• The Journal of Internal Korean Medicine
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• v.19 no.1
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• pp.134-143
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• 1998

Background : The purpose of this study was to investigate the prodromal of cerebral infarction in attacked patients and to prove the traditional hypothesis that some symptoms were to be prodromes of cerebral infarction in the oriental medicine. Methods : The questionnaire which was based on symptoms of traditional hypothesis was distributed cerebral infarction patients who were confirmed by Brain CT or MRI.. Results : Fifty-six patients(93.3%) felt some symptoms within three years before onset. Most common prodromal symptoms was dizziness(50%), failure of memory(45%), numbness of arm(45%). Conclusion : This results suggest that the prodromal symptoms before cerebral infarction can be regarded as predicting sign. and we think that these research may contributed to preventing stroke and relapse.

• Clinical and Experimental Pediatrics
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• v.59 no.3
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• pp.149-152
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• 2016

We report a case of a 5-year-old girl who developed left hemiparesis and left facial palsy, 6 days after the initiation of fever and respiratory symptoms due to pneumonia. Chest radiography, conducted upon admission, showed pneumonic infiltration and pleural effusion in the left lung field. Brain magnetic resonance imaging showed acute ischemic infarction in the right middle cerebral artery territory. Brain magnetic resonance angiography and transfemoral cerebral angiography revealed complete occlusion of the right middle cerebral artery. Mycoplasma pneumoniae infection was identified by a 4-fold increase in IgG antibodies to M. pneumoniae between acute and convalescent sera by enzyme-linked immunosorbent assay. Fibrinogen and D-dimer levels were elevated, while laboratory exams in order to identify other predisposing factors of pediatric stroke were all negative. This is the first reported pediatric case in English literature of a M. pneumoniae-associated cerebral infarction involving complete occlusion of the right middle cerebral artery.

• The Journal of Korean Physical Therapy
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• v.27 no.1
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• pp.78-80
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• 2015

Purpose: Many studies have attempted to elucidate the motor recovery mechanisms of stroke. In the current study, we report on a patient with infarction who showed recovery of an injured corticospinal tract (CST), using diffusion tensor imaging (DTI). Methods: A 20-year-old male presented with severe paralysis of the left extremities following an infarction in the right corona radiate and basal ganglia. The patient showed good motor recovery as much as being able to manipulate object using his left hand and could walk independently on stairs at 9 months after onset. Results: At 1 month after onset, the right CST showed decreased fiber volume due to the partial injury at the level of the corona radiate, and no (motor evoked potential) MEP was evoked from the right hemisphere. By contrast, the results at 9 months showed increased fiber volume of the right CST and the amplitude of MEP had improved to normal range on TMS. Conclusion: These results suggest that the severely injured right CST and MEP amplitude had been recovered during 9 months. Therefore, this result has important implications for brain plasticity and brain rehabilitation in patients with infarction.

• Journal of Veterinary Clinics
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• v.31 no.5
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• pp.457-460
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• 2014

This case study describes the magnetic resonance characteristics of brain infarction in three dogs. Locations of the brain infarcts were cerebella, thalamus, and multifocal. The infarcts were sharply demarcated from adjacent brain parenchyma, homogeneous, T1-hypointense, T2-hyperintense with/without contrast enhancement, and minimal or no mass effect. Diffusion-weighted imaging (DWI) sequences were available in a dog and the infarcts were hyperintense on DWI and were hypointense on the apparent diffusion coefficient map.

• Journal of Korean Neurosurgical Society
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• v.54 no.6
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• pp.467-476
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• 2013

