• 사상체질의학회지
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• 제28권2호
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• pp.193-204
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• 2016

Objectives This case study is about a Taeeumin patient with advanced Parkinson's disease identified as Dry-heat (Joyeol) pattern. In this study, we report significant improvement of non-motor and motor symptoms after treatment with Cheongsimyeonja-tang.Methods The patient was identified as Taeeumin Dry-heat (Joyeol) pattern and treated with Cheongsimyeonja-tang and acupuncture. The Unified Parkinson Disease Rating Scale (UPDRS) was used to assess the overall functions of the patient. And the global assessment scale (GAS) was used to assess the improvements of dizziness, bradykinesia and tremor after the treatment.Result and Conclusion The UPDRS total score decreased from 138 points to 86 points after 5 weeks treatment. And symptoms of dizziness caused by hypotension, bradykinesia, and tremor showed significant improvement in GAS after the treatment. Furthermore, sleep disturbance and constipation were reported to be improved after the treatment. In conclusion, this study shows that Sasang constitutional medicine can be effective treatment for Taeeumin patient with advanced Parkinson's disease having orthostatic hypotension.

• Annals of Clinical Neurophysiology
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• 제22권2호
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• pp.75-81
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• 2020

This paper introduces new diagnostic criteria and differential diagnosis of orthostatic dizziness to help clinicians to diagnose hemodynamic orthostatic dizziness. Clinicians need to be able to discriminate hemodynamic orthostatic dizziness from other types of dizziness that are induced or aggravated when standing or walking. Measurements of the orthostatic blood pressure and heart rate are important when screening hemodynamic orthostatic dizziness. Detailed history-taking, a physical examination, and laboratory tests are essential for finding the cause of hemodynamic orthostatic dizziness. The differential diagnosis of hemodynamic orthostatic dizziness is crucial because it can be caused by various autonomic neuropathies.

• 한국산학기술학회논문지
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• 제22권6호
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• pp.108-115
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• 2021

본 연구는 기립성 저혈압이 동반된 경수부 척수손상 환자에서 플루드로코티손의 치료 효과에 대해 알아보고자 하였다. 기립경사도 검사를 통해 기립성 저혈압으로 진단된 경수부 척수손상 환자 26명을 무작위로 배정하였고, 보존적 치료 혹은 추가로 플루드로코티손 치료 중 한가지를 시행하였다. 플루드로코티손은 주마다 0.1mg에서 0.2mg로 증량하여 총 2주간 투약하였고, 초기 및 2주 후의 혈압 및 심박수, 혈액학적 검사 수치의 변화를 평가하였다. 치료 2주 후에 치료군에서 기저 혈압의 유의미한 상승이 나타났다(p<.05). 기립성 혈압 감소의 비율 분석에서 치료군의 기립성 혈압 감소가 덜 나타나는 경향성을 보였다. 플루드로코티손 치료군의 7.69%에서 경증의 이상 반응을 보고하였다. 이를 통해 플루드로코티손이 기저 혈압의 상승 및 기립성 저혈압 감소를 통해 심혈관계 합병증 방지 및 재활치료 지속 등의 치료 효과를 나타내었음을 알 수 있으며, 척수손상 환자의 기립성 저혈압에서 하나의 치료 방안으로 고려해볼 수 있다고 생각된다.

• Annals of Clinical Neurophysiology
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• 제8권2호
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• pp.190-192
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• 2006

Intracranial hypotension is a benign disorder characterized by orthostatic headache. It is caused by CSF leakage, therefore its treatment of choice has been epidural blood patch when initial conservative treatments were not effective. We would like to report a 26-year-old patient with recurrent orthostatic intracranial hypotension in spite of the successful epidural blood patch several times. Her headache was caused by myelography 8 month ago. Cisternography showed a CSF leakage at the level of L1 vertebral body. Headache was resolved completely after epidural blood patch and then recurred 3 times several months after blood patch. Now, she is free from headache for 5 months after last blood patch.

• Annals of Clinical Neurophysiology
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• 제11권1호
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• pp.1-8
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• 2009

Orthostatic intolerance is defined as the development of various symptoms during standing that are relieved by recumbency. Postural tachycardia syndrome (POTS) is another nomenclature of orthostatic intolerance. POTS characterized by a heart rate increase ${\geq}30$ bpm from supine to standing or >120 bpm at standing without orthostatic hypotension. POTS is a heterogenous in presentation with various pathophysiologic mechanisms. Important mechanisms are hypovolemia, denervation, hyperadrenergic and deconditioning state. There are presented as lightheadness or dizziness, palpitations, presyncope, sense of weakness, tremulousness, shortness of breath. POTS are classified under 3 groups that are neuropathic, hyperadrenergic, and deconditioning POTS. Most patients can be improved from a pathophysiologically based regimen of management.

