• Journal of Korean Neurosurgical Society
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• 제30권sup1호
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• pp.99-107
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• 2001

Objective : Hydrocephalus and vasospasm are the common complications following subarachnoid hemorrhage (SAH). In spite of development of perioperative management and operative technique, hydrocephalus cause neurological deficit and poor prognosis. Usually CSF drainage procedure(external ventricular drainage(EVD) or shunt) is needed in hydrocephalus following SAH. The aim of this study was to investigate whether the need for shunting and the outcome after shunting in hydrocephaus following SAH can be related to the duration, daily and total amount of cerebrospinal fluid(CSF) drainage at EVD. Material and Method : IVH is one of several factors which cause hydrocephalus. In this retrospective study, firstly we investigated the incidence of IVH in total cases and frequency of IVH according to aneurysmal site and then prognosis of IVH following SAH. Among 629 patients with SAH, hydrocephalus was diagnosed by CT scan and symptoms. And then those 102 hydrocephalus following SAH were divided into two groups which were hydrocephalus with IVH group and without IVH group. In these two groups, we investigated and compared the incidence of hydrocephalus in all case, frequency of hydrocephalus according to aneurysmal site, the outcome according to H-H grade on admission and the need rate of shunt, etc. Of those hydrocephalus, 100 EVD procedures were done. The duration, daily and total amount of CSF drainage at EVD were investigated. Fifty cases expired during EVD was excluded. We analyzed whether the need rate of shunt and the final outcome after shunting can be related to IVH, the duration and daily and total amount of CSF drainage. Result : The incidence of hydrocephalus following SAH was 20%(with IVH group ; 64%, without IVH group ; 11%). As H-H grade on admission was better, the outcome of hydrocephalus was also better. The mortality rate of hydrocephalus with IVH was 64% which was higher than 40% that of hydrocephalus without IVH. The need rate of shunt in all cases of hydrocephalus following SAH was 20%, but those with IVH group excluding expired patients before shunt was 40%. This was very similar to 41% of the need rate of shunt in hydrocephalus without IVH. The total amount of CSF drainage was statistically related to the need rate of shunt(total amount : need rate of shunt/<1000cc : 15%, 1000-2000cc : 40%, >2000cc : 50%). The duration and daily amount of CSF drainage were not statistically related to the need rate of shunt, but as daily amount of CSF drainage was more and duration was longer, the need rate of shunt was increased(daily amount : need rate of shunt /<100cc : 16%, 100-200cc : 25%, >200cc : 40%//duration : need rate of shunt/<1week : 8%, 1-2weeks : 30%, >2weeks : 47%), and also the final outcome after shunting was poor. Especially the total amount of CSF drainage was significant related to the final outcome after shunting(total amount : GOS/<1000cc : I&II(3/4), 1000-2000cc : II(2/4), III(2/4), >2000cc : III&IV(6/7)). Conclusion : This study revealed that the incidence and mortality rate of hydrocephalus following SAH were influenced by IVH. So SAH associated IVH has the higher incidence of hydrocephalus and poor outcome. As the CSF drainage amount was more and duration of drainage was longer, the need rate of shunt was increased and the final outcome after shunting was poor. Especially the total amount of CSF drainage were strongly related to the need rate of shunt and the outcome after shunting.

• Journal of Korean Neurosurgical Society
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• 제30권1호
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• pp.33-40
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• 2001

