A case of primary cervical intramedullary glioblastoma multiforme which is infrequently reported is presented. An 11 year old girl was admitted to the Department of Neurosurgery, Catholic Medical College in September 1976 because of flaccid paralysis of both upper extremities, neck pain and vomiting for 3 months. On admission, the patient was found to have flaccid paralysis of both arms and weakness of both legs. Sensory examination revealed hyperthesia below C2 dermatome. Babinski's toe sign was positive bilaterally and she was unable to void. Plain cervical spine revealed widening of interpedicular distance at C5 & 6. Myelogram through lumbar and cisternal route showed obstruction and widening of cord at the level of C4 & 7 respectively. Total laminectomy was performed through C3 to C6 and a purplish-blue mass was extruded out through the dorsal myelotomy. Pathologic diagnosis of the tumor was glioblastoma multiforme. Postoperatively there was marked improvement of motor power of all limbs. The patient has not shown any worsening in neurological status until this paper is submitted since she was discharged from the hospital October 1976.
Arm ; Child* ; Diagnosis ; Extremities ; Female ; Glioblastoma* ; Humans ; Laminectomy ; Leg ; Neck Pain ; Neurosurgery ; Paralysis ; Spine ; Toes ; Upper Extremity ; Vomiting

A case of primary cervical intramedullary glioblastoma multiforme which is infrequently reported is presented. An 11 year old girl was admitted to the Department of Neurosurgery, Catholic Medical College in September 1976 because of flaccid paralysis of both upper extremities, neck pain and vomiting for 3 months. On admission, the patient was found to have flaccid paralysis of both arms and weakness of both legs. Sensory examination revealed hyperthesia below C2 dermatome. Babinski's toe sign was positive bilaterally and she was unable to void. Plain cervical spine revealed widening of interpedicular distance at C5 & 6. Myelogram through lumbar and cisternal route showed obstruction and widening of cord at the level of C4 & 7 respectively. Total laminectomy was performed through C3 to C6 and a purplish-blue mass was extruded out through the dorsal myelotomy. Pathologic diagnosis of the tumor was glioblastoma multiforme. Postoperatively there was marked improvement of motor power of all limbs. The patient has not shown any worsening in neurological status until this paper is submitted since she was discharged from the hospital October 1976.
Arm ; Child* ; Diagnosis ; Extremities ; Female ; Glioblastoma* ; Humans ; Laminectomy ; Leg ; Neck Pain ; Neurosurgery ; Paralysis ; Spine ; Toes ; Upper Extremity ; Vomiting

The position of interventricular septum, which was measured by transitional zone of EKG, was compared with that measured by 2-D echocardiography in 51 patient. 1) The position of interventricular septum measured by 2-D echocardiography was very similar to that measured by transitional zone of EKG. 2) Extensive AMI (Anterior Myocardial Infarction) and LBBB showed moderate differences between two method. 3) RBBB and replaced mitral valve state showed severe differences between two methods. Transitional zone of EKG was helpful to define the position of interventricular septum except extensive AMI, bundle branch block and replaced mitral valve state.
Bundle-Branch Block ; Echocardiography ; Electrocardiography* ; Humans ; Mitral Valve

Ten cases of delayed traumatic intracerebral hematomas(DTICH) were found retrospectively among 129 patients with traumatic intracranial hematoma in about 3-year period. The interval from cranial injury to diagnosis of DTICH varied from 1 day to 13 day. The diagnosis was made on repeat computerized tomographic(CT) scans, obtained following neurological deterioration, lack of improvement and/or increase of intracranial pressure(ICP). For early diagnosis of DTICH, continuous ICP monitoring was more effective than routinely repeating CT scan and neurological observation. To analyse the factors influencing the prognosis, we divided DTICH into four groups by initial CT findings:Group I, one case, had negative CT scan on admission. In group II, two cases, an area of parenchymal contusion was noted on the initial CT scan with DTICH subsequently developing in the contused region. In group III, six cases, the initial CT scan showed intracranial hematoma and prior surgical management was done on admission. Group IV, one case, showed generalized brain edema. The prognoses of group III and IV were poorer than those of group I and II. The overall mortality was about 20%. We also discussed the pathogenesis and prognostic factors of DTICH in light of pertinent literatures.
Brain Edema ; Contusions ; Diagnosis ; Early Diagnosis* ; Hematoma* ; Humans ; Intracranial Hemorrhage, Traumatic ; Mortality ; Prognosis* ; Retrospective Studies ; Tomography, X-Ray Computed

