No abstract available.

The use of steroids has long been reported many side effects. Steroid-induced mental disorder is one of many complications associated with corticosteroid therapy. Steroid psychosis is not common disease but it may be more popular due to high steroid therapy such as pulse therapy or high dose steroid therapy. Euphoria, irritability, insomnia, and hallucination are predominating symptoms. The dosage, duration of the treatment may not be correlated with the time of the onset, duration, severity, or type of mental disturbances, but the risk of developing psychosis is increased to the high dose of steroid. It is usually reversible on dose reduction or discontinuation of the drug.
Euphoria ; Hallucinations ; Mental Disorders ; Psychotic Disorders* ; Sleep Initiation and Maintenance Disorders ; Steroids

Postoperative brain edema and/or hemorrhage is a serious problem especially arteriovenous malformations(AVM) in an eloquent area. It has ben a neurosurgical dilemma whether to surgically remove an unruptured AVM in an eloquent area. It is necessary to define the anatomic location, understand the hemodynamics, vasoreactivity of the adjacent brain parenchyma for safe removal of an AVM in an eloquent area. A successful removal of an AVM at an eloquent motor area without neurological deficit was made. We report method of localizating, angiographic anatomy, mechanism of possible hemodynamic insult related to operation.
Arteriovenous Malformations* ; Brain ; Brain Edema ; Hemodynamics ; Hemorrhage

The authors present a case of cerebrellar venous hemorrhagic infarction which developed after removal of a cerebellopontine angle meningioma. The clinical course was rapidly fatal inspite of an aggressive management including surgical decompression beginning from 30 minutes after complete recovery from anesthesia. The brain C-T scan showed flame-shaped subcortical hemorrhage which is known to be a typical finding of a venous hemorrhagic infarction. The causes may be two fold:One is the cautrization and resection of multiple petrosal veins which were inevitable because of a bleeding from the vein and the other is the venous congestion caused by the compression of an internal jugular vein in oblique supine position. Reminding of one or oth of the above possibilities whenever we are performing surgery around the superior petrosal vein may help us to prevent the rare but fatal complication of this kind.
Anesthesia ; Brain ; Cerebellopontine Angle* ; Decompression, Surgical ; Hemorrhage ; Hyperemia ; Infarction* ; Jugular Veins ; Meningioma ; Supine Position ; Veins

The growth or rebleeding of the spontaneous ICH is catastrophic so that prevention of them is critical in management. We reviewed 233 cases of spontaneous ICH from Jan. 1990 to Dec. 1994 to evaluate the factors associated with the hematoma enlargement. The relationship among the admission time from hematoma onset, the systolic BP at admission, hemostatic parameter, liver dysfunction with rebleeding incidence were assessed. Also, hematoma shape, density, site, volume, and operation tiem from hematoma onset were evaluated. Hematoma growth was oserved at 26 patients(11.6%). Incidence of rebleeding was significantly associated in patients with shorter admission time from hematoma onset, high systoic BP at admission, inhomogenous, irregular-shaped hematoma at CT and liver dysfunction. The incidence of hematoma growth was higher in the early operation group but there was no significant relationship in statistic analysis. Patients admitted within 6 hours of hematoma onset, with irregular-shaped, inhomogenous hematoma on CT, and liver dysfunction should be observed closely for the enlargement of hematoma. The operation time might be delayed at least 6 hours after hematoma onset.
Cerebral Hemorrhage* ; Hematoma ; Humans ; Incidence ; Liver Diseases

Among the series of 272 cases of surgically treated anterior circulation aneurysms, we experienced 6 cases of central infarctions involving caudate nucleus, globus pallidus, putamen and genu of internal capsule respectively or in combination. These surgery related complications were caused by the injury to the perforators going to the anterior perforated substance during manipulation of the large aneurysm or the aneurysms ruptured prematurely. The clinical courses of these patients, however, were not so severe. The morbidities were minimal or none after the average follow-up periods of 17 months. Thorough knowledge of the anatomy of the perforators may help to minimize the severe morbidity in the management of large or difficult aneurysms.
Aneurysm* ; Caudate Nucleus ; Follow-Up Studies ; Globus Pallidus ; Humans ; Infarction* ; Internal Capsule ; Olfactory Pathways ; Putamen

