• Journal of Korean Neurosurgical Society
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• 제30권3호
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• pp.384-388
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• 2001

A 51-year-old woman presented with sudden severe headache, vomiting, and right hemiparesis at first admission. Computed tomography(CT) scans revealed an hemorrhagic density at left basal ganglia. Preoperative cerebral angiography showed no vascular lesion. Under the diagnosis of hypertensive intracerebral hemorrhage(ICH), total extirpation of hematoma was done. The postoperative neurological condition improved gradually and discharged without any neurological sequelae. Two months later, she revisited with headache, vomiting and progressive right hemiparesis. CT scans at second admission showed an irregular rim enhanced mass with central low density with surrounding edema at the initial bleeding area. Repeated craniotomy was performed and the mass was partially removed. The histopathological diagnosis of the specimen was confirmed as glioblastoma. The authors report a glioblastoma, which occurred at initial ICH site and regarded as a brain abscess with literature review.

• The Korean Journal of Physiology and Pharmacology
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• 제1권2호
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• pp.151-159
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• 1997

In an attempt to investigate whether hemorrhage affects the gene expression of the renin-angioteusin system (RAS) components in the brain and peripheral angiotensin-generating tissues, changes in mRNA levels of the RAS components in response to hemorrhage were measured in conscious unrestrained rats. Wistar rats were bled at a rate of 3 ml/kg/min for 5 min, and then decapitated 7 h after hemorrhage. Levels of mRNA for renin, angiotensinogen and angiotensin $II-AT_1$ receptor subtypes ($AT_{1A}$ and $AT_{1B}$) were determined with the methods of northern blot and reverse transcriptase-polymerase chain reaction (RT-PCR). Hemorrhage produced a profound hypotension with tachycardia, but blood pressure and heart rate recovered close to the basal level at 7 h. Plasma and renal renin levels were significantly increased at 7 h. Hemorrhage induced rapid upregulation of gene expression of both $AT_{1A}$ and $AT_{1B}$ receptor subtypes in the brainstem and hypothalamus, downregulation of them in the adrenal gland and liver. However, renin mRNA level increased in the brainstem, decreased in the liver, but was not changed in the hypothalamus, kidney and adrenals after hemorrhage. Angiotensinogen mRNA level was not significantly changed in any of the tissue except a slight increase in the liver. The kidney and liver did not show any significant change in gene expression of the RAS components. These results suggest that gene expression of the RAS in central and peripheral tissues are, at least in part, under independent control and the local RAS in each organ plays specific physiologic role.

• Journal of Korean Neurosurgical Society
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• 제53권2호
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• pp.118-120
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• 2013

We report a rare case of remote cerebellar hemorrhage after intradural disc surgery at the L1-2 level. Two days after the spine surgery, patient complained unexpected headache, dizziness, nausea and vomiting. From the urgently conducted brain CT, it was reported that the patient had cerebellar hemorrhage. Occipital craniotomy and hematoma evacuation was performed, and hemorrhagic lesion on the right cerebellum was effectively removed. After occipital craniotomy, the patient showed signs of improvement on headache, dizziness, nausea and vomiting. He was able to leave the hospital after two weeks of initial operation without any neurological deficit. Remote cerebellar hemorrhage following spinal surgery is extremely rare, but may occur from dural damage of spinal surgery, accompanied with cerebrospinal fluid leakage. Early diagnosis is particularly important for the optimal treatment of remote cerebellar hemorrhage.

• Advances in pediatric surgery
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• 제1권1호
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• pp.63-67
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• 1995

Although bleeding was reported before as the first symptom in a few cases of biliary atresia, this association is not generally known. We treated 115-day-old female with extrahepatic biliary atresia presented with subdural hemorrhage rather than with prolonged jaundice. Four years after craniectomy and Kasai's hepatic portojejunostomy, she looks happy without jaundice nor brain damage sequela even though she had recent episode of esophageal variceal bleeding.

