• Korean Journal of Clinical Laboratory Science
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• v.50 no.2
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• pp.126-135
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• 2018

This study examined whether the difference in the middle cerebral artery (MCA) velocities can predict the prognosis of stroke and whether the prognostic impact differs among stroke subtypes. Transient ischemic attack (TIA) or acute ischemic stroke patients, who underwent a routine evaluation and transcranial Doppler (TCD), were included in this study. The MCA asymmetry index was calculated using the relative percentage difference in the mean flow velocity (MFV) between the left and right MCA: (|RMCA MFV-LMCA MFV|/mean MCA MFV)${\times}100$. The stroke subtypes were determined using the TOAST classification. Poor functional outcomes were defined as a mRS score ${\geq}3$ at 3 months after the onset of stroke. A total of 988 patients were included, of whom 157 (15.9%) had a poor functional outcome. Multivariable analysis showed that only the MCA asymmetry index was independently associated with a poor functional outcome. ROC curve analysis showed that adding the MCA asymmetry index to the prediction model improved the discrimination of a poor functional outcome from acute ischemic stroke (from 88.6% [95% CI, 85.2~91.9] to 89.2% [95% CI, 85.9~92.5]). The MCA asymmetry index has an independent prognostic value for predicting a poor short-term functional outcome after an acute cerebral infarction. Therefore, TCD may be useful for predicting a poor functional outcome in patients with acute ischemic stroke.

• The Journal of Korean Medicine
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• v.26 no.1 s.61
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• pp.115-122
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• 2005

Background and objective: Gastrodiae Rhizoma (GR), the rhizoma of Gastrodia elata BL., is one of the popular drugs to treat headache, dizziness, blackout, numbness of limbs, hemiplegia, facial paralysis, dysphrasia, and infantile convulsions. It has been reported that it provides an antihypertensive effect and lowers cerebrovascular resistance in animal experiments. However, there has been no data about these effects with human subjects. In this study, the author examined the effect of Gastrodiae water extracts on blood pressure and cerebrovascular reactivity in human subjects. Methods: We selected 16 normal volunteers, who were divided into 2 groups: Gastrodiae extract administration group and placebo (creamy powder) group. Using transcranial Doppler ultrasound, we monitored changes of mean flow velocity and breath-holding induced CO2 reactivity of middle cerebral artery in both groups. Mean blood pressure, heart rate and PETCO2 were measured using Compact Anesthesia Monitor. In both groups, all evaluation was performed during basal condition, and repeated at 30, 60, and 90 min after administration. Results: Gastrodiae extract decreased CO2 reactivity after administration, reaching the lowest level at 90 minutes $(-29.1\%\;vs.\;basal\;level)$, which showed significant difference compared with the placebo group (p = 0.004). In the placebo group, the pulse rates tended to decrease over time (at 90 minute, $-5.2\%$ vs. basal level) while in the Gastrodiae group the values showed nearly no change, which showed significant difference between both groups (p = 0.036). However, the changes of mean blood pressure and mean flow velocity did not show significant difference between both groups. Conclusion : This study demonstrated that Gastrodiae extract significantly decreased breath-holding induced CO2 reactivity. This result suggests that the clinical effect of Gastrodiae extract might be caused by increasing cerebral blood flow via dilation of cerebral resistant vessels instead of antihypertensive effect.

• The Journal of Korean Medicine
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• v.30 no.1
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• pp.95-108
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• 2009

Objectives: Uwhangchungsim-won (DC) has been used in various medical fields such as stroke, hypertension, atherosclerosis, autonomic imbalance and mental instability, etc. The aim of this study was to evaluate the effect of UC on cerebral hemodynamics and estimate the appropriate dose of UC. Methods: We studied changes of hyperventilation-induced cerebrovascular reactivity and mean blood flow velocity of middle cerebral arteries (MCA) using transcranial Doppler. We observed the changes of mean blood pressure, pulse rate and expiratory CO2 using S/5 Compact Anesthesia Monitor from 10 healthy young volunteers who were administered UC twice a day in the 1 st section and then once a day in the 2nd section. Results: Mean blood pressure tended to decrease at 1 hour and pulse rate tended to decrease at 2 hours after second administration. After 2 hours, mean blood pressure rose to state before administration, but pulse rate maintained from 2 hours to 4 hours. The changes were not statistically significant. Cerebral blood flow velocity in middle cerebral artery was not statistically significant after second administration. Cerebrovascular reactivity increased from 2 hours to 4 hours after second administration. Conclusions: This study provides that administration of UC twice a day is more effective on hyperventilation-induced cerebrovascular reactivity than administration of UC once a day.

