• Physical Therapy Korea
• /
• v.3 no.3
• /
• pp.82-91
• /
• 1996

Normal balance is defined as state in which the body is equlilibrium. It is complex motor control task, requring integration of sensory information, neural processing, and biomechanical factors. There are major two factors contribute to balance control, the neurological and the musculoskeletal. The neurological factor provides the sensory processing and motor output mechanisms that are the neurophysiological basis for response. The musculoskeletal factor provides the mechanical structure for response. When all components of two factors are operating effectively, the postural response should be appropriate and effective for good balance control. Therfore, balance can be influenced by above all factors. In addition, balance can be also influenced by muscle tone, hearing, physiological factors, and environmental factors. Physical therapists must understand factors of balance control so that we can accurately assess balance. Therefore, physical therapists have to develop useful balance measurement tools to evaluate balance.

• Journal of Chest Surgery
• /
• v.16 no.1
• /
• pp.97-101
• /
• 1983

The steadily increasing number of operations performed on the heart has given rise to occasional complications involving the nervous system, and this has been interested to cardiac surgeons and neurologists. This survey has been carried out on all Gases submitted to open heart surgery at Seoul National University Hospital during 1982 to determine which operative features were associated with the occurrence of neurological damage. 514 subjects were studied and neurological damage was noted in twenty-five patients [4.9%]. Eight of these 25 patients died in the postoperative period, but neurological damage contributed to the fatal outcome in six cases. Remaining seventeen patients were discharged without problems except one Cortical blindness and one hemiplegic patients who were survived without other problems . A number of features were found to be related to the development of neurological damage, which were age, duration of perfusion, nature of operation, cardiac rhythm and presence of the thrombi or calcification and hypothermic arrest. But many unknown etiological factors are remained out of our sight. A significant increase in the incidence of neurological damage was shown in older age group [13.3% in over 40 year of age], and also the duration of the bypass was associated with subsequent neurological injury especially more than 120 minutes [11.6%]. The presence of atrial fibrillation with intracardiac thrombi or calcification was also a contributing factor to developing neurological complication [16.7%]. These factors were regarded to influence the postoperative neurological complications and more effective method for prevention of these neurologic complication should be studied.

• Journal of Korean Neurosurgical Society
• /
• v.40 no.6
• /
• pp.434-440
• /
• 2006

Objective : The purpose of this study is to examine the influence of cranioplasty on dynamics of cerebral blood flow[CBF] and cerebrovascular reserve capacity[CVRC], and to investigate the usefulness of single photon emission computed tomography [SPECT] as a prognostic factor for neurological improvement after cranioplasty. Methods : Between March 2003 and December 2005, a prospective study was performed on 24 patients who had undergone total 25 cranioplasty operations. Cerebral blood flow velocities in the middle cerebral artery[MCA] and internal carotid artery[ICA] were obtained by transcranial Doppler ultrasonography[TCD]. The CVRC was assessed by SPECT in the natural state and after stimulation with 1g of acetazolamide. Neurological improvement after cranioplasty was compared between patients who showed hyperactivity to acetazolamide-activated SPECT [Group 1, n=7] and hypoactivity to acetazolamide-activated SPECT [Group 2, n=17]. These measurements were obtained two weeks prior to and two weeks after cranioplasty. Results : The blood flow velocities at the opposite site to the cranioplasty as well as at the cranioplasty site were significantly increased [P<0.05]. Compared with Group 2, there was significant increase in CBF and neurological improvement after cranioplasty in Group 1. Conclusion : Among patients with surgical bony defects, the patients who had normal reactivity of the CVRC showed a significant increase in CBF and neurological improvement after cranioplasty. The authors suggest that CVRC measurement prior to surgery may be an important prognostic factor for neurological improvement after cranioplasty.

• Clinical and Experimental Pediatrics
• /
• v.63 no.5
• /
• pp.164-170
• /
• 2020

The prognosis of patients who are comatose after resuscitation remains uncertain. The accurate prediction of neurological outcome is important for management decisions and counseling. A neurological examination is an important factor for prognostication, but widely used sedatives alter the neurological examination and delay the response recovery. Additional studies including electroencephalography, somatosensory-evoked potentials, brain imaging, and blood biomarkers are useful for evaluating the extent of brain injury. This review aimed to assess the usefulness of and provide practical prognostic strategy for pediatric postresuscitation patients. The principles of prognostication are that the assessment should be delayed until at least 72 hours after cardiac arrest and the assessment should be multimodal. Furthermore, multiple factors including unmeasured confounders in individual patients should be considered when applying the prognostication strategy.

