1.Effect of Extracranial-Intracranial Bypass on Cerebral Blood Flow and Vasomotor Reactivity in patients with Compromised Cerebral Hemodynamics.
Hak Seung LEE ; Yo Sik KIM ; Sung Don KANG
Journal of the Korean Neurological Association 2002;20(5):453-458
BACKGROUND: The obstruction of intracranial arteries causes cerebral hemodynamic impairment. It is now evident that patients with cerebral hemodynamic compromise have a higher risk of stroke than those with normal cerebral blood flow. The purpose of this study is to investigate the changes of cerebral blood flow and vascular reactivity after extra-intracranial arterial bypass (EIAB) surgery in patients with cerebral hemodynamic compromise. METHODS: We enrolled 16 consecutive patients (8 female and 8 male patients) with transient ischemic attack or cerebral infarction resulted from the occlusion of distal internal carotid artery (ICA) or middle cerebral artery (MCA). We measured the relative regional cerebral blood flow (rrCBF) at rest and after Diamox infusion, and vasomotor reactivity by using single photon emission computed tomography (SPECT). We performed extra-intracranial arterial bypass (EIAB) surgery in patients with impaired vasomotor reactivity. Follow-up brain SPECT was done at 3months after EIAB. We compared the rrCBF and vasomotor reactivity before and after EIAB, and evaluated the effect of collateral vessels on the cerebral hemodynamic after surgery. RESULTS: EIAB increases the vasomotor reactivity significantly (-19.6+/-10 before EIAB, 11.2+/-27 after EIAB, p=0.003) but does not increase the cerebral blood flow at rest (70.5% before EIAB, 70.9% after EIAB). The degree of collateral vessel development did not influence on the restoration of vasomotor reactivity. CONCLUSIONS: These results demonstrate that EIAB increases the vasomotor reactivity of the distal part on the occluded ICA or MCA, but does not increase the cerebral blood flow at rest.
Acetazolamide
;
Arteries
;
Brain
;
Carotid Artery, Internal
;
Cerebral Infarction
;
Female
;
Follow-Up Studies
;
Hemodynamics*
;
Humans
;
Ischemic Attack, Transient
;
Male
;
Middle Cerebral Artery
;
Stroke
;
Tomography, Emission-Computed, Single-Photon
2.A Case of Secondary Erythromelalgia with Regional Arterial Blood Pressure Change between Symptomatic and Asymptomatic Period.
Han Saem LEE ; Hyuk JANG ; Yo Sik KIM
Journal of the Korean Neurological Association 2002;20(2):211-212
No abstract available.
Arterial Pressure*
;
Aspirin
;
Erythromelalgia*
;
Thrombocytosis
3.Deep Cerebral Venous Thrombosis Showing Parkinsonism such as Micrographia, Hypophonia and Bradykinesia.
Seung Hoi LEE ; Hyuk CHANG ; Yo Sik KIM
Journal of the Korean Neurological Association 2002;20(2):187-190
Deep cerebral venous thrombosis is a rare condition associated with edema, infarction or hemorrhage in basal ganglia, thalamus and periventricular white matter. It presents nonspecific clinical manifestations such as altered consciousness, headache, focal neurological deficit, nausea and vomiting. Extrapyramidal signs are very rare in deep cerebral venous thrombosis. We report a patient who presented micrographia, hypophonia and bradykinesia as an early manifestation of deep cerebral venous thrombosis.
Basal Ganglia
;
Consciousness
;
Edema
;
Headache
;
Hemorrhage
;
Humans
;
Hypokinesia*
;
Infarction
;
Nausea
;
Parkinsonian Disorders*
;
Thalamus
;
Venous Thrombosis*
;
Vomiting
4.Vascular Endothelial Dysfunction in Cerebral Leukoaraiosis.
Jae Hoon JO ; Hyung Jong PARK ; Soo Sung KIM ; Hyun Gu KANG ; Young Jin KIM ; Hyun Young PARK ; Hak Seung LEE ; Yosik KIM ; Nam Ho KIM ; Hyoung Suk HAN
Journal of the Korean Neurological Association 2011;29(1):25-30
BACKGROUND: Chronic subclinical ischemia has been considered as one of major causes of leukoaraiosis, although its trigger is unknown. The vascular endothelium plays a major role in maintaining cerebral perfusion through autoregulation. In this study we evaluated the endothelial bioavailability of nitric oxide (NO) in patients with leukoaraiosis. METHODS: We enrolled consecutive patients with lacunar syndrome or transient ischemic attack; the control group comprised age- and sex-matched patients with hypertension but with no neurological abnormality. All participants underwent flow-mediated dilatation of the brachial artery (FMD) to evaluate endothelial function. Leukoaraiosis was defined as ill-defined patches with high signal intensities on FLAIR and low signal intensities on T1-weighted images. Patients were defined as having ischemic leukoaraiosis if they presented with leukoaraiosis and lacunar infarction. Leukoaraiosis only was defined when patient had leukoaraiosis without lacunar infarction leukoaraiosis without lacunar infarction. RESULTS: In total, 75 patients (37 with leukoaraiosis and 38 controls) were enrolled in this study. The demographic and clinical characteristics were similar in the two groups. FMD was lower in patients with leukoaraiosis than in controls (p<0.05), and lower in patients with only leukoaraiosis and in those who also had ischemic leukoaraiosis than in the controls (p<0.05). However, FMD did not differ significantly between patients with leukoaraiosis only and those who also had ischemic leukoaraiosis (p>0.05). CONCLUSIONS: The bioavailability of NO in the vascular endothelium is decreased in patients with leukoaraiosis only and in those who also have ischemic leukoaraiosis compared to controls. These results are suggestive of a causative role of endothelial dysfunction in the pathomechanism of leukoaraiosis.
Biological Availability
;
Brachial Artery
;
Dilatation
;
Endothelium
;
Endothelium, Vascular
;
Homeostasis
;
Humans
;
Hypertension
;
Ischemia
;
Leukoaraiosis
;
Nitric Oxide
;
Perfusion
;
Stroke, Lacunar
;
Vasodilation
5.A Case of Extrapontine Myelinolysis with both Frontal Lobe Dysfunction and Decreased Perfusion in SPECT.
Seung Hoi LEE ; Bong Kee CHOI ; Hak Seung LEE ; Han Saem LEE ; Seong Wook PARK ; Hyuk CHANG ; Yo Sik KIM ; Kwang Ho CHO ; Hak Ryul KIM ; Eun Tak JUNG
Journal of the Korean Neurological Association 2003;21(2):195-198
A thirty-nine year old woman was consulted because of personality change, agitation and memory disturbance. She received chemotherapy and oral steroids because of carcinoma within the bronchus. She had a high serum osmolarity caused by hyperglycemia and hypernatremia, and it was corrected rapidly. Her brain MRI showed EPM (extrapontine myelinolysis). Brain SPECT showed hypoperfusion in the bilateral orbitofrontal regions. We report a patient with EPM with typical frontal lobe dysfunction as an initial manifestation and bilateral orbitofrontal hypoperfusion.
Brain
;
Bronchi
;
Dihydroergotamine
;
Drug Therapy
;
Female
;
Frontal Lobe*
;
Humans
;
Hyperglycemia
;
Hypernatremia
;
Magnetic Resonance Imaging
;
Memory
;
Myelinolysis, Central Pontine*
;
Osmolar Concentration
;
Perfusion*
;
Steroids
;
Tomography, Emission-Computed, Single-Photon*