Vertebral artery hypoplasia (VAH) can be easily overlooked if the contralateral side vertebral artery is intact, because of compensation by the contralateral artery or cerebral collateral network. The clinical relevance and hemodynamic impact of VAH is still controversial. However, VAH has recently been considered a risk factor for posterior circulation ischemia. Ischemic stroke is seldom caused by free floating thrombi (FFT) in the artery. Pathophysiology of FFT has not yet been clarified. The state of reduced blood flow such as a vertebral artery origin stenosis may cause FFT. Their instability may make them sources of recurrent artery to artery embolism. Patients with FFT will require appropriate medical and endovascular treatment. The current case illustrates a short-term angiographic change of spontaneous thrombolysis of VAH and multiple thrombi at the distal region of the stenosed lesion after stent-assisted angioplasty for a vertebral artery origin stenosis.
Angioplasty* ; Arteries ; Compensation and Redress ; Constriction, Pathologic* ; Embolism ; Follow-Up Studies* ; Hemodynamics ; Humans ; Ischemia ; Risk Factors ; Stroke ; Vertebral Artery*

Von Meyenburg complexes (VMC) have many synonyms such as bile duct hamartomas and biliary hamartoma. These rare benign disorders are considered as congenital diseases caused by malformed differentiation of ductal plate. The diagnosis of VMC by common radiologic modality such as ultrasound and computed tomography was nearly impossible until the emergence of cholangiopancreatography by magnetic resonance imaging (MRCP) and the pathologic examination was the only way to confirm the diagnosis of VMC. But MRCP is now considered as most accurate noninvasive method for diagnosis of VMC. We report a histologically proven case of VMC associated with calculous cholecystitis, cerebral aneurysm and renal cortical cyst. To our knowledge, no comparable case has been reported and this would be the only second reported case of VMC, which was diagnosed by MRCP.
Bile Ducts ; Cholecystitis* ; Diagnosis ; Hamartoma ; Intracranial Aneurysm* ; Magnetic Resonance Imaging ; Ultrasonography

No abstract available.
Diabetic Retinopathy ; Follow-Up Studies ; Humans ; Photography

Cerebral somatosensory evoked potentials(SEPs) produced by stimulation of peripheral nerves provide a useful diagnostic index of conduction in somatosensory pathways to the cortex. Thus the integrity of both the dorsal column-medial lemniscus pathway and primary sensorimotor area has been considered an essential requirement to record a normal SEP. There are suggestions that SEPs contain several components arising from different neuronal sources, the early short latency potentials corresponding to the lemniscus-mediated responses and the late waves to the diffuse spino-thalamic projections. The present work analyses the influence on SEPs of focal brain lesions, using the computerized tomography in detecting and localizing brain lesions. Somatosensory evoked potentials were recorded in 20 patients with focal brain lesions recognized by computerized tomography. 1) Patients with primary sensorimotor area(PSMA) damages(group I) had a very abnormal of the early component(No, Po, Nl, Pl) in 100% on the lesion side. 2) Patients presented supratentorial lesions, sparing PSMA(group II), 87.5% showing abnormal SEPs in early components and characterized by increment of amplitude in late components. 3) Brainstem damage(group III) produced a distortion of the early components especially N11, N20msec in latency. 4) In incomplete spinal cord injuries, the SEPs is indeed signal of functional recovery, of posterior column, and incorrespondance with clinical improvement.
Brain Stem ; Brain* ; Evoked Potentials, Somatosensory* ; Humans ; Neurons ; Peripheral Nerves ; Spinal Cord Injuries

