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

No abstract available.

A rare case of Takasu's arteritis associated with subarachnoid hemorrhage and intracranial aneurysm is described. It is well known that diseases such as intracranial venous malformations, carotid artery stenosis, moyamoya syndrome, brain neoplasm, coarcatation of aorta, polycystic kidney disease, connective tissue diseases, etc are often associated with aneurysms, however an association with Takayasu's arteritis has not been reported. We discussed clinical features, radiologic finding, treatments of the case and reviewed the literatures of this disease entity.
Aneurysm ; Aorta ; Arteritis ; Brain Neoplasms ; Carotid Stenosis ; Connective Tissue Diseases ; Intracranial Aneurysm* ; Moyamoya Disease ; Polycystic Kidney Diseases ; Subarachnoid Hemorrhage* ; Takayasu Arteritis*

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 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

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

This study was performed in order to compare the functional imaging by 99m Tc-HMPAO brain SPECT with structural neuroimaging by CT or MRI. Eighteen patients with diffuse axonal injury underwent HMPAO brain SPECT(18), CT(9) and MR(14), and neurological status were then evaluated. Seventeen patients(94%) were revealed abnormal SPECT whereas nine patients(50%) demonstrated abnormal CT compared with ten patients(71%) demonstrated abnormal MRI. The neurololgical deficits correlated well with abnormal SPECT lesion except in one case. It is therefore concluded that brain perfusion SPECT is not only more sensitive than CT or MRI, it is also more cost effective and clinically well correlated in diffuse axonal injury patient.
Brain* ; Diffuse Axonal Injury* ; Humans ; Magnetic Resonance Imaging ; Neuroimaging ; Perfusion ; Tomography, Emission-Computed, Single-Photon*

The purpose of this study is to assess the usefulness of digital infrared thermographic image(DITI) in patients with surgically treated lumbar disc disease. A series of 480 patients with lumbar herniated disc was studied. The mean age of the patients was 37 years, with a range of 18 to 64 years. Of which 126 cases of chemonucleolysis. 18 cases of percutaneous endoscopic laser discectomy, and 336 cases of laminectomy with discectomy were performed. Among these patients, 336 cases of laminectomy were assessed by DITI preoperatively. The thermal differences(delta T) between the symptomatic and asymptomatic limbs were evaluated. We have categorized the types of herniations into 3 classes: 200 protruded, 99 extruded, and 37 sequestered. The thermal differences were classified into 3 groups: 177 patients had delta T < 0.5 degrees C, 74 patients had 0.5 degrees C < or = delta T < 0.8 degrees C and 85 patients had delta T > or = 0.8 degrees C. Among the group of patients with the sequestered disc, 30(i.e. 80%) had delta T > or = 0.8 degrees C. Among the surgically treated 336 patients, non-visualization of a part of the sciatic limb on preoperative DITI was the condition used to coin the term amputation sign by the authors. In the sequestered group, the "amputation sign" was observed in 28 cases(75%). We conclude that DITI can predict a sequestered disc disease, and it allows more precise indication regarding open surgery.
Amputation ; Diskectomy ; Extremities ; Humans ; Intervertebral Disc Chemolysis ; Intervertebral Disc Displacement ; Laminectomy ; Numismatics