We report a rare case of brain abscess associated with intracerebral hematoma in a child at the age of 3. A 3 years old female child has been suffered from the cellulites with pustule on her right leg since 3 weeks before, which has aggravated gradually, and developed acute bacterial meningitis for 2 weeks before transfer to Department of Neurosurgery. The acute bacterial meningitis has been treated for 2 weeks in Pediatric Department. The brain CT revealed a small brain abscesses in the occipital region bilaterally. With methicillin, the clinical progress including C.S.F. findings has got improvement, which has been almost complete. We found the staphylococcus from the pustule on her right leg by smear and culture. At that time, 3 weeks since the onset, suddenly vomiting, consciousness change(drowsy to semicomatose), left hemiparesis developed. Immediate brain CT revealed multiple abscess in both occipital poles with bulky intracerrebral hematoma in right perietooccipital region. Immediate craniectomy was performed for removal of intracranial hematoma, which was ca 50cc in amount, at first, and bilateral trephination with aspiration and drainage for the multiple brain abscess at second. The postoperative course was satisfactory with mannitolization and antibiotic treatment. The recovery was dramatic one.
Abscess ; Brain Abscess* ; Brain* ; Child* ; Child, Preschool ; Consciousness ; Drainage ; Female ; Hematoma* ; Humans ; Leg ; Mannitol ; Meningitis, Bacterial ; Methicillin ; Neurosurgery ; Paresis ; Staphylococcus ; Trephining ; Vomiting

The intramedullary glioma of spinal cord has occupied 22.5% of intraspinal neoplasm, and is the most common among the intramedullary spinal cord tumor, and the first successful operative removal was performed in 1907 by Elsberg. The intramedullary astrocytoma has frequent incidence in the thoracic and cervical region of the spinal cord, which has more frequent grade I astrocytoma. We experienced a case of intramedullary grade II astrocytoma of the thoracolumbar region which has associated a paraplegia as neurological deficit. A 26 year old Korean female has admitted to our clinic because of paraplegia with incontinence for 2 years. On admission, the neurological examination revealed a paraparesis below T12 level with urinary and fecal incontinence and then local tenderness from T10 to L1 level. The simple X-ray film of the thracolumbar spine has showed erosion of both pedicle, widening of interpeduncular distance and scalloping change of posterior vertebral margin from T12 to L1, which were similar to the picture of intramedullary spinal cord tumor. We performed a myelography by pantopaque through the lumbar and cisternal puncture for accurate site of lesion, and found a complete block at L1 level and T10 level on myelogram. Then the immediate total laminectomy from T8 to L1 was applied. The operative finding was a intramedullary mass with cystic fluid, which has compressed the spinal cord. After aspiration of cystic fluid, we removed the tumor mass incompletely because of intermingling with spinal cord but the decompression was enough. The neurological defict was improved gradually for post-operative 4 weeks, thereafter improvement was stopped and remained the paraparesis. The post-operative pathological diagnosis was grade II astrocytoma, which composed of anaplastic cell and radiotherapy has followed.
Adult ; Astrocytoma* ; Decompression ; Diagnosis ; Fecal Incontinence ; Female ; Glioma ; Humans ; Incidence ; Iophendylate ; Laminectomy ; Myelography ; Neurologic Examination ; Paraparesis ; Paraplegia ; Pectinidae ; Punctures ; Radiotherapy ; Spinal Cord Neoplasms ; Spinal Cord* ; Spine ; X-Ray Film

Nerve-root anomalies are very uncommon, and there symptoms and signs are nearly similar with those of disc herniation. So we can misdiagnois them for intervertebral disc herniation. The negative Lasegue' sign is the only distinct feature of the nerve root anomalies. The authors report a case of Nerve-Root Anomaly associated with disc herniation in lumbar 4-5 interspace, which was diagnosed preoperatively in myelogram and confirmed surgically.
Intervertebral Disc*

Storch is credited as being the first to describe in 1899 what we call "ependymoma" today. And ependymomas were first set apart as a single group by Bailey in 1924. The literature up to the present contains numerous reports of tumors classified as "ependymoma". From 1 to 6 percent of all intracranial tumors are ependymomas. As the above, the tumors are very rare. The incidence is higher in those with large proportion of young patients and average age is approximately 20 years. About 40 percent of intracranial ependymomas are supratentorial and the remainders are infratentorial. We experienced a case of 4th ventricular ependymoma with subarachnoid hemorrhage. A 23 year old female was admitted to the hospital because of severe headache and frequent vomiting, who had been intermittently suffered from the headache for 8 months prior to admission. On admission, the neurologic examinations revealed irritable mentality, vomiting and papilledema, and xanthochromic CSF was identified on lumbar puncture. X-ray films of skull series showed evidence of increased ICP. A mass lesion was suspected in the posterior fossa on vertebral angiogram and brain C-T films revealed a mass lesion in the midline of the posterior fossa, slightly enhanced on contrast study and associated with hydrocephalus. Following Torkildsen's shunting procedure suboccipital craniectomy was performed, and we removed the tumor mass incompletely within the 4th ventricle. The pathologically microscopic finding was papillary ependymoma, grade II. Total neuraxis irradiation was applied for 6 weeks. The post-operative course was satisfactory.
Brain ; Ependymoma* ; Female ; Headache ; Humans ; Hydrocephalus ; Incidence ; Neurologic Examination ; Papilledema ; Skull ; Spinal Puncture ; Subarachnoid Hemorrhage ; Vomiting ; X-Ray Film ; Young Adult

