• Physical Therapy Korea
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• v.12 no.2
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• pp.98-104
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• 2005

This study was done to research the general information, causes of stroke, risk factors, complications during admission of geriatric CVA inpatients. We retrospectively studied 208 above 65 years old geriatric CVA inpatients treated in Ajou university hospital from 1994 to 2003 by medical record. These were divided into two groups by following years. We were gathered information about sex, onset age, cause of stroke, number of stroke, complications, housing, family, insurance, smoking, alcohol. Most of incidence of the stroke was noted in the group of young old age (65~74 years old) and old age (75~84 years old). The occurrence rate of male stroke (38.5%) was less than of female stroke (61.5%) and the ratio of male to female was 1:1.6. The occurrence rate of ischemic stroke (72.6%) was higher than of hemorrhagic stroke. The occurrence rate of ischemic stroke increased more and more at the late stage. The most common risk factors for stroke was hypertension and complications during hospitalization were neurogenic bowl and bladder. These results of epidemiologic study may help above 65 years old geriatric CVA early treatment and prevention, rehabilitation and use basic data for multiple prospective study using stroke registry.

• Clinical and Experimental Pediatrics
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• v.55 no.11
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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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• v.64 no.4
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• pp.665-670
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• 2021

Symptomatic cerebral vasospasm (CVS) and delayed ischemic neurologic deficit (DIND) after unruptured aneurysm surgery are extremely rare. Its onset timing is variable, and its mechanisms are unclear. We report two cases of CVS with DIND after unruptured aneurysm surgery and review the literature regarding potential mechanisms. The first case is a 51-year-old woman with non-hemorrhagic vasospasm after unruptured left anterior communicating artery aneurysm surgery. She presented with delayed vasospasm on postoperative day 14. The second case is a 45-year-old woman who suffered from oculomotor nerve palsy caused by an unruptured posterior communicatig artery (PCoA) aneurysm. DIND with non-hemorrhagic vasospasm developed on postoperative day 12. To our knowledge, this is the first report of symptomatic CVS with oculomotor nerve palsy following unruptured PCoA aneurysm surgery. CVS with DIND after unruptured aneurysm surgery is very rare and can be triggered by multiple mechanisms, such as hemorrhage, mechanical stress to the arterial wall, or the trigemino-cerebrovascular system. For unruptured aneurysm surgery, although it is rare, careful observation and treatments can be needed for postoperative CVS with DIND.

• Journal of Cerebrovascular and Endovascular Neurosurgery
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• v.26 no.2
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• pp.196-203
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• 2024

Isolated middle cerebral artery dissection (MCAD) is rare but increasingly recognized as a significant clinical entity, particularly in younger adults. Ischemic stroke is the most common manifestation in symptomatic cases but symptoms can vary in severity from headaches to severe neurologic deficits. Due to its rarity and unpredictable clinical course, there is no established treatment strategy for isolated MCAD. Through two case reports, we reviewed the post-operative clinical course of MCAD under different treatment modalities. Case 1 was a 21-year-old woman who presented to the emergency department with headaches and left-side hemiparesis. Isolated MCAD was diagnosed and she was successfully treated with the placement of a self-expandable stent and subsequent chemical angioplasty for post-stent vasospasm. Case 2 was a 35-year-old woman who presented to the emergency department with left-side hemiparesis and dysarthria. Isolated MCAD was diagnosed and she was successfully treated with superficial temporal artery (STA) to middle cerebral artery (MCA) anastomosis.

• Korean Journal of Acupuncture
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• v.21 no.1
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• pp.15-27
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• 2004

