• Nuclear Medicine and Molecular Imaging
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• v.42 no.5
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• pp.347-353
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• 2008

Purpose: Cortical reorganization has an important role in the recovery of stroke. We analyzed the compensatory cerebral and cerebellar perfusion change in patients with unilateral cerebral infarction using statistical parametric mapping (SPM). Materials and Methods: Fifty seven $^{99m}TC-Ethylene$ Cystein Diethylester (ECD) cerebral perfusion SPECT images of 57 patients (male/female=38/19, mean age=$56{\pm}17\;years$) with unilateral cerebral infarction were evaluated retrospectively. Patients were divided into subgroups according to the location (left, right) and the onset (acute, chronic) of infarction. Each subgroup was compared with normal controls (male/female=11/1, mean age=$36{\pm}10\;years$) in a voxel-by-voxel manner (two sample t-test, p<0.001) using SPM. Results: All 4 subgroups showed hyperperfusion in the ipsilateral cerebral cortex, but not in the contralateral cerebral cortex. Chronic left and right infarction groups revealed hyperperfusion in the ipsilateral primary sensorimotor cortex, meanwhile, acute subgroups did not. Contralateral cerebellar hyperperfusion was also demonstrated in the chronic left infarction group. Conclusion: Using $^{99m}Tc-ECD$ SPECT, we observed ipsilateral cerebral and contralateral cerebeller hyperperfusion in patients with cerebral infarction. However, whether these findings are related to the recovery of cerebral functions should be further evaluated.

• The Journal of Korean Medicine
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• v.42 no.4
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• pp.164-175
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• 2021

Objectives: The LI11 (Quchi) acupuncture point has always been included in the Seven acupoints for stroke; however, additional LI11 acupuncture research is needed. In this study, the effect of LI11 acupuncture on cerebral blood flow of the anterior cerebral arteries (ACA) and middle cerebral arteries (MCA) was investigated. Method: This study included 10 healthy young male subjects. Cerebral blood flow velocity and cerebrovascular reactivity were measured using transcranial Doppler sonography. Changes in hyperventilation-induced carbon dioxide (CO₂) reactivity and modified ACA and MCA blood flow velocity at 40 mmHg (CV40), blood pressure, and heart rate were observed before and after LI11 acupuncture treatment. Results: A statistically significant increase in contralateral anterior cerebral artery CO₂ reactivity (p=0.036) and decrease in contralateral middle cerebral artery CV40 (p=0.047) were observed. No significant difference in mean blood pressure was shown. A statistically significant increase in heart rate occurred after LI11 acupuncture; however, it was not clinically significant as there were negligible changes in the heart rhythm. Conclusions: LI11 acupuncture treatment could improve cerebral blood flow velocity. These results might be explained by regulating endothelium-dependent vessel dilation in the anterior cerebral artery region. Trial registration: This trial has been registered with Clinical Research Information Service, a service of the Korea Centers for Disease Control and Prevention: KCT0004494 (retrospectively registered). https://cris.nih.go.kr/cris/search/search_result_st01.jsp?seq=15359

• The Journal of the Society of Stroke on Korean Medicine
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• v.7 no.1
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• pp.46-53
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• 2006

Objectives : The purposes of this study were to investigate that a blepharospasm means the presymptom of stroke based on the traditional hypothesis in the oriental medicine and to compare a blepharospasm with warning signs of stroke in the western medicine. Methods : In the time period Oct. 2005 to Oct. 2006, 409 patients with a first-ever stroke admitted in the department of Internal Medicine of Kyungwon University In-cheon Oriental Medical Hospital, Kyunghee University Oriental Medical Hospital, Dongguk Il-san Oriental Medical Hospital were included. Patients were hospitalized within 14 days after the onset of stroke. Stroke patients were interviewed by residents who studied standard operation procedures in Fundamental Study for Standardization and Objectification of Differentiation and Pattern Identification of Syndrome of Oriental Medicine for Stroke. A questionnaire was completed by a question-and-answer form between patients and residents after explanation details to patients and the agreement of patients. Results : Age, care of patients or grandson, diabetes mellitus, and smoking were higher among cerebral infarction group, while smoking was higher among hemorrhage group. Female, young age, hyperlipidemia, hypertension in the family history and fat body in waist-hip ratio were higher among patients undergoing the blepharospasm before stroke onset. And the incidence of blepharospasm was lower in patients who dislike the fast food. Finally, when we compared a blepharospasm with warning signs of stroke in the western medicine, the incidence of blepharospasm in this study were the most frequent. Conclusion : In this study, the incidence of blepharospasm in patients before stroke onset was more frequent than that of warning signs in the western medicine. But more data from prospective cohort studies should be collected to be accepted that the blepharospasm is the presymptom of stroke as like warning signs in the western medicine.

