No abstract available.
Hematoma*

Both direct and indirect environmental stress to brain were increase the expression of transcription factor c-fos in various populations of neurons. In this study, we examined whether the intraperitoneal injections of lidocaine at doses inducing convulsion within 10 min increased the level of c-fos mRNA and protein in forebrain areas. In situ hybridization using (35S)UTP-labeled antisense c-fos, cRNA increased c-fos mRNA levels though hippocampal formation, piriform cortex, septum, caudate-putamen, neostriatum, and amygdala within 2 hr. In parallel with the mRNA expression, c-FOS protein immunoreactivity was also observed in the same forebrain areas. In contrast to the seizure activity and widespread neuronal degeneration following a kainate treatment, injections of lidocaine did not produce neuronal death within 3 days. The present study indicates that lidocaine induces convulsion and c-fos expression without causing neuro-toxicity.
Adult* ; Amygdala ; Animals ; Brain* ; Hippocampus ; Humans ; In Situ Hybridization ; Injections, Intraperitoneal ; Kainic Acid ; Lidocaine* ; Neostriatum ; Neurons ; Prosencephalon ; Rats* ; RNA, Complementary ; RNA, Messenger* ; Seizures ; Transcription Factors

OBJECTIVE: Shunt-dependent hydrocephalus (SdHCP) is a well-known complication of aneurysmal subarachnoid hemorrhage (SAH). The risk factors for SdHCP have been widely investigated, but few risk scoring systems have been established to predict SdHCP. This study was performed to investigate the risk factors for SdHCP and devise a risk scoring system for use before aneurysm obliteration.METHODS: We reviewed the data of 301 consecutive patients who underwent aneurysm obliteration following SAH from September 2007 to December 2016. The exclusion criteria for this study were previous aneurysm obliteration, previous major cerebral infarction, the presence of a cavum septum pellucidum, a midline shift of >10 mm on initial computed tomography (CT), and in-hospital mortality. We finally recruited 254 patients and analyzed the following data according to the presence or absence of SdHCP : age, sex, history of hypertension and diabetes mellitus, Hunt-Hess grade, Fisher grade, aneurysm size and location, type of treatment, bicaudate index on initial CT, intraventricular hemorrhage, cerebrospinal fluid drainage, vasospasm, and modified Rankin scale score at discharge.RESULTS: In the multivariate analysis, acute HCP (bicaudate index of ≥0.2) (odds ratio [OR], 6.749; 95% confidence interval [CI], 2.843–16.021; p=0.000), Fisher grade of 4 (OR, 4.108; 95% CI, 1.044–16.169; p=0.043), and an age of ≥50 years (OR, 3.938; 95% CI, 1.375–11.275; p=0.011) were significantly associated with the occurrence of SdHCP. The risk scoring system using above parameters of acute HCP, Fisher grade, and age (AFA score) assigned 1 point to each (total score of 0–3 points). SdHCP occurred in 4.3% of patients with a score of 0, 8.5% with a score of 1, 25.5% with a score of 2, and 61.7% with a score of 3 (p=0.000). In the receiver operating characteristic curve analysis, the area under the curve (AUC) for the risk scoring system was 0.820 (p=0.080; 95% CI, 0.750–0.890). In the internal validation of the risk scoring system, the score reliably predicted SdHCP (AUC, 0.895; p=0.000; 95% CI, 0.847–0.943).CONCLUSION: Our results suggest that the herein-described AFA score is a useful tool for predicting SdHCP before aneurysm obliteration. Prospective validation is needed.
Aneurysm ; Cerebral Infarction ; Cerebrospinal Fluid Leak ; Diabetes Mellitus ; Hemorrhage ; Hospital Mortality ; Humans ; Hydrocephalus ; Hypertension ; Multivariate Analysis ; Prospective Studies ; Risk Factors ; ROC Curve ; Septum Pellucidum ; Subarachnoid Hemorrhage ; Ventriculoperitoneal Shunt

