A clinical studies were conducted on 71 patients with subarachnoid hemorrhage by ruptured intracranial aneurysms, to evaluate the significance of fundal hemorrhage. Fundal hemorrhage was found in 20 patients(28%), mainly preretinal in location, and it occurred more frequently in patients with aneurysms of internal carotid artery, and in ipsilateral or bilateral, rather than contralateral side. Significant relationship was noted between fundal hemorrhage and increased intracranial pressure. However, there was no such relationship with frequency of aneurismal rupture and hypertension. Intracranial complications by ruptured aneurysms were significantly higher(50%) in patients with fundal hemorrhage, compared to patients without it. Also, there were more severe neurological abnormalities as grade III-V according to Botterell's classification in patients with fundal hemorrhage. After surgical and/or nonsurgical treatment, 20% of patients with and 11.7% of patients without fundal hemorrhage could not lead their normal lives. Mortality rate in patients with fundal hemorrhage was higher by 30%, compared to that in patients without fundal hemorrhage(19.6%).
Aneurysm ; Aneurysm, Ruptured ; Carotid Artery, Internal ; Classification ; Hemorrhage* ; Humans ; Hypertension ; Intracranial Aneurysm* ; Intracranial Pressure ; Mortality ; Rupture ; Subarachnoid Hemorrhage*

No abstract available.
Spinal Cord Vascular Diseases*

No abstract available.
Aneurysm* ; Humans ; Hydrocephalus*

No abstract available.
Animals ; Brain* ; Cats* ; Magnetic Resonance Spectroscopy*

PURPOSE: Hypothalamic hamartomas are non-neoplastic malformations which are composed of hyperplastic neuronal tissue of varying size. Clinically, they are characterized by gelastic seizure, precocious puberty, and behavioral and psychiatric disorders. This study was performed to examine the various features of hypothalamic hamartomas such as neurologic manifestations, other clinical manifestations, and EEG and brain MRI findings. Response to AEDs or outcome of operation on hypothalamic hamartoma was evaluated. METHODS: Eleven patients who were admitted to Seoul National University Children's Hospital from July 1986 to January 1997 and diagnosed as hypothalamic hamartoma by brain MRI or CT were enrolled in this study. Clinical manifestations and EEG were reviewed retrospectively through the medical records. The size and type of the hypothalamic hamartoma on brain MRl were analyzed. RESULTS: 1) The range of age at visit was 1yr 9mo to 17yr 2mo (mean 10yr 8mo), and the age at onset was 1yr 1mo to 14yr to 2mo (mean 5yr 8mo). Six patients were male and five were female. 2) The clinical manifestations included gelastic seizure (n=9), behavioral and psychiatric disorders (n=9), other types of seizure (n=8), and precocious puberty (n=6). Other types of seizure were complex partial seizure (n=3), generalized tonic seizure(n=3), and infantile spasm (n=2). 3) The interictal EEG findings included focal spike discharges (n=8), diffuse delta slowings (n=1), hypsarrhythmia (n=1), and normal record (n=1). The focal spike discharges originated from the temporal (n=2), fronto-temporal (n=1), occipital (n=3), or frontal area(n=2). 4) The brain MRI showed that the size of the hypothalamic hamartomas was 2.47+/-1.12cm, and the origin of the tumors was tuber cinereum (n=6) or tuber cinereum and mamillary body (n=5). All lesions were isointense on T1-weighted image relative to normal gray matter, with a sessile attachment to the hypothalamus, and were not enhanced by Gadolinium. 5) Operations were done in 5 cases, those were subtotal removal of the tumor (n=4), and gamma knife radiosurgery (n=1). Seizures were not completely controlled in all but one case on which gamma knife radiosurgery was done. CONCLUSIONS: The hypothalamic hamartomas presented variable clinical pictures including gelastic seizure, precocious puberty, and behavioral and psychiatric disorders. The gelastic and other types of seizure associated with hypothalamic hamartomas were refractory to medication and might be controlled by total removal of the tumor.
Brain ; Electroencephalography ; Female ; Gadolinium ; Hamartoma* ; Humans ; Hypothalamus ; Infant ; Infant, Newborn ; Magnetic Resonance Imaging* ; Male ; Mamillary Bodies ; Medical Records ; Neurologic Manifestations ; Neurons ; Puberty, Precocious ; Radiosurgery ; Retrospective Studies ; Seizures ; Seoul ; Spasms, Infantile ; Tuber Cinereum

