Hypertensive pontine hemorrhage usually causes profound, irreversible neurological deficits, with ominous prognosis, and is often fatal. There is controversy as to the appropriate treatment modality, but in general, surgical intervention is considered unethical. The authors report the outcome of hypertensive pontine hemorrhage in 13 patients whose Glasgow Coma Scale was 4-9, who on brain CT scan were seen to have over 10cc of hematoma and who underwent suboccipital craniectomy for hematoma removal. These patients could be divided in two groups: 'early'(9 patients), who underwent surgery within 24 hours of ictus, and 'late'(4 patients), who underwent surgery 6 to 20 days after ictus: all had shown neurological deterioration in spite of optimal medical treatment. Surgical outcome did not vary according to the extent of hematoma removal. For patients in the 'early' group, surgery was not useful, but three in the 'late' group, the GCS score improved to between 7 and 11. This study suggests that in hypertensive pontine hemorrhage, an early direct approach may not improve outcome, but for selected patients, who deteriorate during conservative treatment, surgery may be beneficial.
Brain ; Glasgow Coma Scale ; Hematoma ; Hemorrhage* ; Humans ; Prognosis ; Tomography, X-Ray Computed

No abstract available.
Meningioma* ; Proliferating Cell Nuclear Antigen*

We describe the case of a 59-year-old man whose occipital condyle was fractured in a traffic accident, resulting in severe neck pain and blurred vision. Neurological examination revealed palsy of the right side sixth cranial and ipsilateral lower cranial nerve. In fracture of the occipital condyle, persistent neck pain and lower cranial nerve palsy may be common clinical features. Conventional plain radiography may often be inadequate for the detection and evaluation of this lesion, and high-resolution CT and coronal reconstruction is the diagnostic modality of choice. The patient was treated conservatively using a Philadelphia collar, and this led to excellent clinical improvement. To demonstrate this rare form of traumatic lesion in patients with sustained post-traumatic neck pain and lower cranial nerve palsy, the authors recommend CT of the craniocervical junction.
Accidents, Traffic ; Cranial Nerve Diseases* ; Cranial Nerves* ; Humans ; Middle Aged ; Neck Pain ; Neurologic Examination ; Paralysis ; Radiography

We describe the case of a 59-year-old man whose occipital condyle was fractured in a traffic accident, resulting in severe neck pain and blurred vision. Neurological examination revealed palsy of the right side sixth cranial and ipsilateral lower cranial nerve. In fracture of the occipital condyle, persistent neck pain and lower cranial nerve palsy may be common clinical features. Conventional plain radiography may often be inadequate for the detection and evaluation of this lesion, and high-resolution CT and coronal reconstruction is the diagnostic modality of choice. The patient was treated conservatively using a Philadelphia collar, and this led to excellent clinical improvement. To demonstrate this rare form of traumatic lesion in patients with sustained post-traumatic neck pain and lower cranial nerve palsy, the authors recommend CT of the craniocervical junction.
Accidents, Traffic ; Cranial Nerve Diseases* ; Cranial Nerves* ; Humans ; Middle Aged ; Neck Pain ; Neurologic Examination ; Paralysis ; Radiography

Recently the change in medical informatics enabled us to use medical information whenever we want and wherever we are. There are many homepages on the web, which provide hospital information, medical counseling. Our multimedia center began its service as a internet Hospital in MIDAS Dongailbo, one of the major daily newspaper in Korea, on March 25th, 1997. The aim of this study is to examine the content and purpose of medical counseling on the web. The subjects consisted of 1,000 counsellings which were called 'Dongailbo Internet Hospital' for March, 25th, 1997 through October 30th, 1997. Many questioners wanted to know treatment principles, to make a diagnosis, and to know specific medical knowledges. The most common questions are as follows: general and unspecified, musculoskeletal, skin, digestive, respiratory, neurological problems.
Computer Communication Networks ; Counseling* ; Diagnosis ; Internet ; Korea ; Medical Informatics ; Multimedia ; Periodicals* ; Skin

Recently the change in medical informatics enabled us to use medical information whenever we want and wherever we are. There are many homepages on the web, which provide hospital information, medical counseling. Our multimedia center began its service as a internet Hospital in MIDAS Dongailbo, one of the major daily newspaper in Korea, on March 25th, 1997. The aim of this study is to examine the content and purpose of medical counseling on the web. The subjects consisted of 1,000 counsellings which were called 'Dongailbo Internet Hospital' for March, 25th, 1997 through October 30th, 1997. Many questioners wanted to know treatment principles, to make a diagnosis, and to know specific medical knowledges. The most common questions are as follows: general and unspecified, musculoskeletal, skin, digestive, respiratory, neurological problems.
Computer Communication Networks ; Counseling* ; Diagnosis ; Internet ; Korea ; Medical Informatics ; Multimedia ; Periodicals* ; Skin