• Neonatal Medicine
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• 제25권1호
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• pp.1-6
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• 2018

Extremely low birth weight infants remain at increased risk of intraventricular hemorrhage from the fragile vascular bed of the germinal matrix; the roles of hypotension (ischemia) and reperfusion (hyperemia) in the development of intraventricular hemorrhage are still debated. Cerebrovascular pressure autoregulation protects the brain by maintaining constant cerebral blood flow despite changes in blood pressure. The ontogeny of cerebrovascular pressure autoregulation has not been well established and uncertainty remains about the optimal arterial blood pressure required to support brain perfusion. Another important aspect of premature cerebral hemodynamics is the critical closing pressure--the arterial blood pressure at which cerebral blood flow ceases. Interestingly, in premature infants, the critical closing pressure approximates the mean arterial blood pressure. Often in this unique population, cerebral blood flow occurs only during systole when the diastolic arterial blood pressure is equal to the critical closing pressure. Moreover, the diastolic closing margin, a metric of cerebral perfusion that normalizes diastolic arterial blood pressure to the critical closing pressure, may be a better measure than arterial blood pressure for defining cerebral perfusion in premature infants. Elevated diastolic closing margin has been associated with intraventricular hemorrhage. This review summarizes the current state of understanding of cerebral hemodynamics in premature infants.

• Investigative Magnetic Resonance Imaging
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• 제3권2호
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• pp.167-172
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• 1999

목적 : Echo planar image (EPn와 다론 MR 영상기법에서 2시간 이내의 초급성 출혈의 발견율의 차이를 비교해 보고자 한다. 대상 및 방법 : 인위적으로 뇌출혈을 유발시킨 백서 10마리를 대상으로 EP1, 급속 스핀에코 (FSE) T2 강조영상, Fluid attenuated inversion recovery (FLAIR) 영상, 스펀에코 (SE) Tl 강조영상과 Tl 강조 Gradient echo (GE) 영상을 이용하여, 뇌출혈을 일으킨 2시간 후에 MR 촬영을 하였다. 추가적으로 3마리는 출혈 30분 후에, 6마리는 1시간 후에 각각 EPI와 FSE T2 강조영상을 얻었다. 얻어진 영상에 대한 주관적인 시각적 평가를 하기위하여 세명의 방사선과 의사가 출혈 병변이 어느 MR 영상 기법에서 제일 잘 보이는지를 평가하였다. 정량적인 평가 로는 병변-정상 뇌설질의 대조잡음비(contrast-to-noise ratio, CNR)를 측정하였다. 통계처리는 Wilcoxon-Ranks test를 이용하였다. 결과 : 시각적 평가에서 출혈 병변이 높은 신호강도로 나타난 EP1, FLAIR, FSE T2 영상 중 EPI 영상이 특히 높은 신호강도로 나타나 제일 쉽게 병변이 구별되었다. 정량적인 평가에서 출혈 병 변-정상 뇌설질의 CNR은 EPI와 FLAIR 영상에서 다른 세 영상기법에 비해 통계적으로 유의하게 우월하였다 (p<0.01). 그러나 EPI와 FLAIR 영상간의 CNR은 동계적으로 유의한 차이가 없었다 (p>0.10). 추가적으로 출혈 30분과 1l시간 후 촬영한 모두에서 EPI영상과 FSE T2 강조 영상은 정상에 비해 높은 신호강도를 보여 병변의 구별이 가능하였다. 결론 : 백서에서 유발시킨 초급성기 뇌출혈의 여러 기법의 MR 영상 중 EPI 영상이 영상획득 시간이 가장 빠르면서 시각적 평가와 정량적 평가에서 출혈의 발견율이 가장 높아 출혈의 선속한 진단에 유용할 것으로 생각된다.

• Journal of Korean Neurosurgical Society
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• 제63권6호
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• pp.689-697
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• 2020

Objective : Cerebral edema is the predominant mechanism of secondary inflammation after intracerebral hemorrhage (ICH). Pioglitazone, peroxisome proliferator-activated receptor gamma agonist has been shown to play a role in regulation of central nervous system inflammation. Here, we examined the pharmacological effects of pioglitazone in an ICH mouse model and investigated its regulation on NLRP3 inflammasome and glucose metabolism. Methods : The ICH model was established in C57 BL/6 mice by the stereotactical inoculation of blood (30 µL) into the right frontal lobe. The treatment group was administered i.p. pioglitazone (20 mg/kg) for 1, 3, and 6 days. The control group was administered i.p. phosphate-buffered saline for 1, 3, and 6 days. We investigated brain water contents, NLRP3 expression, and changes in the metabolites in the ICH model using liquid chromatography-tandem mass spectrometry. Results : On day 3, brain edema in the mice treated with pioglitazone was decreased more than that in the control group. Expression levels of NLRP3 in the ICH model treated with pioglitazone were decreased more than those of the control mice on days 3 and 7. The pioglitazone group showed higher levels of glycolytic metabolites than those in the ICH mice. Lactate production was increased in the ICH mice treated with pioglitazone. Conclusion : Our results demonstrated less brain swelling following ICH in mice treated with pioglitazone. Pioglitazone decreased NLRP3-related brain edema and increased anaerobic glycolysis, resulting in the production of lactate in the ICH mice model. NLRP3 might be a therapeutic target for ICH recovery.

