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 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

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

Intracranial germinoma usually occurs in the pineal and suprasellar regions. It is relatively rare that germinoma occurs in the thalamus and basal ganglia. The authors report a case of germinoma involving the posterior part of thalamus and basal ganglia involving the posterior part of thalamus and basal ganglia. The patient was 20 years old male who complained left side hemiparesis for 2 months. A successful result was obtained through radiation therapy after partial removal of tumor mass.
Basal Ganglia* ; Germinoma* ; Humans ; Male ; Paresis ; Thalamus* ; Young Adult

The authors present the case of sciatica due to bicortical sacral screw impingement on the lumbosacral plexus across the anterior sacrum. The placement of sacral screw across the anterior sacral cortex carries significant inherent risks to neurovascular and visceral structures. However, the clinical reports of lumbosacral plexus involvement by the misplaced screw are not well documented in the literature. This is an unique case of sciatica due to sacral screw impingement on the lumbosacral plexus after motor vehicle accident(MVA), and confirmed by CT scan and intraoperative electrical stimulation. We reviewed sacral anatomy and preventive measures for avoiding complication of this type are discussed.
Electric Stimulation ; Lumbosacral Plexus* ; Motor Vehicles ; Sacrum ; Sciatica* ; Tomography, X-Ray Computed

A 35-year-old man, with a previous history of intermittent generalized seizure attacks since 13 years of age, presented with status epilepticus and spastic right hemiparesis. Plain skull films showed a mottled, granular calcified core and a surrounding halo of calcification in the subcortical area of the central fissure, and a smooth erosion of the overlying skull inner table. Left carotid angiogram revealed neither definite mass effect nor abnormal vascularities. Surgery through a left parietal craniotomy was performed. Upon direct inspection of the brain a 2.5+/-3.0cm, stony hard, generally circular mass was noted within the left frontal lobe. Although embedded within the frontal lobe, the mass was partially covered by a gliotic cyst which might be made from cortical tissue. The tumor was obviously calcified, demonstrating numerous superficial white excrescences, and readily removed without difficulty. Microscopic, pathological evaluation confirmed the diagnosis of densely calcified arteriovenous malformation. The patient was discharged without any evidence of neurological deficit except dull mentality.
Adult ; Arteriovenous Malformations* ; Brain* ; Craniotomy ; Diagnosis ; Frontal Lobe ; Humans ; Muscle Spasticity ; Paresis ; Rabeprazole ; Seizures ; Skull ; Status Epilepticus

An intracerebral aneurysm usually bleeds into the subarachnoid space in addition it may also rupture into the subdural space or into the brain, and it is reported that approximately 2-8 percent of all ruptured aneurysm have an associated subdural hematoma. We had experienced 4 cases of subdural hematoma following ruptured intracerebral saccular aneurysm from 1983 to 1985. They were distal anterior cerebral artery aneurysm and middle cerebral artery aneurysm, and 2 cases of anterior communicating artery aneurysm. There were no relationship between the amount of subdural hematoma and clinical course. With a view to the clinical course, 3 cases were acute, and one was chronic.
Aneurysm* ; Aneurysm, Ruptured ; Brain ; Hematoma, Subdural* ; Intracranial Aneurysm ; Rupture ; Subarachnoid Space ; Subdural Space

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