• Clinical and Experimental Pediatrics
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• v.58 no.6
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• pp.230-233
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• 2015

Lethargy in newborns usually indicates central nervous system dysfunction, and many conditions such as cerebrovascular events, infections, and metabolic diseases should be considered in the differential diagnosis. Nonketotic hyperglycinemia is an autosomal recessive error of glycine metabolism, characterized by myoclonic jerks, hypotonia, hiccups, apnea, and progressive lethargy that may progress to encephalopathy or even death. Cerebral sinovenous thrombosis is a rare condition with various clinical presentations such as seizures, cerebral edema, lethargy, and encephalopathy. Here, we report the case of a newborn infant who presented with progressive lethargy. An initial diagnosis of cerebral venous sinus thrombosis was followed by confirmation of the presence of nonketotic hyperglycinemia.

• Journal of Korean Neurosurgical Society
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• v.38 no.1
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• pp.12-15
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• 2005

Objective : Cerebral edema develops in the brain tumors by loosening of the endothelial tight junction. Tight junction[TJ] proteins, such as occludin and claudin bind adjacent cells tightly. Authors examine the expression rate of occludin in human brain tumors to evaluate the effect of altered expression of occludin on cerebral edema. Methods : Seventy surgical specimens stored at $-70^{\circ}C$ were used. It included 14 astrocytic tumors, 27 meningiomas, 12 scwannomas, 7 pituitary adenomas, 6 hemangioblastomas. and 4 craniopharyngiomas. After protein extraction, expression of occludin was investigated by Western blot analysis. The tumors were classified according to World Health Organization[WHO] classification. Results : The expression rates of occludin in brain tumors were : glioma [8/14=57.1%]. meningioma [16/27=59.3%], schwannoma [10/12=83.3%], pituitary adenoma [6/7=85.7%], hemangioblastoma [6/6=100%], and craniopharyngioma [3/4=75.0%]. The expression rate in glioma and meningioma was lower than other brain tumors. In gliomas, high grade tumor [1/4=25.0%] exhibited lower expression rate of occludin than low grade one [7/10=70.0%]. Conclusion : These results suggest that the expression of occludin is different among the various kinds of brain tumors. In gliomas, its expression is correlated with the histological grade. It may indicate that occludin plays a role in the development of edema in the brain tumors.

• The Journal of Korean Medicine
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• v.22 no.1
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• pp.78-89
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• 2001

Objectives : The purpose of this investigation is to evaluate the effects of Woohwangcheongsim-won on reperfusion following MCA occlusion in rats. Methods : To evaluate the effect of Woohwangcheongsim-won on reperfusion following MCA occlusion, the volume of cerebral ischemia and edema were measured and the change of the CAI pyramidal neuron in the hippocampus was investigated by light microscopy. And the changes of several neurotransmitters and enzymes were investigated with the immunohistochemical methods. Results : 1. The volume of the control group, which was ischemic-damaged was 23.6%, and that of the sample group was 13.5%. 2. The voluminalratio of the right/left hemisphere was 116 in the control group, and that of the sample group was 107. 3. The pyramidal cells of CAI area in the control group were greatly damaged. The cells were changed into discontinuous and unsystematic forms, and nuclei, and cytoplasms were shrunk. On the other hand, the cells of the sample group were less damaged. 4. On the immunohistochemical methods, the sensitivities of GABA, NOS, DBH in the control group were increased, and those of synapsin and $eEF-l{\alpha}$ were decreased as compared with the normal group. NOS and DBH which were negative in the normal group showed positive reaction. On the other hand, the sensitivities of GABA, NOS and DBH in the sample group were decreased, but those of NPY, synapsin, CaMKII and $eEF-l{\alpha}$ were increased as compared with the control group. Conclusions : Woohwangcheongsim-won reduced the volume of cerebral ischemia and edema, and minimized the damage of pyramidal cells. The mechanism was related to protein synthesis, such as synapsin, ${\alpha}CaMKII$ and $eEF-l{\alpha}$, which resist neurotoxicity of glutamate receptors.

