A 35-year-old woman, previously treated for systemic metastases from retroperitoneal yolk sac tumor, presented with progressive painful paraparesis. Preoperative images showed severe cord compression by the metastatic infiltration of the lumbar vertebrae and epidural mass as well as a huge retroperitoneal mass. While performing unremarkable surgery in prone position, the patient abruptly fell into hypoxic insults and circulatory arrest. Intraoperative pulmonary tumor embolism was deemed a cause of death. When planning operative procedure for this dangerous malignancy, scrupulous manipulation is mandated and the possibility of fatal pulmonary tumor embolism should also be addressed and fully discussed preoperatively.
Adult* ; Cause of Death ; Endodermal Sinus Tumor* ; Female ; Humans ; Lumbar Vertebrae ; Neoplasm Metastasis ; Neoplastic Cells, Circulating* ; Paraparesis ; Prone Position ; Spinal Cord Compression* ; Spinal Cord* ; Surgical Procedures, Operative ; Yolk Sac*

OBJECTIVE: Prognostic factors of metastatic brain tumors have been widely reported and their operative indications also have been extended gradually even to the poor grade patients. Authors intended to analyze the causative factors for the clinical outcome of metastatic brain tumors, especially with relevant to the poor prognosis by one year follow-up evaluation. PATIENTS AND METHODS: The authors retrospectively studied the clinical characteristics of 46 cases(35 patients) with metastatic brain tumors among 466 cases(437 patients) which were operated on due to the brain tumor, during the period between January 1994 to June 1999. Statistical analysis was performed by using SPSS 8.0(r). A p-value of less than 0.05 was considered clinically significant. RESULT: Among the variable clinical factors in patients with metastatic brain tumors, Karnofsky Performance Scale (KPS) score of less than 70(16 patients), uncontrolled primary tumor(8 patients), and surgical resection without further adjuvant therapy(9 patients) showed statistically significant poor prognosis; p value of 0.002, 0.032, and 0.001, respectively. Other tested variables, such as old age(greater than 65 years; 10 patients), gender(male; 20 patients), type of primary cancer(primary undefined; 6 patients, lung cancer; 15 patients), location(infratentorial; 9 patients, sellar; 5 patients), number of lesion(multiple; 12 patients), and number of operation(multiple craniotomy; 7 patients) were not related to the poor prognosis. CONCLUSIONS: The most common primary site of distant metastasis was lung. The poorer prognosis was highly correlated with various factors including low KPS score(<70), no postoperative adjuvant therapy, and uncontrolled primary tumors.
Brain Neoplasms* ; Brain* ; Craniotomy ; Follow-Up Studies* ; Humans ; Lung ; Lung Neoplasms ; Neoplasm Metastasis ; Prognosis* ; Retrospective Studies

Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by sudden-onset headache with focal neurologic deficit and prolonged but reversible multifocal narrowing of the distal cerebral arteries. Stroke, either hemorrhagic or ischemic, is a relatively frequent presentation in RCVS, but progressive manifestations of subarachnoid hemorrhage, intracerebral hemorrhage, cerebral infarction in a patient is seldom described. We report a rare case of a 56-year-old woman with reversible cerebral vasoconstriction syndrome consecutively presenting as cortical subarachnoid hemorrhage, intracerebral hemorrhage, and cerebral infarction. When she complained of severe headache with subtle cortical subarachnoid hemorrhage, her angiography was non-specific. But, computed tomographic angiography showed typical angiographic features of this syndrome after four days. Day 12, she suffered mental deterioration and hemiplegia due to contralateral intracerebral hematoma, and she was surgically treated. For recurrent attacks of headache, medical management with calcium channel blockers has been instituted. Normalized angiographic features were documented after 8 weeks. Reversible cerebral vasoconstriction syndrome should be considered as differential diagnosis of non-aneurysmal subarachnoid hemorrhage, and repeated angiography is recommended for the diagnosis of this under-recognized syndrome.
Angiography ; Calcium Channel Blockers ; Cerebral Arteries ; Cerebral Hemorrhage* ; Cerebral Infarction* ; Diagnosis ; Diagnosis, Differential ; Female ; Headache ; Hematoma ; Hemiplegia ; Humans ; Middle Aged ; Neurologic Manifestations ; Stroke ; Subarachnoid Hemorrhage* ; Vasoconstriction*

Post-clipping intraparenchymal hemorrhage of the contralateral hemisphere is a very unusual phenomenon in a patient with aneurysmal subarachnoid hemorrhage, unless there is an underlying condition. We report a complicated case of 47-year-old man, who underwent uneventful clipping of ruptured aneurysm and experienced vasospasm two weeks later. Vasospasm was treated by intra-arterial nimodipine and systemic hyperdynamic therapy. One week thereafter, he became unconscious due to intraparenchymal hemorrhage on the anterior border-zone of contalateral hemisphere, but intraoperative and pathologic findings failed to disclose any vascular anomaly. We suggest that the anti-spastic regimens cause local hemodynamic redistribution through the vasodilatory effect and in turn, resulted in such an unexpected bleeding.
Aneurysm ; Aneurysm, Ruptured ; Hemodynamics ; Hemorrhage ; Humans ; Intracranial Aneurysm ; Middle Aged ; Nimodipine ; Subarachnoid Hemorrhage ; Unconscious (Psychology)

