, 26) were
included. Thrombi from the active cancer
group exhibited a higher fibrin/platelets
composition than did those from the CE and
LAA groups (median: 85.7% vs. 43.9% and
42.5%, P<.001). Fibrin/platelets composition
was the only independent factor (odds ratio,
1.05; 95% confidence interval, 1.02–1.08)
in differentiating cancer-related stroke from
stroke caused by CE and LAA. A fibrin/
platelets proportion of ≥65% accurately
335
 年會壁報論文
predicted cancer-related stroke (area under
curve 0.84; P<.001).
Conclusion: In thrombi retrieved from
patients undergoing EVT, a high fibrin/
platelets composition was a probable
indicator of cancer-related stroke.
甘精胰島素在急性腦中風病患併有高
血糖且需加護照護的效力及安全性：
隨機臨床試驗研究
湯頌君 1、施翔蓉 2、林欣儀 3、陳志昊 1、葉馨
喬 1、蔡力凱 1、楊偉勛 2、鄭建興 1
1
臺大醫院神經部、 2內科部、 3藥劑部
Efficacy and Safety of Insulin Glargine
in Patients With Acute Stroke and
Hyperglycemia Receiving Intensive
Care: A Randomized Controlled Study
Sung-Chun Tang 1, Shyang-Rong Shih 2, Shin-
Yi Lin3, Chih-Hao Chen1, Shin-Joe Yeh1, Li-Kai
Tsai1, Wei-Shiung Yang2, Jiann-Shing Jeng1
1
D epartment of Neurology, National Taiwan
University Hospital, Taipei, Taiwan
2
D epartment of Internal Medicine, National
Taiwan University Hospital, Taipei, Taiwan
3
D epartment of Pharmacy, National Taiwan
University Hospital, Taipei, Taiwan
Objectives/Background: This pilot study
compared the basal–bolus regimens of long-
acting insulin glargine (IG) and neutral
protamine Hagedorn (NPH) insulin in
efficacy and safety in acute stroke patients
with hyperglycemia receiving intensive care.
Material and Method: This was a
randomized, open-label, clinical trial. Stroke
patients who were admitted to the intensive
care unit within 72 h of onset and met
the inclusion criteria were enrolled. They
received either IG or NPH with added short-
336
acting prandial regular insulin over a 72-h
period. The primary endpoints were the
percentage of glucose within the range of 80
to 180 mg/dL, assessed through continuous
glucose monitoring (CGM).
Result: A total of 50 patients were included,
26 and 24 were randomly assigned to the
IG and NPH, respectively. The participant
baseline characteristics were comparable
between groups, except the IG had a
significantly higher glucose level pre-
randomization than the NPH (290.69 ± 82.31
versus 246.04 ± 41.76 mg/dL, P=.021).
CGM data showed that the percentage of
time with glucose levels between 80 and 180
mg/dL was 45.88 ± 27.04% in the IG and
53.56 ± 22.89% in the NPH (P=.341) and the
percentage of glucose reduction was 31.47
± 17.52% in the IG and 27.28 ± 14.56% in
the NPH (P=.374). The percentage of time
with hypoglycemia (<60 mg/dl) was 0.14
± 0.49% in the IG and 0.47 ± 1.74% in the
NPH (P=.361). Parameters representative
of glucose variabilities, and poststroke
outcomes were not significantly different
between the groups.
Conclusion: Our study results suggest that
early initiation of an IG-based basal–bolus
regimen is safe and equally effective as an
NPH-based basal-bolus regimen for patients
with acute stroke and hyperglycemia
requiring intensive care.
