Encapsulated and free pus in the substance of the brain tissue following an acute purulent infection is known as brain abscess, and which is uncommon. The brain abscess arise either as direct extention from infections within the cranial cavity or as hematogenous metastasis from infections elsewhere in the body. Since 1945, the antibiotics associated use of steroid and mannitol have been available for the treatment of brain abscess, and the result are very hopeful. The common method of surgical treatment are consist of excision and drainage and the problem of the best operative procedure has been disputed on the many neurosurgical literatures for many years. Recently we had treated 2 cases of severe otogenic brain abscesses with semicomatose patient by drainage, and good was the result compared with the other literatures. Result; 1. One case with semicoma recovered completely without any neurologic sequelae, and the other case recovered with visual disturbance. 2. The best operative procedure for the severe brain abscess considered a drainage.
Anti-Bacterial Agents ; Brain Abscess ; Brain* ; Drainage* ; Hope ; Humans ; Mannitol ; Neoplasm Metastasis ; Suppuration ; Surgical Procedures, Operative

Nerve-root anomalies are very uncommon, and there symptoms and signs are nearly similar with those of disc herniation. So we can misdiagnois them for intervertebral disc herniation. The negative Lasegue' sign is the only distinct feature of the nerve root anomalies. The authors report a case of Nerve-Root Anomaly associated with disc herniation in lumbar 4-5 interspace, which was diagnosed preoperatively in myelogram and confirmed surgically.
Intervertebral Disc*

We have experienced a case of cerebellar hemangioblastoma associated with polycythemia in 44-year old male adult who has suffered from the headache, chocked disc and visual disturbance for about 1 year and 4 months. A marked polycythemia was found but retinal angioma, cysts on the pancreas and kidney and then familial incidence were not detected. The signs of increased intracranial pressure was marked, accompanying the decreased visual acuity. Liver and spleen were not palpable. On bilateral carotid angiogram, it revealed a severe hydrocephalus, on Conray ventriculogram, obstruction of 4th ventricle by huge mass in the posterior fossa. The right vertebral angiography revealed a midline hen egg sized tumor mass which was highly vascular and was supplied mainly by PICA, SCA and PCA brances. Brain C-T scan showed the vascular mass in midline of posterior fossa by enhancement. We operated the cerebellar tumor which was solid. The uncontrollable bleeding was encountered. We performed the biopsy which revealed a hemangioblastoma. Inspite of the V-A shunt, the patient expired suddenly on 5th post-operative day.
Adult ; Angiography ; Biopsy ; Brain ; Cerebellar Neoplasms ; Headache ; Hemangioblastoma* ; Hemangioma ; Hemorrhage ; Humans ; Hydrocephalus ; Incidence ; Intracranial Pressure ; Kidney ; Liver ; Male ; Ovum ; Pancreas ; Passive Cutaneous Anaphylaxis ; Pica ; Polycythemia* ; Retinaldehyde ; Spleen ; Visual Acuity

Despite of their frequent occurrence among the brain tumor, meningiomas are rarely seen as a multiple growth, and the incidence of multiplicity in meningioma is about 2%, except for 6.7% in Horrax' series. The authors report a case of multiple meningiomas without evidence of von Recklinghausen's disease. The patient had suffered from the headache, chocked disc and right hemiplegia for about two years which had been aggravated in these two weeks before admission. Left carotid angiogram revealed as a parasagittal giant meningioma. On operation, we did not remove single giant meningioma, but six lumps of mass variably sized from walnut to hen egg, with success. The postoperative course was uneventful and the recovery from hemiplegia was dramatic.
Brain Neoplasms ; Headache ; Hemiplegia ; Humans ; Incidence ; Juglans ; Meningioma* ; Neurofibromatosis 1 ; Ovum

Cerebral paragonimiasis, occuring as an extrapulmonary infestation, still reamans an important intracranial parasitic disease in Korea. The authors report a 32-year-old female patient who had developed headache, vomiting and signs of the left hemispheric dysfunction for 5 months. A diagnosis of the cerebral paragonimiasis was made on the basis of brain CT findings, a positive intradermal test, and the positive results of serum and CSF levels of the anti-Paragonimus IgG antibodies(by micro-ELISA). She was treated with 75 mg/kg/day of praziquantel for 7days to confirm healing of the intracranial lesion by the follow-up brain CT and micro-ELISA associated with a marked clinical improvement. This case report highly suggests the anticipated effectiveness of praziquantel in the treatment of the cerebral infestation of Paragonimus westermani, especially in its early stage.
Adult ; Brain ; Diagnosis ; Female ; Follow-Up Studies ; Headache ; Humans ; Immunoglobulin G ; Intradermal Tests ; Korea ; Paragonimiasis* ; Paragonimus westermani ; Parasitic Diseases ; Praziquantel* ; Vomiting

