Chronic subdural hematoma (SDH) is a well-known disease entity and is traditionally managed with surgery. However, when associated with spontaneous intracranial hypotension (SIH), the treatment strategy ought to be modified, as classical treatment could lead to unwanted consequences. A 59-year-old man presented with a case of SIH that manifested as a bilateral chronic SDH. He developed fatal extensive pneumocephalus and SDH re-accumulation as a complication of burr-hole drainage. Despite application of an epidural blood patch, the spinal cerebrospinal fluid leak continued, which required open spinal surgery. Chronic SDH management should not be overlooked, especially if the exact cause has not been determined. When chronic SDH assumed to be associated with SIH, the neurosurgeon should determine the exact cause of SIH in order to effectively correct the cause.
Blood Patch, Epidural ; Cerebrospinal Fluid ; Drainage* ; Hematoma, Subdural, Chronic* ; Humans ; Intracranial Hypotension* ; Middle Aged ; Pneumocephalus*

Objective: : Preoperative prediction of the arachnoid membrane descent in pituitary surgery is useful for achieving gross total removal and avoiding cerebrospinal fluid leakage resulting from tearing of the arachnoid membrane in the chiasmatic cistern. In this study, we analyzed the patterns of arachnoid membrane descent during or after pituitary tumor surgery and identified the factors related to this descent. Methods: : Analysis was restricted to pituitary macroadenomas not extending into the third ventricle or over the internal carotid artery. To minimize confounding factors, patients who underwent revision surgery, those who had a torn arachnoid during operation or small medial diaphragma sellae (DS) opening, and subtotal resections were excluded. We enrolled 41 consecutive patients in this retrospective analysis. The degree of arachnoid descent was categorized using intraoperative videos. Preoperative magnetic resonance findings, including tumor height, suprasellar extension, and variables including DS area and medial opening size, tumor composition, and displacement of the pituitary stalk and gland were evaluated to determine their correlations with arachnoid membrane descent. Results: : Arachnoid membrane descent was significantly correlated with DS area and medial opening size. Based on T2-weighted images (T2WI) magnetic resonance (MR) images, tumor composition was significantly associated with arachnoid membrane descent. Other factors were not significantly correlated with arachnoid membrane descent. Conclusion : T2WI of tumor composition and preoperative MR imaging of DS area and medial opening provided valuable information regarding arachnoid membrane descent. These parameters may serve as fundamental measures to facilitate complete resection of pituitary macroadenomas.

OBJECTIVE: Early rebleeding after coil embolization of ruptured intracranial aneurysms is rare, however serious and fatal results of rebleeding have been reported. We studied the incidence and angiographic and clinical characteristics of rebleeding of ruptured aneurysms occurring in the immediate postoperative period after coil embolization. MATERIALS AND METHODS: We analyzed patients who had aneurysmal subarachnoid hemorrhage and underwent coil embolization. Patients with dissecting aneurysms, blood blister-like aneurysms, fusiform aneurysms, and pseudoaneurysms were excluded. This study included 330 consecutive patients. The clinical and radiological data of 7 of these patients with acute rebleeding after coil embolization were reviewed. RESULTS: The incidence of rebleeding of ruptured aneurysms after coil embolization was 2.1% (7/330), and all cases of rebleeding occurred in the immediate postoperative period within 3 days after coiling. The radiological characteristics were as follows: anterior communicating artery (ACoA) aneurysm (71.4%, 5/7); presence of intracerebral hemorrhage (ICH, 71.4%, 5/7); dome-to-neck ratio < 2 (42.9%, 3/7); presence of bleb (42.9%, 3/7); and subtotal occlusion of aneurysm after coiling (14.3%, 1/7). A thrombolytic agent was administered in 1 patient and continued anticoagulation was performed in 2 patients. Rebleeding patients showed a very poor outcome (Glasgow Outcome Scale 1, 85.7%, 6/7). CONCLUSION: The prognosis of early rebleeding was very poor. Location of aneurysms on ACoA, the unilateral hypoplasia of A1 segment, presence of ICH and bleb, and adverse events during the procedure were probably associated with early rebleeding of ruptured intracranial aneurysms in the immediate postoperative period after coil embolization.
Aneurysm ; Aneurysm, Dissecting ; Aneurysm, False ; Aneurysm, Ruptured ; Arteries ; Blister ; Cerebral Hemorrhage ; Embolization, Therapeutic* ; Humans ; Incidence ; Intracranial Aneurysm* ; Postoperative Period* ; Prognosis ; Subarachnoid Hemorrhage