Objective : Aneurysms of vertebral artery and its branches make up approximately 3% of all intracranial aneurysms. As the aneurysm have an intimate relationship with lower cranial nerves and medulla, surgical management of the aneurysms are one of the challenging neurosurgical problems. The authors analyzed the management outcomes for aneurysms arising from vertebral artery and its branches. Methods : At the authors' institution between May 1989 and Jan. 2000, 42 patients were treated with transcranial and endovascular surgery for aneurysms of vertebral artery and its branches. The medical records and neuroimaging studies of the patients were reviewed retrospectively. Results : Forty two patients were comprised of 28 female and 14 male patients aged from 26-80 year old(mean : 51.8). Of the 42 patients, 37 patients(88%) had subarachnoid hemorrhage. Of the 37 patients with subarachnoid hemorrahge, 35 patients(95%) were in good neurological status(Hunt Hess grade I-III), 2 patients(5%) in poor grade(H-H grade IV-V) before operation. Location of the aneurysm were 16 in vertebral artery, 12 in vertebro-PICA junction, and 14 in the peripheral PICA. Twenty nine patients were treated with transcranial surgery and 13 patients with endovascular surgery. The management outcome of the transcranial surgery was : Glasgow outcome scale(GOS) I and II ; 24, GOS III ; 2, GOS IV ; 1 and GOS V(death) ; 2. The causes of mortality related to transcranial surgery were rebleeding after failure in clipping in one and suspected brainstem infarct in one. Morbidity was attributed to vasospasm(3), lower CN palsy(7, including temporary dysfunction) and pseudomeningocele(1). The management outcome of the endovascular surgery was : Glasgow outcome scale(GOS) I-II ; 9, GOS III ; 1, GOS IV ; 1, and GOS V(death) ; 2. The causes of mortality related to endovascular surgery were sepsis from pneumonia(1) and vasospasm(1). There were one cerebellar infarct and one lateral medullary syndrome. Conclusion : Excellent and good surgical results can be expected in 80% of the patients with aneurysms of vertebral arery and its branches. The outcomes of endovascular surgery in treating vertebral artery aneurysm were satisfactory and endovascular surgery may offer a therapeutic alternative especially in vertebral dissecting aneurysm.

• 대한영상의학회지
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• 제83권4호
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• pp.887-897
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• 2022

목적 심각한 증상이 없는 파열된 급성뇌동맥류에서 스텐트를 이용한 코일 색전술 기법의 안전성과 유효성을 평가하고, 지주막하출혈 환자에서 스텐트 자체의 유용성을 평가해 보고자 한다. 대상과 방법 2017년 1월부터 2019년 6월까지 심한 증상이 없는(헌트 앤드 헤스 등급 3 이하) 파열된 뇌동맥류에 대해 코일 색전술로 치료받은 118명의 환자를 대상으로 하였다. 스텐트를 사용한 56명과 스텐트를 사용하지 않은 62명에 대해 시술 이후 합병증, 6개월 수정 랜킨척도, 6개월 영상의학적 결과에 대해 비교하였다. 결과 스텐트를 사용한 군과 스텐트 사용하지 않은 군에서 좋은 임상 결과의 비율(수정 랜킨척도 2 이하)과 출혈성 및 허혈성 합병증의 비율은 유의한 차이를 보이지 않았다. 그러나 스텐트를 사용한 군은 6개월 추적 뇌혈관조영술에서 재개통률이 낮았다(20.0% 대 39.3%, p = 0.001). 결론 심한 증상이 없는(헌트 앤드 헤스 등급 3 이하) 파열된 뇌동맥류의 코일 색전술에서 스텐트의 사용은 임상 결과와 유의한 관련성이 없었다. 스텐트를 사용함으로써 추적 뇌혈관조영술에서 재개통률이 감소하였다.

• 대한한의학회지
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• 제16권2호
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• pp.17-35
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• 1995

