외상성 뇌지주막하출혈을 동반한 두부외상 환자의 예후인자

길승배,김헌주,허철,한용표,홍순기,변진수 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.9

The presence of traumatic subarachnoid hemorrhage on the initial computerized tomographic scans has been known to be associated with worse results. By means of a simple and reliable computerized tomographic grade system proposed by Greene and his colleagues, prognostic factors of the traumatic subarachnoid hemorrhage was significantly related to clinical outcome at the time of discharge from acute hospitalization. Between February 1992 and August 1995, 3975 patients were admitted to our department of neurosurgery due to head injury. Clinical data were retrospectively reviewed to ascertain the relationship of the thickness of traumatic subarachnoid hemorrhage, its location, evidence of mass lesion(s), midline shift, obliteration of the basal cistern, and cortical sulcal effacement to outcome. Additionally initial Glasgow coma scale score, arterial gas study systemic blood pressure and prothrombin time were also analyzed for the same purpose. Among 3975 head-injured patients. 213 patients were identified to have traumatic subarachnoid hemorrhage on the initial computerized tomographic scan. Among 213 traumatic subarachnoid hemorrhage patients, the patients treated with calcium channal blocker(32 patients) and 3 patients lost to follow-up were excluded from this study for a total of 178. The computerized tomographic scan findings were divided into a 3 grade system : Grade 1 indicating only traumatic subarachnoid hemorrhage. Grade 2 indicating traumatic subarachnoid hemorrhage with mass lesion(s). Grade 3 indicating traumatic subarachnoid hemorrhage with mass lesion(s) and midline shift. All these data were compared to Glasgow outcome scale on discharge, and arbitarily these were divided into the good(good recovery and moderate disability) and the bad(severe disability, vegetative state and death). The authors conclude that the contributing factors to outcome at discharge were as follows : 1 midline shift(p=0.002), PT≤70%(p<0.001), obliteration of the basal cistern(p=0.001) and cortical sulcal effacement(p=0.001) were shown to the statistically significant. 2. initial computerized tomographic grade contributed to outcome at discharge.

Short and Long-term Outcomes of Subarachnoid Hemorrhage Treatment according to Hospital Volume in Korea: a Nationwide Multicenter Registry

Lee Ji Young,Heo Nam-Hun,Lee Man Ryul,Ahn Jae Min,Oh Hyuk-Jin,Shim Jai Joon,Yoon Seok Mann,Lee Bo Yeon,Shin Ji Hyeon,Oh Jae Sang 대한의학회 2021 Journal of Korean medical science Vol.36 No.22

Background: Subarachnoid hemorrhage is a potentially devastating cerebrovascular attack with a high proportion of poor outcomes and mortality. Recent studies have reported decreased mortality with the improvement in devices and techniques for treating ruptured aneurysms and neurocritical care. This study investigated the relationship between hospital volume and shortand long-term mortality in patients treated with subarachnoid hemorrhage. Methods: We selected subarachnoid hemorrhage patients treated with clipping and coiling from March–May 2013 to June–August 2014 using data from Acute Stroke Registry, and the selected subarachnoid hemorrhage (SAH) patients were tracked in connection with data of Health Insurance Review and Assessment Service to evaluate the short-term and long-term mortality. Results: A total of 625 subarachnoid hemorrhage patients were admitted to high-volume hospitals (n = 355, 57%) and low-volume hospitals (n = 270, 43%) for six months. The mortality of SAH patients treated with clipping and coiling was 12.3%, 20.2%, 21.4%, and 24.3% at 14 days, three months, one year, and five years, respectively. The short-term and long-term mortality in high-volume hospitals was significantly lower than that in low-volume hospitals. On Cox regression analysis of death in patients with severe clinical status, lowvolume hospitals had significantly higher mortality than high-volume hospitals during shortterm follow-up. On Cox regression analysis in the mild clinical status group, there was no statistical difference between high-volume hospitals and low-volume hospitals. Conclusion: In subarachnoid hemorrhage patients treated with clipping and coiling, lowvolume hospitals had higher short-term mortality than high-volume hospitals. These results from a nationwide database imply that acute SAH should be treated by a skilled neurosurgeon with adequate facilities in a high-volume hospital.

