• The Korean Journal of Pain
• /
• 제11권2호
• /
• pp.346-349
• /
• 1998

The technique of the stellate ganglion block is widely used as it is relatively simple and safe. But it can cause severe complications because there are major blood vessels and nerves around the stellate ganglion. We practiced CPR because of the respiratory failure caused by severe hematoma in the neck following the stellate ganglion block. A 46-year-old male patient admitted to ENT department because of the both sudden sensorineural hearing loss that happened after URI. He was referred to Pain Clinic for further evaluation and treatment. We decided to block the stellate ganglion. We injected 6ml of 0.5% mepivacaine on both sides of the stellate ganglion. There were no blood aspiration and abnormal vital signs during the 30 minute observation, either. Three hours after he went to the private room, he had pain and edema in his neck, but no respiratory defficulty. But later, respiratory failure was suddenly followed. So we practiced CPR. We confirmed severe hematomas in the neck through CT scanning. Hematomas is removed and the ruptured blood vessels which is supposed to be muscular branch of vertebral artery is ligated under general anesthesia. The patient was discharged from hospital after the treatment of pneumonia and duodenal ulcer as complications. We recommand you to compress the block site more than five minutes and not to prick with the needle several times at one point to prevent the formation of hematomas.

• Journal of Korean Neurosurgical Society
• /
• 제29권1호
• /
• pp.95-100
• /
• 2000

Objective : Posterior transarticular screw fixation is known to be one of the best surgical method for the atlantoaxial instability. We assessed the complication and operative risk in 15 patients. Patients and Methods : Between January 1997 and April 1998, 15 patients suffering from this condition were admitted to our institution. Atlantoaxial instability was caused by C1 or C2 fractures in 11, rheumatoid arthritis in 2, and os odontoideum in 2. This technique was used in the treatment of 13 patients and 2 patients was used in sublaminar wire fixation only. Bilateral C1-C2 screws were placed in 11 patients ; 2 patients had only one screw placed becauce of an anomalous vertebral artery and axial destruction. Follow-up period ranged from 5 to 20 months. Results : Most screws were positioned satisfactorily. One screw was malpositioned. No patients had neurological complications. Conclusion : Rigidly fixating C1-C2 instability with transarticular screws showed a significantly higher fusion rate than that achieved using wired grafts alone. The risk of screw malpositioning and catastrophic vascular or neural injury is small and can be minimized by assessing the position of the transverse foramen on preoperative computed tomographic scans and by correctly using intraoperative fluoroscopy and surgeon's precaution.

• 사상체질의학회지
• /
• 제13권2호
• /
• pp.182-189
• /
• 2001

If the proximal portion of the fourth segment of the vertebral onery is occluded before the posterior inferior cerebellar artery branch, ischemia usually affects the lateral medulla oblongata or the ipsilateral side of the cerebellum. The lateral medullary syndrome(wallenberg syndrome) resulting from occlusion in this area is common. 62 years old male who has swallowing difficulty, dizziness and diagnosed as the lateral medullary syndrome(wallenberg syndrome) is admitted in Wonkwang university oriental medical hospital Kwangju. We have diagnosed him as Taeumin and treated by east integrated therapy. We classified this as Taenmin-liyoiljung(太陰人 裏熱症) and prescribed chungsimyoinjatang(淸心蓮子湯) to the principle of cheongganjoyoil(淸肝燥熱). In the result, we had the improvement of the symptoms. This report described the process and contents about the way the patient was cured.

