Intracranial Aneurysm with Takayasu's Arteritis in a Child: Case Report

The authors present a case of intracranial aneurysm with Takayasu's arteritis. A 10-year-old boy was admitted with complaints of sudden bursting headache and vomiting. Computed tomographic(CT) scan showed subarachnoid hemorrhage and measure blood pressures between in each side did differ significantly. Aortoangiogram showed narrowing of the abdominal aorta and stenosis at their origins of the renal arteries. An angiogram of the right carotid artery revealed a saccular aneurysm located at the proximal portion of the middle cerebral artery. Intracranial aneurysm with Takayasu's arteritis is a rare entity, even more in children.

Clinical Experience of the Primitive Neuroectodermal Tumors

Primitive neuroectodermal tumors(PNETs) are composed of undifferentiated cells resembling germinal matrix cells of the embryonic neural tube. The concept of the primitive neuroectodermal tumors is controversial due to indistinct clinicopathologic entities. While some neuropathologists believe that the PNET concept should be applied to all these tumors with the addition of qualifying terms, the opponents of this approach believe this concept to be too simplistic and that well-established diagnostic entities should not be grouped together as a single entity. Four patients with PNET were reviewed. Although the PNETs bear some differences to posterior fossa medulloblastomas, we should be grouped together as a single pathologic entity because of their primitive nature. The purpose of this study is to review the similarties and differences between two tumors from their histologic and embryologic features.

A Case of Gonadotropin-Producing Pituitary Adenoma

A 58-year-old male with a pituitary adenoma was investigated and demonstrated to have hypersecretion of both gonadotropins in the basal state. Presenting symptoms included visual disturbance, headache, loss of libido, impotence, cold intolerance and urinary frequency. The patient denied alteration of hair distribution and did not disclosed the aral features, galactorrheaor gynecomastia. Dynamic assay with synthetic thyrotropin-releasing hormone and synthetic gonadotropin-releasing hormone result in increase of serum luteinizing hormone(LH) and follicle stimulating hormone(FSH). Immunochemically, tumor cell revealed positive reaction for chromogranin and FSH, but negative for LH. Electron microscopic examination using paraffin embedded block was failed to demonstrate classic neurosecretory granule, but some electron dense granules were found in the cytoplasm. Gonadotropin-producing pituitary adenomas are rare, but have been diagnosed more frequently as radiographic techniques and biochemical assays have improved. A review of the literatures documents pituitary tumor secreting both FSH and LH in the basal state and we report a case of gonadotropin-producing pituitary adenoma.

Clinical Experiences of Petrous Pyramid Fractures

A retrospective analysis of 36 cases of petrous pyramid fractures was studied clinically and radiographically during last 5 years. Of 503 patients with skull fractures admitted to the Inha University hospital, of which 7.1% involved the petrous pyramid. The most common mode of injury was a motor vehicle accident and the most common age group was the first decade. The anatomic location of fractures in the petrous pyramid were evaluated by high resolution computed tomography and it disclosed 20 longitudinal and 16 transverse fractures. The principal symptoms and signs, occurring alone or in combination, were a otologic problem, facial paralysis and CSF liquorrhea. The otologic problems were noted in almost every case. The facial palsy and CSF liquorrhea were present in 16 cases(36%) and 9 cases(25%), respectively. The anatomic type of fractures well corresponded to the principal symptoms and signs and the prognosis, the development rate of principal symptoms and signs of the transverse fracture was more higher and the prognosis of that was worse than the longitudinal fracture.

Clinical Analysis on 34 Diffuse Axonal Injured Cases Under 8 on the GCS

Thirty four patients with diffuse axonal injury, defined as post-traumatic coma for over 24 hours with Glasgow Coma Scale(GCS) score of 8 or less following nonsurgical resuscitation, admitted to Inha Hospital from January to December 1991, were studied in order to identify clinical analysis. The aim of this study was to find out the effects of barbiturates or other intensive therapy or head elevation on the intracranial pressure(ICP), arteriovenous oxygen difference(AVDO2) and outcome. The results were as follows; The ratio of male to female was about 6 to 1. 2) In clinical signs at the emergency room, abnormal pupil size was shown 17 cases(61%) under 8-5 on the GCS, but all cases under 5 on the GCS showed abnormal pupil size. 3) Ventricular compression was shown in 29 cases(85%), 17 cases(50%) was showed the ventricular compression & cisternal obliteration. 4) Post-traumatic cerebral infarction was developed 59% of DAI and occurred in 88% of ventricular compression and cisternal obliteration. 5) On admission, above 5 ml/100 ml in AVDO2 was developed in 32 cases(94%) under 8 on the GCS, but in all cases under 5 on the GCS. Recording of ICP showed above 20 mmHg in 15 cases(44%). On coagulopathy, our cases showed that decrease of platelet was involved in 5 cases(15%), prothrombin time(PT) prolongation in 11 cases(32%), activated partial thromboplastin time(APTT) in 4 cases, fibrinogen in 5 cases. 6) The mean ICP was slightly lower when the patient's head was elevated at 30 degree than at 0 degree. The mean ICP was moderately lower when the patients were taken barbiturates therapy. ICP tends to increase from the 1st to 3rd day after injury. 7) The mean AVDO2 was significantly lower when the patients were taken barbiturates therapy, especially at the 1st day. 8) On the relation between Glasgow Outcome Scale(GOS) and Neurological grading(NG), GOS IV was developed in 8 cases(NG score 3-6), GOS III in 5 cases(NG score 7-9), GOS II in 2 cases(NG score 10). Total mortality rate was 56%.