• Journal of Korean Neurosurgical Society
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• v.56 no.5
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• pp.428-430
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• 2014

Isolated traumatic pseudoaneurysms of the basilar artery are extremely rare but often fatal resulting in a mortality rate as high as 50%. A 51-year-old man presented with craniofacial injury after blunt trauma. A brain computed tomography (CT) scan showed thick basal subarachnoid hemorrhage associated with multiple craniofacial fractures, while CT angiography revealed contrast extravasation at the distal basilar artery with pseudoaneurysm formation. After this primary survey, the condition of the patient suddenly deteriorated. Conventional angiography confirmed the contrast extravasation resulted from pseudoaneurysm formation, which was successfully treated with endovascular coil embolization. Decompressive craniectomy and coma therapy with propofol were also performed. However, the patient died on the 7th hospital day because of the poor initial clinical condition. The current case is the first report of acute pseudoaneurysm rupture arising from the basilar artery within the first day after trauma. Our findings suggest the possibility that pseudoaneurysm rupture should be considered if brain CT shows thick traumatic subarachnoid hemorrhage on the basal cistern with a basal skull fracture.

• Journal of Korean Neurosurgical Society
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• v.56 no.5
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• pp.448-450
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• 2014

Nefopam, a centrally acting analgesic, has been used to control postoperative pain. Reported adverse effects are anticholinergic, cardiovascular or neuropsychiatric. Neurologic adverse reactions to nefopam are confusion, hallucinations, delirium and convulsions. There are several reports about fatal convulsive seizures, presumably related to nefopam. A 71-year-old man was admitted for surgery for a lumbar spinal stenosis. He was administered intravenous analgesics : ketorolac, tramadol, orphenadrine citrate and nefopam HCl. His back pain was so severe that he hardly slept for several days; he even needed morphine and pethidine. At 4 days of administration of intravenous analgesics, the patient suddenly started generalized tonic-clonic seizures for 15 seconds, and subsequently, status epilepticus; these were not responsive to phenytoin and midazolam. After 3 days of barbiturate coma therapy the seizures were controlled. Convulsive seizures related to nefopam appear as focal, generalized, myoclonic types, or status epilepticus, and are not dose-related manifestations. In our case, the possibility of convulsions caused by other drugs or the misuse of drugs was considered. However, we first identified the introduced drugs and excluded the possibility of an accidental misuse of other drugs. Physicians should be aware of the possible occurrence of unpredictable and serious convulsions when using nefopam.

• The Journal of Pediatrics of Korean Medicine
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• v.18 no.2
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• pp.143-160
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• 2004

Objective: There were few reports on the treatment of Hypoxic ischemic encephalopathy. We treated a hypoxic ischemic encephalopathic patient after accident with Oriental medical approach, and get a significant result. this treatment shows the possibility of healing Hypoxic ischemic encephalopathy, So we are reporting that case. Method : The acupuncture, herb medication. rehabilitation therapy was applied for treting patient's chife symptom(involuntary movement, dystonia, aphasia, dysuria, constipation) Results : 1. Generally patients with Hypoxic ischemic encephalopathy show language impairment and cognition disorder for several weeks to months. After coma stage, first they recover consciousness but have various degree of confusional mentality, visual agnosia, extrapyramidal stiffness and motor disturbance. 2. Consciousness loss in acute stage of Hypoxic ischemic encephalopathy can be considered as Mental Confusion due to Phlegm(Dammisimgyu) in veiw point of Oriental medicine. 3. After oriental medical treatment, patient's chief symptoms were improved. Conclusion: We treated a hypoxic ischemic encephalopathic patient with Oriental medical approach and patient's chief symptoms were improved. this treatment shows the possibility of healing Hypoxic ischemic encephalopathy.

