• Journal of Trauma and Injury
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• v.19 no.1
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• pp.89-92
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• 2006

Penetrating facial wounds are uncommon and are usually life threatening because of the possibility of brain damage. There are three possible pathways for penetrating the cranium through the orbit: via the orbital roof, via the superior orbital fissure, or between the optic canal and lateral wall of the orbit. Brain injuries resulting from the penetrating wounds show extensive parenchymal damage, hemorrhage, and brain edema. Transorbital penetrating wounds can lead to diverse lesions of the optical apparatus, including the eye globe, the optical nerve, and the chiasm. Moreover, intracerebral structures may be hurt, and bleeding and infection may occur. Early diagnosis and prompt debridement are the fundamental factors affecting the outcome of a penetrating facial wound. An 87-year-old man was admitted to the emergency department with a grinder impacted into the medial aspect of the right eye. On presentation, the man was fully conscious with a Glasgow Coma Scale score of 15 and complained of a visual disturbance of the right eye. Computed tomography demonstrated a right orbital medial and inferior wall fracture, a frontal bone fracture, and a contusional hemorrhage in frontal lobe of the brain. A craniotomy with hematoma removal and repair of the orbital floor was done. He showed no neurological deficits except right visual loss. This appears to be the first report of a man with a penetrating facial wound caused by a grinder, who presented with a potentially disastrous craniocerebral injury that did not lead to any serious neurological seguelae.

• Journal of Korean Public Health Nursing
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• v.10 no.1
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• pp.106-117
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• 1996

This study aims to provide information about the acute poisoning patients transferred by 119 ambulance service for nurses and emergency medical technicians. The data is based on 119 ambulance services patients charts of Seocho area in Seoul. The results were as follows: 1. Total number of emergency patients all over the country has been nearly fourtimes in 1995 compared to 1991. Total number of emergency patients were 322.051 in 1994. 2. About $35\%$ of total E.R. patients were transferred by 119 ambulance services in Seoul in the last 5years. Acute drug intoxication patients occupied $2-3\%$ of E.R. patients in Seoul. 3. About $4\%$ of E.R. patients in Seoul were transferred by 119 E.R. services of Seocho area in Seoul in 1995. Among them $2.4\%$ patients were drug intoxication patients. 4. Data were collected from available patients of 119 ambulance services from Jan. 1993 to Dec. 1995 in Seocho area. Total poisoning patients were 184. - The female/male ratio was 69.7:30.4 and most of patients$(69.7\%)$ were in the age of 20th and 30th. - The busy time of calling 119 ambulance service was from 6P.M. to midnight$(37.5\%)$ - It took within 10 minutes for patients$(62.8\%)$ from notification to arrival in hospital. - Regarding poisoning substances. hypnotics $(22.8\%)$, tranquilizer$(14.7\%)$, agricultural agents$(6.0\%)$ rodenticide$(27\%)$ and others $(10.3\%)$ were in order and unknown were $43.5\%$. - Most of the patients or protector $(72.8\%)$ chose hospitals. Among them $(87.3\%)$ were general hospital. - The most predominant symptoms were coma$(22.3\%)$. dizziness$(6.5\%)$ and then allergy. vomiting. gastrointestinal cramps etc. - Airway management and oxygen administration together was the main medical control of prehospital emergency medical services$(33.7\%)$. It is proposed that first, a systematic survey of drug intoxication patients must be conducted to give an appropriate prehospital emergency care for the emergency medical technician and second, a wide and regular public education to improve understanding of first aids should be undertaken.

• Journal of Korean Neurosurgical Society
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• v.57 no.3
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• pp.197-203
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• 2015

