• Annals of Clinical Neurophysiology
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• 제9권1호
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• pp.1-4
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• 2007

Vertigo is an illusion of rotation, which results from an imbalance within the vestibular system. This review focuses on two common presentations of spontaneous vertigo: acute prolonged spontaneous vertigo and recurrent spontaneous vertigo. Common causes of acute prolonged spontaneous vertigo include vestibular neuritis, labyrinthitis, and brainstem or cerebellar stroke. The history and detailed neurological/neurotological examinations usually provide the key information for distinguishing between peripheral and central causes of vertigo. Brain MRI is indicated in any patient with acute vertigo accompanied by abnormal neurological signs, profound imbalance, severe headache, and central patterns of nystagmus. Recurrent spontaneous vertigo occurs when there is a sudden, temporary, and largely reversible impairment of resting neural activity of one labyrinth or its central connections, with subsequent recovery to normal or near-normal function. Meniere's disease, migrainous vertigo, and vertebrobasilar insufficiency (VBI) are common causes. The duration of the vertigo attack is a key piece of information in recurrent spontaneous vertigo. Vertigo of vascular origin, such as VBI, typically lasts for several minutes, whereas recurrent vertigo due to peripheral inner-ear abnormalities lasts for hours. Screening neurotological evaluations, and blood tests for autoimmune and otosyphilis are useful in assessment of recurrent spontaneous vertigo that are likely to be peripheral in origin.

• Journal of Cerebrovascular and Endovascular Neurosurgery
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• 제20권4호
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• pp.235-240
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• 2018

The safety and feasibility of simple coil embolization and stent deployment for the treatment of posterior inferior cerebellar artery (PICA) aneurysms, as well as their radiologic and clinical results, have not been adequately understood. Especially, if dissecting aneurysm of proximal PICA is associated with small caliber PICA and stenosis of ipsilateral vertebral artery orifice (VAO), endovascular coiling with saving of PICA is not always easy. This 64-year-old man presented with subarachnoid hemorrhage due to a ruptured dissecting aneurysm of left proximal PICA. The aneurysm was irregularly fusiform in nature with a shallow PICA orifice (1.4 mm) and narrow caliber (0.9-1.5 mm). Moreover, the ipsilateral VAO showed severe stenosis (1.8 mm). We performed bifemoral puncture and chose additional route from right vertebral artery to left vertebrobasilar junction for retrograde approach and deployment of LVIS Jr. intraluminal support at proximal PICA. And then, the antegrade approach and coiling of aneurysm was done. Despite of transient thrombus of PICA, the aneurysm was successfully secured with preservation of whole PICA course. For preservation of narrow PICA with ipsilateral VAO stenosis, the contralateral approach and deployment of LVIS Jr. intraluminal support may be considered.

• Journal of Korean Neurosurgical Society
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• 제53권3호
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• pp.194-196
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• 2013

Isolated abducens nerve paresis related to ruptured vertebral artery (VA) aneurysm is rare. It usually occurs bilaterally or ipsilaterally to the pathologic lesions. We report the case of a contralateral sixth nerve palsy following ruptured dissecting VA aneurysm. A 38-year-old man was admitted for the evaluation of a 6-day history of headache. Abnormalities were not seen on initial computed tomography (CT). On admission, the patient was alert and no signs reflecting neurologic deficits were noted. Time of flight magnetic resonance angiography revealed a fusiform dilatation of the right VA involving origin of the posterior inferior cerebellar artery. The patient suddenly suffered from severe headache with diplopia the day before the scheduled cerebral angiography. Neurologic examination disclosed nuchal rigidity and isolated left abducens nerve palsy. Emergent CT scan showed high density in the basal and prepontine cistern compatible with ruptured aneurismal hemorrhage. Right vertebral angiography illustrated a right VA dissecting aneurysm with prominent displaced vertebrobasilar artery to inferiorly on left side. Double-stent placement was conducted for the treatment of ruptured dissecting VA aneurysm. No diffusion restriction signals were observed in follow-up magnetic resonance imaging of the brain stem. Eleven weeks later, full recovery of left sixth nerve palsy was documented photographically. In conclusion, isolated contralateral abducens nerve palsy associated with ruptured VA aneurysm may develop due to direct nerve compression by displaced verterobasilar artery triggered by primary thick clot in the prepontine cistern.

• 대한한방내과학회지
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• 제41권2호
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• pp.267-274
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• 2020

Objectives: This study is aimed to describe the effects of using a traditional Korean herbal medicine, Jaeumkunbi-tang, on acute dizziness and gait disturbance that arose during treatment for trigeminal neuralgia. Methods: We closely observed one female patient who had been hospitalized complaining of trigeminal neuralgia and acute onset of dizziness. The patient was treated using Korean medical treatments, such as Oyaksungi-san, Jaeumkunbi-tang, acupuncture, and moxibustion. We evaluated the patient's condition using the visual analog scale (VAS) at the Department of Hepato-Hemopoietic System, Kyung Hee University Korean Medicine Hospital in June 2019 for 12 days. Results: The patient's dizziness was decreased after treating with Jaeumkunbi-tang for five days as measured by the VAS score. Conclusions: Jaeumkunbi-tang appears to be effective for controlling dizziness.

