• Journal of Acupuncture Research
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• 제27권3호
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• pp.83-92
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• 2010

Objectives : The aim of this study is to research the trend of the TCD-related studies in Korean medicine and to establish the hereafter direction for the study on celebral blood flow. Methods : We reviewed the domestic papers searched by search engine of Korean Acupuncture & Moxibustion Society and Korea Institute of Oriental Medicine etc. Results : We have searched 42 articles in 14 journals. 1. There were 2 or more articles every year. In 2004 there were 5 articles. 2. 11 studies were associated with the usefulness of TCD as a diagnostic tool for CVA. 3. 8 studies were associated with the effect of acupuncture on cerebral blood flow. 5 studies were about acupuncture, 2 studies were about electro-acupuncture, and 1 study was about pharmacopuncture. Conclusions : These results suggest that acupuncture could have a specific effect on cerebral blood flow. But we need more studies about the effect of various acupuncture point on cerebral blood flow.

• Journal of Korean Neurosurgical Society
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• 제39권5호
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• pp.347-354
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• 2006

Objective : We evaluate the role of multislice computerized tomographic angiography[MCTA] in the diagnosis of intracranial vasospasm following subarachnoid hemorrhage[SAH] in patients suspected of having vasospasm on clinical ground. Methods : Between October 2003 and June 2005, patients with ruptured cerebral aneurysms of the anterior circulation clipped within 3 days of the onset were included. We performed follow-up MCTAs in patients who were suspected to have vasospasm on transcranial doppler sonography[TCD] findings and clinical grounds. Based on the clinical presentation of symptomatic vasospasm, we investigated the correlation between clinical, TCD, and MCTA signs of vasospasm and evaluated the role of MCTA in vasospasm. Results : One hundred one patients met the inclusion criteria and symptomatic vasospasm developed in 25 patients [24.8%]. We performed follow-up MCTAs in 28 patients. MCTA revealed spasm in the vessels of 26 patients. The sensitivity of MCTA was 100%. Among the 26 patients with MCTA evidence of vasospasm, 3 patients had TCD signs of vasospasm after symptomatic vasospasm presentation. Another 3 patients with symptomatic vasospasm had no TCD signs of vasospasm in daily serial recordings. Six other patients without symptomatic vasospasm showed MCTA evidence of vasospasm [false positive result] but these patients had also positive TCD signs of vasospasm. Volume rendering[VR] images tended to show significantly more exaggerated vasospasm than maximum intensity projection[MIP] images. The mean cerebral blood flow velocity of both proximal segment of the middle cerebral artery [M1] was significantly correlated with each reduced M1 diameter on MCTA [P<005]. Conclusion : MCTA could be a useful tool for evaluation and planning management of critically ill patients suspected of having vasospasm; however, more randomized controlled trials are necessary to assess these points definitively.

• 한국콘텐츠학회논문지
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• 제15권6호
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• pp.276-282
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• 2015

태아의 소뇌는 임신주수에 따라 성장하며 소뇌횡직경 길이의 측정은 임상에서 태아성장 예측의 중요한 지표로 활용하고 있다. 본 연구에서는 임신 20~37주 사이의 산모를 임신 주수별 각 20명씩 총 340명을 대상으로 3차원초음파 탐촉자를 이용하여 태아의 태령 및 태아의 소뇌 양쪽 외단을 측정해 기초자료를 획득하였다. 결과적으로 임신 주수에 따른 태아 소뇌횡직경의 성장을 회귀곡선으로 표시하였고 선형회귀방정식에서 결정계수를 얻었다. 3차원초음파를 이용한 임신주수에 따른 소뇌횡직경 측정방법은 통계적으로 유의(p<0.001)하였으며, 태령을 예측함에 있어 유용하다는 것을 알 수 있었다. 그러므로 임신주수에 따라 증가하는 소뇌횡직경의 측정은 정확한 임신주수의 산정이 가능 할 것이며 임상에서 현재 이용되고 있는 태령측정 방법의 대체 또는 개선방법이라 사료된다. 태아의 성장에 따라 측정하는 소뇌형직경은 임신주수에 따른 태아 성장의 평가가 가능하며, 태아의 머리 모양에 관계없이 성장장애가 있는 경우에도 임신주수의 예측이 가능하다. 따라서 본 연구를 기초자료로 하여 지속적인 연구가 시행된다면 3차원초음파를 이용한 소뇌횡 직경의 측정은 정확한 임신주수 예측에 유용할 것으로 사료된다.