Objective : The potassium disturbance associated with thiopental continuous infusion in neurosurgical patients is well known. However, the effect of propofol continuous infusion on serum potassium levels has not been investigated extensively. Methods : We reviewed the medical records of 60 consecutive patients who received coma therapy or deep sedation for intracranial pressure control using either thiopental or propofol between January 2010 and January 2012. Results : The overall incidence of hypokalemia (K<3.5 mmol/L) was comparable between thiopental and propofol groups (89.2% vs. 82.6%). But, the incidence of moderate to severe hypokalemia (K<3.0 mmol/L) was significantly higher in thiopental group (51.4% vs. 13.0%, p=0.003). The lowest potassium level (2.9 mmol/L vs. 3.2 mmol/L, p=0.020) was lower in thiopental group. The patients in the thiopental group required greater potassium replacement than the propofol group patients (0.08 mmol/kg/h vs. 0.02 mmol/kg/h, p<0.001). On multivariate analysis, thiopental [odds ratio, 95% confidence interval, 7.31 (1.78-27.81); p=0.005] was associated with moderate to severe hypokalemia during continuous infusion. The incidence of rebound hyperkalemia (K>5.0 mmol/L, 32.4% vs. 4.3%, p=0.010) and the peak potassium concentration (4.8 mmol/L vs. 4.2 mmol/L, p=0.037) after the cessation of therapy were higher in thiopental group. On multivariate analysis, thiopental [8.82 (1.00-77.81); p=0.049] and duration of continuous infusion [1.02 (1.00-1.04); p=0.016] were associated with rebound hyperkalemia once therapy was discontinued. Conclusion : Propofol was less frequently associated with moderate to severe hypokalemia after induction and rebound hyperkalemia following the cessation of continuous infusion than thiopental.

• Journal of Korean Neurosurgical Society
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• v.46 no.2
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• pp.109-115
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• 2009

Objective: The decision to adopt a conservative or surgical modality for a relatively small volume of spontaneous intracerebral hemorrhage (SICH) is difficult and often controversial, especially when consciousness is tolerable. The authors examined the results of stereotactic-guided evacuation of SICH for relatively small volumes with respect to functional outcome. Methods: This prospective study was performed on 387 patients with SICH who underwent stereotactic-guided evacuation (n = 204, group A) or conservative treatment (n = 183, group B) during the past 8 years. The primary end-point was recovery of functional status, which was estimated using the Modified Barthel Index (MBI) and the modified Rankin Scale (mRS). Results: All patients had a Glasgow coma scale (GCS) score of $\geq$ 13 and unilateral hemiparesis of less than motor power grade 3. Group demographic characteristics and initial neurological statuses were similar. In all cases, the volume of SICH involved was < 30 cm$^3$ and location was limited to basal ganglia and thalamus. At 6-month follow-ups, MBI was 90.9 in group A and 62.4 in group B (p < 005), and MRS was 1.2 in group A and 3.0 in group B (p < 0.05). Better motor function and stereotactic-guided evacuation had a significant effect on a functional recovery in regression analyses. Conclusion: Even in patients with a small volume of SICH, stereotactic-guided evacuation improved functional recovery in activities in daily life than conservative treatment did.

• Journal of Korean Neurosurgical Society
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• v.54 no.4
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• pp.296-301
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• 2013

Objective : We conducted a retrospective study examining the outcomes of intracerebral hemorrhage (ICH) in patients with chronic kidney disease (CKD) to identify parameters associated with prognosis. Methods : From January 2001 to June 2008, we treated 32 ICH patients (21 men, 11 women; mean age, 62 years) with CKD. We surveyed patients age, sex, underlying disease, neurological status using Glasgow Coma Scale (GCS), ICH volume, hematoma location, accompanying intraventricular hemorrhage, anti-platelet agents, initial and 3rd day systolic blood pressure (SBP), clinical outcome using the modified Rankin Scale (mRS) and complications. The severity of renal functions was categorized using a modified glomerular filtration rate (mGFR). Multifactorial effects were identified by regression analysis. Results : The mean GCS score on admission was $9.4{\pm}4.4$ and the mean mRS was $4.3{\pm}1.8$. The overall clinical outcomes showed a significant relationship on initial neurological status, hematoma volume, and mGFR. Also, the outcomes of patients with a severe renal dysfunction were significantly different from those with mild/moderate renal dysfunction (p<0.05). Particularly, initial hematoma volume and sBP on the 3rd day after ICH onset were related with mortality (p<0.05). However, the other factors showed no correlation with clinical outcome. Conclusion : Neurological outcome was based on initial neurological status, renal function and the volume of the hematoma. In addition, hematoma volume and uncontrolled blood pressure were significantly related to mortality. Hence, the severity of renal function, initial neurological status, hematoma volume, and uncontrolled blood pressure emerged as significant prognostic factors in ICH patients with CKD.

