No abstract available.
Cerebral Ventriculitis* ; Enterobacter aerogenes* ; Enterobacter* ; Pefloxacin*

No abstract available.

The size of unruptured intracranial aneurysms is an important factor that determines their rupture potential; however, the critical threshold size remains to be established. Some useful informations for determining the threshold size have been provided by the reports on the long-term follow-up of previously diagnosed unruptured aneurysms and clinical or autopsy studies on the size of ruptured aneurysms. Among the ninety-eight patients with ruptured cerebral aneurysms the authors managed during the last 4 years and the size of which were identified neuroradiologically and/or intraoperatively, eight cases(8.2%) had very small (maximum diameter less than 5mm) aneurysms. Their clinical features were not remarkably different from the usual aneurysmal SAH. As for the morphology, all of the eight had thin wall and narrow neck; in five cases the aneurysmsal sac had elongated shape. Several clinical reports on the ultimate rupture of previously diagnosed very small unruptured aneurysms and the formidable incidence of very small ruptured aneurysms in such clinical studies as this suggest that very small aneurysms also have a definite risk of rupture. The clinical significance of the narrow neck and elongated sac of the very small ruptured aneurysms observed in the authors' cases seems to be characteristic enough to deserve further investigation.
Aneurysm* ; Aneurysm, Ruptured ; Autopsy ; Follow-Up Studies ; Humans ; Incidence ; Intracranial Aneurysm ; Neck ; Rupture

To elucidate the early sequential morphogenetic progress of exencephaly and myeloschisis, rat embryos whose mothers had been treated with hypervitaminosis A were studied at 1-day interval from gestation day 10.5 to 15.5. In exposed animals sequential change was found in both exencephaly and myeloschisis as the embryos grew up. The 10.5-day old exencephalic embryos had still widely open cephalic neural tubes. Exencephalic embryos older than 13.5 days of gestation showed strikingly severe eversion and overgrowth of the cephalic neuroepithelium, thus failed in forming normal primitive brain. The convex dorsal surface of the exencephaly was covered with ependyma, which was connected directly with surrounding surface eqithelium at the periphery. The earliest morphologically recognized myeloschisis was in the 13.5-day old embryos. In myeloschisis, divergence at the roof plate and eversion of the spinal neural tube, disorganized overgrowth of the neuroepithelium, malformed and misplaced spinal ganglia and nerve roots, and absence of the neural arch and dermal covering were characteristic. It is suggested that exencephaly results from failure of the cephalic neural tube closure which is followed by eversion and overgrowth of the neuroepithelium. And failure in closure of the posterior neuropore and disturbance in the development of the tail bud probably play major role in the morphogenesis of myeloschisis.
Animals ; *Embryonic and Fetal Development ; Female ; Hypervitaminosis A ; Neural Tube Defects/chemically induced/*pathology ; Pregnancy ; Rats ; Rats, Inbred Strains ; Spinal Cord/*abnormalities/embryology

The authors report an anomalous fenestration at the M1 portion of the middle cerebral artery found incidentally in a patient affected with a ruptured aneurysm at the ipsilateral internal carotid artery(ICA) and unruptured small aneurysms at the contralateral P1 and ICA. The anomaly was confirmed both angiographically and intraoperatively. A review of the literature indicated several reports of this same anomaly, many of which were associated with aneurysms involving either the proximal end of the fenestration or other cerebral arteries. In the interpretation of cerebral angiograms and during intracranial operations, clinical attention should be paid to this rare anomaly.
Aneurysm* ; Aneurysm, Ruptured ; Cerebral Arteries ; Humans ; Intracranial Aneurysm ; Middle Cerebral Artery

We report a rare case of cervical intradural extramedullary neurilemmoma associated with extradural cavernous angioma in adolescent male patient. This 19-year-old man complained of increasing weakness of left extremities with pain and numbness, starting upwards from the region of left leg since 2 months before, which has aggravated gradually and developed to right side. Neither the patient nor any family member displayed the stigmata of spinal tumor. Neurological examination showed spastic qudriparesis, more severe on left side, disclosed absent vibratory sense and diminution of pain and touch below level of cervico-thoracic junction. Myelogram demonstrated a large filling defect at the C4-6 vertebral level, which was interpreted as an intradural extramedullary or extradural mass. Laminectomy was performed 4 days after admission. At surgery, reddish, diffuse and well demarcated friable mass was found extradural space at the level of C4-6. But post-operative course was not improved for 2 weeks, so we are performed second operation after identified another intradural extramedullary mass by spinal CT. A total removal of tumor mass was accomplished at second procedure. Hostological examination confirmed the diagnosis of cavernous angioma at the extradural mass, neurilemmoma at the intradural extramedullary mass. The post-operative course was satisfactory.
Adolescent ; Christianity ; Diagnosis ; Extremities ; Hemangioma, Cavernous* ; Humans ; Hypesthesia ; Laminectomy ; Leg ; Male ; Muscle Spasticity ; Myelography ; Neurilemmoma* ; Neurologic Examination ; Young Adult

