There are so many differences between the elderly patients and the younger patients in the aspects of a causes and the clinical course of spontaneous intracerebral hemorrage (ICH). As the mean life-time of a general population goes longer, the incidence of spontaneous ICH increases but the aggressive support in ICH is withdrawn more commonly and a prognosis of ICH becomes poor. Therefore, a prevention of ICH and a strict control of hypertension is very very important.
Aged ; Cerebral Hemorrhage* ; Humans ; Hypertension ; Incidence ; Mortality ; Prognosis

As the number of elderly people increases, the incidence of stroke, especially the hemorrhagic stroke, is increasing. A large-scale survey of the entire country pertaining to the incidence and demographic characteristics of hemorrhagic stroke in elderly is necessary. Through information garnered from a basic survey and clinical study, we must design a treatment program to reduce the mortality of elderly people through elucidating the specific properties of stroke pathophysiology.
Aged* ; Humans ; Incidence* ; Mortality ; Stroke*

Hypertension is a very common disorder in the aged persons. There exist several hemodynamic characteristics associated with hypertension in the geriatric population, - decreased elasticity of arterioles due to fibrosis, decreased renin activity, and decreased cardiac output and renal blood flow. Clinically, isolated systolic hypertension, blood pressure variation within a day, and white coat hypertension, are more common in the aged population. Furthermore, aged persons have more chances to suffer other diseases, diabetes, COPD, and renal dysfunction, for example. These characteristics need tailored approaches in diagnosing and managing hypertension in the aged. In the current literature, detailed characteristics of 'geriatric hypertension', are described, including definition, grade of hypertension, importance of treatment of hypertension, complications of hypertension, drug or non-drug treatment, and principles of drug treatment especially in the specific age group.
Arterioles ; Blood Pressure ; Cardiac Output ; Elasticity ; Fibrosis ; Geriatrics* ; Hemodynamics ; Humans ; Hypertension* ; Pulmonary Disease, Chronic Obstructive ; Renal Circulation ; Renin ; White Coat Hypertension

The stereotactic radiosurgery for arteriovenous malformation (AVM) began in the early 1970s. Nowadays, by 2000 world-wide, more than 27,500 patients have undergone Gamma Knife radiosurgery for cerebrovascular disease (CVD). New concepts, consisting of obliteration rate, postradiosurgical hemorrhagic risk, dose selection for treatment, and radiosurgery for pediatric AVM, medium-to-large sized AVM, cavernous malformation, venous angioma, so on, have been established. Gamma Knife radiosurgery has been considered as an effective management stratege with relatively few side effects for AVM. However, recently delayed radiation-induced complications were reported in 3.2 to 12.5% in range. Therefore, the long-term follow-up is thought to be mandatory even after treatment goal, complete obliteration, is confirmed.
Arteriovenous Malformations ; Follow-Up Studies ; Hemangioma ; Humans ; Patient Selection ; Radiosurgery*

These days, a less invasive surgery is stressed. One current thought is that the endovascular surgery itself is the less invasive and safer surgery for a cerebral aneurysm, and not the microsurgery. Is this true? We have evaluated the merits and demerits of each method. Our conclusion is as follows. Endovascular Surgery should be considered as an alternative, only for the specific patients. Microsurgery itself retains its position of the first treatment of choice for a cerebral aneurysm. "Less invasive" cannot be equated with "less dangerous". We will show the above reasons using slides and videotapes of several patients.
Humans ; Intracranial Aneurysm ; Microsurgery ; Videotape Recording

