Chronic subdural hematoma (SDH) is a common condition encountered in neurosurgical practice; however, its pathogenesis remains controversial.Current Concepts: SDH refers to blood accumulation inside the dura and is classified into acute, subacute, and chronic types. Histopathologically, acute SDH shows no neomembrane formation and the hematoma is a clot, in contrast to chronic SDH characterized by a neomembrane surrounding the liquefied hematoma. SDH is usually categorized into acute and chronic types, with subacute SDH being more similar to chronic SDH. Posttraumatic subdural lesions include acute and chronic SDH, subdural hygroma (SDG), or effusion. SDG is a blood-tinged fluid accompanied by neomembrane formation in some cases. These lesions are pathologically different from each other but may change depending on the situation.Discussion and Conclusion: Chronic SDH mainly originates from an SDG and acute SDH. SDG is usually triggered by trauma but only occurs in patients in whom sufficient potential space is available and may occur spontaneously in such cases. Therefore, SDG frequently occurs in children and in elderly patients, in men with a larger skull size, and on the left side of the body, which usually shows a wider hemisphere. Separation of the dural border cell layer causes inflammation, indicated by fibroblast proliferation and neovascularization. Conversion of an SDG into a chronic SDH or enlargement of a chronic SDH is attributable to formation of neomembranes, neovascularization, and repeated microhemorrhages from fragile capillaries. Chronic SDH is treated with removal of the hematoma to relieve the mass effect and embolization of the feeding artery for the bleeder. Outcomes of chronic SDH depend on the absorptive-expansion capacity dynamics.

No abstract available.
Fatigue* ; Sciatica*

No abstract available.

We report a case of cerebral lymphomatoid granulomatosis in a 50-year-old man. Lymphomatoid granulomatosis is an unusual condition which usually presents as a pulmonary manifestation, which occasionally affects the brain, and causes focal inflammatory lesions. Primary cerebral lymphomatoid granulomatosis is very rare. We describe a case of lymphomatoid granulomatosis in the left frontal lobe without pulmonary involvement.
Brain ; Frontal Lobe* ; Humans ; Lymphomatoid Granulomatosis* ; Middle Aged

We present a study on the systemic insults in the early death(within one week) after head injury. The patient population consisted of 192 patients who were admitted to the Soonchunhyang University Chonan Hospital from August 1986 to May 1990 after head injury. We collected clinical features and systemic insults including blood pressure, arterial pH, PaO2, PaCO2, hematocrit, and serum concentration of Na, retrospectively. The most common cause of injury was road traffic accident(77.6%). More than half(57.8%) were under the age of 40 years. The interval from injury to admission was within one hour in 63.2%, and within four hours in 91.4%. The mean interval was 1.8 hours. However, in 154(80.2%) patients, we found the evidence of systemic insults on admission. We found hypotension(ststolic less than 90mmHg) in 22.9%, acidemia(pH<7.35) in 71.3%, arterial hypoxemia(PaO2<60mmHg) in 42.7%, hypercarbia(PaCO2>45mmHg) in 28.7%, anemia(hematocrit<30%) in 13.0%, hyponatremia(Na<135mEq/L) in 10.7%, and hypernatremia(Na>145mEq/L) in 11.2%. These results imply that the prehospital emergency care system useful at the scene of accident and during the transportation is more important than the simple quick-transport-system.
Arterial Pressure ; Chungcheongnam-do ; Craniocerebral Trauma* ; Emergency Medical Services ; Head* ; Hematocrit ; Humans ; Hydrogen-Ion Concentration ; Retrospective Studies ; Transportation

To determine the incidence rate of accidents and its associated factors, a prospective survey was carried out in a rural area of a total of 1,360 residents for 1 year from January 1 to December 31, 1988 in Shin-am Ri, Jungdong Myun, Sangju Kun, Kyeongpook Province. Data for accidents were collected by the community health practitioner who is working at Primary Health Post in Shin-am Ri. A total number of accident cases was 85 among 1,360 persons during one year study period, and annual incidence rate was 62.5 per 1,000 persons. The highest incidence rate of accident was observed in the age group of 30-39 was 179.8. The incidence rate of accident in male was 86.5 which was about 2 times that in female. In male, the highest incidence rate was seen in 30-39 age group and in female, 60-69 age group. The highest incidence rate of accident was observed in spring (29.4%) and summer (29.4%), and the lowest in fall (17.7%). The highest incidence rate of accident was observed in Friday (24.5%) by day of week, and between 9 a.m. to 12 a.m. by time zone. The most frequent use of medical facilities was Primary Health Post (51.8%) and the next was clinic (38.8%). Mean duration of treatment was 9.8 days. The accident occurred in the room and kitchen (23.5%), in the yard and barn (23.5%), on the road (22.4%), and in the rice field and dry field (20.0%). The causes of accident were motor vehicle accident (20.0%), piercing or cutting (20.0%), collision or fighting (12.9%), and poisoning (11.8%) in order of frequency. The most common type of injury was open wound which was 43.5%. The most common tool of accident was farm machine which was 23.5%. The most common injured part of body was extremity 55.3%.
Agriculture ; Extremities ; Female ; Gyeongsangbuk-do ; Humans ; Incidence ; Male ; Motor Vehicles ; Poisoning ; Prospective Studies ; Wounds and Injuries

