Authors experienced the myelotomy for the syringomyelia in 3 cases. Moreover a recent case who underwent the craniovertebral decompression with myelotomy was associated with Arnold-Chiari malformation. Post-operative courses were uneventful in two but a case with the thoracic myelotomy became paraparetic after 5 years of follow up due to the spinal arachnoiditis. It seems that the careful studies, including the ventriculography and/or C-T scan are necessary to find the hind-brain malformation and to give the appropriate management.
Arachnoid ; Arachnoiditis ; Arnold-Chiari Malformation ; Decompression ; Follow-Up Studies ; Syringomyelia*

We have experienced 17 cases of the upper brain stem compression lesions diagnosed by serial vertebral angiography and other ancillary studies from October, 1972 to August, 1975. All the cases were proven by serial vertebral angioraphy using the Seldinger catheter technique through the femoral artery and other studies such as carotid angiography, conray ventriculograpy, brain scan and pneumoencephalography. Angiographical analysis were attempted. The results were as following: 1. The location of lesion is:supratentorial lesions; 8 cases, infratentorial lesions; 5 cases, tentorial lesions; 3 cases, bilateral hippocampal herniation due to otitic hydrocephalus; 1 case. 2. We have tried to classify the upper brain stem compression lesions according to the direction of compression, i.e., (1) forward, (2) medial, (3) backward and (4) downward and analyzed their angiographic findings in detail. 3. Lesions compressed the upper brain stem forward were one case of bilateral occipital meningioma, one case of fourth ventricle tumor, two cases of medulloblastoma and one case of cerebellar hemispheric tumor. Their main angiographic findings were as follows;(1) Separation of quadrigeminal segment of superior cerebellar artery and posterior cerebral artery, (2) Compression of basilar artery against clivus and depression or elevation of bifurcation of basilar artery, (3) Stretching of thalamoperforating artery, (4) Elevation and forward basilar artery, (3) Stretching of thalamoperforating artery, (4) Elevation and forward displacement of posterior mesencephalic vein and posterior displacement of precentral cerebellar vein, (5) Elevation of vein of Rosenthal. 4. Lesions compressed the upper brain stem medially were two cases of parietal ependymoma, one case of temporal meningioma, one case of bilateral hippocampal herniation and three cases of tentorial tumors. Their main angiography findings were as follows; (1) Medial displacement of posterior cerebral artery, superior cerebelar artery, bifurcation of basilar artery, distal portion of vein of Rosenthal, lateral mesencephalic vein and internal cerebral vein in Towne's view, (2) Elevation or depression of posterior mesencephalic vein, (3) Depression of bifurcation of basilar artery, (4) Stretching of thalamoperforating artery, (5) Depression of crural and ambient segment of superior cerebellar artery. 5. Lesions compressed the upper brain stem backward were one case of pituitary tumor and one case of cerebellopontine angle tumor. Their main angiographic findings were as follows; (2) Posterior displacement of distal portion of basilar artery, (2) Posterior displacement of anterior pontomesencephalic vein, (3) Elevation of posterior cerebral artery and superior cerebellar artery, (4) Elevation of vein of Rosenthal and posterior mesencephalic vein, (5) Stretching and elevation of posterior communicating artery. 6. Lesions compressed the upper brain stem downward were one case of thalamic tumor, one case of thalamic hemorrhage, and one case of pinealoma. Their main angiographic findings were as follows; (1) Stretching of posterior cerebral artery and superior cerebellar artery, (2) Displacement and stretching of internal cerebral vein, vein of Rosenthal and posterior mesencephalic vein, (3) Depression of bifurcation of basilar artery, (4) Stretching of thalamoperforating artery, (5) Depression of posterior cerebral artery and superior cerebellar artery, (6) Depression of internal cerebral vein, vein of Rosenthal, posterior mesencephalic vein and anterior pontomesencephalic vein. 7. We have concluded that in order to diagnosis the upper brain stem compression lesions serial vertebral angiography is the most important procedure and at the same time the analysis of the arteriographic and venographic findings in detail is important.
Angiography* ; Arteries ; Basilar Artery ; Brain Stem* ; Brain* ; Catheters ; Cerebral Veins ; Cranial Fossa, Posterior ; Depression ; Diagnosis ; Ependymoma ; Femoral Artery ; Fourth Ventricle ; Hemorrhage ; Hydrocephalus ; Medulloblastoma ; Meningioma ; Neuroma, Acoustic ; Pinealoma ; Pituitary Neoplasms ; Pneumoencephalography ; Posterior Cerebral Artery ; Rabeprazole ; Veins

