• The Journal of Internal Korean Medicine
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• v.22 no.2
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• pp.127-134
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• 2001

The purpose of this investigation is to evaluate the effects of Samwha-tang(三化湯) Extracts on reversible forebrain ischemia experimentally induced from the occlusion of middle cerebral artery. The volume of cerebral ischemia, the volume of cerebral edema, and the change of pyramidal neuron of the CA1 area in hippocampus through light microscopy were investigated. we obtained the following results. The volume of the control group, which had ischemic damage was 21%, and the volume of the sample group, which had ischemic damage, was 16%. The ratio of the volume of the right/left hemisphere was 117.2 in the control group, and 108.8 in the sample group. Also, the light microscopy revealed that the pyramidal cells of CA1 area in hippocampus had many damages like changes into discontinuous and unsystematic forms. But, in the sample group, the cells were less damaged compared with the control group.

• Journal of Korean Neurosurgical Society
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• v.42 no.5
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• pp.416-418
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• 2007

Hematomas caused by ruptured traumatic pseudoaneurysms of the middle meningeal artery (MMA) usually present with extradural hematomas, whereas intradural intraparenchymal hematomas are extremely rare. We report a case of traumatic pseudoaneurysm of the MMA giving rise to an intracerebral hematoma after head trauma. A 70-year-old man suffered a massive intracerebral temporoparietal hemorrhage after a head injury. CT angiogram of the brain revealed a large hematoma in the right middle cranial fossa extending to the right sylvian fissure. Cerebral angiogram also revealed a pseudoaneurysm of the MMA, which was successfully treated surgically. Although traumatic MMA pseudoaneurysm producing intracerebral hematoma (ICH) is rare, it should be considered as a possible cause of intracerebral hematoma.

• Journal of Korean Neurosurgical Society
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• v.29 no.2
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• pp.167-179
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• 2000

Objective : We studied to clarify the effective time zone of mild hypothermic neural protection during ischemia and/or reperfusion after middle cerebral artery occlusion. Methods : In a reversible cerebral infarct model which maintained reperfusion of blood flow after middle cerebral artery occlusion for two hours, the size of cerebral infarction, cerebral edema and the extent of neurological deficit were observed and analyzed for comparison between the control and the experimental groups under hypothermia($33.5^{\circ}C$). The temporalis muscle temperature was reduced to $33.5^{\circ}C$ by surface cooling for two hours during middle cerebral artery occlusion for study group I. The following groups applied hypothermia for two-hour periods after reperfusion : group II(0-2 hours), group III(2-4 hours), and group IV(4-6 hours). They were rewarmed to $36.5^{\circ}C$ until sacrified at 2, 4, 6, 12, and 24 hours after reperfusion. Control group was maintained at normothermia without hypothermia. Results : In the experimental groups with hypothermia, the average value of the size of cerebral infarction($mean{\pm}SD$) was $1.97{\pm}1.65%$, which was a remarkable reduction over that of the control, $4.93{\pm}3.79%$. In the control, a progressive increase was shown in the size of infarction from point of reperfusion to 6 hours after reperfusion without further changes in size afterward. Intra-ischemic hypothermia(group I) prevented ischemic injury but did not prevent reperfusion injury. Group II examplified the most neural protective effect in comparison to the control group and group IV(p<0.05). The cortex was more vulnerable to reperfusion injury than the subcortex. Mild hypothermia showed more neural protective effects on the cortex than subcortex. Conclusion : The most appropriate time zone for application of mild hypothermia was defined to be within four hours following reperfusion.

