Brain stem hematomas, expecially due to ruptured angiographically occult vascular malformation(AOVM), are of great interest because they are potentially curable. Preoperative diagnosis has been difficult due to poor resolution of CT scans in the posterior fossa region. The advent of MRI has made the identification of the angiographically occult vascular malformation possible before surgical excision. We preset 3 cases of brainstem hematoma due to vascular malformations which wre not visualized by angiography but were diagnosted by MRI. The patients were treated surgically and vascular malformations were confirmed.
Angiography ; Brain Stem* ; Diagnosis ; Hematoma* ; Humans ; Magnetic Resonance Imaging ; Tomography, X-Ray Computed ; Vascular Malformations

Malignant CNS lymphoma is a malignant intracranial tumor and in most cases they run a fulminating course if left untreated, with 3 to 5 months survival after appearance of the initial symptoms. Sixteen patients with malignant lymphoma were treated in Asan Medical Center from 1989 to 1994. All patients were underwent tissue diagnosis with subtotal resection or stereotactic biopsy and followed by cranial or craniospinal irradiation with or without systemic chemotherapy. One and three year survival rate of the patients was 88% and 78% respectively. In conclusion, addition of chemotherapy and/or cranial radiation for treatment of the CNS lymphoma may improve survival.
Biopsy ; Chungcheongnam-do ; Craniospinal Irradiation ; Diagnosis ; Drug Therapy ; Humans ; Lymphoma* ; Survival Rate

The association of nephrotic syndrome with a hypercoagulable state and vascular thrombosis is well recognized. In all adult series of nephrotics, venous thrombosis are much more common than arterial thrombosis, which has been mainly reported in children. Intracoronary thrombus is among the rarest arterial thromboses. We present a case of acute myocardial infarction in a 39-year-old women with nephrotic syndrome secondary to membranous glomeluronephritis, in which subsequent coronary angiography showed no evidence of atherosclerotic change and thrombotic occlusion in the left main coronary artery which was successfully treated with intracoronary stent and intravenous abciximab.
Adult ; Child ; Coronary Angiography ; Coronary Vessels ; Female ; Glomerulonephritis, Membranous* ; Humans ; Myocardial Infarction ; Nephrotic Syndrome ; Stents* ; Thrombosis* ; Venous Thrombosis

Essential thrombocythemia, a subcategory of chronic myeloproliferative disorder, is characterized by absolute thrombocytosis due to excessive clonal proliferation of platelets, hyperaggregability of platelets and increased incidence of thrombosis and hemorrhage. Essential thrombocythemia may cause frequent vascular thrombosis, but it can be a rare cause of acute ischemic heart diseases such as acute myocardial infarction without atherosclerosis, unstable angina and angina pectoris. We report a case of essential thrombocythemia complicated by acute myocardial infarction. A patient with a previous history of vascular thrombotic complications (such as transient ischemic attack and deep vein thrombosis) was managed with 2.8 million units of intravenous urokinase, antiplatelet agent, ACEI, antianginal medications and hydroxyurea. There were clinically remarkable improvements and no further episodes of thrombotic ischemic vascular complications, including acute myocardial infarction.
Angina Pectoris ; Angina, Unstable ; Atherosclerosis ; Hemorrhage ; Humans ; Hydroxyurea ; Incidence ; Ischemic Attack, Transient ; Myeloproliferative Disorders ; Myocardial Infarction* ; Myocardial Ischemia ; Thrombocythemia, Essential* ; Thrombocytosis ; Thrombosis ; Urokinase-Type Plasminogen Activator ; Veins

