No abstract available.
Pregnancy*

A 31-year-old man presented with dull headache and memory disturbance lasting for one week. Computed tomographic scans revealed acute hydrocephalus. The cerebrospinal fluid contained 53 leukocytes/mm3, with a mononuclear preponderance and no erythrocytes. Magnetic resonance imaging revealed hydrocephalus and leptomeningeal enhancement. Magnetic resonance angiography and digital subtraction angiography showed supraclinoid occlusion of the right internal carotid artery, which resembled unilateral moyamoya disease. Neuroendoscopic biopsy of a lesion in the septum pellucidum revealed noncaseating granulomas, which was consistent with sarcoidosis. The patient was successfully managed with intravenous methylprednisolone and ventriculoperitoneal shunting. To our knowledge, this is the first case of moyamoya-like vasculopathy associated with neurosarcoidosis.
Adult ; Angiography, Digital Subtraction ; Biopsy ; Carotid Artery, Internal ; Central Nervous System Diseases ; Erythrocytes ; Granuloma ; Headache ; Humans ; Hydrocephalus ; Magnetic Resonance Angiography ; Magnetic Resonance Imaging ; Memory ; Methylprednisolone ; Moyamoya Disease ; Sarcoidosis ; Septum Pellucidum ; Ventriculoperitoneal Shunt

The authors describe a case of intradural epidermoid tumor in which the patient presented with low back pain and weakness of right lower extremity. The magnetic resonance imaging study showed intraspinal mass lesion at L2-3. The patient had no history of previous lumbar puncture. It was removed totally through laminectomy of L2 and L3 without any injury of the neural structure. The pathological findings were compatible with epidermoid tumor. The postoperative course was uneventful without any neurologic deficit. Characteristics of this lesion with a pertinent literature is reviewed.
Humans ; Laminectomy ; Low Back Pain ; Lower Extremity ; Lumbosacral Region* ; Magnetic Resonance Imaging ; Neurologic Manifestations ; Spinal Puncture

We report a case of suspicious neurofibromatosis associated with multiple spinal tumors with dual pathology. The patient was a 16-year-old girl who had developed progressive paraparesis for 6 months. She had cafe-au-lait spots and multiple subcutaneous nodule. Magnetic resonance(MR) imaging of the lumbar spine had shown dumbbell-shape spinal tumor at L1-2. The tumor had been removed successfully at the local hospital. But, she had got worse to paraplegia. Postoperative MR image of the whole spine had revealed multiple spinal tumors at T3-4, T6-7, C2-3, C7-T1. She underwent 3 additional operations to remove the compressive lesions. Histopathologic findings documented 3 schwannomas and 2 meningiomas. She improved dramatically and was discharged from the hospital. Subsequent MR images of the whole spine revealed numerous small spinal tumors around the spinal cord and cauda quina.
Adolescent ; Cafe-au-Lait Spots ; Female ; Humans ; Meningioma* ; Neurilemmoma* ; Neurofibromatoses ; Paraparesis ; Paraplegia ; Pathology ; Spinal Cord ; Spine

A 31-year-old man presented with right hemiparesis, and magnetic resonance imaging revealed a small infarct at left basal ganglia. Digital subtraction angiography showed left cervical internal carotid artery (ICA) occlusion and severe stenosis of the ipsilateral external carotid artery (ECA) with collateral cerebral circulation fed by ECAs. Based on the results of a functional evaluation of cerebral blood flow, we performed preventive ECA angioplasty and stenting for advanced ECA stenosis to ensure sufficient blood flow to the superficial temporal artery. Eight weeks later, superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis was performed. His postoperative course was uneventful and no additional transient ischemic attacks have occurred. To our knowledge, this is the first report of preventive angioplasty and stenting for advanced narrowing of an ECA before STA-MCA anastomosis for ipsilateral ICA occlusion.
Adult ; Angiography, Digital Subtraction ; Angioplasty ; Basal Ganglia ; Carotid Artery, External ; Carotid Artery, Internal ; Constriction, Pathologic ; Dietary Sucrose ; Humans ; Ischemic Attack, Transient ; Magnetic Resonance Imaging ; Middle Cerebral Artery ; Paresis ; Stents ; Temporal Arteries

We present a rare case of massive intracerebral hemorrhage resulting from a small, superficially-located supratentorial cavernous malformation, or cavernoma. These lesions rarely lead to massive, life-threatening intracerebral hemorrhages. A 17-year-old female presented with a 3-week history of declining mental status. Brain computed tomography and magnetic resonance imaging revealed a sizable intracranial hemorrhage, within the right occipital region, associated with a small nodule at the hematoma's posterior margin. An emergency operation removed the entire hematoma and nodule. Histological examination of the nodule was compatible with a diagnosis of cavernous malformation. The patient's post-operative course was uneventful.
Adolescent ; Brain ; Caves ; Cerebral Hemorrhage ; Emergencies ; Female ; Hematoma ; Humans ; Intracranial Hemorrhages ; Magnetic Resonance Imaging

