• Clinical and Experimental Pediatrics
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• v.46 no.10
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• pp.983-988
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• 2003

Purpose : Syncope appears to be common. However, the mechanism of syncope is not clear. Increased vagal activity and withdrawal of sympathetic stimulation cause hypotension, bradycardia and finally loss of consciousness. The purpose of this study was to evaluate changes of cerebral blood flow velocity, blood pressure, and heart rate during tilt test in children with vasovagal syncope. Methods : Sixty four children with a past history of syncope were evaluated. The stand up test was performed for 15 minutes after a rest at supine position for 10 minutes, followed by an $80^{\circ}$ tilt test lasting 45 minutes. If presyncope(lightheadedness, nausea, blurred vision, or sweating) or syncope occurred, the study was discontinued. 12-lead electrocardiography, echocardiography, and electroencephalography were performed. Transcranial Doppler study was performed at the middle cerebral artery with 2 MHz continuous Doppler probe in 10 children with positive tilt test. Systolic, diastolic, mean cerebral blood flow velocity, integral, and pulsatility index were measured with blood pressure, heart rate, and $O_2$ saturation. Results : The positive rate of tilt test was 31.3%(20/64). Systolic, diastolic, and mean cerebral blood flow velocity decreased significantly in absence of hypotension or bradycardia during presyncope. Time velocity integral of cerebral artery also decreased significantly. Conclusion : Decreased cerebral blood flow velocity can predict the presyncope manifestation. Impairment of autoregulation of cerebral blood flow might play an important role in the pathophysiology of vasovagal syncope.

• Journal of Korean Neurosurgical Society
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• v.51 no.2
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• pp.117-119
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• 2012

The sinking skin flap syndrome is a rare complication after a large craniectomy. It consists of a sunken skin above the bone defect with neurological symptoms such as severe headache, mental changes, focal deficits, or seizures. In patient with sinking skin flap syndrome, cerebral blood flow and cerebral metabolism are decreased by sinking skin flap syndrome, and it may cause the deterioration of autoregulation of brain. We report a case of a patient with sinking skin flap syndrome who suffered from reperfusion injury after cranioplasty with review of pertinent literature.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.13 no.2
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• pp.108-113
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• 2017

Moyamoya disease is a disorder in which certain arteries in the brain are constricted. Blood flow can be blocked by the constriction and blood clots. The patients frequently experience transient ischemic attacks (TIA), cerebral hemorrhage, or may not experience any symptoms at all. It is reported that they have a higher risk of recurrent stroke and a distinct underlying pathophysiology. A 3-year-8-month old boy with moyamoya disease experienced cerebral infarctions five times, and he underwent a cerebrovascular anastomosis surgery four years ago. He showed swallow disturbance, general delayed development, hemiplegia, and strabismus. Also he had hypocalcified teeth with or without multiple caries lesions in all dentitions. Dental treatment under general anesthesia using sevoflurane was performed due to his lack of cooperation. Moyamoya disease is associated with various medical conditions requiring a thoughtful deliberation and a careful examination before and during dental treatment. Pain and anxiety control during dental treatment is important because hyperventilation induced by crying has been seen to trigger TIA. Both isoflurane and sevoflurane are commonly used in patients with MMD, but dynamic autoregulation is better preserved during sevoflurane than isoflurane anesthesia. So sevoflurance general anesthesia may be recommendable to manage dental patients having multiple caries with moyamoya disease.