No abstract available.
Diagnosis* ; Ischemia* ; Subarachnoid Hemorrhage*

No abstract available.
Latex* ; Polystyrenes* ; Potassium Channels* ; Potassium* ; Vasospasm, Intracranial*

No abstract available.
Bacteremia* ; Staphylococcus aureus* ; Staphylococcus*

The authors recently reported that over the years, the outcome of aneurysm surgery improved, and that surgical complications importantly affected this change. The present study was conducted to determine whether the incidence of symptomatic vasospasm in fact changed during the period under review, and the factors contributing to any changes. Between 1990 and 1995, 219 Hunt-Hess grade I to III patients with ruptured intracranial aneurysm underwent surgery within 3 days of subarachnoid hemorrhage ; all operations were performed by the same surgeon. Age, Hunt-Hess grade on admission, Fisher grade, hypertension, and hydrocephalus were analyzed to determine which factors were significant for syptomatic vasospasm, and for the periods 1990 to 1993, and 1994 to 1995, the distribution of each significant factor was then examined. Syptomatic vasospasm decreased significantly (p<0.05), but was seen in 28 of 124 patients(22.6%) treated beween 1990 and 1993 and 11 of 95(11.6%) treated between 1994 and 1995 ; no significant reduction of syptomatic vasospasm as a cause of mortality and morbidity (irreversible vasospasm) was seen, however, Fisher grade(p<0.05) and Hunt-Hess grade(p<0.05) significantly contributed to the development of symptomatic vasospasm, though the distribution of these two biologically significant factors was not statistically different. The question of whether or not surgery aggravates symptomatic vasospasm is controversial, and symptomatic vasospasm is, in addition, still an ill-defined disease entity. Except for the occurrence of fewer surgical complication and the fact that the incidence of reversible symptomatic vasospasm was less during the second period of treatment, no differences were found in the distribution of factors which significantly influenced symptomatic vasospasm, and this suggests that surgery affects the development of reversible symptomatic vasospasm. On the basis of increased risk of cerebral ischemia associated with surgery in vulnerable ischemic brain resulting from subarachnoid hemorrhage, the use of the term 'delayed ischemic neurologic deficit' after such hemorrhage appears to be more suitable than 'symptomatic vasospasm'.
Aneurysm* ; Brain ; Brain Ischemia ; Hemorrhage ; Humans ; Hydrocephalus ; Hypertension ; Incidence ; Intracranial Aneurysm ; Mortality ; Neurologic Manifestations* ; Subarachnoid Hemorrhage

A case of isolated dissecting aneurysm of the posterior cerebral artery responsible for ischemic episode and subarachnoid hemorrhage is reported. Angiogram showed a fusiform dilatation of the P1-P2 segment of the right posterior cerebral artery. The dissecting aneurysm was disappeared spontaneously on follow-up angiogram. It is recommended that, in a subset of neurologically stable patient who represents fusiform dilatation angiographically, angiographic monitoring should be undertaken to assess the tendency for spontaneous resolution before planning of surgical intervention.
Aneurysm, Dissecting* ; Dilatation ; Follow-Up Studies ; Humans ; Posterior Cerebral Artery* ; Subarachnoid Hemorrhage

Trichinellosis is a parasitic zoonosis of public health importance. It is caused by Trichinella spiralis which has a wide host range including humans. In the present communication, the ELISA technique was employed on a total of 803 blood samples from 7 selected pig breeding farms in 1996 for diagnosis and surveillance of trichinellosis. Out of the entire 803 samples, nine were found to be suspected while one was positive by ELISA. But western blot analyses employed for further confirmation have shown that all of 10 samples did not react to larval excretory-secretory product antigens. These results indicate that pig breeding farms included in the present study are free from trichinellosis. However, it does not mean Korea is free from trichinellosis since human trichinellosis has recently been reported. The necessity of continued surveillance for trichinellosis in both pigs and wild animals was discussed.
Animals ; *Animals, Domestic ; Antibodies, Helminth/*blood ; Biological Markers/blood ; Blotting, Western ; Enzyme-Linked Immunosorbent Assay ; Human ; Korea/epidemiology ; Swine ; Swine Diseases/*diagnosis/epidemiology ; Trichinella spiralis/*immunology ; Trichinosis/*diagnosis/epidemiology/*veterinary

