A Clinical Analysis of Chronic Subdural Hematoma in Aged Person

A series of 41 patients with chronic subdural hematoma, admitted to the Department of Neurosurgery of Catholic Medical College Hospital from May 1, 1980 to May 1, 1984 is presented. The following results were obtained : 1) Male were more frequently involved than female with the ratio of 4.9:1. The over 50 years old age group were predominately 75.6%. 2) The etiologic factors reveal younger group(under 50) has mainly unidentified factors, but older group(over 50) has mainly head trauma history and alcoholism. 3) Older group had more frequently focal neurologic deficit such as hemiplegia, however younger group presented as increased intracranial pressure signs such as headache and vomiting. 4) The hematoma density of C-T scan on admission was hypodense 50%, isodense 30%, mixed 28%, hyperdense 2% and no correlation to age. 5) Younger group performed burr hole with drainage, and older group performed craniotomy with removal of hematoma, but post-operative results were significantly good in older group with craniotomy.

Pontine Hemorrhages and Prognosis

Pontine hematomas are very rare lesions that in the past found at postmortem examination rather than diagnosed from the clinical presentations. Computed tomography has particularly stimulated further neurosurgical interest in this relatively rare condition, making surgical evacuation possible in some cases. Four patients suffering from pontine hemorrhages, revealed by computed tomography, are discussed. The classification regard to the site, clinical features and outcomes of this lesion are discussed in an attempt to establish general criteria for adequate management. With regard to the site, three types of hemorrhage are to be considered the tegmentotectal(type I), the tegmentolateral(type II) and the tegmentobasilar(type III), 2 patients(type I II, treated conservatively) had a fair outcome, and 2 patients(one of type III, treated conservatively, and one of type I, by surgical evacuation) had a death. Surgical management for the pontine hemorrhages should be reserved for the type I(tegmontotectal) and type II(tegmentolateral), whenever the neurological conditions deteriorate progressively.

Somatosensory Evoked Potential Responses in Focal Brain Lesions

Cerebral somatosensory evoked potentials(SEPs) produced by stimulation of peripheral nerves provide a useful diagnostic index of conduction in somatosensory pathways to the cortex. Thus the integrity of both the dorsal column-medial lemniscus pathway and primary sensorimotor area has been considered an essential requirement to record a normal SEP. There are suggestions that SEPs contain several components arising from different neuronal sources, the early short latency potentials corresponding to the lemniscus-mediated responses and the late waves to the diffuse spino-thalamic projections. The present work analyses the influence on SEPs of focal brain lesions, using the computerized tomography in detecting and localizing brain lesions. Somatosensory evoked potentials were recorded in 20 patients with focal brain lesions recognized by computerized tomography. 1) Patients with primary sensorimotor area(PSMA) damages(group I) had a very abnormal of the early component(No, Po, Nl, Pl) in 100% on the lesion side. 2) Patients presented supratentorial lesions, sparing PSMA(group II), 87.5% showing abnormal SEPs in early components and characterized by increment of amplitude in late components. 3) Brainstem damage(group III) produced a distortion of the early components especially N11, N20msec in latency. 4) In incomplete spinal cord injuries, the SEPs is indeed signal of functional recovery, of posterior column, and incorrespondance with clinical improvement.

A Case of Congenital Binocular Cataracts with Posterior Fossa Cyst Simulating Marinesco-Sjogren Syndrome

A case of 10 months old Korean female infant with congenital binocular cataracts, posterior fossa cyst, and macrodactyly simulating Marinesco-Sjogren Syndrome is presented. The diagnosis of the posterior fossa cyst was added by brain computerized tomogram, conray ventriculogram and vertebral angiogram. The studies demonstrated marked hydrocephalus with a huge posterior fossa cyst displacing 4 th ventricle and cerebellum anteriorly. The cyst was also extending upward displacing the tentorium superiorly. Following ventriculoperioneal shunt an exploration of the cyst was performed. The cerebellar hemispheres and vermis were appeared to be atrophic and displaced anteriorly due to the cyst. The histologic study of the biopsied cyst wall was normal arachnoid membrane. The authors assume that some of the reported cases of Marinesco- sjogren Syndrome could have similar cystic lesion which was found in this case to cause cerebellar ataxia and mental retardation.