• Biomedical Science Letters
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• v.25 no.4
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• pp.381-389
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• 2019

The physiological function test is the only patient contact area in the field of clinical laboratory. We need to recruit and encourage the experts due to requiring the expertise and long time for examination. However, there is currently no rule for estimating optimal workforce in the field of physiological function tests. The purpose of this study is to establish the basis of the studies for mid- to long-long term job creation in the field of ultrasound by evaluating the number of appropriate tests and appropriate workforce. We calculated the quantitative and qualitative workload for the number of appropriate tests and appropriate workforce using online questionnaire. All statistical analyses were performed using SPSS version 18.0 (SPSS Inc., Chicago, IL, USA). A total of 216 respondents were 48 (22.2%) male and 168 (77.8%) female. A total of 157 laboratories were 62 (39.5%) for echocardiography, 91 (58.0%) for the transcranial Doppler (TCD) and 4 (5.7%) for the carotid ultrasound. The mean number of appropriate tests was 10 ± 2 in the echocardiography, 9 ± 2 in TCD and 11 ± 2 in the carotid ultrasound. In addition, the number of laboratories required to recruit employees for appropriate workforce was 19 in echocardiography, 18 in TCD, and 0 in carotid ultrasound. The number of hospital required to recruit workforce were 7 primary hospitals, 22 secondary hospitals, 7 third hospitals. This study can be used as an important data as the first study at present time when the data on the workforce status and work environment of the ultrasonic laboratories is insufficient. Based on the quantitative and qualitative workloads, the number of appropriate tests and appropriate workforce can support mid- to long-long term job creation in the field of ultrasound.

• Journal of Physiology & Pathology in Korean Medicine
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• v.23 no.6
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• pp.1513-1520
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• 2009

The purpose of this study was to compare cerebral blood flow between hyperlipidemic patient group and normal healthy aldult group using transcranial doppler ultrasonography(TCD). I investigated cerebral blood flow of 63 hyperlipidemic patients and 42 healthy adults. To evaluate the cerebral blood flow, I measured the systolic peak velocity(Vs) and mean flow velocity(Vm) of the milddle cerebral artery(MCA), anterior cerebral artery(ACA), posterior cerebral artery(PCA), basilar artery(BA), internal carotid artery(ICA) in the two groups using TCD. In normal healthy adults, subjects showed a decerease in Vs and Vm with advancing in age. There was a significant difference in the Vm of ICA. There was no significant differences in the Vm of ACA and ICA. In normal healthy adults, females showed high velocities of all examined vessel. There was a significant difference in the Vs of ICA. There was a significant differences in the Vm of MCA and ICA. Normal healthy adults higher than hyperlipidemic patients in the Vs of MCA, ACA, PCA. There was no significant difference in the Vs of all exmined vessels. Hyperlipidemic patientsincrease higher than normal healthy adults in the Vm of ACA. There was a significant difference in the Vs of BA. In the patients aged under 50's, normal healthy adults higher than hyperlipidemic patients in the Vs and Vm except BA. But there was no significant difference in all exmined vessels. In the patients aged over 50's, hyperlipidemic patients higher than normal healthy adults in all examined vessel expect PCA. There was a significant difference in the Vs of BA and ICA. And hyperlipidemic patients higher than that normal healthy adults in all exmined vessels. There was a significant difference in BA and ICA. In this study, visible differences in blood flow between hyperlipidemic patient group and normal healthy aldult group were shown. However, these results do not come up to the previous values that were reported and known worldwide.

