Recurrent Spontaneous Intracerebral Hemorrhage

OBJECTIVE: Recently, the survival rate and prognosis of spontaneous intracerebral hemorrhage(S-ICH) has improved, and their enhanced survival has become associated with a consequent rise in the recurrence of S-ICH. The aim of this study is to improve the prevention of recurrent S-ICH. METHODS: Between January 1999 and March 2004, we experienced 48 cases of recurrence. We classified the patients into the two groups; a double ICH group and a triple ICH group. We investigated their brain CTs, MRIs, cerebral angiographies, and medical records, retrospectively. RESULTS: Majority of patients had the intervals at least 12 months, and most of patients underwent conservative treatment. The most common hemorrhage pattern of recurrence was ganglionic-ganglionic (basal ganglia-basal ganglia), and the second attack was contralateral side of the first attack in a large percentage of all patients. Prognosis of patients was worsened in recurrent attack. Nearly all patients had medical history of hypertension, and most patients have taken antihypertensive medication at the arrival of emergency room. CONCLUSION: In treating hypertension for S-ICH patients, we stress that blood pressure must be thoroughly controlled over a long period of time.

Inhibitory Effects of Toxoplasma Antigen on Proliferation and Invasion of Human Glioma Cells

OBJECTIVE: Currently available therapies for human malignant gliomas have limited efficacy. Toxoplasma gondii, an obligate intracellular protozoan parasite, and Quil-A are nonspecific, potent immune stimulants. T. gondii is shown to have antitumor activity in some types of cancers. Therefore, this study is undertaken to evaluate the antitumor effect of Toxoplasma lysate antigen (TLA), alone or in combination with Quil-A, on human glioma U373MG and U87MG cells. METHODS: The in vitro effects of TLA alone or in combination with Quil-A on the proliferation, invasion, and apoptosis of glioma cells were tested using MTT, Matrigel invasion, and DNA fragmentation assays, and the in vivo effects on the growth of gliomas were evaluated in athymic nude mice transplanted with glioma cells. RESULTS: Treatment with TLA resulted in the suppressed proliferation and invasion of both U373MG and U87MG cells, in a dose-dependent manner. In addition, at high concentration, TLA induced glioma cell apoptosis. When TLA was administered in the mouse glioma model, malignant glioma growth was decreased. The combined treatment of TLA with Quil-A significantly inhibited the proliferation and invasion of cultured cells as well as tumor mass of implanted mice. CONCLUSION: TLA inhibits the proliferation and invasion of glioma cells in vitro and in vivo, and these antitumor effects of TLA are significantly enhanced by the addition of Quil-A.

Traumatic Pericallosal Artery Aneurysm

No abstract available.

Analysis of Factors Affecting Survival Period in Glioblastoma

No abstract available.

Clinical Analysis of the Risk Factors and Prognostic Factors of Delayed Deterioration Following Mild Head Injury

OBJECTIVE: The objective of this study was to analyze the clinical course of mild head injury patients and to investigate the risk and prognostic factors of delayed deterioration. METHODS: We retrospectively studied 366 consecutive patients with Glasgow Coma Scale scores ranging from 13 to 15 who were admitted to the neurosugery department from January 1995 to December 1997. RESULTS: Among 51(13.9%) patients with delayed deterioration, 13(25.5%) died and 36(70.6%) patients had favorable outcomes. Statistically correlated risk factors of delayed deterioration were: old age, drowsiness or speech disturbance, a low GCS score, abnormal laboratory findings including coagulopathy, electrolyte imbalance, hyperglycemia, and presence of subdural hematoma in initial brain CT. Twentyeight(54.9%) patients with delayed deterioration underwent neurosurgical intervention and 229(72.1%) patients without delayed deterioration were treated conservatively. Only sex, age and the GCS score on admission or deterioration were statistically correlated with prognosis of delayed deteriorated patients. CONCLUSION: Delayed deterioration following mild head injury may need an urgent operation, or lead to serious complication or disability. Therefore, physicians treating these patients must aware of the risk factors and prognostic factors of delayed deterioration to prevent more serious sequelae or to make an early diagnosis allowing for proper treatment. We also recommend special caution in patients with the abovementioned risk factors to ensure a even better prognosis for patients with mild head injury.

