• Journal of Cerebrovascular and Endovascular Neurosurgery
• /
• v.26 no.1
• /
• pp.65-70
• /
• 2024

We present a case of intracranial aneurysm located in the P1 segment of left posterior cerebral artery in the context of tetralogy of Fallot. Complex variations included right aortic arch with abnormal branching. Also, the bilateral vertebral arteries were absent, with a type I persistent proatlantal intersegmental artery of the left side. The aneurysm was treated with endovascular intervention with a Tubridge flow diverter and was noted to be completely cured on 6-month follow-up. We discuss the many considerations in this patient including developmental and modern-era treatment.

• Journal of Korean Medicine Rehabilitation
• /
• v.19 no.3
• /
• pp.1-13
• /
• 2009

Objectives : This study evaluates neuroprotective effect of Gastrodiae Rhizoma on apoptosis in the cerebral infarct. Methods : Cerebral infarct was induced by the middle cerebral artery occlusion (MCAO) for 2 hours with intraluminal thread method in Sprague-Dawley rats. Then ethanol extract of Gastrodiae Rhizoma was administered orally for 3 days. Infarct area and volume were evaluated with TTC staining. Neuronal apoptosis was identified with TUNEL labeling. Apoptosis modulatory effect was observed with immunohistochemical Bax, Bcl-2, iNOS, and MMP-9 expressions in penumbra. Results : 1. Ethanol extract of Gastrodiae Rhizoma reduced infarct size partly and volume significantly of in the MCAO rat brain. 2. Ethanol extract of Gastrodiae Rhizoma reduced TUNEL positive cell ratio in the penumbra of MCAO rat brain significantly. 3. Ethanol extract of Gastrodiae Rhizoma suppressed Bax, iNOS and MMP-9 expression in the penumbra of MCAO rat brain significantly. 4. Ethanol extract of Gastrodiae Rhizoma did not change Bcl-2 expression in the penumbra of MCAO rat brain. But expression ratio of Bcl-2 against Bax was increased in the Gastrodiae Rhizoma group. Conclusions : These results suggest that Gastrodiae Rhizoma plays an anti-apoptotic neuroprotective effect through suppression of Bax, iNOS, and MMP-9 expressions and relative up-regulation of Bcl-2 in the ischemic brain tissue.

• Journal of TMJ Balancing Medicine
• /
• v.9 no.1
• /
• pp.4-11
• /
• 2019

Objectives: Although intraoral balancing appliance therapy has been used effective to several diseases, verification studies through cerebral diseases are poorly reported so far. Thus we investigated the effect of tooth-cut induced dental malocclusion against mouse model of ischemic stroke. Methods: Tooth-cut and 90 min middle cerebral artery occlusion (MCAO) were loaded to C57BL/6 male mice, and total infarct area, neurological deficit scores (NDS), histological change of hippocampal region were observed. Production levels of reactive oxygen species (ROS) and inducible nitric oxide synthase (iNOS) in cerebral tissue were also measured. Results: The longer the tooth-cut period, the greater the area of cerebral infarction caused by MCAO, and NDS began to increase as the tooth was cut, and the results were more negative when MCAO was loaded. Histological change of hippocampal cells was significant when tooth-cut was maintained for 7 days. Those damages were thought to depend on the generation of ROS and iNOS in brain tissue. Conclusions: Since tooth-cut increased total area of cerebral infarction due to MCAO in mice, it is able to be confirmed that anomaly of the temporomandibular occlusion can affect neurological diseases.

• Biomedical Science Letters
• /
• v.11 no.2
• /
• pp.211-219
• /
• 2005

Trigeminovascular system plays an important role for the cerebral memodynamics. The aim of this study was to investigate the alterations in cerebrovascular reactivity by trigeminovascular system injury in rats. Trigeminovascular system of male Sprague-Dawley rats was injured by either denervation of nasocilliary nerve or neonatal capsaicin treatment. Trigeminovascular system was stimulated by controlled hemorrhagic hypotension or somatosensory (whisker) stimulation. Changes in regional cerebral blood flow (rCBF) and pial arterial diameter were continuously measured by laser-Doppler flowmetry and videomicroscopy, respectively. Nitric oxide synthase (NOS) activity in cerebral cortex was determined by measuring the conversion of $L-^3H-arginine\;to\;L-^3H-citrulline$. Cyclic GMP levels in cerebral cortex and pial artery were determined using the cyclic GMP $^{125}I$ scintillation proximity assay system. rCBF autoregulation was impaired or almost abolished by trigeminovascular system injury. rCBF response to whisker stimulation was significantly attenuated by trigeminovascular system injury. NOS activity as well as cyclic GMP level in cerebral cortex and pial artery were significantly reduced in the group of trigeminovascular system injury. These results suggest that trigeminovascular system injury causes prominent alterations in cerebrovascular reactivity, and that NO, which is generated by neuronal NOS in the trigeminovascular system, is implicated in the regulation of rCBF.

