• Journal of Korean Neurosurgical Society
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• 제46권3호
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• pp.205-209
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• 2009

Objective : This study was conducted to investigate the correlation between the degrees of injury on brain magnetic resonance imaging (MRI) and the time interval to recovery of consciousness in patients with diffuse axonal injury. Methods : From January 2004 to December 2008, 25 patients with diffuse axonal injury were treated at our hospital. We retrospectively investigated the patients' medical records and radiological findings. We divided the patients into three groups according to the grade of MRI finding : grade I, small scattered lesions on the white matter of the cerebral hemisphere; grade II, focal lesions on the corpus callosum; and grade III, additional focal lesions on the brain stem. Result : Seven patients belonged to the grade I group; 10 to the grade II group; and 8 to the grade III group. The mean Glasgow Coma Scale (GCS) score of all patients at the time of admission was 7.28. Recovery of consciousness was observed in 23 of the 25 patients; the remaining two patients never regained consciousness. The time interval to recovery of consciousness (awake status) ranged from 1 day to 125 days (mean 22.1 days) : grade I group patients, within approximately 1 week (mean 3.7 days); grade II group patients, within approximately 2 weeks (mean 12.5 days); and grade III group patients, within approximately 2 months (mean 59.5 days). Conclusion : Our study results suggest a correlation between the mean time interval to recovery of consciousness in patients with diffuse axonal injuries and the degrees of brain injuries seen on MRI. Patients with grade I and II diffuse axonal injuries recovered consciousness within 2 weeks, while patients with grade III injuries required approximately 2 months.

• 대한간호학회지
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• 제38권6호
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• pp.923-932
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• 2008

Purpose: This study was conducted to investigate the individual and cross influences of age, gender, and severity on recovery of patients with brain injury. Methods: For the purpose of the study, traumatic or spontaneous brain injury patients admitted to the intensive care unit (ICU) were conveniently selected. The data regarding outcomes were collected 3 months after admission. Results: Individual influences of the study variables on patients' recovery were significant, except for gender. But while the individual influence of gender on recovery was not significant, cross influence of gender and age was significant, but only for the sub-dimension of 'arousalbility and awareness'. The study results also showed that 3-way cross influence of gender, age, and severity was only significant on the sub-dimension of 'arousalbility and awareness'. Conclusion: The sub-dimension of recovery cross influenced by the demographic factors of gender and age, and severity was 'arousalbility and awareness'. This might indicate that the study variables that cross influencing recovery had more influence on consciousness compared to physical function and psycho-social adaptation.

• 임상간호연구
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• 제22권3호
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• pp.265-275
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• 2016

Purpose: The purpose of this study was to develop an evidence-based guideline for fever management for critically ill adult patients after a brain injury. Methods: Development of the guideline process was done according to the De Novo development Korean Medical Guideline Information Center (KoMGI) and consists of 12 steps. Results: This developed guideline included 3 domains and 19 recommendations. The number of recommendations for each domain was 7 on measuring temperature, 9 on managing fever, and 3 on managing shivering. The level of evidence was as follows: 58% were at level I, and 42% at level II. Of the recommendations, 58% were graded as A, 37% as B, and 5% as C. Conclusion: These findings indicate that this guideline can be used as a guide for nursing in critically ill adult patients with brain injury. This guideline can also contribute to improvements in the quality of nursing care for critically ill adult patients with brain injury.

• 성인간호학회지
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• 제20권1호
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• pp.44-54
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• 2008

Purpose: The purpose of the study were to examine the nutritional status of severe brain injury adult patients in critical period, and to compare the nutritional states before and after tube feeding. Methods: Data from 19 patients admitted to the SICU in a university hospital due to severe brain injury were analyzed. Nutritional states were measured by anthropometric and blood biochemical indicators. Results: MAC and MAMC were significantly decreased only at 7 days after admission compared with those on the day of admission. TSF was significantly decreased from 7 days to 14 days after admission. Fat rate was significantly decreased from 3 days to 14 days after admission. Hb was significantly decreased only at 3 days after admission. Albumin was significantly decreased from 3 days to 14 days after admission. However, lymphocyte was significantly increased at 14 days after admission. TSF and Albumin became significantly worse even after initiating tube feeding. Conclusions: Nutritional status of severe brain injury patients in SICU became worse after admission whichever indicators were adopted to evaluate nutritional status, anthropometric or blood biochemical indicators, and became worse even after initiating tube feeding.

