아세트아졸아마이드 부하 뇌 단일광자방출 전산화단층촬영으로 평가한 알쯔하이머형 치매에서의 뇌혈관 반응성

이동우,이재성,이동수,정준기,이명철,조경형,정희연,조맹제 大韓神經精神醫學會 2002 신경정신의학 Vol.41 No.6

연구목적 : 본 연구의 목적은 Acetazolamide 부하 뇌 단일광자 방출 전산화 단층촬영(Brain Single Photon Emission computed Tomography : Brain SPECT)을 알쯔하이머형 치매 환자군과 정상대조군을 대상으로 시행한 후 여기에서 얻어진 영상을 3차원적인 관심용법 접근법으로 분석함으로써 알쯔하이머형 치매에서의 뇌혈관반응성의 이상 유무를 규명하기 위한 것이다. 방 법 : 60세 이상의 알쯔하이머형 치매 환자군 18명과, 60세 이상의 정상대조군 10명을 대상으로 하였다. 알쯔하이머형 치매 환자군은 정신과적 면담을 통해 DSM-IV와 NINCDS-ADRDA의 알쯔하이머형 치매의 진단기준에 따라 진단하고 선정하였다. 정상대조군도 정신과적 면담을 거쳐 선정하였으며, 환자군과 정상대조군 모두에 대해 한국형 간이정신상태 검사, 매티스 치매 평정척도, 해밀턴 우울 평정척도를 적용하여 평가하였다. 이들에 대해 다이아목스 부하 뇌 SPECT를 시행한 후 3차원적인 관심 용적 접근법을 이용, 영상을 분석하였다. 결 과 : 뇌혈관반응성(cerebrovascular reactivity) 수치에서 양군 간에 유의한 차이가 발견되었다. 즉, 알쯔하이머형 치매 환자군의 뇌혈관반응성 수치가 우측 전두엽에서는 정상대조군보다 유의하게 낮았고(p<0.05), 좌측 측두엽에서는 정상대조군보다 유의하게 높았다(p<0.05). 결 론 : 알쯔하이머형 치매 환자들을 대상으로 시행한 다이아목스 부하 뇌 SPECT 영상을 분석한 결과 알쯔하이머형 치매의 주요 병소 부위인 측두엽과 전두엽에 국재화된 뇌혈관 이상소견을 보여줌으로써, 알쯔하이머형 치매의 병태생리에서 뇌혈관반응성 이상의 중요성을 부각시켜 주었다. Objectives : The purpose of this study was to investigate the abnormality of cerebrovascular reactivity in patients with dementia of Alzheimer's type by the acetazolamide brain SPECT, which has been used in the assessment of cerebrovascular diseases. Methods : Eighteen patients with dementia of Alzheimer's type, as diagnosed by the criteria of DSM-IV and NINCDS-ADRDA, and ten normal comparison subjects were recruited. They were rated by Mini-Mental Status Examination, Mattis Ddementia Rating Scale, and Hamilton Depression Rating Scale. Acetazolamide brain SPECT scans of dementia patients and comparison subjects were analyzed by 3-dimensional volume of interest method. Results : The results were as follows. There were significant differences in the values of cerebrovascular reactivity between the two groups. The cerebrovascular reactivity of dementia patients was significantly decreased in the right frontal lobes, and increased in left temporal lobe, compared to comparison subjects(p<0.05). Conclusion : These results imply the possible role of the abnormality of cerebrovascular reactivity in the pathophysiology of dementia of Alzheimer's type.

우황청심원(牛黃淸心元)이 정상인의 혈압(血壓), 맥박수(脈搏數), 뇌혈류(腦血流) 및 뇌혈관반응도(腦血管反應度)에 미치는 영향(影響)

윤상필,이상호,김은주,나병조,정동원,신원준,문상관,배형섭,김이동,Yun, Sang-Pil,Lee, Sang-Ho,Kim, Eun-Ju,Na, Byong-Jo,Jung, Dong-Won,Shin, Won-Jun,Moon, Sang-Kwan,Bae, Hyung-Sup,Kim, Lee-Dong 대한한방내과학회 2004 大韓韓方內科學會誌 Vol.25 No.3

