• Clinical and Experimental Pediatrics
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• 제46권11호
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• pp.1067-1072
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• 2003

목 적 : 소아에서 사고에 의하지 않은(non-accidental) 두개내출혈은 빈도가 아주 드물지 않으며 성인과 다른 임상 양상을 보이고 높은 사망률과 심각한 후유증을 남긴다. 특히 흔들린 아이증후군은 소아에서만 있는 두개내출혈로 최근 본원에서 여려 사례를 경험하였다. 이에 저자들은 사고에 의하지 않은 두개내 출혈로 한림대학교성심병원에 입원한 소아 환아들을 대상으로 성별, 연령 분포, 원인, 내원 당시 임상 증상, 출혈 유형, 사망률과 후유증에 대해 조사하였다. 방 법 : 1999년 1월부터 2002년 6월까지 3년 6개월간 한림대학교 성심병원 소아과와 신경외과에 사고에 의하지 않은 두개내출혈로 입원한 15세 이하의 환아 중 신생아의 두개내출혈 환아를 제외한 20례를 대상으로 병력지를 검토하여 후향적으로 분석하였다. 결 과 : 1) 남녀비는 1 : 0.8이었고 연령 분포는 1세 미만 9례(45%), 1-5세 2례(10%), 6-10세 3례(15%), 11-15세 6례(30%)로 1세 미만과 11-15세에서 가장 많이 분포하였다. 2) 원인은 흔들린 아이 증후군 5례(25%), 동정맥 기형 5례(25%), 해면상 혈관종 2례(10%), 뇌종양 2례(10%), 동맥류 1례(5%), 원인 질환이 밝혀지지 않은 경우가 5례(25%)로 흔들린 아이 증후군과 동정맥 기형이 가장 많았다. 3) 내원 당시 임상 증상으로 경련 11례(55%), 의식 변화 6례(30%), 구토 5례(25%), 두통 3례(15%), 편측 부전마비 1례(5%), 보챔 1례(5%), 안면 경축 1례(5%)로 경련이 가장 많았다. 4) 출혈 유형은 경막하 출혈 8례(40%), 뇌내 출혈 5례(25%), 복합 두개내 출혈 5례(25%), 지주막하 출혈 2례(10%)였다. 5) 대상 환아 20례 중 사망률은 3례로 15%였고 생존율은 17례로 85%였다. 생존아 중 추적 관찰이 되지 않은 5례를 제외한 12례에서 완전 회복된 경우가 6례였으며 후유증이 남은 경우가 6례였다. 후유증이 남은 6례 중 편측 부전마비 2례, 동측성 반맹 2례, 발달 장애 2례, 사지 마비 2례, 단마비 1례, 학습 장애 1례, 시력 장애 1례였다. 결 론 : 소아에서 사고에 의하지 않은 두개내 출혈의 발생률은 아주 낮지 않으며 사망률과 후유증 발생 가능성이 높기 때문에 조기 진단과 적절한 치료가 필요하다. 또한 최근 의학의 발달로 생존율이 높아지면서 신경학적 후유증을 가진 소아들이 늘어남에 따라 이들에 대한 적극적인 재활 관리가 필요하다고 생각된다.

• 보건의료산업학회지
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• 제11권1호
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• pp.91-105
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• 2017

Objectives : This study analyzed the differences in length of stay(LoS), total hospital charges(THC), and cost of rehabilitation(CoR) between two types of stroke patients, intracerebral hemorrhage(ICH) and cerebral infarction(CI). Factors associated with these differences were also assessed. Methods : Data were obtained from the 2011 National Inpatient Sample data of Health Insurance Review and Assessment Service. We used propensity score matching to match the characteristics of the two types of stroke patients, and conducted a regression analysis to analyze their associations. Results : The differences between THC, LoS, and CoR by stroke and hospital types were shown. Each type of hospital showed different results. Conclusions : A rapidly aging population will accelerate the number of stroke patients requiring effective management. Studies evaluating healthcare utilization of stroke patients will provide evidence for both healthcare resources allocation and healthcare policy decisions.