OBJECTIVE: The purpose of this study is to compare the incidence of shunt-dependent chronic hydrocephalus and symptomatic vasospasm in elderly patients following intracranial aneurysm rupture with those of younger patients. METHODS: We retrospectively reviewed the medical records of 189 patients who were treated with open surgery between May 1994 and December 2000. They were divided into two groups; elderly (> or =60 yrs) and younger (< or =59 yrs) group. Incidence of shunt-dependent chronic hydrocephalus and symptomatic vasospasm was analysed in each group during 6 months after surgery. RESULTS: Shunt-dependent chronic hydrocephalus has developed more frequently in the elderly group (27.8%) than in the younger group (7.3%). Incidence of symptomatic vasospasm was not significantly different between two groups, even though poor grade patients were more represented in the elderly group. CONCLUSION: Meticulous clinical long-term follow-up is needed to detect shunt-dependent chronic hydrocephalus as early as possble in the elderly patients with operated ruptured intracranial aneurysms and in that case, shunt operation should be undertaken.
Aged* ; Follow-Up Studies ; Humans ; Hydrocephalus* ; Incidence ; Intracranial Aneurysm* ; Medical Records ; Retrospective Studies ; Rupture

Percutaneous balloon angioplasty has been reported to be useful in the treatment of intracranial atherosclerotic arterial stenosis. However, arterial dissection with increased risk of acute closure and stroke has limited its widespread implementation. Stenting of the intracranial vasculature recently has been shown to be feasible in a variety of circumstance. However, stenting of middle cerebral artery has been limited because of difficulty with tracking stents across the carotid siphon. We report a case of successful percutaneous stenting of a symptomatic middle cerebral artery stenosis using a balloon-expandible flexible coronary stent.
Angioplasty ; Angioplasty, Balloon ; Constriction, Pathologic* ; Middle Cerebral Artery* ; Stents* ; Stroke

Microsurgical neck clipping has been believed to be the most reliable treatment for the intracranial aneurysm. However, recurrence or regrowth from so called "completely clipped aneurysm" with catastrophic outcome has been infrequently reported. We describe an unusual case of regrowth of posterior communicating artery aneurysm which was found 13 years after the first successful clipping at the same site. Surgeons should pay attention to the possibility of such a regrowth even though the initial clipping seemed to be perfect. Additional deliberate postoperative angiography might resolve this late consequence.
Aneurysm ; Angiography ; Intracranial Aneurysm* ; Neck ; Recurrence