The authors analyzed and compared three prognostic factors of the intraparenchymal metastatic brain tumors, regardless of therapeutic modalities, to evaluate the value of time-interval between diagnosis of primary cancer and brain metastasis as a prognostic factor. Our of the 109 patients of metastatic brain tumor admitted to Kosin Medical College from 1984 to 1991, 93 patients were included in this retrospective study. The survival time of these patients was statistically evaluated according to each prognostic factor. The results were as follows. Patients with mild or no neurological deficits and patients with moderate neurological deficits showed longer survival than the patients with severe neurological deficits(P<0.001). The presence of systemic metastasis at the time of diagnosis also significantly shortened overall survival(P<0.0095). Primary-to-metastatic interval did not significantly affect overall survival(P<0.6164), but the patients with brain metastasis detected within 1 year after diagnosis of the primary cancer had a longer median survival than those detected after 1 year(P<0.001). We conclude that the primary-to-metastatic interval is not valuable as a prognostic factor for intraparenchymal metastatic brain tumor, and further prospective study tailored to each specific condition will be needed for more accurate evaluation of prognostic factors.
Brain Neoplasms ; Brain* ; Diagnosis ; Humans ; Neoplasm Metastasis* ; Prognosis* ; Retrospective Studies

The authors experienced a case of cystic cerebellar astrocytoma which showed sudden respiratory arrest after an uneventful operation. Preoperative cerebrospinal fluid diversion was not performed despite moderate hydrocephalus because we thought that complete removal of tumor enables the cerebrospinal fluid pathway to be reconstitute. After full awakening from anesthesia postoperatively, the patient's mentality deteriorated again rapidly with sudden respiratory arrest. Brain CT scan taken immediately after revealed no specific finding except moderate hydrocephalus which was the same degree as the preoperative one. This hydrocephalus was alleviated and the patient recovered slowly. We postulate several pathogenic mechanisms for this unusual event. First, chronic compression of fourth ventricle resulted in marked subependymal gliosis and obliteration of outlets of fourth ventricle. Therefore, postoperative reaccumlation of cerebrospinal fluid in ventricles caused serious pressure effect on the lower brain stem with resultant sudden respiratory arrest. Second, sudden decompression of brain stem might induce marked hemodynamic change in the brain stem. Third, there was some traction injury to brain stem by gravity in the sitting position. We suggest that preoperative cerebrospinal fluid diversion and its adeqaute postoperative maintenance is important in posterior fossa tumor surgery in cases with obliteration of perimesencephalic cistern and fourth ventricle, and with brain stem compression or angulation in preoperative magnetic resonance images.
Anesthesia ; Astrocytoma* ; Brain ; Brain Stem ; Cerebrospinal Fluid ; Decompression ; Fourth Ventricle ; Glioma, Subependymal ; Gravitation ; Hemodynamics ; Humans ; Hydrocephalus ; Infratentorial Neoplasms ; Tomography, X-Ray Computed ; Traction

The authors have operated on fifteen cases of intracranial arachnoid cyst during the last 4 years. Among them, eleven cases of middle cranial fossa arachnoid cyst have undergone uniformly cystoperitoneal shunt. The craniotomy and fenestration(open surgery) was performed in three cases which located in quadrigeminal cistern(1 case) and harvored other combined problems(2 cases, intracystic hemorrhage and exophthalmos due to defect of lateral orbital wall respectively). A case of intraventricular arachnoid cyst was managed by ventriculocystostomy. All of above procedures showed good clinical and radiological results with acceptable morbidity and no mortality. With these observation, we thought as follows : 1) In middle cranial fossa cysts, cystoperitoneal shunt is sufficient as the first choice of operative intervention because it revealed good results with low morbidity and negligible complications. 2) Open surgery seems to be indicated only in deep seated cyst around brainsterm where the introduction of shunt catheter is difficult and dangerous and in cyst combinind other problems necessitating surgical intervation also.
Arachnoid ; Arachnoid Cysts* ; Catheters ; Cranial Fossa, Middle ; Craniotomy ; Exophthalmos ; Hemorrhage ; Mortality ; Orbit

Neurological grade on admission is an important prognostic factor for aneurysmal patients. The decision for operation in comatose patients with ruptured aneurysm is difficult and remains controversial. Recent literatures tend to emphasize the benefit of operative treatment for these patients because of the higher mortality of the patients who were managed conservatively. We performed early surgery in ten comatose aneurysmal patients combining lumbar drainage, intravenous and cisternal nimodipine therapy, and intermittent brain retraction. Among these ten patients, four showed survival over three months. We suggest that early surgery with aggressive postoperative management should be considered in comatose aneurysmal rupture patients for life-saving.
Aneurysm ; Aneurysm, Ruptured ; Brain ; Coma* ; Drainage ; Humans ; Intracranial Aneurysm* ; Mortality ; Nimodipine ; Rupture