• Clinical and Experimental Pediatrics
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• 제55권11호
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• pp.408-413
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• 2012

Moyamoya disease (MMD) is the most common pediatric cerebrovascular disease in Far Eastern countries. In children, MMD frequently manifests as ischemic symptomatology. Cerebral perfusion gradually decreases as the disease progresses, which often leads to cerebral infarction. The benefits of revascularization surgery, whether direct or indirect, have been well established in MMD patients with ischemic symptoms. In adults, the increase in cerebral blood flow achieved with indirect revascularization is often unsatisfactory, and direct revascularization is usually feasible. In children, however, direct revascularization is frequently technically not feasible, whereas the response to indirect revascularization is excellent, although 1 or 2 weeks are required for stabilization of symptoms. The authors describe surgical procedures and perioperative care in indirect revascularization for MMD. In addition, special considerations with regard to very young patients, patients with recent cerebral infarction, and patients with hyperthyroidism are discussed.

• Journal of Korean Neurosurgical Society
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• 제50권3호
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• pp.252-255
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• 2011

Authors report a case of a painless acute dissecting aneurysm of the descending aorta in a patient who presented with unexplained hypotension followed by simultaneous paraplegia and right arm monoparesis. To our knowledge, case like this has not been reported previously. Magnetic resonance imaging of the brain and spine revealed hemodynamic cerebral infarction and extensive cord ischemia, respectively. Computerized tomography angiography confirmed a dissecting aneurysm of the descending aorta. The cause of the brain infarction may not have been embolic, but hemodynamic one. Dissection-induced hypotension may have elicited cerebral perfusion insufficiency. The cause of cord ischemia may be embolic or hemodynamic. The dissected aorta was successfully replaced into an artificial patch graft. The arm monoparesis was improved, but the paraplegia was not improved. In rare cases of brain and/or spinal cord infarction caused by painless acute dissecting aneurysm of the aorta, accurate diagnosis is critical because careless thrombolytic therapy can result in life-threatening bleeding.

• 대한인간공학회지
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• 제24권4호
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• pp.47-53
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• 2005

This study aim to investigate the effects of supply of oxygen enhances cerebral activation through increased activation in the brain and using a 3 Tesla fMRI system. Five volunteers (right handed, average age of 21.3) were selected as subjects for this study. Oxygen supply equipment that provides 30% oxygen at a constant rate of 15L/min was given using face mask. A 3 Tesla fMRI system using the EPI BOLD technique, and three-pulse sequence technique get of the true axial planes scanned brain images. The author can get the perfusion images of the brain by oxygen inhalation with susceptibility contrast EPI sequence at the volunteers. Complex movement consisted of a finger task in which subjects flexed and extended all fingers repeatedly in union, without the fingers touching each other. Both task consisted of 96 phases including 6 activations and rests contents. Post-processing was done on MRDx software program by using cross-correlation method. The result shows that there was an improvement in performance and also increased activation in several areas in the oxygen method. These finding demonstrates that while performing cognitive tasks, oxygen administration was due to increase of cerebral activation.

• 대한치매학회지
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• 제16권3호
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• pp.72-77
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• 2017

Background and Purpose Although sleep disturbances are common and considered a major burden for patients with Alzheimer's disease (AD), the fundamental mechanisms underlying the development and maintenance of sleep disturbance in AD patients have yet to be elucidated. The aim of this study was to examine the correlation between regional cerebral blood flow (rCBF) and sleep disturbance in AD patients using technetium-99m hexamethylpropylene amine oxime single-photon emission computed tomography (SPECT). Methods A total of 140 AD patients were included in this cross-sectional study. Seventy patients were assigned to the AD with sleep loss (SL) group and the rest were assigned to the AD without SL group. SL was measured using the sleep subscale of the Neuropsychiatric Inventory. A whole-brain voxel-wise analysis of brain SPECT data was conducted to compare the rCBF between the two groups. Results The two groups did not differ in demographic characteristics, severity of dementia, general cognitive function, and neuropsychiatric symptoms, with the exception of sleep disturbances. The SPECT imaging analysis displayed decreased perfusion in the bilateral inferior frontal gyrus, bilateral temporal pole, and right precentral gyrus in the AD patients with SL group compared with the AD patients without SL group. It also revealed increased perfusion in the right precuneus, right occipital pole, and left middle occipital gyrus in the AD with SL group compared with the AD without SL group. Conclusions The AD patients who experienced sleep disturbance had notably decreased perfusion in the frontal and temporal lobes and increased rCBF in the parietal and occipital regions. The findings of this study suggest that functional alterations in these brain areas may be the underlying neural correlates of sleep disturbance in AD patients.

