급성기 뇌경색 환자의 두통에 대한 파한활혈탕(破寒滑血湯)의 임상적 효능

심윤섭,성기원,Shim, Yun-Seub,Seong, Ki-Won 대한한방내과학회 2004 大韓韓方內科學會誌 Vol.25 No.4

Objectives : The purpose of this clinical study is to evaluate the clinical efficacy of Pasaekhwalhyeol-Tang on acute headache from acute cerebral infarct. Methods : Pasaekhwalhyeol-Tang was prescribed to 15 acute cerebral infarct patients for two weeks. Symptoms were checked and VAS(Visual Analog Scale) scores were kept every week. Results : After prescription of Pasaekhwalhyeol-Tang, VAS scores on headache and accompanying symptoms decreased. No significant changes were shown in laboratory findings. As for the laboratory findings, ALT showed an upward tendency within a week and increased over normal values in two cases(13%). But two weeks later, ALT decreased within normal values. And the mean serum level was within normal values and the other hepatic enzymes did not increase over normal values in either week nor week 2. Conclusions : Results suggest that Pasaekhwalhyeol-Tang is effective in reducing the severity of acute headache from acute cerebral infarct.

편타손상에 기인한 급성두통환자의 한방치료에 대한 후향적 증례 연구

김석우,진소리,박무진,김동우,강경래,김수연,오승주,김은송,진동은 대한한방내과학회 2020 大韓韓方內科學會誌 Vol.41 No.4

Objectives: The aim of this study was to report improvement of acute headache incurred in a traffic accident in five patients who underwent inpatient treatment with Korean medicine. Methods: We collected data for traffic accident patients with acute headache who were admitted to the Ja-Seng Hospital of Korean Medicine from November 2019 to April 2020 and received combinational Korean medical treatment. All patients had numerical rating scale (NRS) values of 6 or greater. The patients were treated with acupuncture, pharmacopuncture, herbal medicine, and chuna treatment. We measured the validity of the treatment with the NRS, Headache Impact Test-6 (HIT-6), and Henry Ford Headache Disability Inventory (HDI) at admission and on the date of hospital discharge. Results: At the end of the treatment, all patients showed decreases in NRS, HDI, and HIT scores. Conclusions: The combination of Korean medicine at admission was effective in five patients with acute headache after a traffic accident. However, the number of subjects was insufficient and individual efficacy was not measured in this study. Therefore, further studies are needed on this topic.

교통사고 후 두통을 호소하는 환자의 풍지혈․후계혈 자침 효과에 대한 임상적 고찰 -무작위 임상 연구-

정원제,왕개하,김경호,배재익,김승현,조현석 대한침구의학회 2010 대한침구의학회지 Vol.24 No.5

Objectives : The main purpose of this study is to evaluate effects of acupuncture at Fengchi(GB20) and Houxi(SI3) for acute headache due to whiplash injury. Methods : This study was observed among 50 patients with acute headache due to whiplash injury who admitted to Bundang oriental medicine hospital of Dongguk University from June 16, 2009 to January 31, 2010. These patients were divided into two groups; One was control group that was acupunctured at general acupuncture points except Fengchi(GB20), Houxi(SI3)(Control group) and the other was acupunctured at Fengchi(GB20), Houxi(SI3) with general acupuncture points(Experimental group). Each patient was acupunctured once a day. The effect was assessed through self-rating headache index. Results & Conclusions : As a result of evaluation by using self-rating headache index, pain score at 8th day declined in both groups. But they were not difference between two groups at 8th day.

소아에서 급성 신부전을 동반한 자발성 두개내 저압 1예

김은정(Eun Jeong Kim),이선주(Sun Joo Lee),이보련(Bo Lyun Lee) 대한소아신경학회 2018 대한소아신경학회지 Vol.26 No.2

