• Investigative Magnetic Resonance Imaging
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• 제25권3호
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• pp.193-196
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• 2021

Congenital absence of the bilateral internal carotid arteries (ICA) is a very rare occurrence. Recognition of this rare anomaly is important, when considering intracranial endovascular interventions in the event of thromboembolic events with revascularization, transsphenoidal surgery, and the surveillance and detection of associated cerebral aneurysms. We report a case of a 25-year-old man who presented with headache since 2 years ago, and was incidentally discovered to have a congenital bilateral absence of ICAs.

• Journal of Korean Neurosurgical Society
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• 제56권5호
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• pp.419-422
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• 2014

Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by sudden-onset headache with focal neurologic deficit and prolonged but reversible multifocal narrowing of the distal cerebral arteries. Stroke, either hemorrhagic or ischemic, is a relatively frequent presentation in RCVS, but progressive manifestations of subarachnoid hemorrhage, intracerebral hemorrhage, cerebral infarction in a patient is seldom described. We report a rare case of a 56-year-old woman with reversible cerebral vasoconstriction syndrome consecutively presenting as cortical subarachnoid hemorrhage, intracerebral hemorrhage, and cerebral infarction. When she complained of severe headache with subtle cortical subarachnoid hemorrhage, her angiography was non-specific. But, computed tomographic angiography showed typical angiographic features of this syndrome after four days. Day 12, she suffered mental deterioration and hemiplegia due to contralateral intracerebral hematoma, and she was surgically treated. For recurrent attacks of headache, medical management with calcium channel blockers has been instituted. Normalized angiographic features were documented after 8 weeks. Reversible cerebral vasoconstriction syndrome should be considered as differential diagnosis of non-aneurysmal subarachnoid hemorrhage, and repeated angiography is recommended for the diagnosis of this under-recognized syndrome.

• 대한한방내과학회지
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• 제43권4호
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• pp.582-595
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• 2022

Objectives: To investigate the effects of acupuncture at GV20 and EX-HN1 on cerebral blood flow (CBF) velocity and cerebrovascular reactivity (CVR) in the middle cerebral arteries (MCA) and anterior cerebral arteries (ACA) and to compare the effects to acupuncture at GV20. Methods: The study was a randomized, crossover trial that included 10 healthy men aged 20 to 29 years who underwent acupuncture treatment four times with a washout period of one week. The CBF velocity and CVR were measured by transcranial Doppler sonography (TCD) on both MCAs at the first and second visits, and both ACAs at the third and fourth visits. Participants were randomly assigned to one of two groups (A and B) before the first and third visits. Group A received two phases of acupuncture intervention at a single GV20 point and a combination of GV20 and EX-HN1 acupoints. Group B received the same interventions, but in the reverse order. Results: The increase in CO₂ reactivity was significantly higher for the combination acupoints of GV20 and EX-HN1 than for the GV20 single acupoint in both MCAs (Right: 136 to 178, p=0.017; Left: 127 to 191, p=0.017) and ACAs (Right: 133 to 158, p=0.013; Left: 122 to 168, p=0.025). No significant change was noted in the corrected velocity at PETCO₂ 40 mmHg, blood pressure, or heart rate. Conclusions: The findings suggest that improvement of the CBF in the MCA and ACA after GV20 acupuncture increases when acupuncture is also performed at EX-HN1. These results clinically support the combined use of EX-HN1 and GV20 to treat disorders of MCA and ACA circulation.

