Postmortem Study on a Korean Woman with Cerebral Rete Mirabile

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A Clinical Observation on Craniocerebral Injuries in Adult

In modern society, characterized by variability of daily life, complicated industrial structure and surprisingly increased traffics, the danger of unexpected accident if always threatening the people. In America, for instance, almost 0.5% of the whole population annually suffers from head injury. About two thirds of traffic accident patients have head injury of various forms. Among the head injury patients due to traffic accidents, the commonest cause of death is head injury itself in about 70%. In this study, 585 cases of adult head injury patients over 15 years of age, observed at the Department of Neurosurgery, Seoul National University Hospital during the period from January, 1966 till September, 1971 were reviewed. 1) There were 447 men and 138 women; male female ratio was 3:1.2) The commonest cause of head injury was traffic accident (57.3% of the total patients). A second common cause was "falls"(25.5%). 3) In skull fracture patients, vault fractures were twice as frequent as basal skull fracture. The incidence of simple fractures was remarkably higher than that of compound fractures, the ratio being 7:4. The incidence of linear fractures was slightly higher than that of depressed fractures, the ratio being 6:5. Most of linear fractures were simple fractures, but about 79% of depressed fractures were compound fractures. 4) Among the intracranial hemorrhagic lesion, subdural hematoma occupied about half of the total cases, most of whom were acute cases. The predilection site of subdural hematoma was the cerebral convexity (frontal, parietal and temporal areas). The epidural hematoma , of which the predilection site was temporal area, occupied about 30 % of the total intracranial hemorrhage lesions. Temporal lobe was the predilection site of intracerebral hematoma. 5) About half of the patients with intracranial hemorrhagic lesions were accompanied by skull fractures. About 28% of the cases with skull fractures were accompanied by intracranial hemorrhagic lesions. 6) Altered consciousness was observed in about 90% of the total patients. Lucid interval was observed in 26% of the cases with intracranial hemorrhagic lesion. Vomiting occurred in a quarter of the total patients and early convulsive attacks were noticed in 5%. 7) Overall mortality rate of all the head injury patients was 12.3% and their operative mortality rate was 20.1%. The mortality rate in the patients with skull fractures was five times as high as in the patients without skull fractures. The mortality rate in the patients with intracranial hemorrhagic lesions was nearly three times as high as in those without. The mortality rate in the patients with linear skull fractures was about three times as high as in those with depressed skull fractures. 8) Sequelae were noticed in about half of the total patients. The most frequent one was postconcussion syndrome, the incidence being 36% of the total patients. 9) Associated injuries were found in about 10% of the total patients. The frequent ones were clavicle fracture, tibia/fibula fracture and mandible fracture, in order.

A Clinical Observation on Craniocerebral Injuries in Infants and Children

A Clinical analysis was carried out with 340 cases of craniocerebral injuries under 15 years of age, admitted at the Department of Neurosurgery, Seoul National University Hospital in 12 years between Jan., 1987 and Dec., 1969. The matrial was classified four groups according to main lesions, i.e. (1) mild cerebral contusion without skull fractures. (2) moderate or severe cerebral contusion without skull fractures. (3) various types of skull fractures. (4) intracranial hemorrhagic lesions, representing such lesions as follows: a. epidural hematoma, b. subdural hematoma, c. subdural hygroma, d. intracerebral hematoma, e. traumatic subarachnoid hemorrhage. The results were as follows: 1) The age incidence was greatest in 6 years of age, and 120 cases (32.6% of the total) were included in the age group between four and six. 2) Males outnumbered females by almost 2 to 1. 3) The accident occurred mostly between 1 p.m. and 4 p.m. in a day. 4) The craniocerebral injuries were caused by traffic accident(173 cases; 50.8%), falls from heights(108 cases; 31.8%), hit(55 cases; 10.9%), firearms(2 cases; 0.6%) and birth injury (2 cases; 0.6%). 5) Early convulsion was the frequent symptom in the age group between 2 and 7. It was felt that convulsions frequently occurred in epidural and subdural hematoma patients. 6) Forty eight per cent of patients had no deterioration of consciousness on admission examination. 7) Epidural hematoma was the common finding in most of the depressed skull fracture cases. 8) The location of skull fractures in the order of frequency were parietal, temporal, frontal and occipital bone. 9) The epidural hematoma was most common lesion in the 13 to 15 year-old group. 10) The over-all mortality rate was 7.1%. In the surgical group(79 cases) the operative mortality was 11.4%(9 cases): the mortality rate of the subdural hematoma, 25.0%(3 cases); the epidural hematoma, 11.1%(2 cases); the compound depressed fracture, 7.8%(2 cases). In the non-surgical group(261 cases) it was 5.8%. The mortality rate of those who and been unconscious after injuries was significantly high(75.0%). 11) The period of hospitalization was two weeks on an average.

Dense Calcification in Medulloblastoma: Case Report

The medulloblastoma, a neoplastic emtity which was first identified and described in 1925 by Bailey and Cushing, is a highly malignant, rapidly growing tumor mainly confined to the first decade of life. The medulloblastoma rarely calcifies. Many investigator have reported that medulloblastoma may exhibit calcification only on microscopic examination. Roentgenographic evidence of calcification was found in one case of 54 patients with medulloblastomas by McRae, and in only one case of 96 patients with medulloblastomas by Kalan. A twelve-year-old Korean male was admitted to Seoul National University Hospital on May 1, 1972 with the complaints of severe occipital headache, vomiting, and unsteady gait of five months duration. Neurological examination revealed bilateral papilledema of 3 diopters, signs of cerebellar dysfunction on the left side including truncal ataxia, adiadochokinesia, positive Romberg test and markedlv distured tandem gait. Horizontal nystagmus with quick component directed to the left side was also found. Plain skull films showed suture separation and an abnormal calcific shadow measuring about 2 by 2.5cm in the posterior fossa. Reflux brachial angiogram showed marked bowing of anterior cerebral artery, and elevation of middle and posterior cerebral arteries suggesting a large mass in the posterior fossa causing obstruction of CFS pathways resulting in marked dilatation of ventricular system. Exploring the posterior fossa, a soft grayish tumor mass was removed partially. Microscopic diagnosis was medulloblastoma of desmoplastic type with calcification. Postoperatively CSF leakage through the incision site was encountered, but was controlled to be healed up by compression bandage. The patient showed no significant change of neurological status by the time of discharge. The patient was scheduled to undergo Co60 radiation therapy after discharge.