Computed tomography(CT) has enabled early recognition and treatment of focal injuries in patients with head trauma. However, CT has been less beneficial in identifying diffuse brain injury(DBI). The authors have analyzed retrospectively, a series of 132 patients with OBI observed for 2 years from Aug. 1986 to Jul. 1988 to evaluate the significance of the factors affecting outcome. Eighty-three patients were selected as being compatible with moderate and severe diffuse axonal injury(DAI) classified by Gennarelli, defined by coma without a CT lesion that is an obvious cause and coma greater than 24 hr with or without decerebration. The results are summarized as follows: 1) The 38(45.7%) out of 83 patients were found below age of 20, but there was no statistical significance between age distribution and outcome. 2) In case of initial Glasgow coma scale(GCS) of 7 or 8, 32(86.5%) out of 37 patients revealed good outcome, but 18(90%) of 20 patients with a score of 3 or 4 revealed poor outcome(p<0.01). 3) With regard to brain swelling in CT, there was significant statistical difference to outcome(p<0.05). 4) Small hemorrhages on corpus callosum, basal ganglia, basal cistern, peritentorial, lateral ventricle that is characteristic CT findings for DAI were showed 58(70%) out of all cases. It might be concluded that initial GCS, brain swelling and small hemorrhages in CT were significant factors affecting outcome in DAI.
Age Distribution ; Axons ; Basal Ganglia ; Brain ; Brain Edema ; Brain Injuries* ; Coma ; Corpus Callosum ; Craniocerebral Trauma ; Diffuse Axonal Injury ; Hemorrhage ; Humans ; Lateral Ventricles ; Retrospective Studies ; Tomography, X-Ray Computed

No abstract available.
Hematoma*

Neuroblastoma originate in neural crest and is one of the most frequent tumor next to leukemia and brain tumor in child. The tumor is most highly malignant tumor due to early metastasis at diagnosis. It could be diagnosed by various diagnostic modalities such as roentgenologic examination, laboratory data and confirmed by pathologic diagnosis. Management of neuroblastoma is surgery, radiotherapy and chemotherapy. We experienced a case of adrenal neuroblastoma at age of 20-month male child and report with a brief review of literature
Adrenal Glands ; Brain Neoplasms ; Child ; Diagnosis ; Drug Therapy ; Humans ; Leukemia ; Male ; Neoplasm Metastasis ; Neural Crest ; Neuroblastoma* ; Radiotherapy

No abstract available.
Bronchiolitis*

Cortical dysplasia(CD) is recently known as a cause of intractable partial epilepsies that are amenable to surgical treatment. The development of new neuroimaging has facilitated the recognition of these neuronal migration disorders. Here we examine some clinical features that permit early suspicion of focal cortical dysplasia and better surgical results. From a consecutive surgical series of 239 patients with intractable epilepsy since 1992, pathologically verified 31 CD including 6 CD with dysembryoplastic neuroepithelial tumor(DNT) were selected for this study. The location and extent of resection were determined by both epileptogenic zones and the structural lesion, according to presurgical evaluation(neuroimaging, EEG, intracranial recording), intraoperative electrocorticography(ECoG) and functional brain mapping. The series consisted of 21 men and 10 women with ages at seizure onset ranging from 1 to 26 years(mean 11.1year). The duration of the epilepsy prior to surgery ranged from 3 to 30 years(mean 14.3). The CD was verified in 17(11.1%) of 153 cases with temporal lobe epilepsy and 8(16.6%) of 48 cases with extratemporal epilepsy, mainly peri-Rolandic area. The lesion location of CD with DNT were temporal(4 cases) and extratemporal(2 cases). The histology of the surgical specimens showed cortical dyslamination in 26 patients, additional dysplastic neurons in 2 patients, and additional balloon cells in 3 patients. Excellent and good clinical results were achieved in 29 cases. CD should be suspected when intractable partial epilepsy occur in children. Careful investigation of neuroimaging techniques with high resolution MRI and sophisticated presurgical and intraoperative tailoring is essential for better outcome with identification of CD.
Brain Mapping ; Child ; Electroencephalography ; Epilepsies, Partial ; Epilepsy* ; Epilepsy, Temporal Lobe ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Malformations of Cortical Development* ; Neuroimaging ; Neuronal Migration Disorders ; Neurons ; Seizures

