Prognostic Factors of Primary Intraventricular Hemorrhage

OBJECTIVE: Primary intraventricular hemorrhage(PIVH) is uncommon and accounts for only 3.1 % of all non-traumatic intracerebral hemorrhage. The aim of this study is to analyze clinical characteristics, image features, etiology and prognostic factors of outcome in patients with PIVH. METHODS: We identified 25 patients with PIVH during 9-year period between 1994 and 2002 at our institute. The clinical data, complimentary examination, outcome and computed tomographic blood amounts were reviewed. RESULTS: Major symptoms included sudden decreased level of consciousness, headache, nausea/vomiting and neck stiffness. Cerebral angiography was performed in 12 patients(48%) and revealed vascular malformation in 6 patients(24%). The positive result of angiography was more common in young patients and among vascular malformation the incidence of Moyamoya disease was relatively high(4 patients). Other causative factors were coagulation disorder, arterial hypertension, tumor bleeding. Outcome were death in 9 patients(36%): 7 patients(28%) died by direct consequence of bleeding and 2 patients died after other adverse events(sepsis, hepatic failure) but prognosis of survivor was good. Factors correlating with the outcome were the presence of coagulopathy, initial Glasgow Coma Scale(GCS), obstruction of 4th ventricle and ventricular blood amount including hemorrhagic dilatation of temporal horn of lateral ventricle, 3rd and 4th ventricle. CONCLUSION: The poor prognosis factors of PIVH are the presence of coagulopathy, low initial GCS, obstruction of 4th ventricle and large ventricular blood amount. Additionally patients whose initial clinical condition is not serious need an appropriate work up including cerebral angiography, because cause of bleeding is vascular malformation especially in young patients.

The Effect of Intraventricular Methotrexate in a Patient of Disseminated Anaplastic Oligodendroglioma: Case Report

Oligodendrogiomas account for about 4 per cent of intracranial gliomas and surgery is known to be an essential first step to establish an accurate diagnosis and when oligodendrogliomas recur with or without anaplastic features after initial resection, radiation and chemotherapy consisting of the administration of procarbazine, lomustine, and vincristine are usually indicated. We report our experience of an excellent result with intraventricular methotrexate chemotherapy for a patient with disseminated anaplastic oligodendroglioma. A 29-year-old male patient presented with diplopia and headache for two months. MRI showed a irregular, faintly enhanced mass in the posterior fossa. The hisotological diagnosis was an anaplaplastic oligodendroglioma and he was treated with chemotherapy of PCV regimen and radiotherapy followed by surgery. CSF dissemination was revealed by a follow-up MRI during the period. Intraventricular methotrexate(0.175mg/kg) was given twice a week for 4 weeks through ommaya reservoir and the size of the multiple tumors was decreased significantly on follow-up MRI. This case report suggests that an aggressive treatment involving intravent-ricular chemotherapy may be helpful even when anaplastic oligodendrogliomas disseminates to leptomeninges.

Extramedullary Plsasmacytoma Developed in the Thoracic Epidural Space: Case Report

Spinal cord compression associated with plasma cell neoplasm is observed always in the patients suffering from the multiple myeloma or solitary plasmacytoma that occur in the marrow of the spine. Authors report a rare case of extramedullary plasmacytoma forming a mass in the epidural space of the thoracic spine. In 70 year old woman with paraplegia, MRI of the thoracic spine indicated a presence of epidural mass at the 2nd to 8th thoracic vertebrae. There was no abnormal bony changes in the spine on plain X-ray and MRI. Total removal of the epidural mass was performed by posterior approach. Histopathologic examination including immunohistochemical stain showed the plasma cell neoplasm producing IgM and kappa light chain. Cancer workup after operation including bone marrow study and whole body simple radiologic studies supported the diagnosis of extramedullary plasmacytoma.

A Case of Live Sparganum in Spinal Epidural Space

Clinical experience with a rare case of sparganosis invading the spinal epidural space was reported with review of the literatures. A 58-year-old man who had food hakit of eating raw snakes was hospitalized with chief complaint of low back and left leg pain.

