• Journal of Korean Neurosurgical Society
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• v.29 no.7
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• pp.923-928
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• 2000

Objective : The reliability of transcranial doppler sonography(TCD) for predicting delayed ischemic neurologic deficit( DIND) was investigated in patients with aneurysmal subarachnoid hemorrhage(SAH). Methods : The velocity of blood flow through the middle cerebral artery was measured by TCD in 70 patients treated surgically within 72 hours due to ruptured cerebral aneurysm. A correlation between measured maximal mean blood flow velocities and clinical factors including age, hypertension, Hunt-Hess grade, Fisher grade, DIND, and outcome was made. Results : An age-dependent reduction of the measured maximal mean velocities was found(r＝-0.4043, p<0.001). Flow velocities in hypertensive patients were significantly lower than in the normotensive individuals(two-tailed T test, p<0.05). There was no significant difference between the flow velocities and evaluated other clinical factors. When the flow velocities of 14 patients who developed DIND were compared with those of patients without deficits, no significant difference was seen. A significant increase in flow velocities in the days before the onset of DIND was found only in 4 of 14 cases. High flow velocities did not necessarily mean impending neurological deficits : 6 of 70 patients tolerated flow velocities over 160cm/s. Conclusion : We suggest that TCD readings have limited utility for predicting DIND following SAH, especially in older or hypertensive patients. More direct measurements of blood flow are necessary to adequately predict which patients are at high risk of DIND.

• Journal of Korean Neurosurgical Society
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• v.30 no.sup2
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• pp.281-288
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• 2001

Objectives : The purpose of this study is to evaluate the usefulness of SSEP monitoring during intracranial aneurysm surgery and compare the characteristics of wave change in relation to neurologic changes between ACA aneurysms and MCA aneurysms. Methods : During recent three years(between January 1997 and November 1999), intraoperative SSEP monitoring had been done in 63 operations for intracranial aneurysms. We had monitored the median nerve SSEP during surgery for aneurysms of MCA and the posterior tibial nerve SSEP for aneurysms of ACoA or ACA. A more than 50% reduction of any cortical SEP response was considered to be a significant SEP change, compared to its baseline value before the start of surgery. Changes in the SEPs were categorized as follows : Type IA, no significant amplitude changes without temporary clipping ; Type IB, no significant amplitude changes with temporary clipping ; Type II, significant changes with temporary clipping and complete return to control amplitude ; Type III, significant changes with temporary clipping and incomplete return to control amplitude ; Type IV, significant changes with temporary clipping and more decreased amplitude changes. Results : Among the 63 intraoperative monitoring, there were 37 cases of ACA aneurysms(An), and 26 of MCA An. The temporary proximal arterial occlusion during surgery were performed in 31(83.8%)cases of ACA An, 22(84.6%) of MCA An. Seven of the 31 ACA An(22.6%) and ten of the 22 MCA An(45.5%) had significant changes. The type were as follows : 4 patients with type II and 3 with type III in the ACA An ; 3 patients with type II and 3 with type III and 4 with type IV in the MCA An. In both group type II changes had no new postoperative neurological deficit. All 6 patients with type III had new neurological deficits ; However, One case in the ACA An and two cases in the MCA An. had transient neurologic deficit and improved markedly over the next two months. All 4 type IV changes in the MCA An. had permanant neurologic deficits. Two out of 30 cases(6.7%) in the ACA An. and one out of 16 cases(6.3%) in the MCA An. without significant amplitude change had new neurologic deficit postoperatively. Conclusion : Based on this study, Intraoperative SSEP monitoring during aneurysm surgery would provide useful information for detecting cerebral ischemia. SSEP response during surgery for MCA An. is more sensitive than ACA An. Otherwise, there were no meaningful difference in rate of false negativity.

• Journal of Korean Neurosurgical Society
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• v.30 no.4
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• pp.463-471
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• 2001

Objective : The authors reviewed 51 patients of spinal cord tumor located at the craniovertebral junction and high cervical area to determine which factors influenced resectability, complications, and postoperative outcomes. Methods : Radiological examinations, clinical data, and operation notes were evaluated, and additional follow-up information was obtained from outpatient examinations. The mean follow-up period was 3.5 years Results : The most common neurological findings were motor deficit(72.5%) and sensory change(47.1%). There was no clinical finding that is considered as pathognomic. Meningioma(18 cases, 35.3%) was the most common tumor in this region. Total removal was achieved in 45 patients. There was no surgical mortality. Immediate postoperative motor weakness were encounted in 11 cases(21.6%) which improved in long term followup except two patients. Conclusions : The location and relationship of the tumor to surrounding struncture determine its resectability. Postoperative results were related to the preoperative neurological status and pathological findings.

