• Journal of Korean Neurosurgical Society
• /
• 제41권3호
• /
• pp.196-199
• /
• 2007

Dissecting aneurysms frequently involve the vertebral arteries and their branches, but those involving the posterior inferior cerebellar artery [PICA] and not vertebral artery at all are extremely rare. We present a case of an isolated dissecting aneurysm of the PICA without involvement of vertebral artery. A 54-year-old man presented with dizziness and headache. MR imaging of the brain showed a cerebellar infarction of the left PICA territory. MR angiographic and cerebral angiographic studies revealed a dissecting fusiform aneurysm involving the left proximal PICA. Subsequently, the patient underwent GDC embolization. A postembolization angiogram demonstrated complete obliteration of the aneurysm. In this report, the treatment modalities for this rare condition is described with review of the literature.

• 한국방사선학회논문지
• /
• 제11권6호
• /
• pp.493-500
• /
• 2017

본 데이터 분석은 INFINITT 프로그램을 사용하여 유속증강 자기공명 혈관 조영술(FRE-MRA)과 전산화단층 촬영 혈관 조영술(CTA)에서 신호대 잡음비(SNR)와 대조도대 잡음비(CNR) 분석에 따른 뇌혈관 질환에 대한 정량적 평가를 하고자 하였다. 2017년 1월~4월까지 C대학병원에서 뇌혈관영상검사를 시행한 63명의 환자 중 FRE-MRA와 CTA를 동시에 시행한 19명의 뇌혈관 질환 환자영상 중 움직임으로 인한 인공물로 분석이 어려운 2명의 영상을 제외한 17명의 영상을 분석하였다. 분석 방법으로 FRE-MRA와 CTA에 대하여 각각 5 부위(앞대뇌동맥, 좌 우 중간대뇌동맥, 좌 우 뒤대뇌동맥)에 관심영역을 설정하고 SNR과 CNR를 평가하였고, 분석결과에 대한 유의성 평가는 독립 t 검정을 통하여 유의성을 확인하였다. 본 연구에 대한 결과로서 각각의 SNR과 CNR을 평균하였을 때 FRE-MRA는 앞대뇌동맥($1500.73{\pm}12.23/970.43{\pm}14.55$), 좌중간대뇌동맥($1470.16{\pm}11.46/919.44{\pm}13.29$), 우중간대뇌동맥($1457.48{\pm}17.11/903.96{\pm}14.53$), 좌뒤대뇌동맥($1385.83{\pm}16.52/852.11{\pm}14.58$), 우뒤대뇌동맥($1318.52{\pm}13.49/756.21{\pm}10.88$)의 값이 측정되었고, CTA는 각각 앞대뇌동맥($159.95{\pm}12.23/123.36{\pm}11.78$), 좌중간대뇌동맥($236.66{\pm}17.52/202.37{\pm}15.20$), 우중간대뇌동맥($224.85{\pm}13.45/193.14{\pm}11.88$), 좌뒤대뇌동맥($183.65{\pm}13.47/151.44{\pm}11.48$), 우뒤대뇌동맥($177.7{\pm}16.72/144.71{\pm}11.43$)의 값이 측정되었다(p<0.05). 결론적으로 5부위의 뇌혈관 질환 영상을 분석한 결과 뇌경색이나 뇌출혈과는 관계없이 MRA가 SNR과 CNR값이 높은 것으로 나타났다. 따라서 환자협조가 가능하여 검사시간이 길다는 단점만 극복할 수 있으면 CTA에 비해 조영제의 부작용으로부터 자유로운 FRE-MRA가 유용하였다.

• Journal of Korean Neurosurgical Society
• /
• 제42권5호
• /
• pp.413-415
• /
• 2007

A 26-year-old man was admitted to our department due to intermittent left hemiparesis for 3 months. Magnetic resonance Image showed subacute infarction in the right precentral gyrus. Digital subtraction angiography and magnetic resonance angiography revealed an aneurysmal protrusion at the right middle cerebral artery (MCA) bifurcation. It was difficult to differentiate the aneurysm from the occlusion of the middle trunk of the MCA trifurcation. Brain single photon emission computerized tomography showed a decrease in perfusion in the right posterior frontal lobe without vascular reserve. Therefore, we planned a superficial temporal artery MCA anastomosis with an exploration of the right MCA bifurcation. Intraoperatively, the aneurysmal opacification on preoperative angiography proved to be the proximal stump of the occluded middle trunk of the MCA trifurcation. An aneurysmal protrusion at the MCA bifurcation does not always indicate an aneurysm. In diagnosing protruding vascular lesions at the MCA bifurcation, the possibility of a vascular stump should be considered according to their angioanatomical appearance and the history of the patient.

