• 한국의학물리학회지:의학물리
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• 제14권4호
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• pp.259-267
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• 2003

실험적 뇌손상 전후에 쥐의 뇌대사물질 변화를 4.7 T 자기공명분광법을 이용하여 조사하여 보았다. 자기공명 스펙트럼는 비교대상 그룹으로서 정상 쥐 우측 두전엽 피질에서 획득되었다. 유체타진손상기법(Fluid Percussion Injury)을 사용하여 뇌손상을 유발시킨후 3일 후 스펙트럼이 얻어졌다. 뇌손상 쥐의 뇌대사불질들의 변화는 정상쥐의 뇌대사물질들과 비교되었다. Neuronal marker로써 NAA/Cr 비율은 대조군에서 1.13$\pm$0.12이었고 뇌좌상부위에서 0.90$\pm$0.11로 손상전과 비교하여 대조군에 비해 유의성있는 감소소견을 나타내었으며 이는 neuronal loss를 의미하는 것으로 추정된다(P=0.001). Cho/Cr 비율은 대조군에서 0.76$\pm$0.15이었고 뇌좌상부위에서 0.91$\pm$0.17로 손상전과 비교하여 대조군에 비해 유의성있게 증가하는 경향을 나타내었으며 이는 생체막의 파괴나 염증반응과 관련된 것으로 추정된다(P=0.02). 하지만 Glx/Cr 비율은 손상전후에 유의성있는 변화를 나타내지 않았다. Lac/Cr 비율은 대조군에 비해 증가하는 경향을 나타내었고 이는 외상후 에너지 대사의 변위양상으로 고려되어진다. 이러한 소견들은 자기 공명분광법이 유체타진손상기법을 이용한 외상성 뇌좌상에서 신경병리학적 변화과정에 대한 이해를 증진시키고 나아가 외상에 의한 뇌좌상의 임상적인 평가를 위해 매우 유용한 modality임을 시사하는 것이라고 사료된다. 그러나 본 연구에서 몇몇의 케이스에서 voxel을 선정하면서 두개골의 일부가 포함되거나 혹은 죄상과 동반된 출혈로 인해 유용한 데이터를 획득하는데 어려움을 주기도 하였다. 앞으로 보다 더 세밀한 분석과 연구를 위해 유체타진 손상의 다양한 정도에서 대사물질들의 변화양상을 평가할 필요가 있을 것으로 사료된다. .

• Journal of Trauma and Injury
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• 제27권3호
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• pp.63-70
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• 2014

Purpose: In children, mild traumatic brain injuries (TBI) account for 70~90% of head injuries. Without guidelines, many of these children may be exposed to excess radiation due to unnecessary imaging. The purpose of this study was to evaluate the impact of a mild TBI guideline in imaging of pediatric patients. Methods: The medical records of all children who had head computed tomography and were admitted to our hospital with a TBI with Pediatric Glasgow Coma Scale and Glasgow Coma Scale of 14 to 15 were retrospectively reviewed and compared with PECARN Rule. Results: A total of 1260 children were included and all children checked with head computed tomography. 61 pediatrics had CT positive and presented skull fracture 40, hemorrhage 8, hemorrhagic contusion 7, and diffuse axonal injury 1. Also, 4 patients diagnosed both skull fracture and brain haemorrhage and 1 patient diagnosed both haemorrhage and haemorrhagic contusion. Conclusion: There are many pediatric traumatic patients who exposed to radiation due to CT. But, the most of results were negative. So, consider to follow the CT guideline for children and many do not require brain CT.

• 대한자기공명의과학회:학술대회논문집
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• 대한자기공명의과학회 2004년도 제9차 학술대회 초록집
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• pp.75-75
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• 2004

• Journal of Korean Neurosurgical Society
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• 제29권9호
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• pp.1233-1237
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• 2000