The tethered cord syndrome is a clinical entity manifested by progressive motor and sensory changes in the legs, incontinence, back or leg pain, and scoliosis in young children. Based on remarkable neurological improvement after release of cord tension by sectioning the filum, it might be concluded that the neurological deficit was effected by cord tethering. The main objective of this experiments was to elucidate the pathophysiology involved in the tethered cord by observing the effect of tethered cord on regional spinal cord blood flow(rSCBF) and somatosensory evoked potentials(SEPs) and define a threshold relationship between SEP and rSCBF. Thirty adult cats, weighing 2.7 to 4.2kg were used in this study. The cats were divided into three groups as follows: Control group=non-tethered(10 cats), 5g-traction group=cord traction with 5g weight(10 cats). 10g-traction group=cord traction with 10g weight(10 cats). The rSCBF and SEP measurements were performed immediately after cord traction in each animal, at 30, 60, 90, 120 minutes and the final rSCBF at 3 hours by the hydrogen clearance technique. The results obtained were as follows: 1. Traction and resulted in a reduction of flow to 30%(6.0+/-1.4ml/100g/min) of normal control spinal cord flow(18.2+/-1.6ml/100g/min) at adjacent area of traction(L1) in 5g-traction group and 18%(3.5+/-0.7ml/100g/min) of normal control flow in 10g-traction group during the cord traction for 3 hours. 2. From 30 minutes to 3 hours following the cord traction, there was a tendency toward marked reduction of the blood flow at the adjacent area(L1, T10) in 10-traction group. 3. The rostral area of spinal cord away from traction was less influenced in a reduction of blood flow following the cord traction. 4. A close correlation was found between spinal evoked potentials and flow suggesting a threshold relationship. 1) The SEP was present shortly after traction though marked by altered in shape and suppressed. 2) The SEP responses progressively decreased in latency at the adjacent distal area of the cord during traction, however less changed in shape at the rostral area of the cord. 3) The SEP suppressed in shape if the blood flow in spinal cord was below 14ml/100g/min. 4) The neuronal dysfunction caused by tethered cord could be due to impairment of blood flow. It is assumed that prolonged neuronal dysfunction may lead to structural damage of the neuron.
Adult ; Animals ; Cats* ; Child ; Evoked Potentials ; Humans ; Hydrogen ; Leg ; Neural Tube Defects ; Neurons ; Scoliosis ; Spinal Cord* ; Traction

The purpose of this study is to clarify the effectiveness and the indications of the dopamine induced hypertension therapy(IHT) in the treatment of symptomatic cerebral ischemia secondary to aneurysm surgery. Eight patients suffering from ischemic complication of postoperative vasospasm were treated with dopamine induced hypertension therapy and intravascular volume expansion. All of patients underwent CT scan in order to ascertain if their neurological deteriorations were due to vasospasm. The criteria of the indication of IHT are as follows : 1) ischemic symptoms were progressively advanced, 2) there is no hematoma or infarction on CT scan, 3) there is no responses to ischemic symptoms with hyperventilation, intravascular volume expansion, 4) there is no hypovolemia. The blood pressure was raised to 30% above the mean arterial pressure that required for reversal of the ischemic deficit with dopamine induced hypertension and increasing the intravascular volume. In seven of eight patient, a marked improvement in ischemic symptoms occurred after raising blood pressure, and blood volume. In 4 cases, the level of consciousness and neurological deficits were improved within 12 hours after IHT started. IHT is expected to restore the brain tissue from ischemia by increasing blood flow through the arteries of vasospasm and collateral circulation.
Aneurysm* ; Arterial Pressure ; Arteries ; Blood Pressure ; Blood Volume ; Brain ; Brain Ischemia* ; Collateral Circulation ; Consciousness ; Dopamine ; Hematoma ; Humans ; Hypertension* ; Hyperventilation ; Hypovolemia ; Infarction ; Intracranial Aneurysm ; Ischemia ; Tomography, X-Ray Computed ; Vasospasm, Intracranial

