Analysis of 6 Cases of Brain Stem Glioma

An analysis of recent experiences for the brain stem glioma with surgery and autopsy established confirmation of the characteristic symptoms and signs, and of diagnostic criterias of Conray-ventriculogram and vertebral-angiogram. The cases consisted of 2 cases of exophytic brain stem glioma and 4 cases of pontomedullary glioma, and 5 of 6 patients had the signs of the increased intracranial pressure in this cases. A resurgence of interest in the Conray ventriculogram has been produced by cut-off sign of aqueduct of Sylvius in 2 cases of the exophytic brain stem glioma. The survival period in adults (1-3 years) were longer than that in children (less than 3 months) in this series.

Cerebral Paragonimiasis: An Analysis of 7 Cases

Pagonimus Westmani, occuring as an important human infestation of the lung, is widely distributed in the Far East ; Korea, Japan, China and the Philippines. Since Otani found the parasites for the first time in the human brain in 1887, it has been established that cerebral infestation occurs with the highest frequency among extrapulmonary involvement. In 0.8 to 25 percent of patients infested with the lung flukes cerebral paragonimiasis may be developed. The larvae may procedure arachnoiditis, abscess, fibrous cystic lesions and granulomas in the brain. Based on a review of the literatures and upon the 7 cases of cerebral paragonimiasis which have been observed by the authors at the National Medical Center, Seoul, Korea, the following points are stressed. 1) Males had a significantly higher prevalence than females. Cerebral paragonimiasis was most commonly found in young adults(16 to 25yrs). 2) Clinically the patients with cerebral involvement were characterized by Jacksonian type of epilepsy, headache and visual disturbance. Mental deterioration, hemiplegia, hemihypesthesia, homonymous hemianopsia and optic atrophy were the five major signs. 3) The patients having symptoms for less than 6 months developed mild leukocytosis in many cases. All the cases of cerebral paragonimiasis revealed positive reaction in the intradermal tests with purified antigens of P. Westermani. 4) On skull films multiple round or oval cystic calcification was diagnostic value for cerebral paragonimiasis. On angiogram vascular staining and abnormal vessels were not disclosed. On pneumoencephalogram subcortical atrophy or filling defect of the ventricle may be showed. 5) The predilection area of the granuloma and fibrous cystic mass were the occipital, posterior parietal and posterior temporal lobes. 6) The patients with chronic stabilized cerebral paragonimiasis. having intractable symptoms and signs, could not be improved with Bithionol treatment. But headache, vomiting, visual disturbance, facial weakness and especially intractable seizure were improved in our cases treated with surgical operation.

A Case of Primary Rhabdomyosarcoma in the Left Cerebello-Pontine Angle

The primary rhabdomyosarcoma of the brain is very rare. There are only 14 cases reported in the literatures till 1975, and the majority of them were arised in the cerebellum. The intracranial rhabdomyosarcomas may be originated from the multipotent mesenchymal cells of aberrent muscle tissue in the leptomeninges. The histological 3 types are adult pleomorphic, alveolar and embryonal type. The demonstration of cross-striation is confirmed for diagnosis of this tumor. All of these tumors tend to have a short clinical course, but the survival time seems to be slightly improved by surgical excision followed by radiotherapy. We have recently experienced one case of primary rhabdomyosarcoma in the left cerebellopontine angle of 9 year-old girl, which was confirmed by operation and complete autopsy.

Clinical Analysis of Brain Scans Using Technetium-99M

Technetium 99 M pertechnetate has become a valuable for the radioisotopic brain scan. This was introduced by Haper in 1963 and is now widely used in the medical field. The advantages are easy administration, high count rate with potential for high speed scanning, absence of beta radiation and decreasing time for test. We used Siemens Scintimat 2 Scanner with a 3x2 inch Na(T1) crystal and 151-hole collimator in our study. 10 mci Technetium 99 M was injected intravenously and obtained both lateral, anterior and posterior view in 80 cases of brain lesion from Mar. 75 to Sep. 76. The scans were classified as positive, negative and suspicious. The overall detection rate in 40 cases of brain tumors was 60%, especially high uptake in mengioma, malignant pituitary tumor, astrocytoma, metastatic brain tumor and acoustic neuroma. But in nontumors diseases of the brain including CVA, head injury and hydrocephalus the uptake rate was a little value.

Vascular Tumor of the Spine

Although a vascular tumor of the spinal cord is a fairly common lesion, and is often asymptomatic, it was recently found more frequently by contrast myelography and selective spinal angiography. The first report on an angioma of the spinal cord was made by Hebold in 1885. They may be classified as malformation composed of masses of tortuous interlacing vessels. A benign vascular tumor of the spinal cord may occur at any level and within the structures of the spinal canal. The cord involved directly by portions of the varix, foci of infarction of the involved cord may be thrombosis of the vessels of the angioma. Vascular tumors of the cord are difficult to treatment. An attempt can be made to reduce the size of the angioma by ligation or resection, but it is imperative that the blood supply to the spinal cord or nerve roots should not be injured. Roentgen therapy may be of value. We have experienced in 3 patients with vascular tumor involving the spinal epidural space. They had paraparesis or paraplegia with sensory level and urinary difficulity. Roentgenograms show perpendicular striations in the vertebral body owing to coarse trabeculations surrounding the dilated vascular spaces. Myelogram shows subarachnoid blockade in the epidural space by a tumor mass. Total laminectomy was performed, and the vascular tumor mass was removed, thereafter the neurological signs were some improved.

Acute Subdural Hematomas Review of 100 Cases

The authors reported 100 cases of acute subdural hematomas confirmed by operation from Jan. 1972 to Sept. 1975. We discussed the relationship of the type of operation to mortality in acute subdural hematomas. The types of surgical operations were divided in 4 groups. The surgical mortality rate was 19% for frontotemporoparietal craniotomy, 29% for multiple burr holes technique, 42% for craniectomy and 48% for subtemporal decompression with burr holes and total over-all mortality was 36% in our cases. The authors reviewed the literatures described the surgical operative method and it's mortality and so we thought large frontotemporoparietal craniotomy is more valuable method for operation of the acute subdural hematomas.