OBJECTIVE: It has been known that the prognosis of aneurysm rupture is depend on the preoperative clinical state, presence of rebleeding, vasospasm, hydrocephalus, but the direction of aneurysm might be one of the important prognostic factors in the anterior communicating artery (ACOM) aneurysm. METHODS: One hundred forty three cases of ACOM aneurysms, operated from 1996 to 2005, were analysed retrospectively according to the surgical outcomes and directions of aneurysms. RESULT: The results of analysis were summarized as follows 1) The direction of ACOM aneurysms were as follows; anterior-superior direction in 33.6%, anterior-inferior 30.1%, posterior-superior 10.5%, anterior 7.7%, superior 7.0%, inferior 7.0% and posterior-inferior in 4.2%. 2) There was no significant relationship between the direction of aneurysm and the preopertive clinical state, but the incidence of Hunt-Hess grade IV and V was high in the posterior-superior and anterior-superior direction groups. 3) Intraventricular hemorrhage (IVH) or intracerebral hemorrhage (ICH) was accompanied in 28.7%. In posterior-superior and anterior-superior direction group, there is statistically significance between direction and IVH or ICH (p < 0.05). 4) Vasospasm was observed in 23.8% and cerebral infarction in 17.5%. The incidence was increased in the posterior-superior group. 5) Superior and posterior-superior direction group showed high mortality rate (20.0%). CONCLUSION: Although there was no statistic significance, we found that the direction of aneurysm might affect the clinical characteristics and prognosis in the patients underwent clipping surgery of ACOM aneurysm. Especially, posterior-superior and anterior-superior direction groups revealed the high incidence of ICH, IVH, vasospasm and cerebral infarction. Therefore, we should pay more careful attention to the patients with the superiorly directed ACOM aneurysms.
Aneurysm ; Arteries ; Cerebral Hemorrhage ; Cerebral Infarction ; Hemorrhage ; Humans ; Hydrocephalus ; Incidence ; Intracranial Aneurysm ; Prognosis ; Retrospective Studies ; Rupture

OBJECTIVE: It has been known that the prognosis of aneurysm rupture is depend on the preoperative clinical state, presence of rebleeding, vasospasm, hydrocephalus, but the direction of aneurysm might be one of the important prognostic factors in the anterior communicating artery (ACOM) aneurysm. METHODS: One hundred forty three cases of ACOM aneurysms, operated from 1996 to 2005, were analysed retrospectively according to the surgical outcomes and directions of aneurysms. RESULT: The results of analysis were summarized as follows 1) The direction of ACOM aneurysms were as follows; anterior-superior direction in 33.6%, anterior-inferior 30.1%, posterior-superior 10.5%, anterior 7.7%, superior 7.0%, inferior 7.0% and posterior-inferior in 4.2%. 2) There was no significant relationship between the direction of aneurysm and the preopertive clinical state, but the incidence of Hunt-Hess grade IV and V was high in the posterior-superior and anterior-superior direction groups. 3) Intraventricular hemorrhage (IVH) or intracerebral hemorrhage (ICH) was accompanied in 28.7%. In posterior-superior and anterior-superior direction group, there is statistically significance between direction and IVH or ICH (p < 0.05). 4) Vasospasm was observed in 23.8% and cerebral infarction in 17.5%. The incidence was increased in the posterior-superior group. 5) Superior and posterior-superior direction group showed high mortality rate (20.0%). CONCLUSION: Although there was no statistic significance, we found that the direction of aneurysm might affect the clinical characteristics and prognosis in the patients underwent clipping surgery of ACOM aneurysm. Especially, posterior-superior and anterior-superior direction groups revealed the high incidence of ICH, IVH, vasospasm and cerebral infarction. Therefore, we should pay more careful attention to the patients with the superiorly directed ACOM aneurysms.
Aneurysm ; Arteries ; Cerebral Hemorrhage ; Cerebral Infarction ; Hemorrhage ; Humans ; Hydrocephalus ; Incidence ; Intracranial Aneurysm ; Prognosis ; Retrospective Studies ; Rupture

OBJECTIVE: The authors evaluate the usefulness, results, and technical problem of endovascular treatment of cerebral aneurysms with Guglielmi detachable coil(GDC). METHODS: Forty patients with 31 ruptured and 11 unruptured aneurysms were treated with GDC embolization. Twenty-four aneurysms were located in the anterior circulation and 18 in the posterior circulation. Aneurysms size was categorized small(n=31) or large(n=11) and neck size was categorized narrow(n=30) or wide(n=12). We statistically analyzed occlusion rate according to the location, rupture, size, and neck size of aneurysms, and investigated the procedure-related complications and clinical outcomes. RESULTS: GDC treatment of aneursyms was successful in 40 aneurysms of 39 patients(95.2%). Total occlusion was achieved in 24(60.0%) cases, subtotal occlusion in 12(30%), and incomplete occlusion in 4(10.0%). Each total occlusion rate was 69.0% in small-sized, 36.4% in large-sized, 69.0% in narrow-necked, and 36.4% in wide-necked aneurysms. Location and rupture of aneurysms did not influence occlusion rate. The technical complications included 4 thromboembolisms, 3 parent artery occlusions, and 1 perforation of aneurysm. Procedure-related morbidity and mortality were 10.3% and 2.6%. 3 subtotally or incompletely embolized aneurysms in posterior circulation rebled during the follow-up period. CONCLUSION: The results of this study indicate that endovascular GDC treatment is an appropriate therapeutic alternative in cerebral aneurysms. However, the rebleeding by aneurysmal recanalization or regrowth is a major limitation of GDC treatment. Follow-up angiography and further technical improvement are mandatory to overcome rebleeding.
Aneurysm ; Angiography ; Arteries ; Follow-Up Studies ; Humans ; Intracranial Aneurysm* ; Mortality ; Neck ; Parents ; Retrospective Studies* ; Rupture ; Thromboembolism