• 대한본초학회지
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• 제29권1호
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• pp.19-26
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• 2014

Objectives : This study was performed in order to evaluate the effects of Salviae Miltiorrhizae Radix (SMR) water extract against the cerebral hemorrhage and the blood-brain barrier (BBB) impairment in the intracerebral hemorrhage (ICH). Method : ICH was induced by the stereotaxic intrastriatal injection of bacterial collagenase type IV in Sprague-Dawley rats. SMR was orally given three times every 20 hours during 3 days after the ICH induction. Hematoma volume, water content of brain tissue and volume of evans blue leakage were examined. Myeloperoxidase (MPO) positive neutrophils and tumor necrosis factor-${\alpha}$ (TNF-${\alpha}$) were observed with immunofluorescence labeling and confocal microscope. Results : SMR significantly reduced the hematoma volume of the ICH-induced rat brain. SMR significantly reduced the water content of brain tissue of the ICH-induced rat brain. SMR reduced the percentage of the evans blue leakage around the hematoma on the caudate putamen compared to the ICH group, especially on the cerebral cortex. SMR significantly reduced the volume of the evans blue leakage level in the peri-hematoma regions of the ICH-induced rat brain. SMR significantly reduced MPO positive neutrophils in the peri-hematoma regions of the ICH-induced rat brain. SMR reduced the TNF-${\alpha}$ expression in peri-hematoma regions of the ICH-induced rat brain. TNF-${\alpha}$ immuno-labeled cells were coincided with MPO immuno-labeled neutrophils in peri-hematoma regions of the ICH-induced rat brain. Conclusion : These results suggest that SMR plays a protective role against the blood-brain barrier impairment in the ICH through suppression of inflammation in the rat brain tissues.

• Journal of Korean Neurosurgical Society
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• 제46권5호
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• pp.501-504
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• 2009

Remote cerebellar hemorrhage (RCH) is rare but potentially lethal as a complication of spinal surgery. We recently experienced a case of RCH in a 61-year-old man who showed mental deterioration after lumbar spinal surgery. There was dural tearing with subsequent cerebrospinal fluid (CSF) loss during the surgery. Brain computed tomography scan revealed cerebellar hemorrhage, 3rd and 4th ventricular hemorrhage and pneumocephalus. He underwent suboccipital craniectomy and hematoma removal. The most important pathomechanism leading to RCH after spinal surgery has been known to be venous bleeding due to caudal sagging of cerebellum by rapid leak of large amount of CSF which seems to be related with this case. Dural repair and minimizing CSF loss after intraoperative dural tearing would be helpful to prevent postoperative RCH.

• 대한수의학회지
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• 제22권1호
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• pp.31-36
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• 1982

This study was taken to clarify the clinical signs and macroscopical lesions of pigs naturally infected with hog cholera. The clinical and macroscopical observation on the natural cases of hog cholera and experimental cases inoculated with ALD Virus and isolated virus strains were carried out. The results obtained are as follow; In clinical inspection of the natural cases, diarrhea (73.1%) blotching of ear (50.0%), staggering (42.3%), erythema of skin (40.0%), constipation (38.5%), conjunctivitis (32.7%) and dyspnea (30.8%) were observed. Dyspnea, constipation and erythema of skin were observed mainly in the experimental cases, however, staggering and conjunctivitis in pigs infected with ALD virus were found and convulsion and hemorrhage of skin of pigs infected with isolated virus were seen, respectively. The gross lesions of natural cases were hemorrhage of lymph node (82.5%), enteritis and hemorrhage of large intestine (65.0%), splenic infarction (57.5%), pneumonia (55.0%), gastritis and hemorrhage (52.5%), cardiac hemorrhage (40.0%) and renal petechiation (37.5%), while in the experimental cases, hemorrhage of lymph node, pneumonia, gastritis and hemorrhage, enteritis and hemorrhage of laryge intestine and splenic infarction were seen mainly.