• Journal of Veterinary Clinics
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• v.40 no.1
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• pp.56-61
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• 2023

A 5-month-old female domestic short-haired cat presented with a history of seizure episodes for two months following an animal bite injury to the head. There were no remarkable findings on physical and neurological examination or blood analysis. Computed tomography revealed a fracture of the left parietal bone with an inward displacement of the bone fragment while magnetic resonance imaging revealed an enlarged temporal horn of the left lateral ventricle and a pseudomeningocele compressing the adjacent cerebral parenchyma. Subsequently, cerebrospinal fluid analysis results were normal. The patient was diagnosed with traumatic brain injury (TBI), with subsequent post-traumatic hydrocephalus (PTH) and pseudomeningocele. Despite treatment with phenobarbital and levetiracetam, seizures were not sufficiently controlled. Craniectomy for bone fragment removal and duraplasty were performed after a week. The patient then returned to normal condition with no further seizure activity. On repeated MRI two months after discharge, the hydrocephalus of the lateral ventricle and pseudomeningocele were enlarged; however, the patient maintained a good clinical status without any neurological signs. To the best of our knowledge, PTH and intracranial pseudomeningoceles have not yet been reported in cats. PTH and pseudomeningocele are among the complications of TBI and may not have any significant relevance with the clinical signs in this case. Thus, to broaden our knowledge about PTH and pseudomeningocele in cats, we describe serial changes in the clinical findings of this cat over the treatment period.

• Journal of Korean Neurosurgical Society
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• v.42 no.1
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• pp.1-5
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• 2007

Objective : We studied whether frontal skull base fracture has an impact on the occurrence and recovery of anosmia and/or ageusia following frontal traumatic brain injury (TBI). Methods : Between May 2003 and April 2005, 102 consecutive patients who had hemorrhage or contusion on the frontal lobe base were conservatively treated. Relevant clinical and radiographic data were collected, and assessment of impaired smell and taste sensation were also surveyed up to at least 12 months post-injury. Results : Among 102 patients, anosmia was noted in 22 (21.6%), of whom 10 had ageusia at a mean 4.4 days after trauma. Bilateral frontal lobe injuries were noted in 20 of 22 patients with anosmia and in all 10 patients with ageusia. Frontal skull base fracture was noted in 41 patients, of whom 9 (21.4%) had anosmia and 4 (9.5%) had ageusia. There was no statistical difference in the occurrence of anosmia and ageusia between patients with or without fracture. Of the 22 patients with anosmia, recovery from anosmia occurred in nine (40.9%) at the interval of 6 to 24 months after trauma, of whom six had frontal skull base fracture and three were not associated with fracture. Recovery of anosmia was significantly higher in patients without fracture than those with fracture (p<0.05). Recovery from ageusia occurred in only two of 10 patients at the interval of 18 to 20 months after trauma and was not eminent in patients without fracture. Conclusion : One should be alert and seek possibile occurrence of the anosmia and/or ageusia following frontal TBI. It is suggested that recovery is quite less likely if such patients have fractures on the frontal base, and these patients should wait for at least 6 to 18 months to anticipate such recovery if there is no injury to the central olfactory structures.

• Korean Journal of Biological Psychiatry
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• v.14 no.1
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• pp.61-67
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• 2007

Objectives : The purpose of this study was to test stage model in Traumatic Brain Injury(TBI) patients. According to the stage model, attention deficits which is basic stage in information processing lead to memory disturbance and subsequently affect higher-order cognitive function such as memory, decision-making, abstract thinking, and judgement related to executive function. Therefore, it was hypothesized that attention affect recall(retrieval efficacy) related to executive function mostly relative to other cognitive function, in TBI patients with low executive function. Methods : Participants were referred to a TBI clinic and then was rated on K-WAIS and Executive Intelligence Test(EXIT). Participants were divided into two groups according to Executive IQ(EIQ) score, which of high function group(N=67) was more than 80(above low average) and of low function group(N=52) was under 80 (under borderline). To test the stage model, using hierarchical regression analysis, recall(retrieval efficacy) was regressed on 3 subscales(attention, verbal, visuospatial scale) after controlling for IQ according to each group. Furthermore, the mediation effect of attention between retrieval efficacy and verbal, visuospatial score was analyzed. Results : In the low function group, only attention area predicted significantly recall(retrieval efficacy), indicating that lower attention were related to lower EIQ after controlling for IQ. In the high function group, no area predicted significantly retrieval efficacy. In the low function group, verbal and visuospatial scale did not predicted significantly retrieval efficacy, indicating that there was no evidences supporting the mediation model. Conclusion : Only attention affect retrieval efficacy in TBI patients with low executive function. But, the mediation effect of attention between retrieval efficacy and verbal and visuospatial scale was not tested in the low function group. These results implied that stage model was tested partially. In treating cognitive deficit in TBI patients, it is necessary to develop cognitive rehabilitation program based on stage model. Furthermore, it is necessary to necessary to test mediation model in the future study.