• The Journal of the Society of Korean Medicine Diagnostics
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• v.14 no.2
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• pp.85-100
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• 2010

Objectives: The purpose of this study was to evaluate diagnostic value of Transcranial Doppler Ultrasound about risk factor of stroke by comparing blood flow between patients with metabolic syndrome(MS group) and Normal group. Methods: 62 metabolic syndrome patients and 106 healthy adults were selected who had no cerebrovascular diseases, cardiovascular diseases and other systemic diseases. We measured the mean velocity(Vm), peak systolic velocity(Vs) and pulsatility index(PI) of MCA, ACA, PCA, VA, ICA in two groups using TCD. All subjects were divided by gender and age. Results: In comparing Ms group with normal group, Vm in the MCA, ACA, PCA, ICA and Vs in the MCA, ICA were lower in MS group. In all vessels, PI of MS group were higher than that of Normal group. In all vessels, Vm and Vs revealed negative correlation with age and PI revealed positive correlation with age. In 20-39 year olds, there was decrease in the Vs and Vm and increase of PI of MS group in comparison with normal group. There was significant difference in the Vm of PCA, ICA, Vs of MCA, PCA, ICA and PI of MCA, ACA. In 40-59 year olds, Vm in the MCA, ACA, ICA and Vs in the MCA, ACA were lower in MS group. PI in the MCA, ACA, PCA, ICA were higher in MS group. In 60-79 year olds, Vm of MCA, PCA, ICA was decreased in MS group than Normal group with no statistical signification. Vs in the MCA was lower and PI in the PCA was higher in MS group. In male, Vm of PCA and Vs of MCA were lower and PI of MCA, ACA, PCA, ICA were higher in MS group. In female, Vm of MCA, PCA, ICA and Vs of MCA, ICA were lower and PI of ACA, PCA, VA, ICA were higher in MS group. Conclusions: The significant difference in Vm, Vs, PI between MS group and normal group suggests hemodynamic disorder. Screening and prognosing high risk group can be done through TCD and this can be used to prevent stroke. More detailed study will be needed.

• The Journal of Internal Korean Medicine
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• v.22 no.2
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• pp.199-205
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• 2001

Background and Purpose : Transcranial doppler ultrasonography(TCD) is a noninvasive and nonradioactive technique for evaluation of the hemodynamics in large cerebral vessels. Sahyangsohap-won(SS) has been considered to be effective for the treatment of various disease, especially cerebrovascular, cardiovascular, and psychosomatoform disorders. But, there is no study about the effect of SS on the cerebral hemodynamics in humans. The aim of this study was to assess the effect of SS on the changes in cerebral hemodynamics and the dose-dependant effect by using TCD. Subjects and Methods : 30 healthy subjects were randomly divided into three group: group 1 took no drug, group 2 took SS one pill, and group 3 took SS 2 pills. Changes in the mean blood flow velocity(MBFV) and pulsatility index(PI) in the middle cerebral artery were evaluated by means of TCD. We obtained hypercapnia with breath-holding and evaluated cerebrovascular reactivity with the breath-holding index(BHI). Systolic blood pressure(SBP), diastolic blood pressure(DBP), and heart rate(HR) were measured by means of ambulatory blood pressure monitoring. In group 2 and group 3, the evaluations were performed during the baseline and were repeated at 20, 40, and 60 minutes after SS administration. In group 1, the evaluation was performed at corresponding time intervals. Results : In mean values of MSFV, PI, SSP, DBP, and HR, no stastically significant differences were found between the 3 groups. However, BHI values were significantly lower in groups 2 and 3 than in group 1 at 40 minutes after SS administration(P<0.05, group 1 vs group 2, group 1 vs group 3 by post-hoc analysis: Scheffe's test) but in dose-dependant effect, there was no difference between group 2 and group 3. Conclusion : These results suggest that SS can decrease vascular resistance in cerebral small arteries or arterioles and enhance their distensibility. Further studies on larger numbers of subjects are needed to confirm these effects and the dose-dependant effects.

