Spontaneous Thrombolysis of Multiple Thrombi at Distal Region of Hypoplastic Vertebral Artery After Stent-assisted Angioplasty on Vertebral Artery Origin Stenosis: Angiographic Follow-up

Vertebral artery hypoplasia (VAH) can be easily overlooked if the contralateral side vertebral artery is intact, because of compensation by the contralateral artery or cerebral collateral network. The clinical relevance and hemodynamic impact of VAH is still controversial. However, VAH has recently been considered a risk factor for posterior circulation ischemia. Ischemic stroke is seldom caused by free floating thrombi (FFT) in the artery. Pathophysiology of FFT has not yet been clarified. The state of reduced blood flow such as a vertebral artery origin stenosis may cause FFT. Their instability may make them sources of recurrent artery to artery embolism. Patients with FFT will require appropriate medical and endovascular treatment. The current case illustrates a short-term angiographic change of spontaneous thrombolysis of VAH and multiple thrombi at the distal region of the stenosed lesion after stent-assisted angioplasty for a vertebral artery origin stenosis.

The Factors Affecting Enlargement of Spontaneous Intracerebral Hemorrhage

OBJECTIVE: The goal of this study is to evaluate the incidence and factors of hematoma enlargement in patients with spontaneous intracerebral hemorrhage(ICH). METHODS: We analyzed 149 cases with spontaneous ICH who underwent computerized tomography (CT) scans from January, 1995 to December, 1998. The clinical characteristics, past medical history, laboratory findings, time intervals between onset of ICH and CT scan, CT findings and results of treatment were reviewed. RESULTS: Of the total 149 patients, 28(18.8%) had hematoma enlargement, of whom 24(85.7%) underwent a first CT scan within 3 hours after onset of ICH. The incidence of hematoma enlargement significantly decreased in patients who had CT scans 3 hours later after attack. Age, sex, and site of hematoma were not related to hematoma enlargement. Patients with an irregularly shaped hematoma, inhomogenous hematoma and large hematoma had a high risk of hematoma enlargement. Hematoma enlargement was associated with a poor clinical outcome and high mortality(46.7%). CONCLUSION: Patients admitted to a hospital within 3 hours of onset of ICH, and patients with inhomogenous hematoma on CT scan, irregularly shaped hematoma, or large hematoma should be closely observed for hematoma enlargement.

Comparison of Fluid-Attenuated Inversion-Recovery Magnetic Resonance Imaging with Computed Tomography in Acute Intraventricular Hemorrhage

OBJECTIVE: Our aim is to evaluate the usefulness of fluid-attenuated inversion recovery(FLAIR) magnetic resonance(MR) imaging for detection of acute intraventricular hemorrhage(IVH) compared with pre-contrast computed tomography(CT). METHODS: Twenty-eight patients with acute IVH were evaluated with FLAIR MR imaging and precontrast CT. All MR and CT examination were performed within two days from symptom onset. One neurosurgeon and one radiologist evaluated the detectability and conspicuity of acute IVH on FLAIR MR imaging and pre-contrast CT. RESULTS: Acute IVH was detected in all patients on FLAIR MR imaging and in 23(82%) of 28 patients on pre-contrast CT. The conspicuity of IVH on FLAIR MR imaging was as good as or better than that on pre-contrast CT in 28 patient. CONCLUSION: It is suggested that FLAIR MR imaging is superior to pre-contrast CT in the diagnosis of acute IVH.

The Effects of Lipoxygenase and Cyclooxygenase Inhibitors to Meningioma Cell Proliferation in vitro

No abstract available.

A Clinical Analysis on Traumatic Subarachnoid Hemorrhage

No abstract available.

Spontaneous Thoracic Epidural Hematoma: Case Report

No abstract available.

Skull Metastasis of Thyroid Carcinoma: Case Report

No abstract available.

