PURPOSE: We investigated the causes and mechanisms driving acute border zone infarctions using diffusion-weighted imaging (DWI). MATERIALS AND METHODS: We analyzed DWI in 104 patients (male: 72 years, female: 32 years, age range: 44 to 84 years) with acute border zone infarction. The DWI patterns were classified as follows: pattern A- An acute border zone infarction combined with multiple small disseminated cortical infarctions, pattern B- An acute border zone infarction only. RESULTS: The most common cause of acute border zone infarctions was extracranial internal carotid artery (ICA) stenosis (45 cases, 43%). Other causes included middle cerebral artery stenosis (22 cases, 21%), intracranial ICA stenosis (14 cases, 13%), unknown, (12 cases 12%), iatrogenic (6 cases, 6%) and cardiogenic (5 cases, 5%), respectively. The most common pattern for DWI was pattern A (83 cases, 80%). We performed a transcranial Doppler in 7 of 75 cases (11%), and found at least 1 embolic pulse. CONCLUSION: The most common pattern of DWI for acute border zone infarctions was pattern A. We propose that the mechanisms driving acute border zone infarctions are emboli coupled with hypoperfusion.
Brain Infarction ; Carotid Artery, Internal ; Cerebral Infarction ; Constriction, Pathologic ; Diffusion ; Diffusion Magnetic Resonance Imaging ; Humans ; Infarction ; Middle Cerebral Artery

A 46 year-old male with drowsy mentality and left hemiparesis had been treated. Right carotid angiogram showed a mass effect on the posterior temporal region. Preoperative CT brain scan revealed two separated hypodense masses with ring enhancement on the each hemisphere. The right-sided mass was totally removed and there was no invasion into the ventricle and meninges. The histological diagnosis was a glioblastoma multiforme. The left-sided mass was followed with the repeated CT scan, which showed the similar CT findings of a glioblastoma multiforme, and there was no evidence of commiccural extension. The above findings were consistent with the criteria of multicentric tumor.
Brain ; Diagnosis ; Glioblastoma* ; Humans ; Male ; Meninges ; Middle Aged ; Paresis ; Tomography, X-Ray Computed

We present a series of 10 Patients(Seven men and three women with an average age of 53 years) who underwent decompressive craniectomy for treatment to massive brain swelling following acute cerebral infarction. Clinical signs of cerebral herniation(anisocoria or fixed and dilated pupil, and/or hemiplegia with decerebrate righidity) were present in all patients. Computed tomography and magnetic resonance imaging showed the mass effect by cerebral edema through midline shift. All patients were treated with an extensive craniectomy and duroplasty. Among them, one recovered without neurological deficit, three were moderately disabled but functionally dependent, three remained in a persistent vegetative state and three died within 9 days after surgery(good recovery=1, moderate disability=3, persistent vegetative state=3, death=3). The results suggest that decompressive craniectomy can be an useful lifesaving procedure for massive cerebral edema following widespread hemispheric infarction.
Brain Edema ; Cerebral Infarction* ; Decompressive Craniectomy* ; Female ; Hemiplegia ; Humans ; Infarction ; Magnetic Resonance Imaging ; Male ; Persistent Vegetative State ; Prognosis ; Pupil

OBJECTIVE: Using the standardization of disease diagnosis of disease, and surgical procedures, the authors have made a clinical application for the analysis of inpatient data with the ability to search for information pertinent for writing of clinical articles. METHODS: A client-server system and database software was developed for networking. For clinical application, a computerized daily report has been developed. Data from Neurosurgical patients admitted at Soonchunyang University Hospital from January to December 1998 were analyzed with this system. Data for clinical articles was obtained using the search mode, information such as orbital infarction syndrome following intracranial aneurysm surgery and epidemiological analysis or geriatric neurosurgical patients. RESULTS: For the daily report it takes approximately 10 minutes to input the patients demographic information, name of disease, diagnosis and surgical procedure. The daily report also numbers and sorts the inpatients according to large categories of diagnosis, reports the ratio between inpatients and operative patients. The annual report that was obtained was very accurate and gave rapid statistics for the one year. By retrospective study for the past 18 years, we calculated the incidence of orbital infarction syndrome following intracranial aneurysm surgery as 1.4%, and also estimated the population of geriatric inpatients as 18.3% by retrospective study. CONCLUSIONS: It has been found to be most useful to make a daily and annual report for tracking and research purposes. For use in clinical articles, it can be possible to do a search of the patients using the standardized disease, diagnosis and neurosurgical procedures application and obtain pertinent information in a timely manner.
Diagnosis ; Epidemiology* ; Humans ; Incidence ; Infarction ; Inpatients ; Intracranial Aneurysm ; Neurosurgical Procedures* ; Orbit ; Retrospective Studies ; Writing

OBJECTIVE: The the international classification of disease and surgical procedure has been found to be a lengthy and time-consuming text for use by neurosurgeons. A more subject matter related classification system is needed for use by this specialty. The author has developed a more comprehensive and standardized classification system specified for diagnosis of neurological disease and neurosurgical procedures. METHODS: Standardization of disease was completed by modifying the name of disease according to that which was used for daily report past 10 years, and from textbook of neurosurgery. The fields of international coding are continued in each. Neurosurgical procedures were designated and modified according to Current Procedure Terminology 96. Client-server system will be used for networking and database software applications have been developed. RESULTS: Disease was classified in 14 large categories and 379 subcategories. Diagnosis was classified in 12 large categories and 43 subcategories. Neurosurgical procedure has 20 large and 202 subcategories. The international coding system such as ICD-10 and ICD-9CM is maintained for the diagnosis and procedures to each category. CONCLUSIONS: It could be possible to make and use a standardized database model of disease, diagnosis and neurosurgical procedures to be used by physician.
Classification ; Clinical Coding ; Diagnosis ; Epidemiology* ; International Classification of Diseases ; Neurosurgery ; Neurosurgical Procedures*

