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Persistent Trigeminal Artery : An Unusual Cause of Cerebral Infarction.

Dong Chul HAN ; Yeong Bae LEE ; Dong Jin SHIN

Korean Journal of Cerebrovascular Surgery.2005;7(2):161-163.

Persistent trigeminal artery (PTA) can be associated with hypoplasia of the proximal basilar and ipsilatereal vertebral artery. This can predispose adults to posterior circulation ischemia by a low flow state. A 40 year-old male presented with diplopia, dizziness and motor weakness in all extremities. He had no conventional risk factors of ischemic stroke. In brain Magnetic Resonance Imaging (MRI), acute infarction was observed in medulla, pons and cerebellum. PTA was also discovered with hypoplasia of vertebrobasilar system in brain Magnetic Resonance Angiography (MRA).
Adult ; Arteries* ; Brain ; Cerebellum ; Cerebral Infarction* ; Diplopia ; Dizziness ; Extremities ; Humans ; Infarction ; Ischemia ; Magnetic Resonance Angiography ; Magnetic Resonance Imaging ; Male ; Pons ; Risk Factors ; Stroke ; Vertebral Artery

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Middle Cerebral Artery Fenestration Associated with an Aneurysm: Case Report.

Dae Won KIM ; Sung Don KANG

Korean Journal of Cerebrovascular Surgery.2005;7(2):158-160.

Rare middle cerebral artery (MCA) fenestration and unruptured aneurysms of the both MCA bifurcations was discovered by CT angiography and confirmed during surgery. An aneurysm arising from the left MCA bifurcation was clipped. The postoperative course was excellent. The authors discuss the pathogenesis and clinical meanings of the MCA fenestration.
Aneurysm* ; Angiography ; Middle Cerebral Artery*

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Progressive Visual Loss after Endovascular Coiling Treatment of a Large Paraclinoid Aneurysm.

Soon Don PARK ; Tong Keun LEE ; Yu Sam WON ; Young Joon KWON ; Jae Young YANG ; Chun Sik CHOI

Korean Journal of Cerebrovascular Surgery.2005;7(2):154-157.

Recently, favorable outcomes have been reported after the endovascular treatment of either ruptured or unruptured paraclinoid aneurysms. The complications specifically related to the endovascular treatment of paraclinoid aneurysms have also been reported in other studies. Visual symptoms related to the mass effects associated with giant paraclinoid aneurysm normally improve after coil embolization. However, these symptoms have also been reported to be exacerbated in some cases. The authors here report an unusual case of progressive visual loss occurring after endovascular coiling treatment in a case of a large paraclinoid aneurysm.
Aneurysm* ; Embolization, Therapeutic

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Unusual Clinical Course of Giant Vertebral Artery Aneurysm after Proximal Artery Embolization: Case Report.

Ki Youl LEE ; Won Il JOO ; Tae Kyu LEE ; Kwan Sung LEE ; Yong Kil HONG ; Chun Kun PARK ; Joon Ki KANG ; Sin Soo JEUN ; Moon Chan KIM

Korean Journal of Cerebrovascular Surgery.2005;7(2):150-153.

The authors present the case of a patient who suffered from cerebellar dysfunction, radiographically documented brainstem compression, and neurological deterioration after proximal artery occlusion in a giant vertebral artery aneurysm. Symptom resolution was achieved after complete embolization of remained lumen of aneurysm. The cause of neurological deterioration is brainstem compression due to mass effect of the aneurysm. In order to avoid this fatal complication, it is necessary to determine appropriate therapy for the vertebral artery giant aneurysm by evaluating cerebral blood flow and other factors about growth of aneurysm.
Aneurysm* ; Arteries* ; Brain Stem ; Cerebellar Diseases ; Humans ; Vertebral Artery*

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Role of Transcranial Doppler to Detect Cerebral Vasospasm after Aneurysmal Subarachnoid Hemorrhage.

