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Rapid Growing Eosinophilic Granuloma in Skull after Minor Trauma.

Korean Journal of Neurotrauma.2015;11(1):22-25. doi:10.13004/kjnt.2015.11.1.22

The authors present a case of rapidly progressing eosinophilic granuloma (EG) of the skull without hemorrhage after minor trauma. A 6-year-old boy presented with a soft mass on the midline of his forehead. He had a surgery for EG 19 months ago. One month earlier, computed tomography (CT) and bone scans were performed to evaluate the possible recurrence of EG, and there was no evidence of recurrence in CT. However, a slightly increased uptake in the bone scan was noted on the midline of the forehead. A rapid growing mass developed in a new spot after a minor trauma 7 days before the patient arrived at the clinic. His physical examination was unremarkable, except for a non-tender, soft, and immobile mass. A plain skull X-ray and CT showed a lytic bony defect on the midline of the frontal bone. Magnetic resonance imaging showed a 1.4 cm sized enhancing mass. Surgical resection and cranioplasty were done. The role of trauma in the development of EG is unclear. However, our case suggests that minor trauma is an aggravating factor for EG formation. Careful observation with regular follow-up is necessary in patients with EG after minor trauma.
Child ; Craniocerebral Trauma ; Eosinophilic Granuloma* ; Forehead ; Frontal Bone ; Hemorrhage ; Humans ; Magnetic Resonance Imaging ; Male ; Physical Examination ; Recurrence ; Skull*

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Pyogenic Intradural Abscess of Lumbar Spine: A Case Report.

Jeong Eun CHEON ; Hee Jin YANG ; You Nam CHUNG ; Sung Bae PARK

Korean Journal of Neurotrauma.2015;11(1):18-21. doi:10.13004/kjnt.2015.11.1.18

We report a case of spinal intradural abscess which shows serial changes on magnetic resonance imaging (MRI). Well-encapsulated, rim-enhancing lesion with mass effect was visualized at ventral side of lumbar spinal canal on 17 days after initial negative MRI, which was thought to be epidural abscess. It was revealed to be intradural in location on operation and successfully treated by drainage and antibiotics. Follow-up MRI showed resolution of abscess. Clinical significance and pathogenesis of this case was briefly discussed.
Abscess* ; Anti-Bacterial Agents ; Drainage ; Epidural Abscess ; Follow-Up Studies ; Magnetic Resonance Imaging ; Spinal Canal ; Spine*

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Results of Isotope Cisternography in 175 Patients with a Suspected Hydrocephalus.

Kyeong Seok LEE ; Sang Mi LEE ; Jae Joon SHIM ; Seok Mann YOON ; Hack Gun BAE ; Jae Won DOH

Korean Journal of Neurotrauma.2015;11(1):11-17. doi:10.13004/kjnt.2015.11.1.11

OBJECTIVE: Normal pressure hydrocephalus (NPH) is a syndrome characterized by gait disturbance, memory impairment and urinary incontinence. The isotope cisternography (ICG) became less useful because of low accuracy and complications. We tried to evaluate the safety and value of the ICG. METHODS: We retrospectively collected data on ICG of 175 consecutive patients with a suspected hydrocephalus. We classified the ICG into four types by the ventricular reflux and circulation time. The ventricular size was measured by Evans index and the width of the third ventricle. RESULTS: There were three complications including one case of paraplegia. Type 4 was the most common type, observed in 53%. Type 3 (33%), type 2 (7%), and type 1 (7%) were observed less often. Type 4 was more common in patients with large ventricles. Types of the ICG were not related to the causes of hydrocephalus, gender, or age of the patients. Shunting was more frequently performed in type 4 (71%), compared to type 1 (17%), type 2 (33%), and type 3 (46%). Surgery was more common when the cause was vascular. After the shunt surgery, 33.0% were graded as the improved. Although there were some improvements even in the not-improved patients, they still needed many helps. The improvement was related to the preoperative state. CONCLUSION: ICG may bring a serious complication, however the incidence is very low. Although the predictability of response rate on the shunting is doubtful, ICG is a cheap and useful tool to select surgical candidates in NPH.
Diagnosis ; Gait ; Humans ; Hydrocephalus* ; Hydrocephalus, Normal Pressure ; Incidence ; Malpractice ; Memory ; Meningitis, Aseptic ; Paraplegia ; Radionuclide Imaging ; Retrospective Studies ; Third Ventricle ; Urinary Incontinence

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Serial Mini-Mental Status Examination to Evaluate Cognitive Outcome in Patients with Traumatic Brain Injury.

