Anticoagulant(heparin, warfarin) or thrombolytic agent(urokinase, tissue plasminogen activator) can be one of the causes of spontaneous ICH. Even though ICH related with anticoagulants and thrombolytic agents represent low incidence and slow progression, the final outcome usually very poor. Recently the use of anticoagulants and thrombolytic agents have been increased for recanalization of cerebral and myocardial infarction. Therefore, the importance of possible ICHs related to these agents need to be reemphesized. The authors analysed 18 patients of ICH related with anticoagulants and thrombolytic agents to evaluate the underlying mechanism, their characters, the factors which influence the formation of ICH and the prognosis. Eighteen cases of ICH related with anticoagulants and thrombolytic agents were analysed through the medical record, operation record and brain CT. In this study, patients in sixth decade showed the highest incidence. The most common primary disease was middle cerebral infarction(67%). Urokinase was most commonly infused for recanalization of cerebral and myocardial infarction. The mean duration between drug administration and hemorrhagic attack was 59 hours(with range from 1 hour to 96 hours). After onset of the hemorrhage, fourteen of eighteen cases revealed prolonged prothrombin time more than 1 1/2 to 2 times of control and nine of fourteen cases revealed prolonged thrombin time more than 1 1/2 to 2 times of cotrol. The mean volume of ICH was 31cc and locations of hemorrhage were lobar(45%), ganglionic(22%), thalamic(22%) and cerebellar(11%) in decreasing orders. Brain CT scans revealed that 12 cases were single hematoma and 6 cases were multiple hematoma. Twelve cases were treated conservatively and six cases were operated with stereotactic surgery(3 cases) and open craniotomy (3 cases). One case with stereotactic surgery and the other case with craniotomy were reoperated because of rebleeding and retained hematoma, respectively. The neurological condition before administration of anticoagulants and thromb-olytic agents was relatively good, but suddenly deteriorated after hemorrhage attack. Almost all cases(94%) prese-nted poor porgnosis as wholly dependent, vegetative and dead at discharge except one case of small cerebellar ICH. In this study, previously existed infarction and anticoagulants itself contributed to the occurrence of intracerebral hemorrhage. The prolonged prothrombin time may be useful predictable value in the formation of ICH. Although we could not find definitive factors to influence the prognosis, the mortality rate of multiple hematoma was much higher than single hematoma. The final outcome of these patients were very poor. Therefore, the choice of agents, dosage and duration of administration should be considered more judicious.
Anticoagulants* ; Brain ; Cerebral Hemorrhage* ; Craniotomy ; Fibrinolytic Agents* ; Hematoma ; Hemorrhage ; Humans ; Incidence ; Infarction ; Medical Records ; Mortality ; Myocardial Infarction ; Plasminogen ; Prognosis ; Prothrombin Time ; Thrombin Time ; Tomography, X-Ray Computed ; Urokinase-Type Plasminogen Activator

We report a case of thoracic post-herpetic neuralgia which was improved by dorsal root ganglionectomy. The patient had failed to obtain adequate pain relief from conservative therapy such as carbamazepine, amitriptyline, thioridazine, gabapentin, and transcutaneous lidocaine infiltration. Thoracic dorsal root ganglionectomy from T5 to T7 on left side was performed and satisfactory pain relief without significant postoperative neurologic deficit was achieved. Although dorsal root entry zone operation for refractory pain was the most commonly performed procedure in past, dorsal root ganglionectomy is an alternative anatomically and technically safe procedure for the pain in the thoracic lesion. The clinical feature, operative technique and clinical result are presented with review of the literatures.
Amitriptyline ; Carbamazepine ; Ganglionectomy* ; Humans ; Lidocaine ; Neuralgia* ; Neurologic Manifestations ; Pain, Intractable ; Spinal Nerve Roots ; Thioridazine

Isolated fourth ventricle(IFV) is a rare entity producing symptoms of a progressive posterior fossa mass lesion. It is mainly reported in a patient who undergo shunt placement as its late complication. However, its surgical management has been difficult and its optional treatment remains controversial. We had an occasion to admit 19-year-old female to our hospital due to hydrocephalus: she had a history of meningitis when she was 2 years old. Ten years later, she was diagnosed as hydrocephalus and managed by lateral ventriculo-peritoneal shunting procedure. Seven years after the procedure, the patient presented with headache, nausea, truncal ataxia and nystagmus. Computed tomography and magnetic resonance image scan demonstrated markedly enlarged fourth ventricle: and thus, neuroendoscopic aqueductoplasty and aqueductal stent insertion was performed. The authors present a case of an IFV after lateral ventriculo-peritoneal shunting for hydrocephalus, which was treated successfully with a neuroendoscopic surgery. The technique of this procedure is described below.
Ataxia ; Child, Preschool ; Female ; Fourth Ventricle* ; Headache ; Humans ; Hydrocephalus ; Meningitis ; Nausea ; Stents* ; Ventriculoperitoneal Shunt ; Young Adult

No abstract available.
Catheters*

The most common cause of isolated oculomotor nerve palsy is ischemia of the peripheral nerve caused by a disease, such as diabetes mellitus. Another common cause of isolated oculomotor nerve palsy is compression by an intracranial aneurysm, usually an posterior communicating artery aneurysm. However, it is extremely rare in the pituitary tumor. We report an unusual case of pituitary adenoma presenting with isolated oculomotor nerve palsy in the setting of pituitary apoplexy. We suggest that pituitary apoplexy should be included in the differential diagnosis of a patient with isolated oculomotor nerve palsy and early surgery should be considered for preservation of oculomotor nerve function.
Diabetes Mellitus ; Diagnosis, Differential ; Humans ; Intracranial Aneurysm ; Ischemia ; Oculomotor Nerve Diseases* ; Oculomotor Nerve* ; Peripheral Nerves ; Pituitary Apoplexy* ; Pituitary Neoplasms

