There are several difficulties in treating aneurysmal subarachnoid hemorrhage(SAH) with chronic renal failure(CRF). First, fluid therapy is not feasible especially in vasospasm. Second, hypertonic solution therapy used to reduce intracranial pressure(ICP) is restricted. Third, hemorrhage2) and disequilibrium syndrome1)2)9) associated hemodialysis can occur. In this article, the authors experienced two cases of aneurysmal SAH with CRF. The first patient was a 57-year old man who suffered from CRF for 8 years. Magnetic resonance angiography had demonstrated a middle cerebral artery(MCA) bifurcation aneurysm on right side. He was treated with early surgery and recovered without neurological deficits. The second patient was a 43-year old woman who suffered from CRF for 5 years. Posterior communicating artery(P-Com) aneurysm was identified on the left side and delayed surgery was performed. After operation, vasospasm occurred and she died of brain swelling from infraction on the left MCA territory. It is noteworthy that the most important factor in aneurysmal SAH with CRF is the prevention vasospasm, because the use of fluid and hypertonic solution therapy is not feasible. To prevent vasospasm, early operation is warranted for the removal of SAH during operation. Non-anticoagulant agent hemodialysis is used during pre and post operative period.
Adult ; Aneurysm* ; Brain Edema ; Female ; Fluid Therapy ; Humans ; Magnetic Resonance Angiography ; Middle Aged ; Renal Dialysis

Intraosseous meningioma of the skull is a rare benign tumor. A case of calvarial origin examined with computed tomography and bone scintigram is reported. The tumor was located in the left fronto-temporo-parietal region, involving the superior orbital fissure. Total removal of the tumor was performed and histological diagnosis of intraosseous meningioma was obtained. Radiological findings and possible histogenetic mechanism of the intraosseous meningioma are discussed.
Diagnosis ; Meningioma* ; Orbit ; Skull

The simultaneous occurrence of one or more intracranial aneurysm and an intracranial arteriovenous malformation(AVM) in a patient is unusual. Four cases of intracranial aneurysm associated with cerebral arteriovenous malformation(AVM) were found in a total of 67 patients with cerebral malformation(AVM). The site of aneurysm was related anatomically to the arterial supplying arteriovenous malformation(AVM) in 3 cases and the bleeding source was aneurismal rupture in all four cases(100%). It is generally accepted that aneurysm is caused by hemodynamic stress result from the presence of an arteriovenous malformation(AVM). The management of the unusual problem is controversial which are surgical obliteration of both vascular lesion in one stage(2 cases) and surgical obliteration of both vascular lesion in two stages(1 case) were accomplinished with good surgical result.
Aneurysm ; Hemodynamics ; Hemorrhage ; Humans ; Intracranial Aneurysm* ; Intracranial Arteriovenous Malformations* ; Rupture

The authors have experienced 62 cases of chronic subdural hematoma from Jan. 1987 to May 1992 at National Medical Center. In these cases, 58 cases of chronic subdural hematoma were treated with burr hole and closed draninage, 4 cases were managed with conservative management. Male was predominant to female with the ratio of 6:1 and common age was 50-60 years old. Most common causes was head injury and there was cases of chronic subdural hematoma developed after shunt operation. Common symptom was mental change and headache. Brain expansion was delayed in old age group(over 50 years old), Brain CT was available in diagnosis but brain MRI was useful in diagnosis of scantly chronic subdural hematoma. Surgical outcome was related to preoperative neurologic grade and time interval of diagnosis. In this study, clinical improvement rates was 88% in surgically treated cases.
Brain ; Craniocerebral Trauma ; Diagnosis ; Female ; Headache ; Hematoma, Subdural, Chronic* ; Humans ; Magnetic Resonance Imaging ; Male

Bifucation of the internal carotid artery aneurysms are rare. But they are paticulary difficult to treat surgically because of perforating arteries surrounding and adherent to the aneurysm. In this series, fourteen patients with bifucation of internal carotid artery aneurysms were treated with direct surgery. Tweleve patients of these were treated with clipping, two were treated with coating. 57% of the patients had a good or excellent result and there was a 7% mortality.
Aneurysm* ; Arteries ; Carotid Artery, Internal* ; Humans ; Mortality

