• Journal of Korean Neurosurgical Society
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• 제60권6호
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• pp.620-626
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• 2017

Objective : Although venous thromboembolism (VTE) is frequently related to dehydration, the impact of dehydration on VTE in acute ischemic stroke (AIS) is not clear. This study investigated whether dehydration, as measured by blood urea nitrogen (BUN)/creatinine (Cr) ratio, influences the occurrence of VTE in patients with AIS. Methods : This is a retrospective study of patients with AIS between January 2012 and December 2013. Patients with newly diagnosed AIS who experienced prolonged hospitalization for at least 4 weeks were included in this study. Results : Of 182 patients included in this study, 17 (9.3%) suffered VTE during the follow-up period; in two cases, VTE was accompanied by deep vein thrombosis and pulmonary embolism. Patients with VTE were more frequently female and had higher National Institutes of Health Stroke Scale (NIHSS) score, more lower limb weakness, and elevated blood urea nitrogen BUN/Cr ratio on admission. In a multivariate analysis, BUN/Cr ratio >15 (odds ratio [OR] 8.75) and severe lower limb weakness (OR 4.38) were independent risk factors for VTE. Conclusion : Dehydration on admission in cases of AIS might be a significant independent risk factor for VTE.

• Journal of Preventive Medicine and Public Health
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• 제56권2호
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• pp.145-153
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• 2023

Objectives: Although it is difficult to define the quality of stroke care, acute ischemic stroke (AIS) patients with moderate-to-severe neurological deficits may benefit from thrombectomy-capable hospitals (TCHs) that have a stroke unit, stroke specialists, and a substantial endovascular thrombectomy (EVT) case volume. Methods: From national audit data collected between 2013 and 2016, potential EVT candidates arriving within 24 hours with a baseline National Institutes of Health Stroke Scale score ≥6 were identified. Hospitals were classified as TCHs (≥15 EVT case/y, stroke unit, and stroke specialists), primary stroke hospitals (PSHs) without EVT (PSHs-without-EVT, 0 case/y), and PSHs-with-EVT. Thirty-day and 1-year case-fatality rates (CFRs) were analyzed using random intercept multilevel logistic regression. Results: Out of 35 004 AIS patients, 7954 (22.7%) EVT candidates were included in this study. The average 30-day CFR was 16.3% in PSHs-without-EVT, 14.8% in PSHs-with-EVT, and 11.0% in TCHs. The average 1-year CFR was 37.5% in PSHs-without-EVT, 31.3% in PSHs-with-EVT, and 26.2% in TCHs. In TCHs, a significant reduction was not found in the 30-day CFR (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.76 to 1.12), but was found in the 1-year CFR (OR, 0.84; 95% CI, 0.73 to 0.96). Conclusions: The 1-year CFR was significantly reduced when EVT candidates were treated at TCHs. TCHs are not defined based solely on the number of EVTs, but also based on the presence of a stroke unit and stroke specialists. This supports the need for TCH certification in Korea and suggests that annual EVT case volume could be used to qualify TCHs.

• 대한예방한의학회지
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• 제3권1호
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• pp.147-155
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• 1999

In order to investigate the effect of circulating blood and extinguishing blood stasis method on acute ischemic stroke treatment, we compared muscle weakness in two groups. Dansamhwanotang was administered to experimental group and the Sopungtang was administered to comparison group. In prospective and consecutive study, 24 patients(male 14, female 10) were admitted to hospital within 6hours(median $4.21{\pm}2.45)$ after stroke attack. All of them were diagnosed computed tomography as acute cerebral infarction. We divided that patients into two groups. The experimental group was 13, took median $4.17{\pm}1.72hrs$ to admission after stroke attack and the comparison group 11, median $4.31{\pm}2.72hrs$ to admission after stroke attack. There was no statistical difference in time consumed from stroke onset to admission(P>0.05). Muscle weakness was measured on admission and 7 days later on AMA(American Medical Association) method. In the experimental group, muscle weakness on admission was $2.23{\pm}0.51$ and $2.79{\pm}0.72$ in upper and lower extremity, respectively. In comparison group, muscle weakness on admission was $2.17{\pm}0.43$ and $2.67{\pm}0.82$ in upper and lower extremity, respectively. There was no difference in muscle weakness(P〈0.05). In 7 days after, muscle weakness was $2.31{\pm}0.35$ in upper extremity and $3.15{\pm}0.12$ in lower extremity in experimental group, and $2.27{\pm}0.74$ in upper extremity and $3.45{\pm}0.48$, lower extremity in comparison group. There was no meaningful improvement statistically in upper extremity(p<0.05) but significant evolution in lower extremity(p<0.05). The muscle weakness comparison between admission time and 7 days later was as follows. Experimental group had improvement at the degree of $0.24{\pm}0.92$, $0.42{\pm}0.82$ in upper and lower extremity, respectively and comparison group, $0.12{\pm}0.82$, $0.27{\pm}0.97$ in same part(p<0.05). So, Dansamhwanotang administered group had more good muscle weakness improvement than Sopungtang administered group(P>0.05). From the above result, I suppose that circulating blood and extinguishing blood stasis method helps recover hemiparesis caused by acute ischemic cerabral disease, in acute stage at least.

