184 paraplegics and tetraplegics of Korean male(159 alive and 25 dead) subjected to spinal cord injury during 1950~1976 were followed up for 10~36 years. The 38 patients were interviewed individually and for the other 146 patients, various records of Korean Patriots and Veteran Affairs Agency were analysed. 95.1% out of 1984 patients were service men and 86.9% were second decade. Among 159 living patients, survival rate after injury markedly reduced at 15 years after injury in cervical cord injury group and at 20 years in lumbar cord injury group, thereafter it had gradually reduced in both groups. The changes of survival rate in the thoracic cord injury group showed intermediate form of cervical and lumbar cord group. Of 25 patients dead (thoracic and lumbar cord injuries), survival rate reduced markedly from 20 years after trauma. In 38 patients who were interviewed individually, 55.2% and 76.3 of patients were recovered to get in the wheel-chair within 1 year and 2 year after trauma respectively and in 45.8% the decubitus were not healed after 2 years of trauma. The 39.4% out of 38 patients were able to urinate involuntarily, if any, with voiding desire. And the penile erection and ejaculation were possible or occasionally possible in the 55% and 34% respectively.
Ejaculation ; Follow-Up Studies* ; Humans ; Male ; Penile Erection ; Sexual Behavior ; Spinal Cord Injuries ; Spinal Cord* ; Survival Rate ; Veterans

Cryptococcosis is the most common form of fungal infection of the central nervous system, which is classified as meningeal, embolic and perivascular type. Cryptococcal meningitis and meningo-encephalitis are not infrequent, but the only 40 cases of localized torula granuloma in the central nervous system had been reported in the worldwide literature until 1973 since the first reports of LeCount and Myers in 1907. Our new case reported here, a thirty-eight tear old female patient was admitted to our department because of abruptly appeared headache with nausea and vomiting, drowsy mental state and left hemiparesis. On admission the left hemiparesis and remarkable meningeal irritation signs were found. Chest film and skull films showed no evidence of abnormality. The right carotid angiogram revealed the shifting of the anterior cerebral artery to the left side with concomittant U-loop widening (Fig-1), Sylvian triangle displaced posteriorly, closed carotid siphon(Fig. 2) and abnormal draining vessels with staining on the frontal base of cerebrum (Fig. 1,2,3,4). Examination of the cerebrospinal fluid showed remarkable polymorphonuclear leucocyte predominant pleocytosis, elevated protein and normal sugar content. And negative smear for cryptococci and other microorganisms. A right frontal craniotomy and brain exploration exposed grayish gelatinous mass of about 3.5cm in diameter, which was partially removed. Microscopic findings were acute and chronic inflammatory changes in different stages with various types of giant cells and cryptococci (Fig. 5,6). On the third postoperative day, the patient died. Neither amphotericin-B nor 5-Fluorocytosine was administered because preoperative diagnosis was tumor, and postmortem examination couldn't be done.
Anterior Cerebral Artery ; Autopsy ; Brain ; Central Nervous System ; Cerebrospinal Fluid ; Cerebrum ; Craniotomy ; Cryptococcosis ; Cryptococcus* ; Diagnosis ; Female ; Flucytosine ; Gelatin ; Giant Cells ; Granuloma* ; Headache ; Humans ; Leukocytosis ; Meningitis, Cryptococcal ; Nausea ; Paresis ; Skull ; Thorax ; Vomiting

