Frequency of Aneurysmal Subarachnoid Hemorrhage in Perimesencephalic Subarachnoid Hemorrhage and Need of 4-vessel Angiography

OBJECTIVE: In this study, each of the frequency of nonaneurysmal perimesencephalic subarachnoid hemorrhage(N-PMSH), and the clinical and radiologic features, incidence and location of aneurysmal perimesencephalic subarachnoid hemorrhage(A-PMSH), based on aneurysmal rupture and nonaneurysmal subarachnoid hemorrhage in patients with spontaneous subarachnoid hemorrhage, are investigated for clinical application. METHODS: Patients who showed perimesencephalic subarachnoid hemorrhage, among the 388 patients with subarachnoid hemorrhage admitted into the our hospital from March 1994 to November 2002, were extracted ; and their charts and angiographies were examined retrospectively. They were divided into two groups - aneurysmal perimesencephalic subarachnoid hemorrhage group and nonaneurysmal perimesencephalic subarachnoid hemorrhage group - and comparative analysis was conducted on the clinical patterns and radiologic characteristics of each group. RESULTS: There were 22 patients(5.68%) with perimesencephalic subarachnoid hemorrhage(PMSH) among 388 patients with spontaneous subarachnoid hemorrhage. Of the 22 PMSH, 8 patients(36%) were aneurysmal PMSH(A-PMSH), 14 patients(64%) were nonaneurysmal PMSH(N-PMSH). N-PMSH occurred not only in the posterior circulation(5 cases), but also in the anterior circulation(3 cases). There was no difference in the CT features of PMSH between aneurysmal and nonaneurysmal cause. CONCLUSION: According to the above results, 4-vessel angiography is essential for patients with perimesencephalic subarachnoid hemorrhage, and CTA and MRA can be used as assisting diagnosis methods.

Surgical Removal of Cavernous Angioma in the Midbrain: A Case Report

We report a case in which a cavernous hemangioma in the midbrain was completely removed. Two days prior to hospitalization, a 32-year-old female patient, who had complained of intermittent headache, presented with deteriorated consciousness. Neurological examination revealed anisocoria, no response to lights, diplopia in a superior and inferior direction, increased deep tendon reflexes, and an unceratin response to examination. Radiology revealed a deep cavernous hemagioma in the midbrain and there was evidence of recurrent bleeding, especially on MRI. To remove the cavernous hemangioma, she underwent extraventricular drainage(EVD), craniotomy(using the suboccipital transtentorial approach), and ventriculoperitoneal shunt and recovered. She has now been followed up for 1 year and 6 months, and is leading a normal life. We have concluded that excellent results may be possible with in the case of symptomatic cavernous hemangioma, an awareness precise anatomical location, a well designed approach and of possible neurologic deficits, this is so even in the midbrain.

An Analysis of Operative Treatment of Lower Cervical Spine Injury

The authors retrospectively reviewed the operative cases of 28 patients with lower cervical spine injury from August 1991 to July 1996. Data from charts were reviewed the following clinical parameters, e.g.) etiologies, neurologic findings, degrees of recovery, managements including operative treatments, and complications. The lower cervical injury was most common in men in the third decade. The most common cause, mechanism and site of lower cervical injury were motor vehicle accidents, flexion type injury and C5-6 respectively. The head trauma was frequently combined. In most cases operation for stabilization was done around two weeks after the trauma, but for decompression purpose it was done before two weeks. Three patients who had complete neural injuries died due to pneumonia, adult respiratory distress syndrome, and upper gastrointestinal bleeding. A neurological recovery rate was high in incomplete neural injury group. In conclusion, early reduction and decompression of spinal canal in incomplete neural injury group is favorable for good recovery. Careful attention should be paid on the patient with complete injury for the development of serious complications such as upper gastrointestinal bleeding, ARDS and pneumonia.

A Case of Cavernous ICA Occlusion after Radiation Therapy in Pituitary Adenoma

Stenosis or occlusion of large arteries after radiation are rare. The authors report a case of internal carotid arterial occlusion after radiation therapy. The patient was 45 year-old female. She received postoperative radiation therapy, a total dose of 4940cGy, to treat the remnant tumor after transsphenoidal surgery for the asymptomatic nonfunctioning pituitary adenoma. She suffered intermittant ischemic symptoms from 18 month after radiation therapy, and died with global infarction due to stenotic occlusion of the internal carotid artery at 30 month after surgery. Endocrine or vascular complications occasionally follow radiation therapy of pituitary tumor. But with improved therapies for pituitary tumors and hypopituitarism, patients are expect to live longer. Yet we must consider another delayed complication of radiation induced carotid arterial disease. As a whole, hemispheric transient ischemic attacks, amaurosis fugax, and seizure are the major presenting symptoms and signs. In such a case, it is important to consider the possibility of radiation induced arterial stenosis, and prompt cerebral angiography and proper management are mandatory.