• Journal of Yeungnam Medical Science
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• v.39 no.4
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• pp.332-335
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• 2022

We report on changes in the ascending reticular activating system (ARAS) concurrent with the recovery of impaired consciousness following rehabilitation and cranioplasty in a patient with traumatic brain injury (TBI), which were demonstrated on diffusion tensor tractography (DTT). A 34-year-old male patient was diagnosed with a traumatic intracerebral hemorrhage after falling from a height of approximately 7 m and underwent a right frontoparietotemporal decompressive craniectomy and hematoma removal. At 5 months after onset, when starting rehabilitation, the patient showed impaired consciousness, with a Glasgow Coma Scale (GCS) score of 4. Comprehensive rehabilitative therapy was provided until 14 months after onset, and his GCS score improved to 8. Cranioplasty was performed using auto-bone at 14 months after onset. One month after cranioplasty, his GCS score improved to 12. On the 15-month DTT, the deviated lower dorsal ARAS was restored on both sides, and the right side had become thicker. The right lower ventral ARAS was reconstructed, and increased neural connectivity of the upper ARAS was detected in both the prefrontal cortices. Thus, changes in the ARAS were demonstrated in a patient with TBI during recovery of consciousness following rehabilitation and cranioplasty.

• Journal of Yeungnam Medical Science
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• v.15 no.2
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• pp.371-380
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• 1998

Systemic lupus erythematosus(SLE) is an autoimmune disease which may affect many different organs and disclose various clinical manifestations. Recently central nervous system(CNS) involvement has been recognized as an increasingly significant contributor to morbidity and mortality of SLE. The clinical manifestations of CNS-lupus are highly variable and range from mild cognitive dysfunction, movement disorder, headache, psychosis to life-threatening stroke and coma. Among the neuropsychiatric disorders encountered in patients with SLE, cerebrovascular disease has been a relatively rare complication. The diagnosis and management of CNS-lupus is difficult because of the lack of useful diagnostic methods. If cerebrovascular involvement is suspected, aggressive treatment such as high dose steroid, immunosuppressive therapy, plasma exchange may be required to reduce high mortality rate. We experienced 2 cases cerebrovascular dis eases occurring in SLE patients which presented with various neuropsychiatric manifestations. They were diagnosed as CNS-lupus by neuropsychiatric symptoms, brain MRI, and BEG, and showed good response to high dose steroid pulse therapy.

• Journal of Haehwa Medicine
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• v.13 no.2
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• pp.277-287
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• 2004

I have come to next conclusions in consequence of documentary study about medical books of many generations regarding venesection therapy. 1. Venesection therapy is much used for five sensory organ disease. Besides that internal disease, pain paralysis disease of muscle and joints, sugical disease, disease of woman and children, fever sunstroke CVA emergency case follow that in the order of frequency of use. 2. It is used for swollen tongue, eye pain, pharyngitis, swelling and pain in the throat, bleeding from the eye ear nose mouth or subcutaneous tissue, tonsillitis, aphthae and so on in the five sensory organ disease. Focus, sosang, jinjin yuye, taiyang, baihui are used for five sensory organ disease in the order of frequency of use. 3. It is used for malaria, headache, precordial pain, head-wind, abdominal colic, diseases characterized by acute diarrhea and vomiting, and so on in the Internal disease. Superficial venules and lymph vessesls, taiyang, quze are used for Internal disease in the order of frequency of use. 4. It is used for low back pain, hypochondriac pain, numbness, knee pain, tinea pedis, red swelling pain of hand and arm, flaccidity-syndrome, and so on in the pain paralysis disease of muscle and joints. Weizhong, superficial venules and lymph vessesls, Ashi point, zhigou are used for pain paralysis disease of muscle and joints in the order of frequency of use. 5. It is used for furuncle, tinea capitis, and so on in the sugical disease. Focus, weizhong are used for sugical disease in the order of frequency of use. 6. It is used for inflammatory disease with redness of skin, and so on in the disease of woman and children. Focus, weizhong, yanglingquan, yaoshu, sanyinjiao are used for disease of woman and children in the order of frequency of use. 7. It is used for fever, CVA, sunstroke, cadaverous coma, common cold, and so on in the fever sunstroke CVA emergency case. Sosang, weizhong, chize are used for fever sunstroke CVA emergency case in the order of frequency of use. 8. The urinary bladder channel of foot-taiyang is most used. Next there are the du channel, the stomach channel of foot-yangming, the lung channel of hand-taiyin, the gall baldder channel of foot-shaoyang, the triple-warmer channel of hand-shaoyang, the large intestine channel of hand-yangming, the spleen channel of foot-taiyin, the kidney channel of foot-shaoyin the pericardium channel of hand-jueyin the liver channel of foot-jueyin, the ren channel, the heart channel of hand-shaoyin, the small intestine channel of hand-taiyang in the order of frequency in use. 9. Superficial venules and lymph vessesls, focus, five shu points, extra-point, back point are used in the venesection therapy, those are characteristic of locating an acupuncture point.

