1.Spinal Extradural Arachnoid Cyst.
Joon Bum WOO ; Dong Wuk SON ; Kyung Taek KANG ; Jun Seok LEE ; Geun Seong SONG ; Soon Ki SUNG ; Sang Weon LEE
Korean Journal of Neurotrauma 2016;12(2):185-190
A spinal extradural arachnoid cyst (SEAC) results from a rare small defect of the dura matter that leads to cerebrospinal fluid accumulation and communication defects between the cyst and the subarachnoid space. There is consensus for the treatment of the dural defect, but not for the treatment of the cyst. Some advocate a total resection of the cysts and repair of the communication site to prevent the recurrence of a SEAC, while others recommended more conservative therapy. Here we report the outcomes of selective laminectomy and closure of the dural defect for a 72-year-old and a 33-year-old woman. Magnetic resonance imaging of these patients showed an extradural cyst from T12 to L4 and an arachnoid cyst at the posterior epidural space of T12 to L2. For both patients, we surgically fenestrated the cyst and repaired the dural defect using a partial hemi-laminectomy. The patient’s symptoms dramatically subsided, and follow-up radiological images show a complete disappearance of the cyst in both patients. Our results suggest that fenestration of the cyst can be a safe and effective approach in treating SEACs compared to a classical complete resection of the cyst wall with multilevel laminectomy.
Adult
;
Aged
;
Arachnoid*
;
Cerebrospinal Fluid
;
Consensus
;
Epidural Space
;
Female
;
Fenestration, Labyrinth
;
Follow-Up Studies
;
Humans
;
Laminectomy
;
Magnetic Resonance Imaging
;
Recurrence
;
Subarachnoid Space
2.Retro-Odontoid Pseudotumor without Atlantoaxial Subluxation or Rheumatic Arthritis.
Seung Han YU ; Hyuk Jin CHOI ; Won Ho CHO ; Seung Heon CHA ; In Ho HAN
Korean Journal of Neurotrauma 2016;12(2):180-184
We present a case of retro-odontoid pseudotumor (ROP) without rheumatoid arthritis (RA) or atlantoaxial subluxation (AAS). A 76-year-old woman presented with paresthesia and weakness of both lower and upper extremities. She had no laboratory or physical findings of RA. Dynamic X-ray showed no AAS and magnetic resonance imaging (MRI) showed a retro-odontoid mass compressing the spinal cord. Transdural mass debulking and biopsy were performed via minimal left suboccipital craniectomy and C1 hemilaminectomy. Two months after surgery, her symptoms were aggravated. Follow-up MRI visualized mass re-growth and spinal cord compression due to the mass and AAS. Posterior C1-2 fixation was performed without further decompression. Twelve months after posterior fixation, no symptoms were apparent and follow-up MRI showed complete resolution of the ROP with C1-2 bony fusion. The ROP with C1-2 instability might be completely resolved only C1-2 fusion without decompression. Furthermore, we speculated that osteoarthritis of C1-2 itself causes a partial tear or degradation of the transverse ligament, that induced formation of ROP.
Aged
;
Arthritis, Rheumatoid
;
Atlanto-Axial Joint
;
Biopsy
;
Decompression
;
Female
;
Follow-Up Studies
;
Humans
;
Ligaments
;
Magnetic Resonance Imaging
;
Odontoid Process
;
Osteoarthritis
;
Paresthesia
;
Rheumatic Fever*
;
Spinal Cord
;
Spinal Cord Compression
;
Tears
;
Upper Extremity
3.The Neck and Posterior Fossa Combined Penetrating Injury: A Case Report.
Hyun Jin HAN ; Jun Ho JUNG ; Chang Ki HONG ; Yong Bae KIM
Korean Journal of Neurotrauma 2016;12(2):175-179
Here we report a case of penetrating neck injury to the posterior fossa that was shown, using high-resolution computed tomography (HRCT) and digital subtraction angiography (DSA), to involve no vascular injury. A 54-year-old man was brought to the emergency department after a penetrating injury to the left side of the posterior neck and occipital area with a knife. He was in an intoxicated state and could not communicate readily. On initial examination, his vital signs were stable and there was no active bleeding from the penetrating site. Because of concern about possible injury to adjacent vessels, we performed HRCT and DSA sequentially, and identified that the blade of the knife had just missed the arteriovenous structures in the neck and posterior fossa. The patient was then transferred to the operating room where the knife was gently removed. Further careful exploration was performed through the penetrating wound, and we confirmed that there were no major injuries to the vessels and neural structures. Postoperative computed tomography revealed that there was minimal hemorrhage in the left cerebellar hemisphere. The patient made a full recovery without any neurologic deficit. In this case, HRCT is a suitable tool for the initial overall evaluation. For the evaluation of vascular injury, DSA can be a specific and accurate tool. Mandatory exploration widely used for penetrating injuries. After careful preoperative evaluation and interpretation, simple withdrawal of material can be a choice of treatment.
