• Journal of Korean Neurosurgical Society
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• 제58권2호
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• pp.144-146
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• 2015

Postdural punctural headache (PDPH) following spinal anesthesia is due to intracranial hypotension caused by cerebrospinal fluid (CSF) leakage, and it is occasionally accompanied by an intracranial hematoma. To the best of our knowledge, an intracranial chronic subdural hematoma (CSDH) presenting with an intractable headache after a cervical epidural steroid injection (ESI) has not been reported. A 39-year-old woman without any history of trauma underwent a cervical ESI for a herniated nucleus pulposus at the C5-6 level. One month later, she presented with a severe headache that was not relieved by analgesic medication, which changed in character from being positional to non-positional during the preceding month. Brain magnetic resonance imaging revealed a CSDH along the left convexity. Emergency burr-hole drainage was performed and the headache abated. This report indicates that an intracranial CSDH should be considered a possible complication after ESI. In addition, the event of an intractable and changing PDPH after ESI suggests further evaluation for diagnosis of an intracranial hematoma.

• 한국응용약물학회:학술대회논문집
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• 한국응용약물학회 1994년도 춘계학술대회 and 제3회 신약개발 연구발표회
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• pp.287-287
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• 1994

In the present study, it was aimed to asses the possibility that calcitonin gene-related peptide (CGRP) released in response to transient hypotension may contribute to the reflex autoregulation of cerebral blood flow as a putative modulator. Changes in pial arterial diameter (mean, 33.0 ${\pm}$ 1.1 $\mu\textrm{m}$) with changes in systemic arterial blood pressure (mean, 101.9 ${\pm}$ 2.7 mmHg) were observed directly through a closed cranial window in anesthetized normotensive rats. Image of the pial vessels was captured with a stereoscope connected to a CCD video camera and the diameter was measured with a microscaler. In the capsaicin-treated rats (one day prior to experiment, 50 nmol capsaicin injected intracisternally), both vasodilater and vasoconstrictor responses evoked by a transient hypotension and the reverse of blood pressure were markedly attenuated or almost abolished. When changes in pial arterial diameter were plotted as a function of changes in blood pressure, the slopes of both regression lines (for vasodilators and vasoconstrictors ) were markedly reduced. Similar reductions were evidenced under treatment wi th the CGRP antibody serum (1:1,000) and following CGRP receptor desensitization. However, the autoregulatory mechanics were neither affected by treatment wi th spantide (1 ${\mu}$M), substance P antagonist, nor by substance P receptor desensitization. Suffusion wi th mock cerebrospinal fluid containing CGRP and cromakalim caused a vasodilatation in a concentration-dependent manner, respectively and their effects were antagonized by glibenclamide. Substance P produced a vasodilatation, which was, however, little affected by glibenclamide. These observations indicate that the CGRP released from the perivascular sensory fibers in response to a hypotension is implicated in the modulation of the autoregulation of cerebral blood flow.

• Journal of Korean Neurosurgical Society
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• 제57권5호
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• pp.379-385
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• 2015

Chronic subdural hematomas mainly occur amongst elderly people and usually develop after minor head injuries. In younger patients, subdural collections may be related to hypertension, coagulopathies, vascular abnormalities, and substance abuse. Different techniques can be used for the surgical treatment of symptomatic chronic subdural hematomas : single or double burr-hole evacuation, with or without subdural drainage, twist-drill craniostomies and classical craniotomies. Failure of the brain to re-expand, pneumocephalus, incomplete evacuation, and recurrence of the fluid collection are common complications following these procedures. Acute subdural hematomas may also occur. Rarely reported hemorrhagic complications include subarachnoid, intracerebral, intraventricular, and remote cerebellar hemorrhages. The causes of such uncommon complications are difficult to explain and remain poorly understood. Overdrainage and intracranial hypotension, rapid brain decompression and shift of the intracranial contents, cerebrospinal fluid loss, vascular dysregulation and impairment of venous outflow are the main mechanisms discussed in the literature. In this article we report three cases of different post-operative intracranial bleeding and review the related literature.

