OBJECTIVE: We tried to investigate impact of early tracheostomy on hospital-acquired pneumonia and infection of anterior cervical fusion site in patients with acute cervical cord injury undergoing respiratory difficulty. METHODS: A retrospective analysis was done with 42 subjects received tracheostomy of patients with acute cervical cord injury admitted in our institution from Jan. 2001 to Dec. 2010. The subjects were classified into early tracheostomy group (< or =7 days after endotracheal intubation) and delayed (>7 days). We analyzed the incidence of post-tracheostomy pneumonia, intensive care unit (ICU) stay, hospital stay, in-hospital mortality and tracheostomy or anterior cervical fusion site infections. RESULTS: Early tracheostomy was performed in 13 patients (31.0%) and delayed in 29 (69.0%). The incidence of post-tracheostomy pneumonia was significantly lower in the early tracheostomy group than in the delayed (p=0.018). ICU stay was also significantly lower in the early tracheostomy group than in the delayed (p=0.013). Hospital stay was lower in the early tracheostomy group than in the delayed (p=0.061), but was not statistically significant. In-hospital mortality was not different between two groups. There were no patients with infection of anterior cervical fusion site as a consequence of tracheostomy in both groups. CONCLUSION: This study suggests that early tracheostomy may have beneficial effects in patients with acute cervical cord injury. Tracheostomy was not found to increase the risk of infection in previous anterior cervical surgery.
Hospital Mortality ; Humans ; Incidence ; Intensive Care Units ; Length of Stay ; Pneumonia ; Retrospective Studies ; Spinal Cord Injuries ; Tracheostomy

We report a rare case of a 71-year-old male patient who had suffered from long-lasting neurogenic shock for 13 weeks after cervical spinal cord injury (SCI) caused by a bicycle accident. The neurogenic shock was resolved dramatically 2 weeks after the administration of alpha-1-adrenergic agonist, midodrine hydrochloride. In usual cases, neurogenic shock tends to improve between 2 and 6 weeks after SCI; however, in a few cases, the shock lasts for several months. In our case, spinal shock lasted for 13 weeks and exhibited very sensitive decline of blood pressure for even a slight decrease of dopamine despite recovered bulbospongiosus reflex. Three days after midodrine hydrochloride was added, hypotension improved dramatically. We discuss our rare case with pertinent literatures.
Adrenergic alpha-Agonists ; Aged ; Blood Pressure ; Dopamine ; Humans ; Hypotension ; Male ; Midodrine* ; Reflex ; Shock* ; Spinal Cord Injuries* ; Spinal Cord*

Pituitary apoplexy usually presented with abrupt onset of neurological deterioration of headache, visual disturbance and decreased mental status. Post-traumatic pituitary apoplexy generally occurs in patients who have suffered from severe head injury, but there are rare reports occurred in patients with mild head injury. We describe a rare case of atypical presentation of acute pituitary apoplexy following mild head injury. A 68-year-old woman presented with right parietal scalp swelling after minor head trauma. Glasgow Coma Scale (GCS) score was 14. Initial computed tomography (CT) scans showed multiple contusions in the basal forebrain, falx hemorrhage and a linear skull fracture near the midline. In addition, there was a suprasellar-extended pituitary macroadenoma with suspicious intratumoral hemorrhage. After admission, cloudy consciousness, poor oral intake and high fever continued for several days. On seventh day, her condition has abruptly deteriorated and hypotensive shock developed. She recovered dramatically two days after steroid replacement therapy. The mechanism of pituitary apoplexy after mild head injury discussed with a relevant literature.
Consciousness ; Contusions ; Craniocerebral Trauma ; Female ; Fever ; Glasgow Coma Scale ; Head ; Headache ; Hemorrhage ; Humans ; Pituitary Apoplexy ; Pituitary Neoplasms ; Prosencephalon ; Scalp ; Shock ; Skull Fractures

