• Journal of Korean Neurosurgical Society
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• v.49 no.3
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• pp.157-162
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• 2011

Objective : Vasospasm of cerebral vessels remains a major source of morbidity and mortality after an aneurysmal subarachnoid hemorrhage (SAH). The purpose of this study was to evaluate the safety and efficacy of transluminal balloon angioplasty (TBA) for SAH-induced vasospasm. Methods : Eleven patients with an angiographically confirmed significant vasospasm (>50% vessel narrowing and clinical deterioration) were studied. A total of 54 vessel segments with significant vasospasm were treated by TBA. Digital subtraction angiography was used to confirm the presence of vasospasm, and TBA was performed to dilate vasospastic arteries. Medical and angiographic reports were reviewed to determine technical efficacy and for procedural complications. Results : TBA using Hyper-Glide or Hyper-Form balloons (MicroTherapeutics, Irvine, CA) was successfully accomplished in 88.9% vasospastic segments (48 of 54), namely, in the distal internal carotid artery (100%, n=7), the middle cerebral artery (100%), including the M1 (n=10), M2 (n=10), and M3 segments (n=4), in the vertebral artery (100%, n=2), basilar artery (100%, n=1), and in the anterior cerebral artery (ACA), including the A1 (66%), A2 (66%), and A3 segments (100%). Vessel diameters significantly increased after TBA. There were no cases of vessel rupture or thromboembolic complications. GCS at one day after TBA showed an improvement in all patients except one. Conclusion : This study suggests that TBA using Hyper-Glide or Hyper-Form balloons is a safe and effective treatment for subarachnoid hemorrhage-induced cerebral vasospasm.

• Journal of Korean Neurosurgical Society
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• v.65 no.5
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• pp.652-664
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• 2022

The Kernohan-Woltman notch phenomenon (KWNP) refers to an intracranial lesion causing massive side-to-side mass effect which leads to compression of the contralateral cerebral peduncle against the free edge of the cerebellar tentorium. Diagnosis is based on "paradoxical" motor deficit ipsilateral to the lesion associated with radiologic evidence of damage to the contralateral cerebral peduncle. To date, there is scarce evidence regarding KWNP associated neuroimaging patterns and motor function prognostic factors. A systematic review was conducted on Medline database from inception to July 2021 looking for English-language articles concerning KWNP, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The research yielded 45 articles for a total of 51 patients. The mean age was 40.7 years-old and the male/female sex ratio was 2/1. 63% of the patients (32/51) suffered from head trauma with a majority of acute subdural hematomas (57%, 29/51). 57% (29/51) of the patients were in the coma upon admission and 47% (24/51) presented pupil anomalies. KWNP presented the neuroimaging features of compression ischemic stroke located in the contralateral cerebral peduncle, with edema in the surrounding structures and sometimes compression stroke of the cerebral arteries passing nearby. 45% of the patients (23/51) presented a good motor functional outcome; nevertheless, no predisposing factor was identified. A Glasgow coma scale (GCS) of more than 3 showed a trend (p=0.1065) toward a better motor functional outcome. The KWNP is a regional compression syndrome oftentimes caused by sudden and massive uncal herniation and leading to contralateral cerebral peduncle ischemia. Even though patients suffering from KWNP usually present a good overall recovery, patients with a GCS of 3 may present a worse motor functional outcome. In order to better understand this syndrome, future studies will have to focus on more personalized criteria such as individual variation of tentorial notch width.

• Journal of the Korean Society of Radiology
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• v.81 no.3
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• pp.739-745
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• 2020

A major concern associated with carotid artery angioplasty and stenting (CAS) is a periprocedural distal cerebral embolization. To prevent distal embolization, embolic protection devices (EPDs) have been developed. However, the risk of cerebral embolism after protected CAS in patents with a vulnerable plaque is controversial and either a silent or a symptomatic stroke can occur despite the use of EPDs. Here, we report a case of a massive cerebral microemboli after a protected CAS using a distal filter EPD for a vulnerable plaque with a lipid rich necrotic core and intraplaque hemorrhage.