• 대한한방내과학회지
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• 제19권2호
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• pp.28-36
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• 1998

Background : Yang-do-rack is frequently used in diagnosing syndromes in oriental medical hospital, but there has been few clinical report on Yang-do-rack. So we intended to find out the relationship among Yang-do-rack, general characteristics and the differentiaion of syndromes in acute stroke patients. Materials and Methods : In this study we selected the subjects who were hospitalized from March 1, 1998 to July 31. 1998 at the department of circulatory internal medicine at college of oriental medicine, in Kyung-Hee University, diagnosed acute cerebral infarction or hemorrhage within 7 days after onset time. We checked Yang-do-rack scores with Autonomic Nervous System YORAK (Sord Medicom co. Ltd, Korea) and calculated the scores of each diffentiation of syndroms. Resuts : 1. In left leg meridian, there was more numerical value male than female on LF1, LF2, LF4, LF6. The value of LF1, LF3, LF4, LF5 was getting lower as the score of heat-transformation syndrom(火熱證) increased. 2. In left arm meridian, there was more numerical value male than female on LH2, LH5. The value of LH1, LH3, LH5 was getting lower as the score of exuberance of Yang due to deficiency of Yin syndrom(陰虛陽亢證) increased. 3. In right leg meridian, there was more numerical value male than female on RF1, RF2, RF4, RF6. The value of RF3, RF5 was getting lower as the score of heat-transformation syndrom(火熱證) increased and RF4 as the score of exuberance of Yang due to deficiency of Yin syndrom(陰虛陽亢證) increased. 4. In right arm meridian, the value of RH1 was getting lower as the score of exuberance of Yang due to deficiency of Yin syndrom(陰虛陽亢證) increased. These results show that the Yang-do-rack diagnosis could offer supplemental help for diffrentiation of syndroms in acute stroke patient.

• Journal of Korean Neurosurgical Society
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• 제30권10호
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• pp.1200-1209
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• 2001

Objective : A thorough understanding of the related venous structure is mandatory for successful removal of the petroclival meningiomas. This study was planned to investigate the guideline for safe ligation and incision of transverse or sigmoid sinuses and the importance of drainage pattern of vein of $Labb{\acute{e}}$ in surgical removal of petroclival meningiomas. Patients and Methods : The authors reviewed the venogram of the consecutive 37 cases of petroclival meningiomas and retrospectively analyzed their surgical findings. The drainage pattern of confluence of Herophili was classified as Type A(confluent & equal on both sides), Type B(confluent & non-dominant on tumor side), Type C(confluent & dominant on tumor side) and Type D(unilateral drainage only) as these findings gave the information on safe ligation and resection of the sinus. Usefulness of intraoperative test clamping of sinus for safe ligation was also reviewed. The vein of $Labb{\acute{e}}$ was analyzed with respect to its draining point and its collaterals to other superficial veins. Results : Contraindications of the sinus ligation and resection according to the drainage pattern at the confluence of Herophili were Type C(n=10, 27%)and Type D(n=4, 11%). Patients with Type A(n=12, 32%)and Type B(n=11, 30%) were tolerable to sinus ligation ipsilateral to tumor, if the test clamping proved to be safe. Identification of no brain swelling, after intraoperative test clamping of the sinus for more than 30 minutes performed in 7 out of 11 cases, was a reliable indicator of safe sinus ligation. The drainage pattern of the vein of $Labb{\acute{e}}$, especially low-lying type, could predict the possibility of postoperative hemorrhage and infarction. Its drainage into tentorium or superior petrosal sinus, however, made the transtentorial approach impossible, leading to restricted operative field. Conclusion : For a successful removal of the petroclival meningiomas preoperative venogram should be examined carefully. The extent of exposure in a planned approach can be estimated by analyzing the variation of sinuses and the drainage pattern of vein of $Labb{\acute{e}}$.