Objectives : In order to evaluate the metabolic changes associated with pericontusional edematous area in mild head injury, proton magnetic resonance spectroscopy(1H-MRS) was performed in mild head injury patients (initial GCS score 13-15) with focal brain contusion. Methods : Seven head injury patients with initial GCS 13-15(3 males and 4 females : age range 15-65 years, mean age 33 years) have underwent 1H-MRS evaluations. The patients were examined within 7 days after injury(n=7) and 2 months after injury(n=5). The region of interest(ROI) was selected in the edematous area adjacent to traumatic brain contusion upon T2-weighted MR images and a corresponding region of the contralateral hemisphere (ROC, region of contralateral corresponding hemisphere) was examined as well. The metabolic ratios of NAA/Cr and lactate/Cr were compared between ROIs, ROCs and control values. Results : In initial NAA/Cr ratios, the values of ROIs were significantly lower than those of the controls(p=0.009), but there was no difference either between ROIs and ROCs(p=0.410) or between ROCs of patients and the control (p=0.199). In lactate/Cr ratios, the ROIs in all seven patients and the ROCs in two showed increased lactate signals. The lactate/Cr ratios of the ROIs were significantly elevated as compared to those of the ROCs(p=0.02) and the control(p=0.015). In two months follow-up, lactate signals were absent or significantly reduced(p=0.015). In no patients, clinical or radiological deterioration has been observed. Conclusion : Our 1H-MRS results demonstrate that there are significant ischemic changes in pericontusional edematous areas as indicated by elevated lactate signals in the patients with mild head injury. But there were no consistent neural loss or dysfunction in these area. There findings suggest that pericontusional edematous areas can be vulnerable to secondary brain insults even in the patients with mild head injury.

• 동의신경정신과학회지
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• 제18권3호
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• pp.289-298
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• 2007

Delirium is a acute syndrome of disorientation caused by disfunction of brain tissue and has a variety of symptomes. It is characterized by disturbance of consciousness and attention, cognition, and perception for a brief period of time and tends to fluctuate during the course of the day. We experienced a 56 year-old woman who had a hypertension as well as Delirium caused by cranial contusion and whose condition was improved by Oriental medical treatment. this case study illustrates what the manifestation of Delirium caused by cranial contusion. This study shows more objective mecical pregress by grading Korean version of Delirium Rating Scale(K-DRS) and Korean version of Mini-Mental State Examination(K-MMSE). After our treatments, Delirium and some other symptoms were improved.

• Journal of Korean Neurosurgical Society
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• 제45권3호
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• pp.176-178
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• 2009

Traumatic brainstem hemorrhage after blunt head injury is an uncommon event. The most frequent site of hemorrhage is the midline rostral brainstem. The prognosis of these patients is poor because of its critical location. We experienced a case of traumatic brainstem hemorrhage. A 41-year-old male was presented with drowsy mentality and right hemiparesis after blunt head injury. Plain skull radiographs and brain computerized tomography scans revealed a depressed skull fracture, epidural hematoma, and hemorrhagic contusion in the right parieto-occipital region. But, these findings did not explain the right hemiparesis. T2-weighted magnetic resonance (MR) image of the cervical spine demonstrated a focal hyperintense lesion in the left pontomedullary junction. Brain diffusion-weighted and FLAIR MR images showed a focal hyperintensity in the ventral pontomedullary lesion and it was more prominent in the left side. His mentality and weakness were progressively improved with conservative treatment. We should keep in mind the possibility of brainstem hemorrhage if supratentorial lesions or spinal cord lesions that caused neurological deficits in the head injured patients are unexplainable.

• Journal of Chest Surgery
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• 제14권2호
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• pp.123-126
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• 1981

190 cases of the thoracic injuries experienced at the department of chest surgery, Chungnam National University Hospital, for 5 years from Jan. 1976 till Dec 1980, were analysed. The results are as follows; 1. The incidence rate of male to female was 5.1:1. The common age groups were 3rd, 4th and 5th decades, and the most common age group in the penetrating injury was 3rd decade. 2. The most common mode of the nonpenetrating injuries was a traffic accident [63.0%], and the most commonly used tool in the penetrating injuries is a knife [66.7%]. 3. The most common nonpenetrating injury was rib fracture [73.9%], and the common fracture sites were 5th, 6th, 7th and 8th ribs [especially, 7th rib]. The incidence rate of flail chest was 15% of the cases of the rib fractures. 4. The common associated injuries of the nonpenetrating were long bone fracture [18.3%], brain contusion [15.9%], and clavicle fracture etc.. 5. The common method of surgical treatment were closed thoracostomy [46.7%], thoracentesis, and open thoracotomy [7.4%] etc.. 6. The overall mortality was 2.8%. [Nonpenetrating; 0.8%, Penetrating; 6.3%]

• Journal of Korean Neurosurgical Society
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• 제48권3호
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• pp.244-250
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• 2010

