Central retinal artery occlusion (CRAO) typically causes severe and permanent visual loss in the affected eye and vision does not recover in 90% of the patients. It is believed that it occurs by occlusion of the central retinal artery with small emboli from atherosclerotic plaque of internal cerebral artery. Various methods have been introduced to recanalize the occluded artery and remove emboli but considered to fail except thrombolytic therapy. Retina is a part of the brain so basically CRAO is corresponding to acute occlusion of intracerebral artery and retinal ischemia is to cerebral stroke. Accordingly rapid procedure within therapeutic time window, choosing appropriate drugs and doses, reducing hemorrhagic and ischemic complications associated with neurovascular intervention is very important. However, clinical significance of CRAO is much different from that of acute cerebral arterial occlusion, therefore, neurointerventionists should perform this procedure within appropriate range of safety.
Arteries ; Brain ; Cerebral Arteries ; Humans ; Ischemia ; Plaque, Atherosclerotic ; Retina ; Retinal Artery Occlusion* ; Retinal Artery* ; Retinaldehyde ; Stroke ; Thrombolytic Therapy

Posttraumatic high-flow communications between the intracavernous internal carotid artery (ICA) and the cavernous sinus may give rise to two different pathological entities. A connection from the intracavernous ICA system can theoretically connect with two different structures; the vein of the plexus (CCF) or the perivascular bare spaces between the veins (pseudoaneurysm). A CCF and a pseudoaneurysm can be present in the same patient. A 24-year-old man was admitted to our hospital due to sudden mental deterioration. Carotid angiography revealed a CCF, which had occurred after a trauma 5 years earlier, associated with left visual disturbance and skull base fractures. The treatment of choice was permanent coil occlusion of the intracavernous ICA at the level of the lesion. The collateral circulation was evaluated before the endovascular treatment using a balloon test occlusion (BTO). During the BTO, adequate collateral circulation was defined as symmetric angiographic filling of both hemispheres. A continuous neurological examination was performed during the procedure. The follow-up angiography showed a persistent aneurysm occlusion. We report our experience of the successful endovascular treatment of combined lesions with a review of the relevant literature.
Aneurysm ; Aneurysm, False* ; Angiography ; Carotid Artery, Internal ; Cavernous Sinus ; Collateral Circulation ; Fistula* ; Follow-Up Studies ; Humans ; Neurologic Examination ; Skull Base ; Veins ; Young Adult

OBJECTIVE: The authors investigated the clinical and radiographic characteristics of patients who exhibited contrast extravasation on initial computed tomographic angiography (CTA) and assessed the its association with hematoma expansion. METHODS: Ninety six patients who were diagnosed with intracerebral hemorrhage and who received CTA within 12 hours from initial onset of symptoms and who received a follow up brain CT within 48 hours from the initial CTA between April 2004 and March 2007 were retrospectively assessed. Contrast extravasation was defined as the presence of high-density material within the hematoma. Patients were classified into the extravasation and no extravasation groups. Clinical and radiographic variables were compared between the two groups. RESULTS: Fifteen patients (19%) demonstrated presence of extravasation on initial CTA. A significantly higher rate of hematoma expansion was seen in the extravasation group compared to the non extravasation group (47% vs 17%, p=0.027). Mean time from onset of symptoms to initial CTA was significantly shorter in the extravasation group (3.5+/-1.3 hours vs 7.6+/-2.5 hours, p<0.001). Also, detection of extravasation on CTA significantly correlated with time from symptom onset to intial CTA, especially when it was less than 4 hours (p>0.001). CONCLUSIONS: Earlier detection of extravasation using CTA may help in identifying possibly life threatening complications caused by hematoma expansion. However, a larger prospective cohort is warranted to validate this result.
Angiography* ; Brain ; Cerebral Hemorrhage* ; Cohort Studies ; Follow-Up Studies ; Hematoma ; Humans ; Retrospective Studies

