Clinical Analysis and Operative Management of Spontaneous Brain Stem Hemorrhage

Spontaneous brain stem hemorrhage usually results in higher mortality and morbidity with poorer prognosis than any other intracranial vascular lesions in spite of meticulous medical or surgical treatment. We have experienced 86 cases of spontaneous brain stem hemorrhage who were admitted to Wonju college of medicine from January 1983 to Octobr 1995. 33 cases were treated with operation and 53 cases with non-operative treatment. The results were as follows: 1) Clinical parameters in both operative and non-operative groups showed no significant differences. 2) Treatment results were better in the operative group. Operative treatment is recommended in cases of GCS score below 7, hematoma size larger than 10ml, young age, and normotensive patients. 3) Appropriate operative approaches should be considered according to the patient's status. Recently, we most frequently performed a stereotactic approach. 4) Better outcome was obtained when the patients were operated from 72 hours to one or two weeks following the h emorrhage. 5) Hypertension, old age, and GCS score above 7 showed no statistical differences in terms of outcome between the operative and non-operative groups.

Miliary Tuberculosis Involving the Central Nervous System

In recent times, central nervous system(CNS) tuberculosis has been rare and the prevalence of the focal form, the tuberculoma, varies from 1 per 20 to 1 per 1000. CNS tuberculosis occurs as a result of hematogenous sparead from a primary focus, mostly pulmonary tuberculosis. It can be diffuse exudative leptomeningitis or a localized tuberculoma; the former is more common. We report a case of military cerebral tuberculosis in a 24-year-old female who had been having headaches for 4 months. Magnetic resonance imaging showed numerous small round Gadolinium-enhanced supratentorial and infratentorial lesions scattered throughtout the brain. Histologic examination confirmed well-defined tuberculous granulomas with central caseous necrosis in open biopsy, containing several acid-fast bacilli, the patient was treated with isoniazid, rifampin, ethambutol, pyrazinamide in combination with prednisolone.