• Journal of Korean Biological Nursing Science
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• v.2 no.2
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• pp.67-80
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• 2000

The purpose of this study was to identify hindlimb muscle atrophy in stroke induced rat and determine the effect of endurance exercise on body weight, weight of hindlimb muscle during 7 days after stroke induction. Thirty four male Sprague-Dawley rats with 200-270g body weight were divided into four groups : control, control+exercise(Con+Ex), stroke, and exercise after stroke(St+Ex) group. The control group and Con+Ex group received sham operation and the stroke group and St+Ex group received right MCA occlusion operation by using silicon-coated probe. The Con+Ex and St+Ex groups ran on a treadmill for 20min/day at 10m/min and $10^{\circ}grade$. Daily body weight and diet intake were measured every morning for 7 days. Cerebral infarction of stroke and St+Ex groups were identified by staining with TCC for 30minutes. The data were analyzed by Kruskal-Wallis test and Mann-Whitney U test using the SPSSWIN 9.0 program. Body weight of the control group at the 7th day increased by 18.3% significantly from the first day of experiment, that of the stroke group at the 7th day decreased by 6.7% significantly compared to the day of receiving right MCA occlusion operation. Body weight of the Con+Ex group at the 7th day increased by 10.3% significantly form the first day of experiment, that of St+Ex group at the 7th day also increased by 13.4% significantly compared to the day of receiving right MCA occlusion operation. The total amount of diet in stroke group decreased significantly compared to that of St+Ex and that of control group. In stroke group the wet weight of both sides of soleus, plantaris, and gastrocnemius muscles decreased significantly compared to that of control group. The relative weight of affected(left) plantaris and gastrocnemius muscles decreased significantly compared to that of the control group. The difference between the weight of affected and unaffected soleus, plantaris, and gastrocnemius muscles were not significant in stroke group. The wet weight of right gastrocnemius muscles in Con+Ex group increased compared to that of control group. The relative weight of right gastrocnemius muscle increased significantly compared to that of the control group. The wet weight of St+Ex group increased significantly compared to that of the stroke group in both sides of soleus, plantaris, and gastrocnemius muscles. The relative weight of affected plantaris muscle increased significantly compared to that of the stroke group. The difference between the weight of affected and unaffected soleus, plantaris, and gastrocnemius muscles were not significant in St+Ex group. Body weight and wet weight of soleus, plantaris, and gastrocnemius muscles in the St+Ex group did not recover to the values of control group. Based on these results, it can be suggested that endurance exercise during acute stage of stroke can reduce muscle atrophy related to denervation, inactivity and undernutrition.

• Therapeutic Science for Rehabilitation
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• v.8 no.4
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• pp.7-18
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• 2019

Objective : This systematic review aimed to investigate the impact of transcranial direct current stimulation combined with constraint-induced movement therapy (CIMT) in patients with stroke Methods : PubMed and NDSL databases were employed to review literature published between January 2009 and December 2018. The main search terms were "Transcranial direct current stimulation" or "tDCS," "Constraint-induced movement therapy" or "CIMT," "Upper extremity function," "Upper limb," and "Stroke." Based on the inclusion and exclusion criteria, 6 articles were selected. Furthermore, intervention effects on upper extremity function, activities of daily living, and cortical activity were assessed. Results : The current intensity, application time, and protocol of the CIMT varied the between studies. However, the intervention procedures to perform CIMT immediately after transcranial direct current stimulation was the same. Transcranial direct current stimulation combined with CIMT was effective in improving upper limb function and activities of daily living in patients with stoke and had a significant effect on cerebral cortex activation. Conclusions : This study provides information on transcranial direct current stimulation combined with CIMT for use by clinical therapists. Further studies are needed to standardize the stimulation time, current intensity, and electrode attachment position. Furthermore, randomized controlled trials, including long-term follow up, are needed for larger populations using the most appropriate CIMT protocol.