In order to determine if there was an enhancing therapeutic effect of ACNU(1-4-amino-2-methyl-5-pyrimidinyl)-methyl-3-(2-chloroethyl)-3-nitrosourea hydrochloride, nimustine chloride given in addition to radiotherapy, we performed a randomized clinical study of irradiation alone and combination of irradiation with ACNU in the treatment of malignant gliomas. Thirty-seven patients who were treated in our hospital from August 1990 to September 1992 were included in this study. An effect was defined as a statistically improved survival times. Radiotherpy with a total dose of 5000 to 6500 rads was applied to the whole brain and to a generous field surrounding the tumor. Patients who were assigned to receive chemotherapy were given ACNU intravenously at a dose of 1-2mg/kg. The survival rates of patients with anaplastic astrocytoma and glioblastoma multiforme at 18 months after the surgery were 0% and 37% for radiotherapy alone, and 66.7% and 40.1% for radiotherapy plus ACNU, respectively. The median survival times of patients with anaplastic astrocytoma and glioblastoma multiforme were 14 and 15 months for radiotherapy alone, and 19 and 16 months for radiotherapy plus ACNU, respectively. The survival rates of patients with malignant gliomas(anaplastic astrocytoma plus glioblastoma multiforme) at 18 months were 5.5% for radiotherapy alone and 45.4% for radiotherapy plus ACNU, and the median survival times were 15 and 16 months, respectively, Althouh the survival rate of patients with malignant gliomas at initial 6 months was much higher in radiotherapy plus ACNU than in radiotherapy alone, the differences between survival curves were not significant at the p=0.05 level. This study demonstrated that, although the use of ACNU during radiotherapy suppressed malignant gliomas more than radiotherapy alone, the survival time was not extended significantly. It is necessary to continue to search for an effective chemotherapapeutic regimen to prolong survival of patients with malignant gliomas.
Astrocytoma ; Brain ; Drug Therapy* ; Glioblastoma ; Glioma* ; Humans ; Nimustine* ; Radiotherapy ; Survival Rate

Rathke's cleft cysts(RCCs) are classically described as benign epithelium-lined intrasellar cysts containing mucoid material. They are thought to orignate from remamants of the Rathke's pouch. These cysts are most frequently small and asymptomatic, and generally regarded as rare lesions. With the introduction of modern neuroimaging technology, they are being diagnosed much more frequently. We reviewed clinical, radiographic, and pathological findings in nine patients with symptomatic RCCs who were treated at out hospital from June 1989 to October 1994. The lesions were more often encountered in female than male patients, and the mean age at presentation was 25 years. The most common symptom and sign were headache, visual disturbance, and pituitary dysfunction. Two cysts were entirely intrasellar and seven had intra- and suprasellar components. Pre-enhanced CT scans revealed low dense or isodense lesions in five cases, and contrast-enhanced CT scans showed ring enhancement in two of five cases. MRI findings were varied with no characteristic pattern. Six patients underwent surgery by the transsphenoidal approach, and another three patients were treated by the transcranial approach. Partial excision and drainage of the cysts was most commonly performed, and there was no cyst recurrence. The cyst lining was usually composed of couboidal or columnar epithelium. Most symptoms and signs improved or resolved following surgery with the exception of hypopituitarism. Because of the relative safety and low recurrence rate, we think that partial excision and drainage of the cyst by the transsphenoidal approache is the treatment of choice.
Central Nervous System Cysts* ; Drainage ; Epithelium ; Female ; Headache ; Humans ; Hypopituitarism ; Magnetic Resonance Imaging ; Male ; Neuroimaging ; Recurrence ; Tomography, X-Ray Computed

A case of hemangioblastoma of the left lateral ventricle is presented. Only six other cases of the intraventricular hemangioblastoma have been reported. The literature on supratentorial intraventricular hemangioblastoma is reviewed.
Hemangioblastoma* ; Lateral Ventricles*

Asan Medical Center has installed the first Korean and Asian 201 Cobalt 60 sources gamma knife for stereotactic radiosurgery of intracranial tumors and arteriovenous malformations. The Unit became operational at the center on May 7, 1990. In the first 4 months of it's operation, we treated 69 patients. However the unit unfortunately became disabled from heavy flooding on September 11, 190. The new unit has been operational since May 6, 1991 and we have added 105 more patients to make a total of 174 patients(61 with arteriovenous malformations, 113 with brain tumors:23 with acoustic 174 patients(61 with arteriovenous malformations, 113 with brain tumors:23 with acoustic neurinomas, 19 with meningiomas, 15 with pituitary tumors, 13 with metastatic tumors, 9 with astrocytomas, 7 with angiographically occult vascular malformations, 6 with seizure disorders who had discrete areas of bliotic changes on neuroimaging studies and 6 with schwannomas. etc). With accumulated experience of more than 6000 patients world treated with the gamma knife unit and with our own experience obtained in a short period of time, it is accurate to say that the gamma knife radiosurgery offers innovative and effective means to treat various intracranial lesions for selected patients.
Acoustics ; Arteriovenous Malformations ; Asian Continental Ancestry Group ; Astrocytoma ; Brain ; Brain Neoplasms ; Chungcheongnam-do ; Cobalt ; Epilepsy ; Humans ; Korea* ; Meningioma ; Neurilemmoma ; Neuroimaging ; Neuroma, Acoustic ; Pituitary Neoplasms ; Radiosurgery* ; Vascular Malformations