Objective : This study aimed to evaluate the hypotheses that administration routes [intra-arterial (IA) vs. intravenous (IV)] affect the early stage migration of transplanted human bone marrow-derived mesenchymal stem cells (hBM-MSCs) in acute brain infarction. Methods : Male Sprague-Dawley rats (n=40) were subjected to photothrombotic infarction. Three days after photothrombotic infarction, rats were randomly allocated to one of four experimental groups [IA group : n=12, IV group : n=12, superparamagnetic iron oxide (SPIO) group : n=8, control group : n=8]. All groups were subdivided into 1, 6, 24, and 48 hours groups according to time point of sacrifice. Magnetic resonance imaging (MRI) consisting of T2 weighted image (T2WI), $T2^*$ weighted image ($T2^*WI$), susceptibility weighted image (SWI), and diffusion weighted image of rat brain were obtained prior to and at 1, 6, 24, and 48 hours post-implantation. After final MRI, rats were sacrificed and grafted cells were analyzed in brain and lung specimen using Prussian blue and immunohistochemical staining. Results : Grafted cells appeared as dark signal intensity regions at the peri-lesional zone. In IA group, dark signals in peri-lesional zone were more prominent compared with IV group. SWI showed largest dark signal followed by $T2^*WI$ and T2WI in both IA and IV groups. On Prussian blue staining, IA administration showed substantially increased migration and a large number of transplanted hBM-MSCs in the target brain than IV administration. The Prussian blue-positive cells were not detected in SPIO and control groups. Conclusion : In a rat photothrombotic model of ischemic stroke, selective IA administration of human mesenchymal stem cells is more effective than IV administration. MRI and histological analyses revealed the time course of cell migration, and the numbers and distribution of hBM-MSCs delivered into the brain.

• Journal of Pharmacopuncture
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• v.14 no.3
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• pp.5-17
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• 2011

Objectives : Gliosis becomes physical and mechanical barrier to axonal regeneration. Reactive gliosis induced by middle cerebral artery occlusion is involved with up-regulation of CD81 and GFAP (Glial fibrillary acidic protein). The current study is to examine the effect of the Angelica gigas Nakai(intravenous injection. 100 mg/kg twice in a day) on CD81 and GFAP of the rat in the brain after middle cerebral artery occlusion. Methods : Cerebral infarction was induced by middle cerebral artery occlusion. And after intravenous injection of water extract of Angelica gigas Nakai, the size of cerebral infarction was measured. Examination of optical microscope were also used to detect the expression of CD81 and GFAP in the brain of the rat. Results : The following results were obtained : We found that size of cerebral infarcion induced by MCAO (Middle Cerebral Artery Occlusion) in rats were decreased after intravenous injection of Angelica gigas Nakai. We injected the extract of Angelica gigas Nakai to the MCAO in rats, and the optical microscope study showed that Angelica gigas Nakai had effect on protecting the cells of hippocampus. We found that GFAP, CD81 and ERK of the brain in rats with cerebral infarction after MCAO were meaningfully decreased after intravenous injecting Angelica gigas Nakai. We found that c-Fos expression of the brain in rats with cerebral infarction after MCAO were significantly increased after intravenous injecting Angelica gigas Nakai. Conclusions : These results indicate that Angelica gigas Nakai could suppress the reactive gliosis, which disturbs the astrocyte regeneration in the brain of the rat with cerebral infarction after MCAO by controlling the expression of CD81 and GFAP. And the effect may be modulated by the up-regulation of c-Fos and ERK.

• The Journal of Korean Medicine
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• v.30 no.6
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• pp.53-68
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• 2009

Objectives: This study demonstrates the neurological effects of Bojungikki-tang and Bojungikki-tang-gamibang on the focal cerebral ischemia of rats with ischemic damage caused by middle cerebral artery occlusion (MCAO). Methods: Rats were treated with Bojungikki-tang and Bojungikki-tang-gamibang extracts for about five days after MCAO, and the size and volume of cerebral infarction and the ratio of cerebral edema were observed. From the immunohistochemical view, significant changes of outbreak of Bax, Bcl-2, c-Fos, HSP72, and iNOS were observed in the brain tissues. Results: Bojungikki-tang repressed only brain edema and iNOS revelation led by focal cerebral ischemia, when considering significance. In contrast, Bojungikki-tang-gamibang demonstrated significant suppression of cerebral infarction, brain edema, Bax, c-Fos, HSP72, and iNOS induced by focal cerebral ischemia. Conclusions: Bojungikki-tang is considered functional treatment for cerebral ischemic damage; it can be effective to relieve secondary brain edema and immune response. Bojungikki-tang-gamibang can have a direct function to alleviate brain infarct and to control the natural death of nerve cells which cerebral ischemic damage brings about.

