Brown-Sequard Syndrome due to Herniated Cervical Disc

The Brown-Sequard syndrome is commonly related with a traumatic injury to the spinal cord. Degenerative spine disease is not often reported as the cause of the Brown-Sequard syndrome, and most reports document cervical spondylosis. There are few citation, describing herniated cervical disc as the cause of a Brown-Sequard syndrome. We report a rare case of Brown-Sequard syndrome produced by herniated cervical disc.

Brown-Sequard Syndrome due to Herniated Cervical Disc

The Brown-Sequard syndrome is commonly related with a traumatic injury to the spinal cord. Degenerative spine disease is not often reported as the cause of the Brown-Sequard syndrome, and most reports document cervical spondylosis. There are few citation, describing herniated cervical disc as the cause of a Brown-Sequard syndrome. We report a rare case of Brown-Sequard syndrome produced by herniated cervical disc.

Cholesterol Granuloma of Frontal Bone

Cholesterol granuloma of frontal bone is a rare disease which usually occurs at the lateral part of the supraorbital ridge. This expanding lesion grows slowly and extends into the orbit and anterior cranial fossa. The most common symptom is proptosis. This granuloma is composed of a granulomatous reaction surrounding cholesterol crystals. Surgical treatment involves aspiration of contents and stripping or curettage of the lining which is highly successful. We experienced a case of cholesterol granuloma of frontal bone with huge intracranial extension, which was cured by surgical removal. The clinical features, radiologic, and pathologic finding were discussed and the pertinent literatures were reviewed.

Cervicomedullary Junction AVM Presenting Recurrent Intraventricular Hemorrhage

Cervicomedullary junction arteriovenous malformation(AVM) is extremely rare. The authors present a case of a cervicomedullary junction AVM in a 31-year-old woman presenting with recurrent intraventricular hemorrhage(IVH). Magnetic resonance imaging revealed the AVM(of a size of approximately 2X2.5X4cm) extending from a lower medulla to C2-3 level. Vertebral angiography demonstrated a tightly coiled vascular mass with multiple feeders (radiculomedullary arteries) and irregular-shaped aneurysm at distal part of feeder originating at right C-1 level. The patient underwent superselective embolization of upper nidus and the aneurysm. The pertinent literature is reviewed, and diagnostic and therapeutic implications are discussed.

A Case of Idiopathic Hypertrophic Cranial Pachymeningitis Associated with Tolosa-Hunt Syndrome

Idiopathic hypertrophic cranial pachymeningitis (IHCP) is a rare disease, which causes chronic progressive inflammation and thickening of the basal dura mater and produces multiple cranial neuropathies, headache, ataxia, and seizure. A 40 year-old man presented with a continuous, diffuse, dull headache with left periorbital pain, exophthalmos, ptosis and loss of visual perception. Brain MRI revealed thickened, highly enhanced pachymeninges in all supratentorial areas in association with the left cavernous sinus. A subsequent meningeal biopsy showed non-specific chronic inflammations of the pachymeninges. The patient dramatically responded to steroid therapy. To our knowledge, this is an extremely rare case of IHCP associated with Tolosa-Hunt syndrome. (J Korean Neurol Assoc 19(1):56~59, 2001

A Case of Intracardiac Migration of Distal Ventriculo-Peritonal(V-P) Shunt Catheter

No abstract available.

