No abstract available.
Intracranial Arteriovenous Malformations* ; Risk Factors*

No abstract available in English.
Knee Prosthesis ; Knee

For the management of small intracranial arteriovenous malformation(AVM), various methods were proposed and their clinical outcomes have been analyzed. Microsurgery, radiosurgery, and embolization can be effective for the treatment of small AVM. Small AVM is known to be at a higher risk of bleeding. Therefore, the aim of treatment should be the prevention of neurological deterioration from bleeding. Microsurgery has the advantage of prompt elimination of the risk of rebleeding by complete excision with single procedure. With the advance of microsurgical techniques, small AVM can be cured with minimal neurological deficit. Outcome of microsurgery depends on location, size, and numbers and patterns of draining veins, which mean Spetzler-Martin grades. Stereotactic device guided surgery, preoperative careful evaluation, intraoperative electrophysiological and hemodynamic monitoring, and experienced surgical skills can greatly reduce adverse brain injury and help complete and exact excision of malformations. Radiosurgery has its unique role for the deep seated AVM, but long term outcome remains to be evaluated. In the management of small AVM, surgery should be considered as the first line of treatment, and radiosurgery can be an alternative for the surgically inaccessible lesions.
Brain Injuries ; Hemodynamics ; Hemorrhage ; Microsurgery ; Radiosurgery ; Veins

BACKGROUND: There exist considerable debates concerning about the effects of epilepsy surgery on cognitive function. To evaluate the effects of tailored anterior temporal lobectomy with amygdalohippocampectomy (ATLAH) on intelligence and memory, we compared the pre- and post-operative cognitive function in patients with mesial temporal lobe epilepsy (MTLE). METHODS: Thirty six patients who received unilateral tailored ATLAH from 1993 to 1997 and had been seizure-free for at least two years postoperatively were selected. Mean age at the time of surgery was 26.8 years and mean period of postoperative follow-up was 47 months. The change of cognitive function was assessed pre-and post-operatively using Korean Wechsler Adult Intelligence Scale (K-WAIS) and Rey memory test. We also assessed the correlation between the extent of hippocampal and lateral temporal cortical resection and cognitive changes respectively. RESULTS: In total patients (N=36), there was statistically significant improvement in performance IQ (PIQ, p<0.05), full scale IQ (FIQ, p<0.05), and auditory verbal learning test (AVLT). In the right temporal lobectomy group (N=16), improvement in PIQ, FIQ, and AVLT reached to statistical significance (p<0.05). In the left temporal lobecto-my group (N=20), improvement in PIQ was significant (p<0.05). In terms of the size of resection, there were tendencies that the cognitive function is more improved in patients with larger hippocampal resection (>2 cm) and in patients with smaller temporal cortical resection (4 cm). CONCLUSIONS: Patients became seizure free after tailored ATLAH may have improvement in performance IQ and full scale IQ. Right side resection, larger hippocampal resection, and smaller lateral temporal resection show better postoperative cognitive function. (J Korean Neurol Assoc 19(2):116~124, 2001)
Adult ; Anterior Temporal Lobectomy* ; Epilepsy ; Epilepsy, Temporal Lobe* ; Follow-Up Studies ; Humans ; Intelligence* ; Memory* ; Seizures ; Temporal Lobe* ; Verbal Learning

BACKGROUND: There exist considerable debates concerning about the effects of epilepsy surgery on cognitive function. To evaluate the effects of tailored anterior temporal lobectomy with amygdalohippocampectomy (ATLAH) on intelligence and memory, we compared the pre- and post-operative cognitive function in patients with mesial temporal lobe epilepsy (MTLE). METHODS: Thirty six patients who received unilateral tailored ATLAH from 1993 to 1997 and had been seizure-free for at least two years postoperatively were selected. Mean age at the time of surgery was 26.8 years and mean period of postoperative follow-up was 47 months. The change of cognitive function was assessed pre-and post-operatively using Korean Wechsler Adult Intelligence Scale (K-WAIS) and Rey memory test. We also assessed the correlation between the extent of hippocampal and lateral temporal cortical resection and cognitive changes respectively. RESULTS: In total patients (N=36), there was statistically significant improvement in performance IQ (PIQ, p<0.05), full scale IQ (FIQ, p<0.05), and auditory verbal learning test (AVLT). In the right temporal lobectomy group (N=16), improvement in PIQ, FIQ, and AVLT reached to statistical significance (p<0.05). In the left temporal lobecto-my group (N=20), improvement in PIQ was significant (p<0.05). In terms of the size of resection, there were tendencies that the cognitive function is more improved in patients with larger hippocampal resection (>2 cm) and in patients with smaller temporal cortical resection (4 cm). CONCLUSIONS: Patients became seizure free after tailored ATLAH may have improvement in performance IQ and full scale IQ. Right side resection, larger hippocampal resection, and smaller lateral temporal resection show better postoperative cognitive function. (J Korean Neurol Assoc 19(2):116~124, 2001)
Adult ; Anterior Temporal Lobectomy* ; Epilepsy ; Epilepsy, Temporal Lobe* ; Follow-Up Studies ; Humans ; Intelligence* ; Memory* ; Seizures ; Temporal Lobe* ; Verbal Learning