• Journal of Korean Neurosurgical Society
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• v.38 no.4
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• pp.316-319
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• 2005

A 42-year-old female was admitted with an 11-month history of progressive spastic paraparesis and ataxic gait. Magnetic resonance imaging showed intraspinal space occupying lesion compressing the spinal cord posteriorly, located from C5 to T2 with iso to high signal intensity at T2-weighted images and high signal intensity at T1-weighted images. The patient underwent surgery for decompression of the affected spinal cord because of the progressive neurological deficit. At surgery, the lesion was intradural extramedullary lipoma composed with mature adipose tissue. Partial tumor removal to decompress the neural structures and laminoplasty to avoid postoperative instability and deformity were performed. Postoperatively, she demonstrated improvement in paraparesis and was able to walk without assistance. Though attempts to decrease the size of or even to totally remove a lipoma are not required to achieve satisfactory results and carry considerable risks of surgical morbidity, a careful and limited decompression of the affected spinal cord through a partial removal of the tumor and laminoplasty could result in a significant neurological improvement.

• Journal of TMJ Balancing Medicine
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• v.9 no.1
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• pp.4-11
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• 2019

Objectives: Although intraoral balancing appliance therapy has been used effective to several diseases, verification studies through cerebral diseases are poorly reported so far. Thus we investigated the effect of tooth-cut induced dental malocclusion against mouse model of ischemic stroke. Methods: Tooth-cut and 90 min middle cerebral artery occlusion (MCAO) were loaded to C57BL/6 male mice, and total infarct area, neurological deficit scores (NDS), histological change of hippocampal region were observed. Production levels of reactive oxygen species (ROS) and inducible nitric oxide synthase (iNOS) in cerebral tissue were also measured. Results: The longer the tooth-cut period, the greater the area of cerebral infarction caused by MCAO, and NDS began to increase as the tooth was cut, and the results were more negative when MCAO was loaded. Histological change of hippocampal cells was significant when tooth-cut was maintained for 7 days. Those damages were thought to depend on the generation of ROS and iNOS in brain tissue. Conclusions: Since tooth-cut increased total area of cerebral infarction due to MCAO in mice, it is able to be confirmed that anomaly of the temporomandibular occlusion can affect neurological diseases.

• Journal of The Korean Society of Clinical Toxicology
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• v.13 no.1
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• pp.46-49
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• 2015

Carbon monoxide (CO) intoxication is a leading cause of severe neuropsychological impairments. Peripheral nerve injury has rarely been reported. Following are brief statements describing the motor peripheral neuropathy involved bilateral lower extremities of a patient who recovered following acute carbon monoxide poisoning. After inhalation of smoke from a fire, a 60-year-old woman experienced bilateral leg weakness without edema or injury. Neurological examination showed diplegia and deep tendon areflexia in lower limbs. There was no sensory deficit in lower extremities, and no cognitive disturbances were detected. Creatine kinase was normal. Electroneuromyogram patterns were compatible with the diagnosis of bilateral axonal injury. Clinical course after normobaric oxygen and rehabilitation therapy was marked by complete recovery of neurological disorders. Peripheral neuropathy is an unusual complication of CO intoxication. Motor peripheral neuropathy involvement of bilateral lower extremities is exceptional. Various mechanisms have been implicated, including nerve compression secondary to rhabdomyolysis, nerve ischemia due to hypoxia, and direct nerve toxicity of carbon monoxide. Prognosis is commonly excellent without sequelae. Emergency physicians should understand the possible-neurologic presentations of CO intoxication and make a proper decision regarding treatment.

• Laboraroty Animal Research
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• v.33 no.3
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• pp.244-250
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• 2017

${\alpha}$-Synuclein is abundantly expressed in neuronal tissue, plays an essential role in the pathogenesis of neurodegenerative disorders, and exerts a neuroprotective effect against oxidative stress. Cerebral ischemia causes severe neurological disorders and neuronal dysfunction. In this study, we examined ${\alpha}$-synuclein expression in middle cerebral artery occlusion (MCAO)-induced cerebral ischemic injury and neuronal cells damaged by glutamate treatment. MCAO surgical operation was performed on male Sprague-Dawley rats, and brain samples were isolated 24 hours after MCAO. We confirmed neurological behavior deficit, infarction area, and histopathological changes following MCAO injury. A proteomic approach and Western blot analysis demonstrated a decrease in ${\alpha}$-synuclein in the cerebral cortices after MCAO injury. Moreover, glutamate treatment induced neuronal cell death and decreased ${\alpha}$-synuclein expression in a hippocampal-derived cell line in a dose-dependent manner. It is known that ${\alpha}$-synuclein regulates neuronal survival, and low levels of ${\alpha}$-synuclein expression result in cytotoxicity. Thus, these results suggest that cerebral ischemic injury leads to a reduction in ${\alpha}$-synuclein and consequently causes serious brain damage.

