Hemorrhagic metastatic brain tumors of hepatocellular carcinoma (HCC) are rare and have been mostly presented as intracranial hemorrhage (ICH). A 51-year-old male patient presented with sudden altered level of consciousness. He suffered from HCC since 2010 and transarterial chemoembolization was performed three times for HCC. The brain computed tomography (CT) scans revealed subdural hematoma (SDH) in the right fronto-temporal area and 6.0x3.5 cm sized ICH in the right parieto-occipital lobe. Brain angiographic CT scans demonstrated that the hemorrhagic lesions did not include any enhancing lesions and vascular abnormalities. We undertook a decompressive craniectomy and evacuation of the acute SDH and ICH. During evacuation of ICH, the yellowish mass was observed in the cortical surface of the right occipital lobe. Pathological examination displayed the findings of metastatic brain tumor from HCC. Metastatic brain tumors should be considered in the differential diagnosis as a cause of spontaneous SDH with ICH.
Brain Neoplasms ; Brain* ; Carcinoma, Hepatocellular* ; Cerebral Hemorrhage* ; Consciousness Disorders ; Decompressive Craniectomy ; Diagnosis, Differential ; Hematoma, Subdural* ; Humans ; Intracranial Hemorrhages ; Male ; Middle Aged ; Neoplasm Metastasis* ; Occipital Lobe ; Tomography, X-Ray Computed

OBJECTIVES: The purpose of this study was to determine the differences of expression of TGF-betaS(TGF-beta1 and TGF-beta2) in the human proliferative endometrium, secretory endometrium, and the decidua during early pregnancy. And we also have studied the endometrial expression of TGF-beta1 and TGF-beta2 in the menopause and compared that to the expression in the endometrium and decidua. METHODS: We have studied the expression of TGF-beta1 and TGF-beta2 by immunohistochemical staining method in the proliferative endometrium, secretory endometrium, decidua during early pregnancy, and menopausal endometrium. RESULTS: In the epithelial cells, TGF-beta1 was moderately expressed in the secretory phase and was weakly expressed in the proliferative phase and menopause. In the stromal cells, TGF-beta1 was not expressed in the whole menstrual phase and menopause. And in the epithelial cells, TGF-beta2 was moderately expressed in the proliferative phase, secretory phase, and menopause. In the stromal cells, TGF-beta2 was not expressed in the whole menstrual phase and menopause. Especially, TGF-beta1 and TGF-beta2 were markedly expressed in the decidua during early pregnancy compared to the expression in the proliferative, secretory endometrium, and menopausal endometrium. CONCLUSIONS: These findings suggest that TGF-beta1 may have an important role in the epithelial cells during the secretory phase, not stromal cells. And TGF-beta1 and TGF-beta2 may have a paracrine and autocrine role in the decidua/trophoblast interaction during pregnancy , especially in the normal pregnancy.
Decidua ; Endometrium* ; Epithelial Cells ; Female ; Humans* ; Menopause ; Menstrual Cycle* ; Pregnancy ; Stromal Cells ; Transforming Growth Factor beta1 ; Transforming Growth Factor beta2

Meningioma is a common primary tumor of central nervous system. However, extracranial extension of the intracranial meningioma is unusual, and mostly accompanied the osteolytic change of the skull. We herein describe an atypical meningioma having extracranial extension with hyperostotic change of the skull. The patient was a 72-year-old woman who presented a large mass in the right frontal scalp and left hemiparesis. Brain magnetic resonance imaging and computed tomography scans revealed an intracranial mass, diffuse meningeal thickening, hyperostotic change of the skull with focal extension into the right frontal scalp. She underwent total removal of extracranial tumor, bifrontal craniectomy, and partial removal of intracranial tumor followed by cranioplasty. Tumor pathology was confirmed as atypical meningioma, and she received adjuvant radiotherapy. In this report, we present and discuss a meningioma en plaque of atypical histopathology having an extracranial extension with diffuse intracranial growth and hyperostotic change of the skull.
Aged ; Brain ; Central Nervous System ; Female ; Humans ; Magnetic Resonance Imaging ; Meningioma* ; Osteoblasts* ; Paresis ; Pathology ; Radiotherapy, Adjuvant ; Scalp ; Skull*

