• Journal of Trauma and Injury
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• 제31권2호
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• pp.51-57
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• 2018

Purpose: Patients with diffuse axonal injury experience various disabilities and have a high cost of treatment. Recent researches have revealed the underlying mechanism and pathogenesis of diffuse axonal injury. This study aimed to investigate the correlation between the radiological grading of diffuse axonal injury and the clinical outcomes of patients. Methods: From January 2011 to December 2016, among 294 patients with traumatic brain injury, 44 patients underwent magnetic resonance imaging (MRI). A total of 18 patients were enrolled in this study except for other cerebral injuries, such as cerebral hemorrhage or hypoxic brain damage. Demographic data, clinical data, and radiological findings were retrospectively reviewed. The grading of diffuse axonal injury was analyzed based on patient's MRI findings. Results: For the most severe diffuse axonal injury patients, prolonged intensive care unit (ICU) stay (p=0.035), hospital stay (p=0.012), and prolonged mechanical ventilation (p=0.030) were observed. However, there was no significant difference in healthcare-associated infection rates between MRI grading (p=0.123). Massive transfusion, initial hemoglobin and lactate levels, and MRI gradings were found to be highly significant in predicting the duration of unconsciousness. Conclusions: This study showed that patients with high grade diffuse axonal injury have prolonged ICU stays and significantly longer hospital stays. Deteriorated mental patients with high energy injuries should be evaluated to identify diffuse axonal injuries by using an appropriate imaging tool, such as MRI. It will be important to predict the duration of consciousness recovery using MRI scans.

• 대한한방내과학회지
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• 제40권5호
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• pp.804-813
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• 2019

The purpose of this study was to evaluate the effect of Korean medicine in a patient with cognitive impairment, emotional disturbance, and sleep disturbance due to a diffuse axonal injury associated with a traumatic brain injury. The patient was treated with herbal medicine and acupuncture. The treatment effects were evaluated using the Korean version of the Mini-Mental State Examination (MMSE-K) and the Global Detraction Scale (GDS), and by observing clinical symptoms. Improvements in the total scores of MMSE-K and GDS were observed after the Korean medicine treatments; the MMSE-K score increased from 13 to 23 and the GDS score decreased from 5 to 4. The emotional and sleep disturbances were also reduced. These case report findings suggest that Korean medicine may be effective for treating symptoms of diffuse axonal injury in patients with traumatic brain injury.

• 생물정신의학
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• 제2권2호
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• pp.157-168
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• 1995

The neuropsychiatric sequelae of traumatic brain unjury(TBI) are effects on complex aspect of behavior, cognition and emotional expression. They include psychiatric disorders such as depression, psychosis, personality change, dementia, and postconcussion syndrome. The damage is done not only to the cortex of the brain but also to subcortical and axial structures. The diffuse degeneration of cerebral white mailer is axonal damage that is caused by mechanical forces shearing the neuronal fiber at the moment of impact(diffuse axonal injury, DAI). The DAI and the changed receptor-agonist mechanism ore the most important mechanisms in genesis of neuropsychiatric sequalae by mild TBI. The most important instrument for diagnosis of neuropsychiatric sequalae of TBI is a physician or psychiatrist with experience and knowledge. The most effective therapeutic tool is a professional who understands the nature of the problem.

• Journal of Korean Neurosurgical Society
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• 제46권3호
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• pp.205-209
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• 2009

Objective : This study was conducted to investigate the correlation between the degrees of injury on brain magnetic resonance imaging (MRI) and the time interval to recovery of consciousness in patients with diffuse axonal injury. Methods : From January 2004 to December 2008, 25 patients with diffuse axonal injury were treated at our hospital. We retrospectively investigated the patients' medical records and radiological findings. We divided the patients into three groups according to the grade of MRI finding : grade I, small scattered lesions on the white matter of the cerebral hemisphere; grade II, focal lesions on the corpus callosum; and grade III, additional focal lesions on the brain stem. Result : Seven patients belonged to the grade I group; 10 to the grade II group; and 8 to the grade III group. The mean Glasgow Coma Scale (GCS) score of all patients at the time of admission was 7.28. Recovery of consciousness was observed in 23 of the 25 patients; the remaining two patients never regained consciousness. The time interval to recovery of consciousness (awake status) ranged from 1 day to 125 days (mean 22.1 days) : grade I group patients, within approximately 1 week (mean 3.7 days); grade II group patients, within approximately 2 weeks (mean 12.5 days); and grade III group patients, within approximately 2 months (mean 59.5 days). Conclusion : Our study results suggest a correlation between the mean time interval to recovery of consciousness in patients with diffuse axonal injuries and the degrees of brain injuries seen on MRI. Patients with grade I and II diffuse axonal injuries recovered consciousness within 2 weeks, while patients with grade III injuries required approximately 2 months.

