• Korean Journal of Radiology
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• 제23권3호
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• pp.333-342
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• 2022

Objective: Intracranial atherosclerotic stroke occurs through various mechanisms, mainly by artery-to-artery embolism (AA) or branch occlusive disease (BOD). This study evaluated the spatial relationship between middle cerebral artery (MCA) plaques and perforating arteries among different MCA territory infarction types using vessel wall magnetic resonance imaging (VW-MRI). Materials and Methods: We retrospectively enrolled patients with acute MCA infarction who underwent VW-MRI. Thirty-four patients were divided into three groups according to infarction pattern: 1) BOD, 2) both BOD and AA (BOD-AA), and 3) AA. To determine the factors related to BOD, the BOD and BOD-AA groups were combined into one group (with striatocapsular infarction [BOD+]) and compared with the AA group. To determine the factors related to AA, the BOD-AA and AA groups were combined into another group (with cortical infarction [AA+]) and compared with the BOD group. Plaque morphology and the spatial relationship between the perforating artery orifice and plaque were evaluated both quantitatively and qualitatively. Results: The plaque margin in the BOD+ group was closer to the perforating artery orifice than that in the AA group (p = 0.011), with less enhancing plaque (p = 0.030). In the BOD group, plaques were mainly located on the dorsal (41.2%) and superior (41.2%) sides where the perforating arteries mainly arose. No patient in the AA group had overlapping plaques with perforating arteries at the cross-section where the perforator arose. Perforating arteries associated with culprit plaques were most frequently located in the middle two-thirds of the M1 segment (41.4%). The AA+ group had more stenosis (%) than the BOD group (39.73 ± 24.52 vs. 14.42 ± 20.96; p = 0.003). Conclusion: The spatial relationship between the perforating artery orifice and plaque varied among different types of MCA territory infarctions. In patients with BOD, the plaque margin was closer and blocked the perforating artery orifice, and stenosis degree and enhancement were less than those in patients with AA.

• 대한한의학회지
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• 제27권2호
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• pp.70-85
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• 2006

Objectives; This study examined the neuroprotective effect of Hyulbuchookautang (血府逐瘀湯, HBCAT)against neural damage following focal cerebral infarction. Methods : Sprague-Dawley Rats were induced with focal cerebral infarction by temporal middle cerebral artery occlusion (MCAO). The rats were divided into 2 groups. We treated extract of HBCAT to one group after operation (sample group), and the other group wasn't treated after operation (control group). We observed neurological scores and TIC-stained infarct area, total infarct volume in brain sections and Bax-positive neurons, HSP70- positive neurons in brain regions. Results : HBCAT treatment at 3 days after MCAO reduced neurological scores induced by MCAO. HBCAT treatment at 5 days after MCAO reduced TTC-stained infarct area in brain sections induced by MCAO. HBCAT treatment at 5 days after MCAO reduced total infarct volume in brain sections induced by MCAO. HBCAT treatment after MCAO reduced Bax-positive neurons in cortex infarct core and cortex infarct penumbra and caudo-putamen of brain regions induced by MCAO. HBCAT treatment after MCAO reduced HSP70- positive neurons in cortex infarct penumbra of brain regions induced by MCAO. Conclusions : These results suggest that HBCAT has a neuroprotective effect against focal cerebral ischemia.

• 대한한의학회지
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• 제18권2호
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• pp.316-325
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• 1997

In a 36-month period, 23 selected Patients with Acute Cerebral Infarction were studied utilizing Computerized Tomography, Barthel Index in an attempt to correlate Brain Computerized Tomography findings with 1week, 4weeks rehabilitation and evaluate the influences of the size and location of the lesion. The study suggested that the size of the lesion had impact on 4 weeks rehabilitation. There was significant different between the patients with Middle Cerebral Artery Pial Territory Infarction(I.P.B.M.C.A.) lesion and the patients with Lacunar Infarction(L.I.), Striatocapsular Infarction(S.C.I.), Internal Watershed Infarction(I.W.I.) lesion, but there was no significant difference between the patients with L.I. lesion and the patients with S.C.I. lesion and the patients with I.W.I. lesion. The size and location of the lesion should be considered together in predicting the functional outcomes of Acute Cerebral Infarction.