自發性腦出血患者30天死亡率之預測
─回溯性研究
黃蕙琦 1、蔡瑞窈 1、林靜薇 1、林姿君 2、劉子
菁 1、梁穎 1、李怡慧 2, 3、鍾芷萍 2, 3
1
臺北榮總護理部
2
臺北榮總神經醫學部
3
國立陽明大學

Predictors of 30-day Mortality in
Patients with Spontaneous Intracerebral
Hemorrhage: A Retrospective Study
Hui-Chi Huang1, Jui-Yao Tsai1, Ching-Wei Lin1,
Tzu-Chun Lin 2, Tzu-Ching Liu 1, Ying Liang 1,
I-Hui Lee2, 3, Chih-Ping Chung2, 3
1
Department of Nursing, Taipei Veterans General
Hospital, Taipei, Taiwan
2
Department of Neurology, Taipei Veterans
General Hospital, Taipei, Taiwan
3
School of Medicine, National Yang Ming
University, Taipei, Taiwan
Background: Spontaneous intracerebral
hemorrhage (ICH) accounts for approximately
4-14% of all strokes with a higher reported
incidence in Asian countries compared to the
West and is associated with a high mortality
and morbidity.
Purpose: To explore the predictors of 30-
day mortality in patients with spontaneous
ICH.
Methods: We retrogradely retrieved patients’
data from Stroke Registry of Taipei Veterans
General Hospital. Patients with spontaneous
ICH who were admitted between January,
2019 and January, 2020 were included.
Demographics, stroke mortality rate and risk
factor of all subjects were analyzed.
Results: There were 275 patients (65.33 ±
16.88 years, 60% men) with Glasgow Coma
Scale (GCS) score 11.66 ± 4.37 and ICH
score 1.39 ± 1.35 included. 42 (15.27%)
died within 30 days of hospitalization. The
30-day mortality rate of each ICH score
was ICH score 0: 1.12%, ICH score 1:
7.32%, ICH score 2: 6.98%, ICH score 3:
40%, ICH score 4: 66.67% and ICH score
5: 80%. Multivariate analyses adjusted
for age, sex, ICH score and vascular risk
factors (hypertension, diabetes, smoking
and alcohol), GCS score, baseline National
Institutes of Health Stroke Scale (NIHSS),
年會壁報論文
intraventricular hemorrhage, estimated
Glomerular filtration rate and the location
of ICH showed that ICH score ≥ 3 (Odds
ratio [OR] = 2.527, 95% confidence interval
[CI] = 1.673‒3.815, p=0.001), eGFR ≤
60 (OR=0.911, 95% CI=0.061‒1.961,
p=0.036), GCS score ≤ 9 (OR=1.343, 95%
CI=0.219‒2.361, p = 0.004) and the ICH
location of basal ganglion (OR=1.310, 95%
CI=0.279‒2.458, p=0.007) were independent
predictors of 30-day mortality. After receiver
operating characteristics analysis, we defined
a high-risk group for unfavorable short-
term outcome with ICH score ≥ 3, eGFR ≤
60, GCS ≤ 9 and the ICH location of BG
(Figure1‒4).
Conclusions: The present study has found
significant and independent predictors of 30-
day mortality in patients with spontaneous
ICH. The results help identify high-risk
patients with poor short-term outcome.
Key Words: intracerebral hemorrhage,
multivariate analysis, risk factors, mortality.
嚴重脂肪栓塞症候群併發癲癇重積症
後完全痊癒：一病例報告
葉柏寬
臺北三軍總醫院神經科部
Total Recovery from Severe Fat
Embolism Syndrome Complicated
with Status Epilepticus: A Case Report
Po-Kuan Yeh
Department of Neurology, Tri-Service General
Hospital, Taipei, Taiwan
Fat embolism syndrome (FES) with coma
and status epilepticus indicates a severe brain
damage. Early intervention with Hyperbaric
oxygen (HBO) therapy and cerebrolysin
337
 年會壁報論文
treatment may enhance microcirculation,
decrease neuronal injury, and facilitate
recovery. Further research about efficiency
and mechanisms of HBO and cerebrolysin
treatment for FES is warranted.
