Computed tomography(CT) has enabled early recognition and treatment of focal injuries in patients with head trauma. However, CT has been less beneficial in identifying diffuse brain injury(DBI). The authors have analyzed retrospectively, a series of 132 patients with OBI observed for 2 years from Aug. 1986 to Jul. 1988 to evaluate the significance of the factors affecting outcome. Eighty-three patients were selected as being compatible with moderate and severe diffuse axonal injury(DAI) classified by Gennarelli, defined by coma without a CT lesion that is an obvious cause and coma greater than 24 hr with or without decerebration. The results are summarized as follows: 1) The 38(45.7%) out of 83 patients were found below age of 20, but there was no statistical significance between age distribution and outcome. 2) In case of initial Glasgow coma scale(GCS) of 7 or 8, 32(86.5%) out of 37 patients revealed good outcome, but 18(90%) of 20 patients with a score of 3 or 4 revealed poor outcome(p<0.01). 3) With regard to brain swelling in CT, there was significant statistical difference to outcome(p<0.05). 4) Small hemorrhages on corpus callosum, basal ganglia, basal cistern, peritentorial, lateral ventricle that is characteristic CT findings for DAI were showed 58(70%) out of all cases. It might be concluded that initial GCS, brain swelling and small hemorrhages in CT were significant factors affecting outcome in DAI.
Age Distribution ; Axons ; Basal Ganglia ; Brain ; Brain Edema ; Brain Injuries* ; Coma ; Corpus Callosum ; Craniocerebral Trauma ; Diffuse Axonal Injury ; Hemorrhage ; Humans ; Lateral Ventricles ; Retrospective Studies ; Tomography, X-Ray Computed

No abstract available.
Hematoma*

The main pathophysiology of cerebral ischemia caused by occlusive cerebrovascular disease(CVD) are hemodynamic low perfusion and embolic mechanism. The main objects of surgical method for occlusive CVD are improvement of low perfusion and elimination of embolic source with surgical procedure. The causes of occlusive CVD can be devided as a atheromatous and non-atheromatous occlusion. The frequent sites of occlusion in atheromatous origin are carotid bifurcation, carotid siphon and middle cerebral artery(MCA), proximal subclavian and vertebral artery origin, vertebral artery proximal to origin of posterior inferior cerebellar artery(PICA), vertebral artery distal to origin of PICA and mid-basilar artery. The lesions of non-atheromatous occlusive disease are extracranial internal carotid artery(ICA) aneurysm, traumatic dissection with or without false aneurysm of ICA, loops and kinds of ICA, osteophytic or traumatic vertebral artery compression, traumatic dissection with or without false aneurysm of vertebral artery and Moya Moya disease. Depend on occlusion site and disease, the surgical procedures are different. The main surgical procedures for occlusive CVD are carotid endarterectomy, extracranial-intracranial(EC-IC) bypass surgery, vertebral artery endarterectomy, vertebral artery to common carotid artery transposition, resection and end-to-end or interposition vein graft of ICA, indirect revascularization for Moya Moya disease and unroof the transverse foramen of cervical vertebra. The author reviews the surgical indication and procedure of occlusive CVD briefly.
Aneurysm ; Aneurysm, False ; Arteries ; Brain Ischemia ; Carotid Artery, Common ; Endarterectomy ; Endarterectomy, Carotid ; Hemodynamics ; Moyamoya Disease ; Perfusion ; Pica ; Spine ; Transplants ; Veins ; Vertebral Artery

