Microbleeds in the Corpus Callosum in Anoxic Brain Injury

Purpose@#This study was performed to evaluate the relationship between callosal microbleeds and anoxic brain injury. @*Materials and Methods@#Twenty-seven patients with anoxic brain injuries were analyzed and retrospectively compared to the control group of patients without a history of anoxic brain injury using Fisher's exact test regarding comorbidities and cerebral microbleeds. The patient group was subdivided according to the presence of callosal microbleeds. Fisher's exact test was used to compare the presence of typical MRI findings of anoxic brain injury, use of cardiopulmonary resuscitation, and prognosis. The Mann-Whitney U test was used to compare the interval between the occurrence of anoxic brain injury to MRI acquisition. @*Results@#The prevalence of cerebral microbleeds in the patient group was 29.6%, which was significantly higher than that in the control group at 3.7% (p = 0.012). All cerebral microbleeds in the patient group were in the corpus callosum. Compared with the callosal microbleed-absent group, the callosal microbleed-present group showed a tendency of good prognosis (6/8 vs. 11/19), fewer typical MRI findings of anoxic brain injury (2/8 vs. 10/19), and more cardiopulmonary resuscitation (6/8 vs. 12/19), although these differences did not reach statistical significance (p = 0.35, p = 0.19, and p = 0.45, respectively). @*Conclusion@#Callosal microbleeds may be an adjunctive MRI marker for anoxic brain injury.

Respiratory syncytial virus-associated seizures in Korean children, 2011–2016 / 소아과

PURPOSE: Respiratory syncytial virus (RSV) infection can cause various neurological complications. This study aimed to investigate the RSV-associated neurologic manifestations that present with seizures. METHODS: We retrospectively reviewed the medical records of patients aged less than 15 years with laboratory-confirmed RSV infections and seizures between January 2011 and December 2016 in a regional hospital in South Korea. RESULTS: During this period, 1,193 patients with laboratory-confirmed RSV infection were identified. Of these, 35 (35 of 1,193, 2.93%; boys, 19; girls, 16; mean age: 20.8±16.6 months) presented with seizure. Febrile seizure was the most common diagnosis (27 of 35, 77.1%); simple febrile seizures in 13 patients (13 of 27, 48.1%) and complex febrile seizures in 14 (14 of 27, 51.9%). Afebrile seizures without meningitis or encephalopathy were observed in 5 patients (5 of 35, 14.3%), seizures with meningitis in 2 (2 of 35, 5.7%), and seizure with encephalopathy in 1 (1 of 35, 2.9%) patient. Lower respiratory symptoms were not observed in 8 patients. In a patient with encephalopathy, brain diffusion-weighted magnetic resonance imaging revealed transient changes in white matter, suggesting cytotoxic edema as the mechanism underlying encephalopathy. Most patients recovered with general management, and progression to epilepsy was noted in only 1 patient. CONCLUSION: Although febrile seizures are the most common type of seizure associated with RSV infection, the proportion of patients with complex febrile seizures was higher than that of those with general febrile seizures. Transient cytotoxic edema may be a pathogenic mechanism in RSV-related encephalopathy with seizures.

Diffusion Tensor Imaging and Quantitative Magnetic Resonance Volumetric Assessment in the Diagnosis of Hemimegalencephaly: A Case Report

A 27-year-old female presented with repeated seizures. As the left frontal lobe volume was enlarged in comparison with the right frontal lobe, hemimegalencephaly was suggested. Abnormal white matter fiber tracts running from the left frontal lobe to the fornix and hippocampus were found on diffusion tensor imaging (DTI). We performed quantitative measurements of brain volume and confirmed hemimegalencephaly. DTI and MRI-based volumetry techniques could be useful to objectively diagnose hemimegalencephaly.

Size Reduction of an Intracranial Aneurysm after Resolution of Vasospasm: A Case Report

Vasospasm after subarachnoid hemorrhage may alter intracranial hemodynamics. We report a case which showed significant size reduction of an unruptured intracranial aneurysm after resolution of vasospasm. This case may suggest that aneurysm size can be affected by vasospasm, which is presumably related to changes in hemodynamics or spontaneous thrombosis.

