Min-Keun Song

The Effect of Combined Therapy of Exercise and Nootropic Agent on Cognitive Function in Focal Cerebral Infarction Rat Model

Objective To investigate the effect of combined therapy of exercise and nootropic agent on cognitive function in a focal cerebral infarction rat model. Method Forty 10-week old male Sprague-Dawley rats were subjected to photothrombotic cerebral infarction of the left parietal lobe. All rats were randomly divided into 4 groups: group A was photothrombotic cerebral infarction rats without any treatment (n=10); group B was photothrombotic cerebral infarction rats with swimming exercise (n=10); group C was photothrombotic cerebral infarction rats with oral administration of acetyl-L-carnitine (n=10); group D was photothrombotic cerebral infarction rats with swimming exercise and oral administration of acetyl-L-carnitine (n=10). Cognitive function was evaluated using the Morris water maze test on the 1st day, and the 1st, 2nd, and 4th week after the induction of cerebral infarction. The activity of superoxide dismutase (SOD) and the level of malondialdehyde (MDA) in the hippocampus were measured. The neuronal cells of the hippocampus were histopathologically evaluated. Results The escape latency was shorter in groups B, C, and D than in group A. However, the differences were not statistically significant at the 1st, 2nd and 4th week. The activity of SOD was the highest in group D. The level of MDA was the lowest in group D. We observed more normal neuronal cells in groups B, C, and D. Conclusion The combined therapy of exercise and nootropic agent was helpful in ameliorating oxidative stress in the focal cerebral infarction rat model. However, the effect did not translate into improvement of cognitive function.

Spontaneous Cervical Epidural Hematoma Presenting as Brown-Sequard Syndrome Following Repetitive Korean Traditional Deep Bows

Spontaneous cervical epidural hematoma (SCEH) is an uncommon cause of acute nontraumatic myelopathy. SCEH presenting as Brown-Sequard syndrome is extremely rare. A 65-year-old man had motor weakness in the left extremities right after his mothers funeral. He received thrombolytic therapy under the impression of acute cerebral infarction at a local hospital. However, motor weakness of the left extremities became aggravated without mental change. After being transferred to our hospital, he showed motor weakness in the left extremities with diminished pain sensation in the right extremities. Diagnosis of SCEH was made by cervical magnetic resonance imaging. He underwent left C3 to C5 hemilaminectomy with hematoma removal. It is important for physicians to be aware that SCEH can be considered as one of the differential diagnoses of hemiplegia, since early diagnosis and management can influence the neurological outcome. We think that increased venous pressure owing to repetitive Korean traditional deep bows may be the cause of SCEH in this case.

Effect of Biofeedback Balance Training on Walking Ability in Acute Stroke Patients

Setting: Eighteen male Sprague-Dawley rats, weighing 250w280 grams, aged 8 weeks old, were used. All rats were randomly divided into 2 groups: rTMS (RT) group and sham rTMS (SRT) group. Morris water maze (MWM) test was performed before rTMS stimulation (RT: n1⁄43, SRT: n1⁄43) and after 10 consecutive days of rTMS stimulation (RT: n1⁄46, SRT: n1⁄46) to evaluate the long-term effects of rTMS. All rats were fixed in stereotactic frame under general anesthesia with 2% isoflurane during rTMS stimulation. The intermittent theta-burst stimulation (iTBS) protocol for rTMS was applied. The iTBS was applied using a Rapid2 stimulator and a 70 mm figure of eight coil at 20 trains of TBS (10 times of 50 Hz-3 bursts pulses) were applied at 10 second inter train intervals (600 stimuli) for 10 consecutive days (6,000 stimuli in total). The intersection of coil was placed over the frontal area with 10 mm distance from the scalp. For sham stimulation, the coil was placed perpendicular to the surface of head and all other conditions were identical to the conditions in the RT group. Stimulus strength was in a range of 25% of maximal device output. Before and after 10 consecutive days of stimulation, rats were sacrificed. H & E staining, IHC and western blot for BDNF and VEGF in the hippocampus were conducted. Results or Clinical Course: 1) Escape latencies before and after rTMS or sham rTMS stimulation, there was no significant difference between two groups (p>.05). 2) The average protein expression level of BDNF was higher in the RT group than in the SRT group (p<.05). 3) The average protein expression level of VEGF was significantly higher in the RT group than in the SRT group (p<.05). Conclusions: We think that rTMS plays a beneficial role in the hippocampus of rat brain to increase protein expressions of VEGF as well as BDNF. It may suggest that the induction of angiogenesis supports the promotion of neurogenesis in the rat brain.