Objective : Adequate management of increased intracranial pressure (ICP) is critical in patients with traumatic brain injury (TBI), and decompressive craniectomy is widely used to treat refractory increased ICP. The authors reviewed and analyzed complications following decompressive craniectomy for the management of TBI. Methods : A total of 89 consecutive patients who underwent decompressive craniectomy for TBI between February 2004 and February 2009 were reviewed retrospectively. Incidence rates of complications secondary to decompressive craniectomy were determined, and analyses were performed to identify clinical factors associated with the development of complications and the poor outcome. Results : Complications secondary to decompressive craniectomy occurred in 48 of the 89 (53.9%) patients. Furthermore, these complications occurred in a sequential fashion at specific times after surgical intervention; cerebral contusion expansion ($2.2{\pm}1.2$ days), newly appearing subdural or epidural hematoma contralateral to the craniectomy defect ($1.5{\pm}0.9$ days), epilepsy ($2.7{\pm}1.5$ days), cerebrospinal fluid leakage through the scalp incision ($7.0{\pm}4.2$ days), and external cerebral herniation ($5.5{\pm}3.3$ days). Subdural effusion ($10.8{\pm}5.2$ days) and postoperative infection ($9.8{\pm}3.1$ days) developed between one and four weeks postoperatively. Trephined and post-traumatic hydrocephalus syndromes developed after one month postoperatively (at $79.5{\pm}23.6$ and $49.2{\pm}14.1$ days, respectively). Conclusion : A poor GCS score ($\leq$ 8) and an age of $\geq$ 65 were found to be related to the occurrence of one of the above-mentioned complications. These results should help neurosurgeons anticipate these complications, to adopt management strategies that reduce the risks of complications, and to improve clinical outcomes.

• Journal of Korean Neurosurgical Society
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• 제42권1호
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• pp.1-5
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• 2007

Objective : We studied whether frontal skull base fracture has an impact on the occurrence and recovery of anosmia and/or ageusia following frontal traumatic brain injury (TBI). Methods : Between May 2003 and April 2005, 102 consecutive patients who had hemorrhage or contusion on the frontal lobe base were conservatively treated. Relevant clinical and radiographic data were collected, and assessment of impaired smell and taste sensation were also surveyed up to at least 12 months post-injury. Results : Among 102 patients, anosmia was noted in 22 (21.6%), of whom 10 had ageusia at a mean 4.4 days after trauma. Bilateral frontal lobe injuries were noted in 20 of 22 patients with anosmia and in all 10 patients with ageusia. Frontal skull base fracture was noted in 41 patients, of whom 9 (21.4%) had anosmia and 4 (9.5%) had ageusia. There was no statistical difference in the occurrence of anosmia and ageusia between patients with or without fracture. Of the 22 patients with anosmia, recovery from anosmia occurred in nine (40.9%) at the interval of 6 to 24 months after trauma, of whom six had frontal skull base fracture and three were not associated with fracture. Recovery of anosmia was significantly higher in patients without fracture than those with fracture (p<0.05). Recovery from ageusia occurred in only two of 10 patients at the interval of 18 to 20 months after trauma and was not eminent in patients without fracture. Conclusion : One should be alert and seek possibile occurrence of the anosmia and/or ageusia following frontal TBI. It is suggested that recovery is quite less likely if such patients have fractures on the frontal base, and these patients should wait for at least 6 to 18 months to anticipate such recovery if there is no injury to the central olfactory structures.

• 대한핵의학회지
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• 제28권3호
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• pp.301-306
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• 1994

The purpose of this study was to compare Tc-99m-HMPAO SPECT with MRI after acute and subacute closed-head injury. There were thirty two focal lesions in all cases of these. Fifteen lesions(47%) were seen on both MRI and SPECT. Fourteen lesions(44%) were seen only on MRI. Three lesions(9%) were seen only on SPECT. Of the 14 lesions seen only on MRI, one was epidural hematoma, two were subdural hematoma, three were subdural hygroma, one was intracerebral hematoma, four were contusion, and three were diffuse axonal injuries. SPECT detected 52% of the focal lesions found on MRI. For the detection of lesions, MRI was superior to SPECT in fourteen cases, while SPECT was superior to MRI in three cases. In conclusion, there was a tendency that detection rate of the traumatic lesions was higher on MRI, but the SPECT could delineate more wide extent of lesion.