Objectives: Uwhangchungsim-won(UC) has been used in the treatment of a wide variety of conditions including stroke, hypertension, arterosclerosis, autonomic imbalance, and mental instability, in Korean traditional hospitals. The aim of this study was to evaluate the effect of DC on cerebral hemodynamics and to determine the appropriate dosage. Methods: We studied changes in hyperventilation-induced cerebrovascular reactivity and mean blood flow velocity of the middle cerebral arteries(MCAs) were studied by means of transcranial Doppler ultrasound. Changes in mean blood pressure, pulse rate and expiratory CO2(PECO2) were observed using Cardiocap TM/5. Six healthy young volunteers who were administrated with full doses of DC for group A, and half doses for group B. Six other healthy subjects comprised the control group. The evaluation was performed during basal condition, and repeated at 20, 40, 60, 120, and 180 minutes after administration. Results: Increases of cerebrovascular reactivity and mean blood flow velocity in the middle cerebral artery in group A were significantly different compared with group B and the control group (p<0.1). Mean blood pressure, pulse rate and expiratory CO2 did not change during the observation and were not different among these three groups. We observed that in cerebrovascular reactivity induced hyperventilation, group A was most effective at 40 minutes after administration, and its effectiveness lasted for 120 minutes. Conclusions: This study provides evidence for UC, in full doses, as an agent for dilation of the cerebral arteriols to increase hyperventilation-induced cerebrovascular reactivity as a consequence of faster recovery of blood flow velocity.

Evaluation of cerebral blood flow and cerebrovascular reactivity in Ischemic Stroke Patients Using Transcranial Doppler

Lee,Kyung-sup,Cho,Ki-ho,Ko,Chang-nam,Moon,Sang-kwan,Kim,Young-suk,Bae,Hyung-sup INSTITUTE OF ORIENTAL MEDICINE KYUNG-HEE UNIVERSIT 1996 JOURNAL OF ORIENTAL MEDICINE Vol.1 No.1

<Background and Purpose> The assessment of cerebrovascular reactivity(CVR) provides information on the reserve capacity of cerebral circulation in patients with cerebrovascular disease. It also seems to be of prognostic relevance for patients with occlusive cerebrovascular disease. To estimate the CVR, we used a breath-holding maneuver with a transcranial doppler(TCD). So, we studied whether or not the blood flow and CVR could show differences between normal and ischemic stroke groups. <Methods> Using TCD, we measured mean velocities and a side-to-side difference (asymmetry index, Al) at a resting state in 43 normal and 65 ischemic stroke groups, diagnosed by brain CT or MRI. And CVR was estimated by the increase of middle cerebral artery mean blood velocity using a breath-holding maneuver. We calculated each breath holding indexes(BHI) in both the normal and patient groups. So, we estimated theh change of BHI by age in the normal group and compared the differences between symptomatic and asymptomatic hemispheres in the patient group. <Results> The BHI was 1.12±0.33 in normal group. There was no significant difference by age and no side-to-side differences. But BHI in the symptomatic hemisphere was significantly lower than the asymptomatic hemisphere in the ischemic stroke group(P<0.05). As for AI, the patient's group showed lower values than the normal group in middle(MCA), anterior(ACA) and posterior cerebral artery(PCA). Especially, there was a significant difference between theh normal and patient groups in the middle cerebral artery(P<0.05). But, mean velocities showed no significant differences between the symptomatic and asymptomatic hemispheres in MCA, ACA and PCA. <Conclusion> Using TCD, a breath holding method could be a useful method in the estimation of the CVR, and BHI could be applied in the basal and follow-up study of CVR of the ischemic stroke patients. So we suggest that the study of BHI may provide a useful information for the understanding of hemodynamic status and prognosis in ischemic stroke.

두개경유도플러초음파를 이용한 성인 여성 무조짐편두통 환자의 식사 상태에 따른 뇌혈관반응성 변화

박정호,박선아,이태경,성기범 대한임상신경생리학회 2012 Annals of Clinical Neurophysiology Vol.14 No.1

Background: Migraine patients can be sensitive to external or internal stimuli, such as light, noise, or hormonal changes. Using transcranial Doppler ultrasonography (TCD) with breath-holding method, we evaluated the changes of cerebrovascular reactivity (CVR) to hypercapnia in women with migraine without aura between fasting and postprandial period. Methods:Twelve women with migraine without aura and the same number of age and sex-matched healthy controls with no significant history of headache participated in this study. Using TCD examinations, we studied mean flow velocity in middle cerebral artery with better temporal window. Each subject was examined consecutively before and after a standard meal, together with serum glucose level and blood pressure. CVR was evaluated with breath-holding index (BHI). Results: Postprandial-BHI (mean+SD) was significantly higher than fasting-BHI (mean+SD) in patients group but not in controls (in patient group;postprandial-BHI=1.38, fasting-BHI=1.08, in control group; postprandial-BHI=1.25, fasting-BHI=1.18, P=0.021 and 0.239,respectively). After meal, serum glucose level was significantly enhanced but blood pressure was not in both groups. Serum glucose level of patients showed a tendency of mild positive correlation with BHIs (γ=0.448, P=0.032). Conclusions:Although exact mechanisms are unclear, cerebrovascular reactivity of some women with migraine without aura may be influenced by prandial state.