• The Korean Journal of Physiology and Pharmacology
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• 제2권2호
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• pp.193-199
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• 1998

To elucidate the mechanism involved in the cerebral vascular spasm following subarachnoid hemorrhage (SAH), the effects of the cerebrospinal fluid (CSF) obtained from the SAH patients on the resting tension and its influence on the contractile responses to various vasoactive agents and to hypoxia were investigated in isolated porcine cerebral arteries. All the CSFs containing hemoglobin (Hb) produced contraction and some Hb-free CSFs also elicited contraction. When the Hb-free CSF was separated by microfilter, the filtrate of ＜30,000 MW did not produce contraction, while the fraction above 30,000 MW elicited more marked contractile responses than the unfractionated CSF. The CSF contraction was significantly attenuated in the presence of indomethacin or nimodipine, whereas the contractions induced by KCl, prostaglandin $F_{2{\alpha}}$ ($PGF_{2{\alpha}}$), or endothelin-1 (ET-1) were not affected by the CSF pretreatment. However, the contractile responses induced by 5-hydroxytryptamine (5-HT) and phenylephrine (PE) were markedly potentiated by the pretreatment. Hypoxia-induced vasoconstriction was significantly potentiated by the pretreatment with either unfractionated CSF or the CSF fraction of above 30,000 MW. These results suggest that unknown vasocontractile substance(s) exists in the Hb-free CSF and that the substance, with its MW above 30,000, is activated by hypoxia and acts synergistically with 5-HT and PE, and that extracellular calcium influx and cyclooxygenase are also involved in the cerebral vasoconstrictory effect of Hb-free CSF.

• 대한신경집중치료학회지
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• 제11권2호
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• pp.129-133
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• 2018

Background: A few cases of moyamoya syndrome associated with thyrotoxicosis have been reported. However, studies on the association of hyperthyroidism with moyamoya syndrome are insufficient. Case Report: Here we report a case of hyperthyroidism associated with moyamoya syndrome in a 41-year-old woman with aphasia and right side weakness. Brain imaging revealed acute cerebral infarction of left middle cerebral artery territory and occlusion of bilateral distal internal carotid arteries. Conclusion: Antithyroid medication stabilized the patient's neurologic deterioration, suggesting that thyrotoxicosis could aggravate acute cerebral infarction caused by moyamoya syndrome.

• Journal of Chest Surgery
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• 제22권2호
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• pp.330-336
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• 1989

The patient was 47-year-old male who had suffered from aphasia and hemiplegia of the right side, but mental state was alert. On physical examination, BP was 130/80 mmHg in the right arm, but not checked in the left arm. The pulses of the left common carotid, brachial, and radial arteries were not palpable. The pulses of the right femoral, popliteal, and dorsalis pedis arteries were weakly palpable. Brain CT Scan revealed cerebral infarction of the left hemisphere. Aortogram showed occlusion of the left common carotid, and the right internal carotid and common iliac arteries. Subclavian steal phenomena were observed in the delayed aortogram. Double extra-anatomic bypasses; Axillo-Axillar bypass and Femora-Femoral bypass, were performed in the local anesthesia at two stages, because of risk of major operation under general anesthesia. Postoperatively, all pulses except for pulse of the left common carotid artery were equally palpable. On discharge, the hemiplegia of the right side was improved and able to walk with assistance.

• Journal of Chest Surgery
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• 제39권11호
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• pp.815-821
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• 2006