• 대한임상독성학회지
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• 제12권2호
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• pp.92-96
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• 2014

Dabigatran is the first oral direct thrombin inhibitor approved by the US Food and Drug Administration (FDA) for prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. Because dabigatran is excreted mainly by the kidneys, serum levels of dabigatran can be elevated to a supratherapeutic range in patients with renal failure, predisposing to emergent bleeding. We describe the case of a 66-year-old man taking dabigatran 150 mg twice daily for atrial fibrillation and cerebral infarction who presented with hematochezia and disseminated intravascular coagulation. Laboratory evaluation showed a hemoglobin level of 6.3 g/dL, platelets of $138,000/mm^3$, activated partial thromboplastin time (aPTT) of 10 s, and an international normalized ratio (INR) of 8.17. Colonoscopy showed a bleeding anal fissure. Hemostasis was provided by hemoclips and packed red blood cells and fresh frozen plasma were transfused. Since then, there was no further hematochezia, however, bleeding including oral mucosal bleeding, hematuria, and intravenous site bleeding persisted. At presentation, his serum creatinine was 4.96 mg/dL (baseline creatinine, 0.9 mg/dL). Dabigatran toxicity secondary to acute kidney injury was presumed. Because acute kidney injury of unknown cause was progressing after admission, he was treated with hemodialysis. Fresh frozen plasma transfusion was provided with hemodialysis. At 15 days from admission, there was no further bleeding, and laboratory values, including hemoglobin, partial thromboplastin time, and prothrombin time were normalized. He was discharged without bleeding. After 2 months, he undergoes dialysis three times per week and no recurrence of bleeding has been observed.

• 한국산학기술학회논문지
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• 제19권2호
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• pp.456-461
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• 2018

목동맥 스텐트 삽입술은 목동맥 내막절제술에 적합하지 않은 환자에게 시행할 수 있는 목동맥 협착증의 대체 치료법으로 알려져 있다. 목동맥 내막절제술, 혈관성형술 또는 스텐트 삽입술 후에 드문 부작용으로 뇌내출혈이 발생할 수 있고, 이러한 출혈이 발생하는 원인은 대부분의 경우 재관류 손상과 관련이 있는 것으로 추정하고 있다. 이전의 연구에서는 내막절제술과 비교하여 목동맥 스텐트 삽입술 후 뇌내출혈의 빈도가 더 높다고 보고한 바 있다. 본 연구에서는 뇌경색으로 내원한 80세 남자환자를 대상으로 증례보고를 통해 동일 분야 연구에 활용하고자 자료 분석을 하였다. 80세 남자가 갑자기 발생한 오른 팔의 근력저하를 주소로 방문하였다. 왼쪽 속목동맥의 90% 협착이 발견되어 목동맥 스텐트 삽입술을 시행하였고, 시술 후 실시한 뇌 CT에서 시상을 포함하는 후대뇌동맥 영역의 뇌출혈이 뇌실내출혈까지 진행되어 있음을 관찰하였다. 이러한 출혈은 스텐트 삽입술이 시행된 동맥에서 공급될 가능성이 낮은 혈관 영역에서 발생했기 때문에, 이 경우에 내막절제술 시행 후 과다혈류에 의한 출혈과 다른 양상을 확인하였다.