Chung Nam LEE ; Young Cho KOH ; Chang Taek MOON ; Dong Sun PARK ; Sang Woo SONG

Korean Journal of Neurotrauma.2015;11(1):6-10. doi:10.13004/kjnt.2015.11.1.6

OBJECTIVE: This study was aimed at finding out the changes in cognitive dysfunction in patients with traumatic brain injury (TBI) and investigating the factors limiting their cognitive improvement. METHODS: Between January 2010 and March 2014, 33 patients with TBI participated in serial mini-mental status examination (MMSE). Their cognitive functions were statistically analyzed to clarify their relationship with different TBI status. Patients who developed hydrocephalus were separately analyzed in regards to their cognitive function depending on the placement of ventriculoperitoneal shunt (VPS). RESULTS: Bi-frontal lobe injury (beta=-10.441, p<0.001), contre-coup injury (beta=-6.592, p=0.007), severe parenchymal injury (beta=-7.210, p=0.012), temporal lobe injury (beta=-5.524, p=0.027), and dominant hemisphere injury (beta=-5.388, p=0.037) significantly lowered the final MMSE scores. The risk of down-grade in the prognosis was higher in severe parenchymal injury [odds ratio (OR)=13.41, 95% confidence interval (CI)=1.31-136.78], temporal lobe injury (OR=12.3, 95% CI=2.07-73.08), dominant hemisphere injury (OR=8.19, 95% CI=1.43-46.78), and bi-frontal lobe injury (OR=7.52, 95% CI=1.31-43.11). In the 11 post-traumatic hydrocephalus patients who underwent VPS, the final MMSE scores (17.7+/-6.8) substantially increased from the initial MMSE scores (11.2+/-8.6). CONCLUSION: Presence of bi-frontal lobe injury, temporal lobe injury, dominant hemisphere injury, and contre-coup injury and severe parenchymal injury adversely influenced the final MMSE scores. They can be concluded to be poor prognostic factors in terms of cognitive function in TBI patients. Development of hydrocephalus aggravates cognitive impairment with unpredictable time of onset. Thus, close observation and routine image follow-up are mandatory for early detection and surgical intervention for hydrocephalus.
Brain Injuries* ; Cognition Disorders ; Contrecoup Injury ; Humans ; Hydrocephalus ; Neuropsychological Tests ; Prognosis ; Temporal Lobe ; Ventriculoperitoneal Shunt

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Bone Flap Resorption Following Cranioplasty after Decompressive Craniectomy: Preliminary Report.

Ji Sang KIM ; Jin Hwan CHEONG ; Je Il RYU ; Jae Min KIM ; Choong Hyun KIM

Korean Journal of Neurotrauma.2015;11(1):1-5. doi:10.13004/kjnt.2015.11.1.1

OBJECTIVE: Resorption of autologous bone flap grafts is a known long-term complication of cranioplasty following decompressive craniectomy (DC). We analyzed our data to identify risk factors for bone flap resorption (BFR) following cranioplasty. METHODS: A total of 162 patients who underwent cranioplasty following DC due to life-threatening elevated intracranial pressure between October 2003 and December 2012, were included in our investigation. Follow-up exceeded one year. RESULTS: BFR occurred as a long-term complication in 9 of the 162 patients (5.6%). The affected patients consisted of individuals who had undergone DC for traumatic brain injury (TBI; n=4), for subarachnoid hemorrhage (SAH; n=3), for cerebral infarction (n=1), and intracerebral hemorrhage (n=1). Logistic regression analysis identified no significant risk factors for BFR. CONCLUSION: TBI and SAH as initial diagnoses are more often associated with BFR than other diagnoses. This finding may influence future surgical decision making, especially in patients with possible risk factors for BFR. A prospective study with a large number of patients is needed to identify potential predictors of BFR such as bone flap sterilization and preservation.
Bone Resorption ; Brain Injuries ; Cerebral Hemorrhage ; Cerebral Infarction ; Decision Making ; Decompressive Craniectomy* ; Diagnosis ; Follow-Up Studies ; Humans ; Intracranial Hypertension ; Logistic Models ; Risk Factors ; Sterilization ; Subarachnoid Hemorrhage ; Transplants

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Risk Factors of New Adjacent Compression Fracture after Percutaneous Vertebroplasty: Effectiveness of Bisphosphonate in Osteoporotic or Osteopenic Elderly Patients.