연구배경(硏究背景) 및 목적(目的): 국내(國內) 대부분(大部分)의 한방병원(韓方病院)에서 많은 수의 환자(患者)가 중풍(中風)으로 입원(入院)하고 있다. 이에 한방병원(韓方病院)을 찾고 있는 중풍환자(中風患者)에 대한 임상적(臨床的) 통계분석(統計分析)과 더불어 앞으로 나아가야 할 방향(方向)등에 대해 많은 연구(硏究)가 필요(必要)할 것으로 여겨져 본 연구(硏究)를 시작(始作)하였다. 대상(對象) 및 방법(方法): 1994년 1월(月) 1일(日)부터 동년(同年) 12월(月) 31일(日) 까지 경원대학교(暻園大學校) 부속(附屬) 한방병원(韓方病院) 순환기내과(循環器內科)에 Brain CT나 MRI상(上) 뇌혈관질환(腦血管疾患)으로 진단(診斷)받거나, 임상적(臨床的) 증상(症狀)으로 뇌졸중(腦卒中)으로 진단(診斷)받은 161예(例)의 환자(患者)를 대상(對象)으로 조사(調査)하였다. 결과(結果) 및 결론(結論): 1. 뇌졸중(腦卒中)의 종류별(種類別) 빈도(頻度)에서 뇌경색(腦梗塞)이 가장 많았으며 뇌출혈(腦出血), 지주막하출혈(蜘蛛膜下出血), 고혈압성뇌증(高血壓性腦症), 일과성뇌허혈발작(一過性腦虛血發作)의 순(順)이었다. 2. 선행질환(先行疾患)은 고혈압(高血壓)이 가장 많았으며, 당뇨(糖尿)도 많은 예(例)에서 나타났다. 3. 일반적(一般的)인 통례(通例)와는 달리 겨울보다는 여름에 많이 발생(發生), 입원(入院)하였다. 4. 입원당시(入院當時) 의식상태(意識狀態)가 안 좋았던 환자(患者)에게서 예후불량(豫後不良)한 환자(患者)가 많이 나타났다. 5. 물리치료(物理治療)의 평균(平均) 개시시기(開始時期)는 뇌경색(腦梗塞)에서 11.4일(日), 뇌출혈(腦出血)에서 22.7일(日)이었다. 6. 한(韓), 양방(洋方) 협진(協診)을 실시(實施)한 경우가 많았으며, 그 필요성(必要性)이 많이 나타났다.진단(診斷)에서부터 치료(治療)의 전과정(全過程)을 통(通)해서 서의치료(西醫治療)와 동의치료(東醫治療)를 결합(結合)하여 종합치료(綜合治療)를 하므로써 폐암(肺癌)의 치료효과(治療效果)를 높일 수 있는 새로운 치료법(治療法)으로 계속적인 연구(硏究)가 필요(必要)할 것으로 사료(思料)된다.較)하였다. 끝으로 본(本) 연구는 1965 年度 서울대학교 대학원(大學院) 연구비(硏究費)로 수행(遂行)한 것이며 본 연구를 시종 지도편달(指導鞭撻) 해 주신 서울대학교 농과대학 농화학과 주임교수 이춘영박사(李春寧博士)에게 감사(感謝)를 드리며 또한 본 연구의 시료를 제공하여 주신 서울대학교 농과대학 농학과 이고웅박사(李股雄博士)에 게 사의(謝意)를 표하는 동시에 본 연구의 분석에 협력하여 준 서울대학교 대학원 농화학과 김수영군(金洙榮君)에게 사의(謝意)를 표하는 바이다. 5 참조(參照)) (4) 벼를 pot에 심고 2회(回)에 걸쳐 control, Imidan, N-hydroxy methyl phthalimide, anthranilic acid 및 phthalimide의 10, 25, 50, 100 ppm 농도(濃度)의 각(各) 유제(乳劑)를 살포하고 일정기간후(一定期間後) 생육상(生育相)을 조사(調査)하였더니 Imidan 구(區)와 N-hydroxy methyl phthalimide 구(區)가 control 보다 좋은 성적(成績)을 보였다. (5) Imidan 250 ppm 유제(乳劑)를 수도엽면(水稻葉面)에 살포(撒布)하고 3 일(日), 5 일(日), 7 일(日) 및 14일후(日後)에 일정량(一定量)의 엽경(葉莖)을 채취(採取)하여 acetone으로 추출(抽出)k고 acetonitrile을 가지고 prechromatographic piriication 을 거쳐 paper chromatography에 의(依)하여 다음과

• 대한한의학회지
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• 제18권1호
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• pp.5-24
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• 1997

