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

The authors present surgical experience with 33 patients who had incurred unstable thoracic or lumbar spine pathology(22 degenerative lumbar spine disease, 6 trauma, 3 tumor, 2 vertebral tuberculosis) and who were intraoperatively stabilized with the Texas Scottish Rite-Hospital(TSRH) universal instrumentation system over 20 months period. The 11 men and 22 women(mean age 45 years, range 23 to 71 years) presenting with signs or symptoms of neural compression underwent surgery consisting of neural decompression, internal fixation, and bone grafting. Spondylolisthesis were fused in situ without reduction. For thoracic and thoracolumbar junction pathology, multisegment fixations were performed. A 95% fusion rate was obtained with a mean follow-up period of 15 months. There were no cases of instrumentation failure. Major postoperative complications included 2 isolated nerve root deficits(one transient, one permanent) and 3 pulmonary embolism(one fatal). The construct design of the TSRH system offers some advantag es compared to other forms of interal fixation:simple assembly, rigid stability, safety, and ability to remove easily. This system provides a highly successful method to obtain arthrodesis for unstable thoracic or lumbar spine.
Arthrodesis ; Bone Transplantation ; Decompression ; Follow-Up Studies ; Humans ; Male ; Pathology ; Postoperative Complications ; Spinal Fusion ; Spine* ; Spondylolisthesis ; Texas

The treatment of patients with spontaneous intracerebral hemorrhage remains a matter of debate in neurosurgery and neurology. We analyzed 203 patients with spontaneous intracerebral hematoma and compared the result of treatment between two groups:100 patients with stereotactic hematoma evacuation and 103 patients with conservative treatment. Evaluation of outcome was performed at discharge with Glasgow coma scale, motor deficit, Glasgow outcome scle. Stereotactic surgical patients with medium sized(20-50 cc) hematoma, which located in basal gaglia and thalamic area made a significantly better functional recovery than did patients with conservative treated group. Patients with relatively mild neurologic deficit preoperatively had better functional outcomes in the stereotactic surgical group. Stuporous or comatose patients had no better outcome after surgery, but showed a significantly lower mortality rate than conservative treated group. There was no significant difference in the outcome in relation to the timing of surgery, but rebleeding risk was high on early operated patients. Stereotactic surgery can minimized the brain damage and be performed under local anesthesia, so there was a trend toward better quality of survival and chance of survival in the operated group.
Anesthesia, Local ; Brain ; Cerebral Hemorrhage* ; Coma ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Hematoma ; Humans ; Mortality ; Neurologic Manifestations ; Neurology ; Neurosurgery ; Stupor

A case of cerebral glioma which was developed 5 years after brain irradiation for medulloblastoma is reported. The etiology and pathogenesis of human glioma are still unknown. The possible causal role of radiation therapy in inducing cerebral glioma is discussed on the basis of these observations.
Brain ; Child* ; Glioma* ; Humans ; Medulloblastoma

Paraclinoid aneurysms arose from the proximal internal carotid artery between the site of emergence of carotid artery from the roof of the cavernous sinus and posterior communicating artery. Surgery of these aneurysms presents special difficulties because of its complicated osseous, dura, and neurovascular structures;sella turcica, cavernous sinus, optic nerve. The clinical and radiological characteristics in twenty-seven patients with the paraclinoid aneurysms were reviewed and classified into four subgroups according to their branch of origin in this segment;1) carotid cave aneurysm(2 cases), 2) ophthalmic artery aneurysm(11 cases), 3) superior hypophyseal artery aneurysm(11 cases), 4) proximal posterior carotid artery wall aneurysm or global type aneurysm(3 cases). Surgery required orbital unroofing and removal of anterior clinid process with release of dural ring. To provide easy proximal control, exposure of cervical carotid artery was helpful in some cases. Preoperative balloon occlusion testing was man datory. Outcomes were considered as good to fair in 19 patients, poor in five, and three patients died. The patients who had poor results were poor preoperative status-four were grade IV, one was grade II(Hunt-Hess grade). The causes of death were premature rupture(2 cases) and extensive vasospasm(1 case). Preoperative classification of these lesions provides excellent correlation of operative findings and surgical preparation to expose the proximal part of internal carotid artery.
Aneurysm* ; Arteries ; Balloon Occlusion ; Carotid Arteries ; Carotid Artery, Internal ; Cause of Death ; Cavernous Sinus ; Classification* ; Humans ; Ophthalmic Artery ; Optic Nerve ; Orbit

