• The Journal of Internal Korean Medicine
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• v.41 no.6
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• pp.1245-1254
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• 2020

Introduction: The aim of this study was to report the effect of Korean medicine treatments on a stroke patient with acute cerebral infarction. Method: A 63-year-old male with anterior and middle cerebral artery infarction had symptoms of dizziness and disorientation. The patient was treated with Korean medicine therapy, including the herbal medicine "Sunghyuangjunggi-san-gamibang." Treatment progress was assessed using the Korean version of the Modified Barthel Index (K-MBI) and the Korean dizziness handicap inventory (K-DHI). Results: After 14 days of treatment, the K-DHI score decreased from 78 to 7 and the K-MBI score increased from 18 to 24. The patient's main symptoms were improved after the treatment, and no side effects were observed. Conclusion: Korean medicine treatment, including Sunghyuangjunggi-san, might be a recommended therapeutic option for dizziness and disorientation in stroke patients.

• Journal of Korean Neurosurgical Society
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• v.66 no.1
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• pp.24-32
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• 2023

Objective : With the recent increase in mechanical thrombectomy (MT) for acute ischemic stroke (AIS), the role of neurosurgeons in AIS treatment has become increasingly important. This study aimed to assess the outcomes of patients with AIS treated by neurosurgeons and neurologists in the emergency room (ER) of a tertiary hospital in South Korea. Methods : From January 2020 to June 2021, 536 patients with AIS within 24 hours of symptom onset were admitted to our hospital via the ER. Based on the type of doctors who provided initial care for AIS in the ER, patients were divided into two groups : (a) neurosurgeon group (n=119, 22.2%) and (b) neurologist group (n=417, 77.8%). Results : Intravenous tissue plasminogen activator (tPA) was administered in 82 (15.3%) of 536 patients (n=17 [14.3%] in the neurosurgeon group and n=65 [15.6%] in the neurologist group). The door-to-tPA time was not significantly different between both groups (median, 53 minutes; interquartile range [IQR], 45-58 vs. median, 54 minutes; IQR, 46-74; p=0.372). MT was performed in 69 patients (12.9%) (n=25, 36.2% in the neurosurgeon group and n=44, 63.8% in the neurologist group). The neurosurgeon group achieved a shorter door-to-puncture time than the neurologist group (median, 115 minutes; IQR, 107-151 vs. median, 162 minutes; IQR, 117-189; p=0.049). Good clinical outcomes (3-month modified Rankin Scale 0-2) did not differ significantly between the two groups (96/119 [80.7%] vs. 322/417 [77.2%], p=0.454). Conclusion : The neurosurgeon group showed similar door-to-treatment time and clinical outcomes to the neurologist group in patients with AIS in the ER. This study suggests that neurosurgeons have comparable abilities to care for patients with AIS in the ER.

• Korean Journal of Acupuncture
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• v.41 no.3
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• pp.101-109
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• 2024

Objectives : Cervical myofascial pain syndrome (C-MPS), a key aspect of Visual Display Terminals (VDT) Syndrome, leads to acute and chronic pain due to muscle shortening, potentially causing headaches and movement disorders. This study examines the effectiveness of Pharmacoacupuncture at the intersection of the Splenius Capitis (SC), Levator Scapulae (LS), and Serratus Posterior Superior(SPS) muscles under ultrasound guidance, known as the "SLS triangle" in treating C-MPS. Methods : Three patients (aged 30 to 37) with acute C-MPS presented at two Korean medicine clinics with severe neck pain and restricted cervical rotation. The evaluation of symptoms before treatment, immediately after treatment, and one day after treatment was conducted using the cervical rotation Range of motion (ROM) and the Numeric Rating Scale (NRS) for cervical pain. Treatments included Acupuncture, Cupping therapy, Chuna manipulation, Physical Therapy, and Pharmacopuncture (Jaha-geo extract, 2cc at the SLS triangle). Results : All three patients showed significant improvement post-treatment. Immediately after treatment, Patient 1's NRS improved from 7 to 2, Patient 2's NRS improved from 4 to 1, and Patient 3's NRS improved from 6 to 2. Directly after the procedure, there were no significant adverse reactions except for one patient experiencing temporary dizziness. When the patients were followed up by phone 24 hours later, no adverse reactions were reported. Conclusions : This study demonstrates that ultrasound-guided pharmacopuncture can significantly reduce pain and improve cervical rotation in patients with cervical myofascial pain syndrome. The findings suggest this non-invasive treatment is both safe and effective, warranting further research through larger-scale clinical trials to validate its efficacy and establish standardized protocols.