Dae Hyun SEO ; Si Hyuck OH ; Kyeong Wook YOON ; Jung Ho KO ; Young Jin KIM ; Jee Young LEE

Korean Journal of Neurotrauma.2014;10(2):86-91. doi:10.13004/kjnt.2014.10.2.86

OBJECTIVE: The purpose of this study is to investigate the incidence of new compression and to analyze factors that influence the fractures in adjacent levels after percutaneous vertebroplasty (PVP). METHODS: This retrospective study examined 206 patients who had undergone PVP for single level osteoporotic or osteopenic compression fractures during the last seven years in our department. After PVP, the patients were observed for at least over one year, and 29 patients showed new additional compression fractures in adjacent levels. One hundred seventy seven patients who did not show additional compression fractures were analyzed as the control group. Statistical comparisons were performed between the groups, in terms of age, gender, bone mineral density, whether bisphosphonate (BPP) was treated, preoperative kyphosis, preoperative wedge angle, change in wedge angle, amount of bone cement, existence of intradiscal bone cement leakage, and initial fracture levels. RESULTS: The statistically significant factors that influence new compression fractures in adjacent levels after PVP were as follows: being female, initial thoracolumbar junction fracture, preoperative large kyphotic, preoperative large wedge angle, change in wedge angle, administration of BPP in osteopenia group, and intradiscal cement leakage. CONCLUSION: This study identified many factors that influence newly developed compression fractures in adjacent levels after PVP. Interestingly, the administration of BPP in osteopenia group had positive influence on new fractures in this study. Therefore, we recommend early administration of BPP to patients with osteopenia.
Aged* ; Bone Density ; Bone Diseases, Metabolic ; Diphosphonates ; Female ; Fractures, Compression* ; Humans ; Incidence ; Kyphosis ; Retrospective Studies ; Risk Factors* ; Spinal Fractures ; Vertebroplasty*

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Influence of Gender on Occurrence of Chronic Subdural Hematoma; Is It an Effect of Cranial Asymmetry?.

Jae Sang OH ; Jai Joon SHIM ; Seok Mann YOON ; Kyeong Seok LEE

Korean Journal of Neurotrauma.2014;10(2):82-85. doi:10.13004/kjnt.2014.10.2.82

OBJECTIVE: Chronic subdural hematoma (CSDH) is a condition mostly present in older people. Men are more commonly affected than women. Several theories about male predominance could not enough to explain the reason for male predominance on CSDH. The purpose of this study is to find out whether there were any differences in the anatomy of cranium, which may contribute the pathogenesis or risk factors of CSDH. METHODS: The study population was consisted of 87 patients with CSDH and 100 patients with transient ischemic attack (TIA) from 2006 to 2013. We classified into four groups; group A (CSDH male 47), group B (CSDH female 40), group C (TIA male 50), and group D (TIA female 50). We measured the size of the cranium in the computed tomography scans, retrospectively. We define the difference of cranium (Dc), which is difference between the right and left radiuses. RESULTS: The Dc was significantly higher in patients with CSDH (group A and B)(p=0.03). The mean Dc was 3.49 mm in CSDH group (group A and B) and 2.14 mm in TIA group (group C and D). The mean Dc of CSDH group was significantly larger than that of TIA group (by t-test, p<0.01). CONCLUSION: Size and asymmetry of the cranium may be a risk factor of CSDH. Gender differences in the anatomy of cranium may contribute pathogenesis of CSDH.
Craniocerebral Trauma ; Female ; Hematoma, Subdural, Chronic* ; Humans ; Ischemic Attack, Transient ; Male ; Radius ; Retrospective Studies ; Risk Factors ; Skull

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The Efficacy of Titanium Burr Hole Cover for Reconstruction of Skull Defect after Burr Hole Trephination of Chronic Subdural Hematoma.

