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韓國人 腦血管疾患에 대한 臨床的 硏究

A CLINICAL STUDY ON CEREBROVASCULAR DISEASES IN KOREA

대한의학협회지 1970년 13권 1호 p.70 ~ 90
김순욱,
소속 상세정보
김순욱 (  ) - 서강의원

Abstract


It is a recent trend that the incidence of cerebrovascular diseaes has steadily increased in all countries. The author has analysed 581 cases of cerebrovascular diseases in Korea, chiefly from neurosurgical aspects, collected from 1961 to 1967 in serial cases. The results of the analysis can be summarized as follows:
1) Classification and clinical cases are illustrated in Table 1. The hemorrhagic diseases occupied 55.9%, dominant than the occlusive type.
2) The youngest patient was 3 of age, and the oldest 84 years old. The average age of the patients was 42. The ratio of sexes was 1.7 : 1, in favor of male.
3) In larger proportions, most patients were attacked by hemorrhagic diseases while working, and excitement, in particular, provoked the hemorrhage in cases of cerebral aneurysms. The occlusive diseon the contrary, affected the patients mostly during rest time.
4) Fainting, dyspnea, dizziness and/or bradycardia appeared in 51.1% by carotid compression test in the occlusive diseases, whereas such symptomes were demonstrated in only 4.0% in the hemorrhatype.
5) Cerebral arteriograms of the occlusive type disclosed abnormalities in 50%. However, occlusion or stenosis of the extracranial neck arteries were found in 5.3%, of which no appropriate surgical candidate was noted.
6) Anticoagulation therapy was carried out in 229 cases of occlusive diseases, and vasodilator in 79, surgical intervention in 6, digitalization in 2 and no treatment for 124patients. Cure and improvement were resulted in 60.2%. Worsening and death came in 6.7%. The uppermost effect of such treatment was detected in cases of transient ischemic attack (TIA).
7) Among 214 cases of intracerebral hemorrhage, 163 patients or 76.2% were believed to be hypertensieve hemorrhage. Their cerebral angiograms were within normal limits in 46.5%, shift of anterior cerebrals was demonstrated in 45.5% and figures of temporal lobe herniation in 4.0%. Intracerebral hematomas were formed in the cerebral lobes in 44.4%, of which frontal lobe hematomas were found in the greatest proportion of 31.8%. Operative removal of the hematoma was performed for 25 patients and subtemporal decompression for 1. The surgery was carried out for 21 of the 25 patients within 3 days after the onset to reveal mortality of 73.1%. The later the operation was performed, the better was the prognosis. On the other hand, the mortality of conservatively treated patient group was 78.2%. Hypotensive plus hypothermia treatment resulted in remarkable reduction of the mortafrom 84.3% to 27.5%.
8) 52 cerebral aneurysms were confirmed by cerebral arteriograms in 49 patients. There were 3 multiple aneurysms. Aneurysms of posterior communicating artery were found most frequently (34.6%). The follow-up mortality, 2 to 8 years, was 14.3%, significantly lower than that of consertive treatment, 46.9%.
9) The incidence of sites favored by arteriovenous malformation (AVM) was more prevalent on parietal and frontoparietal regionin 4 cases respectively. Out of 21 patients, 14 had bled. The hemorrhages were 6 subarachnoid hemorrhages (SAH) and 8 intracerebral hemorrhages. All SAH patients survived. 16 cases were given surgical treatment to result in mortality of 25.0%. Conservative treatment was administered to 6 patients with mortality of 33.3%.
10) The mortality of unknown SAH, the etiology of which could not be detected by cerebral angiogram was 25%. The mortality of the SAH patients whose etiology was not explored was 50%. The mortality of both cases thus was 32.5%, lower than that of ruptured aneurysms.
11) The mortality of unclassified group was 59.1 %, while cases lost in follow-up study amounted to 27.0%.
12) 2 cases of spontaneous carotid-cavernous fist2 cases of true vascular tumor-one hemangioma of bilateral choroid plexuses and one hemangioblastoma on the parietal region-and 1 case of Sturge-Weber´s disease were described.

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