• Korean Journal of Psychosomatic Medicine
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• v.23 no.1
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• pp.12-19
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• 2015

Objectives : This study examined the characteristics and differences of PAI(Personality Assessment Inventory) profile between compensation-seeking(CS) and treatment-seeking(TS) patients with traumatic brain injury(TBI) and assessed the clinical meaning of the characteristics and differences of profiles between the two groups. Methods : 36 TBI patients who visited the Wonkwang University Hospital were selected. The patients were categorized as compensation-seeking TBI patients(n=22) and treatment-seeking TBI patients(n=14). The PAI scales and subscales were used to compare differences between two groups. t-verification for each variable and comparison analysis were performed. Results:In validity scales, CS group showed significantly higher NIM scores and lower PIM scores than TS groups. In full scales, CS group showed significantly higher SOM, ANX, ARD, DEP, and SCZ scores than TS group. In subscales, CS group showed significantly higher SOM-S, ANX-A, ARD-P, DEP(-C, A, P), (MAN-I), PAR-H, SCZ(-T, P), BOR(-A, N), and ANT-S scores than TS groups. In supplementary scales, CS group showed significantly higher SUI, NON and AGG-P, and lower RXR scores than TS group. Conclusions:There were significant differences in PAI scales with validity scales, some full and subscales according to compensation seeking status in TBI patients. The CS patients tended to exaggerate their symptoms on PAI, and showed higher scores representing somatic preoccupation and emotional distress. These results show the usefulness of PAI in reflecting the significant psychological differences between two groups.

• Korean Journal of Biological Psychiatry
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• v.8 no.1
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• pp.156-161
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• 2001

We reported two cases of amantadine treatment in traumatic brain injury patients and reviewed the literature of amantadine treatment of those patients. Problems with short-term memory, attention, planning, problem solving, impulsivity, disinhibition, poor motivation, and other behavioral and cognitive deficit could occur following traumatic brain injury or other types of acquired brain injury. This report described results of amantadine using in two patients with this type of symptom profile. Patients received neuropsychiatric examination as well as BPRS and Barthel index. These patients were improved, respectively from 57 point to 82 point(case 1), from 85 to 94(case 2) in Barthel index, and from 66 point to 35 point(case 1), from 55 to 32 point(case 2) in BPRS. These two patients did not reveal any other adverse effect. The rationale for using amantadine were discussed.

• Journal of Korean Neurosurgical Society
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• v.64 no.6
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• pp.950-956
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• 2021

