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CT Evalution and Clinical Course in Cerebral Contusion.

In Chang LEE ; Young Suk KIM ; Soon Kwan CHOI ; Bark Jang BYUN ; In Soo LEE

Journal of Korean Neurosurgical Society.1985;14(4):721-728.

This study includes 398 cases of cerebral contusion among 1137 cases of craniocerebral injury diagnosed by neurological finding and CT brain scan, who were admitted from January 1983 to June 1985 in our neurological department. 68 cases showed abnormalities on CT scanning, among these 48 cases were heterogenous hyperdensity with surrounding irregular marginated hypodensity, 26 cases midline shift, 13 cases local increased density, 9 cases recurrence of new lesion. The authors studied comparison and correlation of clinical course and CT finding of cerebral contusion.
Brain ; Contusions* ; Craniocerebral Trauma ; Recurrence ; Tomography, X-Ray Computed

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Dorsal Root Entry Zone Lesion for Intractable Pain.

Young Sup PARK ; Cheul JI ; Myung Soo AHN ; Chang Pak CHOI ; Jin Un SUNG

Journal of Korean Neurosurgical Society.1985;14(4):717-720.

Intractable pain was controlled in 5 cases using dorsal root entry zone lesions. All patients had failed to conservative therapy. Dorsal root entry zone lesions were made to include the involved dermatomes added one half of the dermatomes above and below the painful areas. Four patient noticed good pain relief with follow up period ranging from 6 to 24 months. Patient whose lesions were performed using a CO2 laser mas suffered no complicated deficit. Dorsal root entry zone lesions appeared to be a satisfactory treatment for intractable pain in patients, who have failed to respond to more conservative mode of therapy.
Evoked Potentials ; Follow-Up Studies ; Humans ; Lasers, Gas ; Pain, Intractable* ; Spinal Nerve Roots*

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Management of Cervical Ossification of the Posterior Longitudinal Ligament.

Yong Gou PARK ; Young Soo KIM

Journal of Korean Neurosurgical Society.1985;14(4):705-716.

The authors treatment 35 patients with ossification of the posterior longitudinal ligament(OPLL). Sixteen of these patients had surgery during the past 3 years between 1983 and 1985. In this paper wer present a radiological and clinical analysis of these cases with a literature review. We also discuss a clinical system of grading, different types of radiological patterns, the indications of surgical treatment and the choice of operative methods. 1) The ages of the patients ranged from 31 to 79 with a mean of 55.4 years. 57.1% of the patients were in the sixth decade. The male to female ration was 28:7. 2) The cases were graded on the bases of symptoms. Grade I, no symptoms or mild neck pain, 1 case(2.9%) ; Grade II only radiculopathy, 14 cases(40.0%) ; Grade III, mild myelopathy but able to walk, 11 cases(31.4%) ; Grade IV, severe myelopathy and unable to walk alone, 7 cases(20.0%) ; Grade V, complete paralysis of one or more extremities, 2 cases(5.7%). 3) Lateral tomogram and CT scan were most useful for assesment of OPLL. 4) The pattern of OPLL was divided into a continuous type(25.7%), a multiple segmented type(31.4%), a single segmented type(20.0%), and a mixed type(22.9%). 5) In cases of a clinical grading of more than III, surgery must be considered In grade II, surgery is indicative if conservative management failed to improve the clinical symptoms. 6) Extensive total laminectomies and foraminotomies were found to be advisable in cases of OPLL involving more than two vertebrae. 7) The modified Smith-Robinson approach showed the best surgical results in cases of single segmented OPLL.
Equidae ; Extremities ; Female ; Foraminotomy ; Humans ; Laminectomy ; Longitudinal Ligaments* ; Male ; Neck Pain ; Paralysis ; Radiculopathy ; Spinal Cord Diseases ; Spine ; Spondylosis ; Tomography, X-Ray Computed

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Treatment of Pontine Hemorrhage.

Yong Pyo HAN ; Bum Soo YOON ; Soon Kee HONG ; Chul HU ; Byuong Woo LEE ; Jae Hoon CHANG ; Hoon Joo KIM

Journal of Korean Neurosurgical Society.1985;14(4):695-704.

Most of untreated pontine hematoma are known to be fatal. Even though the patient may survive, the sequelae of pontine hematoma is serious. Fourteen cases of pontine hematoma who were treated either surgically or conservatively were analysed. Among nine cases treated surgically, three showed good recovery, three died postoperatively, and moderate to severe disability remained in three cases. On the other hand, conservative treatment resulted in one good recovery, one moderate disability, and four deaths. We hope to emphasize the efficacy of surgical treatment on pontine hematoma.
Hand ; Hematoma ; Hemorrhage* ; Hope ; Humans

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Classification of Spontaneous Thalamic Hemorrhagy for Management and Prediction of Prognosis.