Effect of regular swimming exercise to duration-intensity on neurocognitive function in cerebral infarction rat model

ABSTRACT Objective: This study investigated the effect of regular swimming exercise according to the duration-intensity on neurocognitive function in a cerebral infarction rat model. Methods: Forty male Sprague–Dawley 10-week-old rats, weighing 300 ± 50 g, were subjected to photothrombotic cerebral infarction. The remaining 36 rats were randomly divided into four groups (n = 9 per group: non-exercise (group A); swimming exercise of short duration-intensity (5 min/day, group B); swimming exercise of moderate duration-intensity (10 min/day, group C); and swimming exercise of long duration-intensity (20 min/day, group D). Exercise was performed five times a week for 4 weeks, beginning the day after cerebral infarction. Neurocognitive function was evaluated with the Morris water maze test. Immunohistochemistry and western blot analysis examined brain-derived neurotrophic factor (BDNF) and vascular endothelial growth factor (VEGF) at 4 weeks postinfarction. Results: At 4 weeks postinfarction, escape latency was found to be shorter in group C than in any of groups A, B, or D. Immunohistochemistry revealed the most significant immunoreactivity for BDNF and VEGF in group C. Western blot analysis demonstrated that BDNF and VEGF proteins were markedly expressed in group C. Conclusions: Regular swimming exercise of moderate duration-intensity may be the most effective exercise protocol for the recovery of neurocognitive function in cerebral infarction rat model.

Relationship Between Post-exercise Heart Rate Recovery and Changing Ratio of Cardiopulmonary Exercise Capacity

Objective To determine whether heart rate recovery (HRR) following an exercise tolerance test (ETT) is correlated with a changing ratio of peak oxygen consumption (VO2) and maximal metabolic equivalents (METmax). Methods A total of 60 acute myocardial infarction (AMI) patients who underwent ETT at both assessment points - 3 weeks (T0) after the AMI attack and 3 months after T0 (T1) were included. After achieving a peak workload, the treadmill was stopped with a 5-minute cooldown period, and the patients recovered in a comfortable and relaxed seated position. HRR was defined as the difference between the maximal heart rate (HRmax) and the HR measured at specific time intervals - immediately after the cool down period (HRR-0) and 3 minutes after the completion of the ETT (HRR-3). Results HRR-0 and HRR-3 increased over time, whereas VO2max and METmax did not show significant changes. There was a positive correlation between HRR at T0 and the exercise capacity at T0. HRR at T0 also showed a positive correlation with the exercise capacity at T1. There was no significant correlation between HRR measured at T0 and the change in the ratio of VO2max and METmax, as calculated by subtracting VO2max and METmax obtained at T0 from those obtained at T1, divided by VO2max at T0 and multiplied by 100. Conclusion Post-exercise HRR measured at 3 weeks after the AMI onset can reflect the exercise capacity 3 months after the first ETT. However, it may be difficult to correlate post-exercise HRR at T0 with the degree of increase in cardiopulmonary exercise capacity in patients with AMI.

