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A Case of Parkinsonism Associated with Secondary Hydrocephalus following Aneurysmal Subarachnoid Hemorrhage.

Sook Young SIM ; Yong Sam SHIN ; Se Hyuk KIM ; Young Hwan AHN ; Soo Han YOON ; Ki Hong CHO ; Kyung Gi CHO

Korean Journal of Cerebrovascular Surgery.2003;5(1):63-66.

A case of parkinsonism caused by hydrocephalus after aneurysmal subarachnoid hemorrhage is reported. A 42-year-old man was admitted with typical symptoms of hydrocephalus, including deteriorated mental status, poor oral intake, gait disturbance and urinary incontinence. He had a past history of aneurysmal subarachnoid hemorrhage clipped one month before. Computed tomographic (CT) scan of the brain revealed dilatation of ventricles with periventricular low densities. He underwent a shunt operation and the symptoms of hydrocephalus were dramatically improved. However, new symptoms just like cogwheel rigidity, masked face, dysarthria and sialorrhea were developed. Levodopa was administrated and the patient showed marked improvement in above symptoms and discharged with independent daily activities. We report this rare clinical presentation and successful management with dopaminergic agent in parkinsonism induced by hydrocephalus after aneurysmal subarachnoid hemorrhage.
Adult ; Aneurysm* ; Brain ; Dilatation ; Dysarthria ; Gait ; Humans ; Hydrocephalus* ; Levodopa ; Masks ; Muscle Rigidity ; Parkinsonian Disorders* ; Sialorrhea ; Subarachnoid Hemorrhage* ; Urinary Incontinence ; Ventriculoperitoneal Shunt

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Hemodynamic Infarction Associated with Coil Embolization of Intracranial Aneurysm.

Sang Won HWANG ; Yoon HA ; Seung Hwan YOON ; Young Kook CHO ; Eun Young KIM ; Hyung Chun PARK ; Hyeon Seon PARK

Korean Journal of Cerebrovascular Surgery.2003;5(1):58-62.

We report a case of borderzone infarction which was developed after the coil embolization of unruptured internal carotid-posterior communicating artery aneurysm. Post-procedural angiography and brain computerized tomographic scan did not reveal any abnormality. However, brain magnetic resonance image (MRI) showed a wedge-shaped borderzone cerebral infarction between left middle cerebral artery and left anterior cerebral artery territory. It was suspected to be a manifestation of hypoperfusion in the internal carotid artery territory, caused by hemodynamic instability during the procedure. In order to prevent this unexpected serious complication, using the continuous hemodynamic monitoring during aneurysmal coil embolization, such as transcranial doppler ultrasonography, should be considered.
Aneurysm ; Angiography ; Anterior Cerebral Artery ; Arteries ; Brain ; Carotid Artery, Internal ; Cerebral Infarction ; Embolization, Therapeutic* ; Hemodynamics* ; Infarction* ; Intracranial Aneurysm* ; Middle Cerebral Artery ; Ultrasonography, Doppler, Transcranial

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Five Cases of Orbital Infarction Syndrome Caused by Compression of Surgical Scalp Flap.

Cheong Ho NOH ; Hyung Jin LEE ; Jin Seok YI ; Ji Ho YANG ; Il Woo LEE ; Dal Soo KIM ; Mun Chan KIM

Korean Journal of Cerebrovascular Surgery.2003;5(1):53-57.

Orbital infarction syndrome is a rare disorder resulting from ischemia of the intraocular and intraorbital structures due to hypoperfusion of the ophthalmic artery and its branches. The syndrome can occur with common carotid artery occlusion, orbital mucormycosis, giant cell arteritis and complications of surgery and manifests proptosis, ophthalmoplegia, and unilateral blindness. We recently experienced 5 cases of proptosis, ophthalmoplegia and unilateral blindness immediately after operation for 2 years. The cause of orbital infarction syndrome in these cases appeared to be the direct compression of orbit by the tightly retracted frontal scalp flap. We report and discuss possible mechanism with literature review.
Blindness ; Carotid Artery, Common ; Exophthalmos ; Giant Cell Arteritis ; Infarction* ; Ischemia ; Mucormycosis ; Ophthalmic Artery ; Ophthalmoplegia ; Orbit* ; Scalp*

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Enhanced Focus in Hypertensive Intracerebral Hematoma on CT Scan and Hematoma Enlargement.

