• Korean Journal of Radiology
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• 제23권2호
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• pp.226-236
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• 2022

Objective: This study aimed to explore the myelin volume change in patients with mild traumatic brain injury (mTBI) with post-concussion syndrome (PCS) using a multidynamic multiecho (MDME) sequence and automatic whole-brain segmentation. Materials and Methods: Forty-one consecutive mTBI patients with PCS and 29 controls, who had undergone MRI including the MDME sequence between October 2016 and April 2018, were included. Myelin volume fraction (MVF) maps were derived from the MDME sequence. After three dimensional T1-based brain segmentation, the average MVF was analyzed at the bilateral cerebral white matter (WM), bilateral cerebral gray matter (GM), corpus callosum, and brainstem. The Mann-Whitney U-test was performed to compare MVF and myelin volume between patients with mTBI and controls. Myelin volume was correlated with neuropsychological test scores using the Spearman rank correlation test. Results: The average MVF at the bilateral cerebral WM was lower in mTBI patients with PCS (median [interquartile range], 25.2% [22.6%-26.4%]) than that in controls (26.8% [25.6%-27.8%]) (p = 0.004). The region-of-interest myelin volume was lower in mTBI patients with PCS than that in controls at the corpus callosum (1.87 cm³ [1.70-2.05 cm³] vs. 2.21 cm³ [1.86-3.46 cm³]; p = 0.003) and brainstem (9.98 cm³ [9.45-11.00 cm³] vs. 11.05 cm³ [10.10-11.53 cm³]; p = 0.015). The total myelin volume was lower in mTBI patients with PCS than that in controls at the corpus callosum (0.45 cm³ [0.39-0.48 cm³] vs. 0.48 cm³ [0.45-0.54 cm³]; p = 0.004) and brainstem (1.45 cm³ [1.28-1.59 cm³] vs. 1.54 cm³ [1.42-1.67 cm³]; p = 0.042). No significant correlation was observed between myelin volume parameters and neuropsychological test scores, except for the total myelin volume at the bilateral cerebral WM and verbal learning test (delayed recall) (r = 0.425; p = 0.048). Conclusion: MVF quantified from the MDME sequence was decreased at the bilateral cerebral WM in mTBI patients with PCS. The total myelin volumes at the corpus callosum and brainstem were decreased in mTBI patients with PCS due to atrophic changes.

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

• Journal of Trauma and Injury
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• 제35권1호
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• pp.3-11
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• 2022

Purpose: The increasing use of electric personal mobility devices (ePMDs) has been accompanied by an increasing incidence of associated accidents. This study aimed to investigate the characteristics of ePMD-related injuries and their associated factors. Methods: This cross-sectional study was conducted using data from the Emergency Department-based Injury In-depth Surveillance database from 2014 to 2018. All patients who were injured while operating an ePMD were eligible. The primary outcome was the rate of severe injury, defined as an excess mortality ratio-adjusted Injury Severity Score of ≥25. We calculated the adjusted odds ratios (AORs) of outcomes associated with ePMD-related injuries. Results: Of 1,391,980 injured patients, 684 (0.05%) were eligible for inclusion in this study. Their median age was 28 years old, and most injuries were sustained by men (68.0%). The rate of ePMD-related injuries increased from 3.1 injuries per 100,000 population in 2014 to 100.3 per 100,000 population in 2018. A majority of the injuries occurred on the street (32.7%). The most commonly injured area was the head and face (49.6%), and the most common diagnosis was superficial injuries or contusions (32.9%). Being aged 55 years or older (AOR, 3.88; 95% confidence interval, 1.33-11.36) and operating an ePMD while intoxicated (AOR, 2.78; 95% confidence interval, 1.52-5.08) were associated with severe injuries. Conclusions: The number of emergency room visits due to ePMD-related injuries is increasing. Old age and drunk driving are both associated with serious injuries. Active traffic enforcement and safety regulations regarding ePMDs should be implemented to prevent severe injuries caused by ePMD-related accidents.

