BACKGROUND: More than 90% of acute stroke patients have measurable cardiovascular sequelae, but we have been often overlooked in formal discussions of treatment. If we estimate the incidence of myocardial injury in patient with spontaneous SAH, we may figure the possibility of cardiac dysfunction in such patients. This study was designed to investigate the incidence of myocardial injury in patients with spontaneous SAH using cardiac troponin I(cTnI). METHODS: A prospective single emergency center study was performed to determined preoperative incidence of unrecognized cardiac injury in patients suffering spontaneous SAH. We include the spontaneous SAH patients who underwent serum measurements of the cardic troponin I immediately upon admission last six month period. ECG, CK, CK-MB and myoglobin were also performed at admission. We excluded the spontaneous SAH patients who had past history of myocardial ischemia and ECG abnormality. RESULTS: Fifty-two patients(34 females, 18 males) with spontaneous SAH were studied prospectively. 18 patients(34.6% of the total study population) had cTnI level above 0.5ng/ml. ECG was performed in 52 patients and was abnormal in 15 of the 52 patients(28.8%). CONCLUSION: The measurement of cTnI has provided physicians with a myocardial marker that has a cardiac sensitivity for cardiac injury equal to that of CK-MB yet with greater specificity. So, cardiac troponin I is useful to estimate the incidence of myocardial injury in patients with spontaneous SAH. And we may estimate the possibility of cardiac dysfunction in such patients. This knowledge will hopefully aid in the care and improve the outcome.
Electrocardiography ; Emergencies ; Female ; Humans ; Incidence* ; Myocardial Ischemia ; Myoglobin ; Prospective Studies ; Sensitivity and Specificity ; Stroke ; Troponin I* ; Troponin*

A case of a patient diagnosed as the chronic spinal epidural hematoma in the lumbar region is reported. There was no history of trauma except the repeated epidural block for controlling the lower back pain at the pain clinic. The symptoms were occurred after epidural block and were exaggerated by repeated injections. Magnetic resonance imaging showed a spinal epidural mass located dorsolaterally at the level of L3-L4. After removal of the hematoma, the symptoms were completely relieved. The diagnosis of a chronic spinal epidural hematoma was confirmed with both operative and histological findings.
Hematoma ; Hematoma, Epidural, Spinal ; Humans ; Low Back Pain ; Lumbosacral Region ; Magnetic Resonance Imaging ; Pain Clinics

OBJECTIVE: Ventricular enlargement following head injury is a frequent finding but cases requiring shunt operation are rare. The incidence and developing factors of post-traumatic hydrocephalus (PTH) have been variously reported, but studies for factors influencing outcomes of shunt operation for PTH are rare. The incidence of PTH requiring shunt operation, causing injuries, and factors influencing outcome of shunt operation need to be identified. METHODS: In total, 1,142 patients suffering from traumatic brain injury (TBI) between January 2007 and December 2012 were admitted to our department. Of them, 23 patients underwent shunt operation for diagnosed PTH. In this clinical study, we reviewed retrospectively our TBI database and in the 23 patients, we evaluated outcomes with Glasgow Outcome Score just before the operation, at 14 days, 3 months, and 6 months according to initial Glasgow Coma Scale (GCS) score, interval time between shunt operation and trauma, and lumbar cerebrospinal fluid (CSF) pressure. RESULTS: The incidence of PTH treated with shunt operation was 2.01%. Subdural hematoma (SDH) was the most common preceding head injury. The outcomes of shunt operation were not related with lumbar CSF pressure or interval time from trauma, but initial GCS score correlated with the outcome. CONCLUSION: In present study, 2.01% of TBI patients underwent shunt operation. SDH was the most common preceding injury. Admission GCS score was related to the outcome of shunt operation. However, there were no correlation between the outcome of shunt operation and initial lumbar CSF pressure or interval time of shunt operation after the trauma.
Brain Injuries* ; Cerebrospinal Fluid ; Craniocerebral Trauma ; Glasgow Coma Scale ; Hematoma, Subdural ; Humans ; Hydrocephalus* ; Incidence ; Retrospective Studies ; Treatment Outcome

Familial intracranial aneurysm is rare. We have clipped two posterior circulation intracranial aneurysms in mother and son. Mother was 48 years old and presented with severe headache and drowsy mentality. A basilar artery bifurcation aneurysm was found on DSA(digital subtraction angiography) and successfully clipped with transsylvian pterional approach. Her son was 24-year-old and presented with seizure and drowsy mentality. An aneurysmal sac was found on the bifurcation of vertebral artery and posterior inferior cerebellar artery. We have clipped it successfully with far lateral suboccipital approach. The authors recommended the use of screening test, such as MRIand high resolution CT, on the group of patients with the characteristic features of familial intracranial aneurysm.
Aneurysm* ; Arteries ; Basilar Artery ; Headache ; Humans ; Intracranial Aneurysm ; Mass Screening ; Middle Aged ; Mothers* ; Seizures ; Vertebral Artery ; Young Adult

Primary leptomeningeal malignant melanoma is rare entity. We present a case of primary leptomeningeal malignant melanoma of 66-year-old male, who had suffered severe headache, confusion, and right hemiparesis. The brain computed tomography and magnetic resonance image revealed a well enhancing mass with hemorrhage in the left fronto-parietal region. Total surgical removal of the lesion was performed without neurological deficit. He died at home 6 months after operation. Probably, it seems that the cause of death was poor general condition due to obtunded mentality or brain herniation due to increased intracranial pressure. The literature on this subject is briefly reviewed.
Aged ; Brain ; Cause of Death ; Headache ; Hemorrhage ; Humans ; Intracranial Pressure ; Male ; Melanoma* ; Paresis

