No abstract available.
Ependymoma*

A series of 1909 computed tomography(CT) scan performed for head injury mostly after traffic accident was retrospectively reviewed. 17 patients were found to have clearly definable traumatic intraventricular hemorrhage(TIVH). TIVH was associated with various brain lesions in most cases; Intracerebral lesions with contusional hemorrhage and subdural hematoma(Glasgow Coma Scale Score) coexisted in 6 and 5 instances. The outcome(Glasgow Outcome Scale) of this series was related with initial clinical findings, and 11 patiens survived. We have designed this study to assess the occurrence of TIVH in our series of head-injured patients in Korea, and to correlate these findngs with the clinical status, the presence of associated lesions, and their relation to final outcome of these patients, and conculsions are as follows: 1) The incidence of TIVH and its associated mortality is 0.9% and 35.3%, respectively, Most of them occurs below 5 th decade(70.6%) with male predominace(88.2%). 2) Mode of injury is mainly from traffic accident(94.1%), followed by fall down(5.9%). 3) The presence of concomitant lesions has a definite influence on poor outcome(P<0.02), whereas skull fracture or multiplicity of TIVH deos not. 4) Primary impact site to induce TIVH is primarily on frontal portion(58.9%). 5) With regard to brain stem injury in TIVH, the final outcome clearly depends on pathological demonstration on CT(P<0.005%), but not on location of hemorrhage(P<0.5%).
Accidents, Traffic ; Brain ; Brain Stem ; Coma ; Contusions ; Craniocerebral Trauma ; Hemorrhage ; Humans ; Incidence ; Korea ; Male ; Mortality ; Retrospective Studies ; Skull Fractures

The diagnosis and appropriate management of blunt abdominal trauma including retroperitoneal hematoma associated head injury is difficult. In our case, psoas muscle hematoma was revealed during the evaluation of fever. Psoas muscle hematoma most commonly results secondarily from coagulation defect or from retroperitoneal bleeding into the psoas sheath. The presenting signs and symptoms of this case are hypotension and anemia. Pain is also present in the back or abdomen. If it is associated with head injury and not presented massive hemorrhage, the actual diagnosis is not easy. The appropriate management depends on a careful initial evaluation including suspicion of physician, repetitive physical examination, the timely use of diagnostic procedures.
Abdomen ; Anemia ; Craniocerebral Trauma* ; Diagnosis ; Fever ; Head* ; Hematoma* ; Hemorrhage ; Hypotension ; Physical Examination ; Psoas Muscles

A retrospective analysis of 60 patients with traumatic subdural hygroma who had been managed and followed up at least 6 months, was done in relation to time of development and associated intracranial lesion, initial Glasgow Coma Scale(GCS), sequeritial changes of subdural hygroma, and Glasgow Outcome Scale(GOS). The incidence of traumatic subdural hygroma was 8.4%, 131 cases among 1,563 head-injured cases. And most of them was subacute from(55%, 33 cases among 60 cases), complex subdural hygroma was 65%(39 cases among 60 cases). The conversion rate of traumatic subdural hygroma into chronic subdural hematoma was 15%(9 cases among 60 cases). There was no statistically significant relation between initial GCS score and time of development and also intial GCS score and development of complex subdural hygroma and time of development and GOS of 6 months follow-up(P>0.05). There noted only highly significant relation between initial GCS score and GOS of 6 months follow-up(P<0.001).
Coma ; Craniocerebral Trauma ; Hematoma, Subdural, Chronic ; Humans ; Incidence ; Retrospective Studies ; Subdural Effusion*

