Dural arteriovenous fistula (AVF) is very rare, acquired lesion that may present with intracranial hemorrhage or neurological deficits. The etiology is not completely understood but dural AVF often has been associated with thrombosis of the involved dural sinuses. To our knowledge, this is the first well documented intracranial hemorrhage case caused by dural AVF following microvascular decompression for hemifacial spasm. A 49-year-old male patient had left microvascular decompression of anterior inferior cerebellar artery via retrosigmoid suboccipital craniotomy. The patient was in good condition without any residual spasm or surgery-related complications. However, after 10 months, he suffered sudden onset of amnesia and dysarthria. Computed tomography and magnetic resonance imaging revealed the presence of dural AVF around the left transverse-sigmoid sinus. The dural AVF was treated with Onyx(R) (ev3) embolization. At the one-year follow up visit, there were no evidence of recurrence and morbidity related to dural AVF and its treatment. This case confirms that the acquired etiology of dural AVF may be associated with retrosigmoid suboccipital craniotomy for hemifacial spasm, even though it is an extremely consequence of this procedure.
Amnesia ; Arteries ; Central Nervous System Vascular Malformations* ; Craniotomy ; Dysarthria ; Follow-Up Studies ; Hemifacial Spasm* ; Humans ; Intracranial Hemorrhages ; Magnetic Resonance Imaging ; Male ; Microvascular Decompression Surgery* ; Middle Aged ; Recurrence ; Spasm ; Thrombosis

Subdural hemorrhage (SDH) can manifest various neurologic symptoms. However, SDH presenting with only hand weakness has rarely been reported. We report two SDH cases with only hand weakness mimicking peripheral neuropathy. Since SDH can present with hand weakness only, we suggest the clinicians to do a careful history taking and recommend a CT scan in the elderly patients.
Aged ; Hand ; Hematoma, Subdural* ; Humans ; Neurologic Manifestations ; Paresis ; Peripheral Nervous System Diseases* ; Tomography, X-Ray Computed

Idiopathic hypertrophic spinal pachymeningitis (IHSP) is a chronic, progressive, inflammatory disorder characterized by marked fibrosis of the spinal dura mater with unknown etiology. According to the location of the lesion, it might induce neurologic deficits by compression of spinal cord and nerve root. A 58-year old female with a 3-year history of progressive weakness in both lower extremities was referred to our institute. Spinal computed tomography (CT) scan showed an osteolytic lesion involving base of the C6 spinous process with adjacent epidural mass. Magnetic resonance imaging (MRI) revealed an epidural mass involving dorsal aspect of cervical spinal canal from C5 to C7 level, with low signal intensity on T1 and T2 weighted images and non-enhancement on T1 weighted-enhanced images. We decided to undertake surgical exploration. At the operation field, there was yellow colored, thickened fibrous tissue over the dura mater. The lesion was removed totally, and decompression of spinal cord was achieved. Symptoms improved partially after the operation. Histopathologically, fibrotic pachymeninges with scanty inflammatory cells was revealed, which was compatible with diagnosis of idiopathic hypertrophic pachymeningitis. Six months after operation, motor power grade of both lower extremities was normal on physical examination. However, the patient still complained of mild weakness in the right lower extremity. Although the nature of IHSP is generally indolent, decompressive surgery should be considered for the patient with definite or progressive neurologic symptoms in order to prevent further deterioration. In addition, IHSP can present as an osteolytic lesion. Differential diagnosis with neoplastic disease, including giant cell tumor, is important.
Decompression ; Diagnosis ; Diagnosis, Differential ; Dura Mater ; Female ; Fibrosis ; Giant Cell Tumors ; Humans ; Lower Extremity ; Magnetic Resonance Imaging ; Meningitis* ; Neurologic Manifestations ; Physical Examination ; Spinal Canal ; Spinal Cord

A 49 years old male patient who suffered from deterioration of posterior neck pain, left hand numbness, left lower limb pain and gait disturbance for 3 years visited our outpatient department. He had been diagnosed as non-dysraphic cervical intradural lipoma and operated in August 1990. On the radiologic images, we found the regrowth of non-dysraphic cervical intradural lipoma from C2 to C7 level, which surrounds and compresses the cervical spinal cord. Previous subtotal laminectomy from C2 to C7 and severe cervical lordosis were also found. Appropriate debulking of lipoma mass without duroplasty was successfully done with intraoperative neurophysiological monitoring (IONM). We are following up the patient for 24 months via outpatient department, his neurologic symptoms such as hand numbness, gait disturbance, left lower limb pain and posterior neck pain have improved. We describe a rare case of regrowth of non-dysraphic cervical intradural lipoma.
Animals ; Gait ; Hand ; Humans ; Hypesthesia ; Intraoperative Neurophysiological Monitoring ; Laminectomy ; Lipoma* ; Lordosis ; Lower Extremity ; Male ; Neck Pain ; Neurologic Manifestations ; Outpatients ; Spinal Cord ; Spinal Dysraphism*