Purpose: This study was performed to examine a comprehensive profile of ophthalmic (OPH) referrals based on diagnosis in a single emergency department (ED) in Korea. Methods: We analyzed the clinical profiles of children (< 18 years) who underwent immediate OPH referrals in a tertiary hospital ED, from March 2013 through December 2022. Exclusion criteria were a visit related to procedural complication and a discharge before thorough evaluation. We focused on a diagnosis-based high OPH severity requiring emergency surgery or hospitalization. The profiles were compared according to the severity and age group (0-3, 4-6, 7-12, and 13-17 years). Results: A total of 1,939 children consisted of 1,281 (66.1%) with injury and 658 (33.9%) with non-injury. Top 3 injuries were orbital fracture, hyphema, and corneal abrasion whereas top 3 non-injuries were keratoconjunctivitis, cellulitis, and hordeolum. Children with high OPH severity (54.5%) had significantly lower proportions of girls (26.5% vs. 38.9%), visits on weekend/holiday (34.4% vs. 43.4%), and most non-injury chief complaints, and higher proportions of 13-17 years (41.1% vs. 23.6%), injury (87.7% vs. 40.1%), emergency surgery (4.9% vs. 0.1%), in-ED procedure (9.3% vs. 2.4%), hospitalization (4.0% vs. 0.8%), and most injury mechanisms. With increasing age, high OPH severity, orbital fracture, and hyphema increased in proportions, in contrast to a decreasing tendency in corneal abrasion, keratoconjunctivitis, cellulitis, and hordeolum (all Ps for trend ≤ 0.001). There were 610 (31.5%) children with low OPH severity or no OPH diagnosis. Conclusion True OPH emergencies may be more common in injured, older, or male children. This finding could be useful in focusing on emergencies while diverting less urgent cases to outpatient departments or outside ophthalmology clinics.

OBJECTIVE: Computed tomographic angiography (CTA) is useful for rapid and relatively noninvasive detection of aneurysms in the circle of Willis. The purpose of this study is to compare CTA with conventional cerebral angiography (CCA) and to assess usefulness of CTA in detection of the anatomic delination of intracranial aneurysms of the circle of Willis in subarachnoid hemorrhage. PATEINTS AND METHODS: 126 consecutive patients with known SAH or suspected intracranial saccular aneurysms underwent CTA and CCA from January 2002 to June 2003. Using surface shaded display post-processing technique, CTA was interpreted for the presence, location and anatomic features of the aneurysms and also the image obtained with CTA was compared with CCA image. RESULTS: In 112 operated patients, 125 aneurysms were detected. CCA revealed 123 cerebral aneurysms and CTA revealed 113 aneurysms. Two of the 125 cerebral aneurysms were located outside of the imaging volume of CTA, 10 cases were not detected and false positive were 2 cases. The sensitivity of CTA was 90.3%. The results obtained with CTA comparing with that of CCA were almostly equal in detection of aneurysm location and delineation of aneurysmal neck. However, CTA provided a 3-dimensional representation of aneurysm and also it was very useful for surgical planning. CONCLUSION: CTA can be a diagnostic tool for the patients with acute subarachnoid hemorrge due to a ruptured aneurysm of the circle of Willis and provides adequate anatomic detail for surgical planning especially to complex cerebral aneurysms. However, it is obvious that CCA is necessary because of the limitations of CTA including its difficulty in detecting unusually located aneurysms including those in cavernous sinus or distal artery, and acquiring dynamic flow information.
Aneurysm ; Aneurysm, Ruptured ; Angiography* ; Arteries ; Cavernous Sinus ; Cerebral Angiography* ; Circle of Willis ; Humans ; Intracranial Aneurysm* ; Neck ; Subarachnoid Hemorrhage

Fibrous dysplasia (FD) is a non-malignant progressive condition, which replaces normal bone and marrow with fibrous tissue and woven bone. Sinus mucocele is a cystic, expansile, and destructive lesion that occurs as a result of obstruction of the sinus ostium secondary to inflammation, trauma, anatomical variation, previous sinus surgery, tumor or FD. Among them, FD combined with mucocele has been rarely reported. Here we report the first case of FD combined with ethmoid mucocele. The patient underwent endoscopic debulking of FD and marsupialization of mucocele. The mucocele was successfully marsupialized, and the patient’s symptoms were completely resolved. We propose a new hypothesis that nasal mucosa invaginates into FD and forms a mucocele. For the treatment of ethmoid FD combined with mucocele, we recommend an endoscopic transnasal approach for debulking and marsupialization.

Vascular anomaly and aneurysmal formation of an anterior communicating artery (ACOM) complex has often been reported. Because of such a complicated relationship between the vascular structure and aneurysms, ACOM aneurysm is one of the most difficult aneurysms to treat among other common anterior circulation aneurysms. We herein report a case of wire perforation of a missed tiny aneurysm arising from the fenestrated A1 segment during the endovascular approach to ACOM aneurysm. Although the fenestration of A1 segment is a rare vascular anomaly, it is likely to accompany saccular type aneurysms in the vicinity of the vascular anomaly. Endovascular treatment for ACOM aneurysm requires more detailed evaluations of the accompanying vascular anomaly and hemodynamics around ACOM to avoid complications.