• Journal of Korean Neurosurgical Society
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• 제61권2호
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• pp.219-223
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• 2018

Objective : To investigate nationwide statistics on flow-diverting stent usage for cerebral aneurysm treatment and related mortality data. Methods : We requested data extraction from the National Health Insurance Service claims database using electronic data interchange codes (J3207064, J3207073). Patient and hospital information as well as death statistics were collected from the database. Results : A total of 169 procedures were performed using flow-diverting stents for cerebral aneurysm treatment from November 2014 to December 2016 in Korea. The majority of primary diagnosis was unruptured intracranial aneurysm. During the study period, nine subjects died, including one patient initially diagnosed with subarachnoid hemorrhage. The crude mortality rate was 5.3%. Five patients died within one month after the procedure; therefore, the estimated periprocedural mortality rate was $3.0{\pm}1.3%$. The mortality rate as of the last day of 2016 was $6.3{\pm}2.1%$. Conclusion : In a 171 person-year follow-up in a Korean series, nine deaths occurred after flow-diverting stent treatment. The crude mortality rate in Korea (5.3%) was higher than that reported in a previous meta-analysis (3.8%).

• 대한장애인치과학회지
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• 제4권1호
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• pp.26-31
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• 2008

Cerebrovascular Accident(stroke) is that a sudden, nonconvulsive loss of neurologic function due to an ischemic or hemorrhagic intracranial vascular event. If stroke happens at the portion of trigeminal motor nucleus or its control part of cerebral cortex, masticatory muscles will be atrophy or paralyzed. So it is possible that dental occlusion changes after stroke. A 74-aged woman recurred mild stroke 2 month ago, who had experienced severe stroke 2 years ago. After recurrence, suddenly her upper full denture was dropped when lower denture contacted upper one. According to the her occlusion exam, her lower jaw moved back slightly compared with the occlusion of old denture. And her face had asymmetry and lower jaw dislocated to paralyzed side. A 50-aged man was treated because many cervical caries, which would occur because of an aftereffect of stroke, long-herm hospitalization and limits of self oral-care. 6 years ago he had cerebral hemorrhage and he claimed that he cannot bite exactly. Just two pairs of teeth was contact on biting, his lower jaw was located back, too. This two case suggests that dental occlusion can change after stroke.

• Journal of Korean Neurosurgical Society
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• 제49권1호
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• pp.49-52
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• 2011

Traumatic intracranial aneurysms are rare, comprising 1% or less of all cerebral aneurysms. The majority of these aneurysms arise at the skull base or in the distal anterior and middle cerebral arteries or their branches following direct mural injury or acceleration-induced shearing force. We present a 50-year-old patient in whom subarachnoid hemorrhage (SAH) was developed as a result of traumatic aneurysm rupture after a closed craniofacial injury. Through careful evaluation of the three-dimensional computed tomography and conventional angiographies, the possible mechanism of the traumatic internal carotid artery trunk aneurysm is correlated with a hit injury by the bony protuberances on the anterior and posterior clinoid processes. This traumatic aneurysm was successfully obliterated with clipping and wrapping technique. The possibility of a traumatic intracranial aneurysm should be considered when patient with SAH demonstrates bony protuberances on the clinoid process as a traumatic aneurysm may result from mechanical injury by the sharp bony edges.

• Journal of Korean Neurosurgical Society
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• 제42권1호
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• pp.59-63
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• 2007

Operative clipping after previous endovascular coiling in an aneurysm is a different problem from primary clipping procedure for neurosurgeons. With the increasing use of coil embolization, neurosurgeons will more and more face the similar situation. We report surgical clipping cases of intracranial aneurysm regrown after endovascular coiling. Three patients with a history of subarachnoid hemorrhage due to ruptured aneurysm underwent endovascular treatment (EVT) with detachable coils. The aneurysms were in the posterior communicating artery, the middle cerebral artery and distal anterior cerebral artery (DACA). Two near-total occlusions and one partial occlusion were achieved by EVT. After several months, angiographic follow-up revealed regrowth of the aneurysm requiring surgical clipping. Here, we report three cases in which surgical clipping was more difficult than a usual clipping procedure performed several months after EVT, because of adhesion and coil bulging into the aneurysmal neck. The difficulty of the treatment of the residual aneurysm after coiling is discussed, as are the surgical complications and limitations of clipping.

