• Journal of Korean Neurosurgical Society
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• v.30 no.1
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• pp.66-72
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• 2001

Apatient with multiple dissecting aneurysms of a posterior inferior cerebellar artery trunk who presented with SAH is reported. A 58-year-old woman presented with sudden occipital headache, dizziness and vomiting. The intial vertebral angiography revealed a suspicious pearl and string sign at the proximal posterior inferior cerebellar artery(PICA) segment. After 2 weeks, follow up angiography showed a progression of the proximal PICA dissection and newly developed dissecting aneurysm of the distal PICA segment. A far lateral suboccipital transcondylar appoach confirmed two dissecting aneurysms at distant sites of the PICA trunk. The dissection segments were wrapped with muslin wrap, which preserved the flow through the PICA and brain stem perforators. The angiographys at 3 weeks and 6 months after operation revealed serial disappearance of the dissecting aneurysms which is distal to proximal. The diagnosis, course and treatment of the dissecting aneurysms of the PICA are discussed with literature review.

• Journal of Korean Neurosurgical Society
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• v.54 no.2
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• pp.139-141
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• 2013

Presented here is a 36-year-old male with arterial hypertension who developed brainstem edema and intracranial hemorrhage. Magnetic resonance scan revealed diffuse brainstem hyperintensity in T2-weighted and fluid-attenuated inversion-recovery images, with an increase in apparent diffusion coefficient values. After a reduction in blood pressure, rapid resolution of the brainstem edema was observed on follow-up. The patient's condition was thus interpreted as hypertensive brainstem encephalopathy. While many consider this a vasogenic phenomenon, induced by sudden, severe hypertension, the precise mechanism remains unclear. Prompt recognition and aggressive antihypertensive treatment in such patients are essential to prevent permanent or life-threatening neurologic injury.

• The Korean Journal of Physiology and Pharmacology
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• v.8 no.4
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• pp.181-185
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• 2004

Extracellular regulated protein kinase1/2 (pERK1/2) is one of the major regulatory factors for transcription of the c-fos oncogene in neurons. The purpose of this study was to evaluate the expression of phosphorylated ERK1/2 within the vestibular nuclei (VN) of rats following acute arterial hypotension. Following the acute arterial hypotension induced by rapid hemorrhage, a significant number of pERK1/2-immunoreactive neurons appeared bilaterally in the caudal aspect of the medial and inferior VN. No labeling of pERK1/2 was observed in the lateral VN. The peak expression of pERK1/2 in these nuclei occurred within 5 min after hemorrhage. However, in bilaterally labyrinthectomized rats, the appearance of pERK1/2-immunoreactive neurons was eliminated in the VN. Western blot confirmed the effect of bilateral labyrinthectomy on pERK1/2 protein expression in the medial vestibular nucleus 5 min after hemorrhage. These results suggest that, following acute hypotension, afferent signals from the peripheral vestibular receptors are required for activation of ERK 1/2 in the VN.

• Clinical and Experimental Pediatrics
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• v.51 no.12
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• pp.1363-1367
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• 2008

Cavernous hemangioma can occur in the entire brain but rarely in cerebellum, especially in the pediatric age group. Headache, seizure, gait disturbance, recurrent bleeding may be seen. This tumor is a relatively benign condition but if the lesion located in the posterior fossa or the brain stem bleeds, irreversible brain damage may occur because of its restrictive space. Moreover, it must be differentiated from malignant tumors. We report 12.6 year-old boy who represented posterior neck myalgia as the presenting symptom. The pain continued for about a month despite analgesic medications. Brain MRI showed intracranial hemorrhage in the left cerebellum (4.5 cm) representing repeated hemorrhages at different times and originated from the cavernous hemangioma accompanied by mild hydrocephalus. The lesion was surgically removed successfully and the cavernous hemangioma was confirmed by pathologic findings. After the follow-up period of 14 months, he is in good condition without any complications.

• The Journal of Internal Korean Medicine
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• v.23 no.2
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• pp.298-305
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• 2002

These cases were performed on the bases of clinical consideration about patients who had Methicillin-Resistant Staphylococcus aureus(MRSA) infection. One patient was a 67-years-old women who had sequela of inter cranial hemorrhage & inter ventricular hemorrhage, hypertention, urinary tract infection and pneumonia. Clinical symptoms were intermittent fever, sputum, Lt. side hemiparesis and dysphagia. She was chronic, repeated infection state. It could be regarded as "unpreparedness of the spirit which animates and controls the universe; 正氣虛", the oriental term which indicates a condition of chronic disease or general weakness. According to the oriental medicine principle, oriental medicine was taken such as Wunggunza-tang(六君子湯) and the patient had taken a turn for the better. After 3 months, MRSA infection diappeared. The other patient was a 43-years-old women who had Both brain stem infarction, Lt. cerebellar infarction, hypercholesterolemia, urinary tract infection and pneumonia, Clinical symptoms were quadriplegia, dysphagia(levin tube insert state), aphasia, respiration disorder(tracheostomy cannular keep state) and sputum. She was chronic, repeated infection state. It could be regarded as "unpreparedness of spleen energy, unpreparedness of both energy and blood; 脾氣虛, 氣血兩虛", the oriental term which indicates a condition of chronic disease or immunodeficiency. According to the oriental medicine principle, oriental medicine was taken such as Bojungyggi-tang(補中益氣湯), Palmul-tang(八物湯) and the patient had taken a turn for the better. After I month, MRSA was turned into Escherichia coli.