• The Korean Journal of Physiology and Pharmacology
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• 제21권6호
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• pp.675-686
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• 2017

Orthostatic hypotension (OH) is associated with symptoms including headache, dizziness, and syncope. The incidence of OH increases with age. Attenuation of the vestibulosympathetic reflex (VSR) is also associated with an increased incidence of OH. In order to understand the pathophysiology of OH, we investigated the physiological characteristics of the VSR in the disorder. We applied sodium nitroprusside (SNP) to conscious rats with sinoaortic denervation in order to induce hypotension. Expression of pERK in the intermediolateral cell column (IMC) of the T4~7 thoracic spinal regions, blood epinephrine levels, and blood pressure were evaluated following the administration of glutamate and/or SNP. SNP-induced hypotension led to increased pERK expression in the medial vestibular nucleus (MVN), rostral ventrolateral medullary nucleus (RVLM) and the IMC, as well as increased blood epinephrine levels. We co-administered either a glutamate receptor agonist or a glutamate receptor antagonist to the MVN or the RVLM. The administration of the glutamate receptor agonists, AMPA or NMDA, to the MVN or RVLM led to elevated blood pressure, increased pERK expression in the IMC, and increased blood epinephrine levels. Administration of the glutamate receptor antagonists, CNQX or MK801, to the MVN or RVLM attenuated the increased pERK expression and blood epinephrine levels caused by SNP-induced hypotension. These results suggest that two components of the pathway which maintains blood pressure are involved in the VSR induced by SNP. These are the neurogenic control of blood pressure via the RVLM and the humoral control of blood pressure via epinephrine release from the adrenal medulla.

• Annals of Clinical Neurophysiology
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• 제23권2호
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• pp.126-129
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• 2021

We present a patient with a primitive neuroectodermal tumor arising from the right atrium who experienced multiple syncope episodes daily, which had first appeared 1 month after surgery. The symptoms continued to worsen over the course of chemotherapy, and the autonomic function test (AFT) was performed after the 14th chemotherapy cycle. The AFT revealed orthostatic hypotension and reduced baroreflex-dependent sympathetic reactivity. Physical counterpressure techniques were applied with a visual biofeedback intervention, and were found to be effective in reducing the syncope episodes.

• Journal of Korean Neurosurgical Society
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• 제47권1호
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• pp.48-50
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• 2010

Spontaneous intracranial hypotension is often idiopathic. We report on a patient presenting with symptomatic intracranial hypotension and pain radiating to the right leg caused by a transdurallumbar disc herniation. Magnetic resonance (MR) imaging of the brain revealed classic signs of intracranial hypotension, and an additional spinal MR confirmed a lumbar transdural herniated disc as the cause. The patient was treated with a partial hemilaminectomy and discectomy. We were able to find the source of cerebrospinal fluid leak, and packed it with epidural glue and gelfoam. Postoperatively, the patient's headache and log radiating pain resolved and there-was no neurological deficit. Thus, in this case, lumbar disc herniation may have been a cause of spontaneous intracranial hypotension.

• Genomics & Informatics
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• 제11권3호
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• pp.129-134
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• 2013

Orthostatic hypotension (OH) is defined by a 20-mm Hg difference of systolic blood pressure (dtSBP) and/or a 10-mm Hg difference of diastolic blood pressure (dtDBP) between supine and standing, and OH is associated with a failure of the cardiovascular reflex to maintain blood pressure on standing from a supine position. To understand the underlying genetic factors for OH traits (OH, dtSBP, and dtDBP), genome-wide association studies (GWASs) using 333,651 single nucleotide polymorphisms (SNPs) were conducted separately for two population-based cohorts, Ansung (n = 3,173) and Ansan (n = 3,255). We identified 8 SNPs (5 SNPs for dtSBP and 3 SNPs for dtDBP) that were repeatedly associated in both the Ansung and Ansan cohorts and had p-values of < $1{\times}10^{-5}$ in the meta-analysis. Unfortunately, the SNPs of the OH case control GWAS did not pass our p-value criteria. Four of 8 SNPs were located in the intergenic region of chromosome 2, and the nearest gene (CTNNA2) was located at 1 Mb of distance. CTNNA2 is a linker between cadherin adhesion receptors and the actin cytoskeleton and is essential for stabilizing dendritic spines in rodent hippocampal neurons. Although there is no report about the function in blood pressure regulation, hippocampal neurons interact primarily with the autonomic nervous system and might be related to OH. The remaining SNPs, rs7098785 of dtSBP trait and rs6892553, rs16887217, and rs4959677 of dtDBP trait were located in the PIK3AP1 intron, ACTBL2-3' flanking, STAR intron, and intergenic region, respectively, but there was no clear functional link to blood pressure regulation.

• 대한신경과학회지
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• 제36권4호
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• pp.302-309
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• 2018

Background: Although orthostatic hypotension (OH) and cognitive impairment (CI) are common non- motor symptoms of Parkinson's disease (PD), the relationship between OH and CI remains to be clarified. This study was aimed to investigate the relationship between OH and CI in PD. Methods: We recruited 192 patients who were diagnosed as PD based on the UK Brain Bank diagnostic criteria. The Hoehn & Yahr stages were ranged I to III and patients underwent extensive clinical evaluation, including brain magnetic resonance imaging (MRI) for cerebral white matter hyperintensity (WMH), tilt table test, the Korean version of Montreal Cognitive Assessments and the Korean version of Mini-Mental Status Examination in one month from the first clinic visit. The participants were divided into two groups according to the presence of OH (OH+ vs. OH-) and cognitive function (cognitive normal, CN vs. CI), respectively. Results: Significant relationship between OH and cognitive function (p=0.04) was found in our patients. The patients with OH+ had higher risk of CI by 2.6 times than that of OH- patients. Maximum heart rate change during tilt table test was correlated with cognitive function and white matter changes, whereas blood pressure change during tilt table test showed no correlation with those parameters. Conclusions: There was significant relationship between OH and CI in PD. Therefore, PD patients with either symptom may need periodic evaluation and proper management for OH and cognitive functions.