Objective : Psoas and masseter muscles are known markers of sarcopenia. However, the relative superiority of either muscle as a marker is unclear. Therefore, this study analyzed the two muscles in patients with a prognosis of traumatic brain injury (TBI). Methods : Patients with TBI visiting a regional trauma center between January 2017 and December 2018 were selected, and their medical records were reviewed. TBI patients with an abbreviated injury score (AIS) of 4 or 5 were selected. Patients with an AIS of 4 or 5 at the chest, abdomen, and extremity were excluded. Patients with a hospital stay of 1 to 2 days were excluded. Both muscle areas were measured based on the initial computed tomography. The psoas muscle index (PMI) and the masseter muscle index (MMI) were calculated by dividing both muscle areas by height in meters squared (cm²/m²). These muscle parameters along with other medical information were used to analyze mortality and the Glasgow outcome scale (GOS). Results : A total of 179 patients, including 147 males (82.1%), were analyzed statistically. The mean patient age was 58.0 years. The mortality rate was 16.8% (30 patients). The mean GOS score was 3.7. Analysis was performed to identify the parameters associated with mortality, which was a qualitative study outcome. The psoas muscle area (16.9 vs. 14.4 cm², p=0.028) and PMI (5.9 vs. 5.1 cm²/m², p=0.004) showed statistical differences between the groups. The PMI was also statistically significant as a risk factor for mortality in logistic regression analysis (p=0.023; odds ratio, 0.715; 95% confidence interval, 0.535-0.954). Quantitative analyses were performed with the GOS scores. Bivariate correlation analysis showed a statistically significant correlation between PMI and GOS scores (correlation coefficient, 0.168; p=0.003). PMI (p=0.004, variation inflation factor 1.001) was significant in multiple regression analysis. The masseter muscle area and MMI did not show significance in the study. Conclusion : Larger PMI was associated with statistically significant improved survival and GOS scores, indicating its performance as a superior prognostic marker. Further analyses involving a larger number of patients, additional parameters, and more precise settings would yield a better understanding of sarcopenia and TBI.

• Journal of Korean Neurosurgical Society
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• v.63 no.5
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• pp.649-656
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• 2020

Objective : Unclear mental state is one of the major factors contributing to diagnostic failure of occult skeletal trauma in patients with traumatic brain injury (TBI). The aim of this study was to evaluate the overlooked co-occurring skeletal trauma through whole body bone scan (WBBS) in TBI. Methods : A retrospective study of 547 TBI patients admitted between 2015 and 2017 was performed to investigate their cooccurring skeletal injuries detected by WBBS. The patients were divided into three groups based on the timing of suspecting skeletal trauma confirmed : 1) before WBBS (pre-WBBS); 2) after the routine WBBS (post-WBBS) with good mental state and no initial musculoskeletal complaints; and 3) after the routine WBBS with poor mental state (poor MS). The skeletal trauma detected by WBBS was classified into six skeletal categories : spine, upper and lower extremities, pelvis, chest wall, and clavicles. The skeletal injuries identified by WBBS were confirmed to be simple contusion or fractures by other imaging modalities such as X-ray or computed tomography (CT) scans. Of the six categorizations of skeletal trauma detected as hot uptake lesions in WBBS, the lesions of spine, upper and lower extremities were further statistically analyzed to calculate the incidence rates of actual fractures (AF) and actual surgery (AS) cases over the total number of hot uptake lesions in WBBS. Results : Of 547 patients with TBI, 112 patients (20.4 %) were presented with TBI alone. Four hundred and thirty-five patients with TBI had co-occurring skeletal injuries confirmed by WBBS. The incidences were as follows : chest wall (27.4%), spine (22.9%), lower extremities (20.2%), upper extremities (13.5%), pelvis (9.4%), and clavicles (6.3%). It is notable that relatively larger number of positive hot uptakes were observed in the groups of post-WBBS and poor MS. The percentage of post-WBBS group over the total hot uptake lesions in upper and lower extremities, and spines were 51.0%, 43.8%, and 41.7%, respectively, while their percentages of AS were 2.73%, 1.1%, and 0%, respectively. The percentages of poor MS group in the upper and lower extremities, and spines were 10.4%, 17.4%, and 7.8%, respectively, while their percentages of AS were 26.7%, 14.2%, and 11.1%, respectively. There was a statistical difference in the percentage of AS between the groups of post-WBBS and poor MS (p=0.000). Conclusion : WBBS is a potential diagnostic tool in understanding the skeletal conditions of patients with head injuries which may be undetected during the initial assessment.