• Journal of Preventive Medicine and Public Health
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• v.17 no.1
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• pp.5-24
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• 1984

There has been an immense need for elaborate studies on the complications and the neuological sequelae generated by acute carbon monoxide (CO) poisoning which is highly prevalent in Korea due to widespread adoption of the anthracite coal briquette as domestic fuel for heating and for cooking. For this epidemiological study, a total of 444 subjects who received hospital emergency care for acute CO poisoning during the period of March 1982 to February 1983 were randomly selected from the emergency patients's lists of 13 general hospitals in Seoul area. Informations on the neurological sequelae were elucidated by means of home visiting with prearranged questionnaire consisting questions and concise neurological examination. The findings obtained were summarized as follows; 1. The complications were found in 18% of the surveyed and acute decubitus was comprised 67.5% of the complications. 2. The total cumulative incidence of the neurological sequelae was 41.2 per 100 patients and the absolute incidence rate regardless of the duration after poisoning was 40.8%. 3. The incidence of the neurological sequelae was higher in the older age than in the younger and also higher in female than in male. Twice higher incidence was observed in the admitted patients than in the non-admitted patients and the incidence became higher in proportion to the duration of CO exposure, coma and admission. The poorer the consciousness level of patients found, at emergency room and at discharge, the higher the incidence. The incidence of the neurological sequelae by emergency care was higher in hyperbaric oxygen therapy group(51.9%) than in 100% $O_2$ group(38.0%) 4. A total of five variables significantly associated with the occurrence of the neurological sequelae were selected by the stepwise discriminant analysis. The variables were following course of emergency care, age, consciousness level at discharge, admission duration, and consciousness level at emergency room in their sequence of discriminant power. Eight variables were selected as those associated with the degree of the neurological sequelae through the stepwise multiple regression analysis. Of these variables, the acute decubitus alone explained 21.1% of the total variation ana all the eight variables could explain 36.5% of the same. The remaining seven variables listed in the order of their relative importance were: age, consciousness level at discharge, admission duration, coma duration and consciousness level at emergency room. 5. It was postulated that unexpectedly high incidence of the neurological sequelae of the CO poisoning in this epidemiological study was mainly due to the inadequate emergency care and the lack of efficient and sophisticated treatment measure. In the effort to minimize the incidence of grave neurological sequelae of acute CO poisoning, new guidelines for the emergency care and treatment should be pursued with efficient ways.

• Journal of The Korean Society of Inherited Metabolic disease
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• v.16 no.1
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• pp.52-56
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• 2016

Propionic acidemia (PA) is a rare autosomal recessive metabolic disease caused by the deficiency of propionyl-CoA carboxylase (PCC). PA affects the catabolism of branched chain amino acid and oddchain fatty acid then results in accumulation of propionic acid and other metabolites in plasma and urine. Catabolic stress such as infection, illness or any stress can precipitate cause acute metabolic decompensation, especially in the first years of life. Acute metabolic decompensation commonly calls for emergency treatment or admission and if the patient is in a serious condition, it can lead to coma or death. But frequent admissions or visiting the emergency room are much burden to the patients and their kins. And we experienced the propionic academia with a confirmed novel mutation and the patient suffered from frequent admission and visiting the emergency room. So, we tried the regular home carebased fluid therapy after securing a central venous line. Finally, we succeeded in preventing frequent admissions resulted from acute metabolic decompensation and could contribute to relieving the burden to the patient and their family.