Effects of Insulin, 2-Deoxyglucose and Dichloroacetate on Acute Focal Cerebral Ischemia in Rats

Hyperglycemia has been reported to worsen the tolerance of the brain to ischemia, and it has therefore been recommended that patient undergoing neurosurgical procedures not receive glucose-containing solutions. Since ischemic events lead to increased lactate production and accumulation and hence neuronal damage, the present study was designed to test the effect of insulin-induced hypoglycemia and decreased lactate by 2-Deoxyglucose and Dichloroacetate on focal cerebral ischemia in rats. Although the pre and post-ischemic blood glucose levels of control group and Dichloroacetate group showed no change, the blood glucose level of 2-Deoxyglucose group showed a significant increase(p=0.001), and insulim group a significant decrease(p=0.004). The reducing effects on the infarct zone in these three treated groups were found with statistical significance. As compared with control group, the tissue lactate levels of treated groups were decreased in both infarct zone and border zone but these data did not show statistical significance. From these observations, it is suggested that reduction of lactate production and accumulation could be beneficial by affording neuronal protection in ischemic tissues.

Post-Traumatic Cerebral Infarction

We report a series of 19 consecutive patients with post-traumatic cerebral infarction. Post-traumatic cerebral infarction(PTCI) was diagnosed by CT within 24 hours of admission in 6 cases and up to 14 days after admission in 13 cases of 1092 patients who required cranial CT for trauma during the period. The frequency, vaascular territories, cause, and mortality rate of post traumatic cerebral infarction were discussed.

The Effect of Intracisternal Urokinase for the Development of Hydrocephalus after Experimental Subarachnoid Hemorrhage

The authors has investigated the effect of intracisternal urokinase on the multihemorrhage canine model of chronic post-subarachnoid hemorrhage(SAH) hydrocephalus. Each of 16 adult mongrel dogs was assigned to one of two experimental groups. All animals received a total of 13ml of fresh unheparinized autologous blood via three cisternal injections. Eight animals were treated by intracisternal injection of 20,000 IU of Urokinase every 12 hours for 3 days, and the remaining were not treated. The changes in ventricular volumes were measured by computed tomography(CT) before and 3 months after the initial subarachnoid blood injection. To compare the changes of hydrodynamic properties in chronic phases of post-SAH hydrocephalus, the pressure-volume index(PVI) technique of bolus manipulation of cerebrospinal fluid(CSF) was used to measure the volume-buffering capacity of neural axis and the resistance to the absorption of CSF(before SAH, post-SAH 1 month, 3 months). The final ventricular volume at 3 months of control group was 4 times greater than the initial volume, but Urokinase group less than two times. The mean measured PVI values of control group and Urokinase group were 3.98+/-0.76ml(+/- standard deviation(SD)) and 4.01+/-0.82ml in baseline study, 3.09+/-0.96ml and 3.70+/-0.84ml in post-SAH 3 months. The mean resistance of CSF outflow of control group and Urokinase group were 10.30+/-2.24mm Hg/ml/min), and 10.34+/-1.98mm Hg/ml/min in baseline study. At 1 month and 3 months after SAH control group maintained high absorptive resistance(29.54+/-11.50mm Hg/ml/min, 22.43+/-3.82mm Hg/ml/min), whereas the resistances of Urokinase group were slightly increased and then returned to the original levels(16.04+/-4.87mm Hg/ml/min, 12.87+/-3.06mm Hg/ml/min). The results described in this experimental study indicated that if fibrinolysis of the subarachnoid blood clot can be achieved rapidly after SAH, the complicating chronic hydrocephalus might be prevented.

Effect of Allopurinol on Brain Infarction Following Middle Cerebral Artery Occlusion in Rats

Of the many potential source of free radial generation, the enzyme xanthine oxidase has been shown to be important in ischemia in non-cerebral tissues. Oxygen-derived free radicals have been implicated in various pathological conditions including ischemia. Xanthine oxidase serve as a source of oxidizing agents such as superoxide radical and hydrogen peroxide. It is investigated that the effect of a specific xanthine oxidase inhibitor, allopurinol, on infarct size in a model of continuous partial cerebral ischemia in rats. Infarct volume was measured by triphenyl tetrazolium chloride staining of brains removed 24 hours after middle cerebral arterial occlusion. Cortical tissue was more effectively protected than basal tissue, especially in allopurinol pretreated group. On histological examinations, hemispheric swelling, PMN cell infiltration and endothelial damage were noted irrespective of allopurinol treatment. It was speculated that free radicals are important in infarction secondary to partial continuous cerebral ischemia and that xanthine oxidase may by the primary source of these radicals.