• Biomedical Science Letters
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• v.12 no.4
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• pp.375-383
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• 2006

The physiological responses following stress are different in individual or personality. We performed this study to clarify gender differences in influences of noise stress on physiological factors. 70 healthy subjects, which was divided man (n=30) and woman (n=40) groups, were exposed to 85 decibels of excavator noise for 15 minutes. Cardiac factors such as heart rate (HR), systolic and diastolic blood pressures (SBP and DBP, respectively), and heart rate-systolic pressure product (RPP) were determined. Transcranial Doppler ultrasound (TCD) was used to measure mean blood flow velocity (Vm), pulsatility index (PI), and resistance index (RI) in the middle, anterior and posterior cerebral arteries (MCA, ACA and PCA, respectively) before and during noise exposure. Cortisol level and hematological variables were also measured before (baseline) and immediately after the end of noise exposure. In the both groups HR, SBP, and RPP significantly decreased during noise exposure (P<0.05) but not significantly different between two groups (P>0.05). Vms of three cerebral arteries in man group decreased, whereas Vm of PCA in woman group fell during noise exposure (P<0.05). Vm, PI and RI in MCA and ACA during noise exposure were low in man group compared with woman group (P<0.05). Vm of PCA was low, whereas PI and RI of PCA were high in man group compared with woman group during noise exposure (P<0.05). Total leukocyte and red blood cell (RBC) counts slightly decreased during noise exposure but not significant (P>0.05). Levels in hematological variables decreased but not significant changed following noise exposure. Decreased rate of total leukocyte in man group was higher (P<0.05). Cortisol levels in the both groups decreased immediately after the end of noise exposure, while the decreased rate in man group was greater than that in woman group (p<0.05). These findings indicate that a transient exposure to experimental excavator noise may cause decreased changes in cardiac factors, cerebral hemodynamics and cortisol levels and the changes may be greater in men than in women.

• Journal of Chest Surgery
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• v.36 no.10
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• pp.772-775
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• 2003

Moyamoya disease is an unusual cerebrovascular disorder characterized by occlusive intimal dysplasia of the distal internal carotid and proximal cerebral arteries, but the etiology remains unclear. Angiographic characteristics include bilateral stenosis or occlusion of the terminal portions of the intracranial internal carotid arteries and bilateral development of fine collateral vessels at the base of the brain known as ‘Moyamoya vessels’. Cardiac surgery using cardiopulmonary bypass due to coronary artery disease and others among patients with moyamoya disease is very rare, and cardiac surgery for such patients has a potential risk of intraoperative and perioperative brain ischemia. We successfully treated a patient who underwent artrial septal defect closure and coronary artery bypass graft using the cardiopulmonary bypass, so we report this case with a brief literature review.

• Journal of Korean Neurosurgical Society
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• v.29 no.11
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• pp.1538-1541
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• 2000

Apenetrating head injury by an arrow is extremely rare being only two cases reported in the literature. We report a case of 12-year-old boy who presented with an arrow lodged at the posterior fossa through nasal nostril. He was slightly drowsy, but neurologically intact except a sixth nerve palsy in the left eye. Brain CT showed no intracerebral hemorrhage. The arrow was entered through the right nostril and the tip was stucked in the left cere-bello-pontine angle through the sphenoid sinus. We removed the arrow without craniotomy since the tip was verified smooth and no cerebral arteries were in contact with the arrow. The patient recovered well without any significant complications. The sixth nerve palsy resolved completely after six months. The verification of the shape of the offending material, a retrograde removal of the arrow in the direction of its line of trajectory, and an identification of adjacent cerebral arteries seem to be important in the management of this type of injury.

• The Korean Journal of Pharmacology
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• v.28 no.2
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• pp.147-162
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• 1992

The objectives of the present experiments were to characterize the effects of the peptides belonging to the pancreatic polypeptide family on the contractility of cerebral arteries and to observe the interactions of these peptides with the cyclic nucleotide activators and the potassium channel openers. Dogs of either sex, $20{\sim}30\;Kg$ in weight, were sacrificed. Basilar and middle cerebral arteries from brain were isolated and prepared for myography in the PSS equilibrated with 95% $O_2$ and 5% $CO_2$ at $37^{\circ}C$. The endothelial cells of the spiral strips were removed by CHAPS solution (0.3% w/v, 15 seconds). 1. PP, PYY and NPY contracted the arterial strips concentration-dependently with a rank order of potency of PYY>NPY>PP. These peptides were 20 to 200 times more potent than norepinephrine, and only PYY showed a greater potency than 5-HT. 2. Cyclic nucleotide activators, forskolin (for cAMP) and sodium nitroprusside (for cGMP) reduced the basal tone and inhibited the PP-, PYY- and NPY- induced contractions by concentration-dependent manners. Forskolin was more potent in reducing basal tone than sodium nitroprusside. 3. Potassium channel openers, RP 49356, P 1060 and BRL 38227 reduced the basal tone concentration-dependently and tended to inhibit the PP-, PYY- and NPY- induced contractions. Notably, BRL 38227 with low concentration $(0.1\;{\mu}M)$ enhanced the contractions induced by those peptides while P 1060 inhibited the contractions concentration-dependently. 4. The combinations of the cyclic nucleotide activators and the potassium channel openers were slightly additive in reducing the basal tone. P 1060 and BRL 38227 enhanced the relaxant effect of sodium nitroprusside significantly. On the PYY-induced contration $(0.1\;{\mu}M)$, $K^+$ channel openers tended to inhibit the inhibitory actions of forskolin and sodium nitroprusside. P 1060 and BRL 38227 antagonized the inhibitory action of sodium nitroprusside significantly. The results of the present study may be summarized that in canine cerebral arteries, not only NPY but also PYY may play a role in a cerebrovascular spasm, and intracellular concentration of either cAMP or cGMP may be involved in the mechanism of vasoconstrictive actions of these peptides, which may be affected either positively or negatively by a $K^+$ channel opener.

