• Journal of Korean Neurosurgical Society
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• 제60권6호
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• pp.730-737
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• 2017

Objective : Postoperative hydrocephalus is a common complication following craniectomy in patients with traumatic brain injury, and affects patients' long-term outcomes. This study aimed to verify the risk factors associated with the development of hydrocephalus after craniectomy in patients with acute traumatic subdural hemorrhage (tSDH). Methods : Patients with acute traumatic SDH who had received a craniectomy between December 2005 and January 2016 were retrospectively assessed by reviewing the coexistence of other types of hemorrahges, measurable variables on computed tomography (CT) scans, and the development of hydrocephalus during the follow-up period. Results : Data from a total of 63 patients who underwent unilateral craniectomy were analyzed. Postoperative hydrocephalus was identified in 34 patients (54%) via brain CT scans. Preoperative intraventricular hemorrhage (IVH) was associated with the development of hydrocephalus. Furthermore, the thickness of SDH (p=0.006) and the extent of midline shift before craniectomy (p=0.001) were significantly larger in patients with postoperative hydrocephalus. Indeed, multivariate analyses showed that the thickness of SDH (p=0.019), the extent of midline shift (p<0.001) and the coexistence of IVH (p=0.012) were significant risk factors for the development of postoperative hydrocephalus. However, the distance from the midline to the craniectomy margin was not an associated risk factor for postoperative hydrocephalus. Conclusion : In patients with acute traumatic SDH with coexisting IVH, a large amount of SDH, and a larger midline shift, close follow-up is necessary for the early prediction of postoperative hydrocephalus. Furthermore, craniectomy margin need not be limited in acute traumatic SDH patients for the reason of postoperative hydrocephalus.

• 대한물리치료과학회지
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• 제5권4호
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• pp.785-794
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• 1998

We have made a survey of 40 patients in the university hospitals and oriental medical centers in Seoul from Sep. 1, 1997 to Mar. 1, 1998. We sampled 25 of them and the result shows that there were 12 MCA damaged patients(48%), 5 SAH(20%), 5 ACA(20%), 2 PCA (8%), 1 PCOA(4%). The number of MCA patients were the most. 1. As the cause of each disease, 4 of the 12 MCA damaged patients(33.35%) have infarction and cerebral hemorrhage, 2 of 5 SAH patients(40%) have cerebral hemorrhage and head injury, 3 ACA damaged patients have cerebral hemorrhage. 11 of 25 brain bloodvessel damaged patients(44%) were hemorrhage patients. 2. Rt. hemiparesis was the main symptom of 6 of 12 MCA damaged patients(50%) and 3 of 5 SAH patients(60%), and the main symptom of 3 of 5 ACA patients(60%) was Lt. hemiparesis. The main symptom of 13 of 25 brain bloodvessel damaged patients(52%) was Lt. hemiparesis 11 of them(44%) Rt. hemiparesis, and 1 of them(8.3%) Quadriplegia. 3. Language was the most well preserved function. 12 MCA damaged patients could understand language. 4. Retraction of shoulder girdle, among VIE flexor synergy, was the most frequent element because 9 of 12 MCA damaged patients had it. Among VIE flexor synergy, 5 SAH patient's most frequent synergy was Elbow flexion because all of them had it. All of 5 ACA damaged patients have shoulder girdle elevation, shoulder joint, hyperextension, abduction, and external rotation among VIE flexor synergy. 5. 7 of 12 MCA damaged patients(58.3%) were stereognosis handicapped patients, 3 of 5 SAH patients(60%) have handicap of position sense, light touch, and temperature, 3 of 5 ACA patients(60%) have position handicap. 13 of brain bloodvessel damaged patients(52%) have light touch handicap. 6. 8 of MCA damaged patients(66.7%) have facial palsy, 4 of SAH damaged patients(80%) have memory and action decline, and 3 of ACA damaged patients(60%) have action decline and facial palsy. The problem of Hemiplegia is very extensive from muscle weakness, atrophy, or deformation to psychical problems. Therefore physical therapists should have sufficient interest in psychological handicap as well as physical handicap as they deal with adult hemiplegia.

• 운동영양학회지
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• 제13권2호
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• pp.147-153
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• 2009

Effect of whole body vibration exercise on intracerebral hemorrhage in rats. Intracerebral hemorrhage is one of the most devastating types of stroke. This disease is known to cause severe neurological damage and also has a very high mortality rate. In the present study, the effects of whole body vibration exercise on memory capability and apoptotic neuronal cell death in the hippocampal CA1 region following intracerebral hemorrhage in rats were investigated. Intracerebral hemorrhage was induced by injection of collagenase into the hippocampal CA1 region using a stereotaxic instrument. The rats were divided into 5 groups: the sham-operation group, the hemorrhage-induction group, the hemorrhage-induction and 8 Hz vibration exercise group, the hemorrhage-induction and 16 Hz vibration exercise group, and the hemorrhage-induction and 24 Hz vibration exercise group. The animals in the whole body vibration exercise groups received whole body vibration at 8 Hz, 16 Hz, and 24 Hz, respectively for 30 min once a day during 14 consecutive days. In the present results, the apoptotic neuronal cell death in the hippocampal CA1 region was significantly increased following induction of intracerebral hemorrhage, resulting in memory impairment. Whole body vibration exercise suppressed hemorrhage-induced apoptosis in the hippocampal CA1 region. This suppressive effect of whole body vibration exercise also alleviated hemorrhage-induced memory impairment. Here in this study, we have shown that whole body vibration exercise inhibited intracerebral hemorrhage-induced apoptotic neuronal cell death and thus facilitated recovery of brain function following intracerebral hemorrhage.

