• Journal of Korean Neurosurgical Society
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• 제60권5호
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• pp.511-517
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• 2017

Objective : Spontaneous intracerebral hemorrhage (ICH) and ischemic stroke share common vascular risk factors such as aging and hypertension. Previous studies suggested that the rate of recurrent ICH and ischemic stroke might be similar after ICH. Presence of cerebral arterial stenosis is a potential risk factor for future ischemic stroke. This study investigated the prevalence and factors associated with cerebral arterial stenosis in Korean patients with spontaneous ICH. Methods : A total of 167 patients with spontaneous ICH were enrolled. Intracranial arterial stenosis (ICAS) and extracranial arterial stenosis (ECAS) were assessed by computed tomography angiography. Presence of ICAS was defined if patients had arterial stenosis in at least one intracranial artery. ECAS was assessed in the extracranial carotid artery. More than 50% luminal stenosis was defined as presence of stenosis. Prevalence and factors associated with presence of ICAS and cerebral arterial stenosis (presence of ICAS and/or ECAS) were investigated by multivariable logistic regression analysis. Results : Thirty-two (19.2%) patients had ICAS, 7.2% had ECAS, and 39 (23.4%) patients had any cerebral arterial stenosis. Frequency of ICAS and ECAS did not differ among ganglionic ICH, lobar ICH, and brainstem ICH. Age was higher in patients with ICAS ($67.6{\pm}11.8$ vs. $58.9{\pm}13.6years$ p=0.004) and cerebral arterial stenosis ($67.9{\pm}11.6$ vs. $59.3{\pm}13.5years$, p<0.001) compared to those without stenosis. Patients with ICAS were older, more frequently had diabetes, had a higher serum glucose level, and had a lower hemoglobin level than those without ICAS. Patients with cerebral arterial stenosis were older, had diabetes and lower hemoglobin level, which was consistent with findings in patients with ICAS. However, patients with cerebral arterial stenosis showed higher prevalence of hypertension and decreased kidney function compared to those without cerebral arterial stenosis. Multivariable logistic regression analyses showed that aging and presence of diabetes independently predicted the presence of ICAS, and aging, diabetes, and hypertension were independently associated with presence of cerebral arterial stenosis. Conclusion : 19.2% of patients with spontaneous ICH had ICAS, but the prevalence of ECAS was relatively lower (7.2%) compared with ICAS. Aging and diabetes were independent factors for the presence of ICAS, whereas aging, hypertension, and diabetes were factors for the cerebral arterial stenosis.

• Journal of Korean Neurosurgical Society
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• 제29권6호
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• pp.786-793
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• 2000

Objectives : A clinical analysis was performed to provide management strategy and to improve management outcome of elderly patients with intracranial aneurysm. Patients and Methods : We reviewed medical records of 746 consecutive patients with intracranial aneurysm who were admitted from July 1991 to December 1996. They were divided into two age groups : elderly(120 patients aged 65 years or older) and non-elderly(626 patients aged 64 years or younger). We investigated the differences between the two groups in clinical characteristics, management outcome and surgical results. Results : Female(80.0%), internal carotid artery aneurysm(48.9%), poor clinical grade(Hunt and Hess Grade IV, V : 39.8%), postoperative subdural fluid collection(38.2%), and postoperative hydrocephalus(39.7%) were more frequent in the elderly patients. There were no significant differences in the incidence of hypertension, multiple aneurysm, unruptured aneurysm, rebleeding, delayed ischemic neurological deficits, postoperative hemorrhage, and low density on the postoperative brain CT scan. In some cases, surgical clipping of ruptured aneurysm could not be performed due to moribund state or refusal of surgery by the elderly patient's family. Both management outcome and surgical results in elderly aneurysm patients at 3 months after rupture were worse than those of the non-elderly group. The most common reason of unfavorable outcome was poor clinical grade in both groups, while serious medical illness causing unfavorable outcome was more common in the elderly group. Conclusion : Surgical treatment of a ruptured aneurysm should not be avoided in elderly patient solely on the basis of advanced age. If the patients are in good clinical grade, early aneurysm surgery followed by early ambulation should be recommended. Further improvements in outcome may be achieved by thorough knowledge of poor resilience of brain, CSF flow dynamics, and diminished cardiopulmonary reserve in elderly patients with intracranial aneurysm.