• The Korean Journal of Physiology and Pharmacology
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• 제11권3호
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• pp.85-88
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• 2007

Matrix metalloproteinases (MMPs) can degrade a wide range of extracellular matrix components. It has been reported that MMP-9 are activated after focal ischemia in experimental animals. (-)-Epigallocatechin-3-gallate (EGCG), a major constituent of green tea polyphenols, is a potent free radical scavenger and reduces the neuronal damage caused by oxygen free radicals. And it has been known that EGCG could reduce the infarction volume in focal brain ischemia and inhibit MMP-9 activity. To delineate the relationship between the anti-ischemic action and the MMP-9-inhibiting action of EGCG, we investigated the effect of EGCG on brain infarction and the activity of matrix metalloproteinase-9 induced by permanent middle cerebral artery occlusion (pMCAO) in ICR mice. EGCG (40 mg/kg, i.p. $15{\sim}30min$ prior to MCAO) significantly decreased infarction volume at 24 hr after MCAO. GM 6001 (50 mg/kg, i.p. $15{\sim}30min$ prior to MCAO), a MMP inhibitor, also significantly reduced infarction volume. In zymogram, MMP-9 activities began to increase at ipsilateral cortex at 2 hr after MCAO, and the increments of MMP-9 activities were attenuated by EGCG treatment. Western blot for MMP-9 also showed patterns similar to that of zymogram. These findings demonstrate that the anti-ischemic action of EGCG ire mouse focal cerebral ischemia involves its inhibitory effect on MMP-9.

• Journal of Korean Neurosurgical Society
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• 제30권3호
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• pp.278-283
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• 2001

Objective : Massive cerebral infarction could be accompanied by severe brain swelling and death secondary to transtentorial herniation. Approximately 10% to 15% of middle cerebral artery infarctions are associated with this phenomenon. However, the effectiveness and timing of decompressive surgery are still controversial. In this study, we present our results on the effect of decompressive craniectomy in life threatening cerebral infarction. Method : We retrospectively analyzed 15 patients who underwent decompressive craniectomy for massive cerebral infarction from January 1997 to April 1999. Surgical indication was based on the clinical signs such as neurological deterioration, pupillary reflex, and radiological findings. Clinical outcome was assessed by Glasgow Outcome Scale (GOS). Results : All 15 patients(five men, ten women ; mean age, 52.3 years ; right 11, left 4) were treated with wide craniectomy and duroplasty. The average time interval between onset of symptom and surgical decompression was 2.9 days. Clinical signs of uncal herniation(anisocoria, or fixed and dilated pupils) were presented in 13 of 15 patients. Mean Glasgow coma scale(GCS) was 12.4 points on admission, 8.1 points on preoperative state and 11.8 points postoperatively. Overall outcomes were favorable in 5 cases(Glasgow outcome scale : GOS I, II), unfavorable in 6 cases(Glasgow outcome scale : GOS III, IV) and dead in 4 cases. Conclusion : Early decompressive craniectomy before brain stem compression is considered as an effective lifesaving procedure for massive cerebral infarction unresponsive to aggressive medical therapy.

• Journal of Chest Surgery
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• 제18권4호
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• pp.746-752
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• 1985

A retrospective clinical observation was made of 40 patients with postoperative cerebral dysfunction among 2634 patients who underwent open-heart operations in Severance Hospital. Yonsei University between 1962, the year the first successful open heart operation was done, and June 1985. Suspected causes of brain damage were reviewed. Brain CT findings were evaluated in 24 patients. There were 15 cerebral infarcts, 4 intracerebral bleedings, 3 ischemic brain damages, 1 infarction with intracerebral hemorrhage and 1 diffuse cortical atrophy from unknown cause. The most frequent site of cerebral infarction was the middle cerebral artery area with no predilection on the right of left.