• Journal of Korean Neurosurgical Society
• /
• v.60 no.4
• /
• pp.404-416
• /
• 2017

Objective : Functional and neural tissue recovery has been reported in many animal studies conducted with stem cells. However, the combined effect of cytokines and stem cells has not yet been adequately researched. Here, we analyzed the additive effects of granulocyte colony-stimulating factor (GCSF) on adipose-derived stem cells (ADSCs) infusion in the treatment of acute spinal cord injury (SCI) in rats. Methods : Four days after intrathecal infusion tubes implantation in Sprague-Dawley rats, SCI was induced with an infinite horizon impactor. In the Sham group (n=5), phosphate-buffered saline was injected 3, 7, and 14 days after SCI. GCSF, ADSCs, and ADSCs with GCSF were injected at the same time in the GCSF (n=8), ADSC (n=8), and ADSC+GCSF groups (n=7), respectively. Results : The ADSC and ADSC+GCSF groups, but not the GCSF group, showed significantly higher Basso-Beattie-Bresnahan scores than the Sham group during 8 weeks (p<0.01), but no significant difference between the ADSC and ADSC+GCSF groups. In the ladder rung test, all four groups were significantly different from each other, with the ADSC+GCSF group showing the best improvement (p<0.01). On immunofluorescent staining (GAP43, MAP2), western blotting (GAP43), and reverse transcription polymerase chain reaction (GAP43, nerve growth factor), the ADSC and ADSC+GCSF groups showed higher levels than the Sham and GCSF groups. Conclusion : Our analyses suggest that the combination of GCSF and ADSCs infusions in acute SCI in the rat does not have a significant additive effect. Hence, when combination agents for SCI stem cell therapy are considered, molecules other than GCSF, or modifications to the methodology, should be investigated.

• Journal of Korean Neurosurgical Society
• /
• v.63 no.4
• /
• pp.487-494
• /
• 2020

Objective : To analyze the incidence and characteristics of delayed postoperative fever in posterior cervical fusion using cervical pedicle screws (CPS). Methods : This study analyzed 119 patients who underwent posterior cervical fusion surgery using CPS. Delayed fever was defined as no fever for the first 3 postoperative days, followed by an ear temperature ≥38℃ on postoperative day 4 and subsequent days. Patient age, sex, diagnosis, laminectomy, surgical level, revision status, body mass index, underlying medical disease, surgical duration, and transfusion status were retrospectively reviewed. Results : Of 119 patients, seven were excluded due to surgical site infection, spondylitis, pneumonia, or surgical level that included the thoracic spine. Of the 112 included patients, 28 (25%) were febrile and 84 (75%) were afebrile. Multivariate logistic regression analysis showed that laminectomy was a statistically significant risk factor for postoperative non-pathological fever (odds ratio, 10.251; p=0.000). In contrast, trauma or tumor surgery and underlying medical disease were not significant risk factors for fever. Conclusion : Patients who develop delayed fever 4 days after posterior cervical fusion surgery using CPS are more likely to have non-pathologic fever than surgical site infection. Laminectomy is a significant risk factor for non-pathologic fever.

• Journal of Korean Neurosurgical Society
• /
• v.38 no.1
• /
• pp.35-40
• /
• 2005

Objective : Limited data are available concerning the outcome of the patients with atypical meningioma due to lack of the studies with large series. The authors review atypical meningioma retrospectively and analyzed various parameters concerning its outcome. Methods : Of the 866 meningioma patients treated between 1990 and 2003, pathologically proven 54 atypical meningiomas were reviewed. Various factors of the patients were analyzed, and surgical specimens were re-examined blindly by neuropathologist without any patient information. Extent of surgical resection was determined according to Simpson's classification by reviewing the chart and postoperative scan if possible. Results : Twenty-three [42.6%] had local recurrences during the follow-up, of which 13 [32.5%] of 40 complete excisions and 10 [71.4%] of 14 incomplete excisions. The median time to recurrence was 47 months, and the overall 3-, 5-, and 10-year local control rates were 62.4%, 41.5%, and 31.1%, respectively. Five [9.3%] died during follow-up period. The mean survival time was 123months, and the overall 3-, 5-, and 10-year survival rates were 94.2%, 87.2%, and 78.5%, respectively. The extent of surgical excision was the most significant prognostic factor not for survival but for local control [p=0.2179 and 0.0005, respectively]. Extracranial metastasis was not seen in our cases. Conclusion : Complete surgical excision is the most important factor in improving local control. Careful long-term follow-up is mandatory because atypical meningioma shows a broad range of aggressiveness and natural history.

