• Journal of Korean Neurosurgical Society
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• v.45 no.4
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• pp.240-242
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• 2009

Oculomotor nerve palsy (ONP) with subarachnoid hemorrhage (SAH) occurs usually when oculomotor nerve is compressed by growing or budding of posterior communicating artery (PcoA) aneurysm. Midbrain injury, increased intracranial pressure (lCP), or uncal herniation may also cause it. We report herein a rare case of ONP associated with SAH which was caused by middle cerebral artery (MCA) bifurcation aneurysm rupture. A 58-year-old woman with clear consciousness suffered from headache and sudden onset of unilateral ONP. Computed tomography showed SAH caused by the rupture of MCA aneurysm. The unilateral ONP was not associated with midbrain injury, increased ICP, or uncal herniation. The patient was treated with coil embolization, and the signs of oculomotor nerve palsy completely resolved after a few days. We suggest that bloody jet flow from the rupture of distant aneurysm other than PcoA aneurysm may also be considered as a cause of sudden unilateral ONP in patients with SAH.

• Proceedings of the KSME Conference
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• 2003.04a
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• pp.1930-1935
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• 2003

The aim of this study is to apply engineering modeling tools to examine hemodynamics such as blood flow patterns or shear stress distributions, in order to determine the link between hemodynamics and cerebral aneurysms. Image-Based Simulation is used to analyze the realistic middle cerebral artery constructed from computed tomography raw data. As a result of simulation, high wall shear stress is appeared at the bifurcated region. And existence of the recirculation flow at the inlet of bifurcation($D_2$) is predict to affect at the development of the cerebral aneurysm.

• Journal of Korean Neurosurgical Society
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• v.49 no.2
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• pp.102-106
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• 2011

Objective : Although there are several explanations for a duplicated middle cerebral artery (DMCA), its embryological origin is still an open question. We reviewed these anomalous vessels to postulate a theory of their different origins, sizes, and courses. Methods : A retrospective review of 1,250 cerebral angiographies, 1,452 computed tomography (CT)-angiographies, and 2,527 magnetic resonance (MR)-angiographies was performed to identify patients with DMCA. Results : Twenty-five patients had 25 DMCAs. Conventional angiography detected nine patients with DMCA (9/1250, 0.72%), MR-angiography detected seven patients with DMCA 0.28%), and CT-angiography detected nine patients with DMCA (9/1452, 0.62%). The DMCAs originated near the internal carotid artery terminal in eight patients (type A), and between the origin of the anterior choroidal artery and the terminal internal carotid artery in 17 patients (type B). The diameters of the eight type A DMCAs were the same or slightly smaller than those of the other branch of the DMCA. All type A DMCAs showed a course parallel to that of the other branch of the DMCA. The diameters of the 17 type B DMCAs were the same, slightly smaller, or very much smaller than that of the other branch of the DMCA. Nine type B DMCAs showed parallel courses, and the other eight curved toward the temporal lobe. Conclusion : The two branches of the type A DMCAs can be regarded as early bifurcations of the MCA. The branches of the type B DMCAs had parallel courses or a course that curved toward the temporal lobe. The type B DMCA can be regarded as direct bifurcations of the MCA trunk or the early ramification of the temporal branch of the MCA.

• Journal of Korean Neurosurgical Society
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• v.40 no.2
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• pp.131-134
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• 2006

The cerebral vasospasm after clipping surgery of unruptured aneurysm is uncommon. A 44-year-old man with unruptured left middle cerebral artery[MCA] aneurysm had clipping surgery. From the third postoperative day, he presented with drowsy mentality, dysphasia and right hemiparesis. Computed tomographic scans showed low density area in frontotemporal lobe and midline shift. Transfemoral cerebral angiography revealed severe vasospasm in supraclinoid internal carotid artery, anterior cerebral artery, and MCA on the operative side. We performed left frontotemporoparietal craniectomy and hypertensive-hypervolemic therapy. He recovered without neurological deficits but for dysphasia. Neurosurgeon should be alert to the possibility of vasospasm after clipping surgery even in case of unruptured cerebral aneurysm.

