• Annals of Clinical Neurophysiology
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• 제1권1호
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• pp.55-59
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• 1999

Vasoconstriction of intracerebral arteries is the leading cause of delayed cerebral infarction and mortality following aneurysmal subarachnoid hemorrhage. Transcranial Doppler studies show and increase in the flow velocities of basal cerebral arteries, which usually start around day 4 following a subarachnoid hemorrhage, and peaking by days 7 to 14. Angiographic studies confirm the presence of at least some degree of MCA vasospasm when the flow velocities are higher than 100 cm/sec. Mean velocities in the 120 to 200 cm/sec range correspond to 25 to 50% luminal narrowing. MCA and ACA vsospasm is detected with around 90% specificity. Sensitivity is 80% and 50% respectively. A 200cm/sec threshold and rapid flow velocity increase exceeding 50 cm/sec on consecutive days, has been associated with subsequent infarction. Transcranial Doppler is also used to monitor the effects of endovascular treatment of vasospasm. Flow velocities decrease following successful angioplasty or papaverine infusion. Overall, transcranial Doppler studies are considered to have acceptable accuracy for the evaluation of vasospasm in aneurysmal subarachnoid hemorrhage, with limitations that have to be taken into consideration in the clinical setting.

• 사상체질의학회지
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• 제21권3호
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• pp.186-192
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• 2009

1. Objective: This study is about a Soyangin patient with vertigo after subarachnoid hemorrhage. In this study, we report the effects of Sasang constitutional treatment to this patient. 2. Methods: This patient was treated by Soyangin's constitutional medications and acupunture according to the result of Sasang constitutional diagnosis. 3. Results and Conclusions: This patient's chief complaints were vertigo and gait disturbance. By using Yangkyuksanhwa-tang mainly, she showed positive response about her symptom. This study shows that Yangkyuksanhwa-tang has effect to vertigo in Soyangin.

• 사상체질의학회지
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• 제31권4호
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• pp.57-64
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• 2019

Objectives This study is to investigate the effect of sasang constitutional medicine on the delirium and cognitive decline caused by traumatic subarachnoid hemorrhage in a soeumin alzheimer patient Methods We have treated a 79-year-old Soeumin patient mainly with Doksampalmul-tang. She was already suffering from Alzheimer's disease. After traumatic subarachnoid hemorrhage, there were symptoms of delirium and cognitive decline. The degree of improvement was checked by K-MMSE and K-MOCA scores. Results The K-MMSE score improved from 0 to 11 and the K-MOCA score from 0 to 3. Conclusions Sasang constitutional medicine has been effective in the treatment of delirium and cognitive decline caused by traumatic subarachnoid hemorrhage.

• 대한약침학회지
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• 제11권2호
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• pp.131-140
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• 2008

Objective Spinal SAH is an unusual disease that occasionally occurs spinal cord injury. This report intended to estimate the effect that taken by using oriental treatment on the patient with the sequelae of spinal SAH. Methods We have observed this case of patient treated by Dong's acupuncture therapy, pharmacopuncture therapy, Mae-sun therapy and herbal medication, etc. Results The patient showed improvements in pain, power and sensory function. Conclusion Oriental treatments such as Dong's acupuncture therapy, pharmacopuncture therapy, Mae-sun therapy and herbal medication can be effective for the sequelae of spinal SAH.

• 대한한방내과학회지
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• 제39권5호
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• pp.955-963
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• 2018

This case report documents one patient with acute cortical cisternal subarachnoid hemorrhage. The patient had a central pain in the right upper limb and was treated with traditional Korean medicine in the Oriental Hospital of Se-Myung University. The patient was treated with Yangkyuksanwha-tang and acupuncture and followed up with a symptoms checklist and brain computed tomography (CT) scan. Initially, the frequency of right upper extremity pain was 18 per day, but this disappeared after treatment. CT follow up showed that subarachnoid hemorrhage was resolved. There were no side effects associated with treatment. This case shows that traditional Korean medicine treatment is effective in treating acute cortical subarachnoid hemorrhage.