OBJECTIVE: This study is designed to evaluate the therapeutic effects and prognostic factors for barbituate coma therapy(BCT)in severe and refractory vasospasm following subarachnoid hemorrhage. METHODS: Barbiturate coma therapy was used in 18 patients with severe and refractory vasospasm in spite of "3-H therapy" and intra-arterial papaverine infusion. The authors analyzed the clinical parameters including Glasgow Coma Scale(GCS), electroenceplographic finding, and brain computerized tomography(CT) scan findings in relation to outcome at discharge. RESULTS: Among 18 patients, burst suppression pattern could be obtained in 17. In cases with good outcome, the duration elapsed from coma to drowsiness after BCT was 14.09+/-5.82 days and GCS score at this time was significant in the prediction of final outcome(p<0.05). Patients with ideal burst suppression pattern attainable more than 24 to 48 hours showed good outcome in 81.8%(p<0.05). The group that showed focal low density in the brain CT scan taken before BCT fared better prognosis compared with that of multifocal or diffuse low density(p<0.05), and patients with resolution of perimesencephalic cistern effacement on follow-up brain CT scan taken 48 hours after BCT showed better prognosis(p<0.05). Overall, 72.2% showed improvement of GCS score by 2 or more, and good outcome was noted in 50%. CONCLUSION: The barbiturate coma therapy seems to have a beneficial therapeutic effect on severe and refractory vasospasm and can be considered as a useful therapeutic modality.
Brain ; Coma* ; Follow-Up Studies ; Humans ; Papaverine ; Prognosis ; Sleep Stages ; Subarachnoid Hemorrhage* ; Tomography, X-Ray Computed

The presence of traumatic subarachnoid hemorrhage on the initial computerized tomographic scans has been known to be associated with worse results. By means of a simple and reliable computerized tomographic grade system proposed by Greene and his colleagues, prognostic factors of the traumatic subarachnoid hemorrhage was significantly related to clinical outcome at the time of discharge from acute hospitalization. Between February 1992 and August 1995, 3975 patients were admitted to our department of neurosurgery due to head injury. Clinical data were retrospectively reviewed to ascertain the relationship of the thickness of traumatic subarachnoid hemorrhage, its location, evidence of mass lesion(s), midline shift, obliteration of the basal cistern, and cortical sulcal effacement to outcome. Additionally, initial Glasgow coma scale score, arterial gas study, systemic blood pressure and prothrombin time were also analyzed for the same purpose. Among 3975 head-injured patients, 213 patients were identified to h ave traumatic subarachnoid hemorrhage on the initial computerized tomographic scan. Among 213 traumatic subarachnoid hemorrhage patients, the patients treated with calcium channal blocker(32 patients) and 3 patients lost to follow-up were excluded from this study for a total of 178. The computerized tomographic scan findings were divided into a 3 grade system;Grade 1 indicating only traumatic subarachnoid hemorrhage, Grade 2 indicating traumatic subarachnoid hemorrhage with mass lesion(s) , Grade 3 indicating traumatic subarachnoid hemorrhage with mass lesion(s) and midline shift. All these data were compared to Glasgow outcome scale on discharge, and arbitrarily these were divided into the good(good recovery and moderate disability) and the bad(severe disability, vegetative state and death). The authors conclude that the contributing factors to outcome at discharge were as follows:1. midline shift(p=0.002), PT< or =70%(p<0.001), obliteration of the basal cistern(p=0.001) and cortical sulcal effacement(p=0.001) were shown to the statistically significant. 2. initial computerized tomographic grade contributed to outcome at discharge.
Blood Pressure ; Calcium ; Craniocerebral Trauma ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Hospitalization ; Humans ; Lost to Follow-Up ; Neurosurgery ; Persistent Vegetative State ; Prothrombin Time ; Retrospective Studies ; Subarachnoid Hemorrhage, Traumatic*

Spontaneous brain stem hemorrhage usually results in higher mortality and morbidity with poorer prognosis than any other intracranial vascular lesions in spite of meticulous medical or surgical treatment. We have experienced 86 cases of spontaneous brain stem hemorrhage who were admitted to Wonju college of medicine from January 1983 to Octobr 1995. 33 cases were treated with operation and 53 cases with non-operative treatment. The results were as follows: 1) Clinical parameters in both operative and non-operative groups showed no significant differences. 2) Treatment results were better in the operative group. Operative treatment is recommended in cases of GCS score below 7, hematoma size larger than 10ml, young age, and normotensive patients. 3) Appropriate operative approaches should be considered according to the patient's status. Recently, we most frequently performed a stereotactic approach. 4) Better outcome was obtained when the patients were operated from 72 hours to one or two weeks following the h emorrhage. 5) Hypertension, old age, and GCS score above 7 showed no statistical differences in terms of outcome between the operative and non-operative groups.
Brain Stem* ; Brain* ; Gangwon-do ; Hematoma ; Hemorrhage* ; Humans ; Hypertension ; Mortality ; Prognosis

