A 49 years old male patient who suffered from deterioration of posterior neck pain, left hand numbness, left lower limb pain and gait disturbance for 3 years visited our outpatient department. He had been diagnosed as non-dysraphic cervical intradural lipoma and operated in August 1990. On the radiologic images, we found the regrowth of non-dysraphic cervical intradural lipoma from C2 to C7 level, which surrounds and compresses the cervical spinal cord. Previous subtotal laminectomy from C2 to C7 and severe cervical lordosis were also found. Appropriate debulking of lipoma mass without duroplasty was successfully done with intraoperative neurophysiological monitoring (IONM). We are following up the patient for 24 months via outpatient department, his neurologic symptoms such as hand numbness, gait disturbance, left lower limb pain and posterior neck pain have improved. We describe a rare case of regrowth of non-dysraphic cervical intradural lipoma.
Animals ; Gait ; Hand ; Humans ; Hypesthesia ; Intraoperative Neurophysiological Monitoring ; Laminectomy ; Lipoma* ; Lordosis ; Lower Extremity ; Male ; Neck Pain ; Neurologic Manifestations ; Outpatients ; Spinal Cord ; Spinal Dysraphism*

Giant cavernous malformations (GCMs) occur very rarely and little has been reported about their clinical characteristics. The authors present a case of a 20-year-old woman with a GCM. She was referred due to two episodes of generalized seizure. Computed tomography and magnetic resonance image demonstrated a heterogeneous multi-cystic lesion of 7 x 5 x 5 cm size in the left frontal lobe and basal ganglia, and enhancing vascular structure abutting medial portion of the mass. These fingings suggested a diagnosis of GCM accompanying venous angioma. After left frontal craniotomy, transcortical approach was done. Total removal was accomplished and the postoperative course was uneventful. GCMs do not seem differ clinically, surgically or histopathologically from small cavernous angiomas, but imaging appearance of GCMs may be variable. The clinical, radiological feature and management of GCMs are described based on pertinent literature review.
Basal Ganglia ; Caves ; Craniotomy ; Female ; Frontal Lobe ; Gas Chromatography-Mass Spectrometry ; Hemangioma ; Hemangioma, Cavernous ; Humans ; Magnetic Resonance Spectroscopy ; Seizures ; Young Adult

We report a case of thoracic post-herpetic neuralgia which was improved by dorsal root ganglionectomy. The patient had failed to obtain adequate pain relief from conservative therapy such as carbamazepine, amitriptyline, thioridazine, gabapentin, and transcutaneous lidocaine infiltration. Thoracic dorsal root ganglionectomy from T5 to T7 on left side was performed and satisfactory pain relief without significant postoperative neurologic deficit was achieved. Although dorsal root entry zone operation for refractory pain was the most commonly performed procedure in past, dorsal root ganglionectomy is an alternative anatomically and technically safe procedure for the pain in the thoracic lesion. The clinical feature, operative technique and clinical result are presented with review of the literatures.
Amitriptyline ; Carbamazepine ; Ganglionectomy* ; Humans ; Lidocaine ; Neuralgia* ; Neurologic Manifestations ; Pain, Intractable ; Spinal Nerve Roots ; Thioridazine

Primary intramedullary oligodendroglioma is very rare, accounting for only about 1% of all intramedullary spinal cord tumor. We present a case of intramedullary oligodendroglioma in a 30-year-old women. Magnetic resonance image showed an intramedullary mass in the T11-L1 region. Decompressive laminectomy and partial mass removal was performed, however, neurologic state became worse. The histological examination revealed oligodendroglioma. The intramedullary oligodendroglioma, although it is a rare entity, must be considered in the differential diagnosis of spinal cord tumors.
Adult ; Diagnosis, Differential ; Female ; Humans ; Laminectomy ; Oligodendroglioma* ; Spinal Cord Neoplasms

Cavernous malformations (CMs) arising from the optic nerve and chiasm are extremely rare. The authors present a case of 39-year-old woman with CMs of the optic chiasm. She was referred due to sudden onset of bitemporal hemianopsia and headache, the so-called 'chiasmal apoplexy'. MRI findings suggested a diagnosis of hemorrhage and vascular malformation of the optic chiasm. Pterional craniotomy revealed an intrachiasmatic cavernous malformation with hemorrhage. The malformation was totally excised, but field deficits remained unchanged after surgery.
Adult ; Caves ; Craniotomy ; Female ; Headache ; Hemianopsia ; Hemorrhage ; Humans ; Optic Chiasm ; Optic Nerve ; Stroke ; Vascular Malformations