• Journal of Physiology & Pathology in Korean Medicine
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• v.29 no.2
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• pp.160-167
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• 2015

The purpose of this study was to investigate the correlation of Intima-Media Thickness of common carotid artery(CCA-IMT) and The Second Derivative of Photoplethysmogram Waveforms(SDPTG). 38 subjects with acute ischemic stroke were recruited from the patients admitted to Dong-Eui Medical Center from the June 2013 to January 2014. We assessed 38 patient's SDPTG data and CCA-IMT data by B Mode ultrasonography. then 38 subjects were divided into two groups by the CCA-IMT difference; CCA-IMT 〈 0.8 mm group(n=11), CCA-IMT $$\geq_-$$ 0.8 mm group(n=27). We analyzed their characteristics, risk factor, blood test result, life style by CCA-IMT difference. As a result, Age, Hypertension were significantly higher in the CCA-IMT $$\geq_-$$ 0.8 mm group then in the CCA-IMT < 0.8 mm group. Regular exercise were significantly higher in the CCA-IMT < 0.8 mm group then in the CCA-IMT $$\geq_-$$ 0.8 mm group. The result of Multiple regression analysis on the factors affecting the CCA-IMT was hypertension, total cholesterol, age. and The result of Pearson's Correlation analysis on CCA-IMT and SDPTG is that e/a ratio, SDPTG AI were respectively and significantly correlated with CCA-IMT. According to the analysis, the Relationship between CCA-IMT and SDPTG in Ischemic Stroke Patients were founded. We suggest that further investigation with larger and better controlled trials of the Relationship between CCA-IMT and SDPTG could contribute to better understand the effects of risk factors on atherosclerosis.

• Journal of Korean Neurosurgical Society
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• v.56 no.6
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• pp.463-468
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• 2014

Objective : Unexpected Solitaire stent detachment can occur during mechanical Solitaire thrombectomy. The purpose of this study was to retrospectively evaluate the influencing factors causing unexpected Solitaire stent detachment and the clinical outcomes. Methods : Between October 2011 to December 2013, 232 cases of mechanical Solitaire thrombectomy for acute ischemic stroke were performed in 3 stroke centers. During this period, we encountered unexpected Solitaire stent detachments during mechanical Solitaire thrombectomies in 9 cases. Results : Solitaire stents unexpectedly detached in 9 cases (3.9%) during the retrieval of Solitaire stents. The median patient age was 76 years. The occlusion sites of the unexpected stent detachment were the proximal middle cerebral artery (MCA) in 7 cases and the internal carotid artery in 2 cases. The sizes of the stents that unexpectedly detached were $6{\times}30$ mm in 7 cases, $5{\times}30$ mm in 1 case, and $4{\times}20$ mm in 1 case. Four patients had unexpected detachment at the first retrieval, 1 patient at the second, 3 patients at the third, and 1 patient at the fifth. In all of the cases of unexpected detachment at the first retrieval, the stent deployment site was the proximal MCA. After detachment, a proximal marker of the Solitaire stent was observed in 3 patients. However, no marker was visible in the remaining 6 patients. Conclusion : Unexpected Solitaire stent detachment should be considered in the first instance of stent retrieval for a relatively large-diameter stent, especially in elderly patients with MCA occlusions.

• The Journal of Internal Korean Medicine
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• v.28 no.4
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• pp.902-910
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• 2007

Objective : Peroxisome proliferator-activated receptor (PPAR)-gamma, a transcription factor in adipocyte differentiation, has important effects on insulin sensitivity, atherosclerosis, endothelial cell function and inflammation. Through these effects, PPAR-gamma2 might be involved with type 2 diabetes and vascular disease, including diabetic complications. Recently, it has been reported that the C161T polymorphism in the exon 6 of PPAR-gamma is associated with type 2 diabetes interacting with uncoupling protein 2 (UCP2) gene, and is associated with acute myocardial infarction. We studied the association of this polymorphism with type 2 diabetes and its complications, such as retinopathy, ischemic stroke, nephropathy and neuropathy in Korean non-diabetic and type 2 diabetic populations. Methods : Three hundred and thirty eight type 2 diabetic patients (retinopathy: 64, ischemic stroke: 67, nephropathy: 39 and neuropathy: 76) and 152 healthy matched control subjects were evaluated. The PPAR-gamma C161T polymorphism was analyzed by PCR-RFLP. Results : PPAR-gamma C161T genotype and allele frequency did not show significant differences between type 2 diabetic patients and healthy controls (T allele: 17.0 vs. 14.5, OR= 1.21, P=0.3188). In the analysis for diabetic complications, T allele in diabetic nephropathy was significantly higher than controls (P=0.0358). T allele in the ischemic stroke patients was also higher than healthy controls, although it had no significance (P=0.1375). Conclusions : These results suggest that the C161T polymorphism of the PPAR-gamma gene might be associated with diabetic nephropathy in type 2 diabetes.

• Journal of the Korean neurological association
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• v.36 no.4
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• pp.337-340
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• 2018

Human immunodeficiency virus (HIV) infection can result in ischemic stroke via several mechanisms, including opportunistic infection, vasculopathy, cardioembolism, and coagulopathy. HIV-vasculopathy is related to endothelial dysfunction, stenosis and aneurysm formation, infectious vasculitis, dissection and accelerated atherosclerosis during highly active antiretroviral therapy (HAART). We represent a case of HIV infection manifested as an acute ischemic stroke attack. After 4 months during HAART, our patient experienced a recurrent ischemic stroke with progression of middle cerebral artery stenosis.

