Multiple Schwannomas: Case Report

The authors report a rare case of multiple schwannomas associated with intracranial, intraspinal and peripheral involvements. A 63-year-old woman presented with a seven-year history of palpable lumps on both sides of the supraclavicular area and hearing impairment in both ears. On physical examination, no skin manifestations were evident. Facial sensory change, deafness in the left ear and decreased gag reflex were revealed by neurological examination. Magnetic resonance imaging revealed multiple lesions of the trigeminal nerves, acoustic nerves, lower cranial nerves, spinal accessory nerve, brachial plexuses, and spinal nerves. Pathological examination of tumors from the bilateral brachial plexuses, the spinal nerve in the T8 spinal position and the neck mass revealed benign schwannomas.

Meningeal Chloromain in Acute Lymphoblastic Leukemia

Isolated chloromas(granulocytic sarcomas) are rare tumors. Chloromas are masses composed of immature granulocytic cells. Granulocytic sarcoma occurs primarily in patients with acute myelogenous leukemia as well as in patients with other myeloproliferative disorders, but rarely in patients with acute lymphoblastic leukemia(ALL). We now describe one patient affected by ALL with isolated granulocytic sarcoma as initial CNS relapses. These unusual clinical manifestation and radiological finding in acute lymphoblastic leukemia should be considered as recurrence of leukemia. Early detection and antileukemic treatment of granulocytic sarcoma are necessarily important for favorable prognosis.

A Case of Multiple Schwannomas of the Trigeminal Nerves, Acoustic Nerves, Lower Cranial Nerves, Brachial Plexuses and Spinal Canal: Schwannomatosis or Neurofibromatosis?

In most cases, while schwannoma is sporadically manifested as a single benign neoplasm, the presence of multiple schwannomas in one patient is usually indicative of neurofibromatosis 2. However, several recent reports have suggested that schwannomatosis itself may also be a distinct clinical entity. This study examines an extremely rare case of probable schwannomatosis associated with intracranial, intraspinal and peripheral involvements. A 63-year-old woman presented with a seven-year history of palpable lumps on both sides of the supraclavicular area and hearing impairment in both ears. On physical examination, no skin manifestations were evident. Facial sensory change, deafness in the left ear and decreased gag reflex were revealed by neurological examination. Magnetic resonance imaging revealed multiple lesions of the trigeminal nerves, acoustic nerves, lower cranial nerves, spinal accessory nerve, brachial plexuses, and spinal nerves. Pathological examination of tumors from the bilateral brachial plexuses, the spinal nerve in the T8 spinal position and the neck mass revealed benign schwannomas. Following is this patient case report of multiple schwannomas presenting with no skin manifestations of neurofibromatosis.

Embolization of Dural Arteriovenous Malformation of the Jugular Bulb

The authors report a 39-year-old male suffering pulsatile tinnitus of the left ear with dural arteriovenous malformation of the jugular bulb. There was a venous hypertension due to partial occlusion of the internal jugular vein and sigmoid sinus and venous drainage to the contralateral sinuses. Superselective embolization of these feeding arteries was successfully performed using 25% mixture of histoacryl and lipiodol. After embolization, his complaints of pulsatile tinnitus and buzzing noise behind his left ear disappeared. We present a case of dural arteriovenous malformation involving the jugular bulb, which completely disappeared after transarterial embolization with liquid adhesive.

Morphological Analysis of the Pterion in Korean / 체질인류학회지

The morphology and location of the pterion was investigated in total of 149 Korean skulls (298 pteria). The most common form of the pterion was a sphenoparietal articulation in the incidence of 76.5%. The most common location of the pterion was in an area which covers 5 mm from the supraorbital horizontal line parallel to Frankfurt line and the incidence was 81.8%. The metric location of the pterion was on 36.9 +/-3.8 mm above the upper margin of the zygomatic arch and 26.8 +/-4.5 mm behind the posterior margin of the frontozygomatic suture. The average length of the pterion was 12.2 +/-4.4 mm. The most common form of the epipteric bone was a single bone which articulated with the frontal, parietal, temporal and sphenoid bone, and the incidence was 40.3%. The most common location of the epipteric bone was in an area which covers 5 mm from the supraorbital horizontal line parallel to Frankfurt line and the incidence was 45.2%. Morphological analysis of the pterion, when combined with some other non -metric and metric variants, may become useful physical anthropologic tools for the identification of the Korean skull.

