A Case of Central Pontine Myelinolysis Unrelated Serum Sodium Level in Traumatic Brain Injury Patient / 대한신경손상학회지

Central pontine myelinolysis (CPM) is a disorder wherein variable symptoms are associated with pontine dysfunction. It has been known to occur inconstantly, particularly when serum sodium in patients with prolonged hyponatremia is rapidly corrected. Further, it is known that patients with liver diseases, malnutrition, malignancy, adrenal insufficiency, and metabolic derangements are more vulnerable to this disorder. However, there is limited literature about the occurrence of CPM in patients with traumatic brain injury, especially in those with normal serum sodium levels. A 36-year-old man having no medical history was bought to our hospital due to an open skull fracture and underwent surgery. During the hospitalization period, he showed a sudden pseudobulbar palsy and rigidity. Imaging study of the brain was characteristic for CPM. He had no fluctuation of serum sodium levels during the hospitalization period. We speculate that the brain trauma itself might cause a CPM, and its pathophysiology may not be related to rapid serum sodium correction.

A Case of Penetrating Brain Injury Followed by Delayed Cerebrospinal Fluid Leakage / 대한신경손상학회지

Although penetrating brain injury is rare, it is associated with high morbidity and mortality. In several studies, even if very few patients arrive at the hospital alive, half of them eventually die, and the other half have significant neurological sequelae. Cerebrospinal fluid (CSF) leakage caused by traumatic brain injury is common. Therefore, we should be aware of the complications, prognosis, and follow-up strategies of penetrating brain injuries. A 55-yearold man was brought to our hospital with diffuse cerebral contusion and skull fracture. Three weeks after successful surgery, the patient returned with a large amount of pneumocephalus and pneumoventricle caused by delayed CSF leakage. Fortunately, the patient was discharged without neurological deficits after reoperation. In the urgent situation of penetrating brain injury, the treatment and prognosis vary depending on the initial actions and clinical factors. In addition, we should be aware that a variety of complications, as well as CSF leakage, can occur in patients with penetrating brain injuries.

Clinical Feature and Outcomes of Secondary Hydrocephalus Caused by Head Trauma / 대한신경손상학회지

OBJECTIVE: Post-traumatic hydrocephalus (PTH) is a frequent and serious complication following brain injury. The incidence of PTH varies greatly among studies. The purpose of this study was to investigate the incidence and treatment of PTH in patients with head trauma. METHODS: We examined 956 patients with head trauma who visited our center from January 2012 to December 2015. The hydrocephalus diagnosis was based on radiologic findings and clinical features, and patients were classified into the mild (Group 1, Glasgow Coma Scale score [GCS] 13–15), moderate (Group 2, GCS 9–12), or severe (Group 3, GCS 3–8) brain injury group according to their GCS at admission. To compare these groups, we used age, gender, radiologic findings, PTH developmental period, and postoperative results (Glasgow Outcome Scale). RESULTS: Of the 956 patients, 24 (2.5%) developed PTH. PTH occurred in 11 (1.4%), 3 (5.6%), and 10 (7.0%) patients in Groups 1, 2, and 3, respectively. Of the 24 patients with PTH, 22 (91.7%) developed PTH within 12 weeks post-trauma; the higher the GCS, the later the onset, and the lower the GCS, the earlier the onset (p=0.019). Twenty-one patients underwent ventriculoperitoneal shunting, and 13 had improved symptoms. CONCLUSION: The incidence of PTH cannot be ignored. The possibility of PTH needs to be considered in patients with head trauma and appropriate follow-up should be undertaken. PTH is a treatable complication and patients' quality of life and neurological status can be improved if the appropriate treatment is selected and applied.

Results of Combined 360-Degree Fusion versus Posterior Fixation Alone for Thoracolumbar Burst Fractures / 대한신경손상학회지

OBJECTIVES: To identify the better option of treatment, we compared the surgical results and efficacy of combined anterior-posterior approach versus posterior fixation alone. METHODS: During a 10 years period from 2002 to 2011, 111 patients with thoracolumbar burst fracture was surgically managed at our institute. 25 patients were managed by a combined anterior-posterior surgery and 86 patients were managed by posterior fusion alone. Radiographs were repeated at 3, 6, 12 and 24 months after operation. Radiologic outcome was evaluated by measuring Kyphotic angulation and vertebral height and the clinical outcome was evaluated by visual analogue scale (VAS) score comparison. RESULTS: The average Cobb's angle difference between immediate post operative and last follow up was 15.0degrees in combined 360-degree fusion group and 7.5degrees in posterior surgery alone group. A corrections of vertebral body height between immediate post operative and last follow up was 2.27 mm in 360-degree fusion group while 0.59 mm in posterior fixation group. The VAS score decreased from 8.4 to 2.2 after post operation 24 months in 360-degree fusion group and the posterior surgery alone group decreased 9.3 to 6.2 after post operation 24 months. CONCLUSION: The combined anterior-posterior approach resulted in less deterioration of the kyphotic angle postoperatively and improvement of vertebral height (sagittal index). Clinical outcome was also better in the combined group.