Cerebral Paragonimiasis Treated with Praziquantel: Case Report

Cerebral paragonimiasis, occuring as an extrapulmonary infestation, still reamans an important intracranial parasitic disease in Korea. The authors report a 32-year-old female patient who had developed headache, vomiting and signs of the left hemispheric dysfunction for 5 months. A diagnosis of the cerebral paragonimiasis was made on the basis of brain CT findings, a positive intradermal test, and the positive results of serum and CSF levels of the anti-Paragonimus IgG antibodies(by micro-ELISA). She was treated with 75 mg/kg/day of praziquantel for 7days to confirm healing of the intracranial lesion by the follow-up brain CT and micro-ELISA associated with a marked clinical improvement. This case report highly suggests the anticipated effectiveness of praziquantel in the treatment of the cerebral infestation of Paragonimus westermani, especially in its early stage.

A Case of Multiple Meningiomas: Case Report

Despite of their frequent occurrence among the brain tumor, meningiomas are rarely seen as a multiple growth, and the incidence of multiplicity in meningioma is about 2%, except for 6.7% in Horrax' series. The authors report a case of multiple meningiomas without evidence of von Recklinghausen's disease. The patient had suffered from the headache, chocked disc and right hemiplegia for about two years which had been aggravated in these two weeks before admission. Left carotid angiogram revealed as a parasagittal giant meningioma. On operation, we did not remove single giant meningioma, but six lumps of mass variably sized from walnut to hen egg, with success. The postoperative course was uneventful and the recovery from hemiplegia was dramatic.

Cerebellar Hemangioblastoma Associated with Polycythemia: Case Report

We have experienced a case of cerebellar hemangioblastoma associated with polycythemia in 44-year old male adult who has suffered from the headache, chocked disc and visual disturbance for about 1 year and 4 months. A marked polycythemia was found but retinal angioma, cysts on the pancreas and kidney and then familial incidence were not detected. The signs of increased intracranial pressure was marked, accompanying the decreased visual acuity. Liver and spleen were not palpable. On bilateral carotid angiogram, it revealed a severe hydrocephalus, on Conray ventriculogram, obstruction of 4th ventricle by huge mass in the posterior fossa. The right vertebral angiography revealed a midline hen egg sized tumor mass which was highly vascular and was supplied mainly by PICA, SCA and PCA brances. Brain C-T scan showed the vascular mass in midline of posterior fossa by enhancement. We operated the cerebellar tumor which was solid. The uncontrollable bleeding was encountered. We performed the biopsy which revealed a hemangioblastoma. Inspite of the V-A shunt, the patient expired suddenly on 5th post-operative day.

A Case of Nerve-Root Anomaly Associated with Herniated Intervertebral Disc in Lumbar: Case Report

Nerve-root anomalies are very uncommon, and there symptoms and signs are nearly similar with those of disc herniation. So we can misdiagnois them for intervertebral disc herniation. The negative Lasegue' sign is the only distinct feature of the nerve root anomalies. The authors report a case of Nerve-Root Anomaly associated with disc herniation in lumbar 4-5 interspace, which was diagnosed preoperatively in myelogram and confirmed surgically.

Drainage of Severe Brain Abscesses(2 Cases)

Encapsulated and free pus in the substance of the brain tissue following an acute purulent infection is known as brain abscess, and which is uncommon. The brain abscess arise either as direct extention from infections within the cranial cavity or as hematogenous metastasis from infections elsewhere in the body. Since 1945, the antibiotics associated use of steroid and mannitol have been available for the treatment of brain abscess, and the result are very hopeful. The common method of surgical treatment are consist of excision and drainage and the problem of the best operative procedure has been disputed on the many neurosurgical literatures for many years. Recently we had treated 2 cases of severe otogenic brain abscesses with semicomatose patient by drainage, and good was the result compared with the other literatures. Result; 1. One case with semicoma recovered completely without any neurologic sequelae, and the other case recovered with visual disturbance. 2. The best operative procedure for the severe brain abscess considered a drainage.

Brain abscess Associated with Tetralogy of Fallot

The incidence of brain abscess in congenital heart disease marks 4-6%. Of these, tetralogy of Fallot is the most common congenital heart disase. We had experienced 2 cases of brain abscess associated with tetralogy of Fallot among 32 cases Of brain abscess from March -'57 to September-'74. Case 1;A 10 years old boy was admitted to our hospital in March-'66 because of headaches and vomiting. He had a history of Potts' operation under the impression of tetralogy of Fallot at the age of 5. Findings of clinical examination and diagnostic studies gave us an impression of a huge cystic mass in the right posterior temporo-occipital area. We aspirated about 80cc of pus, but no microoraganisms were noted on direct smear and culture. Case 2;A 7 years old boy was admitted to our hospital in August-'74 because of headaches and fever. He had been suffered from tetralogy of Fallot from the age of 3 without any surgical intervention. We made a burr hole on the right anterior temporal area under the impression of right posterior fronto-temporal mass, and aspirated about 15cc of pus. Multiple Gram positive cocci were noted on direct smear, but nothing on culture.