• PNF and Movement
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• v.16 no.1
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• pp.7-17
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• 2018

Purpose: The aim of this study was to investigate the effects of coordinative locomotor training in a chronic stroke patient. Methods: A left hemiplegic patient diagnosed with a right middle cerebral artery stroke participated in this research. The patient's functional conditions were assessed, and a coordinative locomotor training program was initiated to resolve the problems identified. A set of movements deemed difficult based on the brief International Classification of Functioning, Disability and Health core set for stroke and d4501 (long-distance walking) were agreed as improvement targets. The program comprised warm up, main, cool-down, and home exercises. Repeated measurements were obtained, as follows: five times at baseline (A), 10 times during the intervention (B), and five times after the intervention (A). The study period was 7 weeks, and the intervention period was 1 h per day, twice a week for 5 weeks. Various tools, including the community walking test (CWT), 10-m walking test (10 MWT), 6-min walking test (6 MWT), and timed up and go (TUG) test, were conducted to assess the patient's walking ability. Changes in functional domains before and after the ICF Qualifier were compared. The mean values of the descriptive statistics were calculated, and a visual analysis using graphs was used to compare the rates of change. Results: The results showed that the CWT, 10 MWT, 6 MWT, and TUG test scores during the intervention period improved and that this improvement remained, even during the baseline period. In addition, the ICF Qualifier before and after the comparison decreased from moderate to mild. Conclusion: Based on the results, we propose that coordinative locomotor training can have positive effects on community ambulation of chronic stroke patients.

• Biomedical Science Letters
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• v.15 no.1
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• pp.17-23
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• 2009

The prevalence of patent foramen ovale (PFO) in healthy persons was estimated as about $10{\sim}25%$ and was up to 40% in patients with stroke. Transesophageal echocardiography (TEE) was considered to be the most sensitive method to detect PFO and was used as the gold standard. Transcranial doppler sonography (TCD) of the middle cerebral artery (MCA) during a contrast (saline bubble) injection has recently been proposed as an alternative detecting method for PFO. In this study, we would like to know the difference between TCD value and TEE value in subjects with cryptogenic ischemic stroke. We performed TCD and TEE tests to detect PFO on 64 patients (30 women and 34 men, mean age was 59.4 years) with cryptogenic ischemic stroke. PFO prevalence through TCD was 45.3% (29 of 64 patients) and the prevalence through TEE was 34.4% (22 of 64 patients). There was no statistical significance between PFO test and TCD test (P=0.206). But TCD had a sensitivity of 90.9% (20 of 22 patients), specificity of 78.6% (33 of 42 patients), positive predictive value of 69.0% (20 of 29 patients), and negative predictive value of 94.3% (33 of 35 patients). We concluded that TCD was a highly sensitive method for detecting a right-left shunt. Therefore, the non-invasive TCD test is a method more effective than the anti-invasive TEE test in the cost and evaluation of the existence or nonexistence of right to left shunt in addition to the screening method of the cerebrovascular disorder. Considering these points, TCD test could be recommended for patients with cryptogenic ischemic stroke as a useful and convenient method for screening of the existence or nonexistence of a right to left shunt caused by PFO.

• Journal of Korean Neurosurgical Society
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• v.41 no.2
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• pp.134-136
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• 2007

A woman who had a spontaneous subarachnoid hemorrhage [SAH] and temporal intracerebral hemorrhge [ICH] without any causative lesions on computed tomography [CT] and digital angiography at the day of the stroke. She was considered to have an angiographically negative SAH and scheduled for a repeated angiography. While she was waiting for the next study, she developed a second hemorrhage. CT angiography showed an aneurysmal shadow in the course of the posterior cerebral artery. After the operation, the aneurysm proved to be a pseudoaneurysm.

• Journal of Physiology & Pathology in Korean Medicine
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• v.17 no.5
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• pp.1339-1342
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• 2003

CVA is a kind of cerebrovascular disease which has a few local functional lesions of brain tissue, and it is generally caused by cerebral infarction, cerebral hemorrhage, and so on. It is also known as a stroke of paralysis, which leaves a lot of sequelae in a patient such as lesion of movement, perceiving, memory, sense, emotion, etc. A CVA patient which has a sequela, the sense disorder of equilibrium, took the Saam Acupuncture Therapy and Dr. Dong's Acupuncture Therapy, and then he was cured.

• Journal of Korean Neurosurgical Society
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• v.60 no.3
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• pp.362-366
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• 2017

Vascular compromise is a well-known consequence of brain herniation syndromes. Transtentorial brain herniation most often involves posterior cerebral arteries. However, isolated involvement of contralateral superior cerebellar artery (SCA) during unilateral impending brain herniation is reported only once and we present another case of this exceedingly rare entity. A 24-year-old man was referred to us with impending herniation due to a multiloculated hydrocephalus, and during the course of illness, he developed an isolated SCA ischemia in the opposite side of the most dilated entrapped horn. In the current article we discuss the probable pathophysiologic mechanisms of this phenomenon, as well as recommending more inclusive brain studies in cases suspected of Kernohan-Woltman notch phenomenon in unilateral brain herniation. The rationale for this commentary is that contralateral SCA transient ischemia or infarct might be the underdiagnosed underlying pathomechanism of ipsilateral hemiparesis occurring in many cases of this somehow vague phenomenon.