If in the aneurysmal rupture patients the brain metabolic parameters obtained from blood chemistry were significant and useful in clinical practice, it cannot be overstimated. Hansdorfer er al.(1973) reported that lactate, pyruvate, uric acid and alpha-HBDH of central venous blood obtained form the patients with brain contusion in basal metabolic state were significantly increased and they were useful in evaluating the prognosis of the patients. Zooping(1970) and Broderson(1974) also had tried to evaluate the prognosis and brain metabolic status of the comatous patients with blood gas analysis and CSF biochemistry. They encouraged us to estimate lactate and lactate/pyruvate ratios of canine jugular venous blood combined with gas analysis. Complete cerebral bloody-ischemia similar with initial stage of aneurysmal rupture was induced by the instanteneous elevation of intracranial pressure 30 mmHg above systemic arterial pressure by infusion of blood and mock CSF mixture into the cisterna arrest or pulmonary hypertension were discarded. At the end of the 5 minutes ischemic period, the needle tip which was inserted in to cisterna magna was removed without decreasing intracranial pressure. At 3 hours, 24 hours, 48 hours and 72 hours after ischemic period jugular venous and arterial blood were sampled for determination of lactate and pyruvate, and blood gas analysis. The following results were obtained. ie ; 1. Both lactate and pyruvate of canine jugular venous blood were increased from 3 hours and reached peak level at 24 hours after insult. Standard value of lactate and pyruvate were 1.416mM and 0.075mM and peak values were 2.429 and 0.165mM(P<0.05). 2. The more severe the neurological deficits of the animals, the highest levels of lactate and pyruvate were observed. 3. The lactate concentrations in 48 hours and 72 hours sample slopped down from 24 hours peak level but were significantly higher than those of standard. 4. Pyruvate returned to the normal range within 48 hours after insult. 5. L/P ratios were not changed significantly until 48 hours after insult but steeply elevated in 72 hours sample. 6. In gas analysis all the animals show respiratory alkalosis after insult. 7. In arterial boundary zones multiple focal ischemia were found in necropsy which was thought as reflecting no-reflow phenomenon. We concluded that elevation of lactate and pyruvate in early stage must be due to the hyperventilation after insult and lactate of late stage reflected CSF lactic acidosis.
Acidosis, Lactic ; Alkalosis, Respiratory ; Aneurysm ; Animals ; Arterial Pressure ; Biochemistry ; Blood Gas Analysis ; Brain ; Brain Injuries ; Chemistry ; Cisterna Magna ; Humans ; Hypertension, Pulmonary ; Hyperventilation ; Intracranial Pressure ; Ischemia ; Lactic Acid* ; Needles ; No-Reflow Phenomenon ; Prognosis ; Pyruvic Acid ; Reference Values ; Rupture ; Uric Acid

We have recently experienced a case of ependymoblastoma arising in the posterior fossa. 8 years old Korean boy suffered from headache, vomiting, diplopia and ataxic gait since 4 months prior to admission revealed drowsy mental state papilledema of both eyes, left abducens nerve paralysis, mild cerebellar syndrome in the neurologic examination. The radiological findings of skull revealed increased intracranial pressure and brain CT scan showed calcified round high density mass in the posterior fossa. After 3 weeks of V-P shunt operation, relatively well demarcated grayish-pink mass between the vermis of cerebellum and right cerebellar hemisphere was removed. The histological finding had a pattern of solid cord aroused thin walled blood vessel and typical ependymal rosette. The patient died at 6th postoperative day due to brain stem swelling.
Abducens Nerve ; Blood Vessels ; Brain ; Brain Stem ; Cerebellar Diseases ; Cerebellum ; Child ; Diplopia ; Gait ; Headache ; Humans ; Intracranial Pressure ; Male ; Neuroectodermal Tumors, Primitive* ; Neurologic Examination ; Papilledema ; Paralysis ; Skull ; Tomography, X-Ray Computed ; Vomiting