Primitive neuroectodermal tumors(PNETs) may be a term established recently for a tumor group(?) which is composed of prominent undifferentiated cells with variable foci of differentiation along glial and neuronal lines. The authors experienced a case of 'primitive glioma' regarded as a subclass of PNETs, in a 14 year old boy who had suffered from headache and vomiting for about 40 days prior to admission. Brain CT and angiographic studies reveal a huge hypovascular mass lesion with multiple cysts in the left frontal lobe. The patient was satisfactorily treated by total tumor excision and following irradiation, and is now in follow up. We present the case with review of the literatures.
Adolescent ; Brain ; Follow-Up Studies ; Frontal Lobe ; Headache ; Humans ; Male ; Neural Plate ; Neuroectodermal Tumors, Primitive* ; Neurons ; Vomiting

Intracranial calcification is relatively common, but calcification of chronic subdural hematoma is rare condition. Nevertheless, already in 1884 Von Rokitansky had described a calcified chronic subdural hematoma found at autopsy. Subsequently Lewis(1889), Elsner(1896), and O'sullivan(1925) mentioned calcification of intracranial hematoma. In 1930, Goldham reported the first case treated by operation. A 15-year-old Korean male was admitted to this hospital because of a episode of generalized epileptic seizure, one day before admission. Past history was unknown about head injury and his past birth condition. Patient has complained weakness of right upper and lower extremely since his infant. Neurological examination revealed the left hemiparesis, but others were normal. Skull X-ray films showed dense conglomerated calcific density with surrounding rim like lucency in left fronto-parietal region. Left carotid angiogram revealed no abnormalities except hypoplasia of left hemisphere. Brain computed tomogram demonstrated hyperdense subdural mass surrounding decreased parenchymal density in left fronto-parietal region. A craniectomy was performed for removal of the calcified mass. A oval concaved bony hard mass was found in subdural space. The calcified bony hard mass was adherent with the surface of cortex by loose sonnective tissue. We removed the bony hard mass completely. The postoperative course was very satisfactory and seizure has not been appeared after discharge. Microscopic findings demonstrated ossification and fibrosis, consisting with old hematoma which showed up a calcification of chronic subdural hematoma.
Adolescent ; Autopsy ; Brain ; Child* ; Craniocerebral Trauma ; Epilepsy ; Fibrosis ; Hematoma ; Hematoma, Subdural, Chronic* ; Humans ; Infant ; Male ; Neurologic Examination ; Paresis ; Parturition ; Seizures ; Skull ; Subdural Space ; X-Ray Film

The meningioma constitutes 12 to 16 percent of all intracranial tumors. Generally, meningiomas arise from intracranial arachnoid villi and located intracranially. Extension of an intracranial meningioma onto the frontal and ethmoidal sinus occurs occassionally, but primary meningiomas of the frontal and ethmoidal sinus are extremely rare. The authors experienced a case of cystic, meningotheliomatous meningioma containing lamellated calcification involving of the lest frontal and ethmoidal sinus, which presented with protrusion of frontal bone and exophthalmos. In addition to our case, other types of extracranial meningioma are discussed with review of literature.
Arachnoid ; Exophthalmos ; Frontal Bone ; Meningioma*

Encapsulated and free pus in the substance of the brain tissue following an acute purulent infection is known as brain abscess, and which is uncommon. The brain abscess arise either as direct extention from infections within the cranial cavity or as hematogenous metastasis from infections elsewhere in the body. Since 1945, the antibiotics associated use of steroid and mannitol have been available for the treatment of brain abscess, and the result are very hopeful. The common method of surgical treatment are consist of excision and drainage and the problem of the best operative procedure has been disputed on the many neurosurgical literatures for many years. Recently we had treated 2 cases of severe otogenic brain abscesses with semicomatose patient by drainage, and good was the result compared with the other literatures. Result; 1. One case with semicoma recovered completely without any neurologic sequelae, and the other case recovered with visual disturbance. 2. The best operative procedure for the severe brain abscess considered a drainage.
Anti-Bacterial Agents ; Brain Abscess ; Brain* ; Drainage* ; Hope ; Humans ; Mannitol ; Neoplasm Metastasis ; Suppuration ; Surgical Procedures, Operative

Metastatic involvement of the central nervous system during the course of leukemia is an increasingly frequent occurrence because of the longer survival time brought about by the efficacious cytotoxic therapy available today. The onset of acute leukemia may be abrupt with a great variety of clinical manifestations. Most commonly, such as vomiting, headache, papilledema, lethargy and vertigo, are referable to increased intracranial pressure caused by infiltration of the cortex and meninges. The acute paraplegia as the initial symptom of acute leukemia is very rare. A case in which acute paraplegia occurred as the initial symptom of acute leukemia in a 15-year-old boy is reported.
Adolescent ; Central Nervous System ; Headache ; Humans ; Intracranial Pressure ; Lethargy ; Leukemia* ; Male ; Meninges ; Papilledema ; Paraplegia* ; Vertigo ; Vomiting

Metastatic involvement of the central nervous system during the course of leukemia is an increasingly frequent occurrence because of the longer survival time brought about by the efficacious cytotoxic therapy available today. The onset of acute leukemia may be abrupt with a great variety of clinical manifestations. Most commonly, such as vomiting, headache, papilledema, lethargy and vertigo, are referable to increased intracranial pressure caused by infiltration of the cortex and meninges. The acute paraplegia as the initial symptom of acute leukemia is very rare. A case in which acute paraplegia occurred as the initial symptom of acute leukemia in a 15-year-old boy is reported.
Adolescent ; Central Nervous System ; Headache ; Humans ; Intracranial Pressure ; Lethargy ; Leukemia* ; Male ; Meninges ; Papilledema ; Paraplegia* ; Vertigo ; Vomiting