A Case of Ophthalmofacial-Diencephalic Arteriovenous Malformation: A Variant of Bonnet-Dechaume-Blanc Syndrome

Authors experienced a rare case of ophthalmofacial-diencephalic arteriovenous malformation, named Bonnet-Dechaume-Blanc syndrome in 12 year-old girl. Clinically patient had an episode of frequent bleeding from the nose and gingival. Also she was left blindness of which the ophthalmologist gave the warning for cerebral hemorrhage because of the tangled, engorged vessels in left fundus. The multiple nidus on angiography revealed on left intraorbital, maxillopalatal, hypothalamic and basal ganglia area. Surgery underwent for huge intracerebral hematoma. The patient passed away due to rebleeding 15 months after initial hemorrhage.

A Clinical Observation on Head Injuries in Infants and Children

A clinical analysis was carried out with 400 cases of head injuries under 15 years of age admitted at the Department of Neurosurgery, Inha University Hospital during 4 years from 1987 to 1990. The material was classified into three groups according to main lesions, i.e. 1) simple cerebral contusion without skull fractures, 2) various types of skull fractures, 3) intracranial hemorrhagic lesions, representing such lesions as follows;a) epidural hematoma, b) subdural hematoma, c) intracerebral hematoma, intraventricular and subarachnoid hemorrhage. The results were as follows; 1) The age incidence was greatest in 7 years of age, and 188 cases(47%) were included in the age group between seven and ten. The accident occurred mostly from March to May, especially in April. 2) The head injuries were caused by traffic accident(203 cases:51%), fall down(152 cases:38%), etc. In clinical pictures, neck sprain(52.8%), nausea and vomiting(47.5%), and early epilepsy)9%) were developed. 3) The linear skull fracture was higher than other type fractures(74.6%) and the locations of skull fractures were parietal, occipital, temporal and frontal bone in order of frequency. 4) Among the intracranial hemorrhagic lesions, EDH was most common lesion, 73 cases(79%) of the patients with intracranial hemorrhagic lesions were accompanied by skull fractures but of the patients with skull fracture, 51.4% were accompanied by hemorrhagic lesions. Lucid interval was observed in 15 of the cases with intracranial hemorrhagic lesions and contre-coup injury was developed in 19(12%). 5) In the GOS, the high scored cases on the GCS were better than the low scored cases. 4 cases of 23 people scored under 8 on the GCS died. 14 cases of them were included in the age between 6 and 10(61%). 6) Associated injuries were found in about 16% of the total patient, the most common injury was clavicle fracture and most frequent sequala was post traumatic syndrome. The late epilepsy was occurred in about 13% of the early epilepsy cases except the cases had pre-traumatic epilepsy history.

The Clinical Consideration on the Prognosis of the Pontine Hematoma

Pontine hematoma would be diagnosed and made its follow-up readily as the extent of hematoma could be clearly defined since the CT scan was available, especially with MRI in recent. Authors attemped to analyse 20 cases of pontine hematoma clinically, considering factors of influence their prognosis, admitted in Inha hospital from March 1989 to February 1992. Classification of pontine hematoma was made out according to the findings of brain CT scan taken on admission:2 cases of Type T1 to the hematoma localized in the tegmentum unilaterally, 1 case of Type T to those in the tegmentum bilaterally with some extent into the 4th ventricle, 12 in Type T to those in the tegmentum, midbrain and mostly the 4th ventricle, and 5 in Type B to those in the basis pontis mainly with tegmentum and midbrain. Of 219 spontaneous intracerebral hematoma, pontine hematoma was 9.1%. 17 hypertension and 11 previous CVA episodes including 7 cerebral infarction and 4 ICH were endountered. Age distribution was 50% in 6th decade and male to female ratio was 3:2. On admission 14 cases were under 6 in Glasgow coma scale, 6 small reactive pupils and 11 ocular bobbing. Particularly, nuclear facial paralysis was 14 in initial bilateral type, of which 7 dead within 10 days, 5 fixed in left facial paralysis and 1 case into right paralysis later. Four surgical interventions were 1 simple EVD, 1 Urokinase irrigation through EVD, 1 steretactic aspiration and 1 direct hematoma removal. Prognosis was related to various factos:GCS on entry, volume and classification of hematoma, in addition to laterality of nuclear facial paralysis. Clinical course was better in cases over 10 GCS on entry, volume and classification of hematoma, in addition to laterality of nuclear facial paralysis. Clinical course was better in cases over 10 GCS, Type T1 and T2, and unilateral facial paralysis in which the ratio of left to right was 2:1, while it was very poor in patients who were GCS below 6, Type B and bilateral facial paralysis. On the contrary, 7 of 20 cases were dead within 10 days, 13 patients alive for more 3 months after the hemorrhage were observed with fixed facial paralysis in nuclear type, 1 ilateral, 4 right, and 8 left side. It is suggested and requested for further careful follow-up that the hemorrhage may occur from the border zone between paramedian, short and long circumferential arteries supplying transection area of the pons unilaterally, near on around the facial nucleus, more frequent in left side.

