• The Korean Journal of Nuclear Medicine
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• v.34 no.5
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• pp.433-435
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• 2000

A 6000-year-old male with carcinoma of the prostate and cerebral infarction underwent a Tc-99m MDP bone scintigraphy for the evaluation of skeletal metastases. Bone scintigraphy (Fig. 1) showed multiple areas of increased uptake of Tc-99m MDP in the skull, spine, and ribs representing skeletal metastases. Two different patterns of uptake occurred in the skull region (Fig. 1A-C); one represents bony metastasis and the ether represents cerebral infarction. The shape, size, location, intensity, and border of the increased uptake differed between the two lesions. An oval-shaped pattern with smaller size, greater intensity and more sharply defined border in the frontal region was consistent with bony metastasis. A rectangular-shaped pattern with larger size, lesser intensity and relatively indistinct border in the temporo-parieto-occipital region was consistent with cerebral infarction. Increased uptake of bone-seeking radiotracers in cerebral infarction has been reported previously.$^{1-4)}$ A suggested mechanism by which bone-seeking radiotracers accumulate in the necrotizing cerebral tissue is an alteration of the blood-brain barrier induced during cerebral infarction, which results in entry of the radiotracers into the extracellular space of the brain.$^{4)}$ Brain CT (Fig. 2) performed 7 days before and one month after the bone scintigraphy revealed lesions on the right temporo-parieto-occipital region consistent with acute hemorrhagic and chronic cerebral infarction, respectively.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.18 no.10
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• pp.178-184
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• 2017

This study was performed on 16 patients diagnosed with tsutsugamushi disease and cerebral infarction from January 2007 to December 2015. An acute cerebral infarction was diagnosed by brain MRI and MRA. Tsutsugamushi disease was diagnosed using a polymerase chain reaction. To distinguish the difference between the generalized cerebral infarction and infarction with tsutsugamushi disease, the blood pressure and body temperature were measured uponadmission. In general, the blood pressure increases during an acute cerebral infarction. Interestingly, in this study, 12 patients showed a systolic blood pressure less than 130 mmHg uponadmission. The location of the cerebral infarction and whether single or multiple cerebral infarction were examined. Thirteen patients had a cerebral infarction in anterior circulation and 3 patients developed in posterior circulation. To evaluate the coagulation disorders, prothrombin time (PT), activated partial thromboplastin time (aPTT), D-dimer, fibrinogen, fibrin degradation product (FDP). D-dimer, which is generally known to increase in an acute cerebral infarction, showed a significant increase in the 13 patients. Fibrin degradation products (FDP) showed a significant increase in 15 patients. The pathophysiological mechanism of tsutsugamushi disease is known as vasculitis, which may result in an endothelial cell injury and proliferation of the endothelial wall, which may lead to a cerebral infarction accompanied by coagulopathy. Without endothelial cell damage and proliferation, a vasospasm caused by vasculitis may cause vasoconstriction and cerebral infarction.

• Journal of Korean Neurosurgical Society
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• v.49 no.2
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• pp.92-96
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• 2011

Objective : We retrospectively evaluated the prognostic factors that can influence long-term survival in patients who suffered acute large cerebral infarction. Methods : Between June 2003 and October 2008, a total of 178 patients were diagnosed with a large cerebral infarction, and, among them, 122 patients were alive one month after the onset of stroke. We investigated the multiple factors that might have influenced the life expectancies of these 122 patients. Results : The mean age of the patients was $70{\pm}13.4$ years and the mean survival was $41.7{\pm}2.8$ months. The mean survival of the poor functional outcome group ($mRS{\geq}4$) was $33.9{\pm}3.3$ months, whereas that of the good functional outcome group ($mRS{\leq}3$) was $58.6{\pm}2.6$ months (p value=0.000). The mean survival of the older patients (270 years) was $29.7{\pm}3.4$ months, whereas that of the younger patients (<70 years) was much better as $58.9{\pm}3.2$ months (p value=0.000). Involvement of ACA or PCA territory in MCA infarction is also a poor prognostic factor (p value=0.021). But, other factors that are also known as significant predictors of poor survival (male gender, hypertension, heart failure, atrial fibrillation, diabetes mellitus, a previous history of stroke, smoking, and dyslipidemia) did not significantly influence the mean survival time in the current study. Conclusion : Age (older versus younger than 70 years old) and functional outcome at one month could be critical prognostic factors for survival after acute large cerebral infarction. Involvement of ACA or PCA territory is also an important poor prognostic factor in patients with MCA territorial infarction.