Objectives : Acupuncture has been used to prevent and treat the cerebrovascular accident, such as a stroke, and many studies of acupuncture and moxibustion concerning to the stroke have been undertaken in the human and various animals. Also, herbal acupuncture, namely aqua acupuncture has been applied and developed to various diseases including the cerebrovascular accident. FOLIUM ARTEMISIAE ARGYI is the dry leaf of Artemisia argyi Levl. et Vant. collected in summer before the plant blooms and used to moxibustion and has been recommended for use as an analgesic and hemostatic. In this study, effects of FOLIUM ARTEMISIAE ARGYI (艾葉)' herbal acupuncture on the $LR_3$, namely Taechung on neuroprotection after the transient forebrain ischemia were investigated in Sprague-Dawely rats. Methods : Expressions of neuronal nitric oxide synthase (nNOS) protein in the hippocampus and cortex were observed at 2 hrs after transient forebrain ischemia by immunohistochemistry. Results : Expression of nNOS protein was increased in the hippocampus and cortex at 2 hrs after transient forebrain ischemia. However, pretreatment with FOLIUM ARTEMISIAE ARGYI' herbal acupuncture on $LR_3$ significantly decreased expression of nNOS protein protein compared to ischemia group. These features were observed in the motor cortex and the hippocampus. Conclusions : These results suggest that pretreatment with FOLIUM ARTEMISIAE ARGYI' herbal acupuncture on $LR_3$ inhibits the expression of nNOS protein induced by transient forebrain ischemia and may modulate excitatory toxicity of neuron related to neuronal cell death.

• Journal of Korean Neurosurgical Society
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• v.67 no.1
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• pp.73-83
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• 2024

Objective : The Act on Life-Sustaining Treatment (LST) decisions for end-of-life patients has been effective since February 2018. An increasing number of patients and their families want to withhold or withdraw from LST when medical futility is expected. This study aimed to investigate the status of the Act on LST decisions for patients with acute cerebrovascular disease at a single hospital. Methods : Between January 2017 and December 2021, 227 patients with acute cerebrovascular diseases, including hemorrhagic stroke (n=184) and ischemic stroke (n=43), died at the hospital. The study period was divided into the periods before and after the Act. Results : The duration of hospitalization decreased after the Act was implemented compared to before (15.9±16.1 vs. 11.2±18.6 days, p=0.127). The rate of obtaining consent for the LST plan tended to increase after the Act (139/183 [76.0%] vs. 27/44 [61.4%], p=0.077). Notably, none of the patients made an LST decision independently. Ventilator withdrawal was more frequently performed after the Act than before (52/183 [28.4%] vs. 0/44 [0%], p<0.001). Conversely, the rate of organ donation decreased after the Act was implemented (5/183 [2.7%] vs. 6/44 [13.6%], p=0.008). Refusal to undergo surgery was more common after the Act was implemented than before (87/149 [58.4%] vs. 15/41 [36.6%], p=0.021) among the 190 patients who required surgery. Conclusion : After the Act on LST decisions was implemented, the rate of LST withdrawal increased in patients with acute cerebrovascular disease. However, the decision to withdraw LST was made by the patient's family rather than the patient themselves. After the execution of the Act, we also observed an increased rate of refusal to undergo surgery and a decreased rate of organ donation. The Act on LST decisions may reduce unnecessary treatments that prolong end-of-life processes without a curative effect. However, the widespread application of this law may also reduce beneficial treatments and contribute to a decline in organ donation.

• Journal of Physiology & Pathology in Korean Medicine
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• v.16 no.1
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• pp.104-110
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• 2002

Citri Reticulatae Viride Pericarpium extract(CRVP) have been used in oriental medicine for many centuries as a therapeutic agent for Soothing the liver and regulating the circulation of qi(疏肝理氣), and promoting digestion and removing stagnated food(消積化滯). The effects of CRVP on the vascular system is not known. The purpose of this Study was to investigate the effects of CRVP on the pial arterial diameter and regional cerebral blood flow(rCBF) in normal rats and ischemic cerebrovascular pathologic model rats. The changes in rCBF was determinated by Laser-Doppler Flowmetry(LDF), and the changes in pial arterial diameter were determinated by video microscopy methods and video analyzer. The results were as follows ; 1. Pial arterial diameter was significantly increased by CRVP in a dose-dependent manner. 2. Pretreatment with L-NNA significantly inhibited CRVP induced increased rCBF and pial arterial diameter. 3. Both the methylene chloride fraction and the hexane fraction of CRVP dose-dependently improved the altered cerebral hemodynamics of cerebral ischemic animal by increasing rCBF. 4. Pretreatment with L-NNA and indomethacin significantly inhibited CRVP(MC) induced increased rCBF. 5. Pretreatment with L-NNA and indomethacin significantly inhibited CRVP(hexane) induced increased rCBF. 6. Pretreatment with CRVP maredly stabilized the changes rCBF and pial arterial diameter during the period of cerebral reperusion. In conclusion, CRVP causes a diverse response of rCBF and pial arterial diameter, and CRVP dose-dependently improved the altered cerebral hemodynamics of cerebral ischemic animal by increasing rCBF and pial arterial diameter. These results suggest that the improvement of cerebral hemodynamics is also mediated by nitric oxide synthase and cyclooxygenase.