Hypertensive cerebellar hemorrhage was rarely diagnosed in the past and therefore thought to be infrequent, but after the introduction of computerized tomography(CT) scans it has been more commonly diagnosed. We present 36 patients with hypertensive cerebellar hemorrhage who were treated in our hospital from June 1989 to January 1994. There were 15 men and 21 women, with ages ranging between 34 and 91 years. The volume of cerebellar hematoma and the grade of quadrigeminal cisternal obliteration on CT scans significantly correlated to the level of consciousness at admission. Several prognostic factors which might influence the outcome were statistically analysed:the level of consciousness at admission, the volume of hematoma, the treatment modality, the presence of hydrocephalus, the presence of quadrigeminal cisternal obliteration on CT scans, and the location of hematoma. Overall mortality rate was 13.9% and many of the above factors affected the outcome except for the treatment modality and the presence of hydrocephalus. The outcome in patients with GCS scores of 14 or 15 at admission was excellent. We conclude that the level of consciousness at admission is the most important prognostic factor and surgical decompression is indicated particularly in patients with an impaired level of consciousness, provided that brainstem reflexes are still intact. An accurate monitoring of the patient's clinical status is very important since its worsening is an absolute indication for surgery independent of the size of hematoma.
Brain Stem ; Consciousness ; Decompression, Surgical ; Female ; Hematoma ; Hemorrhage ; Humans ; Hydrocephalus ; Male ; Mortality ; Reflex ; Tomography, X-Ray Computed

In vitro studies have shown that the nonsteroidal antiestrogen tamoxifen can suppress deoxyribonucleic acid(DNA) synthesis and cell proliferation in cultured human gliomas. This growth suppression is independent on its antiestrogenic properties. Tamoxifen may act through the inhibition of the enzyme protein kinase C(PKC), which transduces mitogenic signals from the cell surface to the nucleus. In order to evaluate the therapeutic response and side effect of high-dose tamoxifen, we performed a clinical study of 28 patients with malignant gliomas who were treated with high-dose tamoxifen in our hospital between February 1991 and January 1993. An effect was defined as a statistically improved survival times/rates. In patients who were assigned to receive high-dose tamoxifen, it was first administered at standard antiestrogen doses(20mg orally bid/day) to observe for any side effect and if tolerated, the dose was increased weekly to achieve target doses(100mg orally bid/day) over a 1 month period. We compared the survival times/rates between anaplastic astrocytomas and glioblastoma mutiformes. Although the median survival time was slightly longer in anaplastic astrocytomas than that of glioblastoma multiformes, there was no statistical difference of survival curves between two groups at the p=0.05 level. We also examined the survival times/rates of malignant gliomas according to treatment modalities(radiotherapy alone, radiotherapy plus ACNU, and radiotherapy plus tamoxifen). Although the survival rate and time were slightly higher in radiotherapy plus tamoxifen group than those of another treatment groups, we could not find the statistical significance of survival curves between three treatment groups(p>0.05). High-dose oral tamoxifen appeared to be well tolerated in most patients. Five patients developed anorexia following dose escalation of tamoxifen. Another complications were amenorrhea, nausea/vomiting, and constipation. There were no changes in hematological studies that could be attributed to tamoxifen. We think that high-dose tamoxifen cah be administered safely to malignant gliomas patients. Our results were not impressive. We conclude that the definition of the true efficacy of high-dose tamoxifen in patients harboring malignant gliomas is not possible from this limited study, and a further large scale, randomized trial of this agent is necessary.
Amenorrhea ; Anorexia ; Astrocytoma ; Cell Proliferation ; Constipation ; Estrogen Receptor Modulators ; Female ; Glioblastoma ; Glioma* ; Humans ; Nimustine ; Protein Kinase C ; Protein Kinases ; Radiotherapy ; Survival Rate ; Tamoxifen*