We present a series of 10 Patients(Seven men and three women with an average age of 53 years) who underwent decompressive craniectomy for treatment to massive brain swelling following acute cerebral infarction. Clinical signs of cerebral herniation(anisocoria or fixed and dilated pupil, and/or hemiplegia with decerebrate righidity) were present in all patients. Computed tomography and magnetic resonance imaging showed the mass effect by cerebral edema through midline shift. All patients were treated with an extensive craniectomy and duroplasty. Among them, one recovered without neurological deficit, three were moderately disabled but functionally dependent, three remained in a persistent vegetative state and three died within 9 days after surgery(good recovery=1, moderate disability=3, persistent vegetative state=3, death=3). The results suggest that decompressive craniectomy can be an useful lifesaving procedure for massive cerebral edema following widespread hemispheric infarction.
Brain Edema ; Cerebral Infarction* ; Decompressive Craniectomy* ; Female ; Hemiplegia ; Humans ; Infarction ; Magnetic Resonance Imaging ; Male ; Persistent Vegetative State ; Prognosis ; Pupil

A 46 year-old male with drowsy mentality and left hemiparesis had been treated. Right carotid angiogram showed a mass effect on the posterior temporal region. Preoperative CT brain scan revealed two separated hypodense masses with ring enhancement on the each hemisphere. The right-sided mass was totally removed and there was no invasion into the ventricle and meninges. The histological diagnosis was a glioblastoma multiforme. The left-sided mass was followed with the repeated CT scan, which showed the similar CT findings of a glioblastoma multiforme, and there was no evidence of commiccural extension. The above findings were consistent with the criteria of multicentric tumor.
Brain ; Diagnosis ; Glioblastoma* ; Humans ; Male ; Meninges ; Middle Aged ; Paresis ; Tomography, X-Ray Computed

The author studied the changes of the plasma arginine vasopressin(AVP) levels in 10 brain surgery patient to evaluate the water balance during the postoperative period. The control group was 15 normally hydrated adult subjects. The plasma AVP levels were measured by the radioimmunoassays(RIA). The plasma and urine osmolality was also measured simultaneously using the conventional method. The followings were presented here-in as the results. 1) In control group, the average plasma AVP level was 2.00pg/mL with the range of 0.4 to 5.6pg/mL. There was relative constant relationship between the plasma AVP and the plasma osmolality. The osmotic threshold was 280.4mosm/Kg. 2) In preoperative brain surgery group, the plasma AVP level was similar to control group but the range was wider than control group. There was no constant relationship between the plasma AVP level and the plasma osmolality. 3) The plasma AVP levels were markedly increased in the postoperative brain surgery group. The average level was 10.99pg/mL ranging 0.4 to 47.50pg/mL. In spite of increased plasma AVP concentration, the plasma osmolality and urine/plasma osmolality(Uosm/Posm) ratios were relatively constant to normal control and preoperative brain surgery group. 4) The relationship between the plasma AVP level and the Uosm/Posm ratio was changed according to the plasma AVP level but above 3.0pg/mL it was nearly constant.
Adult ; Arginine ; Brain* ; Humans ; Osmolar Concentration ; Plasma* ; Postoperative Period

We report a case of cerebral lymphomatoid granulomatosis in a 50-year-old man. Lymphomatoid granulomatosis is an unusual condition which usually presents as a pulmonary manifestation, which occasionally affects the brain, and causes focal inflammatory lesions. Primary cerebral lymphomatoid granulomatosis is very rare. We describe a case of lymphomatoid granulomatosis in the left frontal lobe without pulmonary involvement.
Brain ; Frontal Lobe* ; Humans ; Lymphomatoid Granulomatosis* ; Middle Aged