No abstract available.
Child* ; Colon* ; Humans ; Mucins*

No abstract available.
Aneurysm ; Arteriovenous Malformations* ; Brain* ; Intracranial Aneurysm*

In order to obtain more accurate pathological diagosis of the angiographically occult vascular malformations(AOVM) of the brain in the future and to examine the clinical, and radiological characteristics and management outcome of the AOVM, the authors retrospectively reviewed the 30 cases of AOVM in which patients were treated at our instituition during the past 11-year period. The pathological specimens were reexamined, and the lesions were reclassified according to the strict histopathological criteria. The clinical characteristics, radiological features, the difference between the clinical and pathological diagnosis and the management results were studied. There were 15 males and 15 females. The mean age at the time of diagnosis was 31 years, ranging from 3 months to 74 years. The clinical diagnosis were arteriovenous malformation(AVM) in 18 cases, cavernous angioma in 11 and mixed lesion in 1. The pathologic diagnosis was AVM in 14 cases, cavernous angioma in 2, and unclassified lesion in 12. The common presenting symptoms were hemorrhage(53.3%), seizure(20.0%) and mass lesions(20.0%). Twenty four lesions were located at the supratentorial region, 4 at cerebellum and 2 at pons. Most of the lesions were revealed as high density masses with minimal or no contrast enhancement on CT and a core of mixed signal intensity with a peripheral low signal intensity rim on T2-weight MRI. Preoperative clinically significant recurrent hemorrhages were noted in 8 cases and one of them showed marked deterioration of the neurological functions a result of recurrent hemorrhage. Twenty-eight patients underwent surgery and all except one improved neurologically. Six patients initially presented with seizure showed improvement in seizure frequency after operation. One patient who had the lesion at the pons was managed by a radiosurgery and one patient who refused surgery was managed by a conservative method. The conservatively managed patient and another patient who was not found AVM at the hematoma cavity during initial operation rebled about 2 years later following diagnosis and surgery. Thse findings suggest that the complete microsurgical excision, which prevents rebleeding and suppresses seizure activity, represents the treatment of choice for patients with clinically symptomatic AOVM. Avoiding the injury of the vascular mass, obtaining sufficient biopsy specimen during surgery, together with careful histopathological observation of operative specimens through complete clinical-radiological-pathological context are necessary to obtain more accurate pathological diagnosis.
Arteriovenous Malformations ; Biopsy ; Brain ; Cerebellum ; Diagnosis ; Female ; Hemangioma, Cavernous ; Hematoma ; Hemorrhage ; Humans ; Magnetic Resonance Imaging ; Male ; Pathology ; Pons ; Radiosurgery ; Retrospective Studies ; Seizures ; Vascular Malformations*