The microvasculature of the brain is also quite susceptible to ischemic insult, and substantial portions of the brain are not reperfused after restoration of the blood supply following overtime of critical ischemic periods. The purpose of this series of experiments was to determine the effects of ischemia on subsequential regional cerebral blood flow measurements and cortical electric activities following reperfusion after ischemia and also to define the proper time of vascular occlusion without irreversible neural damage. Cerebral ischemia was induced in cat by bilateral common carotid occlusions for periods of 10, 30, to 60 minutes, and the blood flow(rCBF) was measured by hydrogen clearance technique following ischemia, restoration of blood supply and electroencephalogram recovery could be predicted according to the rCBF. Forty adult cats weighing 2.7 to 4.0kg were used in this study. The animals were divided into 4 groups of 10 cats each : normal control, 10 min-clamped, 30 min-clamped, and 60 min-clamped groups. The results obtained were as follows : 1) The mean rCBF was 24.6+/-7.0ml/100g/min in control group. 2) Bilateral carotid occlusions resulted in a reduction of the rCBF (12.4+/-4.1ml/100g/min) to 50% of control flow on both hemispheres. 3) Sequential changes of the rCBF after reperfusion. (1) There was restored the rCBF(21.3+/-5.1ml/100g/min) to control flow in the 10 minutes-clamped group. (2) There was a 85% recovery of control flow in the 30 minutes-clamped group. (3) There was a only 25% recovery of control flow in the 60 minutes-clamped group. 4) A close correlation was found between cortical electrical activity and rCBF suggesting a threshold relationship. (1) The changes of cortical electric activity began to notice at rCBF less than 17.4+/-4.7ml/100g/min. (2) The changes of cortical electric activity noted at rCBF more than 10.2+/-2.3ml/100g/min. 5) There was no evidence of ischemic involvement at the cortex, white matter and basal ganglia in the 10 minutes clamped group, but demonstrated a dense wedge shaped infarct at the cortex and uncus herniation in the 60 minutes clamped group. The rCBF and cortical electric activity restorted to normal values in reperfusion within 10 minutes after occlusion of both common carotid arteries.
Adult ; Animals ; Basal Ganglia ; Brain ; Brain Ischemia ; Carotid Artery, Common* ; Cats* ; Electroencephalography ; Humans ; Hydrogen ; Ischemia ; Microvessels ; Reference Values ; Reperfusion*

Epilepsy can be defined as a paroxysmal, neuronal discharge within the brain originating from either corticalor sugcortical regions. The incidence of epilepsy is increasing possibly due to the survival of persons who shouldhave died of brain injuries or other cerebral abnormalities acquired in earlylife. the use of abtibiotics andimprovement in the medical care have saved many children who might have died of meningitis, brain abscess,encephalitis, severe head injuries, etc. CCT scan is new radiologic procedure for defining cranial andintracranial structures and also an useful procedure for evaluation and follow-up(FU) of patient with focalseizure disorder. Recently we experienced nodules which were isodense or hypodense on initial noncontrasted CT(NECT) and scans became hyperdense of the enhancement in 4 cases of focal epileptic seizures. Nearly completedisappearance or regression of the epileptic foci occurred on the FU CT scans in 2 cases. Operation was performedin 2 cases. The tissue specimen obtianed from the CT nodule revealed cerebral edema in one case and localizedgliosis and congestion in the other. All the patients showed marked clinical improvement when the CT noduleimporved. Review of literature failed to disclose any previous report on such observation.
Brain ; Brain Edema ; Brain Injuries ; Child ; Craniocerebral Trauma ; Epilepsy ; Estrogens, Conjugated (USP) ; Humans ; Incidence ; Meningitis ; Neurons ; Tomography, X-Ray Computed

Microscopic calcification within the basal ganglia was reported by Virchow and Bamberger in 1855. The description of symmetrical cerebral calcification, particularly of the basal ganglia and often of the dentate nuclei, associated with hypoparathyrodism as related by Eaton, Camp and Love(1939) was a significant development in the field of calcification. Calcification of the basal ganglia has been visualized by skull radiography and computed tomography(CT) scan, and in two-third of cases, it has been associated with metabolic and endocrine abnormalities. Computed tomography is more sensitive to detect the intracranial calcification than plain skull radiography. The purpose of our report was evaluate the significance of basal ganglia calcification as visualized by CT, discusses on pathogensis of calcification, clinical significance and management under the hypocalemia.
Basal Ganglia* ; Hypoparathyroidism* ; Radiography ; Skull

Laboratory and clinical evidence indicates a potentially important role for barbiturates in the management of brain injury and intracranial hypertension. The present report describes our experience with the thiopental and mannitol therapy in 30 consecutive patients who were over 20mmHg of intracranial pressure(ICP) in severe head injuries and the other comatous conditions. The anothers have analyzed the effects of thiopental on outcome in comatous 30 patients by continuous monitoring of ICP. High dose barbiturate therapy was induced with an intravenous bolus of thiopental, 40mg/kg and the infusion of barbiturates intermittently continued until control of the ICP(below 20mmHg) was obtained. In those patients responding to thiopental, the daily mannitol requirement was reduced from 3.5 to 0.5mg/kg/day. Our overall results are presented; 1) In patients with intracranial mass lesions only very high ICP(>40mmHg) on barbiturate management was significantly associated with a poor neurological deficit and outcome from injury, while the patients with any increased in ICP above 20 to 29mmHg was associated with a moderate neurological disability and better outcome with thiopental and mannitol treatment. 2) In patients with surgical mass lesion ICP between 20 to 29mmHg was significantly associated good neurological picture and outcome, but the patients in ICP above 40mmHg, had a 75% motality. 3) Decreases in ICP over 20mmHg were seen in 75%of the patient who had managed with thiopental and mannitol. 4) Thiopental responders have returned to a good recovered and minimal deficit, but thiopental nonresponsiveness was associated with a completely unfavorable outcome:5 deaths, 1 vegetative survior.
Barbiturates ; Brain Injuries ; Craniocerebral Trauma* ; Head* ; Humans ; Intracranial Hypertension* ; Mannitol* ; Thiopental*