• The Korean Journal of Physiology and Pharmacology
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• 제2권5호
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• pp.573-580
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• 1998

The study aims to identify the mechanism (s) underlying the altered vasodilatory responses of the pial artery of spontaneously hypertensive rats (SHR) under a hypothesis that calcitonin gene-related peptide (CGRP) exerts a modulator role in the autoregulation of cerebral blood flow (CBF). The animals were divided into four groups: 1) Sprague-Dawley rats (SDR), 2) Wistar rats (WR), 3) SHR with high blood pressure $(BP{\ge}150\;mmHg),$ and 4) SHR with normotensive BP $({\le}150\;mmHg).$ The lower limit of CBF autoregulation in SHR shifted to a higher BP $(82.8{\pm}9.3\'mmHg,\;P<0.05)$ than that in SDR $(58.9{\pm}5.7\;mmHg)$. In SHR, whether the BP levels were high or normotensive, the vasodilator responses to a stepwise hypotension were significantly attenuated unlike with SDR and WR. When artificial cerebrospinal fluid (CSF) containing capsaicin $(3{\times}10^{-7}\;M)$ was suffused over the cortical surface, a transient increase in pial arterial diameter was observed in the SHR with high or normotensive BP. In contrast, SDR and WR showed a large increase in diameter, and the increase was sustained for over 10 minutes. In line with these results, the basal releases of CGRP-like immunoreactivity (CGRP-LI) in the isolated pial arteries from SHR with high and normotensive BP were $12.5{\pm}1.4\;and\;9.8{\pm}2.8\;fmole/mm^2/60\;min\;(P<0.05)$, while those from SDR and WR were $25.5{\pm}3.1\;and\;24.6{\pm}3.1\;fmole/mm^2/60\;min,$ respectively. The isolated basilar arteries showed similar results to those of the pial arteries in SHR. Thus, it is summarized that, in the SHR, the reduced autoregulatory vasodilator responses to stepwise hypotension and capsaicin may be, in part, ascribed to the decreased release of CGRP from the perivascular sensory nerve fibers of the pial arteries, and that altered vasomotor activity in SHR may not be related with the hypertensive tone.

• The Korean Journal of Pain
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• 제9권1호
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• pp.260-263
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• 1996

High spinal block is a rare complication during epidural block, but it may result in serious events. 56-year-old man with gall stones was scheduled for cholecystectomy under general anesthesia. After operation, lumbar epidural catheterization was done at $T_{8-9}$ interspace for postoperative pain control. At the recovery room, initial bolus drug (0.1% bupivacaine 10 ml containing fentanyl $100{\mu}g$) was administered via epidural catheter and observed carefully. 15 minutes later, hypotension and bradycardia ouccurred. Hartman' solution was administered rapidly and ephedrine 5 mg was injected. 30 minutes after drug administration, loss of consciousness and respiratory arrest developed. Tracheal intubation was done immediately. Cardiovascular and respiratory functions were monitored continuously. The location of intrathecal catheter was confirmed by cerebrospinal fluid (CSF) seen in syringe after aspiration of catheter. The patient recovered gradually and was placed in the ward 4 hours after drug administration, without any problems. He was discharged 1 week later in good health.

• Journal of Korean Neurosurgical Society
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• 제55권4호
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• pp.218-221
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• 2014

Chronic subdural hematoma (CSDH), which rarely happens in the young, is thought to be a disease of the elderly. Whereas unspecific symptoms and insidious onset in juveniles and young adults, as a result of its relative low morbidity, CSDH is usually neglected even undertreated in the young. Through the three cases and review of the current literature on this subject, we tried to illustrate the clinical and etiopathological characteristics of this entity and find out the most appropriate treatment strategy. We report three young CSDH patients with different but similar symptoms. The present histories, tests and examinations revealed different predisposing factors accounting for the genesis of CSDH. Their preoperative symptoms were all resolved with burr hole and drainage operation. Juveniles and young adults suffering from CSDH differ from that of their elderly counterparts in their clinical and etiopathological characteristics. Although trauma is the most important risk factor in young and old CSDH patients, some other predisposing factors may exist. Burr hole and drainage surgery could resolve the problem most of the time. But further tests and examinations even specific management should be made in some cases.

