• Title/Summary/Keyword: 지주막하출혈

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Usefulness of $^{99m}Tc$-HMPAO SPECT in Patients with Subarachnoid Hemorrhage due to Ruptured Intracranial Aneurysm (뇌동맥류파열에 의한 지주막하출혈 환자에서 $^{99m}Tc$-HMPAO SPECT 검사의 유용성)

  • Choi, C.W.;Lee, K.H.;Kim, J.H.;Kwark, C.;Lee, D.S.;Chung, J.K.;Lee, M.C.;Han, D.H.;Koh, C.S.
    • The Korean Journal of Nuclear Medicine
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    • v.27 no.2
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    • pp.175-182
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    • 1993
  • We evaluated the usefulness of $^{99m}Tc$-HMPAO SPECT in 21 Patients with subarachnoid hemorrhage due to ruptured intracranial aneurysm and in 3 patients with unruptured intracranial aneurysm. SPECT study could detect the bilaterally hypoperfused cases in 10 patients (48%), but CT/MRI showed the bilateral abnormalities in only 3 patients (14%). The number of abnormal lesions were 56 in SPECT and 25 in CT/MRI. The lesions found in SPECT were well correlated with the neurological signs of the patients such as aphasia or hemiplegia. SPECT study during Matas test was helpful in evaluating the risk for carotid artery occlusion therapy. We thought that $^{99m}Tc$-HMPAO brain SPECT is helpful in evaluating the functional changes in patients with subarachnoid hemorrhage.

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Utility of Acetazolamide-Enhanced Brain Perfusion SPECT in Predicting Outcome of the Patients with Aneurysmal Subarachnoid Hemorrhage (뇌동맥류파열에 의한 지주막하 출혈환자의 예후평가에 있어서 아세타졸아미드 부하 뇌혈류 SPECT의 유용성)

  • Choi, Yun-Young;Kim, Jae-Min;Kim, Kwang-Myung;Choe, Il-Seung;Cho, Suk-Shin
    • The Korean Journal of Nuclear Medicine
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    • v.35 no.4
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    • pp.241-250
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    • 2001
  • Purpose: Vasospasm is a complication of aneurysmal subarachnoid hemorrhage (aSAH). We assessed the role of acetazolamide-enhanced brain perfusion SPECT (ACZ-SPECT) with Tc-99m ECD for predicting the prognosis of patients with aSAH. Materials and methods: Two SPECT studios (baseline with 740 MBq and ACZ-SPECT with 1480 MBq) with image subtraction were performed in 21 patients with aSAH. All patients had brain CT and angiogram. Vasoreactivity on ACZ-SPECT, perfusion defect on baseline SPECT, and vasospasm on angiogram were correlated with Hunt-Hess grading, extent of SAH (unilateral or bilateral) on CT, and clinical outcome. Vasoreactivity was considered decreased when cerebral/cerebellar uptake ratio difference from baseline SPECT to ACZ-SPECT was greater than 2SD of normal control values. Results: Decreased vasoreactivity was observed in 38% (8/21), perfusion defect in 81% (17/21), and vasospasm in 38% (8/21). The preserved vasoreactivity group showed better outcome scale (92%, 12/13) and the decreased vasoreactivity group showed poorer outcome scale (62.5%, 5/8) (p=0.014). Extensive SAH was more frequently seen in the decreased vasoreactlvlty group (87.5%, 7/8) than in the preserved vasoreactivity group (30.7%, 4/13)(p=0.017). The perfusion defect and vasospasm did not show good correlation with outcome scale, extent of SAH, and Hunt-Hess grading (p=ns). Vasoreactivity represented the patient's outcome better than the vasospasm in all of the vasoreactivity/vasospasm-mismatched cases (6 cases). Conclusions: Our data show that decreased vasoreactivity on ACZ-SPECT does not always represent vasospastic condition. But patients with decreased vasoreactivity reveal poorer outcome than patients with angiographic vasospasm do. Therefore ACZ-SPECT is a valuable, noninvasive test for predicting the prognosis of patients with aSAH.