• Journal of Korean Neurosurgical Society
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• 제44권3호
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• pp.178-181
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• 2008

Although endovascular intervention is the first-line treatment of intracranial aneurysm, intraprocedural rupture or extravasation is still an endangering event. We describe two interesting cases of extravasation during embolotherapy for ruptured peripheral cerebral pseudoaneurysms. Two male patients were admitted after development of sudden headache with presentation of intracerebral and subarachnoid hemorrhage, respectively. Initial angiographic assessment failed to uncover any aneurysmal dilatation in both patients. Two weeks afterwards, catheter angiography revealed aneurysms each in the peripheral middle cerebral artery and anterior inferior cerebellar artery. Under a general anesthesia, endovascular embolization was attempted without systemic heparinization. In each case, sudden extravasation was noted around the aneurysm during manual injection of contrast after microcatheter navigation. Immediate computed tomographic scan showed a large amount of contrast collection within the brain, but they tolerated and made an unremarkable recovery thereafter. Intraprocedural extravasation is an endangering event and needs prompt management, however proximal plugging with coil deployment can be sufficient alternative, if one confronts with peripheral pseudoaneurysm. Peculiar angiographic features are deemed attributable to extremely fragile, porous vascular wall of the pseudoaneurysm. Accordingly, it should be noted that extreme caution being needed to handle such a friable vascular lesion.

• The Journal of Korean Physical Therapy
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• 제29권2호
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• pp.62-68
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• 2017

Purpose: This study was conducted to identify the impacts of stroke patients' general and disease-related properties on depression and family support. Methods: Subjects consisted of 79 persons who were diagnosed with cerebral hemorrhage and cerebral infarction and met the criteria for selection. The Korean version of Beck depression inventory (BDI) and a revision of the family support developed by Cobb were used. Frequency analysis of the subjects' general and medical history properties was conducted, and one way ANOVA was utilized to evaluate the degree of depression and family support with respect to the properties. Pearson's correlation coefficient was conducted to investigate the degree of depression and family support. Results: Participants showed no significant difference in depression based on the subjects' general and disease-related properties (p>0.05), although there were significant differences in family support based on marital status, hobbies and the medical expenses payers (p<0.05). The correlation between family support and depression was r=-0.491 (p<0.01). Conclusion: Through the results of this study, it was found that general and disease-related properties would not have any impact on depression while they would affect family support.

• Journal of Chest Surgery
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• 제14권3호
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• pp.247-253
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• 1981

A total and consecutive 46 patients have undergone cardiac valvular surgery including 8 open mitral commissurotomy and 38 mitral, aortic, mitral-aortic, mitral-tricuspid, tricuspid valve replacements using 46 artificial valves in a period between September 1976 and July 1981. They were 19 males and 27 females with the age ranging from 16 to 50 (mean 32.6) years. Out of 46 valves replaced, 6 were prosthetic valves and 40 were tissue valves, and 33 were replaced in mitral, 9 in aortic and 3 In tricuspid position. Isolated replacements were 33 mitral valves, 6 aortic valves and 1 tricuspid valve; double valve replacements were 6 mitral-aortic valves and 2 mitral-tricuspid valves. . Early mortality within 30 days after operation was noted in 4 cases; 3 after MVR and 1 after open mitral commissurotomy. Causes of death were thrombus obstruction of Beall-Surgitool, Cerebral air embolism, acute renal shut down due to low output syndrome, and left upper pUlmonary vein rupture after open mitral commissurotomy (early mortality 8.7%). 3 late deaths were noted during the follow-up period from 2 to 59 months; 1 due to cerebral hemorrhage from warfarin overdose 3 months, 1 due to miliary tuberculosis 9 months, and another 1 due to cardiac failure after open mitral commissurotomy 42 months postoperatively. Total survival rate 59 months after valvular surgery was 84.8%; there were no early and late death in the group of AVR, TVR and double valve replacements. Preoperative NYHA Class III & IV were 35 cases (76%) out of total 46 cases, and 38 cases (94.8%) out of 39 survival cases were included In NYHA Class I & II during the follow-up period.

