• 생물정신의학
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• 제2권2호
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• pp.157-168
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• 1995

The neuropsychiatric sequelae of traumatic brain unjury(TBI) are effects on complex aspect of behavior, cognition and emotional expression. They include psychiatric disorders such as depression, psychosis, personality change, dementia, and postconcussion syndrome. The damage is done not only to the cortex of the brain but also to subcortical and axial structures. The diffuse degeneration of cerebral white mailer is axonal damage that is caused by mechanical forces shearing the neuronal fiber at the moment of impact(diffuse axonal injury, DAI). The DAI and the changed receptor-agonist mechanism ore the most important mechanisms in genesis of neuropsychiatric sequalae by mild TBI. The most important instrument for diagnosis of neuropsychiatric sequalae of TBI is a physician or psychiatrist with experience and knowledge. The most effective therapeutic tool is a professional who understands the nature of the problem.

• 대한한방소아과학회지
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• 제19권1호
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• pp.25-33
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• 2005

Objectives : This study is to investigate the effects of oriental medical treatment of traumatic brain injury. Methods : We treated the patient with Herb medicine, acupuncture, moxa, fumigation, rubdown and negative and occupational therapy. And we evaluated the case with Modified Bathel Index, Activity Index, Jebsen Test. Results : There is improvement in his symptom (manual muscle power, finger apraxia, memory loss, dysarthria, urinary frequency), after oriental medical treatment. Conclusions : We report the good result of oriental medical treatment on this case. The more clinical study of oriental medical treatment for traumatic brain injury is needed.

• Journal of Trauma and Injury
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• 제33권4호
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• pp.227-235
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• 2020

Purpose: Alcohol intoxication is commonly associated with traumatic brain injury (TBI), but the influence of alcohol on the Glasgow Coma Scale (GCS) score remains unclear. This study investigates the effects of blood alcohol concentration (BAC) on the GCS score in head trauma patients with alcohol intoxication. Methods: In total, 369 head trauma patients with alcohol intoxication in a 1-year period were retrospectively analyzed. The patients underwent head computed tomography and had a BAC ≥80 mg/dL. Patients were divided into TBI and non-TBI groups. Brain injury severity was further classified using the head Abbreviated Injury Score (AIS). The effects according to 5 BAC groups were examined. Results: The TBI group consisted of 64 patients (16.2%). The mean BAC was significantly higher in the non-TBI group (293.4±87.3 mg/dL) than in the TBI group (242.8±89.9 mg/dL). The mean GCS score was significantly lower in the TBI group (10.3±4.6) than in the non-TBI group (13.0±2.5). A higher BAC showed a significant association with a lower mean GCS score in the TBI group, but not in the non-TBI group. Above ≥150 mg/dL, higher BACs showed significant odds ratios for a lower GCS score. Conclusions: The influence of alcohol in patients with head trauma depended on the presence of a brain injury. An association between a higher BAC and a lower GCS score was only observed in patients with TBI. Therefore, if a severe brain injury is suspected based on a GCS evaluation in patients with alcohol intoxication, prompt diagnosis and intensive care should be performed without delay.

• Journal of Trauma and Injury
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• 제19권1호
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• pp.8-13
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• 2006

Purpose: Traumatic head injury is very common in the emergency room. Early diagnosis and treatment can significantly reduce mortality and morbidity. When diagnosis is delayed, however, it could be critical to the patients. In reality, it is difficult to take a brain CT for all patients with head trauma, so this study examined the relationship between type and size of scalp injury and intracranial injury. Methods: This prospective study was conducted from May 2005 to July 2005. The participants were 193 patients who had had a brain CT. Head trauma included obvious external injury or was based on reports of witnesses to the accident. Children under three years of age were also included if there was a witness to the accident. The size of the injury was measured based on the maximum diameter. Results: Out of the total of 193 patients, patients with scalp bleeding totaled 126 (65.2%), and patients without scalp bleeding totaled 67 (34.8%). Among patients with scalp bleeding, patients with intracranial injuries numbered nine, and among patients without scalp bleeding, patients with intracranial injuries numbered 17 (P=0.001). Among patients who showed evidence of scalp swelling with no scalp bleeding, the relationship between the size of the scalp swelling and intracranial injury was statistically significant when the size of the scalp swelling was between 2 cm and 5 cm. Conclusion: Among patients who visit an emergency medical center due to traumatic head injury, patients with no scalp bleeding, but with scalp swelling between 2 cm and 5 cm, should undergone more accurate and careful examination, as well as as a brain CT.