• 대한한방내과학회지
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• 제42권2호
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• pp.197-206
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• 2021

Subarachnoid hemorrhage (SAH) is a disease that causes bleeding in the subarachnoid space; 70%-80% of nontraumatic subarachnoid hemorrhages are caused by saccular aneurysms. If the patient has already experienced a ruptured aneurysm that causes subarachnoid bleeding, rebleeding can result in a high mortality rate and serious sequelae. Therefore, if the patient can undergo surgical or interventional treatment, it should always be performed. This patient was diagnosed with acute aneurysmal subarachnoid hemorrhage and hydrocephalus. The patient was hospitalized for uncontrolled headache and vertigo after aneurysm coil embolization and ventriculoperitoneal shunting. The patient was treated with Yangkyuksanwha-tang and acupuncture and was observed with a symptom checklist for 25 days. Headache improved, from a visual analog scale (VAS) score of 7 to 0. Vertigo also improved, from a numeric rating scale (NRS) of 6 to 2, and the vertigo pattern changed from rotational to nonrotational. This case suggests that Korean medicine treatment is helpful in managing subarachnoid hemorrhage sequelae.

• Clinical and Experimental Pediatrics
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• 제46권11호
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• pp.1067-1072
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• 2003

목 적 : 소아에서 사고에 의하지 않은(non-accidental) 두개내출혈은 빈도가 아주 드물지 않으며 성인과 다른 임상 양상을 보이고 높은 사망률과 심각한 후유증을 남긴다. 특히 흔들린 아이증후군은 소아에서만 있는 두개내출혈로 최근 본원에서 여려 사례를 경험하였다. 이에 저자들은 사고에 의하지 않은 두개내 출혈로 한림대학교성심병원에 입원한 소아 환아들을 대상으로 성별, 연령 분포, 원인, 내원 당시 임상 증상, 출혈 유형, 사망률과 후유증에 대해 조사하였다. 방 법 : 1999년 1월부터 2002년 6월까지 3년 6개월간 한림대학교 성심병원 소아과와 신경외과에 사고에 의하지 않은 두개내출혈로 입원한 15세 이하의 환아 중 신생아의 두개내출혈 환아를 제외한 20례를 대상으로 병력지를 검토하여 후향적으로 분석하였다. 결 과 : 1) 남녀비는 1 : 0.8이었고 연령 분포는 1세 미만 9례(45%), 1-5세 2례(10%), 6-10세 3례(15%), 11-15세 6례(30%)로 1세 미만과 11-15세에서 가장 많이 분포하였다. 2) 원인은 흔들린 아이 증후군 5례(25%), 동정맥 기형 5례(25%), 해면상 혈관종 2례(10%), 뇌종양 2례(10%), 동맥류 1례(5%), 원인 질환이 밝혀지지 않은 경우가 5례(25%)로 흔들린 아이 증후군과 동정맥 기형이 가장 많았다. 3) 내원 당시 임상 증상으로 경련 11례(55%), 의식 변화 6례(30%), 구토 5례(25%), 두통 3례(15%), 편측 부전마비 1례(5%), 보챔 1례(5%), 안면 경축 1례(5%)로 경련이 가장 많았다. 4) 출혈 유형은 경막하 출혈 8례(40%), 뇌내 출혈 5례(25%), 복합 두개내 출혈 5례(25%), 지주막하 출혈 2례(10%)였다. 5) 대상 환아 20례 중 사망률은 3례로 15%였고 생존율은 17례로 85%였다. 생존아 중 추적 관찰이 되지 않은 5례를 제외한 12례에서 완전 회복된 경우가 6례였으며 후유증이 남은 경우가 6례였다. 후유증이 남은 6례 중 편측 부전마비 2례, 동측성 반맹 2례, 발달 장애 2례, 사지 마비 2례, 단마비 1례, 학습 장애 1례, 시력 장애 1례였다. 결 론 : 소아에서 사고에 의하지 않은 두개내 출혈의 발생률은 아주 낮지 않으며 사망률과 후유증 발생 가능성이 높기 때문에 조기 진단과 적절한 치료가 필요하다. 또한 최근 의학의 발달로 생존율이 높아지면서 신경학적 후유증을 가진 소아들이 늘어남에 따라 이들에 대한 적극적인 재활 관리가 필요하다고 생각된다.

