• 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.

• 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.

• 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.

• Journal of Trauma and Injury
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• 제25권4호
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• pp.122-131
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• 2012

Purpose: Diffuse axonal injury (DAI) is clinically defined as a coma of over six hours in a head trauma victim without a focal mass lesion. The emergency physician usually resuscitates and stabilizes a comatose head trauma victim in the emergency Department. After assessment and treatment, the prognosis is very important to both the victim and the physician. The prognosis for DAI is based on Glasgow Coma Scale (GCS) and other imaging data. We investigated the prognostic value of computed tomography (CT) and gradient-echo magnetic resonance imaging (GRI) for head trauma victims with DAI. Methods: Fifty-three(53) head trauma victims of DAI were enrolled in this study from 2007 to 2012. During the study period of six years, data on trauma victims were collected retrospectively. We analyzed the differences in the Glasgow Outcome Scale (GOS) result between the CT and the GRI modalities. Results: We classified the study group by using GOS. Between the good outcome subgroup (GOS scores of 4 and 5) and the poor outcome subgroup (GOS score of 1-3), there were no statistical difference in sex, age, initial vital signs and initial GCS score. The good outcome subgroup had non-hemorrhage on CT(52%), which was correlated with good outcome and a shorter awakening time, while a larger number and a deeper location of hemorrhagic lesions on in GRI were correlated with poor outcome in DAI. Conclusion: We conclude that the existence of hemorrhagic lesions on CT, and the number and location of those lesions on GRI had good prognostic value for head trauma victims with DAI.

• 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.

• 대한의용생체공학회:의공학회지
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• 제19권6호
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• pp.603-609
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• 1998

가속도 변화에 따른 뇌의 미만성 부상을 해석하기 위하여 성인 및 2세, 6세아의 머리 부분에 대한 유한 요소 모델을 개발하였다. 외력은 최대값이 200g인 삼각형 형태의 가속도를 가하였으며, 가속도의 방향, 지속시간에 따른 변화를 해석하였다. 가속도 변화에 따라 발생되는 뇌내의 전단력 분포는 뇌간, 뇌교 및 중뇌등 신경조직이 밀집된 곳에서 크게 발생되어 이곳에서 미만형 부상이 발생할 확률이 높음을 알 수 있었으며, 특히 6세아 모델의 경우 뇌간에서의 최대 전단력이 굴전 형태의 회전가속도 받았을 때 가장 크게 나타나는 결과를 보여 개발된 모델이 임상결과와 일치함을 보여주고 있었다. 가속도 지속 시간이 길어짐에 따라 뇌내에 발생되는 압력 및 최대 전단력의 크기가 증대되고 있었으며, 유아모델의 경우 성인모델에 비하여 가속도 방향과 관계없이 낮은 압력이 발생하였지만 발생압력이 감소하지 않고 지속되는 현상을 보이고 있었다. 그리고 각 가속도에 의한 미만성 부상을 예방하기 위한 안전지수로는 현재 탑승자의 안전 설계에 활용되고 있는 HIC보다는 최대 전단응력이 더 적절한 부상 예측인자임을 알 수 있었다.

• Journal of Korean Neurosurgical Society
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• 제30권2호
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• pp.168-172
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• 2001