• Nuclear Medicine and Molecular Imaging
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• 제42권1호
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• pp.8-16
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• 2008

목적: 내경동맥 또는 중대뇌동맥의 죽상 동맥 경화증 환자에서의 두개외강-내강 우회로술(이하 우회로술) 후의 연속적인 혈류 역학적 변화를 $^{99m}Tc$-ECD 아세타졸아마이드 부하 뇌혈류 단일 광자 방출 전산화 단층 촬영(이하 아세타졸아마이드 부하 SPECT)으로 평가하여 중대뇌 동맥의 각 분지별 영역에 대한 우회로술의 혈류역학적 개선효과를 알아보고자 하였다. 대상 및 방법: 전향적 방법으로 최근 3개월 내에 혈관 폐색성 징후가 발생하여 우회로술을 시행받은 환자를 대상으로 수술 전과 수술 1 주 후, 3-6 개월 후에 아세타졸아마이드 부하 SPECT를 시행하였다. 영상 분석을 위해 SPM의 SPECT 표준 뇌에 공간 정규화한 후 Anatomical Automated Labeling으로 중대뇌동맥의 지배를 받는 양측 전두, 측두, 두정 영역에 관심 구역을 설정하여 각 관심 영역별로 뇌혈류 지표(PI; $C_{region}/C_{ipsilateral\;cerebellum}$) 및 뇌혈관 예비능 지표$((PI_{acetazolamide}-PI_{basal})/PI_{basal})$로 정하여 이들 지표의 수술 전후 변화를 평가하였다. 결과한 측에 성공적인 우회로술을 시행한 환자 17 명(남:여=12:5, 나이 $53{\pm}2$세)을 분석하였다. 전체적으로 뇌혈류는 수술 1 주 후 유의하게 증가하나 3-6 개월 후 감소하여 수술 이전의 수준으로 유지되었으며 ($1.01{\pm}0.09{\rightarrow}1.06{\pm}0.09}{\rightarrow}1.02{\pm}0.10,\;p=0.005$) 뇌 혈관 예비능은 수술 1 주 후 유의하게 증가한 이후 유의하지는 않으나, 3-6개월 이후까지 계속 호전되었다($-0.14{\pm}0.05{\rightarrow}-0.07{\pm}0.04{\rightarrow}0.05{\pm}0.05,\;p=0.004$). 각 뇌 영역별로 뇌혈류는 두정 영역에서 수술 직후 증가하였다가($1.12{\pm}0.09{\rightarrow}1.18{\pm}0.09,\;p=0.003$) 수술 3-6개월 이후 감소하여($1.12{\pm}0.09,\;p=0.003$) 수술 이전의 수준으로 유지되었다. 뇌혈관 예비능은 수술 측의 전두 영역($-0.15{\pm}0.07{\rightarrow}0.08{\pm}0.05$), 두정 영역($-0.16{\pm}0.07{\rightarrow}-0.07{\pm}0.05$)에서 모두 수술 직후 유의하게 증가하였고(p<0.01) 이후 유의하지는 않으나 3-6개월까지 계속 호전되었다. 결론: 성공적인 우회로술 후 뇌혈류는 전체적으로 유의한 변화가 없었으나 뇌혈관 예비능은 중대뇌동맥 영역 전체에 걸쳐 수술 후 단기간에 유의한 호전을 보였으며 장기간 유지되었다. 따라서 뇌혈관 예비능의 호전여부는 우회로술에 의해 증가된 뇌관류압을 평가할 수 있는 중요한 지표로 생각되며 향후 우회로술에 의한 뇌졸중 재발방지 효과를 알아보기 위해 뇌혈관 예비능의 변화와 예후와의 상관관계에 대한 연구가 필요하리라 생각된다.