Neuroprotective Effects of Magnesium Sulfate and Dextromethorphan on Cerebral Ischemia after Middle Cerebral Artery Occlusion in Rats

OBJECTIVE: Much evidence implicates that excitatory amino acids play a crucial role in neuronal death under ischemic conditions, of which the neurotoxic effects are thought to be mediated by overstimulation of glutamate receptors causing a massive influx of calcium ions into the cell. The author examined the effect of MgSO4 and dextromethorphan, N-methyl-D-aspartate(NMDA) receptor antagonists, on ischemic injury in a reversible model of middle cerebral artery(MCA) occlusion in rats. MATERIALS AND METHODS: Forty Sprague-Dawley rats were equally divided into four groups and treated with vehicle(group I), MgSO4 in the amount of 90mg/kg(group II), dextromethorphan of 50mg/kg(group III), and simultaneously MgSO4 of 90mg/kg and dextromethorphan of 50mg/kg(group IV). Following the pretreatment, the animals were subjected to 90 minutes of temporary middle cerebral artery occlusion induced by means of a 3-0 poly-L-lysine coated nylon suture inserted retrogradely via the external carotid artery into the internal carotid artery and MCA. Reperfusion was achieved by retracting the occluding suture. RESULTS: Automated, volumetric measurements of the infarct size demonstrated a statistically significant decrease in GroupII, III, IV compared with GroupI. Neuroprotection was greater in Group IV(64.3% reduction in infarct volume, p<0.001, Student's t-test)than that of Group II or Group III(55.0%, p<0.001, 22.9% reduction, p<0.01, respectively). Group II showed a 41.6% reduction in infarct volume compared with Group III(p<0.001), and Group IV showed a 53.7% reduction in infarct volume compared with Group III(p<0.001). Only Group IV demonstrated protection of both cortex and striatum(p<0.001). CONCLUSION: This beneficial effect of MgSO4 and dextromethorphan in transient focal cerebral ischemia, particularly their combined synergistic effect, indicates their possible usefulness in treating patients with acute ischemic stroke.

Supratentorial Meningeal Hemangioblastoma: Case Report

Supratentorial hemangioblastomas are rare and a meningeal location is even rarer. We report a solid meningeal hemangiblastoma in left parietal region, mimicking a meningioma on CT scan. There was no manifestation of von Hippel-Lindau disease. The literature on supratentorial meningeal hemangioblastoma was reviewed.

Multiple Hypertensive Intracerebral Hemorrhage: A Case Report

Spontaneous intracerebral hemorrhage is one of the most devastating forms of cerebrovascular disease, and is most frequently caused by hypertension in the distribution of the perforating arteries. Generally, hypertensive intracerebral hemorrhage is usually a single lesion, and recurrent intracerebral hemorrhage due to hypertension is not a rare condition. But multiple simultaneous intracerebral hemorrhage caused by hypertension is very rare. The authors report 4 cases of multiple hypertensive intracerebral hemorrhage. This represents 0.77% of total 514 hypertensive intracerebral hemorrhages treated between January, 1994 and December, 1997 in our institution. All patients had chronic history of hypertension, and the locations of the hematomas were as follows: both basal ganglia in two cases, right basal ganglia and left thalamus in one case, cerebellum and left parietal lobe in one case. Two cases were treated by surgical evacuation of hematoma and remaining two were treated by conservative management. The results of treatment were poor in all patients.

Clinical Analysis of Posttraumatic Infarct Patients

Posttraumatic cerebral infarction is a recognized complication of craniocerebral trauma, but, its frequency, cause, and influence on mortality are not well defined. During a two year period, 706 patients with head trauma were examined in our hospital with cranial CT studies. The CT findings which strongly suggested the herniation were seen in 46 patients. The posttraumatic cerebral infarction was diagnosed retrospectively in 18 of these patients. Detailed information, including CT findings were recorded from 1 to 10 days after admission. Posttraumatic cerebral infarctions were seen in the vascular territories of the middle cerebral artery(PCA) in 9 patients, posterior cerebral artery(PCA) in 4 patients, anterior cerebral artery(ACA) in 3 patients, and multiple in 2 patients. Outcomes of these 18 patients were severely disabled in 8 patients, moderate disabled in 6 patients, and death in 3 patients. Only one remaining patient was demonstrated a good recovery. These results suggest that cerebral infarction with severe head trauma might be associated with significantly bad influence on outcome of these patients when compared with those without cerebral infarction.