OBJECT: It is reported that spontaneous subcortical intracerebral hemorrhage consists about 10 to 44% of spontaneous intracerebral hemorrhage. Recently, spontaneous subcortical intracerebral hemorrhage due to the complication of the systemic disease has been increasing, and the selection of management strategy according to the cause of hemorrhage closely affected the management outcome. This study was designed to analyze the cause of spontaneous subcortical intracerebral hemorrhage and the outcome in order to establish the appropriate management strategy. SUBJECT: One hundred and seventy-nine cases of spontaneous subcortical intracerebral hemorrhage managed at Yonsei University Hospital from January 1998 to December 2000 were included in this study. Patients who suffered from subcortical intracerebral hemorrhage due to the ruptured intracranial aneurysm were excluded. The patient's sex, age, mental state on admission, neurologic condition, past history, systemic disease related to hemorrhage, location of hemorrhage, the diagnosis of intracranial or systemic disease, treatment methods, and clinical outcome were analyzed. Consciousness on admission was evaluated and scored based on Glasgow Coma Eye Motor Scale (GCEMS), which was the sum of eye response score and motor response score of the Glasgow Coma Scale. Patients were categorized into 4 groups according to GCEMS: Group 1 (10 points), Group 2 (8, 9 points), Group 3 (5-7 points), and Group 4 (2-4 points). The clinical outcome of the patient was evaluated based on Glasgow outcome scale (GOS). Differences in diagnostic procedure were present depending on the condition of the patients, thus the final diagnostic procedure was used to diagnose the reason behind bleeding. When accurate diagnosis was difficult to perform, the reasons with the highest likelihood were chosen. RESULTS: The patients corresponding to each group were as follow: 79 (44.1%) in Group 1, 35 (19.6%) in Group 2, 27 (15.1%) in Group 3, and 38 (21.2%) in Group 4. Fifty-five patients (30.7%) were hypertensive intracerebral hemorrhage, 45 patients (25.1%) had anticoagulant therapy and thrombocytopenia due to the systemic disease and bleeding diathesis after anticancer drug therapy, 23 patients (12.8%) had brain tumor including the metastatic tumor, 19 patients (10.6%) had arteriovenous malformation, 18 patients (10.1%) had postinfarct hemorrhages, 5 patients (2.8%) had infective endocarditis, 2 patients (1.1%) had cerebral vasculitis. Conservative treatment was done in 115 patients (64.2%), open craniotomy in 31 patients (17.3%), and catheter insertion in 33 patients (18.4%). Group 1 mainly had conservative treatment (58 patients, 73.4%), Group 2 and 3 had 12 patients (37.1%) and 16 patients (59.3%) each underwent open craniotomy respectively. In Group 4, conservative treatment was done for 24 patients (63.2%), and open craniotomy was done for only one patients among 14 patients treated surgically. Overall clinical outcome was: 77 patients (43.0%) in GOS 5, 21 (11.7%) in GOS 4, 14 (7.8%) in GOS 3, 11 (6.1%) in GOS 2, and 56 patients (31.3%) died. Poor neurological state (low GCEMS) on admission was closely related to mortality (Group 1, 7.6%; Group 2, 22.8%; Group 3, 45.0%; Group 4, 78.9%). CONCLUSION: The major causes of spontaneous subcortical intracerebral hemorrhage were hypertension, metastatic brain tumor, vascular malformation, and the bleeding tendency due to the systemic disease, complication of the anticancer drug, anticoagulant, and thrombolytics therapy. Conservative treatment could be considered for the patients with GCEMS 10, removal of hematoma by open craniotomy or catheter insertion for the patients with GCEMS 5-9, and the catheter insertion or deferring the active treatment could be considered for the patients with GCEMS 2-4.
Arteriovenous Malformations ; Brain Neoplasms ; Catheters ; Cerebral Hemorrhage* ; Coma ; Consciousness ; Craniotomy ; Diagnosis ; Disease Susceptibility ; Drug Therapy ; Endocarditis ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Hematoma ; Hemorrhage ; Humans ; Hypertension ; Intracranial Aneurysm ; Intracranial Hemorrhage, Hypertensive ; Mortality ; Thrombocytopenia ; Vascular Malformations ; Vasculitis, Central Nervous System

OBJECTIVE: The purpose of this study is to investigate changes of vasoreactivity after STA-MCA anastomosis in patients who develop hemodynamic cerebral ischemia associated with ICA or MCA occlusion. METHODS: Twenty-five patients with hemodyamic infarction due to symptomatic ICA or MCA occlusion were treated with extracranial-intracranial bypass surgery (EIAB). Of these, we enrolled 17 patients who underwent follow-up SPECT and follow-up angiogram. To test vasomotor reactivity, we measured relative regional cerebral blood flow (rrCBF) with SPECT both at rest and after diamox infusion. rrCBF were calculated using the following equation: (lesional radioactivity/contralateral radioactivity) x100. We performed EIAB in patients with impaired vasomotor reactivity. To evaluate changes in vasomotor reactivity after surgery, follow-up brain SPECT was performed 1-6 months after surgery and compared rrCBF before and after surgery. RESULTS: Base line radioactivity ratios did not change after surgery. These ratios after diamox challenge were 59.8+/-4.2%, however, 1-6 months after surgery, ratios increased to 77.7+/-.6% (p<0.05, Paired T-test). Preoperative degree of angiographic collateral circulation did not influence the restoration of vasoreactivity. All but two patients showed good collateral circulation through the bypass. There were no cerebral accidents in any these patients at 6 months to 2 years follow-up. CONCLUSION: These results demonstrate the restoration of vasomotor reactivity distal to the occluded ICA or MCA after EIAB, and also show that measurement of rrCBF using SPECT are useful indicators of the clinical and hemodynamic improvement.
Acetazolamide ; Brain ; Brain Ischemia ; Collateral Circulation ; Follow-Up Studies ; Hemodynamics ; Humans ; Infarction ; Radioactivity ; Tomography, Emission-Computed, Single-Photon