Rerupture of Cerebral Aneurysms during Angiography: Report of 3 Cases

Rerupture of intracranial aneurysms during cerebral angiography is a rare complication and it usually occurs with in 24 hours after initial bleeding. We experienced three cases of aneurysmal rerupture during cerebral angiography, and in each case, angiography was performed after 24 hours from the initial attack. We have noticed extravasation of contrast medium to subarachnoid space or intraventricular space during angiography. In result, two patients died and one patient was disabled moderately.

Distal Posterior Cerebral Artery Aneurysms: Report of 2 Cases

Two cases of aneurysms in the P3 segment of the posterior cerebral artery are described. These were managed by the subtemporal approach. One giant aneurysm in a 47-year-old male was treated by clipping the afferent artery, and the other small saccular aneurysm in a 41-year-old female was treated by clipping the aneurysmal neck. There were no complications after surgery, and the patients were discharged without neurological deficit. The operative approaches and procedures are also discussed in relation to the anatomy of posterior cerebral artery aneurysms.

Clinical Comparative Study of Cerebral Aneurysms in Young and Old Aged Patients

Among the four-hundred patients with cerebral aneurysms confirmed by cerebral angiography, we divided them into two age groups, one with ages 39 years or younger(young-aged group: 51 patients, 12.8%), and another with ages 65 years or older(old aged group: 45 patients, 11.3%). A comparison was undertaken in regard to clinical characteristics and overall outcome in two groups. In young-aged group, the female-to-male ratio was 2.2: 1 whereas, women was predominant by five times more in old aged group. Anterior communicating artery aneurysm was the most common site(43.1%) in young-aged group, unlike to old aged group where posterior communicating artery was the most common site(33.3%). The most common symptom was headache in both groups, and the hypertension was more frequent in young-aged group(45.5%) than old-aged group(33.3%). Surgery was performed in 43 patients(84%) in younger group, and 37 patients(82.2%) in elderly group. Young-aged group showed more favorable outcome(91%) than old-aged group(70%).

Clinical Analysis of Surgically Treated 134 Cases of Anterior Communicating Artery Aneurysms

This study is a retrospective clinical analysis of 134 cases of anterior communicating artery aneurysms surgically treated in the Department of Neurosurgery, Chungnam National University Hospital from January 1990 to December 1996. The results of analysis were summarized as follows; 1) Peak age incidence was in the sixth decade and male to female ratio was 1: 1.2, showing female predominancy. 2) There was no statistically significant relationship between direction of aneurysm and Fisher's grade, and occurrence of hydrocephalus, and also between the direction, size and shape of aneurysm and preoperative Hunt-Hess grade. 3) There was statistically significant relationship between the shape of aneurysm and angiographic vasospasm; there was high incidence of vasospasm in lobulated and oval shape of aneurysm. But there was no statistically significant relationship between the direction, size of aneurysm and angiographic vasospasm. 4) The correlations between outcome and preoperative Hunt-Hess grade, and occurrence of angiographic vasospasm, and temporary clipping were statistically significant; the outcome was good in cases of no vasospasm, temporay clipping and better preoperative Hunt-Hess grade. 5) The direction, shape and size of aneurysm, existence or not of abnormality in circle of willis, timing of surgery and operative procedure had no statistically significant relationship with outcome. 6) Postoperative complications were vasospasm and infarction(18.7%), brain edema, hydrocephalus, in order of frequency, and the mortality rate was 3%.

A Case of Mixed Germ Cell Tumor in the Third and Lateral Ventricle

The authors report a case of mixed germ cell tumor arising at the third ventricle and extending to the lateral ventricle in a sixteen-year-old male who presented with headache, nausea, vomiting and polydipsia. Magnetic resonance imaging of the brain demonstrated a lobulated mass in the third and left lateral ventricle. For surgery, the anterior interhemispheric transcallosal approach was used, and on histologic examination three concurrent histologic components were found: germinoma, embryonal carcinoma, and endodermal sinus tumor.