• Health Policy and Management
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• v.28 no.1
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• pp.48-52
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• 2018

Background: The current study evaluated the hospital utilization and characteristics of patients who received health care services for acute cerebral infarction outside their own residential area. Methods: Using the 2014 national patient survey data, information on 2,982 patients diagnosed with acute cerebral infarction through emergency department were retrieved for the analyses. Multiple logistic regression was performed to investigate the characteristics associated with using hospitals outside residential area among patients diagnosed with acute cerebral infarction. Results: Fifteen point nine percent of patients admitted for acute cerebral infarction utilized hospitals outside their residential area. Patients residing in a province were 7.7 times more likely to utilize hospitals located outside their residential areas compared to those living in Seoul metropolitan city. Patients living in Gangwon and Jeolla were 0.26 times and 0.48 times more likely to go to hospitals in different geographical areas. Also, patients within the age group of 80 years and over were 0.65 times less likely to be admitted to hospitals outside their residential area compared to those in their 40s-50s. Conclusion: The use of hospitals outside patient's residential area is shown to be substantial, given that the acute cerebral infarction requires immediate recognition and treatment. The findings on the geographical differences in the hospital utilization suggest further investigation.

• Korean Journal of Veterinary Service
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• v.24 no.2
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• pp.139-146
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• 2001

To examine the prevalence and types of kidney lesions in Korean cattle, a survey was carried out at a abattoir in september 2000 and January 2001. The collected kidneys were examined grossly and histopathologically and investigated for the patterns of renal diseases with considering season and sex. Of 735 cattle (99 bulls and 246 cows in September and 140 bulls, 3 steers, and 247 cows in January) surveyed, 301 (41%) cattle had various renal lesions. The most common prominent finding was focal or multiple interstitial nephritis (36.2%). Other lesions included focal or multiple renal cyst (9.1%), infarction (0.1%), hemorrhage (0.3%), and renal atrophy (0.3%). Microscopically, main pathological lesions were acute or chronic interstitial nephritis with moderate infiltration of neutrophil or lymphocyte, respectively. Finally, the kidney lesions are more or less correlated with the meat quality, especially in female Korean cattle.

• Journal of Korean Neurosurgical Society
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• v.42 no.4
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• pp.337-341
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• 2007

Objective : Repeated administration of mannitol in the setting of large hemispheric infarction is a controversial and poorly defined therapeutic intervention. This study was performed to examine the effects of multiple-dose mannitol on a brain edema after large hemispheric infarction. Methods : A middle cerebral artery was occluded with the rat suture model for 6 hours and reperfused in 22 rats. The rats were randomly assigned to either control (n=10) or the mannitol-treated group (n=12) in which intravenous mannitol infusions (0.8 g/kg) were performed six times every four hours. After staining a brain slice with 2,3,5-triphenyltetrazolium chloride, the weight of hemispheres, infarcted (IH) and contralateral (CH), and the IH/CH weight ratio were examined, and then hemispheric accumulation of mannitol was photometrically evaluated based on formation of NADH catalyzed by mannitol dehydrogenase. Results : Mannitol administration produced changes in body weight of $-7.6{\pm}1.1%$, increased plasma osmolality to $312{\pm}8\;mOsm/L$. It remarkably increased weight of IH ($0.77{\pm}0.06\;gm$ versus $0.68{\pm}0.03\;gm$ : p<0.01) and the IH/CH weight ratio ($1.23{\pm}0.07$ versus $1.12{\pm}0.05$ : p<0.01). The photometric absorption at 340 nm of the cerebral tissue in the mannitol-treated group was increased to $0.375{\pm}0.071$ and $0.239{\pm}0.051$ in the IH and CH, respectively from $0.167{\pm}0.082$ and $0.162{\pm}0.091$ in the IH and CH of the control group (p<0.01). Conclusion : Multiple-dose mannitol is likely to aggravate cerebral edema due to parenchymal accumulation of mannitol in the infarcted brain tissue.

• The Journal of Internal Korean Medicine
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• v.29 no.4
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• pp.970-978
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• 2008

Objectives : This study aimed to clarify the relationship between the Oriental medical diagnosis and arteriosclerosis by measuring carotid-ankle vascular index(CAVI) in acute cerebral infarction patients. Method : One hundred thirty-one subjects were recruited from the patients admitted to the Internal Medical Department at Kyunghee University Oriental Medical Center from April 2007 to August 2008. We sorted cerebral infarction patients and assessed one hundred fourteen patients' CAVI data. We diagnosed dampness-phlegm by Oriental medical diagnosis and evaluated stroke type by single or multiple infarctions. then, we analyzed their characteristics with type of stroke, risk factor, lifestyle, metabolic syndrome and dampness-phlegm diagnosis. Result : 1. On the demographic variables of the patients, age, hypertension, hyperlipidemia, multiple infarction group and metabolic syndrome and dampness-phlegm group were significantly higher in the high CAVI score group than in the control. 2. According to the significant difference in the dampness-phlegm group, we analyzed dampness-phlegm related index for pattern identifications by CAVI score. As a result, dark circles, insomnia, headache, white coating tongue. slippery pulse, and rough pulse were significantly higher in the high CAVI score group then in the control. 3. In multivariate analysis, age, hypertension, multiple infarction and dampness-phlegm groups showed a close relationship with the high CAVI score group. Conclusions : According to the analysis, significance between dampness-phlegm diagnosed patients group and high CAVI score were clarified. Moreover, multiple location infarctions also have a relationship with high CAVI score in cerebral infarction patients. These results can be utilized in the future as a basis material.