Hong Jik DOH ; Man Bin YIM ; Il Man KIM ; Chang Young LEE ; Eun Ik SON ; Dong Won KIM

Korean Journal of Cerebrovascular Surgery.2003;5(1):48-52.

OBJECTIVE: Although most of hypertensive intracerebral hematoma (HICH) are static after ictus, a minority of them can enlarge in the acute phase after onset. This study performs to find the predicting factors and signs of hematoma enlargement in patients with HICH. METHODS: Among 140 cases of HICH treated during 1.5 years, the authors selected 107 cases who underwent contrast enhanced and nonenhanced initial CT scanning within 12 hours after symptom onset and a follow-up CT scan in order to investigate the enlargement of hematoma. Those cases were divided into two groups:hematoma enlargement (group I) and non-enlargement group (group II). The comparison of predicting factors (bleeding tendency, abnormal liver function and blood pressure) and signs (enhanced focus in hematoma on CT) of hematoma enlargement between group I and II was performed. RESULTS: There were 8 cases in group I and 99 cases in group II. The incidence of an enhanced focus in hematoma on CT scan was higher in group I than group II (87.5% vs. 9.1%, p<0.05). The systolic blood pressure (BP) at 6 hours after symptom onset and at the time of the first CT scan was higher in group I than group II (172.5 vs. 152.0 mm Hg, and 182.5 vs. 158.6 mm Hg, respectively, p<0.05). There was no difference in the incidence of bleeding tendency and abnormal liver function between group I and II. CONCLUSION: Contrast enhanced brain CT scan to detect the enhanced focus in the hematoma is one of useful methods to predict the early enlargement of hematoma in patients with HICH. The continuance of a high BP in spite of medication of antihypertensive drugs during the acute period after the onset of symptoms is another predictive sign of hematoma enlargement in patients with HICH.
Antihypertensive Agents ; Blood Pressure ; Brain ; Follow-Up Studies ; Hematoma* ; Hemorrhage ; Humans ; Incidence ; Liver ; Tomography, X-Ray Computed*

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Analysis of Mortality Cases of Transcranial Aneurysm Surgery.

Jae Sung AHN ; Soon Chan KWON ; Jae Myeong KIM ; Jung Hoon KIM ; Yang KWON ; Byung Duk KWUN ; Jung Kyo LEE

Korean Journal of Cerebrovascular Surgery.2003;5(1):43-47.

OBJECTIVES: The authors analyze the causes of mortality cases after transcranial aneurysm surgery for comparing the safety of the treating methods and for the improvement of treatment outcomes of transcranial surgery. METHODS: Patients recordings and radiological studies were retrospectively reviewed. Causes of postoperative mortality were divided into death related to vasospasm, procedure-related, medical complications and preoperative poor neurological conditions. RESULTS: Postoperative mortality cases were 61 (5.78%) of 1054 transcranial aneurysm surgery during a period of from Jul. 1996 to Nov. 2001. Delayed ischemia related to cerebral vasospasm was a leading cause of death following transcranial aneurysm surgery and accounts for 2% (n=21) of all transcranial surgery and 34.4% of all mortality cases. Procedure-related death were 1.23% (n=13) and were related to inadvertent major artery occlusion, vital perforator injury or intraoperative aneurysm rupture. Death related to medical complications (n=8, 0.75%) were mainly from pneumonia (n=6) in the old age (>65) patients. Patients of initial poor neurological grade (Hunt-Hess grade IV-V, n=19) were mainly from large intracranial hematoma (>30 cc) in temporal lobe or sylvian fissure or multiple aneurysmal bleeding before admission. CONCLUSION: The procedure-related mortality of the transcranial aneurysm surgery is about 1% in this large transcranial aneurysm surgery series and transcranial surgery can be a safe mean of treating intracranial aneurysms compared with other tratment modalities.
Aneurysm* ; Arteries ; Cause of Death ; Hematoma ; Hemorrhage ; Humans ; Intracranial Aneurysm ; Ischemia ; Mortality* ; Pneumonia ; Retrospective Studies ; Rupture ; Temporal Lobe ; Vasospasm, Intracranial

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Current State and Future in Interventional Treatment of Intracranial Aneurysm.

Dong Ik KIM

Korean Journal of Cerebrovascular Surgery.2003;5(1):41-42.