OBJECTIVE: In recent years, the neurosurgeon's role in managing cerebrovascular diseases (CVD) has becomes rapidly challenged and overlapped with other specialists. Furthermore, the patterns of CVD and patient recruitment have also changed. We conducted a retrospective study regarding the practical trends of CVD with reference to the management paradigms at our institute. METHOD: We reviewed all the available data, including the annual reports, the daily department records, the medical records and the radiographic films of the CVD patients who had been admitted to our Neurosurgery Department during the five years between Jan. 2004 and Dec. 2008. RESULTS: The total numbers of CVD operations showed a slight initial increase, but then they remained steady for the latter 3 years. The number of cases of non-angiomatous hemorrhage has been relatively steady, regardless of surgery. The total numbers of treated aneurysms increased, but the main body of this increment was attributed to the initiation of endovascular treatment and increased identification of unruptured vascular lesions. Vascular malformations were sustained with a small number of cases due to referring them to other institutes for radiosurgery, except for the cases that required urgent hemorrhagic evacuation. CONCLUSION: Hemorrhagic CVDs tended to decrease either due to increasing identification before rupture or shifting such patients into a large volume hospital. The increasing awareness of ischemic CVD, the early detection of unruptured aneurysms, and the separation of medical responsibilities from neurologists have all pushed neurosurgeons to make treatment plans in a more cooperative fashion, instead of a competitive way. Neurosurgeons should be furnished with several revolutionary surgical options to widen their scope of managing patients with CVD.
Academies and Institutes ; Aneurysm ; Hemorrhage ; Humans ; Infarction ; Intracranial Aneurysm ; Medical Records ; Neurosurgery ; Patient Selection ; Radiosurgery ; Retrospective Studies ; Rupture ; Specialization ; Subarachnoid Hemorrhage ; Vascular Malformations ; X-Ray Film

We report two cases of consecutive 3 level compression fractures in two female previously treated for 1 level osteoporotic compression fracture with kyphoplasty after 1 month and 2 weeks, respectively. First patient showed T12, L1, L2 level compression fractures after kyphoplasty on L3, and second patient showed L2, L4, L5 level fractures after same prcedure on L3. Any other specific pathologic lesions were not seen on bone scan. Bone mineral density (BMD) showed severe osteoporsis of multiple levels. We suggest that patients with severe osteoporosis must be thoroughly informed of this infrequent, albeit troblesome acute new compression fractures adjacent to the previously augmented level occurred following such a short period of kyphoplasty.
Bone Density ; Female ; Fractures, Compression* ; Humans ; Kyphoplasty* ; Osteoporosis

No abstract available.
Arteries* ; Intracranial Aneurysm*

Sildenafil citrate (Viagra(R); Pfeizer US Pharmaceutical Group, New York, NY, USA) is a potent vasodilating agent to treat male erectile dysfunction. Among its adverse effects, hemorrhagic stroke has not been widely reported yet. We present a case of a 33-year-old healthy man who ingested 50 mg sildenafil a half hour before onset of headache, nervousness and speech disturbance. Head computed tomogram of this stuporous man showed huge intracerebral hemorrhage and thick subarachnoid hemorrhage, but angiography failed to disclose any vascular anomalies. Subsequent surgical procedure was followed, and rehabilitation was provided thereafter. Sildenafil seems to act by redistributing arterial blood flow, and concurrent sympathetic hyperactivity, which lead to such hemorrhagic presentation. Extreme caution should be paid on even in a young adult male patient wven without known risk factors.
Adult ; Angiography ; Anxiety ; Cerebral Hemorrhage ; Citric Acid ; Eating ; Erectile Dysfunction ; Head ; Headache ; Hematoma ; Humans ; Male ; New York ; Piperazines ; Purines ; Risk Factors ; Stroke ; Stupor ; Subarachnoid Hemorrhage ; Sulfones ; Young Adult ; Sildenafil Citrate

Microsurgical neck clipping has been believed to be the most reliable treatment for the intracranial aneurysm. However, recurrence or regrowth from so called "completely clipped aneurysm" with catastrophic outcome has been infrequently reported. We describe an unusual case of regrowth of posterior communicating artery aneurysm which was found 13 years after the first successful clipping at the same site. Surgeons should pay attention to the possibility of such a regrowth even though the initial clipping seemed to be perfect. Additional deliberate postoperative angiography might resolve this late consequence.
Aneurysm ; Angiography ; Intracranial Aneurysm* ; Neck ; Recurrence

No abstract available.
Aneurysm*