안면 손상의 위치와 외상성 뇌 출혈과의 관계

박상협,한승백,서영주,강 수,김아름,이형민,김아진 대한응급의학회 2016 大韓應急醫學會誌 Vol.27 No.6

Purpose: Several studies have reported that facial fractures were associated with traumatic brain injuries or cervical injuries. The purpose of this study was to analyze the relationship between the location of facial injury and traumatic brain hemorrhage in order to support future decisions for image evaluation in facial injury patients. Methods: In this retrospective cohort study, we evaluated facial injury patients without external head trauma who visited the emergency department at our hospital between January 1, 2014 and October 31, 2014. We divided the cohort into 2 groups: Facial injury patients with associated traumatic brain hemorrhage and those without traumatic brain hemorrhage. We compared the factors related to traumatic brain hemorrhage, such as facial injury locations, mechanism of accident, types of wounds, altered mentality, headache, and loss of consciousness between the two groups. Results: In 873 patients, 73 (8.36%) presented traumatic brain hemorrhage and the other 800 had no traumatic brain hemorrhage on a brain computed tomography (CT) scan. The rate of headache, loss of consciousness, altered mentality, traffic accident, fall down, fracture, temporal injury, frontal injury, multiple facial area injury, and upper facial area (frontal and upper orbital area) injury were higher in the traumatic brain hemorrhage group than in the non-traumatic brain hemorrhage group (p<0.05). The risk factors of traumatic brain hemorrhage were headache, loss of consciousness, altered mentality, facial bone fracture, and temporal area injury of the face. Conclusion: If a facial injury patient has any of the following factors temporal area injury, facial bone fracture, altered mentality, headache, and loss of consciousness, we have to evaluate the brain CT scan even if the patient had no external head injury.

Brain-lung interaction: a vicious cycle in traumatic brain injury

Ariana Alejandra Chacón-Aponte,Érika Andrea Durán-Vargas,Jaime Adolfo Arévalo-Carrillo,Iván David Lozada-Martínez,Maria Paz Bolaño-Romero,Moscote-Salazar Luis Rafael,Pedro Grille,Janjua Tariq 대한중환자의학회 2022 Acute and Critical Care Vol.37 No.1

The brain-lung interaction can seriously affect patients with traumatic brain injury, triggering a vicious cycle that worsens patient prognosis. Although the mechanisms of the interaction are not fully elucidated, several hypotheses, notably the “blast injury” theory or “double hit” model, have been proposed and constitute the basis of its development and progression. The brain and lungs strongly interact via complex pathways from the brain to the lungs but also from the lungs to the brain. The main pulmonary disorders that occur after brain injuries are neurogenic pulmonary edema, acute respiratory distress syndrome, and ventilator-associated pneumonia, and the principal brain disorders after lung injuries include brain hypoxia and intracranial hypertension. All of these conditions are key considerations for management therapies after traumatic brain injury and need exceptional case-by-case monitoring to avoid neurological or pulmonary complications. This review aims to describe the history, pathophysiology, risk factors, characteristics, and complications of brain-lung and lung-brain interactions and the impact of different old and recent modalities of treatment in the context of traumatic brain injury.

후유장애 평가 의뢰된 외상성 뇌손상 환자에 있어서 기억장애의 임상적 특성

신수미,김민정,정영인 대한신경정신의학회 2003 신경정신의학 Vol.42 No.6

Objectives:The purpose of this study is to investigate the characteristics of memory disturbance caused by traumatic brain injury. Methods:We measured the memory functions of 90 patients who complained of memory impairment after traumatic brain injury and were referred for mental disability evaluation, using Rey-Kim Memory Test. The patients were divided into three groups according to Memory Quotient and brain imaging studies. We also examined their intelligence and emotional characteristics using K-WAIS and MMPI. Results:1) Among the patients who complained of memory impairment and had abnormal brain imaging after traumatic brain injury, more than half showed no actual memory disturbance. 2) The group with actual memory disturbance showed normal verbal short-term memory but showed deficits in verbal long-term memory. And their visuospatial functions were preserved but visual short- and long-term memory were impaired. 3) There was notable correlation between memory function and intelligence in patients with traumatic brain injury. 4) The group with abnormal brain imaging showed more social withdrawal than the group without abnormal brain imaging. The group without abnormal brain imaging showed more somatization than the group with abnormal brain imaging. Conclusion:We suggest the special memory function test as well as brain imaging studies for patients who complain of memory impairment after traumatic brain injury