BACKGROUND AND OBJECTIVES: The purpose of the study was to evaluate the time-dependent progress and the delayed improvement in patients who were already treated by combination therapy including oral steroid for idiopathic sudden sensorineural hearing loss. SUBJECTS AND METHOD: This study examined patients presenting with idiopathic sudden sensorineural hearing loss at a secondary referral and a university-based center over 10 years. This retrospective study included only those patients who could be followed up for at least 3 months. RESULTS: Of 121 patients who recovered over the 3 months of follow-up period, 9.9% showed a delayed recovery of later than 1 month after discharge. Of 55 patients who did not recover until the discharge but recovered thereafter, 78.2% recovered within 1 month, 5.5% recovered between 1 to 2 months, 12.7% recovered between 2 to 3 months, and 3.6% recovered 3 months later after the discharge. The delayed recovery was found frequently in partial or slightly recovery groups by Siegel's criteria. CONCLUSION: This study demonstrated the presence of delayed recovery in patients who were treated by combination therapy, including oral steroid for idiopathic sudden sensorineural hearing loss, although this result should be further studied by additional research.
Follow-Up Studies ; Hearing Loss, Sensorineural* ; Hearing Loss, Sudden ; Humans ; Recovery of Function ; Referral and Consultation ; Retrospective Studies

Synovial sarcoma is a rare renal neoplasm that is not easy to diagnose unless SYT-SSX fusion transcripts are identified. We report here on a case of primary renal synovial sarcoma in a 35-year-old woman. A mass was discovered by accident in the lower part of the right kidney when ultrasonography was performed, and it was removed via radical nephrectomy. Grossly, the tumor was a homogeneously tan-brown soft mass that measured 4.5x3.2x3.0 cm, and it was encircled by a well-defined cystic space. The lesion exhibited hypercellularity of the oval or short spindle cells that were arranged in various solid sheets or intersecting fascicles. Immunohistochemically, the tumor showed diffuse positivity for vimentin, bcl-2 and CD99, and it showed focal positivity for epithelial membrane antigen. The SYT-SSX fusion transcripts were detected by reverse transcription-polymerase chain reaction (RT-PCR). Synovial sarcoma should be considered in the differential diagnosis when a spindle cell neoplasm is encountered in the kidney.
Adult ; Diagnosis, Differential ; Female ; Humans ; Kidney ; Kidney Neoplasms ; Mucin-1 ; Nephrectomy ; Oncogene Proteins, Fusion ; Sarcoma, Synovial ; Vimentin

An 81-year-old woman was admitted to our hospital with bilateral chest wall mass in the infrascapular region. Considering the possible diagnosis of a malignant chest wall tumor at such location, we performed excision and biopsy. Both masses were histologically diagnosed as elastofibroma. We experienced this rare disease, bilateral elastofibroma, so we report this case with a bibliography.
Aged, 80 and over ; Biopsy ; Diagnosis ; Female ; Humans ; Rare Diseases ; Thoracic Wall

OBJECTIVE: The purpose of this study is to evaluate the clinical characteristics and surgical outcome of cerebellopontine angle (CPA) epidermoids presenting with trigeminal neuralgia. METHODS: Between 1996 and 2004, 10 patients with typical symptoms of trigeminal neuralgia were found to have cerebellopontine angle epidermoids and treated surgically at our hospital. We retrospectively analyzed the clinico-radiological records of the patients. RESULTS: Total resection was done in 6 patients (60%). Surgical removal of tumor and microvascular decompression of the trigeminal nerve were performed simultaneously in one case. One patient died due to postoperative aseptic meningitis. The others showed total relief from pain. During follow-up, no patients experienced recurrence of their trigeminal neuralgia (TN). CONCLUSION: The clinical features of TN from CPA epidermoids are characterized by symptom onset at a younger age compared to TN from vascular causes. In addition to removal of the tumor, the possibility of vascular compression at the root entry zone of the trigeminal nerve should be kept in mind. If it exists, a microvascular decompression (MVD) should be performed. Recurrence of tumor is rare in both total and subtotal removal cases, but long-term follow-up is required.
Cerebellopontine Angle ; Follow-Up Studies ; Humans ; Meningitis, Aseptic ; Microvascular Decompression Surgery ; Recurrence ; Retrospective Studies ; Trigeminal Nerve ; Trigeminal Neuralgia

Glanzmann's thrombasthenia is a rare autosomal recessive hemorrhagic disorder of platelet function with missing or abnormal platelet plasma membrane glycoprotein IIb-IIIa, which functions as a receptor for fibrinogen. We have experienced a case of thrombasthenia in a 6-year-old female whose chief complaints were easy bruising, frequent epistaxis, arthralgia and swelling of the right ankle joint. Bleeding time was prolonged in the presence of normal platelet levels and the platelet aggregation test showed lack of aggregation after exposure to ADP, epinephrine and collagen, but showed an aggregation response to ristocetin. Platelet analysis by flow cytometry is a successful alternative rapid diagnostic technique for Glanzmann's thrombasthenia patients as well as for carriers of this disease. Flow cytometry technique provides an effective tool for investigating platelet function defects caused by altered expression or deficiency of platelet surface proteins.
Adenosine Diphosphate ; Ankle Joint ; Arthralgia ; Bleeding Time ; Blood Platelets ; Cell Membrane ; Child ; Collagen ; Epinephrine ; Epistaxis ; Female ; Fibrinogen ; Flow Cytometry* ; Glycoproteins ; Hemorrhagic Disorders ; Humans ; Membrane Proteins ; Platelet Aggregation ; Ristocetin ; Thrombasthenia*