Fifty-one consecutive 186 patients with aneurysmal subarachnoid hemorrhage were treated from the day of admission with nimodipine which was given first as an IV infusion at 30ug/kg/hr for 1 week and then orally in a dose of 360mg/day for 2 weeks and compared with 135 patients which were treated without nimodipine for the past 2 years. A comparision based on clinical and radiological variables influencing both the coruse and the outcome of the disease showed no significant difference between the nimodipine treated group and the control group except the delayed timing of surgery in the control group. There was no significant difference in the outcome between the nimodipine treated patients and the patients treated without nimodipine, however in Hung & Hess grade IV patients nimodipine treatment was associated with a significantly better outcome. Nimodipine treatment reduced the occurrence of delayed ischemic deficts(DID) in grade III, IV patients. Significant improvement in the outcome occurred in the nimodipine treated patients with subarachnoid hemorrhage of large amount(Fisher classification III).
Aneurysm* ; Classification ; Humans ; Intracranial Aneurysm ; Nimodipine* ; Subarachnoid Hemorrhage*

No abstract available.
Intracranial Arteriovenous Malformations* ; Risk Factors*

The authors reviewed forty cases of acoustic neurinomas operated on from July 1974 to June 1984, analyzing our data obtained during 10 years in the following three periods: 1974 to 1978, 1978 to 1981, 1981 to 1984. A suboccipital approach was used for the removal of acoustic neurinomas in all cases. 1) A peak in the age distribution was seen at 40-50 years of age and no sexual difference was present. 2) The earliest symptoms were hearing loss(50%), headaches(25%), tinnitus(15%) in order of frequency. The time between onset of complaints and admission was mostly within 5 years(83%). 3) Most of the patients had large tumors(78%), greater than 3cm, of whom 4 patients were free of cerebellar and brain stem dysfunction. 4) Total removal was carried out in 27 out of 40 patients(67%) and particularly in 8 out of 14 patients(57%) with large tumors greater than 5cm. The total mortality was 7.5%. 5) In the last 3 years with the advance of microsurgical technique and CT scan, 25 patients were operated on only with a single death and total removal was carried out in 20 out of 25 patients. 6) In total removal, the total mortality was 7.4% and the mortality was 8% in patients with 3-5cm sized tumors and 13% in patients with tumors greater than 5cm, particularly 5% in the recent 3 years. 7) Preservation of the facial nerve following total removal was achieved in 59%. In the recent 3 years, the facial nerve was preserved in 65%. In the large tumors, 3-5cm sized and greater than 5cm, the rates of 75% and 37% were obtained.
Acoustics* ; Age Distribution ; Brain Stem ; Facial Nerve ; Hearing ; Humans ; Mortality ; Neuroma, Acoustic* ; Tomography, X-Ray Computed

Adenocarcinoma of the urinary bladder, including urachal carcinoma, is a rare tumor with incidence in the range between 0.5% and 2.2% of all epithelial bladder neoplasms. Ten cases of adenocarcinoma of the urinary bladder(eight cases of primary adenocarcinoma and two cases of urachal carcinoma)are presented. We described the computed tomography(CT)appearances of adenocarcinoma of the urinary bladder and tried to find out the characteristic CT findings of urachal carcinoma. CT scan were evaluated for the location of the tumors, presence of calcification in the tumor, and the tumor extension. Seven tumors were located at the dome of the bladder(70%0, two were at lateral walls, and one was at anterior wall. Seven were single mass and three were multicentric masses in the bladder. Fine punctate calcifications scattered within the tumors were detected in four cases(40%); three of the eight, primary adenocarcinoma, and one of the two, urachal carcinoma. Two urachal carcinomas were characterized by midline position and predominantly extravesical growth along the urachus. Gross extravesical extension with distant metastasis were presented in seven cases(70%) at the time of initial diagnosis. CT may be useful in evaluating the adenocarcinoma of the urinary bladder and differentiating urachal carcinoma from bladder cancer.
Adenocarcinoma* ; Diagnosis ; Incidence ; Neoplasm Metastasis ; Tomography, X-Ray Computed ; Urachus ; Urinary Bladder Neoplasms ; Urinary Bladder*