• Investigative Magnetic Resonance Imaging
• /
• 제9권2호
• /
• pp.94-100
• /
• 2005

목적 : 뇌혈관 평가에 있어서 경두개 도플러 초음파(transcranial doppler; TCD)와 고식적 뇌혈관조영술(CA)과 비교하여 3T 장비를 이용한 Time-of-flight(TOF) 자기공명 뇌혈관 조영술(3T-TOF MRA)의 유용성에 대해 알아보고자 하였다. 대상 및 방법 : 뇌혈관 질환이 의심된 54명의 환자를 대상으로 3T-TOF MRA를 시행하였다. 54명 모두에서 TCD를 시행하였으며, 이중 11명은 CA를 함께 시행하였다. 뇌혈관의 평가를 위해 추골동맥과 기저동맥을 포함하여 I군, 총경동맥의 분지부위 2 cm 전부터 내 외경동맥 분지 부위에서 내경동맥의 무릎(genu)부위 까지를 II군, 내경동맥의 추체부위에서 전 중 대뇌동맥의 1차분지 부위까지를 III군, 그리고 각각 전 중 대뇌동맥 1차분지 그 이하 부위를 IV군으로 임의로 구분하였다. 평가는 2명의 방사선과 의사가 3T-TOF MRA와 TCD, 그리고 CA의 결과를 모르는 상태에서 각 군에서 혈관의 양상이 잘 나타나는 경우를 3점, 양상이 잘 나타나지 않으나 판독이 가능한 경우를 2점, 잡상 등으로 혈관의 평가가 어려운 경우를 1점으로 하였다. 혈관의 협착 정도에 대한 평가는 TCD 및 CA와 각각 비교하여 그 일치 정도를 평가하였다. 결과 : 각 군당 좌우를 합하여 108 혈관분절, 총 432 혈관분절을 평가하였다. 정성평가에서 I, II, III, IV군은 각각 2.98, 2.96, 2.91, 2.88로 혈관의 양상에 대한 파악은 잘 되는 것으로 나타났다. TCD만을 시행한 43명 중 41명에서 3T-TOF MRA와 TCD가 일치하였고, TCD와 CA를 모두 함께 시행한 11명에서는 3T-TOF MRA가 TCD 및 CA와 모두 일치하였다. 결론 : 3T-TOF MRA는 뇌혈관 평가에 있어서 CA 및 TCD와 비교해서 빠르고 비침습적이며 혈관상태를 적절하게 평가할 수 있는 유용한 검사라고 생각한다.

• 대한한방내과학회지
• /
• 제25권3호
• /
• pp.418-426
• /
• 2004

Objectives : This study was designed to research whether transcranial doppler ultrasound(TCD) can yield a suitable diagnosis or prognosis for dizziness. Methods : To evaluate the blood flow, we measured the mean velocity(Vm), peak systolic velocity(Vs) and pulsatility index(PI) of the middle cerebral artery(MCA), vertebral artery(VA) and basilar artery(BA) in 54 dizziness patients and 44 normal subjects. To investigate the difference between dizziness patients and normal subjects, we selected 54 dizziness patients diagnosed normal by Brain MRI, and 44 normal subjects who did not have any symptoms of hyperlipemia, hypertension, diabetes melitus, heart disease, or smoking, diagnosed normal by Brain MRI. 30-69 year olds were divided into 30-49 year olds, 50-59 year olds and 60-69 year olds. Results : In normal subjects, there was a significantly higher Vm, Vs in the MCA and BA, and Vs in the VA of female subjects, and there was a significant difference in PI in the MCA and BA increasing with age. In comparison with normal subjects, dizziness patients had a significantly lower Vm in the BA. Male dizziness patients had significantly lower PI in the MCA. 30-49 year olds had significantly lower Vm in the BA. Conclusions : The significant difference in blood flow velocities in the BA between dizziness patients and normal subjects suggests that dizziness is related to blocking of blood flow in the BA and that diagnosis and prognosis can be made through TCD. More detailed study of dizziness patients will be needed.