Eun Young KANG ; Seong Hyun PARK ; In Suk HAMM

Korean Journal of Cerebrovascular Surgery.2005;7(2):143-149.

OBJECTIVE: The authors investigated the role of transcranial Doppler ultrasound (TCD) in clinical decision making about vasospasm due to subarachnoid hemorrhage (SAH). METHODS: In this retrospective study, a total of 383 patients, admitted to our hospital between January 2001 to December 2004 and treated surgically with the diagnosis of aneurysmal SAH, were examined by TCD. RESULTS: Blood flow velocity (BFV) was significantly lower in older patients than in younger patients (p<0.01). BFV in the hypertensive patients were not significantly lower than in the normotensive individuals (p=0.93). The amount of blood clots in the computed tomography after SAH was significantly correlated with BFV (p<0.01). However, there was no statistically significant difference between Hunt-Hess Grade and BFV (p=0.54). The maximum mean flow velocity was greater in 54 patients who developed a delayed ischemic neurological deficit(DIND, 144.1 cm/sec) than in 221 patients who did not develop DIND (94.3 cm/sec, p=0.04). A maximum velocity increase of 40.6 cm/sec/24hr was recorded higher in patients with DIND, compared to that of 22.6 cm/sec/24 hr in patients without DIND (p<0.01). Lindegaard's index (LI) was higher in patients with DIND (4.6) than in those without DIND (2.8, p<0.01). Peak velocity, maximum velocity increase, and LI can thus assist in diagnosis of DIND, however, when those readings made before onset of DIND were considered, there was only significant difference in LI between the groups. CONCLUSION: Serial TCD studies after SAH are of value to detect cerebral vasospasm, especially, LI is significantly correlated with identifying patients who later develop DIND.
Aneurysm* ; Blood Flow Velocity ; Decision Making ; Diagnosis ; Humans ; Intracranial Aneurysm ; Reading ; Retrospective Studies ; Subarachnoid Hemorrhage* ; Ultrasonography ; Vasospasm, Intracranial*

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Familial Occurrence of Moyamoya Disease - Report of Two Cases -.

So Jung MIN ; Youm KIM ; Woong Heum KIM ; Hyun Koo LEE ; Myoung Soo KIM

Korean Journal of Cerebrovascular Surgery.2005;7(1):75-79.

Moyamoya disease is a rare occlusive cerebrovascular disease characterized by stenosis or occlusion of the main cerebral arteries. It has a tendency for multifactorial inheritance and familial occurrence, although its pathogenesis is not clear. We observed this disease in two girls from the same family:one was eight years old and the other was 45 months. They presented with transient ischemic attacks. We performed cerebral angiography on both patients and magnetic resonance angiography (MRA) on the younger. Both approaches showed the typical features of moyamoya disease, and MRA successfully revealed abnormal findings specific for the disease in the second child. Both children received encephaloduroarteriosynangiosis (EDAS) and this produced good results. MRA is thus a powerful and noninvasive way of detecting individuals at high risk of developing this disease. Considering the reported familial incidence of moyamoya disease in Japan, a careful search for family members using MRA would probably reveal many more such cases in Korea.
Cerebral Angiography ; Cerebral Arteries ; Child ; Constriction, Pathologic ; Female ; Humans ; Incidence ; Ischemic Attack, Transient ; Japan ; Korea ; Magnetic Resonance Angiography ; Moyamoya Disease* ; Multifactorial Inheritance

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Effect of Diazepam on the Expression of Transforming Growth Factor-Beta in Rat Brain Following Transient Cerebral Ischemia.

Jong Hwan SHIN ; Jin Joo KIM ; Tae Gyo JUNG ; Hyuk Jun YANG ; Jae Kwang KIM ; Gun LEE ; Cheol Wan PARK ; Sung Youn HWANG

Korean Journal of Cerebrovascular Surgery.2005;7(1):69-74.

