Hemorrhagic Subependymal Giant Cell Astrocytoma without the Clinical Feature of Tuberous Sclerosis : Case Report

Subependymal giant cell astrocytoma(SEGA) is a rare intraventricular tumor that mainly occurs in patients with tuberous sclerosis. The tumor characteristrically arises in the wall of the lateral ventricle and presents as an intraventricular mass causing hydrocephalus by obstruction of the foramen of Morno. Hemorrhagic presentation of SEGA has been very rarely reported only in patients with tuberous sclerosis. A 41-year-old man presented with sudden onset of severe headache, nausea and vomiting. There was no clinical feature of tuberous sclerosis. Preoperative neuroimaging studies showed a intraventricular tumor with hemorrhage. The mass was totally removed throught interhemispheric transcallosal approach. The authors report an unusual case of hemorrhagic SEGA, which is devoid of any clinical feature of tuberous sclerosis with review of pertinent liteatures.

Oculo-Cerebral Syndrome after Spontaneous Subarachnoid Hemorrhage

OBJECTIVE: Oculo-cerebral syndrome is an intraocular hemorrhage and related ocular symptoms caused by sudden increase in intracranial pressure. The authors investigate the clinical significance of oculo-cerebral syndrome after spontaneous subarachnoid hemorrhage and analyze the characteristics of aneurysms which caused intraocular hemorrhage in order to help the treatment of intracranial aneurysm patients. METHODS: From January 2000 to May 2001, 103 patients were admitted to our hospital and diagnosed as spontaneous subarachnoid hemorrhage. We divided the patients into two groups:81 patients without intraocular hemorrhage(non-IOH) and 22 patients with intraocular hemorrhage(IOH). The authors prospectively analyzed the prognostic factors of spontaneous subarachnoid hemorrhage by chi-square test. RESULTS: The initial neurologic state was poor in the IOH group(p<0.001). The Fisher's grade was higher than non-IOH group(p<0.001), and intracranial hemorrhage was great in the IOH group(p<0.001). The prognosis was poor in the IOH group at discharge(p<0.001). The most common rupture site in the IOH group was the anterior communicating artery(p<0.001). Frontal intracerebral hematoma was specific to intraocular hemorrhage(p<0.05). There was a positive correlation between intraocular hemorrhage and rebleeding(p<0.001). CONCLUSION: The authors suggest that oculo-cerebral syndrome is clinically significant with a poor prognostic factor in patients with spontaneous subarachnoid hemorrhage.