• 대한한의학회지
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• 제26권1호
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• pp.115-122
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• 2005

Background and objective: Gastrodiae Rhizoma (GR), the rhizoma of Gastrodia elata BL., is one of the popular drugs to treat headache, dizziness, blackout, numbness of limbs, hemiplegia, facial paralysis, dysphrasia, and infantile convulsions. It has been reported that it provides an antihypertensive effect and lowers cerebrovascular resistance in animal experiments. However, there has been no data about these effects with human subjects. In this study, the author examined the effect of Gastrodiae water extracts on blood pressure and cerebrovascular reactivity in human subjects. Methods: We selected 16 normal volunteers, who were divided into 2 groups: Gastrodiae extract administration group and placebo (creamy powder) group. Using transcranial Doppler ultrasound, we monitored changes of mean flow velocity and breath-holding induced CO2 reactivity of middle cerebral artery in both groups. Mean blood pressure, heart rate and PETCO2 were measured using Compact Anesthesia Monitor. In both groups, all evaluation was performed during basal condition, and repeated at 30, 60, and 90 min after administration. Results: Gastrodiae extract decreased CO2 reactivity after administration, reaching the lowest level at 90 minutes $(-29.1\%\;vs.\;basal\;level)$, which showed significant difference compared with the placebo group (p = 0.004). In the placebo group, the pulse rates tended to decrease over time (at 90 minute, $-5.2\%$ vs. basal level) while in the Gastrodiae group the values showed nearly no change, which showed significant difference between both groups (p = 0.036). However, the changes of mean blood pressure and mean flow velocity did not show significant difference between both groups. Conclusion : This study demonstrated that Gastrodiae extract significantly decreased breath-holding induced CO2 reactivity. This result suggests that the clinical effect of Gastrodiae extract might be caused by increasing cerebral blood flow via dilation of cerebral resistant vessels instead of antihypertensive effect.

• 대한임상검사과학회지
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• 제42권3호
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• pp.155-160
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• 2010

Transcranial Doppler ultrasonography (TCD) allows measurement of blood flow velocity to be made from the basal intracerebral vessels. Blood flow velocity in TCD is highly affected not only by blood vessel diameter, blood flow volume, blood viscosity, but also age and sex. Therefore, the study is focused on the correlation between TCD measurement index and sex/age. Subjects were 214 (male 147, famale 67) who had TCD for headache and stroke evaluations at Dongguk University Ilsan Hospital neurology department from December 2009 to April 2010. Sex did not show significant differences with mean flow velocity (MFV), peak systolic flow velocity (PSFV), end diastolic flow velocity (EDFV), pulsatility index (PI) and resistance index (RI) in middle cerebral artery (MCA). Although age also did not show significant differences with MFV and PSFV, EDFV has statistically decreased with age, and PI and RI has statistically increased with age. In addition, age showed significant correlation with MFV, EDFV, PI and RI, but not with PSFV. Therefore, TCD is definitely correlated with age and sex, so that those influencial factors must be considered when being tested.

• The Korean Journal of Pain
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• 제21권1호
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• pp.33-37
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• 2008

Background: Cerebral blood vessels are innervated by sympathetic nerves from the superior cervical ganglion (SCG). The purpose of the present study was to evaluate the neuroprotective effect of superior cervical sympathetic ganglion block in rats subjected to permanent focal cerebral ischemia. Methods: Thirty male Sprague-Dawley rats (270-320 g) were randomly assigned to one of three groups (control, lidocaine and ropivacaine). A brain injury was induced in all rats by middle cerebral artery occlusion with a nylon thread. The animals of the local anesthetic group received $30{\mu}l$ of 2% lidocaine or 0.75% ropivacaine in the SCG. Neurologic scores were assessed 24 hours after brain injury. Brain samples were then collected. The infarct and edema ratios were measured by 2.3.5-triphenyltetrazolium chloride staining. Results: There were no differences in the death rates, neurologic scores, or infarction and edema ratios between the three groups. Conclusions: These findings suggest that superior cervical sympathetic ganglion block may not influence the brain damage induced by permanent focal cerebral ischemia in rats.

• 대한방사선기술학회지:방사선기술과학
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• 제42권5호
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• pp.351-356
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• 2019

This study aimed to determine whether there was a difference in measurements between North American Symptomatic Carotid Endarterectomy Trial(NASCET) and Warfarin-Aspirin Symptomatic Intracranial Disease(WASID) methods that measure the middle cerebral artery stenosis in Digital Subtraction Angiography (DSA) and Magnetic Resonance Angiography (MRA). It involved 24 patients who had completed both DSA and MRA among patients with Middle Cerebral Artery (MCA) stenosis. The Middle Cerebral Artery (MCA) stenosis was measured using the NASCET and WASID methods through a retrospective analysis. For the NASCET and WASID methods, they performed measurements on normal blood vessels located far from and close to the stenosis, respectively. The mean value and standard deviation of the Digital Subtraction Angiography (DSA) measured by the NASCET method were 59.23% and 13.27%. On the other hand, those of the Digital Subtraction Angiography (DSA) measured by the WASID method were 66.64% and 12.47%. And, the mean value and standard deviation of the Magnetic Resonance Angiography (MRA) measured by the NASCET method were 49.82% and 12.06%. By contrast, those of the Magnetic Resonance Angiography (MRA) measured by the WASID method were 56.63% and 10.67%. All the p-values obtained by the Pearson and Spearman correlation tests in the Digital Subtraction Angiography (DSA) and the Magnetic Resonance Angiography (MRA) were <0.01. In conclusion, this study suggests that both the NASCET and WASID methods to measure the middle cerebral artery stenosis in the Digital Subtraction Angiography (DSA) and the Magnetic Resonance Angiography (MRA) can be used if they are not used interchangeably.