• Journal of Korean Neurosurgical Society
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• 제63권6호
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• pp.717-722
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• 2020

Objective : Dissection of the middle cerebral artery (MCA) is less common than dissection of vessels in the vertebrobasilar system or carotid artery. Acute complete occlusion related to MCA dissection is extremely rare. We report an endovascular approach in patients with acute complete occlusion due to MCA dissection. Methods : We reviewed retrospectively the endovascular procedure and clinical results for acute-stroke patients who underwent recanalization from October 2014 through December 2018. Initial imaging findings and the endovascular procedure were analyzed for patients with acute complete occlusion due to MCA dissection. Results : We undertook first-line aspiration thrombectomy using a Penumbra catheter in 294 patients with acute occlusion of the M1 segment. Of these patients, seven were confirmed to have acute complete occlusion due to MCA dissection. All patients had angiographic findings of an intimal flap at the proximal occlusion site of the MCA. One patient complained of severe headache during microcatheter passage through the occluded lesion and died due to massive bleeding caused by rupture of the false lumen. The remaining patients underwent initial contact aspiration thrombectomy without microcatheter passage. After aspiration thrombectomy, six patients had delayed flow through the MCA. One patient underwent stenting of the MCA because of progressive symptoms. Conclusion : An intimal flap at the proximal portion of an occluded MCA can suggest the possibility of MCA dissection. Contrast aspiration thrombectomy without microcatheter passage can reduce the risk of false lumen rupture in cases of MCA dissection.

• Journal of Korean Neurosurgical Society
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• 제64권1호
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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.

• 대한영상의학회지
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• 제82권5호
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• pp.1281-1286
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• 2021

척추기저동맥의 혈류공급감소로 인한 뇌간 경색은 매우 드문 전신성 루푸스 환자의 초기 증상으로, 경색의 직접적인 원인으로 매우 작은 기저동맥 분지인 교뇌공급혈관의 박리성 동맥류는 보고된 사례가 없다. 이에 저자들은 디지털감산 혈관조영술과 고해상도 혈관벽 자기공명영상를 이용하여 작은 교뇌공급혈관의 박리성 동맥류의 진단과 추적관찰 중 치유된 20세 여성의 사례를 보고하고자 한다. 전신성 루푸스의 진단은 신경학적장애의 유무와 혈액화학검사 결과를 바탕으로 하였다. 추적 고해상도 혈관벽 자기공명영상에서 환자의 교뇌천공지의 박리성동맥류는 폐색되어 있었고 우측 척추동맥의 박리성동맥류는 치유되어 보이지 않았다. 환자는 퇴원 시 수정랭킨척도 점수가 1점으로 증상 개선을 보였으며 3개월과 12개월 추적관찰에서도 증상이 악화되지 않고 1점을 유지하였다.

• 대한영상의학회지
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• 제83권5호
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• pp.1153-1159
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• 2022

긴머리확장증은 확장, 연장 및 구불구불한 형태의 대뇌동맥을 특징으로 하는 드문 질환이다. 주요 병리기전은 내탄력판의 파괴로 알려져 있으며, 위험요인으로 고령, 만성 고혈압, 그리고 대사성 질환 등이 있다. 긴머리확장증은 주로 후순환계의 척추뇌기저동맥을 침범하는 것으로 알려져 있으나, 전순환계, 특히 전대뇌동맥에 이환되는 경우도 있다. 긴머리확장증이 전순환계와 후순환계를 모두 침범한 사례는 아직 국내에 보고된 바가 없다. 이에 우리는 기저 질환이 없는 젊은 여자 환자에서 전순환계와 후순환계가 모두 이환된 매우 희귀한 형태의 긴머리확장증 사례를 현저한 영상 소견을 토대로 보고하고자 한다.