Central nervous system (CNS) sparganosis is a rare parasitic infestation caused by ingestion of the raw or inadequately cooked snakes or frogs. Sparganum is well known for its ability of migrating though the tissue, therefore, it can cause various neurological symptoms if it involves neurological systems. A 51-year-old male patient visited our department of neurosurgery complaining of the motor weakness and radiating pain on both upper extremities over 4 months. He had a history of ingesting raw snakes untill his late twenties. The magnetic resonance (MR) images of cervical spine revealed an intramedullary ill-defined enhancing lesion with the aggregated cysts in the upper cervical spinal cord. Under presumptive diagnosis of sparganosis, we took brain MR image. The brain MR images revealed the signal change in right fronto-temporal lobe suggesting the trajectory of parasitic migration via ventricular systems. He underwent a midline myelotomy and granuloma removal followed by the posterior laminoplasty. Pathologic findings showed inflammatory changes and necrosis with keratinized tissue suggesting the CNS sparganosis. We report an uncommon case of CNS sparganosis migrated from the brain to the spinal cord with literature review.
Brain ; Central Nervous System ; Eating ; Granuloma ; Humans ; Keratins ; Magnetic Resonance Spectroscopy ; Male ; Middle Aged ; Necrosis ; Neurosurgery ; Snakes ; Sparganosis ; Sparganum ; Spinal Cord ; Spine ; Upper Extremity

OBJECTIVE: Placement of a ventriculoperitoneal (VP) shunt is a common neurosurgical procedure for cerebrospinal fluid diversion. A rare complication is delayed intracranial hemorrhage (ICH) secondary to VP shunting, and only a few patients with this complication have been reported. We investigate the incidence and risk factors of delayed ICH development following VP shunt placement. METHODS: Over an 11-year period, 167 patients received a VP shunt for hydrocephalus, and of these, 138 patients were eligible for this study. All medical records and computed tomography scans obtained within 48 h after the operation and at postoperative day 7 were reviewed. The risk factors of developing delayed ICH (≥48 hr after VP shunt placement) were analyzed according to the demographic data, including sex and age, original intracranial lesions, co-morbid diseases, and laboratory findings. RESULTS: Delayed ICH following VP shunt placement developed in 34 (24.6%) of the 138 patients. Risk factors for developing delayed ICH were age (p=0.037) and the partial thromboplastin time (PTT) (p=0.032). Intraventricular hemorrhage after VP shunting was the most common complication, occurring in 16 cases. Hemorrhagic volume was < 1 mL in 28 cases and >1 mL in 6 cases. CONCLUSION: This study suggests that old age and delayed PTT are major risk factors for developing delayed ICH following VP shunting. Additionally, delayed ICH after VP shunting commonly occurs even when most patients are asymptomatic. Therefore, extra care should be taken to observe and follow-up with patients who have undergone VP shunt placement.
Cerebrospinal Fluid ; Follow-Up Studies ; Hemorrhage ; Humans ; Hydrocephalus ; Incidence ; Intracranial Hemorrhages* ; Medical Records ; Neurosurgical Procedures ; Partial Thromboplastin Time ; Risk Factors* ; Ventriculoperitoneal Shunt*

OBJECTIVE: To investigate the effectiveness of radiographic parameters on segmental instability in the lumbar spine using Kinetic magnetic resonance imaging (MRI). METHODS: Segmental motion, defined as excessive (more than 3 mm) translational motion from flexion to extension, was investigated in 309 subjects (927 segments) using Kinetic MRI. Radiographic parameters which can help indicate segmental instability include disc degeneration (DD), facet joint osteoarthritis (FJO), and ligament flavum hypertrophy (LFH). These three radiographic parameters were simultaneously evaluated, and the combinations corresponding to significant segmental instability at each level were determined. RESULTS: The overall incidence of segmental instability was 10.5% at L3-L4, 16.5% at L4-L5, and 7.3% at L5-S1. DD and LFH at L3-L4 and FJO and LFH at L4-L5 were individually associated with segmental instability (p<0.05). At L4-L5, the following combinations had a higher incidence of segmental instability (p<0.05) when compared to other segments : (1) Grade IV DD with grade 3 FJO, (2) Grade 2 or 3 FJO with the presence of LFH, and (3) Grade IV DD with the presence of LFH. At L5-S1, the group with Grade III disc and Grade 3 FJO had a higher incidence of segmental instability than the group with Grade I or II DD and Grade 1 FJO. CONCLUSION: This study showed that the presences of either Grade IV DD or grade 3 FJO with LFH at L4-L5 were good indicators for segmental instability. Therefore, using these parameters simultaneously in patients with segmental instability would be useful for determining candidacy for surgical treatment.
Humans ; Hypertrophy ; Incidence ; Intervertebral Disc Degeneration ; Ligaments ; Magnetic Resonance Imaging ; Osteoarthritis ; Spine ; Zygapophyseal Joint

