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)

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*

No abstract available.
Arteries* ; Intracranial Aneurysm*

Although endovascular intervention is the first-line treatment of intracranial aneurysm, intraprocedural rupture or extravasation is still an endangering event. We describe two interesting cases of extravasation during embolotherapy for ruptured peripheral cerebral pseudoaneurysms. Two male patients were admitted after development of sudden headache with presentation of intracerebral and subarachnoid hemorrhage, respectively. Initial angiographic assessment failed to uncover any aneurysmal dilatation in both patients. Two weeks afterwards, catheter angiography revealed aneurysms each in the peripheral middle cerebral artery and anterior inferior cerebellar artery. Under a general anesthesia, endovascular embolization was attempted without systemic heparinization. In each case, sudden extravasation was noted around the aneurysm during manual injection of contrast after microcatheter navigation. Immediate computed tomographic scan showed a large amount of contrast collection within the brain, but they tolerated and made an unremarkable recovery thereafter. Intraprocedural extravasation is an endangering event and needs prompt management, however proximal plugging with coil deployment can be sufficient alternative, if one confronts with peripheral pseudoaneurysm. Peculiar angiographic features are deemed attributable to extremely fragile, porous vascular wall of the pseudoaneurysm. Accordingly, it should be noted that extreme caution being needed to handle such a friable vascular lesion.
Anesthesia, General ; Aneurysm ; Aneurysm, False ; Angiography ; Arteries ; Brain ; Catheters ; Dilatation ; Embolization, Therapeutic ; Headache ; Heparin ; Humans ; Intracranial Aneurysm ; Male ; Middle Cerebral Artery ; Rupture ; Subarachnoid Hemorrhage

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

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

We report a case of cervical ossification of the anterior longitudinal ligament(OALL) that contributed to dysphagia with ossification of posterior longitudinal ligament. A 63-year-old man complained of progressive dysphagia for solid foods. Clinical and radiographical findings including barium esophagogram and computed tomography showed OALL in cervical vertebrae from C2 to C7. Magnetic resonance images demonstrated displacement of the trachea and esophagus by OALL. The patient underwent anterior ostectomy from C2 to C7 via anterior cervical approach with excellent relief of dysphagia.
Barium ; Cervical Vertebrae ; Deglutition Disorders* ; Esophagus ; Female ; Humans ; Longitudinal Ligaments* ; Middle Aged ; Ossification of Posterior Longitudinal Ligament ; Trachea

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