• Investigative Magnetic Resonance Imaging
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• 제2권1호
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• pp.96-103
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• 1998

목적 : 고식적인 자기공명혈관조영술 (MR Angiography, MRA) 기법으로는 영상화가 어려웠던 대동맥궁의 주요 분지들의 평가에 있어서 새로운 MR기법인 조영증강 MRA의 임상적 유용성을 알아보고, 그 화질을 사용한 코일의 종류에 따라 비교해 보고자 한다. 대상 및 방법 : 뇌혈관 질환을 의심하여 고식적인 기법으로 뇌 및 경동맥 MRA를 시행한 29명에서 전향적으로 Gd-DAPA 15-20ml를 일시에 손으로 주입한 후 대동맥궁과 그의 주요 분지들에 대해 3시기의 고속 MRA를 시행하여 그 화질을 분석하였다. MRA는 1.0T MR기종에서 3D-FISP기법으로 얻었으며 총 영상 획득 시간은 40-60초였다. 영상 분석은 무명동맥, 양측 총경동맥, 양측 쇄골하동맥과 양측 척추 동맥들의 기시부로부터 전장에 걸쳐 화질을 주관적으로 3등급(good; 명백히 정상소견을 보이는 경우, fair; 약간 낮은 신호를 보이나 정상으로 진단하기에 비교적 만족할 만한 경우, poor; 협착이 모호하거나, 인공물이나 너무 낮은 신호로 혈관을 볼 수 없어 카테터 혈관조영술을 요하는 경우)으로 나누어 평가하였으며, 양측 총경동맥의 분기(bifurcation) 부위에서는 고식적인 기법의 영상과 그 화질을 비교평가하였다. 또한 세가지 사용한 코일의 종류(CP body array 12예, CP neck array 9예, head-and-neck 8예)에 따른 화질 차이를 정성적 및 정량적(신호대 잡음비)으로 분석하였다. 결과 : 대동맥궁 주요 분지들의 전반적인 화질은 55% (16/29)에서 'good', 34%(10/29)에서 'fair'로 평가되어 대부분 고식적인 카테터 혈과조영술이 피요치 않을 정도로 만족할 만한 화질을 보였다. 양측 총경 동맥분지 부위에서는 65%(17/26)에서 고식적인 3D-TOF기법과 같거나 나은 영상을 보였다. CP body array 코일을 사용한 경우가 CP neck array 코일이나 head-and-neck 코일을 사용한 경우보다 정성적 및 정량적으로 유의하게 나은 영상을 보였다(p<0.05). 결론 : 고속 조영증강 MRA기법은 단시간내 (40-60초)에 대동맥구의 주요 분지들을 그 기시부위부터 두개골 저부에 이르기까지 대부분에서 잘 나타내주므로 선별검사로서 임상적으로 유용하리라 생각되며 CP body array 코일을 사용하였을 경우에 CP neck array 코일이나 head-and-neck 코일을 사용한 경우보다 좀더 나은 화질을 얻을 수 있으리라 생각된다.

• 대한본초학회지
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• 제29권6호
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• pp.73-83
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• 2014