Occipito-atlantalrotatory subluxation that occurs in conjunction with atlanto-axial rotator fixation is extremely rare. The common clinical characteristics are painful torticollis and cock robin position presented with the head tilted to one side and rotated to the other side. The object of this report is to emphasize that AARF combined with OARF may be caused by a variety of conditions, to be must need algorithm for proper management, apparently. A torticollis patient who had cerebral palsy presented with severe nuchal pain and wryneck for a long period. The patient had a history of fallen down 16 years ago which caused severe nuchal pain. The conservative management had failed to correct the deformity and instability. we decided to operate using occiput-C1-C2 arthrodesis and C3-4-5 bilateral screw fixation for reinforcement. Now he doesn't have neurologic deficit and shows good outcome enough to sustain his head, not using his hands, in his daily life.
Arthrodesis ; Atlanto-Axial Joint ; Atlanto-Occipital Joint ; Cerebral Palsy* ; Congenital Abnormalities ; Hand ; Head ; Humans ; Neurologic Manifestations ; Songbirds ; Torticollis

OBJECTIVE: To investigate the cases of intracranial abnormal brain MRI findings even in the negative brain CT scan after mild head injury. METHODS: During a 2-year period (January 2009-December 2010), we prospectively evaluated both brain CT and brain MRI of 180 patients with mild head injury. Patients were classified into two groups according to presence or absence of abnormal brain MRI finding even in the negative brain CT scan after mild head injury. Two neurosurgeons and one neuroradiologist validated the images from both brain CT scan and brain MRI double blindly. RESULTS: Intracranial injury with negative brain CT scan after mild head injury occurred in 18 patients (10.0%). Headache (51.7%) without neurologic signs was the most common symptom. Locations of intracranial lesions showing abnormal brain MRI were as follows; temporal base (n=8), frontal pole (n=5), falx cerebri (n=2), basal ganglia (n=1), tentorium (n=1), and sylvian fissure (n=1). Intracranial injury was common in patients with a loss of consciousness, symptom duration >2 weeks, or in cases of patients with linear skull fracture (p=0.00013), and also more frequent in multiple associated injury than simple one (35.7%>8.6%) (p=0.105). CONCLUSION: Our investigation showed that patients with mild head injury even in the negative brain CT scan had a few cases of intracranial injury. These findings indicate that even though the brain CT does not show abnormal findings, they should be thoroughly watched in further study including brain MRI in cases of multiple injuries and when their complaints are sustained.
Basal Ganglia ; Brain ; Craniocerebral Trauma ; Head ; Headache ; Humans ; Magnetic Resonance Imaging ; Magnetics ; Magnets ; Multiple Trauma ; Neurologic Manifestations ; Prospective Studies ; Skull Fractures ; Unconsciousness

The first case of intracranial metastases of a cervical intramedullary low-grade astrocytoma without malignant transformation in adult is presented in this report. Seven years ago, a 45 year-old male patient underwent biopsy to confirm pathologic characteristics and received craniocervical radiation and chemotherapy for a grade II astrocytoma in the cervical spinal cord. Two years later, posterior fusion was necessary for progressive kyphosis in the cervical spine. He was well for approximately 7 years after the primary surgery. Two months ago, he presented with partial weakness and incoordination with gait difficulty. MRI Scan demonstrated multiple small lesions in the cerebellar vermis and left hemisphere. After suboccipital craniectomy and posterior cervical exposure, the small masses in the cerebellar vermis and hemispheres were excised to a large extent by guidance of an intraoperative navigation system. The tumor at the cervical and brain lesions was classified as an astrocytoma (WHO grade II). When a patient with low-grade astrocytoma in the spinal cord has new cranial symptoms after surgery, radiaton, and chemotherapy, the possibility of its metastasis should be suspected because it can spread to the intracranial cavity even without malignant transformation as shown in this case.
Adult ; Astrocytoma ; Ataxia ; Biopsy ; Brain ; Gait ; Humans ; Kyphosis ; Magnetic Resonance Imaging ; Male ; Neoplasm Metastasis ; Spinal Cord ; Spinal Cord Neoplasms ; Spine

We experienced a 73-year-old male with lumbar nerve root compression due to leakage of bone cement after vertebroplasty. He was underwent vertebroplasty for acute osteoporotic L4 compression fracture at our hospital. After vertebroplasty, his back pain was improved but right leg pain was newly developed. Lumbar computed tomography scanning showed that bone cements were leaked along the L4 nerve root. The leaked cements around L4 nerve root were removed carefully via paraspinal muscle-splitting approach. After operation, severe right leg radiating pain was improved. We recommend proper entry point, high viscosity of polymethylmethacrylate and constant monitoring can reduce complication.
Aged ; Back Pain ; Bone Cements ; Fractures, Compression ; Humans ; Leg ; Male ; Osteoporosis ; Polymethyl Methacrylate ; Radiculopathy* ; Vertebroplasty* ; Viscosity