透析患者及非慢性腎臟病人口中風之
風險－納入失智症為變項分析
劉媛 1、胡凱傑 2、鍾季容 1
1
中國醫公共衛生學系
2
中國醫藥大學附設醫院健康資料中心
Risk of Stroke between Non-CKD
and Dialysis CKD Patients with and
Without Dementia
Yuan Liu1, Kai-Chieh Hu2, Chi-Jung Chung1
1
Department of Public Health, China Medical
University, Taichung, Taiwan
2
Management office for Health Data, China
Medical University Hospital, Taichung, Taiwan
Background and Purpose: Taiwan has
relatively high incidence and prevalence rates
of Chronic Kidney Disease (CKD) in the
world. There has been several studies report
that CKD is one of the risk factors of stroke
and dementia. This study aims to find out
risk of stroke between non-CKD and dialysis
CKD patients with and without dementia in
Taiwan.
Methods: We used the data of 2013 cohort
sample of National Health Insurance to
estimate the incidence rate of stroke, and we
used dementia as time-dependent covariate.
This cohort consists of 1,000,000 persons.
Cases of stroke were identified according to
International Classification of Disease 9th
edition (ICD9).
Results: The incident rate of stroke in people
with and without CKD were 62.71/1,000
and 29.33/1,000 ( p < 0.0001), respectively.
338
Patients with CKD had a higher risk of
stroke than patients without CKD (HR=2.08,
95%CI=1.92‒2.25). However, after adjusting
dementia as time-dependent covariate,
the incidence of stroke in people with
CKD was still higher than people without
CKD (HR=1.86, 95%CI=1.70‒2.03),
and people with dementia had 1.25
times risk than people without dementia
(95%CI=1.11‒1.40). While comparing the
different type of stroke, people with CKD
had higher risk of ischemia stroke (HR=3.38,
95%CI=2.76‒4.14) and higher risk of
hemorrhage stroke (HR=2.36, 95%CI=
2.11‒2.64) than people without CKD.
Conclusion: Our findings suggest that
whether ischemia or hemorrhage stroke,
patients with CKD had a higher risk of
stroke than patients without CKD in Taiwan,
and after putting dementia as time-dependent
covariate to adjust, the result remained the
same. Thus, it is worthy to reduce incidence
rate of stroke by preventing dementia and
CKD.
有症狀之孤立性內頸靜脈血栓的早期
發現及再灌流：一病例報告
劉懿
臺北三軍總醫院神經部
Early Detection and Recanalization of
Symptomatic Isolated Internal Jugular
Vein Thrombosis: A Case Report
Yi Liu
Department of Neurology, Tri-Service General
Hospital, National Defense Medical Center,
Taipei, Taiwan
Background and Purpose: Spontaneous
internal jugular vein thrombosis (IJVT) is
rare. It may be fatal due to risk of intracranial

propagation of the thrombus and pulmonary
embolism. Most patients present as cervical
pain, edema and swelling in clinical scenario
then developed post thrombosis symptoms.
We are aimed to highlight the importance
of early recognition and recanalization of
isolated internal jugular vein thrombosis.
Case: A 42-year-old woman presented with
a progressively worsening headache for 7
days. A thrombosis with critical stenosis
in her left IJV was diagnosed using color-
coded Duplex ultrasonography (CCDU)
and confirmed with magnetic resonance
venography (MRV). The patient was
treated with subcutaneous low-molecular-
weight heparin followed by warfarin. Seven
days later, the patient showed remarkable
improvement. At this time, recanalization
of the previously highly stenosed IJV was
seen in the follow-up CCDU, and it was
confirmed by three-dimensional computed
tomography angiography (CTA), and there
was no recurrence nor residual neurologic
sequelae during years of follow up.
Conclusion: We recommend that physicians
consider IJVT as a potential cause for
secondary headache. Early detection and
early recanalization with CCDU, MRV or
CTV, following systemic anticoagulants—all
safe and minimally invasive methods—are
important to offer appropriate management
in time and minimize the complication and
residual sequelae.
