No abstract available.

No abstract available.
Cerebral Ventriculitis* ; Enterobacter aerogenes* ; Enterobacter* ; Pefloxacin*

No abstract available.
Adult* ; Humans ; Treatment Outcome*

The size of unruptured intracranial aneurysms is an important factor that determines their rupture potential; however, the critical threshold size remains to be established. Some useful informations for determining the threshold size have been provided by the reports on the long-term follow-up of previously diagnosed unruptured aneurysms and clinical or autopsy studies on the size of ruptured aneurysms. Among the ninety-eight patients with ruptured cerebral aneurysms the authors managed during the last 4 years and the size of which were identified neuroradiologically and/or intraoperatively, eight cases(8.2%) had very small (maximum diameter less than 5mm) aneurysms. Their clinical features were not remarkably different from the usual aneurysmal SAH. As for the morphology, all of the eight had thin wall and narrow neck; in five cases the aneurysmsal sac had elongated shape. Several clinical reports on the ultimate rupture of previously diagnosed very small unruptured aneurysms and the formidable incidence of very small ruptured aneurysms in such clinical studies as this suggest that very small aneurysms also have a definite risk of rupture. The clinical significance of the narrow neck and elongated sac of the very small ruptured aneurysms observed in the authors' cases seems to be characteristic enough to deserve further investigation.
Aneurysm* ; Aneurysm, Ruptured ; Autopsy ; Follow-Up Studies ; Humans ; Incidence ; Intracranial Aneurysm ; Neck ; Rupture

The preferred site of spontaneous intracerebral hemorrhage(SICH) is the supratentorial area, especially the basal ganglia. Large hematomas frequently spread into the ventricle, and in the case of intraventricular hematomas, varying degrees of fresh blood are found within the subarachnoid space. Cases in which SICH of the basal ganglia ruptures the insular cortex and causes thick subarachnoid hemorrhage(SAH) in the basal cisterns, are, however, rare. The authors report a rare case of putaminal SICH with intraventricular hemorrhage(IVH) and SAH in the basal cisterns. This 58-year-old female was stuporous on admission. Neurological examination revealed Glasgow coma scale score 7, left hemiparesis, positive Babinski's sign and neck stiffness. Brain CT showed a large intracerebral hematoma in the right basal ganglion and associated intraventricular hematoma and SAH in the basal cistern. Cerebral angiography demonstrated a small saccular aneurysm at the right M1. Right pterional and trans-sylvian approach revealed thick SAH in the sylvian fissure and a small unruptured aneurysm at the early bifurcation of the middle cerebral artery. The putaminal hematoma had ruptured into the sylvian fissure through a natural opening at the insular cortex between M2 branches. This case illustrates that hypertensive SICH should be included in the differential diagnosis of basal cistern SAH associated with SICH.
Aneurysm ; Basal Ganglia ; Brain ; Cerebral Angiography ; Diagnosis, Differential ; Female ; Ganglion Cysts ; Glasgow Coma Scale ; Hematoma ; Humans ; Middle Aged ; Middle Cerebral Artery ; Neck ; Neurologic Examination ; Paresis ; Putaminal Hemorrhage* ; Reflex, Babinski ; Rupture ; Stupor ; Subarachnoid Hemorrhage* ; Subarachnoid Space

The authors report an anomalous fenestration at the M1 portion of the middle cerebral artery found incidentally in a patient affected with a ruptured aneurysm at the ipsilateral internal carotid artery(ICA) and unruptured small aneurysms at the contralateral P1 and ICA. The anomaly was confirmed both angiographically and intraoperatively. A review of the literature indicated several reports of this same anomaly, many of which were associated with aneurysms involving either the proximal end of the fenestration or other cerebral arteries. In the interpretation of cerebral angiograms and during intracranial operations, clinical attention should be paid to this rare anomaly.
Aneurysm* ; Aneurysm, Ruptured ; Cerebral Arteries ; Humans ; Intracranial Aneurysm ; Middle Cerebral Artery

Spontaneous fracture of the Silastic shunt catheter is a rare complication of lumboperitoneal shunt. A review of the literature revealed only one case in which spontaneous fracture occurred after this procedure. The authors report a case in which fracture of a lumboperitoneal shunt catheter occurred within the interspinous ligament probably due to repeated tension caused by flexion and extension during lumbar motion. The fractured proximal catheter was located entirely within the intrathecal space exclusively from the level of L1 to S1, and caused incomplete cauda equina syndrome.
Catheters* ; Fractures, Spontaneous* ; Ligaments ; Polyradiculopathy

