뇌출혈 유발 흰쥐에서 수영운동이 nitric oxide synthase 발현에 미치는 영향

김보균(Bo-Kyun Kim),신말순(Mal-Soon Shin),김창주(Chang-Ju Kim),임백빈(Baek-Vin Lim),윤진환(Jin-Hwan Yoon),이희혁(Hee-Hyuk Lee) 한국생활환경학회 2009 한국생활환경학회지 Vol.16 No.4

Intracerebral hemorrhage is one of the most devastating types of stroke. This disease is known to cause severe neurological damage and also has a very high mortality rate. Nitric oxide (NO) is synthetized from L-arginine by nitric oxide sy nthase (NOS). NO play many physiological functions, however excessive NO production induces neuronal cell death. There are three distinct isoforms of NOS: neuronal NOS (nNOS), inducible NOS (iNOS), and endothelial NOS (eNOS). In the present study, we investigated the effect of swimming on nitric oxide synthase expression in the hippocampal CA1 region following intracerebral hemorrhage using rats. Intracerebral hemorrhage was induced by injection of collagenase into the hippocampal CA1 region using a stereotaxic instrument. The rats were divided into 3 groups: the sham-operation group, the hemorrhage-induction group, and the hemorrhage-induction and swimming group. The animals in the swimming group performed swimming for 30 min once a day during 14 consecutive days. For this experiment, Nissl staining, nNOS immunohistochemistry, and nicotinamide adenine dinucleotide phosphate diaphorase (NADPH-d) histochemistry were performed. In the present results, induction of intracerebral hemorrhage caused neuronal cell death in the hippocampal CA1 region, while swimming decreased hemorrhage-induced neuronal death (p<0.05). The numbers of nNOS-positive cells and NADPH-d-positive cells in the hippocampal CA1 region were significantly increased following induction of intracerebral hemorrhage (p<0.05). Swimming suppressed the numbers of hemorrhage-induced nNOS-positive cells and NADPH-d-positive cells in the hippocampal CA1 region (p<0.05). Here in this study, we have shown that swimming inhibited intracerebral hemorrhage-induced NOS expression and thus exerted neuroprotective effect against intracerebral hemorrhage.

고혈압성 뇌실질내출혈의 장기추적결과의 평가 : 외과적 및 보존적 치료의 비교연구 A Comparative Study of Surgical and Conservative Treatment in 1009 Cases

임영진,이기홍,김태성,김국기,이봉암,임언 대한신경외과학회 1990 Journal of Korean neurosurgical society Vol.19 No.8-9

Hypertensive intracerebral hemorrhage is one of the important diseases in Korea, sociomedically, in view of high incidence and mortality rate of the disease, severity of its sequelae and the affected productive age-group of 40 to 50 years old. The indications for surgery in hypertensive intracerebral hemorrhage are still controversial. The reason for this may be : 1) lack of adequate and comparable data in conservative and surgical therapy from the same institution : 2) lack of adequate close follow-up monitoring over an extended period of time : or 3) lack of proper classification of hematomas for comparison of results from different institutions. The author analysed 1009 cases of hypertensive intracerebral hemorrhage admitted to the Department of Neurosurgery, Kyung-Hee University Medical centre for five years from January 1983 to December 1987. The site of hemorrhage have classified according to their anatomical site on computerized tomography. The long term outcome was analysed with reference to comparison between surgical treatment and conservative treatment. The results were as follows : 1) The incidence was high in the age-group of 50 years old and the sex ratio was 1.23 : 1.0. 2) There was no seasonal variation in the incidence. 3) The occurrence of putamino-thalamic hemorrhage(38.7%) was most frequent, and then followed by putaminal(17.9%), thalamic(17.9%), subcortical(13.6%), pontine(7.5%), cerebellar(4.4%) hemorrhage in order. 4) The outcome was satisfactory in the cases of subcortical hemorrhage and cerebellar hemorrhage. The outcome was poorest in the cases of pontine hemorrhage. Both putamen and thalamic hemorrhages had brought about a high incidence of severe sequelae. 5) In correlation between the therapeutic modality and the outcome, surgical treatment increased the frequency of improvement towards Grade Ⅰ-Ⅱ, and also decreased the frequency of Grade Ⅲ. but brought about the increase of the mortality rate. In general this results failed to support the view that the surgical treatment is superior to the conservative one in the management of hypertensive intracerebral hemorrhage. But, in the subcortical and cerebellar hemorrhage, surgical treatment showed better outcome than conservative treatment 6) The outcome was poor in large sized hemorrhage than small one. In cases with large sized subcortical and cerebellar hemorrhage, surgical treatment had low mortality rate. 7) The level of consciousness at attack had closely related to the outcome. 8) In correlation between the time interval from ictus till operation and outcome, generally speaking, the outcome of delayed operation was slightly better than early operation. But, when the level of consciousness was good, the outcome of early operation was satisfactory. 9) Intraventricular hemorrhage occurred in 38.9% of all cases, and most frequently associated with thalamic hemorrhage. In the case of association with intraventricular hemorrhage, the mortality rate was greatly increased than in cases without intraventricular hemorrhage. 10) As far as the causes of death were concerned, cerebral swelling was most frequent and overall mortality rate was 22%.