We have experienced a case of suprasellar germinoma metastasized to the lumbar spinal canal. A 22-year-old man was admitted to St. Mary's Hospital May, 1975 with complaints of low back pain, progressive weakness of both lower extremities and voiding difficulty for about one month. About 7 months ago he received craniotomy and irradiation therapy for suprasellar germinoma. Neurological examination revealed foot drop on the left side with sensory change and atonic neurogenic bladder. Pantopaque myelogram showed a total block at the level of the 3 rd lumbar vertebra suggestive an epidural mass compressing dural sac posteriolaterally. Total laminectomy of lumbar first to fifth vertebrae disclosed a firm, rubbery hard and vascular mass in the epidural space, which was not adherent to the dura. Histological examination of the tumor revealed typical germinoma. Pathogenesis of geminoma and possible mode of epidural metastasis are discussed.
Craniotomy ; Epidural Space* ; Foot ; Germinoma* ; Humans ; Iophendylate ; Laminectomy ; Low Back Pain ; Lower Extremity ; Neoplasm Metastasis ; Neurologic Examination ; Spinal Canal* ; Spine ; Urinary Bladder, Neurogenic ; Young Adult

The intracranial arachnoid cyst is distinctly uncommon and they have unusual clinical course. The plain skull series were usually shown bulging of the overlying skull due to progressive collection of cerebrospinal fluid in cystic cavity. Pre-operative diagnosis is unlikely to be made. The predilection sites of this lesion are usually convexity of hemisphere, cisterna chiasmaticus, especiaily forebrain along the axis of main cerebral artery. The authors report a case of intracranial arachnoid cyst arisen along the Sylvian fissure combined chronic subdural hematoma follwoing sustained mild head injury. The pathologic diagnosis was arachnoid cyst, since the removed cyst wall was normal arachnoid tissue.
Arachnoid ; Arachnoid Cysts* ; Axis, Cervical Vertebra ; Cerebral Arteries ; Cerebrospinal Fluid ; Craniocerebral Trauma ; Diagnosis ; Hematoma, Subdural, Chronic ; Prosencephalon ; Skull

The pharmacological treatment of Alzheimer's disease is based on symptomatic therapy of cognitive decline and behavioral problems. Numerous therapies have been investigated for the treatment and prevention of Alzheimer's disease. We reviewed the current evidence-based medical research and guidelines of treatment for Alzheimer's disease. The use of cholinesterase inhibitors (ChEI) and N-methyl-D-aspartate (NMDA) inhibitors can bring about significant but modest therapeutic improvement. There is insufficient evidence to recommend vitamine E, estrogen, ginko biloba, or nonsteroidal anti-inflammatory drugs (NSAIDs) for the prevention or treatment of Alzheimer's disease. This article reviews the available data on current pharmacological treatments through evidence-based medicine.
Alzheimer Disease ; Cholinesterase Inhibitors ; Estrogens ; Evidence-Based Medicine ; Ginkgo biloba ; Memantine ; N-Methylaspartate ; Vitamins

The arteriovenous malformations(AVMs) of the corpus callosum are distinct anatomical and surgical entities. The AVMs of the corpus callosum are supplied by the pericallosal arteries if the malformations are located in the anterior and middle portion of the callosum and the AVMs of the splenium are usually fed by the pericallosal and posterior cerebral arteries. Radical excision of the callosal AVMs became successful with microsurgical techniques since a few years ago. The authors report a case of the callosal AVM, who had subarachnoid hemorrhage twice prior to this admission, and the studies with angiography and computed tomography revealed an AVM involing the middle portions of the corpus callosum. Radical excision of the AVM was accomplished by microsurgical techniques without neurologic sequela.
Angiography ; Arteries ; Corpus Callosum* ; Posterior Cerebral Artery ; Subarachnoid Hemorrhage

BACKGROUND: The patients visiting the primary care complain of the various symptoms. This symptoms may induce the stress or the reverse. In fact the stress can influence the symptoms and signs. So this study was done for the correlation of the symptoms and signs with stress. METHODS: This study was done about the patients visiting the family medicine department of the one university hospital. We collected the all items that can find in the charts for examining the symptoms and signs, and did the requests pater the patients wrote by themselves. The stress test was Psychosocial well being index to be constructed from the General Health Questionnaire. We tested the study by t-test, anova, chi-square, linear logistic regression. RESULTS: The total study numbers were 351. The stress cut-off point was 63 score. The stress group was consisted of 15 males and 43 females. The meaningful symptoms were headache, dizziness, fatigue, weakness, insomnia, anxiety or depression. The meaningful diagnoses were anxiety or depression, tension headache(p<0.05). The meaningful sociodemographic factors were female, housewife or unemployed, menopause, monthly income below 200 ten thousands won. CONCLUSIONS: It was found that the some symptoms and signs were statistically correlated with stress.
Anxiety ; Depression ; Diagnosis ; Dizziness ; Exercise Test ; Fatigue ; Female ; Headache ; Humans ; Logistic Models ; Male ; Menopause ; Primary Health Care ; Sleep Initiation and Maintenance Disorders ; Surveys and Questionnaires