• Clinics in Shoulder and Elbow
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• 제1권1호
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• pp.46-50
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• 1998

The superior shoulder suspensory complex is composed of glenoid fossa, coracoid process, coracoclavicular ligament, distal clavicle, acromioclavicular ligament, acromion. Traumatic double disruptions of this complex lose its suspensory action on the shoulder joint and result in functional loss and deformity. Careful radiologic evaluation and appropriate management are required for injuries to this complex. Ipsilateral fractures of clavicle and scapula create unstable anatomic situation on shoulder joint. Conservative treatment usually fails to achieve good functional recovery due to rotator cuff weakness, nonunion, delayed union, malunion and neurovascular injury. Authors studied the result of operative treatment of ipsilateral clavicle and scapular fractures to prevent such complications. Seven cases were treated with open reduction and internal fixations of clavicle alone or clavicle and scapula simultaneously and followed up for nineteen months(twelve months - thirty-eight months). All but one patient showed good or excellent functional result according to the scoring system of Rowe. Poor result was developed in the case which had brain injury. Rigid fixations of clavicle alone or clavicle and scapular fractures both can achieve stable reduction of the fractures and prevent sequelae. We concluded that operative treatment of ipsilateral fractures of clavicle and scapula is safe and yields predictable good results.

• The Journal of Korean Physical Therapy
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• 제9권1호
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• pp.167-175
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• 1997

The purpose of this study was to determine the efforts of cold applied for reducing spasticity in patients with traumatic brain injury and cerebrovascular accident who did not take neurosurgical treatment and medication except patients with spinal cord injury. The participants consisted of 17 men and 28 female was ramdomly assigned to three groups with each 15. The results were as followings after making on observation about the change of skin temperature and spasticity throughout cryotherapy which was performed with cooling air in Group I (1 min), Group II (5 min) and Group III (10 min). 1. It was found that the Group III, Group II, Group I, in the order named, had the statistically significant reduction of skin temperature, the reduction of spasticity showed statistically significance in Group III, Group II, in order named, but did net show it even though there was a little increase in Group I. 2. The reduction of skin temperature and spasticity did not continue over 24 hours at the same time every day for 5 days. 3. The longer cryotherapy was applied the more skin temperature and spasticity reduced, the more skin temperature was reduced the more spasticity reduced.

• The Journal of Korean Physical Therapy
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• 제10권2호
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• pp.87-95
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• 1998

The purpose of this study was to determine the effects of cold application for reducing spasticity in patients with traumatic brain min injury cerebrovascular accident who did not take neurosurgical treatment and medication except patients with spinal cord injury. The participants consisted of 24 men and 21 female were ramdomly assigned to three groups with each 15. The result were as followings after making an observation about the change of skin temperature and spasticity throughout cryotherapy which was performed with ice stick in Group I (1 min), Group II (5 min) and Group III(10 min). 1. It was found that the Group III, Croup II, Group I, in order named, had the statistically significant reduction of skin temperature, the reduction of spasticity showed statistically significance in Group III, Group II, in order named, but did not show it even though there was a little increase in Group I. 2. The reduction of skin temperature and spasticity did not continue over 24 hours at the same time every day for 5 days. 3. The longer cryotherapy was applied the mere skin temperature and spasticity reduced, the more skin temperature was reduced the more spasticity reduced.

• Journal of Trauma and Injury
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• 제35권4호
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• pp.232-239
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• 2022

Purpose: The recent increase in electric scooter (e-scooter) use has been accompanied by an increase in injuries from e-scooter-related accidents. Studies have reported that most such injuries are minor, and physicians may therefore underestimate the severity of such injuries. This study investigated the types and severity of injuries caused by isolated e-scooter accidents (i.e., those that did not involve colliding with other cars or falling from heights). Methods: This prospective observational study was conducted from May to December 2021 at Dankook University Hospital tertiary medical center. The demographic data of patients injured in isolated e-scooter-related accidents were collected. All injuries were categorized by body part. Results: Fifty eligible patients visited our emergency department during the study period. Of these, 76% were categorized as nonemergency, and 62% were discharged after initial evaluation and treatment at the emergency department. Another 10% were admitted to the intensive care unit (ICU) and 18% to the ward, with nine patients receiving at least one operation. The average hospital stays were 2.4 days in the ICU and 9 days in the ward. One death occurred due to traumatic brain injury (overall mortality rate, 2%). Multiple fractures of the left third through ninth ribs combined with lung laceration and fractures of T12 and L4 were noted. Conclusions: Various types and severities of injuries can occur in isolated e-scooter accidents. While most such injuries are minor, some will require ICU admission or surgery, and deaths can occur. Physicians should not underestimate the severity of such injuries.

