• Journal of Korean Neurosurgical Society
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• 제53권6호
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• pp.368-370
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• 2013

Post-stroke atrial fibrillation has been frequently reported especially in the patients with right insular infarct as an evidence of cerebrogenic mechanism affecting on cardiac rhythm. However, conversion to normal sinus rhythm after stroke in patients who had atrial fibrillation has not been reported. A 88-year-old men who had untreated atrial fibrillation was admitted to hospital due to left middle cerebral artery territory infarction. During admission, second ischemic attack occurred in right middle cerebral artery territory. At that time, his atrial fibrillation converted spontaneously to normal sinus rhythm. Restored sinus rhythm sustained until he died due to sepsis. This case is evidence supporting a theory that brain is associated with control of cardiac rhythm. If no risk factor is revealed by intensive investigation in patients with acute cerebral infarctions that cardioembolism is strongly suspected as a cause, physicians should concern transformation of atrial fibrillation to normal sinus rhythm after stroke.

• 대한중풍순환신경학회지
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• 제18권1호
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• pp.55-65
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• 2017

■ Objectives Atrial fibrillation is the most common cause of cardioembolic stroke. Of the 44 ischemic stroke patients with atrial fibrillation who were hospitalized in hospital of Korean Medicine from July 1, 2014 to June 30, 2017, we selected 39 patients who have had Magnetic Resonance Angiography. We divided them into Atrial Fibrillation group with no stenosis or less than 50% stenosis in the ipsilateral artery of the lesion and Artery to Artery Embolism group with more than 50% stenosis or occlusion in the ipsilateral artery of the lesion. ■ Methods Clinical characteristics, examination and evaluation tools were collected from the patient's electronic medical records. CHADS2, Initial National Institutes of Health Stroke Scale, 8-item Stroke Scale and Improved 8-item Stroke Scale Number were checked. ■ Results & Atrial Fibrillation group showed differences in age, brain lesion location, vascular lesion, Conclusion initial National Institutes of Health Stroke Scale, initial 8-item Stroke Scale and progress compared to Artery to Artery Embolism group.

• 대한영상의학회지
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• 제83권5호
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• pp.1046-1058
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• 2022

해마는 뇌에서 가장 대사가 활발한 부위 중 하나이다. 그러므로 해마는 다양한 급성기 질환으로부터 영향을 받을 수 있다. 이 연구의 목적은 해마와 관련된 다양한 질환들을 소개 및 분류하며 특히 확산강조영상을 중심으로 자기공명영상 소견에 대해 설명하는 것이다. 급성기 해마 질환은 감염, 염증, 대사성, 허혈성, 외상성 그리고 기타 총 6가지로 분류하였다. 환자들은 임상적 소견 그리고 확산강조영상 중심의 자기공명영상을 토대로 후향적으로 검토되었다. 모든 질환들은 임상적 또는 병리학적으로 진단되었다. 급성기 해마 질환들은 임상 양상이 겹치는 경우가 많다. 그러므로 감별 진단을 위해서 급성기 해마 질환들을 분류하고 각각의 특징적인 영상 소견을 이해하는 것이 중요하다.

• 대한디지털의료영상학회논문지
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• 제16권1호
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• pp.13-19
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• 2014