• Journal of Pharmacopuncture
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• v.16 no.4
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• pp.30-35
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• 2013

Objectives: This study was designed to investigate the effects of Calculus Bovis-Fel Uris-Moschus pharmacopuncture (BUM) on the regional cerebral blood flow (rCBF) and the mean arterial blood pressure (MABP) in normal and cerebral ischemic rats and to investigate a possible pathway involved in the effects of BUM. Methods: The changes in the rCBF and the MABP following BUM into Fengfu (GV16) were determined by using a laser-Doppler flow meter and a pressure transducer, respectively. Results: BUM significantly increased the rCBF and decreased the MABP in normal rats in a dose-dependent manner. The effect on the rCBF was significantly inhibited by pretreatment with methylene blue (0.01 mg/kg, intraperitoneal), an inhibitor of guanylate cyclase, but was not affected by pretreatment with indomethacin (1 mg/kg, intraperitoneal), an inhibitor of cyclooxygenase. The BUM-induced decrease of the MABP was changed neither by methylene blue nor by indomethacin pretreatment. In the cerebral ischemic rats, the rCBF was stably increased upon cerebral reperfusion in the BUM group in contrast to the rapid and marked increase in the control group. Conclusion: This study demonstrated that BUM into Fengbu (GV16) increased the rCBF in a dose-dependent manner in the normal state; furthermore, it improved the stability of the rCBF in the ischemic state upon reperfusion. Also, the effects of BUM on the rCBF were attenuated by inhibition of guanylate cyclase, suggesting that the effects involved the guanylate cyclase pathway.

• Journal of the Korean Society of Radiology
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• v.82 no.1
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• pp.261-266
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• 2021

Ischemic stroke is one of the manifestations of reversible cerebral vasoconstriction syndrome (RCVS). Many precipitants and associated disorders of RCVS have been suggested. However, few case reports have indicated an association between anemia and RCVS. Here, we report a case of a 66-year-old female with severe iron deficiency anemia (IDA), who presented with ischemic stroke and cerebral vasoconstriction, which gradually improved with conservative treatment. High-resolution vessel wall magnetic resonance imaging findings and reversibility suggested the possibility of RCVS. In patients with RCVS and ischemic stroke, IDA should be considered. Prompt management should be delivered to prevent disease progression and recurrence.

• Journal of Cerebrovascular and Endovascular Neurosurgery
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• v.25 no.2
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• pp.143-149
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• 2023

Objective: The purpose of this nationwide age- and sex- matched longitudinal study was to determine the pyogenic spondylitis (PS) increases the incidence of ischemic stroke (IS) in Korea. Methods: From the National Health Insurance Service (NHIS), we collected the patient data for the period from January 1, 2004 to December 31, 2015. PS was classified according to the International Classification of Disease codes M46.2-M46.8, M49.2, and M49.3. By using a 1:5 age- and sex- stratified matching, a total of 628 patients and 3140 control subjects were included in the study. The IS incidence rates in PS and control group was calculated by using the Kaplan-Meier method. The outcome of hazard ratio of IS was estimated by Cox proportional hazards regression analyses. This study did not exclude PS as a result of postoperative complications. Results: According to the study, 51 patients (8.12%) in the PS group and 201 patients (6.4%) in the control group experienced IS. The adjusted hazard ratio of IS in the PS group was 3.419 (95% CI: 2.473-4.729) after adjusting individual medical condition and demographics. Following the results of subgroup analysis, the risk ratio of IS was greater in most of the subgroup categories (male, female, age <65, age >65, non-diabetic, hypertensive, non-hypertensive, dyslipidemic and non-dyslipidemic subgroup). However, the risk of IS did not differ significantly in diabetic subgroup (95% CI: 0.953-4.360). Conclusions: The risk rate of IS increased in patient with pyogenic spondylitis.