• Journal of Korean Neurosurgical Society
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• v.59 no.5
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• pp.485-491
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• 2016

Objective : The aims of the Korean Neuro-Trauma Data Bank System (KNTDBS) are to evaluate and improve treatment outcomes for brain trauma, prevent trauma, and provide data for research. Our purpose was to examine the mortality rates following traumatic brain injury (TBI) in a retrospective study and to investigate the sociodemographic variables, characteristics, and causes of TBI-related death based on data from the KNTDBS. Methods : From 2010 to 2014, we analyzed the data of 2617 patients registered in the KNTDBS. The demographic characteristics of patients with TBI were investigated. We divided patients into 2 groups, survivors and nonsurvivors, and compared variables between the groups to investigate variables that are related to death after TBI. We also analyzed variables related to the interval between TBI and death, mortality by region, and cause of death in the nonsurvivor group. Results : The frequency of TBI in men was higher than that in women. With increasing age of the patients, the incidence of TBI also increased. Among 2617 patients, 688 patients (26.2%) underwent surgical treatment and 125 patients (4.7%) died. The age distributions of survivors vs. nonsurvivor groups and mortality rates according the severity of the brain injury, surgical treatment, and initial Glasgow Coma Scale (GCS) scores were statistically significantly different. Among 125 hospitalized nonsurvivors, 70 patients (56%) died within 7 days and direct brain damage was the most common cause of death (80.8%). The time interval from TBI to death differed depending on the diagnosis, surgical or nonsurgical treatment, severity of brain injury, initial GCS score, and cause of death, and this difference was statistically significant. Conclusion : Using the KNTDBS, we identified epidemiology, mortality, and various factors related to nonsurvival. Building on our study, we should make a conscious effort to increase the survival duration and provide rapid and adequate treatment for TBI patients.

• Journal of Korean Neurosurgical Society
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• v.30 no.9
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• pp.1072-1078
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• 2001

Objectives : There is continuing controversy about the benefits of decompressive craniectomy in massive cerebral edema following space occupying hemispheric cerebral infarction. The aims of this study are to determine the effectiveness and to confirm the life-saving nature of decompressive craniectomy with dural augmentation for massive cerebral infarction. Patients and Methods : We present twelve patients with medically uncontrollable hemispheric cerebral infarction. All were treated with extensive craniectomy and duroplasty without resection of necrotic tissue. We evaluated various characteristics(size of hemispheric infarction, Glasgow Coma Scale, volume of low density and midline shift in CT) at three different periods(preoperative, immediate postoperative and 3-4weeks after operation) and evaluated effectiveness of hemicraniectomy for massive cerebral edema after large hemispheric infarction. Results : All patients have survived from surgery. Nine patients with nondominant hemispheric infarction showed significant functional recovery with minimal assistance, and remaining two patients with dominant hemispheric infarction and one patient with nondominant hemispheric infarction have functionally dependent. The volume of low density and midline shift in CT were significantly reduced after decompressive craniectomy. Conclusions : Our results indicate that decompressive craniectomy with dural augmentation without resection of necrotic tissue for massive cerebral hemispheric infarction not only reduce the mortality and infarction size but also significantly improve the outcome, especially for nondominant hemispheric infarction.

• Journal of Korean Neurosurgical Society
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• v.43 no.5
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• pp.227-231
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• 2008

Objective : Earlier reports have revealed that the incidence of posttraumatic hydrocephalus (PTH) is higher among patients who underwent decompressive craniectomy (DC). The aim of this study was to determine the influencing factors for the development of PTH after DC. Methods : A total of 693 head trauma patients admitted in our hospital between March 2004 and May 2007 were reviewed. Among thee, we analyzed 55 patients with severe traumatic brain injury who underwent DC. We excluded patients who had confounding variables. The 33 patients were finally enrolled in the study and data were collected retrospectively for these patients. The patients were divided into two groups: non-hydrocephalus group (Group I) and hydrocephalus group (Group II). Related factors assessed were individual Glasgow Coma Score (GCS), age, sex, radiological findings, type of operation, re-operation and outcome. Results : Of the 693 patients with head trauma, 28 (4.0%) developed PTH. Fifty-five patients underwent DC and 13 (23.6%) developed PTH. Eleven of the 33 study patients (30.3%) who had no confounding factors were diagnosed with PTH. Significant differences in the type of craniectomy and re-operation were found between Group I and II. Conclusion : It is suggested that the size of DC and repeated operation may promote posttraumatic hydrocephalus in severe head trauma patients who underwent DC.

