No abstract available.
Pancreas*

Brain abscess commonly occurs secondary to an adjacent infection (mostly in the middle ear or paranasal sinuses) or due to hematogenous spread from a distant infection or trauma. Pulmonary arteriovenous fistulas (AVFs) are abnormal direct communications between the pulmonary artery and vein. We present two cases of brain abscess associated with asymptomatic pulmonary AVF. A 65-year-old woman was admitted with a headache and cognitive impairment that aggravated 10 days prior. An magnetic resonance (MR) imaging revealed a brain abscess with severe edema in the right frontal lobe. We performed a craniotomy and abscess removal. Bacteriological culture proved negative. Her chest computed tomography (CT) showed multiple AVFs. Therapeutic embolization of multiple pulmonary AVFs was performed and antibiotics were administered for 8 weeks. A 45-year-old woman presented with a 7-day history of progressive left hemiparesis. She had no remarkable past medical history or family history. On admission, blood examination showed a white blood cell count of 6290 cells/uL and a high sensitive C-reactive protein of 2.62 mg/L. CT and MR imaging with MR spectroscopy revealed an enhancing lesion involving the right motor and sensory cortex with marked perilesional edema that suggested a brain abscess. A chest CT revealed a pulmonary AVF in the right upper lung. The pulmonary AVF was obliterated with embolization. There needs to consider pulmonary AVF as an etiology of cerebral abscess when routine investigations fail to detect a source.
Abscess ; Aged ; Anti-Bacterial Agents ; Arteriovenous Fistula* ; Arteriovenous Malformations ; Brain Abscess* ; Brain* ; C-Reactive Protein ; Cognition Disorders ; Craniotomy ; Ear, Middle ; Edema ; Embolization, Therapeutic ; Female ; Frontal Lobe ; Headache ; Humans ; Leukocyte Count ; Lung ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Middle Aged ; Paresis ; Pulmonary Artery ; Thorax ; Tomography, X-Ray Computed ; Veins

Clear cell ependymomas (CCEs) are rare variants of ependymomas. Tumors show anaplastic histological features and behave as an aggressive manner. CCEs have a predilection for extraneural metastases and early recurrence, and they demonstrate characteristic radiographic features. These tumors should be radiologically and pathologically differentiated from oligodendrogliomas. On microscopic examination, CCEs are composed of sheets of cells and resemble oligodendroglioma. However, upon closer examination, the nature of CCEs can be detected earlier, resulting in prompt treatment of the tumor. Although we report only one case, we emphasize the importance of early diagnosis and treatment. Future description of more cases of these rare cancers is necessary to aid in their diagnosis and treatment.
Diagnosis ; Early Diagnosis ; Ependymoma* ; Neoplasm Metastasis ; Oligodendroglioma* ; Prognosis ; Recurrence

Langerhans' cell histiocytosis (LCH) is a rare immunologic disorder characterized by histiocyte proliferation in multiple organ systems. Eosinophilic granuloma, a benign bone lesion, represents a focal form of LCH. We experienced a case of Langerhans' cell histiocytosis in a patient who presented with intracranial epidural hematoma and cyst on the midline of the frontal skull. A 10-year-old boy presented with a rapidly growing large scalp mass on the midline frontal area after mild head trauma. The scalp mass was painless and immobile. Plain skull x-ray showed a punched-out bone lesion. Computed tomography and magnetic resonance imaging showed a non-enhancing osteolytic lesion presenting with an epidural hematoma and cyst on the midline of the frontal skull. The lesion of the skull was completely resected and the patient's recovery was uneventful. The acute presentation of a solitary eosinophilic granuloma of skull with an epidural hematoma has been described in only five cases in the literature and we report the first case of LCH presenting as an intracranial epidural hematoma on frontal area.
Child ; Craniocerebral Trauma ; Eosinophilic Granuloma ; Eosinophils ; Hematoma ; Hematoma, Epidural, Cranial ; Histiocytes ; Histiocytosis ; Humans ; Magnetic Resonance Imaging ; Scalp ; Skull

