A rare case of idiopathic subcortical intracerebral hematoma superimposed on the subarachnoid hemorrhage due to the rupture of an ipsilateral middle cerebral artery bifurcation aneurysm is reported and pertinent literatures are reviewed.
Aneurysm* ; Hematoma* ; Middle Cerebral Artery* ; Rupture ; Subarachnoid Hemorrhage*

Myoclonus is a rare side effect of gabapentin (GBP) and has been reported in patients with preexisting myoclonus, mental retardation, chronic static encephalopathy, diffuse brain damage, impaired renal function, or end stage renal disease. We report a case of myoclonus in a patient with normal renal function and no previous disorders. A 69-year-old female underwent diskectomy and foraminotomy at the left L4-L5 level. Postoperatively,she complained of paresthesia in her left leg, which was thought to be due to root manipulation during surgery. To relieve the paresthesia, she was given tramadol, an oral opioid agonist, and GBP. One week after GBP was increased to 900 mg per day, myoclonus developed, which severely impaired her normal activity. Her symptoms resolved 2 days after discontinuation of GBP. The coadministration of tramadol and GBP may mutually enhance the myoclonic potential of each drug. The causal relationship between GBP and myoclonus was suggested by cessation of myoclonus after GBP discontinuation despite continued therapy with tramadol.
Aged ; Amines ; Analgesics, Opioid ; Brain ; Cyclohexanecarboxylic Acids ; Diskectomy ; Female ; Foraminotomy ; gamma-Aminobutyric Acid ; Humans ; Intellectual Disability ; Kidney Failure, Chronic ; Leg ; Myoclonus ; Paresthesia ; Tramadol

Most of Tarlov or perineurial cysts remain asymptomatic throughout the patient's life. The pathogenesis is still unclear. Hemorrhage has been suggested as one of the possible causes and trauma with resultant hemorrhage into subarachnoid space has been suggested as an origin of these cysts. However, Tarlov cysts related to spontaneous subarachnoid hemorrhage has not been reported. The authors report a case of Tarlov cyst which was symptomatic following spontaneous subarachnoid hemorrhage.
Hemorrhage ; Subarachnoid Hemorrhage ; Subarachnoid Space ; Tarlov Cysts

Acupuncture is one of the most popular complimentary therapies these days not only in Asia, but also in USA and Europe. Acupuncture is generally regarded as a safe procedure in the general public. However, acupuncture is not free of risk; complications of acupuncture have been repeatedly reported in the medical literatures. The authors report a rare case of hemorrhage in the cisterna magna after acupuncture. Acute frontal headache, dizziness, neck pain, neck stiffness, and paresthesia or tingling discomfort at arms and legs developed immediately after an acupuncture treatment that had been performed to treat her chronic posterior neck pain. Computerized tomography scans and magnetic resonance images(MRI) showed a 1.2x0.8cm-sized high density and high signal mass within the cisterna magna. It is probable that the acupuncture needle had been inserted deep enough to enter the cisterna magna and provoked a small hemorrhage in the cistern. She gradually recovered from the symptoms. Physicians and acupuncture therapists should be aware of the adverse events associated with acupuncture.
Acupuncture* ; Arm ; Asia ; Cisterna Magna* ; Dizziness ; Europe ; Headache ; Hemorrhage* ; Leg ; Neck ; Neck Pain ; Needles ; Paresthesia

OBJECTIVE: Considerable recurrence rates have been reported for chronic subdural hematoma (CSDH) following surgical evacuation. The aim of this study was to determine the independent factors and features of CSDH that are associated with postoperative recurrence. METHODS: Retrospective analysis of 136 consecutive patients diagnosed with CSDH who were surgically treated from September 2005 to December 2011 was performed. The demographic data, clinical characteristics, radiologic features were analyzed to clarify the correlation between independent variables and postoperative recurrence of CSDH. RESULTS: CSDH was resolved within 1 month following surgery in 51 patients (37.5%), between 1 to 3 months in 59 patients (43.4%), and past 3 months in 14 patients (10.3%). A total of 12 patients (8.8%) experienced recurrence of CSDH, and reoperation was performed in all recurred cases. The average duration between initial surgery and reoperation was 20.1 days. Delayed resolution and recurrence were more commonly presented in bilateral CSDH, but this data was not statistically significant. Large hematomas with maximum thickness over 20 mm were significantly correlated with higher recurrence rates of CSDH (p=0.032). In addition, the incidence of recurrence was significantly higher in the cases with high-density and mixed-density hematomas according to brain computed tomography (CT) findings (p=0.0026). CONCLUSION: The thickness and density of the hematoma is significantly correlated with higher recurrence rates of CSDH. Discerning these risk factors could be beneficial in predicting the postoperative recurrence of CSDH.
Brain ; Hematoma ; Hematoma, Subdural, Chronic ; Humans ; Incidence ; Recurrence ; Reoperation ; Retrospective Studies ; Risk Factors

A case with a true posterior communicating artery aneurysm is reported, who had been managed by early surgical neck clipping and post-operative intensive cares for numerous complications. The small saccular aneurysm was located at the proximal posterior communicating artery and directed superiorly. A lacunar infarct developed at right anterior thalamus post-operatively, which had resulted probably from the occlusion of a fine posterior communicating arterial perforator. Aneurysms of the posterior communicating artery itself are saccular or fusiform. Great cares should be taken in surgical aneurysmal neck clipping to avoid any injury of the perforators and the oculomotor nerve;trapping of the posterior communicating artery to treat fusiform or wide-necked aneurysms will result in unpredictable outcomes.
Aneurysm ; Arteries ; Intracranial Aneurysm* ; Neck ; Stroke, Lacunar ; Thalamus