OBJECTIVE: We have investigated the risk factors associated with angiographic recurrence of intracranial aneurysms after endovascular coil embolization in a retrospective manner. METHODS: From January 2000 to June 2005, 128 aneurysms in 114 patients were treated with coil embolization. Among them, 54 aneurysms in 51 patients were followed by repeated intraarterial angiography at 6, 12, 18, and 24 months post-embolization. Recurrence was defined when either coil compaction or aneurysm regrowth was identified on follow-up angiography. Patients were divided into stable and recurred groups according to angiographic recurrence. Clinical parameters, anatomical factors, and the degree of occlusion were retrospectively reviewed. RESULTS: The overall recurrence rate was 29% in our study. The diameter of the largest dimension of the fundus was larger in the recurred group of patients as compared to the stable group of patients (7.33+/-2.26 mm vs. 5.87+/-1.93mm, p = 0.048), and a significant rate of recurrence was seen in fundus size of the same or greater than 10 mm (41.7% vs 14.3%, p = 0.038). The coil packing density was significantly smaller in the recurred group of patients (p = 0.002), with a recurrence rate of 47.0% in cases with a coil packing density below 25% (p = 0.017). CONCLUSIONS: Our study showed that maximum aneurysm fundus size and coil packing density had a close correlation to recurrence. However, a larger number of patients with longer observation times may be needed to define the risk factors affecting angiographic recurrence.
Aneurysm ; Angiography ; Embolization, Therapeutic* ; Follow-Up Studies ; Humans ; Intracranial Aneurysm* ; Recurrence* ; Retrospective Studies ; Risk Factors

OBJECTIVE: TA retrospective study is performed on 28 patients with primary intraventricular hemorrhage(PIVH) to examine the outcome and prognostic factors associated with this disorder. METHODS: Clinical data collected between 1998 and 2002 was used in the present study. The outcomes of these patients were compared by age, etiology, initial Glasgow Coma Score(GCS), Graeb's score, ventriculocranial ratio(VCR), hemorrhagic dilation of the third ventricle, and hemorrhagic dilation of the fourth ventricle. The Glasgow Outcome Scale(GOS) at discharge was used for the comparison of outcomes. RESULTS: The mean age of these patients was 48.4+/-17.4 years. The underlying causes of PIVH were hypertension(53.6%), moyamoya disease(17.9%), arteriovenous malformation(10.7%), cerebral aneurysm(7.1%), and unknown(10.7%). The age and etiology were not correlated with outcome. Patients with a GCS of 13-15 showed a good outcome in 90.5%(p<0.05). Those with a higher VCR(> or =0.23) showed a poor outcome in 64.3%(p<0.05). Patients with a Graeb's score of 9-12 showed a poor outcome in 87.5%(p<0.05). Those with hemorrhagic dilatation of the third ventricle showed a poor outcome in 80.0%, and those with hemorrhagic dilatation of the fourth ventricle showed a poor outcome in 85.7%(p<0.05). The overall mortality rate was 17.9%. CONCLUSION: Low initial GCS, high Graeb's score, high VCR, and hemorrhagic dilatation of the third ventricle or the fourth ventricle are correlated with poor outcome in PIVH.
Coma ; Dilatation ; Fourth Ventricle ; Hemorrhage* ; Humans ; Mortality ; Retrospective Studies ; Third Ventricle