Spontaneous Spinal Subarachnoid Hematoma of Unknown Origin: A Case Report

Spontaneous spinal subarachnoid hemorrhage occurs less than 1% of all cases of subarachnoid hemorrhage or hematoma. The causes of spinal subarachnoid hemorrhage or hematoma, include trauma(often caused by lumbar puncture), vascular lesions, neoplastic lesions, coagulopathy, hypertension and Behcet's disease. The occurrence of spontaneous spinal subarachnoid hematoma of unknown pathogenesis is extremely rare. We report a case of spontaneous spinal subarachnoid hematoma of unknown origin at thoracic level of a 33-year-old woman. At admission, she presented with back pain and paraparesis for 3 days prior to admission. There was no history of trauma and use of anticoagulants. On thoracic CT, the lunate shaped high density mass which displaced the spinal cord to right side at T3 to T6 was showed, but did not show contrast enhancement. On thoracic MRI, this mass was iso-signal intensity in T1 weighted image and low-signal intensity in T2 weighted image. In GDTA-enhanced MRI, the mass was not enhanced. We removed subarachnoid hematoma with total laminectomy through T4 to T6. Her neurologic deficit was fully improved and discharged. We conclude that even if the rate of spontaneous spinal subarachnoid hematoma of unknown is low, the clinical symptom may progress rapidly. Therefore, early diagnosis and removal of hematoma is essential for improvement of the patient's neurologic deficit. inhibition of vestibular nuclear complex through nhibitory Purkinje system.

Clinical Analysis of the Factors Affecting the Prognosis of Spontaneous Pontine Hemorrhage

The prognosis of pontine hemorrhage has been reported to be extremely poor, but the wide-spread use of CT scan and MRI has led to the discovery of ssmall pontinehemorrhage which previously could not have been discovered. We analysed 28 cases of pontine hemorrhage for evaluation of contributing factors to the patients prognosis from January 1994 to December 1996. A good prognosis was achieved in patients with no or mild disturbance of consciousness, 20mm or less in the transverse diameter of the hematoma, small numbers of slices in which the hematoma was found, and the hematoma localized in the tegmentum. Two patients underwent suboccipital craniectomy with removal of hematoma. But all patients died immediate postoperative period. A comatose state on admission, transverse diameter of hematoma over 20mm, large numbers of slices in which the hematoma was found, and the hematoma localized in the basotegmentum were significant poor prognostic factors.

Calcified Chronic Subdural Hematoma Associated with Arachnoid Cyst

The authors report a case of calcified chronic subdural hematoma with arachnoid cyst. A 45-year-old man had a 30-year history of epilepsy. Brain CT revealed lentiform calcified mass lesion with a cyst on the right temporal lobe, and an osteoplastic craniotomy was performed. The mass contained a clay-like substance with shiny crystal. And microscopically, a thick fibrous membrane with a band of calcification was seen.Postoperatively, the frequency of epolepsy decreased. To the author's knowledge, this is the first report to document calcified chronic subdural hematoma associated with arachnoid cyst.

Extrasinusal Dural Arteriovenous Malformation Misdiagnosed as Intraorbital Tumor

Dural arteriovenous malformations are rare, accounting for 10-15% of all intracranial arteriovenous malformation and are thought to be acquired lesion caused by dural sinus thrombosis. The authors report a rare case of extrasinusal dural arteriovenous fistula in the right middle fossa adjacent to the superior orbital fissure. During the preceding 17 years, this 31-year-old female had complained of proptosis and ocular pain in the right eye. Computed tomography and magnetic resonance imaging showed a retrobular intraconal mass in the right orbit; Angiography revealed an extrasinusal dural arteriovenous fistula in the right middle fossa adjacent to the superior orbital fissure, which drains into the superior ophthalmic and inferior temporal vein. After embolization of the fistula by injection of N-butylcyanoacrylate(NBCA), we intended to remove the retrobulbar intraconal mass seen on CT and MRI by means of a unilateral partial orbitotomy on the supraorbital rim and orbital roof, and to this end, explored the right orbit. We were unable, however, to locate any mass lesion in the orbital cavity, and postoperative CT and MRI showed no such lesion. We were of the opinion that the mass shown on preoperative CT and MRI was a dilated intraorbital vein structure which disappeared after embolization, operative ligation and cutting of the dural arterivenous fistula. Finally, proptosis and ocular pain disappeared, and the patient recovered with any no neurologic deficit.

