Brain abscess commonly occurs secondary to an adjacent infection (mostly in the middle ear or paranasal sinuses) or due to hematogenous spread from a distant infection or trauma. Pulmonary arteriovenous fistulas (AVFs) are abnormal direct communications between the pulmonary artery and vein. We present two cases of brain abscess associated with asymptomatic pulmonary AVF. A 65-year-old woman was admitted with a headache and cognitive impairment that aggravated 10 days prior. An magnetic resonance (MR) imaging revealed a brain abscess with severe edema in the right frontal lobe. We performed a craniotomy and abscess removal. Bacteriological culture proved negative. Her chest computed tomography (CT) showed multiple AVFs. Therapeutic embolization of multiple pulmonary AVFs was performed and antibiotics were administered for 8 weeks. A 45-year-old woman presented with a 7-day history of progressive left hemiparesis. She had no remarkable past medical history or family history. On admission, blood examination showed a white blood cell count of 6290 cells/uL and a high sensitive C-reactive protein of 2.62 mg/L. CT and MR imaging with MR spectroscopy revealed an enhancing lesion involving the right motor and sensory cortex with marked perilesional edema that suggested a brain abscess. A chest CT revealed a pulmonary AVF in the right upper lung. The pulmonary AVF was obliterated with embolization. There needs to consider pulmonary AVF as an etiology of cerebral abscess when routine investigations fail to detect a source.
Abscess ; Aged ; Anti-Bacterial Agents ; Arteriovenous Fistula* ; Arteriovenous Malformations ; Brain Abscess* ; Brain* ; C-Reactive Protein ; Cognition Disorders ; Craniotomy ; Ear, Middle ; Edema ; Embolization, Therapeutic ; Female ; Frontal Lobe ; Headache ; Humans ; Leukocyte Count ; Lung ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Middle Aged ; Paresis ; Pulmonary Artery ; Thorax ; Tomography, X-Ray Computed ; Veins

Odontogenic keratocysts are developmental odontogenic cysts which derived from rests of dental laminas and often found in posterior area of mandible. Because this lesion has tendency of frequent recurrence, treatment of choice is often radical removal of the lesion. Sometimes in case of large cysts, however, conservative therapy like marsupialization is often selected in treatment plan. A 39-years old woman referred to our department for evaluation of large radiolucent lesion that occupies the areas from mandible angle to upper part of ramus and condyle. In cytology, the lesion was identified as odontogenic keratocyst. Marsupialization was our treatment of choice, and the result was so favorable. 2 years later, there was small radiolucent lesion on upper part of mandibular ramus on panoramic view. It was suspected as recurred lesion, and excisional biopsy was done. On biopsy result, it was not a cystic lesion but fibrosis.
Adult ; Biopsy ; Female ; Fibrosis* ; Humans ; Mandible ; Odontogenic Cysts* ; Recurrence

OBJECTIVE: Cerebral vasospasm is a common and potentially devastating complication of aneurysmal subarachnoid hemorrhage (aSAH). Inflammatory processes seem to play a major role in the pathogenesis of vasospasm. C-reactive protein (CRP) constitutes a highly sensitive inflammatory marker. Elevation of serum CRP levels has been demonstrated in patients with aSAH. The purpose of the current study was to evaluate the possible relationship between CRP levels in the serum and transcranial Doppler (TCD) and the development of vasospasm in patients with aSAH. METHODS: A total of 61 adult patients in whom aSAH was diagnosed were included in the study from November 2008 to May 2011. The patients' demographics, Hunt and Hess grade, Fisher grade, CT scans, digital subtraction angiography studies, and daily neurological examinations were recorded. Serial serum CRP measurements were obtained on days 1, 3, 5, 7, 9, 11 and 13 and TCD was measured on days 3, 5, 7, 9, 11 and 13. All patients underwent either surgical or endovascular treatment within 24 hours of their hemorrhagic attacks. RESULTS: Serum CRP levels peaked on the 3rd postoperative day. There were significant differences between the vasospasm group and the non-vasospasm group on the 1st, 3rd and 5th day. There were significant differences between the vasospasm group and the non-vasospasm group on the 3rd day in the mean middle cerebral artery velocities on TCD. CONCLUSION: Patients with high levels of CRP on the 1st postoperative day and high velocity of mean TCD on the 3rd postoperative day may require closer observation to monitor for the development of vasospasm.
Adult ; Aneurysm* ; Angiography, Digital Subtraction ; C-Reactive Protein* ; Demography ; Humans ; Intracranial Aneurysm ; Middle Cerebral Artery ; Neurologic Examination ; Organothiophosphorus Compounds ; Subarachnoid Hemorrhage* ; Vasospasm, Intracranial*