Osteolipoma is an ossified lipoma with distinct components of fat and bone. We present a case of interhemispheric osteolipoma associated with total agenesis of the corpus callosum. A 20-year-old man complained of severe headache, nausea and vomiting. Brain computed tomography showed a low-density mass in an interhemispheric fissure, with high T1 and T2 magnetic resonance signals compatible with fat. The mass measured 4.9 x 2.9 cm in size and showed peripheral calcifications. There was another small piece of same signal mass within the lateral ventricular choroid plexus. The interhemispheric lesion was removed by an interhemispheric approach. Osteolipoma is rare in interhemispheric region, however, it should be a differential diagnosis of lesions with fat intensity mass and calcifications.
Brain ; Choroid Plexus ; Corpus Callosum ; Diagnosis, Differential ; Headache ; Humans ; Lipoma ; Magnetic Resonance Spectroscopy ; Nausea ; Vomiting ; Young Adult

Arteriovenous malformations (AVM) are generally considered to be cured following angiographically proven complete resection. However, rare instances of AVM recurrence have been reported in both children and adults with negative findings on postoperative angiography. The authors present the case of a 12-year-old boy with recurrent AVM. The AVM was originally fed by the pericallosal arteries on both sides, and it showed changing patterns of supply at recurrence. The authors concluded that a negative postoperative angiogram is not necessarily indicative of a cure. Repeat angiography and regular follow-up examinations should be performed to exclude the possibility of recurrence, especially in children.
Adult ; Angiography ; Arteries ; Arteriovenous Malformations ; Cerebral Angiography ; Child ; Humans ; Intracranial Arteriovenous Malformations ; Recurrence

Lumbar spinal stenosis (LSS) is a common spinal disease in the elderly. The cardinal symptom of LSS is neurogenic claudication, but not all patients present with such typical symptom. The clinical symptoms are often confused with symptoms of peripheral neuropathy, musculo-skeletal disease and other medical conditions in elderly patients. In particular, LSS presenting with rapid progression of leg weakness must be distinguished from other combined diseases. We report a case of rapid progressive leg weakness in a patient with LSS and iatrogenic adrenal insufficiency that was induced by obscure health supplement.
Adrenal Insufficiency ; Aged ; Constriction, Pathologic ; Humans ; Leg ; Peripheral Nervous System Diseases ; Spinal Diseases ; Spinal Stenosis

BACKGROUND: In Korea, cerebrovascular accident (CVA) is the most significant cause of death among older people, and the incidence of cerebral hemorrhage is much higher than that of developed countries. There have been many investigations about the risk factors for CVA in both Korea as well as developed countries. A few papers reported various risk factors for cerebral hemorrhage in developed countries:however, well-designed studies of risk factors for the various causes of CVA were rare in Korea. Therefore, the purpose of this study was to compare the risk factors for the various causes of CVA and to evaluate the risk factors compared with age- and sex-matched control groups. In addition, duplex sonographic findings of the carotid artery were evaluated in patients with cerebral infarction. METHODS: One hundred and sixty-four patients admitted to the hospital in 1996 were enrolled. The four groups were divided based on the following states: cerebral infarction (n-63), cerebral hemorrhage (n-64), cerebral infarction with atrial fibrillation (n-19), and lacunar infarction (n-18). Major risk factors were compared with age- and sex-matched control groups and among CVA groups. Duplex sonography of the carotid artery was done in 14 patients with cerebral infarction. RESULTS: In multiple logistic regression analysis, patients with cerebral infarction had higher prevalence of diabetes mellitus and lower high density lipoprotein-cholesterol level than the control group, and hypertension showed borderline significance. Patients with cerebral hemorrhage had higher prevalence of hypertension, higher high density lipoprotein-cholesterol level, and more frequent prevalence of smoking compared with the control group. Patients with cerebral infarction showed lower high density lipoprotein-cholesterol, higher low density lipoprotein-cholesterol levels, more frequent diabetes mellitus, lower prevalence of hypertension and older age than patients with cerebral hemorrhage. Patients with cerebral infarction and atrial fibrillation showed only older age than patients with cerebral infarction only. There were no differences in risk factors between patients with cerebral infarction and lacuna infarction. Atheromatous plaque was found in 71% of patients with cerebral infarction. CONCLUSION: Metabolic abnormalities played more important role in the development of cerebral infarction and hemodynamic abnormalities in cerebral infarction. Sonographic examination of the carotid artery may be useful for predicting the occurrence of cerebrovascular accident in high risk patients.
Atrial Fibrillation ; Carotid Arteries* ; Cause of Death ; Cerebral Hemorrhage ; Cerebral Infarction* ; Developed Countries ; Diabetes Mellitus ; Hemodynamics ; Humans ; Hypertension ; Incidence ; Infarction ; Korea ; Logistic Models ; Prevalence ; Risk Factors* ; Smoke ; Smoking ; Stroke ; Stroke, Lacunar ; Ultrasonography*