OBJECTIVE: Authors report the usefulness and limitation of shunt function test. METHODS: Of 457 who underwent shunt placement from 1993 to 2001, 33 patients with suspected shunt malfunction underwent the shunt function test using radioisotope and intracranial pressure(ICP) monitoring to evaluate shunt patency and to determine the site of obstruction. We analyzed retrospectively results of 36 shunt function test with operative finding in shunt revision. RESULTS: Of 36 results, 21 cases(58.3%) had patent shunt on the shunt function test and one of those underwent shunt revision regardless of the result. Five cases(13.8%) had proximal malfunction on test and three cases of those had obstruction in the shunt revision. Ten cases(27.2%) had distal malfunction on test and eight cases of those had obstruction. The sensitivity of shunt function test was 91.6%, the specificity 90.9%, and the accuracy 81.6%. CONCLUSION: The shunt function test using radioisotope and ICP monitoring is a reliable method to evaluate shunt patency. However, interpretation of the result should be based on the clinical and radiological findings of the patient, particularly in case of partial obstruction and functional malfunction due to valve system.
Humans ; Retrospective Studies ; Sensitivity and Specificity

OBJECTIVE: Identification of risk factors and prevention of the seizures are very important in the management of the pediatric traumatic brain injury(TBI). The authors conduct a study to find the risk factors of the pediatric posttraumatic seizures(PTS) and effectiveness of the prophylactic antiepileptic drugs(AED). METHODS: We respectively analyzed 82 pediatric patients below the age of 15 who visited our hospital with TBI from August 1995 to May 2001. Mean age at arrival was 6.1 years, ranging from 2 months to 15 years. Male to female ratio was 1.9 : 1. Mean follow-up period was 3.9 months ranging from 0.5 to 42 months. RESULTS: Among the 82 patients, 13(15.8%) experienced PTS. In eight of the 13 seizure patients, the seizures developed within 24 hours after trauma. Patients with Glascow coma scale score less than 8 had higher rate of seizure attack. Forty-seven patients(58%) used AED within 24 hours after trauma. Among them, two patients experienced seizure attacks. Among the other 35 patients who had not received prophylactic AED, 11 patients(31%) had seizures with significantly higher rate of PTS. CONCLUSION: PTS are common complication in pediatric TBI. Use of prophylactic AED in the early stage of TBI can reduce the development of early seizures.
Anticonvulsants* ; Brain ; Brain Injuries ; Child* ; Coma ; Female ; Follow-Up Studies ; Humans ; Male ; Risk Factors* ; Seizures*

C-T guided stereotactic early burr hole aspirations performed on 106 spontaneous deep intracerebral hematoma patients in the Department of Neurosurgery, Kyungpook University Hospital, between January 1992 and December 1993. For average five days following the operation, continual urokinase(UK) irrigation was done for complete removal of the remaining hematoma. Of the patients, 73 who were operated on within three days of bleeding ictus were chosen for analyses and evaluation by factors believed to affect the final results. Eighty six percent was found to have hypertension as it's cause. The hematoma was removed completely in 13.7% of all the patients on post operation 1st day and 45% within 7 days by urokinase irrigation. The site of hematoma in thalamocapsulo-lenticular area showed a rather poor remission rate compared with those in other locations along with a higher mortality rate. By comparison between the time of admission and discharge, the state of consciousness of patients showed much improvement with 440% of the number of alert patients on discharge:motor function also showed significant improvement with 450% good patients number. In case of poor state of consciousness or motor function on admission, the mortality rate was higher. Rebleeding after aspiration was found in 6.8% and in all the cases except one the operation was done within 24 hours of bleeding, which resulted in poor postoperative outcome without improvement. Pneumonia was most common complication during admission followed by hydrocephalus. Mortality rate was 8.2%, most of which resulted from direct brain damage through bleeding. This surgical method is simple, safe and efficient in treating spontaneous deep intracerebral hematoma with no significant outcome difference when compared with early craniotomy.
Aspirations (Psychology) ; Brain ; Cerebral Hemorrhage* ; Consciousness ; Craniotomy ; Gyeongsangbuk-do ; Hematoma ; Hemorrhage ; Humans ; Hydrocephalus ; Hypertension ; Mortality ; Neurosurgery ; Pneumonia ; Urokinase-Type Plasminogen Activator*