Angiography, Digital Subtraction
;
Emergency Service, Hospital
;
Hemorrhage
;
Humans
;
Middle Aged
;
Multidetector Computed Tomography
;
Neck Injuries
;
Neck*
;
Neurologic Manifestations
;
Operating Rooms
;
Vascular System Injuries
;
Vital Signs
;
Wounds, Penetrating
4.Iatrogenic Vascular Injury Occurring during Discectomy in a Spondylodiscitis Patient.
Do Hyun KIM ; Tae Wan KIM ; Min Ki KIM ; Kwan Ho PARK
Korean Journal of Neurotrauma 2016;12(2):171-174
All iatrogenic vascular injury occurring during discectomy is a rare complication, but fatal if not immediately diagnosed. When a vascular injury is highly suspected during discectomy, immediate vascular evaluation is needed even vital signs are stable during and immediately after the operation. We describe a case of iatrogenic abdominal aortic injury that occurred during discectomy in a spondylodiscitis patient, which was treated by endovascular repair.
Discitis*
;
Diskectomy*
;
Humans
;
Vascular System Injuries*
;
Vital Signs
5.Neural Axis Metastasis from Metachronous Pulmonary Basaloid Carcinoma Developed after Chemotherapy & Radiation Therapy of Uterine Cervical Carcinoma.
Myeong Jin OH ; Je Hoon JEONG ; Soo Bin IM ; Jeong Ja KWAK ; Kye Hyun NAM
Korean Journal of Neurotrauma 2016;12(2):167-170
Multiple primary or secondary malignancies after anticancer therapy were recently reported to be increasing in frequency. The authors describe a case of metachronous metastatic pulmonary basaloid carcinoma to the central nervous system that was discovered after chemotherapy and radiation therapy for cervical uterine carcinoma. Two different types of cancer developed within some interval. There's the possibility that a secondary pulmonary neoplasm developed after the chemotherapy and radiotherapy conducted as cervical cancer treatment.
Central Nervous System
;
Drug Therapy*
;
Lung Neoplasms
;
Neoplasm Metastasis*
;
Neoplasms, Second Primary
;
Radiotherapy
;
Uterine Cervical Neoplasms
6.Shunt Overdrainage Caused by Displacement of the Pressure Control Cam after Pressure Adjustment.
Su Ho KIM ; Yoon Soo LEE ; Min Seok LEE ; Sang Jun SUH ; Jeong Ho LEE ; Dong Gee KANG
Korean Journal of Neurotrauma 2016;12(2):163-166
Although the Codman-Hakim programmable valve is one of most popular shunt systems used in the clinical practice for the treatment of hydrocephalus, malfunctions related with this system have been also reported which lead to underdrainage or overdrainage of the cerebrospinal fluid. While obstruction of the ventricular catheter by tissue materials or hematoma and catheter disconnection are relatively common, the malfunction of the valve itself is rare. Herein, we report on a rare case of shunt overdrainage caused by displacement of the pressure control cam after pressure adjustment. A 57-year-old female, who underwent a ventriculoperitoneal shunt eight years ago, experienced aggravating symptoms of shunt overdrainage after pressure adjustment. Displacement of the pressure control cam was revealed on the X-ray, and a shunt revision was performed. The purpose of this report is to provide a working knowledge of the valve structure and to enhance the ability to interpret the valve setting on an X-ray for diagnosis of valve malfunction.
Catheters
;
Cerebrospinal Fluid
;
Cerebrospinal Fluid Shunts
;
Diagnosis
;
Equipment Failure
;
Female
;
Hematoma
;
Humans
;
Hydrocephalus
;
Middle Aged
;
Ventriculoperitoneal Shunt
7.Spinal Subarachnoid Hemorrhage Migrated from Traumatic Intracranial Subarachnoid Hemorrhage.
Tae Jin KIM ; Eun Jung KOH ; Keun Tae CHO
Korean Journal of Neurotrauma 2016;12(2):159-162
Very rarely, spinal subarachnoid hemorrhage (SSAH) can occur without any direct spinal injury in patients with traumatic intracranial SAH. A-59-year-old male with traumatic intracranial subarachnoid hemorrhage (SAH) presented with pain and numbness in his buttock and thigh two days after trauma. Pain and numbness rapidly worsened and perianal numbness and voiding difficulty began on the next day. Magnetic resonance imaging showed intraspinal hemorrhage in the lumbosacral region. The cauda equina was displaced and compressed. Emergent laminectomy and drainage of hemorrhage were performed and SSAH was found intraoperatively. The symptoms were relieved immediately after the surgery. Patients with traumatic intracranial hemorrhage who present with delayed pain or neurological deficits should be evaluated for intraspinal hemorrhage promptly, even when the patients had no history of direct spinal injury and had no apparent symptoms related to the spinal injury in the initial period of trauma.
