Endovascular Embolization of a Traumatic Vertebral Artery Fistula of the Cervical Spinal Canal: Case Report

Cervical vertebral artery fistula is rare arteriovenous malformations between the vertebral artery and veins of the neighborhood. We report a case of traumatic vertebral artery fistula of the cervical spinal canal in a 35-year-old-man who developed posterior neck pain, radiating pain and motor weakness on the left upper arm 25 days after penetrating injury by glass pieces on the anterolateral side of both neck. MRI revealed the signal void on T1-weighted sequence and vertebral angiogram demonstrated the fistula between the left vertebral artery and epidural venous channel at the C4-5 level. Complete occlusion of the fistula was achieved by endovascular embolization with microcoil(Spiral Coil). The patient had improvement of radicular pain and motor weakness and no complications related to the embolization procedure occurred. A brief review of the literature is given.

Hospital Stay in 1000 Consecutive Head Injuries

We present a study on hospital stay in 1000 consecutive head injuries. The mean hospital stay and standard deviation were calculated in a given condition according to some variables, such as sex, age, Glasgow Coma Score on admission, skull fracture, CT findings, and treatment. Usually, standard deviation was greater than the mean value in a given condition and hospital stay varied in a wide range, representing that the duration of treatment is related not only to the severity but also various individual properties. Since the associated injuries were variable in location, type and severity, they altered hospital stay greatly. Thus hospital stay was analyzed in patients without associated injuries. Hospital stay was largely dependant on three variables. Low Glasgow Coma Score on admission, presence of intracranial mass lesion or diffuse axonal injury, and operative treatment prolonged hospital stay. Skull fracture also lengthened hospital stay but only in patients without associated injuries. Duration of treatment should be recorded in all medical certificates related to the injury. For the proper estimation of duration of treatment, more reports are needed in this field.

Traumatic Intracerebral Hematoma

During a 36-month period, clinical outcome in 170 patients with traumatic intracerebral hematoma(TICH) was analysed. These patients represented 5.1% of 3328 consecutive patients with head injuries admitted to the Soonchunhyang University Chunan Hospital. The overall mortality was 33.5%. A significant number of patients(52.6%), who were not comators at the time of admission(GCS0.005) ; 2) the presence of associated lesions(p>0.01) ; 3) time delay of two hours or more from admission to operation(p>0.05) ; 4) actual midline shift of 4.5mm or above on initial CT scan(p>0.005) ; 5) obliteration of suprasellar cistern(p>0.005) ; 6) the presence of delayed traumatic intracerebral hematoma(DTICH) in non-surgical patients with GCS score of 8 or above(p>0.01). Age and location of hematoma did not affect outcome, but the patients with multiple located hematoma showed higher mortality than the others. Time delay in the treatment of TICH and DTICH contribute significantly to poor outocme. Rapidly progressive DTICH within 48 hours after trauma is high in mortality. Follow-up CT scan might as well be performed till 48 hours after injury and 8 hours after initial operation, even though neurological status did not alter for the worse.

Primary Intracranial Tumors of Different Histological Types(Multiple Primary Brain Tumors): Report of Two Cases

The presence of multiple, diverse primary brain tumors is infrequent in patients without phakomatosis. We wish to report two cases of multiple primary brain tumors. The first case, a 38-year-old female, suffered from headache, bilateral hearing loss for about 6 years prior to hospitalization. Camputed tomography scan demonstrated multiple well enhanced masses in the right frontal convexity, falx and both cerebellopontine angles. These lesions were removed successfully in 3 successive operations. Histologically the tumors were diagnosed as afibroblastic meningiomas and a acoustic neurinoma. Although none of the cutaneous stigmata of von Reck1inghausen's disease has been observed in her and any member of her family, we cant's exclude this case that belongs in the central form of neurofibromatosis. The 2nd case, a 71-year-old male, suffered from frontal headache with confusion for about 7 days prior to hospitalization. Computed tomography scan demonstrated a ring enhanced mass with surrounding edema in the left frontal lobe. The left frontal osteoplastic craniotomy was performed, a small mass with the dura attached could be found incidentally, and this small mass and the ring enhanced tumor in the frontal deep portion were grossly totally removed. Histologically the two tumors were dIagnosed as a menigotheliomatous meningioma and a malignant astrocytoma.

Vasospasm in Intracranial Aneurysm

The literature concerning cerebral vasospasm associated with subarachnoid hemorrhage(SAH) due to ruptured intracranial aneurysm contains no definitive study of patients to determine whether there is (1) any clinical picture consistently present coincident with known cerebral vasospoasm, (2) any relationship between mortality and known vasospasm, and (3) any relationship between serious brain damage(morbidity) and known vasospasm. To answer these important questions, experience with 138 consecutive acute SAH patients due to ruptured intracranial aneurysm was studied. The results were (1) The vasospasm was seen in 61 patients(44.2%) and the clinical vasospasm was seen in 41 patients(29.8%);(2) The average interval between last SAH and vasospasm was 8.3 days;(3) The most common neurological deficit was a hemiparesis or a hemiplegia;(4) There is no relationship between mortality and vasospasm.

Vasospasm in Intracranial Aneurysm

The literature concerning cerebral vasospasm associated with subarachnoid hemorrhage(SAH) due to ruptured intracranial aneurysm contains no definitive study of patients to determine whether there is (1) any clinical picture consistently present coincident with known cerebral vasospoasm, (2) any relationship between mortality and known vasospasm, and (3) any relationship between serious brain damage(morbidity) and known vasospasm. To answer these important questions, experience with 138 consecutive acute SAH patients due to ruptured intracranial aneurysm was studied. The results were (1) The vasospasm was seen in 61 patients(44.2%) and the clinical vasospasm was seen in 41 patients(29.8%);(2) The average interval between last SAH and vasospasm was 8.3 days;(3) The most common neurological deficit was a hemiparesis or a hemiplegia;(4) There is no relationship between mortality and vasospasm.

A Case of Huge Calcified Chronic Subdural Hematoma in the Elderly

After von Rokitansky's description in 1984 of a calcified chronic subdural hematoma, the number of such lesions has reached so far a total of 108. The majority of patients reported have been children and young adults. On review of the literature, elderly patients reported over the age of sixty five years are only 5, so far as we know. A 68-year-old Korean male with a calcified chronic subdural hematoma is reported. He was admitted to our department because of a status epilepticus. During Korean war (1950), abut 37 years before admission, he had been suffered from a blunt head injury, but mistreated then, and afterwards th had several episodes of convulsion. Neurological examination on admission revealed only a drowsy consciousness and mild papilledema on the left. Plain skull X-ray films and brain CT scan demonstrated a left sided biconvex type of intracranial calcification. A left frentoparietal craniotomy was performed. After opening the dura mater, the thickened outer membrane, the subdural hematoma and the thin bone like plate were removed thoroughly. Content of the subdural hematoma was brown muddy substance. In the eight months following the operation, the generalized seizure did not appear. Postoperative CT scan demonstrated complete re-expansion of the brain parenchyme.