• Journal of Korean Neurosurgical Society
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• v.49 no.5
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• pp.287-289
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• 2011

Thalamoperforating artery aneurysms are rarely reported in the literature. We report an extremely rare case of ruptured distal anterior thalamoperforating artery aneurysm which was treated by endovascular obliteration in a patient with occlusion of both the internal carotid arteries (ICAs) : A 72-year-old woman presented with severe headache and loss of consciousness. Initial level of consciousness at the time of admission was drowsy and the Glasgow Coma Scale score was 14. Brain computed tomography (CT) scan was performed which revealed intracerebral hemorrhage in right basal ganglia, subarachnoid hemorrhage, and intraventricular hemorrhage. The location of the aneurysm was identified as within the globus pallidus on CT angiogram. Conventional cerebral angiogram demonstrated occlusion of both the ICAs just distal to the fetal type of posterior communicating artery and the aneurysm was arising from right anterior thalamoperforating artery (ATPA). A microcatheter was navigated into ATPA and the ATPA proximal to aneurysm was embolized with 20% glue. Post-procedural ICA angiogram demonstrated no contrast filling of the aneurysm sac. The patient was discharged without any neurologic deficit. Endovascular treatment of ATPA aneurysm is probably a more feasible and safe treatment modality than surgical clipping because of the deep seated location of aneurysm and the possibility of brain retraction injury during surgical operation.

• The Journal of Pediatrics of Korean Medicine
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• v.14 no.2
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• pp.141-147
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• 2000

Moyamoya is a chronic cerebrovascular disease chracterized by progressive stenosis or occlusion of the terminal parts of both internal carotid arteries with telangiectatic vascular network of collateral circuration at the base of the brain and leptomeningeal arteries. The etiology and pathophysiology of this disease are still unknown. The clinical course in those whose first symptoms occur in childhood is different from those in whom symptoms develop in adult life. The term moyamoya disease should be resserved for those cases in which the chracteristic angiographic pattern is idiopathic; moayamoya syndrome is used when the underlying condition is known. we have experienced a case of moyamoya syndrome in a 5-year-2-month-old boy who presented right-sided hemiparesis. A cerebral angiogram revealed occlusion of abnomal collateral network. Moyamoya disease is applicable to stroke of an infant from oriental medicine point of view, and The symptoms is similar to adult stroke, we have treated adult stroke patint with herb medicine and acupuncutre and physical treatment. The acute stage of stroke is applied to the external treatment(標治), and The recovery stage is applied to the basic treament(本治).

• The Journal of Korean Medicine
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• v.16 no.2 s.30
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• pp.299-311
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• 1995

The studies were investigated in the coma time and the survival time induced by KCN, the duration of breathing after decapitation, the survival time following ligation of both common carotid arteries and the survival time after it is treated for normobaric bypoxia with a nitrogen gas, a carbon dioxide gas or a vaccum in mice. The results were as follows: 1. In histotoxic anoxia, Moschus(0.4mg／kg, p.o) demonstrated a protective effect on coma induced by a sublethal dose of KCN(1.8mg／kg, i.v.) in mice. 2. Mice subjected to a lethal dose of KCN(3.0mg／kg, i.v.) did not die by administration of Moschus. 3. Moschus was significantly extended the duration of breathing after decapitation in mice. 4. Moschus showed a significant extension of survival time in mice following ligation of both common carotid arteries. 5. In the normobaric hypoxia with a nitrogen gas, Moschus showed a significant extension of survival time in mice. 6. In the normobaric hypoxia with a carbon dioxide gas, Moschus showed a significant shortness of survival time in mice. 7. In the normobaric hypoxia with a vaccum, Moschus showed a significant extension of survival time in mice. From the above results, it is suggested that Moschus demonstrated protective effects on the brain damages induced by cerebral anoxia.