Klippel-Trenaunay syndrome is a rare congenital mesodermal abnormality characterized by varicose veins, cutaneous hemangiomas, soft tissue and bony hypertrophy of limb. Potential complications such as deep venous thrombosis and pulmonary thromboembolism have not been reported in Korea to date. We demonstrate the case of a 48-year-old woman with Klippel-Trenaunay syndrome with extensive varicose veins on right lower limb, hypertrophy of left big toe and basilar artery tip aneurysm, complicated with acute submassive pulmonary thromboembolism treated successfully with intravenous thrombolytic therapy.
Aneurysm ; Basilar Artery ; Extremities ; Female ; Heart Failure ; Hemangioma ; Humans ; Hypertrophy ; Intracranial Aneurysm ; Klippel-Trenaunay-Weber Syndrome* ; Korea ; Lower Extremity ; Mesoderm ; Middle Aged ; Pulmonary Embolism* ; Thrombolytic Therapy* ; Toes ; Varicose Veins ; Venous Thromboembolism ; Venous Thrombosis

BACKGROUND: It is a trend that the average life span is prolonged in proportion to the advance of socio-economy and medical science. Consequently, the number of elderly patients with skin diseases is increasing. OBJECTIVE: This study was performed to see the change of patterns of skin diseases in elderly patients. METHODS: One thousand four hundred and twenty elderly patients, over the age of 65, who visited the departments of dermatology and in five hospitals, from January 1, 1997 to December 31, 1997 were selected. We surveyed the frequeney of skin disease by types and the distributions by month, season and age.
Aged* ; Dermatology ; Epidemiologic Studies ; Humans ; Seasons ; Skin Diseases* ; Skin*

The cerebral aneurysm 'clip scissoring' phenomenon resulting from clip blade twisting is an unpredictable surgical complication. Additionally, incomplete clipping resulting from the presence of an atherosclerotic wall in the neck of the aneurysm can also cause unforeseen problems. Here, the authors present an unusual case of incomplete clipping of a large, atheromatous aneurysm resulting from clip scissoring, which was treated with additional endovascular coiling.
Aneurysm* ; Intracranial Aneurysm ; Neck ; Plaque, Atherosclerotic ; Surgical Instruments ; Treatment Failure

BACKGROUND: Vitiligo is an acquired depigmentary disorder of the skin and hair. The etiology is unknown, however an autoimmune hypothesis is favored. OBJECTIVE: We performed this study to develop a better understanding of the clinical features of vitiligo patients. METHOD: We evaluated clinical manifestations of 1203 vitiligo patients(556 males and 647 females). RESULTS AND CONCLUSIONS: 1. The mean age of onset and that of the first visits made by patients were 22.9+/-18 and 27.9+/-19 years, respectively. 2. The face(37.4%) was the most common site of initial involvement. In decreasing order of frequency, the common sites of involvement were the face and neck(65.9%), thorax and abdomen(42.9%), upper extremities(42.3%). 44.5% of the cases had the vulgaris type, 26.1% the focal type, and 21.1% the segmental type. During the three months before a visit, 44% of patients experienced progression of disease. Within one year, about 75% of patients reported that the disease had progressed. 3. Precipitating or aggravating factors such as trauma(13.1%), psychological stress(9.2%), sun light (2.8%) and pregnancy(2.5%), were found in 30.9% of patients. Thyroid disease was the most common associated disease.
Age of Onset ; Hair ; Humans ; Male ; Skin ; Solar System ; Thorax ; Thyroid Diseases ; Vitiligo*

