• The Journal of Internal Korean Medicine
• /
• v.43 no.4
• /
• pp.582-595
• /
• 2022

Objectives: To investigate the effects of acupuncture at GV20 and EX-HN1 on cerebral blood flow (CBF) velocity and cerebrovascular reactivity (CVR) in the middle cerebral arteries (MCA) and anterior cerebral arteries (ACA) and to compare the effects to acupuncture at GV20. Methods: The study was a randomized, crossover trial that included 10 healthy men aged 20 to 29 years who underwent acupuncture treatment four times with a washout period of one week. The CBF velocity and CVR were measured by transcranial Doppler sonography (TCD) on both MCAs at the first and second visits, and both ACAs at the third and fourth visits. Participants were randomly assigned to one of two groups (A and B) before the first and third visits. Group A received two phases of acupuncture intervention at a single GV20 point and a combination of GV20 and EX-HN1 acupoints. Group B received the same interventions, but in the reverse order. Results: The increase in CO₂ reactivity was significantly higher for the combination acupoints of GV20 and EX-HN1 than for the GV20 single acupoint in both MCAs (Right: 136 to 178, p=0.017; Left: 127 to 191, p=0.017) and ACAs (Right: 133 to 158, p=0.013; Left: 122 to 168, p=0.025). No significant change was noted in the corrected velocity at PETCO₂ 40 mmHg, blood pressure, or heart rate. Conclusions: The findings suggest that improvement of the CBF in the MCA and ACA after GV20 acupuncture increases when acupuncture is also performed at EX-HN1. These results clinically support the combined use of EX-HN1 and GV20 to treat disorders of MCA and ACA circulation.

• The Journal of Internal Korean Medicine
• /
• v.20 no.1
• /
• pp.222-231
• /
• 1999

Uwhangchungsimwon(UC) has been used in the treatment of a wide variety of conditions including stroke, hypertension, arteriosclerosis, autonomic imbalance, mental instablity, etc in Korean traditional hospitals, In particular it is often initialy chosen for emergency care of acute stroke. The aim of this study was to evaluate the effect of UC on cerebral hemodynamics. Using transcranial Doppler ultrasound, we studied changes of mean flow velocity and pulsatility index(PI) of middle cerebral arteries (MCAs) from 11 health young volunteers who were administrated with 1 pill UC and 11 health controls who were not. We obtained hypercapnia with breath-holding and evaluated cerebrovascular reactivity with breath-holding index(BHI). Systolic blood pressure, diastolic blood pressure, and heart rate were measured using ambulatory blood pressure monitoring(ABPM). In UC administration group, the evaluation was performed during basal condition. and repeated at 20, 40, and 60 min after administration. In controls, the evaluation was performed at corresponding time intervals. Mean flow velocity in middle cerebral artery, systolic blood pressure, diastolic blood pressure, and heart rate did not change during the observation period and were not different between these two groups. However, administration of UC was associated with decreases in PI by $3.6{\sim}12.4%$ in BHI by $17.9{\sim}24.8%$ compared with pre-administration period. Decreases in PI and BHI with UC were significantly different compared with control group (p<0.05). These results indicate that UC decreases PI and BHI in cerebral artery, which is due to a dilation of cerebral resistance vessels.

• Journal of Korean Neurosurgical Society
• /
• v.62 no.1
• /
• pp.3-9
• /
• 2019

As more intracranial aneurysms and other cerebrovascular pathologies are treated with neurointervention procedure, thromboembolic events that frequently lead to serious neurological deficit or fatal outcomes are increasing. In order to prevent the thromboembolic events, antiplatelet therapy is used in most procedures including coil embolization, stenting, and flow diversion. However, because of variable individual pharmacodynamics responses to antiplatelet drugs, especially clopidogrel, it is difficult for clinicians to select the adequate antiplatelet regimen and its optimal dose. This article reviews the neurointervention literature related to antiplatelet therapy and suggests a strategy for tailoring antiplatelet therapy in individual patients undergoing neurointervention based on the results of platelet function testing.

