• The Journal of Internal Korean Medicine
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• v.38 no.2
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• pp.93-102
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• 2017

Objective: We describe the case of an 84-year-old man with a midbrain infarction causing pupil sparing oculomotor nerve palsy, with ipsilateral cerebellar ataxia diagnosed as Claude's syndrome. Methods: The patient was treated with Korean medicine, including herbal medicine, acupuncture, and electro-acupuncture, during 45 days of hospitalization. Improvements in the patient's symptoms and changes in ptosis were evaluated using the Korean version of the Scale for the Assessment and Rating of Ataxia (SARA). Results: After 45 days of treatment with the Korean medicine, the patient's symptoms, including ataxia and ptosis, improved. Conclusions: This study suggests that the treatment with Korean medicine was effective in aiding the patient's recovery.

• Investigative Magnetic Resonance Imaging
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• v.18 no.1
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• pp.17-24
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• 2014

Purpose : To determine whether high-resolution contrast-enhanced three dimensional imaging with spoiled gradient-recalled sequence (HR-CE 3D-SPGR) plays a meaningful role in the assessment of intracranial vertebral artery (ICVA) and posterior inferior cerebellar artery (PICA) in lateral medullary infarction (LMI). Materials and Methods: Twenty-five patients confirmed with LMI were retrospectively enrolled with approval by the IRB of our institute, and 3T MRI with HR-CE 3D-SPGR and contrast-enhanced magnetic resonance angiography (CE-MRA) were performed. Two radiologists who were blinded to clinical information and other brain MR images including diffusion weighted image independently evaluated arterial lesions in ICVA and PICA. The demographic characteristics, the area of LMI and cerebellar involvement were analyzed and compared between patients with arterial lesion in ICVA only and patients with arterial lesions in both ICVA and PICA on HR-CE 3D-SPGR. Results: Twenty-two of twenty-five LMI patients had arterial lesions in ICVA or PICA on HR-CE 3D SPGR. However twelve arterial lesions in PICA were not shown on CE-MRA. Concurrent cerebellar involvement appeared more in LMI patients with arterial lesion in ICVA and PICA than those with arterial lesion in ICVA alone (p = 0.069). Conclusion: HR-CE 3D-SPGR can help evaluate arterial lesions in ICVA and PICA for LMI patients.

• Journal of Korean Medicine Rehabilitation
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• v.28 no.4
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• pp.103-112
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• 2018

Pathological laughing and crying (PLC) is a condition defined by relatively uncontrollable episodes of laughter, crying or both. PLC is an uncommon symptom usually caused by cerebral lesions. Midbrain involvement causing PLC is extremely unusual and the exact mechanism by which this condition develops is poorly understood. We recently experienced a 51-year-old woman who were diagnosed as PLC after midbrain infarction. She was treated by acupuncture, pulsed electromagnetic therapy (PEMT). After 6 weeks treatment, Pathological Laughter and Crying Scale (PLACS), Korean version of the Scale for the Assessment and Rating of Ataxia (K-SARA) are decreased and Korean version of Modified Barthel Index (K-MBI) is increased. Treatment of traditional Korean Medicine could be effective for stoke rehabilitation including post-stroke PLC. And we have considered mechanism of PLC associated with midbrain lesion, dysfunction of cortex-thalamus-hypothalamus-basal ganglia-mesencephalon and faciorespiratory nuclei pathways, cerebro-ponto-cerebellar pathways and damaged serotonergic neurotransmission can cause this based on recent neurobiology of emotion. To define exact mechanism and find effective treatment, further studies are needed.

• Journal of Sasang Constitutional Medicine
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• v.15 no.3
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• pp.216-220
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• 2003

We treated a Taiyangin(太陽人) patient with Yulkyuk(?膈) disease. He was diagnosed as acute cerebellar infarction, hypertension and trigeminal neuralgia(rule out). His chief complaint was nausea, dysphagia, trigeminal neuralgia, anorexia, and numbness of upper and lower extremity. He was orally administrated with Mihudeung Sikjang Tan(??藤植腸湯) additions. Mihudeung Sikjang Tang(??藤植腸湯) additions was Fructus Chaenomelis(木瓜), Grape root(葡萄根), Buckwheat(蕎麥), Semen pruni(櫻桃肉) etc. His chief complaint was improved by oral administration of Mihudeung Sikjang Tan(??藤植腸湯) additions, and we do report this clinical case study.