• Journal of Korean Neurosurgical Society
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• v.62 no.2
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• pp.201-208
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• 2019

Objective : In patients with internal carotid artery (ICA) occlusion, collateral middle cerebral artery (MCA) flow has a protective role against ischemia. However, some of these patients may experience initial major neurological deficits and major worsening on following days. Thus, we investigated the safety and efficacy of endovascular treatment (EVT) for ICA occlusion with collateral MCA flow by comparing clinical outcomes of medical treatment versus EVT. Methods : The inclusion criteria were as follows : 1) acute ischemic stroke with ICA occlusion and presence of collateral MCA flow on transfemoral cerebral angiography (TFCA) and 2) hospital arrival within 12 hours from symptom onset. The treatment strategy was made by the attending physician based on the patient's clinical status and results of TFCA. Results : Eighty-one patients were included (30 medical treatment, 51 EVT). The EVT group revealed a high incidence of intracranial ICA occlusion, longer ipsilesional MCA contrast filling time, and a similar rate of favorable clinical outcome despite a higher mean baseline the National Institutes of Health Stroke Scale (NIHSS) score. By binary logistic regression analysis, intravenous recombinant tissue plasminogen activator and EVT were independent predictors of favorable clinical outcome. In subgroup analysis based on stroke etiology, the non-atherosclerotic group showed a higher baseline NIHSS score, higher incidence of EVT, and a higher rate of distal embolization during EVT in comparison with the atherosclerotic group. Conclusion : In patients with ICA occlusion and collateral MCA flow, decisions regarding treatment strategy based on TFCA can help achieve favorable clinical outcomes. EVT strategy with respect to etiology of ICA occlusion might help achieve better angiographic outcomes.

• Journal of Korean Neurosurgical Society
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• v.67 no.4
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• pp.442-450
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• 2024

Objective : Cerebral hyperperfusion syndrome (CHS) manifests as a collection of symptoms brought on by heightened focal cerebral blood flow (CBF), afflicting nearly 30% of patients who have undergone superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis. The aim of this study was to investigate whether the amalgamation of magnetic resonance imaging (MRI) fluid-attenuated inversion recovery (FLAIR) and apparent diffusion coefficient (ADC) imaging via MRI can discern cerebral hyperemia after STA-MCA anastomosis surgery. Methods : A retrospective study was performed of patients who underwent STA-MCA anastomosis due to Moyamoya disease or atherosclerotic steno-occlusive disease. A protocol aimed at preventing CHS was instituted, leveraging the use of MRI FLAIR. Patients underwent MRI diffusion with FLAIR imaging 24 hours after STA-MCA anastomosis. A high signal on FLAIR images signified the presence of hyperemia at the bypass site, triggering a protocol of hyperemia care. All patients underwent hemodynamic evaluations, including perfusion MRI, single-photon emission computed tomography (SPECT), and digital subtraction angiography, both before and after the surgery. If a high signal intensity is observed on MRI FLAIR within 24 hours of the surgery, a repeat MRI is performed to confirm the presence of hyperemia. Patients with confirmed hyperemia are managed according to a protocol aimed at preventing further progression. Results : Out of a total of 162 patients, 24 individuals (comprising 16 women and 8 men) exhibited hyperemia on their MRI FLAIR scans following the procedure. SPECT was conducted on 23 patients, and 11 of them yielded positive results. All 24 patients underwent perfusion MRI, but nine of them showed no significant findings. Among the patients, 10 displayed elevations in both CBF and cerebral blood volume (CBV), three only showed elevation in CBF, and two only showed elevation in CBV. Follow-up MRI FLAIR scans conducted 6 months later on these patients revealed complete normalization of the previously observed high signal intensity, with no evidence of ischemic injury. Conclusion : The study determined that the use of MRI FLAIR and ADC mapping is a competent means of early detection of hyperemia after STA-MCA anastomosis surgery. The protocol established can be adopted by other neurosurgical institutions to enhance patient outcomes and mitigate the hazard of permanent cerebral injury caused by cerebral hyperemia.

• Journal of Korean Medical classics
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• v.20 no.2
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• pp.53-59
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• 2007

In Oriental medicine, different suggestions regarding how cerebrovascular accident(CVA) may develop have been offered by several physicians. In Jin(金)Yuan(元) dynasty, Liu Wan Su(劉完素) asserted that CVA was not developed by external PungSa(風邪) but internal HwaYul, which was noted in the "SoMunHyunKiWonByungSik". To verify experimentally Liu's HwaYul theory in rats, normothermic control group (37$^{circ}C$) and hypothermic test group (32$^{circ}C$) were subjected to transient middle cerebral artery occlusion(MCAO) of 1hour. In 7days after MCAO, the rats were sacrified and the volume of infarct and the size of edema were measured. The present findings expand our understanding of the pathophysiology as to the CVA which is related to the HwaYul theory.

