• Proceedings of the Korean Society of Applied Pharmacology
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• 1995.04a
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• pp.38-40
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• 1995

There have reports suggested that cerebral blood flow (CBF) has decreased in patients with both senile dementia of the Alzheimer's type and multi-infarct dementia, which are characterized by marked cognitive impairments. In addition, recent studies have demonstrated that decrease of CBF precedes the onset of multi-infarct dementia. These findings further suggest that chronic reduction of CBF may play an important role in the formation and progression of cerebral vascular dementia. Although transient cerebral ischemia, based upon vascular “reperfusion”, is apparently not paralleling the clinical condition, the transient cerebral ischemia model is one of the major methods investigated and the other is the cerebral embolism operation. Cognitive impairment and neuronal damages have been fully studied using these transient and/or embolic ischemia models. There are, however, few investigations focused the attention on the influence of chronic decrease of CBF on cognitive processes. In the present study, we have chosen a chronic ischemic model which is produced by permanent occlusion of bilateral common carotid arteries (2VO) in rats to investigate the neuronal damage and cognitive deficits through radial maze performance. We investigated furtherly the effects of tetramethylpyrazine (TMP), a constituent isolated from Ligusticum Chuanxiong on such a model.

• Journal of Chest Surgery
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• v.35 no.3
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• pp.231-234
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• 2002

Moyamoya disease is an unusual cerebrovascular disorder characterized by occlusive intimal dysplasia of the distal internal carotid and proximal cerebral arteries as well as other collateral arteries. However, moyamoya diseases are recently being reported as a systemic process. We experienced one case of coronary artery occlusive disease affected by moyamoya disease. The patient was a 35-year-old female, experiencing intermittent NYHA class ll dyspnea and exertional chest pain for 6 months and right paresthesia for 1 month before admission. Cerebral artery angiogram showed abnormal cerebrovascular systems and confirmed moyamoya disease with cerebral infarction of the left frontal lobe. In coronary artery angiogram, left coronary artery was not visualized due to total occlusion of the left main ostium and left coronary blood flow was supplied from normal right coronary artery. CABG was performed with OPCAB. Both internal mammary arteries were used for LAD and LCx. Intraoperative coronary artery findings showed intimal hyperplasia and no definite thrombi, and nondiseased coronary arteries were good and patent. We concluded that this patient's coronary artery disease was affected by moyamoya disease, and moyamoya disease should be evaluated in the extracerebral cardiovascular system.

• Korean Journal of Radiology
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• v.23 no.3
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• pp.333-342
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• 2022

Objective: Intracranial atherosclerotic stroke occurs through various mechanisms, mainly by artery-to-artery embolism (AA) or branch occlusive disease (BOD). This study evaluated the spatial relationship between middle cerebral artery (MCA) plaques and perforating arteries among different MCA territory infarction types using vessel wall magnetic resonance imaging (VW-MRI). Materials and Methods: We retrospectively enrolled patients with acute MCA infarction who underwent VW-MRI. Thirty-four patients were divided into three groups according to infarction pattern: 1) BOD, 2) both BOD and AA (BOD-AA), and 3) AA. To determine the factors related to BOD, the BOD and BOD-AA groups were combined into one group (with striatocapsular infarction [BOD+]) and compared with the AA group. To determine the factors related to AA, the BOD-AA and AA groups were combined into another group (with cortical infarction [AA+]) and compared with the BOD group. Plaque morphology and the spatial relationship between the perforating artery orifice and plaque were evaluated both quantitatively and qualitatively. Results: The plaque margin in the BOD+ group was closer to the perforating artery orifice than that in the AA group (p = 0.011), with less enhancing plaque (p = 0.030). In the BOD group, plaques were mainly located on the dorsal (41.2%) and superior (41.2%) sides where the perforating arteries mainly arose. No patient in the AA group had overlapping plaques with perforating arteries at the cross-section where the perforator arose. Perforating arteries associated with culprit plaques were most frequently located in the middle two-thirds of the M1 segment (41.4%). The AA+ group had more stenosis (%) than the BOD group (39.73 ± 24.52 vs. 14.42 ± 20.96; p = 0.003). Conclusion: The spatial relationship between the perforating artery orifice and plaque varied among different types of MCA territory infarctions. In patients with BOD, the plaque margin was closer and blocked the perforating artery orifice, and stenosis degree and enhancement were less than those in patients with AA.