경두개 도플러(TCD)를 이용한 정상군과 뇌경색군의 상호비교연구

최재영,이동원,정승현,이원철,Choi, Jae-Young,Lee, Dong-Won,Jeong, Sung-Hyun,Lee, Won-Chul 대한한방내과학회 1998 大韓韓方內科學會誌 Vol.19 No.1

Background and Purpose : Cerebrovascular reactivity(CVR) can be estimated by measuring the change of cerebral blood flow that occurs during vasostimulation. To estimate the cerebrovascular reactivity, we investigated the change of flow velocity of the middle cerebral artery(MCA) during hyperventilation and hypoventilation with the transcranial doppler. So we studied whether the CVR measured by this method could show a significant difference between the normal and the cerebral infarction subjects and whether the CVR may decrease with age in normal subjects. Methods : Using transcranial doppler, we measured the mean velocity(Vm), the pulsatility index(P.I.) at the resting state, the end of breath-holding and the end of hyperventilation in 36 normal and 10 cerebral infarction subjects, so we calculated the percentile change of mean velocity(%${\Delta}$Vm) and P.I.(%${\Delta}$P.I.) after the vasostimulation. We estimated the change of Vm, P.I., %${\Delta}$Vm and %${\Delta}$P.I. by the age group and compared those parameters between the age-matched normal control and cerebral infarction subjects. Results : The Vm in MCA significantly decreased with age(p<0.05), but there was no significant difference in Vm and P.I. between normal and cerebral infarction subjects. The %${\Delta}$Vm and %${\Delta}$P.I. in response to hyperventilation significantly decreased with age in MCA and there was significant difference in $%{\Delta}Vm$ of MCA after breath-holding between the normal and cerebral infarction subjects. Conclusion : The breath-holding and hyperventilation tests could be non-invasive and useful methods in estimation of the cerebrovascular reactivity and could be applied in the basal and follow-up evaluation of the cerebrovascular reserve of the ischemic stroke patients.

牛黃淸心元의 단독투여 및 연속투여에 따른 정상인의 뇌혈관반응도의 비교연구

황재웅(Jae-Woong Hwang),김창현(Chang-Hyun Kim),민인규(In-Kyu Min),김영지(Young-Ji Kim),임정태(Jung-Tae Leem),나병조(Byong-Jo Na),박성욱(Sung-Wook Park),박정미(Jung-Mi Park),고창남(Chang-Nam Ko),배형섭(Hyung-Sup Bae),정우상(Woo-Sang J 대한한의학회 2009 대한한의학회지 Vol.30 No.1

Effects of Cardiotonic Pills® on Cerebrovascular CO2 Reactivity and Erythrocyte Deformability in Normal Subjects: A Pilot Study

문상관,이한결,권승원,조승연,박성욱,정우상,박정미,고창남,Cho Ki-Ho 대한한의학회 2023 대한한의학회지 Vol.44 No.4

Backgrounds and objectives: Cardiotonic Pills® (CP) are used for vascular diseases such as coronary diseases, atherosclerosis, and cerebral infarction. This study aimed to determine the transient effects of CP on cerebrovascular CO2 reactivity (CVR) and erythrocyte deformability in normal subjects. Methods: This study had a crossover design and included 10 participants who were randomly allocated to 2 groups. The experimental group was given CP with water, while the control group was given only water. CVR was measured by hyperventilation-induced CVR of the middle cerebral artery (MCA) using transcranial Doppler (TCD). Erythrocyte deformability was measured using a Rheoscan-D microfluidic ektacytometer. All measurements were performed prior to and 1, 2, and 3 hours after CP or water administration. Blood pressure and heart rate were also measured before and after administration. Results: CP significantly improved CVR 3 hours after administration in the experimental group compared to the control group (p = 0.042). The corrected blood flow velocity at partial pressure of end-tidal carbon dioxide (PETCO2) = 40mmHg (CV40) was also significantly improved 2 and 3 hours after administration in the CP group compared to the control group (p = 0.036 and p = 0.021, respectively). CP significantly improved erythrocyte deformability 3 hours after administration in the experimental group compared to the control group (p = 0.027). Mean heart rate and mean blood pressure showed no change. Conclusions: This study demonstrated that CP increases CVR and erythrocyte deformability. These results suggested that CP improves cerebral microcirculation which provide evidence for the future use of CP for prevention of ischemic stroke and neurodegenerative diseases.

