• 제목/요약/키워드: cerebrospinal fluid

검색결과 510건 처리시간 0.03초

노령견에서 병발한 육아종성 뇌수막염 증례 보고: 자기 공명 영상 및 면역조직병리학 소견 (Granulomatous Meningoencephalitis in an Old Dog ; magnetic resonance imaging and immunohistopathologic findings)

  • 정동인;유종현;강병택;박철;구수현;김주원;전효원;이소영;우응제;서정향;박희명
    • 한국임상수의학회지
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    • 제24권3호
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    • pp.406-409
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    • 2007
  • 12년령의 암컷 치와와 믹스견이 급성 시력 상실과 진행성 사지마비 증상으로 내원하였다. 두부 자기공명 영상 촬영 결과 뇌에서 다발성 병변이 확인되었고 뇌척수액 검사 결과에서는 단핵구 증가 소견이 나타났다. 이러한 결과들을 토대로 육아종성 뇌수막염이 강력하게 의심되었다. 뇌의 병변은 조직 병리 검사를 통해 최종적으로 육아종성 뇌수막염으로 진단되었고 면역 조직 염색 상에서 T-cell 항원에 양성을 나타내었다. 본 증례 보고는 노령견에서 육아종성 뇌수막염의 임상적인 증상, 진단 영상의 특징, 그리고 면역조직병리학적인 소견 등을 나타내고 있다. 또한 본 증례 보고는 뇌혈관 주위의 T 림프구 침착에 기인한 육아종성 뇌수막염의 임상 증상들에 관해 서술하고 있으며 T세포 매개 염증의 원인 규명에 관한 고찰이 더 필요하다.

정상뇌압수두증(正常腦壓水頭症) 환자(患者) 치험(治驗) 2례(例)에 대(對)한 임상보고(臨床報告) (A Clinical Study of Two Patients Suffering from Normal Pressure Hydrocephalus)

  • 조봉현;유병찬;김윤식;설인찬
    • Korean Journal of Acupuncture
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    • 제22권1호
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    • pp.43-53
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    • 2005
  • 저자(著者)는 사암침(舍岩鍼)을 응용한 수두증(水頭症) 환자(患者) 치료(治療) 2례(例)를 통한 임상적 고찰을 통한 결과 다음과 같이 요약(要約)할 수 있다. 1. 수두증(水頭症)이란 다양한 원인들에 의해서 뇌척수액(腦脊髓液)(cerebrospinal fluid; CSF)의 생성(生成)과 흡수(吸收)에 장애가 생겨 뇌척수액(腦脊髓液)이 뇌실(腦室)이나 두개강내(頭蓋腔內)에 축적되어 발생하는 질병이다. 2. 본 예(例)에서는 뇌경색과 병발(竝發)한 점진적(漸進的)인 정상뇌압수두증(正常腦壓水頭症) 환자(患者)에게는 담정격(膽正格), 신정격(腎正格)을 사용하였으며, 지주막하출혈 후(後) 병발(竝發)한 정상뇌압수두증(正常腦壓水頭症) 환자(患者)에게는 비정격(脾正格), 신정격(賢正格)을 사용하였다. 3. 전자(前者)의 예(例)에서는 별다른 호전(好轉) 양상(樣相)을 경험(經驗)하지 못한 반면, 후자(後者)의 예(例)에서는 치료(治療) 2주(週)만에 양호(良好)한 임상적(臨床的) 호전(好轉)을 보였다. 4. 수두증(水頭症)의 치료(治療)에 있어서 사암침(舍岩鍼)을 포함한 더 다양(多樣)한 한방적(韓方的) 임상연구(臨床硏究)를 기대(期待)하는 바이다.

