Radiotherapy is a standard postoperative treatment for various cerebral neoplasms. Howewr, radiation has the potential to produce severe injury to normal brain tissue in and around the tumor bed. The authors encountered 7 patients with delayed cerebral necrosis. These unacceptable complication prompted us to analyze cases with such a complication particularly in regard to the differential diagnosis between the recurrence of the tumor and radiation necrosis of the brain. This article summarizes factors related to the radiation necrosis, including clinical observations and treatment.
Brain Injuries ; Brain* ; Diagnosis, Differential ; Humans ; Necrosis* ; Radiotherapy ; Recurrence

Traumatic brain injury (TBI) could give rise to variable clinical manifestations based on the involved structures of our bodies. Although there are no structural abnormalities proven, the patients with mild TBI suffer from chronic dizziness and imbalance. Herein, I will discuss the visuo-vestibular interaction and neurotological finding in TBI, which could demonstrate the clue to the diagnosis and management in dizzy patients with TBI.
Brain Concussion ; Brain Injuries ; Diagnosis ; Dizziness ; Humans ; Vestibular Diseases

OBJECTIVE: To explore the usability of regional saturation of cerebral oxygenation (rScO₂) combined with percentage of α variability (PAV) in predicting brain function prognosis in patients with traumatic brain injury (TBI). METHODS: A retrospective analysis was conducted. The clinical data of patients with TBI who were monitored rScO₂ and bedside quantitative electroencephalogram (qEEG) admitted to intensive care unit (ICU) of Henan Provincial People's Hospital from August 2018 to July 2019 were collected. The rScO₂, PAV, and Glasgow coma scale (GCS) score were recorded within 72 hours after the TBI. The primary prognostic indicator was the 3-month Glasgow outcome score (GOS) score. The differences between the two groups of poor prognosis of brain function (GOS score 1-3) and good prognosis (GOS score 4-5) were compared. Binary multivariate Logistic regression analysis was used to analyze the correlation between rScO₂, PAV, GCS score and the prognosis of brain function in patients with TBI. In addition, receiver operating characteristic (ROC) curve was plotted to analyze the predicting value of rScO₂ and PAV only or combination for prognosis of brain function. RESULTS: A total of 42 patients with TBI were enrolled in the study, with rScO₂ ≥ 0.60 (grade I) in 14 patients, 0.50 ≤ rScO₂ < 0.60 (grade II) in 16 patients, and rScO₂ < 0.50 (grade III) in 12 patients. PAV 3-4 scores (grade I) were detected in 16 patients, 2 scores (grade II) in 17 patients, and 1 score (grade III) in 9 patients. GCS score 9-14 (grade I) were observed in 13 patients, 4-8 (grade II) in 23 patients, and 3 (grade III) in 6 patients; 18 patients had poor prognosis and 24 had good one. The rScO₂, PAV and GCS scores of the poor-prognosis group were significantly higher than those in the good-prognosis group [rScO₂ with grade III: 55.6% (10/18) vs. 8.3% (2/24), PAV with grade III: 38.9% (7/18) vs. 8.4% (2/24), GCS score with grade III: 27.7% (5/18) vs. 4.1% (1/24)] with significant differences (all P < 0.05). There was no significant difference in other general data including gender, age, total length of hospital stay or acute physiology and chronic health evaluation II (APACHE II) score between the two groups. Binary multivariate Logistic regression analysis showed that rScO₂ and PAV were independent risk factors for prognosis of brain in patients with TBI [rScO₂: odds ratio (OR) = 4.656, 95% confidence interval (95%CI) was 1.071-20.233, P = 0.040; PAV: OR = 3.525, 95%CI was 1.044-11.906, P = 0.042]. ROC curve analysis showed that both of rScO₂ and PAV had predictive value for the prognosis of brain function in patients with TBI (AUC was 0.796 and 0.780, respectively, both P < 0.01), and rScO₂ combined with PAV had higher predictive value with the AUC of 0.851 (P < 0.01) than rScO₂ or PAV alone, the sensitivity was 94.4% and the specificity was 62.5%. CONCLUSIONS rScO₂ and PAV were associated with early brain function prognosis in patients with TBI. The combination of two monitoring indicators can reliably assess the prognosis of brain function in patients with TBI.
APACHE ; Brain ; Brain Injuries, Traumatic/diagnosis* ; Humans ; Prognosis ; Retrospective Studies