The Clinical analysis of 130 spontaneous intracebral & cerebellar hematoma confirmed by brain CT & admitted to this neurosurgical clinic past years & 5 months were made with literature review. 1) The age incidence showed increase over fourth decade and male to female ratio was 56.1:43.9. 2) 50.4% of total patients showed hypertension but 40.3% did not checked their B.P. & 9.3% had normal B.P. before cerebral hemorrhage. Among 50.4% of hypertension cases, 72% received antihypertensive treatment intermittently, 2.9% regularly and the rest 24.3% did not. 3) 69.7% of hematoma located in basal ganglia & thalamus. In nonoperated patients, the morbidity & mortality showed no marked difference in their location except pontine & cerebellar hematomas. In operated patients the morbidity & mortality was prominent in putaminal hemorrhage than in thalamus and cerebellum. Most of putaminal hematoma had semicomatose or comatose mental state and ventricular hemorrhage in 87.5%. 4) The morbidity & mortality increased in proportion to size of hematomas, grade of unconsciousness in admisson and state of intraventricular hemorrhage. 5) About time interval from ictus to operation, the patients within first 24 hours are 29 cases(51.1%) and the next 24 hours are 13 cases(26.5%). The mortality rate of two groups were 55.1% & 53.8% respectively but no death in the patients with operation performed after 48 hours. 6) The morbidity & mortality rate were as follows. In the non operated patients (90 patients), no or mild neurological deficits:22.2% moderate:21.1% severe:20% and moribund or death:36.6%. In the operated patients no or mild neurological deficits:16.3% moderate:18.4% severe:18.4% and moribund or death:46.9%. The results of total patients showed no or mild neurological deficits:20.1%, moderate:20.1%, severe:19.4% and moribund or death:40.2%.
Basal Ganglia ; Brain ; Cerebellum ; Cerebral Hemorrhage ; Coma ; Female ; Hematoma* ; Hemorrhage ; Humans ; Hypertension ; Incidence ; Male ; Mortality ; Putaminal Hemorrhage ; Thalamus ; Unconsciousness

The authors attempted to make experimental intraventricular hemorrhage by injection of autogenous whole blood into the lateral ventricle through a small burr hole and to observe the outcome of the intraventricular hematoma and the consequent change of the ventricular system in the rabbits. 1) The maximum duration of remaining hematoma was 4 days in the ventricular system and 28 days in the subarachnoid space. 2) In the ventricular hemorrhage group, the ventricular began to dilate after 1 day of hemorrhage. 3) The degree of the ventricular dilatation related to the amount of the injected blood into the lateral ventricle. 4) In the microscopic findings of the ventricular dilatation, flattening of the periventricular white matter fiber were more prominent in acute phase and subsided thereafter. Hemosiderin or siderophage observed before 1 week at the ventricular wall and after 1 week at the leptomeninges. The meningeal fibrosis or thickening was almost constantly presented throughout the 4 weeks. 5) The gross and microscopic changes were milder in the steroid therapy group than the others.
Dilatation ; Ependyma ; Fibrosis ; Hematoma ; Hemorrhage ; Hemosiderin ; Hydrocephalus ; Injections, Intraventricular* ; Lateral Ventricles ; Rabbits ; Subarachnoid Space

The lysing capability urokinase(UK) and streptokinase (SK) in intracerebral hematoma were examined in vitro and in a rabbit model. Intracerebral-intraventricular(IC-IV) hematomas were created by stereotaxically injecting 0.2ml of clotted human blood into the frontal lobe and lateral ventricle of a total of 87 house rabbits(weighing 1.5-2.7kg). Control animals received 0.2ml of physiologic saline infused into the clot, and the experimental group received an equal volume of UK solution(50,000units/ml), SK solution(50,000units/ml), UK-SK mixture(0.1ml of UK solution, 0.1ml of SK solution) respectively after the clot infusion. Forty two animals were sacrificed at 3 hours and 45 animals at 24 hours after infusion, The results obtained were as follows: 1) At 3 hours, clot lysis had been achieved in 8(67%) of 12 UK-infused animals, 5(36%) of 14 SK-infused animals and 6(60%) of 10 UK-SK-infused animals as compared to zero of 6 controls. 2) At 24 hours, clots had been lysed in 11(73%) of 15 UK-infused animals, 8(67%) of 12 SK-infused animals, 8(67%) of 12 UK-SK-infused animals and in 2(33%) of 6 controls. 3) There was mild inflammatory reaction by the clotted blood, but no additional histologic abnormality by thrombolytic agents(UK,SK) on microscopic examination. 4) Therefore we suggest that UK, SK or UK-SK mixture may be effectively used for the lysis of clotted intracerebral hematoma in the rabbit model and UK, UK-SK mixture are more effective than SK at 3 hours.
Animals ; Fibrinolytic Agents* ; Frontal Lobe ; Hematoma* ; Humans ; Lateral Ventricles ; Streptokinase ; Urokinase-Type Plasminogen Activator