• Journal of Korean Neurosurgical Society
• /
• 제50권4호
• /
• pp.370-376
• /
• 2011

Objective : Posttraumatic cerebral infarction (PTCI), an infarction in well-defined arterial distributions after head trauma, is a known complication in patients with severe head trauma. The primary aims of this study were to evaluate the clinical and radiographic characteristics of PTCI, and to assess the effect on outcome of decompressive hemicraniectomy (DHC) in patients with PTCI. Methods : We present a retrospective analysis of 20 patients with PTCI who were treated between January 2003 and August 2005. Twelve patients among them showed malignant PTCI, which is defined as PTCI including the territory of Middle Cerebral Artery (MCA). Medical records and radiologic imaging studies of patients were reviewed. Results : Infarction of posterior cerebral artery distribution was the most common site of PTCI. Fourteen patients underwent DHC an average of 16 hours after trauma. The overall mortality rate was 75%. Glasgow outcome scale (GOS) of survivors showed that one patient was remained in a persistent vegetative state, two patients were severely disabled and only two patients were moderately disabled at the time of discharge. Despite aggressive treatments, all patients with malignant PTCI had died. Malignant PTCI was the indicator of poor clinical outcome. Furthermore, Glasgow coma scale (GCS) at the admission was the most valuable prognostic factor. Significant correlation was observed between a GCS less than 5 on admission and high mortality (p<0.05). Conclusion : In patients who developed non-malignant PTCI and GCS higher than 5 after head injury, early DHC and duroplasty should be considered, before occurrence of irreversible ischemic brain damage. High mortality rate was observed in patients with malignant PTCI or PTCI with a GCS of 3-5 at the admission. A large prospective randomized controlled study will be required to justify for aggressive treatments including DHC and medical treatment in these patients.

• 대한중풍순환신경학회지
• /
• 제22권1호
• /
• pp.21-30
• /
• 2021

■ Background Patients with posterior cerebral artery infarction could complain of visual field defects or prosopagnosia that does not recognize a person's face. However, there has been no standardized treatment for these symptoms. ■ Case report A 57-year-old male patient complained homonymous hemianopia and prosopagnosia after posterior cerebral artery infarction. After combined Korean medicine treatment for 49 days, subjective visual field was improved and the discomfort associated with visual field defect and the disability of recognizing people was decreased. Evaluations were took place by assessing visual field using Automated Perimetry and Confrontation visual field exam. Discomfort caused by visual field defects or prosopagnosia was evaluated by visual analog scale. The patient was treated with acupuncture, moxibustion, and herbal medications. ■ Conclusion The present case report suggests that combined Korean medicine treatment might be effective to resolution of homonymous hemianopia and prosopagnosia after stroke.

• Journal of Korean Neurosurgical Society
• /
• 제44권4호
• /
• pp.228-233
• /
• 2008

Objective : The standard treatment strategy of intracranial aneurysms includes either endovascular coiling or microsurgical clipping. In certain situations such as in giant or dissecting aneurysms, bypass surgery followed by proximal occlusion or trapping of parent artery is required. Methods : The authors assessed the result of extracranial-intracranial (EC-IC) bypass surgery in the treatment of complex intracranial aneurysms in one institute between 2003 and 2007 retrospectively to propose its role as treatment modality. The outcomes of 15 patients with complex aneurysms treated during the last 5 years were reviewed. Six male and 9 female patients, aged 14 to 76 years, presented with symptoms related to hemorrhage in 6 cases, transient ischemic attack (TIA) in 2 un ruptured cases, and permanent infarction in one, and compressive symptoms in 3 cases. Aneurysms were mainly in the internal carotid artery (ICA) in 11 cases, middle cerebral artery (MCA) in 2, posterior cerebral artery (PCA) in one and posterior inferior cerebellar artery (PICA) in one case. Results : The types of aneurysms were 8 cases of large to giant size aneurysms, 5 cases of ICA blood blister-like aneurysms, one dissecting aneurysm, and one pseudoaneurysm related to trauma. High-flow bypass surgery was done in 6 cases with radial artery graft (RAG) in five and saphenous vein graft (SVG) in one. Low-flow bypass was done in nine cases using superficial temporal artery (STA) in eight and occipital artery (OA) in one case. Parent artery occlusion was performed with clipping in 9 patients, with coiling in 4, and with balloon plus coil in 1. Direct aneurysm clip was done in one case. The follow up period ranged from 2 to 48 months (mean 15.0 months). There was no mortality case. The long-term clinical outcome measured by Glasgow outcome scale (GOS) showed good or excellent outcome in 13/15. The overall surgery related morbidity was 20% (3/15) including 2 emergency bypass surgeries due to unexpected parent artery occlusion during direct clipping procedure. The short-term postoperative bypass graft patency rates were 100% but the long-term bypass patency rates were 86.7% (13/15). Nonetheless, there was no bypass surgery related morbidity due to occlusion of the graft. Conclusion : Revascularization technique is a pivotal armament in managing complex aneurysms and scrupulous prior planning is essential to successful outcomes.