• PNF and Movement
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• 제16권2호
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• pp.179-185
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• 2018

Purpose: This study aimed to analyze the visual and spatial elements of the gait of a stroke patient who had diverse ankle weight loads applied, according to weight changes. Methods: The subject was a 57-year-old stroke patient diagnosed and hospitalized with a left intracerebral hemorrhage. A weight equivalent to 0%, 1%, and 2% of his body weight was applied to the area 5cm upward from the ankle using a Velcro strap. He was then trained on a treadmill, receiving a six-minute walk test to evaluate his gait ability. A gait analyzer was used to collect visual and spatial elements, such as gait distance, gait velocity, cadence, step length, stride length, and swing phase, according to a weight load equivalent to 0%, 1%, and 2% of his body weight. Results: According to the results of applying 0%, 1%, and 2% of his body weight on the ankle, except for gait velocity, his gait distance, cadence, step length, stride length, and swing phase were higher when 1% of his body weight was applied compared to 0% or 2% of his body weight. Conclusion: Applying a weight equivalent to 1% of the body weight to the ankle positively affected the visual and spatial element of the gait and heightened the efficiency of exercise during treadmill training, a gait-training tool generally used for stroke patients. However, the result is difficult to generalize because the number of subjects was small with only one subject.

• 대한한방내과학회지
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• 제21권4호
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• pp.583-590
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• 2000

Objective : The major risk factors of stroke are hyperlipemia, ateriosclerosis, hypertension, diabetis mellitus, smoking, drinking, age, personal history, family history etc. Hypertension, smoking and hyperlipemia are very important factor to promote stroke. We intended to observe the serum lipid density of 51 patients come to Joongpoong & Chronic Disease Center of Conmaul Oriental hospital, comparing with already reported study. Methods : We studied 51 stroke-patients( 38 cerebral infarction, 13 intracerebral hemorrhage) of Conmaul Oriental hospital, Department of oriental internal medicine, Joongpoong & Chronic Disease Center from January 1. 1999 to August 31. 2000, which examined by neurologic test, brain-CT, brain-MRI. . We used DOSHISA TBA-30FR(Japan) as instrument for measuring total cholesterol and triglyceride of serum. Results and conclusions : The results are as follows 1. The rate of hyperlipemia and presumed-hyperlipemia is higher in female patient-group than male patient-group. 2. The rate of hyperlipemia and presumed-hyperlipemia is higher in drinking group than non-drinking group. 3. The rate of hyperlipemia and presumed-hyperlipemia is higher in hypertension group than normotention group.

• 한국콘텐츠학회논문지
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• 제13권11호
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• pp.236-248
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• 2013

본 연구의 목적은 표준화 환자를 활용한 신경계 환자 간호 시뮬레이션 학습을 위한 시나리오 개발과 그의 효과를 평가하기 위함이다. 단일군 사전 사후 설계이며 연구 참여자는 4학년 간호대학생이다. 본 연구는 자발성 뇌출혈 환자 사례의 시나리오를 개발하였고, 표준화 환자를 활용한 간호시뮬레이션 학습시나리오는 간호학생의 문제해결능력 및 임상수행능력을 향상시켰다. 본 연구를 통해 간호학생이 의식사정 등을 포함한 간호사정을 학습함으로써 보다 전문적인 간호사로 성장할 수 있는 계기가 될 수 있다는 점에서 의의가 있으며, 추후 표준화 환자를 활용한 시뮬레이션 학습 시나리오가 다양한 분야에서 개발되어야 함을 제언한다.

• Journal of Korean Neurosurgical Society
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• 제57권3호
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• pp.204-207
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• 2015

We are reporting an unusual case of dural arteriovenous fistula (AVF) of the superior sagittal sinus (SSS) after tamoxifen treatment for breast cancer. A 30-year-old female arrived at the emergency room with a sudden headache and left sided weakness and sensory loss. In her past medical history, she was diagnosed with breast cancer 1 year prior, and subsequently underwent a breast conserving mastectomy with whole breast radiation and adjuvant chemotherapy with tamoxifen. At the time of admission, computed tomography showed a small acute intracerebral hemorrhage at the right parietal cortex, and magnetic resonance imaging showed that a dural AVF at the SSS with a prominent and tortuous venous enhancement along the centrum semiovale was present. Cerebral angiography showed that the dural AVF at the mid-portion of the SSS with meningeal arterial feeding vessels entering the wall of the SSS, then draining through the dilated cortical veins. Our patient had no signs of active malignancy or any abnormalities in her coagulation profile, so it can be concluded that the tamoxifen was the likely cause of the SSS thrombosis and dural AVF. The dural AVF was treated by an endovascular coil embolization for the arterialized segment of the SSS. The patient dramatically recovered favorably from left side motor and sensory deficit. The best clinical approach is to screen potential patients of tamoxifen hormonal therapy and educate them on the sign and symptoms of life threatening thromboembolic events while taking tamoxifen.