OBJECTIVE: The aim of this study was to investigate the correlation between meteorological factors and occurrence of spontaneous intracerebral hemorrhage (ICH) according to age. MATERIALS AND METHODS: We retrospectively analyzed the records of 735 ICH patients in a metropolitan hospital-based population. Observed and expected numbers of ICH patients were obtained at 5degrees C intervals of ambient temperature and a ratio of observed to expected frequency was then calculated. Changes in ambient temperature from the day before ICH onset day were observed. The Wilcoxon-Mann-Whitney test was used to test differences in meteorological variables between the onset and non-onset days. The Kruskal-Wallis test was used for comparison of meteorological variables across gender and age. RESULTS: ICH was observed more frequently (observed/expected ratio > or = 1) at lower mean, minimum, and maximum ambient temperature (p = 0.0002, 0.0003, and 0.0002, respectively). Significantly lower mean, minimum, and maximum ambient temperature, dew point temperature, wind speed, and atmospheric pressure (p = 0.0003, 0.0005, 0.0001, 0.0013, 0.0431, and 0.0453, respectively) was observed for days on which spontaneous ICH occurred. In the subgroup analysis, the ICH onset day showed significantly lower mean, minimum, and maximum ambient temperature, dew point temperature, relative humidity, and higher atmospheric pressure in the older (> or = 65 years) female group (p = 0.0093, 0.0077, 0.0165, 0.0028, 0.0055, and 0.0205, respectively). CONCLUSION: Occurrence of spontaneous ICH is closely associated with meteorological factors and older females are more susceptible to lower ambient temperature.
Atmospheric Pressure ; Cerebral Hemorrhage* ; Female ; Humans ; Humidity ; Meteorological Concepts* ; Meteorology ; Retrospective Studies ; Wind

OBJECTIVE: The reaccumulation of hematoma is one of the most frequent problems on the chronic subdural hematoma. The aim of this study is to determine the factors affecting the reaccumulation of hematoma and the reasonable site for the burr-hole trephination to achieve a low reaccumulation rate after burr-hole trephination and closed-system drainage METHODS: The authors studied 93 patients with chronic subdural hematoma in whom the location of burr-hole trephination was randomly placed and precisely determined on postoperative brain computerized tomographic scans or skull roentgenogram. Eighty five patients with chronic subdural hematoma were obtained with brain computerized tomographic scans the postoperative 3 day. The location of the burr-hole trephination, the location of subdural catheter tip, the maximum postoperative width of the subdural space, and the percentage of the ipsilateral subdural space occupied by air postoperatively were measured and analyzed the correlation with the postoperative reaccumulation rates. RESULTS: Patients with the parietal trephination had much more subdural air and a higher of chronic subdural hematoma reaccumulation than those with the frontal one. In addition, patients with residual subdural air on brain computerized tomographic scans obtained the postoperative 3 day also had a higher reaccumulation rate than those without subdural air collections. CONCLUSION: The incidence of postoperative subdural fluid reaccumulation can be reduced by the burr-hole trephination on the frontal convexity and by preventing subdural air accumulation during operation.
Brain ; Catheters ; Drainage* ; Hematoma ; Hematoma, Subdural ; Hematoma, Subdural, Chronic* ; Humans ; Incidence ; Rabeprazole ; Skull ; Subdural Space ; Trephining*

We report a case of meningeal hemangiopericytoma presenting as metastasis in the vertebral body and pedicle of the thoracic spine. Hemangiopericytoma is a rare vascular neoplasm. Although the tumor has a strong propensity for both local recurrence and extracranial metastasis, metastasis to thoracic spine is very rare and only two cases were found in the literature. A 44-year-old woman with paraparesis and pain in the thoracic and lower legs was examined by plain radiographs and magnetic resonance imaging. The intracranial hemangiopericytoma was operated 3 years ago. Magnetic resonance imaging demonstrated a tumor invading the left vertebral body and pedicle of the 11th thoracic spine, and compressing the dural sac. The patient was gradually improved after surgical removal of the lesions and the histologic findings were characteristics of hemangiopericytoma.
Adult ; Female ; Hemangiopericytoma* ; Humans ; Leg ; Magnetic Resonance Imaging ; Neoplasm Metastasis* ; Paraparesis ; Recurrence ; Spine* ; Vascular Neoplasms

OBJECTIVE: About 40% of patients who admit to the hospital after subarachnoid hemorrhage are poor clinical grade(Hunt-Hess grade IV, V). The majority of these patients have been excluded from early, aggressive treatment. The current study was undertaken to evaluate the outcome of urgent surgery for Hunt-Hess grade IV aneurysmal subarachnoid hemorrhage. MATERIALS AND METHODS: We reviewed hospital records and radiographic studies of 36 patients who were Hunt-Hess grade IV among 201 cases with ruptured intracranial aneurysm admitted between Sep. 1995 and Dec. 2000. Operated patients were treated with urgent angiography and surgery within 24 hours of presentation, except six patients, and medical records of these patients were reviewed for the clinical course and Glasgow outcome scale(GOS). RESULTS: Overall management results of the 36 patients were good recovery in 13(36.1%), moderate disability in 12 (33.3%), severe disability in 1(2.8%), vegetative state in 1(2.8%) and 9(25.0%) of surgically treated patients had died. CONCLUSION: Although with limited number of patients, we conclude that urgent surgery for Hunt-Hess grade IV patients results in a better neurologic outcome and urgent surgery combined with aggressive postoperative management can minimize mortality.
Angiography ; Hospital Records ; Humans ; Intracranial Aneurysm* ; Medical Records ; Mortality ; Persistent Vegetative State ; Subarachnoid Hemorrhage