An experimental ischemic model in cats is described in which we have attempted to produce acute cerebral ischemia by occlusion of the middle cerebral artery(MCA) through the orbit. The main objectives of this experiment were:to observe the effect of thiopental in the tophographic distribution of infarct;the size of the infarct;histological changes of ischemic nerve cells following occlusion of a major cerebral artery;to investigate the best timing of the administration and dosage of thiopental after the occlusion. 80 adult cats weighing 2.7 to 4.0kg, were used in this study. The components of the pathophysiological responses, systemic changes, cerebral infarct size and histopathological ischemic neuronal changes were studid in these groups of animals. We observed the protective effect of the thiopental on acute focal cerebral ischemia in 40 cats by effecting permanent occlusion of MCA. The EEG was monitored continuously using bifrontal electrodes from the time of administration of thiopental(10mg/kg). The animals were divided into 4 groups of 20 cats each. The 4 different groups were used to investigate the effects of thiopental on focal ischemia according to different time interval. The time intervals were 6 hours, 24 hours, 48 hours, and 72 hours after occlusion of MCA. Each animal group were divided into two groups, which one was control(n=10) the other, thiopental treated group(n=10). The results obtained were as follows: 1) Blood gases, artrial pressure, body temperature, and intracranial pressure differed among groups only as follows: (a) Normal blood pressure was maintained but pulse rate was slightly fast in each control group. (b) Blood pressure and pulse rate in the thiopental treated groups were significantly lower than in the control groups. In the thiopental treated groups, the value of PaO2 was significantly higher than control groups, however, PaCO2 was not significantly higher in the thiopental treated groups as compared to the control group. 2) In the control groups, severe contralateral hemiplegia(grade III) developed in the early stage of MCA occlusion, however the neurological deficit progressively improved to the state of abnormal climbing(neurological grade II) 48 hours to 72 hours after the occlusion. In the thiopental treated groups, minimum to mild neurological deficit significantly developed in the early stage of MCA occlusion and in one case walking ability was regained. 3) The size and distribution of the infarct significantly decreased to 60% in the thiopental treated groups(p<0.01). The value of the size of the size of the infarct in the thiopental treated groups 72 hours after occlusion was minimized to 0.3+/-0.6%(p<0.01). In 80 percent of the control group cases severe extensive ischemic neuronal damage(score 3 or 4), was observed, 70 percent in the thiopental treated groups showed mild ischemic nerve cell changes(score 1 or 2) when the histological examination was given. Although the severity of the ischemic neuronal damage was gradually improved from 6 hours to 72 hours after occlusion of the MCA in the control, the thiopental treated group was not significantly affected to the time factor. 4) Significantly reduction of experimentally induced acute focal cerebral ischemia was associated in the cat model with the administration of thiopental at 5 minute, 30 minute, and one hour postocclusion. Also we have defined the best barbiturate, best does, and best timing of administration to protect the acute focal ischemia.
Adult ; Animals ; Blood Pressure ; Body Temperature ; Brain Ischemia ; Cats ; Cerebral Infarction* ; Electrodes ; Electroencephalography ; Gases ; Heart Rate ; Humans ; Intracranial Pressure ; Ischemia ; Middle Cerebral Artery* ; Neurons ; Orbit ; Thiopental* ; Time Factors ; Walking

The size of the cisterna magna is still detatable. Robertson13) stated that the cisterna magna varies greatly in capacity and described the large cisterna magna as a separate entity. He also found that in most cases the cisterna magna extended approximately 2.5cm above the foramen magnum and was usually 5mm deep with a variable width. Liliequist8) proposed a mean heigh of 28mm for the normal cisterna magna with a wide variation of 15 to 60mm, and a depth of 6mm at the foramen magnum with a variation of 2 to 10mm:however, he did not quote measurements for the width. Gonsette, et al.5) reported 28 cases of enlarged cisterna magna diagnosed by ventriculography and coined the phrase "mega grande citerne" or mega cisterna magna. All of these cases, however, had symptoms of posterior fossa disease. Our study of the syndrome of the mega cisterna magna without specific syndrome is presented nystagmus, transient syncope in the first & third cases were operated under suboccipital craniectomy and was confimed the large cisterna magna. This paper presents the clinical diagnosis with vertebral angiogrraphy, pneumoencephalography and computed tomography.
Cisterna Magna* ; Diagnosis ; Foramen Magnum ; Numismatics ; Pneumoencephalography ; Syncope