우황청심원이 정상인의 뇌혈류 및 혈압에 미치는 영향

김영석,Kim, Young-Suk 대한한방내과학회 1999 大韓韓方內科學會誌 Vol.20 No.1

Uwhangchungsimwon(UC) has been used in the treatment of a wide variety of conditions including stroke, hypertension, arteriosclerosis, autonomic imbalance, mental instablity, etc in Korean traditional hospitals, In particular it is often initialy chosen for emergency care of acute stroke. The aim of this study was to evaluate the effect of UC on cerebral hemodynamics. Using transcranial Doppler ultrasound, we studied changes of mean flow velocity and pulsatility index(PI) of middle cerebral arteries (MCAs) from 11 health young volunteers who were administrated with 1 pill UC and 11 health controls who were not. We obtained hypercapnia with breath-holding and evaluated cerebrovascular reactivity with breath-holding index(BHI). Systolic blood pressure, diastolic blood pressure, and heart rate were measured using ambulatory blood pressure monitoring(ABPM). In UC administration group, the evaluation was performed during basal condition. and repeated at 20, 40, and 60 min after administration. In controls, the evaluation was performed at corresponding time intervals. Mean flow velocity in middle cerebral artery, systolic blood pressure, diastolic blood pressure, and heart rate did not change during the observation period and were not different between these two groups. However, administration of UC was associated with decreases in PI by $3.6{\sim}12.4%$ in BHI by $17.9{\sim}24.8%$ compared with pre-administration period. Decreases in PI and BHI with UC were significantly different compared with control group (p<0.05). These results indicate that UC decreases PI and BHI in cerebral artery, which is due to a dilation of cerebral resistance vessels.

Effects of LI11 Acupuncture on CO2 reactivity in the anterior and middle cerebral arteries during hyperventilation-induced hypocapnia in normal subjects: A before and after study

김경묵,정우상,권승원,진철,조승연,박성욱,문상관,박정미,고창남,조기호 대한한의학회 2021 대한한의학회지 Vol.42 No.4

Objectives: The LI11 (Quchi) acupuncture point has always been included in the Seven acupoints for stroke; however, additional LI11 acupuncture research is needed. In this study, the effect of LI11 acupuncture on cerebral blood flow of the anterior cerebral arteries (ACA) and middle cerebral arteries (MCA) was investigated. Method: This study included 10 healthy young male subjects. Cerebral blood flow velocity and cerebrovascular reactivity were measured using transcranial Doppler sonography. Changes in hyperventilation-induced carbon dioxide (CO2) reactivity and modified ACA and MCA blood flow velocity at 40 mmHg (CV40), blood pressure, and heart rate were observed before and after LI11 acupuncture treatment. Results: A statistically significant increase in contralateral anterior cerebral artery CO2 reactivity (p=0.036) and decrease in contralateral middle cerebral artery CV40 (p=0.047) were observed. No significant difference in mean blood pressure was shown. A statistically significant increase in heart rate occurred after LI11 acupuncture; however, it was not clinically significant as there were negligible changes in the heart rhythm. Conclusions: LI11 acupuncture treatment could improve cerebral blood flow velocity. These results might be explained by regulating endothelium-dependent vessel dilation in the anterior cerebral artery region. Trial registration: This trial has been registered with Clinical Research Information Service, a service of the Korea Centers for Disease Control and Prevention: KCT0004494 (retrospectively registered). https://cris.nih.go.kr/cris/search/ search_result_st01.jsp?seq=15359

Effects of Acupuncture with a Combination of GV20 and EX-HN1 Acupoints on CO2 Reactivity in the Anterior and Middle Cerebral Arteries during Hypercapnia in Normal Subjects: A Randomized Crossover Trial

박호정,문상관,이한결,권승원,조승연,박성욱,정우상,박정미,고창남,조기호 대한한방내과학회 2022 大韓韓方內科學會誌 Vol.43 No.4

Objectives: To investigate the effects of acupuncture at GV20 and EX-HN1 on cerebral blood flow (CBF) velocity and cerebrovascular reactivity (CVR) in the middle cerebral arteries (MCA) and anterior cerebral arteries (ACA) and to compare the effects to acupuncture at GV20. Methods: The study was a randomized, crossover trial that included 10 healthy men aged 20 to 29 years who underwent acupuncture treatment four times with a washout period of one week. The CBF velocity and CVR were measured by transcranial Doppler sonography (TCD) on both MCAs at the first and second visits, and both ACAs at the third and fourth visits. Participants were randomly assigned to one of two groups (A and B) before the first and third visits. Group A received two phases of acupuncture intervention at a single GV20 point and a combination of GV20 and EX-HN1 acupoints. Group B received the same interventions, but in the reverse order. Results: The increase in CO2 reactivity was significantly higher for the combination acupoints of GV20 and EX-HN1 than for the GV20 single acupoint in both MCAs (Right: 136 to 178, p=0.017; Left: 127 to 191, p=0.017) and ACAs (Right: 133 to 158, p=0.013; Left: 122 to 168, p=0.025). No significant change was noted in the corrected velocity at PETCO2 40 mmHg, blood pressure, or heart rate. Conclusions: The findings suggest that improvement of the CBF in the MCA and ACA after GV20 acupuncture increases when acupuncture is also performed at EX-HN1. These results clinically support the combined use of EX-HN1 and GV20 to treat disorders of MCA and ACA circulation.