Significance of Aspect Ratio as Predictor of Intracranial Aneurysm Rupture / 대한뇌혈관외과학회지

OBJECTIVE: The size of intracranial aneurysm has been well known as a risk factor of aneurysmal rupture. The aneurysmal shape affects risk of rupture differently even though the size is similar. Aspect ratio corresponds well with morphologic variability. In this study we investigated the significance of aspect ratio as a predictor of intracranial aneurysm rupture. METHODS: The authors reviewed the retrospectively the medical records of consecutive patients with ruptured and unruptured intracranial aneurysms who underwent cerebral angiography from January 2001 to December 2005. A total of 156 patients underwent cerebral angiography and 171 aneurysms were detected. One hundred forty ruptured and 31 unruptured aneurysms were included. We measured aspect ratio which aneurysmal dome distance and neck width on angiographic images. To compare the difference of size and aspect ratio between ruptured and unrupteured aneurysms, we performed statistical analysis of aspect ratio to obtain the odds ratio(OR) for risk of rupture. RESULTS: The mean aspect ratio was 2.33+/-0.96 for ruptured aneurysms, compared with 1.71+/-0.55 for unruptured aneurysms. The difference of the aspect ratios between ruptured and unruptured groups was statistically significant (p<0.001). The odds ratio of rupture was 6.3 fold greater when the aspect ratio was larger than 2.66 compared with an aspect ratio less than 1.54. CONCLUSION: We suggest that aspect ratio is a significant independent predictor for aneurysmal rupture. The rupture risk was increased significantly when aspect ratio increased.

Spontaneous Intracerebral Hemorrhage in the Patients Undergoing Dialysis Therapy / 대한뇌혈관외과학회지

OBJECTIVE: The management of spontaneous intracerebral hemorrhage in the patients with chronic renal failure is frequently influenced by factors such as coagulopathy, electrolyte imbalance, hemodialysis and malnutrition. This study aimed at evaluating the aggravating factors in the patients with intracerebral hemorrhage and who also underwent dialysis therapy. METHODS: Eight patients with chronic renal failure and who suffered from intracerebral hemorrhage were investigated. The clinical features, the location and amount of the hematomas, the treatment methods and the hemodialysis patterns were compared. RESULTS: The locations of hematoma were the subcortex (3 cases), putamen (2 cases), thalamus (2 csaes), and intraventricle (1 case), respectively. The types of dialysis were hemodialysis (6 cases), peritoneal dialysis (1 case), and a continuous form of renal replacement therapy (1 case). The average GCS was 8.4 (range: 5-14). All the patients underwent surgical treatment, which were EVD (3 cases), streotactic hematoma aspiration (2 cases), and decompressive craniectomy with hematoma removal (3 cases). The clinical outcomes were good recovery (1 case), moderate disability (1 case), a vegetative state (1 case) and death (5 cases). For the cases of death, the factors for aggravating the outcome were brain swelling (1 case), rebleeding (2 cases), aspiration pneumonia (1 case), and uncontrolled bleeding during the operation (1 case). The poor outcomes of intracerebral hemorrhage in the dialysis failure patients were caused by poor consciousness during bleeding, (ED note: this word ictus seems to makes no sense here.) and a high risk of rebleeding and brain edema due to anticoagulant and dialysis. CONCLUSION: We suggest that consideration of the patients' medical problems and an adequate environment for dialysis should be taken into account to achieve favorable patient outcomes.

Thoracic Spinal Cord Injury without Radiographic Abnormality Following Minor Trauma in Adult

Spinal cord injury without radiographic abnormality often occurs at cervical spine after major trauma predominantly in the skeletally immature pediatric population. We report an adult patient with this diagnosis involving the thoracic spine after minor trauma. A 44-year-old woman was stretched on the back of her husband, which left her bent backward markedly. Neurological examination at admission revealed flaccid paraparesis and sensory disturbance below the T-10 level. The patient was treated conservatively. But she showed neurological deterioration. The relevant literature is reviewed.

A Case of Germinoma Involving the Posterior Part of Thalamus and Basal Ganglia

Intracranial germinoma usually occurs in the pineal and suprasellar regions. It is relatively rare that germinoma occurs in the thalamus and basal ganglia. The authors report a case of germinoma involving the posterior part of thalamus and basal ganglia involving the posterior part of thalamus and basal ganglia. The patient was 20 years old male who complained left side hemiparesis for 2 months. A successful result was obtained through radiation therapy after partial removal of tumor mass.

A Case of Coexisting Cervical and Lumbar Spinal Stenosis

Spinal stenosis denoting a critical reduction of the A-P diameter of spinal canal, foramina and lateral recesses can be existed in both cervical and lumbar regions. But it is relatively rare that cervical and lumbar spinal stenosis are coexisted simulataneously. The authors report a case of coexisting cervical and lumbar spinal stenosis with historical background and discussion. The patient was 49 years old male who complained intermittent neurogenic claudication, paraparesis and voiding disturbance. A successful result was obtained through one stage decompressive laminectomies in cervical and lumbar reaions.