A Clinical Analysis of Delayed Traumatic Intracerebral Hemorrhage

The occurrence of delayed intracerebral hemorrhage is more frequent than previously reported and is associated with a poor outcome. Early detection and proper management is important in that aspect. The progression tends to be insidious. When the patient's consciousness gets worse or is not improving within resonable time, the second CT scan should be performed. In a retrospective study of 211 consecutive patients with traumatic intracranial hematomas, we identified 12 cases(5.6%) with delayed traumatic intracerebral hemorrhage(DTICH). Among these, five(41.6%) died of DTICH. Cerebral contusion on initial CT, acceleration-deceleration injury with rotational forces, surgical decompression would be important contributors in the development of DTICH.

An Analysis of Operative Treatment of Lower Cervical Spine Injury

The authors retrospectively reviewed the operative cases of 28 patients with lower cervical spine injury from August 1991 to July 1996. Data from charts were reviewed the following clinical parameters, e.g.) etiologies, neurologic findings, degrees of recovery, managements including operative treatments, and complications. The lower cervical injury was most common in men in the third decade. The most common cause, mechanism and site of lower cervical injury were motor vehicle accidents, flexion type injury and C5-6 respectively. The head trauma was frequently combined. In most cases operation for stabilization was done around two weeks after the trauma, but for decompression purpose it was done before two weeks. Three patients who had complete neural injuries died due to pneumonia, adult respiratory distress syndrome, and upper gastrointestinal bleeding. A neurological recovery rate was high in incomplete neural injury group. In conclusion, early reduction and decompression of spinal canal in incomplete neural injury group is favorable for good recovery. Careful attention should be paid on the patient with complete injury for the development of serious complications such as upper gastrointestinal bleeding, ARDS and pneumonia.

A Case of Cavernous ICA Occlusion after Radiation Therapy in Pituitary Adenoma

Stenosis or occlusion of large arteries after radiation are rare. The authors report a case of internal carotid arterial occlusion after radiation therapy. The patient was 45 year-old female. She received postoperative radiation therapy, a total dose of 4940cGy, to treat the remnant tumor after transsphenoidal surgery for the asymptomatic nonfunctioning pituitary adenoma. She suffered intermittant ischemic symptoms from 18 month after radiation therapy, and died with global infarction due to stenotic occlusion of the internal carotid artery at 30 month after surgery. Endocrine or vascular complications occasionally follow radiation therapy of pituitary tumor. But with improved therapies for pituitary tumors and hypopituitarism, patients are expect to live longer. Yet we must consider another delayed complication of radiation induced carotid arterial disease. As a whole, hemispheric transient ischemic attacks, amaurosis fugax, and seizure are the major presenting symptoms and signs. In such a case, it is important to consider the possibility of radiation induced arterial stenosis, and prompt cerebral angiography and proper management are mandatory.