연구배경(硏究背景) 및 목적(目的): 국내(國內) 대부분(大部分)의 한방병원(韓方病院)에서 많은 수의 환자(患者)가 중풍(中風)으로 입원(入院)하고 있다. 이에 한방병원(韓方病院)을 찾고 있는 중풍환자(中風患者)에 대한 임상적(臨床的) 통계분석(統計分析)과 94年(년) 본원(本院)의 임상통계논문(臨床統計論文)과의 비교(比較), 그리고 앞으로 나아가야 할 방향(方向)등에 대해 많은 연구(硏究)가 필요(必要)할 것으로 여겨져 본 고찰(考察)을 시작(始作)하였다. 대상(對象) 및 방법(方法): 1995년 1월(月) 1일(日)부터 동년(同年) 12월(月) 31일(日) 까지 경원대학교(景園大學校) 부속(附屬) 한방병원(韓方病院) 순환기내과(循環器內科)에 Brain CT, TCD나 MRI上 뇌혈관질환자(腦血管疾患)으로 진단(診斷)받거나, 임상적(臨床的) 증상(症狀)으로 뇌졸중(腦卒中)으로 진단(診斷)받은 226예(例)를 환자(患者)를 대상(對象)으로 조사(調査)하였다. 결과(結果) 및 결론(結論): 1. 뇌졸중(腦卒中)의 종류별(種類別) 빈도(頻度)에서 뇌경색(腦梗塞)이 가장 많았으며 뇌출혈(腦出血), 일과성뇌허혈발작(一過性腦虛血發作), 지주막하출혈(蜘蛛膜下出血)의 순(順)이었다. 2. 선행질환(先行疾患)은 고혈압(高血壓)이 가장 많았으며, 당뇨(糖尿)도 많은 예(例)에서 나타났다. 3. 일반적(一般的)인 통례(通例)와는 달리 겨울보다는 봄과 여름에 많이 발생(發生), 입원(入院)하였다. 4. 입원당시(入院當時) 인식상태(認識狀態)가 좋지 않았던 환자(患者)에게서 예후불량(豫後不良)한 환자(患者)가 많이 나타났다. 5. 한(韓), 양방(洋方) 협진(協診)을 실시(實施)한 경우가 많았으며, 그 필요성(必要性)이 많이 나타났다.

• Genomics & Informatics
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• 제8권4호
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• pp.206-211
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• 2010

The Fas (TNF receptor superfamily, member 6) (FAS)/FAS ligand (FASLG) interaction plays a central role in the regulation of programmed cell death. FAS and FASLG polymorphisms in promoter regions affect transcriptional activities. To investigate whether FAS and FASLG polymorphisms are associated with the development and clinical phenotypes of stroke, 2 promoter single nucleotide polymorphisms (SNPs) in FAS (rs1800682, -670C/T) and FASLG (rs763110, -844C/T) were selected and genotyped by direct sequencing in 220 stroke patients [107 ischemic stroke (IS), 77 intracerebral hemorrhage (ICH), and 36 subarachnoid hemorrhage (SAH)] and 369 control subjects. For the analysis of clinical symptoms, all stroke patients were divided into 3 clinical phenotypes according to the respective results of the National Institutes of Health Stroke Survey (NIHSS) and the Modified Barthel Index (MBI) and the presence or absence of complex regional pain syndrome (CRPS). The SNPStats, SNPAnalyzer, and Helixtree programs were used to analyze the genetic data. Multiple logistic regression models (codominant, dominant, and recessive) were used to estimate odds ratios (ORs), 95% confidence intervals (CIs), and p-values. The promoter SNP rs1800682 was associated with stroke in the codominant (OR=0.48, 95% CI=0.25-0.94, p=0.04) and dominant models (OR=0.51, 95% CI=0.30-0.87, p=0.011). However, a FASLG SNP (rs763110) was not in Hardy-Weinberg equilibrium (p<0.05). In the analysis of stroke types, rs1800682 was associated with IS in the codominant (OR=0.30, 95% CI=0.12-0.74, p=0.025), dominant (OR=0.44, 95% CI=0.23-0.88, p=0.018), and recessive models (OR=0.45, 95% CI=0.21-0.99, p=0.042). The genotype frequencies of rs1800682 were different between ICH and controls in the dominant model (OR=0.49, 95% CI=0.26-0.94, p=0.031) but not between SAH and controls. In the analysis of clinical symptoms, however, rs1800682 was not related to the 3 clinical phenotypes (NIHSS, MBI, and CRPS). These results suggest that a promoter SNP (rs1800682, -670C/T) in FAS may be associated with the development of stroke in the Korean population.