成人型毛毛樣血管疾病造成暫時性腦
缺血之個案報告
蔡明真、李俊泰、周中興
臺北三軍總醫院神經部
A Case of Adult-onset Moyamoya
Disease-caused Transient Ischemic
年會壁報論文
Attack
Ming-Chen Tsai, Jiunn-Tay Lee, Chung-Hsing
Chou
Department of Neurology, Tri-Service General
Hospital, Taipei, Taiwan
Background and Purpose: Adult-onset
moyamoya disease is characterized by
chronic and progressive disorder of brain
vessels. Clinical presentations include
cerebral hemorrhage (most common), stroke,
transient ischemic attack, seizure, headache,
and/or progressive cognitive impairment.
Routine non-enhanced magnetic resonance
angiography (MRA) in stroke work-up has
limitation in diagnosing the disease. To rule
out moyamoya disease, cerebral angiography
should be performed.
Methods: We report a patient presenting
with transient ischemic attack, who was
eventually diagnosed with moyamoya
disease.
Results: A 35-year-old man was admitted
due to sudden onset of left hemiparesis and
dysarthria with spontaneous recovery. Non-
enhanced magnetic resonance angiography
(MRA) of brain showed no flow signal in
the left middle cerebral artery and distal
branches and focal stenosis in the M1
segment of right middle cerebral artery.
Cerebral angiogram confirmed the diagnosis
of moyamoya disease.
Conclusion: This is a case of moyamoya
disease-caused transient ischemic attack
which demonstrated the limitation of
diagnostic value of non-enhanced MRA
due to unreliability in evaluating cerebral
circulation despite its high spatial resolution.
Cerebral angiography should be performed
if intracerebral vessel disorder is suspected.
339
 年會壁報論文
中國醫藥大學附設安南醫院急性梗塞
性腦中風機械取栓術後立即良好預後
因子分析
蔡銘駿 1、張哲肇 2
1
中國醫藥大學附設醫院
2
中國醫藥大學附設安南醫院
The Predicting Factor Analysis of
Good Prognosis Immediately after
Mechanical Thrombectomy in An Nan
Hospital, China Medical Universi
Ming-Jun Tsai1, Che-Chao Chang2
1
Department of Neurology, China Medical
University Hospital, Taichung, Taiwan
2
An Nan Hospital, China Medical Univeristy,
Taiwan
Introduction: Since 2015, mechanical
thrombectomy (IA) has been introduced for
the patient suffering from a large intracranial
artery occlusion in selected cases dominantly
within 24 hours, even though intravenous
alteplase is prior to IA. 24 hour mechanical
thrombectomy for acute ischemic stroke has
been established in An Nan hospital since
2019.10. Good prognosis immediately after
mechanical thrombectomy is important for
the evaluation of the patient and the decision
making of the doctor. Here, we proposed the
condition of good prognosis immediately
after mechanical thrombectomy and analyze
the predicting factor of the good prognosis.
Method: All 21 patients receiving mechanical
thrombectomy in An Nan Hospital, China
Medical University were included since
2019.10. In this study, we set up the
condition of the good prognosis immediately
after mechanical thrombectomy as
improvement of muscle power of suffering
limb (at least ≥1 on upper or low limb)
and minimal impaired conscious level (E
of GCS≥3) within two days and the other
patients without immediate good prognosis
340
as the control. Basic patient information,
stroke pattern, initial NIHSS, ASPECTS
before IA, onset to needle time, perfusion
scan, recanalization rate (TICI), ASPECTS
24 hours after IA and co-morbidity were
analyzed between the immediate good
prognosis group and the control.
Results: 10 patients (48% of all patients)
have immediate good prognosis after IA. The
mean age of the immediate good prognosis
group is 20.3, and the control is 23.6 (P=0.5).
