No abstract available.
Aneurysm* ; Humans ; Hydrocephalus*

No abstract available.
Spinal Cord Vascular Diseases*

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*

OBJECTIVE: The purpose of this study was to investigate changes in the plasma level of vascular endothelial growth factor (VEGF) after Gamma Knife radiosurgery (GKRS) for the treatment of meningioma. METHODS: Fourteen patients with meningiomas had peripheral venous blood collected at the time of GKRS and at 1 week, 1 month, 3 month and 6 month visits. Plasma VEGF levels were measured using commercially available enzyme-linked immunosorbent assay. For controls, peripheral blood samples were obtained from 20 healthy volunteers. RESULTS: The mean plasma VEGF level (29.6 pg/mL) in patients with meningiomas before GKRS was significantly lower than that of the control group (62.4 pg/mL, p=0.019). At 1 week after GKRS, the mean plasma VEGF levels decreased to 23.4 pg/mL, and dropped to 13.9 pg/mL at 1 month, 14.8 pg/mL at 3 months, then increased to 27.7 pg/mL at 6 months. Two patients (14.3%) with peritumoral edema (PTE) showed a level of VEGF 6 months after GKRS higher than their preradiosurgical level. There was no significant association found in an analysis of correlation between PTE and tumor size, marginal dose, age, and sex. CONCLUSION: Our study is first in demonstrating changes of plasma VEGF after stereotactic radiosurgery (SRS) for meningioma. This study may provide a stimulus for more work related to whether measurement of plasma level has a correlation with tumor response after SRS for meningioma.
Edema ; Enzyme-Linked Immunosorbent Assay ; Healthy Volunteers ; Humans ; Meningioma* ; Plasma* ; Radiosurgery* ; Vascular Endothelial Growth Factor A*

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

Most craniosynostoses are sporadic, but may have an underlying genetic basis. Secondary and syndromic craniosynostosis accompanies various systemic diseases or associated anomalies. Early detection of an associated disease may facilitate the interdisciplinary management of patients and improve outcomes. For that reason, systematic evaluation of craniosynostosis is mandatory. The authors reviewed systematic evaluation of craniosynostosis with an emphasis on genetic analysis.
Craniosynostoses* ; Diagnosis ; Humans

OBJECTIVE: The purpose of this study was to evaluate whether 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) can be used to assess the therapeutic response of brain abscess. METHODS: A study was conducted on 10 consecutive patients with brain abscess. Magnetic resonance imaging (MRI) with diffuse-weighted imaging (DWI) was performed at 3 and 6 weeks after surgical treatment and intravenous antibiotics therapy and FDG-PET at 6 weeks after treatment. The extent of the abscess, signal changes on MRI, and FDG-PET standardized uptake values were analyzed and correlated with the response to therapy. RESULTS: Aspiration or craniotomy with excision of the abscess followed by intravenous antibiotics for 6-8 weeks resulted in good recovery with no recurrence. In 10 patients, two had low signal intensity on the DWI; one had no uptake on FDG-PET imaging after 6 weeks antibiotics and discontinued intravenous treatment, but the other patient had diffuse, increased uptake on FDG-PET imaging after 6 weeks antibiotics and underwent an additional 2 weeks of intravenous antibiotics. The remaining eight patients had high signals on the DWI. Four had no uptake on FDG-PET imaging and the treatment period varied from 6 to 8 weeks (mean, 6.75 weeks). Among the other four patients, FDG was accumulated in a diffuse or local area corresponding to a high signal area within the DWI and 2 weeks of intravenous antibiotics was added. CONCLUSION: MRI plus FDG-PET improved the accuracy of assessing therapeutic responses to antibiotics treatment of brain abscess and aided in optimizing therapy.
Abscess ; Anti-Bacterial Agents ; Brain ; Brain Abscess ; Craniotomy ; Electrons ; Humans ; Magnetic Resonance Imaging ; Positron-Emission Tomography ; Recurrence

PURPOSE: Intracranial hemorrhage (ICH) in hemophilia patients is the most common cause of death in Korea. Early suspicion and prompt treatment of ICH is a very important for saving their life and minimizing neurologic sequelae. We investigate the prognosis of the hemophilia patients with ICH who registered in Daegu & Kyungpook area. METHODS: We evaluated the clinical courses, laboratory findings, brain image, effect of treatment and prognosis of ICH. Nine of 161 patients registered in our Department of Pediatrics suffered 16 episodes of ICH from Dec. 1996 to Mar. 2002. RESULTS: All were male hemophilia A patients (severe; 5, moderate; 3 and mild; 1) with median age of 48 (17~312) months at diagnosis of ICH. Two patients who had inhibitor became negative and one patient who had found inhibitor on annual routine follow-up has had inhibitor until now. One had trauma history and seven had family history. The median time interval from first symptom to hospital visit was 7 hours (15 minutes~10 days). Chief complaints were vomiting in 6 patients, headache in 4, seizure in 3 and mental change in 1. All patients except one were initially given factor VIII concentrate, 50 units/kg and then continuous infusion, 2~3 units/kg/hour. One patient who had factor VIII inhibitor was given factor IX concentrates, 100 units/kg with activated prothrombin complex (FEIBA ), 75 units/kg at every 12 hours. All except one with hematoma in cerebellar vermis and the third ventricle are alive without any neurologic sequela. CONCLUSION: ICH in hemophilia patients can be severe with no trauma history, or can be recurred several times with life-threatening event. So, it is desirable to have early treatment, prophylaxis, regular follow-up and patient education about abnormal symptoms to reduce the complications of them.
Brain ; Cause of Death ; Daegu ; Diagnosis ; Factor IX ; Factor VIII ; Follow-Up Studies ; Gyeongsangbuk-do ; Headache ; Hematoma ; Hemophilia A* ; Humans ; Intracranial Hemorrhages* ; Korea ; Male ; Patient Education as Topic ; Pediatrics ; Prognosis ; Prothrombin ; Seizures ; Third Ventricle ; Vomiting

The cerebrospinal fluid tap test (CSFTT) is recommended as a key step in the diagnosis of idiopathic normal pressure hydrocephalus (iNPH). While there is no generally accepted evaluation period for ascertaining a CSFTT responder, a substantial number of patients are evaluated only once within 24 hours of the test for improvement in gait. We report an iNPH patient with a favorable response to shunt surgery, who was first judged a non-responder by this standard, though subsequently was judged a responder in virtue of repetitively testing gait over 7 days. A 68-year-old man presented with progressive impairment of gait, balance, and memory. He was diagnosed as iNPH with an Evans' ratio of 0.35. At first hospitalization, change in gait was evaluated 24 hours after the CSFTT. He didn't show any significant improvement and was judged as a non-responder. However, at the second CSFTT, we repetitively tested his change in gait over seven days. Forty-eight hours after the tap, he showed significant improvement in his gait. He was then confirmed as a responder. After the operation, the gait difficulties were almost fully resolved. Further studies developing the standard procedure of the CSFTT should be considered.
Aged ; Cerebrospinal Fluid ; Cerebrospinal Fluid Shunts ; Diagnosis ; Gait ; Hospitalization ; Humans ; Hydrocephalus, Normal Pressure* ; Memory ; Predictive Value of Tests ; Virtues

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