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Adjustable Ghajar Guide Technique for Accurate Placement of Ventricular Catheters : A Pilot Study

  • Yoon, Sang-Youl;Kwak, Youngseok;Park, Jaechan
    • Journal of Korean Neurosurgical Society
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    • 제60권5호
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    • pp.604-609
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    • 2017
  • Objective : An adjustable Ghajar guide is presented to improve the accuracy of the original Ghajar guide technique. The accuracy of the adjustable Ghajar guide technique is also investigated. Methods : The coronal adjustment angle from the orthogonal catheter trajectory at Kocher's point is determined based on coronal head images using an electronic picture archiving and communication system. For the adjustable Ghajar guide, a protractor is mounted on a C-shaped basal plate that is placed in contact with the margin of a burrhole, keeping the central $0^{\circ}$ line of the protractor orthogonal to the calvarial surface. A catheter guide, which is moved along the protractor and fixed at the pre-determined adjustment angle, is then used to guide the ventricular catheter into the frontal horn adjacent to the foramen of Monro. The adjustable Ghajar guide technique was applied to 20 patients, while a freehand technique based on the surface anatomy of the head was applied to another 47 patients. The accuracy of the ventricular catheter placement was then evaluated using postoperative computed tomography scans. Results : For the adjustable Ghajar guide technique (AGT) patients, the bicaudate index ranged from 0.23 to 0.33 ($mean{\pm}standard$ deviation [SD] : $0.27{\pm}0.03$) and the adjustment angle ranged from $0^{\circ}$ to $10^{\circ}$ ($mean{\pm}SD:5.2^{\circ}{\pm}3.2^{\circ}$). All the AGT patients experienced successful cerebrospinal fluid diversion with only one pass of the catheter. Optimal placement of the ventricular catheter in the ipsilateral frontal horn approximating the foramen of Monro (grade 1) was achieved in 19 patients (95.0%), while a suboptimal trajectory into a lateral corner of the frontal horn passing along a lateral wall of the frontal horn (grade 3) occurred in 1 patient (5.0%). Thus, the AGT patients experienced a significantly higher incidence of optimal catheter placement than the freehand catheterized patients (95.0% vs. 68.3%, p=0.024). Moreover, none of the AGT patients experienced any tract hemorrhages along the catheter or procedure-related complications. Conclusion : The proposed adjustable Ghajar guide technique, using angular adjustment in the coronal plane from the orthogonal trajectory at Kocher's point, facilitates accurate freehand placement of a ventricular catheter for hydrocephalic patients.

Risk Factors and Preoperative Risk Scoring System for Shunt-Dependent Hydrocephalus Following Aneurysmal Subarachnoid Hemorrhage

  • Kim, Joo Hyun;Kim, Jae Hoon;Kang, Hee In;Kim, Deok Ryeong;Moon, Byung Gwan;Kim, Joo Seung
    • Journal of Korean Neurosurgical Society
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    • 제62권6호
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    • pp.643-648
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    • 2019
  • Objective : Shunt-dependent hydrocephalus (SdHCP) is a well-known complication of aneurysmal subarachnoid hemorrhage (SAH). The risk factors for SdHCP have been widely investigated, but few risk scoring systems have been established to predict SdHCP. This study was performed to investigate the risk factors for SdHCP and devise a risk scoring system for use before aneurysm obliteration. Methods : We reviewed the data of 301 consecutive patients who underwent aneurysm obliteration following SAH from September 2007 to December 2016. The exclusion criteria for this study were previous aneurysm obliteration, previous major cerebral infarction, the presence of a cavum septum pellucidum, a midline shift of >10 mm on initial computed tomography (CT), and in-hospital mortality. We finally recruited 254 patients and analyzed the following data according to the presence or absence of SdHCP : age, sex, history of hypertension and diabetes mellitus, Hunt-Hess grade, Fisher grade, aneurysm size and location, type of treatment, bicaudate index on initial CT, intraventricular hemorrhage, cerebrospinal fluid drainage, vasospasm, and modified Rankin scale score at discharge. Results : In the multivariate analysis, acute HCP (bicaudate index of ${\geq}0.2$) (odds ratio [OR], 6.749; 95% confidence interval [CI], 2.843-16.021; p=0.000), Fisher grade of 4 (OR, 4.108; 95% CI, 1.044-16.169; p=0.043), and an age of ${\geq}50years$ (OR, 3.938; 95% CI, 1.375-11.275; p=0.011) were significantly associated with the occurrence of SdHCP. The risk scoring system using above parameters of acute HCP, Fisher grade, and age (AFA score) assigned 1 point to each (total score of 0-3 points). SdHCP occurred in 4.3% of patients with a score of 0, 8.5% with a score of 1, 25.5% with a score of 2, and 61.7% with a score of 3 (p=0.000). In the receiver operating characteristic curve analysis, the area under the curve (AUC) for the risk scoring system was 0.820 (p=0.080; 95% CI, 0.750-0.890). In the internal validation of the risk scoring system, the score reliably predicted SdHCP (AUC, 0.895; p=0.000; 95% CI, 0.847-0.943). Conclusion : Our results suggest that the herein-described AFA score is a useful tool for predicting SdHCP before aneurysm obliteration. Prospective validation is needed.