Supersensitivity of the iris sphincter to dilute parasympathetic or sympathetic agents in a preganglionic oculomotor nerve disorder is considered a diagnostic test of a brain death. We studied pupillary response to 0.06% pilocarpine and 1.25% phenylephrine in cases of brain death confirmed with EEG9(19 cases) and clinical brain death not confirmed with EEG(10 cases). 0.06% pilocarpine was instilled if the diameter of the pupil was over 4.0 mm, 1.25% phenylephrine under 4.0 mm. Among 8 cases of clinical brain death associated with dilated pupil, four cases showed positive response to 0.06% pilocarpine. Not only two cases of them who showed flat EEG considered the brain death(50%) but the other two cases who showed lower voltage in EEG also were dead in 36 hours after the test. Two cases associated with constricted pupils who showed positive response to 1.25% phenylephrine, but only lower voltage in EEG, were consequently dead in 48 hours. Nineteen brain death patents confirmed with flat EEG showed strong positive response to these drugs. Our results suggest that the dilated pupil is not necessarily considered as a diagnostic hallmark of the brain death which has been established by Korean Medical Association, and it seems that pupillary responses to the autonomic stimulating agents appears more reliable than vestibuloocular reflex test.
Brain Death* ; Brain* ; Diagnostic Tests, Routine ; Electroencephalography ; Iris ; Miosis ; Oculomotor Nerve Diseases ; Phenylephrine* ; Pilocarpine* ; Pupil ; Reflex, Vestibulo-Ocular

Among the four-hundred patients with cerebral aneurysms confirmed by cerebral angiography, we divided them into two age groups, one with ages 39 years or younger(young-aged group: 51 patients, 12.8%), and another with ages 65 years or older(old aged group: 45 patients, 11.3%). A comparison was undertaken in regard to clinical characteristics and overall outcome in two groups. In young-aged group, the female-to-male ratio was 2.2: 1 whereas, women was predominant by five times more in old aged group. Anterior communicating artery aneurysm was the most common site(43.1%) in young-aged group, unlike to old aged group where posterior communicating artery was the most common site(33.3%). The most common symptom was headache in both groups, and the hypertension was more frequent in young-aged group(45.5%) than old-aged group(33.3%). Surgery was performed in 43 patients(84%) in younger group, and 37 patients(82.2%) in elderly group. Young-aged group showed more favorable outcome(91%) than old-aged group(70%).
Aged ; Arteries ; Cerebral Angiography ; Female ; Headache ; Humans ; Hypertension ; Intracranial Aneurysm* ; Prognosis

Amajor role in sustaining tumors like gliomas has been attributed to growth factors. Many questions remain unanswered about how such external signals are transduced into a transformed phenotype. Growth factors such as PDGF and epidermal growth factor(EGF) activate PLC, and this activation requires the intrinsic tyrosine kinase activity of the growth factor receptor. There are only a few reports on PKC activity in astrocytoma cells, especially in human glioma cells. We focused on signal transduction of phospholipase C(PLC) and phospholipase D(PLD) in human glioma cells. In this study, using genistein and calphostin C, the regulation of PLC, PLD, and PKC was investigated. The results are as follows; 1) Genistein is a selective inhibitor of PDGF-induced PLC- and PLD activation in T98G glioblastoma cells but not in Hs 683 glioma cells. 2) Calphostin-C stimulates PLC and PLD, possibly through a PKC-independent pathway in both T98G and Hs 683 cells. 3) Both genistein and calphostin-C inhibit glioma cell proliferation, indicating that the pathway for activation of PLC and PLD is not relevant to the pathway of cell proliferation in glioma cells.
Astrocytoma ; Cell Proliferation* ; Genistein* ; Glioblastoma* ; Glioma* ; Humans* ; Intercellular Signaling Peptides and Proteins ; Phenotype ; Phospholipases* ; Protein-Tyrosine Kinases ; Signal Transduction ; Type C Phospholipases*