Purpose: FLAIR image is beneficial for the diagnosis of various bran diseases including ischemic CVS, brain tumors and infections. However the border between the legion of brain metastasis and surrounding edema may not be clear. Therefore, this study aims to investigate the practical benefits of delayed imaging by comparing the image from a patient with brain metastasis before a contrast enhancement and the image 10 minutes after a contrast enhancement. Materials and methods: Of the 92 people who underwent MRI brain metastases in suspected patients 13 people in three patients there is no video to target the 37 people confirmed cases, and motion artifacts brain metastases in our hospital June-December 2013, 18 people measurement position except for the three incorrect patient (male: 11 people, female: 7 people, average age: 60 years) in the target, test equipment, 3.0T MR System (ACHIEVA Release, Philips, I was 8ChannelSENSE Head Coil use Best, and the Netherlands). TR 11000 ms, TE 125 ms, TI2800 ms, Slice Thickness 5 mm, gap 5 mm, is a Slice number 21, the parameters of the 3D FFE, T2 FLAIR variable that was used to test, TR 8.1 ms, TE 3.7 ms, Slice number 240 I set to. The experiment was conducted by acquiring the FLAIR prior to contrast enhancement (heretofore referred to as Pre FLAIR), and acquiring the 3D FFE CE five minutes after the contrast enhancement, and recomposing the images in an axial plane of S/T 3mm, G 0mm (heretofore referred to as MPR TRA CE). Using the FLAIR 10 minutes after the contrast enhancement (heretofore referred to as Post FLAIR) and Pi-View, a retrospective study was conducted. Using MRIcro on the image of a patient confirmed for his diagnosis, the images before and after the contrast media, as well as the CNR and SNR of the MPR TRA CE images of the lesion and the site absent of lesion were compared and analyzed using a one-way analysis of variance. Results: CNR for Pre FLAIR and Post FLAIR were 34.35 and 60.13, respectively, with MPR TRA CE at 23.77 showing no significant difference (p<0.050). Post-experiment analysis shows a difference between Pre FLAIR and Post FLAIR in terms of CNR (p<0.050), but no difference in CNR between Post FLAIR and MPR TRA CE (p>0.050), indicating that the contrast media had an effect only on Pre FLAIR and Post FLAIR. The SNR for the normal site Pre FLAIR was 106.43, and for the lesion site 140.79. Post FLAIR for the normal site was 107.79, and for the lesion site 167.91. MPR TRA CE for the normal site was 140.23 and for the lesion site 183.19, showing significant difference (p<0.050), and post-experiment analysis shows that there was a difference in SNR only on the lesion sites for Pre FLAIR and Post FLAIR (p<0.050). There was no difference in SNR between the normal site and lesion site for Post FLAIR and MPR TRA CE, indicating no effect from the contrast media (p>0.050). Conclusions: This experiment shows that Post FLAIR has a higher contrast than Pre FLAIR, and a higher SNR for lesions, It was not not statistically significant and MPR TRA CE but CNR came out high. Inspection of post-contrast which is used in a high magnetic field is frequently used images of 3D T1 but, since the signal of the contrast medium and the blood flow is included, this method can be diagnostic accuracy is reduced, it is believed that when used in combination with Post FLAIR, and that can provide video information added to the diagnosis of brain metastases.

• 대한한의학방제학회지
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• 제22권1호
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• pp.13-32
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• 2014

Objectives : Until now the study of Cnidii Rhizoma, hemorrhage, brain waves, such as ischemic brain injury, analgesic, effect overcome of the stress from pregnancy melanin formation and inhibiting effects skin whitening have been published regarding this article. Cnidii Rhizoma demonstrates its different abilities depending on the characteristics. This paper reported that effect of Cnidii Rhizoma in Dongeuibogam blended prescriptions as main medicine. In addition, by analyzing data, we studied about utilizing of Cnidii Rhizoma. Methods : Cnidii Rhizoma in Dongeuibogam Prescriptions as the main ingredient was built with database of 202 prescriptions. Thus analyzed data was summarized in detail.(Table-1) If there is no difference in the title of the prescription but in other case the configuration information is different, formulations 1 and 2 were divided by the table. Results : The following results were reached through investigations on the prescriptions usikng Cnidii Rhizoma as a key component. 1. Prescriptions taking Cnidii Rhizoma as a monarch drug are utilized for 40 therapeutic purposes. In particular, 12.3% of prescriptions appear in the chapter of head, and 10.8% of those appear in the chapter of women, and 9.4% of eye, 8.9% of child, 6.4% of wind disease respectively. 2. Prescriptions utilizing Cnidii Rhizoma as the main ingredient are used in the treatment of headache, dizziness and pregnancy hemorrhage fetal movement, premature birth and they are also used for treating 131 different types of disease. 3. The dosage of Cnidii Rhizoma in formulas is from 2pun(about 0.75g) to 5don(nearly 18.75g), however 1don(nearly 3.75g) has been taken the most for clinical application. 4. We find out that according to herbs or prescriptions, Cnidii Rhizoma has a variety of functions such as ascending & descending of energy. Samultang is the most useful base prescription which used the Cnidii Rhizoma as the main component. Conclusion : These results suggest that, Cnidii Rhizoma once-amount use (don nearly 3.75g) 4g in head, gynecology, ophthalmology, pediatrics and paralysis disease associated with oriental medicine resource development can be considered to be widely used These results suggest that Cnidii Rhizoma was used most with 1 don(4g) and can be widely used for the resource development to the disease such as brain, gynecology, ophthalmologhy, pediatrics and wind-associated symptoms.