PURPOSE: Large rearrangements in the dystrophin gene is detected in about 65-70% of patients by multiplex PCR or Southern blot, although detection of point mutations and microlesions is currently in progress. The purpose of this study is to carry out mutation analysis of the dystrophin gene by application of PCR-related molecular diagnostic methods in Duchenne muscular dystrophy (DMD). METHODS: Five patients diagnosed as a DMD by muscle biopsy, and their first-degree relatives and mothers were enrolled in this study. The genomic DNA was extracted from the peripheral blood lymphocyte. We used a total of 28 pairs of primers including Beggs' and Chamberlain's primers. The multiplex PCR was performed in 4 groups; 5'Rxn2, 3'Rxn2, Rxn2, and CRxn2. For exon duplication analysis, multiplex PCR and gel densitometry were carried out by comparing the band intensities among individual bands. For groups with no detectable deletion, single strand conformation polymorphism (SSCP) analysis and direct DNA sequencing method were performed with individual PCR of candidate exons. RESULTS: About 12-20microg of genomic DNA was extracted from 1mL of blood, and the size of DNA was over 50kb. Up to 9 PCR products were made from multiplex PCR using the genomic DNA. Among 5 families with DMD, No. 6 had about 240kb DNA deletion from exon 45 and 47-53, and No. 11 had about 130kb deletion from exon 47-49 and 53. No. 1 showed duplication of exon 43 when the multiplex PCR products were analyzed by a densitometer. When the deletion/duplication negative No. 3 was analyzed by SSCP method, exon 43 and 49 showed abnormal band patterns. The abnormal band pattern of exon 43 was caused by deletion mutation of A residue, which resulted in pretermination of dystrophin synthesis, meanwhile exon 49 showed transversion mutation of C G at intron 49. CONCLUSION: Based on the results of this study, the methods of multiplex PCR, SSCP and direct DNA sequencing of PCR products made it possible to analyze several types of mutation of DMD.
Biopsy ; Blotting, Southern ; Densitometry ; DNA ; Dystrophin* ; Exons ; Humans ; Introns ; Lymphocytes ; Mothers ; Multiplex Polymerase Chain Reaction ; Muscular Dystrophy, Duchenne* ; Pathology, Molecular ; Point Mutation ; Polymerase Chain Reaction* ; Polymorphism, Single-Stranded Conformational ; Sequence Analysis, DNA ; Sequence Deletion

OBJECTIVE: Central nervous system has unique inflammatory responses to the exposure to the endotoxin and immature brain may have a different response with that of the mature. The authors conduct this experiment to elucidate the characteristics of inflammatory response in immature brain. METHODS: Lipopolysaccharide(LPS) was injected in the right caudate nucleus in 7-day-old and adult Sprague-Dawley rats. The doses were 1 microliter of 0.1, 0.5, and 2.0mg/ml of LPS and the same amount of saline for controls. The rats were sacrificed 24hours after injections. Light microscopic examination was performed to evaluate the leukocyte recruitment, and reverse transcriptase-polymerase chain reaction(RT-PCR) to measure the expression of interleukin-1beta(IL-1beta) and tumor necrosis factor-alpha(TNF-alpha) mRNA. RESULTS: Light microscopic examination revealed more pronounced leukocyte infiltration in neonatal brain than in adult, even though lower than in peripheral tissue. RT-PCR revealed dose dependent expression of IL-1beta and TNF-alpha mRNA in both neonatal and adult brain as in peripheral tissue. CONCLUSION: These results support that the immature brain is more vulnerable to the LPS induced inflammation in terms of leukocyte infiltration and possibly resultant brain damage. However, the mechanism of inflammatory response in immature brain should be studied further in association with the research of the activity of microglia, astrocyte, blood brain barrier, chemokine, and adhesion molecule in immature brain.
Adult ; Animals ; Astrocytes ; Blood-Brain Barrier ; Brain* ; Caudate Nucleus ; Central Nervous System ; Humans ; Inflammation ; Interleukin-1beta ; Leukocytes ; Microglia ; Necrosis ; Rats* ; Rats, Sprague-Dawley ; RNA, Messenger ; Tumor Necrosis Factor-alpha