Ultrastructural Changes in the Feline Basilar Artery following Experimental Subarachnoid Hemorrhage

Experimental subarachnoid hemorrhage(SAH) was produced in adult cats by injection of autologous blood(6ml) into prepontine cistern by tranclival approach and cisterna magna. The animals were sacrificed 1, 3, 5, 7 or 14 days later and basilar artery segments were prepared for electron microscopy. The following observations were made: 1) 1 to 7 days after SAH, electron micrograph showed round-shaped endothelial cells in tunica intima and disappearance of zonular occludens. Endothelial detachment from internal elastic membrane and intracytoplasmic vacuolation of endothelial cells as well as destruction of mitochondrial cirstae in tunica media. 2) 14 days after SAH, electron micrograph showed the normal findings in tunica intima and tunica media of the vessel walls. On the basis of the above findings, I found that the ultrastructural changes in the basilar arterial wall, which had presumably developed as a consequence of experimental SAH were reversible.

Ultrastructural Changes in the Feline Basilar Artery following Experimental Subarachnoid Hemorrhage

Experimental subarachnoid hemorrhage(SAH) was produced in adult cats by injection of autologous blood(6ml) into prepontine cistern by tranclival approach and cisterna magna. The animals were sacrificed 1, 3, 5, 7 or 14 days later and basilar artery segments were prepared for electron microscopy. The following observations were made: 1) 1 to 7 days after SAH, electron micrograph showed round-shaped endothelial cells in tunica intima and disappearance of zonular occludens. Endothelial detachment from internal elastic membrane and intracytoplasmic vacuolation of endothelial cells as well as destruction of mitochondrial cirstae in tunica media. 2) 14 days after SAH, electron micrograph showed the normal findings in tunica intima and tunica media of the vessel walls. On the basis of the above findings, I found that the ultrastructural changes in the basilar arterial wall, which had presumably developed as a consequence of experimental SAH were reversible.

Experiences of Reoperation on Failed Lumbar Disc Surgery

Nine patients, who had once low back operation due to herniated lumbar disc, underwent repeated low back surgery at the same level because of persistent or recurred symptoms. All patients were proved to have no psychological or compensative problems. Seven of them had satisfactory results but two, one who had no definite symptom free interval and had surgically proven epidural fibrosis only and another who underwent reoperation as early as 45 days after the first operation had persistent previous symptoms. After review of these cases we obtained several favorable factors which influence the post-operative results. When a patient had a definite symptoms free interval longer than 2 years or the main offending lesion was proved to be a disc herniation or spinal stenosis, satisfactory results could be anticipated.

Intracranial Subdural Empyema: Case Report

Subdural empyema is a uncommon fulminating disease which rapidly terminates in death if untreated. When a patient with acute sinus or otitic infection complain headache, vomiting, impairment of consciousness, seizures of focal neurological signs, the possibility of intracranial infection should be considered. We recently experienced a case of subdural empyema in a 22 yrs old male who had not any previous history of infection. This patient with signs of IICP and seizures was diagnosed as space occupying lesion in the subdural space, right frontotemporal by carotid angiography but trephination revealed a subdural empyema which was drainaged through multiple burr holes. After 2 weeks of uneventful course, the computed tomography was done because of reappeared signs of IICP and three encapsualated subdural abscess were found. The patient was discharged from hospital in the excellent condition after total extirpation through craniotomy of above abscess.

A Clinical Analysis of Spontaneous Intracerebral Hemorrhage

We have experienced 40 cases of spontaneous intracerebral hemorrhage admitted to the Chung Ang University Hospital. We analized the result of the treatment of spontaneous intracerebral hemorrhage and assessed prognostic factors affecting the result of treatment of intracerebral hemorrhage. 1) The age distribution was ranged from 26 to 69 and 67.5% of them were in fourth and fifth decade. The ratio of male to female was about 5:3 and the age of the patients did not significantly influence on the result of operative or non-operative cases(P:0.22 P>0.05). 2) The predilection sites of hemorrhage were basal ganglia(60%) and thalamus(15%). 3) There was a correlation between the conscious status on admission and that of two weeks after admission, not so strong, in the operated cases. I.e., the higher Glasgow Coma Score on admission, the better results two weeks after admission. But such a correlation was not found in the non-operated cases(P:0.5732 P0.05). The hemorrhage in the dominant hemisphere had little correlation with the outcome(P:0.5068 P<0.01). 4) The pre or post-operative conscious status appeared to have no correlation with the hematoma volume. The large hematoma not always lead to poor prognosis when it was removed in proper time unless the secondary change of the hematoma did not develop(P:0.4257 P<0.05, P:0.4644 P<0.05). 5) The blood pressure on admission, not his proper pressure, had no correlation with the result two weeks after admission in the operated or non-operated cases(P:4988 P<0.01, P:0.4120 P<0.05). 6) The midline shift on the carotid angiogram had a closed correlation with the conscious status of the operated or non-operated cases in spite of little influence of hematoma volume to the conscious state(2:0.7350 P<0.01, P:0.5377 P<0.01).