Clinical Analysis of Lymphocyte Population Changes in Severe Head Injured Patients Using Flow Cytometry

Despite advancement in diagnosis and progress in the management of intracranial pressure, infection remains a common complication following severe head injury. This following study attempts to better define the cell mediated immunity that decreased immediately following severe head injury. Twenty-five patients admitted with severe head injury(mean Glasgow Coma Scale, 5.32) were studied at the emergency rooms. The control group consisted of 25 mildly head-injured patients requiring hospital observation. Phenotyping of peripheral blood lymphocytes(PBL), determined by flow cytometry using monoclonal antibodies to lymphocytes subpopulation and HLA-DR receptors, was performed immediately following head injury. When severely head-injured patients were compared with controls, it was observed that the total T-cell counts(p<0.01) were markedly decreased, whereas the NK cell counts(p<0.01) were found to be increased. Infection rate of the study group was 44% and the majority of infections occur within the first 10 days after sever head injury. The results of this study suggests that severely head-injured patients had a decreased T-cell population and subpopulation in lines with higher infection rate.

Clinical Analyis of Acute Epidural Hematoma: Factors Affecting Its Outcome

As the development of CT scan enabled rapid and precise diagnoses of epidural hematoma, recent efforts have been sought to reduce its mortality rate. This study is a retrospective clinical analysis of one hundred eighty-one consecutive cases of epidural hematoma treated at the Department of Neurosurgery in Dong-guk University Hospital between Jan. 1991 and Dec. 1994. The rate of unsatisfactory outcome is 10.5%, While the mortality rate is 4.9%. Delayed epidural hematoma was founded tobe 12%. The authors have attempted to identify the factors influencing the prognosis of epidural hematoma. Based on the results of the above study we concluded that age, initial Glasgow coma scale, pupillary reflex and its size, IICP findings on brain CT, hematoma amount, associated intracranial lesions, rate of development of symptoms and timing of operation after injury are all relevant prognostic factors.

Acute Subdural Hematoma: An Analysis of 244 Operated Cases

This study is a retrospective clinical analysis of two hundred forty-four consecutive cases of acute subdural hematoma which were confirmed by operation during the last five years at the Department of Neurosurgery of the Dong-guk University Hospital. The authors have attempted, through this analysis to identify the factors affecting the outcome of acute subdural hematoma. A favorable outcome occurred in 40%, and an unfavorable outcome in 21% of patients at the time of discharge while a death ocurred in 39% of the cases. We have concluded that initial GCS, pupillary status, systolic arterial blood pressure, FDP vaules, presence or absence of skull fracture. IICP findings on brain CT, hematoma amount, and associated intracranial lesions are all prognostic factors, although the timing of operation did not reflect a significant difference in the outcome, however the sooner the intracranial hematoma lesion is evacuated, the better the outcome will be.

Periventricular Heterotopia: A Case Report

Anomalies of cell migration are due to various kinds of damage(vascular, infectious, teratogenic etc.) which interfere with neuronal migration between the 8th and 24th week of gestation. Periventricular heterotopias are nodular masses which protrude into the ventricular lumen. There is a high frequency of convulsive disorders. A 38-year-old woman presented to a intermittent headache, seizure-like activity and post-ictal subjective weakness on the left side. The computerized tomography findings and physical and neurologic examinations with an EEG revealed no specific abnormal findings. The MRI showed tumor-like nodular mass lesions at right periventricular area. The histological study of stereotactic excised biopsy demonstrated a composition of neuron and glia. After operation, headaches were slightly reduced and there was no reattack of seizure activity. Authors reports one case of periventricular heterotopia with a review of the literature.

Clinical Study According to the Modality of Treatment of Cerebral Arteriovenous Malformations

A series of 44 patients with cerebral arteriovenous malformations(AVM's) treated by various modalities from January, 1987, to March, 1994, at Chung-Ang University Hospital were reviewed with emphasis on the outcome. Of these patients, 8 received conservative treatment, 16 only surgery, 4 combined embolization and surgery, and 16 embolization alone. The follow-up period ranged from 7 months to 54 months with a mean of 20.6 months. The efficacy of the combined treatment was evaluated by the complications and the clinical outcome. When compared with surgery alone, preoperative embolization facilitated surgery by reducing intraoperative bleeding and shortening the time of surgery. Clinical outcome was better after preoperative embolization, with no occurrence of major complications and mortality. Five AVM's were totally occluded by embolization alone, but of the 5 cases, 1 case was readmitted due to bleeding 2 years after the embolization. It is concluded that combined treatment with preoperative embolization and surgery was helpful in the management of large, high grade AVM's by reducing the complications associated with their surgical removal.