수영 운동이 외상성 뇌손상 유발 흰쥐에서의 c-Fos 발현에 미치는 영향

김보균(Kim Bo-Kyun),윤성진(Yoon Sung-Jin),김승희(Kim Seung-Hee),서진희(Seo Jin-Hee),김대영(Kim Dae-Young),성윤희(Sung Yun-Hee),김창주(Kim Chang-Ju),신말순(Shin Mal-Soon),윤진환(Yun Jin-Hwan),이희혁(Lee Hee-Hyuk) 한국체육과학회 2009 한국체육과학회지 Vol.18 No.1

Traumatic brain injury is known to cause severe neurological damage and has a high mortality rate. c-Fos expression is recognized as a marker of increased neuronal activity, however, excessive c-Fos expression represents apoptotic neuronal cell death. In the present study, the effect of swimming exercise on traumatic brain injury-induced c-Fos expression in rats was investigated by c-Fos immunohistochemistry. The rats were divided into 3 groups: the sham-operation group, the traumatic brain injury-induction group, and the traumatic brain injury-induction and swimming exercise group. The animals in the exercise group were forced to swim for 30 min once a day during 14 consecutive days. The present results showed that traumatic brain injury enhanced the number of c-Fos-positive cells in the paraventricular nucleus (PVN) and ventrolateral periaqueductal gray (vlPAG) regions and that swimming exercise significantly suppressed the traumatic brain injury-induced c-Fos expression. In the traumatic brain injury rats, swimming exercise exerted inhibitory effect on the c-Fos exepression in the PVN and vlPAG regions. Based on the present results, it can be suggested that swimming exercise has a neuroprotective against traumatic brain injury by suppressing c-Fos expression.

뇌손상 심도에 따른 외상성 뇌손상 환자의 지능 장애와 기억 장애 비교

오상우,이소영,권혁철 한국임상심리학회 2002 Korean Journal of Clinical Psychology Vol.21 No.2

This study was to investigate the intelligence and memory disturbances of patients with traumatic brain injury. The subjects consisted of three following groups by its severity: the patients with mild traumatic brain injury(n=30); the patients with moderate traumatic brain injury(n=17); the patients with severe traumatic brain injury(n=67). The K-WAIS and the Rey-Kim Memory Test was administered and scored by manual and premorbid intelligence was estimated Kim(2000)'s method. The following results could be obtained. First, measured IQ of the severe traumatic brain injury group was significantly lower than that of mild brain injury group. Second, the differences between the premorbid IQ and the measured IQ of the severe traumatic brain injury group were significantly higher than those of the mild brain injury group. Third, the MQ of the severe group was lower than the MQ of the mild traumatic brain injury group. Finally, the clinical implications and limitations of this study were discussed.

뇌 손상 정도 및 전두엽 손상 유무에 따른 외상성 뇌 손상 환자의 주관적 정신병리

김경근(Kyoung-Keun Kim),주열(Yeol Joo),김진성(Jin-Sung Kim),이종범(Jong-Bum Lee),김오룡(Oh-Lyong Kim),서완석(Wan-Seok Seo),배대석(Dai-Seg Bai),구본훈(Bon-Hoon Koo) 대한생물치료정신의학회 2010 생물치료정신의학 Vol.16 No.1