Clinical Investigation of Seizure Disorder Associated with Temporal Lobe Lesions

We evaluated the temporal lobe lesions in 24 patients who had various types of seizure as initial neurologic symptoms between 1987 and 1992. All patients were studied with radiologic and pathologic procedures. The types of seizure were classified with the International League Against Epilepsy classification. The results were as follows:The age of distribution of patients were 3 to 72 years old. The most common seizure type was generalized tonic-clonic and then complex partial, unclassified type, generalized absence and simple partial motor in order. The usual associated diseases were arachnoid cyst, abscess, blioblastoma multiforme, meningioma and temporal sclerosis. The most common location of the lesions was the inferomedial area in the temporal lobe. The maximal diameters of lesions were ranged from 7 to 78 mm(mean 36 mm) .

Skull Metastasis of Hepatocelluar Carcinoma: A Case Report

Skull metastasis of hepatocelluar carcinoma are rarely reported, even in the Orient and the Africa where this carcinoma is one of the relatively common malignancies. One case with the skull metastasis of the hepatocelluar carcinoma, which no literature was found about the distant metastasis to the skull bone only in Korea, is reported with the histochemical stain and the relevant literatures are reviewed.

The Study in Frontal Ventricular Measurement and Correlation between Cerebroventricular Index and Cephalic Index on Normal Computed Tomography

The study was undertaken to assess the ventricular system of the brain in normal Korean, using the computed tomography(CT). The CT examination of 1000 normal patients between the ages of 1 to 83 years, performed at Inha hospital, were evaluated. Determination of the ratio between the width of the brain and a dimension representing the distance between the outer borders of the lateral ventricles was made at two levels. The ratio, the cerebroventricular index(CVI), seems to be a reliable, easier indicator of ventricular size. The standards vary with the age of the patients. The results are as follows ; 1) There was no significant difference with sex. 2) The cerebroventricular indexes of the lateral ventricular at the widest bifrontal(CVI) and narrowest bicaudate diameters(CCI) were 0.300+/-0.033, and 0.105+/-0.022. 3) There was correlation between cerebroventricular ratio and age with increase of age, cerebroventricular ratio increased slightly. 4) There was slight correlation between cerebroventricular index(CVI) and cephalic index(CI). 5) The CVI appears to be more sensitive than the CCI in the detection of changes in ventricular size. 6) Our suspected hydrocephalic indexes(HI) are as follows ; CVI < or = 1/3 : within normal range, 1/3

Tremendous Skull Metastasis from Follicular Thyroid Carcinoma: Case Reort

A rare and tremendous skull metastasis from the follicular thyroid carcinoma is reported with review of the articles. Follicular carcinoma of the thyroid with distant metastasis is considered a relatively progressive tumor associated with poor five-year survival rate. The insidious character of the primary growth of the thyroid carcinoma is the long latent period which supervenes between the recognition of the primary growth and its secondary metastasis. The clinicopathological features, plain X-ray and C-T findings are discussed.

Cerebral Metastases and Menifestation of the Alveolar Soft Part Sarcoma

Alveolar Soft Part Sarcoma(ASPS) in an unusual tumor of soft tissue, it has invariably ended in death from disseminated disease, and the lung has been the most common site of metastasis, but the brain was the 3rd most common site of metastasis. That proportion seems 0.4% of all soft tissue sarcoma. Clinical, pathological, and radiological features of metastatic cerebral lesions resulting from ASPS are presented. Angioarchitecture, and radiotherapic finding and chemotherapy are discussed. The unusual juxtaposition of the tumor cells to the endothelium seems responsible for the highly vascular appearance of the lesion on angiography, the frequency of hematogenous spread, and the grave, although delayed, prognosis. The purpose of this paper is to be report ASPS which has never been reported in Korea yet, with some references.