Systematic and effective means for promoting and protecting the welfare of the disabled requires reliable criteria that accurately demonstrate the presence and measure the severity of the disability. Given the same disability, however, the degree of that disability may measure differently according to the particular criteria used in Korea. In addition to inconsistency, the varying set of criteria has resulted in significant diagnostic errors, fraud, and malingers, leading to overall distrust and dissatisfaction. Accurate disability evaluation is the key for the welfare for the disabled. Evaluation of the physical impairment is possible only by the medical doctors. Doctors should know the concept, purpose, and methods of disability evaluation.
Diagnostic Errors ; Disability Evaluation ; Fraud ; Korea ; Public Health ; Social Welfare ; Workers' Compensation

Head injury is a leading cause of death and disability in Korea. It usually results from an avoidable accident. Epidemiologic data on the head injury is important for the effective reduction of this controllable disaster. The aim of this study is to estimate the incidence of head injury in Korea. Data on the incidence of the traffic accidents were collected from Traffic Accident Statistics 1998 by the National Police Agency. Proportion of head injuries due to traffic accidents was obtained from various literatures. The incidence of head injury was approximated simply by a formula H=T/0.625 [the total number of patients after traffic accidents (T) would be 62.5% of the total number of patients with head injury (H)]. In 1998, the estimated number of head injury was 109,462. The annual incidence was 236/100,000 person, 334/100,000 for males and 136/100,000 for females. The causes were road traffic accident in 62.5%, and falls in 15.6%. The operation was performed in 20.2% with a mortality of 4.0% in average. Case fatality rate was 8.2%. Annual death rate was 19/100,000 population. A public campaign is required on the basis of trustworthy epidemiologic data to reduce the incidence of head injury for the public health.
Accidents, Traffic/*statistics & numerical data ; Craniocerebral Trauma/*epidemiology ; Female ; Human ; Incidence ; Korea/epidemiology ; Male

Hepatitis E was formerly caused enterically-transmitted, waterborne, or fecal-oral non-A, non-B hepatitis. Hepatitis E has its highest care-fatality rates in pregnant women. The study was undertaken with the objection of searching the Anti-HEV(IgG) positive rate in Kyeong Ju, Korea. A total of 500 pregnant women who visited the antenatal clinic were selected during the period from November, 1993 to June, 1994 at the department of Obstetrics and Gynecology, Kyeong Ju hospital, Dongguk university and taken the test for IgG anti-HEV with ELISA kit. The positive rate of IgG anti-HEV was 2.8%. So we recommanded that anti-HEV is included in addition to HBsAg and ALT in prenatal screening tests for pregnant women, who have had clinical history of hepatitis.
Enzyme-Linked Immunosorbent Assay ; Female ; Gyeongsangbuk-do* ; Gynecology ; Hepatitis ; Hepatitis B Surface Antigens ; Hepatitis E ; Humans ; Immunoglobulin G ; Korea ; Obstetrics ; Pregnant Women* ; Prenatal Diagnosis

Trephination or trepanation is an intentional surgical procedure performed from the Stone Age. It looks like escaping a black evil from the head. This technique is still used for treatment of chronic subdural hematoma (SDH). Now, we know the origin, pathogenesis and natural history of this lesion. The author try to explore the history of trephination and modern discovery of chronic SDH. The author performed a detailed electronic search of PubMed. By the key word of chronic SDH, 2,593 articles were found without language restriction in May 2015. The author reviewed the fact and way, discovering the present knowledge on the chronic SDH. The first authentic report of chronic SDH was that of Wepfer in 1657. Chronic SDH was regarded as a stroke in 17th century. It was changed as an inflammatory disease in 19th century by Virchow, and became a traumatic lesion in 20th century. However, trauma is not necessary in many cases of chronic SDHs. The more important prerequisite is sufficient potential subdural space, degeneration of the brain. Modifying Virchow's description, chronic SDH is sometimes traumatic, but most often caused by severe degeneration of the brain. From Wepfer's first description, nearly 350 years passed to explore the origin, pathogenesis, and fate of chronic SDH. The nature of the black evil in the head of the Stone Age is uncovering by many authors riding the giant's shoulder. Chronic SDH should be categorized as a degenerative lesion instead of a traumatic lesion.
Aging ; Brain ; Craniocerebral Trauma ; Head ; Hematoma, Subdural, Chronic* ; Natural History ; Shoulder ; Stroke ; Subdural Space ; Trephining ; United Nations