Spontaneous fracture of the Silastic shunt catheter is a rare complication of lumboperitoneal shunt. A review of the literature revealed only one case in which spontaneous fracture occurred after this procedure. The authors report a case in which fracture of a lumboperitoneal shunt catheter occurred within the interspinous ligament probably due to repeated tension caused by flexion and extension during lumbar motion. The fractured proximal catheter was located entirely within the intrathecal space exclusively from the level of L1 to S1, and caused incomplete cauda equina syndrome.
Catheters* ; Fractures, Spontaneous* ; Ligaments ; Polyradiculopathy

A rare case of thoracic myelopathy caused by the ossification of hypertrophied ligamentum flavum is presented. A fourty-year old male complained of decreased pain, temperature, touch sense at right lower limb, weak urinary stream, poor penile erection, and constipation. CT revealed an ovoid, homogeneously high density at the site of left T10-11 ligamentum flavum, which compressed the spinal cord posterolaterally. MR imaging showed significant spinal cord compression on the left posterolateral aspect at T10-11 level by a well-defined purely low-intensity signal lesion. Simple spine X-rays did not show any abnormality. T10 total laminectomy and removal of the ossified ligamentum flavum resolved his neurological dysfunction. Clinical summary of the case is presented and the corresponding literature are reviewed.
Constipation ; Humans ; Laminectomy ; Ligamentum Flavum* ; Lower Extremity ; Magnetic Resonance Imaging ; Male ; Penile Erection ; Rivers ; Spinal Cord ; Spinal Cord Compression ; Spinal Cord Diseases* ; Spine

The authors retrospecitviely analyzed the MRI findings of the 8 head-injured patiens who had showed persistent unconsciousness and severe neurologic deficite after trauma. T2-weighted MR images disclosed high signal intensity lesions of various size and shape at lobar white matter and corpus callosum, subcortical gray matter, brain stem, and cerebral cortex, and assisted greatly in understanding the neurologic deficits of the corresponding patients. The lesions were mostly multiple and involved multiple structures. CT's revealed in those patients only small hemorrhages, suspicious low densities, such nonspecific findings as slit ventricles and diffuse brain atrophy, or no abnormality at all. Post-traumatic parenchymatous lesions detected by MR images were either missed or quite underestimated on CT's. MRI was very supeior to CT in the detection and anatomic localization of nonhemorrhagic intraaxial cerebral injuries. especially in the cases of small corical contusions, brainstem and white matter injuries. For the evaluation of the acute posttraumatic patients, CT ios indicated in order to fastly detect intracranial hemagomas which may need emergent surgical evacuation. If CT findings does not explain the neurologic degicits of the patients, especially in the late stage. MRI is indicated. MRI is expected to play a major role in the diagnosis of shear injuries involoving white matter and brainstem where CT has been of little contribution or misleading.
Atrophy ; Brain ; Brain Stem ; Cerebral Cortex ; Contusions ; Corpus Callosum ; Diagnosis ; Hemorrhage ; Humans ; Magnetic Resonance Imaging* ; Neurologic Manifestations ; Unconsciousness

The preferred site of spontaneous intracerebral hemorrhage(SICH) is the supratentorial area, especially the basal ganglia. Large hematomas frequently spread into the ventricle, and in the case of intraventricular hematomas, varying degrees of fresh blood are found within the subarachnoid space. Cases in which SICH of the basal ganglia ruptures the insular cortex and causes thick subarachnoid hemorrhage(SAH) in the basal cisterns, are, however, rare. The authors report a rare case of putaminal SICH with intraventricular hemorrhage(IVH) and SAH in the basal cisterns. This 58-year-old female was stuporous on admission. Neurological examination revealed Glasgow coma scale score 7, left hemiparesis, positive Babinski's sign and neck stiffness. Brain CT showed a large intracerebral hematoma in the right basal ganglion and associated intraventricular hematoma and SAH in the basal cistern. Cerebral angiography demonstrated a small saccular aneurysm at the right M1. Right pterional and trans-sylvian approach revealed thick SAH in the sylvian fissure and a small unruptured aneurysm at the early bifurcation of the middle cerebral artery. The putaminal hematoma had ruptured into the sylvian fissure through a natural opening at the insular cortex between M2 branches. This case illustrates that hypertensive SICH should be included in the differential diagnosis of basal cistern SAH associated with SICH.
Aneurysm ; Basal Ganglia ; Brain ; Cerebral Angiography ; Diagnosis, Differential ; Female ; Ganglion Cysts ; Glasgow Coma Scale ; Hematoma ; Humans ; Middle Aged ; Middle Cerebral Artery ; Neck ; Neurologic Examination ; Paresis ; Putaminal Hemorrhage* ; Reflex, Babinski ; Rupture ; Stupor ; Subarachnoid Hemorrhage* ; Subarachnoid Space