• The Korean Journal of Pain
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• 제21권2호
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• pp.119-125
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• 2008

Background: Cerebral blood vessels are innervated by sympathetic nerves from the superior cervical ganglia (SCG), and these nerves may influence the cerebral blood flow. The purpose of the present study was to evaluate the neuroprotective effect of superior cervical sympathetic ganglion block in rats that were subjected to focal cerebral ischemia/reperfusion injury. Methods: Eighty male Sprague-Dawley rats (270-320 g) were randomly assigned to one of two groups (the ropivacaine group and a control group). In all the animals, brain injury was induced by middle cerebral artery (MCA) reperfusion that followed MCA occlusion for 2 hours. The animals of the ropivacaine group received $30{\mu}l$ of 0.75% ropivacaine, and their SCG. Neurologic score was assessed at 1, 3, 7 and 14 days after brain injury. Brain tissue samples were then collected. The infarct ratio was measured by 2.3.5-triphenyltetrazolium chloride staining. The terminal deoxynucleotidyl transferase mediated dUTP-biotin nick-end labeled (TUNEL) reactive cells and the cells showing caspase-3 activity were counted as markers of apoptosis at the caudoputamen and frontoparietal cortex. Results: The death rate, the neurologic score and the infarction ratio were significantly less in the ropivacaine group 24 hr after ischemia/reperfusion injury. The number of TUNEL positive cells in the ropivacaine group was significantly lower than those values of the control group in the frontoparietal cortex at 3 days after injury, but the caspase-3 activity was higher in the ropivacaine group than that in the control group at 1 day after injury. Conclusions: The study data indicated that a superior cervical sympathetic ganglion block may reduce the neuronal injury caused by focal cerebral ischemia/reperfusion, but it may not prevent the delayed damage.

• Journal of Korean Neurosurgical Society
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• 제30권7호
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• pp.849-854
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• 2001

Delayed cerebral infarction after resection of craniopharyngioma is a uncommon entity, but leads to high morbidity and mortality. We present 3 such cases and discuss the etiology and pathogenesis with review of pertinent literatures. In our cases, delayed deterioration of consciousness was observed in all cases. All of them expired. The cause may be multifactorial and the surgical approach may contribute to the pathogenesis of delayed cerebral infarction. We suspect vasospasm might be the major mechanism of pathogenesis. Vessels were primed to spasm during operation due to blood in the cistern or mechanical injury. Vasoactive materials may have been liberated from the pituitary stalk or injured hypothalamus, either at the time of surgery, or later, after portions of tumor have undergone necrosis. The high degree of suspicion to detect vasospasm should be done in the case of the delayed deterioration of mental status at an early stage of craniopharyngioma surgery. Possible mechanism underlying this delayed cerebral infarction are discussed.

• Journal of Korean Neurosurgical Society
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• 제50권6호
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• pp.492-496
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• 2011

Objective : Direct revascularization surgery is regarded as the most effective method of treatment of adults with moyamoya disease. These patients, however, have a higher risk of perioperative ischemic complications than do patients with atherosclerotic stroke, and are at risk for ischemic complications in the hemisphere contralateral to the one operated on. We investigated the incidence and risk factors for ischemic stroke in the contralateral hemisphere after surgical treatment of adults with moyamoya disease. Methods : We retrospectively reviewed the medical records and results of neuroimaging studies on 79 hemispheres of 73 consecutive patients with adult moyamoya disease ($mean{\pm}SD$ age, $37.96{\pm}11.27$ years; range, 18-62 years) who underwent direct bypass surgery over 6 years. Results : Ischemic complications occurred in 4 of 79 (5.1%) contralateral hemispheres, one with Suzuki stage 3 and three with Suzuki stage 4. Three patients showed posterior cerebral artery (PCA) involvement by moyamoya vessels. Advanced stage of moyamoya disease (Suzuki stages 4/5/6; $p$=0.001), PCA involvement ($p$=0.001) and postoperative hypotension (mean arterial blood pressure <80% of preoperative mean arterial blood pressure) on the first ($p$<0.0001) and second ($p$=0.003) days after surgery were significantly correlated with postoperative contralateral ischemic complications. Conclusion : In patients with advanced moyamoya disease and involvement of the PCA, intentional hypotension can result in ischemic stroke in the hemisphere contralateral to the one operated on. Careful control of perioperative blood pressure is crucial for good surgical results.