The purpose of this study is to clarify the effectiveness and the indications of the dopamine induced hypertension therapy(IHT) in the treatment of symptomatic cerebral ischemia secondary to aneurysm surgery. Eight patients suffering from ischemic complication of postoperative vasospasm were treated with dopamine induced hypertension therapy and intravascular volume expansion. All of patients underwent CT scan in order to ascertain if their neurological deteriorations were due to vasospasm. The criteria of the indication of IHT are as follows : 1) ischemic symptoms were progressively advanced, 2) there is no hematoma or infarction on CT scan, 3) there is no responses to ischemic symptoms with hyperventilation, intravascular volume expansion, 4) there is no hypovolemia. The blood pressure was raised to 30% above the mean arterial pressure that required for reversal of the ischemic deficit with dopamine induced hypertension and increasing the intravascular volume. In seven of eight patient, a marked improvement in ischemic symptoms occurred after raising blood pressure, and blood volume. In 4 cases, the level of consciousness and neurological deficits were improved within 12 hours after IHT started. IHT is expected to restore the brain tissue from ischemia by increasing blood flow through the arteries of vasospasm and collateral circulation.
Aneurysm* ; Arterial Pressure ; Arteries ; Blood Pressure ; Blood Volume ; Brain ; Brain Ischemia* ; Collateral Circulation ; Consciousness ; Dopamine ; Hematoma ; Humans ; Hypertension* ; Hyperventilation ; Hypovolemia ; Infarction ; Intracranial Aneurysm ; Ischemia ; Tomography, X-Ray Computed ; Vasospasm, Intracranial