자발성 뇌출혈의 치료 : Medical versus Surgical Therapy for Spontaneous Intracerebral Hemorrhage

김태호,정신,이제혁,박종근,김재휴,김수한,강삼석 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.2

The results of treatment for 248 patients with spontaneous intracerebral hemorrhage are described. Spontaneous intracerebral hemorrhage are classified into primary(215 patients) and secondary(33 patients) hemorrhages. Most of the secondary hemorrhages were located in the subcortical area(64%). In the Non-treated group, eighty patients died immediately after diagnosis. In the treated group, the overall mortality was 5% in primary hemorrhage and 15% in secondary hemorrhages, and the percentages of hypertensive intracerebral hemorrhage patients returning to full-time work or independent life without disability or with minimal disability were 30% in putaminal hemorrhages, 86% in caudate hemorrhages, 44% in thalamic hemorrhages, 61% in subcortical hemorrhage, 78% in cerebellar hemorrhages and 40% in brainstem hemorrhages respectively. This study showed that surgical treatment did not give better result over conservative treatment in the management of hypertensive supratentorial and brainstem hemorrhage. However hypertensive caudate and cerebellar hemorrhage were associated with favorable outcomes regardless of the mode of therapy chosen in severe hemorrhages, surgery may improve the length of survival, but the quality of life remains poor. The authors have shown again that aspiration surgery for hypertensive cerebellar hemorrhage is a valuable alternative to craniotomy.

재발된 고혈압성 뇌실질내 출혈

박상익,강동기,김상철 대한신경외과학회 1993 Journal of Korean neurosurgical society Vol.22 No.11

Thirty six consecutive patients with recurrent hypertensive intracerebral hemorrhage were identified in a retrospective review of 307 cases of hypertensive intracerebral hemorrhage(HICH) treated at the Fatima Hospital between September, 1989, and August, 1992. The recurrence rate was 11.7%. There were 14 males and 22 females, aged 38 to 83 years. Only one patient had recieved regular antihypertensive therapy after initial hemorrhage. The mean volume of hemorrhage was 21.7㏄ at first attack and 19.5㏄ at recurrent attack. The site of recurrent hemorrhage was putamen in 18 cases, thalamus in 12 cases, cerebellum in 8 cases and lobar in 3 cases. The most common pattern of recurrence was "Ganglionic-Ganglionic"(10cases). Recument hemorrhage occured at the same side in 54.8% and same side & same site in 16.7% of recurrent hemorrhage. Mean interval between the hemorrhage was 17.4 months and 55.8% of recurrent hemorrhage occured within 1 yeat. Initial condition was worse at recurrent hemorrhage and outcome also was worse regardless of treatment methods. We concluded that recurrent intracerebral hemorrhage in HICH patients was not a rare condition and regular follow up and antihypertensive therapy was important in prevention of recurrent hypertensive intracerebral hemorrhage.

Multiple Spontaneous Intracerebral Hematoma without Presenting Risk Factors

박상만,박은경,김주성,심규원 대한뇌혈관외과학회 2016 Journal of Cerebrovascular and Endovascular Neuros Vol.18 No.3

The incidence of intracerebral hemorrhage in those aged 45-84 years is 0.3-0.5%. In people over 80 years of age, this incidence increases 25-fold compared with that of the total population. The most common causes of spontaneous intracerebral hemorrhage in the younger population are vascular malformation, aneurysm, and overuse of drugs. In contrast, common causes in the elderly include hypertension, tumors, and coagulation disorders. Here, we present a case involving a 72-year-old male patient who, without any of these predisposing conditions, was admitted to the hospital with spontaneous intracerebral hemorrhage and showed signs of multifocal intracerebral hemorrhage during his stay. We conclude that spontaneous intracerebral hemorrhage can occur without any predisposing factors, and can lead to a patient's death. Therefore, the possibility of recurrent spontaneous intracerebral hemorrhage must be considered in patients with primary spontaneous intracerebral hemorrhage.

평형침을 포함한 한의치료로 호전된 뇌내출혈 환자의 한의치험 1례에 대한 증례보고-

김해융,원서영,김정희,유주영,정은선,유호룡,설인찬,김윤식,Kim, Hae-yoong,Won, Seo-young,Kim, Jeong-hui,Ryu, Ju-young,Jung, Eun-sun,Yoo, Ho-ryong,Seol, In-chan,Kim, Yoon-sik 대한한방내과학회 2021 大韓韓方內科學會誌 Vol.42 No.5

Objective: This study examined the effectiveness of Pyung-Hyung acupuncture and herbal medicine for a hemiplegic patient diagnosed with intracerebral hemorrhage. Methods: The patient was treated with Pyung-Hyung acupuncture and herbal medicine for one month. Intracerebral hemorrhage symptoms were evaluated using the Korean version of the Modified Barthel Index (K-MBI), the Manual Muscle Test (MMT), and brain CT images. Results: Following Pyung-Hyung acupuncture and herbal medicine, K-MBI, MMT, and brain CT image results improved. Conclusion: This case showed that Pyung-Hyung acupuncture and herbal medicine effectively treated intracerebral hemorrhage with hemiplegia.