A Case of Thyroid Follicular Carcinoma Metastatic to the Petrous Bone

Among thyroid cancer patients, metastatic skull bone is rare, especially in the skull base region. The authors describe the case of a 42-year-old man with thyroid follicular carcinoma which metastasized to the left petrous bone. During the previous year, the patient had suffered from left tinnitus, hearing loss and peripheral facial nerve palsy; An CT and MRI scans demonstrated severe permeative bone destruction, as well as an enhancing soft tissue mass in the left petrous bone. Left carotid angiography revealed multiple feeding vessels, mainly via the occipital and superior laryngeal artery. The feeders were occluded by intra-arterial embolization with N-butylcyanoacrylate(NBCA). The patient underwent subtotal petrosectomy with near total removal of the tumor, followed by total thyroidectomy. He returned to work one month postoperatively and showed no evidence of recurrence during the follow-up period of seven months.

Factors Contributing to the Facial Paralysis after Temporal Petrous Fractures

One of the common serious consequences of trauma to the temporal bone is facial nerve paralysis. Several attempts have been made to evaluate the relationship between the radiological findings and traumatic facial paralysis. These works have demonstrated the usefulness of high-resolution computed tomogrphy in assessment of facial nerve pathway. The authors tried to clarify the significant factors contributing to the facial nerve paralysis due to temporal petrous fractures clinically and radiologically including the high resolution CT findings. Fifty eight patients with 66 petrous fractures were reviewed in this context. Various clinical factors including hearing disturbance, CSF otorrhea demonstrating the objective traumatic evidences were reviewed. Plain X-ray findings and CT findings were reviewed as radiologic evidences. The radiologic factors were fracture evidence and wide fracture gap(more than 1mm) in plain film. Among CT findings, evidence for blood in middle ear, blood in mastoid air cells, ossicular disruption, fracture line compromising the facial nerve pathway from internal acoustic canal to mastoid portion and multiplicity of fracture lines were reviewed. These factors were analyzed statistically. In this study, it was found that traumatic bony involvement in facial nerve pathway did not necessarily mean facial paralysis. The most relavent factor contributing to the traumatic facial paralysis was multiple petrous fractures.

A Case of Axis Spondylolysis Causing Quadriparesis: Case Report

Cervical spondylolysis is an extremely rare abnomality of unknown etilogy, first described by Hadley. It is defined s a corticated cleft between the superior and inferior articular facets of the articular pillar, the cervical equivalent of the pars interarticularis in the lumbar spine. A 50-yar-old woman was presented with occipital headache, and pain in the upper neck region. Neurological examination revealed the patients inability to walk because of quadriparesis with mild hypesthesia in both hands and feet. The DTR was hyperactive and pathological reflexes, including Babinski's and Hoffman's, were positive bilaterally. CT showed the bilateral pars interarticularis defects and spinal canal stenosis. MRI revealed signal alteration on the upper spinal cord which was compromised due to the hypertrophied ligamentum flavum. Decompressive laminectomy of C2 was performed and the patient's neurological deficits had recovered to some extent and resulting to her ability to walk without assistance.

Primary Spinal Malignant Melanoma in the Cervical Spinal Cord: Case Report

The primary melanoma of spinal cord was rarely reported in the literatures. The authors report a case of primary spinal maligmant melanoma in the cervical spinal cord. A 41-year-old man presented several months history of right shoulder pain and right hemiparesis. Plain X-ray of the cervical spine, myelography, computerized tomography and magnetic resonance imaging showed intradural mass from third to fifth cervical spine level. The operation was performed, and intradural intra-and extramedullary brownish black tumor, which focally infiltrated to the dura and inner surface of lamina, was removed and the histological diagnosis was maligmant melanoma. And then chemotherapy with vincristine, bleomycin, cisplatine, followed by whole central nervous system radiation therapy was performed. The patient was discharged and followed up with no neurological interval change. The pertinent literature of spinal cord melanoma is reviewed and its rareness is discussed.

A case of Metastatic Brain Tumor Associated with Typical Meningeal "Tail Sign"

Many authors have been concerned with the diagnosis and management of meningioma which is widely-known to have a high incidence and that its total removal can result in a good prognosis. Magnetic resonance imaging (MRI) with gadolinium enhancement technique has enabled an easier diagnosis of meningioma. Among the radiographic signs of meningioma, the so-called meningeal "tail sign" is thought to be a highly specific sign for meningiomas. However, some cases of dural based tumors(lympoma, schwannoma, sarcoidosis) with the meningeal tail sign have recently been reported. Also, some authors have suggested that the meningeal tail sign may also been taken to indicate the extent of dural involvement of meningiomas. We report our experience of a case of metastatic brain tumor with the typical meningeal tail sign along with a review of the literatures. The findings of this case suggest that the meningeal tail sign is not a specific sign reserved only for meningioma.