Controlled hypotension and temporary clip of feeding artery are used to reduce bleeding and to facilitate the neurosurgical operations, especially in intracranial aneurysm surgery, but the microvasculature of acute ischemic brain from impaired blood flow is quite susceptible to decrease in blood pressure and blood volume. The reversibility of brain damage following an ischemic brain lesion depends on the amount of regional cerebral flow as well as the severity of ischemia. The present study was designed to elucidate the effect of controlled hypotension on cerebral blood flow, cerebrovascular resistance, and pathological changes in acute ischemic brain lesion. Cerebral ischemia was induced in cats by middle cerebral artery occlusion for 6 hours through the transorbital approach. Forty-nine cats were divided into 3 groups, namely control group with mean blood pressure maintained at normal after right middle cerebral artery occlusion, hemorrhagic hypotension group with mean blood pressure decreased to 80, 60, and 40mmHg by with drawing of blood after right middle cerebral artery occlusion and drug-induced hypotension group with mean blood pressure decreased to 80, 60, and 40mmHg with arfonad infusion after right middle cerebral artery occlusion. Regional cerebral blood flow was measured by the hydrogen clearance method following middle cerebral artery clipping and gradual decreasing mean blood pressure. Cerebrovascular resistance was calculated after regional cerebral blood flow was measured and size of infarct were examined in each groups after the experiment was completed. Results were as follows : 1) In control group, regional cerebral blood flow and cerebrovascular resistance of the right parietal area with mean blood pressure maintained at normal after right middle cerebral artery occlusion were 19.4+/-2.1ml/2.1ml/100g/min and 5.5+/-0.4mmHg/ml/100g/min. The size of cerebral infarct was minimal in 71% of the control group. 2) In hemorrhagic hypotension group, regional cerebral blood flow of the right parietal area with mean blood pressure decreased to 80, 60, and 40mmHg was 17.6+/-1.5, 15.4+/-3.8, 7.8+/-2.9ml/100g/min respectively, thus 6, 25, and 57% lower than the control group. Cerebrovascular resistance of the right parietal area with mean blood pressure. With mean blood pressure reduced to 40mmHg, the cerebrovascular resistance drastically increased to 5.1+/-0.5mmHg/ml/100g/min. When mean blood pressure was reduced to 60 and 40mmHg, the size of infarct was marked in 57 and 85% of the hemorrhagic hypotension group. 3) In drug-induced hypotension group, regional cerebral blood flow of the right parietal area with mean blood pressure reduced to 80, 60, and 40mmHg was 19.1+/-2.3, 17.8+/-3.1, and 7.4+/-2.7ml/100g/min respectively, thus 2, 10, and 38% lower than the control group. the regional cerebral blood flow of the right parietal area in the drug-induced hypotension group was slightly higher than the hemorrhagic hypotension group when mean blood pressure was reduced to 80 or 60mmHg, while there was no significant difference of regional cerebral blood flow in the both groups when mean blood pressure was reduced to 40mmHg. Cerebrovascular resistance of the right parietal area with mean blood pressure at 80 and 60mmHg was 4.1+/-0.3 and 3.1+/-0.2mmHg/ml/100g/min respectively, thus showing a gradual decrease in relation to decreasing mean blood pressure. With mean blood pressure reduced to 40mmHg, the cerebrovascular resistance was 5.6+/-0.9mmHg/ml/100g/min, thus higher than the hemorrhagic hypotension group. When mean blood pressure was decreased to 60 and 40mmHg, the size of infarct was marked in 42 and 85% of the drug-induced hypotension group. The extent of cerebral infarct was more extensive in the hemorrhagic hypotension group than in the drug-induced hypotension group. 4) In the contralateral hemisphere of the infarct, there was no change in regional cerebral blood flow when the mean blood pressure was decreased to 80 and 60mmHg but when the mean blood pressure decreased to 40mmHg, the regional cerebral blood flow was markedly reduced in all groups. When the mean blood pressure decreased to 60mmHg there was no change in cerebrovascular resistance, however when the mean blood pressure was at 40mmHg, there was a drastic increase in cerebrovascular resistance in all groups. Due to to loss of autoregulation in the ischemic brain lesion, the regional cerebral blood flow depends on the brain perfusion and accordingly when there is ischemic brain lesion, the hemorrhagic hypotension produces serious brain infarction and edema than drug-induced hypotension.
Animals ; Arteries ; Blood Pressure ; Blood Volume ; Brain Infarction ; Brain Ischemia ; Brain* ; Cats ; Edema ; Hemorrhage ; Homeostasis ; Hydrogen ; Hypotension ; Hypotension, Controlled* ; Infarction, Middle Cerebral Artery ; Intracranial Aneurysm ; Ischemia ; Microvessels ; Middle Cerebral Artery ; Perfusion ; Rabeprazole

The brain-stem auditory evoked potentials(BAEPs) were evaluated in 5 adult patients with various posterior fossa lesions in the diagnosis and during operative manipulation to determine whether this technique was capable of providing useful information to the operating surgeon. The BAEPs were not only very sensitive noninvasive screening test in the diagnosis of small acoustic neuroma, but also very to preserve hearing during dissection of the tumor from the auditory nerve. In case of large acoustic neuroma, intraoperative BAEPs were helpful to monitor the effect of an operative procedure even on the contralateral brain-stem auditory pathway. Besides BAEP monitoring was also useful for operative manipulation in the region of the 8th nerve such as microvascular decompression of cranial nerve.
Adult ; Auditory Pathways ; Cochlear Nerve ; Cranial Fossa, Posterior ; Cranial Nerves ; Diagnosis* ; Evoked Potentials, Auditory* ; Hearing ; Humans ; Mass Screening ; Microvascular Decompression Surgery ; Monitoring, Intraoperative ; Neuroma, Acoustic ; Surgical Procedures, Operative