The main pathophysiology of cerebral ischemia caused by occlusive cerebrovascular disease(CVD) are hemodynamic low perfusion and embolic mechanism. The main objects of surgical method for occlusive CVD are improvement of low perfusion and elimination of embolic source with surgical procedure. The causes of occlusive CVD can be devided as a atheromatous and non-atheromatous occlusion. The frequent sites of occlusion in atheromatous origin are carotid bifurcation, carotid siphon and middle cerebral artery(MCA), proximal subclavian and vertebral artery origin, vertebral artery proximal to origin of posterior inferior cerebellar artery(PICA), vertebral artery distal to origin of PICA and mid-basilar artery. The lesions of non-atheromatous occlusive disease are extracranial internal carotid artery(ICA) aneurysm, traumatic dissection with or without false aneurysm of ICA, loops and kinds of ICA, osteophytic or traumatic vertebral artery compression, traumatic dissection with or without false aneurysm of vertebral artery and Moya Moya disease. Depend on occlusion site and disease, the surgical procedures are different. The main surgical procedures for occlusive CVD are carotid endarterectomy, extracranial-intracranial(EC-IC) bypass surgery, vertebral artery endarterectomy, vertebral artery to common carotid artery transposition, resection and end-to-end or interposition vein graft of ICA, indirect revascularization for Moya Moya disease and unroof the transverse foramen of cervical vertebra. The author reviews the surgical indication and procedure of occlusive CVD briefly.
Aneurysm ; Aneurysm, False ; Arteries ; Brain Ischemia ; Carotid Artery, Common ; Endarterectomy ; Endarterectomy, Carotid ; Hemodynamics ; Moyamoya Disease ; Perfusion ; Pica ; Spine ; Transplants ; Veins ; Vertebral Artery

Activation of the sympathetic nervous system in mediating the stress response attends traumatic brain injury. Plasma dopamine(DA), epinephrine(E), norepinephrine(NE) levels were measured in 26 severe traumatically brain injured patients to determine whether catecholamine levels obtained within 24 hours after injury provide reliable prognostic endogenous markers of outcome. Patient outcome was determine at 1 week using the Glasgow Coma Scale(GCS) and at the time of discharge the Glasgow Outcome Scale(GOS), 7 patients with diseases except those with a severe traumatic brain injury were selected as a control group. Firstly, we analyzed the difference of the average DA, E, and NE between the control group and severe traumatic brain injury patients. Secondly, we analyzed the difference of the average catecholamine levels in the 3 groups according to admission GCS scores(respectively 3~4, 5~7, 8~9). Third, we analyzed the difference of the average catecholamine levels in the 5 groups according to GOS scores at 1 week(respectively dead, 3~4, 5~7, 8~11, >11). Finally, we analyzed the difference of the average catecholamine levels in the 5 groups according to GOS at the time of discharge. As a result, there was no statical difference between the level of DA in the control group and those of the severe brain injury patients. But the level of E an NE in the experimental group were higher than the control group(respectively p<0.03, p<0.04). The admission GCS score correlated highly with the catecholamine levels(NE : r=0.69, p<0.001 ; E ; r=0.42, p<0.03 ; DA ; r=0.42, p<0.03). In patients with admission GCS of 3 to 4, NE levels increaed fourfold above other group(p<0.005). In the 13 patients with GCS scores of 3 or 4 on admission. NE levels predicted outcome at 1 week. All two patients with NE levels less then 750 pg/ml were survived, while 10 of 11 with NE levels greater than 750 pg/ml were died(p<0.02). The levels of NE was significantly higher in patients who died than in those with better outcome(p<0.02). Therefore, these findings indicated that the level of circulating NE is an excellent endogenous marker that appear to reflect the extent of brain injury and that may predict the likelihood of recovery.
Brain ; Brain Injuries* ; Coma ; Dopamine ; Epinephrine ; Humans ; Negotiating ; Norepinephrine ; Plasma* ; Prognosis* ; Sympathetic Nervous System