• Journal of Korean Neurosurgical Society
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• 제47권5호
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• pp.332-337
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• 2010

Objective : Although a transradial angiography is accepted as the gold standard for cardiovascular procedures, cerebral angiography has been performed via transfemoral approach in most institutions. The purpose of this study is to present our experience concerning the feasibility, efficacy, and safety of a transradial approach to cerebral angiography as an alternative to a transfemoral approach. Methods : Between February 2007 and October 2009, a total of 1,240 cerebral angiographies were performed via a transradial approach in a single center. The right radial approach was used as an initial access route. The procedure continued only after the ulnar artery was proven to provide satisfactory collateral perfusion according to two tests (a modified Allen's test and forearm angiography). Results : The procedural success rate was 94.8% with a mean duration of 28 minutes. All supra-aortic vessels were successfully catheterized with a success rate of 100%. The success rates of selective catheterization to the right vertebral artery, right internal carotid artery, left internal carotid artery, and left vertebral artery were 96.1%, 98.6%, 82.6% and 52.2%, respectively. The procedure was performed more than twice in 73 patients (5.9%), including up to 4 times in 2 patients. The radial artery occlusion was found in 4 patients (5.4%) on follow-up cerebral angiography, but no ischemic symptoms were observed in any of the cases. Conclusion : This study suggests that cerebral angiography using a transradial approach can be performed with minimal risk of morbidity. In particular, this procedure might be useful for follow-up angiographies and place less stress on patients.

• 대한임상검사과학회지
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• 제36권1호
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• pp.43-48
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• 2004

Cerebral vasoreactivity is an index of autoregulation of cerebral perfusion, and can be measured using functional images such as Xe CT, SPECT and PET in reponse to hypercapneic stimulus. In order to measure cerebral $CO_2$ vasoreactivity in routine TCD study conveniently and reliably, we devised a method of rebreathing into closed volume of reservoir bag as a hypercapneic stimulus, and applied it to 44 healthy volunteers. As a hypercapneic stimulus, we applied fitting mask connected with closed reservoir bag for about 90 seconds, and mean blood flow velocity(MBFV) and pulsatility index(PI) were evaluated at proximal middle cerebral arteries(MCA) of 50-55 mm depth, before and after the hypercapneic stimulus. Age affected the MFV and PI value showed significant and the MFV was 56.45(SD=9.75)cm/sec, while PI was 0.406(SD=0.089). As age increases the flow velocity decreased significantly whereas PI value increased(P<0.05). The vasoreactvity significantly decreased with age(P<0.05). The decrease of cerebral blood flow quantity and cerebral blood flow velocity is not only because of increase of diameter of cerebrovascular resulting from aging, but the resistance increase of small blood vessel resulting from the increase of PI & RI value is regarded. We suppose that the rebreathing method is a reliable and convenient technique as a hypercapneic stimulus in determining cerebral $CO_2$ vasoreactivity. The rebreathing method could be non-invasive and useful methods in estimation of the cerebrovascular reactivity and could be applied to the basal and follow-up evaluation of the cerebrovascular reserve of the ischemic stroke patients.

• 혜화의학회지
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• 제15권2호
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• pp.263-272
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• 2006

Purpose Brain vessles have autoregulation function, so even when perfusion pressure drops, cerebral blood flow remain stable by vasodilation. Latest research on this reserve of cerebral vessels is being done using TCD, which measures the reserve of the vessels. We did a research comparing cerebral vessel and peripheral vessel reserve between Taeumin, who are more likely to suffer CVA, and the normal. We observed blood flow of Internal carotid artery siphon and radial indicis artery of the two group with TCD. Method We picked 20 people out of patients diagnosed as cerebral infarction at Cheon-An Oriental hospital of Daejeon University. They were diagnosed as Taeumin with QSCCII questionnaire and constitutional differentiation. Using TCD, we measured highest blood flow rate, mean blood flow and asymmetric counting blood flow of Internal carotid artery siphon and radial indicis artery at rest. And then we measured again after stimulating cerebral vessels, by triggering hypercapnia by self apnea and peripheral vessels by palm heating. Result At rest, mean blood flow rate of Internal carotid artery siphon showed significant decrease compared to control group. Blood flow rate of Internal carotid artery siphon after hypercapnia showed significant decline in highest blood flow rate and mean blood flow compared to control group. Cerebral vessel reaction after the hypercapnia induction showed great change in experiment group than the control group. Peripheral vessel reaction after palm heating showed significant decline in experiment group compared to control group. Conclusion In conclusion, measuring the alteration of blood flow used in diagnosing cerebral infarction, is more sensitive when vessel stimulation is done. Non-invasive TCD is effective especially in case of Taeumin who are more likely to suffer vascular disorder than others.