• Journal of Korean Neurosurgical Society
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• 제44권3호
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• pp.178-181
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• 2008

Although endovascular intervention is the first-line treatment of intracranial aneurysm, intraprocedural rupture or extravasation is still an endangering event. We describe two interesting cases of extravasation during embolotherapy for ruptured peripheral cerebral pseudoaneurysms. Two male patients were admitted after development of sudden headache with presentation of intracerebral and subarachnoid hemorrhage, respectively. Initial angiographic assessment failed to uncover any aneurysmal dilatation in both patients. Two weeks afterwards, catheter angiography revealed aneurysms each in the peripheral middle cerebral artery and anterior inferior cerebellar artery. Under a general anesthesia, endovascular embolization was attempted without systemic heparinization. In each case, sudden extravasation was noted around the aneurysm during manual injection of contrast after microcatheter navigation. Immediate computed tomographic scan showed a large amount of contrast collection within the brain, but they tolerated and made an unremarkable recovery thereafter. Intraprocedural extravasation is an endangering event and needs prompt management, however proximal plugging with coil deployment can be sufficient alternative, if one confronts with peripheral pseudoaneurysm. Peculiar angiographic features are deemed attributable to extremely fragile, porous vascular wall of the pseudoaneurysm. Accordingly, it should be noted that extreme caution being needed to handle such a friable vascular lesion.

• 대한유전성대사질환학회지
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• 제14권1호
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• pp.10-18
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• 2014

Recent advances in the diagnosis and treatment of inborn errors of metabolism have improved substantially the prognosis of many of these diseases, if diagnosed early enough before irreversible damage occurs. This makes it essential that the practicing pediatrician, especially neonatologists be familliar with the clinical presentations and systematic approaches of these disorders. Characteristic clinical presentations, methods of systematic approach and typing of various disorders is discussed in this review. The signs of neurological dysfunctions of many IEMs manifesting in the neonatal period is very nonspecific, such as poor feeding, poor sucking, apnea or tachypnea, vomiting, hypertonia, hypotonia, seizure, letharginess, consciousness change and coma. Many other non-metabolic severe disorders of neonatal period such as neonatal sepsis and intracerebral hemorrhage share these nonspecific symptoms. Hyperammonemia, metabolic acidosis, ketosis and hyperlatic acidemia are observed in many of these conditions but there are exceptions in which conditions all basal laboratory tests are normal, such as NKH, sulfite oxidase deficiency and peroxisomal disorders. According to the results of basal laboratory tests, IEMs in the neonatal period can be categorized in to 6 types. Grouping of IEMs into 6 types will make confirmatory tests and early emergency treatment more efficient.

• The Journal of Korean Physical Therapy
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• 제23권2호
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• pp.85-90
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• 2011

Purpose: The contribution of the supplementary motor area (SMA) to the control of voluntary movement has been revealed. We investigated the changesin the SMA for motor learning of the reaching movement in stroke patient using functional MRI. Methods: The subject was a right-handed 55 year-old woman with left hemiparesis due to an intracerebral hemorrhage. She performed reaching movement during fMRI scanning before and after reaching training in four weeks. The motor assessment scale and surface EMG were used to evaluate the paretic upper limb function and muscle activation. Results: In the fMRI result, contralateral primary sensorimotor cortex (SM1) was activated before and after training. SMA was only activated after training. In addition, muscle activation of the paretic upper limb was similar to that of the unaffected upper limb after training. Conclusion: These findings suggest SMA is related to the execution of a novel movement pattern resulting in motor learning in stroke patients.

• Journal of Trauma and Injury
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• 제34권3호
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• pp.203-207
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• 2021

Penetrating brain injury caused by a nail gun is an uncommon clinical scenario reported in the literature. A 36-year-old male presented with a nail that had penetrated through the occipital bone. He was alert and neurologically intact except for visual disturbance. Computed tomography (CT) of the brain showed the nail lodged at the occipital lobe and the parietal lobe, with minimal intracerebral hemorrhage. The nail was placed in the occipital lobe close to the superior sagittal sinus. We removed the nail with craniotomy since the entrance of the nail was close to the superior sagittal sinus. There were no newly developed neurological deficits postoperatively. Immediate postoperative CT showed no newly developed lesions. The patient recovered well without any significant complications. Two weeks postoperatively, magnetic resonance imaging showed no remarkable lesions. The visual disturbance was followed up at the outpatient department. To summarize, we report a rare case of penetrating head injury by a nail gun and discuss relevant aspects of the clinical management.