The immediate good prognosis group has 10
patients with MCA occlusion and one with
BA occlusion and no any ICA occlusion,
but the control have 50% ICA occlusion
(P<0.01). The mean ASPECTS before IA in
the immediate good prognosis group is 2.4,
and the control is 2.8 (P=0.05). The mean
onset-to-needle time in the immediate good
prognosis group is 375 minutes, and the
control is 391 minutes (P=0.06). The CBV/
Tmax mismatch (CBV/Tmax <1) in the
immediate good prognosis (n=9, one patient
was not done) is 78% (7/9), and the control
(n=9, two patients were not done) is 67%
(6/9). Re-canalization rate (TICI=3 or 2b) is
60% in the immediate good prognosis group
and the control is up to 91% (P<0.05). The
mean ASPECTS 24 hours after IA in the
immediate good prognosis (n=9, one patient
is not done) is 3.8 and the control is 9.3
(n=11) (P<0.01).
Discussion: Using An Nan hospital one
year 24 hour mechanical thrombectomy
experience, we analyze predicting factors
of immediate good prognosis after IA.
We found only MCA or BA occlusion and
low score of ASPECTS 24 hours after
IA are contribute to the immediate good
prognosis, and whereas, initial NIHSS and
re-canalization rate seemed not to be related
to immediate good prognosis.

影響放射後頸動脈狹窄惡化的可改變
危險因子
鄭雅文、陳志昊、葉馨喬、蔡力凱、湯頌
君、鄭建興
臺大醫院神經部
Modifiable Vascular Risk Factors are
Associated with Progression of Post-
radiation Carotid Artery Stenosis
Ya-Wen Cheng, Chih-Hao Chen, Shin-Jeo Yeh,
Li-Kai Tsai, Sung-Chun Tang, Jiann-Shing Jeng
Department of Neurology, National Taiwan
University Hospital, Taipei, Taiwan
B a c k g ro u n d : P o s t - r a d i a t i o n c a r o t i d
artery stenosis (CAS) is an uncommon
complication in patients with head and neck
cancers. This study aims to identify factors
that are significantly associated with the
progression of CAS in these patients.
Method: We retrospectively reviewed
patients who underwent radiotherapy for
head and neck cancers from October 2011
to May 2019 in National Taiwan University
Hospital. Those who had received two
consecutive carotid duplex examinations
between an interval of 1 to 3 years were
included. The severity of CAS was evaluated
by the modified plaque scoring system, and
the progression of CAS was defined as an
increase of plaque score 3 in either side of
the carotid artery between two examinations.
Result: During the study period, 736
patients (age 57.9±9.9 years; male, 75.1%;
nasopharyngeal cancer, 73.2%) had received
at least two examinations. The mean duration
between the last radiation and first carotid
duplex examination was 99.1±77.4 months.
At baseline, higher severity of plaque
scores was significantly associated with
hypertension, smoking, drinking, coronary
artery disease, previous stroke, conventional
type of radiotherapy, and longer duration
年會壁報論文
after the last radiotherapy. Of 736 patients,
11 9 ( 1 6 . 2 % ) h a d t h e p r o g r e s s i o n o f
CAS. Patients with progression of CAS
were more likely to have hypertension,
diabetes mellitus, hypercholesterolemia,
nasopharyngeal cancer in cancer types,
and higher baseline plaque scores.
Multivariable analysis shows that
nasopharyngeal cancer (OR=2.45, 95% CI
1.41-4.27, p=0.001], baseline plaque score
(OR=1.13, 95% CI 1.07-1.20, p<0.001],
and hypercholesterolemia (OR=1.768, 95%
CI 1.16-2.70, p=0.009] were independently
associated with the progression of CAS.
Conclusion: Besides cancer type and
baseline severity, our study suggested that
modifiable vascular risk factors are crucially
involved in the progression of post-radiation
CAS in patients with head and neck cancers.
