No abstract available.
Acoustics* ; Ear, Inner ; Hearing* ; Neuroma, Acoustic* ; Semicircular Canals*

STUDY DESIGN: Case report OBJECTIVES: To report a case of Brown-Séquard syndrome after blunt cervical trauma. SUMMARY OF LITERATURE REVIEW: Brown-Séquard syndrome is a rare disease characterized by hemisection of the spinal cord, and it shows the best prognosis of the various types of incomplete spinal cord injuries. MATERIALS AND METHODS: A patient with Brown-Séquard syndrome that occurred after a traffic accident was followed up for 2 years and 6 months. RESULTS: We observed normal recovery of motor strength, but sensory impairment and deep tendon hyperreflexia remained. CONCLUSIONS: Brown-Séquard syndrome is known to have a good prognosis, but in this case, the neurological abnormality did not fully recover; therefore, we report this rare case and present a review of the literature.
Accidents, Traffic* ; Cervical Vertebrae ; Female ; Humans ; Prognosis ; Rare Diseases ; Reflex, Abnormal ; Spinal Cord ; Spinal Cord Injuries ; Tendons

It is established that intracranial hemorrhage is relatively common benign intracranial diseases in adult. This is very rare in children reports are limited to a few cases or to those cited in reviews of series of intracranial hemorrhage in adult group. We wish to report three cases of large intracranial hematoma in three infants. The diagnosis was greatly facilitated by the CT scan and the treatment did by the microsurgical methods.
Adult ; Cerebral Hemorrhage* ; Child ; Diagnosis ; Hematoma ; Humans ; Infant ; Intracranial Hemorrhages ; Tomography, X-Ray Computed

We performed experiments to study the effects of acutely increased inracranial pressure on cereral gas metabolism. The results and findings were reported to The Journal of Catholic Medical College,(Vol. 24) 1973. We thereafter evaluated cerebral gas metabolism of fifty patients with acute cerebral lesions. Cerebral gas metabolism was measured by determining the pO2, pCO2, and pH values of arterial and venous blood and of the cerebrospinal fluid. Samplings of venous blood were obtained from the internal jugular vein. In the determination of the pH, pO2 and pCO2 of arterial and venous blood and cerebro-spinal fluid, the "Radiometer BMS 3 with Digital Acid-Base Analyser PHM 72" was used. These 50 patients had their gas metabolism measured at interval of 2 or 3 days, from the time of their admission to the time of either their recovery or death. The following observations were made 1. The 50 patients studied and observed included. a) Brain contusion 13 cases. b) Epidural or subdural hematoma 11 cases. c) Skull fracture 10 cases. d) Intracerebral hemorrhage 5 cases. e) Scalp laceration 1 cases. f) Arteriovenous malformation or cerebral rete 5 cases. g) Traumatic subarachnoid hemorrhage 1 cases. h) Intracranial aneurysm 4 cases. 2. There 50 patients have been subdivided according to level of consciousness as follows: a) Group A-Those who were alert with no neurological deficit. b) Group B-Those who were drowsy with mild neurological deficit. c) Group C-Those who were stuporous with severe neurological deficit. d) Group D-Those who were in coma. 3. It was observed that the pH, pO2, and pCO2 content of the arterial and venous blood and cerebrospinal fluid of those in Group A were within normal ranges. 4. Many cases classified under Group B had respiratory alkalosis of the arterial blood. However those who recovered or became worse revealed no noticeable changes in the cerebral gas metabolism studies. 5. Many cases classified under Group C had respiratory alkalosis in their arterial blood but only a few showed metabolic acidosis in the cerebrospinal fluid. However the patients who became worse manifested a marked metabolic acidosis in the cerebrospinal fluid. 6. Several patients in Group D had severe respiratory alkalosis as well as metabolic alkalosis in their arterial blood and marked metabolic acidosis in the their cerebrospinal fluid. 7. "Luxury perfusion syndrome" was not seen in any of the fifty cases studied. 8. Only a few cases manifested arterial hypoxemia in the all group. We believe this was due to the fact that tracheostomy and hyperventilation were done in the early stages with the aim of reducing the raised intracranial pressure.
Acidosis ; Alkalosis ; Alkalosis, Respiratory ; Anoxia ; Arteriovenous Malformations ; Brain Injuries ; Brain* ; Cerebral Hemorrhage ; Cerebrospinal Fluid ; Coma ; Consciousness ; Hematoma, Subdural ; Humans ; Hydrogen-Ion Concentration ; Hyperventilation ; Intracranial Aneurysm ; Intracranial Pressure ; Jugular Veins ; Lacerations ; Metabolism ; Perfusion ; Reference Values ; Scalp ; Skull Fractures ; Stupor ; Subarachnoid Hemorrhage, Traumatic ; Tracheostomy