• Journal of Korean Neurosurgical Society
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• v.49 no.4
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• pp.226-228
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• 2011

We report a case of spontaneous right carotid-cavernous fistula (CCF) in a proximal segment of persistent primitive trigeminal artery (PPTA) and combined vascular anomalies such as left duplicated hypoplastic proximal posterior cerebral arteries and a variation of anterior choroidal artery supplying temporal and occipital lobe. A 45-year-old male presented with progressive right exophthalmos, diplopia, and ocular pain. With manual compression of the internal carotid artery, a cerebral angiography revealed a right CCF from a PPTA. Treatment involved the placement of detachable non-fibered and fibered coils, and use of a hyperglide balloon to protect against coil herniation into the internal carotid artery. A final angiograph revealed complete occlusion of PPTA resulted in no contrast filling of CCF.

• Journal of Physiology & Pathology in Korean Medicine
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• v.18 no.1
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• pp.167-171
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• 2004

This study investigated a HSP70 expression of Puerariae Radix in cerebral ischemia. The global cerebral ischemia was induced by bilateral common carotid arteries occlusion under hypotension (40 mmHg) in Sprague-Dawley rats. After the treatment of Puerariae Radix extract, the heat shock protein 70 (HSP70) expressions were measured immunohistochemically. The upregulation of HSP70 expression in hippocampal regions resulted by cerebral ischemia. Then Puerariae Radix treatment demonstrated significant decrease of HSP70 expressions in CA1 region and dentate gyrus of the hippocampus as compared with control group. These results suggested that Puerariae Radix reveals the neuroprotective effect through the control of noxious stress stimulations to neurons.

• Biomolecules & Therapeutics
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• v.26 no.2
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• pp.115-120
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• 2018

Chronic cerebral hypoperfusion (CCH), which is associated with onset of vascular dementia, causes cognitive impairment and neuropathological alterations in the brain. In the present study, we examined the neuroprotective effect of duloxetine (DXT), a potent and balanced serotonin/norepinephrine reuptake inhibitor, on CCH-induced neuronal damage in the hippocampal CA1 region using a rat model of permanent bilateral common carotid arteries occlusion. We found that treatment with 20 mg/kg DXT could attenuate the neuronal damage, the reduction of phosphorylations of mTOR and p70S6K as well as the elevations of $TNF-{\alpha}$ and $IL-1{\beta}$ levels in the hippocampal CA1 region at 28 days following CCH. These results indicate that DXT displays the neuroprotective effect against CCH-induced hippocampal neuronal death, and that neuroprotective effect of DXT may be closely related with the attenuations of CCH-induced decrease of mTOR/p70S6K signaling pathway as well as CCH-induced neuroinflammatory process.

• Journal of Korean Neurosurgical Society
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• v.29 no.6
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• pp.719-724
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• 2000

Objectives : It has been reported that the presence of a pharmacologically inactive foreign substance, polystyrene latex bead, in subarachnoid space activates a non-specific immunological response and elicits arterial narrowing. Recently the activation of potassium($K^+$) channels may be of benefit in relieving cerebral vasospasm. The present study examined the effects of systemic administration of a ATP-sensitive $K^+$ channel activator, cromakalim, on the polystyrene latex bead-induced cerebral vasospasm. Methods : The spasm models similar to that caused by subarachnoid blood injection were created by injection of bead into rabbit cisterna magna. Intravenous injections of cromakalim were administered twice daily(bid) 30 minutes after induction of vasospasm. Animals were killed by perfusion-fixation 2 days after vasospasm. Basilar arteries were removed and sectioned, and the luminal cross-sectional areas were measured. Results : Injection of bead elicited an arterial constriction, reducing arterial diameter to 33.3% of resting tone. Cromakalim inhibited bead-induced constriction at a dose of 0.3mg/kg(Mann-Whitney test, p<0.01). Conclusion : These results support the concept that the cellular events triggered by inactivation of ATP-sensitive $K^+$ channels are responsible for the pathogenesis of vasospasm. The findings also indicate that cromakalim represents a potential therapeutic agents for the treatment of cerebral vasospasm.