BACKGROUND AND PURPOSE: Although thrombolytic strategies with streptokinase(STK) and tissue-type plasminogen activator(t-PA) in the treatment of acute myocardial infarction(AMI) have been studied in large-scale clinical trials in the western countries, such large-scale studies with urokinase(UK) are scanty. Even though UK is most commonly used thrombolytic agent for the treatment of AMI in Korea, there is no consensus on the dosage and the way of administration of UK in patients with AMI. Accordingly, a prospective clinical study was performed to evaluate the effects of thrombolytic strategies of intravenous double bolus method and standard double-infusion method with different dosage of UK in the treatment of AMI. SUBJECTS AND METHODS: Ninety there patients with AMI(male 75, female 18, age 57.5+/-10.8 years) were studied. The patients were divided into 3 groups according to dosage of UK and method of administration. Group I : 19 patients who received 1.5 million U of UK IV bolus, followed by 1.5 million U IV infusion for an hour(High Dose Group). Group II : 34 patients received 20,000U/kg body weight of UK IV bolus, followed by 20,000U/kg IV infusion for an hour(Double Dose Group). Group III : 40 patients received 1.5 million U of UK IV bolus and followed by 20,000U/kg IV bolus in 30 minutes with total dose of no more than 3 million U(Double Bolus Group). Coronary angiography(CAG) and left ventriculography(LVG) were performed 90 minutes after the administration of UK and post-AMI 7-10 days to investigate the patency of infarct-related artery(IRA) and LV function. Patency of IRA was graded according to the extent of flow of IRA. TIMI grade 0-1 was regarded as occluded, and grade 2-3 flow as patent. LV ejection fraction(EF) by echocardiography was measured on day 1, day 7-10 and 1 month after AMI. Indirect clinical parameters of thrombolysis were evaluated and were compared with CAG findings. RESULTS: 1) The 90 minutes IRA patency in Group III(Double bolus ; 79.0%) was higher than that in Group 1, but showed no statistically significant difference(High dose ; 61.5%, p=0.790). The 90 minutes IRA patency in Group III showed borderline significance with Group II(Double dose ; 57.1%, p=0.057). TIMI flow III in Group III(60.6%) was significantly higher than that in Group II(53.6%, p=0.0468) but showed no statistically significant difference with Group I(61.5%, p=0.158). 2) The EF by LVG were 49.1% in Group I, 41.7% in Group II and 49.2% in Group III. The difference in EF between Group I and Group III vs Group II was significant(p=0.008 in Group I, p=0.014 in Group III vs Group II). 3) Fatal bleeding complications(1 intracranial hemorrhage and 1 gastric ulcer bleeding) developed in Group II (Double dose). 4) Pain to door time, pain to needle time and door to needle time tended to be shorter in open(TIMI flow II-III) IRA group than in closed IRA group. 5) Initial EF were similar between open IRA group and closed IRA group(46.1% and 42.1% ; p=NS). The EF of open IRA group measured by LVG on initail coronary angiography(41.8% in closed IRA vs 48.0%, in open IRA, p=0.03) and by 2D-Echo on 7-10 day(41.7% in closed IRA vs 51.0% in open IRA, p=0.004) were better than those of closed IRA group. 6) Indirect clinical indices of reperfusion such as mean CPK peak, time to CPK peak significantly lower in open IRA group than in closed IRA group. 7) Fatal bleeding complications(1 intacranial hemorrhage and 1 gastric ulcer bleeding) developed in closed IRA group. CONCLUSION: The findings we observed in this trial showed that earlier initiation and more rapid infusion of UK were associated with more increased 90min patency of infarct-related artery and more improved LV function without any obviously increased bleeding complications or other serious life-threatening complications than conventional UK therapy. Specifically, double bolus IV injection of UK(1.5 million U bolus followed by 20,000 U/Kg bolus in 30min)was more effective method of thrombolysis than conventional method for achieving optimal reperfusion in AMI patients. Also, IRA patency at 90 minutes after the initiation of thrombolysis was important in preserving global LV function in early recovery phase of AMI. Further trials may be needed to determine more effective thrombolysis with UK in AMI.
Arteries ; Body Weight ; Consensus ; Echocardiography ; Female ; Hemorrhage ; Humans ; Intracranial Hemorrhages ; Korea ; Myocardial Infarction* ; Needles ; Plasminogen ; Prospective Studies ; Reperfusion ; Stomach Ulcer ; Urokinase-Type Plasminogen Activator*

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*