• Journal of Trauma and Injury
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• 제24권2호
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• pp.151-154
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• 2011

In trauma patients, cognitive impairment may develop due to several causes: traumatic brain injury such as intracranial hemorrhage, diffuse axonal injury, hypoxic brain injury or reperfusion injury, the psychologic disorder, such as acute stress disorder, post-traumatic disorder or delirium. We describe a 62-year-old male with post-trauma cognitive impairment due to a primary central nervous system lymphoma.

• 한국콘텐츠학회논문지
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• 제9권12호
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• pp.656-664
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• 2009

본 논문은 산업화와 교통 환경의 발달로 인해 최근 들어 발생빈도가 크게 증가되고 있는 외상성 뇌손상을 대상으로 하여, 치료적 운동의 적용에 있어 수중운동의 뇌신경 가소성에 미치는 영향과 전정-운동에 대한 영향에 대해 알아보고자 한 연구이다. 수중운동이라는 운동학적 특성을 통해 기능적 독립을 위해선 반드시 전제되어야 하는 뇌신경 가소성과 전정-운동 기능의 회복에 어떠한 영향을 주는지를 알아보기 위하여 80마리의 백서를 대상으로 4군으로 나누고, 3주간 서로 다른 방식의 운동 훈련(실험군 I: 대조군, II: 수중운동군, III: 속도 및 경사 조절 트레드밀 운동군, IV: 단순 트레드밀 운동군)을 적용하여 전정-운동 기능에 미치는 영향을 Rota-Rod 검사를 통해 알아보고, 신경가소성에 대한 영향성에 대해서는 대뇌피질에서의 GAP-43 인자를 조직면역화학적 방법으로 검사해 보았다. 연구결과, 수중운동을 적용한 군에서, 다른 군들에 비해 뇌신경 가소성에 긍정적이고도 유의한 영향을 미칠 수 있음을 확인할 수 있었으며, 전정-운동 기능 향상에 있어서도 다른 군들에 비해 유의한 향상 효과를 나타내었다. 이는 물이 가지고 있는 다양한 감각적 특성과 환경적 상황이 뇌손상으로 인해 불안정한 신체의 운동에 긍정적인 영향을 미치기 때문인 것으로 사료된다.

• 대한한방내과학회지
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• 제28권3호
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• pp.645-654
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• 2007

The purpose of this study is to present a case of secondary dementia caused by diffuse axonal injury. We diagnosed this patient with diffuse axonal injury by using brain computerized tomography(CT) and magnetic resonance imaging(MRI), and also diagnosed secondary dementia based on DSM-IV. To evaluate prognosis of the patient, we used K-DRS(Korean-Dementia Rating Scale) and gave him a written test. As a result of treating this patient with oriental medicine, the K-DRS score increased and the overall clinical symptoms improved. In oriental medicine, case studies of diffuse axonal injury are yet insufficient, hence more clinical studies and researches will be needed.

• Clinical and Experimental Pediatrics
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• 제61권8호
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• pp.245-252
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• 2018