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Development of a Quality Evaluation Tool for Aneurysmal Subarachnoid Homorrhage Patient Care (뇌 동맥류성 지주막하출혈 환자간호의 질 평가 도구 개발)

  • Bae, So-Hyun;Shin, Sung-Rae
    • Korean Journal of Adult Nursing
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    • v.15 no.4
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    • pp.628-638
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    • 2003
  • Purpose: The purpose of this study was to develope a evaluation tool of the quality of nursing care for aneurysmal subarachnoid hemorrhage patients at Hunt & Hess Grade I~III. Method: The data was gathered from April 15, 2002 to June 14, 2002. The tool proceeded in six steps according to Bloch's framework. Result: The results of this study are as follows: 1) The quality evaluation tool for neurosurgery ICU consisted of 25 standards and 138 criteria. The quality evaluation tool for ward consisted of 27 standards and 144 criteria.; 2) The content validities of the tools for neurosurgery ICU and ward were 0.96 and 0.98, respectively.; 3) The Pearson coefficients for evaluating the interrated reliability of the tools for neurosurgery ICU and ward were r=0.9106 (p<0.1) and r=0.8807 (p<0.1), respectively.; 4) The ranges of corrected item-total correlations for evaluating the construct validity of the tools for neurosurgery ICU and ward were 0.0279~0.9354 and 0.0174~0.9682, respectively.; And 5) The ranges of Cronbach's ${\alpha}$ reliabilities for evaluating the internal consistency reliability of the tools for neurosurgery ICU and ward were 0.6040~0.8554 and 0.6212~0.9584, respectively. Conclusion: The tools developed in this study seem useful in evaluating the quality of nursing care for aneurismal subarachnoid hemorrhage patients at Hunt & Hess Grade I-III.

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The Effect of Yangkyuksanhoa-tang Extracts on the Changes of the Immunoreactive Nerve Fiber in the Rat Basilar Artery after Subarachnoid Hemorrhage (지주막하출혈 후 뇌기저동맥벽에 존재하는 면역양성 신경섬유의 변화에 미치는 양격산화탕(凉膈散火湯)의 효과)

  • Lee, Dong-Weon;Lee, Won-Chul
    • The Journal of Dong Guk Oriental Medicine
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    • v.8 no.1
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    • pp.117-131
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    • 1999
  • Yangkyuksanhoa-tang is frequently used for cerebrovascular accident(CVA). The present study was performed to investigate the effect of Yangkyuksanhoa-tang on the peri vascular immunoreactive nerve fiber of the basilar artery after experimentally induced subarachnoid hemorrhage(SAH). Sprague Dawley rats weighing between 350-400g were used. The SAH induced by injection of the fresh autologus heart blood(0.3-0.4ml) into the cisterna magna through the posterior atlanto-occipital membrane. Sample group was given a $3.3m{\ell}/kg/day$ of Yangkyuksanhoa-tang extracts for 2 days after SAH. The experimental animals divided into 48hrs after SAH. The changes of perivascular immunoreactive nerve fiber was examined by using indirect immunofluorescence method. The meshlike perivascular nerve fiber appeared in the basilar artery of normal rats. In basilar artery of SAH elicitated rat, the distribution of calcitonin gene-related peptide (CGRP)-immunoreactivity(IR) and vasoactive intestinal polypeptide(VIP)-IR of the perivascular nerve fiber were remarkably diminished, also dopamine beta hydroxylase(DBH)-IR, neuropeptide Y(NPY)-IR and serotonin-IR were diminished. In SAH elicitated rat with Yangkyuksanhoa-tang treatment, the CGRP-IR and VIP-IR degree were repaired as well as normal rat's, but DBH-IR, NPY-IR and serotonin-IR had no changes. These results provide the basic data to investigate the effect of Yangkyuksanhoa-tang on the vasospasm after SAH.

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