• Journal of Korean Neurosurgical Society
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• 제51권4호
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• pp.215-218
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• 2012

Objective: Traumatic epidural hematomas (EDHs) in children are a relatively unusual occurrence. The cause and outcome vary depending on period and reg ion of study. The aims of this analysis were to review the cause and outcome of pediatric EDHs nowadays and to discuss outcome-related variables in a large consecutive series of surgically treated EDH in children. Methods: This is a retrospective review of 29 patients with surgically treated EDHs between Jan 2000 and February 2010. Patients' medical records, computed tomographic (Cl) scans, and, if performed, magnetic resonance imaging (MRI) were reviewed to define variables associated with outcome. Variables included in the analysis were age, associated severe intracranial injury, abnormal pupillary response, hematoma thickness, severity of head injury (Glasgow Coma Scale score), parenchymal brain injury, and diffuse axonal injury. Results: The mean (SO) age of the patients was 109 months (0-185 months). Most of the injuries with EDHs occurred in traffic accident (14 cases, 48.2%) and followed by slip down in 6 cases and falls in 6 cases. There were one birth injury and one unknown cause. EDHs in traffic accidents occurred in pedestrians hit by a motor vehicle, 9 cases; motorbike and car accidents, 5 cases and bicycle accidents, 1 case. The locations of hematoma were almost same in both sides (left side in 15 cases). Temporal lobe is the most common site of hematomas (13 cases, 44%). The mean size of the EDHs was 18 mm (range, 5-40 mm). Heterogeneous hematomas in CT scans were 20 cases (67%). Two patients were referred with unilateral or bilateral dilated pupil(s). There was enlargement of EDH in 5 patients (17%). All of them were heterogeneous hematomas in CT scans. Except for 4 patients, all EDHs were associated with skull fracture(s) (87%). There was no case of patient with major organ injury. CT or MRI revealed brain contusion in 5 patients, and diffuse axonal injury in one patient The mortality was zero, and the outcomes were excellent in 26 and good in 2 patients. None of the tested variables were found to have a prognostic relevance. Conclusion: Regardless of the EDH size, the clinical status of the patients, the abnormal pupillary findings, or the cause of injury, the outcome and prognosis of the patients with EDH were excellent.

• Structural Engineering and Mechanics
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• 제48권5호
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• pp.661-679
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• 2013

In this work, the safety performance of a commercial motorcycle helmet already placed on the market is assessed. The assessed motorcycle helmet is currently homologated by several relevant motorcycle standards. Impacts including translational and rotational motions are accurately simulated through a finite element numerical framework. The developed model was validated against experimental results: firstly, a validation concerning the constitutive model for the expanded polystyrene, the material responsible for energy absorption during impact; secondly, a validation regarding the acceleration measured at the headform's centre of gravity during the linear impacts defined in the ECE R22.05 standard. Both were successfully validated. After model validation, an oblique impact was simulated and the results were compared against head injury thresholds in order to predict the resultant head injuries. From this comparison, it was concluded that brain injuries such as concussion and diffuse axonal injury may occur even with a helmet certified by the majority of the motorcycle helmet standards. Unfortunately, these standards currently do not contemplate rotational components of acceleration. Conclusion points out to a strong recommendation on the necessity of including rotational motion in forthcoming motorcycle helmet standards and improving the current test procedures and head injury criteria used by the standards, to improve the safety between the motorcyclists.

• Journal of Korean Neurosurgical Society
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• 제56권6호
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• pp.531-533
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• 2014

We present a case of angiographically confirmed transection of the cisternal segment of the anterior choroidal artery (AChA) associated with a severe head trauma in a 15-year old boy. The initial brain computed tomography scan revealed a diffuse subarachnoid hemorrhage (SAH) and pneumocephalus with multiple skull fractures. Subsequent cerebral angiography clearly demonstrated a complete transection of the AChA at its origin with a massive extravasation of contrast medium as a jet trajectory creating a plume. We speculate that severe blunt traumatic force stretched and tore the left AChA between the internal carotid artery and the optic tract. In a simulation of the patient's brain using a fresh-frozen male cadaver, the AChA is shown to be vulnerable to stretching injury as the ipsilateral optic tract is retracted. We conclude that the arterial injury like an AChA rupture should be considered in the differential diagnosis of severe traumatic SAH.