• Journal of Korean Neurosurgical Society
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• v.42 no.4
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• pp.326-330
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• 2007

Objective : Stroke is the most prevalent disease involving the central nervous system. Since medical modalities are sometimes ineffective for the acute edema following massive infarction, surgical decompression may be an effective option when medical treatments fail. The present study was undertaken to assess the outcome and prognostic factors of decompressive surgery in life threatening acute, severe, brain infarction. Methods : We retrospectively analyzed twenty-six patients (17 males and 9 females; average age, 49.7yrs) who underwent decompressive surgery for severe cerebral or cerebellar infarction from January 2003 to December 2006. Surgical indication was based on the clinical signs such as neurological deterioration, pupillary reflex, and radiological findings. Clinical outcome was assessed by Glasgow Outcome Scale (GOS). Results : Of the 26 patients, 5 (19.2%) showed good recovery, 5 (19.2%) showed moderate disability, 2 (7.7%) severe disability, 6 (23.1%) persistent experienced vegetative state, and 8 (30.8%) death. In this study, the surgical decompression improved outcome for cerebellar infarction, but decompressive surgery did not show a good result for MCA infarction (30.8% overall mortality vs 100% mortality). The dominant-hemisphere infarcts showed worse prognosis, compared with nondominant-hemisphere infarcts (54.5% vs 70%). Poor prognostic factors were diabetes mellitus, dominant-hemisphere infarcts and low preoperative Glasgow Coma Scale (GCS) score. Conclusion : The patients who exhibit clinical deterioration despite aggressive medical management following severe cerebral infarction should be considered for decompressive surgery. For better outcome, prompt surgical treatment is mandatory. We recommend that patients with severe cerebral infarction should be referred to neurosurgical department primarily in emergency setting or as early as possible for such prompt surgical treatment.

• Journal of Cerebrovascular and Endovascular Neurosurgery
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• v.25 no.4
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• pp.434-439
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• 2023

Pseudoaneurysms are rare but devastating complications of penetrating head traumas. They require rapid surgical or endovascular intervention due to their high risk of rupture; however, complex presentations may limit treatment options. Our objective is to report a case of severe vasospasm, flow diversion, and in-stent stenosis complicating the treatment of a middle cerebral artery pseudoaneurysm following a gunshot wound. A 33-year-old woman presented with multiple calvarial and bullet fragments within the right frontotemporal lobes and a large right frontotemporal intraparenchymal hemorrhage with significant cerebral edema. She underwent an emergent right hemicraniectomy for decompression, removal of bullet fragments, and evacuation of hemorrhage. Once stable enough for diagnostic cerebral angiography, she was found to have an M1 pseudoaneurysm with severe vasospasm that precluded endovascular treatment until the vasospasm resolved. The pseudoaneurysm was treated with flow diversion and in-stent stenosis was found at 4-month follow-up angiography that resolved by 8 months post-embolization. We report the successful flow diversion of an middle cerebral artery (MCA) pseudoaneurysm complicated by severe vasospasm and later in-stent stenosis. The presence of asymptomatic stenosis is believed to be reversible intimal hyperplasia and a normal aspect of endothelial healing. We suggest careful observation and dual-antiplatelet therapy as a justified approach.

• The Journal of Korean Medicine
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• v.30 no.5
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• pp.77-87
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• 2009

Objectives: This study aimed to evaluate the effect of purgation therapy with Natrii sulfas, an oriental medical therapy for stroke patients with constipation, on physiological indexes and the brain edema of rats. Methods: Brain edema was induced by the middle cerebral artery occlusion (MCAO); Natrii sulfas was administered once after the MCAO. At 3, 6, 15, 24, 48 hours after reperfusion, physiological indexes such as fecal weight, urine volume and water content in stool were assessed, and at 48 hours after reperfusion the edema index was measured. Results: 1. Purgation therapy with Natrii sulfas significantly improved the reduction of fecal weight caused by ischemic insult (P<0.05). 2. Purgation therapy with Natrii sulfas significantly improved the reduction of urine volume caused by ischemic insult (P<0.05). 3. Purgation therapy with Natrii sulfas significantly improved the reduction of water content in stool caused by ischemic insult (P<0.05). 4. Purgation therapy with Natrii sulfas did not improve the neurological symptom caused by ischemic insult. 5. Purgation therapy with Natrii sulfas did not attenuate the total infarct volume caused by ischemic insult. 6. Purgation therapy with Natrii sulfas attenuated the brain edema caused by ischemic insult (P<0.05). Conclusions: These results suggest that purgation therapy with Natrii sulfas improves some important symptoms and has a protective effect on the brain edema caused by ischemic insult.