• 대한본초학회지
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• 제26권4호
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• pp.169-180
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• 2011

Objectives : This study aimed at evaluation of the effects of Rhodiola rosea on brain edema and expressions of matrix metalloproteinases (MMPs) related to blood-brain barrier (BBB) disruption. Methods : Brain edema following intracerebral hemorrhage (ICH) was induced by the stereotaxic intrastriatal injection of bacterial collagenase type VII in rats (Sprague-Dawley). Then ethanol extract of Rhodiola rosea was treated once a day for 3 days. Brain edema % and water contents, and BBB leakage were examined. Immunohistochemistry was processed for MMP-9, MMP-12, and iNOS expressions in the brain sections and each immuno-labeled cells were analyzed with image analysis software. Results : 1. Ethanol extract of Rhodiola rosea reduced brain edema following ICH in rats significantly. 2. Ethanol extract of Rhodiola rosea reduced excessive brain tissue water contents following ICH in rats significantly. 3. Ethanol extract of Rhodiola rosea reduced BBB leakage in the cerebral cortex following ICH in rats. 4. Ethanol extract of Rhodiola rosea reduced cellular edema of neurons in peri-hematoma and the cerebral cortex following ICH in rats significantly. 5. Ethanol extract of Rhodiola rosea reduced MMP-9 positive cells in the cerebral cortex following ICH in rats significantly. 6. Ethanol extract of Rhodiola rosea reduced MMP-12 positive vessels in the cerebral cortex following ICH in rats significantly. 7. Ethanol extract of Rhodiola rosea reduced iNOS positive cells in the cerebral cortex and external capsule following ICH in rats significantly. Conclusions : These results suggest that Rhodiola rosea reveals protective effect against brain edema and cytotoxic edema of neurons by means of down-regulation of MMPs and iNOS expressions, and inhibition of BBB leakage.

• Journal of Korean Neurosurgical Society
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• 제58권3호
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• pp.262-270
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• 2015

Objective : Long-term oral anticoagulation or antiplatelet therapy has been used with increasing frequency in the elderly. These patients are at increased risk of morbidity and mortality from expansion of intracranial hemorrhage. We conducted a single-center retrospective case control study to evaluate risk factors associated with outcomes and to identify the differences in outcome in traumatic brain injury between preinjury anticoagulation use and without anticoagulation. Methods : A retrospective study of patients who underwent craniotomy or craniectomy for acute traumatic cerebral hemorrhage, between January 2005 and December 2014 was performed. Results : A consecutive series of 50 patients were evaluated. The factors significantly differed between the two groups were initial Prothrombin Time-International Normalized Ratio, initial platelet count, initial Glasgow Coma Scale score, and postoperative intracranial bleeding. Mean Glasgow Outcome Scale (GOS) score were similar between the two groups. In the patient with low-energy trauma only, no significant differences in GOS score, postoperative bleeding and many other factors were observed. The contributing factors to postoperative bleeding was preinjury anticoagulation and its adjusted odds ratio was 12 [adjusted odds ratio (OR), 12.242; p=0.0070]. The contributing factors to low GOS scores, which mean unfavorable neurological outcomes, were age (adjusted OR, 1.073; p=0.039) and Rotterdam scale score for CT scans (adjusted OR, 3.123; p=0.0020). Conclusion : Preinjury anticoagulation therapy contributed significantly to the occurrence of postoperative bleeding. However, preinjury anticoagulation therapy in the patients with low-energy trauma did not contribute to the poor clinical outcomes or total hospital stay. Careful attention should be given to older patients and severity of hemorrhage on initial brain CT.

• Journal of Korean Neurosurgical Society
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• 제58권1호
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• pp.76-78
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• 2015

This report details a case of unexpected, severe post-operative cerebral edema following cranioplasty. We discuss the possible pathological mechanisms of this complication. A 50-year-old female was admitted to our department with sudden onset of stuporous consciousness. A brain computed tomography (CT) revealed a subarachnoid hemorrhage with intracranial hemorrhage and subdural hematoma. Emergency decompressive craniectomy and aneurysmal neck clipping were performed. Following recovery, the decision was made to proceed with an autologous cranioplasty. The cranioplasty procedure was free of complications. An epidural drain was placed and connected to a suction system during skin closure to avoid epidural blood accumulation. However, following the procedure, the patient had a seizure in the recovery room. An emergency brain CT scan revealed widespread cerebral edema, and the catheter drain was clamped. The increased intracranial pressure and cerebral edema were controlled with osmotic diuretics, corticosteroids, and antiepileptic drugs. The edema slowly subsided, but new low-density areas were noted in the brain on follow-up CT 1 week later. We speculated that placing the epidural drain on active suction may have caused an acute decrease in intracranial pressure and subsequent rapid expansion of the brain, which impaired autoregulation and led to reperfusion injury.