A case of persistent monocular blindness probably resulting from the post-subarachnoid hemorrhage ischemic injury of the posterior optic nerve is reported. On admission, the patient was assessed as Hunt-Hess classification grade III, Fisher group IV. Uneventful surgery for clipping the neck of her small saccular anterior communicating artery aneurysm was performed on second hospital day via left pterional approach. She complained of total blindness of her left eye as she recovered from drowsy consciousness to be lethargic on first post-operative day; her left eye showed sluggish direct pupillary light reflex and normal optic fundoscopy. Her ensuing hospital course had been complicated by symptomatic vasospasm, bleeding tendency, subacute epidural hematoma, and hydrocephalus. She was independent on discharge. Ophthalmologic evaluation on 60th post-subarachnoid hemorrhage day showed total blindness and optic disc atrophy of her left eye. Probable ischemic optic neuropathy is another cause of the post-subarachnoid hemorrhage visual disturbance, especially after the rupture of anterior communicating artery aneurysms.
Atrophy ; Blindness ; Classification ; Consciousness ; Hematoma ; Hemorrhage ; Humans ; Hydrocephalus ; Intracranial Aneurysm* ; Neck ; Optic Nerve ; Optic Neuropathy, Ischemic* ; Reflex ; Rupture ; Subarachnoid Hemorrhage

Spinal arachnoid cyst is a rare cause of myelopathy secondary to spinal cord compression. We report a case presenting extradural arachnoid cyst of probable traumatic origin leading to irreversible neurological deficits including paraparesis and neurogenic bladder. The patient presented progressive paraparesis and voiding difficulty. Magnetic resonance imaging (MRI) of the spine revealed long segmental cystic lesion of cerebrospinal fluid (CSF) signal intensity at dorsal extramedullary space of T11 to L3 level suggesting arachnoid cyst with diffuse cord compression. On the operation, an ovoid shaped dural defect was identified at right sided dorsolateral aspect of the dura mater between nerve root sleeves at T11 and T12 level. The patient was treated by microsurgical repair of the dural defect and intraoperative findings revealed no further leakage of CSF. The neurological status of the patient was stationary on follow-up examination postoperatively. We postulate that delayed-onset post-traumatic extradural arachnoid cyst should be taken into consideration on the differential diagnosis of intrapinal cysts.
Arachnoid ; Diagnosis, Differential ; Dura Mater ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Paraparesis ; Spinal Cord Compression ; Spinal Cord Diseases ; Spine ; Urinary Bladder, Neurogenic

OBJECTIVE: The authors present eight cases of immediate post-operative epidural hematomas(EDHs) adjacent to the craniotomy site, describe clinical details of them, and discuss their pathogenesis. METHODS: Medical records of eight cases were retrospectively reviewed and their clinical data, operation records, and radiological findings analyzed. Any risk factors of the EDHs were searched. RESULTS: In 5 of 8 cases, adjacent EDHs developed after craniotomies for the surgical removal of brain tumors. Three cases of adjacent EDHs developed after a pterional approach and neck clipping of a ruptured anterior communicating artery aneurysm, a ventriculoperitoneal shunt, and a craniotomy for a post-traumatic EDH, respectively. In all eight cases, brain computed tomography (CT) scans checked immediately or a few hours after the surgery, revealed large EDHs adjacent to the previous craniotomy site, but there was no EDH beneath the previous craniotomy flap. After emergent surgical removal of the EDHs, 7 cases demonstrated good clinical outcomes, with one case yielding a poor result. CONCLUSION: Rapid drainage of a large volume of cerebrospinal fluid or intra-operative severe brain collapse may separate the dura from the calvarium and cause postoperative EDH adjacent to the previous craniotomy site. A high-pressure suction drain left in the epidural space may contribute to the pathogenesis. After the craniotomy for brain tumors or intracranial aneurysms, when remarkable brain collapse occurs, an immediate postoperative brain CT is mandatory to detect and adequately manage such unexpected events as adjacent EDHs.
Brain ; Brain Neoplasms ; Cerebrospinal Fluid ; Craniotomy* ; Drainage ; Epidural Space ; Hematoma* ; Intracranial Aneurysm ; Medical Records ; Neck ; Retrospective Studies ; Risk Factors ; Skull ; Suction ; Ventriculoperitoneal Shunt

Pleomorphic xanthoastrocytoma (PXA) has been considered as a low grade tumor of adolescents and young adults. Although this tumor often shows cystic component, the hemorrhage within the cyst is extremely rare. The authors report a rare case of cystic PXA with a hemorrhage within the cyst and the mural nodule in the left frontal lobe. A 64-year-old male presented with a week history of the right side hemiparesis. After gross total resection of the tumor, the patient was fully recovered from neurological deficit. It is suggested that this typically benign tumor could be presented with hemorrhage, causing a rapid neurological deterioration. Prompt surgical intervention, especially total removal of the tumor can provide an excellent functional recovery.
Adolescent ; Frontal Lobe ; Hemorrhage* ; Humans ; Male ; Middle Aged ; Paresis ; Young Adult