Objective : The authors have studied the clinical outcome of patients with diffuse axonal injuries(DAI) to evaluate the prognostic value of gradient-echo MR imaging findings. Materials and Methods : From March 1995 to March 1998, there were nineteen patients with DAI whose initial Glasgow coma scales were eight or less. Authors divided them into two groups according to Glasgow outcome scales ; those patients with GOS 3 or less(group A ; 9) and those with 4 or more(group B ; 10). We subdivided the lesions as superficial and deep lesion, and analyzed the numbers, anatomical loci of the lesions on the gradient echo images of each group. Results : Mean numbers of the lesions were 15 per case in group A(135/9) and 10 in group B(100/10). The common loci involved in DAI were cerebral cortex, brain stem, and corpus callosum. Cortical lesions were 31.1% in group A(42/135) and 47% in group B(47/100). Brain stem lesions were 25.9%(35/135) and 15%(15/100) each. Callosal lesions were 31.1%(26/135) and 13%(13/100) each. The frequency of callosal and brain stem lesions was significantly different between two groups(p<0.05). We divided callosal lesions as genu, body, and splenium and body lesions as anterior, middle, posterior, but no significant topographical difference of lesions was observed between two groups. Deep lesions were observed more frequently in group A(58.5%, 79/135) than group B(36%, 36/100). Conclusion : The poor outcome group showed more numbers of lesion and more frequent involvement of brain stem and corpus callosum than favorable outcome group. Gradient-echo MR imaging seems to have predictive value for clinical outcome in patients with DAI.

• Journal of Korean Neurosurgical Society
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• 제60권6호
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• pp.710-716
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• 2017

Objective : Among pediatric injury, brain injury is a leading cause of death and disability. To improve outcomes, many developed countries built neurotrauma databank (NTDB) system but there was not established nationwide coverage NTDB until 2009 and there have been few studies on pediatric traumatic head injury (THI) patients in Korea. Therefore, we analyzed epidemiology and outcome from the big data of pediatric THI. Methods : We collected data on pediatric patients from 23 university hospitals including 9 regional trauma centers from 2010 to 2014 and analyzed their clinical factors (sex, age, initial Glasgow coma scale, cause and mechanism of head injury, presence of surgery). Results : Among all the 2617 THI patients, total number of pediatric patients was 256. The average age of the subjects was 9.07 (standard deviation${\pm}6.3$) years old. The male-to female ratio was 1.87 to 1 and male dominance increases with age. The most common cause for trauma were falls and traffic accidents. Age (p=0.007), surgery (p<0.001), mechanism of trauma (p=0.016), subdural hemorrhage (SDH) (p<0.001), diffuse axonal injury (DAI) (p<0.001) were statistically significant associated with severe brain injury. Conclusion : Falls were the most common cause of trauma, and age, surgery, mechanism of trauma, SDH, DAI increased with injury severity. There is a critical need for effective fall and traffic accidents prevention strategies for children, and we should give attention to these predicting factors for more effective care.

• Journal of Korean Neurosurgical Society
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• 제51권1호
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• pp.24-30
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• 2012

Objective : This study was conducted to assess the clinical significance of traumatic brain stem injury (TBSI) reflected on Glasgow Coma Score (GCS) and Glasgow Outcome Score (GOS) by various clinical variables. Methods : A total of 136 TBSI patients were selected out of 2695 head-injured patients. All initial computerized tomography and/or magnetic resonance imaging studies were retrospectively analyzed according to demographic- and injury variables which result in GCS and GOS. Results : In univariate analysis, mode of injury showed a significant effect on combined injury (p<0.001), as were the cases with skull fracture on radiologic finding (p<0.000). The GCS showed a various correlation with radiologic finding (p<0.000), mode of injury (p<0.002), but less favorably with impact site (p<0.052), age (p<0.054) and skull fracture (p<0.057), in order of statistical significances. However, only GOS showed a definite correlation to radiologic finding (p<0.000). In multivariate analysis, the individual variables to enhance an unfavorable effect on GCS were radiologic finding [odds ratio (OR) 7.327, 95% confidence interval (CI)], mode of injury (OR; 4.499, 95% CI) and age (OR; 3.141, 95% CI). Those which influence an unfavorable effect on GOS were radiologic finding (OR; 25.420, 95% CI) and age (OR; 2.674, 95% CI). Conclusion : In evaluation of TBSI on outcome, the variables such as radiological finding, mode of injury, and age were revealed as three important ones to have an unfavorable effect on early stage outcome expressed as GCS. However, mode of injury was shown not to have an unfavorable effect on late stage outcome as GOS. Among all unfavorable variables, radiological finding was confirmed as the only powerful prognostic variable both on GCS and GOS.