Delayed Onset of Malignant Hyperthermia: A Case Report / 대한구급학회지

Malignant hyperthermia is a potentially fatal genetic and metabolic myopathy that presents with high fever, and muscle rigidity, and it often occurs after administering anesthetic medication. Most cases of malignant hyperthermia occur during anesthesia or surgery, but delayed malignant hyperthermia is very rare, and if it is detected late, it has a high mortality rate. A 39-year-old male with an acute subdural hematoma underwent decompressive craniectomy without any intraoperative medical problems, but a high fever above 40degrees C occurred after 8 hours and he was dead in spite of aggressive management after 48 hours postoperatively. We present here a case of delayed malignant hyperthermia along with a review of the related literature.

Management of Posterior Inferior Cerebellar Artery Aneurysms: A Single Institution Retrospective Analysis (1989-2007) / 대한뇌혈관외과학회지

OBJECTIVE: The incidence of posterior inferior cerebellar artery (PICA) aneurysms is rare, and neurosurgeons have found that the direct open surgical approach for PICA aneurysms is challenging. [0]We analyzed the results of treating posterior inferior cerebellar artery (PICA) aneurysms by embolization or by open surgery. METHODS: 41 patients (1% of all the aneurysms treated; 13 (32%) men, 18 (68%) women; mean age: 55.5 yr) with ruptured or unruptured PICA aneurysms underwent treatment at our hospital. The clinical outcomes of these patients were studied retrospectively by using the medical records and the neuroimaging studies. RESULTS: The sites of PICA aneurysms were at the junction of the vertebral artery and PICA (63%), the lateral medullary segment (7%), the tosillomedullary segment (10%), the telovelotonsillar segment (13%) and the cortical segment (7%). The shapes of the PICA aneurysm were either the saccular type (85%) or the fusiform type (15%). 25 patients with PICA aneurysm underwent surgical treatment and 16 patients with PICA aneurysms underwent endovascular treatment. Open surgery was used more often to treat a distal PICA than an endovascular procedure. Within the open surgery group, 24% of the patients received the Hunt and Hess (HH) grades IV and V, whereas among the endovascular-treated patients, 37.5% of the patient had HH IV and V grades. Twenty eight percent of the patients In the surgery group achieved a Glasgow Outcome Scale (GOS) score of I through III, and 72% patients had gained a GOS score IV or V. For the endovascular-treated patients, 37% of these patients achieved a GOS score of I through III and 63% patients gained a GOS score IV or V. CONCLUSION: We found that the open surgery patients had better clinical outcomes than the endovascular treated patients and they especially achieved higher HH grades. However, Fisher's exact test and Chi-square tests did not show any statistically significant difference between the two groups (p=0.49, which is explained by the selection bias). In the previous literature, the predictors of the outcome for intracranial aneurysms, such as age, the size of the aneurysms, the HH grade and the Fisher grade showed statistical significance for the GOS grade. Yet in our study, we showed that there was no statistical significance between the above mentioned predictors and the GOS grade, while a strong correlation existed between the HH grade and the GOS grade.

Intracranial Epithelioid Hemangioendothelioma

Intracranial epithelioid hemangioendothelioma is extremely rare. We report a case of intracranial epithelioid hemangioendothelioma which developed in a 55-year-old man who presented with dysarthria for two weeks. The brain computed tomography scan and magnetic resonance image showed masses which had fat component at the left frontal convexity and at left posterior parietal area. Excisional biopsy at the left frontal convexity confirmed epithelioid hemangioendothelioma which is immunopositive for CD31, supporting endothelial differentiation, and negative for CD68, SMA and HMB-45.