Most thymomas are found in the superior and anterior mediastinum and malignant thymomas are exceedingly rare in the first 20 years of life. A child of malignant thymoma with invasion into the thoracic vertebra and spinal canal is reported. The tumor was originated from posterior mediastinum and involved posteriorly the D8, D9 vertebra resulting in paraparesis was improved. Computed tomography is mandatory in detecting the metastasis and evaluation of treatment.
Child ; Humans ; Mediastinum ; Neoplasm Metastasis ; Paraparesis ; Spinal Canal* ; Spine ; Thymoma*

OBJECTIVE: The tolerance and the safety of temporary arterial occlusion in aneurysm surgery are variable among patients because of individual variations of their collateral circulation. We recorded continuous intraoperative regional cortical blood flow(rCoBF) with thermal diffusion flowmetry(TDF) in patients with aneurysmal subarachnoid hemorrhage to determine a safe time limit for temporary occlusion in relation to rCoBF. PATIENTS AND METHODS: From Oct. '97 to Sep. '98, 40 patients with cerebral aneurysm at anterior cerebral artery(ACA) or middle cerebral artery(MCA) were included in this study. The TDF probe was placed over the cortex which was supplied by corresponding arteries. For data analysis, we included only the patients with Hunt-Hess grade I or II on admission. RESULTS: The total occlusion time of the proximal parent artery in 24 patients was on average 21.8 minutes, ranging between 9 minutes and 68 minutes. The lowest rCoBF in relation to temporary occlusion time in patient with excellent outcome was as follows: 0ml/100mg/min for 13 minutes and 6ml/100mg/min(11% of basal rCoBF) for 18 minutes in the middle cerebral artery and bilateral anterior cerebral arteries, respectively. The multiple regression equation regarding safe time for temporary clipping was as follows: safe time = 5.5 + 0.06 X rCoBF intra + 0.25 X rCoBF pre. And reperfusion time for the full recovery of rCoBF was within 4 minute in most cases, except some no-reflow cases. CONCLUSION: In our study with proper brain protection, a safe time limit for temporary occlusion was calculated 18 minutes even at 0ml/100mg/min in the MCA and this technique seems to be very useful to detect a continuous real time change of rCoBF during aneurysm surgery.
Aneurysm* ; Anterior Cerebral Artery ; Arteries ; Brain ; Collateral Circulation ; Humans ; Intracranial Aneurysm ; Middle Cerebral Artery ; Parents ; Reperfusion ; Statistics as Topic ; Subarachnoid Hemorrhage ; Thermal Diffusion

BACKGROUND: While gait disturbance is an important feature of idiopathic normal pressure hydrocephalus (NPH), there are only tentative theories explaining its pathophysiology. The mesencephalic locomotor region has been suggested as the anatomical substrate for the development of hypokinetic gait. We evaluated the correlation between gait disturbance and midbrain diameter to investigate the role of mesencephalic locomotor region in development of NPH gait. METHODS: We enrolled 21 patients with NPH and 20 age-matched control subjects. Maximal diameter of midbrain and pons and the width of lateral and third ventricle were measured at midsagittal T1-weighted MRI and axial T2-weighted MRI, respectively. Gait disturbance, cognitive dysfunction, and incontinence were semi quantified. RESULTS: Maximal midbrain diameter was significantly smaller in NPH group, as compared to the controls (14.8 +/- 0.9 vs. 17.1 +/- 0.7 mm, p<0.001). There was an inverse correlation between the midbrain diameter and the ventricular width (r=-0.562, p=0.008 in third ventricle and r=-0.510, p=0.018 in lateral ventricle). Severity of gait disturbance were negatively correlated with midbrain diameter (r=-0.598, p=0.004), but degree of cognitive dysfunction and incontinence showed no significant correlation with brainstem diameter nor ventricular width. CONCLUSIONS: This study suggests that midbrain atrophy is significantly associated with gait disturbance in NPH. Furthermore, this study implies the possible role of midbrain structures including mesencephalic locomotor region in the genesis of NPH gait.
Atrophy ; Brain Stem ; Gait* ; Humans ; Hydrocephalus, Normal Pressure* ; Magnetic Resonance Imaging ; Mesencephalon* ; Pons ; Third Ventricle

