Arachnoid cyst of the velum interpositum is unusual and causes symptoms similar to those seen with a third ventricular mass. This report describes a case in which the arachnoid cyst occupied the cistern of the velum interpositum and was coincident with multiple cranial neuropathies. The patient was treated by endoscopic fenestration of the cyst. The surgery resulted in decreased in the size of the cyst but aggravation of cranial neuropathies. The patient underwent methylprednisolone pulse therapy and intravenous immunoglobulin administration under the impression of the multiple cranial neuropathies and recovered completely 3 months later. The authors conclude that combined neurological disease that needs medical treatment should be differentiated and priority of the treatment should be determined carefully if arachnoid cyst is associated with unrelated or ambiguous neurological symptoms and signs. Careful considerations of cause and effect may avoid an unnecessary surgical manipulation
Arachnoid* ; Cranial Nerve Diseases* ; Humans ; Immunoglobulins ; Methylprednisolone

Clinical studies on neuromodulation intervention for trigeminal neuralgia have not yet shown promising results. This might be due to the fact that the pathophysiology of chronic trigeminal neuropathy is not yet fully understood. Chronic trigeminal neuropathy includes trigeminal autonomic neuropathy, painful trigeminal neuropathy, and persistent idiopathic facial pain. This disorder is caused by complex abnormalities in the pain processing system, which is comprised of the affective, emotional, and sensory components, rather than mere abnormal sensation. Therefore, integrative understanding of the pain system is necessary for appropriate neuromodulation of chronic trigeminal neuropathy. The possible neuromodulation targets that participate in complex pain processing are as follows : the ventral posterior medial nucleus, periaqueductal gray, motor cortex, nucleus accumbens, subthalamic nucleus, globus pallidus internus, anterior cingulate cortex, hypothalamus, sphenopalatine ganglion, and occipital nerve. In conclusion, neuromodulation interventions for trigeminal neuralgia is yet to be elucidated; future advancements in this area are required

No abstract available.
Central Nervous System*

No abstract available.
Aneurysm*

OBJECTIVES: Three-dimensional computed tomographic angiography(3D-CTA) is recently developed diagnostic imaging modality. We have studied this noninvasive method for possible role in replacing conventional angiography(CA) in the detection of aneurysms of the circle of Willis in patients with subarachnoid hemorrahge(SAH). METHODS: We studied retrospectively, the 100 patients with SAH or unruptured aneurysms admitted to our hospital from October 1997 to December 1998. Among there, 85 patients underwent CTA, 82 patients underwent CA and 67 patients underwent both of CTA and CA. 3D-CTA was obtained using maximum intensity projection(MIP) and shaded-surface display(SSD) reconstruction. RESULTS: Total 107 aneurysms were detected in 92 patients, and 64 aneurysms were detected in 67 patients underwent both CTA and CA. In five cases of those 67 cases, aneurysms were detected by CA but not by 3D-CTA. The detection rate of aneurysms(91.8%) and the detection rate of parent artery in cases of anterior communicating artery aneurysms(86.9%) with total 3D-CTA were relatively compatible with that of CA. But 3D-CTA was not enough in detection of posterior communicating artery aneurysms, internal carotid artery aneurysms as well as small sized aneurysm(<3mm). Conclusion : We consider CTA is valuable in as a screening test for cerebral aneurysm and follow-up test. And it is also valuable in early surgery for patients with aneurysmal rebleeding because of simple, quick, non-invasive method.
Aneurysm* ; Angiography* ; Arteries ; Carotid Artery, Internal ; Circle of Willis ; Diagnostic Imaging ; Follow-Up Studies ; Humans ; Intracranial Aneurysm ; Mass Screening ; Parents ; Retrospective Studies ; Subarachnoid Hemorrhage*

There are numerous theories of pathophysiology in intracranial aneurysm, but currently accepted hypothesis was congenital defect of medial layer of vascular wall and the major developing factor was hemodynamics. Almost physicians were belived that treatment of intracranial aneurysm was completely through clipping of aneurysmal neck. But many reports were emphasized newly deloped intracranial(De Novo) aneurysm after clipping of initially identified intracranial aneurysm. The authors have same experienced of 2 cases intracranial "Do Novo" aneurysms. We are stress there were never completed treatment of aneurysm that clipping of initially identified intracranial aneurysm and should be attention to "De Novo" aneurysm.
Aneurysm* ; Congenital Abnormalities ; Hemodynamics ; Intracranial Aneurysm ; Neck