Distribution of Hair on the Phalanges of the Hand in Koreans / 체질인류학회지

The distribution of hair on the phalanges was investigated in the hands of 652 Koreans (402 males and 250 females). The fingers of both hands were examined in eye, using a hand lens. The proximal phalanx of the middle finger was the most frequently haired (98.2%). The middle phalanx of the index finger was mostly hairless (0.6%). The frequency order of occurrence of proximal phalangeal hair was middle finger >ring finger >little finger >index finger >thumb finger (P3 >P4 >P5 >P2 >P1). The frequency order of occurrence of middle phalangeal hair was ring finger >middle finger >little finger >index finger (M4 >M3 >M5 >M2). The score of digital hair in Korean was 5.05. The most co mmon type of digital hair in Korean was type VII which had digital hair in all proximal phalangeal segments and no hair in midphalangeal segments. Sex differences appeared in the digital hairs of midphalangeal segment of ring finger (M4), middle finger (M3) and little finger (M5), and also appeared in the digital hairs of proximal phalangeal segment of thumb (P1).

Deep Cerebral Venous Thrombosis: Successful Treatment by Systemic Urokinase Followed by Heparin: Case Report

We present two cases of deep cerebral venous thrombosis(DCVT) with the totally occluded straight sinus. A 42-year-old female received with altered mentality . She has taken antihistamine for six years to treat the paranasal sinusitis. Another 34-year-old female who used the oral contraceptive for 11 months presented with acute behavior change . Both of these patients were diagnosed by computed tomography(CT), magnetic resonance(MR) imaging, and cerebral angiography. They were fully recovered with systemic urokinase thrombolysis followed by heparin therapy. We report that the intravenous thrombolysis was potentially effective management strategy in our cases of DCVT with the totally occluded straight sinus.

Effects of Continuous Intravenous Analgesia Versus Epidural Analgesia after Lumbar Spinal Surgery: A Prospective Study

OBJECTIVE: The purpose of this non-randomized prospective study was to evaluate the safety and efficacy of continuous intravenous nalbuphine-ketorolac-droperidol(CIA) versus continuous infusion of epidural morphine-bupivacaine(CEA) for pain control after lumbar spinal surgery. METHODS: Twenty-one patients who underwent spine surgery including laminectomy, fusion with fixation were assigned to receive an intravenous bolus of nalbuphine 5mg and ketorolac 15mg, followed by a continuous infusion of nalbuphine 25mg, ketorolac 105mg, and droperidol 5mg mixed with normal saline 98cc(2cc/hr). Twenty patients received a bolus infusion of morphine 2mg and 0.125% bupivacaine 8cc followed by a continuous intravenous infusion of 100cc 0.125% bupivacaine and morphine sulfate 8.0mg(2cc/hr). Pain score was measured on a visual analogue scale(VAS). It's safety and efficacies were compared with the results of continuous infusion of epidural morphine-bupivacaine, which was reported previously by same authors. A continuous infuser was used to give epidural morphine-bupivacaine and intravenous nalbuphine-ketorolac-droperidol. RESULTS: In general, mild pain, pain less than 3 VAS scores, was observed postoperatively from 30minutes to 72hours in CEA group, and from 6 hours to 72 hours in CIA group. The early postoperative pain was controlled easily in 6 hours in CEA group, compared to CIA group(p<0.05). However, there was no statistical significance in 72 hours on pain scores between CEA and CIA groups after 6-12hours of pain managements. Pruritus, nausea and vomiting, and urinary retention were more frequent in CEA group. CONCLUSION: CIA and CEA are considered effective methods in postoperative pain managements. However, adequate doses in early intravenous infusion and continuous intravenous analgesia with nalbuphine-ketorolac-droperidol will be needed for better control in early postoperative pain with less side effects.

Arteriovenous Malformation at Cerebellopontine Angle Associated with a Fenestration of the Vertebral Artery / 대한뇌혈관학회지

A fenestration of the vertebral artery is considered to be an unusual vascular variation that is defined as a bypass artery along the extracranial or at intracranial segment of the artery. A fenestration of the vertebral artery associated with an arteriovenous malformation at the cerebellopontine angle is extremely rare. We report a case of the ruptured arteriovenous malformation with a fenestration of vertebral artery. The embryologic genesis and clinical significance of a fenestration of the vertebral artery are discussed.

A Case of Intrasellar Arachnoid Cyst: Case Report

A rare case of intrasellar arachnoid cyst is reported. The patient was a 55 years old woman presented with 8 years history of blurred vision, headache and bitemporal visual field cuts aggravated for last 4 months. The pathophysiology and the CT and MRI findings being useful in the differentiation of cystic sellar masses were discussed.