• Journal of Korean Neurosurgical Society
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• 제45권1호
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• pp.11-15
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• 2009

Objective : The aim of study was to review our patient population to determine whether there is a critical aneurysm size at which the incidence of rupture increases and whether there is a correlation between aneurysm size and location. Methods : We reviewed charts and radiological findings (computed tomography (CT) scans, angiograms, CT angiography, magnetic resonance angiography) for all patients operated on for intracranial aneurysms in our hospital between September 2002 and May 2004. Of the 336 aneurysms that were reviewed, measurements were obtained from angiograms for 239 ruptured aneurysms by a neuroradiologist at the time of diagnosis in our hospital. Results : There were 115 male and 221 female patients assessed in this study. The locations of aneurysms were the middle cerebral artery (MCA, 61), anterior communicating artery (ACoA, 66), posterior communicating artery (PCoA, 52), the top of the basilar artery (15), internal carotid artery (ICA) including the cavernous portion (13), anterior choroidal artery (AChA, 7), A1 segment of the anterior cerebral artery (3), A2 segment of the anterior cerebral artery (11), posterior inferior cerebellar artery (PICA, 8), superior cerebellar artery (SCA, 2), P2 segment of the posterior cerebral artery (1), and the vertebral artery (2). The mean diameter of aneurysms was $5.47{\pm}2.536\;mm$ in anterior cerebral artery (ACA), $6.84{\pm}3.941\;mm$ in ICA, $7.09{\pm}3.652\;mm$ in MCA and $6.21{\pm}3.697\;mm$ in vertebrobasilar artery. The ACA aneurysms were smaller than the MCA aneurysms. Aneurysms less than 6 mm in diameter included 37 (60.65%) in patients with aneurysms in the MCA, 43 (65.15%) in patients with aneurysms in the ACoA and 29 (55.76%) in patients with aneurysms in the PCoA. Conclusion : Ruptured aneurysms in the ACA were smaller than those in the MCA. The most prevalent aneurysm size was 3-6 mm in the MCA (55.73%), 3-6 mm in the ACoA (57.57%) and 4-6 mm in the PCoA (42.30%). The more prevalent size of the aneurysm to treat may differ in accordance with the location of the aneurysm.

• 대한방사선기술학회지:방사선기술과학
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• 제32권1호
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• pp.87-93
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• 2009

배경/목적 : 경추골동맥 기시부의 동맥경화증은 경추기저 국소빈혈증의 위험인자 중 하나이기 때문에 경추골동맥 기시부를 확인해야 할 필요가 있다. 색도플러 초음파검사에 의한 경추골동맥 기시부의 관찰 및 평가는 기술적으로 어려움이 있으며, 특히 왼쪽 기시부는 더욱 그렇다. 이 연구의 목적은 색도플러 초음파검사 시경추골동맥 기시부의 관찰률을 높이는 것이다. 대상 및 방법 : 경동맥을 포함한 경추골동맥의 색도플러 초음파검사가 198명에 대해 시행되었다. 경추골동맥 기시부를 다른 혈관의 기시부와 더 쉽게 구분하기 위해 목 윗부분의 경추동맥에서부터 쇄골하동맥 측으로 검사를 시행하였다. 검사 기술적으로 경추골동맥 기시부가 바로누운자세의 자연스러운 위치에서 관찰되지 않을 경우, 초음파 트랜스듀서를 쇄골 측으로 밀고, 그래도 관찰되지 않을 경우 다른 손으로 어깨를 밀어 관찰을 시도하였다. 경추골동맥 기시부의 깊이와 위 세 가지 방법 및 그에 따른 관찰률을 확인하기 위하여, 검사된 초음파 영상에서 관찰된 경추골동맥 기시부의 위치를 3.0 cm 이하와 그 이상으로 구분하였다. 결 과 : 오른쪽 경추골동맥 기시부는 97%, 왼쪽 경추골동맥 기시부는 92%에서 관찰되었다. 3.0 cm 이하에서 관찰된 오른쪽 경추골동맥 기시부 중 자연스러운 자세, 트랜스듀서 밀기, 그리고 어깨 밀기에서 관찰된 경우는 각각 98.6%, 1.4%, 그리고 0.0%이었다. 그리고 3.0 cm 보다 더 깊은 위치에서 관찰된 오른쪽 경추골동맥 기시부 중 자연스러운 자세, 트랜스듀서 밀기, 그리고 어깨 밀기에서 관찰된 경우는 각각 81.2%, 14.6%, 그리고 4.2%이었다. 3.0 cm 이하에서 관찰된 왼쪽쪽 경추골동맥 기시부 중 자연스러운 자세, 트랜스듀서 밀기, 그리고 어깨 밀기에서 관찰된 경우는 각각 85.4%, 10.7%, 그리고 3.9%%이었다. 그리고 3.0 cm 보다 더 깊은 위치에서 관찰된 오른쪽 경추골동맥 기시부 중 자연스러운 자세, 트랜스듀서 밀기, 그리고 어깨 밀기에서 관찰된 경우는 각각 55.7%, 30.4%, 그리고 13.9%이었다. 결 론 : 경추골동맥의 색도플러 초음파검사에서 그 기시부가 바로누운자세의 자연스러운 위치에서 관찰되지 않을 경우, 초음파 트랜스듀서를 쇄골 측으로 밀거나 그래도 관찰되지 않을 경우 다른 손으로 어깨를 밀어 관찰을 시도한다면, 관찰률을 좀더 높일 수 있을 것으로 사료된다.