• 혜화의학회지
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• 제15권2호
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• pp.263-272
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• 2006

Purpose Brain vessles have autoregulation function, so even when perfusion pressure drops, cerebral blood flow remain stable by vasodilation. Latest research on this reserve of cerebral vessels is being done using TCD, which measures the reserve of the vessels. We did a research comparing cerebral vessel and peripheral vessel reserve between Taeumin, who are more likely to suffer CVA, and the normal. We observed blood flow of Internal carotid artery siphon and radial indicis artery of the two group with TCD. Method We picked 20 people out of patients diagnosed as cerebral infarction at Cheon-An Oriental hospital of Daejeon University. They were diagnosed as Taeumin with QSCCII questionnaire and constitutional differentiation. Using TCD, we measured highest blood flow rate, mean blood flow and asymmetric counting blood flow of Internal carotid artery siphon and radial indicis artery at rest. And then we measured again after stimulating cerebral vessels, by triggering hypercapnia by self apnea and peripheral vessels by palm heating. Result At rest, mean blood flow rate of Internal carotid artery siphon showed significant decrease compared to control group. Blood flow rate of Internal carotid artery siphon after hypercapnia showed significant decline in highest blood flow rate and mean blood flow compared to control group. Cerebral vessel reaction after the hypercapnia induction showed great change in experiment group than the control group. Peripheral vessel reaction after palm heating showed significant decline in experiment group compared to control group. Conclusion In conclusion, measuring the alteration of blood flow used in diagnosing cerebral infarction, is more sensitive when vessel stimulation is done. Non-invasive TCD is effective especially in case of Taeumin who are more likely to suffer vascular disorder than others.

• Journal of Acupuncture Research
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• 제21권3호
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• pp.83-97
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• 2004

Objective : This study was performed to evaluate the effect acupuncture on cerebral blood flow by Transcranial Doppler Ultrasonography(TCD). Methods : Monitoring of TCD was examined in stroke patients before and after acupuncture on seven points of CVA. Mean Velocity, pulsatility index, systolic velocity, diastolic velocity values are analyzed from TCD at middle cerebral artery. Results : The results showed a insignificant(p>0.05: Paired T-test) decrease in mean velocity, pulsatility index, systolic velocity, diastolic velocity, which was measured at normal middle cerebral artery. The results showed a significant($p{\leq}0.05$: Paired T-test) decrease in mean velocity, pulsatility index, systolic velocity, which was measured at injuried middle cerebral artery, except diastolic velocity. Conclusion : These results suggest that acupuncture could have a specific effect on injuried cerebral artery.

• 대한중풍순환신경학회지
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• 제7권1호
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• pp.11-16
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• 2006