OBJECT: Transforming growth factor-beta (TGF-beta) is involved in many physiological and pathophysiological processes, such as cell growth, differentiation, inflammation, and tissue repair. It is not yet clear whether the presence of this cytokine has deleterious or protective effects for neurons in a given pathophysiological condition. Several authors have demonstrated that TGF-beta has been shown to rescue cultured neurons from excitotoxic and hypoxic cell death and to reduce infarct size after focal cerebral ischemia in mice and rabbits. The present study investigated the effect of diazepam on the expression of TGF-beta in rat brain tissue after inducing transient cerebral ischemia. METHODS: Ten male rats were killed after a mild and reversible ischemic damage produced by a 15-minutes occlusion of both carotid arteries without occlusion of the vertebral arteries. Five ischemia-treated and 5 sham-operated rats were injected with 10 mg/kg diazepam and vehicle, respectively at 30 minutes, and again 90 minutes following the onset of reperfusion. After 1, 2 and 7 days following the reperfusion, brains were removed from control, sham-operated, and ischemia-treated with or without diazepam-injected groups, then immunohistochemistry and Western blotting for TGF-beta were performed. Cerebral cortices and hippocampi were sectioned from ischemia-treated, shamoperated and control group rats, and stained using cresyl violet. RESULTS: When the immunoblot-results of TGF-beta expression were analyzed using a image analysis system, TGF-beta expression were increased in ischemia-treated without diazepam-injected rats, and decreased in ischemia-treated with diazepam-injected rats at 2 and 7 days after reperfusion compared to control and sham-operated groups. Cresyl violet staining became intense in ischemia-treated without diazepam-injected group and became unclear in ischemia-treated with diazepam-injected group compared to sham-operated and control groups, respectively. CONCLUSION: Diazepam influenced the TGF-beta expression in the brain of ischemia-treated rats.
Animals ; Blotting, Western ; Brain Ischemia ; Brain* ; Carotid Arteries ; Cell Death ; Cerebral Cortex ; Diazepam* ; Humans ; Immunohistochemistry ; Inflammation ; Ischemic Attack, Transient* ; Male ; Mice ; Neurons ; Rabbits ; Rats* ; Reperfusion ; Transforming Growth Factor beta ; Vertebral Artery ; Viola

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Histological and Functional Changes after Transplantation of Human Mesenchymal Stem Cell in the Ischemic Rat Model.

Hyung Suk KIM ; Ji Young SONG ; Hyun Soo KIM ; Hee Un YUN ; Kyung Bok LEE ; Kyung Gi CHO

Korean Journal of Cerebrovascular Surgery.2005;7(1):61-68.

OBJECTIVES: Brain transplantation has emerged as an effective treatment for patients suffering from neurodegenerative diseases, including Parkinson's disease, Huntingtons disease and Stroke. We evaluated that cytokine inducted human mesenchymal stem cells (Ci-hMSCs) transplanted in brain differentiated into neural cells and improved neurological functions after stroke in rats. MATERIALS AND METHODS: In the adult female Sprague-Dawley rats, ischemic lesion was induced by transient MCA occlusion lasted for 2 hours. One day later, Ci-hMSCs carrying LacZ gene were implanted via tail vein. The animals were assessed for sensorymotor function and sacrificed for Immunohistochemical staining at 7, 14, 28, 56 days after transplantation. RESULTS: A large number of X-gal positive hMSCs were observed in the ischemic core and ischemic boundary zone. Some hMSCs were reactive for the astrocytic marker - glial fibrillary acidic protein (GFAP) and neuronal marker - neuronal nuclear antigen (NeuN). The ischemic rats that were transplanted with Ci-hMSCs exhibited better functional improvement than control groups and the rats with hMSCs, which was statistically significant. CONCLUSION: The neuronal differentiation of CihMSCs suggested that transplantation of the Ci-hMSCs may provide the possibility of the clinical implication for cerebral stroke.
Adult ; Animals ; Brain ; Female ; Glial Fibrillary Acidic Protein ; Humans* ; Lac Operon ; Mesenchymal Stromal Cells* ; Models, Animal* ; Neurodegenerative Diseases ; Neurons ; Parkinson Disease ; Rats* ; Rats, Sprague-Dawley ; Stroke ; Veins

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First-Pass Perfusion Computed Tomography and Transcranial Doppler in Hydrocephalus.