OBJECTIVE: Detection of focal non-hemorrhagic lesion (NHL) has become more efficient in diffuse axonal injury (DAI) patients using an MRI. The aims of this study are to find out the radiological distribution, progress of NHL and its clinical significance. METHODS: Between September 2005 and October 2011, 32 individuals with NHLs on brain MRI were enrolled. NHLs were classified by brain location into 4 major districts and 13 detailed locations including cortical and subcortical, corpus callosum, deep nuclei and adjacent area, and brainstem. The severity of NHL was scored from grades 1 to 4, according to the number of districts involved. Fourteen patients with NHL were available for MRI follow-up and an investigation of the changes was conducted. RESULTS: Thirty-two patients had 59 NHLs. The most common district of NHL was cortical and subcortical area; 15 patients had 20 NHSs. However the most common specific location was the splenium of the corpus callosum; 14 patients had 14 lesions. The more lesions patients had, the lower the GCS, however, this was not a statistically meaningful difference. On follow-up MRI in 14 patients, out of 24 lesions, 13 NHLs resolved, 5 showed cystic change, and 6 showed atrophic changes. CONCLUSION: NHLs were located most commonly in the splenium and occur frequently in the thalamus and the mesial temporal lobe. Because most NHS occur concomitantly with hemorrhagic lesions, it was difficult to determine their effects on prognosis. Since most NHLs resolve completely, they are probably less significant to prognosis than hemorrhagic lesions.
Brain ; Brain Injuries ; Brain Stem ; Corpus Callosum ; Diffuse Axonal Injury ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Prognosis ; Temporal Lobe ; Thalamus

OBJECTIVE: Cancer pain has been treated by gamma knife radiosurgery(GKS), targeted to the pituitary gland-stalk, as an alternative new pain control method. The purpose of this study is to prove the efficacy and the safety of this treatment. METHODS: Seven patients with intractable cancer pain underwent pituitary gland-stalk irradiation by gamma knife. Selections for patient inclusion in this treatment protocol were no other effective pain treatment options, general condition rated as greater than 40 on Karnofsky Performance Scale, and pain relief by morphine though not satisfactory. The target was the junction between the pituitary stalk and the neurohypophysis. The maximum dose was 150~160Gy with one isocenter in 8mm collimator or two isocenters in 4mm collimator keeping the radiation dose to the optic nerve less than 8Gy. RESULTS: In all seven cases, the significant pain reduction was obtained during immediate post-GKS period without serious complications except one patient who developed transient hypopituitarism and diabetes insipidus. Pain relief was observed within several days, and this effect was prolonged for a quite long time. At a follow up of 1.5 to 13 months, pain recurred in two patients and no hormonal and visual dysfunctions were observed. CONCLUSION: Despite insufficient experience, the efficacy and the safety of GKS for intractable cancer pain were demonstrated in seven patients. This treatment has the potential to ameliorate cancer pain, and GKS will play a more important role in the treatment of intractable pain.
Clinical Protocols ; Diabetes Insipidus ; Follow-Up Studies ; Humans ; Hypopituitarism ; Morphine ; Optic Nerve ; Pain, Intractable ; Pituitary Gland ; Pituitary Gland, Posterior ; Pituitary Irradiation* ; Radiosurgery

Simultaneous occurrence of intracerebral hemorrhage (ICH) in different arterial territories is an uncommon event. We report on two cases of multiple spontaneous simultaneous ICH for which we could find no specific cause. A 73-year-old man, with no related medical history, was admitted to the hospital with simultaneous bithalamic ICH, and subsequently died of recurrent pneumonia. Second patient was a 60-year-old man who presented with simultaneous ICH in the pons and thalamus; he died of recurrent bleeding. We review the possible pathological mechanisms, clinical and radiologic features of simultaneous multiple ICH.
Aged ; Cerebral Hemorrhage* ; Hemorrhage ; Humans ; Hypertension ; Middle Aged ; Pneumonia ; Pons ; Thalamus