외상성 뇌손상(traumatic brain injury;이하 TBI)환자에서 외상의 심각도와 전두엽 손상 여부에 따른 정신과적 증상에 대해 알아보기 위해 1998년 7월부터 2008년 10월까지 TBI 환자 110명을 대상으로 연구를 시행하였다. 이들을 손상의 심각도에 따라 경도 뇌손상군(mild TBI, 이하 MTBI)과 중등도 뇌손상군(moderate TBI, 이하 MOTBI)으로 나누고, 이를 전두엽 손상 유무에 따라 각각 전두엽 손상군(frontal lobe injury, 이하 FLI)과 비전두엽 손상군(non-frontal lobe injury, 이하 NFLI)으로 구분하였다. 각 군에 대해 병록지 자료 수집 및 SCL-90-R과 MMPI를 시행하였다. SCL-90-R에서 뇌 손상이 심한 경우 정신증 척도가 높고 증상을 더 많이 호소하는 경향을 보였으나 전두엽 손상 유무에 따라서는 차이가 없었다. MMPI의 경우에는 경조증 척도가 뇌손상의 심각도와 전두엽 손상 여부 간의 상호작용이 나타났다. 따라서 뇌손상의 정도가 증가하는 경우 인지기능의 저하에 따른 경조증 증상에 대한 주의가 필요하다. Objectives:The objective of this study was to investigate the subjective psychopathology in patients with traumatic brain injury according to their severity and existent of frontal lobe injury. Methods:S110 patients with traumatic brain injury were selected for study. After classifying patients into mild traumatic brain injury(MTBI) group and moderate traumatic brain injury(MOTBI) group with Glasgow Coma Scale score, each group was subdivided into frontal lobe injury(FLI) group and non frontal lobe injury(NFLI) group. Psychological tests were administered using Korean Wechsler adult intelligence scale(K-WAIS), Symptom checklist 90 revised (SCL-90-R) and Minnesota multiphasic personality inventory(MMPI). Results:Psychoticism score and positive symptom distress level in SCL-90-R was higher in MOTBI group than MTBI group. There was significant interaction between injury severity and existent of frontal lobe injury in hypomanic scale score of MMPI. Conclusion:Careful evaluation of psychotic and affective symptoms are warranted for TBI patients with increasing severity and existent of frontal lobe injury.

외상성 뇌손상 환자의 시계 그리기 검사 반응

최성진,국승희 한국임상심리학회 2005 Korean Journal of Clinical Psychology Vol.24 No.1

The Clock Drawing Test(CDT) has the strength to evaluate several domains of the neurocognitive function in a short period of time. However, most studies have been focused mainly on the efficiency of the CDT for differentiating dementia patients. The purpose of this study was to investigate whether the CDT could correctly reflect the severity of brain injury in patients with traumatic brain injury as well as differentiating dementia patients or not. After the clinical characteristics were examined, the CDT and the Korean-Wechsler Adult Intelligence Test(K-WAIS) were administered to 69 patients with mental disorders due to traumatic brain injury. Based on the severity classification of brain injury by Golden and Golden(2003), the patients were classified into two groups; mild to moderate and severe to very severe. The two groups' scores on 3 subscoring systems and the total scores of the CDT were compared. The correlations between the performance of the K-WAIS and the CDT response and the relationships between the severity of brain injury and the error type of the CDT response were tested. As a result, there were correlations between the severity of brain injury and lower CDT scores in patients. Additionally, the CDT score was more correlated with the subtest scores and IQ of the K-WAIS in the severe to very severe group than the mild to moderate group. The group with severe to very severe brain injury showed much more errors in size of the clock and graphic difficulties but didn't show the others of the errors types. These results suggest that the CDT can be useful in assessing the neurocognitive function of the traumatic brain injured patients as well as the dementia patients. Finally, the suggestions, limitations and further issues for future study were discussed.