人工智慧神經類網路模型於腦部核磁
共振文字報告預測急性缺血性腦中風
嚴重度及功能預後
謝孟倉 1、陳益君 2、林義隆 3、黃瑞初 2
1
義大醫療財團法人義大醫院神經科暨腦中風
中心
2
義守大學電機工程學系
3
雲林科技大學資訊工程學系
Artificial Intelligence with Neural
Network Modeling Optimizes Stroke
Severity and Functional Outcome
Prediction by the Context of Brain
MRI Report in Acute Ischemic Stroke
Patient
Meng-Tsang Hsieh1, I-Chun Chen2, Yih-Lon Lin3,
Rey-Chue Hwang2
1
Stroke Center and Department of Neurology,
E-Da Hospital, Taiwan
2
Department of Electrical Engineering, I-Shou
University, Taiwan
341
 年會壁報論文
3
 epartment of Computer Science and
D by the Continuous Bag of Words (CBOW)
Information Engineering, National Yunlin
University of Science and Technology, Taiwan
Background and Purpose: The stroke
severity, determined by the National Institute
of Health Stroke Scale (NIHSS), affects
the outcome after stroke and the decision
making of the management. The modified
Rankin Scale (mRS) can stand the functional
outcome after stroke. The information on
brain magnetic resonance imaging (MRI),
including brain volume, active brain lesion,
old structure insults, and vasculature, can
predict the stroke severity and functional
outcome. The text report of brain MRI is
available in the National Health Insurance
(NHI) Cloud. It is more convenient than
the original image and more structured in
content. Artificial intelligence and machine
learning in modeling can optimize the
prediction of both stroke severity and
function. This study aimed to use artificial
intelligence to investigate the application of
the text report of brain MRI in optimizing
the prediction of NIHSS and discharge mRS.
Methods: This study used the stroke
registry from 2016/10 to 2020/08 in E-Da
Hospital. Patients hospitalized due to
acute ischemic stroke within 10 days were
identified, and the text reports of MRI
were retrieved during hospitalization. The
NIHSS was evaluated when admission and
the mRS were evaluated when discharged
by experienced neurologists. The artificial
neural network (ANN) models were built
by using the context of the MRI report as
input and both NIHSS and mRS as output.
We used the OneHotEncoding method
to preprocess the context of the MRI
report. The tool of Word2Vec was used to
establish the dictionary and to predict the
context which came from the target word
342
approach. In the first model of AAN, we
used the context of the MRI report to predict
the outcome directly; in the second model,
we did different classification of outcome
prediction; in the third model, we used
AAN to determine the key words as first
level selection and combined the key words
to predict the outcome. We used different
ANN models to train and test the ability of
prediction of NIHSS or mRS. The ability
of prediction with ANN was determined by
accuracy for categorical variables and MAE
and mean ratio for ordinal variables.
Results: In phase one, there were 600
hospitalized records with AIS during the
study period and more than 90% of subjects
had a brain MRI. The ANN with brain MRI
report context as input identified NIHSS,
with MAE and mean NIHSS ratio 18.1%;
and similar input identified the different
classification of mRS, with respective 67%
accuracy of mRS 0‒1, 60% of mRS 2‒3,
and 73% of mRS 4‒5. In the next step,
the AAN model will be refined with more
MRI context input and a more precise
classification of mRS.
Conclusion: The application of ANN and
the context of brain MRI report improved
stroke severity and functional prediction
among AIS patients. The convenience and
acquirable of the context of the brain MRI
report in the Taiwan NHI system makes this
application important. This AAN model
application needs more cases to refine
accuracy.
鱗狀上皮子宮頸癌晚期個案發生
Trousseau症候群及靜脈栓塞：一病例
報告
謝承儫、柯玠安、林鈺凱、李俊泰

臺北三軍總醫院神經內科
Trousseau Syndrome and Venous
Thromboembolism in a Patient with
Advanced Cervical Squamous Cell
Carcinoma: A Case Report
Cheng-Hao Hsieh, Chien-An Ko, Yu-Kai Lin,
Jiunn-Tay Lee
Department of Neurology, Tri-service General
Hospital, Taipei, Taiwan
Objective: To present a rare case of
ischemic stroke followed by cervical
squamous cell carcinoma (SqCC) with
venous thromboembolisms.