• Journal of Preventive Medicine and Public Health
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• 제29권3호
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• pp.639-655
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• 1996

Cerebrovascular disease and coronary heart disease are the first and the fourth common causes of death among adults in Korea. Reported risk factors of these diseases are mostly alike. But some risk factors of one of these diseases may prevent other diseases. Therefore, we tried to compare and discriminate the risk factors of these diseases. We recruited four case groups and four control groups among the inpatients who were admitted to Wonju Christian Hospital from March, 1994 to November, 1995. Four control groups were matched with each of four case groups by age and sex. The number of patients in each of four case and control groups were 106 and 168 for acute myocardial infarction(AMI), 84 and 133 for subarachnoid hemorrhage(SAH), 102 and 148 for intracerebral hemorrhage(ICH), and 91 and 182 for ischemic stroke(IS) respectively. Factors whose levels were significantly higher in AMI and IS than in responding control group (RCG) were education, economic status, and triglyceride. Factors whose levels were significantly lower in hemorrhagic stroke than in RCG were age of monarch, and prothrombin time. The factor whose level was higher in AMI than ill RCG was uric acid. The factor whose level was higher in AMI, ICH, and SAM than in RCG was blood sugar. Factors whose levels were significantly higher in all the case groups than in RCG were earlobe crease, Quetelet index, white blood cell count, hemoglobin, hematocrit, and total cholesterol. The list of risk factors were somewhat different among the four diseases, though none of the risk factors to the one disease except prothrombin time acted as a preventive factor to the other diseases. The percent of grouped cases correctly classified was higher in the discrimination of ischemic diseases(AMI and IS) from hemorrhagic diseases(SAM and ICH) than in the discrimination of cerebrovascular disease from AMI. The factors concerned in the discrimination of ischemic diseases from hemorrhagic diseases were prothrombin time, earlobe crease, gender, age, uric acid, education, albumin, hemoglobin, the history of taking steroid, total cholesterol, and hematocrit according to the selection order through forward selection.

• 한국산학기술학회논문지
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• 제18권8호
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• pp.84-87
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• 2017

뇌과관류증후군은 경동맥 스텐트 삽입술 또는 내막 절제술 시행 시 발생할 수 있는 드문 합병증으로 대사 요구량보다 관류가 더 많은 상태를 유발하는 다양한 기전에 의해 발생한다. 주 임상 증상은 편측성 두통, 고혈압, 발작 및 국소 신경계 결손이 있으며, 심한 경우 지주막하 출혈 및 뇌실질 출혈로 영구적 장애 또는 사망까지 유발할 수 있다. 일반적으로 뇌과관류증후군은 두개경유도플러, 관류 뇌자기공명영상 및 단일광자방출컴퓨터단층촬영으로 진단할 수 있다. 저자들의 연구에서는 내경동맥 스텐트 이후 확인한 혈관조영술에서 의미있는 정맥울혈 증상을 보여 뇌과관류증후군을 진단할 수 있었다. 환자는 증상성 양쪽 내경동맥 협착을 보이고 있었고, 협착으로 인해 곁순환 동맥들이 잘 발달하게 되었다. 이렇게 곁순환 동맥이 잘 발달된 상태에서 환자에게 내경동맥 스텐트를 삽입한 이후 대뇌 혈류량이 증가되며 혈류의 방향이 바뀌어 정맥 울혈이 생길 수 있으며, 경동맥 스텐트 삽입술 또는 내막 절제술 시행 이후 정맥울혈이 보일 시 뇌과관류증후군을 예측할 수 있다. 이 연구는 내경동맥 스텐트 삽입 후 바로 시행하는 혈관 조영술을 통해서 뇌과관류증후군을 확진할 수 있음을 보여준 1례의 보고이다.