To elucidate the funcion of arachidonic acid as a secondary brain edema facotr, the infusion edema model was constucted using adult cats with studies of somatosensory evoked potentials, regional cerebral blood flow of white matters, brain water contents, magentic resonance images and histological findings. Among 50 cats, 6 cats were used as sham poerated group without infustion and in 45 cats solutions of various concentrations of arachidonic acid and physiologic saline were infused into the left and right frontal white maters respectively. According to the different concentrations of arachidonic acid, three groups were named as group A(0.1mg/ml), group B(1mg/ml), group C(10mg/ml). During 4 hours of slow infusion of the infusates(average 0.5ml in each side totally) central conduction time(CCT) was measured every an hour with contralateral median nerve stimulation bilaterally and cerebral blood flow(CBF) of white matter was measured by hydrogen clearance method every 2 hours. Finally the cats were sacrificed and specimens of edematous white matter obtained bilaterally at the coresponding points. Water contents were measured with vacuum freeze drying method. T2-weighted magnectic resonance images(MRI) and light microscopic studies were performed in a cat of each groups. The results were as followed ; 1) MRI and histologic findings showed that the infusion brain edema technique was efective in inducing interstitial edema, but the differences in the degree of edema formation between the right and the left sides were not siginificant in all groups. 2) There were no statistically significant difference between the water contents of the right and that of left in all groups. 3) Either infusion of arachidonic acid or physiologic saline in the white matter did not change regional white matter CBF in all groups. 4) The I-N1 interpeak latency was labelled as central conduction time(CT), and the baseline CCT was 5.83+/-0.52msec. 5) The differences of CCT between infusion group and noninfusion group were statistically significant in group C at 2, 3, 4hours(p>0.01) and the differerences of cct between arachidonic acid and physiologic saline infustion sites were statistically significant in group B at 4 hors, group C at 1 hour(p>0.05) and group C at 2, 3, 4hours(p>0.01) after eginning of infusion and the differences increased with time in group C(p>0.01). The results indicate that arachidonic acid does not have edemogenic properties during 4 hours infusion but may induce neurologic dysfunction as to increase the CCT in somatosensory evoked potential studies if it exists in the edema fluid of brain white matter.
Adult ; Animals ; Arachidonic Acid* ; Brain Edema ; Brain* ; Cats ; Edema ; Evoked Potentials, Somatosensory* ; Freeze Drying ; Humans ; Hydrogen ; Magnetic Resonance Imaging ; Median Nerve ; Neurologic Manifestations ; Vacuum

Bilateral abducens nerve palsy related to ruptured aneurysm of the anterior communicating artery (ACoA) has only been reported in four patients. Three cases were treated by surgical clipping. No report has described the clinical course of the isolated bilateral abducens nerve palsy following ruptured ACoA aneurysm obliterated with coil. A 32-year-old man was transferred to our institution after three days of diplopia, dizziness and headache after the onset of a 5-minute generalized tonic-clonic seizure. Computed tomographic angiography revealed an aneurysm of the ACoA. Magnetic resonance imaging showed focal intraventricular hemorrhage without brain stem abnormalities including infarction or space-occupying lesion. Endovascular coil embolization was conducted to obliterate an aneurysmal sac followed by lumbar cerebrospinal fluid (CSF) drainage. Bilateral paresis of abducens nerve completely recovered 9 weeks after ictus. In conclusion, isolated bilateral abducens nerve palsy associated with ruptured ACoA aneurysm may be resolved successfully by coil embolization and lumbar CSF drainage without directly relieving cerebrospinal fluid pressure by opening Lillequist's membrane and prepontine cistern.
Abducens Nerve ; Abducens Nerve Diseases ; Aneurysm ; Aneurysm, Ruptured ; Angiography ; Arteries ; Brain Stem ; Cerebrospinal Fluid Pressure ; Diplopia ; Dizziness ; Drainage ; Headache ; Hemorrhage ; Humans ; Infarction ; Intracranial Aneurysm ; Magnetic Resonance Imaging ; Membranes ; Paresis ; Seizures ; Subarachnoid Hemorrhage ; Surgical Instruments

Isolated abducens nerve paresis related to ruptured vertebral artery (VA) aneurysm is rare. It usually occurs bilaterally or ipsilaterally to the pathologic lesions. We report the case of a contralateral sixth nerve palsy following ruptured dissecting VA aneurysm. A 38-year-old man was admitted for the evaluation of a 6-day history of headache. Abnormalities were not seen on initial computed tomography (CT). On admission, the patient was alert and no signs reflecting neurologic deficits were noted. Time of flight magnetic resonance angiography revealed a fusiform dilatation of the right VA involving origin of the posterior inferior cerebellar artery. The patient suddenly suffered from severe headache with diplopia the day before the scheduled cerebral angiography. Neurologic examination disclosed nuchal rigidity and isolated left abducens nerve palsy. Emergent CT scan showed high density in the basal and prepontine cistern compatible with ruptured aneurismal hemorrhage. Right vertebral angiography illustrated a right VA dissecting aneurysm with prominent displaced vertebrobasilar artery to inferiorly on left side. Double-stent placement was conducted for the treatment of ruptured dissecting VA aneurysm. No diffusion restriction signals were observed in follow-up magnetic resonance imaging of the brain stem. Eleven weeks later, full recovery of left sixth nerve palsy was documented photographically. In conclusion, isolated contralateral abducens nerve palsy associated with ruptured VA aneurysm may develop due to direct nerve compression by displaced verterobasilar artery triggered by primary thick clot in the prepontine cistern.
Abducens Nerve ; Abducens Nerve Diseases ; Aneurysm ; Aneurysm, Dissecting ; Angiography ; Arteries ; Brain Stem ; Cerebral Angiography ; Diffusion ; Dilatation ; Diplopia ; Follow-Up Studies ; Headache ; Hemorrhage ; Humans ; Magnetic Resonance Angiography ; Magnetic Resonance Imaging ; Muscle Rigidity ; Neurologic Examination ; Neurologic Manifestations ; Paresis ; Subarachnoid Hemorrhage ; Vertebral Artery