Purpose: This study investigated patterns of ischemic injury observed in brain images from patients with neonatal group B Streptococcal (GBS) meningitis. Methods: Clinical findings and brain images from eight term or near-term newborn infants with GBS meningitis were reviewed. Results: GBS meningitis was confirmed in all 8 infants via cerebrospinal fluid (CSF) analysis, and patients tested positive for GBS in both blood and CSF cultures. Six infants (75.0%) showed early onset manifestation of the disease (<7 days); the remaining 2 (25.0%) showed late onset manifestation. In 6 infants (75%), cranial ultrasonography showed focal or diffuse echogenicity, suggesting hypoxic-ischemic injury in the basal ganglia, cerebral hemispheres, and periventricular or subcortical white matter; these findings are compatible with meningitis. Findings from magnetic resonance imaging (MRI) were compatible with bacterial meningitis, showing prominent leptomeningeal enhancement, a widening echogenic interhemisphere, and ventricular wall thickening in all infants. Restrictive ischemic lesions observed through diffusion-weighted imaging were evident in all eight infants. Patterns of ischemic injury as detected through MRI were subdivided into 3 groups: 3 infants (37.5%) predominantly showed multiple punctuate lesions in the basal ganglia, 2 infants (25.0%) showed focal or diffuse cerebral infarcts, and 3 infants (37.5%) predominantly showed focal subcortical or periventricular white matter lesions. Four infants (50%) showed significant developmental delay or cerebral palsy. Conclusion: Certain patterns of ischemic injury are commonly recognized in brain images from patients with neonatal GBS meningitis, and this ischemic complication may modify disease processes and contribute to poor neurologic outcomes.

• Journal of Korean Neurosurgical Society
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• 제52권4호
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• pp.377-383
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• 2012

Objective : Detection of focal non-hemorrhagic lesion (NHL) has become more efficient in diffuse axonal injury (DAI) patients using an MRI. The aims of this study are to find out the radiological distribution, progress of NHL and its clinical significance. Methods : Between September 2005 and October 2011, 32 individuals with NHLs on brain MRI were enrolled. NHLs were classified by brain location into 4 major districts and 13 detailed locations including cortical and subcortical, corpus callosum, deep nuclei and adjacent area, and brainstem. The severity of NHL was scored from grades 1 to 4, according to the number of districts involved. Fourteen patients with NHL were available for MRI follow-up and an investigation of the changes was conducted. Results : Thirty-two patients had 59 NHLs. The most common district of NHL was cortical and subcortical area; 15 patients had 20 NHSs. However the most common specific location was the splenium of the corpus callosum; 14 patients had 14 lesions. The more lesions patients had, the lower the GCS, however, this was not a statistically meaningful difference. On follow-up MRI in 14 patients, out of 24 lesions, 13 NHLs resolved, 5 showed cystic change, and 6 showed atrophic changes. Conclusion : NHLs were located most commonly in the splenium and occur frequently in the thalamus and the mesial temporal lobe. Because most NHS occur concomitantly with hemorrhagic lesions, it was difficult to determine their effects on prognosis. Since most NHLs resolve completely, they are probably less significant to prognosis than hemorrhagic lesions.

• 한국콘텐츠학회논문지
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• 제9권1호
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• pp.348-358
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• 2009

미만성 축삭손상(diffuse axonal injury)은 외상성 뇌손상의 일반적인 형태이며, 인지 장애의 주요 원인으로 생각되어 진다. 흔들린 아기 증후군(shaken baby syndrome)과 같이 뇌에 전단력이 심하게 가해졌을 때도 신체 장애 뿐만 아니라 인지 장애가 특징적으로 나타난다. 신체 활동은 건강 증진과 더불어 기억 및 학습과 관련된 해마의 기능 향상에도 영향을 미친다. 본 연구의 목적은 흰쥐를 대상으로 미만성 축삭 손상을 일으킨 후 반복적인 운동 훈련을 통해 운동 수행력을 관찰하고 해마에서 GAP-43의 발현을 통해 축삭 재생의 변화를 관찰하는 것이었다. 실험동물은 운동 훈련을 적용시키는 실험군과 대조군으로 구분하였고, 각각의 군을 다시 1일, 7일 및 14일군으로 구분하였다. 그 결과, 운동 훈련을 적용시킨 실험군이 대조군보다 운동 수행력의 향상이 더 유의했으며, 해마에서 GAP-43의 발현도 같은 양상을 나타냈다. 이러한 차이는 7일군과 14일군보다 1일군과 7일군 사이에 더 크게 나타났다. 그러므로 미만성 축삭손상 후 운동 훈련은 운동 수행력의 향상에 영향을 미치며, 인지와 관련된 해마의 구조적 변화도 야기 시키는 것으로 생각된다.