OBJECTIVE: To define the incidence, the prognosis, and the risk factors of neurologic complications of open heart surgery. Background. Open heart surgery poses many hemodynamic, embolic, and metabolic threats to the brain with multiple factors relating to neurologic complications. Despite the progress in surgical technique, neurologic complications remain major causes of morbidity and occasional mortality. METHODS: Data were obtained from the charts of 297 patients submitted to open heart surgery at SNUH in 1993. We analysed the risk factors for CNS complications and identified the incidence, the type, and the results of the complications. RESULTS: Among 297 patients, CNS complications occurred in 34 patients(11.4%). The incidences of each complication were as follows. ; 6 anoxic encephalopathies(17.7%), 12 encephalopathies of uncertain etiology(35.3%), 7 seizures (20.6%), 6 TIAs or. Infarctions(17.7%), and 3 other complications(8.8%). Of the 34 patients, there were 6 deaths (17.7%), 1 vegetative state(2.9%), 1 major neurologic deficit(2.9%), 3 minor neurologic deficits(8.8%), and full recovery in 23 patients(67.7%). The risk factors such as age, presence of thrombi, type of operation, duration of bypass, duration of aortic clamping time, use of total circulatory arrest, re-operation, and use of ventricular assist device were statistically significant. CONCLUSION: The CNS complications of open heart surgery are infrequent but still remain important causes of morbidity and mortality. Evaluating the risk factors could be of help to prevent the CNS complications.
Brain ; Constriction ; Heart* ; Heart-Assist Devices ; Hemodynamics ; Humans ; Incidence ; Mortality ; Prognosis ; Risk Factors ; Seizures ; Thoracic Surgery*

Intracerebral schwannomas are rare and there have been none reported in Korea. We present the case of a 25-year-old man with newly developed right-side weakness and recent seizure aggravation. His seizures started approximately 9 years prior to admission. At that time, a 1 cm diameter intra-axial enhancing mass at the left precentral gyrus was found on magnetic resonance image (MRI). After 9 years of observation and treatment with antiepileptic medication, an MRI taken due to symptom aggravation revealed peri-tumoral cyst formation with tumor enlargement. The tumor was surgically removed. Subsequently, right-side weakness diminished and there was good seizure control. Pathologic diagnosis was schwannoma. Schwannoma is a very rare tumor and there are no pathognomonic findings on radiologic images; thus, it is challenging to make a correct diagnosis. However, considering the natural course and excellent prognosis after surgical treatment of this kind of intra-axial mass with benign features, early surgery for diagnosis and proper treatment is highly recommended.
Adult ; Diagnosis ; General Surgery ; Humans ; Korea ; Magnetics ; Magnets ; Neurilemmoma* ; Prognosis ; Seizures

Improved operative, anesthetic, and cardiopulmonary bypass (CPB) techniques have significantly reduced postoperative complications; however, neurologic disorders remain a serious complication after open heart surgery. Possible explanations for neurologic complications are microembolism from CPB, decreased cerebral perfusion pressure due to intraoperative hypotension and unexpected metabolic changes. Amomg these, seizure has low incidence and Todd`s paralysis after open heart surgery is extremely rare. Todd's paralysis is a complication of a seizure due to neuronal exhaustion mimicking large cerebral infarction after open heart surgery.
Cardiopulmonary Bypass ; Cerebral Infarction* ; Heart* ; Hypotension ; Incidence ; Nervous System Diseases ; Neurons ; Paralysis* ; Perfusion ; Postoperative Complications ; Seizures ; Thoracic Surgery*

PURPOSE: To report clinical manifestations including neurocutaneous and ocular findings and to evaluate outcomes of trabeculectomy in patients with Sturge-Weber syndrome. METHODS: The medical records of 10 eyes of 8 glaucoma patients with Sturge-Weber syndrome who were followed up for at least 1 year after trabeculectomy were reviewed retrospectively. We analyzed neurocutaneous and ocular findings, cumulative surgical success rates, and complications in patients with Sturge-Weber syndrome. RESULTS: The mean patient age at the time of surgery was 12.6 +/- 13.0 years and mean follow-up period was 71.6 +/- 81.8 months. All patients showed various clinical findings including facial hemangioma (8 patients), seizure (6 patients), intracranial lesion (6 patients), developmental delay (4 patients), conjunctival/episcleral hemangioma (4 eyes), and choroidal hemangioma (4 eyes). Postoperative success was achieved in 8 out of 10 eyes (80.0%). Postoperatively, serous retinal detachment occurred in 2 out of 4 eyes with preoperative diffuse choroidal hemangioma. CONCLUSIONS: Management of glaucoma associated with Sturge-Weber syndrome requires multidisciplinary treatment because of systemic involvement. Trabeculectomy appears to be an effective and relatively safe surgical option for glaucoma associated with Sturge-Weber syndrome. However, serious complications such as serous retinal detachment should be considered when planning trabeculectomy for patients with diffuse choroidal hemangioma.
Choroid ; Follow-Up Studies ; General Surgery ; Glaucoma* ; Hemangioma ; Humans ; Medical Records ; Retinal Detachment ; Retrospective Studies ; Seizures ; Sturge-Weber Syndrome* ; Trabeculectomy

