CNS infection due to Listeria monocytogenes is a rare condition that occurs primarily in immunocompromised patients. A predilection for the brainstem has been proposed but definite abscess formation is extremely rare. We report a case of necrotizing meningoencephalitis with diffuse extensive abscesses caused by Listeria monocytogenes in a chronic diabetic patient, whose diagnosis was based on blood culture and MRI findings.
Abscess ; Brain Abscess* ; Brain Stem ; Brain* ; Diagnosis ; Humans ; Immunocompromised Host ; Listeria monocytogenes* ; Listeria* ; Magnetic Resonance Imaging ; Meningoencephalitis

Intramedullary spinal cord abscess is rare condition, and that, the diagnosis of an abscess is rarely established before operative interference is indicated. A case of spinal cord abscess is reported upon 42 year-old male who was admitted to this hospital because of severe pain in the posterior lower neck and weakness in all 4 extremities. The patient have no history of infection or operation in recent past. On admission the subject was in state of quadriparesis, and the superficial sensory impairement was up to the level of T1 3 spinal dermatome. In an early course of the illness the motor weakness had started to appear in the left arm and the impairement of pain and temperature sensations in the right leg, indicating a picture of Brown-Sequard's syndrome. Radiographic examinations disclosed a localized enlargement of lower cervical canal with a widening of interpedicular distance and showed a defect and obstruction of dye column at C6 spinal level, which were suggestive of picture of intramedullary tumor. Operation the exposed spinal laminae and dura showed nothing abnormal, but the dura mater was under the grerat pressure. Opening the dura the spinal cord was swollen, tense and nonpulsatile with dusky red discoloration on a surface of the cord. Pus contents were obtained by needle aspiration and through a myelotomy opening the contents were evacuated completely. Culture of the pus contents produced no organisms. Pathology reported a nonspecific suppurative inflammation on the biopsy. The surgical treatment was combined with the administration of antibiotics, in full theapeutic doses and steroid postoperatively. Two weeks after the surgery he showed significant recovery from the neurological dysfunctions in his legs.
Abscess* ; Adult ; Anti-Bacterial Agents ; Arm ; Biopsy ; Brown-Sequard Syndrome ; Diagnosis ; Dura Mater ; Extremities ; Humans ; Inflammation ; Leg ; Male ; Neck ; Needles ; Pathology ; Quadriplegia ; Sensation ; Spinal Cord ; Suppuration ; Transcutaneous Electric Nerve Stimulation

The incidence of tuberculoma of the brain in different countries varies reatly. They form a high percentage of intracrnial lesions dealt with in countries of Asia, Eastern Europe, Italy, Spain and South America. The recent introduction of the potent antituberculosis remedies, far from diminishing the incidence of tuberculoma of the brain, is more likely to increase it. This case was a 18 year old male who had increased intracranial pressure signs and characteristic signs which was suggestive lesion in posterior fossa. Conray ventriculography revealed nearly total obstruction of distal portion of aqueduct of Sylvius with displacement to the right side. Intensive antituberclous treatment then was started after removal of tuberculoma in cerebellar vermis and then discharged with fully recovery. References were reviewed as will.
Adolescent ; Asia ; Brain ; Cerebral Aqueduct ; Europe, Eastern ; Humans ; Incidence ; Intracranial Pressure ; Italy ; Male ; South America ; Spain ; Tuberculoma*

The incidence of tuberculoma of the brain in different countries varies reatly. They form a high percentage of intracrnial lesions dealt with in countries of Asia, Eastern Europe, Italy, Spain and South America. The recent introduction of the potent antituberculosis remedies, far from diminishing the incidence of tuberculoma of the brain, is more likely to increase it. This case was a 18 year old male who had increased intracranial pressure signs and characteristic signs which was suggestive lesion in posterior fossa. Conray ventriculography revealed nearly total obstruction of distal portion of aqueduct of Sylvius with displacement to the right side. Intensive antituberclous treatment then was started after removal of tuberculoma in cerebellar vermis and then discharged with fully recovery. References were reviewed as will.
Adolescent ; Asia ; Brain ; Cerebral Aqueduct ; Europe, Eastern ; Humans ; Incidence ; Intracranial Pressure ; Italy ; Male ; South America ; Spain ; Tuberculoma*

A 58-years-old man came to the hospital because of progressive intellectual deterioration, gait disturbance and postural instability for 6 months. Neuropsychological tests showed severe impairment of memory and executive functions, and dural arteriovenous fistula of the superior sagittal sinus (dAVF of SSS) was found on brain MRI and angiography. The symptoms were markedly improved after selective transvascular embolization treatments. Even though the dAVF of SSS is a rare cause of dementia, we suggest that it can be one of the treatable causes of dementia.
Angiography ; Brain ; Central Nervous System Vascular Malformations* ; Dementia* ; Executive Function ; Gait ; Magnetic Resonance Imaging ; Memory ; Neuropsychological Tests ; Superior Sagittal Sinus*