Epilepsy can be defined as a paroxysmal, neuronal discharge within the brain originating from either corticalor sugcortical regions. The incidence of epilepsy is increasing possibly due to the survival of persons who shouldhave died of brain injuries or other cerebral abnormalities acquired in earlylife. the use of abtibiotics andimprovement in the medical care have saved many children who might have died of meningitis, brain abscess,encephalitis, severe head injuries, etc. CCT scan is new radiologic procedure for defining cranial andintracranial structures and also an useful procedure for evaluation and follow-up(FU) of patient with focalseizure disorder. Recently we experienced nodules which were isodense or hypodense on initial noncontrasted CT(NECT) and scans became hyperdense of the enhancement in 4 cases of focal epileptic seizures. Nearly completedisappearance or regression of the epileptic foci occurred on the FU CT scans in 2 cases. Operation was performedin 2 cases. The tissue specimen obtianed from the CT nodule revealed cerebral edema in one case and localizedgliosis and congestion in the other. All the patients showed marked clinical improvement when the CT noduleimporved. Review of literature failed to disclose any previous report on such observation.
Brain ; Brain Edema ; Brain Injuries ; Child ; Craniocerebral Trauma ; Epilepsy ; Estrogens, Conjugated (USP) ; Humans ; Incidence ; Meningitis ; Neurons ; Tomography, X-Ray Computed

Midline lesion at the base of skull have been considered in the past to be inoperable, partially respectable, and even when respectable, unpleasant difficult. According for the above has been the poor visulization of minimal surgical exposure, copious bleeding and lack of adequate fluoroscopic depth monitoring. These built-in difficulties may prove to be a fertile ground for microsurgery. Presently the use of the surgical dissecting microscope, portable image intensifiers and specifically designed microinstruments has enabled to permit approach of clival area for removal of the clival tumor. Authors had experience of transoral approach for removal of lower third of clival meningioma, and reviewed surgical approachs to midline lesion at the base of the skull.
Hemorrhage ; Meningioma* ; Microsurgery ; Skull ; Skull Base

Attention has been called to the sudden expansion of a pituitary tumor by hemorrhage within it, causing sudden loss of vision. Management of the pituitary apoplexy should be regarded as a neurological emergency. The outstanding clinical features of acute pituitary apoplexy were sudden headache, depressed consciousness, opthalmoplegia, meningismus and signs of compression of the optic nerve or chiasm. The authors report two cases of pituitary apoplexy, one was chromophobe adenoma and pathological diagnosis was not obtained in the other. The first case was 45-year-old man admitted to the Department of Neurosurgery, Catholic Medical Center on June 20, 1977, with headache, double vision and impared left side visual acuity. On April 26, 1977, he experienced sudden severe headache and diplopia then became drowsy. The headache and impairment of consciousness improved subsequently. He was admitted to a university hospital following the onset. The work up at the hospital revealed an enlarged sella with hazy dorsum sellae on plain skull films. The carotid angiogram revealed an elevation of the A1 segments bilaterally and cisternal pneumogram revealed an evidence of suprasellar extension of the pituitary tumor. He was advised to have immediate surgery. The patient, however, refused the surgery and noticed the impaired visual acuity and diplopia were persisting. The studies in this hospital revealed marked impairment of left side vision and oculomotor nerve palsy of the left eye. The carotid angiogram and cisternal pneumogram revealed the no evidence of sellar mass or suprasellar extension of the tumor. The second case was 59-year-old woman admitted to the neurosurgical ward on September 30, 1977, after a sudden onset of severe bifrontal headache, vomiting, bilateral ocular pain and drowsy mental state. She was drowsy with panopthalmoplegia of the right side, and spinal fluid was xanthochromic. Skull X-ray, carotid angiogram and air study revealed an evidence of pituitary tumor with minimal suprasellar extension. Removal of pituitary tumor through the trans-sphenoidal approach was performed, and the tumor was proved to be chromophobe adenoma. Panopthalmoplegia was progressively improved postoperatively.
Adenoma, Chromophobe ; Consciousness ; Diagnosis ; Diplopia ; Emergencies ; Female ; Headache ; Hemorrhage ; Humans ; Meningism ; Middle Aged ; Neurosurgery ; Oculomotor Nerve Diseases ; Optic Nerve ; Pituitary Apoplexy* ; Pituitary Neoplasms ; Skull ; Visual Acuity ; Vomiting