뇌지주막하 출혈 후 발생한 수두증에 관한 연구

이정우,김태성,임영진,김국기,이봉암,임언 대한신경외과학회 1994 Journal of Korean neurosurgical society Vol.23 No.1

Hydrocephalus is one of the important complication of subarachnoid hemorrhage. The incidence of significant symptomatic hydrocephalus secondart to spontaneous subarachnoid hemorrhage was 7.9%. We analyzed several factors possibly related to hydrocephalus following subarachnoid hemorrhage in 439 patients between 1990 and 1992. The development of hydrocephalus after subarachnoid hemorrhage is multifactorial. We found the following factors were significnatly related with the development of hydrocephalus after subarachnoid hemorrhage : intraventricular hemorrhage, level of consciousness on admission, increasing age, hypertension history before subarachnoid hemorrhage, subarachnoid blood noted on CT scan, posterior circulation site of aneurysm.

원인불명의 자발성 지주막하 출혈환자의 예후

신문수,최문철,조기홍,김한규,조경기 대한신경외과학회 1987 Journal of Korean neurosurgical society Vol.16 No.3

A clinical analysis and follow-up study were performed with 35 cases of subarachnoid hemorrhage of unknown etiology among 217 cases of spontaneous subarachnoid hemorrhage who were diagnosed by cerebral pan-angiography and brain C-T scan and treated at department of neurosurgery, Chonju Presbyterian Medical Center from 1977 to 1982. The duration of follow-up study was 6 months to 8 years (mean 4.4 years). The author obtained the following results. 1) Subarachnoid hemorrhage of unknown etiology was 16% of 217 cases of spontaneous hemorrhage. 2) The incidence of subarachnoid hemorrhage of unknown etiology was high in 5th decade and higher in women. 3) Manifestations of subarachnoid hemorrhage of unknown etiology were similar to those of ruptured aneurysm. 4) When primary cerebral pan-angiography was normal, the secondary cerebral pan-angiography was not so meaningful. 5) The overall prognosis of the cases of unknown etiology was good in 30 among 35 cases (86%) who were able to return to their previous occupation. 6) Age and blood pressure were probably major prognostic factor.

Terson Syndrome after Subarachnoid Hemorrhage Occurred by Thrombolysis and Mechanical Thrombectomy to Treat Acute Ischemic Stroke −A Case Report−

변하영,정호연,최혜정,이중훈,오민균,윤철호,신희석,이은신 대한뇌신경재활학회 2014 뇌신경재활 Vol.7 No.2

Terson syndrome is a vitreous hemorrhage associated with subarachnoid hemorrhage. This can be caused by spontaneous, aneurysmal rupture or traumatic subarachnoid hemorrhage, but never has been reported as a consequence of hemorrhage due to thrombolysis and thrombectomy treatments of acute ischemic stroke patient. A 48-year-old man presented with left sided weakness was diagnosed as cerebral infarction on right middle cerebral artery territory due to complete occlusion of right distal internal carotid, middle cerebral, and anterior cerebral artery. He underwent thrombolysis and mechanical thrombectomy, and subarachnoid hemorrhage developed. Later, visual disturbance on right eye occurred so he was consulted to ophthalmology. Vitreous hemorrhage was found and surgery was recommended after two weeks of observation. After pars planar vitrectomy, visual acuity improved, along with functional ability. Therefore, possibilities of Terson syndrome in patients with subarachnoid hemorrhage have to be kept in mind to improve not only visual acuity but also rehabilitation outcome.