OBJECTIVE: Contrary to some clinical belief, there were quite a few studies regarding animal models of intracerebral hemorrhage (ICH) in vivo suggesting that prior use of statins may improve outcome after ICH. This study reports the effect of 3-hydroxy-3-methyl-glutaryl-coenzyme A (HMG CoA) reductase inhibitor, simvastatin given before experimental ICH. METHODS: Fifty-one rats were subjected to collagenase-induced ICH, subdivided in 3 groups according to simvastatin treatment modality, and behavioral tests were done. Hematoma volume, brain water content and hemispheric atrophy were analyzed. Immunohistochemical staining for microglia (OX-42) and endothelial nitric oxide synthase (eNOS) was performed and caspase-3 activity was also measured. RESULTS: Pre-simvastatin therapy decreased inflammatory reaction and perihematomal cell death, but resulted in no significant reduction of brain edema and no eNOS expression in the perihematomal region. Finally, prior use of simvastatin showed less significant improvement of neurological outcome after experimental ICH when compared to post-simvastatin therapy. CONCLUSION: The present study suggests that statins therapy after ICH improves neurological outcome, but prior use of statins before ICH might provide only histological improvement, providing no significant impact on neurological outcome against ICH.
Animals ; Atrophy ; Brain ; Brain Edema ; Caspase 3 ; Cell Death ; Cerebral Hemorrhage ; Hematoma ; Inflammation ; Microglia ; Models, Animal ; Nitric Oxide Synthase Type III ; Oxidoreductases ; Rats ; Simvastatin

OBJECTIVE: Delayed ischemic deficit or cerebral infarction is the leading cause of morbidity and mortality after aneurysmal subarachnoid hemorrhage (SAH). The purpose of this study is to reassess the prognostic impact of intraoperative elements, including factors related to surgery and anesthesia, on the development of cerebral infarction in patients with ruptured cerebral aneurysms. METHODS: Variables related to surgery and anesthesia as well as predetermined factors were all evaluated via a retrospective study on 398 consecutive patients who underwent early microsurgery for ruptured cerebral aneurysms in the last 7 years. Patients were dichotomized as following; good clinical grade (Hunt-Hess grade I to III) and poor clinical grade (IV and V). The end-point events were cerebral infarctions and the clinical outcomes were measured at postoperative 6 months. RESULTS: The occurrence of cerebral infarction was eminent when there was an intraoperative rupture, prolonged temporary clipping and retraction time, intraoperative hypotension, or decreased O2 saturation, but there was no statistical significance between the two different clinical groups. Besides the Fisher Grade, multiple logistic regression analyses showed that temporary clipping time, hypotension, and low O2 saturation had odds ratios of 1.574, 3.016, and 1.528, respectively. Cerebral infarction and outcome had a meaningful correlation (gamma=0.147, p=0.038). CONCLUSION: This study results indicate that early surgery for poor grade SAH patients carries a significant risk of ongoing ischemic complication due to the brain's vulnerability or accompanying cardio-pulmonary dysfunction. Thus, these patients should be approached very cautiously to overcome any anticipated intraoperative threat by concerted efforts with neuro-anesthesiologist in point to point manner.
Anesthesia ; Cerebral Infarction ; Chlorobenzenes ; Humans ; Hypotension ; Intracranial Aneurysm ; Logistic Models ; Microsurgery ; Odds Ratio ; Retrospective Studies ; Rupture ; Subarachnoid Hemorrhage ; Triazoles

OBJECTIVE: There is no proven regimen to reduce the severity of stroke in patients with acute cerebral infarction presenting beyond the thrombolytic time window. Ozagrel sodium, a selective thromboxane A2 synthetase inhibitor, has been known to suppress the development of infarction. The antiplatelet effect is improved when aspirin is used together with a thromboxane synthetase inhibitor. METHODS: Patients with non-cardiogenic acute ischemic stroke who were not eligible for thrombolysis were randomly assigned to two groups; one group received ozagrel sodium plus 100 mg of aspirin (group 1, n=43) and the other 100 mg of aspirin alone (group 2, n=43). Demographic data, cardiovascular risk factors, initial stroke severity [National Institute of Health Stroke Scale (NIHSS) and motor strength scale] and stroke subtypes were analyzed in each group. Clinical outcomes were analyzed by NIHSS and motor strength scale at 14 days after the onset of stroke. RESULTS: There were no significant differences in the mean age, gender proportion, the prevalence of cardiovascular risk factors, stroke subtypes, and baseline neurological severity between the two groups. However, the clinical outcome for group 1 was much better at 14 days after the onset of stroke compared to group 2 (NIHSS score, p=0.007, Motor strength scale score, p<0.001). There was one case of hemorrhagic transformation in group 1, but there was no statistically significant difference in bleeding tendency between two groups. CONCLUSION: In this preliminary study, thromboxane A2 synthetase inhibitor plus a low dose of aspirin seems to be safe and has a favorable outcome compared to aspirin alone in patients with acute ischemic stroke who presented beyond the thrombolytic time window.
Aspirin ; Cerebral Infarction ; Hemorrhage ; Humans ; Infarction ; Methacrylates ; Prevalence ; Risk Factors ; Sodium ; Stroke ; Thromboxane A2 ; Thromboxane-A Synthase ; Tissue Plasminogen Activator