Systematic Review and Meta-Analysis of Antibiotic-Impregnated Shunt Catheters on Anti-Infective Effect of Hydrocephalus Shunt

  • Zhou, Wen-xiu;Hou, Wen-bo;Zhou, Chao;Yin, Yu-xia;Lu, Shou-tao;Liu, Guang;Fang, Yi;Li, Jian-wen;Wang, Yan;Liu, Ai-hua;Zhang, Hai-jun
    • Journal of Korean Neurosurgical Society
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    • 제64권2호
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    • pp.297-308
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    • 2021
  • Objective : Shunt infection is a common complication while treating hydrocephalus. The antibiotic-impregnated shunt catheter (AISC) was designed to reduce shunt infection rate. A meta-analysis was conducted to study the effectiveness of AISCs in reduction of shunt infection in terms of age, follow-up time and high-risk patient population. Methods : This study reviewed literature from three databases including PubMed, EMBASE, and Cochrane Library (from 2000 to March 2019). Clinical studies from controlled trials for shunt operation were included in this analysis. A subgroup analysis was performed based on the patient's age, follow-up time and high-risk population. The fixed effect in RevMan 5.3 software (Cochrane Collaboration) was used for this meta-analysis. Results : This study included 19 controlled clinical trials including 10105 operations. The analysis demonstrated that AISC could reduce the infection rate in shunt surgery compared to standard shunt catheter (non-AISC) from 8.13% to 4.09% (odds ratio [OR], 0.48; 95% confidence interval [CI], 0.40-0.58; p=0.01; I2=46%). Subgroup analysis of different age groups showed that AISC had significant antimicrobial effects in all three groups (adult, infant, and adolescent). Follow-up time analysis showed that AISC was effective in preventing early shunt infections (within 6 months after implant). AISC is more effective in high-risk population (OR, 0.24;95% CI, 0.14-0.40; p=0.60; I2=0%) than in general patient population. Conclusion : The results of meta-analysis indicated that AISC is an effective method for reducing shunt infection. We recommend that AISC should be considered for use in infants and high-risk groups. For adult patients, the choice for AISC could be determined based on the treatment cost.

말초 아밀로이드 베타 원천으로서의 혈소판과 알츠하이머병의 혈액 바이오마커로서의 가능성 (Platelets as a Source of Peripheral Aβ Production and Its Potential as a Blood-based Biomarker for Alzheimer's Disease)

  • 강재선;최윤식
    • 생명과학회지
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    • 제30권12호
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    • pp.1118-1127
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    • 2020
  • 알츠하이머병은 점진적인 신경세포의 손상과 이로 인해 인지기능 장애를 유발하는 질병이다. 이 질환은 현재로서는 치료할 수 있는 질환이 아니고 진행을 멈추게 할 수 있는 방법이 없다. 그러나 초기에 알츠하이머병을 치료하는 것이 가장 효과적이므로 초기 진단은 증상을 관리할 수 있는 가장 좋은 기회를 제공할 수 있다. 알츠하이머병을 진단하기 위한 바이오마커로는 아밀로이드 베타(Aβ), 병적인 타우, 그리고 신경퇴화가 있고, Aβ의 축적, 인산화 타우는 뇌척수액이나 양전자 방출 단층촬영술을 통해 분석할 수 있다. 그러나 뇌척수액의 채취는 매우 침습적이고 양전자 방출 단층촬영술은 전문적인 고가의 장비가 필요하다. 지난 수십년 동안 빠르고 최소한의 침습성을 가진 바이오마커 분석법을 개발하기 위하여 혈액에 기반한 바이오마커 분석 기술이 연구되어 왔다. 그 중 주목할 만 한 발견이 혈장에서 Aβ의 주요 원천으로 혈소판과의 관련성이다. 아밀로이드 베타는 혈액-뇌 장벽을 통과 할 수 있고 정상 상태에서는 뇌와 혈액 간 평형을 이루게 된다. 흥미롭게도, 여러 임상시험 결과 혈장에서 Aβ42/Aβ40 비율이 가벼운 인지장애 질환과 알츠하이머병에서 감소되어 있는 것을 증명하였다. 종합하면, 이러한 최근의 발견들은 침습성을 최소화한 알츠하이머병의 초기 진단 기술을 개발하는 데 이용될 수 있다. 본 총설에서, 저자들은 알츠하이머병의 바이오마커에 대한 최근 연구결과들, 특히 말초에서 Aβ를 생산하는 혈소판의 역할과 혈액 기반 바이오마커로서의 개발 가능성에 대해 고찰하였다.