Parkinson's disease(PD) is a neurodegenerative disorder characterised clinically by bradykinesia, rigidity, tremor, and pathologically by neuronal cell death in substantia nigra. The cause of dopaminergic neuronal cell death in PD remains unknown. Recently, decreased mitochondrial complex I activities have been reported in platelets, muscles, substantia nigra of the PD patients. Blood samples were lysed with lysis buffer, and incubated 1 hour with 20mg/ml proteinase K at 37degreesC. DNA was extracted with phenol and chloroform(1: ). The long and accurate polymerase chain reaction(LA PCR) was performed by mitochondrial specific primers. The mitochondrial ND1, ND2, CO I, CO II and 1/3ATPase 6/8, CO III, genes as well as parts of ND3 and 3/4ND5 subunit coding regions were analysed by LA PCR. In this study, it is observed not only 4,977 bp mtDNA deletion but a partial mtDNA deletion of the ND1, ND2, CO I~III genes in blood from patients with PD. The result of this study cannot rule out the possibility of point mutation. It is possible that such a deletion would cause mitochondrial dysfuncton, and as a result of mitochondrial dysfunction, Parkinson's disease could progress.
Cell Death ; Clinical Coding ; DNA ; DNA, Mitochondrial* ; Dopaminergic Neurons ; Endopeptidase K ; Humans ; Hypokinesia ; Muscles ; Neurodegenerative Diseases ; Neurons ; Parkinson Disease* ; Phenol ; Point Mutation ; Polymerase Chain Reaction* ; Substantia Nigra ; Tremor

A K+-channel blocker, 4-aminopyridine(4-AP) increases neurotransmitter release from motor nerve terminals and has been shown to restore neuromuscular transmission in the myasthenic syndrome. It has been reported that the intravenous injection of 4-AP in the myasthenic patients caused many central adverse effects including anxiety and restlessness, but did not affect the blood pressure. The aim of this study was to observe the effect of intracerebroventricularly administered 4-AP on the blood pressure and to elucidate the mechanism of the action in urethane-anesthetized rabbits. Intracerebroventricular(icv) 4-AP produced pressor effects in a dose-dependent fashion, but intravenous(iv) 4-AP of the same dose did not altered the blood pressure. Tetraethylammonium, a K+-channel blocker which differs from 4-AP structurally, had little effect on the blood pressure, but 3,4-diaminopyridine, another derivative of the aminopyridine, produced pressor effect similar to 4-AP. The pressor effect of icv 4-AP was not affected by the treatment with iv phenoxybenzamine and chlorisondamine, and in bilateral adrenalectomized rabbits. These results suggest that the 4-AP pressor effect is not related to the periphral sympathetic nerve nor adrenal gland. The pretreatment with icv phentolamine and prazosin did not altered the 4-AP pressor. However, the icv 4-AP pressor effect was significantly attenuated by the treatment with icv yohimbine, and significantly potentiated by the treatment with icv clonidine. The treatment with icv diltiazem markedly inhibited the icv 4-AP pressor effect. It is concluded that 4-AP-sensitive K+-channels in rabbit brain might play a role in the regulation of blood pressure and that the 4-AP pressor effect is closely related to the central alpha2-adrenoceptors and L-type calcium channels.
4-Aminopyridine* ; Adrenal Glands ; Anxiety ; Arterial Pressure* ; Blood Pressure ; Brain ; Calcium Channels, L-Type ; Chlorisondamine ; Clonidine ; Diltiazem ; Humans ; Injections, Intravenous ; Neurotransmitter Agents ; Phenoxybenzamine ; Phentolamine ; Prazosin ; Psychomotor Agitation ; Rabbits ; Tetraethylammonium ; Yohimbine

A 42-year-old male was admitted to our clinic on May 4, 1980, because of slight neck stiffness, quadriparesis and urinary difficulty. On admission, neurological examination revealed alert mental state, slight neck stiffness, quadriparesis and loss of pain and temperature sense below the level of C3 sensory dermatome. All deep tendon reflexes were hyperactive and Babinski's sign was positive. Roentgenographic examination of the cervical spine showed widened interpedicular distance at C5 to C7 in A-P view. Myelogram disclosed widening of the dye column at C4 to T1 vertebral level, suggesting intramedullary tumor. Laminectomy was performed from the C5 to T2. The cord appeared to be widened and swollen at the C6-7 segment level. 1ml of yellowish pus was aspirated from the distended spinal cord at the C6 level. Mid-line posterior myelotomy was performed and hard cavity wall was visible. Upon incision of cavity wall, about 5ml of yellowish purulent pus exuded, allowing the cord to become "flaccid". The abscess cavity was irrigated with saline and penicillin solutions and a small rubber drain catheter was placed in the abscess cavity. The organism from the abscess was identified as Staphylococcus aureus. Postoperative course was uneventful. Antibiotic therapy was continued for four weeks after operation. The patient's condition was much improved and he could walk with assistance on discharge time.
Abscess* ; Adult ; Catheters ; Humans ; Laminectomy ; Male ; Neck ; Neurologic Examination ; Penicillins ; Quadriplegia ; Reflex, Babinski ; Reflex, Stretch ; Rubber ; Spinal Cord ; Spine ; Staphylococcus aureus ; Suppuration ; Thermosensing