Object : This study was conducted to evaluate the surgical results of the active treatment of unruptured intracranial aneurysms (UIAs) and to suggest treatment indications. METHODS: Operations were performed on 49 patients with 52 UIAs between 1999 and 2005. Medical records and radiologic studies of the patients with UIAs were retrospectively reviewed. The clinical outcomes were evaluated in each patient by the modified Glasgow Outcome Scale (m-GOS) one month after operation. RESULTS: UIAs had a high frequency of a middle cerebral artery (MCA) and an internal carotid artery (ICA) aneurysm. Forty-four UIAs (84.6%) ranged between 5 mm to 15 mm in diameter. Fortysix UIAs were treated by clipping, 2 by wrapping, and coil embolization was used in 3 UIAs. In one patient, which had only one UIA, one procedure and one operation was performed. There was no surgical mortality. In most patients, surgical complications or neurological deteriorations were not found. In three patients, minor neurological deficits of ptosis (2 patients) and spinal subdural hematoma (1 patient) were newly developed after operation. However the patients completely recovered within 3 months after operation. Finally, the surgical mortality and morbidity rate was 0%. CONCLUSION: If the UIAs are larger than 5 mm in diameter and located in a susceptible area for rupture, surgical treatment should be considered for the UIAs. If operation is performed by an expert neurosurgeon, surgical clipping is one of the best treatment modalities with or without endovascular treatment.
Aneurysm ; Carotid Artery, Internal ; Embolization, Therapeutic ; Glasgow Outcome Scale ; Hematoma, Subdural, Spinal ; Humans ; Intracranial Aneurysm* ; Medical Records ; Middle Cerebral Artery ; Mortality ; Retrospective Studies ; Rupture ; Surgical Instruments

OBJECTIVE: A variety of factors are known to have an influence on the recurrence of chronic subdural hematoma (CSDH). In this study, the authors investigated the influential factors for recurrence of CSDH after burr hole drainage. METHODS: 45 patients with unilateral CSDH were treated with one-burr hole trephination and closed drainage in our hospital during last 6 years, whom the drainage catheter tip was randomly located and checked on postoperative computed tomography (CT). The clinical status of patients, thickness of hematoma, midline displacement of before and after surgery, amount of subdural air collection, drainage catheter tip location were estimated and the relationship of those factors with the recurrence was analyzed. RESULTS: Patients with located catheter tip in frontal had a better clinical and radiological result. And the recurrence of CSDH was lower who has lesser amount of subdural air collection in postoperative CT. CONCLUSION: The recurrence rate of unilateral CSDH is influenced by the location of drainage catheter tip and the amount of subdural air collection.
Catheters ; Displacement (Psychology) ; Drainage ; Hematoma ; Hematoma, Subdural, Chronic ; Humans ; Recurrence

OBJECTIVES: We aimed to develop a common health information exchange (HIE) platform that can provide integrated services for implementing the HIE infrastructure in addition to guidelines for participating in an HIE network in South Korea. METHODS: By exploiting the Health Level 7 (HL7) Clinical Document Architecture (CDA) and Integrating the Healthcare Enterprise (IHE) Cross-enterprise Document Sharing-b (XDS.b) profile, we defined the architectural model, exchanging data items and their standardization, messaging standards, and privacy and security guidelines, for a secure, nationwide, interoperable HIE. We then developed a service-oriented common HIE platform to minimize the effort and difficulty of fulfilling the standard requirements for participating in the HIE network. The common platform supports open application program interfaces (APIs) for implementing a document registry, a document repository, a document consumer, and a master patient index. It could also be used for testing environments for the implementation of standard requirements. RESULTS: As the initial phase of implementing a nationwide HIE network in South Korea, we built a regional network for workers' compensation (WC) hospitals and their collaborating clinics to share referral and care record summaries to ensure the continuity of care for industrially injured workers, using the common HIE platform and verifying the feasibility of our technologies. CONCLUSIONS: We expect to expand the HIE network on a national scale with rapid support for implementing HL7 and IHE standards in South Korea.
Computer Security ; Computer Systems ; Continuity of Patient Care ; Delivery of Health Care ; Electronic Health Records ; Health Level Seven ; Humans ; Information Services* ; Korea ; Privacy ; Referral and Consultation ; Workers' Compensation

Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease. Pathologic changes occurred in patients with AS result in a weakened vertebral column with increased susceptibility to fractures, even though a trivial injury. Fractures usually tends to involve the lower cervical spine, but rarely, they are also occurred in thoracolumbar spine. We present our experiences of three cases of spinal fracture in patients with AS, cervical, thoracic, and lumbar spine, with a review of literatures.
Humans ; Rheumatic Diseases ; Spinal Fractures ; Spine ; Spondylitis ; Spondylitis, Ankylosing

Spinal subdural hematoma(SSDH) is rare disease. Furthermore, it rarely occurs as a complication of intracranial surgery. There are few case reports which describing SSDH after craniotomy. Although the exact pathogenetic mechanism is obscure, some investigators propose that downward migration of intracranial hematoma by the effect of gravity is one of the cause of SSDH, and which is commonly suggested. But others propose that cerebrospinal fluid(CSF) hypotension is an another possible mechanism. In this paper, we report two cases of SSDH after clipping of an aneurysmal neck.
Aneurysm ; Craniotomy ; Gravitation ; Hematoma ; Hematoma, Subdural, Spinal* ; Humans ; Hypotension ; Neck ; Rare Diseases ; Research Personnel