• 한국정보통신학회:학술대회논문집
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• 한국정보통신학회 2017년도 춘계학술대회
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• pp.171-174
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• 2017

다음은 요뇌경색의 대표적인 치료법과 예방법중 하나는 대뇌혈류를 증가하는 방법이다. 대뇌 부위로 가는 혈류량을 우회적으로 증가시켜 최종대뇌 손상부위를 최소화 하는 것을 목표로 한다. 이와 같은 대뇌혈류를 증가시키는 방법은 약물에 의한 치료방법과, 수술에 의한 방법 등 칩습적으로 행해져왔다. 하지만 이러한 침습적인 방법은 환자에게 수술의 부담을 주며 합병증 등의 위험에 노출되어 있는 단점이 있다. 본 논문에서는 이러한 침습적인 치료방법의 단점을 보완하고자 비침습적 대뇌혈류증가 장치를 제안한다. 기존의 대뇌 혈류 증가 장치의 단점을 보완하기 위해 가압식 측정법을 적용하여 환자의 사지 혈압을 정확하게 측정하고 사지압박을 실시하여 대뇌부위로 가는 혈류량을 우회적으로 증가시켜 혈류증강 치료를 실시한다. 이는 기존의 침습적 대뇌혈류증강 치료와 비교하여 합병증의 우려가 없고 환자에게 부담을 주지 않으며 대뇌혈류량을 의미 있게 증가시키기 때문에 환자에게 선택적으로 사용될 수 있다.

• Journal of Korean Neurosurgical Society
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• 제29권4호
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• pp.536-542
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• 2000

Objective : This study was performed to evaluate the relationships among intracranial pressure(ICP), cerebral perfusion pressure(CPP), and cerebral arteriovenous oxygen difference($AVDO_2$) which were used as parameters of adequacy of cerebral blood flow to support cerebral metabolism after severe head injury and also to examine the association between delayed cerebral infarction and outcome. Material and Method : The authors studied the ICP, CPP and $AVDO_2$ before and after treatment on 34 head-injured patients from June 1996 to December 1997 and examined the association with the change of an ICP, CPP and $AVDO_2$ following treatment and the development of delayed cerebral infarction. Sixteen patients underwent craniotomy for hematoma evacuation and eighteen patients received mannitol to decrease ICP. Results : The development of delayed cerebral infarction was demonstrated in 3(42.9%) out of 7 patients in no improvement group and 13(48.1%) out of 27 patients in improvement group with an increased ICP following treatment. Also, the development of delayed cerebral infarction was demonstrated in 8(50%) out of 16 patients in no improvement group and 8(44.4%) out of 18 patients in improvement group with a decreased CPP following treatment. The association with changes of ICP and CPP following treatment and development of delayed cerebral infarction was not statistically significant(p>0.01). However, 11(78.6%) out of 14 patients who demonstrated an increase in $AVDO_2$ and 5(25%) out of 20 patients who demonstrated a decrease in $AVDO_2$ following treatment developed delayed cerebral infarction. No improvement(reduction) in $AVDO_2$ following treatment was significantly associated with the development of delayed cerebral infarction(p<0.01). All of 16 patients with delayed cerebral infarction showed poor prognosis. Conlcusion : The change of $AVDO_2$ rather than those of ICP and CPP was considered more important factor for the development of the delayed cerebral infarction and poor outcome.