Many different myelographic contrast media have been employed for the radiographic visualization of the spinal cord. Unfortunately, none has fulfilled all the requirements of an ideal contrast medium-no toxicity, complete and rapid absorption, good radiographic contrast, and miscibility with the cerebrospinal fluid. Toxic reactions have been reported from the water soluble contrast media, which require the administration of a spinal anesthesia and have thus been employed clinically only in examination of the lumbosacral area. Some authors have advocated the use of new contrast media, Conray(Meglumine iothalamate), Dimer-X, for the lumbar myelography without a spinal anesthesia and obtained good results. The present work is an attempt to provoke and emphasize the toxicologic response and the pathologic changes by variation in amount of Conray and rate of injection. Each dog was prepared with a catheter in lumbar subarachnoid space under the light anest hesia. After recovery from the anesthesia, myelography was performed by lumbar subarachnoid injection of Conray by variations in amount of Conray and rate of injection under the control of a fluoroscope. The experimental conditions were varied as follows. 1. Conray was injected in variable amounts from the lumbosacral subarachnoid space to the high cervical and intracranial subarachnoid space. 2. Conray was injected in variable rate of injection. 3. Decadron was added to Conray in another group. 4. The brain and the spinal cord including the dura and the nerve roots were taken for the pathologic study in variable durations after myelography. The results were summarized as follows. 1. A large amount of Conray injection to the high cervical and intracranial subarachnoid space produced wevere toxic reactions followed by death. 2. Rapid injection of Conray was considered to elicit more toxic reactions. 3. The toxic reactions included changes in behavior and respiration, neck muscle spasms, paresis of forelegs and hindlegs, urination, defecation and epileptiform convulsions. 4. There was no difference in toxic reactions in adding Decardon. 5. Radiographic contrast densities were somewhat less than that of Pantopaque. Conray was freely miscible with the cerebrospinal fluid, thus providing total myeloraphy. 6. No recognizable reaction was noted in gross and histopathological examination.
Absorption ; Anesthesia ; Anesthesia, Spinal ; Animals ; Brain ; Catheters ; Cerebrospinal Fluid ; Contrast Media ; Defecation ; Dogs ; Iophendylate ; Myelography* ; Neck Muscles ; Paresis ; Respiration ; Seizures ; Spasm ; Spinal Cord ; Subarachnoid Space ; Urination

The purpose of this report is to present the results of clinical observation upon 21 surgical cases with tic douloureux (female 13, male 8) during the period from January, 1960 to August, 1972 at the Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea. The average age at onset was 48 years of age ranging from 22 to 66 years. The average duration from onset to operation was 5 years. The frequency of involvement was the highest in the maxillary division, next was maxillary and mandibular division, and none in the ophthalmic division. Whole division was involved in one case. Right-sided involvement predominated by a ratio of 2 to 1 and bilateral involvement was found in only one case. Extraction of innocent teeth, ungratifying operation upon paranasal sinus had been carried out in 11 cases as consequence of misdiagnosis. Alcohol injection of peripheral branches of trigeminal nerve and medical treatment produced short-lived or none-effectiveness. Trauma to ipsilateral mandible and epidermoid cyst at cerebellopontine angle seemed to be the cause of tic doulourex in 2 cases, respectively. Major complications observed in Frazier's method group, were paresthesia, facial nerve palsy, partial paralysis of motor root, and recurrence of neuralgia. All of the peripheral nerve avulsion group developed recurrence of pin within three years. Mild decrease of cornea reflex was noted in two cases of Dandy's method group. Posterior fossa operation stands in superiority, when it is considered that some pathologic lesions are frequently found in the posterior fossa, that motor root is less frequently injured, and that the light touch is so fairly preserved in all three divisions that the least damage to the cornea is expected.
Cerebellopontine Angle ; Cornea ; Diagnostic Errors ; Epidermal Cyst ; Facial Nerve ; Humans ; Korea ; Male ; Mandible ; Neuralgia ; Neurosurgery ; Paralysis ; Paresthesia ; Peripheral Nerves ; Recurrence ; Reflex ; Seoul ; Tics ; Tooth ; Trigeminal Nerve ; Trigeminal Neuralgia