배경: 경동맥 내막절제술은 심한 경동맥 협착증이 있는 환자에서 발생 가능성이 높은 뇌졸중을 예방하는 데 효과적인 것으로 알려져 있으나 술 후 사망이나 뇌졸중 등의 심각한 합병증을 유발할 수 있다. 이에 저자들은 경동맥 협착증에 대한 수술적 치료의 결과를 분석하여 향후 수술의 합병증을 줄이고자 본 연구를 시행하였다. 대상 및 방법: 1996년 2월부터 2004년 7월까지 경동맥 협착증으로 한 명의 술자에 의해 경동맥 내막절제술을 시행 받은 74명(76예)의 의무기록을 후향적으로 분석하였다. 결과: 남자가 64명, 여자가 10명이었고 평균연령은 63.6세($40{\sim}77$세)였다. 경동맥 내막절제술만을 시행한 경우가 63예, 내막절제술과 함께 패취를 이용하여 경동맥 성형술을 시행한 경우가 8예, 내막절제술과 함께 경동맥의 일부를 절제한 후 단단 문합한 경우가 5예였다. 수술 중 동맥내 션트는 29예에서 사용되었다. 총경동맥과 외경동맥을 겸자한 후의 평균 내경동맥 역류압은 뇌파의 허혈성 변화가 있었던 25예(A군)의 경우 $23.48{\pm}10.04$ mmHg이었고, 뇌파의 허혈성 변화가 없었던 51예(B군)의 경우 $47.16{\pm}16.04$ mmHg이었다. 두 군 간의 내경동맥 역류압의 평균치는 통계학적으로 차이가 없었으나 (p=0.095) 뇌파의 허혈성 변화가 나타난 환자의 내경동맥 역류압은 모두 40 mmHg 이하였다. 내경동맥 역류압에 관계없이 뇌파의 허혈성 변화가 없으면 동맥내 션트를 시행하지 않고 수술하였다. 합병증은 일시적인 설하신경 마비 4예, 기존의 뇌경색 부위에 발생한 뇌출혈 2예, 경미한 뇌경색 1예, 봉합 부위의 혈액 누출에 의한 혈종 1예, 술 중 과도한 견인에 의해 유발된 것으로 생각되는 후두 부종에 의한 상기도 폐쇄 2예였다. 기존의 뇌경색 부위에 발생한 뇌출혈 2예 중 1예는 응급 수술을 시행한 경우로 뇌출혈이 심해 보존치료 도중 사망하였다. 결론: 경동맥 내막절제술은 수술 사망률이 낮은 비교적 안전한 수술 방법이다. 허혈성 뇌손상을 예방하기 위해 사용되는 동맥내 션트는 내경동맥 역류압보다는 뇌파의 허혈성 변화 여부에 따라 사용되어야 한다고 생각한다. 후두 부종을 예방하기 위해 수술 중 과도한 견인을 피하고 수술 직후 혈압을 엄격히 관리해야 하며, 후두 부종이 의심되면 작은 구경의 튜브를 이용한 기관 삽관이나 응급 기관절개술 등을 통하여 신속하게 기도를 확보해야 한다.

• The Korean Journal of Physiology and Pharmacology
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• 제2권6호
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• pp.705-714
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• 1998

Cerebral blood vessels relax when extracellular $K^+$ concentrations $([K^+])_e$ are elevated moderately $(2{\sim}15$ mM, $K^+-induced$ vasorelaxation). We have therefore studied the underlying mechanism for this $K^+-induced$ vasorelaxation in the isolated middle cerebral arteries (MCAs). The effects of ouabain and $Ba^{2+}\;on\;K^+-induced$ vasorelaxation were examined to determine the role of sodium pump and/or Ba-sensitive process (possibly, inward rectifier K current) in the mechanism. Mulvany myograph was used to study 24 rats, 18 rabbits, and 10 humans MCAs $(216{\pm}3\;{\mu}m,\;347{\pm}7\;{\mu}m,\;and\;597{\pm}39\;{\mu}m$ in diameter when stretched to a tension equivalent to 55 mmHg). High $K^+$ (125 mM) and $PGF_{2{\alpha}}\;(1{\sim}10\;{\mu}M)$ induced concentration-dependent contractions in all 3 species, while histamine $(10{\sim}50\;{\mu}M)$ evoked contraction only in the rabbits and induced relaxation in the rats and humans. Addition of $K^+\;(2{\sim}10\;{\mu}M)$ to the control solution induced vasorelaxations. These effects were inhibited by the pretreatment with both ouabain $(10\;{\mu}M)$ and $Ba^{2+}\;(0.1{\sim}0.3\;mM)$ in the rat, but only with ouabain $(10\;{\mu}M)$ in the rabbit and human. These results suggest that $K^+-induced$ vasorelaxation occurs via the stimulation of electrogenic Na pump in the rabbit and human MCAs, while in the rat MCAs via the activation of both Na pump and Ba-sensitive process.