흰쥐에서 고용량 아질산이온 함유 마늘 발효농축액에 의한 뇌혈류 변화 (Changes in Cerebral Blood flow Following Fermented Garlic Extract Solution with High Content of Nitrite)

  • 유혁;;구호;천현수;유수진;김민선
    • 동의생리병리학회지
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    • 제34권6호
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    • pp.326-333
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    • 2020
  • Nitrate-nitrite-nitric oxide (NO) pathway is a major alternative source of NO and is essential for NO - dependent physiological functions in body. Food supplements having nitrate/nitrite can improve metabolic syndromes including hypertension through antioxidant activity or vasodilation. The purpose of this study was to observe the effects of fermented garlic (F. garlic) having high concentration of NO2- on changes in blood flow and nitric oxide synthesis in the cerebral cortex of rodents. The generation of nitric oxide detected by a chemi-luminescence detector was higher in F. Garlic compared with NaNO2 solution under artificial gastric juice with pH 2.0. Ether F. garlic or NaNO2 diluted with artificial cerebrospinal fluid was directly applied into around the needle probe of laser Doppler flow meter that was located on epidural surface of the cortex. Direct application of F. garlic resulted in increase of cerebral blood flow detected by a laser Doppler flow meter with a dose-dependent manner. Compared with NaNO2 solution, F. garlic produced changes in cerebral blood flow at lower concentration of NO2-. Pretreatment of methylene blue, a guanylyl cyclase inhibitor prevented upregulation of cerebral blood flow by the treatment of F. garlic. In addition, the application of F. garlic with 250, 500ppm of NO2- caused significantly the production of NO in the cortical tissue but NaNO2 solution with 500ppm of NO2- did not. In summary, these results suggested that F. garlic with high content of NO2- induce increase in cerebral blood flow through nitric oxide-dependent signal pathway.

알츠하이머성 치매에서 혈액 진단을 위한 바이오마커 (Blood Biomarkers for Alzheimer's Dementia Diagnosis)

  • 박창은
    • 대한임상검사과학회지
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    • 제54권4호
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    • pp.249-255
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    • 2022
  • 알츠하이머병은 주요한 공중보건 문제로 나타나며 연구분야에서도 최우선적인 과제이다. 알츠하이머병(AD)에서 뇌척수액(CSF)을 활용한 바이오마커인 아밀로이드-β(Aβ42), 총 타우(T-tau) 및 인산화 타우(P-tau)가 알츠하이머병 병태생리학의 핵심 요소를 반영한다. 임상 연구 및 새로운 측정법을 통한 임상적으로 활용되는 진단은 전임상 알츠하이머병에 대해 민감적이고 특이적이며 신뢰할 수 있는 바이오마커의 발굴, 뿐만 아니라 치매의 조기 발견 및 감별 진단과 질병 진행 모니터링에 도움이 되는 검사법의 개발에도 중요할 것이다. 증상 전 단계에서 AD의 조기 발견은 시냅스 손상 및 신경 손실이 확장되기 전에 개입이 수행되기 때문에 치료 개입을 조기에 가능하게 하고 치료 성공을 위한 가능성이 더 큰 좋은 기회로 이어진다. 따라서 새롭고 접근하기 쉽고 비용이 적게 드는 바이오마커를 임상 진단에 활용하는 것이 매우 유익할 것이다. 치매의 초기단계에 일어나는 병리학적 변화나, 질병의 진행정도를 추적할 수 있는 다양한 바이오마커들의 진단방법을 찾는 일은 치료제 개발처럼 중요한 연구 분야이다. 조기진단을 위해 임상증상을 대변하거나(surrogate marker), 증상이 나타나기 이전 상태를 측정할 수 있는 새로운 진단마커가 필요한 상황이다. 이러한 이유로 인지기능 저하정도를 측정하여 정상, 경도인지장애(mild cognition impairment, MCI) 및 전임상(preclinical) 상태의 사람을 판별할 수 있는 바이오마커(biomarker)를 활용한 조기진단법 개발의 중요성이 강조되고 있다.