• The Journal of Korean Medicine
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• v.42 no.4
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• pp.164-175
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• 2021

Objectives: The LI11 (Quchi) acupuncture point has always been included in the Seven acupoints for stroke; however, additional LI11 acupuncture research is needed. In this study, the effect of LI11 acupuncture on cerebral blood flow of the anterior cerebral arteries (ACA) and middle cerebral arteries (MCA) was investigated. Method: This study included 10 healthy young male subjects. Cerebral blood flow velocity and cerebrovascular reactivity were measured using transcranial Doppler sonography. Changes in hyperventilation-induced carbon dioxide (CO₂) reactivity and modified ACA and MCA blood flow velocity at 40 mmHg (CV40), blood pressure, and heart rate were observed before and after LI11 acupuncture treatment. Results: A statistically significant increase in contralateral anterior cerebral artery CO₂ reactivity (p=0.036) and decrease in contralateral middle cerebral artery CV40 (p=0.047) were observed. No significant difference in mean blood pressure was shown. A statistically significant increase in heart rate occurred after LI11 acupuncture; however, it was not clinically significant as there were negligible changes in the heart rhythm. Conclusions: LI11 acupuncture treatment could improve cerebral blood flow velocity. These results might be explained by regulating endothelium-dependent vessel dilation in the anterior cerebral artery region. Trial registration: This trial has been registered with Clinical Research Information Service, a service of the Korea Centers for Disease Control and Prevention: KCT0004494 (retrospectively registered). https://cris.nih.go.kr/cris/search/search_result_st01.jsp?seq=15359

• The Journal of Korean Medicine
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• v.44 no.4
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• pp.87-103
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• 2023

Backgrounds and objectives: Cardiotonic Pills^® (CP) are used for vascular diseases such as coronary diseases, atherosclerosis, and cerebral infarction. This study aimed to determine the transient effects of CP on cerebrovascular CO₂ reactivity (CVR) and erythrocyte deformability in normal subjects. Methods: This study had a crossover design and included 10 participants who were randomly allocated to 2 groups. The experimental group was given CP with water, while the control group was given only water. CVR was measured by hyperventilation-induced CVR of the middle cerebral artery (MCA) using transcranial Doppler (TCD). Erythrocyte deformability was measured using a Rheoscan-D microfluidic ektacytometer. All measurements were performed prior to and 1, 2, and 3 hours after CP or water administration. Blood pressure and heart rate were also measured before and after administration. Results: CP significantly improved CVR 3 hours after administration in the experimental group compared to the control group (p = 0.042). The corrected blood flow velocity at partial pressure of end-tidal carbon dioxide (PETCO₂) = 40mmHg (CV40) was also significantly improved 2 and 3 hours after administration in the CP group compared to the control group (p = 0.036 and p = 0.021, respectively). CP significantly improved erythrocyte deformability 3 hours after administration in the experimental group compared to the control group (p = 0.027). Mean heart rate and mean blood pressure showed no change. Conclusions: This study demonstrated that CP increases CVR and erythrocyte deformability. These results suggested that CP improves cerebral microcirculation which provide evidence for the future use of CP for prevention of ischemic stroke and neurodegenerative diseases.

• Journal of Korean Neurosurgical Society
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• v.59 no.2
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• pp.154-157
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• 2016

A continuous electroencephalography (cEEG) can be helpful in detecting vasospasm and delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage (SAH). We describe a patient with an aneurysmal SAH whose symptomatic vasospasm was detected promptly by using a real-time cEEG. Patient was immediately treated by intraarterial vasodilator therapy. A 50-year-old woman without any significant medical history presented with a severe bifrontal headache due to acute SAH with a ruptured aneurysm on the anterior communicating artery (Fisher grade 3). On bleed day 6, she developed a sudden onset of global aphasia and left hemiparesis preceded by cEEG changes consistent with vasospasm. A stat chemical dilator therapy was performed and she recovered without significant neurological deficits. A real-time and protocol-based cEEG can be utilized in order to avoid any delay in detection of vasospasm in aneurysmal SAH and thereby improve clinical outcomes.