OBJECTIVE: The purpose of this study is to evaluate complications in 70 patients who had underwent endovascular treatment to occlude cerebral aneurysms. METHODS: From May 1999 to December 2002, we treated 70 patients by endovascular treatment or by combination of endovascular treatment and surgery. Complications have been developed in fifteen patients. Twelve patients had anterior circulation aneurysms: 4 posterior commmuncating artery ; 2 anterior communicating artery ; 2 paraclinoid artery ; 2 anterior choroidal artery ; 1 distal internal carotid artery ; 1 middle cerebral artery ; 1 pericallosal artery and three patients had posterior circulation aneurysms: 3 basilar artery tip. RESULTS: The complications related to the coil embolization were the thromboembolic event in 9 cases, rupture of the aneurysm in 3 cases, coil prolapse in 3 cases and coil migration in 1 case. CONCLUSION: The coil embolization can be a alternative good modality in the treatment of cerebral aneurysms. But careful attention should be required to reduce the various complications of procedures and to improve the prognosis of aneurysmal treatment. Effort to overcome the technical problem and to develop more comfortable device are needed for the better results of endovascular treatment.
Aneurysm ; Arteries ; Basilar Artery ; Carotid Artery, Internal ; Choroid ; Embolization, Therapeutic ; Humans ; Intracranial Aneurysm* ; Middle Cerebral Artery ; Prognosis ; Prolapse ; Rupture

PURPOSE: To assess whether ring enhancements of liver metastases on Mn-DPDP enhanced, early MR images were well visualized on delayed images, as compared with those of hepatocellular carcinomas (HCC), and to investigate the detection accuracy and conspicuity of each tumor. MATERIALS AND METHODS: Twenty patients with liver metastases and 15 with HCC were studied by Mn-DPDP enhanced, T1-weighted MR images. Peripheral ring enhancement and conspicuity were investigated. Differences in detection accuracy and frequency of ring enhancement in liver metastases and HCC were assessed. RESULTS: In liver metastases (n=69), 44 cases (63.8%) without ring enhancement and 25 (36.2%) with were noted on early images. Sixteen cases (23.2%) without ring enhancement, 38 (55.1%) with ring enhancement similar to the early images, and 15 (21.7%) with prominent ring enhancement were noted on delayed images. In HCC (n=37), 36 cases (97.3%) without ring enhancement and 1 case (2.7%) with were noted on early images. There was no difference of detection accuracy in liver metastases or HCC between the 2 readings. Ring enhancement and conspicuity of each tumor were superior on delayed images. Ring enhancement in liver metastases was better seen on delayed images. CONCLUSION: Ring enhancement in liver metastases was well presented on Mn-DPDP enhanced, delayed MR images, which was useful to differentiate liver metastases from HCC.
Carcinoma, Hepatocellular* ; Humans ; Liver* ; Magnetic Resonance Imaging* ; Neoplasm Metastasis ; Reading

OBJECTIVE: The elderly population is rapidly growing, and the population over age 65 is expected to increase. To evaluate factors that determine recovery in this population, we report a clinical analysis of 77 elder patients of mild head trauma over 65 years of age. METHODS: The medical records were reviewed retrospectively for 77 head-injured patients aged 65 to 85 years who were admitted to our institution between March, 1995 and December, 1999. The outcome was compared with age, sex, Glasgow Coma Scale score, and radiologic characteristics. RESULTS: As in all age groups, males predominated and motor vehicle accidents accounted for a highest proportion(35%). Of the traffic accidents, pedestrian injuries were more common. The single most common lesion was subdural hematoma. The initial radiologic findings were not correlated with outcome. The GCS score was statistically correlated with prognosis. Sixty-one patients(79.2%) had favorable outcome. Ten of seventy-seven patients(13%) died whereas cerebral injury accounted for 5 deaths. Non-cerebral causes of death were composed of pneumonia, multi-organ failure and sepsis. The mean hospitalization was 52.3+/-12.6 days. CONCLUSION: The mortality rate after injury is higher in elderly patients. It is therefore the factors of intracranial and extracranial cause which influence survival and outcome be carefully treated. Neurologic deficits, even though mild, are the risk factor of poor prognosis in the elderly. Earlier identification of risk and aggressive support may be needed for decreasing the morbidity and the mortality in the elderly.
Accidents, Traffic ; Aged ; Cause of Death ; Craniocerebral Trauma* ; Glasgow Coma Scale ; Head* ; Hematoma, Subdural ; Hospitalization ; Humans ; Male ; Medical Records ; Mortality ; Motor Vehicles ; Neurologic Manifestations ; Pneumonia ; Prognosis* ; Retrospective Studies ; Risk Factors ; Sepsis