Objectives : This study was investigated the effects of the root of Polygala tenuifolia (POL) on learning and memory impairment induced by chronic cerebral hypoperfusion in rats. Methods : Chronic cerebral hypoperfusion was produced by permanent bilateral common carotid artery occlusion (pBCAO). POL was administered orally once a day (130 mg/kg of water-extract) for 28 days starting at 4 weeks after the pBCAO. The acquisition of learning and the retention of memory were tested on 9th week after the pBCAO using the Morris water maze. In addition, effects of POL on $A{\beta}$ generation and expressions of APP and BACE1 were observed in the hippocampus of rats. Results : POL significantly prolonged the swimming time spent in target quadrant and significantly reduced the swimming time spent in the quadrant far from the target. POL significantly increased the percentage of swim in the targer quadrant in the retention test, while POL was not effective on the escape latencies in the acquisition training trials. POL significantly reduced the levels of $A{\beta}_{(1-40)}$ and $A{\beta}_{(1-42)}$ in the cerebral cortex and the level of $A{\beta}_{(1-42)}$ in the hippocampus produced by chronic cerebral hypoperfusion. POL also significantly attenuated the up-regulation of APP and BACE1 expression in the hippocampus produced by chronic cerebral hypoperfusion. Conclusions : The results show that POL alleviated memory deficit and up-regulation of $A{\beta}$ and BACE1 expressions in the hippocampus. This result suggests that POL may exert ameliorating effect on memory deficit through inhibition of ${\beta}$-secretase activity and $A{\beta}$ generation.

• 대한본초학회지
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• 제31권1호
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• pp.7-15
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• 2016

Objectives : Polygalae Radix (POL) has an ameliorating effect on learning and memory impairment caused by cerebral hypoperfusion. In regard to POL's action mechanism, this study was carried out to investigate the effects of POL on oxidative damage and neuronal apoptosis induced by cerebral hypoperfusion in rats.Methods : The cerebral hypoperfusion was induced by permanent bilateral common carotid artery occlusion (pBCAO) in Sprague-Dawley rats. POL was administered orally once a day (130 mg/kg of water-extract) for 28 days starting at 4 weeks after the pBCAO. Superoxide dismutase (SOD) activities and malondialdehyde (MDA) levels in the brain tissue were measured using ELISA method. Expressions of 4-hydroxynonenal (4HNE) and 8-hydroxy-2'- deoxyguanosine (8-OHdG) were observed using immunohistochemistry. In addition, neuronal apoptosis was evaluated with Cresyl violet staining, TUNEL labeling, and immunohistochemistry against Bax and caspase-3.Results : POL treatment significantly increased SOD activities and significantly reduced MDA levels in the cerebral cortex. The up-regulations of 4HNE and 8-OHdG expression caused by pBCAO in the CA1 of hippocampus were significantly attenuated by POL treatment. POL treatment also restored the reduction of CA1 thickness and CA1 neurons caused by pBCAO and significantly attenuated the apoptotic markers including TUNEL-positive cells, Bax, and caspase-3 expression in the CA1 of hippocampus.Conclusions : The results show that POL attenuated the oxidative damage in brain tissue and neuronal apoptosis in the hippocampus caused by the cerebral hypoperfusion. It suggests that POL can be a beneficial medicinal herb to treat the brain diseases related to cerebral hypoperfusion.

• 한국콘텐츠학회논문지
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• 제11권2호
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• pp.341-352
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• 2011

본 연구는 전침자극이 일과성 뇌허혈이 유발된 흰쥐 대뇌피질에서 GFAP으로 표지되는 반응성 별아교세포증에 미치는 효과를 동정하기위해서 시행되었다. 실험동물은 전침자극군과 대조군으로 구분하였고, 다시 각 집단을 1일, 3일, 7일 군으로 나누어 각기 15마리씩 무작위 배분하여 실험에 사용하였다. 전침은 인체의 족삼리, 곡지, 음릉선에 상응하는 부위에 자침하고 2 Hz의 근육수축이 현저히 보일 때까지 고강도 (1mA)를 자극하였으며, 전침은 연속파, 직각파, 0.2 ms duration으로 매일 1회 오전 10~12시에 10 분 씩 총 10 회 시행한 뒤, 뇌의 조직절편을 제작하여 GFAP에 대한 면역조직화학염색을 실시해 다음과 같은 결과를 산출 하였다. GFAP의 발현은 뇌허혈로 인해 손상이 유발된 대뇌피질의 혈관주위 및 대뇌피질에서 현저하게 높은 수준으로 관찰되었다. 실험군에서 면역조직화학적으로 표지된 별아교세포들을 계수한 바, 대조군에 비해 뇌허혈이 유발된 1 일 군에서 전침자극군이 약간 감소하였고, 3 일 후에는 현저히 감소하였으며, 7 일 후에는 그 감소정도가 둔화되는 양상을 나타냈다. 대조군에 비해 전침자극군에서 GFAP으로 표지된 별모양아교세포의 수가 모두 감소한 것은 전침자극에 의해 손상의 정도가 감소하여, 전침자극이 신경가소성을 유발시키고 있다는 것으로 관찰되었다.