A Case of Chordoid Meningioma at Right Temporo-Parietal Lobe: Case Report

A large tumor located at right temporoparietal lobe was found in 25-years-old female. The brain CT scan and MR imaging revealed a large multi-lobulated mass which was composed of solid and cystic portions involving right temporoparietal lobe. Preoperative routine laboratory check showed microcytic hypochromic anemia and monoclonal gammopathy with bate-gamma bridging. The mass was removed totally by operation and histologic diagnosis resulted in chordoid meningioma surrounded by massive polyclonal lymphoplasmacellular infiltrates. After the mass was removed, the blood picture of the patient normalized and the patient discharged with neurologically free stage. We report this case with relative literatures.

Huge Cervical Intradural Lipoma in a Neurologically Intact Patient: Case Report

Intradural lipomas not associated with spinal dysraphism are rare tumors of the spinal canal. The clinical course of most of the patients with intradural lipoma is slowly progressive with increasing leg weakness and gait disturbance during the first 5 years of life or early adulthood. Since neurologic deficits usually occur very slowly and insidiously, symptoms are present over 2 years in the majority of patients before a diagnosis is made. In view of such a clinical course, a huge intradural lipoma presenting with no neurological deficits in an adult is a very rare case. We present our recent experience with a case of a huge intradural lipoma of the cervical cord without any association with spinal dysraphism and other anomalies of the spine in a neurologically intact adult patient. A review of the literature is also discussed.

Aneurysmal Bone Cyst of the Second Cervical Spine

Aneurysmal bone cysts are lytic lesions that have been described in virtually every portion of the skeleton but most commonly occur as solitary lesions in the metaphyseal portions of long bones. One fifth of aneurysmal bone cysts occur in the spine where they most frequently involve the posterior elements. In the spine, aneurysmal bone cyst have been reported to occur in the lower thoracic and lumbar regions, but their occurrence in the cervicodorsal area is uncommon. In this case, the second cervical vertebral body and posterior elements are affected. Fortunately, the lesion didn't invade into the spinal canal. The main symptom on admission was pressure pain, tenderness and motion limitation of the cervical spine. We removed the lesion involving posterior elements of second cervical spine and used horse-shoe shaped pediatric C-D device for occipito-cervical fixation. The clinical symptoms were resolved after operation. The clinical, radiologic, operative and pathological findings are reported and the corresponding literature are reviewed.

Clinical analysis of Stereotactic Aspiration in Basal Ganglia Hematoma

We analyzed 54 cases of spontaneous intracerebral hematoma in the basal ganglia who had been admitted to Pusan National Hospital from June, 1991 to December, 1992 and underwent CT-guided stereotactic aspiration. Fifity four cases had basal ganglia hematoma with or without ventricular rupture. In 12 cases out of them, the residual hematoma could be completely evacuated by urokinase irrigation through a catheter introduced into the cavity of hematoma. Patients with preoperatively poor neurologic condition, large or deep-seated hematoma, or the operation undergone before 6 hours from ictus, had worse outcome. In the case whose hematoma was removed more than 60%, Glasgow Outome Scales were not changed significantly. Patients of spontaneous intracerebral hematoma mostly are older age, so careful observation and medical treatment are required to prevent postoperative complications and improve general condition.

A Case of Oligodendroglioma in the Lateral and Third Ventricles

Oligodendroglioma that occurs in the ventricle has been reported uncommonly. The case is reported of a 38-year-old man who presented with severe headache and vomiting and was discovered to have an oligodendroglioma in the lateral and third ventricles. The clinical presentation, radiological finding, pathology and response to radiation are described with brief review of general biology in oligodendroglioma.