• Journal of Korean Neurosurgical Society
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• 제29권1호
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• pp.108-112
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• 2000

Objective : Many authors suggest that patients with traumatic subarachnoid hemorrhage(tSAH) visible on first CT after heve injury had a significantly worse prognosis than patients who do not. The aim of this study is to identify patients with tSAH who present with a bad prognosis by reviewing their clinicoradiological features and plan appropriate treatments. Patients and Methods : We reviewed and analysed the factors that influenced discharge outcomes in 172 patients with tSAH for a 3-year period. The outcome was divided into good(good recovery and moderate disability of glasgow outcome scale) and good(severe disability, vegetative state and death). Results : A regression analysis of statistical significant factors(p<0.05) among the clinical and CT features ranked them by descending order of contribution to Glasgow Outcome Scale(GOS) scores at the time of discharge from acute hospitalization as follows 1) clinical : admission Glasgow Coma Scale(GCS), hypotension, CT grade, abnormal APTT, skull fracture, hyperglycemia(>160mg/dl), hypoxia, operation, 2) CT : basal cistern effacement(BCE), mass lesion, cortical sulcal effacement(CSE), midline shift. Conclusion : We have also experienced that the CT grading scale proposed by Green et al is a simple and useful prognostic factor. The authors believe that the patients with high CT grade need adjuvant therapies as of well surgery but it seems mandatory to consider early identification and correction of hypotension, hyperglycemia, and hypoxia in emergency setting.

• Journal of Korean Neurosurgical Society
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• 제30권12호
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• pp.1375-1380
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• 2001

Objective : The authors analyzed the incidence, the cause and the prognosis of hydrocephalus following aneurysmal subarachnoid hemorrhage to evaluate the risk factors of hydrocephalus and to provide the proper treatment method for hydrocephalus following aneurysmal subarachnoid hemorrhage. Methods : The 505 cases of subarachnoid hemorrhage followed by aneurysmal surgery from January 1990 to May 1999, were divided into shunt group and shunt-free group and we were reviewed for the clinical status, Fisher's grade, brain CT findings and prognosis. Results : The incidence of acute hydrocephalus was 37.2% of patients and 18.9% to developed chronic hydrocephalus. Shunt surgery due to chronic hydrocephalus was required in 6.5% of patients. We found following variables were significantly related to shunt-dependent hydrocephalus : high Hunt-Hess and Fisher grade, initial CT findings of intraventricular hemorrahge, posterior circulation aneurysm, preoperative rebleeding, delayed ischemic deficits, and initial high ventricular size index. There were no statistically significant relationships between shunt-dependent hydrocephalus and patient age or sex, timing of operation. The previous hypertension was not related to shunt dependent hydrocephalus. Prognosis in shunt group showed poor result. Conclusion : The risk factors of hydrocephalus following aneurysmal subarachnoid hemorrhage are high Hunt-Hess grade, high Fisher's grade, aneurysms of posterior circulations, preoperative aneurysmal rebleeding, delayed ischemic deficits, initial CT findings of intraventricular hemorrahge and initially increased ventricular size. The patients with these factors should the carefully observed and managed accordingly due to poor prognosis related to hydrocephalus requiring shunt operation.

• Journal of Korean Neurosurgical Society
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• 제30권sup1호
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• pp.68-72
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• 2001

Objective : The goal of this study was to document the influence of the treatment modality(surgery versus endovascular treatment) on the development of chronic shunt-dependent hydrocephalus in a series of 296 patients treated after aneurysmal subarachnoid hemorrhage(SAH). Methods : The following parameters were retrospectively analyzed for association with chronic shunt-dependent hydrocephalus : 1) Age and Sex, 2) Hunt and Hess grade, 3) Fisher computed tomographic grade, 4) aneurysm location, and 5) treatment modality(surgery versus endovascular treatment). Results : Thirty-six of 251 patients(14.3%) who survived the SAH and its neurological and/or medical sequelae underwent definitive shunting for treatment of chronic hydrocephalus. The rate of shunt dependency was positively correlated with a higher age, a higher Hunt and Hess grade, a higher Fisher computed tomographic grade, and aneurysms arising at the anterior communicating artery(p<0.05). Conclusion : The results of the present study indicate that the treatment modality used does not affect the risk of the later development of chronic shunt-dependent hydrocephalus(surgery, 16.2% [25 of 154] ; endovascular treatment, 11.3% [11 of 97] ; p=0.45).