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

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

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

Thallium-201 SPECT studies were done on 32 patients with brain tumors : 20 patients with glioma, 3 patients with meningiomas, 2 patients with metarastasis, 2 patients with pineal tumors, 1 patient each with germinoma, neurinoma, neurocytoma, and 2 postradiation patients. A 201T1 index was based on the ratio of thallium uptake tumor versus the homologous contralateral brain. It was calculated and compared with tumor histology. There was a substantial uptake of 201T1 in high grade gliomas with no uptake in low grade glioma. Meningiomas and metastatic tumors show hot uptake, revealing that 201T1 uptake is not exclusive to high grade gliomas. In conclusion, 201TI SPECT could distinguish the benign and malignancy, and seems to be useful in the follow-up after treatment, to period low-or high-grade lesions.
Brain Neoplasms* ; Brain* ; Follow-Up Studies ; Germinoma ; Glioma ; Humans ; Meningioma ; Neurilemmoma ; Neurocytoma ; Pinealoma ; Thallium ; Tomography, Emission-Computed, Single-Photon*

Intracranial meningioma associated with cyst formation is unusual finding, which sometimes makes confusion in preoperative diagnosis. We experienced eleven cases of the cystic meningioma among 188 intracranial meningiomas who underwent operation from June 1989 to May 1993 at the Asan Medical Center. Clinical manifestations, findings of magnetic resonance imaging, preoperative diagnosis, and histopathology were analyzed. Among the 11 patients, the cyst of four were intratumoral type and seven were peritumoral type. There was no relationship between cyst formation and histological type of meningioma.
Chungcheongnam-do ; Diagnosis ; Humans ; Magnetic Resonance Imaging ; Meningioma*

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*

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