Poster 542 Comparison of Treadmill and Swimming Exercises on the Cognitive Function in Cerebral Infarction Rats

Disclosures: I. Choi, No Disclosures. Objective: Regular aerobic exercise programs such as walking and swimming improved the cognitive function in healthy or aged persons. However, there is no evidence which exercise would be more effective on the cognitive function in stroke patients. The aim of this study was to compare the effects of treadmill exercise and swimming exercise on the cognitive function in cerebral infarction rats. Design: A prospective, experimental, group allocation design. Setting: An animal laboratory in the tertiary university hospital. Participants: Twenty-seven 10-week-old male Sprague-Dawley rats. Interventions: Rats were subjected to photothrombotic cerebral infarction on the left parietal lobe. All rats were randomly divided into 3 groups: control group (group A, n 9); swimming exercise group (group B, free swimming, 10 minutes a day, 5 days a week, for 4 weeks, n 9); treadmill exercise group (group C, maximal velocity of 24 m/min, 5 days a week, for 4 weeks, n 9). Main Outcome Measures: Morris water maze tests were performed for the evaluation of the cognitive function. The activity of superoxide dismutase (SOD) in the hippocampus was measured. Cresyl violet stain and immunohistochemistry for brain derived neurotrophic factor (BDNF) in the hippocampus were conducted. Results: After the exercise programs of 4 weeks, escape latencies on hidden platform trial were shorter in group B and C than in group A (P .006). However, there was no significant difference between group B and C. The activity of SOD was more increased in group B and C than in group A (P .000). However, there was no significant difference between group B and C. More normal neuronal cells were found in CA3 region of hippocampus of group B and C. Immunoreactivity for BDNF was more expressed in group B and C. Conclusions: Treadmill exercise and swimming exercise were not different in terms of the effect on the cognitive function. Both exercises would be useful for improving the cognitive function in photothrombotic cerebral infarction rats.

Poster 541 The Effect of Swimming Exercise on Cognitive Function in Cerebral Infarction Rats

Disclosures: H. Akinbiyi, No Disclosures. Case Description: This case describes a previously healthy patient who presented to ER with acute headache, diplopia, and weakness. She was diagnosed with subarachnoid hemorrhage requiring external ventricular drain. Cerebral angiography showed no evidence of aneurysm. She was intubated for airway protection. After extubation she began to experience urinary retention requiring intermittent catheterization and complained of low back pain. She was further evaluated with lumbar spine MRI, which showed epidural hematoma at L2-L3 level. Setting: Single-center. Results or Clinical Course: Prior to discharge patient had resolution of both urinary retention and low back pain. Initial FIM Score:70. After 2 weeks of intensive therapy, including speech/ OT/PT the patient continued to improve with regard to mobility and gait dysfunction with discharge FIM Score:111. Discussion: This is the first reported case of cryptic hemorrhage complicated by epidural hematoma. In 1956, Crawford and Russell first coined the term “cryptic” vascular malformation in reference to small, clinically “latent” vascular lesions, some of which were angiographically occult, that resulted in either apoplectic cerebral hemorrhage or signs of a growing mass lesion. These lesions were pathologically diverse, consisting of arteriovenous malformations (AVMs), venous hamartoma, and are now called cavernous angiomas. Cryptic vascular malformations actually encompass a group of heterogenous malformations. The pathogenesis of cryptic vascular malformation is still unknown. Wilson has proposed that petechial hemorrhage leads to the development of cryptic vascular malformation. Conclusions: This is a unique case of patient with cryptic cerebral hemorrhage with extension to lumbar area, not reported in rehabilitation literature and it is important to raise awareness of physiatrists.

Dural Arteriovenous Fistula on the Brain Stem and Upper Cervical Spinal Cord - A Case Report -

A 53-year-old man abruptly developed headache and unconsciousness. Brain computed tomography (CT) and CT angiography showed subarachnoid hemorrhage, intraventricular hemorrhage, and multiple tortuous vascular structures on the brain stem and upper cervical spinal cord. Four-vessel angiography displayed intradural ventral arteriovenous fistula, supplied by the left vertebral and occipital arteries. Drainage was via both sigmoid sinus and cervical venous plexus. He had been treated with transarterial coil embolization of the left vertebral artery. Subsequently, he suffered from left hemiplegia and cognitive problem. Brain magnetic resonance (MR) and MR angiography performed 4 weeks later revealed multiple infarctions on the left cerebellum, left upper cervical spinal cord, and both medial thalamus, as well as occlusion of the left vertebral artery with reduction in varix size. After rehabilitative management, his muscle strength and cognitive function improved. We report a very rare case of dural arteriovenous fistula on the brain stem and upper cervical spinal cord.