Cerebral vasospasm is the leading cause of death and disability in patients with subarachnoid hemorrhage due to repture of a cerebral aeurysm. But etiology of the vasospasm is not known despite extensive clinical and experimental investigations. The man objectives of this experiment were to develop a new animal model for vasospasm using the femoral artery in rat and to evaluate the pathologic changes of vessel and the effects of nimodipine(calcium angagonist) on vasospasm by quantitative assessment of radial wall thickness, cross-sectional areas of arterial lumen and vessel wall. Thirty rats were divided into three groups;A skin incision was made on both inguinal areas and both proximal femoral arteries were exposed under the surgical microscope. And then 0.1ml of fresh autologous whole blood was applied directly to the femoral artery and covered with silastic cuff(spasm group). The right femoral artery was covered with silastic cuff without application of the blood(control group). A nimodipine group was produced by injection nimodipine through the intraperitoneal route after application of blood on let femoral artery. The morphological changes were investigated at 2(n=3), 5(n=3), 7(n=3), 10(n=3), and 5 days(n=3) after application of whold blood. The results were as follows; 1) A new animal model for vasospasm using the femoral artery in rat was developed. 2) As compared with control group, the arterial narrowing was present at 2days, was maximal at 7 days, and return to near control level by 20 days. 3) In the spasm group, there were a corrugation of the intima and internal elastic lamina, and thickening and vacuolization in the media on the light microscope. These histological changes suggested that the model of the femoral artery in rat was analogous to experimental subarachnoid hemorrhage. 4) There was a significant decrease in cross-sectional areas of the vessel lumen in both spasm(p<0.005) and nimodipine groups(p<0.005). Also the radial wall thickness was significantly increased in the spasm(p< and nimodipine groups(p<0.005), but there was no significant differences in measured cross-sectional areas of the vessel wall among all the groups. 5) The nimodipine group was different from the spasm group for all quantitative assessments, especially in the luminal areas and wall thickness at 7 days(p<0.05). As the results, the femoral artery in rat may serve as a model for investigations of pathogenesis and therapeutic intervention to study vasospasm and nimodipine seemed to be an effective calcium antagonist to treat and prevent vasoapasm.
Animals ; Calcium ; Cause of Death ; Femoral Artery* ; Humans ; Linear Energy Transfer ; Models, Animal ; Nimodipine* ; Phenobarbital ; Rats* ; Skin ; Spasm ; Subarachnoid Hemorrhage ; Vasospasm, Intracranial

Surgical approaches for aneurysms of the basilar artery trunk are variable and utilized depending on the location of the aneurysms and direction of the fundus of the aneurysms. We operated one patient with low lying basilar bifurcation aneurysms facing toward the brain stem by subtemporal transpetrosal approach with successful clipping of aneurysms. The advantage of this approach to low-lying basilar bifurcation or basilar trunk aneurysms over the pterional, subtemporal(transtentorial), combined supratentorial and infratentorial, transoral, and suboccipital approach are discussed.
Aneurysm* ; Basilar Artery ; Brain Stem ; Deception ; Humans

We analyzed 10 cases who had received surgery for acute injuries of the thoracic spine complicated by paralysis. Of those 10 cases, 4 patients had a complete and remaining 6 had an incomplete lesion of the spinal cord. Of the 4 patients who had a complete lesion of the spinal cord, significant neurologic function did not recover in 3, regardless of the type and timing of the surgery. In one of 4 patients who had a complete lesion, there was some improvement of sensation. Of the 6 patients who had an incomplete lesion of the spinal cord, 4 received a surgery within 24 hours of injury, and remaining 2 had surgery on posttrauma 30th and 35th days respectively. Average neurologic improvement was 1.75 Frankel grades per patient in the early surgery group and was 1 Frankel grade in the delayed surgery group. Of 6 patients with incomplete lesion, 4 were treated with laminectomy and fusion with instrumentation, and they improved by average 1.75 Frankel grades. And remaining 2 were treated by laminectomy or anterior transthoracic decompression and fusion respectively and they improved by 1 Frankel grade respectively. Based on the results of this study and other references, we suggest that early surgical intervention improves neurologic recovery in comparison to late surgical intervention and that posterior surgical instrumentation is indicated in acute unstable bursting fracture and flexion-dislocation injury. Also we suggest that anterior transthoracic decompression and fusion is indicated in cases of neural compression by bone or disc fragments.
Decompression ; Humans ; Laminectomy ; Paralysis ; Sensation ; Spinal Cord* ; Spine ; Surgical Instruments