During the eleven months from September, 1989 to July, 1990, a total of 118 subarachnoid hemorrhage(SAH) patients were admitted. Among these, in 2 cases, the etiology was unknown and another 8 cases of Hunt & Hess clinical grade V patients died in the emergency room or intensive care unit within 24 hours after admission. The remaning 108 cases were managed with protocol as follows. 1) Surgery was done within 9 days after the SAH(total 67 cases) : Extraventricular drainage(EVD) was performed and a cisternal drainage(CD) catheter was positioned during surgery. EVD, CD nimodipine irrigation(0.4mg) through the CD catheter, and intravenous injection(IV) of nimodipine(1~2mg/hr)continued for 13days after the SAH. 2) Surgery was done after the 9th SAH day due to late transfer neurology or other hospitals or posterior circulation aneurysms(32 cases), and 9 cases refused surgery : Nimodipine was used orally(240mg/day) in 35 cases and an IV route(1~2mg/hr) in 6 cases. Total management outcome and results were obtained as follows. 1) A total unsatisfactory management outcome was 18.52%(serve disabled : 4.63%, vegetative : 0.93%, death : 12.96%. In the surgical cases only, 40.8%, 1.02%, 9.19%, respectively). 2) An unsatisfactory surgical outcome in cases following surgery after the 9th SAH day was 6.24%(severe disabled : 3.12%, death : 3.12%). 3) An unsatisfactory management outcome in cases of admission grades I & II following surgery within the 9th SAH day or those non-surgical patients was 19.15%(severe disabled : 4.25%, death : 14.89%. In surgical cases only 2.33%, 9.30%, respectively). 4) An unsatisfactory management outcome in cases of admission grades III & IV with surgery within the 9th SAH day or non-surgical patients was 29.63%(severe disabled : 7.41%, vegetative : 3.70%. death : 18.52%. In surgical cases only 9.09%, 4.55%, 13.64%, respectively). One case of admission grade V died. 5) Causes of unsatisfactory outcome were vasospasm : 9 cases(8.33%), SAH itself : 4 cases, rebleeding : 3 cases, surgical complication : 1 case, medical complication : 1 case, anesthesia : 1 case, and head trauma : 1 case. 6) Complications in management protocol with EVD, CD, CD nimodipine irrigation, and IV of nimodipine were transient hypotension(1 case) and meningitis(5 cases). These complications were improved without sequelae with discontinuing the IV of nimodipine and using antibiotics. We concluded that this protocol may improved the total management outcome of aneurysmal SAH patients, especially poor grade patients(Hunt & Hess grade III & IV) without significant complications. However, in spite of this protocol, the leading cause of an unsatisfactory outcome is vasospasm.
Anesthesia ; Aneurysm ; Anti-Bacterial Agents ; Catheters ; Craniocerebral Trauma ; Drainage* ; Emergency Service, Hospital ; Humans ; Intensive Care Units ; Intracranial Aneurysm* ; Neurology ; Nimodipine*

This study was carried out to identify synaptic reorganization by mossy fibers of epileptic dentate gyrus by Timm sulphide silver histochemistry and to investigate degree of synaptic reorganization according to both hippocampal sclerosis and epileptiform discharge in human temporal lobe epilepsy(TLE). The control group was composed of two hippocampal tissues obtained from autopsied brain without neurological abnormalities. TLE group was composed of thirteen hippocampal tissues obtained from surgically resected temporal lobe. Among thirteen hippocampal tissues, five specimens were obtained both of two areas of each hippocampus with or without prominent epileptiform discharges on electrocorticogram(ECoG) for tailored hippocampal resection. Hippocampal cell density was quantitatively analyzed in TLE group and compared with that of control group. A portion of hippocampal tissue was observed under light microscopic and transmission electron microscopes after development with Danscher method. The results were as follows : Hippocampal cell loss was noted in all TLE group. Hippocampal cell loss greater than 30% of control values was found in 12 cases and average hippocampal cell loss was 70%(range 39-88%). The remaining 1 case had 13% hippocampal cell loss. The supragranular Timm granules were noted in inner molecular layer of dentate gyrus and tended to significantly increase in proportion as severity of hippocampal sclerosis. Average of hippocampal cell loss in two areas of five hippocampal tissues with or without prominent epileptiform discharge on ECoG was 73.6%(range 53-90%) and 66.4%(range 50-86%), which showed statistically significant (p<0.05) difference between these two areas and the supragranular Timm granules also tended to increase in the hippocampal tissue with epileptiform discharge. On transmission electron microscope, there showed distinct supragranular Timm granules correspond to mossy fiber synaptic terminals. The results of this study demonstrated that mossy fiber synaptic reorganization seems to play a major role in pathogenesis of human TLE and the development of mossy fiber synaptic reorganization is closely related to severity of hippocampal sclerosis. The result also support the rationale for tailoring the extent of hippocampal resection by intraoperative acute recording(ECoG) according to individual pathophysiology.
Brain ; Cell Count ; Dentate Gyrus* ; Epilepsy, Temporal Lobe* ; Hippocampus ; Humans ; Presynaptic Terminals ; Sclerosis* ; Silver ; Temporal Lobe*