내외전마비를 동반하는 특발성 양안사시 한의 증례보고 1례 (A Case Report of an Idiopathic Bilateral Strabismus with Internal and External Palsy)

  • 변정아;최윤영;백종찬;정현아;정지은
    • 한방안이비인후피부과학회지
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    • 제36권4호
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    • pp.156-163
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    • 2023
  • Objectives : The purpose of this study is to report the effect of Korean medical treatments on idiopathic bilateral strabismus. Methods : We treated a 43-year-old male idiopathic bilateral strabismus patient who was told to wait without a prescription as there was no problem in intraocular pressure test, fundus test, brain computed tomography, brain magnetic resonance imaging and angiography test, and cerebrospinal fluid test. The patient was admitted to Cheonan Korean medical hospital for 3 months to get Korean medical treatments including acupuncture, electroacupuncture, vapor treatment, pharmacopuncture therapy. The degree of improvement in idiopathic bilateral strabismus was determined by the objective measures of internal and external rotation disorders, and the patient's subjective opinions on eye pain and double vision discomfort. Results : The results of this patient showed distinct improvements on objective measures of internal and external rotation disorders in both eyes. Distance from the outer corner of the right eye when abducted decreased from 7mm to 0mm, and left eye decreased from 7mm to 0mm. Distance from the inner corner of the right eye when adducted decreased from 5mm to 0mm, and left eye decreased from 4mm to 0mm. In addition, eye pain decreased from 10 to 0 and diplopia decreased from 10 to 2 according to the patient's subjective opinions. Conclusions : This study shows the possibility that such medical treatment in Koreans can improve the rare idiopathic bilateral perspective among strabismus patients.

Facial Paralysis and Myositis Following the H3N2 Influenza Vaccine in a Dog

  • Ju-Hyun An;Ye-In Oh;So-Hee Kim;Su-Min Park;Jeong-Hwa Lee;Ga-Hyun Lim;Kyung-Won Seo;Hwa-Young Youn
    • 한국임상수의학회지
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    • 제40권5호
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    • pp.336-340
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    • 2023
  • A dog (2-year old, female, Shih-Tzu) presented with hyperthermia and right-sided facial paralysis characterized by the inability to close the right eye and drooling from the right side of the mouth after H3N2 influenza vaccination [A/Canine/Korea/01/07(H3N2) strain; Caniflu-Max, Bionote, Hwaseong, Gyeonggi-do, ROK]. To determine the cause of the fever and neurological symptoms, physical examination, ophthalmic examination, thoracic and abdominal radiography, abdominal ultrasonography, complete blood counts, serum chemistry values, and electrolyte levels were determined. In addition, Cerebrospinal fluid analysis, antinuclear antibody test, fever of unknown origin polymerase chain reaction (PCR) panel, tick-borne pathogen PCR panel were performed. As a result, hyperthermia, leukocytosis, and elevated C-reactive protein were confirmed. In addition, neurological examination revealed decreased right eyelid reflexes, corneal reflexes, threat response, and facial sensation, it was possible to suspect problems with the trigeminal and facial nerves of the cranial nerve. Magnetic resonance imaging revealed a lesion suggestive of myositis in the right muscular lesion at atlanto-occipital junction level on site of vaccine injection. Therefore, right-sided facial paralysis was tentatively determined to be a secondary cause of nerve damage caused by myositis. The patient was treated with immunosuppressants such as prednisolone and mycophenolate mofetil. After 3 months of immunosuppressant therapy, the patient's symptoms improved.