• 사상체질의학회지
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• 제14권2호
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• pp.106-114
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• 2002

The etiology of spontaneous intracerebral hematoma is aneurysmal rupture, arteriovenous malfomation, brain rumor, blood dyscrasia, cerebral infaction, cerebra inflammatory vascular disease, hypertension, and unknown causes. And the primary intracerebral hematoma is caused by unknown causes including hypertension. The clinical diagnosis of intracerebral hematoma, size, location, ventricular penetration, and evolution of brain parenchyme by hemorrhage are confirmed by CT scan. The authors have experienced 1 case of spontaneous intracerebral hematoma confirmed by CT scan. We have diagnosed the patient as Soyangin and treated by east integrated therapy. We classified this case as Soyangin-liyoiljung(少陽人裏熱證) and prescribed Yangkyuksanhwatang' Jihwangbaekhotang Hyungbangsabaeksan to the principle of Cheongyangsangsung(淸陽上升). In the result, we had the improvement of the symptoms. This report discribed the process and contents about the way the patient was cured.

• Journal of Korean Neurosurgical Society
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• 제64권4호
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• pp.665-670
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• 2021

Symptomatic cerebral vasospasm (CVS) and delayed ischemic neurologic deficit (DIND) after unruptured aneurysm surgery are extremely rare. Its onset timing is variable, and its mechanisms are unclear. We report two cases of CVS with DIND after unruptured aneurysm surgery and review the literature regarding potential mechanisms. The first case is a 51-year-old woman with non-hemorrhagic vasospasm after unruptured left anterior communicating artery aneurysm surgery. She presented with delayed vasospasm on postoperative day 14. The second case is a 45-year-old woman who suffered from oculomotor nerve palsy caused by an unruptured posterior communicatig artery (PCoA) aneurysm. DIND with non-hemorrhagic vasospasm developed on postoperative day 12. To our knowledge, this is the first report of symptomatic CVS with oculomotor nerve palsy following unruptured PCoA aneurysm surgery. CVS with DIND after unruptured aneurysm surgery is very rare and can be triggered by multiple mechanisms, such as hemorrhage, mechanical stress to the arterial wall, or the trigemino-cerebrovascular system. For unruptured aneurysm surgery, although it is rare, careful observation and treatments can be needed for postoperative CVS with DIND.

• Journal of Korean Neurosurgical Society
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• 제66권2호
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• pp.199-204
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• 2023

It is critical to identify the ruptured cerebral arteriovenous malformations (AVMs) for secondary prevention. However, there are rare cases unidentified on the radiological evaluation. We report on a patient with the delayed appearance of radiologically occult AVM as a probable cause of the previous intracerebral hemorrhage (ICH). An 18-year-old male patient presented with a right temporal ICH. The preoperative radiological examination did not reveal any causative lesions. Because of the intraoperative findings suggesting an AVM, however, only hematoma was evacuated. Disappointedly, there were no abnormal findings on postoperative and follow-up radiographic examinations. Eleven years later, the patient presented with an epileptic seizure, and an AVM was identified in the right temporal lobe where ICH had occurred before. The patient underwent partial glue embolization followed by total surgical resection of the AVM and anterior temporal lobe. Based on the literature review published in the era of magnetic resonance imaging, common clinical presentation of radiologically occult AVMs included headache and seizure. Most of them were confirmed by pathologic examination after surgery. In cases of the ICH of unknown etiology in young patients, long-term follow-up should be considered.