• Journal of Korean Neurosurgical Society
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• v.53 no.3
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• pp.194-196
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• 2013

Isolated abducens nerve paresis related to ruptured vertebral artery (VA) aneurysm is rare. It usually occurs bilaterally or ipsilaterally to the pathologic lesions. We report the case of a contralateral sixth nerve palsy following ruptured dissecting VA aneurysm. A 38-year-old man was admitted for the evaluation of a 6-day history of headache. Abnormalities were not seen on initial computed tomography (CT). On admission, the patient was alert and no signs reflecting neurologic deficits were noted. Time of flight magnetic resonance angiography revealed a fusiform dilatation of the right VA involving origin of the posterior inferior cerebellar artery. The patient suddenly suffered from severe headache with diplopia the day before the scheduled cerebral angiography. Neurologic examination disclosed nuchal rigidity and isolated left abducens nerve palsy. Emergent CT scan showed high density in the basal and prepontine cistern compatible with ruptured aneurismal hemorrhage. Right vertebral angiography illustrated a right VA dissecting aneurysm with prominent displaced vertebrobasilar artery to inferiorly on left side. Double-stent placement was conducted for the treatment of ruptured dissecting VA aneurysm. No diffusion restriction signals were observed in follow-up magnetic resonance imaging of the brain stem. Eleven weeks later, full recovery of left sixth nerve palsy was documented photographically. In conclusion, isolated contralateral abducens nerve palsy associated with ruptured VA aneurysm may develop due to direct nerve compression by displaced verterobasilar artery triggered by primary thick clot in the prepontine cistern.

• Clinical and Experimental Pediatrics
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• v.59 no.10
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• pp.395-401
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• 2016

Since the outbreak of the enterovirus 71 (EV71) infection in Malaysia in 1997, large epidemics of EV71 have occurred in the Asia-Pacific region. Many children and infants have died from serious neurological complications during these epidemics, and EV71 infection has become a serious public health problem in these areas. EV71 infection causes hand, foot and mouth disease (HFMD) in children, and usually resolves spontaneously. However, EV71 occasionally involves the central nervous system (CNS), and induces diverse neurological complications such as brainstem encephalitis, aseptic meningitis, and acute flaccid paralysis. Among those complications, brainstem encephalitis is the most critical neurological manifestation because it can cause neurogenic pulmonary hemorrhage/edema leading to death. The characteristic clinical symptoms such as myoclonus and ataxia, cerebrospinal fluid (CSF) pleocytosis, and brainstem lesions on magnetic resonance imaging, in conjunction with the skin rash of HFMD and the isolation of EV71 from a stool, throat-swab, or CSF sample are typical findings indicating CNS involvement of EV71 infection. Treatment with intravenous immunoglobulin and milrinone are recommended in cases with severe neurological complications from EV71 infection, such as brainstem encephalitis. Despite the recent discovery of receptors for EV71 in human cells, such as the scavenger receptor B2 and P-selection glycoprotein ligand 1, it is not known why EV71 infection predominantly involves the brainstem. Recently, 3 companies in China have completed phase III clinical trials of EV71 vaccines. However, the promotion and approval of these vaccines in various countries are problems yet to be resolved.

• Journal of Korean Neurosurgical Society
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• v.29 no.6
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• pp.748-753
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• 2000

Objectives : A 10-year retrospective clinical study was undertaken to determine the differences between two groups according to age at presentation(group A, under 50 ; B, over 50). Methods : We analyzed 468 cases with chronic subdural hematoma admitted to the department of neurosurgery in our hospital from January 1987 to December 1996. The patients were divided into two groups according to age at presentation(group A, under 50 ; B, over 50). Results : 1) The number of group A was 126 cases(26.9%) and that of group B was 342 cases(73.1%), respectively. Males were more frequently involved than females in each group. 2) There noted a history of head trauma in 88.9% of group A and 92.4% of group B. Forty-nine patients(38.9%) of group A and 103 cases(30.1%) of group B revealed a history of alcoholism. 3) Group A patients presented with symptoms of increased intracranial pressure such as headache(75.% ), nausea and vomiting(68.0%). However, Group B patients had more frequent mental changes(84.0%) and focal neurological deficits such as hemiparesis(76.5%). 4) Onset of symptom and its duration was shorter in group A than group B. 5) Six patients among 441 cases(1.4%) treated with burr hole drainage and two patients of 27 cases(5.4%) with craniotomy died, and all of these were group B patients. The two cases among six patients with burr hole drainage developed huge intracerebral hemorrhage and brain stem hemorrhage, respectively. Conclusion : In treating patients with chronic subdural hematoma, distinguishing between two age groups is quite helpful to determine treatment strategies.