• 한국산학기술학회논문지
• /
• 제19권2호
• /
• pp.456-461
• /
• 2018

목동맥 스텐트 삽입술은 목동맥 내막절제술에 적합하지 않은 환자에게 시행할 수 있는 목동맥 협착증의 대체 치료법으로 알려져 있다. 목동맥 내막절제술, 혈관성형술 또는 스텐트 삽입술 후에 드문 부작용으로 뇌내출혈이 발생할 수 있고, 이러한 출혈이 발생하는 원인은 대부분의 경우 재관류 손상과 관련이 있는 것으로 추정하고 있다. 이전의 연구에서는 내막절제술과 비교하여 목동맥 스텐트 삽입술 후 뇌내출혈의 빈도가 더 높다고 보고한 바 있다. 본 연구에서는 뇌경색으로 내원한 80세 남자환자를 대상으로 증례보고를 통해 동일 분야 연구에 활용하고자 자료 분석을 하였다. 80세 남자가 갑자기 발생한 오른 팔의 근력저하를 주소로 방문하였다. 왼쪽 속목동맥의 90% 협착이 발견되어 목동맥 스텐트 삽입술을 시행하였고, 시술 후 실시한 뇌 CT에서 시상을 포함하는 후대뇌동맥 영역의 뇌출혈이 뇌실내출혈까지 진행되어 있음을 관찰하였다. 이러한 출혈은 스텐트 삽입술이 시행된 동맥에서 공급될 가능성이 낮은 혈관 영역에서 발생했기 때문에, 이 경우에 내막절제술 시행 후 과다혈류에 의한 출혈과 다른 양상을 확인하였다.

• 동의생리병리학회지
• /
• 제16권6호
• /
• pp.1291-1296
• /
• 2002

Blood circulation of brain is divided into two major categories; anterior one from carotid artery and posterior one from vertebrobasilar artery. In stroke patients, it is important to diagnose which is involved, because there is many difference in the aspects of clinical menifestations and prognosis, especially in the acute stage. In some cases of vertebrobasilar infarction, such as Wallenberg's syndrome, charicteristic cranial nerve signs, eye movement disorders and cerebellar signs are appeared. And in Dejerine's syndrome, only pure motor or sensory defecits can be appeared without any brainstem signs. So It shoud be differenciated by Brain MRI from those of the cerebral hemisphere lesions. And in the cases that nausea, vomitting and dysphagia are the first menifestations, it is frequently misdiagnosed as internal medical disease, causing appropriate treatment delayed. In this case report, we are to describe the clinical menifestations and progresses of two cases of brainstem infarctions, review previously published case reports about them and compare them to our cases. The first is Dejerine's syndrome i.e. medial medullary infarction, the second is Wallenberg's syndrome i.e. lateral medullary infarction. Simultaneously we are to investigate the oriental medical approach in the bran stem infarctions.

• Journal of Korean Neurosurgical Society
• /
• 제59권5호
• /
• pp.521-524
• /
• 2016

Use of the Pipeline embolization device (PED) has increased based on studies about its safety and effectiveness, and new reports that describe perior postprocedural complications are now emerging. We report a rare periprocedural device-related complication that occurred during endovascular treatment with the pipeline embolization device for a dissecting aneurysm on the vertebral artery. A 55-year old woman was admitted due to left medullary infarction, and angiography showed a fusiform dilatation in the left vertebral artery that was suspicious for dissecting aneurysm. Endovascular treatment with PED was planned. Under general anesthesia, the procedure was performed without significant problems and a PED was deployed in an appropriate position. However, in the final step of the procedure, the distal tip of the PED delivery wire became engaged within a small branch of the posterior cerebral artery and fractured. Fortunately, imaging studies after the procedure revealed neither hemorrhagic nor ischemic stroke, and the patient recovered without neurological morbidities except initial symptoms.

• Investigative Magnetic Resonance Imaging
• /
• 제22권2호
• /
• pp.131-134
• /
• 2018

Susceptibility-weighted imaging (SWI) is well known for detecting the presence of hemorrhagic transformation, microbleeds and the susceptibility of vessel signs in acute ischemic stroke. But in some cases, it can provide the tissue perfusion state as well. We describe a case of a patient with hyperacute ischemic infarction that had a slightly hypodense, patchy lesion at the left thalamus on the initial SWI, with a left proximal posterior cerebral artery occlusion on a magnetic resonance (MR) angiography and delayed time-to-peak on an MR perfusion performed two hours after symptom onset. No obvious abnormal signals at any intensity were found on the initial diffusion-weighted imaging (DWI). On a follow-up MR image (MRI), an acute ischemic infarction was seen on DWI, which is the same location as the lesion on SWI. The hypointensity on the initial SWI reflects the susceptibility artifact caused by an increased deoxyhemoglobin in the affected tissue and vessels, which reflects the hypoperfusion state due to decreasing arterial flow. It precedes the signal change on DWI that reflects a cytotoxic edema. This case highlights that, in some hyperacute stages of ischemic stroke, hypointensity on an SWI may be a finding before the hyperintensity is seen on a DWI.