Symptoms of deep cerebral vein thrombosis (DCVT) are variable and nonspecific. Radiologic findings are essential for the diagnoses. In the majority of cases of deep internal cerebral venous thrombosis, the thalamus is affected bilaterally, and venous hypertension by thrombosis causes parenchymal edema or venous infarction and may sometimes cause venous hemorrhage. Intravenous injections of mannitol can be administered or decompressive craniectomy can be performed for reduction of intracranial pressure. The objectives of antithrombotic treatment in DCVT include recanalization of the sinus or vein, and prevention of propagation of the thrombus. Herein, the authors report DCVT which was successfully treated by low molecular weight heparin.
Brain Edema ; Cerebral Infarction ; Cerebral Veins ; Decompressive Craniectomy ; Edema ; Hemorrhage ; Heparin, Low-Molecular-Weight ; Hypertension ; Infarction ; Injections, Intravenous ; Intracranial Pressure ; Intracranial Thrombosis ; Mannitol ; Thalamus ; Thrombosis ; Veins ; Venous Thrombosis

OBJECTIVE: Chronic subdural hematoma (CSDH), a disease commonly encountered by neurosurgeons, is treated by burr hole drainage (BHD). However, the optimal surgical technique among the three types of BHD has not been determined. METHODS: We conducted a retrospective study on BHD performed on 93 patients who were diagnosed with CSDH. The subjects were divided into three groups based on the surgical technique performed: single BHD without irrigation (Group A, n=31), double BHD without irrigation (Group B, n=32), and double BHD with irrigation (Group C, n=30). The clinical factors, radiological factors and recurrences were compared between the three groups. Moreover, independent factors affecting the recurrence were analyzed. RESULTS: The change in hematoma thickness was 29.77+/-7.94%, 49.73+/-12.87%, and 75.29+/-4.32% for Group A, B, and C, respectively, while the change in midline shift was 40.81+/-15.47%, 51.78+/-10.94%, and 56.16+/-16.16%, respectively. Thus, Group C showed the most effective for resolution of hematoma and midline shift (p<0.05). Group A, B, and C had 12 cases (38.7%), 8 cases (25.0%), and 3 cases (10.0%) of recurrences, respectively. Group C had a statistically significantly fewer recurrence rate than Group A (p<0.05). Double burr hole, irrigation, and coagulopathy were each identified as independent factors that reduce recurrence (p<0.05). CONCLUSION: Among the three techniques, the double BHD with saline irrigation resulted in the fewest recurrences. It is probably the most effective technique for preventing the recurrence of CSDH.
Drainage* ; Hematoma ; Hematoma, Subdural, Chronic* ; Humans ; Recurrence* ; Retrospective Studies ; Therapeutic Irrigation ; Trephining

A 43-year-old man was admitted for head trauma after falling backward. The patient complained of diplopia. Unilateral internuclear ophthalmoplegia (INO) was diagnosed during the neurologic examination. Initially, no specific finding was shown on T2-weighted, T1-weighted, and fluid attenuated inversion recovery brain magnetic resonance image (MRI) or brain computed tomography (CT). However, susceptibility-weighted imaging (SWI) definitively demonstrated a tiny hemorrhage at the midline of the pontomesencephalic junction. The patient's symptom improved after 12 weeks. We discuss the clinical significance of SWI when traumatic INO due to a tiny hemorrhage is suspected.
Accidental Falls ; Adult ; Brain ; Craniocerebral Trauma ; Diplopia ; Hemorrhage ; Humans ; Neurologic Examination ; Ocular Motility Disorders*

Unruptured cerebral aneurysms sometimes present with visual symptomsdue to compression of the visual pathways. However, until now, unruptured anterior communicating artery (ACoA) aneurysms presenting visual field defects have been extremely rare. The authors report the case of a 51-year-old woman who presented with left homonymous hemianopsia. Radiological findings demonstrated an ACoA aneurysm filled with thrombus, that was compressing the optic chiasm and post-chiasmal tract. The patient underwent clipping of the aneurysm, which resolved the visual field defect. In cases of visual field defects, an ACoA aneurysm should be included in the differential diagnosis.
Aneurysm ; Arteries ; Diagnosis, Differential ; Female ; Hemianopsia* ; Humans ; Intracranial Aneurysm* ; Middle Aged ; Optic Chiasm ; Thrombosis ; Visual Fields ; Visual Pathways