On rare occasions, sudden hearing loss may be associated with a migraine. To our knowledge, there have only been two prior reports of sudden hearing loss attributed to migraines. A 40 years old man had suffered from recurrent headaches with hemiparesis, vertigo, and hearing loss for the past three years. At this time, he presented with severe bilateral sensorineural hearing loss of sudden onset, anarthria, right hemiplegia, tinnitus, and vertigo. An audiogram showed a down-sloping sensorineural hearing loss of 77dB by pure tone average on the right side and 72dB on the left. Sixteen days later, audiographic findings improved to 30dB of pure tone average on both sides. Vasospasm of the labyrinthine arteries instigated by migraine might explain these inner ear symptoms. A history of migraine should be sought in patients with sudden hearing loss and when found, anti-migraine medications such as calcium channel block-ers should be considered.
Adult ; Arteries ; Calcium Channels ; Ear, Inner ; Headache ; Hearing Loss ; Hearing Loss, Sensorineural ; Hearing Loss, Sudden* ; Hemiplegia ; Humans ; Migraine Disorders* ; Paresis ; Tinnitus ; Vertigo

We present three neuropathologically-verified and two clinically-probable cases of Creutfeldt Jakob disease. All five had nonspecific prodromal complaints or symptoms prior to overt neurological signs and showed striking progressive neurologic deterioration, especially cognitive decline and cerebellar dysfunction. Myoclonic involuntary movements and complete decapitated states followed in one or two months. The characteristic even pathognomonic in proper clinical settings, features of electroencephalography, magnetic resonance imaging and positron emission tomography and pathologic findings are presented.
Cerebellar Diseases ; Creutzfeldt-Jakob Syndrome* ; Dyskinesias ; Electroencephalography ; Magnetic Resonance Imaging ; Positron-Emission Tomography ; Strikes, Employee

OBJECTIVES: Stroke is leading cause of death and more importantly it is cause of serious disability. The effective treatment of acute ischemic stroke still remains a challenge to modern medicine. Recent clinical trials have shown that carotid endareterctomy(CEA) provide overwhelming benefits compared with medical therapy in preventing subsequent stroke for symptomatic carotid stenosis. For the asymptomatic ones, the data are less compelling, but highly suggestive that CEA do have benefits in properly selected patients. MATERIALS AND METHODS: To investigate the clinical manifestations of carotid stenosis and results of CEAs, authors analyzed retrospectively 19 CEAs in 16 patients from June 1986 to June 1999. Age of patients ranged from 55 to 76 years(median, 66) and male to female ratio was 14 to 2. The duration of follow-up was 1 to 144 months (median, 26). All of CEAs were done on the side of stenosis more than 80% and bilateral CEAs were done in three. Six CEAs were performed in asymptomatic patients. RESULTS: Seventeen of 19 CEAs showed excellent results and complication rate was low although ipsilateral ischemic stroke occurred in two. CONCLUSION: CEA may be a valuable surgical treatment for ischemic stroke caused by carotid stenosis and also for prevention of stroke of asymptomatic patients with carotid stenosis.
Carotid Stenosis* ; Cause of Death ; Constriction, Pathologic ; Endarterectomy, Carotid* ; Female ; Follow-Up Studies ; History, Modern 1601- ; Humans ; Male ; Retrospective Studies ; Stroke

OBJECTIVE: We present an evaluation of the clinical outcome and an investigation of the optimal use of papaverine angioplasty for the treatment of symptomatic vasospasm following subarachnoid hemorrhage. METHODS: The authors retrospectively analyzed 24 cases of symptomatic vasospasm treated by papaverine angioplasty from July 1994 to February 1998. Detailed clinical features and detailed techniques of papaverine angioplasty including sex, age, symptoms, time interval from symptom onset to angioplasty, papaverine dose, concentration and duration of infusion were investigated. RESULTS: After papaverine angioplasty, immediate angiographic vasodilatation was achieved in 23 cases (96%). Fifty eight percent showed clinical improvement within 24 hours but symptomatic vasospasm recurred in 21% of them. Retreatment with papaverine for the recurred cases showed a less response than the initial treatment. Statistical analyses showed that time interval from symptom onset to angioplasty was the factor related to the effects of papaverine angioplasty. CONCLUSION: Our study shows that optimal timing of papaverine angioplasty is very important for clinical improvement.
Angioplasty* ; Papaverine* ; Retreatment ; Retrospective Studies ; Subarachnoid Hemorrhage ; Vasodilation ; Vasospasm, Intracranial*

We describe the case of a patient with symptomatic left cervical ICA stenosis and aneurysm of the left distal anterior cerebral artery. She presented with chronic headache and recurrent attack of right hemiparesis, and underwent staged operations. Using the interhemispheric approach, the intracranial aneurysm was clipped, and there was no postoperative neurologic deterioration. Two months later, a carotid endarterectomy was performed. The patient recovered without complications and angiography revealed relief of carotid stenosis and non-visualization of the aneurysm. The coexistence of symptomatic carotid stenosis and an unruptured intracranial aneurysm poses a therapeutic dilemma; correction of significant stenosis of the internal carotid artery may increase the pressure and turbulence to which the aneurysm is subjected, while the intracranial approach to an aneurysm, when blood flow is decreased by carotid stenosis, may also involve increased risk. In view of the theoretical risk of increased blood flow and turbulence after carotid endarterectomy, aneurysm neck clipping followed by this procedure either in a single stage or separate stages seems to be the another safest management strategy.
Aneurysm* ; Angiography ; Anterior Cerebral Artery ; Carotid Artery, Internal ; Carotid Stenosis* ; Constriction, Pathologic ; Endarterectomy, Carotid ; Headache Disorders ; Humans ; Intracranial Aneurysm ; Neck ; Paresis