Extent of Contrast Enhancement on Non-Enhanced Computed Tomography after Intra-Arterial Thrombectomy for Acute Infarction on Anterior Circulation: As a Predictive Value for Malignant Brain Edema

OBJECTIVE: To determine whether the use of contrast enhancement (especially its extent) predicts malignant brain edema after intra-arterial thrombectomy (IAT) in patients with acute ischemic stroke. METHODS: We reviewed the records of patients with acute ischemic stroke who underwent IAT for occlusion of the internal carotid artery or the middle cerebral artery between January 2012 and March 2015. To estimate the extent of contrast enhancement (CE), we used the contrast enhancement area ratio (CEAR)-i.e., the ratio of the CE to the area of the hemisphere, as noted on immediate non-enhanced brain computed tomography (NECT) post-IAT. Patients were categorized into two groups based on the CEAR values being either greater than or less than 0.2. RESULTS: A total of 39 patients were included. Contrast enhancement was found in 26 patients (66.7%). In this subgroup, the CEAR was greater than 0.2 in 7 patients (18%) and less than 0.2 in the other 19 patients (48.7%). On univariate analysis, both CEAR > or =0.2 and the presence of subarachnoid hemorrhage were significantly associated with progression to malignant brain edema (p or =0.2 showed a statistically significant association (p=0.019). In the group with CEAR > or =0.2, the time to malignant brain edema was shorter (p=0.039) than in the group with CEAR or =0.2 (p=0.003) CONCLUSION: The extent of contrast enhancement as noted on NECT scans obtained immediately after IAT could be predictive of malignant brain edema and a poor clinical outcome.

Three Cases of Calcifying Pseudoneoplasm which Involve the Epidural Space of the Spine

Calcifying psuedoneoplasm of the spine is a rare non-neoplastic lesion of unknown origin. Radiologic and histologic manifestations are very variable and clinical symptoms include isolated pain, myelopathy, and radiculopathy. Surgical resection is the preferred option of treatment. This report describes three cases of calcifying pseudoneoplasm in the spine. The first case is a 77-year-old female with pain in both legs. The second case is a 67-year-old woman who presented as right leg pain. The third case is a 78-year-old woman with isolated back pain. The involved sites of each of cases were T12, L2-3, and L1, respectively. Surgical resection of the involved masses relieved symptoms.

The Usefulness of the Frontolateral Approach as a Minimally Invasive Corridor for Clipping of Anterior Circulation Aneurysm

OBJECTIVE: Several studies have reported on the effectiveness of fronto-lateral craniotomy in reducing the operating time and post-operative complications. However, no study has practically evaluated this method from the cosmetic point of view. MATERIALS AND METHODS: We designed this study for comparison of the clinical differences and cosmetic outcomes between the frontolateral craniotomy and the conventional pterional craniotomy for clipping of unruptured intracranial aneurysms. We performed a retrospective analysis of the two groups based on their medical records and radiologic findings juxtaposed with their length of hospital stay, intensive care unit day and operation time, and the emergence of postoperative complication, mean size of aneurysm, and temporal depression. RESULTS: After careful comparison of the thickness of temporalis muscle between the craniotomy side and the contralateral side, the results clearly showed that the conventional pterional craniotomy group was asymmetric by a p value of 0.152 and the frontolateral craniotomy group was symmetric by a p value of 0.002. CONCLUSION: Frontolateral craniotomy could be a practical alternative for patients with an unruptured intracranial aneurysm in the anterior circulation including the posterior communicating artery, particularly those who are in a medically poor state or who highly demand minimal aesthetic mutilation.

Clinicoepidemiological Features of Asymptomatic Moyamoya Disease in Adult Patients

OBJECTIVE: The aim of this study was to document the natural course of asymptomatic adult moyamoya disease (MMD) and the factors related to disease progression to aid in treatment decisions. MATERIALS AND METHODS: Among 459 adult MMD patients (aged > or = 20 years), 42 patients were included in this retrospective cohort study. Clinical records of adult asymptomatic MMD patients (n = 42) and follow-up data from September 2013 were reviewed to determine the factors related to disease progression. RESULTS: The mean age of patients at the time of diagnosis was 41.2 years (range, 23-64 years), and the mean follow-up period was 37.3 months (range, 7.4-108.7 months). Of the 42 patients and 75 hemispheres, there were 12 patients (28.6%) and 13 hemispheres (17.3%) with disease progression. There were four hemispheres (5.3%) with symptomatic progression (three hemorrhage, one transient ischemic attack) and nine hemispheres (12.0%) with asymptomatic radiographic progression. There were no relationships with sex, diabetes, hypertension, thyroid disease, family history of MMD, or family history of stroke. However, reduced initial cerebrovascular reserve capacity was observed in seven hemispheres (9.3%) in patients with disease progression. A relationship was found between disease progression and initial cerebrovascular reserve capacity (p = 0.05). None of the patients underwent bypass surgery during the follow-up period. CONCLUSION: It appears that asymptomatic adult MMD is not a permanent stable disease. In particular, reduced cerebrovascular reserve capacity is an indication of MMD progression, so close regular observation is needed.

Pressure Measurement in Carpal Tunnel Syndrome : Correlation with Electrodiagnostic and Ultrasonographic Findings

OBJECTIVE: This study was done to evaluate the correlation between carpal tunnel pressure (CTP), electrodiagnostic and ultrasonographic findings in patients with carpal tunnel syndrome (CTS). METHODS: CTP was measured during endoscopic carpal tunnel release (ECTR) for CTS using Spiegelberg ICP monitoring device with parenchymal type catheter. Neurophysiologic severity and nerve cross sectional area were evaluated using nerve conductive study and ultrasonography (USG) before ECTR in all patients. RESULTS: Tests were performed in a total of 48 wrists in 39 patients (9 cases bilateral). Maximum CTP was 56.7 +/- 19.3 mmHg (Mean +/- SD) and 7.4 +/- 3.3 mmHg before and after ECTR, respectively. No correlation was found between maximum CTP and either neurophysiologic severity or nerve cross sectional area, whereas we found a significant correlation between the latter two parameters. CONCLUSION: CTP was not correlated with neurophysiologic severity and nerve cross sectional area. Dynamic, rather than static, pressure in carpal tunnel might account for the basic pathophysiology of CTS better.

Carpal Tunnel Syndrome Diagnosed by Carpal Tunnel Pressure Measurement

Carpal tunnel syndrome(CTS), the most common compressive neuropathy, is usually diagnosed by clinical features and nerve conduction test(NCS). However, NCS might show no abnormal finding. Ultrasonography(USG), known as helpful adjunctive in diagnosis of CTS, also might show false negative finding. A 33-year-old woman presented with complaints of pain and numbness in median nerve area on her right hand for 4 years. Despite typical clinical features of CTS, neither NCS nor USG showed abnormal finding. Because of persistent symptom, without significant improvement on conservative management, endoscopic carpal tunnel release(ECTR) was performed with carpal tunnel pressure(CTP) measurement. The measured CTP was 27.9mmHg before ECRT, which was reduced to 5.9mmHg after operation. The pain and numbness subsided after operation. Our case showed the usefulness of CTP measurement in diagnosis of CTS. The measurement of CTP might be an important diagnosis modality for some patients having CTS, especially in cases without definitive findings in NCS and USG.