PURPOSE: To assess the characteristic features of MR imaging in the diagnosis of spinal tuberculosis. MATERIALS AND METHODS: We retrospectively reviewed MR imaging of 27 cases with pathologically-proven spinal tuberculosis and analyzed the MR findings including the extent of the lesions on non-contrast T1, proton density, and T2*VI, and the specific contrast enhancement patterns of the lesion on Gd-DTPA enhnced TIWI. RESULTS: The inflammatory lesions showed low signal intensity on T1WI in 25 patients(93%) and high signal intensity on T2*gradient echo image in 25 patients(93%). Bone destruction was noted in 15 patients(55%), disc-space narrowing in 21 patients(77%), paravertebral abscess in 16 patients(59%), subligamentous extension in 23 patients(85%), kyphosis in 8 patients(29%), and spinal canal narrowing in 19 patients(70%). After Gd-DTPA was administrated, rim-enhancement was noted in all patients(100%). CONCLUSION: We conclude that MR imaging is an excellent imaging modality for establishing the diagnosis of spinal tuberculosis as well as delineating the extent of soft tissue involvement. Characteristic peripheral rim enhancement after injection of Gd-DTPA may provide rather specific diagnosis in spinal tuberculosis.
Abscess ; Diagnosis ; Gadolinium DTPA ; Kyphosis ; Magnetic Resonance Imaging* ; Protons ; Retrospective Studies ; Spinal Canal ; Tuberculosis, Spinal*

PURPOSE: This study was performed to evaluate differentiating features of spinal compression fractures between benign and metastatic lesions. MATERIALS AND METHODS: We reviewed MR imaging in 52 patients (benign 38, metastasis 14) with vertebral compression fracture. Signal intensity of fracture and uninvolved areas, presence of contrast enhancement, fragmentation, and paravertebral mass were analyzed retrospectively. RESULTS: Signal intensity of fracture site was variable in benign lesions, but low signal intensity on T1-weighted image and high on T2*-weighted image were seen in all cases of metastasis. Signal intensity of uninvolved area was high on T1-weighted image and low on T2*-weighted image in 84% of benign lesions. On the contrary, normal marrow signal intensity was not seen in the uninvolved areas of all metastatic fractures. Contrast enhancement were observed in all cases of benign & metastatic compression fractures. Fragmentation were seen in 1 case of metastasis(7%) and in 11 cases of benign lesions(29%). Paravertebral mass were seen in 5 cases of metastasis(36%) and in 7 cases of benign lesions(18%). CONCLUSION: Presence of normal marrow signal intensity in the uninvolved area of fracture site could be the most useful sign for differentiating benign causes from metastasis.
Bone Marrow ; Fractures, Compression* ; Humans ; Magnetic Resonance Imaging* ; Neoplasm Metastasis* ; Retrospective Studies

The medical and radiological records of 66 patients who underwent surgical resection of supratentorial arteriovenous malformations(AVM's) between January 1989 and July 1994 were retrospectively reviewed. Preoperative embolization of these AVM's with N-butyl cyanoacrylate(NBCA) was performed in 23 patients, and in the other 43, the AVM's were removed without embolization. The mean follow-up period was 23.5 months. To evaluate the effects of preoperative embolization on the surgical management of AVM's, the two groups of patients were compared. In the group which underwent preoperative embolization, the mean diameter of the AVM's was larger(4.8cm vs 3.5cm, p=0.0024) and the mean Spetzler-Martin grade of the AVM's was higher(3.3 vs 2.4, p=0.0012) than in the nonembolized group. In the embolized group, operation time was a little longer, though this was not statistically significant, and the amount of transfusion required during surgery was greater with statistical significance(p=0.0067). Multivariate analysis, however, demonstrated that both these factors correlated only with lesion size(p=0.0038, p=0.0099) regardless of grade and embolization. A greater amount of transfusion was required because AVM's in the embolized group were larger. Feeder vessels and a nidus embolized with NBCA were so easily distinguished, compressed, and cut without bleeding that surgical resection was facilitated. Embolization caused one immediate hemorrhage and four neurological complications: permanent deficits in one and transient deficits in three. It was therefore concluded that preoperative embolization with NBCA made surgical resection of larger and higher grade AVM's as effective as surgical removal of those which were smaller and of lower grade, with no significant difference in operation time and surgical outcome; embolization appeared to have no effect on the amount of transfusion required, and was very safe.
Follow-Up Studies ; Hemorrhage ; Humans ; Intracranial Arteriovenous Malformations* ; Multivariate Analysis ; Retrospective Studies