Clinical Study of Surgically Treated Cerebral Aneurysms

The author reviewed 294 cases of surgically treated cerebral aneurysms during the period from January, 1987 to December, 1992. The results were as follow: The sex ratio between male and female was 1:1.53 and the mean age was 51.3 years. 2) At admission, 220 patients were in relatively good neurologic condition and functional recovery was obtained in 229 patients(78%). 3) The most common site was anterior communicating artery and the number of posterior circulation aneurysms was 12(4%). 4) The incidence of multiple aneurysms was 4% and clinical vasospasm was observed in 19% of the patients. 5) Operative mortality was 8.8% and the prognostic factors were related with age, sex, history of hypertension, amount of SAH, size and site of aneurysm, preoperative neurologic state, clinical vasospasm, and timing of operation.

Expression of p53 Protein and PCNA in Brain Tumors

Formalin-fixed, paraffin-embedded samples of 32 brain tumors(8 meningiomas, 10 astrocytomas(low grade 5, anaplastic 5), 8 glioblastoma multiforme, 6 oligodendrogliomas(low grade 2, anaplastic 3) were investigated by immunocytochemistry with monoclonal antibodies against p53 protein and proliferating cell nuclear antigen(PCNA). Expression of p53 protein was detected in 1 of 5 cases(20%) of low grade astrocytomas, 2 of 5 cases(40%) of anaplastic astrocytoma, 4 of 8 cases(50%) of glioblastoma multiforme and 4 of 4 cases(100%) of malignant oligodendroglioma. All low grade oligodendrogliomas, meningiomas fail to express p53. Expression of PCNA was detected in 3 of 8 cases of meningioma with very low labeling index(0-0.3), 2 of 5 cases of low grade astrocytoma with low labeling index(0-11.3), 3 of 5 cases of anaplastic astrocytoma with middle labeling index(0-28.2), 6 of 8 cases of glioblastoma multiforme and 4 of 4 cases of malignant oligodendroglioma with high labelling index(0-92.3, 7.6-48.1). Expression of PCNA was not detected in low grade oligodendrogliomas. Tumor group with high expression of p53 protein showed increment of PCNA expression. A strong positive correlation between tumor grade and extent of p53 protein and PCNA expression was found(p<0.002) .

An Analysis of Factors Related to the Shape of Hypertensive Intracerebral Hematoma and Its Clinical Significance

Eighty three cases of hypertensive intracerebral hemorrhage were retrospectively analyzed with a special emphasis on the shape of the hematoma. The hematomas were classified according to the computerized tomography(CT) findings into three groups as circumscribed hematoma with smooth margin and minimal surrounding edema(Type A). circumscribed hematoma with irregular margin and variable surrounding edema(Type B), and highly destructive hematoma with very irregular margin and usually with severe surrounding edema(Type C). The types of the hematoma were unrelated to the patient's age, blood pressure on arrival, serum triglyceride and cholesterol, liver function(except for SGOT), and coagulation study, and location as seen on CT, but were significantly related to the amount of the hematoma. Type A showed relatively better outcome than type B or type C, and type C invariably showed the poorest outcome.

Outcome of Ruptured Intracranial Aneurysms Treated by Coating

In rare occasions in which aneurysmal neck clipping is nearly impossible, coating is employed. During the period from 1985 to 1992, 312 patients with aneurysm underwent surgery;aneurysmal neck clipping were performed in 284 cases while coating only in 28. The reasons that coating was required were;wide and broad neck in 13, perforators arising from the neck in 4, neck tearing during dissection in 3, very friable neck in 2, severe adhesion with surrounding structures in 3, and small aneurysm without enough room for clipping in 3. In twenty-three cases, cotton wisp and bioglue were used as coating materials. In another five cases, the aneurysmal wall was reinforced using Surgical or Gelfoam. Patients were followed for 24 months on average of all the patients. Four had last contack. Six died(4 due to rebleeding and 2 due to pneumonia). Fourteen were good and 4 were moderately disabled. There were no rebleeding incidences during first three months' follow-up after coating. We thus concluded that coating an aneurysm offers some protection from rebleeding, particularly when the rebleeding risk period is over.