BACKGROUND: Recent advances in stroke therapies require patients to be treated very early after the onset of symptoms. To reduce the delay in time upon stroke and arriving at the hospital, we assessed the time delay, stroke recognition, and awareness before and after a public education program designed to increase recognition and awareness. METHODS: Prospective standardized and structured interviews were performed in 155 patients with ischemic stroke who were admitted to the Severance hospital before and after the public education program. The educational program included local newspaper articles, distribution of pamphlets, and lectures to 119 emergency care teams. Time delay, variable factors, stroke recognition, and stroke awareness of patients were then assessed (75 pre-education and 80 post-education groups). RESULTS: 52% of the pre-education group and 52.5% of the post-education group arrived at the hospital within 24 hours. Those who arrived within 3 hours were only 21.3% and 15% respectively. A direct visit to the hospital and a cardioembolic infarction appeared to be associated with a shorter time delay. About half of the patients recognized their symptoms as a stroke before a diagnosis was made by a doctor. Most of them had known that a stroke should be treated urgently. However, the stroke recognition and awareness was not associated with an early arrival, which suggests that their knowledge was not solid. The efforts to inform the public using local newspaper articles and pamphlets geared towards the local residents for the limited time period was not effective in shortening arrival times. CONCLUSIONS: Many of the stroke patients did not arrive within the therapeutic time window. Our findings suggest that extensive and multi-directional campaigns should be performed to reduce the time delay. Our findings also suggest that educational aims should include the need for the rapid treatment of stroke and a therapeutic time window as well as stroke recognition.
Cerebral Infarction ; Cerebrovascular Disorders ; Diagnosis ; Education ; Emergency Medical Services ; Humans ; Infarction ; Lectures ; Periodicals ; Pamphlets ; Prospective Studies ; Stroke*

The authors present the case of basilar artery bifurcation area aneurysm showing the growth of sac. A 46-year-old man was admitted for evaluation of fluctuating dysarthria. He had a history of lacunar infarction 3 years ago. The cerebral angiogram, taken at that time, showed a small aneurysm on basilar artery bifurcation area. Surgical intervention was not performed because of its small size. Brain MRI, taken for evaluation of dysarthria, showed large signal void at the basilar artery bifurcation area and following cerebral angiogram revealed the growth of previous aneurysm in its size. This observation suggests that careful follow-up examination should be performed for incidental small sized aneurysm.
Aneurysm* ; Basilar Artery* ; Brain ; Dysarthria ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Stroke, Lacunar

We performed a percutaneous vertebroplasty at the compressed L2 vertebral body of a 73-year-old female using a left-sided unilateral extrapedicular approach. She complained severe radiating pain and a tingling sensation in her left leg two hours after the vertebroplasty. Spinal computed tomographic scan showed a large retroperitoneal hematoma, and a subsequent spinal angiography revealed a left L2 segmental artery injury. Bleeding was successfully controlled by endovascular embolization. Recently, extrapedicular approaches have been attempted, allowing for the avoidance of facet and pedicle injury with only a unilateral approach. With this approach, however, the needle punctures the vertebral body directly. Therefore, this procedure carries the potential risk of a spinal segmental artery.
Aged ; Angiography ; Arteries ; Female ; Fractures, Compression ; Hematoma ; Hemorrhage ; Humans ; Leg ; Needles ; Punctures ; Sensation ; Vascular System Injuries ; Vertebroplasty

We report a very rare case of a rapidly calcified chronic epidural hematoma (EDH) in a neonate. A 26-day-old female infant was referred to us from a regional hospital because of drowsy mentality and a seizure attack. She was delivered through caesarian section because normal spontaneous vaginal delivery was prolonged and failed. At birth, mild scalp swelling was found on the right frontal area. Scalp swelling was spontaneously resolved and she was discharged without any problems. On the 25th day after her birth, the baby presented with drowsiness and hypotonia following a generalized tonic-clonic seizure. Magnetic resonance imaging (MRI) and a computed tomography (CT) scan revealed a chronic EDH that had a thick layer of calcification. A small burr-hole trephination was performed and a single silastic drainage catheter was inserted. After the operation, a total of 12 ml of liquefied hematoma was drained, and the patient's mentality improved from drowsiness to alertness. The patient was asymptomatic when discharged.
Catheters ; Dimethylpolysiloxanes ; Drainage ; Female ; Hematoma ; Humans ; Infant ; Infant, Newborn ; Magnetic Resonance Imaging ; Muscle Hypotonia ; Parturition ; Scalp ; Seizures ; Sleep Stages