Brain Injuries
;
Buttocks
;
Cauda Equina
;
Drainage
;
Hemorrhage
;
Humans
;
Hypesthesia
;
Intracranial Hemorrhage, Traumatic
;
Laminectomy
;
Lumbosacral Region
;
Magnetic Resonance Imaging
;
Male
;
Spinal Injuries
;
Spine
;
Subarachnoid Hemorrhage*
;
Thigh
8.A Fatal Adverse Effect of Barbiturate Coma Therapy: Dyskalemia.
Hyun Mook KWON ; Jin Wook BAEK ; Sang Pyung LEE ; Jae Ik CHO
Korean Journal of Neurotrauma 2016;12(2):156-158
The management guideline for traumatic brain injury (TBI) recommends high-dose barbiturate therapy to control increased intracranial pressure refractory to other therapeutic options. High-dose barbiturate therapy, however, may cause many severe side effects; the commonly recognized ones include hypotension, immunosuppression, hepatic dysfunction, renal dysfunction, and prolonged decrease of cortical activity. Meanwhile, dyskalemia remains relatively uncommon. In this study, we report the case of a hypokalemic patient with severe rebound hyperkalemia, which occurred as a result of barbiturate coma therapy administered for TBI treatment.
Brain Injuries
;
Coma*
;
Humans
;
Hyperkalemia
;
Hypokalemia
;
Hypotension
;
Immunosuppression
;
Intracranial Pressure
9.Intracerebral Hemorrhagic Infarction after Cranioplasty in a Patient with Sinking Skin Flap Syndrome.
Korean Journal of Neurotrauma 2016;12(2):152-155
The sinking skin flap syndrome (SSFS) is a rare complication after a large craniectomy. Hemorrhage infarction after a cranioplasty is a very rare complication with only 4 cases to date. We report a case of the patient who underwent an autologous cranioplasty to treat SSFS that developed intracerebral hemorrhage infarction. A 20-year-old male was admitted to our emergency department with stuporous mentality. Emergent decompressive craniectomy (DC) have done. He had suffered from SSFS and fever of unknown origin (FUO) since DC. After 7 months of craniectomy, cranioplasty was done. After 1 day of surgery, acute infarction with hemorrhagic transformation involved left cerebral hemisphere. We controlled increased intracranial pressure by using osmotic diuretics, steroid and antiepileptic drugs. After 14 day of surgery, he improved neurological symptoms and he had not any more hyperthermia. Among several complication of large cranioplasty only 4 cases of intracerebral hemorrhagic infarction due to reperfusion injury has been reported. In this case, unstable autoregulation system made brain hypoxic damage and then reperfusion and recanalization of cerebral vessels resulted in intracerebral hemorrhagic infarction. 7 month long FUO was resolved by cranioplasty.
Anticonvulsants
;
Brain
;
Cerebral Hemorrhage
;
Cerebrum
;
Decompressive Craniectomy
;
Diuretics, Osmotic
;
Emergency Service, Hospital
;
Fever
;
Fever of Unknown Origin
;
Hemorrhage
;
Homeostasis
;
Humans
;
Infarction*
;
Intracranial Pressure
;
Male
;
Reperfusion
;
Reperfusion Injury
;
Skin*
;
Stupor
;
Young Adult
10.A Viewpoint on Treatment of Traumatic Bilateral Basal Ganglia Hemorrhage in a Child: Case Report.
Kyeong Hee BAEK ; Chul Hee LEE ; Sung Kwon KIM ; Hyun PARK ; Dong Ho KANG ; Soo Hyun HWANG
Korean Journal of Neurotrauma 2016;12(2):148-151
Traumatic basal ganglia hemorrhage (TBGH) is a rare presentation of head injuries. Bilateral lesions are extremely rare. The pathophysiologic mechanism of bilateral TBGH seems to be the same as diffuse axonal injury. However, limited information about childhood bilateral TBGH is available in the literature. We report the case of a child with bilateral TBGH treated with stereotactic aspiration of hemorrhage and periodic urokinase irrigation.
Basal Ganglia Hemorrhage*
;
Basal Ganglia*
;
Child*
;
Craniocerebral Trauma
;
Diffuse Axonal Injury
;
Hemorrhage
;
Humans
;
Intracranial Hemorrhages
;
Urokinase-Type Plasminogen Activator