Oral sodium phosphate is commonly used to evacuate the colon and rectum before colonoscopy or colorectal surgery. However, this substance is known to cause electrolyte abnormalities including hyponatremia. The hyponatremic patient usually presents with headache, nausea, vomiting and confusion, but can also present with non-cardiogenic pulmonary edema, seizure and rhabdomyolysis. However, non-cardiogenic pulmonary edema, seizure and rhabdomyolysis caused by hyponatremia associated with bowel preparation have only rarely been reported. We report a case of severe complications including non-cardiogenic pulmonary edema, seizure and rhabdomyolysis associated with hyponatremia following ingestion of sodium phosphate for colonoscopy in a 41-year-old healthy male.
Adult ; Colon ; Colonoscopy ; Colorectal Surgery ; Eating ; Headache ; Humans ; Hyponatremia ; Male ; Nausea ; Phosphates ; Pulmonary Edema ; Rectum ; Rhabdomyolysis ; Seizures ; Sodium ; Vomiting

BACKGROUNDIn the years around 1990, in Beijing Tiantan Hospital Affiliated to Capital Medical University many children with infantile hemiplegia and intractable epilepsy were treated with further modified anatomical hemispherectomy. We report the follow up of the first six cases. To make good use of these precious clinical data and make clear their neuropsychological state, we performed neuropsychological and neurophysiological measurements in these patients, who were at a median of 17.8 years after hemispherectomy.

METHODSOddball task was given to the patients and to a normal control group to collect the peak latency (PL) and peak amplitude (PA) of event-related potentials (ERPs)-P300. The P300 data of the two groups were analyzed and the P300 patterns of the six patients are presented. The baseline characteristics and long-term follow-up of the six hemispherectomized patients, especially the long-term seizure control and cognitive function after surgery, are described.

RESULTSFive patients had no seizures and one was almost seizure-free during the years after surgery. Clear P300 was obtained from every electrode in the patients. Differences of P300 between patients and normal control group had no statistical significance. And the maximum PA was at the site of electrode Pz or Cz which was consistent with that of the control group and with previous findings.

CONCLUSIONSFurther modified anatomical hemispherectomy has preferable long-term antiepileptic effects. The P300 results of the patients mean that the basic cognitive function of the patients has no difference from the control group. This reflects the plasticity of the hemisphere to some extent and increases the affirmation of the long-term curative effects of further modified anatomical hemispherectomy from both neuropsychological and neurophysiological aspects.

Adult ; Disease-Free Survival ; Event-Related Potentials, P300 ; Female ; Follow-Up Studies ; Hemispherectomy ; Humans ; Male ; Seizures ; surgery ; Treatment Outcome

Epilepsy surgery has been demonstrated to be an effective alternative treatment for intractable partial or localization related epilepsy. Primary intracranial neoplasms and other structural lesions of the brain are important etiological factors in patients with partial seizure disorders. A neuroimaging identified lesion in patients with seizures, not necessarily medically refractory, may also be an indication for surgery in selected patients. Twelve patients operated on under local or general anesthesia for resection surgery underwent intraoperative recording(electrocorticogram) and/or functional mapping by electrical stimulation or somatosensory evoked potentials-(SSEPs) for identification of the secondary epileptogenic area and/or functional area; 2 meningiomas, 5 astrocytomas, 1 gangliocytoma, 1 abscess, 1 small AVM, 1 cysticercosis and one gliosis by previous intracerebral hemorrhage with middle cerebral artery(MCA) aneurysm. Among these, additional corticectomy or anterior temporal lobectomy was performed in eleven patients. All the patients did well after surgery with good outcomes as seizure free in nine(75%) out of 12 patients with 11.9 months of follow-up period, without any neurological deficits. Intraoperative recording and functional mapping of adjacent areas of the structural lesions of the brain are useful in surgery and can guide the extent of further resection.
Adolescent ; Adult ; *Brain Mapping ; Brain Neoplasms/physiopathology/*surgery ; Electroencephalography ; Evoked Potentials, Somatosensory ; Female ; Human ; Intraoperative Period ; Male ; Middle Age ; Seizures/physiopathology/*surgery ; Support, Non-U.S. Gov't