Primary leptomeningeal malignant melanoma is rare entity. We present a case of primary leptomeningeal malignant melanoma of 66-year-old male, who had suffered severe headache, confusion, and right hemiparesis. The brain computed tomography and magnetic resonance image revealed a well enhancing mass with hemorrhage in the left fronto-parietal region. Total surgical removal of the lesion was performed without neurological deficit. He died at home 6 months after operation. Probably, it seems that the cause of death was poor general condition due to obtunded mentality or brain herniation due to increased intracranial pressure. The literature on this subject is briefly reviewed.
Aged ; Brain ; Cause of Death ; Headache ; Hemorrhage ; Humans ; Intracranial Pressure ; Male ; Melanoma* ; Paresis

OBJECTIVE: This study is designed to evaluate the therapeutic effects and prognostic factors for barbituate coma therapy(BCT)in severe and refractory vasospasm following subarachnoid hemorrhage. METHODS: Barbiturate coma therapy was used in 18 patients with severe and refractory vasospasm in spite of "3-H therapy" and intra-arterial papaverine infusion. The authors analyzed the clinical parameters including Glasgow Coma Scale(GCS), electroenceplographic finding, and brain computerized tomography(CT) scan findings in relation to outcome at discharge. RESULTS: Among 18 patients, burst suppression pattern could be obtained in 17. In cases with good outcome, the duration elapsed from coma to drowsiness after BCT was 14.09+/-5.82 days and GCS score at this time was significant in the prediction of final outcome(p<0.05). Patients with ideal burst suppression pattern attainable more than 24 to 48 hours showed good outcome in 81.8%(p<0.05). The group that showed focal low density in the brain CT scan taken before BCT fared better prognosis compared with that of multifocal or diffuse low density(p<0.05), and patients with resolution of perimesencephalic cistern effacement on follow-up brain CT scan taken 48 hours after BCT showed better prognosis(p<0.05). Overall, 72.2% showed improvement of GCS score by 2 or more, and good outcome was noted in 50%. CONCLUSION: The barbiturate coma therapy seems to have a beneficial therapeutic effect on severe and refractory vasospasm and can be considered as a useful therapeutic modality.
Brain ; Coma* ; Follow-Up Studies ; Humans ; Papaverine ; Prognosis ; Sleep Stages ; Subarachnoid Hemorrhage* ; Tomography, X-Ray Computed

Obesity is considered a mild inflammatory state, and the secretion of inflammation-related cytokines rises as adipose tissue expands. Inflammatory cytokines, including tumor necrosis factor-alpha (TNF-alpha), interlukin 6 (IL-6) and monocyte-chemoattractant protein 1 (MCP-1), are modulated by adipose tissue and known to play an important role in insulin resistance which is the common characteristics of obesity related disorders. In this study we analyzed the effects of Sasa borealis leaves extract on inflammatory cytokines and insulin resistance in diet induced obese C57/BL6J mice. The obese state was induced by a high fat diet for 20 weeks and then the mice were divided into two groups; obese control group (OBC, n = 7) and experimental group (OB-SBE, n = 7). The OBC group was fed a high fat diet and the OB-SBE group was fed a high fat diet containing 5% Sasa borealis leaves extract (SBE) for 12 weeks. We also used mice fed a standard diet as a normal control (NC, n = 7). The body weight and adipose tissue weight in the OB group were significantly higher than those in the NC group. The effects of the high fat diet were reduced by SBE treatments, and the body weight and adipose tissue deposition in the OB-SBE group were significantly decreased compared to the OBC group. The OBC group showed higher serum glucose and insulin levels which resulted in a significant increase of incremental area under the curve (IAUC) and HOMA-IR than the NC group. Also, serum leptin, TNF-alpha, and IL-6 levels were significantly higher in the OBC group than in the NC group. In contrast, the OB-SBE group showed a reversal in the metabolic defects, including a decrease in glucose, insulin, IAUC, HOMA-IR, TNF-alpha, IL-6 and leptin levels. These results suggest that BSE can suppress increased weight gain and/or fat deposition induced by a high fat diet and theses effects are accompanied by modulation of the inflammatory cytokines, TNF-alpha and IL-6 secretion resulting in improved insulin resistance.
Adipose Tissue ; Animals ; Body Weight ; Cytokines ; Diet ; Diet, High-Fat ; Glucose ; Inflammation ; Insulin ; Insulin Resistance ; Interleukin-6 ; Leptin ; Mice ; Obesity ; Sasa ; Tumor Necrosis Factor-alpha ; Weight Gain