• 대한약리학회지
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• 제24권2호
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• pp.203-216
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• 1988

돼지, 가표 및 가토의 뇌동맥에서 기저동맥 (basilar artery, BA)과 circle of willis동맥 (WC)의 동맥환을 만들어 혈관수축제와 calcium 길항제의 효과 그리고 내피세포의 역할은 검토하였다. 돼지 BA와 WC에 서 norepinephrine (NE), phenylephrine (PE)및 epinephrine (EP)은 propranolol $10^{-6}M$ 전처리하에서 그리고 KCI, histamine, 5-hydroxytryptamine (5-HT) 및 angiotensin은 모두 용량의존성 수축반응을 일으켰다. 그 최대수축력은 angiotensin에서 가장 적었고, 5-HT에서 가장 강력하였다. KCI 35 mM수축반응은 calcium 길항제로 용량의존성으로 억제되었고, 그 효력은 nifedipine > > diltiazem > flunarizine > oxybutynin > isosorbide dinitrate (ISDN) > glycerl trinitrate의 순서였다. 5-HT $10^{-5}M$의 수축반응은 nifedipine으로는 용량의존성으로 억제 되었으나 diltiazem과 ISDN으로는 경미한 억제만을 일으켰다. 내피세포동맥환에서 KCI 35 mM의 수축반응은 acetylcholine (ACh)으로 거의 영향받지 않았으나 $PGF_{2{\alpha}}\;10^{-5}M$의 수축반응은 ACh과 adenosine으로 용량의존성으로 억제되었고, 이 내피세포 의존성억제는 nifedipine $10^{-6}M$로는 영향받지 않으나 methylene blue $50\;{\mu}M$로는 현저히 억제되었다. 네피제거동맥환에의 $PGF_{2{\alpha}}$의 수축반응은 ACh의 영향이 없거나 더욱 수축되었다. 내피세포를 제거하지 않은 가토흉부대동맥편을 bath에 함께 넣어주면 ACh의 용량의존성 이완반응이 나타났고 이 이완반응도methylene blue로 억제되었다. 가묘 BA와 WC에서 5-HT와 NE는 용량의존성 수축반응을 일으켰고 ACh도 내피세포 존재유무와 관계없이 강력한 용량의존성 수축반응을 일으켰으며 그 최대수축력은 ACh에서 가장 강력하였다. 내피세포동맥환에서 5-HT $10^{-5}M$의 수축반응은 ACh에 의하여 이완반응없이 더욱 수측되었다. 가토 BA에서 5-HT와 NE는 응량의존성 수축반응을 일으졌고5-HT의 수축반응이 더욱 현저하였다. 내피세포동맥환에서 5-HT $10^{-5}M$의 수축반응은 ACh $10^{-5}M$로 현저하게 이완되있고 이 내피세포의존성 이완반응은 atropine $10^{-7}M$로는 억제되었으나 diltiazem $10^{-6}M$로는 거의 억제되지 않았다. 이상의 실험성적은 돼지와 가토의 뇌동맥에서 ACh은 내피세포-의존성 이완반응을 일으키며그 이완반응은 muscarinic receptor를 통해 나타났고, 가묘뇌동맥에서 ACh은 혈관수축제의 역할을 갖고 있음을 시사하고 있다.

• 대한한방내과학회지
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• 제25권4호
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• pp.433-441
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• 2004

The posterior cerebral arteries supply the temporal and occipital lobes of the left cerebral hemisphere and the right hemisphere. Clinical symptoms associated with occlusion of the posterior cerebral artery are visual abnormalities including opposite visual field defects, hallucination, visual amnesia and a variety of other symptoms, including confusion, cognitive disorders, thalamic syndrome, Weber's syndrome, contralateral hemplegia. This case report is about a patient with visual and cognitive abnormalities caused by posterior cerebral artery infarction. He was regarded as Soyangin(少陽人) in constitution and was treated with Yangkyuksanhoa-tang(凉膈散火湯) and other treatments. Improvement in his general symptoms was observed.