PURPOSE: This study was conducted to assess the clinical relevance of diffusion tensor tractography (DTT) in pre- and post-operative evaluations of childhood epilepsy surgery. MATERIALS AND METHODS: Seventy-two patients who received epilepsy surgery between March 2004 and July 2008 were retrospectively analyzed (M : F=40 : 32, ages of 3 months to 24 years, mean age=8.9 years). DTT was performed using a 3.0 T scanner and single-shot spin-echo echo-planar imaging with 32-different diffusion gradient directions. We reviewed the data focusing on the type of surgery, final pathological diagnosis, and how the DTT data were clinically used. RESULTS: The most common form of childhood epilepsy surgery was complete resection of an epileptogenic lesion (n=52, 72.2%). The reported etiologies included cortical dysplasia (n=32, 44.4%), hippocampal sclerosis (n=9, 12.5%), brain tumors (n=7, 9.7%), and non-pathologic lesions (n=4, 5.6%) in the final diagnoses. Twenty-one dysplastic cortexes and four brain tumors involved an approximal relationship with the corticospinal tract (n=18), optic radiation (n=2), and arcuate fasciculus (n=5). Additionally, although DTT demonstrated white matter tracts clearly, DTT in the hippocampal sclerosis did not provide any additional information. In cases of callosotomy (n=18, 25%), post-operative DTT was utilized for the evaluation of complete resection in all patients. DTT information was not used in functional hemispherectomy (n=2, 2.8%). CONCLUSION: Preoperatively, DTT was a useful technique in cases of cortical dysplasia and brain tumors, and in cases with callosotomy, postoperatively. DTT should be included among the routine procedures performed in management of epilepsy.
Adolescent ; Adult ; Brain Neoplasms/pathology/surgery ; Child ; Child, Preschool ; Diffusion Tensor Imaging/*methods ; Epilepsy/*pathology/*surgery ; Female ; Hippocampus/pathology ; Humans ; Infant ; Male ; Retrospective Studies ; Sclerosis/pathology/surgery ; Seizures/surgery ; Treatment Outcome ; Young Adult

In this report, we describe a case of brain abscess due to odontogenic infection. A 53-year-old female who had been suffering from headache and trismus for two weeks visited the Department of Oral and Maxillofacial Surgery at the Sun Dental Hospital (Daejeon, Korea). Even after several routine tests, we still could not make a diagnosis. However, after the combined multidisciplinary efforts of oral surgeons and neurosurgeons, the patient was treated for odontogenic infection and made an uneventful recovery. Therefore, patients with infections in the head and neck region showing symptoms such as headache, changes in mental state, nausea, vomiting, seizures, hemiplegia, speech disturbance, and visual disturbance, a brain abscess should be included in the list of differential diagnoses.
Brain Abscess* ; Diagnosis ; Diagnosis, Differential ; Female ; Head ; Headache ; Hemiplegia ; Humans ; Middle Aged ; Nausea ; Neck ; Seizures ; Solar System ; Surgery, Oral ; Trismus ; Vomiting

Despite reductions in surgical mortality, neurologic sequelae remain a devastating complication after cardiac surgery with cardiopulmonary bypass. Neurologic complications may be induced by a massive air embolism during cardiopulmonary bypass, even with extensive monitoring. This report describes a patient who had a fatal cerebral infarct during aortic valve and ascending aorta replacement surgery. We monitored jugular venous O2 saturation (SjvO2) and cerebral oximetry using near-infrared spectroscopy in the perioperative period. The operation and anesthesia were uneventful until the deep hypothermic total arrest for the replacement of the ascending aorta. However, restarting the cardiopulmonary bypass after deep hypothermic total arrest produced a brief (less than 10 seconds) but large amount of air in the root cannula. At this time, although cerebral oximetry did not show any changes, the SjvO2 decreased to 21% for about 3 minutes and then normalized. At 8 hours after surgery, the patient showed seizures and severe edema in both cerebral hemispheres on the MRI. The patient died 21 days after surgery.
Anesthesia ; Aorta ; Aortic Valve ; Cardiopulmonary Bypass ; Catheters ; Cerebrum ; Edema ; Embolism, Air ; Humans ; Oximetry ; Perioperative Period ; Seizures ; Spectroscopy, Near-Infrared ; Thoracic Surgery