• The Journal of the Society of Stroke on Korean Medicine
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• v.10 no.1
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• pp.62-67
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• 2009

Wallenberg's syndrome is a neurological condition caused by a stroke in the vertebral or posterior inferior cerebellar artery of the brain stem. Wallenberg's syndrome is also called Lateral Medullary Syndrome. In this case report, we are going to describe the clinical menifestation and progress of one case of Wallenberg's syndrome and review previously published case reports about it and compare them to our case. In conclusion, significant improvements were observed in some symptoms but there were some symptoms not improved such as paresthesia. So further researches are needed for more effective treatment.

• The Journal of Internal Korean Medicine
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• v.23 no.2
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• pp.298-305
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• 2002

These cases were performed on the bases of clinical consideration about patients who had Methicillin-Resistant Staphylococcus aureus(MRSA) infection. One patient was a 67-years-old women who had sequela of inter cranial hemorrhage & inter ventricular hemorrhage, hypertention, urinary tract infection and pneumonia. Clinical symptoms were intermittent fever, sputum, Lt. side hemiparesis and dysphagia. She was chronic, repeated infection state. It could be regarded as "unpreparedness of the spirit which animates and controls the universe; 正氣虛", the oriental term which indicates a condition of chronic disease or general weakness. According to the oriental medicine principle, oriental medicine was taken such as Wunggunza-tang(六君子湯) and the patient had taken a turn for the better. After 3 months, MRSA infection diappeared. The other patient was a 43-years-old women who had Both brain stem infarction, Lt. cerebellar infarction, hypercholesterolemia, urinary tract infection and pneumonia, Clinical symptoms were quadriplegia, dysphagia(levin tube insert state), aphasia, respiration disorder(tracheostomy cannular keep state) and sputum. She was chronic, repeated infection state. It could be regarded as "unpreparedness of spleen energy, unpreparedness of both energy and blood; 脾氣虛, 氣血兩虛", the oriental term which indicates a condition of chronic disease or immunodeficiency. According to the oriental medicine principle, oriental medicine was taken such as Bojungyggi-tang(補中益氣湯), Palmul-tang(八物湯) and the patient had taken a turn for the better. After I month, MRSA was turned into Escherichia coli.

• Journal of Chest Surgery
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• v.32 no.11
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• pp.1046-1048
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• 1999

A life-long anticoagulation for the prevention of ischemic cerebral events by thromboemboli has been conventionally introduced for the treatment of an atrial septal aneurysm. However, due to the recent decrease of the risks in the open heart surgery, the alternative therapeutic modality has been introduced for the prevention of complications of the anticoagulation. A 41-year old female with dizziness was admitted to our hospital. She was diagnosed a shaving atrial fibrillation and a cerebellar infarction, and an atrial septal aneurysm was detected by transesophagel echocardiography that was not detected by the transthoracic echocardiography. Surgery was approached to the right submammarial anterolateral thoracotomy. The atrial septal aneurysm was obliterated by a purse-string suture and plication. Surgial results were excellent with normal sinus rhythms and esthetically satisfying appearance.

• Journal of Korean Neurosurgical Society
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• v.56 no.4
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• pp.348-352
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• 2014

High-flow vertebral arteriovenous fistulas (VAVF) are rare complications of cervical spine surgery and characterized by iatrogenic direct-communication of the extracranial vertebral artery (VA) to the surrounding venous plexuses. The authors describe two patients with VAVF presenting with ischemic presentation after C1 pedicle screw insertion for a treatment of C2 fracture and nontraumatic atlatoaxial subluxation. The first patient presented with drowsy consciousness with blurred vision. The diffusion MRI showed an acute infarction on bilateral cerebellum and occipital lobes. The second patient presented with pulsatile tinnitus, dysarthria and a subjective weakness and numbness of extremities. In both cases, digital subtraction angiography demonstrated high-flow direct VAVFs adjacent to C1 screws. The VAVF of the second case occurred near the left posterior inferior cerebellar artery originated from the persistent first intersegmental artery of the left VA. Both cases were successfully treated by complete occlusion of the fistulous portion and the involved segment of the left VA using endovascular coil embolization. The authors reviewed the VAVFs after the upper-cervical spine surgery including C1 screw insertion and the feasibility with the attention notes of its endovascular treatment.