• 동의신경정신과학회지
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• 제21권1호
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• pp.59-69
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• 2010

Objectives: The study aims to look into how the application of EA(Electro-acupuncture) in the initial step of ischemic brain injury affects the changes in Bax and Caspase-3 expression among forebrain apoptosis. Methods: It caused GI by using common carotid artery occlusion and conducted the test by dividing into the no applied EA group after 6 hours and 12 hours, the LI 4 EA group that applied EA to LI4, and GV 20 EA group that was applied to GV 20. After that, the following results were obtained by comparing Bax and Caspase-3 expression, which were apoptosis-related factors, with its application time through immunohistochemical staining after extracting brain of each group. Results: According to each group's Bax expression by the application time, the order of expression increase after 6 hours is shown to be the no applied EA group, LI 4 group, and GV 20 group. The stimulation after 12 hours was most lowly expressed in the GV 20 group, and the no applied EA group and LI 4 group showed similar level. Conclusions: EA stimulation in the initial step after ischemia seems to affect positively Bax and Caspase-3 expression that are index of forebrain apoptosis.

• 대한수의학회지
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• 제39권1호
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• pp.34-44
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• 1999

Ischemic damage in the selectively vulnerable populations of neurons is thought to be caused by an abnormal accumulation of intracellular calcium. It has been reported that the neurons, expressing specific calcium binding proteins, might effectively control intracellular calcium concentrations because of a high capacity to buffer intracellular calcium in the brain ischemic condition. It is uncertain that parvalbumin, one of the calcium binding proteins, can protect the neurons from the cerebral ischemic damage. Recently, treatment of kappa opioid agonists increased survival rate, improved neurological function, and decreased tissue damage under the cerebral ischemic condition. Many evidences indicate that these therapeutic effects might result from regulation of calcium concentration. This study was designed to analyze the changes of number in parvalbumin-positive neurons after cerebral ischemic damage according to timepoints after cerebral ischemic induction. In addition, we evaluated the effect of GR89696 (kappa opioid agonist) or naltrexone(non selective opioid antagonist) on the changes of number in parvalbumin expressing neurons under ischemic condition. Cerebral ischemia was induced by occluding the common carotid artery of experimental animals. The hippocampal areas were morphometrically analyzed at different time point after ischemic induction(1, 3, 5 days) by using immuno-histochemical technique and imaging analysis system. The number of parvalbumin-positive neurons in hippocampus was significantly reduced at 1 day after ischemia(p<0.05). Furthermore, the number of parvalbumin-immunoreactive neurons was dramatically reduced at 3 and 5 days after cerebral ischemic induction(p<0.05) as compared to 1 day group after ischemia, as well as sham control group. Significant reduction of parvalbumin positive neurons in CA1 region of hippocampus was observed at 1 day after cerebral ischemic induction. However, significant loss of MAP2 immunoreactivity was observed at 3 day after cerebral ischemia. The loss of parvalbumin-positive neurons and MAP2 immunoreactivity in CA1 region was prevented by pre-administration of GR89696 compared to that of saline-treated ischemic group. Furthermore, protective effect of GR89696 partially reversed by pre-treatment of naltrexone. These data indicate that parvalbumin-positive neurons more sensitively responded to cerebral ischemic damage than MAP2 protein. Moreover, this loss of parvalbumin-positive neurons was effectively prevented by the pretreatment of kappa opioid agonist. It was also suggested that the changes of number in parvalbumin-positive neurons could be used as the specific marker to analyze the degree of ischemic neuronal damage.