The authors reported results of management of warfire craniocerebral abscesses in 53 cases from 1980-1995. The rate of abscess was 16.3%. Retained materials found: bone only 58.49%; both metal and bone: 7.54%; metal only 5.66%; none: 28.30%. Characteristics of abcess: thick capsula: 37.74%; numerous focuses of pus: 15.78%; open abscesses: 50.95%. Organisms found in culture of pus of abscess (23/36 cases: 63.88%) gram positive: 52.17%, gram negative 47.83%). Methods of management: urgent removal of abcess capsula: 71.72%; puncture-aspiration: 1.88% pus drainage: 18.86%; conservative treatment: 4.54%. The overall mortality was 20.76%. The postoperative mortality rate rate was: 13.22%.
diagnosis ; therapeutics ; brain abcess ; Wounds and Injuries ; war ; Social Problems

OBJECTIVETo evaluate the role of perfusion weighted imaging (PWI) in the differentiation between recurrent glioma and radiation-induced brain injuries.

METHODSTwenty-three patients with previously resected and irradiated glioma, presenting newly developed abnormal enhancement, were included in the study. The final diagnosis was determined either histologically or clinicoradiologically. PWI was obtained with a gradient echo echo-planar-imaging (GRE-EPI)technique. The normalized relative cerebral blood volume (rCBV) ratio [rCBV (abnormal enhancement)/rCBV (contralateral tissue)], relative cerebral blood flow (rCBF) ratio [rCBF (abnormal enhancement)/rCBF(contralateral tissue)], mean transit time(MTT) ratio [MTT (abnormal enhancement)/MTT(contralateral tissue)],time to peak(TTP)ratio[TTP(abnormal enhancement)/TTP(contralateral tissue)],and bolus arrive time(BAT)ratio[BAT(abnormal enhancement)/BAT(contralateral tissue)] were calculated. The regions of interest (ROIs) consisting of 20-40mm(2) were placed in the abnormal enhanced areas on postcontrast T1-weighted images.Ten ROIs measurements were performed in each lesion.T test was used to determine whether there was a difference in the rCBV/rCBF/rMTT/rTTP/rBAT ratios between recurrent glioma and irradiated injuries.Significance was set to a P value <0.05.

RESULTSThirteen of the 23 patients were proved recurrent glioma and 10 were proved radiation-induced brain injuries. The rCBV ratio (3.60±3.86 vs. 0.82 ± 0.74, P = 0.000)and rCBF ratio (2.88 ± 2.27 vs. 0.84 ± 0.80, P = 0.000) in glioma recurrence were markedly higher than those in radiation injuries. The areas under rCBV and rCBF ROC curve were both 0.8763. rMTT (P=0.204), rTTP (P=0.260), and rBAT (P=0.071) ratios showed no statistical difference between the two groups.

CONCLUSIONPWI is an effective technique in distinguishing glioma recurrence from radiation injuries,and the ratios of rCBV and rCBF ratio differential diagnosis of critical value to 1.3088 and 1.1235, respectively, can be used as a reliable clinical indicator.

Adult ; Aged ; Brain Injuries ; diagnosis ; Brain Neoplasms ; diagnosis ; Diagnosis, Differential ; Female ; Glioma ; diagnosis ; Humans ; Magnetic Resonance Angiography ; methods ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; diagnosis ; Radiation Injuries ; diagnosis

Although hypoglycemia may be common among neonates, brain injuries resulting from isolated neonatal hypoglycemia are rare. The condition may cause neurological symptoms such as stupor, jitteriness, and seizures, though in their absence, diagnosis is delayed or difficult. Hypoglycemia was diagnosed in a three-day-old neonate after he visited the emergency department with loose stool, poor oral intake, and decreased activity, first experienced two days earlier. Two days after his visity, several episodes of seizure occurred. T2 and diffusion-weighted magnetic resonance (MR) scanning, performed at 11 days of age, revealed bilateral and symmetrical high signal intensity lesions in occipital, parietal, and temporal lobes. We report the MR findings of hypoglycemic encephalopathy in a neonate.
Brain Injuries* ; Brain* ; Diagnosis ; Emergency Service, Hospital ; Humans ; Hypoglycemia* ; Infant, Newborn ; Rabeprazole ; Seizures ; Stupor ; Temporal Lobe