• 대한의생명과학회지
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• 제4권2호
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• pp.153-164
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• 1998

1997년 10월 1일부터 1997년 12월 31일까지 3개월간 대구광역시 소재 3개 한방병원에 입원해 있거나 통원치료를 받고 있는 뇌졸중 환자 163명을 대상으로 조사 분석한 결과 다음과 같은 성적을 얻었다. 조사 대상자의 일반적 특성은 성별에서 163예 중 남 여의 비는 1：1.36이었고, 연령층은 60대에서 36.8%, 50대에서 25.2%, 70세 이상에서 19.6%의 순으로 나타났다. 결혼관계는 기혼이 74.7%, 학력은 초등학교졸업이 41.5%, 직업은 가정 주부와 농축어 업이 각각 27.7%로 가장 높았다. 뇌졸중의 유발원인 및 발병시 상태는 육체적 활동 20.2%,과로 16.2%, 취침중 15.5%, 정신적 충격 14.9%, 사고 7.2%, 음주 2.6%의 순이었다. 병류별 발생빈도는 157예에서 뇌경색 (혈전증, 색전증 포함)이 47.7%, 뇌출혈이 38.2%, 지주막하출혈이 5.1%, 기타가 8.9%였다. 비만정도에 있어서는 161예 중 보통이다가 64.0%, 비만이 26.7%, 저체중이 9.3%였으며, 성별로는 비만인 여자가 19.9%로 남자의 6.8%보다 월등히 높았다 (p<0.05). 음주에 관해서는 163예 중 소주 2홉 1병 기준으로 안한다가 65.6%, 2∼3일에 한번 한다가 11.0%, 한달에 1∼2회는 9.8％, 매일한다가 8.6%, 1주일에 한번은 4.9%의 순이었다. 흡연에 있어서는 162예중 안한다가 63.0%,하루에 0.5∼l갑이 16.0%, 1∼2갑이 15.4%, 반갑 이하가 4.9%, 2갑 이상이 0.6%의 순으로 나타났다.

• PNF and Movement
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• 제14권3호
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• pp.237-244
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• 2016

Purpose: This case report examines the influence of proprioceptive neuromuscular facilitation (PNF) combined with a dynamic neuromuscular stabilization approach on balance in patients with cerebellar atrophy. Methods: The target subject of this case report was a 34-year-old woman who was informed of the purpose of this research and voluntarily agreed to participate in it. The case report conformed to research ethics based on the Helsinki Declaration. The target subject was confirmed to have cerebellar atrophy from an unknown cause in 2009 and was diagnosed with slight ataxia. At that time, she could carry out daily activities without physical therapy. On May 19, 2015, she suffered both a subdural hemorrhage (SDH) and subarachnoid hemorrhage (SAH) in a traffic accident. She was urgently moved to the emergency room and managed by nonsurgical treatment, and then, the cerebellar atrophy and ataxia gradually deteriorated. To evaluate the patient's balance capacity before and after intervention, the trunk impairment scale (TIS), trunk impairment scale (OLST) during eye-closing/opening, timed up and go test (TUG), and visual analogue scale (VAS) were conducted. The PNF intervention program was executed for 30 min, four times a week, for three weeks. Results: The TIS and OLST during eye-closing/opening were improved by as much as a point, by 8.15 s and 6.21 s, respectively, after applying the PNF program. TUG and VAS decreased by 1.33 s and 3 points, respectively, after intervention. According to the result, the OLST during eye-closing/opening and VAS improved remarkably in comparison with those before intervention. Conclusion: As the final result of the case report, PNF intervention combined with DNSA more effectively improved the static balance capacity, such as the OLST during eye-closing/opening and VAS, compared to the dynamic balance capacity. In addition, the intervention duration and period of the exercise program are recommended to be more than 1 h a day for four weeks considering the learning ability of a patient with cerebellar atrophy.