• Journal of Korean Neurosurgical Society
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• 제47권2호
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• pp.112-118
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• 2010

Objective : There have been no clinical studies regarding the epidemiology and treatment outcome for unruptured intracranial aneurysm (UIA) in South Korea yet. Thus, The Korean Society of Cerebrovascular Surgery (KSCVS) decided to evaluate the clinical and epidemiological characteristics, and outcome of the treatment of UIA in 2006, using the nationwide multicenter survey in South Korea. Methods : A total of 1,696 cases were enrolled retrospectively over one year at 48 hospitals. The following data were obtained from all patients : age, sex, presence of symptoms, location and size of the aneurysm, treatment modality, presence of risk factors for stroke, and the postoperative 3D-day morbidity and mortality. Results : The demographic data showed female predominance and peak age of seventh and sixth decades. Supraclinoid internal carotid artery was the most common site of aneurysms with a mean size of 5.6 mm. Eight-hundred-forty-six patients (49.9%) were treated with clipping, 824 (48.6%) with coiling, and 26 with combined method. The choice of the treatment modalities was related to hospital (p=0.000), age (p=0.000), presence of symptom (p=0.003), and location of aneurysm (p=0.000). The overall 30-day morbidity and mortality were 7.4% and 0.3%, respectively. The 30-day mortality was 0.4% for clipping and 0.2% for coiling, and morbidity was 8.4% for clipping and 6.3% for coiling. Age (p=0.010), presence of symptoms (p=0.034), size (p=0.000) of aneurysm, and diabetes mellitus (p=0.000) were significant prognostic factors, while treatment modality was not. Conclusion : This first nation-wide multicenter survey on UIAs demonstrates the epidemiological and clinical characteristics, outcome and the prognostic factors of the treatment of UIAs in South Korea. The 30-day postoperative outcome for UIAs seems to be reasonable morbidity and mortality in South Korea.

• 대한소아치과학회지
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• 제29권3호
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• pp.450-454
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• 2002

연구개 및 구인두부의 열창은 아동들에게 상대적으로 흔한 편이다. 연구개 열창은 신생아부터 노년층까지 모든 연령에 걸쳐 보고된 바 있지만, 어린 아동들 특히 걸음마를 막 시작한 아동들에게서 많이 보고되었다. 이러한 아동들의 경우 입안에 물체를 물고 돌아다니다가 넘어지거나 떨어져서 구인두부 열창을 입게되는 경우가 많은 편이고, 주로 4세 정도에 호발하며, 여아보다는 남아에서 더 이러한 외상이 자주 나타나는 것으로 보고되었다. 주로 손상을 입는 연구개 및 구인두 부위는 좌측 편도 상단부위이며, 관통상없이 선상이나 표면상의 손상으로 주로 발생하고, 손상 형태는 U자 형태 혹은 V자 형태로 나타난다. 이러한 외상에 있어 관통상이나, 크게 조직편이 이개된 경우를 제외하고는 봉합술은 필요하지 않으며, 오히려 이러한 봉합술이 외상부위의 치유를 지연시킬 수 있다. 본 창상의 치유에는 3주정도 소요되며 상흔은 거의 남지 않는 것으로 보고되었다. 그러나 연구개의 창상이 경동맥의 손상을 야기하여 신경학적인 합병증이 발생했다는 보고가 있으므로, 2-3일간은 외상을 입은 환아에 대한 주기적인 관찰이 필요하며, 합병증 발생시 구강외과의 및 이비인후과의 또는 신경외과의와의 협의진료가 필요하다. 본 증례는 2세 및 3세 남환아로 입안에 이물질을 물고 넘어져 연구개의 열창을 입은 경우로 비외과적인 처치 및 신경학적인 평가 후 완치되어 이에 보고하는 바이다.