There have been many reports of angiographic extravasation since the first description by Jamieson in 1952. Preoperative differential diagnosis between epidural and subdural post-traumatic blood collections is not always possible on the basis of cerebral angiographic signs alone, but many authors considered that extravasation of the contrast medium from a ruptured meningeal vessel is commonly considered as a definitive angiographic sign of epidural hematoma. Some authors feel that an extravasation of contrast medium from rupture of the middle meningeal artery does not necessarily indicate an epidural hematoma since it may also be formed rarely in cases of subdural or intracerebral blood collections. The authors report 6 cases of angiographic extravasation in head injury patient, 3 epidural hematoma, 2 subdural hematoma and one intracerebral hematoma.
Craniocerebral Trauma ; Diagnosis, Differential ; Hematoma ; Hematoma, Subdural ; Humans ; Meningeal Arteries ; Rupture

The authors present a consecutive series of 81 patients admitted to the Department of Neurosurgery of Korea University and Ewha Woman's University with an intracranial arteriovenous malformation(AVM). Of these, 56 received surgical treatment, and 23 were treated conservatively. We have reviewed the modes of clinical presentations, result of diagnostic evaluation, and surgical consideration. Partial of total removal of the AVM was performed in all but 7 of the patients treated surgically. Operative mortality in this surgical series was 9%, with significant morbidity in 20%.
Arteriovenous Malformations ; Humans ; Korea ; Mortality ; Neurosurgery

Spitting as an ictal phenomenon has rarely been reported. It is considered to indicate a seizure onset in the nondominant temporal lobe. Three cases with ictal spitting were found in 81 consecutive patients who underwent temporal lobe resections due to intractable temporal lobe epilepsy. Two had evidence of the right temporal ictal onset. One had the left temporal ictal onset, but the Wada test demonstrated language dominance in the right hemisphere. Three all had mesial temporal sclerosis. One had recollection of her episodes of spitting with a gustatory aura, whereas the other patients had no awareness of this symptom. These cases support previous studies suggesting that spitting is a lateralizing sign to nondominant temporal lobe epilepsy.
Epilepsy ; Epilepsy, Temporal Lobe* ; Humans ; Sclerosis ; Seizures ; Temporal Lobe*

PURPOSE: The matrix metalloproteinases (MMPs) have been implicated in proteolysis of basement membrane for initiation of metastatic cascade. Tissue inhibitors of metalloproteinases (TIMPs) are specific inhibitors of MMPs. The purpose of this study was to evaluate the expression of MMP-2 and TIMP-2 in human colorectal carcinomas. METHODS: The paraffin blocks of 140 colorectal carcinomas were recalled and immunostained with monoclonal antibodies specific for MMP-2 and TIMP-2. These antibodies were effective on formalin fixed, paraffin embedded sections. The rate of stain was estimated, and the relationships between the expression and the stage, the differentiation, lymph node metastasis, distant metastasis and the survival rate were assessed. RESULTS: MMP-2 was present in 31.4% of colorectal cancers. TIMP-2 was identified in 63.6% of tumors. The expression of MMP-2 was significantly associated with the presence of lymph-node metastasis, the stage, and the presence of distant metastasis. However the expression of TIMP-2 was not correlated with any risk factors. CONCLUSIONS: These results suggest that MMP-2 could predict the ability of cancer invasion and be used as a prognostic factor for the colorectal adenocarcinoma.
Adenocarcinoma ; Antibodies ; Antibodies, Monoclonal ; Basement Membrane ; Colorectal Neoplasms ; Formaldehyde ; Humans ; Lymph Nodes ; Matrix Metalloproteinases ; Metalloproteases ; Neoplasm Metastasis ; Paraffin ; Proteolysis ; Risk Factors ; Survival Rate ; Tissue Inhibitor of Metalloproteinase-2*

BACKGROUND: Reoperation for recurrent bile duct cancer is almost impossible. We report here on a successfully managed case of recurrent Klatskin tumor. METHODS: A 45-year-old male was referred to our hospital with a relapsed Klatskin tumor 7 months after performing resection of his extrahepatic bile duct for Bismuth type I Klatskin tumor. The CT scan showed type IV Klatskin tumor with peritoneal dissemination. However, the PETCT scan didn't find any evidence of tumor. We decided to perform exploratory laparotomy to check the operability and confirm the diagnosis. RESULTS: No peritoneal dissemination was found during the first operation. After massive adhesiolysis, the jejunum was detached from the hepaticojejunostomy (HJ) site, and frozen biopsy confirmed adenocarcinoma at the strictured HJ site. The preoperatively measured left lateral sector was too small. Therefore, right trisectionectomy and caudate lobectomy were performed with keeping intact the right and left side inflow and outflow. HJ was performed in the normal B2 and B3 segments. Portal vein embolization (PVE) was done one week after the first operation. The volume of the left lateral sector increased three weeks after PVE. We safely and completely removed the right trisector and caudate lobe one month after the first operation. He recovered well and was discharged 4 weeks after the operation. No evidence of recurrence was found 14 months after the last operation. CONCLUSIONS: Although there is a possibility of severe adhesion and tumor spreading due to two-staged operation, this procedure may be one of the alternative methods to prevent liver failure that is due to an inadequate liver volume in the case of performing unexpected, extended liver resection. The authors also confirmed that curative resection was feasible to perform in selected cases of recurrent bile duct cancer.
Adenocarcinoma ; Bile Duct Neoplasms ; Bile Ducts, Extrahepatic ; Biopsy ; Bismuth ; Diagnosis ; Humans ; Jejunum ; Klatskin's Tumor* ; Laparotomy ; Liver ; Liver Failure ; Male ; Middle Aged ; Portal Vein ; Recurrence ; Reoperation ; Tomography, X-Ray Computed