• 재활간호학회지
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• 제20권1호
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• pp.33-41
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• 2017

Purpose: This study is a descriptive study to analyze the relationship between the cognitive function, body image and pain, and the influencing factors on the daily life performance of brain injured patients. Methods: The study subjects were 119 inpatients with brain injury who gave informed consent. The activities of daily living (ADLs), cognitive function, pain and body image were measured by Modified Barthel Index (K-MBI), K-MMSE (Mini-Mental State Examination), Visual Analog Scale (VAS), Semantic Differential Method (SDM), respectively. Results: ADLs was significantly associated with body image, cognitive function, and pain. Multiple regression analysis showed that paralysis, consciousness, cognitive function, and pain were significant factors influencing ADLs. Overall, approximately 48% of total variability in the ADLs could be explained by the 4 variables ($R^2=.477$, p<.001). Conclusion: To improve ADLs of brain injury patients, a deeper understanding of paralysis, consciousness, cognitive function, and pain of patients is required and active nursing invention should be conducted.

• Kidney Research and Clinical Practice
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• 제37권4호
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• pp.315-322
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• 2018

The high mortality rates associated with acute kidney injury are mainly due to extra-renal complications that occur following distant-organ involvement. Damage to these organs, which is commonly referred to as multiple organ dysfunction syndrome, has more severe and persistent effects. The brain and its sub-structures, such as the hippocampus, are vulnerable organs that can be adversely affected. Acute kidney injury may be associated with numerous brain and hippocampal complications, as it may alter the permeability of the blood-brain barrier. Although the pathogenesis of acute uremic encephalopathy is poorly understood, some of the underlying mechanisms that may contribute to hippocampal involvement include the release of multiple inflammatory mediators that coincide with hippocampus inflammation and cytotoxicity, neurotransmitter derangement, transcriptional dysregulation, and changes in the expression of apoptotic genes. Impairment of brain function, especially of a structure that has vital activity in learning and memory and is very sensitive to renal ischemic injury, can ultimately lead to cognitive and functional complications in patients with acute kidney injury. The objective of this review was to assess these complications in the brain following acute kidney injury, with a focus on the hippocampus as a critical region for learning and memory.

• 생물정신의학
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• 제8권1호
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• pp.156-161
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• 2001

두부 외상을 받은 환자는 여러 가지 다양한 병태생리학적인 과정을 통해 뇌손상을 받으며 이로 인해 다양한 신경정신과적인 장애를 나타낸다. 두부외상을 받은 두 명의 환자에서 이에 대한 약물학적인 접근으로 amantadine을 사용하였고 증세의 호전을 경험하였다. 이에 대한 이론적인 근거로는 amantadine은 전연접(presynaptic)과 후연접(postsynaptic)에서 도파민 신경전달(dopamine neurotransmission)을 증진시켜 인지기능과 전두엽 기능장애에서 발생되는 특징적인 정신 행동학적인 증상을 호전시키고, NMDA 수용체 길항제(NMDA receptor antagonist)로 작용하여 흥분성 독성물질(excitotoxic substrate)에 의한 이차적인 신경손상을 차단하는 신경보호제(neuroprotective agent)로 작용한다. 이와 같이 amantadine은 급성과 만성 외상성 뇌손상 환자 모두에서 나타나는 인지, 기분과 행동장애의 치료에 효과적이고 안전하며 비싸지 않은 가격으로 사용될 수 있을 것으로 사료된다. 또한 이 영역에서 더욱 많은 대조군 연구가 필요하고, 나아가서 외상성 뇌손상 환자의 인지기능 호전을 위한 약물학적인 개입에 관한 연구가 필요할 것으로 사료된다.