Intracranial Arachnoid Cyst: Case Report

Intracranial arachnoid cysts are uncommon congenital lesions of considerable interest and importance, the origins and exact nature of which remain uncertain. They account for about 1% of all intracranial space-occupying lesions4). Its predilection sites are in the sylvian fissure, the interhemispheral fissure, the cerebral convexity, the base of the brain, and over the midline of the cerebellum in the posterior fossa6)11). We are reporting a case of arachnoid cyst, developed in the left sylvian fissure in a ten years old male patient.

A Case of a Recurrent Postoperative Discitis

The etiology of the postoperative discitis is not fully known, but most likely, the cause seems to be of a low grade infection and chemical and mechanical injuries. The incidence of these complication is from 0.12% to 2.6% of all cases. The characteristics of this disease are recurrence of severe lower back and gluteal pain, spasm of lumbar paravertebral muscle and elevated E.S.R. following the asymptomatic post-operative period, a roentgenogram showed an early destructive change in the adjacent vertebra, the narrowing of the intervertebral disc space, sclerotic changes in the vertebral bone and occasional fusion of the spine, and relatively good prognosis. We present a case of recurrent postoperative discitis with E.S.R. change and roentgenographic change.

Dermoid Cyst at the Conus Medullaris

Dermoid cysts are very infrequent benign tumors of the spinal canal. They arise from epithelial cell rests that become sequestered during closure of the neural tube between the third and fifth fetal weeks. Consequently, they occupy midline or near midline position characteristically. If the cleavage of the cutaneous and neural ectoderm persists locally anywhere along the neuraxis, a dermal sinus is formed connecting the skin with neuraxis. We present a case of dermoid cyst at the conus medullaris which was confirmed on histologic examination. An eleven years old female patient was admitted to our department because of urinary incontinence and sensory disturbance at the saddle area. Motor weakness was absent. In the plain spine A-P view, widening of the interpedicular distance and flattening and erosion of the pedicle were noted at the L1 and L2 vertebra. The lumbar myelogram A-P view shows almost total obstruction with meniscus sign at the level of the L1 and L2 interspace. In the myelogram lateral view, the dye column was indented in a round fashion from the dorsal side at the L1 and L2 interspace. Under the impression of the intradural extramedullary mass, we performed total laminectomy and removal of the mass.

Primary Osteosarcoma of the Skull

Osteosarcoma is the most frequently encountered primary malignant tumor of the bone. But sarcoma of the skull are rare tumor to be observed even in an extensive neuropathological practice. We presents a case of skull neoplasm identified as osteosarcoma. A twelve year old male patient was admitted to our department because of the large palpable mass on the posterior parietal and occipital region with headache, nausea and vomiting. On admission moderate papilledema was noted in the both eyes. Other neurologic finding were within normal limits. Chest film and long bone series showed no evidence of abnormality. Skull films revealed a large round destructive area on the posterior parietal and occipital region and the right carotid angiogram revealed patch densities in the mass lesion which was supplied by the right occipital artery and possibly the right middle meningeal artery. Serum Alkaline Phosphatase was 14 BL Units. The findings on the pathology side was compatible with osteosarcoma.