Takotsubo cardiomyopathy (TC) is a transient form of acute heart failure that most often occurs in postmenopausal women, typically triggered by a preceding emotional or physical stressor. A 74-year-old woman who suffered from chronic psychiatric stress visited National Medical Center for dyspnea. Acute emotional or physical stress could not be identified despite careful history taking. An electrocardiogram showed diffuse T-wave inversions with prolonged QT interval, and the echocardiogram showed akinesia of mid and apical segments of the left ventricle with hyperkinesia at the base. There was no significant stenosis on coronary angiography. Differing from the typical case of TC, which follows acute stress triggers, our case indicates that underlying chronic psychiatric illness exacerbation can lead to TC. We suggest that cardiologists and psychiatrists be aware of this predisposition to TC, especially in the circumstances of acute heart failure.
Aged* ; Cardiomyopathies ; Constriction, Pathologic ; Coronary Angiography ; Depressive Disorder, Major* ; Dyspnea ; Electrocardiography ; Female ; Heart Failure ; Heart Ventricles ; Humans ; Hyperkinesis ; Psychiatry ; Takotsubo Cardiomyopathy*

PURPOSE: Characteristic signs – the susceptibility vessel sign (SVS) and the prominent hypointense vessel sign (PHVS) – on T2*-based magnetic resonance imaging (T2*MRI) can be seen for acute ischemic stroke with large artery occlusion. In this study, we investigated the evidence to support our hypothesis that these findings may help to predict outcomes after reperfusion therapy. MATERIALS AND METHODS: We searched for papers describing SVS and PHVS in patients treated with reperfusion therapy for acute ischemic stroke, and their functional/radiologic outcomes were systematically reviewed. RESULTS: Nine studies on the SVS and six studies on the PHVS were included. The pooled odds ratio (OR) of recanalization after intravenous thrombolysis or mechanical thrombectomy was not significantly different with the presence of SVS (OR, 0.615; 95% confidence interval [CI], 0.335–1.131 and OR, 0.993; 95% CI, 0.629–1.567). The OR of favorable functional outcome after reperfusion therapy in terms of the presence of PHVS varied (0.083 to 1.831) by study. CONCLUSION: Our meta-analysis of the published data showed that a SVS was not a predictive factor for recanalization after reperfusion therapy for acute ischemic stroke. Currently, the data available on T2*MRI are too limited to warrant reperfusion therapy in routine practice. More data are needed from studies with randomized treatment allocation to determine the role of T2*MRI.
Arteries ; Humans ; Magnetic Resonance Imaging ; Odds Ratio ; Reperfusion* ; Stroke* ; Thrombectomy

BACKGROUND AND AIMS: The frequency of different etiologies of lower gastrointestinal bleeding varies by a number of factors including patient age, the severity of bleeding evaluated, the diagnostic method, and the institution. There were few reports on the clinical analysis of lower gastrointestinal bleeding in Korea. Therefore, this study was conducted to evaluate the frequency of various etiologies, diagnostic methods, and the management of patients with lower gastrointestinal bleeding. METHODS: 474 patients with lower gastrointestinal bleeding who were admitted to Samsung Medical Center from September 1994 to April 1998 were reviewed. The inclusion criteria were as follows: 1) age at least 15 years, and 2) patients whose bleeding was attributed to a lesion distal to the ligament of Treitz. The age and sex distribution, etiology, diagnostic methods, treatment, and transfusion were checked. RESULTS: 474 patients (261 males and 213 females) met the inclusion criteria. The average age of the patients was 51 years old. The etiologies of bleeding were as follows: colorectal cancer, 43%; anorectal disease, 32%; inflammatory bowel disease, 6.6%; ischemic colitis, 5%; miscellaneous, 6%; and unknown, 7.4%. Colonoscopy was the most commonly employed diagnostic modality and was used in 245 (52%) patients of the study group. Other tests included sigmoidoscopy in 136 (29%), barium enema in 90 (19%), small bowel radiography in 24, radionuclide bleeding scans in 8, and mesenteric angiography in 7. Patients who improved with conservative and medical treatment were 29%, and 71% required surgery. Patients who required a transfusion were 37%. 139 patients (68.8%) with diagnosed malignant neoplasm received a transfusion. CONCLUSIONS: The incidence of lower gastrointestinal bleeding was high in old age. Colorectal cancer was the most common cause and required surgery. Colonoscopy was a valuable diagnostic tool for the evaluation of lower gastrointestinal bleeding.
Angiography ; Barium ; Colitis, Ischemic ; Colonoscopy ; Colorectal Neoplasms ; Enema ; Hemorrhage* ; Humans ; Incidence ; Inflammatory Bowel Diseases ; Korea ; Ligaments ; Male ; Middle Aged ; Radiography ; Sex Distribution ; Sigmoidoscopy