• 대한한의학회지
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• 제29권2호
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• pp.21-31
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• 2008

Backgrounds: Singihwan is used "to strengthen inborn energy" and we suspected a protective effect on brain neuron cells. Objectives: The aim of this study was to evaluate the effects of Singihwan (SGH) on traumatic brain injury-induced delayed apoptosis in rat hippocampal dentate gyrus. Methods: For a surgical induction of traumatic brain injury (TBI), a 5 mm diameter stainless rod was used to make traumatic attack from the surface of the brain used by an impactor. The protective effect of the aqueous extract of SGH against TBI in the rat hippocampal dentate gyrus was investigated by using step-down avoidance task, terminal deoxynucleotidyl transferase (TdT)-mediated dUTP nick end labeling (TUNEL) assay, Bax immunohistochemistry, and 5-bromo-2'-deoxyuridine (BrdU) immunohistochemistry. Results: The aqueous extract of SGH suppressed the TBI-induced increase in apoptosis and cell proliferation in the hippocampal dentate gyrus. Conclusions: It is possible that the aqueous extract of SGH has a neuroprotective effect on TBI-induced neuronal cell death.

• 생약학회지
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• 제31권4호
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• pp.373-382
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• 2000

This study was performed to investigate the antithrombotic activity and protective effect of hexane fraction of Kamihyulbuchukeotang (KHCTH) on brain injury by KCN and MCA occlusion a prescription of HCT added with Lumbricus and Notoginseng Radix. Experiemental parameters are brain ischemia by MCA occlusion assay, KCN-induced brain injury, pulmonary thrombosis and platelet aggregation assay. The results were summarized as follows; 1. KHCTH extracts significantly inhibited the duration of KCN-induced coma (67%) and mortality (80%). 2. KHCTH extracts significantly suppressed brain ischemic area and edema following MCA occlusion and protected neuron cells as compared with control data. 3. KHCTH extracts inhibited pulmonary thrombosis induced by collagen and epinephrine. 4. KHCTH extracts inhibited platelet aggregation induced by collagen, ADP as agonist up to 76.9% and 32.3% respectivey at 1 mg/ml more effective than water extract of KHCT These data suggested that KHCTH could be applied as the protector of brain ischemia and injury and antithrombotic agent.

• 대한영상의학회지
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• 제81권5호
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• pp.1184-1193
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• 2020

목적 뇌량 미세출혈이 저산소 뇌 손상과 상관관계가 있는지 알아보고자 하였다. 대상과 방법 임상적으로 진단된 27명의 저산소 뇌 손상 환자군을 대상으로 후향적으로 연구를 진행하였다. 나이와 성별을 매칭한 대조군과 Fisher's exact test로 동반 질환, 뇌 미세출혈 유무를 비교하였다. 환자군은 뇌량 미세출혈의 유무로 나누어 비교하였다. Fisher's exact test로 두 그룹 간의 저산소 뇌 손상의 전형적인 자기공명영상 특징 유무, 심폐소생술 유무, 예후 정도를 비교하였고, Mann-Whitney U test로 저산소 뇌 손상 사건 발생 후 자기공명영상 획득까지의 시간 간격을 비교하였다. 결과 환자군에서 뇌 미세출혈은 29.6%에서 보였으며, 이는 대조군의 3.7%보다 통계적으로 유의하게 높았다(p = 0.012). 환자군에서의 모든 뇌 미세출혈은 뇌량에 국한됐다. 비뇌량 미세출혈군과 비교하여, 뇌량 미세출혈군은 좋은 예후를 보이는 경우가 많았고(6/8 vs. 11/19), 저산소 뇌 손상의 전형적인 자기공명영상 특징을 작은 비율에서 보이며(2/8 vs. 10/19), 심폐소생술이 많은 비율에서 시행됐으나(6/8 vs. 12/19) 통계적 유의성을 보이진 못하였다(p = 0.35, p = 0.19, p = 0.45, respectively). 결론 뇌량 미세출혈은 저산소 뇌 손상을 시사하는 부수적인 자기공명영상 특징이 될 수 있겠다.