• The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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• v.16 no.3
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• pp.38-67
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• 2003

The burn is acute skin injury caused by fire, hot water. steam. hot oil, sour and salty. It is occurred frequently in the daily life as well as oriental therapy like moxibustion therapy, physical therapy. Nevertheless, medical treatment of the burn is almost dependent on western cure. So we chose the oriental medicine textbooks and the oriental medicine journals that were dealing with the drugs, processing the drugs. peculiar treatment put first external cure. The results were as follows; 1. The burn is acute skin injury caused by fire, hot water, steam, hot oil, sour and salty. 2. The burn cause blisters, irritability and restlessness, nausea, dryness of mouth, constipation, in case of serious, coma, dyspnea and death. The early stage of the burn, blisters form by skin damage and they burst into skin ulceration from which pus issues, the latter term, the wound form scab and healed up. 3. In a light case, medical treatment of the burn was used external treatment by medicine for externalism use, in a serious case, it was used both as an internal remedy and medicine for outward application. Also in the early stage, it was careful of using the cold and cool medicine, as the process of healing, it was used alleviating pain, detoxicating, moistening the skin, growing muscle and skin, convergence, evacuating pus, regeneration of the tissue, strengthen the spleen and nourishing the stomach. 4. The external treatment medication is Herba Ephedrae Oil(麻油), Radix ET Rhizoma Rhei(大黃), Glauberitum(寒水石), Water(水), Pig OiI(猪油), Pig Fat(猪脂), Radix Angelicae Gigantis(當歸), Rhizoma Coptidis(黃連), Cortex Phellodindri(黃栢). The White of an Egg(鷄子淸), Raw Honey(生蜜), Honey(蜜), Wine(酒), Etc. It is mostly the cold and cool medications. 5. Soft extracted and powered dosage form in external treatment is much used. The soft extracted form(32times used) are mostly Chung Ryang paste(淸凉膏) and Fructus Papaveris paste(罌粟膏). The powered form(30times used) are mostly Bingsang Powder(氷霜散), Bosaenggugo Powder(保生救苦散), Sahwang Powder(四黃散). The others is much a various powder adding solvent. 6. If varicella stage, erosion after varicella stage, oozing stage and extreme pain stage, the powder adding solvent is much used. If little oozing stage. ulcering stage, scabing stage and a chronic stage, Soft extracted dosage form is much used. 7. The most many(26.65%) used method is that apply each medication power mixed water(水), wine(酒), honey(蜜) in a wounded part.

• Journal of Korean Neurosurgical Society
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• v.44 no.4
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• pp.185-189
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• 2008

Objective : The authors present their experiences with stereotactic multiplanar reformatted (MPR) computed tomography (CT)-guided catheter placement for thrombolysis of spontaneous intracerebral hematoma (sICH) and their clinical results. Methods : In 23 patients with sICH, MPR CT-guided catheter placement was used to select the trajectory and target point of hematoma drainage. This group was comprised of 11 men and 12 women, and the mean age was 57.5 years (range, 31-79 years). The patients' initial Glasgow Coma Scale scores ranged from 7 to 15 with a median of 11. The volume of the hematoma ranged from 24 mL to 86 mL (mean 44.5 mL). A trajectory along the main axis of the hematoma was considered to be optimal for thrombolytic therapy. The trajectory was calculated from the point of entry through the target point of the hematoma using reformatted images. Results : The hematoma catheter was left in place for a median duration of 48.9 hours (range 34 to 62 hours). In an average of two days, the average residual hematoma volume was 6.2 mL (range 1.4 mL to 10.2 mL) and was reduced by an average of 84.7% (range 71.6% to 96.3%). The residual hematoma at postoperative seven days was less than 5 mL in all patients. There was no treatment-related death during hospitalization. Conclusion : The present study indicates that stereotactic MPR CT-guided catheter placement for thrombolysis is an accurate and safe procedure. We suggest that this procedure for stereotactic removal of sICH should be considered for the optimization of the trajectory selection in the future.