• Investigative Magnetic Resonance Imaging
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• v.17 no.4
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• pp.267-274
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• 2013

Purpose : To re-evaluate additional clinical significance of the apparent diffusion coefficient (ADC) map in the inference of infarction stage, authors studied the evolution patterns of the DWI and the ADC map of the brain infarction. Materials and Methods: In 127 patients with cerebral infarctions, including follow-up checks, 199 studies were performed. They were classified as hourly (117 studies)-, daily (108 studies)-, weekly (62 studies)-based groups. The signal intensity (SI) was measured at the core of the infarction and contralateral area with ROI of 0.3 $cm^2$ or more on the images of the DWI and the ADC map, and calculated the ratios of SI and ADC value of the infarction area / contralateral normal area, and compared the patterns of the change according to the evolution. Results: Infarction was detected as early as 1 hour after the attack, and the ratio of SI in the DWI became over than 2 after 12 hours, which showed a plateau until the 6th day. Thereafter, it decreased slowly to 1 on the 30th day, and changed to lower SI than the surrounding brain. The ratio in the ADC map became 0.46 in 24 hours after the attack, and increased slowly to 1 in the 15th day. Thereafter, it became a higher value than the surrounding brain. Overall, the ratio in the ADC map changed earlier than in the DWI, and the ratio curves showed inverse pattern each other according to the evolution of the infarction. Conclusion: The evolution patterns of infarction on the ADC map showed an inverse curve of DWI curve, which means that the ADC value is accurately predictable from DWI, and the ADC map joined with the DWI seems helpful in the determination of subacute infarction between 15 to 30 days.

• Journal of Korean Neurosurgical Society
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• v.30 no.3
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• pp.278-283
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• 2001

Objective : Massive cerebral infarction could be accompanied by severe brain swelling and death secondary to transtentorial herniation. Approximately 10% to 15% of middle cerebral artery infarctions are associated with this phenomenon. However, the effectiveness and timing of decompressive surgery are still controversial. In this study, we present our results on the effect of decompressive craniectomy in life threatening cerebral infarction. Method : We retrospectively analyzed 15 patients who underwent decompressive craniectomy for massive cerebral infarction from January 1997 to April 1999. Surgical indication was based on the clinical signs such as neurological deterioration, pupillary reflex, and radiological findings. Clinical outcome was assessed by Glasgow Outcome Scale (GOS). Results : All 15 patients(five men, ten women ; mean age, 52.3 years ; right 11, left 4) were treated with wide craniectomy and duroplasty. The average time interval between onset of symptom and surgical decompression was 2.9 days. Clinical signs of uncal herniation(anisocoria, or fixed and dilated pupils) were presented in 13 of 15 patients. Mean Glasgow coma scale(GCS) was 12.4 points on admission, 8.1 points on preoperative state and 11.8 points postoperatively. Overall outcomes were favorable in 5 cases(Glasgow outcome scale : GOS I, II), unfavorable in 6 cases(Glasgow outcome scale : GOS III, IV) and dead in 4 cases. Conclusion : Early decompressive craniectomy before brain stem compression is considered as an effective lifesaving procedure for massive cerebral infarction unresponsive to aggressive medical therapy.

• The Journal of Internal Korean Medicine
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• v.26 no.1
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• pp.252-264
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• 2005

This concerns three patients diagnosed as lateral medullary infarction from cerebral infarction of the brain stem and hospitalized. They were diagnosed and treated for 手足??(paralysis of extremities), 痺症(bi syndrome), 麻木(numbness), 不仁(akinesia), 眩暈(Vertigo) through Oriental Medicine. Improvement in both sense disorder and motor disorder was seen and is therefore reported here. To detect symptoms of a brain stem disorder clinically, pathological symptoms must be isolated and the patient must be screened through radiological and neorological examination. If this is properly and carefully done from the first stage, and according to this diagnosis, with the cycle of the disease considered, a treatment plan can be laid. Modem Medicine offers easy diagnosis for cerebro-vascular disease, but the treatment is less effective than that offered by Oriental Medicine. This report is given with a plea for further research and more reportage of clinical cases of cerebro-vascular disease treated through Oriental Medicine.