• Journal of Korean Neurosurgical Society
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• 제29권10호
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• pp.1289-1295
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• 2000

Purpose : Recent evidence suggests a possible role for leukocytes in brain injury following ischemia and reperfusion. This study examined the temporal profile of ischemic tissue damage and leukocyte response after transient middle cerebral artery occlusion(MCAO) with reperfusion in the mouse. Methods : Focal cerebral ischemia was made by temporary occluding of the stem of the proximal MCA. Two groups of the mouse were investigated : (1) sham operation(n＝10), and (2)those having the arterial occlusion released after 90 minute(n＝20). By 4 hours(n＝10) and 24 hours(n＝10) after the onset of ischemia-reperfusion, fluorescein videoimages were under-taken in the pial venules of the mouse using a closed cranial window technique. Rhodamine 6G was administered as a $80-100{\mu}l/min$ i.v. loading dose and a $30-40{\mu}l/min$ i.v. maintenance dose in saline to selectively label circulating leukocytes. Neuropathologic evaluation for brain injury was accomplished using the histochemical stain 2,3,5-triphen-yltetrazolium chloride(TTC) and hematoxylin and eosin(H & E) stain. Results : The mean number of adherent leukocytes to cerebral venules in the 90 minutes MCAO and 24 hours reperfusion group were $306{\pm}24$ compared with $72{\pm}8$ in the sham operation group. In the TTC staining method, the cortical infarct affecting 34.8% of hemispheric volume were created in all of animals (n＝10) undergoing 90 minute MCAO with 24 hours reperfusion, but the infarcted area were not found in the other(sham operation and 90 minute MCAO with 4 hours reperfusion)groups. In the H & E stain, the brain tissue following 90 minute MCAO with 4 hours reperfusion revealed only a pyknosis of the nuclei with shrunken cytoplasm, but infiltrated leukocytes were not observed. After 24 hours of reperfusion, a many leukocytes were infiltrated within parenchyma and blood vessles. Conclusions : These findings demonstrate the feasiblity of continous in vivo monitoring of leukocyte adherence in cerebral venules and suggest that reperfusion induced leukocyte adherence to venular endothelium may contribute to tissue injury following focal cerebral ischemia.

• 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.

• 동의생리병리학회지
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• 제23권3호
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• pp.645-661
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• 2009

The water extract of Dohongsamul-Tang(DHSMT) has been traditionally used to stroke and brain injuries in Oriental Medicine. The present study was designed to investigate the effects of DHSMT on the gene expression profile of cerebral infarction by cDNA microarray in photothrombotic ischemia mouse model. Photothrombotic ischemia was induced in stereotactically held male BALB/c mice using rose bengal and cold light. MRI was performed 24 hours after inducing photothrombosis using 1.5 T MRI and 47 mm surface coil to obtain T2-weighted, and contrast-enhanced images. After MRI test, animal was sacrificed and the brain sections were stained for hematoxylin and eosin and immunohistochemistry. MRI and histological analysis revealed that lesion of thrombotic ischemia was well induced in the cortex with the evidence of biological courses of infarction. The target area of thrombotic infarction was 1 mm anterior to bregma and 3 mm lateral to midline with 2 mm in diameter, which were decreased by administration of DHSMT. To assess gene expression pattern of cerebral infarction, mRNA was isolated and reacted with microarray chip(Agilant's DNA Microarray 44K). Scatter and MA plot analysis were performed to clustering of each functional genes. M value [M=log2(R/G), A={log2(R ${\times}$ G)}/2] was between -0.5 and +0.5 with 40% difference. After pretreatment with DHSMT, the expression levels of mRNA of many genes involved in various signaling pathway such as apoptosis, cell cycle, cell proliferation, response to oxidative stress, immune response, angiogenesis, and inflammatory cytokine were markedly inhibited in photothrombotic ischemia lesion compared to the control group. These results suggest that DHSMT prevent ischemic death of brain on photothrombotic ischemia model of mice through modulation of gene expression at the transcriptional level.