Though several pathogenetic theories concerning the frequent association of Chiari malformation and hydrocephalus with myeloschisis have been suggested, none of them explains all the aspects of the disorder. To investigate whether myeloschisis is the direct cause of Chiari malformation and hydrocephalus or these conditions are the results of another basic event, we observed the morphological changes of the posterior cranial fossa and its components in the chick embryos with surgically induced myeloschisis. To make myeloschistic lesions, we opened the neural tube for a length of 9-11 somites in Hamburger and Hamilton stage 16-19 chick embryos. They were divided into cervicothoracic (C-T) and lumbosacral(L-S) groups according to the area of incision. The embryos were re-incubated until postoperative day 11. In the control group, embryos were incubated with the eggshell window open as their experimental counterparts. The survival rates of each group were as follows; 11% (9 survivors/85 operated embryos), 8% (7/83), and 17% (10/60) in the C-T, L-S and control groups, respectively. Myeloschisis positive rates were 100% in the operated groups and 0% in the control group. The heads of embryos were sectioned along the sagittal plane to observe the morphological changes in the posterior cranial fossa and its components. Of the survivors, five in the C-T group, two in the L-S group and six in the control group were available for light microscopic inspection. In the majority of embryos with myeloschisis, without difference between the C-T and L-S groups, the fourth ventricles were smaller than those of the control group and the subarachnoid spaces in the posterior cranial fossa were also narrower. In embryos with severe changes, the cerebellum displaced downward comparing with that of the control embryos. No evidence of hydrocephalus was present Though not always typical, morphological changes similar to Chiari malformation were observed in chick embryos with surgically induced myeloschisis. It suggests a strong direct causal relationship between the two conditions and supports the theories of derangements in cerebrospinal fluid dynamics rather than those of primary mesenchymal or neural origin as a pathogenetic mechanism of Chiari malformation.
Animal ; Brain/*abnormalities ; Chick Embryo ; Cranial Fossa, Posterior/abnormalities ; Disease Models, Animal ; Hydrocephalus/etiology ; Spinal Cord/*abnormalities ; Subarachnoid Space/abnormalities ; Support, Non-U.S. Gov't

Though several pathogenetic theories concerning the frequent association of Chiari malformation and hydrocephalus with myeloschisis have been suggested, none of them explains all the aspects of the disorder. To investigate whether myeloschisis is the direct cause of Chiari malformation and hydrocephalus or these conditions are the results of another basic event, we observed the morphological changes of the posterior cranial fossa and its components in the chick embryos with surgically induced myeloschisis. To make myeloschistic lesions, we opened the neural tube for a length of 9-11 somites in Hamburger and Hamilton stage 16-19 chick embryos. They were divided into cervicothoracic (C-T) and lumbosacral(L-S) groups according to the area of incision. The embryos were re-incubated until postoperative day 11. In the control group, embryos were incubated with the eggshell window open as their experimental counterparts. The survival rates of each group were as follows; 11% (9 survivors/85 operated embryos), 8% (7/83), and 17% (10/60) in the C-T, L-S and control groups, respectively. Myeloschisis positive rates were 100% in the operated groups and 0% in the control group. The heads of embryos were sectioned along the sagittal plane to observe the morphological changes in the posterior cranial fossa and its components. Of the survivors, five in the C-T group, two in the L-S group and six in the control group were available for light microscopic inspection. In the majority of embryos with myeloschisis, without difference between the C-T and L-S groups, the fourth ventricles were smaller than those of the control group and the subarachnoid spaces in the posterior cranial fossa were also narrower. In embryos with severe changes, the cerebellum displaced downward comparing with that of the control embryos. No evidence of hydrocephalus was present Though not always typical, morphological changes similar to Chiari malformation were observed in chick embryos with surgically induced myeloschisis. It suggests a strong direct causal relationship between the two conditions and supports the theories of derangements in cerebrospinal fluid dynamics rather than those of primary mesenchymal or neural origin as a pathogenetic mechanism of Chiari malformation.
Animal ; Brain/*abnormalities ; Chick Embryo ; Cranial Fossa, Posterior/abnormalities ; Disease Models, Animal ; Hydrocephalus/etiology ; Spinal Cord/*abnormalities ; Subarachnoid Space/abnormalities ; Support, Non-U.S. Gov't

The authors applied extraventricular drainage combined with intermittent intraventricular injection of urokinase to 21 patients with intraventricular hemtoma and ventricular dilatation. Ten-thousand IU of urokinase was injected every 12 hours for 3 days. Follow-up CT on day 4 after the treatment showed complete disappearance of the hematoma in the 3rd and 4th ventricles and a small residual hematoma in the occipital horns of lateral ventricles in the majority(14 patients) of the patients. Obstruction of the drainage catheter did not occur in any case, but transient pleocytosis in CSF study, ventriculitis, and rebleeding complicated 6,4, and 4 cases, respectively. The duration of extraventricular drainage in the 17 patients without major complications was 3-17 days. The clinical and death in 7 cases. The decisive events that were thought to have caused vegetative states or death in the 13 case. The method of extraventricular drainage combined with intermittent intraventricular injection of urokinase seems useful in revoving intraventricular hematomas, futher investigation including prospective studies is necessary to determine whether the intraventricular injection of urokinase significantly improves the final outcomes of those patients with severe intraventricular hematomas.
Animals ; Catheters ; Dilatation ; Drainage* ; Follow-Up Studies ; Hematoma* ; Horns ; Humans ; Injections, Intraventricular* ; Lateral Ventricles ; Leukocytosis ; Persistent Vegetative State ; Urokinase-Type Plasminogen Activator*