• Journal of Korean Neurosurgical Society
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• v.48 no.5
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• pp.399-405
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• 2010

Objective : Patients with spontaneous intracerebral hemorrhage (ICH) presenting within 24 hours of symptom onset are known to be increased risk of hematoma expansion which is closely correlated with morbidity and mortality. We investigated whether tiny enhancing foci ('Spot sign') on axial view of 3-dimensional computed tomography angiography (3D-CTA) source images can predict subsequent hematoma expansion in spontaneous ICH. Methods : During a 2-year period (March 2007-March 2009), we prospectively evaluated 3D-CTA of 110 patients with spontaneous ICH. Based on source images of 3D-CTA, patients were classified according to presence or absence of 'Spot sign'; 'Spot sign' (+) group, 'Spot sign' (-) group. Radiological factors and clinical outcomes were compared between two groups. Results : Hematoma expansion occurred in 16 patients (15%). Mean Glasgow Coma Scale (GCS) score of patients with hematoma expansion was significantly different compared to score of patients without hematoma expansion (5 vs. 9, P < 0.001). Nineteen patients (16%) of 110 ICH patients demonstrated 'spot sign' on 3D-CTA. Among the 'spot sign' (+) group, 53% of patients developed hematoma expansion. Conversely 7% of patients without 'spot sign' demonstrated the hematoma expansion (p < 0.001). Initial volume and location of hematoma were significantly not associated with hematoma expansion except shape of hematoma. Conclusion : Our study showed that patients with hematoma expansion of spontaneous ICH had significant clinical deterioration. And the fact that 'spot sign' (+) group have higher risk of hematoma expansion suggests the presence of 'spot sign' on source images of 3D-CTA can give a clue to predict hematoma expansion in spontaneous ICH.

• Journal of Korean Neurosurgical Society
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• v.46 no.4
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• pp.365-369
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• 2009

Objective : Susceptibility-weighted image (SWI) is a sensitive magnetic resonance image (MRI) technique to detect cerebral microbleeds (MBLs). which would not be detected by conventional MRI. We performed SWI to detect MBLs and investigated its usefulness in the evaluation of mild traumatic brain injury (MTBI) patients. Methods : From December 2006 to June 2007, twenty-one MTBI patients without any parenchymal hemorrhage on conventional MRI were selected. Forty-two patients without trauma were selected for control group. According to the presence of MBLs, we divided the MTBI group into MBLs positive [SWI (+)] and negative [SWI (-)] group. Regional distribution of MBLs and clinical factors were compared between groups. Results : Fifty-one MBLs appeared in 16 patients of SWI (+) group and 16 MBLs in 10 patients of control group [control (+)], respectively. In SWI (+) group, MBLs were located more frequently in white matters than in deep nucleus different from the control (+) group (p<0.05). Nine patients (56.3%) of SW (+) group had various neurological deficits (disorientation in 4, visual field defect in 2, hearing difficulty in 2 and Parkinson syndrome in 1). Initial Glasgow Coma Scale (GCS)/mean Glasgow Outcome Scale (GOS) were $13.9{\pm}1.5/4.7{\pm}0.8$ and $15.0{\pm}0.0/5.0{\pm}0.0$ in SWI (+) and SWI (-) groups, respectively (p<0.05). Conclusion : Traumatic cerebral MBLs showed characteristic regional distribution, and seemed to have an importance on the initial neurological status and the prognosis. SWI is useful for detection of traumatic cerebral MBLs, and can provide etiologic evidences for some post-traumatic neurologic deficits which were unexplainable with conventional MRI.