• The Journal of Internal Korean Medicine
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• v.29 no.3
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• pp.675-683
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• 2008

Objectives : This study was designed to examine the effects of hyperbaric oxygen therapy on cerebral infarction. Methods : Fifty-five patients with acute or subacute cerebral infarction were classified into two groups, the study group and control group. The study group was treated by hyperbaric oxygen therapy(HBOT) for 2 weeks(5 times/week) and the control group wasn't treated by HBOT. We compared the score of National Institutes of Health Scale(NIHSS scale) between two groups. We subdivided the study group by TOAST classification and onset stage, and compared the results. All of this data was analyzed by statistical method. Results : The study group patients who were treated by hyperbaric oxygen therapy saw more improvement than the control group patients in NIHSS score, and there was significant consideration. Among the study group patients, we saw more improvement during the first week period than in the course of the second week, and there was significant consideration. Conclusion : These results suggest that hyperbaric oxygen therapy(HBOT) could be a useful medical treatment to treat cerebral infarction. Further studies are needed on more cases to make sure that hyperbaric oxygen therapy (HBOT) is surely effective for cerebral infarction.

• Journal of Trauma and Injury
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• v.20 no.2
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• pp.101-105
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• 2007

Purpose: This study aimed to find any difference in the clinical or the anatomical findings of vertebral artery dissection (VAD) between the trauma and the non-trauma groups. Methods: We retrospectively reviewed the clinical data and radiologic images of VAD patients. We compared data on symptoms, neurologic deficit, National institutes of health stroke scale (NIHSS) at admission, Rankin score (RS) at admission and discharge, and radiological findings including anatomical features, between the trauma and the non-trauma groups. Results: From January 1997 to May 2006, 42 patients were enrolled and 13 patients (31%) had a history of earlier trauma. Focal neurologic deficit (trauma group 11/13 vs. non-trauma group 11/29), cerebral stroke (10/13 vs. 9/29), and extradural lesions of dissection (6/13 vs. 3/28) were more common in the trauma group than non-trauma group (p=0.007, p=0.017, p=0.018, respectively) and NIHSS at admission and discharge were significantly higher (p=0.012, p=0.001, respectively). Dissecting aneurysms were less frequent in the trauma group (2/13 vs. 19/29, p=0.006). Subarachnoid hemorrhage and unfavorable prognostic value (Rankin score at discharge ${\geq}$ 2) showed no differences between the groups (p=0.540, p=0.267, respectively). Conclusion: In VAD patients after trauma, focal neurologic deficit due to ischemic stroke and a steno-occlusive pattern are more frequent than they are in non-trauma patients. The location of dissection was most frequent at the extradural vertebral artery in the trauma group. NIHSS was higher in the trauma groups but the incidence of an unfavorable prognostic value (RS ${\geq}$ 2) was not significantly different between the groups.

• Journal of Korean Neurosurgical Society
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• v.50 no.1
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• pp.1-5
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• 2011

Objective : There is no proven regimen to reduce the severity of stroke in patients with acute cerebral infarction presenting beyond the thrombolytic time window. Ozagrel sodium, a selective thromboxane A2 synthetase inhibitor, has been known to suppress the development of infarction. The antiplatelet effect is improved when aspirin is used together with a thromboxane synthetase inhibitor. Methods : Patients with non-cardiogenic acute ischemic stroke who were not eligible for thrombolysis were randomly assigned to two groups; one group received ozagrel sodium plus 100 mg of aspirin (group 1, n=43) and the other 100 mg of aspirin alone (group 2, n=43). Demographic data, cardiovascular risk factors, initial stroke severity [National Institute of Health Stroke Scale (NIHSS) and motor strength scale] and stroke subtypes were analyzed in each group. Clinical outcomes were analyzed by NIHSS and motor strength scale at 14 days after the onset of stroke. Results : There were no significant differences in the mean age, gender proportion, the prevalence of cardiovascular risk factors, stroke subtypes, and baseline neurological severity between the two groups. However, the clinical outcome for group 1 was much better at 14 days after the onset of stroke compared to group 2 (NIHSS score, p=0.007, Motor strength scale score, p<0.001). There was one case of hemorrhagic transformation in group 1, but there was no statistically significant difference in bleeding tendency between two groups. Conclusion : In this preliminary study, thromboxane A2 synthetase inhibitor plus a low dose of aspirin seems to be safe and has a favorable outcome compared to aspirin alone in patients with acute ischemic stroke who presented beyond the thrombolytic time window.