The craniopharyngima has been known to be congenital origin and primary tumor of childhood. The craniopharyngioma may be found at all ages, though nearly one half in the first twenty years of life and equally in either sex. Important differences exist between younger and older patients. In children, signs of increased intracranial pressure, endocrine Abnormality and radiological calcification are common. In adults, mental disturbance becomes of increasing importance as well as remaining visual failure and endocrine disturbance. Because of slow growing rate of tumor in adult, subtotal excision is recommended. A 39-year-old male patient, suffering from agitation memory disturbance and almost total blindness, was diagnosed craniopharyngioma by neuroradiologic examinations. After surgical treatment, mental symptoms and visual acuity improved much more than before operation.
Adult* ; Blindness ; Child ; Craniopharyngioma* ; Dihydroergotamine ; Humans ; Intracranial Pressure ; Male ; Memory ; Visual Acuity

Infantile hemiplegia is the end state of various pathological conditions affecting the cerebral hemisphere before or during birth, or in first few years of life. In 1950, Krynauw first reported that total hemispherectomy could be carried out with beneficial results for infantile hemiplegia with uncontrollable convulsion, temper tantrum and mental deficiency. Hemispherectomy is not suitable for all cases of infantile hemiplegia, but is seems clear that it should be undertaken in any case of established infantile hemiplegia with fits which cannot be controlled by drugs, or in which there is backwardness or deterioration in the patient's intellectual or emotional state. We have recently experienced a 8-year-old boy who was suffering left hemiplegia with intractable epilepsy. Both carotid angiogram and pneumoencephalogram showed right cerebral hemiatrophy. After right hemispherectomy intractable seizure was controlled and personality disorder disappeared completely. But left hemiplegia wasn't definitely improved.
Cerebrum ; Child ; Epilepsy* ; Hemiplegia* ; Hemispherectomy* ; Humans ; Intellectual Disability ; Male ; Parturition ; Personality Disorders ; Seizures

The Na+ K+ ATPase activity, whose disturbance have been implicated in the pathophysiology of a variety of disease processes, have been shown to be reduced in traumatized spinal cord and in ischemic brain made by decapitation or carotid artery occlusion by many authors, but MacMillan contrary documented the increase of this ferment in ischemic rat brain following the electrocautery of the bilateral vertebral arteries and carotid arteries. This experiment was intended to study the cause of the above two contradictory results and the effect of Naloxone to the Na+ K+ ATPase activity following experimental spinal cord injury. Thirty cats were divided to 3 groups : Control No. 1, control No.2 and Naloxone groups. The Na+ K+ ATPase activity was measured by variation of Kang & Lee method and the experimental spinal cord injury was made by falling 20 gm. of iron bar from 20 cm height to exposed thoracic cord. 1) In control No. 1 group the Na+ K+ ATPase activity increased 21.4% after 30 minutes of trauma showing significant difference(p<0.05). 2) In control No. 2 group it increased 13.8%(p<0.01) after 5 minutes, 11.6%(p<0.05) after 30 minutes showing significant difference. 3) In Naloxone group (10 mg/kg was injected I.V. before 30 minutes of trauma) it did not show any significant change after 5 and 30 minutes of trauma. 4) Discussion was made upon above experimental results with literature review.
Adenosine Triphosphatases* ; Animals ; Brain ; Carotid Arteries ; Cats ; Decapitation ; Electrocoagulation ; Iron ; Naloxone* ; Rats ; Spinal Cord Injuries* ; Spinal Cord* ; Vertebral Artery