An experimental neurogenic pulmonary edema model in cats is described in which we have attempted to produce a neurogenically mediated hemodynamic storm. This experimental study was done to better define the hemodynamic responses to the elevated intracranial pressure and the effect and role of the alpha-adrenergic blockade in the neurogenic pulmonary edema. 50 adult cats weighing 2.5 to 4.0kg, were used in this study. The components of the pathophysiological hemodynamic responses, systemic changes, lung weight, and histopathological changes of lung in experimental models were studied in groups of animals when intracranial pressure(ICP) was raised for 2 hours by intraventricular infusion with normal saline to 200mmH2O and 300mmH2O. We have also observed the effect of the alpha-adrenergic blockade(pentolamin) in the neurogenic pulmonary edema which was produced by elevated intracranial pressure. The animals were divided into 5 groups: The normal control group was comprised of 10 normal cats. Control and pentolamin treated animal groups which had an elevated ICP of up to 200mmH2O consisted of 10 cats each. Control and pentolamin, treated animal groups which had an elevated ICP of up to 300mmH2O consisted of 10 cats each but in addition they had a neurogenically mediated pulmonary edema. 1) In the animal groups of elevated ICP to 200mmH2O and 300mmH2O, there were hemodynamic systemic changes which were neurogenically mediated and resulted in an immediate elevation in blood pressure from 30mmHg to 60mmHg. There was also bradycardia, a slight elevation of central venous pressure, and reduction of PaO2 during the controlling of the elevated ICP. The hemodynamic responses of the animals that had an elevated ICP of up to 300mmH2O were significantly more changed than the 20mmHO ICP group. The hemodynamic responses of the pentolamin treated animals with elevated ICP to up to 200 and 300mmH2O were less changed and nearly approached the normal limit. 2) This animal model allows quantitative measurement of the neurogenically mediated pulmonary edema of the lungs by weighing. The lung weights of the animals with an elevated ICP of up to 200 and 300mmH2O were significantly greater then the normal control value(P<0.05) and the lung weights of the animals with an elevated ICP of 300mmH2O were significantly greater than those with an ICP of 200mmH2O(P<0.01). The lung weights of the pentolamin treated animal groups with the elevated ICP were significantly less than the control group but showed little increase in the lung weight when compared to the normal value. 3) By controlling the elevated ICP above 200mmH2O in the experimental animals we have confirmed gross and micropic appearances of hemorrhagic pulmonary edema. Partial destruction and congestion appeared along with hemorrhage in the alveolar and alveolar wall in the groups with an ICP of 300mmH2O. Histopathological changes of the pentolamin treated animals with the elevated ICP were significantly less severe than in the control groups and also had a tendency of returning to to a normal state. 4) This experimental model may facilitate clarification of the pathophysiolagical pathogenesis of neurogenic pulmonary edema. The authors defined the concept of neurogenic pulmonary edema as resulting from an increase in pulmonary capillary permeability mediated by massive symphathetic discharges to those vessels. Blockade of the sympathetic innervation to the systemic and pulmonary vascular beds lower the vascular pressures and brings the pulmonary capillary pressures back to normal.
Adult ; Animals ; Blood Pressure ; Bradycardia ; Capillaries ; Capillary Permeability ; Cats* ; Central Venous Pressure ; Estrogens, Conjugated (USP) ; Hemodynamics ; Hemorrhage ; Humans ; Infusions, Intraventricular ; Intracranial Hypertension ; Lung ; Models, Animal ; Models, Theoretical ; Pulmonary Edema* ; Reference Values ; Weights and Measures