• Applied Microscopy
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• v.41 no.4
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• pp.235-248
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• 2011

Traumatic brain injury (TBI) is one of the leading causes of death and disability in children and adults and is a major risk factor for the development of posttraumatic epilepsy (PTE). Recent studies have provided significant insight into the pathophysiological mechanisms underlying the development of epilepsy. Although the link between brain trauma and epilepsy is well recognized, the complex biological mechanisms that result in PTE following TBI have not been fully elucidated. Therefore, this study investigated in order to identify whether or not the abnormal expression of calcium-binding proteins in the lesioned hippocampus plays a role in neuronal damage by brain trauma and whether or not the expressions may change in the contralateral hippocampus during the adaptive stage as early time point following TBI. During early time point following TBI, both parvalbumin (PV) and calbindin D-28k (CB) immunoreactivities were decreased with in the lesioned hippocampus. However, these expressions were recovered to control levels as depend on time courses. On the other hand, PV immunoreactivity in contralateral hippocampus was transiently reduced as compared to the control levels, whereas CB expression was unchanged. These findings indicate that the alterations of the calcium-binding proteins, especially PV and CB, may contribute to the neuronal death and/or damage induced by abnormal inhibitory neurotransmission at early time period following brain trauma and the development of epileptogenesis in patients with traumatic brain injury.

• Journal of Korean Neurosurgical Society
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• v.63 no.5
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• pp.631-639
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• 2020

Objective : Traditionally, staged surgery has been preferred in the treatment of compound comminuted depressed fracture (FCCD) after traumatic brain injury (TBI) and involves the removal of primarily damaged bone and subsequent cranioplasty. The main reason for delayed cranioplasty was to reduce the risk of infection-related complications. Here, the author performed immediate reconstruction using a titanium mesh in consecutive patients with FCCD after TBI, reported the surgical results, and reviewed previous studies. Methods : Nineteen consecutive patients who underwent single-stage reconstruction with titanium mesh for FCCD of the skull from April 2014 to June 2018 were retrospectively analyzed. The demographic and radiological characteristics of the patients with FCCD were investigated. The characteristics associated with surgery and outcome were also evaluated. Results : The frequency of TBI in men (94.7%) was significantly higher than that in women. Most FCCDs (73.7%) occurred during work, the rest were caused by traffic accidents. The mean interval between TBI and surgery was 7.0±3.9 hours. The median Glasgow coma scale score was 15 (range, 8-15) at admission and 15 (range, 10-15) at discharge. FCCD was frequently located in the frontal (57.9%) and parietal (31.6%) bones than in other regions. Of the patients with FCCDs in the frontal bone, 62.5% had paranasal sinus injury. There were five patients with fractures of orbital bone, and they were easily reconstructed using titanium mesh. These patients were cosmetically satisfied. Postoperatively, antibiotics were used for an average of 12.6 days. The mean hospital stay was 17.6±7.5 days (range, 8-33). There was no postoperative seizure or complications, such as infection. Conclusion : Immediate bony fragments replacement and reconstruction with reconstruction titanium mesh for FCCD did not increase infectious sequelae, even though FCCD involved sinus. This suggests that immediate single-stage reconstruction with titanium mesh for FCCD is a suitable surgical option with potential benefits in terms of cost-effectiveness, safety, and cosmetic and psychological outcomes.

• Journal of Korean Neurosurgical Society
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• v.55 no.1
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• pp.26-31
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• 2014

Objective : Early decompressive craniectomy (DC) has been used as the first stage treatment to prevent secondary injuries in cases of severe traumatic brain injury (TBI). Postoperative management is the major factor that influences outcome. The aim of this study is to investigate the effect of postoperative management, using intracranial pressure (ICP) monitoring and including consecutive DC on the other side, on the two-week mortality in severe TBI patients treated with early DC. Methods : Seventy-eight patients with severe TBI [Glasgow Coma Scale (GCS) score <9] underwent early DC were retrospectively investigated. Among 78 patients with early DC, 53 patients were managed by conventional medical treatments and the other, 25 patients were treated under the guidance of ICP monitoring, placed during early DC. In the ICP monitoring group, consecutive DC on the other side were performed on 11 patients due to a high ICP of greater than 30 mm Hg and failure to respond to any other medical treatments. Results : The two-week mortality rate was significantly different between two groups [50.9% (27 patients) and 24% (6 patients), respectively, p=0.025]. After adjusting for confounding factors, including sex, low GCS score, and pupillary abnormalities, ICP monitoring was associated with a 78% lower likelihood of 2-week mortality (p=0.021). Conclusion : ICP monitoring in conjunction with postoperative treatment, after early DC, is associated with a significantly reduced risk of death.