A 57 year-old female with severe right facial pain and ptosis, and diplopia had been treated. Neurologic signs showed marked loss of vision, total ophthalmoplegia of the right eye and paresthesia on the 1st division of the right trigeminal nerve. Simple skull X-ray revealed enlarged sella turcica, thining of dorsum sellae, excavation and sharpening of anterior clinoid process with depressed sella floow on the right side. Right carotid angiogram showed a giant aneurysm in the cavernous portion of the internal carotid artery with parital filling of the contrast dye along proximal portion of the internal carotid artery and considerable collateral circulation through the external carotid-ophthalmic artery route. The aneurysm was managed by the internal carotid ligation initially, and 20 days later, followed by thrombectomy and aneurysmorrhaphy successfully. Two months later of the operation, all neurological deficits were completely recovered.
Aneurysm* ; Arteries ; Carotid Artery, Internal ; Collateral Circulation ; Diplopia ; Facial Pain ; Female ; Humans ; Ligation ; Middle Aged ; Neurologic Manifestations ; Ophthalmoplegia ; Paresthesia ; Sella Turcica ; Skull ; Thrombectomy ; Trigeminal Nerve

A 48 year-old male with back pain and foot drop had been treated. Studies for myelomatosis were all negative. A plain lumbar spin X-ray showed an erosion of the left pedicle of the first lumbar vertebra. A myelography via lumbar and cisternal routes revealed total block with feather appearance at the upper level of the L2 and the lower level of the T12 vertebra. Pathologic evaluation confirmed the diagnosis of solitary myeloma of the bone. After undergoing almost total excision, followed by radiation, the patient was still doing well.
Animals ; Back Pain ; Diagnosis ; Feathers ; Foot ; Humans ; Male ; Middle Aged ; Multiple Myeloma ; Myelography ; Spine*

A 78-year-old woman presented with weakness of the extremities, dysarthria, dizziness, and sensory impairment. Magnetic resonance imaging showed acute bilateral medial medullary infarction. Contrast enhanced magnetic resonance angiography demonstrated stenosis or occlusion of both intracranial vertebral arteries. We present a rare case of bilateral medullary infarction seen on diffusion-weighted imaging.
Aged ; Brain ; Constriction, Pathologic ; Dizziness ; Dysarthria ; Extremities ; Female ; Humans ; Infarction ; Magnetic Resonance Angiography ; Magnetic Resonance Imaging ; Vertebral Artery

Three-dimensional computerized tomography(3DCT) disclosed a valuable tool for the diagnosis of fracture/dislocation involving craniofacial and spinal bony and/or ligamentous structure. We compared the diagnostic accuracy between these non-invasive radiologic diagnostic techniques ; 3DCT, conventional 2DCT and plain X-ray films in patients with traumatic craniofacial or spine fracture. And the other purpose of this study is to define the role of 3DCT in the planning of surgical management. From Jan. 1991 to Jun. 1994, 31 patients with traumatic craniofacial or spine fracture have been studied 3DCT at Soonchunhyang University Hospital. The majority of the patients were male and 3rd decades in ages. 16 cases were operated according to clinical and radiological findings. In 15 cases with craniofacial fracture, 3DCT showed the extent, displacement, angulation, depression and separation of fracture better than plain X-ray or 2DCT. But in one case with frontal basal fracture, 3DCT imaging did not differentiate between skull defect and normal thinning bone. In 16 cases of spine fractures, 3DCT was better diagnostic than 2DCT, paticularlly with subtle lesions. But in 3 cases had bony fragment in spinal canal and one case with pedicle fracture of cervical spine, 2DCT was better accurate than 3DCT. Following conclusions are offered : 3DCT warrants 1) precise, easy looking of direction, extension and shape of fractures, 2) complete perspectives of fracture site in all direction, 3) accurate operative planning with reduced operation time and postoperative complications and 4) amenable to choose instrumentation type and direction of operative approach in spinal surgery. However 3DCT has some disadvantages, 1) It makes difficult to differentiate between normal thin skull basal portion and traumatic skull defect. 2) 3DCT gives an information to only surface cortical bone. 3) It takes additional time and cost for getting complete imaging films.
Depression ; Diagnosis* ; Humans ; Ligaments ; Male ; Postoperative Complications ; Skull ; Spinal Canal ; Spine* ; X-Ray Film

To know recent research works in neurosurgical fields and to analyze neurosurgery related sites on the internet, authors have been searching sites on the web offering the neurosurgical resources. From December 1995 to October 1996 we used a modem(28.8Kbps) and thereafter connected to a LAN(local area network). Under the environment of Windows 95, we used web browsers with Netscape 2.02 and Netterm 2.89. We got an medical information with PC journals or seminars and graded the neurosurgical center/institutes from A to E according to the quality of web sites. We could use the internet resources more rapidly in the early morning than noon or evening. Best sites for neurosurgeon were MedMark(http://www.medmark.bit.co.kr/neurosur.html) and Neurosource (http://www.neurosource.com/). The more comprehensive academic neurosurgical site among all web were the Massachusetts General Hospital(http://neurosurgery.mgh.harvard.edu/) and the University North California (http://sunsite.unc.edu/Neuro/uncns/home.html). In 89 neurosurgical center/institutes, 72 sites(80.9%) couldn't supply sufficient information. In conclusion, there are many webs related to neurosurgery on the internet, but useful sites for neurosurgeon are not common. It is necessary to make an effort to find available sites offering more information in the future.
California ; Internet* ; Massachusetts ; Neurosurgery ; Web Browser