OBJECTIVE: The postoperative subsidence of anterior cervical interbody fusion for cervical degenerative diseases gives rise to segmental kyphotic collapse, screw loosening, and chronic neck pain. So, intraoperative custom-made polymethylmethacrylate (PMMA) C-cage has been developed to prevent subsidence following anterior cervical fusion. METHODS: A total of patients who underwent anterior cervical interbody fusion with a intraoperative custom - made cervical cage filled with local bone and demineralized bone matrix (group A) were analyzed prospectively from June 2004 to June 2005. These were compared with 40 patients who were treated with iliac bone graft (group B). We evaluated subsidence ratio, change of segmental angle, distraction length and segmental angle. Statistical analysis was performed using independent sample t-test and Pearson correlation coefficient. RESULTS: Group A had a statistically significant decrease in subsidence ratio (0.64+/-0.43%, p=0.00), distraction length (2.42+/-1.25 mm, p=0.02), and follow angle change (1.78+/-1.69degrees, p=0.01) as compared with Group B. However, there was no statistically significant difference in postoperative segmental angle change (p=0.66). On the analysis of the correlation coefficient, the parameters showed no interrelationships in the group A. On the other hand, subsidence ratio was affected by distraction length in the group B (Pearson correlation=0.448). CONCLUSION: This operative technique would be contributed for the reduction of a postoperative subsidence after the anterior cervical interbody fusion procedure for cervical disc disease with moderate to severe osteoporotic condition and segmental loss of lordosis.
Animals ; Bone Matrix ; Hand ; Humans ; Lordosis ; Neck Pain ; Polymethyl Methacrylate ; Prospective Studies ; Transplants

Bilateral traumatic abducens nerve palsy is a rare condition. We report a case associated with Hangman's fracture without skull fracture. Seventeen cases of bilateral traumatic nerve palsy were found in the literature and only four cases had bilateral traumatic abducens nerve palsy associated with cervical spine fracture without skull fracture. In case of head and neck injury, the abducens nerve may be damaged at the point of fixation to the dura mater. The pathogenesis, the clinical conditions and the radiological findings are presented.
Abducens Nerve Diseases* ; Abducens Nerve* ; Dura Mater ; Head ; Neck Injuries ; Paralysis ; Skull Fractures ; Spine

OBJECTIVE: Intraoperative ventriculostomy is widely adopted to make the slack brain. However, there are few reports about hemorrhagic or parenchymal injuries after ventriculostomy. We tried to analyze and investigate the incidence of these complications in a consecutive series of patients with aneurysmal subarachnoid hemorrhage (SAH). METHODS: From September 2006 to June 2007, 43 patients underwent surgical clipping for aneurysmal SAH at our hospital. Among 43 patients, we investigated hemorrhagic or parenchymal injuries after intraoperative ventriculostomy using postoperative computed tomographic scan in 26 patients. After standard pterional craniotomy, ventriculostomy catheter was inserted perpendicular to the cortical surface along the bisectional imaginary line from Paine's point. RESULTS: Hemorrhagic injuries were detected in 12 of 26 patients (46.2%). Mean systolic blood pressure during anesthesia was with in statistically significant parameter related to hemorrhage (p = 0.006). On the other hand, parenchymal injuries were detected in 11 of 26 patients (42.3%). Female and the amount of infused mannitol during anesthesia showed statistically significant parameters related to parenchymal injury (p = 0.005, 0.04, respectively). However, there were no ventriculostomy-related severe complications. CONCLUSION: In our series, hemorrhagic or parenchymal injuries after intraoperative ventriculostomy occurred more commonly than previously reported series in aneurysmal SAH patients. Although the clinical outcomes of complications are generally favorable, neurosurgeon must keep in mind the frequent occurrence of brain injury after intraoperative ventriculostomy in the acute stage of aneurysmal SAH.
Anesthesia ; Aneurysm ; Blood Pressure ; Brain ; Brain Injuries ; Catheters ; Craniotomy ; Female ; Hand ; Hemorrhage ; Humans ; Incidence ; Mannitol ; Subarachnoid Hemorrhage ; Surgical Instruments ; Ventriculostomy