• Journal of Chest Surgery
• /
• v.18 no.4
• /
• pp.746-752
• /
• 1985

A retrospective clinical observation was made of 40 patients with postoperative cerebral dysfunction among 2634 patients who underwent open-heart operations in Severance Hospital. Yonsei University between 1962, the year the first successful open heart operation was done, and June 1985. Suspected causes of brain damage were reviewed. Brain CT findings were evaluated in 24 patients. There were 15 cerebral infarcts, 4 intracerebral bleedings, 3 ischemic brain damages, 1 infarction with intracerebral hemorrhage and 1 diffuse cortical atrophy from unknown cause. The most frequent site of cerebral infarction was the middle cerebral artery area with no predilection on the right of left.

• Korean Journal of Radiology
• /
• v.24 no.8
• /
• pp.784-794
• /
• 2023

Objective: To determine whether dynamic susceptibility contrast-enhanced (DSC) perfusion magnetic resonance imaging (MRI) can be used to evaluate posterior cerebral circulation in pediatric patients with moyamoya disease (MMD) who underwent anterior revascularization. Materials and Methods: This study retrospectively included 73 patients with MMD who underwent DSC perfusion MRI (age, 12.2 ± 6.1 years) between January 2016 and December 2020, owing to recent-onset clinical symptoms during the follow-up period after completion of anterior revascularization. DSC perfusion images were analyzed using a dedicated software package (NordicICE; Nordic NeuroLab) for the middle cerebral artery (MCA), posterior cerebral artery (PCA), and posterior border zone between the two regions (PCA-MCA). Patients were divided into two groups; the PCA stenosis group included 30 patients with newly confirmed PCA involvement, while the no PCA stenosis group included 43 patients without PCA involvement. The relationship between DSC perfusion parameters and PCA stenosis, as well as the performance of the parameters in discriminating between groups, were analyzed. Results: In the PCA stenosis group, the mean follow-up duration was 5.3 years after anterior revascularization, and visual disturbances were a common symptom. Normalized cerebral blood volume was increased, and both the normalized time-topeak (nTTP) and mean transit time values were significantly delayed in the PCA stenosis group compared with those in the no PCA stenosis group in the PCA and PCA-MCA border zones. TTP_PCA (odds ratio [OR] = 6.745; 95% confidence interval [CI] = 2.665-17.074; P < 0.001) and CBV_PCA-MCA (OR = 1.567; 95% CI = 1.021-2.406; P = 0.040) were independently associated with PCA stenosis. TTP_PCA showed the highest receiver operating characteristic curve area in discriminating for PCA stenosis (0.895; 95% CI = 0.803-0.986). Conclusion: nTTP can be used to effectively diagnose PCA stenosis. Therefore, DSC perfusion MRI may be a valuable tool for monitoring PCA stenosis in patients with MMD.

• Journal of Cerebrovascular and Endovascular Neurosurgery
• /
• v.25 no.1
• /
• pp.75-80
• /
• 2023

The prevalence of aneurysm formation in adults with Moyamoya disease (MMD) is higher than that in the general population. The treatment strategy is often individualized based on the patient's disease characteristics. A 22-year-old man was diagnosed with MMD after presenting a small thalamic intracerebral and subarachnoid hemorrhage in the quadrigeminal cistern. Cerebral angiography revealed a small aneurysm (2.42 mm) in the left anterior choroidal artery. Since the hemodynamics in the left hemisphere was compromised, an indirect bypass surgery was performed. The patient's condition deteriorated postoperatively because of poor perfusion of the internal carotid artery, and massive hydration was required. During neurocritical care, the aneurysm increased in size (5.33 mm). An observation strategy was adopted because of the distal aneurysmal location and the high risk involved. Subsequently, the patient recovered, and newly developed collateral flow appeared from the external carotid artery. Additionally, a dramatic size reduction of the aneurysm (1.51 mm) was noticed. Our case suggests that MMD-related dissecting aneurysms on a distal cerebral artery, which present a high risk of embolization, could be managed by indirectly reducing the hemodynamic burden. Massive hydration in such cases should be avoided or balanced to avoid the risk of rapid growth and aneurysm rupture.

• Journal of Korean Neurosurgical Society
• /
• v.61 no.2
• /
• pp.212-218
• /
• 2018