다시 생각해 본 리질리언스:외상성 손상 후 적응과정에서 나타나는 특성과 적응 결과의 관계를 중심으로

김동일,이주영,김원호,김명찬,최선 한국상담학회 2011 상담학연구 Vol.12 No.4

The present study explores that the concept of resiliency, consistent with many of the goals of the positive psychology movement, should be broadened so that it is applicable to all individuals who have shown strength after facing adversity. Several theoretical and practical issues for both researchers and clinicians are considered throughout the study. Although a universal definition does not exist, resilience is generally considered a multidimensional construct consisting of behavior a thought a and actions, which can be learned overtime. Consequently, there is a growing body of literature examining resilience in different traumatic injury populations. However, there is a paucity of literature examining the resilience of individuals who have experienced a traumatic injury. Potentially, resilience and rehabilitation process are a very fruitful line of research in terms of that the extreme adversity individuals are faced with post injury when dealing with the trauma of the injury and r sultant impairments. Therefore, the present study is aimed to provide discussions on the construct of resilience in relation to people with traumatic injuries such as Spinal Cord Injury, Traumatic Brain Injury, Traumatic Amputation via literature review, and to offer potential research directions. 최근 긍정심리학이 대두되면서, 심각한 역경에도 불구하고 자신의 삶을 성공적으로 영위하는 사람에 대한 관심이 점증되고 있다. 본 연구에서는 이처럼 역경에 성공적으로 적응하는 사람의 특성인 리질리언스에 대한 이해를 심화시켜 임상이나 연구에서 유용하게 적용할 수 있는 발판을 마련하고자 하였다. 이를 위해 먼저 리질리언스에 대한 선행 연구물들을 통해 개념적인 측면을 재조명하였고, 명시적인 역경으로 외상성 손상(척수손상, 절단장애, 외상성 뇌손상)을 경험한 후 나타난 리질리언스를 다룬 기존 연구 논문을 검토하여 리질리언스의 과정에 대한 보다 심층적인 분석을 하고자 시도하였다. 끝으로 의미 있는 결과와 논의를 바탕으로 향후 임상 및 연구에 리질리언스를 적용할 때 고려할 수 있는 시사점을 제시하였다.

A simple method to isolate structurally and chemically intact brain vascular basement membrane for neural regeneration following traumatic brain injury

Ji Wanqing,Wu Zhiru,Wen Jiaming,Tang Hengxin,Chen Zhuopeng,Xue Bo,Tian Zhenming,Ba Yueyang,Zhang Ning,Wen Xuejun,Hou Bo 한국생체재료학회 2023 생체재료학회지 Vol.27 No.00

The brain vascular basement membrane (brain-VBM) is an important component of the brain extracellular matrix, and the three-dimensional structure of the cerebrovascular network nested with many cell-adhesive proteins may provide guidance for brain tissue regeneration. However, the potential of ability of brain-VBM to promote neural tissue regeneration has not been examined due to the technical difficulty of isolating intact brain-VBM.The present study developed a simple, effective method to isolate structurally and compositionally intact brain-VBM. Structural and component properties of the brain-VBM were characterized to confirm the technique. Seed cells were cocultured with brain-VBM in vitro to analyze biocompatibility and neurite extension. An experimental rat model of focal traumatic brain injury (TBI) induced by controlled cortical impact were conducted to further test the tissue regeneration ability of brain-VBM.Brain-VBM isolated using genipin showed significantly improved mechanical properties, was easy to handle, supported high cell viability, exhibited strong cell adhesive properties, and promoted neurite extension and outgrowth. Further testing of the isolated brain-VBM transplanted at lesion sites in an experimental rat model of focal TBI demonstrated considerable promise for reconstructing a complete blood vessel network that filled in the lesion cavity and promoting repopulation of neural progenitor cells and neurons.The technique allows isolation of intact brain-VBM as a 3D microvascular scaffold to support brain tissue regeneration following TBI and shows considerable promise for the production of naturally-derived biomaterials for neural tissue engineering.