PURPOSE: By virtue of advances in scientific methods and technical systems, there has been a rapid growth in the number of end stage renal disease (ESRD) patients treated using continuous ambulatory peritoneal dialysis (CAPD) as their primary renal replacement therapy. However, there are various catheter related complications that are limiting factors in patient and catheter maintenance. This study was aimed at introducing of the techniques of CAPD catheter implantation designed for reducing the complication rate, as well as conducting an investigation of the incidence of CAPD catheter related complications and patient survival and catheter survival rates. METHODS: We performed 234 cases of CAPD catheter implantation using a conventional surgical method (n=162, between January 1993 and December 1997) or a modified surgical method (n=72, between January 1998 and December 1999), and retrospectively reviewed the patient's medical records to elucidate the incidence of early catheter related complications and the catheter removal rate in relation to the surgical methods. RESULTS: There were 21 cases (23.8%) of peritonitis in the modified group, which was less than that in the conventional group (79 cases, 48.8%) (P=0.036). There were 9 cases (12.5%) of exit site and tunnel infection in the modified group, which was less than that in the conventional group (36 cases, 22.2%) (P=0.019). We were able to reduce the peritonitis as well as exit site and tunnel infection by a long segment of tunneling and immobilization of the catheter to the skin. Nine cases of leakage (5.5%) have occurred in the conventional group and one case (1.3%) in the modified group; the difference was statistically significant (P=0.046). CONCLUSION: These results indicate that our modified surgical methods can reduce the rate of early catheter related complications.
Catheters* ; Humans ; Immobilization ; Incidence ; Kidney Failure, Chronic ; Medical Records ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis ; Renal Replacement Therapy ; Retrospective Studies ; Skin ; Survival Rate ; Virtues

OBJECTIVE: The authors analyze the incidence, etiological and prognostic factors between contralateral and ipsilateral delayed epidural hematoma after evacuation of initial hematoma and to formulate recommendations for early detection of evolving hematoma and improvement of outcome. METHODS: Between July 1997 and December 1999, 417 patients underwent craniotomy at department of neurosurgery to evacuate an acute posttraumatic intracranial hematoma. Analysis of these clinical and neuroradiologic data showed that we underwent a second operation on 24 patient(5.8%) for removal of delayed epidural hematoma. In 10(2.4%) of these patients the second operation was undertaken to evacuate a new hematoma that had developed at a contralateral side from the initial hematoma. In 14 patients(3.4%), the second operation was to remove a epidural hematoma at the same site as the first craniotomy. RESULTS: 24 patients were divided into two groups. In Group A, 10 patients who developed contralateral delayed epidural hematoma were 31.5 years(11-61) of age and had skull fracture at the site of delayed epidual hematoma formation. Two of these patients revealed severe brain swelling during the evacuation of acute subdural hematoma. Eight of them were diagnosed within 24 hours after craniotomy through immediately postoperative computed tomography scan. In Group B, 14 patients who developed ipsilateral epidural hematoma were 56.1 years(27-75) of age. Six of them had hemorrhagic tendency related to past medical history. Eleven of these patients were associated with thrombocytopenia and consumptive coagulopathy when required second operation. Twelve patients were diagnosed within 48-72 hours after craniotomy due to clinical deterioration or failure to improve. There was no significant difference in outcome between two groups. CONCLUSION: The authors sought differential factors between contralateral and ipsilateral delayed epidural hematoma. Delayed epidural hematoma after craniotomy may need an urgent operation or lead to serious complication or disability. Postoperative computed tomography scan, intracranial pressure monitoring and repeat computed tomography scan within 72 hours of injury are strongly recommended in these cases, especially after decompression of cranial cavity.
Brain Edema ; Craniotomy ; Decompression ; Hematoma* ; Hematoma, Subdural, Acute ; Humans ; Incidence ; Intracranial Pressure ; Neurosurgery ; Skull Fractures ; Thrombocytopenia