자발성 지주막하 출혈에 의한 양측 핵사이 눈근육마비

오세진,정대수,최광동 대한평형의학회 2008 Research in Vestibular Science Vol.7 No.2

A 44-year-old woman presented with horizontal diplopia 2 days after spontaneous subarachnoid hemorrhage. Neurological examination disclosed bilateral internuclear ophthalmoplegia and neck stiffness. Neurovascular imagings documented subarachnoid and intraventriclar hemorrhage with an aneurysm arising from the left superior cerebellar artery, and vasogenic edema in the bilateral pontomesencephalic junction. Parenchymal vasogenic edema due to microvascular damage may give rise to bilateral internuclear ophthalmoplegia during the acute stage of spontaneous subarachnoid hemorrhage. A 44-year-old woman presented with horizontal diplopia 2 days after spontaneous subarachnoid hemorrhage. Neurological examination disclosed bilateral internuclear ophthalmoplegia and neck stiffness. Neurovascular imagings documented subarachnoid and intraventriclar hemorrhage with an aneurysm arising from the left superior cerebellar artery, and vasogenic edema in the bilateral pontomesencephalic junction. Parenchymal vasogenic edema due to microvascular damage may give rise to bilateral internuclear ophthalmoplegia during the acute stage of spontaneous subarachnoid hemorrhage.

지주막하 출혈 후 발생한 심부정맥 혈전증 환자에 대한 한양방 병용치료 증례 보고 1례

배고은,최진용,심소현,서희정,서형범,홍진우,이인,김소연,최준용,한창우,윤영주,박성하,권정남,Bae, Go-eun,Choi, Jin-yong,Shim, So-hyun,Seo, Hee-jeong,Seo, Hyung-bum,Hong, Jin-woo,Lee, In,Kim, So-yeon,Choi, Jun-Yong,Han, Chang-woo,Yun, Young-ju 대한한방내과학회 2018 大韓韓方內科學會誌 Vol.39 No.2

Purpose: To report on a patient with subarachnoid hemorrhage and deep vein thrombosis treated with a combination of Korean and Western medicine. Methods: A patient diagnosed with subarachnoid hemorrhage and deep vein thrombosis was treated with herbal medicine (加減淸熱瀉濕湯 (Gagam-cheongyeolsaseub-tang)), acupuncture (GV2, GB20, LI11, LI4, TE5, GB34, ST36, SP9, ST38, GB39, SP6, LR3), moxibustion (CV6, CV9), and Western medicine for deep vein thrombosis and subarachnoid hemorrhage. To evaluate edema, one of the classic symptoms of deep vein thrombosis, we measured leg circumference at a specified time. Results: After taking Gagam-cheongyeolsaseub-tang and being treated with acupuncture, moxibustion, and Western medicine, the patient showed improvement in leg edema. The left calf circumference decreased from 37.5 cm to 34.5 cm. Conclusions: Korean medicine, acupuncture, moxibustion, and Western medicine may provide effective treatment for deep vein thrombosis in patients with subarachnoid hemorrhage, but further study is needed.

자발성 뇌출혈 환자의 발생빈도

윤병운(Byeong Un Yun),김재욱(Jae Uk Kim),한현수(Hyeon Su Han),김영복(Yeong Bok Kim),이동근(Dong Geun Lee) 대한CT영상기술학회 2006 대한CT영상기술학회지 Vol.8 No.1

Purpose The purpose of this thesis is to investigate how incidence of spontaneous intracranial hemorrhage patients can be changed according to age and sex, hours, daily, monthly, and the location of the brain. Materials and Methods The subjects of this study were 1,278 patients of our hospital who got brain CT from january 2002 to december 2004 and were detected of spontaneous intracranial hemorrhage. For the examination, CT scanner, Somatom Volume Zoom(Siemens Medical System, Germany) was used, patients were all positioned supine. About 12 image were detected on the scan parameters are as follows of 120kVp, 380mAs, 10mm slice thickness, 5mm detector row collimation, 20mm feed. Results Among total 1,278 patients, male patients were 604(47.3%) and female patients were 674 (52.7%). Their ages ranged from 22 to 95(average age: 66 year-old). The followings are the incidence of spontaneous intracranial hemorrhage patients; According to age, 233 patients(18.2%) in their 40s, 274 patients(21.5%) in their 50s, 334 patients(26.1%) in their 60s, and 281 patients(22%) in their 70s were measured. The age was mainly distributed between 40s and 70s. According to hourly-incidence, 307 patients(24%) from 9PM to 12AM, and 323 patients(25.3%) from 17PM to 20PM were high ranked. The incidence of those two periods was higher than others. According to daily-incidence, 195 patients(15.3%) on monday and 203 patients(15.9%) on tuesday were high ranked. According to monthly-incidence, 131 patients(10.3%) in january, 120 patients(9.4%) in april, and 131 patients(10.3%) in october, were in high places. And according to the location of the brain, 343 patients(26.8%) with subarachnoid hemorrhage, 386 patients(30.2%) with basal ganglia hemorrhage, and 240 patients(18.8%) with thalamus hemorrhage, were relatively high ranked compared with other location of brain. Conclusion Once intracranial hemorrhage happened, most of cases would lead to senous sequelas. Therefore the prevention is the one and best way for it. A happy and healthy life demands proper body exercise, furthermore, efforts to reduce one’s peril factors of intracranial hemorrhage, such as fatigue, overwork, stress, smoking, hypertension, fatness, glycosuria, sclerosis of the arteries, heart disease, etc. are required.

