Clinical Analysis of Results of Shunt Operation for Hydrocephalus Following Traumatic Brain Injury / 대한신경손상학회지

OBJECTIVE: Ventricular enlargement following head injury is a frequent finding but cases requiring shunt operation are rare. The incidence and developing factors of post-traumatic hydrocephalus (PTH) have been variously reported, but studies for factors influencing outcomes of shunt operation for PTH are rare. The incidence of PTH requiring shunt operation, causing injuries, and factors influencing outcome of shunt operation need to be identified. METHODS: In total, 1,142 patients suffering from traumatic brain injury (TBI) between January 2007 and December 2012 were admitted to our department. Of them, 23 patients underwent shunt operation for diagnosed PTH. In this clinical study, we reviewed retrospectively our TBI database and in the 23 patients, we evaluated outcomes with Glasgow Outcome Score just before the operation, at 14 days, 3 months, and 6 months according to initial Glasgow Coma Scale (GCS) score, interval time between shunt operation and trauma, and lumbar cerebrospinal fluid (CSF) pressure. RESULTS: The incidence of PTH treated with shunt operation was 2.01%. Subdural hematoma (SDH) was the most common preceding head injury. The outcomes of shunt operation were not related with lumbar CSF pressure or interval time from trauma, but initial GCS score correlated with the outcome. CONCLUSION: In present study, 2.01% of TBI patients underwent shunt operation. SDH was the most common preceding injury. Admission GCS score was related to the outcome of shunt operation. However, there were no correlation between the outcome of shunt operation and initial lumbar CSF pressure or interval time of shunt operation after the trauma.

Role of Serum Ca and 1,25(OH)2D3 as Predictor in Bone Metabolism Abnormality by Chronic Medication of Anticonvulsant

PURPOSE: Chronic use of anticonvulsant bring about abnormalities of bone metabolism, as hypocalcemia, rickets and osteomalacia. Early detection and treatment of abnormalities is important to pediatric patients. To investigate the usefulness of the serum Ca and 1,25(OH)2D3 as an predictor of bone metabolism abnormality, the study was done. METHODS: Serum Ca, P, ALP and 1,25(OH)2D3 were measured and analyzed in 48 children who diagnosed as convulsive disorder and took anticonvulsant medication over 6 months in Pediatric Department of Kyung Hee Medical Center. RESULTS: 1) Average duration of medication was 3.4+/-2.5yrs. 2) Values of serum Ca and P, ALP, 1,25(OH)2D3 were normal. 3) Serum levels of anticonvulsants were therapeutic range. 4) 1,25(OH)2D3 had significant correlation to serum Ca (P<0.005) and P (P<0.05) but no correlation to ALP. 5) Duration of medication had significant correlation to 1,25(OH)2D3 (P<0.05) but no correlation to Ca. 6) Duration of medication had no correlation to 1,25(OH)2D3 and Ca. CONCLUSIONS: Because 1,25(OH)2D3 is a good predictor for change of bone metabolism by chronic medication of anticonvulsant than Ca, its regular check is necessary.