• 대한방사선기술학회지:방사선기술과학
• /
• 제33권3호
• /
• pp.223-230
• /
• 2010

본 연구에서는 MRI와 MRA를 이용하여 우리나라 사람의 뇌혈관 질환 중 뇌혈관의 파열에 의한 뇌혈관 질환을 제외하고 뇌혈관이 좁아지거나 막힌 허혈성 뇌혈관 질환의 분포(호발부위)를 분석하여 임상에서 활용할 수 있도록 하였다. 뇌혈관이 좁아지거나 막힌 허혈성 뇌혈관 질환만의 분포를 분석한 이유는 뇌혈관의 파열에 의한 출혈성 뇌혈관 질환과 뇌경색(brain infarction) 등 허혈성 뇌혈관 질환의 발생학적 기전(mechanism)이 다르기 때문이며 그 결과는 아래와 같다. 1. 연구대상자 총 626명 중 성별로는 남자가 55.0%로 여자 45.0%보다 높은 분포를 보였다. 2. 위치별 허혈성 뇌혈관 질환의 분포에서 우측 뇌혈관이 37.5%로 가장 많았으며, 좌측 뇌혈관 35.1%, 양쪽 뇌혈관 27.3% 순으로 나타났다. 3. 허혈성 뇌혈관 질환의 뇌혈관 별 분포는 ICA가 38.9%로 가장 많았으며, 다음으로 MCA 35.7%, PCA 13.4%, ACA 6.0%, VA 3.3% 순으로 나타났다. 4. A-com에 질환이 있는 경우는 한 명도 없었으며 P-com 에도 남자 1명만이 발생했다. 5. MCA에는 여자가 54.6%로 남자 42.2%보다 많아, 성별에 따라 통계적으로 유의미한 차이를 보였다($x^2$=9.64, p < .01). 6. ICA에서는 남자가 56.4%로 여자 46.8%보다 많아 통계적으로 유의미한 차이를 보였다($x^2$=5.71, p < .05). 7. BA에서도 남자가 2.3%로 여자 0.4%보다 많아 성별에 따라 유의미한 차이를 보였다($x^2$=4.25, p < .05). 8. 연령에 따른 혈관별 질환의 분포에 대한 차이는 없었으며 협착과 폐색의 분포에서는 폐색보다 협착이 많았다.

• 대한디지털의료영상학회논문지
• /
• 제13권2호
• /
• pp.83-90
• /
• 2011

To prospectively determine the diagnostic performance a combination of standard bolus-chase magnetic resonance (MR) angiography and MR angiography with time-resolved imaging of contrast kinetics (TRICKS) for depicting severity of the head and neck vascular diseases. Over a period of two months, A total of 100 patients(average ages : $50{\pm}8$, male : 60, female : 40) with head and neck vascular diseases were performed on the GE excite 3.0 T units with 8-channel head coil and 4-channel NV coil. Imaging parameters for a typical study were as follow: SBC(TR/ TE/ FA/ SliceThicken./ Slab/ Freq./ FOV/ BW/Scan Time) = 5.4/ min/ 30/ 2/ zip2/ 70/ $224{\times}448$/ 30/ 62.50/ 28, TRICKS(TR/ TE/ FA/ Slice Thicken/Slab/ Freq./ FOV/ BW/ Temp Res./ Scan Time = 3.6/ min/ 25/ 4/ 30/ $160{\pm}384$, zip512/ 30/ 100/ 1 to 1.5/ 23). The analysis of all MR images, which have respect-ively classified two techniques into some diseases. The results of the former were divided into two groups(SBC, TRICKS)with 4 grading of two reader, respectively. Wilcoxon signed rank test was used to determine if a significant difference between imaging techniques existed(p < 0.05). In 33 of 100 patients, arterio-venous malformation was 11% at TRICKS, subclavian vein stenosis : 8%, fistular sinus : 4%, jugular vein stenosis:6%, Middle Cerebral Artery bypass surgery : 4%, p < 0.05). The rest of 67 patients were considered as the results of SBC(14% in the basilar artery stenosis, carotid stenosis : 16%, vertebral stenosis : 17%, central neuro-cytoma : 5%, meningioma : 5%, Not appliable : 10%, p < 0.05). Sensitivity and specificity of TRICKS MR angiography in SVS, FS, JVS, MCABS were improved compared with those at standard MR angiography. In SBS MR angiography which were improved in BAS, CS, VS, CN, Meningioma. In conclusion, TRICKS MR angiography of the SVS, FS, JVS, MCABS is superior to standard MR angiography regarding the number of diagnostic grading. The SBS MR angiography were improved in BAS, CS, VS, CN, Meningioma. and assessment of the degree of luminal narrowing on both TRICKS and SBS.