Retrograde Stent-assisted Coil Embolization of Wide-neck or Branch-incorporated Posterior Communicating Artery Aneurysm

Endovascular coil embolization using a balloon- or stent-assisted technique for the treatment of wide-necked posterior communicating artery (PcomA) aneurysms is well established. However, complete aneurysm occlusion with preservation of the PcomA can be difficult in case of wide-neck aneurysms with a PcomA incorporation. We present two cases of stent-assisted coil embolization using a retrograde approach through the posterior circulation for wide-neck or branch-incorporated PcomA aneurysms. Retrograde stenting was successful without periprocedural complications. These aneurysms were completely occluded. The patency of the PcomA was maintained in all cases.

Advances in magnetic resonance technique for tumor imaging

The development of advanced magnetic resonance (MR) imaging techniques for tumors has not only lead to improved diagnostic accuracy, but has also assisted with tumor staging, surgical planning, and postoperative follow-up study. Recently introduced and/or clinically used MR imaging techniques for tumors, including chemical exchange saturation transfer imaging, molecular imaging, magnetic resonance spectroscopy, perfusion, and blood flow suppression techniques, could improve diagnostic accuracy and provide useful information to guide the management of tumors. It is essential to properly obtain and evaluate advanced MR images for tumors, depending on the specific characteristics of each tumor.

Pure Intrasellar Meningioma Located Under the Pituitary Gland: Case Report

Most intrasellar meningiomas are located in the subdiaphragmatic and supraglandular region because they originate from the diaphragma sellae. Subglandular meningiomas located under the pituitary gland are extremely rare. Intrasellar meningiomas in the subdiaphragmatic and subglandular region probably originate from the dura in the sellar floor. We report a case of a subglandular meningioma along with a review of the literature.

Risk Factors for Developing Large Emboli Following Carotid Artery Stenting

OBJECTIVE: The introduction and development of the embolic protecting device (EPD) has resulted in a decreased rate of stroke after carotid artery stenting (CAS). The authors performed a retrospective study to investigate the risk factors for developing large emboli after CAS which can lead to ischemic events. METHODS: A total of 35 consecutive patients who underwent CAS between January 2009 and March 2012 were included in this study. Patients were divided into two groups including those with small emboli (group A; grade 1, 2) and those with large emboli (group B; grade 3, 4). The size and number of emboli were assigned one of four grades (1=no clots, 2=1 or 2 small clots, 3=more than 3 small clots, 4=large clots) by microscopic observation of the EPD after CAS. We compared demographic characteristics, medical history, and angiographic findings of each group. RESULTS: Thirty-five patients underwent CAS, and technical success was achieved in all cases. Twenty-three patients were included in group A and 12 patients in group B. Our results demonstrated that advanced age [odds ratio (OR) 1.24; 95% confidence interval (CI) 1.01-1.52; p=0.044] and smoking (OR 42.06; CI 2.828-625.65, p=0.006) were independent risk factors for developing large emboli after CAS. CONCLUSION: In patients with carotid artery stenosis treated with CAS, advanced age and smoking increased the number and size of emboli. Although use of an EPD is controversial, it may be useful in CAS in patients with risk factors for large emboli in order to reduce the risk of ischemic events.

A Case of Cervical Disc Herniation with Paresthesia in Both Arms and Tic Mimicking Motions

Intervertebral disc herniation is rare in children and is reportedly related with disc calcification and traumatic injury. We report an 8 years old girl, who complained of tingling sensation in both arms and intentional tic like neck stretching for about 1 month. She had got unnoticed whiplash Injury 2 weeks before symptoms. She also had been taking lessons for taekwondo for one and half year. Physical examination was unremarkable. Her symptoms got aggravated over the next 4 weeks. Plain vertebral x-ray showed no abnormalities, but cervical spinal MRI revealed disc central herniations at C 5-6 and C 6-7 levels. We concluded that her paresthesia and tic like motion were related with cervical disc herniation from hyperflexion neck injury.

Arteriovenous Fistula at Scalp: Rapid Progression After Embolization of Contralateral Facial Arteriovenous Malformation / 신경중재치료의학

Multiple craniofacial arteriovenous malformations (AVM) are rare, and they are hemodynamically related to each other by complex and intercommunicating vascular networks. This report presents a case with two craniofacial AVMs located in anatomically different regions. One AVM changed in flow amount and venous drainage route after embolization of the other one, which may suggest a new guideline for treatment of multiple craniofacial AVMs.