• Journal of Korean Biological Nursing Science
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• 제23권3호
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• pp.217-226
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• 2021

Purpose: The aim of this study was to investigate the risk factors for brain reperfusion injury in ischemic stroke patients and to analyze the clinical outcomes. Methods: A retrospective study was conducted in 168 patients who underwent mechanical thrombectomy. The data were analyzed using descriptive statistics, t-test, Mann-Whitney U test, Chi-Square test, Fisher's exact test, and logistic regression with IBM SPSS/WIN 24.0. Results: Brain reperfusion injury occurred in 67 patients (39.9%) with a low favored outcome (𝛘²=6.01, p=.014). On multivariable analysis, blood urea nitrogen (Odds ratio [OR]=1.14, 95% Confidence interval [CI]=1.06-1.23), aphasia (OR=6.16, CI=1.62-23.40), anosognosia (OR=4.84, CI=1.13-20.79), presence of both aphasia and anosognosia (OR=7.33, CI=1.20-44.60), and time required to achieve targeted blood pressure (OR=1.00, CI=1.00-1.00) were identified as risk factors for brain reperfusion injury. A statistically significant difference was detected in clinical outcomes, including hemorrhagic transformation (𝛘²=6.32, p=.012), intensive care unit length of stay (Z=-2.08, p=.038), National Institute of Health Stroke scale score at discharge (Z=-3.14, p=.002), and modified Rankin Scale score at discharge (Z=-2.93, p=.003). Conclusion: This study identified the risk factors and presented the clinical outcomes of brain reperfusion injury. It is necessary to consider these risk factors for evaluating the patients and to establish nursing interventions and strategies.

• 대한핵의학회지
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• 제26권1호
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• pp.26-32
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• 1992

Minimal deterioration of cerebral perfusion or microanatomical changes were undetectable on conventional Brain CT or MRI. So evaluation of focal functional changes of the brain parenchyme is essential in chronic head injury patients, who did not show focal anatomical changes on these radiological studies. However, the patients who had longstanding neurologic sequelae following head injury, there had been no available imaging modalities for evaluating these patients precisely. Therefore we tried to detect the focal functional changes on the brain parenchyme using $^{99m}Tc-HMPAO$ Brain SPECT on the patients of chronic head injuries. Twenty three patients who had suffered from headache, memory dysfunction, personality change and insomnia lasting more than six months fellowing head injury were included in our cases, which showed no anatomical abnormalities on Brain CT or MRI. At first they underwent psychological test whether the symptoms were organic or not. Also we were able to evaluate the cerebral perfusion changes with $^{99m}Tc-HMPAO$ Brain SPECT in 22 patients among the 23, which five patients were focal and 17 patients were nonfocally diffuse perfusion changes. Thus we can predict the perfusion changes such as local vascular deterioration or functional defects using $^{99m}Tc-HMPAO$ Brain SPECT in the patients who had suffered from post-traumatic sequelae, which changes were undetectable on Brain CT or MRI.

• Journal of Trauma and Injury
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• 제22권2호
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• pp.134-141
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• 2009

Purpose: Patients with traumatic brain injury (TBI) were referred from other hospitals for further management. In addition, patients routinely underwent computed tomography examinations of the head (HCT) in the referral hospitals. The purpose of this study was to evaluate retrospectively the utility of routine HCT scans according to the severity of TBI. Methods: Patients with TBI referred to our hospital between December 2005 and July 2008 were included in this study. We investigated HCT findings, indications for repeat HCT examinations (routine versus a neurological change), and neurosurgical interventions. The head injury severity was divided into three categories according to the Glasgow Coma Scale (GCS) score, including mild, moderate, and severe TBI. The use of neurosurgical interventions between patients who underwent routine HCT scans and patients who underwent HCT scans for a neurological change were compared according to the severity of TBI. Results: A total of 81 patients met the entry criteria for this study. Among these patients, 67%(n=54) of the patients underwent HCT scans on a routine basis, whereas 33%(n=27) of the patients underwent HCT scans for a neurological change. A total of 21 patients showed signs of a worsening condition on the HCT scans. Neurosurgical intervention was required for 23(28.4%) patients. For patients who underwent routine HCT examinations, no patient with mild TBI underwent a neurosurgical intervention. However, one patient with moderate TBI and three(13%) patients with severe TBI underwent neurosurgical interventions. The kappa index, the level of agreement for HCT indications of intervention and referral reasons for intervention, was 0.65 for high hierarchy hospitals and 0.06 for low hierarchy hospitals. Conclusion: Routine serial HCT examinations in the referred hospitals would be useful for patients with severe head injury and for patients from low hierarchy hospitals where no emergency physicians or neurosurgeons are available.