Cysticercosis is the most common parasitic infection affecting the central nervous system. Spinal neurocysticercosis (NCC) is very rare compared with intracranial NCC and requires more aggressive management because these lesions are poorly tolerated. The authors report a case of intradural extramedullary cysticercosis of the entire level of spine with review of the literature.
Central Nervous System ; Cysticercosis ; Neurocysticercosis ; Spine

Acute vertebrobasilar artery occlusion is a fatal event, even after intra-arterial thrombectomy and thrombolysis. We are reporting a case of acute vertebral artery (VA) occlusion. A 37-year-old man was admitted with mild dizziness, but cardiopulmonary arrest suddenly developed after eleven hours. We performed cardiopulmonary resuscitation immediately and his mental and vital state was recovered. Thus we performed intra-arterial thrombectomy, thrombolysis and balloon angioplasty for left vertebral artery occlusion. But pre-existing stenosis of VA was revealed during intervention so we inserted a stent to the stenotic area. Conclusively, we obtained the good angiographical and clinical outcomes.
Adult ; Angioplasty ; Angioplasty, Balloon ; Arteries ; Cardiopulmonary Resuscitation ; Constriction, Pathologic ; Dizziness ; Emergencies ; Heart Arrest ; Humans ; Stents ; Thrombectomy ; Vertebral Artery

PURPOSE: To compare the short-term clinical outcomes of total hip arthroplasty (THA) with a large diameter femoral head (36 mm) and bipolar hemiarthroplasty (BA) in physiologically active elderly patients with femoral neck fractures. MATERIALS AND METHODS: This non-concurrent clinical trial included 169 patients with femoral neck fractures, who had been treated with prosthetic replacement from February 2004 and June 2007. Eighty-nine and 80 cases underwent BA and THA, respectively. The mean follow-up period was 36 months (18-52). The clinical outcomes were analyzed, and the latest follow-up radiographs were assessed to determine the number of complications. RESULTS: The mean operation time was longer in the THA group. The pain, mobility, and walking ability factors were better in the THA group than in the BA group. There was no limitation in the range of motion in the early post-operative period and no dislocations were encountered in either group. CONCLUSION: THA with a large diameter femoral head is recommended for the management of patients with femoral neck fractures.
Aged ; Arthroplasty ; Dislocations ; Femoral Neck Fractures ; Femur ; Femur Neck ; Follow-Up Studies ; Head ; Hemiarthroplasty ; Hip ; Humans ; Range of Motion, Articular ; Tacrine ; Walking

The aim of this study was to evaluate the clinical effect of a continuous infusion of urokinase in cerebral stoke patients who were late admitted over 6 hours after onset. From January to December in 2008, acute cerebral stroke patients (n=143) treated with intravenous urokinase infusion (Group I, n=93) or not (Group II, n=50) after 6 hours and within 72 hours of stroke onset were reviewed. Continuous intravenous infusion of urokinase was done for 5 days. The clinical outcome for each patient was evaluated by using the modified National Institutes of Health Stroke Scale (NIHSS) on admission and on the day of discharge. The NIHSS score was decreased at discharge compared with admission in the urokinase treatment group (Group I; from 4.8+/-2.2 to 3.8+/-1.9; p=0.002). There was an improvement in the patients who initiated urokinase treatment within 24 hours from stroke onset in Group I (from 5.1+/-1.9 to 3.9+/-1.5; p=0.04). In patients with initiated urokinase treatment within 24 hours from stroke onset, intravenous urokinase infusion could be an effective modality in acute ischemic stroke patients admitted later than 6 hours after onset.
Brain ; Humans ; Infusions, Intravenous ; National Institutes of Health (U.S.) ; Stroke ; Urokinase-Type Plasminogen Activator

Although the incidence of intracranial multiple aneurysms are not low, the occurrence of multiple aneurysms more than three developing on the ipsilateral carotid artery is quite rare. We present a patient with five aneurysms on the left internal carotid artery. Four aneurysms arising from the left internal carotid artery underwent microsurgical clipping and wrapping, and remnant superior hypophyseal artery aneurysm was treated by using coil embolization. Incidence and risk factors for management of multiple aneurysms were investigated with the literature review.
Aneurysm ; Arteries ; Carotid Arteries ; Carotid Artery, Internal ; Humans ; Incidence ; Risk Factors

The authors introduced a new approach for clipping of the incidental aneurysm of the middle cerebral artery (MCA) and reported the clinical results. We retrospectively reviewed 26 patients with 27 incidental MCA aneurysms who were treated from January 2010 to December 2012. All clippings were performed through a small temporal craniotomy and linear skin incision. Follow-up imaging showed complete occlusion of 26 aneurysms (96.3%), residual neck in one (3.7%). In one case, residual neck of the aneurysm did not grow on serial follow up. In one of 26 cases (3.8%), approach-related complication was retraction injury of the temporal cortex. Two patients developed postoperative infarction on the MCA territories due to vasospasm and on the cerebellum due to unknown causes. These were not approach-related complications. Operation time was 95 min-250 min (mean 143 min). There were no complications of temporal muscle atrophy, scar deformity, paresthesia, or pain around the scalp incision and frontalis palsy. This approach offers good surgical possibilities and little approach related morbidity in the clipping of incidental MCA aneurysms.
Aneurysm* ; Atrophy ; Cerebellum ; Cicatrix ; Congenital Abnormalities ; Craniotomy* ; Follow-Up Studies ; Humans ; Infarction ; Middle Cerebral Artery* ; Neck ; Paralysis ; Paresthesia ; Retrospective Studies ; Scalp ; Skin* ; Temporal Muscle