No abstract available.
Echinococcosis, Hepatic*

OBJECTIVE: The incidence and pathophysiologic mechanisms of chronic hydrocephalus requiring shunting after aneurysmal subarachnoid hemorrhage(SAH) is not precisely known. Authors investigated whether the initial external ventricular drainage in patients with aneurysmal subarachnoid hemorrhage can effect on the late onset of shunt-dependent hydrocephalus. METHODS: In this prospective nonrandomized study, 311 patients with aneurysmal SAH treated using either surgical clip application or endovascular coil embolization were studied between Jan 2004 and Dec 2006. Chronic hydrocephalus was defined as clinically and radiographically demonstrated hydrocephalus that lasted 2 weeks or longer after the subarachnoid hemorrhage. 128 patients underwent perioperative extracranial ventricular drainage to allow brain relaxation and to drain intraventricular hematoma. The occurrence of asymptomatic and shunt-dependent hydrocephalus was analyzed in both treatment groups. Patients clinical grade was evaluated with WFNS (World Federation of Neurosurgical Societies) Grades, and Fisher Grades was used for evaluating radiological condition of the patient. RESULTS: Among 128 patients, who underwent perioperative EVD, total 76 patients diagnosed as hydrocephalus later, and 23 patients needed shunt operation. The occurrence of hydrocephalus was significantly higher in patients underwent perioperative EVD (p<0.001), but there were no statistical significance between the perioperative EVD and the onset of shunt-dependent hydrocephalus (p=0.190). Among variable factors, Fisher grade, WFNS grade, amount of IVH on admission, and site of ruptured aneurysm showed statistical significance in related with the shunt-dependent hydrocephalus. Results of logistic regression analyses, perioperative EVD carried low risk of hydrocephalus (OR 0.408, 95% CI 0.224-0.745), but no statistically significant risk was shown related with the onset of shunt-dependent hydrocephalus. CONCLUSION: As a result of this study, perioperative EVD in patients with aneurysmal SAH identified as a risk factor of the hydrocephalus. But there were no statistical significance as a risk factor of the shuntdependent hydrocephalus. Poor clinical and radiological status showed higher valuable risk of the shunt-dependent hydrocephalus rather than perioperative EVD. No hesitation seems to be needed for the perioperative EVD, especially in patients with poor neurological and radiological condition.
Aneurysm* ; Aneurysm, Ruptured ; Brain ; Drainage* ; Embolization, Therapeutic ; Hematoma ; Humans ; Hydrocephalus* ; Incidence ; Logistic Models ; Prospective Studies ; Relaxation ; Risk Factors ; Subarachnoid Hemorrhage* ; Surgical Instruments