OBJECTIVE: The aim of this study is to evaluate of the significance of intraoperative electrophysiologic monitoring and follow up electrophysiologic study at seven days after microvascular decompression(MVD) for hemifacial spasm(HFS). METHODS: Thirty nine patients with hemifacial spasm were included in this study and were treated with MVD of the facial nerve from Jun 1990 to May 2001. The patients were divided into a monitoring group and a non-monitoring group. We compared the surgical outcomes, operation related complications between two groups. The abnormal muscle response(AMR) of preoperative electromyographic recording appeared on the mentalis muscle during stimulation of the zygomatic branch of the facial nerve was compared with those of changed during operation, immediately after operation and at postoperative 7th day(POD 7). The relationship between degree of AMR disappearance and surgical outcome was analyzed. RESULTS: There was no difference in surgical outcomes but significant difference in the incidence of operation-related complications between two groups. The results of electrophysiologic study at POD 7 were significantly correlated with surgical outcome in the monitoring group. CONCLUSION: The electrophysiologic study is helpful for identifying the offenders, determining the adequacy of vascular decompression and decrease of operation-related complications. The clinical and electrophysiologic status of HFS after MVD has continuously changed, and therefore the results of eletrophysiologic study at POD 7 are useful for predicting the surgical outcome.
Criminals ; Decompression ; Electromyography* ; Facial Nerve ; Follow-Up Studies* ; Hemifacial Spasm* ; Humans ; Incidence ; Microvascular Decompression Surgery*

We described two cases of Brown-Sequard syndrome caused by cervical disc herniation that were treated by cervical artificial disc replacement. Two patients presented Brown-Sequard syndrome. Computed tomography scanning and magnetic resonance imaging showed a massive soft disc herniation compressing the spinal cord. We performed a total discectomy to remove the ruptured disc particle and replace it with an artificial disc. The neurologic symptoms of two patients were resolved after the surgery. We suggest that cervical arthroplasty can also be used to treat more severe forms of cervical myelopathy such as Brown-Sequard syndrome.
Arthroplasty ; Brown-Sequard Syndrome ; Cervical Vertebrae ; Diskectomy ; Female ; Humans ; Intervertebral Disc Displacement ; Magnetic Resonance Imaging ; Neurologic Manifestations ; Spinal Cord ; Spinal Cord Diseases ; Total Disc Replacement

Spinal subdural hematoma(SSDH) is rare disease. Furthermore, it rarely occurs as a complication of intracranial surgery. There are few case reports which describing SSDH after craniotomy. Although the exact pathogenetic mechanism is obscure, some investigators propose that downward migration of intracranial hematoma by the effect of gravity is one of the cause of SSDH, and which is commonly suggested. But others propose that cerebrospinal fluid(CSF) hypotension is an another possible mechanism. In this paper, we report two cases of SSDH after clipping of an aneurysmal neck.
Aneurysm ; Craniotomy ; Gravitation ; Hematoma ; Hematoma, Subdural, Spinal* ; Humans ; Hypotension ; Neck ; Rare Diseases ; Research Personnel