• 대한한방내과학회지
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• 제21권2호
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• pp.319-327
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• 2000

To evaluate the effect of Bangpungdangkwi-eum extracts on reperfusion following the middle cerebral artery occulsion in Sprague Dawley rats, the neuron protection effect were investigated through examining the size of cerebral infarction, cerebral edema, and the morphologic change of neuron. The results were obtained as follows; 1. The size of cerabral infarction in sample group is significantly decreased compared with that in control group. Sample group has approximately 17% cerebral infarction parts induced by ischemia in cerebrum while control group has approximately 22%. 2. The volume of cerebral edema in sample group is significantly decreased compared with that in control group. The volumn in sample group is increased by approximately 4.4% compared with that in normal group while that in control group is increased by approximately 7.7%. 3. The optical microscopic examination reveals that the damage of neurons in the ischemic parts and CA1 and CA3 region of hippocampus in the same side of the ischemic parts was the most high and the damage in sample group is decreased compared with that in control group.

• Journal of Korean Neurosurgical Society
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• 제48권3호
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• pp.259-262
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• 2010

Large to giant middle cerebral artery aneurysm is a challenging disease, especially when incorporating important perforating arteries. Surgical risk increases by perforator infarction and anatomical complexity. In this clinical setting, extensive consideration of surgical options is needed. The two cases described here were unruptured and had rather stable wall. Because of their large and giant size, hardness and incorporated arteries, it was not affordable to isolate them by means of clipping or trapping. The procedure as the alternative to conventional treatment modalities, extracranial-intracranial bypass followed by clipping of only the efferent artery successfully treated the aneurysms.

• 대한한의학회지
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• 제23권1호
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• pp.1-10
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• 2002

Objectives: Uncariae Ramulus Et Uncus extract is clinically used in Korea to treat ischemic cerebral damage. The present study was undertaken to study the neuroprotective effect of Uncariae Ramulus Et Uncus extract in middle cerebral artery occlusion (MCAO) rats. Methods: Changes of extracellular levels of dopamine, DOPAC, HVA. and HIAA in striatum were collected at 20 minutes interval by in vivo microdialysis and then analyzed by HPLC (high performance liquid chromatography) in rats subjected to permanent focal cerebral ischemia induced by 2 hours of MCAO. Uncariae Ramulus Et Uncus extract was orally administrated before MCAO. Different animals were used for measurement of cerebral infarction volume induced by 24 hours of MCAO with TIC staining and image analysis. Results: Extracellular levels of dopamine decreased after treatment with Uncariae Ramulus Et Uncus extract, while extracellular levels of DOPAC and HVA significantly increased. Cerebral infarction volume also significantly decreased after treatment with Uncariae Ramulus Et Uncus extract. Conclusions: These results provided evidence that Uncariae Ramulus Et Uncus extract can produce a neuroprotective effect on cerebral ischemia by regulating extracellular excitatory neurotransmitters.

• 대한한의학회지
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• 제21권1호
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• pp.11-19
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• 2000

The present study was carried out to investigate the effects of Woowhangcheongshim-won(WCW) on the extracellular concentrations of amino acid neurotransmitters(glutamate, aspartate, GABA, glycine, taurine, alanine, and tyrosine) and organic acid (lactate and pyruvate) in striatum and cerebral infarction volume in rats subjected to permanent focal cerebral ischemia induced by 2 hours of middle cerebral artery occlusion(MCAO), using intracerebral microdialysis as the sampling technique, Microdialysis probes were inserted into the lateral part of the caudate-putamen 2 hours before the experiment and microdialyzates were collected at 20min intervals and analyzed by high performance liquid chromatography, WCW significantly decreased the infarction volume with reducing focal cerebral ischemia-induced increase of extracellular glutamate, asparate, and tyrosine. On the other hand, the increase of GABA and taurine was enhanced after treatment of WCW in the ischemia-induced rats, These results suggest that WCW can produce a neuroprotective effect against cerebral ischemia by regulating extracellular excitatory and inhibitory amino acid levels in relation to the concept of excitotoxicity in brain ischemia.