OBJECTIVE: The objective of this study is to examine the effects of cranioplasty on the cerebral hemodynamics and cardiac function. METHODS: Twenty seven patients who had undergone cranioplasty were included in this study. Arterial blood flow velocities were assessed by transcranial doppler ultrasonography and the cerebral blood flow(CBF) measurements by perfusion computed tomography. Cardiac functions were evaluated using the echocar-diogram. RESULTS: The blood flow velocity on the cranioplasty side was decreased from 50.5+/-15.4cm/sec to 38.1+/-13.9cm/sec at the middle cerebral artery(MCA) and from 33.1+/-8.3cm/sec to 26.4+/-6.6cm/sec at the internal carotid artery(ICA)(p<0.05). On the opposite side, it was decreased from 61.9+/-15.7cm/sec to 48.7+/-16.9cm/ sec at the MCA and from 31.8+/-7.3cm/sec to 24.5+/-7.1cm/sec at the ICA(p<0.05). The evaluation of cardiac functions revealed that the stroke volume was increased from 64.7+/-18.3ml/beat to 73.3+/-20.4ml/beat(p< 0.05) ; the heart rate was decreased from 91.4+/-14.7beat/min to 82.2+/-15.1beat/min(p<0.05). CBF was increased from 39.1+/-7.2ml/100g/min to 44.7+/-8.9ml/100g/min on the cranioplasty side(p<0.05). CONCLUSION: Cranioplasty can remove the atmospheric pressure on the brain and may decrease the blood flow velocity and increase the CBF as well as improve the cardiac function. The authors insist that a skull defect should be corrected as quickly as possible after neurological stabilization of patients.
Atmospheric Pressure ; Blood Flow Velocity ; Brain ; Heart Rate ; Hemodynamics* ; Humans ; Perfusion ; Skull ; Stroke Volume* ; Stroke* ; Ultrasonography, Doppler, Transcranial

Takayasu's arteritis is a chronic inflammatory disease that produces a narrowing of the aorta and its major branches. Fibrosis and thickening of the arterial wall often occur in later stages, resulting in a cerebrovascular accident. The authors report two young women patients who presented with subarachnoid hemorrhage (SAH) and occlusive cerebrovasular disease associated with Takayasu's arteritis. Both patients had sudden headache and hemiparesis. Physical examination showed weak radial pulse, carotid bruit, and asymmetrical blood pressure. Erythrocyte sedimentation rate (ESR) was elevated in both patients. SAH was confirmed by brain computerized tomography (CT) or lumbar puncture. Occlusive cerebrovascular disease was diagnosed by brain magnetic resonance imaging (MRI), brain magnetic resonance angiography (MRA), and cerebral angiography. The findings of aortography and cerebral angiography were compatible with Takayasu's arteritis, but intracranial aneurysm was not found in either patient.
Adult ; Cerebral Angiography ; Cerebrovascular Disorders/complications/diagnosis ; Female ; Humans ; Subarachnoid Hemorrhage/*complications/diagnosis ; Takayasu Arteritis/*complications/diagnosis ; Tomography, X-Ray Computed

PURPOSE: It has been reported that the Nitroblue Tetrazolium(NBT) test is more accurate than the urine pH, leukocyte esterase and nitrite test as a screening test of urinary tract infection (UTI). The purpose of this study is to compare the NBT test with other screening tests and evaluate the clinical usefulness of the NBT test as a screening test. METHODS: We selected 298 results out of the 304 urine cultures which were performed from March, 1999 to July, 1999 and compared them with screening tests such as NBT, urine pH, leukocyte esterase and nitrite tests. We interpreted those results as the urinary tract infection when the screening results were urine NBT(+), pH(>6.5), leukocyte esterase(>or=++) and nitrite(+). RESULTS: Urine NBT, pH and leukocyte esterase tests showed the statistical significance in comparison with the urine culture results(chi-square tests; P<0.001, <0.05, <0.001), while urine nitrite tests did not show statistical significance. As time passing, the sensitivity of 10 min, 30 min, 60 min NBT test was increased to 35%, 72%, 80% respectively but the sensitivity of urine pH and leukocyte esterase was as low as 33%, 16% respectively. But, the specificity of NBT test was reduced from 93% to 53% as the time went by, while the specificity of urine pH and leukocyte esterase tests were as high as each 79%, 96% respectively. Urine NBT tests at 10 min and 30 min showed a higher positive and negative predictive value than those of the other screening tests. CONCLUSION: Urine NBT test as a screening test for UTI was more accurate than the urine pH, nitrite and leukocyte esterase tests. But we think that we should develop a more quick and precise screening test in the future, because of the long time it requires to perform it.
Child* ; Humans ; Hydrogen-Ion Concentration ; Leukocytes ; Mass Screening* ; Nitroblue Tetrazolium ; Sensitivity and Specificity ; Urinary Tract Infections* ; Urinary Tract*