OBJECTIVE: TA retrospective study is performed on 28 patients with primary intraventricular hemorrhage(PIVH) to examine the outcome and prognostic factors associated with this disorder. METHODS: Clinical data collected between 1998 and 2002 was used in the present study. The outcomes of these patients were compared by age, etiology, initial Glasgow Coma Score(GCS), Graeb's score, ventriculocranial ratio(VCR), hemorrhagic dilation of the third ventricle, and hemorrhagic dilation of the fourth ventricle. The Glasgow Outcome Scale(GOS) at discharge was used for the comparison of outcomes. RESULTS: The mean age of these patients was 48.4+/-17.4 years. The underlying causes of PIVH were hypertension(53.6%), moyamoya disease(17.9%), arteriovenous malformation(10.7%), cerebral aneurysm(7.1%), and unknown(10.7%). The age and etiology were not correlated with outcome. Patients with a GCS of 13-15 showed a good outcome in 90.5%(p<0.05). Those with a higher VCR(> or =0.23) showed a poor outcome in 64.3%(p<0.05). Patients with a Graeb's score of 9-12 showed a poor outcome in 87.5%(p<0.05). Those with hemorrhagic dilatation of the third ventricle showed a poor outcome in 80.0%, and those with hemorrhagic dilatation of the fourth ventricle showed a poor outcome in 85.7%(p<0.05). The overall mortality rate was 17.9%. CONCLUSION: Low initial GCS, high Graeb's score, high VCR, and hemorrhagic dilatation of the third ventricle or the fourth ventricle are correlated with poor outcome in PIVH.
Coma ; Dilatation ; Fourth Ventricle ; Hemorrhage* ; Humans ; Mortality ; Retrospective Studies ; Third Ventricle

Five separate incidences of patients with cerebrovascular disease(CVD) were revealed among 555 craniocerebral traumatic victims between 1991 and 192. The 5 cases of with cerebrovascular disease revealed included 3 aneurysm. 1 arteriovenous malformation and 1 spontaneous intracerebral hematoma caused by angiographic study. The frequent use of computerized tomographic scans in the evaluation of head-injured victims can well demonstrate an intracerebral hemorrhage, but may not ge able to detect the associated cerebrovascular disease;whereas the efficacy of angiogrphy, on the contrary, has been losing its popularity as diagnostic armamentarium. The importance of angiographic study should be considered, if clinical signs and/or brain CT ideate the possibility of cerebrovascular disease even during the course of head injury management.
Aneurysm ; Angiography ; Arteriovenous Malformations ; Brain ; Cerebral Hemorrhage ; Craniocerebral Trauma* ; Hematoma ; Humans ; Incidence

Intraventricular hemorrhage after blunt head trauma, which reflects the severity of head injury, is uncommon. A retrospective study of 109 traumatic intraventricular hemorrhage(TIVH) patients who were admitted between January 1, 1988 and December 31, 1993 was conducted. The results are as follows: 1) Incidence of TIVH and its associated mortality were 2.45% and 28.4%, respectively. 2) TIVH-associated radiological abnormalities were traumatic intracerebral hematoma(62.7%), skull fracture(42.7%), and traumatic subarachnoid hemorrhage(34.5%). 3) Amount of TIVH was related to traumatic intracerebral hematoma(p=0.0003) and traumatic subarachnod hemorrhage(p=0.0385). 4) The poorest prognostic indicator was associated abnormalities, especially corpus callosum or brainstem hemorrhage(p=0.0099). 5) TIVH-associated hydrocephalus was not related to the amount of TIVH(p=0.42), and poor prognosis(p=0.12). 6) Patients with TIVH showed better Glasgow coma scale and Glasgow outcome scale than TIVH-associated abnormalities.
Brain Stem ; Corpus Callosum ; Craniocerebral Trauma ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Hemorrhage ; Humans ; Hydrocephalus ; Incidence ; Mortality ; Prognosis ; Retrospective Studies ; Skull