• The Korean Journal of Health Service Management
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• v.12 no.2
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• pp.125-134
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• 2018

Objectives : The purpose of this study was to analyze factors related to the functional state of stroke patients after discharge from hospital. Methods : The data was provided from a hospital in Wonju, Gangwon-do. The subjects of the analysis were those who were admitted to the emergency room due to stroke from July to December 2016. The dependent variable was the patient's functional status as measured by the modified Rankin Scale(mRS). Independent variables were demographic factors (age, sex, and marriage status), transportation and distance factors (transportation, travel distance), inpatient factors (lengths of stay, Charlson Comorbidity Index (CCI), Tissue plasminogen activator, National Institute of Health Stroke Scale (NIHSS). Hierarchial regression analysis was applied for the analysis. Results : In the hierarchical regression analysis, Model 3, including socio-demographic factors, transportation, distance factors, and inpatient factors, was the best fitted model. It showed that functional status of stroke patients was positively associated with age, length of stay, CCI, NIHSS, and negatively associated with unmarried status. Conclusions : Results indicated that management of stroke requires care from the pre-disease stage, and a customized education program policy is needed for high-risk stroke patients who are older and have comorbid illness.

• Korean Journal of Psychosomatic Medicine
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• v.20 no.2
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• pp.98-104
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• 2012

Objectives : This study aimed to investigate the correlations between neurological and psychiatric symptoms at two weeks after stroke. Methods : For 412 stroke patients, stroke severity was evaluated by the National Institutes of Health Stroke Scale(NIHSS), disability by the Barthel Index(BI) and modified Rankin Scale(mRS), cognitive function by the Korean Mini-Mental State Examination(K-MMSE), and muscle power by grip strength. Psychiatric symptoms were assessed by Symptom check list-90-Revision(SCL-90-R), consisted of nine symptom domains : Somatization, Obsessive-compulsive, Interpersonal sensitivity, Depression, Anxiety, Hostility, Phobic anxiety, Paranoid ideation, Psychoticism, and Additional items. The correlations between the neurological and psychiatric symptoms were investigated at the time of admission and before discharge(i.e. before and after treatment). Results : At the time of admission, NIHSS score was associated with scores on Phobic anxiety and Additional items ; and scores on BI and mRS were associated with Depression, Phobic anxiety and Additional items. At the time of discharge, NIHSS score was associated with scores on Somatization, Depression, Phobic anxiety, and Additional items ; scores on BI and mRS were associated with scores on Depression, Phobic anxiety and Additional items ; MMSE score was associated with Obsessive-compulsive, Depression, Phobic anxiety, and Additional items ; and grip strength was associated with Somatization, Depression, Anxiety and Additional items. Conclusions : More severe neurological symptoms were associated with higher psychiatric morbidity particularly in depression, phobic anxiety, sleep and appetite disturbance at acute stage of stroke. More intensive psychiatric care and intervention are needed for the high risk group.

• The Journal of Internal Korean Medicine
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• v.30 no.4
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• pp.708-718
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• 2009

Objectives : The aim of this study was to assess the relationship between risk factors, warning signs, tongue diagnosis, pulse pattern, pattern identification and National Institute of Health Stroke Scale in acute stroke patients. Methods : We studied patients hospitalized within 4 wks after their ictus who were admitted at the Internal Medical Department at Kyunghee Oriental Medical Center, Kyunghee University East-West Neo Medical Center, Kyungwon University Songpa Oriental Medical Center, Kyungwon University Incheon Oriental Medical Center, Dongguk University Ilsan Oriental Medical Center from April 2007 to August 2009. We analyzed the relationship between risk factors, warning signs, tongue diagnosis, pulse pattern, pattern identification and National Institute of Health Stroke Scale in acute stroke patients. Results : 1506 subjects were included into the final analysis. 1. In the risk factors, the NIHSS mean score of atrial fibrillation was significantly higher than non-atrial fibrillation. 2. In the warning signs, the NIHSS mean scores of weakness, loss of eyesight, dysarthria, and sensory loss were significantly higher than in the non-warning signs. 3. There were no significant differences in lifestyle, tongue fur color, pattern identification between groups. 4. In the tongue color, the NIHSS mean score of red was significantly higher than pale or pale red. 5. There were significant differences statistically between forceful/weak, fine/not fine, slippery/not slippery pulse and NIHSS score. Conclusion : The above results show the relationship between risk factors, warning signs, tongue diagnosis, pulse pattern, pattern identification and National Institute of Health Stroke Scale in acute stroke patients. These results can be utilized in the future as a basis material.