• The Journal of Korean Medicine
• /
• v.27 no.3 s.67
• /
• pp.38-50
• /
• 2006

Objectives: The aim of this study was to evaluate the effects of Korean ginseng (KG), Korean red ginseng (KRG) and fermented Korean red ginseng (FKRG) extracts on cerebral hemodynamics and to compare distinction of each extract. Methods: Ten healthy male volunteers $(26.0{\pm}1.8yrs)$ participated in the study according to double-blind and cross-over protocols. Each volunteer was blindly administered 500mg of KG, KRG, FKRG extract or placebo (Dextrin). Blinded researchers measured changes of hyperventilation-induced cerebrovascular reactivity (CVR), mean blood flow velocity (MBFV) of middle cerebral arteries (MCAs) and corrected blood flow velocity at $P_{ETCO2}=40mmHg$ (CV40) using transcranial Doppler ultrasound (DWL Co., Germany). Researchers also observed changes of mean blood pressure (MBP), pulse rate (PR) and expiratory $CO_2$ using S/5 Collector (Datex-Ohmeda Co., Finland). The evaluation was performed at basal condition, and repeated at 1, 2, 3, 4 and 5 hours after administration. Results: MBFV and CV40 in the KRG group tended to rise at I hour after administration, while those of the FKRG group tended to rise at 2 hours after administration. CVR increased significantly after 1 hour in the KRG group (p=0.009) and after 2 hours in the FKRG group (p=0.035), respectively. The KG group showed increasing tendency at 4 hours after administration. No group showed significant difference from the placebo in changes of MBP and PR. Conclusions: It is suggested that KG, KRG and FKRG extracts have effects of enhancing CVR and thus of increasing cerebral blood flow in human subjects.

• Journal of Korean Neurosurgical Society
• /
• v.40 no.6
• /
• pp.434-440
• /
• 2006

Objective : The purpose of this study is to examine the influence of cranioplasty on dynamics of cerebral blood flow[CBF] and cerebrovascular reserve capacity[CVRC], and to investigate the usefulness of single photon emission computed tomography [SPECT] as a prognostic factor for neurological improvement after cranioplasty. Methods : Between March 2003 and December 2005, a prospective study was performed on 24 patients who had undergone total 25 cranioplasty operations. Cerebral blood flow velocities in the middle cerebral artery[MCA] and internal carotid artery[ICA] were obtained by transcranial Doppler ultrasonography[TCD]. The CVRC was assessed by SPECT in the natural state and after stimulation with 1g of acetazolamide. Neurological improvement after cranioplasty was compared between patients who showed hyperactivity to acetazolamide-activated SPECT [Group 1, n=7] and hypoactivity to acetazolamide-activated SPECT [Group 2, n=17]. These measurements were obtained two weeks prior to and two weeks after cranioplasty. Results : The blood flow velocities at the opposite site to the cranioplasty as well as at the cranioplasty site were significantly increased [P<0.05]. Compared with Group 2, there was significant increase in CBF and neurological improvement after cranioplasty in Group 1. Conclusion : Among patients with surgical bony defects, the patients who had normal reactivity of the CVRC showed a significant increase in CBF and neurological improvement after cranioplasty. The authors suggest that CVRC measurement prior to surgery may be an important prognostic factor for neurological improvement after cranioplasty.

• Biomedical Science Letters
• /
• v.19 no.3
• /
• pp.233-238
• /
• 2013

Aspirin is still the mainstay of antiplatelet therapy in the cardiovascular and cerebrovascular disease. However, some patients are not responsive to the antithrombotic action of aspirin. The aim of this study was to assess the prevalence and clinical characteristics of aspirin resistance in patients with cerebral infarction. We tested platelet function in 557 patients who had been treated with aspirin in J general hospital. Platelet function was tested using the multiple electrode platelet aggregometry (MEA). Platelet reactivity was expressed as area under the aggregation curve (AUC, U) and >30 AUC was defined as aspirin resistance. Aspirin resistance was detected in 16.2% patients. There was not any significant differences in age, gender between aspirin resistance and aspirin sensitive patients. WBC was significantly higher in patients with aspirin resistance (P < .05). HDL-cholesterol was significantly higher in patients with aspirin sensitive (P < .05). Aspirin resistance was positive correlation with platelet count (r =.314, P =.003). The prevalence of aspirin resistance in cerebral infarction was 16.2%, and platelet count were related with aspirin resistance.