PURPOSE: The goal of this study was to directly measure the association between the internal carotid artery (ICA) morphometry and the presence of ICA-posterior communicating artery (PCOM) aneurysm. MATERIALS AND METHODS: The authors intraoperatively measured the length of the supraclinoid ICA because it is impossible to radiologically determine the exact location of the anterior clinoid process. We used an image analyzer with a CT angiogram to measure the angle between the skull midline and the terminal segment of the ICA (ICA angle), as well as the diameter of the ICA. The lengths and diameters of the supraclinoid ICA and the ICA angle were compared among PCOM aneurysms, anterior communicating artery (ACOM) aneurysms, and middle cerebral artery (MCA) bifurcation aneurysms (n=27 each). Additionally, the lengths and the diameters of M1 and A1 were compared for each aneurysm. RESULTS: The lengths of the supraclinoid ICA were 11.9+/-2.3mm. The lengths of the supraclinoid ICA in patients with ICA-PCOM aneurysms (9.7+/-2.8mm) were shorter than those of patients with ACOM aneurysms (13.8+/-2.2mm, Student's t-test, p<0.001) and with MCA bifurcation aneurysms (12.2+/-1.9 mm, Student's t-test, p<0.001). The diameters of the supraclinoid ICA and A1 in patients with ACOM aneurysms were larger than those in patients with MCA bifurcation aneurysms (Student's t-test, p<0.05). There were no significant differences in the lengths of M1 and A1, ICA angle, or diameter of M1 for each aneurysm. CONCLUSION: These results suggest that the relatively shorter length of the supraclinoid ICA may be a novel risk factor for the development of ICA-PCOM aneurysm with higher hemodynamic stress.
Carotid Artery Diseases/congenital/*radiography ; Carotid Artery, Internal/abnormalities/*radiography ; Humans ; Intracranial Aneurysm/*radiography ; Risk Factors

Most so-called aneurysms of the posterior communicating artery(PcomA) are actually aneurysms of the internal carotid-PcomA junction, and microsurgery has enabled us to recognize the relation of these aneurysms to the PcomA. A 62-year-old woman with subarachnoid hemorrhage showed a saccular aneurysm arising from the PcomA itself, and successful clipping was carried out. In this paper, we discuss certain unique characteristics of this aneurysm, and related surgical procedures.
Aneurysm ; Female ; Humans ; Intracranial Aneurysm* ; Microsurgery ; Middle Aged ; Subarachnoid Hemorrhage

Since the proportion of ischemic stroke has been increasing compared to hemorrhagic stroke in our country, only recently the medical community began to systematically emphasize the importance of managing ischemic stroke patients as aggressively as possibly in an attempt to improve outcome and facilitate the development of useful treatment algorithms. It is necessary to estimate initially which vascular territory among large or small artery is compromised for planning treatment strategies in patients with acute ischemic stroke. The author focuses on the efficient assessment and surgical management of patients with acute ischemic stroke by reviewing the operative techniques and perioperative management of carotid endarterectomy and extracranial-intracranial bypass surgery
Arteries ; Brain Ischemia* ; Endarterectomy, Carotid ; Humans ; Stroke

OBJECTIVE: Antifibrinolytic treatment after aneurysmal subarachnoid hemorrhage has been shown to have no significant effect on outcome since a reduction in the rate of rebleeding was offset by an increase in the incidence of hydrocephalus and ischemic events. As the results of early aneurysm surgery and a change of strategy in the intensive medical treatment, outcome in patients with cerebral ischemia has been improved. On the other hand, rebleeding still remains as a major cause of death. A short course of tranexamic acid(TA) was tried to study its efficacy and safety in reducing the incidence of rebleeding before aneurysm surgery. METHODS: A total of 507 patients with ruptured cerebral aneurysm operated within 3 days after the attack from 1990 to 1999 were included in this study. Group A consisted of 302 consecutive patients treated from 1990 through 1995 served as control. Two hundred-five patients in group B were treated with TA from 1996 through 1999. Both groups were evaluated for comparability of demographic and clinical variables including age, Hunt-Hess grade, Fisher grade, aneurysm location, hypertension, day of surgery, and initial hydrocephalus. The relationships of TA with rebleeding, ischemia, and chronic hydrocephalus were also studied. RESULTS: There was no significant difference in patient demographics and clinical characteristics between group A and group B. Sixteen patients(5.3%) suffered a recurrent hemorrhage in group A and three(1.5%) in group B(p<0.05). Chronic hydrocephalus requiring a shunt was found in a significantly greater proportion in group B than in group A(p<0.05). The incidence of cerebral ischemia was not elevated in group B compared with group A. CONCLUSION: Considering the fact that the reduction of fatal rebleeding outweighed the increased incidence of hydrocephalus, the authors believe that a short course of TA is beneficial in diminishing the risk of rebleeding prior to early surgical intervention.
Aneurysm* ; Brain Ischemia ; Cause of Death ; Demography ; Hand ; Hemorrhage ; Humans ; Hydrocephalus ; Hypertension ; Incidence ; Intracranial Aneurysm ; Ischemia ; Subarachnoid Hemorrhage