자발성 두개내 저압은 주로 중년 여성에서 발병하고 앉거나 일어설 때 악화되는 두통이 주 증상으로 나타나며, 소아에서는 흔하지 않은 질환이다. 대게는 결제조직 질환에서 발생하는 경우가 많으나 이 증례의 환아와 같이 특별한 원인을 밝힐 수 없는 소아 환아가 전체 환아들의 반 수 이상을 차지한다. 본 증례의 환아에서는 3일간 지속된 두통을 주소로 내원하였다. 두통은 주로 서 있거나 걸을 때 악화되었으며 허리와 뒷 목의 통증을 동반하였다. 목을 앞으로 굽혔을 때 목과 허리의 통증이 악화되었으며 뻣뻣하였고 늑골척추각의 압통을 보였다. 뇌 컴퓨터단층촬영 및 뇌척수액 분석검사에서는 특이소견이 없었으나, 뇌척수액 초압이 60 mmH2O 미만으로 매우 낮았다. 척수의 자기공명영상에서 흉추와 요추를 따라서 광범위하게 등쪽 경막외공간에 뇌척수액이 저류되어 있었다. 환아의 혈액검사에서는 급성신손상의 소견이 있었으나 신장초음파에서 구조적 이상은 없었다. 환아는 자발성 두개내 저압의 증상으로 탈수가 진행하면서 발생한 급성신부전으로 진단되었다. 절대적인 침상 안정과 수액 요법으로 환아의 증상은 호전되었다. 약 2주 후 시행한 척수 자기공명영상에서 더 이상 뇌척수액의 누출은 없었다. 외상이나 특이 병력이 없는 소아 환아에서 자세 변화에 따른 기립성두통이 발생하였을 때 두통의 드문 원인이긴 하나 자발성 두개내 저압을 의심하여 뇌척수액의 압력 측정 및 영상의학적 검사를 고려해야 할 것이다. Spontaneous intracranial hypotension in childhood is rare, and a few cases have been reported as a cause of headache in children. A 9-year-old boy was admitted to our hospital with a 3-day history of new-onset headache that worsened upon standing or walking, and aggravating low back pain. No medical history of injury, connective tissue disorder or migraine was detected. A neurological examination revealed neck stiffness. His initial blood tests suggested acute kidney injury by increased blood urea nitrogen (BUN) and creatinine. Brain computed tomography (CT) and cerebral spinal fluid (CSF) analysis were normal: however, opening pressure was low (<60 mm H2O). Magnetic resonance imaging (MRI) of the spine showed a collection of cerebral spinal fluid in the dorsal extradural space throughout the entire thoracic and lumbar spine level. The patient was diagnosed as having spontaneous intracranial hypotension accompanied by acute kidney injury. Magnetic resonance myelography and spinal MRI performed 14 days later did not show any cerebrospinal fluid leak. The headache and back pain were alleviated with strict bed rest and hydration. He remained free of headache and back pain at the 2-month follow-up. Here, we report a case of a 9-year-old boy with spontaneous intracranial hypotension.

교통사고 후 두통을 호소하는 환자의 풍지혈.후계혈 자침 효과에 대한 임상적 고찰 -무작위 임상 연구-

정원제,왕개하,김경호,배재익,김승현,조현석,Joung, Won-Je,Wang, Kai-Hsia,Kim, Kyung-Ho,Bae, Jae-Ik,Kim, Seung-Hyeon,Cho, Hyun-Seok 대한침구의학회 2010 대한침구의학회지 Vol.27 No.4

Objectives : The main purpose of this study is to evaluate effects of acupuncture at Fengchi($GB_{20}$) and Houxi($SI_3$) for acute headache due to whiplash injury. Methods : This study was observed among 50 patients with acute headache due to whiplash injury who admitted to Bundang oriental medicine hospital of Dongguk University from June 16, 2009 to January 31, 2010. These patients were divided into two groups; One was control group that was acupunctured at general acupuncture points except Fengchi($GB_{20}$), Houxi($SI_3$)(Control group) and the other was acupunctured at Fengchi($GB_{20}$), Houxi($SI_3$) with general acupuncture points(Experimental group). Each patient was acupunctured once a day. The effect was assessed through self-rating headache index. Results & Conclusions : As a result of evaluation by using self-rating headache index, pain score at 8th day declined in both groups. But they were not difference between two groups at 8th day.

응급실에서 지연 진단된 급성폐쇄각녹내장 환자에 대한 고찰

박지웅(Ji Woong Park),서샘(Sam Seo),이종은(Chong Eun Lee) 대한안과학회 2020 대한안과학회지 Vol.61 No.12