• 대한한방내과학회지
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• 제41권2호
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• pp.141-149
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• 2020

Traumatic brain injury, which can be caused by head trauma, can damage the brain, resulting in physical disorders, such as headache, dizziness, and nausea, as well as mental health problems, such as depression, anxiety, memory loss, and personality changes that reduce a person's quality of life. Therefore, it is important to administer the best treatment at the right time. A 57-year-old patient complained of headache and depression after intracranical hemorrhage caused by a traffic accident. These symptoms are considered to be after effects of brain trauma due to increased pressure on the brain. Herbal medicine was prescribed to release internal brain pressure and acupuncture was applied to ease frontal and occipital head muscle tension. Objective scales were conducted at baseline, and at one month, two months, and four months. It was observed that the degree of headache and depression improved after treatment. This study is meaningful in that it found that Korean medicine treatments help alleviate the after effects of traumatic brain injury.

• 대한자기공명의과학회:학술대회논문집
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• 대한자기공명의과학회 2003년도 제8차 학술대회 초록집
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• pp.99-99
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• 2003

To exhibit our clinical experience of diffusion-weighted (DW) MR imaging for various brain pathologies and to determine its role in characterizing brain pathologies in children. DW images in 177 children (M：F＝96：81, mean age, 4.7 years) with various brain pathologies were retrospectively collected over past 3 years. DW images (b value： 1000 s/mm) were reviewed along with corresponding apparent diffusion coefficient (ADC) maps. Brain pathologies included cystic or solid brain tumor (n = 55), cerebral infarct (n = 32), cerebritis with or without brain abscess (n = 21), metabolic or toxic brain disorder (n = 19), demyelinating disease (n = 16), hypoxic-ischemic encephalopathy (n = 16), intracerebral hemorrhage including traumatic brain lesion (n = 15), and posterior reversible leukoencephalopathy (n = 3). We reviewed whether DW images and ADCmaps contribute to further characterization of brain pathologies by defining a chronological age of lesions, the presence of cytotoxic edema in lesions, and the nature of cystic lesions.

• 대한한방내과학회지
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• 제21권5호
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• pp.715-721
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• 2000

Objective : The purpose of this study is about stroke patients in Seosan. Method : The subjects of this study were 45 patients who were admitted to Hanseo University Oriental Hospital because of stroke. Each patients was diagnosed with Brain CT, sasang constitutional analysis. Results : 1. The rates in CVA was 58% on cerebral infarction, and 42% on cerebral hemorrhage. 2. The sites of cerebral infarction were Basal ganglia, MCA, Internal. External capsule. Thalamus, ect. Sites of cerebral hemorrhage were Thalamus, Basal ganglia, Cerebellum. 3. The ratio of left and right hemiplegia in cerebral infarction was 1:1.6, and in cerebral hemorrhage it was 1:2. 4. The most chief complaints in cerebral infarction, were hemiplegia, dysarthria, facial palsy, headache. In cerebral hemorrhage, their were hemiplegia, dysarthria, headache, dizziness, and facial palsy. 5. Classification of human corporal constitution in cerebral hemorrhage, the most was Taeumin, Soyangin, Soeumin. And in cerebral infarction, the most was Soyangin, Taeumin, Soyumin. 6. The ratio between male and female was 1.25:2 in cerebral hemorrhage, 2.5:5 in cerebral infarction. 7. The most prevalent age groups in cerebral hemorrhage was fifties to sixties. and in cerebral infarction was fifties to sixties. 8. The most common preceding disease in cerebral hemorrhage was HTN, DM. 9. The recurrence rate of cerebral hemorrhage was 16%, and cerebral infarction was 8%. 10. The ratio of recovery in cerebral hemorrhage was 84%, in cerebral infarction 58%. Conclusion : From this study, in cerebral hemorrhage most patients were Taeumin, in their fifties to sixties. And in cerebral infarction most patients were Soyangin, in their sixties to eighties. In both stroke patients, there were more female than male patients.

• 대한한방내과학회지
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• 제42권5호
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• pp.872-882
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• 2021

Objective: This study examined the effectiveness of Pyung-Hyung acupuncture and herbal medicine for a hemiplegic patient diagnosed with intracerebral hemorrhage. Methods: The patient was treated with Pyung-Hyung acupuncture and herbal medicine for one month. Intracerebral hemorrhage symptoms were evaluated using the Korean version of the Modified Barthel Index (K-MBI), the Manual Muscle Test (MMT), and brain CT images. Results: Following Pyung-Hyung acupuncture and herbal medicine, K-MBI, MMT, and brain CT image results improved. Conclusion: This case showed that Pyung-Hyung acupuncture and herbal medicine effectively treated intracerebral hemorrhage with hemiplegia.