During the eleven months from September, 1989 to July, 1990, a total of 118 subarachnoid hemorrhage(SAH) patients were admitted. Among these, in 2 cases, the etiology was unknown and another 8 cases of Hunt & Hess clinical grade V patients died in the emergency room or intensive care unit within 24 hours after admission. The remaning 108 cases were managed with protocol as follows. 1) Surgery was done within 9 days after the SAH(total 67 cases) : Extraventricular drainage(EVD) was performed and a cisternal drainage(CD) catheter was positioned during surgery. EVD, CD nimodipine irrigation(0.4mg) through the CD catheter, and intravenous injection(IV) of nimodipine(1~2mg/hr)continued for 13days after the SAH. 2) Surgery was done after the 9th SAH day due to late transfer neurology or other hospitals or posterior circulation aneurysms(32 cases), and 9 cases refused surgery : Nimodipine was used orally(240mg/day) in 35 cases and an IV route(1~2mg/hr) in 6 cases. Total management outcome and results were obtained as follows. 1) A total unsatisfactory management outcome was 18.52%(serve disabled : 4.63%, vegetative : 0.93%, death : 12.96%. In the surgical cases only, 40.8%, 1.02%, 9.19%, respectively). 2) An unsatisfactory surgical outcome in cases following surgery after the 9th SAH day was 6.24%(severe disabled : 3.12%, death : 3.12%). 3) An unsatisfactory management outcome in cases of admission grades I & II following surgery within the 9th SAH day or those non-surgical patients was 19.15%(severe disabled : 4.25%, death : 14.89%. In surgical cases only 2.33%, 9.30%, respectively). 4) An unsatisfactory management outcome in cases of admission grades III & IV with surgery within the 9th SAH day or non-surgical patients was 29.63%(severe disabled : 7.41%, vegetative : 3.70%. death : 18.52%. In surgical cases only 9.09%, 4.55%, 13.64%, respectively). One case of admission grade V died. 5) Causes of unsatisfactory outcome were vasospasm : 9 cases(8.33%), SAH itself : 4 cases, rebleeding : 3 cases, surgical complication : 1 case, medical complication : 1 case, anesthesia : 1 case, and head trauma : 1 case. 6) Complications in management protocol with EVD, CD, CD nimodipine irrigation, and IV of nimodipine were transient hypotension(1 case) and meningitis(5 cases). These complications were improved without sequelae with discontinuing the IV of nimodipine and using antibiotics. We concluded that this protocol may improved the total management outcome of aneurysmal SAH patients, especially poor grade patients(Hunt & Hess grade III & IV) without significant complications. However, in spite of this protocol, the leading cause of an unsatisfactory outcome is vasospasm.
Anesthesia ; Aneurysm ; Anti-Bacterial Agents ; Catheters ; Craniocerebral Trauma ; Drainage* ; Emergency Service, Hospital ; Humans ; Intensive Care Units ; Intracranial Aneurysm* ; Neurology ; Nimodipine*

Twenty-two patients who had evidence of spontaneous intracerebral hemorrhage in brain computerized tomographic(CT) scan specially with small vascular malformations who were angiographically verified and unknown causes, were reviewed. The majority of patients were in first and second decades of life. The duration of symptoms from onset to admission showed relatively short in verified cases and even distributed from 1 day to 1 month in unknown cases. The most common presenting symptoms and signs were headache and papilledema in unknown cases. In brain CT scan, variable findings were seen as hematoma with surrounding eidence of vascular anomaly, hematoma only and blood-fluid level in verified cases, and tumor-like findings in unknown cases. The most common site of hematoma were parietal and occipital lobes in verified cases and were parietal and infratentorial area in unknown cases. The results achieved with excision of these cases were good. These small vascular malformations require special attention because of following view-points: 1) their relative frequent cause of intracerebral hematoma; 2) their variable findings in CT scan ; 3) more careful serial angiographical identification of anomalous vessel with subtraction and magnification; 4) their careful histopathological observation of operative specimen.
Angiography ; Brain ; Cerebral Hemorrhage* ; Headache ; Hematoma ; Humans ; Occipital Lobe ; Papilledema ; Rabeprazole ; Tomography, X-Ray Computed ; Vascular Malformations*

The authors presented 9 cases of surgically treated CSF rhinorrhea, two of which were spontaneous and 7 were traumatic delayed. The duration of leakage was longer than 1 month in most cases and seven of the nine cases were complicated by meningitis. The leakage site was most accurately detected by metrizamide computed tomographic cisternography(MCTC) and the most frequent leakage site was the cribriform plate. Good surgical results were obtained by direct repair and/or shunt without recurrence during follow-up period from 7 months to 2 years.
Cerebrospinal Fluid Rhinorrhea ; Ethmoid Bone ; Follow-Up Studies ; Meningitis ; Metrizamide ; Recurrence

No abstract available.
Intracranial Arteriovenous Malformations* ; Radiosurgery*

No abstract available.
Aneurysm ; Arteriovenous Malformations* ; Brain* ; Intracranial Aneurysm*