Objective : Surgical clipping of the cerebral aenurysm is considered as a standard therapy with endovascular coil embolization. The surgical clipping is known to be superior to the endovascular coil embolization in terms of recurrent rate. However, a recurrent aneurysm which is initially treated by surgical clipping is difficult to handle. The purpose of this study was to research the management of the recurrent cerebral aneurysm after a surgical clipping and how to overcome them. Methods : From January 1996 to December 2015, medical records and radiologic findings of 14 patients with recurrent aneurysm after surgical clipping were reviewed retrospectively. Detailed case-by-case analysis was performed based on preoperative, postoperative and follow-up radiologic examinations and operative findings. All clinical variables including age, sex, aneurysm size and location, type and number of applied clips, prognosis, and time to recurrence are evaluated. All patients are classified by causes of the recurrence. Possible risk factors that could contribute to those causes and overcoming ways are comprehensively discussed. Results : All recurrent aneurysms after surgical clipping were 14 of 2364 (0.5%). Three cases were males and 11 cases were females. Mean age was 52.3. At first treatment, nine cases were ruptured aneurysms, four cases were unruptured aneurysms, and one case was unknown. Locations of recurrent aneurysm were determined; anterior communicating artery (A-com) (n=7), posterior communicating artery (P-com) (n=3), middle cerebral artery (n=2), anterior cerebral artery (n=1) and basilar artery (n=1). As treatment of the recurrence, 11 cases were treated by surgical clipping and three cases were treated by endovascular coil embolization. Three cases of all 14 cases occurred in a month after the initial treatment. Eleven cases occurred after a longer interval, and three of them occurred after 15 years. By analyzing radiographs and operative findings, several main causes of the recurrent cerebral aneurysm were found. One case was incomplete clipping, five cases were clip slippage, and eight cases were fragility of vessel wall near the clip edge. Conclusion : This study revealed main causes of the recurrent aneurysm and contributing risk factors to be controlled. To manage those risk factors and ultimately prevent the recurrent aneurysm, neurosurgeons have to be careful in the technical aspect during surgery for a complete clipping without a slippage. Even in a perfect surgery, an aneurysm may recur at the clip site due to a hemodynamic change over years. Therefore, all patients must be followed up by imaging for a long period of time.

• Biomedical Science Letters
• /
• v.10 no.4
• /
• pp.467-472
• /
• 2004

Transcranial Doppler sonography (TCD) is a useful diagnostic method to measure cerebral blood flow velocity in various cerebral disorders. However, we haven't data enough to be available for young persons, especially in the twenties in Korea. This study was performed to collect the basic data of the cerebral blood flow velocity and to understand the cerebral physiology in the twenties. We determined the mean velocities of middle, anterior, and posterior cerebral artery, and vertebral and basilar artery (MCA-V, ACA-V, PCA-V, VA-V, and BA-V, respectively) in eighty-two healthy volunteers. For evaluating cerebral autoregulation, only the MCA- V was measured under various conditions such as stable, apnea, and hyperventilation state. Right and left MCA-V were 80.66±14.03 and 83.22±14.40 cm/sec at stable state, 90.13±17.47 and 90.26±16.38 cm/sec at apnea, and 54.83±11.09 and 55.33±10.74 cm/sec at hyperventilation. Right and left ACA-V were 49.11±15.71 and 48.19±13.75 cm/sec. Right and left PCA-V were 39.44±9.12 and 37.91±6.74 cm/sec. Right and left VA-V were 33.65±9.26 and 36.l8±10.39 cm/sec. BA-V was 48.49±11.16 cm/sec. Right and left MCA- V, V A-V, and right ACA- V and PCA- V in women were higher than those of men (P<0.05). No significant differences were found between men and women in the others. These findings indicate that cerebral hemodynamics and autoregulation were normal in young people in their twenties. The velocities of MCA, ACA, PCA, and BA were high values in women as compared with men.

• The Korean Journal of Physiology and Pharmacology
• /
• v.2 no.6
• /
• pp.695-703
• /
• 1998

$[K^+]_o$ can be increased under a variety of conditions including subarachnoid hemorrhage. The increase of $[K^+]_o$ in the range of $5{\sim}15$ mM may affect tensions of blood vessels and can change their sensitivity to various vasoactive substances. Therefore, it was examined in the present study whether the sensitivity of cerebral arteries to vasoactive substances can be changed with the moderate increase of $[K^+]_o$, using Mulvany-type myograph and $[Ca^{2+}]_c$ measurement. The contractions of basilar artery and branch of middle cerebral artery induced by histamine were not increased with the elevation of $[K^+]_o$ from 6 mM to 9 mM or 12 mM. On the contrary, the contractions induced by serotonin were significantly increased with the elevation of $[K^+]_o$. The contractions were also significantly increased by the treatment with nitro-L-arginine $(10^{-4}$ M for 20 minutes). In the nitro-L-arginine treated arteries, the contractions induced by serotonin were significantly increased with the elevation of $[K^+]_o$ from 6 mM to 12 mM. $K^+-induced$ relaxation was evoked with the stepwise increment of extracellular $K^+$ from 0 or 2 mM to 12 mM by 2 mM in basilar arterial rings, which were contracted by histamine. But $[K^+]_o$ elevation from 4 or 6 mM to 12 mM by the stepwise increment evoked no significant relaxation. Basal tension of basilar artery was increased with $[K^+]_o$ elevation from 6 mM to 12 mM by 2 mM steps or by the treatment with ouabain and the increase of basal tension was blocked by verapamil. The cytosolic free $Ca^{2+}$ level was not increased by the single treatment with serotonin or with the elevation of $[K^+]_o$ from 4 mM to 8 or 12 mM. In contrast to the single treatment, the $Ca^{2+}$ level was increased by the combined treatment with serotonin and the elevation of $[K^+]_o$. The increase of free $Ca^{2+}$ concentration was blocked by the treatment with verapamil. These data suggest that the sensitivity of cerebral artery to serotonin is increased with the moderate increase of $[K^+]_o$ and the increased sensitivity to serotonin is due to the increased $[Ca^{2+}]_i$ induced by extracellular $Ca^{2+}$ influx.