Objectives : Transcranial Doppler (TCD) has been reported to be established as useful in detecting spasm after subarachnoid hemorrhage and to be probably useful in diagnosing stenosis or occlusion in intracranial arteries. In the detection of intracranial stenosis using TCD there have been reported some kinds of diagnostic criteria. This study was aimed to evaluate the accordance between TCD and magnetic resonance angiography (MRA) in detection of intracranial stenosis and to find out more accurate criteria for intracranial stenosis using TCD. Methods : Seventy-six stroke patients were evaluated by TCD and MRA. TCD criteria for middle cerebral artery (MCA) stenosis were used by 3 methods; ≥ 80cm/sec of mean velocity(Vm), ≥ 140 cm/sec of systolic velocity(Vs), and both. For stenosis of vertebral(VA) and basilar arteries(BA), the TCD criteria followed by 2 methods; ≥ 70 cm/sec of Vm and ≥ 100 cm/sec of Vs. The stenosis of intracranial artery in MRA followed by the interpretation of specialist in the department of radiology. The sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy and kappa agreement were calculated in each criteria of TCD compared with the result of MRA. Results : The sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy and kappa agreement using ≥ 80cm/sec of Vm for MCA stenosis were 55.6%, 81%, 34.5%, 91.0%, 77.1%, and 0.293, respectively. Using 140 cm/sec of Vs, those were 44.4%, 92.0%, 50.5%, 90.2%, 84.7%, 0.380, and using both criteria those were 44.4%, 95.0%, 61.5%, 90.5%, 87.3%, 0.445, respectively. Those using ≥ 70 cm/sec of Vm for VA and BA stenosis were 71.4%, 93.7%, 26.3%, 99.0%, 93.0%, 0.186 and using ≥ 100 cm/sec of Vs those were 71.4%, 97.3%, 45.5%, 99.1%, 96.5%, 0.539, respectively. Conclusion : These results suggested that for the diagnosis of MCA stenosis using TCD we should use the criteria of both ≥ 80cm/sec of Vm and 140 cm/sec of Vs, and for the VA and BA stenosis we adapt the criteria of ≥ 70 cm/sec of Vm.

• The Journal of Korean Physical Therapy
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• 제17권2호
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• pp.126-147
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• 2005

TCD(transcranial doppler, TCD) units is a equipment that measure a blood flow velocity in the middle cerebral artery(MCA), anterior cerebral artery(ACA), posterior cerebral artery(PCA), and vertebral artery(VA). The aim of this study was to determine the influence on cerebral blood flow velocity according to different stimulation frequency of interferential currents. 50 patients who has a cervical pain were participated in this study and randomly divided into one of the three experimental, placebo, and control group: (1)IFS 1; $10{\sim}30Hz$ was applied, (2)IFS 2; $30{\sim}50Hz$ was applied, (3)IFS 3; $50{\sim}100Hz$ was applied, (4)placebo; suction only applied, and (5)control; neither suction nor interferential stimulation applied. In the IFS groups, interferential stimulations were applied through four suction electrodes application from the 5th cervical to the 1st thoracic level. The results were as follow; 1. MCA was statistically significant with IFS 1, IFS 2, IFS 3, and Placebo group(p<0.05), But there was no statistical significance between IFS 1 and IFS 3 group(p>0.05). 2. ACA was statistically significant with IFS 1, IFS 2, and IFS 3 group(p<0.05). And IFS 1 was more statistical significance than IFS 3 group on ACA(p<0.05). 3. PCA was statistically significant with IFS 1, IFS 2, and IFS 3 group(p<0.05). And IFS 1 was more statistical significance than IFS 3 group on PCA(p<0.05). 4. VA was statistically significant with IFS 1, IFS 2, and IFS 3 group(p<0.05). And IFS 1 was more statistical significance than IFS 3 group on VA(p<0.05).

• Journal of Korean Neurosurgical Society
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• 제54권3호
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• pp.159-163
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• 2013

Objective : Cerebral hyperperfusion syndrome (CHS) is a serious complication after carotid endarterectomy (CEA). However, the prevalence of CHS has decreased as techniques have improved. This study evaluates the role of strict blood pressure (BP) control for the prevention of CHS. Methods : All 18 patients who received CEA from February 2009 through November 2012 were retrospectively reviewed. All patients were routinely managed in an intensive care unit by a same protocol. The cerebral perfusion state was evaluated on the basis of the regional cerebral blood flow (rCBF) study by perfusion computed tomography (pCT) and mean velocity by transcranial doppler (TCD). BP was strictly controlled (<140/90 mm Hg) for 7 days. When either post-CEA hyperperfusion (>100% increase in the rCBF by pCT or in the mean velocity by TCD compared with preoperative values) or CHS was detected, BP was maintained below 120/80 mm Hg. Results : TCD and pCT data on the patients were analyzed. Ipsilateral rCBF was significantly increased after CEA in the pCT (p=0.049). Post-CEA hyperperfusion was observed in 3 patients (18.7%) in the pCT and 2 patients (12.5%) in the TCD study. No patients developed clinical CHS for one month after CEA. Furthermore, no patients developed additional neurological deficits related to postoperative cerebrovascular complications. Conclusion : Intensive care with strict BP control (<140/90 mm Hg) achieved a low prevalence of post-CEA hyperperfusion and prevented CHS. This study suggests that intensive care with strict BP control can prevent the prevalence of post-CEA CHS.

