The authors presented an unusual case of an occipital artery aneurysm which developed spontaneously. The patient was a 41-year-old woman who suffered from the sudden onset of right hemiparesis and slurred speech. Computerized tomography scans of the brain demonstrated an intracerebral hemorrhage in the left parietal lobe. The carotid angiography revealed an incidental saccular aneurysm in the left occipital artery. The aneurysm was not treated because the patient's relatives refused operation and there were no subjective complaints by the patient. Certain particularities of this lesion are discussed in the context of the literature.
Adult ; Aneurysm* ; Angiography ; Arteries* ; Brain ; Cerebral Hemorrhage ; Female ; Humans ; Paresis ; Parietal Lobe

Anatomical information of the circle of Willis is important in evaluating the various cerebrovascular diseases and surgical procedures. In this study, we present the anatomical structures of the circle of Willis in 54 Korean adults. The authors observed the morphological characteristics of the vasculature, the incidence of deficiency or incompleteness in the circle and clinical considerations. Measurements of the outer diameter and the length of each arterial segments were performed. Number and the origin of perforators from individual arteries were also oserved. Results of this study were as followings. Normal circles of Willis was oserved in 35 cases(64.81%) and abnormal circles in 19 cases(35.9%). 2) Incidental detection of aneurysms occurred in 5 cases(9.26%). 3) Frequency of anomalies were most commonly observed in the anterior communicating arteries(N=16, 20.37%). 4) A string-like artery was most frequently observed in te post-erior communicating artery(N=11, 20.37%). 5) Anomalous origin of the P1 segment of the posterior cerebral artery was observed, fetal type was in 12 cases(22.2%) and transitional typ was in 3 cases(5.55%) respectively. 6) The longest artery was the A1 segmnt of the anterior cerebral artery;the second, posterior communicating artery;the third, P1 segment of the posterior cerebral artery;and the shortest, anterior communicating artery. 7) The outer diameters of the basilar artery and internal carotid artery were almost, equal, A1 segment was half of ICA, AcoA was two thirds of A1 segment, PcoA was half of P1 segment and P1 segment was two thirds of the basilar artery. There were difference the anterior and posterior portion of the circle Willis. In the anterior communicating arteries, duplicated structure were frequently found. And also, inequality in the outer diameter of both A1 segmnts was observed. String-like arteries were often revealed in the posterior communicating arteries. Anomalous origin of P1 segments that may be persistant embryonic derivatives were frequently demonstrated in posterior cerebral arteries.
Adult* ; Aneurysm ; Arteries ; Basilar Artery ; Carotid Artery, Internal ; Circle of Willis* ; Humans ; Incidence ; Posterior Cerebral Artery ; Socioeconomic Factors

The authors present a case of Fahr's disease which is characterized by idiopathic symmetrical calcifications in the basal ganglia and the dentate nuclei. Computerized tomographic scans of the brain demonstrated bilateral calcified lesions recognized in the region of the dentate nuclei of both cerebellar hemispheres and the basal ganglia. A review of the literature on several cases of intracranial ferrocalcinosis is presented.
Basal Ganglia ; Brain

Chordomas are uncommon tumors arising from the embryonic remnants of the fetal notochord. The spheno-occipital region accounts for 36 percent of chordomas. The authors are presenting four cases of intracranial chordomas with clinical manifestation was analyzed. All patients were men and their mean age was 37 years old. The presenting complaints were diplopia in 2 patients and decreased visual acuity in the order two. Radiologic studies demonstrated extensive bony destruction of the skull base and soft mass with punctate calcification in all 4 cases. Treatment consisted of subtotal removal of tumor and subsequent radiotherapy. Histopathologically, three of the four patients had typical chordomas and the remaining case was confirmed as chondroid chordoma. The three typical chordomas recurred after initial treatment. 2 of these three were reoperated but died in the 10 months and 33 months, respectively after initial diagnosis. The patient with chondroid chordoma remained well for 46 months after initial treatment without significant neurological deficits. In conclusion, therapeutic outcome of intracranial chordomas are grim because of their aggressive that, frequent recurrence and inability to remove tumors completely. With the exception, chondroid chordoma had good prognosis and long term survival.
Adult ; Chordoma ; Diagnosis ; Diplopia ; Humans ; Male ; Notochord ; Prognosis ; Radiotherapy ; Recurrence ; Skull Base ; Visual Acuity

Functional myelography, applying spinal movements(flexion-extension) in myelography, has been frequently used for accurate diagnosis of posture-related disorders such as herniated lumbar disc or spinal stenosis. Measurements were performed on functional myelographic findings of 62 patients, and in 24 cases surgically verified herniated lumber discs were present. The object of this study was to analyze changes in position and shape of the dural sac in spinal movements and confirm the clinical importance of functional myelography. The present study demonstrated that: 1) The anterior border of the dural sac was straight with flexion, but indented at the level of intervertebral space and this indentation was less prominent at L5-S1. 2) With extension, posterior indentation of the dural sac was more prominent at the level of the intervertebral space than the body, the A-P diameter of the dural sac was narrowed at all levels of the intervertebral spaces except L5-S1, and the dural sac moved anteriorly at the level of L5-S1 and all spinal bodies. 3) In surgically verified disc patients, anterior indentation of the dural sac was persistent in both flexion and extension views, and was more exaggerated with extension, but less prominent at L5-S1. In patient at L5-S1, anterior movement of the anterior dural border at the level of surgery was much decreased.
Diagnosis ; Humans ; Myelography* ; Spinal Stenosis