OBJECTIVE: To report an observational investigation of small high attenuated foci in computed tomography (CT) scan followed by brain parenchymal catheterization. METHODS: From January 2011 to March 2015, we retrospectively reviewed the 381 patients who had undergone brain catheterization in our clinic and enrolled the patients who had newly developed high attenuation foci in the postoperative CT scans. The brain CT scans were reviewed about the lesion location, Hounsfield Unit (HU) and the time of appearance. RESULTS: Twenty seven of 381 patients had high attenuation foci in CT scans after the procedure. The location of high density lesions was as follows: parenchyma in 9 (33.3%) cases, ventricle in 5 (18.5%), combined in parenchyma and ventricle in 13 (48.1%). The lesions were identified in the catheter tract in parenchymal type, and catheter-lodged frontal horn or choroid plexus in ventricular type. We could not find the calcific foci before the catheter removal, and those were found after removal in all cases. The time of appearance after the removal was variable from 0 to 14 days (mean 4.2, median 3). The regular rules of HU change in CT scans were not found as times go on. CONCLUSION: The high attenuation foci in CT scans were bone dust originated from skull during operation. Although these lesions did not make troubles, we should clean the operation field before the insertion of brain catheter and we may use another material, like Surgicel to seal up the burr hole instead of bone dust in the end of operation.
Animals ; Bone Transplantation ; Brain* ; Calcinosis ; Catheterization* ; Catheters* ; Choroid Plexus ; Dust ; Horns ; Humans ; Retrospective Studies ; Skull ; Tomography, X-Ray Computed

Computerized tomography angiography (CTA) and magnetic resonance angiography (MRA) have been frequently used as non-invasive methods for the evaluation of cerebral vessels. The use of an invasive therapeutic method, transfemoral carotid angiography (TFCA), has also recently increased. The complication rate after TFCA is reported to be 0.9 % to 4%, and it is continuously decreasing. We experienced 2 patients who underwent TFCA as a diagnostic tool. The embolic type of cerebral infarction, which occurred within 30 hours, was diagnosed with performing diffusion weighted MRI (DW-MRI). One patient developed temporary dysphasia and motor weakness, but the patient improved after 2 days. The other patient presented with an altered mentality and motor weakness with some permanent deficits. TFCA is a less invasive method for treating cerebral vessels, and because this is a popular therapeutic modality, the frequency of complications will increase. Clinicians should bear in mind that complications may occur when performing TFCA and so they should be prepared to deal with them.
Angiography ; Aphasia ; Cerebral Infarction ; Diffusion Magnetic Resonance Imaging ; Humans ; Magnetic Resonance Angiography ; Ursidae

OBJECTIVE: Despite improvement of therapeutic regimen, incidence of stroke increases and it remains a leading cause of death. Our study aims at offering variable data on recurrent strokes. METHODS: There were 59 patients who admitted from Jan. 2002 to Dec. 2004 due to recurrent strokes. A retrospective longitudinal cohort study was done. RESULTS: Four-hundred-seventy five patients, diagnosed with acute stroke, experienced 491 strokes in 3 years, and there were 75 recurrent strokes (15.3%) in 59 patients. These 59 patients were included in the study. First hemorrhagic cases (H) were 19 (32%), and the first infarction cases (I) were 40 (68%). Subsequent strokes after first stroke were as follows : H-->H 14 (23.7%)cases, H-->I 5 (8.5%), I-->H 8 (13.6%), I-->I 32 (54.2%). A Cox regression analyses showed that the first type of stroke was a significant factor to the second stroke as follows : if one has had a hemorrhagic stroke, the possibility of second hemorrhagic attack (H-->H attack) increase 3.2 times than ischemic type and in ischemic stroke (I-->I attack) 3.6 times increased incidence of second ischemic attack. CONCLUSION: The recurrence rate of stroke was 12.4% (59 of 475 patients). If the first stroke is hemorrhage or infarction, the next stroke would have high potentiality of hemorrhage, or infarction. The possibility of same type in second stroke increase over 3 times. In H-->H group, the time interval between first and second stroke was shorter and the age of onset was earlier than in I-->I group. Moreover, the infarction was more frequent than hemorrhage in multiple strokes. There was a correlation in lacunar type infarction between first and second attack.
Age of Onset ; Cause of Death ; Cerebral Hemorrhage ; Cerebral Infarction ; Cohort Studies ; Epidemiology* ; Hemorrhage ; Humans ; Incidence ; Infarction ; Recurrence ; Retrospective Studies ; Stroke*

PURPOSE: This study evaluated the short-term follow-up results after total hip arthroplasty with using a 36 mm large femoral head. MATERIALS AND METHODS: Between August 2004 and August 2007, 104 patients were treated with total hip arthroplasties using a 36 mm-Cobalt-Chrome femoral head with Longevity (Zimmer, Warsaw, IN) as the polyethylene liner. The average age at the time of the index operation was 61.4 years (range: 23 to 87 years), and the mean follow-up period was 27 months (range: 18 to 46 months). The clinical results and early complications after the operation were analyzed. RESULTS: The Harris Hip Scores were more than 'Good' in all cases with an average score of 93, and the Merle d' Aubigne and Postel scores were more than 'Good' in 75% of the patients. All the femoral stems that were cemented or cementless had satisfactory fixation. Dislocation developed in one case and only one time, and there were no other complications during the follow-up period CONCLUSION: Total hip arthroplasty with using a 36 mm large femoral head is a recommendable treatment with a low dislocation rate and high satisfaction, which comes from the lack of restriction of the postoperative hip position and movement.
Arthroplasty ; Dislocations ; Follow-Up Studies ; Head ; Hip ; Humans ; Longevity ; Polyethylene