만성 뇌경막하 혈종 및 활액낭종의 배액에 따른 대뇌실질내 및 뇌간 출혈

김충현,조창성,송관영,한윤경,하영일 대한신경외과학회 1994 Journal of Korean neurosurgical society Vol.23 No.8

Two cases of intracerebral and brain stem hemorrhage occurring after evacuation of chronic subdural hematoma and subdural hygroma are reported. A patient who had undergone craniostomy with closed drainage for subdural hygroma had intracerbral and fatal brain stem hemorrhage in the immediate postoperative period. Despite rapid and intensive treatment, he died. The other patient had intracerebral hematoma following drainage of chronic subdural hematoma and left with severe disability. Possible pathogenic mechanisms leading to development of the postoperative intraparenchyma1 hemorrhage are suggested. Sudden increase in cerebral blood flow combined with defective autoregulation seemed the most likely pathogenic mechanism ta be responsible for the postoperative hemorrhage. If close neurosurgical observation of patients and clinical awareness for the intraparenchymal hemorrhage after evacuation of chronic extracerebral fluid collections given, this devastating complication may be avoided.

피질하 뇌실질내 출혈 : 42명의 환자에 대한 임상적 분석 Clinical Analysis of 42 Patients

임정택,문재곤,유충선,김한규,황용순,이화동 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.7

Forty two patients were diagnosed as having subcortical(lobar) intracerebral hemorrhage among 407 consecutive patients presenting with spontaneous intracerebral hemorrhage. Brain CT and MRI or angiography were performed in 39 patients. The authors analyzed clinical features. brain CT . etiological factors, and outcome. Headache(69%) and vomiting(55%) were most common symptoms. The incidence of seizure was 14%. The volume of hematoma on CT was below 20cc in 21 patients. between 20cc and 40cc in 16 patients, and above 40cc in 5 patients. The most common site of hemorrhage was parietal lobe in 32 of 42 patients. The mortality rate was 9.5% and the functional outcome of the patients was generally better than in other forms of intracerebral hemorrhage. Thirty one patients had arterial hypertension which was the leading cause. Two patients had AVMs and two patients had blood dyscrasias. Unknown etiology occurred in 7 patients. Neither brain MRI nor cerebral angiograpy showed abnormal vascular lesion in all of the patients who had arterial hypertension. We conclude that no further evaluation is recommended in patients with subcortical hemorrhage who were definiely diagnosed as having arterial hypertension.

자발성 뇌실질내출혈의 뇌정위적 흡인술 및 치료효과에 대한 임상적 분석

이종선,최영주,민경수,이무섭,김영규,김동호 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.5

The best treatment modality for spontaneous intracerebral hemorrhage is still controversial. But stereotactic surgery can minimize the brain damage and can be performed safely and simply under local anesthesia. The purpose of this study was to analyse and evaluate the therapeutic result of stereotactic aspiration of hematoma and urokinass irrigation in patients with spontaneous intracerebral hemorrhage. Consecutively. 33 cases of spontaneous intracerebral hemorrhage admitted to Chung Buk National University Hospital from May, 1991 to January. 1995 and underwent stereotactic aspiration and urokinase irrigation were analysed and evaluated by factors believed to affect the final results. The results of this analysis suggest that stereotactic aspiration and urokinase irrigation is safe and efficient in treating spontaneous intracerebral hemorrhage with similar outcome but lower mortality compared with traditional craniotomy : and we can substitute traditional open craniotomy or conservative treatment for stereotactic aspiration combined with urokinase irrigation.

반복된 뇌실질 출혈로 진단이 늦어진 시상부 신경교모세포종

김병우(Byeong Woo Kim),심유식(Yu Shik Shim),장종희(Jong Hee Chang),안정용(Jung Yong Ahn) 대한두개저학회 2008 대한두개저학회지 Vol.3 No.1

Although rare, neoplasms can be obstructed by intracerebral hemorrhage, delaying histological diagnosis and proper treatment. We report the case of a 30-year-old male presenting with serial intracerebral hemorrhages in the left thalamus. Stereotactic biopsy failed to make histologic diagnosis; open biopsy, two months after the initial hemorrhage, diagnosed glioblastoma. The characteristics of hemorrhage from glioblastoma drawn from our experience and a comprehensive review of the literature include the following: (1) under 14 years of age or old age (2) deep seated supratentorial or posterior fossa location (3) disproportionately diffuse brain edema (4) suspiciously enhancing mass lesion (5) irregular shape and heterogeneous appearance with solid areas of blood, multiple hemorrhage, and a ring-shaped hemorrhage. Direct proof of hemorrhagic origin is necessary for diagnosis and treatment of intracerebral hemorrhage with atypical location, imaging findings, or clinical course.