• Journal of Korean Neurosurgical Society
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• v.50 no.3
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• pp.256-259
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• 2011

We report a rare case of Williams syndrome accompanying moyamoya disease in whom postoperative global cerebral infarction occurred unpredictably. Williams syndrome is an uncommon hereditary disorder associated with the connective tissue abnormalities and cardiovascular disease. To our knowledge, our case report is the second case of Williams syndrome accompanying moyamoya disease. A 9-year-old boy was presented with right hemiparesis after second operation for coarctation of aorta. He was diagnosed as having Williams syndrome at the age of 1 year. Brain MRI showed left cerebral cortical infarction, and angiography showed severe stenosis of bilateral internal carotid arteries and moyamoya vessels. To reduce the risk of furthermore cerebral infarction, we performed indirect anastomosis successfully. Postoperatively, the patient recovered well, but at postoperative third day, without any unusual predictive abnormal findings the patient's pupils were suddenly dilated. Brain CT showed the global cerebral infarction. Despite of vigorous treatment, the patient was not recovered and fell in brain death one week later. We suggest that in this kind of labile patient with Williams syndrome accompanying moyamoya disease, postoperative sedation should be done with more thorough strict patient monitoring than usual moyamoya patients. Also, we should decide the revascularization surgery more cautiously than usual moyamoya disease. The possibility of unpredictable postoperative ischemic complication should be kept in mind.

• Journal of Korean Neurosurgical Society
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• v.44 no.3
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• pp.159-162
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• 2008

Stenting is a useful alternative treatment modality in carotid artery stenosis patients who are too high-risk to undergo carotid endarterectomy (CEA). We report a case of contralateral cerebral infarction after stenting for extracranial carotid stenosis. A 78-year-old woman was admitted to the hospital with left-sided weakness. Based on magnetic resonance imaging (MRI) of the brain and conventional angiography, she was diagnosed with an acute watershed infarct of the right hemisphere secondary to severe carotid stenosis. Stenting was performed for treatment of the right carotid artery stenosis after a one-week cerebral angiogram was completed. Thirty minutes after stent placement, the patient exhibited a generalized seizure. Four hours later, brain MRI revealed left hemispheric cerebral infarction. Complex aorta-like arch elongation, tortuosity, calcification, and acute angulation at the origin of the supra-aortic arteries may increase the risk of procedural complications. In our case, we suggest that difficult carotid artery catheterization, with aggressive maneuvering during stenting, likely injured the tortuous, atherosclerotic aortic arch, and led to infarction of the contralateral cerebral hemisphere by thromboemboli formed on the wall of the atherosclerotic aorta.

• Journal of Korean Neurosurgical Society
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• v.45 no.5
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• pp.284-288
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• 2009

Objective : Our retrospective study aimed to determine whether 16-slice computerized tomography (CT) angiography optimized sharp kernel is suitable for the evaluation of visibility, luminal patency and re-stenosis of intracranial stents in comparison with conventional angiography. Methods : Fifteen patients with symptomatic intracranial stenotic lesions underwent balloon expandable stent deployment of these lesions (10 middle cerebral arteries, 2 intracranial vertebral arteries, and 3 intracranial internal carotid arteries). CT angiography follow-up ranged from 6 to 15 months (mean follow-up, 8 months) after implantation of intracranial stents and conventional angiography was confirmed within 2 days. Curved multiplanar reformations with maximal intensity projection (MIP) with optimal window settings for assessment of lumen of intracranial stents were evaluated for visible lumen diameter, stent patency (contrast distal to the stent as an indirect sign), and re-stenosis by two experienced radiologists who blinded to the reports from the conventional angiography. Results : All of stents deployed into symptomatic stenotic lesions. All stents were classified as patent and no re-stenosis, which was correlated with results of conventional angiography. Parts of the stent lumen could be visualized in all cases. On average, 57% of the stent lumen diameter was visible using optimized sharp kernel. Significant improvement of lumen visualization (22%, p<0.01) was observed using the optimized sharp kernel compared with the standard sharp kernel. Inter-observer agreements on the measurement of lumen diameter and density were judged as good, respectively (p<0.05). Conclusion : Sixteen-slice CT using the optimized sharp kernel may provide a useful information for evaluation of lumen diameter patency, and re-stenosis of intracranial stents.