Clinical Analysis of 58 Cases of Intracranial Tumors in Korean Children

It should be stressed that intracranial tumors in childhood are common. If the leukemia are excluded, intracranial neoplasms are the relatively common type of neoplasms seen in childhood. There are many different kinds of tumor which occur within the cranial cavity. These different tumors grow at different rates of speed and the diversity of location is sufficient so that there is a broad spectrum of different clinical syndromes. However, it is important to recognize the earliest symptoms because of the possibility of operable management and high cure rate on some cases. The author analyzed 58 cases of intracranial neoplasm which were histologically confirmed after operation and autopsy, seen at the Department of Neurosurgery, Jung-Ang University, Sung-Sim Hospital and National Medical Center over the recent several years. These tumors were explored surgically and the diagnosis was made through histological examination. The cases were reviewed as to history, development and progression of the neurological features, laboratory findings, neuroradiological findings, operative methods and pathology. The author emphasized some interesting points and the following were presented here-in as the results. 1) Among 58 cases of intracranial neoplasms in Korean children below 15 years old, the most common tumor was astrocytoma(36%), and the next common tumors were craniopharyngioma(15.5%), ependymoma(12%), and medulloblastoma(10.3%) in that orders. It was interesting that 3 cases of tuberculomas were found in recent three years(1975-1977) and all were located in the cerebellum. A 5 years old boy who was operated for 4 th. Ventricle medulloblastoma confirmed by clinicopathological finding, had another tumor, craniopharyngioma which was found at the postmortem examination. 2) The tumors were occupied on the infratentorial region in 30(5.7%) cases and supratentorial region in 28(48.3%) cases. The most frequent tumor in supratentorial region was craniopharyngioma and in infratentorial region was cerebellar astrocytoma. And the glioma and medulloblatoma were common in turn. 3) Fifty eight cases comprised 36 males and 22 females with a ratio of 1.5 to 1. The age ranged from 5 months old to 15 years old with the peak in the incidence between 5-11 years of age. 4) The main clinical symptoms and signs were headache(84.5%), vomiting(77.6%), papilledema(67.2%), and cranial nerve dysfunction(62%). It was interesting points that neck stiffness(27.6%) and abdominal pain(15.5%) were frequent complaints which should not overlook for the symptoms of simple gastritis or tuberculous meningitis. 5) The results of operative management obtained as follows with excellent in 4, good in 8, fair in 13, and poor in 9 cases. The overall mortality rare was 41% and recurrence rate was 14% during 5 years follow up.

A Clinical Observation on Craniocerebral Injuries in Infants and Children(Analysis of 481 Cases)

Clinical observation and analysis were performed on 481 cases of craniocerebral injuries under 15 years of age those were treated at Chung-ang University hospital during the period from January, 1972 to August, 1975. Following results were obtained: 1. There were 302 males and 179 females and sex ratio was 1.7:1. 2. Age incidence of the accidents was greatest at 5 years of age and mostly distributed to the age group between 5 to 7. 3. Seasonal peak of the accidents was at June. 4. The most frequent cause of the craniocerebral injuries was traffic accident(277 cases, 57.59%), and the next was fall from height(159 cases, 33.06%). 5. No deterioration of consciousness before and after the admission was observed in 176 cases(3.6%). 6. Pupillary change was observed in 28 cases in which unilateral were 21 and bilateral were 7. Babinski sign was elicitable in 91 cases. 7. Early convulsion and vomiting were frequent symptoms in childhood. 8. Skull fracture was observed in 204 cases(40.33%) in which linear fracture was most frequent. The location of the linear fracture was parietal and the predilection sites of the depressed fractures were frontal and parietal. 9. The accompanying rate of skull fracture in intracranial hemorrhage was;epidural 75%, subdural 50% and subarachnoid 17.3%. 10. The overall mortality was 8.32%. In non-surgical group(442 cases), the mortality rate was 7.47% but in surgical group(39 cases), operation mortality was 17.95%.

Postoperative Discitis

Twelve cases of postoperative discitis, experienced during the past 9 years, are presented and discussed along with review of literatures. The etiology of these postoperative complications is not fully known, but most likely, the cause seems to be of a low-grade infection and chemical and mechanical injuries are given as the causes in literature. It is presumed that the high incidence (3.9%) of postoperative discitis may have some relation with the use of steroids for a long period prior to operation in our series. The characteristic of this disease are recurrence of severe lowback & gluteal pain, spasm of lumbar paravertebral muscle and elevated E.S.R. following the asymptomatic postoperative period, a roentgenogram showed an early destructive change in the adjacent vertebrae, the narrowing of the intervertebral disc space, sclerotic changes in the vertebral bone and occasional fusion of the spine, and relatively good prognosis. The most important treatment was found to be an adequate immobilization of the vertebral column by means of a plaster of paris cast or absolute bed rest. The authors stress the importance of a regular check of E.S.R and an X-ray examination of the spine after surgery for an early diagnosis of postoperative discitis.