• Journal of Korean Neurosurgical Society
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• v.65 no.6
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• pp.816-824
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• 2022

Objective : Emergency superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis in patients with large vessel occlusion who fails mechanical thrombectomy or does not become an indication due to over the time window can be done as an alternative for blood flow restoration. The authors planned this study to quantitatively measure the degree of improvement in cerebral perfusion flow using perfusion magnetic resonance imaging (MRI) after bypass surgery and to find out what factors are related to the outcome of the bypass surgery. Methods : For a total of 107 patients who underwent emergent STA-MCA bypass surgery with large vessel occlusion, the National Institute of Health stroke scale (NIHSS), modified Rankin score (mRS), infarction volume, and hypoperfusion area volume was calculated, the duration between symptom onset and reperfusion time, occlusion site and infarction type were analyzed. After emergency STA-MCA bypass, hypoperfusion area volume at post-operative 7 days was calculated and analyzed compared with pre-operative hypoperfusion area volume. The factors affecting the improvement of mRS were analyzed. The clinical status of patients who underwent emergency bypass was investigated by mRS and NIHSS before and after surgery, and changes in infarct volume, extent, degree of collateral circulation, and hypoperfusion area volume were measured using MRI and digital subtraction angiography (DSA). Results : The preoperative infarction volume was median 10 mL and the hypoperfusion area volume was median 101 mL. NIHSS was a median of 8 points, and the last normal to operation time was a median of 60.7 hours. STA patency was fair in 97.1% of patients at 6 months follow-up DSA and recanalization of the occluded vessel was confirmed at 26.5% of patients. Infarction volume significantly influenced the improvement of mRS (p=0.010) but preoperative hypoperfusion volume was not significantly influenced (p=0.192), and the infarction type showed marginal significance (p=0.0508). Preoperative NIHSS, initial mRS, occlusion vessel type, and last normal to operation time did not influence the improvement of mRS (p=0.272, 0.941, 0.354, and 0.391). Conclusion : In a patient who had an acute cerebral infarction due to large vessel occlusion with large ischemic penumbra but was unable to perform mechanical thrombectomy, STA-MCA bypass could be performed. By using time-to-peak images of perfusion MRI, it is possible to quickly and easily confirm that the brain tissue at risk is preserved and that the ischemic penumbra is recovered to a normal blood flow state.

• The Journal of Internal Korean Medicine
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• v.37 no.5
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• pp.786-795
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• 2016

Objective: To evaluate the effectiveness of traditional Korean medicine treatment (TKM) on a patient with ACA infarction and hemorrhagic transformation with hemiplegia and urinary disturbance. Methods: A patient diagnosed with left anterior cerebral artery (ACA) infarction and hemorrhagic transformation was treated with electroacupuncture, moxibustion, and herbal medicine. Results: Improvements in the Manual Muscle Test (MMT), modified Barthel Index (MBI), National Institutes of Health Stroke Scale (NIHSS), modified Rankin scale (mRS), and K-MMSE were observed following the TKM treatment [MMT Gr. (3/0)→Gr. (4+/4+), MBI 20→89, NIHSS 8→2, mRS 5→1, MMSE-K 21→28]. Conclusion: TKM treatment could help improve the symptoms of patients with ACA infarction and hemorrhagic transformation.

• Journal of Korean Neurosurgical Society
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• v.59 no.4
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• pp.352-356
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• 2016

Objective : The efficacy and safety of manual aspiration thrombectomy using Penumbra in an acute occlusion of large intracranial arteries has been proven in many previous studies. Our study aimed to retrospectively assess the efficacy and safety of manual aspiration thrombectomy using Penumbra in patients with small vessel occlusions (M2 segment of the MCA). Methods : We conducted a retrospective review of 32 patients who underwent manual aspiration thrombectomy using the Penumbra 4 MAX Reperfusion Catheter for treatment of an M2 occlusion between January 2013 and November 2014. We evaluated immediate angiographic results and clinical outcomes through review of patient electronic medical records. Results : There were slightly more men in this study (M : F=18 : 14) and the median age was 72.5 (age range : 41-90). The rate of successful recanalization (TICI grade ${\geq}2b$) was 84% (27/32). NIHSS at discharge and favorable clinical outcomes at 3 months were significantly improved than baseline. Median initial NIHSS score was 10 (range : 4-25) and was 4 (range : 0-14) at discharge. Favorable clinical outcomes (mRS score ${\leq}2$ at 3 months) were seen in 25 out of 32 patients (78%). There were no procedure-related symptomatic intracerebral hemorrhages. One patient expired after discharge due to a cardiac problem. Conclusion : Manual aspiration thrombectomy might be safe and is capable of achieving a high rate of successful recanalization and favorable clinical outcomes in patients with distal cerebral vessel occlusion (M2).

• Journal of Korean Medicine Rehabilitation
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• v.18 no.3
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• pp.157-171
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• 2008

Objectives : To report one case of semi-coma patient was treated by scalp acupuncture with electric stimulation. Methods : Patient (state of semi-coma) was treated by scalp acupuncture with electric stimulation, herbal medication and physical therapy. The improvement of patient was measured every other week by Glasgow Coma Scale(GCS), Modified Bathel Index(MBI), National Institutes of Health Stroke Scale(NIHSS). Results : We observed the patient decrease in NIHSS score and increase in GCS and MBI. Symptoms of patient such as semi-coma were improved following the treatment. Conclusions : It is suggested that oriental medical treatment; scalp acupuncture with electric stimulation, herbal medication and physical therapy were effective in semi-coma caused by traumatic brain injury.