Timing and Causes of Death of Stroke Patients Died in Hospitalization

OBJECTIVE: To evaluate the frequency distribution and causes of death according to number of days after stroke. METHOD: We reviewed in 158 cases of the stroke patients who had died in hospitalization from January 2000 to June 2002 by medical records retrospectively. We evaluated the correlations between the frequency of death and causes of death by frequency analysis. RESULTS: Mean age was 65.8 11.5 years old and average survival days after stroke were 16.2 24.1 days. The proportion of stroke subtypes were infarct (51.3%), intracranial hemorrhage (36.7%), and subarachnoid hemorrhage (12.0%). The frequency of death at 7 days and 30 days after stroke onset were 52.5% and 89.2%, respectively. The most frequent cause of death was respiratory arrest due to transtentorial herniation or brain stem lesion (48.1%), followed in frequency by pneumonia (22.2%), cardiac origin (10.8%), and vasospasm (6.3%). Within the first 30 days, the leading cause of death was respiratory arrest due to transtentorial herniation or brain stem lesion. After the first 30 days, the most frequent cause of death was pneumonia. CONCLUSION: The results of this study are valuable as basic data of mortality and causes of death after stroke during an acute stroke management and early rehabilitation.

Primary Spinal Malignant Melanoma in the Cervical Spinal Cord: Case Report

The primary melanoma of spinal cord was rarely reported in the literatures. The authors report a case of primary spinal maligmant melanoma in the cervical spinal cord. A 41-year-old man presented several months history of right shoulder pain and right hemiparesis. Plain X-ray of the cervical spine, myelography, computerized tomography and magnetic resonance imaging showed intradural mass from third to fifth cervical spine level. The operation was performed, and intradural intra-and extramedullary brownish black tumor, which focally infiltrated to the dura and inner surface of lamina, was removed and the histological diagnosis was maligmant melanoma. And then chemotherapy with vincristine, bleomycin, cisplatine, followed by whole central nervous system radiation therapy was performed. The patient was discharged and followed up with no neurological interval change. The pertinent literature of spinal cord melanoma is reviewed and its rareness is discussed.

Clinical Analysis of Traumatic Carotid-Cavernous Fistula

Traumatic carotid-cavernous fistula(CCF) is a rare complication of moderate to severe head injury. A series of 15 traumatic carotid-cavernous fistulas has been analyzed and 13 cases have been treated with 3 different methods:direct obliteration through pterional approach(5 cases), ligation of internal, common and external carotid artery in the neck(2 cases), occlusion of CCF with detachable balloon technique(6 cases). The remaining 2 cases were treated by conservative procedures. There were 12 cases(80%) with skull fractures, the majority of which(10 cases) had frontal vault and basal skull fractures. The results of each method were as follows:1) Among the 5 direct obliteration procedure groups, we got satisfactory results in only 2 cases(40%), and the other 2 cases needed additional instantaneous carotid trapping procedures, which corrected the fistula. Internal carotid artery patency was also preserved in 2 cases(40%). 2) Among the 2 cases of carotid trapping group, only 1 case(50%) improved to good. 3) Amo ng the detachable balloon group, 5 cases(83.3%) recovered to good or corrected. Carotid patency was preserved in 4 cases(67.7%). As a result, initial treatment modality of CCF should be detachable balloon technique because of good preservation of carotid patency, better result, simplicity, and safety compared with other operative methods.

Clinical Analysis of Traumatic Carotid-Cavernous Fistula

Traumatic carotid-cavernous fistula(CCF) is a rare complication of moderate to severe head injury. A series of 15 traumatic carotid-cavernous fistulas has been analyzed and 13 cases have been treated with 3 different methods:direct obliteration through pterional approach(5 cases), ligation of internal, common and external carotid artery in the neck(2 cases), occlusion of CCF with detachable balloon technique(6 cases). The remaining 2 cases were treated by conservative procedures. There were 12 cases(80%) with skull fractures, the majority of which(10 cases) had frontal vault and basal skull fractures. The results of each method were as follows:1) Among the 5 direct obliteration procedure groups, we got satisfactory results in only 2 cases(40%), and the other 2 cases needed additional instantaneous carotid trapping procedures, which corrected the fistula. Internal carotid artery patency was also preserved in 2 cases(40%). 2) Among the 2 cases of carotid trapping group, only 1 case(50%) improved to good. 3) Amo ng the detachable balloon group, 5 cases(83.3%) recovered to good or corrected. Carotid patency was preserved in 4 cases(67.7%). As a result, initial treatment modality of CCF should be detachable balloon technique because of good preservation of carotid patency, better result, simplicity, and safety compared with other operative methods.