Tae Seop IM ; Yoon Soo LEE ; Sang Jun SUH ; Jeong Ho LEE ; Kee Young RYU ; Dong Gee KANG

Korean Journal of Neurotrauma.2014;10(2):76-81. doi:10.13004/kjnt.2014.10.2.76

OBJECTIVE: Although burr hole trephination is a safe and effective surgical option to treat patients with chronic subdural hematoma (CSDH), it often results in a small but undesirable scalp depression from burr hole defect. This study is to evaluate the efficacy of titanium burr hole cover (BHC) for reconstruction of skull defects in these patients. METHODS: A hundred and ninety-six cases of burr hole trephinations for CSDHs between January 2009 and December 2013 were assigned into two groups; Gelfoam packing only (GPO) and reconstruction using titanium BHC group, according to the modalities of burr hole reconstructions. The incidences and depths of scalp depressions and incidences of postoperative complications such as infections or instrument failures were analyzed in both groups. We also conducted telephone surveys to evaluate the cosmetic and functional outcomes from patient's aspect. RESULTS: Significantly lower incidence (p<0.0001) and smaller mean depth (p<0.0001) of scalp depressions were observed in BHC than GPO group. No statistical differences were seen in postoperative infection rates (p=0.498) between the two groups. There were no instrument failures in BHC group. According to the telephone surveys, 73.9% of respondents with scalp depressions had cosmetic inferiority complexes and 62.3% experienced functional handicaps during activities of daily life. CONCLUSION: Titanium BHC is highly effective for reconstruction of skull defect after burr hole trephination of CSDH, and provides excellent cosmetic and functional outcomes without significant complications.
Surveys and Questionnaires ; Depression ; Gelatin Sponge, Absorbable ; Hematoma, Subdural, Chronic* ; Humans ; Incidence ; Postoperative Complications ; Scalp ; Skull* ; Telephone ; Titanium* ; Treatment Outcome ; Trephining*

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Burst Fractures as a Result of Attempted Suicide by Jumping.

Do Young KIM ; Hong June CHOI ; Jeong Yoon PARK ; Kyung Hyun KIM ; Sung Uk KUH ; Dong Kyu CHIN ; Keun Su KIM ; Yong Eun CHO ; Byoung Ho JIN

Korean Journal of Neurotrauma.2014;10(2):70-75. doi:10.13004/kjnt.2014.10.2.70

OBJECTIVE: Jumping from high place for the purpose of suicide results in various damages to body area. A burst fracture of vertebrae is representative of them and we reviewed eight patients who were diagnosed with spinal burst fracture following suicide falling-down. The demographics, characteristics, performed operation, combined injuries, psychological past histories of the patients were analyzed. METHODS: A retrospective study was made of patients who are diagnosed with vertebral burst fracture from falling-down with the purpose of suicide admitted to department of neurosurgery of the author's hospital, covering the period between 2003 and 2012. RESULTS: Total eight patients were suicidal jumper. There were eleven vertebral burst fractures in eight patients and mean age was 26.5 years old. Seven patients already had psychological past history and there were various combined injuries except vertebrae burst fracture. The ankle fracture such as calcaneus, talus, navicular and malleolus was the most common injury and there were also various combined injury. CONCLUSION: Suicidal jumper is different from incidental faller in some aspects because of different injury mechanism. For managing suicidal jumper, physician had to consider patients' age, affected site, psychiatric problem and combined injuries. Each department related to the injuries of patient have to cooperate each other with departments of psychiatry and rehabilitation from beginning to end.
Ankle Fractures ; Calcaneus ; Demography ; Humans ; Neurosurgery ; Rehabilitation ; Retrospective Studies ; Spinal Fractures ; Spine ; Suicide ; Suicide, Attempted* ; Talus

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Clinical Features of Post-Traumatic Syringomyelia.

Hyun Gon KIM ; Han San OH ; Tae Wan KIM ; Kwan Ho PARK

Korean Journal of Neurotrauma.2014;10(2):66-69. doi:10.13004/kjnt.2014.10.2.66

OBJECTIVE: The purpose of this study was to analyze the clinical manifestations, radiological findings, treatment results, and clinical significance of post-traumatic syringomyelia (PTS). METHODS: We retrospectively reviewed the medical charts of nine surgical patients with symptomatic PTS between 1992 and 2012. RESULTS: The most common clinical manifestation was development of new motor weakness. The mean interval between the initial injury and the onset of new symptoms 21.9 years. The mean length of the syringes observed on preoperative magnetic resonance images was 7.8 spinal levels. Shunting procedures were performed in five patients. Four patients underwent arachnoidolysis and duraplasty. Patients developed mechanical shunt failure. Postoperatively, one patient showed clinical improvement, four patients were stable, and four patients showed deterioration. CONCLUSION: PTS is a disabling sequelae of spinal cord injury, which develops months to years after spinal injury. We have to consider that patients with PTS may have poor long-term outcome.
Humans ; Retrospective Studies ; Spinal Cord Injuries ; Spinal Injuries ; Syringes ; Syringomyelia*

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