• 대한임상검사과학회지
• /
• 제49권3호
• /
• pp.316-321
• /
• 2017

빗장밑혈류빼앗김증후군은 좌측 몸쪽부분 빗장밑동맥 혹은 팔머리동맥에 심한 혈관 협착이나 폐색이 원인이 되어 발생한다. 병변이 있는 부위에서는 제한적이며, 불충분한 혈류가 발생하여 반대쪽으로부터 연결혈관을 통해 일부 혈액이 유입될 수 있다. 이러한 현상을 빗장밑혈류빼앗김현상이라고 한다. 이중초음파검사는 빗장밑혈류빼앗김현상을 측정하는데 유용한다. 빗장밑혈류빼앗김현상을 보이는 일부 환자에서는 척추뇌바닥혈류부전 혹은 허혈성 말초동맥질환 증상을 호소한다. 빗장밑혈류빼앗김증후군은 빗장밑혈류빼앗김현상과 더불어 신경학적 증상이 반드시 동반될 경우로 정의할 수 있다. 저자는 팔머리동맥의 심한 협착을 보이는 환자에서 척추동맥과 더불어 바깥목동맥과 전방순환계를 담당하는 온목동맥 및 속목동맥에서 이중초음파검사를 이용한 혈류빼앗김현상이 관찰된 증례를 보고하고자 한다.

• Journal of Korean Neurosurgical Society
• /
• 제37권3호
• /
• pp.201-206
• /
• 2005

Objective: To evaluate the accuracy and safety of C1-C2 transarticular screw insertion, we retrospectively review surgical records and postoperative radiological findings. Methods: From January 2001 to October 2003, the C1-C2 transarticular screw fixation and posterior wiring with iliac bone grafts was performed in 16 patients. 6 patients had rheumatoid arthritis which caused cervical instability, 3 patients had os odontoideum, 3 patients had type 2 odontoid process fracture, 3 patients had traumatic transverse ligament injury and 1 patients who had been managed with C1-C2 wire fixation had psoriatic arthritis. Results: Osseous fusion was documented in 15 patients(93.8%). Only one patient was recorded screw loosening because of postoperative infection. One patient had only one screw placed because of abnormal anatomical structure, one patients was breakage of a Kirschner wire, and one screw was medial location to lateral mass of C1, but clinical results was excellent and radiological instability was not noted. Conclusion: The author's experience demonstrates that C1-C2 transarticular screw fixation with wired bone graft is a safe procedure with higher fusion rate but precaution is needed to avoid the neural damage, vertebral artery injury, and hardware failure.

• Journal of Korean Neurosurgical Society
• /
• 제53권4호
• /
• pp.223-227
• /
• 2013

Objective : Although there is no consensus on the ideal treatment of the craniocervical instability, biomechanical stabilization and bone fusion can be induced through occipito-cervical fusion (OCF). The authors conducted this study to evaluate efficacy of OCF, as well as to explore methods in reducing complications. Methods : A total of 16 cases with craniocervical instability underwent OCF since the year 2002. The mean age of the patients was 51.5 years with a mean follow-up period of 34.9 months. The subjects were compared using lateral X-ray taken before the operation, after the operation, and during last follow-up. The Nurick score was used to assess neurological function pre and postoperatively. Results : All patients showed improvements in myelopathic symptoms after the operation. The mean preoperative Nurick score was 3.1. At the end of follow-up after surgery, the mean Nurick score was 2.0. After surgery, most patients' posterior occipito-cervical angle entered the normal range as the pre operation angle decresed from 121 to 114 degree. There were three cases with complications, such as, vertebral artery injury, occipital screw failure and wound infection. In two cases with cerebral palsy, occipital screw failures occurred. But, reoperation was performed in one case. Conclusion : OCF is an effective method in treating craniocervical instability. However, the complication rate can be quite high when performing OCF in patients with cerebral palsy, rheumatoid arthritis. Much precaution should be taken when performing this procedure on high risk patients.