A Case of Wernicke's Encephalopathy in a Patient with Multiple System Atrophy

A 41-year-old man was admitted due to altered mentality and confusion. He had showed progressive cerebellar ataxia, dysarthria, gait disturbance from his age of 33 years old. Brain MRI revealed high signal lesions in periaqueductal gray matter, mammillary bodies, median thalami and postcentral gyri bilaterally on T2-weighted images. Severe cerebellar atrophy was noted, too. We report a case of Wernicke's encephalopathy in a patient with probable multiple system atrophy. As far as we know, there have been no published report on this kind of case.

Therapeutic Results of Posterior Fossa Tumors with Hydrocephalus

OBJECTIVE: This study is designed to identify the clinical characteristics and the optimal treatment modality of hydrocephalus in posterior fossa tumors. METHODS: The authors reviewed 154 infratentorial tumor patients. Age, sex, clinical symptoms, types of treatment, and surgical results of posterior fossa tumor patients with hydrocephalus were analyzed, retros-pectively. Factors which might predict the need for external ventricular drainage(EVD) or ventriculo-peritoneal shunt were analyzed statistically. RESULTS: Hydrocephalus was noted in 86 cases(56%), and it was associated with medulloblastoma in 16 cases(89%), hemangioblastoma in 12(63%) and brain stem glioma in three(33%). The surgical results of the posterior fossa tumors with hydrocephalus were poorer than those without hydrocephalus(p<0.05). A large tumor(p<0.05) and an incomplete removal(p<0.05) were factors predicting the need for EVD or shunt. Complications of intraoperative EVD or shunt developed in four cases. They were infection, he-morrhage at puncture site, and obstruction. Five patients in whom intraoperative EVD or shunt had not been performed developed a fatal hydrocephalic attack at immediate postoperative period, and the pos-toperative computed tomography scan revealed intraventricular hemorrhages in three cases cerebellar swellings in two cases. CONCLUSION: Intraoperative EVD or shunt is a safe, effective treatment modality especially in large size tumor and/or incomplete tumor resection. Intraventricular hemorrhages or cerebellar swellings during immediate postoperative period might cause fatal hydrocephalic attack, therefore EVD or shunt might be recommended in selected cases.

Analysis of Radiologic Factors Affecting Longterm Surgical Results of Anterior Cervical Fusion Patients

OBJECTIVE: Anterior cervical discectomy and fusion is accepted as appropriate surgical intervention for disease processes of the ventral cervical spine. In some cases, however, improvement of symptom following operation develop myelopathy or rhizopathy at longterm follow-up. We studied to clarify the correlation between clinical results and plain radiologic findings at long term follow-up. METHODS: A total of 86 patients who underwent anterior cervical discectomy and fusion were grouped into deteriorated and good recovery group. These two groups were compared in lateral functional roentgenograms on the cervical kyphosis and disc height at fused level, sagittal plane rotation and dynamic sagittal canal diameter at adjacent level. RESULTS: The presence of cervical kyphosis and disc height at fused level do not correlate with long term follow-up results. Sagittal plane rotation of more than 20 degrees were identified in 36% of the cases in deteriorated group, whereas the same findings were identified in 15% of the cases in good group. Sagittal diameter of less than 12mm were identified in 48% of the cases in deteriorated group, whereas the same finding were identified in 8% of the cases in good group. Preoperatively, sagittal plane rotation of more than 20 degrees at adjacent level were identified in 28% of the cases in deteriorated group, whereas the same findings were identified in 13% of the cases in good group. Preoperatively sagittal diameter of less than 12mm at adjacent level were identified in 40% of the cases in deteriorated group, whereas the same finding were identified in 7% of the cases in good group. CONCLUSION: Large sagittal plane rotation and small dynamic sagittal diameter at adjacent level were factors that might be associated with later clinical deterioration after cervical anterior fusion.

Vertebral Artery Obstruction due to Anterior and Vertical Subluxation of Atlanto-Axial and Atlanto-Occipital Joint in Ankylosing Spondylitis

OBJECTIVE: We report a case with a long-standing history of the ankylosing spondylitis(AS) who showed multiple cerebellar infarctions with bulbar symptom owing to vertebral artery obstruction, due to anterior and vertical subluxation of atlanto-axial and atlanto-occipital joint. CLINICAL PRESENTARION: An 51-year-old male patient with swallowing difficulty, tongue deviation to the left side and severe nuchal pain and rigidity is presented. INTERVENTION: After removal of posterior portion of foramen magnum, posterior portion of left transverse foramen of axis was decompressed. CONCLUSIONS: Spontaneous anterior atlanto-axial subluxation occurs in patients with AS about 2% of presents with or without signs of spinal cord compression. Vertical subluxation occurs in 3-8% of patient with rheumatoid arthritis but it is an exceedingly rare complication of AS. Close observation and follow-up are needed in patients with AS and if subluxation occurs, good prognosis is anticipated using an early operative treatment.

Clinical Evaluation of Cervical Ossification of the Posterior Longitudinal Ligament

The authors treated 32 patients with Ossification of the Posterior Longitudinal Ligament(OPLL). Seventeen of these patient had surgery during the past 1 year between 1987 and 1988. In this study we present a radiological and clinical analysis of these cases with a literature review. We also discuss a clinical system of grading, different types of radiological patterns, the indication of surgical treatment and the choice of operative methods. 1) The incidence of the cervical OPLL was about 5.4% in our annual study, which was based on the cervical CT and CTM. 2) The highest incidence was in patients 50-60 years of age and male: female ratio was about 3:1. 3) The highest incidence was in C5, C6 and C4 levels of cervical spine and two and three level involvement was prominent. 4) The pattern of OPLL was devided into a continuous type (21%), a multiple segmented type(48%), a mixed type(25%), a localized type(6%). 5) Absolute diameter did not always parallel the extent of spinal cord signs as did the percentage of spinal canal narrowing. 6) In cases of a clinical grading of more than III, surgery must be considered. In grade II, surgery is indicative if conservative management failed to improve the clinical symptoms. 7) For the evaluation of the cervical OPLL, the CT-Scan of CT metrizamide myelography was more useful method. 8) Cervical Corpectomy and fusion with or without bone cement were found to be advisable in Cases of cervical OPLL.

Thoracic Arteriovenous Malformation: Case Report

The authors experience a case of juvenile type thoracic arteriovenous malformation. It is acute onset and represent spastic paraparesis, sensory Impairment and voiding difficult. Intradural spinal arteriovenous malformation is relatively rare lesion. The authors treated with total excision of A-V malformed vessel with good results.