• Journal of Korean Neurosurgical Society
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• 제62권5호
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• pp.545-550
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• 2019

Objective : Penumbra ACE68 reperfusion catheter is a new large bore aspiration catheter used for reperfusion of large vessel occlusion. The objective of this study was to investigate the efficacy of this catheter in comparison to that of previous Penumbra catheters in patients with acute ischemic stroke related to internal carotid artery (ICA) occlusion. Methods : Data of all eligible patients who received endovascular treatment (EVT) for ICA occlusion using Penumbra aspiration catheters between January 2015 and December 2018 were retrospectively reviewed. After dividing into two groups according to use of penumbra ACE68, baseline characteristics of patients, successful recanalization rate, puncture to recanalization time, and switch to stent base technique rate were assessed. Successful recanalization was defined by a thrombolysis in cerebral infarction (TICI) score ${\geq}2b$ and favorable functional outcome was defined according to modified Rankin scale (score, 0-2). Results : ACE68 reperfusion catheter was used in 29 of 75 eligible patients (39%). The puncture to recanalization time was significantly shorter ($26{\pm}18.2$ minutes vs. $40{\pm}24.9$ minutes, p=0.011) and the rate of switch to stent-based retrieval was significantly lower (3% vs. 20%, p=0.046) in ACE68 catheter group. Moreover, although not statistically significant, the successful recanalization rate was higher (83% vs. 76%, p=0.492) in ACE68 catheter group. Favorable functional outcome was observed in 48% of patients treated with ACE68 reperfusion catheter and in 30% of patients treated using other Penumbra systems (p=0.120). Baseline Alberta Stroke Program Early CT Scores ${\geq}8$ (odds ratio [OR], 9.74; 95% confidence interval [CI], 1.72-54.99; p=0.010) and successful recanalization (OR, 10.20; 95% CI, 1.13-92.46; p=0.039) were independent predictors of favorable outcome. Conclusion : EVT using ACE68 reperfusion catheter can be considered a first-line therapy in patients with acute ICA occlusion as it can achieve rapid recanalization and reduce the frequency of conversion to stent-retrieve therapy.

• 동의생리병리학회지
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• 제16권2호
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• pp.245-256
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• 2002

This studt was investigated to prove the effect of SPBST on the hypertension, the thrombosis and the brain damage. The results were as follows; 1. SPBST affected the htpertension as adepressant, but insignificant. 2. SPBST decreased significantly dopamine, aldosterone but ineffective on the epinephrine, norepinephrine and renin activity. 3. SPBST increased the NO product but insignificant. 4. SPBST had a death suppression effect by 50% in pulmonary thrombosis inducement experiment and activated slightly on the fibrinolytic activity. 5. SPBST suppressed significantly platelet diminution and prolonged insignificantly PT and APTT. 6. On the measure of the blood flow rate induced by the thrombus, in vivo SPBST accelerated the blood flow rate, in vitro insignificant. 7. SPBST had no toxicity on the PC12 cell and B103 cell induced by amyloid β protein (-35) and a protective effect, in proportion to the density. 8. SPBST decreased significantly coma duration time in a Infatal dose of KCN and showed 50% of survival rate in a fatal dose. 9. SPBST decreased significantly ischemic area and edema incited by the MCA blood flow block. These results indicate that SPBST can be used in hypertension, the thrombosis, the brain damage, the ischemic cerebral infarction and the acute stage of the brain damage. Further study will be needed about the functional mechanism and etc.

• 대한임상검사과학회지
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• 제47권1호
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• pp.35-38
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• 2015

Lateral canal benign paroxysmal vertigo (BPPV) causing dizziness is a common cause is not found while continuing to appeal for vertigo is a typical disease. It is characterized by acute stand up, brief and rotatory vertigo attacks provoked by change in head position. Treatment requires only one treatment visit in most patients. However, there are significant numbers of patients who require multiple treatment visits for relief. The purpose of this study benign paroxysmal positional vertigo treatment of type affect is to analyze the cause. Dizziness and vertigo patient's in patients admitted to the dizziness center of lateral canal benign paroxysmal positional vertigo were classified. In patients with lateral canal benign paroxysmal positional vertigo and accompanying lateral 15 treatment affects disease were investigated. March 2008 to November 2010 lateral canal benign paroxysmal positional vertigo 166 people cure rate of patients was investigated. First time the success rate of 74.1%, twice times the success rate of 12.0%, three times the success rate of 9.6%, more than three times the success rate was 4.2%. Affecting factor treatment of benign paroxysmal positional vertigo in post-traumatic, medicine disease, headache, cerebral infarction, small vessel disease, vestibulopathy, (p<0.05). Statistical analysis using SPSS (version 12K) in coefficient measure through descriptive statistical of cross table.