Significance of Temporary Occlusion of Blood Flow in the Treatment of Middle Cerebral Artery Aneurysm

After acute interruption of cerebral blood flow, various hemodynamic, morphologic and metabolic changes ensue in the occluded area. Such changes and subsequent brain damage are of great concern in the course of temporary arterial occlusion during aneurysmal surgery. Many experimental studies investigating the processes of cerebral infarction have been done through selective occlusion of intracranial vessels, and it has been known that 4 to 8 minutes interruption of cerebral blood flow results in irreversible brain damage. Cerebral resistance following vascular occlusion may be influenced by collateral circulation, hypothermia and hyperventilation. Recently we experienced two patients with right middle cerebral artery aneurysms, who were operated upon under normothermia, slight hypotension, and hyperventilation using microsurgical technique. The technique of temporary occlusion of middle cerebral artery was applied as an adjunctive method.

Studies of the Findings o Fluorescein Retinoangiographic Pictures of Papilledema in the Brain Tumor

Fluorescein retinal angography has been used in order to make differential diagnosis between true papilledema and pseudopapilledema, and to make early confirmation of the incipient papilledema. After injection of 5 cc of 10% fluorescein sodium into antecubital vein, the fluorescein retinal angiographic findings of 6 normal adults and 17 papilledematous patients of the brain tumor were obtained by Zeiss fundus camera(exciter filter:Kodak Wratten 47 A, barrier filter:Schott GG 14). 1. The characteristic findings of papilledema in the disc are: a. Leakage of fluorescein from capillaries and persistence of the fluorescence till late stage. b. Capillary dilatation. c. Microaneurysm. 2. The massive leakage of the fluorescen is seen in the patients of the 3 rd ventricular or posterior fossa tumors. 3. The decreased visual acuity is prominent in the patients showing marked capillary dilatation and microaneurysm.

A Case of Glioblastoma Multiforme Involving High Cervical, Brain Stem and Sellar Regions

A number of authors have called attention to the difficulty encountered in diagnosing tumors near the foramen magnum and have formulated symptom complexes in an effort to facilitate early recognition of these lesions. Emphasis has been placed on their bizarre symptoms and on their resemblance to the clinical picture associated with some degenerative diseases of the central nervous system, ruptured cervical disc and cervical spondylosis. Fortunately, it has been known that most of tumors around the foramen magnum are benign, extramedullary and amenable to cure by surgical excision and with minimal morbidity and mortality, provided they are diagnosed early. Recently we experienced a rare case of glioblastoma multiforme at the cervico-medullary junction. A 28-year-old Korean man was admitted to the Dept. of Neurosurgery on May 27, 1974, with 5 months history of cervical and suboccipital pain, and progressive visual disturbance. He had sustained hyperextension injury to his neck 8 months ago, and subsequently developed mild suboccipital and cervical pain which subsided easily with some analgesice. Three months later, he noticed paresthesia and tingling sensation in his upper limbs and anterior chest, especially when he turned his neck to either side. He also had pain in suboccipital region radiating to his both shoulders. Seven months later, he developed sudden paraperesis, poor vision and incoordination with severe suboccipital headache and vomiting. On admission, neurological examination disclosed clear consciousness, bilateral papilledema and abducens nerve palsy and markedly decreased vision. There were clumsiness of movement of both legs, hypesthesia in the face, decreased perception of vibration and position sense below the neck and increased deep tendon reflexes. Fine coordination movements in the upper limbs were disturbed and horizontal hystagmus was also present. Simple skull films showed destruction of the dorsum sellae and the posterior clinoid process, suggesting increased intracranial pressure. Cervical spine films were interpreted as normal. Right carotid angiograms demonstrated marked hydrocephalic patterns, and right vertebral angiograms demonstrated posterior displacement of the tip of the basilar artery and of the choroidal point. Conray ventriculogram showed a sharp filling defect at the level of lateral recess of the fourth ventricle. Suboccipital craniectomy and bilateral laminectomy of the first two cervical vertebrae were performed, disclosing a nodular, meaty, firm mass with some necrosis. The tumor was located posterolateral to the medulla and the spinal cord from the obex to the C2, compressing them and displacing the right cerebellar tonsil upward and laterally. The tumor was removed partially and Torkildsen's shunt was performed. Post-operatively he died suddenly at the end of the second week without any remarkable improvement in symptoms and signs. Pathological report was a glioblastoma multiforme. At autopsy, the tumor was originated from the cervicomedullary junction, extending posteriorly from the obex to the C2 and anteriorly along the brain stem up to the perichiasmatic region.

A Case of Pituitary Abscess

Intrasellar or pituitary abscess was first reported about a century ago, after then once relatively common but now is rare. Since 1925, about 50 cases have been reported in the literatures, of which characters were variable, but clinical very similar to one of pituitary tumor. So they were often diagnosed preoperatively as pituitary tumor. Several pathogenic factors were postulated in relation to clinical aspects. We had recently experienced a case of pituitary abscess combined with chromophobe adenoma. A 28 years old clerkman was admitted to our hospital with complaints of impared ejaculation and visual disturbance. Clinical aspects and diagnostic studies gave us a strong impression of pituitary tumor. Upon surgery we found a cystic mass in pituitary region, of which aspiration showed whitish-gray, tenacious and liquid material. Many polymorphous leukocytes were noted by direct smear, but no microorganisms were detected in culture. He had postoperatively suffered from transient polyuria and polydipsia, which soon disappeared under the medication of Esidrex. He was discharged from this hospital with recommendation of radiation therapy. Clinical features and treatment were also discussed with review of ever reported cases.