Recently microvascular decompressive approach to the hyperactive type of low cranial nerves dysfunction has been popular procedures in neurosurgical operation. The neurosurgical teams at St. Paul's Hospital, Catholic Medical College operated on 11 patients employing this technique for 2 years. The patients were diagnosed as 9 patients with hemifacial spasm, one with trigeminal neuralgia, and one with glossopharyngeal neuralgia. The results were very encouraging of the 10 patients. But remaining one patient was failed with therapy. The authors would like to share with you their experiences employing the microvascular surgical technique, the results & the prognosis.
Cranial Nerves* ; Glossopharyngeal Nerve Diseases ; Hemifacial Spasm ; Humans ; Microvascular Decompression Surgery ; Prognosis ; Trigeminal Neuralgia

The safety and efficacy of intravenous tissue plasminogen activator(tPA) on the condition of ruling out the significant risk were studied at 6 and 12 hours after cerebral artery embolization in rabbit model. The time selection was chosen to stimulate the analogous clinical situation. The safety and effectiveness of tPA in experimental and clinical treatment of acute coronary thrombosis have been established. Tissue plasminogen activator is an endogenous fibrin-specific serine protease with the potent thrombolytic activity that has been produced recently by recombinant DNA technology. The acute cerebral thromboembolic model was induced by injecting three 0.5X1.0mm fragments of autologous arterial thromi into internal carotid artery through the intra-arterial catheter. The autologous arterial thrombi was obtained from the traumatized arterial endothelium by scratching the lumen of auricular artery using modified spinal needle. The experimental group was divided into four groups : (1) group Ia : saline-treated(1 ml/kg) control group at 6 hours after embolization(n=10), (2) group Ib : tPA-treated(1 mg/kg) at 6 hours after embolization(n=10), (3) group IIa : saline-treated control group 12 hours after embolization(n=10), (4) group Iib : tPA-treated group 12 hours after embolization(n=13). The experimental rabbits were sacrificed at 24 hours after injection of tPA(1 mg/kg) or saline(1 ml/kg) in each group. Brain was cut into 0.5 cm thick coronal sections, which were stained with triphenyltetrazolium chloride to define the areas of infarction. The transparent plastic sheets were placed on the each section, and the total area of the brain slice and the area of infarction were measured by the plannimeter(as outlined by TTC staining). The percentage area of whole brain infarction was calculated as(the sum of infarcted area/the sum of brain slice areas)x100% for each rabbit. We also observed the pathologic findings with hematoxylin-eosin staining. The results were as follows : 1) Only 1 rabbit treated with tPA at 12 hours after occlusion exhibited the gross hemorrhage. 2) The infarcted area was limited to the basal ganglia and cortex in all group. 3) The mean percentage area of whole brain infarction averaged 18.6+/-1.94% in group Ia, 6.32+/-1.02% in group Ib, and 20.8+/-3.34% in group IIa, 6.78+/-1.40% in group IIb. One-way ANOVA test of infarction size showed the significant differences(p<0.05) between the tPA-treated group and the saline-treated control group, but no difference between the groups treated with same agent. 4) Under the study of microscope, infarcted area of saline-treated control group was more extended than that of tPA-treated group. Congulation necrosis and degeneration of neuronal cells could be seen. But the infarcted area of tPA-treated group was smaller than that of saline-treated control group. Only collection of foamy macrophages adjacent the necrotic area could be seen in tPA-treated group. These results suggest that tPA therapy may be safe and efficacious during the interval of 6 to 12 hours after embolization.
Arteries ; Basal Ganglia ; Brain ; Brain Infarction ; Carotid Artery, Internal ; Catheters ; Cerebral Arteries ; Coronary Thrombosis ; DNA, Recombinant ; Endothelium ; Hemorrhage ; Infarction ; Macrophages ; Necrosis ; Needles ; Neurons ; Plasminogen ; Plastics ; Rabbits ; Serine Proteases ; Tissue Plasminogen Activator*

Since 1967 the STA-MCA anastomosis has been popular procedure in neurosurgical operation. The meurosurgical teams at St. Paul's Hospital, Catholic Medical College, recently operated on 8 patients employing 9 times of this technique. The patients were diagnosed as four patients with complete stroke, one with traumatic middle cerebral stenosis, two with moyamoya disease, and one with huge aneurysm at intracavernous portion of ICA. The results were very encouraging of the 8 patients, 7 had favorably improved clinically, and proved by follow-up cerebral angiographies, CT Scanning, EEG or MEP recordings. The remaining one patient had intracerebral and intracerebellar hematoma, two months later after discharge, thus the result was poor. The authors would like to share with you their experiences employing the STA-MCA anastomosis technique, indications the results and the prognosis.
Aneurysm ; Cerebral Angiography ; Constriction, Pathologic ; Electroencephalography ; Follow-Up Studies ; Hematoma ; Humans ; Moyamoya Disease ; Prognosis ; Stroke ; Tomography, X-Ray Computed