Chun Kun PARK ; Tae Hoon JO ; Moon Shan KIM ; Jae Soo LEE ; Min Woo BAIK ; Dal Soo KIM ; Young Soo HA ; Joon Ki KANG ; Jin Un SONG

Journal of Korean Neurosurgical Society.1985;14(4):685-694.

65 patients with spontaneous thalamic hemorrhage(TH) diagnosed by CT scan were treated in Catholic Medical Center. Of total 340 patients with spontaneous intracerebral hemorrhage from 1980 to 1983, TH occured in 19.1%. In order to analyse prognosis and guideline of management we classified TH into 4 types with the topographic involvement of thalamus : Type I-the anteromedial TH in 3 cases(4.8%) showed no specific correlation between symptoms and site of hematoma. The prognosis was good with medical treatment alone. Type II-the posterolateral TH in 23 cases(35.2%), mainly spreaded into the internal capsule and the midbrain. Aphasia was one of the main clinical features and the prognosis was worse with both conservative and surgical treatment than those of type I and III. Type III-the dorsal TH in 26 cases(40%), often extended to the lateral ventricle and were localizing in the thalamic area. Emotional change was more occasionally indicated. Type IV-the massive TH in 13 cases(20%), was extensively involved in the thalamus and spreaded to all direction. Symptoms and signs were various and surgery was not indicated because the prognosis was poor. Aphasia was noted in the left TH, but right-hemisphere cortical dysfunction were found mainly in the right TH. The prognoses of the patients with aphaia and/or right hemisphere cortical dysfunction were poorer than those of the patients without. We consider that the patients in type II or III with aphasia and/or right-hemisphere cortical dysfunction should be managed with EVD or stereotaxic urokinase therapy for better neurological outcome.
Aphasia ; Cerebral Hemorrhage ; Classification* ; Hematoma ; Humans ; Internal Capsule ; Lateral Ventricles ; Mesencephalon ; Prognosis* ; Thalamus ; Tomography, X-Ray Computed ; Urokinase-Type Plasminogen Activator

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Delayed CT Guided Stereotaxic Evacuation of Hypertensive Intracerebral Hematoma.

Sang Sup CHUNG ; Hyong Chun PARK ; Yong Wan KIM ; Yong Gu PARK ; Sang Kun PARK ; Kyu Chang LEE

Journal of Korean Neurosurgical Society.1985;14(4):679-684.

The authors analyzed 11 patients of hypertensive intracerebral hematoma who had undergone the delayed CT guided stereotaxic evacuation. this delayed stereotaxic evacuation seemed to be highly effective in improving the motor weakness rather than mental state. Such effect was appeared immediately after the procedures in most of the patients, even in very small amount of hematoma. In addition, we could shorten the total hospital periods. The most effective time of this delayed stereotaxic evacuation was seemed to be in around 2 weeks after the hemorrhage.
Hematoma* ; Hemorrhage ; Humans ; Hypertension

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Treatment of Hypertensive Intracerebral Hematoma.

Soon Ki HONG ; Yong Pyo HAN ; Chul HU ; Byung Woo LEE ; Bum Soo YOON ; Hun Joo KIM

Journal of Korean Neurosurgical Society.1985;14(4):671-678.

212 cases of hypertensive intracerebral hematoma were treated and followed for more than 3 months. The outcome was analysed in point of comparison between conservative treatment and operative treatment. The precipitating factors on prognosis depend on size and site of hematoma, level of mental deterioration, and blood pressure on admisson. Operative treatment showed better outcome than conservative treatment in cases of severly mentally deteriorated patients, large hematoma, and pontine hematoma.
Blood Pressure ; Hematoma* ; Humans ; Precipitating Factors ; Prognosis

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Evaluation of Subarachnoid Hemorrhage due to Aneurysmal Rupture and Cerebral Vasospasm by CT.

Shin Ha LEE ; Kwan Hee PARK ; Jin Sub CHOI ; Woo Young PARK ; Dong Hee KIM ; Dae Jo KIM

Journal of Korean Neurosurgical Society.1985;14(4):655-664.

Cerebral vasospasm is one of the most serious complication after subarachnoid hemorrhage due to aneurysmal rupture. To date, the treatment of vasospasm remains unsatisfactory in a large numbers of cases in spite of recent therapeutic advances. Prompt diagnosis of this complication, before the establishment of lasting ischemic damage, should obviously improve the results of treatment. The possibility of predicting which patients will develop vasospasm, constitutes a further advance in the management of this complication. In this study, the value of the computed tomographic scan for the prediction of vasospasm was investigated in a consecutive series of 67 patients submitted to computed tomography within 7 days of the most recent subarachnoid hemorrhage.
Aneurysm* ; Diagnosis ; Humans ; Rupture* ; Subarachnoid Hemorrhage* ; Vasospasm, Intracranial*

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Significance of Cranial Computed Tomography in Aneurysmal Subarachnoid Hemorrhage.