• The Journal of Internal Korean Medicine
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• v.39 no.2
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• pp.139-146
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• 2018

Objective: The purpose of this clinical study is to report the effect of Banhahoobak-tang in the case of a 57-year-old woman with multiple cerebral infarction causing dysphagia and dysarthria diagnosed as pseudobulbar palsy. Methods: A patient was treated with Korean medicine, including herbal medication, acupuncture, and language therapy. We focused on the effect of Banhahoobak-tang by evaluating improvements in symptoms by examining times of aspiration and changes in Speech Mechanism Screening Test scores. Results: After three months of Korean medicine treatment and language therapy, there was improvement in the patient's symptoms, including dysphagia and dysarthria. Conclusions: This study suggests that Korean medicine treatment could be effective for improving the symptoms of pseudobulbar palsy in patients. Specifically, herbal medicine (Banhahoobak-tang) could be an effective choice for treating dysphagia.

• Journal of Korean Neurosurgical Society
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• v.41 no.4
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• pp.224-229
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• 2007

Objective : Despite improvement of therapeutic regimen, incidence of stroke increases and it remains a leading cause of death. Our study aims at offering variable data on recurrent strokes. Methods : There were 59 patients who admitted from Jan. 2002 to Dec. 2004 due to recurrent strokes. A retrospective longitudinal cohort study was done. Results : Four-hundred-seventy five patients, diagnosed with acute stroke, experienced 491 strokes in 3 years, and there were 75 recurrent strokes [15.3%] in 59 patients. These 59 patients were included in the study. First hemorrhagic cases [H] were 19 [32%], and the first infarction cases [I] were 40 [68%]. Subsequent strokes after first stroke were as follows : $H{\to}H$ 14 [23.7%] cases, $H{\to}I$ 5 [8.5%], $I{\to}H$ 8 [13.6%], $I{\to}I$ 32 (54.2%]. A Cox regression analyses showed that the first type of stroke was a significant factor to the second stroke as follows : if one has had a hemorrhagic stroke, the possibility of second hemorrhagic attack ($H{\to}H$ attack) increase 3.2 times than ischemic type and in ischemic stroke [$I{\to}I$ attack] 3.6 times increased incidence of second ischemic attack. Conclusion : The recurrence rate of stroke was 12.4% [59 of 475 patients]. If the first stroke is hemorrhage or infarction, the next stroke would have high potentiality of hemorrhage, or infarction. The possibility of same type in second stroke Increase over 3 times. In $H{\to}H$ group, the time interval between first and second stroke was shorter and the age of onset was earlier than in $I{\to}I$ group. Moreover, the infarction was more frequent than hemorrhage in multiple strokes. There was a correlation in lacunar type infarction between first and second attack.

• Journal of Korean Neurosurgical Society
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• v.43 no.2
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• pp.90-96
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• 2008

Objective: Delayed ischemic deficit or cerebral infarction is the leading cause of morbidity and mortality after aneurysmal subarachnoid hemorrhage (SAH). The purpose of this study is to reassess the prognostic impact of intraoperative elements, including factors related to surgery and anesthesia, on the development of cerebral infarction in patients with ruptured cerebral aneurysms. Methods: Variables related to surgery and anesthesia as well as predetermined factors were all evaluated via a retrospective study on 398 consecutive patients who underwent early microsurgery for ruptured cerebral aneurysms in the last 7 years. Patients were dichotomized as following; good clinical grade (Hunt-Hess grade I to III) and poor clinical grade (IV and V). The end-point events were cerebral infarctions and the clinical outcomes were measured at postoperative 6 months. Results: The occurrence of cerebral infarction was eminent when there was an intraoperative rupture, prolonged temporary clipping and retraction time, intraoperative hypotension, or decreased $O_2$ saturation, but there was no statistical significance between the two different clinical groups. Besides the Fisher Grade, multiple logistic regression analyses showed that temporary clipping time, hypotension, and low $O_2$ saturation had odds ratios of 1.574, 3.016, and 1.528, respectively. Cerebral infarction and outcome had a meaningful correlation (${\gamma}$=0.147, p=0.038). Conclusion: This study results indicate that early surgery for poor grade SAH patients carries a significant risk of ongoing ischemic complication due to the brain's vulnerability or accompanying cardio-pulmonary dysfunction. Thus, these patients should be approached very cautiously to overcome any anticipated intraoperative threat by concerted efforts with neuro-anesthesiologist in point to point manner.