Cerebrolysin Attenuates Astrocyte Activation Following Repetitive Mild Traumatic Brain Injury

Hyun Bae Kang(강현배),GiHun Kim(김기훈),HyunJoong Kim(김현중),Sa Rang Han(한사랑),Dong Jin Chae(채동진),Hee-Jung Song(송희정),Dong Woon Kim(김동운) 한국생명과학회 2013 생명과학회지 Vol.23 No.9

만성외상성뇌병증(Chronic traumatic encephalopathy, CTE)은 운동선수와 매우 밀접하게 관련되어 있으며 장기간에 걸쳐 반복적인 외상성뇌손상(traumatic brain injury, TBI)로 인한 퇴행성뇌질환이다. 신경영양인자(neurotrophic factor)는 여러 종류가 알려져 있으며 이들은 뇌와 척수의 물리적 손상시에 신경보호효과가 있다. 따라서, 신경영양인자의 혼합물인 cebrolysin을 이용하여 CTE질환에 가장 적합하다고 여겨지는 repetitive mild TBI (rmTBI) 모델에서 cerebrolysin의 신경보호효과를 알아보고자 하였다. 실험군은 5군(groups 1 and 2: rmTBI for 4 weeks following cerebrolysin injection for 4 weeks; groups 3 and 4: rmTBI for 8 weeks with or without cerebrolysin injection for 4 weeks; group 5: control)으로 나누어 진행하였다. CTE의 가장 대표적 표시인자인 tau 단백질의 인산화를 조직학적으로 조사한 결과, 대뇌겉질과 해마내 CA3 영역에서 phospho-tau단백질의 발현이 증가되었으며 cerebrolysin (10 μl of 1 mg/ml)를 미정맥으로 투여시 p-tau발현이 감소되었다. CTE의 병인으로 알려진 별아교세포와 미세아교세포의 활성을 각각의 표시인인 GFAP, iba-1을 이용하여 면역조직화학염색을 시행 하였다. 별아교세포의 활성은 rmTBI에 의하여 증가하였으며 cerebrolysin에 의해 회복되었으나 미세아교세포의 활성은 관찰되지 않았다. 또한 rmTBI모델에서 체내 탐식세포(macrophage)의 뇌내유입유무를 관찰하고자 CD45 염색을 시행하였으나 유의한 차이를 관찰하지 못하였다. 이상의 결과를 종합하면, cerebrolysin이 rmTBI에 의한 tau단백질의 인산화 및 별아교세포의 활성을 조절하는 것으로 사료된다. 따라서 cerebrolysin이 CTE 환자에 대한 치료 약물의 후보가 될 수 있음을 시사한다. Chronic traumatic encephalopathy (CTE), which is common in athletes, is a progressive neurodegenerative disease and a long-term consequence of repetitive closed head injuries. CTE is regarded as a chronic brain syndrome due to the effects of repetitive traumatic brain injury (TBI). Because neurotrophic factors are neuroprotective in models of brain and spinal cord injuries, we examined the effects of cerebrolysin, a mixture of various neurotrophic factors, on brain pathology in a mouse model of repetitive mild TBI (rmTBI), which is a good model of CTE. Five groups were created and treated as follows: groups 1 and 2: rmTBI for 4 weeks following cerebrolysin injection for 4 weeks; groups 3 and 4: rmTBI for 8 weeks with or without cerebrolysin injection for 4 weeks; group 5: control. We found that p-tau expression was increased in the pyramidal layer of the cortex and hippocampus, particularly the CA3 region, but not in the CA1 region and the dentate gyrus (DG). Intra-tail vein administration of cerebrolysin (10 ml of 1 mg/ml) after/during rmTBI treatment reduced p-tau expression in both the cortex and hippocampus. Histological analysis revealed mild astrocyte activation (increased expression of glial fibrillary acidic protein (GFAP)) but not microglia activation (ionized calcium binding adaptor molecule 1 (iba-1) expression) and peripheral macrophage infiltration (CD45). Additionally, administration of cerebrolysin after rmTBI resulted in reduced astrocyte activation. These observations in rmTBI demonstrated that cerebrolysin treatment reduces phosphorylation of tau and astrocyte activation, attenuates brain pathology, and mitigates function deficits in TBI. Taken together, our observations suggest that cerebrolysin has potential therapeutic value in CTE.