• Archives of Reconstructive Microsurgery
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• v.8 no.2
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• pp.170-175
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• 1999

Objective : Extracranial-intracranial(EC-IC) microvascular anastomosis was performed in 18 patients with hemodynamic cerebral ischemia and traumatic cerebral aneurysm, the aim of this retrospective study was to assess its value in neurosurgical field. Method : Of 18 cases, 17 case were hemodynamic cerebral ischemia and one was traumatic cerebral aneurysm. There were 14 superficial temporal artery(STA)-to-middle cerebral artery(MCA) anastomosis, 3 saphenous vein graft bypass(2 external carotid artery(ECA)-to-MCA, 1main trunk of the STA-to-MCA) and 1 radial artery bypass(ECA-to-MCA). Results : Bypass patency was confirmed by postoperative angiography in all cases except for two cases, postoperative cerebral blood flow of ischemic brain showed significant increased in all cases with good patency through bypass. Conclusion : Revascularization by EC-IC microvascular anastomosis to the ischemic brain eliminated ischemia and was associated with excellent good outcome and good patency rates.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.8 no.2
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• pp.5-17
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• 2002

The aim of study carried out to determine the effects of myofascial release on the cranial arteries velocity from November 11, 2001 to March 29, 2002 the objects were 10 patients who having the tension-type headache at H-hospital This research compared with measure the mean flow velocity middle cerebral artery, posterior cerebral artery, vertebral cerebral artery. Result obtain were as follows; 1. Middle cerebral artery blood velocity between pre treatment and after treatment for 10days experiment was significantly increased 9.76cm/s(p<0.05)in right, 4.88cm/s(p<0.05)in left. 2. Posterior cerebral artery blood velocity between pre treatment and after treatment experiment was difference 6.35cm/s(p<0.01)in right, 5.14cm/s(p<0.01)in left, between pre treatment and after treatment for 5days experiment was 11.48cm/s(p<0.01)in right, 10.74cm/s(p<0.01)in left, between pre treatment and treatment for 10days experiment was 12.92cm/s(p<0.001) in right, 12.68cm/s(p<0.001) in left. 3. Vertebral artery blood velocity between pre treatment and post treatment experiment was difference 4.48cm/s(p<0.05)in right, 6.10cm/s(p<0.05) in left, between pre treatment and after treatment for 5days experiment was 12.50cm/s(p<0.001)in right, 14.40cm/s(p<0.001)in left, between pre treatment and after treatment for 10days experiment was 14.70cm/s(p<0.001)in right, 13.90cm/s(p<0.001)in left.

• Journal of Korean Neurosurgical Society
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• v.54 no.4
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• pp.302-308
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• 2013

Objective : MR perfusion and single photon emission computerized tomography (SPECT) are well known imaging studies to evaluate hemodynamic change between prior to and following superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis in moyamoya disease. But their side effects and invasiveness make discomfort to patients. We evaluated the ivy sign on MR fluid attenuated inversion recovery (FLAIR) images in adult patients with moyamoya disease and compared it with result of SPECT and MR perfusion images. Methods : We enrolled twelve patients (thirteen cases) who were diagnosed with moyamoya disease and underwent STA-MCA anastomosis at our medical institution during a period ranging from September of 2010 to December of 2012. The presence of the ivy sign on MR FLAIR images was classified as Negative (0), Minimal (1), and Positive (2). Regions were classified into four territories: the anterior cerebral artery (ACA), the anterior MCA, the posterior MCA and the posterior cerebral artery. Results : Ivy signs on preoperative and postoperative MR FLAIR were improved (8 and 4 in the ACA regions, 13 and 4 in the anterior MCA regions and 19 and 9 in the posterior MCA regions). Like this result, the cerebrovascular reserve (CVR) on SPECT was significantly increased in the sum of CVR in same regions after STA-MCA anastomosis. Conclusion : After STA-MCA anastomosis, ivy signs were decreased in the cerebral hemisphere. As compared with conventional diagnostic modalities such as SPECT and MR perfusion images, the ivy sign on MR FLAIR is considered as a useful indicator in detecting brain hemodynamic changes between preoperatively and postoperatively in adult moyamoya patients.