Hypereosinophilia with Multiple Thromboembolic Cerebral Infarcts and Focal Intracerebral Hemorrhage

We report a case of hypereosinophilia causing multiple areas of cerebral infarcts. A 52-year-old Korean man presented with dysarthria and weakness in both arms. A brain MRI revealed multiple acute infarcts in the distal border zone with focal intracerebral hemorrhage, whereas a cerebral angiogram was not remarkable. The eosinophil count was 5,500/microLiter and was accompanied by elevated cardiac enzyme levels. The pattern of cerebral infarcts and laboratory results suggest a thromboembolic infarction associated with hypereosinophilia.

Brain MR Finding of beta-Fluoroethyl Acetate Rodenticide Intoxication: A Case Report

beta-fluoroethyl acetate rodenticide intoxication can manifest as several different clinical abnormalities such as respiratory, neurologic, cardiologic and fluid-electrolyte problems. We report here on the MR findings of a case that showed symmetric cytotoxic edema in the white matter of the cerebral hemispheres after the ingestion of beta-fluoroethyl acetate rodenticide by a woman who was attempting suicide.

Clinical Manifestation and Differential Diagnosis of Thyroid Follicular Neoplasm / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: A preoperative differential diagnosis between follicular adenoma and follicular carcinoma of thyroid is very difficult, and the standard basis for distinction is the presence of capsular and/or vascular invasion. In this study, we analyzed the findings of preoperative tests and clinical features to facilitate the differential diagnosis and treatment of the follicular neoplasm. SUBJECTS AND METHOD: A retrospective review of medical records was carried out on 104 patients who had undergone thyroid surgery and had been diagnosed with thyroid follicular adenoma or carcinoma from 1995 through 2004. The final pathologic diagnosis was compared to the various clinical data including the result of fine needle aspiration cytology (FNAC) and ultrasonographic findings. RESULTS: Of total 104 cases, 82 were follicular adenoma and 22 were follicular carcinoma. The incidence of carcinoma was significantly higher in male than in female. The result of FNAC were divided into 6 cytodiagnostic groups, namely, inadequate, colloid nodule without atypia, colloid nodule with atypia, follicular neoplasm without atypia, follicular neoplasm with atypia, or highly suspicious malignancy. The incidence of carcinoma was significantly higher in the groups with atypia such as colloid nodule with atypia, follicular neoplasm with atypia, and highly suspicious malignancy than in the groups without atypia. The incidence of follicular carcinoma was significantly higher in ill-defined marginal cases. Calcification on ultrasonography also indicated the possibility of malignancy. CONCLUSION: The incidence of follicular carcinoma was significantly high in male patients, atypia in FNAC, and ill-defined margin and calcification on ultrasonography.

A Case of Paraneoplastic Limbic Encephalitis Associated with Primary Adenocarcinoma of Lung / 결핵및호흡기질환

Paraneoplastic limbic encephalitis is a rare disorder that is characterized by personality changes, irritability, depression, seizures, memory loss and dementia, and is commonly associated with small cell lung cancer. The cause is unknown but it is believed to be an autoimmune disorder that develops secondary to a carcinomatous process. We report a patient with the clinical feature consistent with limbic encephalitis. A 64-year-old women developed disorientation, memory loss and general weakness. She was diagnosed with NSCLC (adenocarcinoma) with a brain metastasis 1 year earlier and was treated with radiation and chemotherapy. Although the lung mass and brain metastatic lesions had improved, the brain T2-weighted MRI showed high signal intensity in the right temporal region. This lesion consisted of with limbic encephalitis and was negative to the other viral and immune markers. The patient's symptoms did not improve after steroid treatment. Our case demonstrated that a NSCLC (adenocarcinoma) also can be associated with paraneoplastic limbic encephalitis.

Radiologic Diagnosis and Surgical Treatment of Primary Hyperparathyroidism / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: With the advance in serum chemical analyses, the diagnosis of primary hyperparathyroidism has become more common, and patients without signs or symptoms attributable to the disease have increased. We performed this study to obtain further understanding and more supporting ideas for the diagnosis and treatment of primary hyperparathyroidism. SUBJECTS AND METHOD: A retrospective study of 19 patients with primary hyperparathyroidism who were treated by surgery from march 1999 to June 2005 was performed. RESULTS: Preoperative localization was performed with computerized tomography, ultrasonography and 99m Tc-sestamibi scan. A 99m Tc-sestamibi scan has an accuracy of 84% and ultrasonography has an accuracy of 67% for parathyroid tumors. Combination of ultrasonography and 99m Tc-sestamibi scan had the accuracy of 93%. All patients were treated by surgery. After surgery, serum calcium and intact parathyroid hormone levels returned rapidly to normal. Parathyroid carcinomas were firm in consistency and adhered to the surrounding tissue and thyroid gland. CONCLUSION: Ultrasonogram and 99m Tc-sestamibi scan was effective for preoperative localization of tumor. If parathyroid carcinoma is suspected, the mass with potential local invasion or regional metastasis should be removed with en bloc resection.