• Journal of Korean Biological Nursing Science
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• 제23권3호
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• pp.217-226
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• 2021

Purpose: The aim of this study was to investigate the risk factors for brain reperfusion injury in ischemic stroke patients and to analyze the clinical outcomes. Methods: A retrospective study was conducted in 168 patients who underwent mechanical thrombectomy. The data were analyzed using descriptive statistics, t-test, Mann-Whitney U test, Chi-Square test, Fisher's exact test, and logistic regression with IBM SPSS/WIN 24.0. Results: Brain reperfusion injury occurred in 67 patients (39.9%) with a low favored outcome (𝛘²=6.01, p=.014). On multivariable analysis, blood urea nitrogen (Odds ratio [OR]=1.14, 95% Confidence interval [CI]=1.06-1.23), aphasia (OR=6.16, CI=1.62-23.40), anosognosia (OR=4.84, CI=1.13-20.79), presence of both aphasia and anosognosia (OR=7.33, CI=1.20-44.60), and time required to achieve targeted blood pressure (OR=1.00, CI=1.00-1.00) were identified as risk factors for brain reperfusion injury. A statistically significant difference was detected in clinical outcomes, including hemorrhagic transformation (𝛘²=6.32, p=.012), intensive care unit length of stay (Z=-2.08, p=.038), National Institute of Health Stroke scale score at discharge (Z=-3.14, p=.002), and modified Rankin Scale score at discharge (Z=-2.93, p=.003). Conclusion: This study identified the risk factors and presented the clinical outcomes of brain reperfusion injury. It is necessary to consider these risk factors for evaluating the patients and to establish nursing interventions and strategies.

• Journal of Trauma and Injury
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• 제21권2호
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• pp.71-77
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• 2008

Purpose: The Glasgow Coma Scale (GCS), though it is widely used for triage, has been criticized as being unnecessarily complex. Recently, a 3-point Simplified Motor Score (SMS, defined as obeys commands=2; localizes pain=1; withdrawals to pain or worse=0) was developed from the motor component of the GCS and was found to have a similar test performance for triage after traumatic brain injury when compared with the GCS as the criterion standard. The purpose of this study was to validate the SMS. Methods: We analyzed the patients who visited Kyungpook National University Hospital emergency center after traumatic brain injury from 2006 January to 2006 June. The test performance of the GCS, its motor component, and SMS relative to three clinically relevant traumatic brain injury outcomes (abnormal brain CT scans, Abbreviated Injury Scale $(AIS){\geq}4$, and mortality) were evaluated with areas under the receiver operating characteristic curves (AUCs). Results: Of 504 patients included in the analysis, 25.6% had an abnormal brain CT scans, 13.1% had $AIS{\geq}4$, and 5.0% died. The AUCs for the GCS, its motor component, and SMS with respect to the abnormal CT scans were 0.776, 0.715, and 0.716, and respectively, those for $AIS{\geq}4$ and mortality, were 0.969, 0.973, and 0.968, and 0.931, 0.909, and 0.909, respectively. Conclusion: The 3-point SMS demonstrated similar test performance when compared with the 15-point GCS score and its motor component for triage after traumatic brain injury in our populations.

• 생물정신의학
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• 제9권2호
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• pp.152-158
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• 2002

Background & Purpose:Neuropsychological disorders after traumatic brain injury(TBI) are poorly correlated with structural lesions detected by structural neuroimaging techniques such as computed tomography(CT) scan or magnetic resonance imaging(MRI). It is well known that patients with TBI have cognitive and behavioral disorders even in the absence of structural lesions of the brain. This study investigated whether there are abnormalities of regional cerebral blood flow(rCBF) in TBI patients without structural abnormality on MRI, using technetium 99m ethyl cysteinate dimer(Tc-99m-ECD) single photon emission computed tomography(SPECT) scans. Materials and Methods:Twenty-eight TBI patients without structural abnormality on MRI(mild, n=13/moderate, n=9/severe, n=6) and fifteen normal controls were scanned by SPECT. A voxel-based analysis using statistical parametric mapping(SPM) was performed to compare the patients with the normal controls. Results:rCBF was reduced in the right uncus and the right lateral orbitofrontal gyrus in the TBI patients. However, no increase of rCBF was noted in the patients in comparison to the normal controls. Conclusions:These results suggest that the TBI patients, even in the absence of structural lesion of the brain, may have dysfunction of the brain, particularly of the orbitofrontal and anterior pole of the temporal cortex. They also suggest that SPECT can be a useful method to identify brain dysfunctions in combination with structural brain imaging and neuropsychological tests.