Seung Jung PAIK ; Hui Keun LEE ; Chul HU ; Myung Sub LEE ; Jhin Soo PYEN ; Hun Joo KIM

Korean Journal of Cerebrovascular Surgery.2005;7(1):54-60.

OBJECTIVES: The aim of this study are clinical application of perfusion computed tomography (perfusion CT) in hydrocephalus and comparison its cerebral blood flow parameters with transcranial doppler (TCD) and clinical outcome. METHOD: 25 patients with hydrocephalus took pre- and postoperative perfusion CT and TCD. 15 patients without neurologic deficit were also examined with same protocol as a control. Blood flow parameters of perfusion CT, such as cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) were analyzed according to clinical status and postoperative outcome. So did the TCD parameters, mean flow velocity (mFv) and pulsatility index (PI) with regard to clinical outcome. RESULTS: Perfusion CT parameters of the hydrocephalus showed decrease in CBF (gray matter P=0.035, periventricular region P=0.042) and increase in MTT (gray matter P=0.039, periventricular region P=0.045) compared to control. In postoperative improvement group, there noted reversal of perfusion parameters close to those of the control. TCD parameters showed increase in mFv (P=0.047), and decrease in PI (P=0.042) in cases with improvement. CONCLUSION: Perfusion brain CT and TCD can used as clinically useful tools to predict the postoperative outcome on hydrocephalus.
Blood Volume ; Brain ; Humans ; Hydrocephalus* ; Neurologic Manifestations ; Perfusion*

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Perfusion Computed Tomography and Trancranial Doppler in Aneurysmal Subarachnoid Hemorrhage.

Seung Jung PAIK ; Jong Yeon KIM ; Hee Keun LEE ; Chul HU ; Myung Sub LEE ; Jhin Soo PYEN ; Hun Joo KIM

Korean Journal of Cerebrovascular Surgery.2005;7(1):48-53.

OBJECT: This study is designed to estimate the clinical usefulness of perfusion computed tomography (perfusion CT) as an easily accessible tool to evaluate cerebral blood flow (CBF) in patients with aneurysmal subarachnoid hemorrhage. METHOD: Twenty patients with aneurysmal spontaneous subarachnoid hemorrhage who underwent either aneurysmal neck clipping or interventional coil embolization and who also had taken transcranial doppler study and perfusion CT were included as study group. And as a control group, fifteen patients without neurologic deficit were studied with the same devices. We compared the cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) from obtained perfusion CT with the results of transcranial doppler and clinical course. RESULTS: CBF parameters of perfusion CT in control group showed close accordance with those values of reported xenon CT and positron emission tomography data. In doppler study, the blood flow velocity was higher in cases with vasospasm than without it (p=0.027). There showed significant relationship between vasospasm and perfusion CT parameters, as decrease in CBF (p=0.061) and increase in MTT (p=0.013). Perfusion CT parameters were closely correlated with TCD parameters in clinical vasospasm as reverse correlation in CBF (R2=0.45) and positive in MTT (R2=0.58). CONCLUSION: The cerebral blood flow parameters of Perfusion CT showed reliable and accurate values in control group. The perfusion CT and TCD can be used as easily accessible non-invasive tools to evaluate cerebral blood flow parameters in clinical settings of patients with aneurysmal subarachnoid hemorrhage.
Aneurysm* ; Blood Flow Velocity ; Blood Volume ; Embolization, Therapeutic ; Humans ; Neck ; Neurologic Manifestations ; Perfusion* ; Positron-Emission Tomography ; Subarachnoid Hemorrhage* ; Xenon

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