Primary Intracranial Subdural Empyema: Case Report

Two cases of primary intracranial subdural empyema are reported. One is 15 yr-old male and the other is 14 yr-old female. Clinical presentation was high fever, severe headache, impaired consciousness, marked neck stiffness and periorbital swelling in both cases. Since CT brain scan with contract enhancement clearly demonstrated the lesion, angiography was not performed. In one case, craniotomy was done with drainage of pus and thorough irrigation. He died on the 9th postoperative day after generalized covulsive seizure. In the other case, craniectomy was taken. She received additional two craniectomies due to reaccumulation of pus and osteomyelitis, and discharged without major disability on the 64th hospital day. Related reports were briefly reviewed.

Clinical Analysis of Intracranial Tuberculomas

We have experienced 10 cases of intracranial tuberculoma which were confirmed by CT scan in National Medical Center from Jan. '79 to Aug. '82. The analysis is based on 10 cases with intracranial tuberculoma on whom operation was performed in 7 cases and conservative treatment was done in 3 cases. Extracranial disease or a past history of tuberculosis are evident in half of patients. The common presenting features are intracranial hypertension and papilledema. These are usually located in the supratentorial region. The use of CT brain scanning can be of great help in diagnosis and follow up more than others. The current treatment consists of medical therapy such as combined antituberculous agents, but surgical exploration may be reserved for intractable seizure, suspected brain tumor and medical failure or severe intracranial hypertension.

Early Prognostic Evaluation with C-T Scan in Cerebral Contusion

The cerebral contusion(necrotic brain tissue infiltrated with blood) is common post-traumatic lesion, In 851 consecutive C-T scan performed by 48 hours from injury, the contusion were present in 193(22.%) of the case. Comparing the midline shift, area, number, size of the lesions and their etiopathogenesis with the clinical course(assessed by Glasgow coma scale), it is possible to evaluate the early prognosis. The patient who showed 1) midline shift over 15mm, 2) the contusional lesion in basal ganglia, brain stem or corpus callosum, 3) multiple or large sized lesion took poor prognosis. Cortical contusion especially in the frontal region had relatively good prognosis. The pathogenetic mechanisms(angular acceleration of the brain) is the same in basal ganglia, brain stem and corpus callosum, but a direct impact of the In conclusion, the etiopathogenetic mechanism and consequent site of the cerebral contusion are the most important factors on the evaluation of the severity of the brain damage and their prognosis.