• Journal of Korean Neurosurgical Society
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• 제54권4호
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• pp.289-295
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• 2013

Objective : Cerebral vasospasm is a common and potentially devastating complication of aneurysmal subarachnoid hemorrhage (aSAH). Inflammatory processes seem to play a major role in the pathogenesis of vasospasm. C-reactive protein (CRP) constitutes a highly sensitive inflammatory marker. Elevation of serum CRP levels has been demonstrated in patients with aSAH. The purpose of the current study was to evaluate the possible relationship between CRP levels in the serum and transcranial Doppler (TCD) and the development of vasospasm in patients with aSAH. Methods : A total of 61 adult patients in whom aSAH was diagnosed were included in the study from November 2008 to May 2011. The patients' demographics, Hunt and Hess grade, Fisher grade, CT scans, digital subtraction angiography studies, and daily neurological examinations were recorded. Serial serum CRP measurements were obtained on days 1, 3, 5, 7, 9, 11 and 13 and TCD was measured on days 3, 5, 7, 9, 11 and 13. All patients underwent either surgical or endovascular treatment within 24 hours of their hemorrhagic attacks. Results : Serum CRP levels peaked on the 3rd postoperative day. There were significant differences between the vasospasm group and the non-vasospasm group on the 1st, 3rd and 5th day. There were significant differences between the vasospasm group and the non-vasospasm group on the 3rd day in the mean middle cerebral artery velocities on TCD. Conclusion : Patients with high levels of CRP on the 1st postoperative day and high velocity of mean TCD on the 3rd postoperative day may require closer observation to monitor for the development of vasospasm.

• Journal of Chest Surgery
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• 제49권1호
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• pp.22-28
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• 2016

Background: Carotid endarterectomy (CEA) with selective shunting is the surgical method currently used to treat patients with carotid artery disease. We evaluated the incidence of major postoperative complications in patients who underwent CEA with selective shunting under transcranial Doppler (TCD) at our institution. Methods: The records of 45 patients who underwent CEA with TCD-based selective shunting under general anesthesia from November 2009 to June 2015 were reviewed. The risk factors for postoperative complications were analyzed using univariate and multivariate analysis. Results: Preoperative atrial fibrillation was observed in three patients. Plaque ulceration was detected in 10 patients (22.2%) by preoperative computed tomography imaging. High-level stenosis was observed in 16 patients (35.5%), and 18 patients had contralateral stenosis. Twenty patients (44.4%) required shunt placement due to reduced TCD flow or a poor temporal window. The 30-day mortality rate was 2.2%. No cases of major stroke were observed in the 30 days after surgery, but four cases of minor stroke were noted. Univariate analysis showed that preoperative atrial fibrillation (odds ratio [OR], 40; p=0.018) and ex-smoker status (OR, 17.5; p=0.021) were statistically significant risk factors for a minor stroke in the 30-day postoperative period. Analogously, multivariate analysis also found that atrial fibrillation (p<0.001) and ex-smoker status (p=0.002) were significant risk factors for a minor stroke in the 30-day postoperative period. No variables were identified as risk factors for 30-day major stroke or death. No wound complications were found, although one (2.2%) of the patients suffered from a hypoglossal nerve injury. Conclusion: TCD-based CEA is a safe and reliable method to treat patients with carotid artery disease. Preoperative atrial fibrillation and ex-smoker status were found to increase the postoperative risk of a small embolism leading to a minor neurologic deficit.