OBJECTIVE: Spinal epidural hematoma (SEDH) and spinal subdural hematoma (SSDH) are rare diseases and they may have various causes such as trauma, lumbar puncture, anticoagulant therapy, tumor, blood dyscrasia and vascular malformation. In general, SEDH and SSDH are regarded as surgical emergency. We reviewed our cases with patients with SEDH or SSDH. They were surgically treated or conservatively treated. We examined the relationship between the surgical timing and the neurological outcome. METHODS: Twelve patients (8 cases for SEDH, 4 cases for SSDH) were included in our study. There were seven male and five female patients (mean age: 50.2 yrs, ranged from 18 to 87 years). Ten patients were surgically treated (7 cases for SEDH, 3 cases for SSDH) and two patients were conservatively treated (1 case for SEDH, 1 case for SSDH). We checked preoperative Frankel grade, time interval between onset of symptom and operation and post-operative neurologic change of each case. We investigated relationship between surgical timing and neurological outcome and also relationship between pre-operative Frankel grade and post-operative outcome. RESULTS: In seven cases (70%) of operated cases, there were postoperative improvements in clinical symptoms. Two cases had time interval within 6 hours from onset of symptoms to operations and their neurologic deficits were not improved. There were 2 cases with time interval of more than 6 hours and within 12 hours. And there were 6 cases with time interval over 12 hours. Seven of eight cases with time interval over 6 hours were improved after surgical treatments. CONCLUSION: There are various factors which may affect post-operative neurologic prognosis. Surgical timing is generally regarded as one of the most critical factors. However, in our study, preoperative neurologic status of patients functioned as the most important factor in clinical outcomes. We thought that the initial neurologic status of patient, as well as the surgical timing, may predict the prognosis.
Emergencies ; Female ; Hematoma, Epidural, Spinal ; Hematoma, Subdural ; Hematoma, Subdural, Spinal ; Humans ; Male ; Neurologic Manifestations ; Prognosis ; Rare Diseases ; Spinal Fractures ; Spinal Puncture ; Vascular Malformations

A 39-year-old woman developed Wernicke's encephalopathy in the sixteenth week of her pregnancy after eight weeks of severe nausea and vomiting. Because of her protracted severe vomiting, she had inpatient treatment with intravenous dextrose and electrolytes without thiamine. In her fourteenth week of pregnancy, she began showing neurologic symptoms such as dizziness, tinnitus, hearing impairment, nystagmus and ataxia. To rule out possibility of brain stem lesions, MRI of brain was performed. MRI showed tectal lesions as well as bilateral symm-etric midline lesions along the third ventricle and cerebral aqueduct. Further evaluate for these lesions, FLAIR(fluid-attenuated inversion-recovery) MR imaging was performed. Based on her clinical symptoms and FLAIR MR imaging, she was diagnosed as Wernicke's encephalopathy. Combined therapy with vitamin B1(50mg/day) and steroid(met-hylprednosolone 1g/day) was immediately started. Two days later, her neurologic symptoms improved. FLAIR imaging technique allows easier identification of specific periventricular distribution of the lesions. The preventive steroid therapy may have resulted in beneficial outcome on Wernicke's encephalopathy.
Adult ; Ataxia ; Brain ; Brain Stem ; Cerebral Aqueduct ; Dizziness ; Electrolytes ; Female ; Glucose ; Hearing Loss ; Humans ; Hyperemesis Gravidarum* ; Inpatients ; Magnetic Resonance Imaging ; Nausea ; Neurologic Manifestations ; Pregnancy ; Thiamine ; Thiamine Deficiency ; Third Ventricle ; Tinnitus ; Vitamins ; Vomiting ; Wernicke Encephalopathy*