The purpose of this report is to present the results of clinical observations on the surgical treatment of 26 patients (16 male, 10 female) with intractable pain during the period from May, 1960 to April, 1972 at the Department of Neurosurgery, Seoul National University Hospital. Age at the time of operation raged from 27 to 69 years. Duration of the pain from the onset to surgery was less than one year in most of the cases. The most common causes of the pain were the pelvic malignancies, lung cancer, and metastatic spine tumors in the order. In 20 cases of anterolateral cordotomies, the main complications were urinary retention, ipsilateral motor weakness, and decubitus. The high cervical cordotomy produced high analgesic level and less dropping of established analgesic level postoperatively. Posterior rhizotomy for intercostal neuralgia and a case of thoracic commissurotomy for intramedullary tumor were of gratifying result. The higher the pain located, the longer the pain existed, the operation was less likely to relieve the pain. High cervical cordotomy seems to be superior to high thoracic cordotomy even in the pain of leg, when it is considered in the respect of the high analgesic level, the lack of "island" of pain, and technical easiness.
Cordotomy ; Humans ; Leg ; Lung Neoplasms ; Male ; Neuralgia ; Neurosurgery ; Pain, Intractable* ; Rage ; Rhizotomy ; Seoul ; Spine ; Urinary Retention

The hepatopulmonary syndrome is defined as the triad of liver disease, an increased alveolar-arterial gradient while breathing room air, and evidence of intrapulmonary dilatation. Other cardiopulmonary abnormalities(such as pleural effusion or decreased lung volumes) are common and may coexist in patients with the hepatopulmonary syndrome. An abnormal dilatation of intrapulmonary capillaries is evidenced by Tc 99m-MAA perfusion scan, contrast-enhanced echocardiography, and pulmonary angiography. We have experienced a case of hepatopulmonary syndrome in a fi7 year old woman with liver cirrhosis who complained of severe dyspnea and cyanosis. Her arterial blood gas analysis (ABGA) showed severe hypoxemia(PaO2 59mmHg), suggesting the hepatopulmonary syndrome, which was confirmed with the contrast-enhanced echocardiography. It showed delayc4 opacification of left side chambers during agitated saline injection', thus, intrapulmonary shunt was confirmed. So we report a case of hepatopulmonary syndrome with a rewiew of literature.
Angiography ; Blood Gas Analysis ; Capillaries ; Cyanosis ; Dihydroergotamine ; Dilatation ; Dyspnea ; Echocardiography ; Female ; Hepatopulmonary Syndrome* ; Humans ; Liver Cirrhosis* ; Liver Diseases ; Liver* ; Lung ; Perfusion ; Pleural Effusion ; Respiration

PURPOSE: Conventional contrast dacryocystography(C-DCG) has been used mainly for anatomical assessment of the lacrimal drainage apparatus, due to its limited information on the dynamics of the lacrimal system, and thus correlation role in epiphora. The purpose of study was to improve the diagnostic value in epiphora by utilizing RI dacryocystography(RI-DCG) with quantitative criteria. MATERIALS AND METHODS: The patient for RI dacryocystography set erect with the head fixed in front of gamma camera fitted with a standard 6 mm pinhole collimater. Both eyes of 85 patients(170 eyes) were scanned with 99rnTc-pertechnetate followed by conventional dacryocystography. The data from gamma camera were recorded simultaneously on a computer system for subsequent quantitative analysis. RESULTS: In 94 of 96 eyes without epiphora, RI-DCG was correlated with normal C-DCG and % of emptying was at least over 50%. In 58 of 74 eyes with epiphora, RI-DCG was correlated with abnormal C-DCG and % of emptying was at most below 50%. In 16 eyes with functional block, quantitative RI-DCG showed abnormal % of emptying. CONCLUSION: Nuclear DCG with quantitation had higher diagnostic yield in functional block and correlated higher with epiphora. Thus nuclear DCG with quantitation would be a valuable functional test after postprocedures such as dacryocystoplasty.
Computer Systems ; Drainage ; Gamma Cameras ; Head ; Humans ; Lacrimal Apparatus Diseases* ; Radionuclide Imaging*