뇌출혈로 발현한 척추기저동맥의 동맥경화성 폐색 일례

남병극,이재홍,이순금,이명종 울산대학교 의과대학 1996 울산의대학술지 Vol.5 No.1

Background : There have been some reports of intracranial hemorrhage which were attributed to atherosclerotic occlusive disease of major intracranial arteries, mostly the carotid system. The vertebrobasilar system very rarely presents hemorrhage as a result of occlusion or stenosis. We report a case of cerebellar and subarachnoid hemorrhage with vertebrobasilar atherosclerotic occlusion. Case report : A patient with severe vertigo, diplopia and ataxia of sudden onset was managed with intraarterial thrombolytic therapy for the left vertebral artery occlusion. After that, the arterial occlusion and the neurologic deficits resolved rapidly. Four years later, he developed a sudden headache and vertigo. Brain CT revealed right cerebellar hemorrhage with adjacent subarachnoid hemorrhage. Follow-up angiography showed occlusion of the right vertebral artery with fine collateral vessels. Rupture of small collateral vessels secondary to the atherosclerotic occlusion of the distal vertebral artery was postulated as the underlying cause of hemorrhage. Conclusion : Atherosclerotic occlusive disease of the vertebrobasilar system may bring about intracranial hemorrhage just like moyamoya disease does in the carotid system. The same pathomecha-nism seems to play in these clinical situations.

비외상성 동맥류성지주막하출혈 환자에서 SAFARI 점수를 이용한경련 발생 예측의 유용성

백승준,홍대영,김신영,김종원,박상오,이경룡,백광제 대한응급의학회 2018 대한응급의학회지 Vol.29 No.5

Objective: The SAFARI score was introduced to assess the risk of convulsive seizure during admission for aneurysmal subarachnoid hemorrhage in 2017. This study was conducted to determine whether the SAFARI score derived from the afore-mentioned study could be applied to patients with aneurysmal subarachnoid hemorrhage in Korea. Methods: We conducted a retrospective study of patients who were diagnosed with aneurysmal subarachnoid hemorrhage from March 2013 to October 2017. Patients’ age, sex, blood pressure, pulse rate, body temperature, Glasgow- Coma Scale, Hunt-Hess scale, modified Fisher grade, size of ruptured aneurysm, surgery type, transfusion, and SAFARI score were compared between the seizure and non-seizure groups. The area under the receiver operator characteristic curves was calculated to evaluate the predictive ability for seizure during admission. Logistic regression analysis was used to analyze predictive factors for seizure during admission. Results: A total of 220 patients were included. Ninety-seven (44.1%) were male and 123 (55.9%) were female. The mean age of the patients was 65.8 years old (range, 56-75). The area under the curve of the SAFARI score for predicting seizure was 0.813. The SAFARI score was the only significant predictor of seizure during admission, while other factors were not statistically significant upon logistic regression analysis. Conclusion: The SAFARI score could be used for predicting seizure during admission in patients with aneurysmal subarachnoid hemorrhage.