A postoperative contralateral supra- and infratentorial epidural hematoma after decompressive surgery is an extremely rare event. We describe a 38-year-old male with a contralateral supra- and infratentorial acute epidural hematoma just after decompressive surgery for an acute subdural hematoma. A contralateral skull fracture involving a lambdoidal suture and an intraoperative brain protrusion may be warning signs. The mechanisms, along with relevant literature, are discussed.
Adult ; Brain ; Hematoma ; Hematoma, Subdural, Acute ; Humans ; Male ; Skull Fractures ; Sutures

The authors report a case of fusiform aneurysm in the proximal anterior cerebral artery(ACA). A 44-year-old woman presented with severe headache after subarachnoid hemorrhage. The right carotid angiography demonstrated a fusiform aneurysm in the A1 segment of right ACA with vasospasm. Clipping of a fusiform right A1 aneurysm was performed via the right pterional approach. The postoperative cerebral angiography demonstrated complete occlusion of the fusiform aneurysm and moderate degree of vasospasm with preservation of A1 segment. The postoperative course was uneventful. We report a case of fusiform aneurysm of A1 segment that was successfully clipped with the fenestrated aneurysmal clip.
Adult ; Aneurysm* ; Angiography ; Anterior Cerebral Artery* ; Cerebral Angiography ; Female ; Headache ; Humans ; Subarachnoid Hemorrhage

OBJECTIVE: We investigated clinical characteristics and independent outcome predictors of hypertensive intracerebral hemorrhage(ICH) in the very elderly patients. METHODS: From January 2001 to December 2005, we analyzed retrospectively 28 very elderly patients(> or = 80 years) with hypertensive ICH admitted to our neurosurgical department. As a control group, 200 younger patients(< 80 years) with hypertensive ICH were selected. We analyzed risk factors, clinical and radiologic characteristics, outcomes of hypertensive ICH in very elderly. Multivariate logistic regression analyses were performed to find out independent predictors of 30-day mortality. RESULTS: Diastolic blood pressure, white blood cell counts and serum albumin on admission were significantly lower among patients < or = 80 years than in the control group(all p < 0.05). Thirty-day mortality was higher among patients > or = 80 years than in the control group(35.7% vs. 19.0%, respectively, p = 0.005). By multivariate analysis, in ICH patients > or = 80 years, only coma(Glasgow coma scale score < or = 8) was independently associated with 30-day mortality(odds rati[OR]25.5, 95% confidence interva[CI]2.36 - 275.74, p < 0.001). CONCLUSION: Our result suggests that the very elderly patients with hypertensive ICH may present some different clinical characteristics from those in their younger counterparts.
Aged ; Blood Pressure ; Cerebral Hemorrhage ; Coma ; Humans ; Intracranial Hemorrhage, Hypertensive ; Leukocyte Count ; Logistic Models ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Serum Albumin

Bilateral traumatic hemorrhage of the basal ganglia is an extremely rare neuropathologic entity. This report describes a 50-year-old man with bilateral basal ganglia hemorrhage with occipital fracture of the skull after head trauma. The mechanism of development of traumatic hemorrhage of the basal ganglia has been not clear. But, it is presumed to be secondary to rupture of the lenticulostriate or anterior choroidal artery by shearing as a result of acceleration/deceleration forces. We briefly summarize our uncommon case and discuss its possible mechanisms.
Arteries ; Basal Ganglia Hemorrhage ; Basal Ganglia* ; Choroid ; Contusions ; Craniocerebral Trauma ; Hemorrhage* ; Humans ; Middle Aged ; Rupture ; Skull