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

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

We experienced a case of an extradural cyst of lumbar spine associated with a freshly ruptured intervertebral disc on L3-4 intervertebral space. A 22-years old Korean female was admitted to hospital because of low back pain radiating to the both legs for about 7 weeks, after mild trauma in the running bus. The low back pain and bilateral sciatic pain had aggravated by coughing and sneezing, similar to the protruded intervertebral disc. Neurological examination revealed the signs similar to those of the protruded intervertebral disc. Simple X-ray films of lumbar spine revealed scoliosis, stretching of lumbar lordotic curve. Myelography showed a complete block from lower one third of L3 vertebral body to upper one fourth of L4 vertebral body by spinal puncture of L2-3 and L5-S1 interspace, respectively. We performed a total laminectomy of L3-4 for the above lesion. The operative finding showed an extradural cyst adhesive with L3 nerve root sheath and freshly ruptured intervertebral disc on L3-4 interspace. The extradural cyst was 2.0x1.5x0.5cm in size and its surface was not smooth but coarse. The contents of cyst was yellowish brown fluid(xanthochromic). We removed the extradural cyst completely and the ruptured(tiny tagged) contents of nucleus pulposus. The post-operative course was satisfactory, dramatically. The microscopic findings of the extradural cyst showed a simple cyst including a profuse pigments of hemosiderin, highly suggested one formed from and epidural hematoma by trauma.
Adhesives ; Cough ; Female ; Hematoma ; Hemosiderin ; Humans ; Intervertebral Disc ; Laminectomy ; Leg ; Low Back Pain ; Myelography ; Neurologic Examination ; Running ; Scoliosis ; Sneezing ; Spinal Puncture ; Spine ; X-Ray Film ; Young Adult

We report a rare case of cervical intradural extramedullary neurilemmoma associated with extradural cavernous angioma in adolescent male patient. This 19-year-old man complained of increasing weakness of left extremities with pain and numbness, starting upwards from the region of left leg since 2 months before, which has aggravated gradually and developed to right side. Neither the patient nor any family member displayed the stigmata of spinal tumor. Neurological examination showed spastic qudriparesis, more severe on left side, disclosed absent vibratory sense and diminution of pain and touch below level of cervico-thoracic junction. Myelogram demonstrated a large filling defect at the C4-6 vertebral level, which was interpreted as an intradural extramedullary or extradural mass. Laminectomy was performed 4 days after admission. At surgery, reddish, diffuse and well demarcated friable mass was found extradural space at the level of C4-6. But post-operative course was not improved for 2 weeks, so we are performed second operation after identified another intradural extramedullary mass by spinal CT. A total removal of tumor mass was accomplished at second procedure. Hostological examination confirmed the diagnosis of cavernous angioma at the extradural mass, neurilemmoma at the intradural extramedullary mass. The post-operative course was satisfactory.
Adolescent ; Christianity ; Diagnosis ; Extremities ; Hemangioma, Cavernous* ; Humans ; Hypesthesia ; Laminectomy ; Leg ; Male ; Muscle Spasticity ; Myelography ; Neurilemmoma* ; Neurologic Examination ; Young Adult

The authors retrospecitviely analyzed the MRI findings of the 8 head-injured patiens who had showed persistent unconsciousness and severe neurologic deficite after trauma. T2-weighted MR images disclosed high signal intensity lesions of various size and shape at lobar white matter and corpus callosum, subcortical gray matter, brain stem, and cerebral cortex, and assisted greatly in understanding the neurologic deficits of the corresponding patients. The lesions were mostly multiple and involved multiple structures. CT's revealed in those patients only small hemorrhages, suspicious low densities, such nonspecific findings as slit ventricles and diffuse brain atrophy, or no abnormality at all. Post-traumatic parenchymatous lesions detected by MR images were either missed or quite underestimated on CT's. MRI was very supeior to CT in the detection and anatomic localization of nonhemorrhagic intraaxial cerebral injuries. especially in the cases of small corical contusions, brainstem and white matter injuries. For the evaluation of the acute posttraumatic patients, CT ios indicated in order to fastly detect intracranial hemagomas which may need emergent surgical evacuation. If CT findings does not explain the neurologic degicits of the patients, especially in the late stage. MRI is indicated. MRI is expected to play a major role in the diagnosis of shear injuries involoving white matter and brainstem where CT has been of little contribution or misleading.
Atrophy ; Brain ; Brain Stem ; Cerebral Cortex ; Contusions ; Corpus Callosum ; Diagnosis ; Hemorrhage ; Humans ; Magnetic Resonance Imaging* ; Neurologic Manifestations ; Unconsciousness

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

The intracranial epidural abscess is a not indenpendent disease which is practically always secondary to osteitis or osteomyelitis of overlying bone. Also it was developed from complication of frontal sinusitis, middle ear or mastoiditis, incomplete debridement of compound comminuted depressed fracture and post-operative complications. Occasionally it was derived from dural sinus thrombophlebitis especially cavernous sinus. It was frequently developed frontal and temporal region. We have experienced 5 cases of intracranial epidural abscesses for this one year. Followings are the results ; 1. The causes were complication of compound depressed fracture, chronic osteomyelitis and post-operative complications. 2. The usual symptom was headache, fever and increased lethargy. 3. The laboratory findings of CBC were the increased WBC count and ESR. The CSF findings revealed occasionally increased the cell count and sugar. 4. The pus culture revealed proteus, coliform bacilli and paracolon bacili. 5. Treatment was surgical removal of overlying diseased bone, drainage of the purulent materials and instillation of antibotics irrigation. 6. The prognosis of the 5 cases of the intracranial epidural abscess was good. There was not appeared any complication or sequelae.
Cavernous Sinus ; Cell Count ; Debridement ; Drainage ; Ear, Middle ; Enterobacteriaceae ; Epidural Abscess* ; Fever ; Frontal Sinus ; Frontal Sinusitis ; Headache ; Lethargy ; Mastoid ; Mastoiditis ; Osteitis ; Osteomyelitis ; Prognosis ; Proteus ; Suppuration ; Thrombophlebitis