• 척추신경추나의학회지
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• 제1권1호
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• pp.45-50
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• 2006

Objectives : A rare case of dural tear ensuing after a cervical Chuna Manipulation Treatment leading to cerebrospinal fluid (CSF) leakage in the lower cervical and upper thoracic spine was found, so we report it. Methods : A 32-year-old woman presented with back and neck pain in 1 days earlier. The patient undertook a cervical Chuna Manipulation Treatment. After this maneuver, the patient complained of an orthostatic headache with nausea. The patient's headache worsened, and lying down gave the only measure of limited relief. In Brain CT and MRI study, nonspecific finding was detected. In Cistemography study, CSF leakage at lower cervical or upper thoracic area was detected. Results and Conclusions : It is supposed that this patient suffered a dural tear and CSF leakage secondarily due to a cervical Chuna Manipulation Treatment. From this case, we can understand the etiology of dural tear to some extent and consider the complication of Chuna Manipulation Treatment. In the future, more study, research and prospective trial for complications of a cervical Chuna Manipulation Treatment is needed.

• Nuclear Medicine and Molecular Imaging
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• 제40권3호
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• pp.148-154
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• 2006

목적 : 방사성동위원소 뇌조조영술은 자발성 두개강내 저뇌압증이 의심되는 환자에서 뇌척수액의 누출을 진단하는데 유용한 검사이지만, 뇌척수액의 누출 부위를 증명하지 못하는 경우가 있다. 본 연구의 목적은 방사성동위원소 뇌조조영술의 검사 방법을 변화함으로써 뇌척수액 누출 부위의 진단율을 향상시키고, 검사 소요시간을 단축할 수 있는지 알아 보고자 한다. 대상 및 방법 : 자발성 두개강내 저뇌압증으로 진단되어 방사성동위원소 뇌조조영술을 시행한 7명의 환자(평균 나이=$38{\pm}8$세, 남자 2명, 여자 5명), 8회 검사를 대상으로 하였다. 모든 환자들은 자주막하강에 $^{99m}Tc$-DTPA 185-222 MBq을 투여한 후 10분, 30분, 1시간, 2시간, 4시간 그리고 6시간에 방광을 포함하는 요추부부터 두부까지의 영상을 얻었다. 그리고 영상시간에 따라 뇌척수액의 누출과 방광의 방사능 조기 출현을 평가하였다. 결과: 방사성동위원소 뇌조조영술을 통해 8예 모두에서 뇌척수액의 누출 부위를 확인할 수 있었다. 뇌척수액의 누출 부위는 경흉추 경계부(cervico-thoracic junction)에서 3예, 경흉추 경계부와 C1-2에서 2예, 경흉추 경계부와 흉추부, 흉요추부 여러 곳 그리고 요추부가 각각 1예씩 이었다. 모든 예에서 1시간까지의 영상을 통해 모든 예에서 뇌척수액의 누출 부위를 발견할 수 있었으며, 모두 두 곳 이상에서 누출이 있었다. 이 중 경흉추 경계부를 포함하는 경우가 5예였다. 지연 영상에서 뇌척수액의 누출 부위가 추가로 발견된 경우는 단 1예 뿐 이었다. 조기 방광방사능 출현은 6예에서 관찰되었으며, 모두 뇌척수액 유출부위가 더 먼저 관찰되었다. 결론: 방사성동위원소 뇌조조영술은 자발성 두개강내 저뇌압증 환자에서 뇌척수액의 누출 부위를 확인하는데 매우 예민한 검사이며, 검사법을 변형함으로써 뇌척수액의 누출 부위를 발견하는 빈도를 향상시키고, 검사시간을 단축할 수 있을 것으로 기대된다.