No abstract available.
Intracranial Aneurysm*

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Unruptured Aneurysms.

Byung Yon CHOI

Korean Journal of Cerebrovascular Surgery.2003;5(1):37-40.

No abstract available.
Aneurysm*

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Rebleeding after Subarachnoid Hemorrhage.

Hack Gun BAE ; Seok Mann YOON ; Il Gyu YUN ; Jae Jun SIM ; Jae Won DOH ; Kyeong Seok LEE

Korean Journal of Cerebrovascular Surgery.2003;5(1):31-36.

Based on the review of literatures, this article discussed the frequency and timing of rebleeding after initial subarachnoid hemorrhage (SAH), and the risk factors and preventive strategy for rebleeding. In view of the active policy of early aneurysm surgery, the peak interval for rebleeding was the first 24 hours after the aneurysmal SAH. Patients with poor grades, ventricular drainage, angiography within 6 hours post-SAH, time interval between the last attack and admission, and reduced platelet function were proposed as a risk factor of rebleeding. Rebleeding from giant aneurysms occurred at a rate comparable to that associated with smaller aneurysm. The efficacy of short-term antifibrinolytic drugs was expected to minimize ultraearly rebleeding. When ventriculostomy is necessary, intracranial pressure should be maintained between 15 and 25 mmHg to minimize transmural pressure gradients. Securing ruptured aneurysm on an emergency basis remained open to debate.
Aneurysm ; Aneurysm, Ruptured ; Angiography ; Blood Platelets ; Drainage ; Emergencies ; Humans ; Intracranial Pressure ; Risk Factors ; Subarachnoid Hemorrhage* ; Ventriculostomy

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Pathophysiology of Aneurysmal Subarachnoid Hemorrhage.

Jae Hoon SUNG ; Sang Won LEE

Korean Journal of Cerebrovascular Surgery.2003;5(1):17-30.

The effects of an intracranial aneurysm and subarachnoid hemorrhage (SAH) are devastating. Therefore thorough consideration for pathophysiology of SAH is fundamental step of vascular neurosurgeon. The cigarette smoking and hypertension are well-known risk factors of its growing and rupture. Medial defect and disruption of internal elastic lamina are prerequisite of initial budging of aneurysm formation. Many laboratory and simulatory experiments confirmed these pathologic and hemodynamic causes of aneurysm evolution. Some hydrodynamic studies contributed to understanding of commonly encountered various characteristics of aneurysm. After ictal bleeding, suddenly increased intracranial pressure elicit marked decrease of cerebral blood flow (CBF) and cerebral metabolic rate of oxygen (CMRO2) and these events decide on the grade of neurologic state. In case of SAH of young age, in is beneficial to rule out familial type. In this modern genetic engineering age, the significance of molecular and genetic approach of aneurysm is gathering strength.
Aneurysm* ; Genetic Engineering ; Hemodynamics ; Hemorrhage ; Hydrodynamics ; Hypertension ; Intracranial Aneurysm ; Intracranial Pressure ; Oxygen ; Risk Factors ; Rupture ; Smoking ; Subarachnoid Hemorrhage*

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Molecular Genetics of Cerebral Aneurysm.

Jung Yong AHN ; Jin Kyeoung KIM

Korean Journal of Cerebrovascular Surgery.2003;5(1):12-16.

Subarachnoid hemorrhage(SAH) secondary to ruptured cerebral aneurysm is a complex trait, with both genetic and environmental risk factors playing an important part. The 30-day mortality rate of patients with SAH is 40% to 44%, with survivors suffering from major disability. Despite the high incidence and catastrophic consequences of a ruptured cerebral aneurysm and the fact that there is considerable evidence that predisposition to cerebral aneurysm has a strong genetic component, very little is understood with regard to the pathology and pathogenesis of this disease. Recent advances in molecular genetics provide evidence that genetic variants of different candidate genes are associated with the occurrence of cerebral aneurysm. This article reviews the evidence supporting a genetic predisposition to SAH from cerebral aneurysm, the conditions commonly associated with cerebral aneurysm, and the search for genetic risk factors.
Genetic Predisposition to Disease ; Humans ; Incidence ; Intracranial Aneurysm* ; Molecular Biology* ; Mortality ; Pathology ; Risk Factors ; Survivors

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