• The Journal of Internal Korean Medicine
• /
• v.22 no.2
• /
• pp.199-205
• /
• 2001

Background and Purpose : Transcranial doppler ultrasonography(TCD) is a noninvasive and nonradioactive technique for evaluation of the hemodynamics in large cerebral vessels. Sahyangsohap-won(SS) has been considered to be effective for the treatment of various disease, especially cerebrovascular, cardiovascular, and psychosomatoform disorders. But, there is no study about the effect of SS on the cerebral hemodynamics in humans. The aim of this study was to assess the effect of SS on the changes in cerebral hemodynamics and the dose-dependant effect by using TCD. Subjects and Methods : 30 healthy subjects were randomly divided into three group: group 1 took no drug, group 2 took SS one pill, and group 3 took SS 2 pills. Changes in the mean blood flow velocity(MBFV) and pulsatility index(PI) in the middle cerebral artery were evaluated by means of TCD. We obtained hypercapnia with breath-holding and evaluated cerebrovascular reactivity with the breath-holding index(BHI). Systolic blood pressure(SBP), diastolic blood pressure(DBP), and heart rate(HR) were measured by means of ambulatory blood pressure monitoring. In group 2 and group 3, the evaluations were performed during the baseline and were repeated at 20, 40, and 60 minutes after SS administration. In group 1, the evaluation was performed at corresponding time intervals. Results : In mean values of MSFV, PI, SSP, DBP, and HR, no stastically significant differences were found between the 3 groups. However, BHI values were significantly lower in groups 2 and 3 than in group 1 at 40 minutes after SS administration(P<0.05, group 1 vs group 2, group 1 vs group 3 by post-hoc analysis: Scheffe's test) but in dose-dependant effect, there was no difference between group 2 and group 3. Conclusion : These results suggest that SS can decrease vascular resistance in cerebral small arteries or arterioles and enhance their distensibility. Further studies on larger numbers of subjects are needed to confirm these effects and the dose-dependant effects.

• The Korean Journal of Nuclear Medicine
• /
• v.37 no.2
• /
• pp.94-102
• /
• 2003

Purpose : Cerebral blood flow (CBF) reactivity to acetazolamide (ACZ) is useful to select patients with hemodynamic failure. However, it is still a matter of speculation that varying degrees of regional CBF increases after ACZ administration represent the severity or stage of regional hemodynamic failure as assessed by positron emission tomography (PET). We studied to elucidate whether ACZ challenge $^{123}I-IMP$ brain single photon emission tomography (SPECT) can accurately grade the seventy of regional hemodynamic failure. Materials and Methods: Eighteen patients (M: 16, F: 2, average age: 61 years) with unilateral occlusive disease of the internal carotid artery or the trunk of the middle cerebral artery (MCA). Patients undewent $^{123}I-IMP$ brain SPECT study with acetazolamide challenge and PET study was carried out within 2 weeks before and after SPECT study. Five healthy volunteers with a mean age of 48 years (range: 28-73 yr, M: 3, F: 2) underwent PET studies to determine normal values. In SPECT study, an asymmetry index (Al)-the percentage of radioactivity of region of interest (ROI) in the occlusive cerebrovascular lesion to the contralateral homologous ROI-was used for numerical evaluation of relative $^{123}I-IMP$ distribution. In PET study, regional CBF, oxygen extraction fraction (OEF), cerebral metabolic rate of oxygen ($CMRO_2$) and cerebral blood volume (CBV) values were measured with $^{15}O-labeled$ gas inhalation method and the values were used for comparison with Al (Al during acetazolamide challenge-Al of basal study) on the SPECT study. ROls were classified by severity into three groups (normal, stage I and stage II). Results: Mean values of Al in areas with normal, stage I and stage II hemodynamic failure were $6.25{\pm}7.77%\;(n=107),\;-10.38{\pm}10.41%\:(n=117)\;and\;13.30{\pm}10.51%\;(n=140)$, respectively. Al significantly differed with each groups (p<0.05). Correlation between Al and CBF, OEF and CBV/CBF in hemisphere with occlusive cerebrovascular lesion was 0.20 (p<0.01), -0.28 (p<0.01) and -0.28 (p<0.01), respectively. Conclusion: We concluded that $^{123}I-IMP$ brain SPECT with acetazolamide challenge could determine the severity ad stage of regional hemodynamic failure as assessed by PET.