Stroke in infant was relatively rare. But recently, development of diagnostic tools and infantile intensive care unit were introduced. So, early detection and follow up study were easily performed and the motality of infant stroke was improved. The pathophysiologic factor was multiple such as structural, development and physiological aspects of brain circulation and cardiorespiratory perinatal accidents, which are the cause of several neuropathology. So, preventable secondary factors such as perinatal asphyxia, respiratory manipulation during daily care should be removed thus, mortality and morbidity were decreased. Therefore, the anthors analysized 16 patient, with storke whom age were younger less than 1 year for searching of preventable secondary factors.
Asphyxia ; Brain ; Follow-Up Studies ; Humans ; Infant ; Infant, Newborn* ; Intensive Care Units ; Mortality ; Stroke

Rupture of an intracranial dissecting aneurysm is a rare but dangerous event and are difficult to diagnosis and manage, and carry a high morbidity and mortality. The angiographic features typically showed fusiform dilatation and proximal and/or distal dilatation of the affected artery. Depending of location of dissection, surgical options are;ligation, trapping, or reenforcement of exposed abnormal portion of vessels. The authors report a case of nontraumatic dissecting aneurysm, stroke with subarachnoid hemorrhage(SAH) and the proximal porton of origin of PICA was treated with dlipping of vertebral artery proximal to dissecting aneurysm.
Aneurysm, Dissecting* ; Arteries ; Diagnosis ; Dilatation ; Mortality ; Pica ; Rupture ; Stroke ; Subarachnoid Hemorrhage ; Vertebral Artery*

Two cases of iatrogenically induced false aneurysm of the superficial temporal artery are presented. One patient showed partially filled aneurysmal sac, 1x1 cm sized, on the main trunk of left superficial temporal artery by external carotid artery angiography. Another patient showed aneurysmal dilatation, 3x2 cm sized, of the superficial temporal artery with direct injection of Urograffin into the pulsatile mass. Aneurysm excision is indicated to reduce the risk of hemorrhage from the subsequent head trauma, to relieve headache, and for any cosmetic defect. The authors have reviewed the literature and discussed the incidence, classification, pathogenesis, clinical and angiographic diagnosis, differential diagnosis, and treatment.
Aneurysm ; Aneurysm, False* ; Angiography ; Carotid Artery, External ; Classification ; Craniocerebral Trauma ; Diagnosis ; Diagnosis, Differential ; Dilatation ; Headache ; Hemorrhage ; Humans ; Incidence ; Temporal Arteries*

Verrucous hyperplasia shows multiple warty like lesion on the amputation stump, but the pathologic findings of viral verrucae has not been discovered. A verrucous plaque on the amputation stump of the right leg was found in 31-year-old man. He had suffered from a traumatic amputation of right leg since 8 years ago. A leg prosthesis had been worn since that time. Histopathologic findings shows hyperkeratosis, acanthosis, papillomatosis, superficial dermal edema and dilated thick-walled venules oriented vertical to the skin surface. Verrucous hyperplasia was diagnosed with lymphedema on the basis of clinical and histological findings.
Adult ; Amputation Stumps* ; Amputation* ; Amputation, Traumatic ; Artificial Limbs ; Edema ; Humans ; Hyperplasia* ; Leg* ; Lymphedema* ; Papilloma ; Skin ; Venules ; Warts

OBJECTIVE: Posttraumatic cerebral infarction (CI) is a well-known complication of traumatic brain injury (TBI). However, the causation and apportionment of trauma in patients with CI after TBI is not easy. There is a scoring method, so-called trauma apportionment score (TAS) for CI, consisted with the age, the interval, and the severity of the TBI. We evaluated the reliability of this score. METHODS: We selected two typical cases of traumatic CI. We also selected consecutive 50 patients due to spontaneous CI. We calculated TAS in both patients with traumatic and spontaneous CI. To enhance the reliability, we revised TAS (rTAS) adding three more items, such as systemic illness, bad health habits, and doctor's opinion. We also calculated rTAS in the same patients. RESULTS: Even in 50 patients with spontaneous CI, the TAS was 4 in 44 patients, and 5 in 6 patients. TAS could not assess the apportionment of trauma efficiently. We recalculated the rTAS in the same patients. The rTAS was not more than 11 in more than 70% of the spontaneous CI. Compared to TAS, rTAS definitely enhanced the discriminating ability. However, there were still significant overlapping areas. CONCLUSION: TAS alone is insufficient to differentiate the cause or apportionment of trauma in some obscure cases of CI. Although the rTAS may enhance the reliability, it also should be used with cautions.
Brain Injuries ; Cerebral Infarction* ; Compensation and Redress ; Craniocerebral Trauma ; Humans ; Research Design