• 대한한방내과학회지
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• 제28권2호
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• pp.250-261
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• 2007

Objectives : The purpose of this study was to evaluate the blood flow using doppler ultrasound of the MCA, ACA, PCA, BA, ICA in the patients with risk factor for stroke. Methods : 110 patients with risk factor for stroke were selected who had hypertension, diabetes mellitus, hyperlipidemia, or heart disease, as well as 89 healthy adults who did not have any symptoms of those diseases. To evaluate the blood flow, the Vs and Vm of the MCA, ACA, PCA, BA, and ICA in the two groups were measured. Result : In normal healthy adults, subjects showed a decrease in the Vs and Vm: with advancing in age, there was a significant difference in the Vs of MCA, PCA, BA, and ICA. There was a significant difference in the Vm of MCA, PCA, BA, and ICA. In normal healthy adults, females showed high velocities in all examined vessels. There was a significant difference in the Vs of BA. There was a significant difference in the Vm of BA, and ICA. There was a decrease in the Vs, and Vm of all examined vessels of patients with risk factors for stroke in comparison with normal healthy adults. There was no significant difference in the Vs. There was a significant difference in the Vm of MCA, ACA, and PCA. Results were the same between patients aged under 50 and total patients in the Vs and Vm of examined vessels. There were differences between patients aged over 50 and total patients in the Vs of MCA, PCA, BA and for patients aged over 50; patients with risk factor for stroke who had hypertension, diabetes mellitus, hyperlipidemia, or heat disease has higher Vs than healthy adults. Conclusions : There was a significant difference in the blood flow velocity between patients with risk factors for stroke and healthy adults. However, this result was different from results of comparison of TCD findings between patients and healthy individuals by age. Therefore, more detailed studies about aged patients are needed.

• The Korean Journal of Physiology and Pharmacology
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• 제2권6호
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• pp.705-714
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• 1998

Cerebral blood vessels relax when extracellular $K^+$ concentrations $([K^+])_e$ are elevated moderately $(2{\sim}15$ mM, $K^+-induced$ vasorelaxation). We have therefore studied the underlying mechanism for this $K^+-induced$ vasorelaxation in the isolated middle cerebral arteries (MCAs). The effects of ouabain and $Ba^{2+}\;on\;K^+-induced$ vasorelaxation were examined to determine the role of sodium pump and/or Ba-sensitive process (possibly, inward rectifier K current) in the mechanism. Mulvany myograph was used to study 24 rats, 18 rabbits, and 10 humans MCAs $(216{\pm}3\;{\mu}m,\;347{\pm}7\;{\mu}m,\;and\;597{\pm}39\;{\mu}m$ in diameter when stretched to a tension equivalent to 55 mmHg). High $K^+$ (125 mM) and $PGF_{2{\alpha}}\;(1{\sim}10\;{\mu}M)$ induced concentration-dependent contractions in all 3 species, while histamine $(10{\sim}50\;{\mu}M)$ evoked contraction only in the rabbits and induced relaxation in the rats and humans. Addition of $K^+\;(2{\sim}10\;{\mu}M)$ to the control solution induced vasorelaxations. These effects were inhibited by the pretreatment with both ouabain $(10\;{\mu}M)$ and $Ba^{2+}\;(0.1{\sim}0.3\;mM)$ in the rat, but only with ouabain $(10\;{\mu}M)$ in the rabbit and human. These results suggest that $K^+-induced$ vasorelaxation occurs via the stimulation of electrogenic Na pump in the rabbit and human MCAs, while in the rat MCAs via the activation of both Na pump and Ba-sensitive process.

• Journal of Korean Neurosurgical Society
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• 제46권3호
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• pp.239-244
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• 2009

Objective : Cerebral vasospasm leading to cerebral ischemic infarction is a major cause of morbidity and mortality in the patients who suffer with aneurysmal subarachnoid hemorrhage. Despite adequate treatment, some patients deteriorate and they develop symptomatic vasospasm. The objective of the present study was to investigate the efficacy and clinical outcome of intraarterial nimodipine infusion on symptomatic vasospasm that is refractory to hemodynamic therapy. Methods : We retrospectively reviewed the procedure reports, the clinical charts and the transcranial doppler, computed tomography and digital subtraction angiography results for the patients who underwent endovascular treatment for symptomatic cerebral vasospasm due to aneurysmal SAH. During the 36 months between Jan. 2005 and Dec. 2007, 19 patients were identified who had undergone a total of 53 procedures. We assessed the difference in the arterial vessel diameter, the blood flow velocity and the clinical outcome before and after these procedures. Results : Vascular dilatation was observed in 42 of 53 procedures. The velocities of the affected vessels before and after procedures were available in 33 of 53 procedures. Twenty-nine procedures exhibited a mean decrease of 84.1 cm/s. We observed clinical improvement and an improved level of consciousness with an improved GCS score after 23 procedures. Conclusion : Based on our results, the use of intraarterial nimodipine is effective and safe in selected cases of vasospasm following aneurysmal SAH. Prospective, randomized studies are needed to confirm these results.