A Study of Experimental Myelography with Water Soluble Contrast Medium

Many different myelographic contrast media have been employed for the radiographic visualization of the spinal cord. Unfortunately, none has fulfilled all the requirements of an ideal contrast medium-no toxicity, complete and rapid absorption, good radiographic contrast, and miscibility with the cerebrospinal fluid. Toxic reactions have been reported from the water soluble contrast media, which require the administration of a spinal anesthesia and have thus been employed clinically only in examination of the lumbosacral area. Some authors have advocated the use of new contrast media, Conray(Meglumine iothalamate), Dimer-X, for the lumbar myelography without a spinal anesthesia and obtained good results. The present work is an attempt to provoke and emphasize the toxicologic response and the pathologic changes by variation in amount of Conray and rate of injection. Each dog was prepared with a catheter in lumbar subarachnoid space under the light anest hesia. After recovery from the anesthesia, myelography was performed by lumbar subarachnoid injection of Conray by variations in amount of Conray and rate of injection under the control of a fluoroscope. The experimental conditions were varied as follows. 1. Conray was injected in variable amounts from the lumbosacral subarachnoid space to the high cervical and intracranial subarachnoid space. 2. Conray was injected in variable rate of injection. 3. Decadron was added to Conray in another group. 4. The brain and the spinal cord including the dura and the nerve roots were taken for the pathologic study in variable durations after myelography. The results were summarized as follows. 1. A large amount of Conray injection to the high cervical and intracranial subarachnoid space produced wevere toxic reactions followed by death. 2. Rapid injection of Conray was considered to elicit more toxic reactions. 3. The toxic reactions included changes in behavior and respiration, neck muscle spasms, paresis of forelegs and hindlegs, urination, defecation and epileptiform convulsions. 4. There was no difference in toxic reactions in adding Decardon. 5. Radiographic contrast densities were somewhat less than that of Pantopaque. Conray was freely miscible with the cerebrospinal fluid, thus providing total myeloraphy. 6. No recognizable reaction was noted in gross and histopathological examination.

Clinical Observation on the Surgical Treatment of the Intractable Pain

The purpose of this report is to present the results of clinical observations on the surgical treatment of 26 patients (16 male, 10 female) with intractable pain during the period from May, 1960 to April, 1972 at the Department of Neurosurgery, Seoul National University Hospital. Age at the time of operation raged from 27 to 69 years. Duration of the pain from the onset to surgery was less than one year in most of the cases. The most common causes of the pain were the pelvic malignancies, lung cancer, and metastatic spine tumors in the order. In 20 cases of anterolateral cordotomies, the main complications were urinary retention, ipsilateral motor weakness, and decubitus. The high cervical cordotomy produced high analgesic level and less dropping of established analgesic level postoperatively. Posterior rhizotomy for intercostal neuralgia and a case of thoracic commissurotomy for intramedullary tumor were of gratifying result. The higher the pain located, the longer the pain existed, the operation was less likely to relieve the pain. High cervical cordotomy seems to be superior to high thoracic cordotomy even in the pain of leg, when it is considered in the respect of the high analgesic level, the lack of "island" of pain, and technical easiness.

Clinical Observation upon Surgical Experience in the Douloureux

The purpose of this report is to present the results of clinical observation upon 21 surgical cases with tic douloureux (female 13, male 8) during the period from January, 1960 to August, 1972 at the Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea. The average age at onset was 48 years of age ranging from 22 to 66 years. The average duration from onset to operation was 5 years. The frequency of involvement was the highest in the maxillary division, next was maxillary and mandibular division, and none in the ophthalmic division. Whole division was involved in one case. Right-sided involvement predominated by a ratio of 2 to 1 and bilateral involvement was found in only one case. Extraction of innocent teeth, ungratifying operation upon paranasal sinus had been carried out in 11 cases as consequence of misdiagnosis. Alcohol injection of peripheral branches of trigeminal nerve and medical treatment produced short-lived or none-effectiveness. Trauma to ipsilateral mandible and epidermoid cyst at cerebellopontine angle seemed to be the cause of tic doulourex in 2 cases, respectively. Major complications observed in Frazier's method group, were paresthesia, facial nerve palsy, partial paralysis of motor root, and recurrence of neuralgia. All of the peripheral nerve avulsion group developed recurrence of pin within three years. Mild decrease of cornea reflex was noted in two cases of Dandy's method group. Posterior fossa operation stands in superiority, when it is considered that some pathologic lesions are frequently found in the posterior fossa, that motor root is less frequently injured, and that the light touch is so fairly preserved in all three divisions that the least damage to the cornea is expected.

Spontaneous Cephalohematoma Associated with the Temporal Meningocele and Hemicranial Dysplasia

No abstract available.