• Journal of Korean Neurosurgical Society
• /
• v.65 no.2
• /
• pp.297-306
• /
• 2022

Objective : Intracranial atypical meningiomas have a poor prognosis and high rates of recurrence. Moreover, up to one-third of the recurrences undergo high-grade transformation into malignant meningiomas. We aimed to investigate the clinical factors that can predict the propensity of malignant transformation from atypical to anaplastic meningiomas. Methods : Between 2001 and 2018, all patients with atypical meningioma, in whom the tumors had undergone malignant transformation to anaplastic meningioma, were included. The patients' medical records documenting the diagnosis of atypical meningioma prior to malignant transformation were reviewed to identify the predictors of transformation. The control group comprised 56 patients with atypical meningiomas who were first diagnosed between January 2017 and December 2018 and had no malignant transformation. Results : Nine patients in whom the atypical meningiomas underwent malignant transformation were included. The median time interval from diagnosis of atypical meningioma to malignant transformation was 19 months (range, 7-78). The study group showed a significant difference in heterogeneous enhancement (77.8% vs. 33.9%), bone invasion (55.6% vs. 12.5%), mitotic index (MI; 14.8±4.9 vs. 3.5±3.9), and Ki-67 index (20.7±13.9 vs. 9.5±7.1) compared with the control group. In multivariate analysis, increased MI (odds ratio, 1.436; 95% confidence interval, 1.127-1.900; p=0.004) was the only significant factor for predicting malignant transformation. Conclusion : An increased MI within atypical meningiomas might be used as a predictor of malignant transformation. Tumors at high risk for malignant transformation might require more attentive surveillance and management than other atypical meningiomas.

• Journal of Korean Neurosurgical Society
• /
• v.45 no.2
• /
• pp.90-95
• /
• 2009

Objective : We aimed to identify clinico-radiological risk factors that may predict unfavorable neurological outcomes in traumatic brain injury (TBI), and to establish a guideline for patient selection in clinical trials that would improve neurological outcome during the early post TBI period. Methods : Initial clinico-radiological data of 115 TBI patients were collected prospectively. Regular neurological assessment after standard treatment divided the above patients into 2 groups after 6 months : the Favorable neurological outcome group (GOS : good & moderate disability, DRS : 0-6, LCFS : 8-10) and the Unfavorable group (GOS : severe disability-death, DRS : 7-29 and death, LCFS : 1-7 and death). Results : There was a higher incidence of age $\geq$35 years, low initial GCS score, at least unilateral pupil dilatation, and neurological deficit in the Unfavorable group. The presence of bilateral parenchymal lesions or lesions involving the midline structures in the initial brain CT was observed to be a radiological risk factor for unfavorable outcome. Multivariate analysis demonstrated that age and initial GCS score were independent risk factors. The majority of the Favorable group patients with at least one or more risk factors showed improvement of GCS scores within 2 months after TBI. Conclusion : Patients with the above mentioned clinico-radiological risk factors who received standard treatment, but did not demonstrate neurological improvement within 2 months after TBI were deemed at risk for unfavorable outcome. These patients may be eligible candidates for clinical trials that would improve functional outcome after TBI.

• Journal of Korean Neurosurgical Society
• /
• v.57 no.6
• /
• pp.440-444
• /
• 2015

Quality of life is the current trend and issue for the most of human diseases. In moyamoya disease (MMD), surgical revascularization has been recognized as the possible assistance to reduce the neurological insult. However, the progressive nature of the disease has been invincible so far. To improve the quality of life of MMD patients not only the protection from the neurological insult but also the maintenance or improvement of cognitive function is inevitable. For pediatric MMD patients, younger age or longer duration of disease is the key factor among the prognostic factors for bad neurological outcomes. Hence, 'the earlier, the better' is the most precious rule for treatment. Protection from neurological insult is very critical and foremost important to improve cognitive outcome. Clinicians need to know the neuropsychological profile of MMD patients for the care of whole person and make an effort to protect the patients from neurological insults to maintain or improve it.