• Journal of Chest Surgery
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• 제26권7호
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• pp.513-520
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• 1993

Surgical treatment of aneurysm or dissection involving the ascending aorta and aortic arch still poses one of the most complicated technical and tactical challenges in surgery. The use of total circulatory arrest[TCA] with profound hypothermia in the surgical treatment of aneurysmal dissection involving the ascending aorta and aortic arch has been reported as popular surgical methods. However, the safe period of prolonged circulatory arrest with hypothermia remains controversial and ischemic damage to the central nervous system and uncontrollable perioperative bleeding have been the major problem. We have found profound hypothermic circulatory arrest with retrograde cerebral perfusion via the superior vena cava to achieve cerebral protection. We experiment the aortic anastomosis in 7 adult mongrel dogs, using profound hypothermic circulatory arrest with continuous retrograde cerebral perfusion[RGCP] via superior vena cava. We also studied the extent of cerebral protection using above surgical methods, by gas analysis of retrograde cerebral perfusion blood and returned blood of aortic arch, preoperative, intraoperative and postoperative electroencephalography and microscopic findings of brain tissue. The results were as follows: 1. The cooling time ranged from 15 minutes to 24 minutes[19.71$\pm$ 3.20 minutes] ; Aorta cross clamp time ranged from 70 minutes to 89 minutes[79.86 $\pm$ 7.54 minutes] ; Rewarming time ranged from 35 minutes to 47 minutes[42.86$\pm$ 4.30 minutes] ; The extracorporeal circulation time ranged from 118 minutes to 140 minutes[128.43$\pm$ 8.98 minutes] [Table 2]. 2. The oxygen content in the oxygenated blood after RGCP was 12.66$\pm$ 1.25 ml/dl. At 5 minutes after the initiation of RGCP, the oxygen content of returnedlood was 7.58$\pm$ 0.21 ml/dl, and at 15 minutes 7.35$\pm$ 0.17 ml/dl, at 30 minutes 7.20$\pm$ 0.19 ml/dl, at 60 minutes 6.63$\pm$ 0.14 ml/dl [Table 3]. 3. Intraoperative electroencephalographic finding revealed low amplitude potential during hypothermia, and no electrical impulse throughout the period of circulatory arrest and RGCP. Electrical activity appeared after reperfusion, and the electroencephalographic reading also recovered rapidly as body temperature returned to normal [Fig. 2]. 4. The microscopic finding of brain tissue showed widening of the interfibrillar spaces. But there was no evidence of tissue necrosis or hemorrhage [Fig. 3]. We concluded the retrograde cerebral perfusion during hypothermic circulatory arrest is a simplified technique that may have a excellent brain protection.

• 대한한의학회지
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• 제24권3호
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• pp.51-64
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• 2003

Objective : This study investigated the alteration of neural activity and effect of Yanggyuksanhwa-tang (Lianggesanhuo-tang) on cerebral ischemia of rats. Methods : Considering age-related impact on cerebral ischemia, aged rats (18 months old) were used for this study. Ischemic damage was induced by the transient occlusion of bilateral common carotid arteries (BCAO) with hypotension. Yanggyuksanhwa-tang (Lianggesanhuo-tang) was administered twice a day orally. Then alterations of neural activities in the brain of aged BCAO rats were measured by the [$^{14}C$]2-deoxyglucose autoradiography method. Results : The BCAO in aged rats led to significant decrease of neural activity in the whole brain. Treatment with Yanggyuksanhwa-tang (Lianggesanhuo-tang) significantly attenuated the decrease of neural activity in the whole brain following BCAO ischemia. Treatment significantly attenuated the decrease of neural activity in the CA1, CA2, CA3, dentate gyrus of the hippocampus, activated barrel, barrel cortex, somatosensory cortex, cingulate cortex, caudate putamen, and medial septal nucleus following BCAO in aged rats. Treatment with Yanggyuksanhwa-tang (Lianggesanhuo-tang) also significantly attenuated the decrease of neural activity in the anteroventral thalamic nucleus, ventral anterior thalamic nucleus, arcuate nucleus, posterior hypothalamic area, medial mammillary nucleus, lateral periaqueductal gray, dorsal raphe nucleus, interpeduncular nucleus, median raphe nucleus, and medial pontine nucleus. Conclusion : It can be suggested that Yanggyuksanhwa-tang (Lianggesanhuo-tang) has a neuroprotecuve effect on cerebral ischemia through the control of glucose metabolic rate and cerebral blood flow.