A Case of Cerebellar Infarction Patient with Ataxia and Vertigo prescribed by Chukdam-tang

(1)

서론

90%

.

1). , , ,

2),

3-5)

.

운동실조와 현훈을 주소로 한 소뇌경색 환자의 척담탕 치험 1례

최인영, 김미경, 김보람, 최동준, 한창호, 정승현, 신길조, 이원철*

동국대학교 한의과대학 한방내과학교실, 부산대학교 한의학전문대학원 한방내과*

A Case of Cerebellar Infarction Patient with Ataxia and Vertigo prescribed by Chukdam-tang

In-Young Choi, Mi-Kyung Kim, Bo-Ram Kim, Dong-Jun Choi, Chang-Ho Han, Seung-Hyun Jung, Gil-Jo Shin, Won-Chul Lee*

Department of Internal Medicine, College of Oriental Medicine, Dongguk University Department of Internal Medicine, Pusan National University School of Oriental Medicine*

Ataxia and vertigo are frequent clinical findings in cerebellar infarction patients. In severe cases, they cannot achieve normal activity in daily life. A 65-year-old man was admitted with ataxia and vertigo diagnosed as acute cerebellar infarction. We prescribed for Chukdam-tang to treat the phlegm disease. After this treatment, ataxia and vertigo improved. We suggest Chukdam-tang is significantly effective on the treatment of cerebellar infarction.

Key Words : cerebellar infarction, ataxia, vertigo, Chukdam-tang

(2)

증례

1. 성명 : 이 O O (M/65) 2. 주소증

3. 현병력

2008 3 15

, .

. 10

.

2008 3 16 2008 4 5

2008 4 5 .

4. 과거력

1988 .

2008 3 L-spine nerve(3~4th) root compression .

2008 3 . warfarin .

5. 가족력 : 별무 6. 사회력

1 /day. 20 .

7. 치료기간

2008 4 5 ~ 2008 6 7

8. 주요검사 소견

Blood Pressure 146/99mm Hg, Pulse 61 /min, Body temperature 36.5 , Respiration 20 /min.

acute right cerebellar infarction Atrial fibrillation, Borderline right axis deviation, Prolonged QT interval.

Total Protein : 6.2 g/dL Albumin : 3.3 g/dL PT INR : 2.26 Urine

- Blood : 5(+/-) - RBC-Micro : 5~9

9. 초진소견

, . (-), (-)

(-), (-), (-) (-), (-), (-)

. (-), (-)

(-), (-), (-)

1 / . . .

6-7 / . Fig. 1. Brain MRI(2008.03.18)

(3)

, .

10. 치료

2 3 / ( 10 , 2 ,

8 ) .

( , , 6g, ,

4g, , , , , ,

2g, 1.2g, 0.8g, 5g) :

2008 4 7 ~ 4 12 , 5 16 ~ 6 7

( 8g, , , , , ,

4g, , , 2g)

2008 4 13 ~ 5 15

- :

2008 4 17 ~ 2008 4 21

- , :

2008 4 22 ~ 2008 5 15

-

warfarin

PT INR 2

1.5 warfarin

6,7)

.

1 1 . , , , , , ,

, , .

Warfarin qd(2.5mg~4mg) Micardis plus 80/12.5mg 1tab qd Lipitor 10mg 1tab qd

Selbex 50mg 1cap bid Nicetile 500mg 1tab bid Ginexin-F 80mg 1tab bid

11. 치료경과 평가

,

“Berg balance scale⁸⁾” . Berg balance

1. Sitting to standing 2. Standing unsupported 3. Sitting unsupported 4. Standing to sitting 5. Transfers

6. Standing with eyes closed 7. Standing with feet together

8. Reaching forward with outstretched arm 9. Retrieving object from floor

10. Turning to look behind 11. Turning 360 degrees

12. Placing alternate foot on stool 13. Standing with one foot in front 14. Standing on one foot

* Item description score(0~4).

maximum score : 56

* 0 20 : wheelchair bound 21 40 : walking with assistance 41 56 : independent

Table 1. Berg Balance Scale

(4)

scale 14 ,

1 .

12. 처치 및 경과 요약

2-3

.

Berg balance scale : 13 (4 7 ).

, .

,

. Finger to nose test

.

4 13

.

Berg balance scale :

14 (4 14 ), 32 (4 21 ).

,

, ,

. 10m

.

300m

. 3

.

Banhabakchulchunma-tang 50

45 40 35 30 25 20 15 10 5 0

04 07

04 14

04 21

04 28

05 05

05 12

05 19

05 26

06 02 Berg balance scale

Chukdam-tang

Banhabakchulchunma-tang

score

Fig. 2. Change of Berg balance scale

(5)

Berg balance scale : 41 (5 06 ). 44 (5 13 ).

.

80% ,

( )

. Berg balance scale

40 2

, .

5 16

.

Finger to nose test

50% ,

. .

Berg balance scale : 46 (05 28 , 06 03 ).

( , ,

) . ,

.

고찰

, , , , ,

, ⁹⁾.

, , ,

, ,

.

, 1-2

, 5-6

. , ,

1-2 ¹⁰⁾.

, ,

. , , ,

, , , , ,

1 ,

.

. ,

3,5)

. , , , , ,

, , ,

,

, , .

, ,

,

. ,

,

.

, ,

Berg balance scale 13~14 .

, ,

.

8g, , , , , ,

4g, , , 2g

,

(6)

, ,

,

, .

, ,

. Berg balance scale

(14 ->32 ->45 ) ,

. 1

,

.

3,5),

3,4), ²⁾, ¹¹⁾ ,

, ,

. ¹²⁾, ¹³⁾,

14) , (

, , , )

.

“ ”

, , ,

,

15)

.

,

( )

. ,

,

.

. .

결론

.

참고문헌

1. , , .

. . 1984; 13(3):439

-44.

2. , , .

. . 2003. 119-25.

3. , , .

1

. . 2007. 135

-42.

4. , , .

1 . . 2003;24(3):662-6.

5. , , .

2 .

(7)

. 2004. 139-45.

6. Janetzky K, Morreale AP. Probable interaction between warfarin and ginseng. Am J Health Syst Pharm 1997;54(6):692 3.

7. Davis NB, Nahlik L, Vogelzang NJ. Does PC- SPES interact with warfarin? J Urol 2002;167 (4):1793.

8. , , . Berg

, , .

. 2002;9(3):47-65.

9. Amarenco P. The spectrum of cerebellar infarction. Neurol 1991;41(7):973-9.

10. , , . . : .

1986:1814-50.

11. , , .

2

. . 2004;25(2):335-43.

12. .

. .

2007;22(2):79-82.

13. , , .

1 . . 2001;15(6):1022-4.

14. , , . 2 .

. 2005;18(3):148-57.

15. . ,

. Korean journal of life science. 2001;11(1):62-9.