Jae Yeon KIM ; Man Bin YIM ; Jung Kyo LEE ; In Hong KIM

Journal of Korean Neurosurgical Society.1985;14(4):637-646.

The authors analysed 74 cases of ruptured aneurysms confirmed by CT, angiography and surgery during the period from September 1982 to August 1984 at Keimyung University Dongsan Hospital for the study of the relationship between the amount of subarachnoid hemorrhage(SAH) detected by CT and the preoperative clinical grade (Hunt & Hess), the later development of cerebral vasospasm, ischemic neurologic deficit(IND) and the postoperative prognosis. We also attempted to investigate the relationship between the low density in the hypothalamus and/or midbrain on CT and the preoperative clinical grade and the angiographic vasospasm. There was no definite difference in age and sex distribution according to the severity of SAH on CT except in predominantly female cases of severe SAH(CT grade III). 75% of the cases with the absence of SAH(CT grade I) were preoperatively clinical grade I or II. However, 76% of the severe SAH cases(CT grade III) showed preopertively clinical grade III, IV or V. In case with no angiographic vasospasm(Ag0), 70% were shown to be clinical grade I or II. But in cases of severe vasospasm seen by angiography(Ag3), 80% were clinical grade III or IV. 17% of the cases that showed an absence of angiographic vasospasm(Ar0) showed a low density in the hypothalamus and/or midbrain on CT as did 48% of the cases with mild angiographic vasospasm(Ag1), 75% with moderate angiographic vasospasm(Ag2) and 100% of the cases with severe angiographic vasospasm(Ag3). It was noticed on the CT in cases of clinical grade I and II, there was a 14% and 24% low density in the hypothalamus and/or midbrain respectively. But in the cases of clinical grade III and IV, it was noticed that there was a 65% and 100% low density in hypothalamus and/or midbrain respectively. Ischemic neurological deficit(IND) developed in 9% of the cases having an absence of SAH(CT grade I) on CT and in 48% of the cases of severe SAH(CT grade III) on CT during the care if the patients. 100% of the cases showed good postoperative results in patients who had an absence of or thin SAH(CT grade I or II) on CT and only 50% of the cases who had severe SAH(CT grade III) obtained good postoperative results. The authors found a correlation between the amount of SAH and the preoperative clinical grade, the development of angiographic cerebral vasospasm, IND and the postoperative prognosis. The low density in the hypothalamus and/or midbrain on CT also has a relationship with the preoperative clinical grade and the development of angiographic vasospsm. We suggest that the severity of SAH on CT and the low density in the hypothalamus and/or midbrain may be of great value in the prediction of cerebral vasospasm and treatment of aneurysmal patients.
Aneurysm* ; Aneurysm, Ruptured ; Angiography ; Female ; Humans ; Hypothalamus ; Intracranial Aneurysm ; Mesencephalon ; Prognosis ; Sex Distribution ; Subarachnoid Hemorrhage* ; Vasospasm, Intracranial

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Clinical Analysis of Aneurysmal Subarachnoid Hemorrhage.

Hyoung Chun PARK ; Kyu Chang LEE ; Kyu Sung LEE ; Jung Ho SUH ; Dong Ik KIM ; Sang Sup CHUNG ; Sang Kun PARK ; Jung Un CHOI ; Young Soo KIM

Journal of Korean Neurosurgical Society.1985;14(4):617-626.

The authors analyzed 377 consecutive cases of aneurysmal subarachnoid hemorrhage admitted to the Department of Neurosurgery at Yonsei University Hospital from 1980 through 1984. The results of analysis were summarized as follows. 1) Mean age of the patients was 48.8 years. Aneurysmal SAH occured more frequently in female(201) than male(176). 2) Incidence of clinical vasospasm was 33.2%(125/377) and of rebleeding was 11.7%(44/377). 3) Surgery was done for 191 patients which accounts for 50.7% of all patients. Functional recovery was noted in 179 of these 191 surgically treated patients(93.7%). Operative mortality was 3.7%. 4) Conservative treatment was done for remaining 186 patients. Among them, 124 patients died or disabled : 40 from initial insult, 59 from vasospasm, 25 from rebleeding. Aneurysm could not be found on angiography in 19 cases. Remaining 43 patients refused surgery. Despite of dramatic improvement of surgical treatment for ruptured intracranial aneurysms, overall mortality and morbidity for ruptured cerebral aneurysm still remain unchanged over the past two decades. As shown in this study, most of the management mortality and morbidity came from the patients who didn't or couldn't receive surgical treatment. The authors suggest several directions to improve overall management outcome in all aneurysmal patients.
Aneurysm* ; Angiography ; Humans ; Incidence ; Intracranial Aneurysm ; Mortality ; Neurosurgery ; Subarachnoid Hemorrhage*

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