Clinical Characteristics of Pilomatricoma in the Head and Neck / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Pilomatricoma, also known as calcifying epitheliomas of Malherbe is uncommon, benign skin neoplasm that arise from outer root sheath cell of hair follicle or hair follicle of sebaceous glands. In more than half of the cases, pilomatricoma typically involves the head and neck followed by upper extremities and trunk, with the majority occurring in children. The purpose of this study is to analyze the data from the author's experience with head and neck pilomatricoma and to discuss diagnostic and therapeutic management. SUBJECTS AND METHOD: A retrospective analysis of the patients of pilomatricoma treated between 1994 and 2004 revealed 21 cases of head and neck pilomatricoma. RESULTS: The typical clinical manifestation of pilomatricoma was non-tender, firm, subcutaneous, and nodular mass. The age range was from 9 months to 62 years (mean 17.4 years). The male-to-female ratio was 4 : 3. The common sites of occurrence were the neck (33%), cheek (24%), suboccipital (14%), preauricular (14%). The size of the mass ranged from 0.5 cm to 3 cm, and the mean was 1.1 cm. CT with contrast enhancement scans revealed densely calcified, mild enhancing and well circumscribed soft tissue densities in subcutaneous tissues. Additionally, MRI with gadolinum enhancement scans revealed partially enhanced, well demarcated and intermediate signal intensity mass lesions. Surgical excision was curative in all cases. CONCLUSION: Pilomatricoma is cutaneous neoplasms that occur commonly in the head and neck region. Even if the preoperative diagnosis may be difficult in some cases, pilomaticoma must be considered in the differential diagnosis of a superficial head and neck mass.

Two Cases of Organized Hematoma of Maxillary Sinus with Bone Erosion

An organized hematoma in the maxillary sinus can be formed by organizing procedure of hematoma in the unaerated maxillary sinus. It is a rare disorder of unknown etiology. Clinical symptoms, signs, and radiologic appearance of the hematoma mimick tumors at the initial diagnosis. An expansile organized hematoma in the maxillary sinus may induce erosion or destruction of the maxillary bony wall. Therefore, it may be difficult to distinguish such lesion from malignant tumors. We report two cases of an organized hematoma in the maxillary sinus presenting with erosion of the maxillary sinus wall with a brief review of the literature.

Extramedullary Plasmacytoma of Small Bowel Mesentery in Associated with Cecal Cancer: A Case Report

Extramedullary plasmacytoma is a rare disease that is histopathologically defined as a solitary tumor composed of a monoclonal proliferation of cells with plasmacytic differentiation in an extramedullary site. Most of these tumors occur in the submucosa of the upper aerodigestive tract, and they rarely occur in the small bowel mesentery. We report here on a case of extramedullary plasmacytoma of the small bowel mesentery that was in association with a cecal cancer. Abdominal ultrasound and CT revealed a lobulated soft tissue mass with a cystic portion and peripheral calcification. In this case, the preoperative radiological diagnosis was difficult due to accompanying cecal cancer.

Pineal Germinoma with Extracranial Metastases: Case Report

Pineal germinoma is the commonest pineal region tumor of childhood and adolescence. Metastatic germinoma most commonly occurs via the cerebrospinal fluid (CSF), and it is usually limited to the cerebrospinal axis. Extacranial hematogenous metastasis is known to be very rare. We report here on a case of pineal germinoma with gradual extracranial metastases that occurred both through the CSF pathway and by hematogenous spread. The patient had multifocal CSF seeding after his surgery for pineal germinoma, and the left iliac metastasis and lung metastasis then occurred.

Bilateral Agenesis of the Internal Carotid Artery: Case Report

Unilateral or, particularly, bilateral congenital agenesis of the internal carotid artery is a rare anomaly. We report an occurrence of the condition, arising bilaterally, and report the findings of magnetic resonance imaging and magnetic resonance angiography.