• Journal of Medicine and Life Science
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• v.16 no.3
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• pp.64-75
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• 2019

Vertigo and dizziness are common symptoms with various etiologies and pathogeneses. Vertigo is an illusion of motion due to disease of the vestibular system, usually a sense of rotation. Dizziness, a term that represents a wide range of non-vertigo symptoms, is commonly associated with non-vestibular disorders including old age, cardiac syncope, orthostatic hypotension, metabolic disease, anxiety, and drugs. Vertigo should be determined whether the cause is central or peripheral. Peripheral vertigo is usually benign but central vertigo is serious and often require urgent treatment. The careful history and detailed physical examinations(pattern of nystagmus, ocular tilt reaction, head impulse test and positional tests such as Dix-Hallpike maneuver) provide important clues to the diagnosis of vertigo. Most of patients have benign peripheral vestibular disorders - vestibular neuritis, benign paroxysmal positional vertigo (BPPV), and Meniere's disease. BPPV is a leading cause of peripheral vertigo and can easily be cured with a canalith repositioning maneuver. In this review, a focus is on the differential diagnosis of common vestibular disorders with peripheral and central causes.

• Research in Community and Public Health Nursing
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• v.10 no.1
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• pp.80-92
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• 1999

The purpose of this study was to survey appropriateness of admission and days of care for the cerebral ischemia patients as a basis to provide an effectiveness of hospitalization. The authors retrospectively reviewed the medical records of cerebral ischemia patients in two hospitals from November 1997 to February 1998. Of 194 medical records reviewed, there were 2108 medical days. I t is used a 'Appropriateness Evaluation Protocol' previously developed by Gertman and Restuccia (1981) and translated by Department of Health Management, Seoul National University and Korea Institute for Health Services Management (1993), It was found that the 'Appropriateness Evaluation Protocol' had a high inter-rater reliability(k=.92), Statistical significant was tested by using the percentage, mean, and logistic regression by SAS 6.12. The results were as follows; 1. The appropriate admissions were 87.6%, days of care 63.4%, and the average length of stay $10.9{\pm}6.7$ days. 2. The reasons of inappropriate admissions were for work-up(75.0%) and conservative care (25.0%). Major reasons of inappropriate days of care were 'cases in which the medical purpose of hospitalization has been accomplish or can be addressed in a less setting(45.0%)', and 'cases in which there is a delay in performing the work-up or treatment which required patients is hospitalized (44.4%)'. 3. Appropriate days of care were higher as ageing. Appropriate days of care were higher in patients with lower accademic back ground than those of upper college graduates, and in the patients who enter a hospital via emergency room than out-patients department. Appropriate days of care were higher in the patient with MCA infarction, and lower in the patient with cerebellar infarction than the patient with lacunar infarction. Appropriate days of care were higher in attack first than attack above second, in nomortension patients than hypertensive, and lower in groups who engaged in semi-private room and public room than private room in hospital. Appropriate days of care were higher in shorter length of stay than longer length of stay. 4. Diagnosis, admission path, and appropriate days of care explained appropriate admissions. Diagnosis, appropriate admissions, hypertension explained appropriate days of care. According to the above results, author confirms the substantial amount of inappropriate hospital bed utilization. To reduce inappropriateness, it is necessary to develop some alternative services such as home care services or nursing home with which can be replaced inpatient services and to introduce policy such as case management which includes Critical Pathway for consistent management. And, it should be followed the further study for the effectiveness.