Compartment syndrome has a wide spectrum from muscle pain to a life-threatening condition, such as acute renal failure and disseminated intravascular coagulation (DIC). Intracerebral hemorrhage (ICH) due to compartment syndrome has not been reported. We report a patient who presented with ICH leading to death. A 25-year-old female with no significant past history developed extensive compartment syndrome followed by rhabdomyolysis, acute renal failure, DIC, and ICH. Although the patient underwent a fasciotomy and hemodialysis and received aggressive resuscitation with massive transfusions of blood and intravenous fluids, she died. This case stresses the importance of early diagnosis and prompt treatment of compartment syndrome to prevent devastating complications.
Acute Kidney Injury ; Adult ; Arm* ; Cerebral Hemorrhage* ; Compartment Syndromes* ; Dacarbazine ; Disseminated Intravascular Coagulation ; Early Diagnosis ; Female ; Humans ; Myalgia ; Renal Dialysis ; Resuscitation ; Rhabdomyolysis

Compartment syndrome has a wide spectrum from muscle pain to a life-threatening condition, such as acute renal failure and disseminated intravascular coagulation (DIC). Intracerebral hemorrhage (ICH) due to compartment syndrome has not been reported. We report a patient who presented with ICH leading to death. A 25-year-old female with no significant past history developed extensive compartment syndrome followed by rhabdomyolysis, acute renal failure, DIC, and ICH. Although the patient underwent a fasciotomy and hemodialysis and received aggressive resuscitation with massive transfusions of blood and intravenous fluids, she died. This case stresses the importance of early diagnosis and prompt treatment of compartment syndrome to prevent devastating complications.
Acute Kidney Injury ; Adult ; Arm* ; Cerebral Hemorrhage* ; Compartment Syndromes* ; Dacarbazine ; Disseminated Intravascular Coagulation ; Early Diagnosis ; Female ; Humans ; Myalgia ; Renal Dialysis ; Resuscitation ; Rhabdomyolysis

Polymethl methacrylate (PMMA) screw reinforcement is frequently used in osteoporotic bone as well as in damaged pilot holes. However, PMMA use can be dangerous, since the amount of applied cement is uncontrolled. A 47-year-old male with traumatic cervical spondylolisthesis at C6-7 underwent anterior cervical plate fixation. During repeated drilling and tapping for false trajectory correction, a pilot hole was damaged. Although it was an unconventional method, PMMA augmentation was tried. However, PMMA was accidentally injected to the cervical spinal cord owing to lack of fluoroscopic guidance. The PMMA was surgically removed after corpectomy and durotomy. The patient had left side hemiparesis (Grade 2/5) immediately post operation. The patient improved spontaneously (Grade 4/5) except for 4th and 5th digit extension. Here, we report a rare complication of PMMA extrusion in the spinal cord during a damaged pilot hole injection, which has not previously been described.
Bone Cements/*adverse effects/therapeutic use ; Bone Screws ; Cervical Vertebrae/*surgery ; Humans ; Male ; Middle Aged ; Polymethyl Methacrylate/adverse effects/therapeutic use

The epidermoid cyst is formed as the result of inclusion of epithelial elements at the time of closure of the neural tube. The incidence of this tumor is less than 3% of all spinal canal tumors in children, The authors have experienced a 6-year old child with intraspinal epidermoid cyst which presented with symptom of back and abdominal pain. The magnetic resonance imaging study showed intraspinal mass lesion from level of T12 to S1. The patient had no history of previous lumbar puncture. We have removed totally the pearly-like intradural mass with laminoplastic laminotomy from T12 to L5. The pathological findings were compatible with epidermoid cyst. The postoperative course was uneventful without any neurologic deficit. Characteristics of this lesion with a pertinent literature is reviewed.
Abdominal Pain ; Child ; Epidermal Cyst* ; Humans ; Incidence ; Laminectomy ; Magnetic Resonance Imaging ; Neural Tube ; Neurologic Manifestations ; Spinal Canal ; Spinal Puncture