• Molecules and Cells
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• v.20 no.3
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• pp.354-360
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• 2005

Neuronal damage subsequent to transient cerebral ischemia is a multifactorial process involving several overlapping mechanisms. Gangliosides, sialic acid-conjugated glycosphingolipids, reduce the severity of acute brain damage in vitro. However their in vivo effects on the cerebral cortex damaged by ischemic infarct are unknown. To assess the possible protective role of gangliosides we examined their expression in the cerebral cortex damaged by ischemic infarct in the rat. Ischemia was induced by middle cerebral artery (MCA) occlusion, and the resulting damage was observed by staining with 2, 3, 5-triphenylterazolium chloride (TTC). High-performance thin-layer chromatography (HPTLC) showed that gangliosides GM3 and GM1 increased in the damaged cerebral cortex, and immunofluorescence microscopy also revealed a significant change in expression of GM1. In addition, in situ hybridization demonstrated an increase in the mRNA for ganglioside GM3 synthase. These results suggest that gangliosides GM1 and GM3 may be synthesized in vivo to protect the cerebral cortex from ischemic damage.

• Journal of Korean Neurosurgical Society
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• v.44 no.5
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• pp.314-319
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• 2008

Objective: For patients with giant or dissecting aneurysm, multimodal treatment consisting extracranial-intracranial bypass surgery plus clip or coil for parent artery occlusion may be necessary. In this study, the safety and efficacy of multimodal treatment in 15 patients with complex aneurysms were evaluated retrospectively. Methods: From January 1995 to June 2007, the authors treated 15 complex aneurysms that were unable to be clipped or coiled. Among them, nine patitents had unruptured aneurysms and 6 had ruptured aneurysms. Aneurysms were located in the internal cerebral artery (ICA) in 11 patients (4 in the dorsal wall. 4 in the terminal ICA, 1 in the paraclinoid, and 2 in the cavernous ICA), in the middle cerebral artery (MCA) in 2, and in the posterior circulation in two patients Results: Fifteen patients with complex aneurysms were treated with bypass surgery previously. Thirteen patients were treated with external carotid middle cerebral artery (ECA-MCA) anastomosis, and one patient with superficial temporal to posterior cerebral artery (STA-PCA) and another patient with occipital artery to posterior inferior cerebellar artery (OA-PICA) anastomosis. Parent artery occlusion was then performed with a clip in 9 patients, with a coil in 4, with balloon plus coil in one patient. All 15 aneurysms were successfully treated with clip or coil combined with bypass surgery. Follow-up angiograms showed good patency of anastomotic site in 10 out of 11 patients, and perfusion study showed sufficient perfusion in 6 out of 9 patients. Conclusion: These findings indicate that for patients with complex aneurysms, clip or coil for parent vessel occlusion with additive bypass surgery can successfully exclude the aneurysm from the neurovascular circulatory system.

• The Journal of Korean Medicine
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• v.20 no.4
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• pp.82-92
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• 2000

The purpose of the present study was to explore the proper method for animal stroke model of Oriental medicine To this end, brain ischemia was induced by distal middle cerebral artery occlusion(dMCAO) and proximal middle cerebral artery occlusion(pMCAO) and evaluated with the method of Triphenyl Tetrazolium Chloride (TTC) staining and Swimming Behavior Test. Results demonstrated that first, infarct size and volume of pMCAO group were significantly bigger that those of dMCAO group. Second, analysis of swimming behavior test revealed that the percentage of left turning angles of pMCAO was significantly bigger than that of dMCAO. Third, during swimming behavior test, there were peculiar traces of small successive circles that represent motor dysfunction and conscious disturbance among dMCAO group. The results of the study thus indicate that non-invasive intraluminal method of pMCAO was the appropriate animal stroke model for Oriental medicine in the light of brain ischemia as hemiplesia and conscious disturbance.