Two cases of intracerebral and brain stem hemorrhage occurring after evacuation of chronic subdural hematoma and subdural hygroma are reported. A patient who had undergone craniotomy with closed drainage for subdural hygroma had intracerbral and fatal brain stem hemorrhage in the immediate postoperative period. Despite rapid and intensive treatment, he died. The other patient had intracerebral hematoma following drainage of chronic subdural hematoma and left with severe disability. Possible pathogenic mechanisms leading to development of the postoperative intraparenchymal hemorrhage are suggested. Sudden increase in cerebral blood flow combined with defective autoregulation seemed the most likely pathogenic mechanism to be responsible for the postoperative hemorrhage. If close neurosurgical observation of patients and clinical awareness for the intraparenchymal hemorrhage after evacuation of chronic extracerebral fluid collections given, this devastating complication may be avoided.
Brain Stem* ; Brain* ; Cerebral Hemorrhage ; Craniotomy ; Drainage ; Hematoma ; Hematoma, Subdural, Chronic* ; Hemorrhage* ; Homeostasis ; Humans ; Lymphangioma, Cystic* ; Postoperative Hemorrhage ; Postoperative Period ; Subdural Effusion

With regard to the outcome of intensive neonatal care, one of the most important concerns in neonatology is the mortality rate of very low birth weight infants (VLBWI; birth weight < 1,500 g) and extremely low birth weight infants (ELBWI; birth weight < 1,000 g). The present study was conducted to analyze and compare the mortality of VLBWI and ELBWI and neonatal care among Korean, Japanese, and American newborns. In Korea, the survival rates of VLBWI have increased significantly; they were 31.8% in the early 1960s, 65.8% in the early 1990s, 77.5% in 2002, 84.7% in 2007, and 85.7% in 2009. The survival rates of ELBWI have also increased; they were 8.2% in the early 1960s, 37.4% in the early 1990s, 56.1% in 2002, 67.7% in 2007, and 71.8% in 2009. The survival rates of VLBWI and ELBWI have significantly improved over the past 50 yr in Korea. However, the Korean survival rates of VLBWI and ELBWI are still lower than for similar groups in Japan and the USA. To achieve better outcomes that reach the level of these countries, the organization of perinatal care centers, nationwide neonatal perinatal research networks, and regionalization are needed in Korea.
Female ; Humans ; Infant Mortality/*trends ; Infant, Newborn ; *Infant, Very Low Birth Weight ; Japan/epidemiology ; Perinatal Care/trends ; Pregnancy ; Republic of Korea/epidemiology ; Survival Rate ; United States/epidemiology

No abstract available.

PURPOSE: To determine the relative accuracy of barium enema findings of Hirschsprung's disease (HD) and to calculate a level of probability for three signs combined. MATERIAL AND METHODS: Barium enema findings in 45 patients who had undergone rectal biopsy to prove or exclude the diagnosis of HD were retrospectively analyzed by evaluating the presence of a transition zone, irregular contractions and delayed evacuation of barium. Seventeen were neonates (group 1) and the other 28 were infants and children (group 2). The sensitivity, specificity, and positive and negative predictive values of the findings were compared. RESULTS: In visualization of a transition zone, sensitivity, specificity and positive predictive value were 76.5%, 72.7% and 89.7%, respectively. Sensitivity for irregular contractions and delayed evacuation of barium was 76.5% and 91.7%, respectively, whereas for specificity, the corresponding values were 63.6% and 40%. Sensitivities for radiologic signs were higher in group 1 than in group 2, but, the specificities were lower. If two or three findings were positive, the level of probability was 85 - 100%. If two findings were negative, however, the corresponding value was 30%. CONCLUSION: We conclude that the most reliable HD finding is the presence of a transition zone. Irregular contractions and the delayed evacuation of barium are not specific. Two or three positive findings may suggest a higher probability of HD than any single positive finding alone.
Barium* ; Biopsy ; Child ; Diagnosis* ; Enema* ; Hirschsprung Disease* ; Humans ; Infant ; Infant, Newborn ; Retrospective Studies ; Sensitivity and Specificity

Iron deficiency is the most common cause of anemia worldwide. The goal of therapy for iron deficiency anemia (IDA) is to supply sufficient iron to repair the hemoglobin deficit and replenish storage iron, combined with correction of underlying conditions. The majority of patients with IDA respond well to oral or parenteral iron replacement therapy if appropriately prescribed, but some rare cases of IDA refractory to both oral and parenteral iron replacement therapy due to in-born error of iron metabolism have been reported previously. We report here a mysterious case of IDA refractory to both oral and parenteral iron therapy and even to red cell transfusions. A 21-year-old male patient was admitted to our hospital due to general weakness and dizziness. His hemogram, iron profiles and bone marrow study showed the findings compatible with IDA. We could not find any conditions that cause acute or chronic blood loss, or any evidence of in-born error of iron metabolism. In spite of adequate iron relplacement therapy via both oral and parenteral routes, and even with red cell transfusions, his hemogram and iron profiles were not improved.
Anemia ; Anemia, Iron-Deficiency* ; Bone Marrow ; Dizziness ; Humans ; Iron* ; Male ; Metabolism ; Young Adult