It should be stressed that intracranial tumors in childhood are common. If the leukemia are excluded, intracranial neoplasms are the relatively common type of neoplasms seen in childhood. There are many different kinds of tumor which occur within the cranial cavity. These different tumors grow at different rates of speed and the diversity of location is sufficient so that there is a broad spectrum of different clinical syndromes. However, it is important to recognize the earliest symptoms because of the possibility of operable management and high cure rate on some cases. The author analyzed 58 cases of intracranial neoplasm which were histologically confirmed after operation and autopsy, seen at the Department of Neurosurgery, Jung-Ang University, Sung-Sim Hospital and National Medical Center over the recent several years. These tumors were explored surgically and the diagnosis was made through histological examination. The cases were reviewed as to history, development and progression of the neurological features, laboratory findings, neuroradiological findings, operative methods and pathology. The author emphasized some interesting points and the following were presented here-in as the results. 1) Among 58 cases of intracranial neoplasms in Korean children below 15 years old, the most common tumor was astrocytoma(36%), and the next common tumors were craniopharyngioma(15.5%), ependymoma(12%), and medulloblastoma(10.3%) in that orders. It was interesting that 3 cases of tuberculomas were found in recent three years(1975-1977) and all were located in the cerebellum. A 5 years old boy who was operated for 4 th. Ventricle medulloblastoma confirmed by clinicopathological finding, had another tumor, craniopharyngioma which was found at the postmortem examination. 2) The tumors were occupied on the infratentorial region in 30(5.7%) cases and supratentorial region in 28(48.3%) cases. The most frequent tumor in supratentorial region was craniopharyngioma and in infratentorial region was cerebellar astrocytoma. And the glioma and medulloblatoma were common in turn. 3) Fifty eight cases comprised 36 males and 22 females with a ratio of 1.5 to 1. The age ranged from 5 months old to 15 years old with the peak in the incidence between 5-11 years of age. 4) The main clinical symptoms and signs were headache(84.5%), vomiting(77.6%), papilledema(67.2%), and cranial nerve dysfunction(62%). It was interesting points that neck stiffness(27.6%) and abdominal pain(15.5%) were frequent complaints which should not overlook for the symptoms of simple gastritis or tuberculous meningitis. 5) The results of operative management obtained as follows with excellent in 4, good in 8, fair in 13, and poor in 9 cases. The overall mortality rare was 41% and recurrence rate was 14% during 5 years follow up.
Adolescent ; Astrocytoma ; Autopsy ; Brain Neoplasms ; Cerebellum ; Child* ; Child, Preschool ; Cranial Nerves ; Craniopharyngioma ; Diagnosis ; Female ; Follow-Up Studies ; Gastritis ; Glioma ; Humans ; Incidence ; Infant ; Leukemia ; Male ; Medulloblastoma ; Mortality ; Neck ; Neurosurgery ; Pathology ; Recurrence ; Tuberculoma ; Tuberculosis, Meningeal

The following report is a case of central cord syndrome in a seven-year-old girl. There was no history of major trauma except instances of standing on her head. Plain x-rays and CT myelography of the cervical spine revealed no abnormalities. Although she was apneic for 12 days and quadriparetic, the patient recovered and was able to walk on the 24th hospital day. Since central cord syndrome as a result of standing on head is unusual in children with a normal cervical spine, the arthors decided to report the above described case for medical interest.
Central Cord Syndrome* ; Child* ; Female ; Head* ; Humans ; Myelography ; Spinal Injuries ; Spine

CT findings justified surgical intervention in three young patients who had suffered from epilepsy and attack like unconsciousness. Other neurodiagnostic procedures with these patients had failed to show focal cerebral lesions amenable to surgical treatment. Two patients of them achieved significant relief from seizures after operation, but one has been suffering from occasional epileptic attacks yet.
Epilepsy ; Humans ; Seizures* ; Unconsciousness

A case of osteoid osteoma of the third thoracic vertebra was presented because of its rarity in number in Korea. The patient was 27 years old male who had complained of severe attack-like referred pain in the right chest whenever he moved this neck. We could treat the patient successfully by surgical removal of it, which also showed the typical radiological and pathological findings of osteoid osteoma.
Adult ; Humans ; Korea ; Male ; Neck ; Osteoma, Osteoid ; Pain, Referred ; Spine* ; Thorax

A case of osteoid osteoma of the third thoracic vertebra was presented because of its rarity in number in Korea. The patient was 27 years old male who had complained of severe attack-like referred pain in the right chest whenever he moved this neck. We could treat the patient successfully by surgical removal of it, which also showed the typical radiological and pathological findings of osteoid osteoma.
Adult ; Humans ; Korea ; Male ; Neck ; Osteoma, Osteoid ; Pain, Referred ; Spine* ; Thorax

Methods for the identification and amplification of signals from quantities of intravascularly administered iodinated contrast agent and their combination with image subtraction have evolved into a clinically useful technique called digital subtraction angiography (DAS). The initial motivation for the development of DSA was the desire to replace standard conventional angiographic procedures with simpler, less invasive techniques. We have evaluated IV-DSA and IA-DSA which are made in 150 patients with clinically suspected intracranial diseases from Dec. 1983 to Mar. 1985. Comparison with IA-DSA and conventional angiography indicated that the quality and information of content of the film were equivalent. IV-DSA image quality was inferior to that of conventional angiography. But IV-DSA can be used for intracranial studies to evaluate results of surgery of aneurysm, AVM or tumor and to revaluate vasospasm after subarachnoid hemorrhage before surgery. Also, IV-DSA can be used for neck vessel appearance due to reveal adequate information.
Aneurysm ; Angiography ; Angiography, Digital Subtraction ; Humans ; Motivation ; Neck ; Subarachnoid Hemorrhage