• 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.

• Journal of Korean Neurosurgical Society
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• v.49 no.3
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• pp.157-162
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• 2011

Objective : Vasospasm of cerebral vessels remains a major source of morbidity and mortality after an aneurysmal subarachnoid hemorrhage (SAH). The purpose of this study was to evaluate the safety and efficacy of transluminal balloon angioplasty (TBA) for SAH-induced vasospasm. Methods : Eleven patients with an angiographically confirmed significant vasospasm (>50% vessel narrowing and clinical deterioration) were studied. A total of 54 vessel segments with significant vasospasm were treated by TBA. Digital subtraction angiography was used to confirm the presence of vasospasm, and TBA was performed to dilate vasospastic arteries. Medical and angiographic reports were reviewed to determine technical efficacy and for procedural complications. Results : TBA using Hyper-Glide or Hyper-Form balloons (MicroTherapeutics, Irvine, CA) was successfully accomplished in 88.9% vasospastic segments (48 of 54), namely, in the distal internal carotid artery (100%, n=7), the middle cerebral artery (100%), including the M1 (n=10), M2 (n=10), and M3 segments (n=4), in the vertebral artery (100%, n=2), basilar artery (100%, n=1), and in the anterior cerebral artery (ACA), including the A1 (66%), A2 (66%), and A3 segments (100%). Vessel diameters significantly increased after TBA. There were no cases of vessel rupture or thromboembolic complications. GCS at one day after TBA showed an improvement in all patients except one. Conclusion : This study suggests that TBA using Hyper-Glide or Hyper-Form balloons is a safe and effective treatment for subarachnoid hemorrhage-induced cerebral vasospasm.

• The Journal of Internal Korean Medicine
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• v.28 no.4
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• pp.709-716
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• 2007

Objective : We present reference values of flow velocities of intracranial and extracranial cerebral arteries and relation with change factor. Method : We checked transcranial Doppler ultrasonography on mean velocity, systolic velocity, pulsatility index, and resistance index of 252 patients. We also compared differences of change factor. Result : The result showed a difference by sex and age and relevance between vessels besides mean velocity of vessels related with past history and social history. Conclusion : According to the above results, females showed higher velocity of all vessels. With advancing age, subjects showed reduction in velocity and increase in pulsatility index and resistance index. Anterior cerebral, middle cerebral, and posterior cerebral artery increased in proportion to velocity of internal carotid artery and basilar artery. Vessel velocity correlated with diabetes mellitus, hypertension and hyperlipidemia.

• Journal of Acupuncture Research
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• v.21 no.4
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• pp.207-215
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• 2004

Objective : In order to prove the effect of Hirudin Herbal-acupuncture this experimental studies were performed by using rats that had neuronal damage due to the Middle Cerebral Artery Occulsion(MCAO). Methods : Microdialysis probes were implanted into the coordinate of striatum of anesthetized rats which consist of sham-operated 8 rats, MCAO-operated 8 rats and Hirudin Herbal-acupuncture administrated 8 rats before MCAO operating. The Hirudin Herbal-acupuncture(0.5mg/kg) was administrated to rats 30 minutes before having an operation causing the MCAO. The surgical excision lead the cross resected brain to the acute ischemic state. The brain was sliced in 2mm thickness and stained with cresyl violet buffer for the measurement of cerebral infarcted area and volume. Results : Based on the result of the tissue inspection for the cerebral ischemic cell, Hirudin Herbal-acupuncture significantly protect neurocytes. Conclusion : We suggest Hirudin Herbal-acupuncture produces protective effects against the neuronal damage induced by MCAO. Therefore, Hirudin Herbal-acupuncture may prevent delayed neuronal death(DND) in selectively vulnerable focal areas of the brain effectively.