• Journal of Korean Neurosurgical Society
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• v.64 no.1
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• pp.60-68
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• 2021

Objective : Until recently, the transfemoral approach (TFA) was used as the primary method of arterial approach in acute ischemic stroke (AIS). However, TFA resulted in longer reperfusion times and worse outcomes in the mechanical thrombectomy (MT) of patients with complex aortic arches and significant carotid tortuosity. We found that the transradial approach (TRA) is a more favorable alternative approach for MT in such cases. Methods : We performed a retrospective review of our institutional database to identify 202 patients who underwent MT for AIS between February 2015 and December 2019. Patient characteristics, cause of TFA failure, procedure time, intra-procedural complications, and outcomes were recorded. Results : Eleven (5.4%) of 202 patients, who underwent MT for AIS, crossed over to TRA for recanalization, and eight (72%) of 11 achieved successful recanalization (≥modified Treatment in Cerebral Infarction 2b). The mean age (mean±standard deviation [median]) was 82.3±6.6 (76) years, and five of the 11 patients were male. The last seen normal to puncture time was 467.9±264.72 (264) minutes; baseline National Institutes of Health Stroke Scale score was 28.9±14.5 (16). Six (55%) of the 11 patients had right vertebrobasilar occlusions, and the remaining five (45%) had anterior circulation occlusive disease. The time from groin puncture to final recanalization time (overall procedural time) was 78.0±20.1 (62) minutes. The mean crossover time from TFA to TRA was 45.2±10.5 (41) minutes. The mean time from radial puncture to final recanalization was 33.8±10.5 (28) minutes. Distal thrombus migration events in previously unaffected territories occurred in 3/8 patients (37%). At 90 days, three patients (28%) had a favorable clinical outcome. Conclusion : Although rare, failure of TFA has been known to occur during MT for AIS. Our results demonstrate that TRA may be an alternative option for AIS intervention for select patients with subsequent timely revascularization. However, the incidence of distal thrombus migration was high, and the first puncture to reperfusion time was prolonged because of the time taken for the crossover to TRA after failure of TFA. This study provides some evidence that the TRA may be a viable alternative option to the TFA for MT of AIS.

• Physical Therapy Rehabilitation Science
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• v.10 no.2
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• pp.212-216
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• 2021

Objective: Mirror therapy is one of the promising methods suggested for the upper limb rehabilitation of stroke patients. While mirror therapy was presented to be effective in improving motor function of stroke patients, problems were raised as preceding studies had various methods in applying mirror therapy. Some studies even reported no effect in mirror therapy. Our supposition for the reason of such problems was a decrease of attention on the illusive image during mirror therapy of stroke patients, and we aimed to observe this. Design: A cross-sectional preliminary study. Methods: Three hemiplegic acute patients were recruited for the traditional mirror therapy. It lasted for 30 minutes, and 12 different tasks were asked to perform. All procedures were video-recorded, and Observer XT was used to analyse mirror-gazing time, gaze-distracted time, preparation time, frequency of mirror gazing, frequency of distraction, frequency of preparation for treatment. Results: Subjects spent an average of 4-5 minutes having instructions about the mirror therapy intervention (preparation duration), an average of 11 minutes watching the mirror during therapy (mirror-gazing duration), and the rest of 14-15 minutes looking around the environment (gaze-distracted duration). During the mirror therapy, the number of distracted moments (frequency of distraction) was eight times more than focusing on the mirror (frequency of mirror gazing). Conclusions: Once the patient looks at the mirror, it only lasts about 5 seconds on average. Thus, we confirmed that patients could not concentrate on the illusion during the session and therefore it may have affected the effectiveness of the therapy.

• The Journal of the Society of Stroke on Korean Medicine
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• v.12 no.1
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• pp.1-7
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• 2011

Objectives : The purpose is to discuss the clinical applications of Orungsan(Goreisan: 五苓散) as an alternative management for increased intracranial pressure in the field of neurosurgery in Japan. Methods and Results : Attention has focused on Kampo medicine(traditional Japanese medicine) for some cerebral disease including chronic subdural hematoma(CSDH) and cerebral infarction in Japan. Orungsan and one of its classes, Sirungtang(Saireto: 柴苓湯) are well known their effects on brain edema. After some studies of Orungsan has the anti-edemic effects by the inhibition of aquaporin, this herbal medicine has been used widely in the neurosurgery field in Japan. It is high time to think about where we are and we go ahead for the progress and the integration in medicine. We have reviewed the studies using Orungsan or Sirungtang, that was reported at the 20th annual meeting of 'the Japan society for Kampo medicine and neurological surgery' was held on November 5, 2011 in Tokyo. Fifteen studies related with Orungsan or Sirungtang were reported among all 32 studies at the meeting. Orungsan in ten, and Sirungtang in five among 14 studies contained specific clinical case. In the aspects of disease, thirteen papers were related with SDH, including CSDH(11), SSDH(1), aneurism clipping for SDH prevention(1), and one was acute cerebral infarction and one was multiple metastatic brain tumor. In the report style, case control study was 7(mostly retrospective), and the case report was 8. Conclusions : Orungsan may be plausible to be an alternative method to reduce brain edema after SDH and other brain injury in the field of neurosurgery.