• The Journal of Internal Korean Medicine
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• v.22 no.1
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• pp.103-108
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• 2001

Nephrotic syndrome(NS) is characterized albuminuria, hypoalbuminemia, hyperlipidemia and edema. The thromboembolic complications of NS are reasonably common and have a broad range of clinical manifestations. The treatment of NS is empirical and symptomatic because the etiology and pathogenesis are unknown. We report treatment of patient who has been afflicted with NS for 20 years. He complained edema, dyspnea, Rt. hemiparesis, aphasia. We treated him with converting enzyme inhibitor, steroid, three kinds of herb-medicine for 45 days. The patient improved in clinical symptoms and routine chemistry, urine analysis test.

• PNF and Movement
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• v.19 no.3
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• pp.441-449
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• 2021

Purpose: The purpose of this study was to investigate the effect of strength training combined with blood flow restriction on leg muscle thickness in children with cerebral palsy. Methods: Nineteen children with cerebral palsy, aged between five and 10 years of age, living in area N, were recruited. Ten participants were classified into a blood flow restriction group and nine into a strength exercise group. The experimental group performed strength training using a blood flow restriction cuff on the leg, and the control group performed strength training without blood flow restriction. A paired t-test was performed to confirm intragroup changes before and after five weeks of the experiment, and an independent t-test was performed to confirm intergroup changes, and the significance level was α=0.05. Results: The rectus femoris, gastrocnemius and gluteus medius muscles showed significant differences in the groups after five weeks (p<0.05). There was a significant difference between the groups in the rectus femoris and gastrocnemius after five weeks (p<0.05). Conclusion: As a result of this study, it was found that strength training combined with blood flow restriction had a positive effect on the changes in leg muscle thickness in children with cerebral palsy. This suggests the possibility of using it in the future as basic data for strength training methods and blood flow restriction exercises for children with cerebral palsy.

• Childhood Kidney Diseases
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• v.28 no.1
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• pp.44-50
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• 2024

Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease that affects multiple organs. More than half of the patients with SLE have kidney involvement, and up to 10% of patients with lupus nephritis develop end-stage renal disease (ESRD). Central nervous system (CNS) involvement in SLE occurs in 21% to 95% of patients. Severe neurological manifestations such as seizures, cerebrovascular disease, meningitis, and cerebrovascular accidents can develop in childhood-onset SLE, but cerebral infections, such as brain abscess and hemorrhage, are seldom reported in lupus nephritis, even in adults. Here, we report a rare case of childhood-onset SLE with ESRD, cerebral abscess, and hemorrhage. A 9-year-old girl diagnosed with lupus nephritis was administered high-dose steroids and immunosuppressant therapy to treat acute kidney injury (AKI) and massive proteinuria. The AKI deteriorated, and after 3 months, she developed ESRD. She received hemodialysis three times a week along with daily peritoneal dialysis to control edema. She developed seizures, and imaging showed a brain abscess. This was complicated by spontaneous cerebral hemorrhage, and she became unstable. She died shortly after the hemorrhage was discovered. In conclusion, CNS complications should always be considered in clinical practice because they increase mortality, especially in those with risk factors for infection.

• Journal of Korean Neurosurgical Society
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• v.40 no.6
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• pp.463-466
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• 2006

A case of parasagittal meningioma en plaque with a peculiar clinical presentation is reported with a review of the literature. A 72-year-old woman presented with dysphasia and right hemiparesis. Computed tomography and magnetic resonance imaging demonstrated focal edema of left frontal lobe and a thick sheet-like parasagittal enhancing lesion with extension along the falx cerebri and adjacent sulcal enhancement. Differential diagnosis included idiopathic hypertrophic pachymeningitis, meningeal neurosarcoidosis, metastasis and meningioma en plaque. Cerebral angiography revealed occlusion of the anterior one-third of the superior sagittal sinus as well as a faint tumor blush supplied from the anterior branch of the middle meningeal artery. At surgery, the tumor invading the dura and skull was removed totally but the tumor invaded into the superior sagittal sinus was removed subtotally. The tumor was confirmed to be a transitional meningioma on pathological examination.