Purpose: To analyze the clinical features of delayed diagnosed acute angle-closure glaucoma (AACG) patients who were misdiagnosed with neurologic disease in an emergency room (ER). Methods: This study was conducted with a total of 77 patients (77 eyes) who had been diagnosed with AACG in the ER. Age, gender, laterality, best-corrected visual acuity (BCVA) of the affected eye at the time of the ER visit and at an outpatient clinic follow-up examination, bilateral intraocular pressure (IOP) at time of visit, previous eye-disease history, previous history of ophthalmic surgery, underlying systemic disease including metabolic syndrome, previous neurologic disease history, referral source, chief complaint, past history of migraine, residence, and specialty of the initial doctor in charge of the ER were statistically analyzed. Results: Among the 77 patients, 34 received a delayed diagnosis and 43 were diagnosed in a timely manner. Higher cases of delayed diagnosis were observed in patients who had lower BCVA at the time of the ER visit (p = 0.001), nonophthalmologic referral source visiting the ER (p < 0.001), a chief complaint of extra-ocular symptoms (p < 0.001), and a non-ophthalmologist as the initial doctor in charge of the ER (p < 0.001). None of the other factors, including IOP, previous eye-disease history, previous ophthalmic surgery, underlying systemic disease including metabolic syndrome, previous neurologic disease history, past history of migraine, or residence showed any statistically significant intergroup difference. Conclusions: Among the AACG patients visiting the ER, many were delayed in their diagnosis and thus required much attention afterwards. Careful examination and a detailed recording of a patient’s medical history by an ophthalmologist is important for accurate and timely diagnosis in the ER. 목적: 응급실에 내원한 급성폐쇄각녹내장 환자 중 신경학적 질환으로 오인되어 지연 진단된 환자들의 임상특징을 분석하고자 한다. 대상과 방법: 응급실을 통해 내원하여 급성폐쇄각녹내장으로 진단 받은 77명(77안)명의 환자들을 분석하였다. 나이, 성별, 안측별 분포, 내원 당시 최대교정시력, 이후 외래로 추적 관찰시 이환된 눈의 최대교정시력, 내원 당시 안압, 안과 질환력, 안과수술력, 대사성증후군을 포함한 전신질환 과거력, 이전 신경학적 질환력, 내원 경로, 주호소 증상, 편두통 과거력, 거주지, 응급실 초진 의사를 확인하여 신경학적 질환으로 오인되어 지연 진단될 위험요인을 통계적으로 분석하였다. 결과: 77명 중에 지연 진단된 군은 34명, 적시 진단된 군은 43명이었다. 두 군에서 응급실 내원 당시 최대교정시력이 낮은 경우(p=0.001), 안과 전문의를 통하지 않은 내원 경로로 응급실로 방문한 경우(p<0.001), 안외 증상이 주호소 증상이었던 경우(p<0.001), 응급실 초진 의사의 전문 과목이 안과가 아닌 경우(p<0.001)에서 지연 진단된 경우가 많았다. 치료 전 안압, 안과 질환력, 안과수술력, 대사성 증후군을 포함한 전신질환 과거력, 이전 신경과적 질환력, 편두통 과거력, 거주지 요인은 지연 진단 여부와 유의한 관계를 보이지 않았다. 결론: 응급실로 내원한 급성폐쇄각녹내장 환자 중 지연 진단되는 경우가 많아 이에 대해 주의를 요한다. 응급실에 내원한 안증상을 동반한 환자에서 안과 의사의 정확한 병력청취가 급성폐쇄각녹내장을 적시에 진단하는 데 도움이 될 것으로 생각된다.

뇌동맥류 파열로 인한 지주막하 출혈 환자에서 중재적 치료 후 조절되지 않은 두통 치험 1례

김은미,김기태,Kim, Eun-mi,Kim, Ki-tae 대한한방내과학회 2021 大韓韓方內科學會誌 Vol.42 No.2

Subarachnoid hemorrhage (SAH) is a disease that causes bleeding in the subarachnoid space; 70%-80% of nontraumatic subarachnoid hemorrhages are caused by saccular aneurysms. If the patient has already experienced a ruptured aneurysm that causes subarachnoid bleeding, rebleeding can result in a high mortality rate and serious sequelae. Therefore, if the patient can undergo surgical or interventional treatment, it should always be performed. This patient was diagnosed with acute aneurysmal subarachnoid hemorrhage and hydrocephalus. The patient was hospitalized for uncontrolled headache and vertigo after aneurysm coil embolization and ventriculoperitoneal shunting. The patient was treated with Yangkyuksanwha-tang and acupuncture and was observed with a symptom checklist for 25 days. Headache improved, from a visual analog scale (VAS) score of 7 to 0. Vertigo also improved, from a numeric rating scale (NRS) of 6 to 2, and the vertigo pattern changed from rotational to nonrotational. This case suggests that Korean medicine treatment is helpful in managing subarachnoid hemorrhage sequelae.

Associations of unspecified pain, idiopathic pain and COVID-19 in South Korea: a nationwide cohort study

Kim, Namwoo,Kim, Jeewuan,Yang, Bo Ram,Hahm, Bong-Jin The Korean Pain Society 2022 The Korean Journal of Pain Vol.35 No.4

Background: Few studies have investigated unspecified or idiopathic pain associated with COIVD-19. This study aimed to provide the incidence rates of unspecified pain and idiopathic pain in patients with COVID-19 for 90 days after COVID-19 diagnosis. Methods: A propensity score matched cohort was used, including all patients with COVID-19 in South Korea, and analyzed their electronic medical records. The control group consisted of those who had not had tests for COVID-19 at all. Unspecified pain diagnoses consisted of diagnoses related to pain included in the ICD-10 Chapter XVIII. Idiopathic pain disorders included fibromyalgia, temporomandibular joint disorders, headaches, chronic prostatitis, complex regional pain syndrome, atypical facial pain, irritable bowel syndrome, and interstitial cystitis. Results: After matching, the number of participants in each group was 7,911. For most unspecified pain, the incidences were higher in the COVID-19 group (11.7%; 95% confidence interval [CI], 11.0-12.5) than in the control group (6.5%; 95% CI, 6.0-7.1). For idiopathic pain, only the headaches had a significantly higher incidence in the COVID-19 group (6.6%; 95% CI, 6.1-7.2) than in the control group (3.7%; 95% CI, 3.3-4.1). However, using a different control group that included only patients who visited a hospital at least once for any reasons, the incidences of most unspecified and idiopathic pain were higher in the control group than in the COVID-19 group. Conclusions: Patients with COVID-19 might be at a higher risk of experiencing unspecified pain in the acute phase or after recovery compared with individuals who had not had tests for COVID-19.