Case report: A 44-year-old woman with
a history of cervical SqCC presented
with advanced stage cervical SqCC.
Computed tomography of the pelvis
revealed thrombosis of the left femoral vein
secondary to metastatic nodal compression,
or Trousseau’s syndrome. The stroke caused
acute onset weakness of the right side of her
body. Magnetic resonance imaging revealed
multifocal infarctions of the patient’s
cerebrum and cerebellum. We diagnosed
the patient with acute cerebral infarctions
derived from her hypercoagulable state.
Conclusion: Cancer patients are at an
increased risk of thromboembolic events,
and the combination of both pathological
c o n d i t i o n s i s k n o w n a s Tr o u s s e a u ’s
syndrome. To minimize patient morbidity
and mortality, early recognition of such
events is critical. Close surveillance and
effective prophylactic treatment regimens
for these patients should be established.
心像治療對於腦中風患者的行走能力
之影響：系統性回顧與統合分析
魏雅瑩
年會壁報論文
高雄國軍總醫院醫療部復健科
Effects of Motor Imagery in Ambulation
Ability After Stroke: Systematic Review
and Meta-Analysis
Ya-Ying Wei
Department of Physical Medicine and
Rehabilitation, Kaohsiung Armed Forces General
Hospital, Kaohsiung, Taiwan
Background: Mental imagery (MI), also
known as visualization, is a subjective
experience of perception without real
sensory stimuli. However, there is a
lack of current systematic reviews that
investigate the functional recovery of the
lower extremity (LE) after receiving MI
intervention. Therefore, the primary purpose
of this study is to investigate the effects of
MI on functional recovery of LE in stroke
patients by a systematic review.
Methods: A comprehensive database
search of the literature up to April 2020
was performed via Cochrane, MEDLINE,
EMBASE, PubMed, Physiotherapy
Evidence Database scale (PEDro). The
keywords were: (1) stroke/cerebrovascular
accident, (3) Motor/Mental Imagery, and (4)
lower/walk/ambulation. Randomized clinical
trials which include MI intervention for
improving the LE recovery of stroke patients
were located. The primary outcomes were
clinical assessments of LE motor recovery
and ambulation ability. Two review authors
independently assessed the risk of bias and
trial quality via the Cochrane risk of bias
tool and the PEDro and then synthesized the
study results. Meta-analysis was performed
with a fixed-effects model due to similar
study in participants and outcome measures.
Results: Four studies (total of 142 stroke
patients) of high-quality and low-bias were
included. These studies show that MI could
343
 年會壁報論文
promote ambulation ability recovery, which
improved the performance of Timed Up-and-
Go (TUG) test by 11.3-38.6%, 10-m Walk
Test (10mWK) by 22.0-42.2%. The overall
treatment effect was small to large for TUG
standardized mean differences (SMD) 0.10
(95% CI: -0.57-0.36), Chi² = 0.78 (P = 0.38),
I² = 0%, and 10mWK SMD 1.47 (95% CI:
2.13–0.80), Chi² = 5.04 (P = 0.02), I² = 80%.
Discussion: MI, has been studied and
showed that it can promote the motor
recovery of stroke patients by repairing the
underlying neural damage. Previous studies
also demonstrated that MI, in combination
with rehabilitation therapy, could promote
344
motor functional recovery after stroke.
Conclusion: This systematic review shows
that MI therapy may have more positive
effects on the recovery of LE motor and
ambulation ability than conventional therapy
for stroke patients. Due to the small number
of studies and high heterogeneity of the
available scientific literature, more studies
are needed to determine the most effective
therapy protocol.
Clinical Relevance: MI could be a viable
intervention for all phases of stroke patients
because it is safe, cost-effective, and
clinically convenient to be combined with
other therapies.