PURPOSE: To characterize the MR findings of hypoxic-ischemic brain injury and to assess the value of the MR imaging. MATERIALS AND METHODS: SE T1 -, T2-weighted, and IR brain MR images of 44 infants and children with the past history of perinatal hypoxic insults were reviewed. Abnormal brain MR findings of 8 patients with birth history of prematurity and 36 patients with birth history of full-term/posterm including 7 with severe anoxic insult history, were compared in regard to the location and the character of the lesions RESULTS: MRI demonstrated the followings;(1)abnormal signal intensity lesions of subcortical and/or deep cerebral white matter, cortex, and deep gray matter, (2)atrophy of the cerebral white matter, cortex and corpus callosum, with/without ventriculomegaly, and (3)delay in myelination. Periventricular and deep white matter lesions were demonstrated in the prematurity, the deep white matter lesions and/or subcortical white matter lesions in the term/post-term, and deep gray matter lesions in the 7 patients with severe anoxic insults history. CONCLUSION: MR imaging was useful in the diagnosis of the hypoxic-ischemic brain injury, and the white and gray matter lesions were correlated with the time of the injury and the severity of hypoxic insult.
Brain Injuries* ; Brain* ; Child ; Corpus Callosum ; Diagnosis ; Humans ; Infant ; Magnetic Resonance Imaging ; Myelin Sheath ; Reproductive History

We report four cases of intracranial hemorrhage after cardiac surgery using cardiopulmonary bypass in the pediatric patients. The pre-, intra-, and postoperative data of these 4 patients are presented. The specific factors causing the intracranial hemorrhage remain unexplained, but anticoagulant (heparin) and a tearing of bridging veins after a rapid change of the brain volume by administration of mannitol can be a cause of intracranial hemorrhage. Intracranial hemorrhagic brain injury after cardiac surgery is rare but devastating. however, we consider early diagnosis and proper treatment to be effective because organic brain damage did not occur.
Brain ; Brain Injuries ; Cardiopulmonary Bypass ; Early Diagnosis ; Heart* ; Humans ; Intracranial Hemorrhages* ; Mannitol ; Thoracic Surgery* ; Veins

Dementia is defined as a primary decline of intellect and/or comportment due to a structural and chemical brain disease to the point that customary activities of daily living (ADLs) become compromised. Korean society is rapidly becoming an aging society where average age increases, and dementia is becoming more prevalent. Therefore, prevention, early detection, and proper management of dementia patients are health- and social-care priorities of Korean society. Neurorehabilitationist means a specialist for rehabilitative care of neurologically compromised patients including stroke, traumatic brain injury, degenerative brain disease, and dementia. However, the role of neurorehabilitationists for the diagnosis and treatment of dementia are not well established compared to that of neurologist and psychiatrist. Therefore, this article deals a role of neurorehabilitationist for proper management of patients with dementia in a way that preventing the functional deterioration as well as reduction of national welfare burden.
Activities of Daily Living ; Aging ; Brain Diseases ; Brain Injuries ; Dementia* ; Diagnosis ; Humans ; Psychiatry ; Specialization ; Stroke

The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is a frequent complication of severe head trauma. Fluid restriction is treatment choice of SIADH in patients with traumatic brain injury (TBI), but fluid restriction is limited because they need sufficient calories. We described a patient who, on the four months after a head injury, presented with deterioration of consciousness, which coincided with the development of the SIADH, and which rapidly reversed with the correction of the hyponatremia by demeclocycline with minimal fluid restriction. We suggest that SIADH should be included in the differential diagnosis of deterioration of consciousness during the recovery period of the patients suffering from head injury because unexpected clinical deterioration may often have a reVersible cause. Also, demeclocycline will be useful, which allows for increased fluid liberalization and for provision of adequate calories, in the treatment of the SIADH in patients with TBI.
Brain Injuries ; Brain* ; Consciousness ; Craniocerebral Trauma ; Demeclocycline* ; Diagnosis, Differential ; Humans ; Hyponatremia ; Inappropriate ADH Syndrome