• 대한약리학회지
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• 제31권1호
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• pp.27-37
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• 1995

본 연구에서는 콜린성 기전에 반응하여 분비되는 내피 의존성 이완물질(endothelium-derived relaxing factor, EDRF)나 nitric oxide(NO)가 마취 흰쥐의 뇌혈류 자가조절기전에 관여할 가능성을 관찰하였다. Acetylcholine($10^{-9}-10^{-6}M$)을 포함한 mock 뇌척수액(CSF)을 관류시 뇌연막 동맥은 농도에 의존하여 이완반응 나타내었고(평균; $19.3{\pm}1.7{\mu}m$, n=36), 이러한 이완반응은 $N{\omega}$-nitro-L-arginine(L-NNA, $10^{-5}M$)에 의해서 억제되었을 뿐 아니라 methylene blue($10^{-6}M$)나 oxyhemoglobin($10^{-6}M$)에 의하여도 억제되었다. 한편 이러한 acethlcholine에 의한 뇌연막동맥의 이완반응을 매게하는 무스카린 수용체는 무스카린 수용체 길항제의 봉쇄효과를 관찰한 실험에서 $M_1$과 $M_3$ 아형으로 생각되었다. L-Arginine을 함유한 mock CSF로 관류시 일어나는 일시적인 혈관이완반응은 NY 83583 ($10^{-5}M$)에 강력히 억제되었으나 L-NNA ($10^{-5}M$)에 의해서는 억제되지 아니하였다. 한편 acetylcholine과 L-arginine에 의한 혈관이완반응은 ATP-sensitive $K^+$ 통로 봉쇄제인 glibenclamide에 의해 유의하게 봉쇄되었다. 나아가 뇌연막동맥의 직경 변화를 동맥압의 변화에 대하여 검정한 결과 혈관이완과 혈관수축의 희귀 직선의 경사도는 $10^{-5}M$ L-NNA의 전처치에 의하여 영향을 받지 아니하였으나, $3{\times}10^{-6}M$ glibenclamide에 의해 유의하게 감소되었다. 이러한 결과로 보아 혈압하강에 대해 쥐의 뇌연막동맥에 나타나는 혈관이완반응은 EDRF(NO)에 의해 매개되지 않는다고 사료된다.

• Pediatric Infection and Vaccine
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• 제27권2호
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• pp.102-110
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• 2020

목적: 이번연구의목적은 human parechovirus (HPeV)로유발된패혈증의증을보였던 3개월미만의영아를대상으로임상적 특징 및 경과를 조사하는 것이다. 방법: 2018년 7월 1일부터 8월 31일까지 패혈증 의증으로 입원한 3개월 미만 영아들의 의무기록을 확인하였다. 환자들은 뇌척수액을 이용하여 역전사 중합효소 연쇄반응 검사를 시행하고 결과에 따라 HPeV 감염군(1군, 11명), 장바이러스 감염군(2군, 13명), 바이러스가 검출되지 않은 군(3군, 15명)으로 구분하였다. 결과: 1군은 빈맥, 빈호흡, 무호흡, 저혈압, 피부 변화를 보이는 환자가 2, 3군 보다 많았다(P<0.05). 또한 1군은 혈중 총 백혈구수가 다른 군에 비해 낮았다(5,622±2,355/μL, 9,397±2,282/μL and 12,312±7,452/μL, P=0.005). 뇌척수액 백혈구 수도 1군은 2, 3군에 비하여 낮았다 (0.9±1.7/μL, 85.1±163.6/μL, and 3.7±6.9/μL, P=0.06). 치료에서도 1군은 2, 3군 보다 승압제 보조(36.6% vs. 0% and 6.6%), 기계 환기 적용(18.1% vs. 0% and 0%)과 고유량 산소 사용(45.4% vs. 15.3% and 6.6%)이 더 많았다. 모든 환자들은 합병증 없이 회복 되었다. 결론: HPeV 감염은 심각한 임상 경과를 보이고, 3개월 미만의 영아에서 패혈증 유사 증후군의 원인이 될 수 있다. 따라서, HPeV 감염 여부를 조기에 진단하고 적절한 치료를 시작하는 것이 필요하다.