The diffuse nodular lung lesion has a diagnostic problem and should be made differential diagnosis. A chest X-ray of 62-year-old male patient with dyspnea showed small-sized scattered multinodular lesion on entire lung field. Bronchoalveolar lavage and transbronchial needle aspiration showed the non-specific findings, so open lung biopsy was done and revealed bronchioloalveolar cell carcinoma.
Biopsy ; Bronchoalveolar Lavage ; Diagnosis, Differential ; Dyspnea ; Humans ; Lung Diseases* ; Lung* ; Male ; Middle Aged ; Needles ; Thorax

The authors report a case of interhemispherical fissure arachnoid cyst with agenesis of the corpus callosum who was 11-year-old child suffering from partial seizure. The interhemispheric area is a rather uncommon site for arachnoid cysts. Careful analysis of the anatomical and radiological features of this case seems to suggest that two morp-hologically distinct types of cysts occurred in the interhemispheric area; (1) Interhemispheric cyst associated with agenesis of the corpus callosum(2) parasagittal cyst, not associated with such an anomaly. The interhemispheric fissure arachnoid cyst occurs in the midline, straddling the falx, and extends about equally on either side, compressing the medial surface of both hemispheres. A coronal CT or MRI view shows a "batwing" appearance of the lateral horns and dorsal displacement of the third ventricle. It should be stressed that a histologically heterogenous group of cysts(ependymal, glial, choroid epithelial, and arachnoid) may give rise to this same morphologic appearance. The anterior interhemispheric approach was performed and removal of cystic membrane was achieved. Postoperatively, there was no focal neurological deficit.
Animals ; Arachnoid Cysts ; Arachnoid* ; Child ; Choroid ; Corpus Callosum* ; Horns ; Humans ; Magnetic Resonance Imaging ; Membranes ; Seizures ; Third Ventricle

Infantile myofibromatosis is a myofibroblastic tumor of childhood which preferentially arises in the dermis, subcutis, muscle, bone, and occasionally viscera. The disorder is usually divided into two forms, solitary and multicentric type, and the clinical course and prognosis are known to be excellent except case with visceral involvement. It is very unfamiliar in neurosurgical field. The authors present an unusual case of solitary infantile myofibromatosis occurring in right temporal bone in aafour-month-old female infant who underwent surgical excision and showed on excellent clinical course without any other adjuvant treatment. The authors propose that this disease entity should be included in differential diagnosis when neurosurgeons meet infant or child whose radiological appearance is similar to finding described.
Child ; Dermis ; Diagnosis, Differential ; Female ; Humans ; Infant ; Myofibroblasts ; Myofibromatosis* ; Prognosis ; Temporal Bone* ; Viscera

Aneurysms arising from the proximal segment(A1) of anterior cerebral artery are rare and not classified as a separate entity. This study reviewed clinical features of A1 aneurysms in four patients the authors experienced with analysis of neurological status, radiological findings, surgical management and outcome. The incidence of A1 aneurysms among 648 aneurysmal patients operated between January. 1995. and January 1998 was 0.6%. The cases were divided into two groups according to the location of aneurysm in the course of A1 segment: distal aneurysm of A1 segment arising near the anterior communicating artery(3 cases) and proximal aneurysm of A1 segment arising near the bifurcation of internal carotid artery(1 case). All three patients of distal aneurysm showed Hunt & Hess grade III-IV on admission and intraventricular hemorrhages in CT scan, on the other hand, one patient of proximal aneurysm showed Hunt & Hess grade II and no other hemorrhage except subarachnoid hemorrhage. In microsurgical fields, the domes of aneurysm of A1 segment directed superiorly in all cases, and in 2 cases of distal aneurysm, the domes were embedded within adjacent parenchyma of gyrus rectus. Distal fenestration of A1 segment which could not be detected in preoperative angiogram was found in 2 cases of distal aneurysm. The authors propose that aneurysms of A1 portion may tend to arise mainly at the distal portion of A1 segment and tend to be accompanied with distal fenestration, and also consider that, when outbreak of aneurysmal rupture, it may give rise to intraventricular hemorrhage through the frontal horn of lateral ventricle due to superior direction of aneurysm and tendency of embedding within brain parenchyma of gyrus rectus, and then it makes the patient worse than aneurysmal rupture of other common sites.
Aneurysm ; Animals ; Anterior Cerebral Artery* ; Brain ; Hand ; Hemorrhage ; Horns ; Humans ; Incidence ; Intracranial Aneurysm* ; Lateral Ventricles ; Rupture ; Subarachnoid Hemorrhage ; Tomography, X-Ray Computed