• Journal of Korean Neurosurgical Society
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• 제65권3호
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• pp.370-379
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• 2022

Abusive head trauma (AHT) is the most severe form of physical abuse in children. Such injury involves traumatic damage to the head and/or spine of infants and young children. The term AHT was introduced to include a wider range of injury mechanisms, such as intentional direct blow, throw, and even penetrating trauma by perpetuator(s). Currently, it is recommended to replace the former term, shaken baby syndrome, which implicates shaking as the only mechanism, with AHT to include diverse clinical and radiological manifestations. The consequences of AHT cause devastating medical, social and financial burdens on families, communities, and victims. The potential harm of AHT to the developing brain and spinal cord of the victims is tremendous. Many studies have reported that the adverse effects of AHT are various and serious, such as blindness, mental retardation, physical limitation of daily activities and even psychological problems. Therefore, appropriate vigilance for the early recognition and diagnosis of AHT is highly recommended to stop and prevent further injuries. The aim of this review is to summarize the relevant evidence concerning the early recognition and diagnosis of AHT. To recognize this severe type of child abuse early, all health care providers maintain a high index of suspicion and vigilance. Such suspicion can be initiated with careful and thorough history taking and physical examinations. Previously developed clinical prediction rules can be helpful for decision-making regarding starting an investigation when considering meaningful findings. Even the combination of biochemical markers may be useful to predict AHT. For a more confirmative evaluation, neuroradiological imaging is required to find AHT-specific findings. Moreover, timely consultation with ophthalmologists is needed to find a very specific finding, retinal hemorrhage.

• Molecules and Cells
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• 제25권1호
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• pp.7-19
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• 2008

Complexins play a critical role in the control of fast synchronous neurotransmitter release. They operate by binding to trimeric SNARE complexes consisting of the vesicle protein Synaptobrevin and the plasma membrane proteins Syntaxin and SNAP-25, which are key executors of membrane fusion reactions. SNARE complex binding by Complexins is thought to stabilize and clamp the SNARE complex in a highly fusogenic state, thereby providing a pool of readily releasable synaptic vesicles that can be released quickly and synchronously in response to an action potential and the concomitant increase in intra-synaptic $Ca^{2+}$ levels. Genetic elimination of Complexins from mammalian neurons causes a strong reduction in evoked neurotransmitter release, and altered Complexin expression levels with consequent deficits in synaptic transmission were suggested to contribute to the etiology or pathogenesis of schizophrenia, Huntington's disease, depression, bipolar disorder, Parkinson's disease, Alzheimer's disease, traumatic brain injury, Wernicke's encephalopathy, and fetal alcohol syndrome. In the present review I provide a summary of available data on the role of altered Complexin expression in brain diseases. On aggregate, the available information indicates that altered Complexin expression levels are unlikely to have a causal role in the etiology of the disorders that they have been implicated in, but that they may contribute to the corresponding symptoms.

• 한국응용약물학회:학술대회논문집
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• 한국응용약물학회 2003년도 Annual Meeting of KSAP : International Symposium on Pharmaceutical and Biomedical Sciences on Obesity
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• pp.67-67
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• 2003

Minocycline is known to protect neurons from microglia-mediated cell death in many experimental models of brain diseases including ischemic stroke, Huntingtons disease (HD), amyotrophic lateral sclerosis (ALS), traumatic brain injury, multiple sclerosis, and Parkinsons disease. When the activity of caspases was assessed using their fluorescent peptide substrates, activation of caspase-2, 3, 8, and 9 was evident within 2 8 hr following oxidative insult with 0.5 mM hydrogen peroxide in PC12 cells. Minocycline significantly attenuated activation of these caspases up to 18 hr, resulting a significant increase in the cell viability as assessed by MTT assay as well as trypan blue staining. However, cleavage of alpha-spectrin and a cdk5 activator p35, which are known to be substrates for calpain, remained unchanged in the presence of minocycline, suggesting that minocycline did not block caspase-3-independent cell death or necrosis. Moreover, co-treatment with minocycline and a calpain inhibitor calpeptin synergistically inhibited hydrogen peroxide-induced cell death. These data suggest that minocycline directly inhibited apoptosis, but not necrosis, after oxidative insult in PC12 cells.