• Korean Journal of Biological Psychiatry
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• v.2 no.1
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• pp.115-122
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• 1995

This study was performed to know the relationship between neurologic soft signs (NSS) and clinical variables such as psychopathology. history of illness, and premorbid social adjustment in patients with schizophrenia. The authors evaluated NSS in 31 patients with schizophrenia using the structured tool for measuring neurologic abnormalities, Neurological Evaluation Scale- Korean Version(NES-K). Relationships between NSS and clinical variables such as duration of illness, intensity of precipitating stressors, duration of outpatient treatment, schooling, peer relationship, total duration of unemployment, total days of psychiatric admission, age, total days of being medicated, age at the first psychiatric admission, frequency of admissions, content of treatment, social adjustment, and severity of symptoms were analyzed. Differences between paranoid and non-paranoid schizophrenics were examined. In addition, Differences between patients with schizophrenia who have predominant positive symptoms and who have predominant negative symptoms were examined too. Total scores of NES-K were correlated with lower schooling (${\gamma}$=0.44, p<0.01). Scores of motor coordination subcategory were correlated with poor peer relationship(${\gamma}$=0.67, p<0.001). Other clinical variables were not correlated with any scores of NES-K. Paranoid and non-paranoid schizophrenics were not different in scores of NES-K. Also positive and negative schizophrenics were not different in scores of NES-K. Most clinical variables except schooling and peer relationship were not related with NSS. This results indicated that the meaning of these signs was not fully be understood. Introduction of the new classification concepts such as deficit or non-deficit syndrome will be helpful to elucidate the meaning of NSS in patients with schizophrenia.

• Journal of Korean Neurosurgical Society
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• v.30 no.5
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• pp.575-580
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• 2001

Purpose : In general, pineal region tumors are managed by using microsurgical approach or stereoctactic biopsy. However, in selected cases endoscopic approach to pineal lesions might prove to be as effective as microsurgery and less invasive. We report an alternative surgical strategy for managing certain patients with pineal neoplasms that allows treatment of the symptomatic hydrocephalus as well as tumor biopsy under direct vision in the same sitting. Materials and Methods : Twenty-two patients with pineal region tumors with associated hydrocephalus were treated in one session by endoscopic third ventriculostomy and endoscopic tumor biopsy at our institution from October 1996 to January 2000. All patients were retrospectively evaluated. Results : There was no operative mortality. There was one cause of significant bleeding during biopsy, but was controlled endoscopically, and the patient recovered completely without neurologic deficit resulting from intra-operative bleeding. The symptoms related to increased intracranial pressure(ICP) have resolved in all patients, and the need for a shunt is completely eliminated. Histological diagnosis was achieved in 21 of the 22 patients by this procedure. A biopsy was not obtained in one patient. Although this pineal region tumor was seen endoscopically, this could not be biopsied because of technical difficulties in working around an enlarged massa intermedia. The lesions included fourteen germinomas, three mixed germ cell tumors, and one each of the followings: pineocytoma, pineoblastoma, pineocytoma/pineoblastoma(intermediate type), meningioma, and low grade glioma. Five of the 22 patients subsequently underwent formal microsurgical tumor removal. Additional chemotherapy or radiotherapy could then be initiated according to the histological diagnosis. Conclusion : We consider that endoscopy affords a minimally invasive way of reaching three objectives by one-step surgery in the management of pineal region tumors with associated hydrocephalus : 1) cerebrospinal fluid(CSF) sample for analysis of tumour markers and cytology, 2) treatment of hydrocephalus by third ventriculostomy, and 3) several biopsy specimens can be obtained identifying tumors which will require further open surgery or adjuvant radiation and/or chemotherapy. However, complications and morbidities should be emphasized so as to be avoided with further technical experience.

• Journal of Trauma and Injury
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• v.28 no.3
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• pp.190-194
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• 2015

Blunt cerebrovascular injury is defined as a vertebral or carotid arterial structural wall injury resulting from nonpenetrating trauma. Complete traumatic internal carotid artery occlusion is very rare condition accounting for 0.08~0.4 0f all trauma patients and believed to be associated with the greatest risk of ischemic stroke reported in 50~90% in a few small series. A 55-year-male was admitted with drowsy mentality and severe headache after a fall down accident. Brain computed tomography showed a subdural hematoma at the both frontal area with a fracture of the occipital skull bone. Two days after admission, he suddenly complained with a right side hemiparesis of motor grade 2. Brain magnetic resonance diffusion demonstrated multiple high flow signal changes from the left frontal and parietal lesion. Computed tomographic angiogram (CTA) revealed absence of the left ICA flow. Trans femoral cerebral angiography (TFCA) showed complete occlusion of the left internal carotid artery (ICA) at ophthalmic segment in the left ICA angiogram and flows on the left whole hemispheric lesions through the anterior communicating artery in the right ICA angiogram. We decided to conduct close observations as a treatment for the patient because of acute subdural hematoma and sufficient contralateral cerebral flow by perfusion SPECT scan. Two weeks after the accident, he was treated with heparin anticoagulation within INR 2~4 ranges. He recovered as the motor grade 4 without another neurologic deficit after 3 months.