• Journal of Korean Neurosurgical Society
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• 제29권10호
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• pp.1296-1302
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• 2000

Objective : Traumatic brain injury including diffuse axonal injury has been shown to result in a decrease in brainfree magnesium concentration, an endogenous inhibitor of calcium entry into neuron, that is associated with the development of neurological motor deficits. The goal of this study is to establish the therapeutic window during which the therapy with $MgSO_4$ and/or hypothermia improve damaged neurons by TUNEL stain. Method : Moderate brain injury was induced in 64 adult Sprague-Dawley rats, weighing 350 to 450gm each, by using a simple weight-drop device(Marmarou model). The animals were randomly assigned to four groups(sixteen rats each, a control group, a group treated with $MgSO_4$, a group treated with hypothermia, and a group treated with $MgSO_4$ and hypothermia) and the rats in each group were sacrificed and studied after 12 hrs, 24 hrs, 1 wk, and 2 wks after insult. In hypothermic group, these rats were subjected to hypothermia after injury, with their rectal temperatures maintained at $32^{\circ}C$ for 1 hour. After 1-hour period of hypothermia, rewarming to normothermic level was accomplished over 30-minute period. In the groups treated $MgSO_4$, hypothermia and $MgSO_4$ were subsequently treated with $MgSO_4$($750{\mu}moles/kg$) infused intra-muscularly at 30 minutes after trauma. Result : In all treated groups, a significant reduction in TUNEL positive cells was found in comparison with the control group each time(p<0.001). Between treatment groups, No differnce was seen 12hrs, 24hrs, and 1wk. However, hypothermic group treated with or without $MgSO_4$ showed more significant reduction in apoptotic cells than group treated with $MgSO_4$ 2 weeks after trauma(p<0.05). However, hypothermic group treated with $MgSO_4$ showed no significant reduction in apoptotic cells compared with hypothermic group(p>0.05). Conclusion : These findings suggest that both hypothermia and $MgSO_4$ significantly improve pathological changes. Otherwise simultaneously $MgSO_4$ and hypothermia treatment groups is failed to provide additional neuroprotection. These results may be relevant to the design of future clinical trials of therapeutic hypothermia and $MgSO_4$ for traumatic brain injury.

• Journal of Chest Surgery
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• 제47권2호
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• pp.181-184
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• 2014

Here, we report a case of massive rhabdomyolysis following an uncomplicated repair of a ventricular septal defect in a five-month-old baby. Postoperatively, the patient was hemodynamically stable but metabolic acidosis continued, accompanied by fever and delayed mental recovery. The next day, he became comatose and never regained consciousness thereafter. The computed tomography of the brain revealed a diffuse brain injury. The patient followed a downhill course and eventually died on postoperative day 33. An unusually high level of creatine phosphokinase was noticed, peaking (21,880 IU/L) on postoperative day 2, suggesting severe rhabdomyolysis. The relevant literature was reviewed, and the possibility of malignant hyperthermia obscured by cardiopulmonary bypass and hypothermia was addressed.

• Journal of Korean Neurosurgical Society
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• 제50권5호
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• pp.472-474
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• 2011

Cortical laminar necrosis appears as hyperinense lesions with a laminar pattern on T1 weighted magnetic resonance (MR) imaging, without signs of hemorrhage or calcification on T2 weighted MR imaging or computed tomography. It has been reported to be associated with hypoxia, metabolic disturbances, drugs, and infections. We present a 12 month-old male infant who suffered diffuse brain injuries following car accident and showed laminar necrosis of cortex.

• Journal of Korean Neurosurgical Society
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• 제30권2호
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• pp.168-172
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• 2001

Objective : The authors have studied the clinical outcome of patients with diffuse axonal injuries(DAI) to evaluate the prognostic value of gradient-echo MR imaging findings. Materials and Methods : From March 1995 to March 1998, there were nineteen patients with DAI whose initial Glasgow coma scales were eight or less. Authors divided them into two groups according to Glasgow outcome scales ; those patients with GOS 3 or less(group A ; 9) and those with 4 or more(group B ; 10). We subdivided the lesions as superficial and deep lesion, and analyzed the numbers, anatomical loci of the lesions on the gradient echo images of each group. Results : Mean numbers of the lesions were 15 per case in group A(135/9) and 10 in group B(100/10). The common loci involved in DAI were cerebral cortex, brain stem, and corpus callosum. Cortical lesions were 31.1% in group A(42/135) and 47% in group B(47/100). Brain stem lesions were 25.9%(35/135) and 15%(15/100) each. Callosal lesions were 31.1%(26/135) and 13%(13/100) each. The frequency of callosal and brain stem lesions was significantly different between two groups(p<0.05). We divided callosal lesions as genu, body, and splenium and body lesions as anterior, middle, posterior, but no significant topographical difference of lesions was observed between two groups. Deep lesions were observed more frequently in group A(58.5%, 79/135) than group B(36%, 36/100). Conclusion : The poor outcome group showed more numbers of lesion and more frequent involvement of brain stem and corpus callosum than favorable outcome group. Gradient-echo MR imaging seems to have predictive value for clinical outcome in patients with DAI.

• 대한핵의학회지
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• 제28권3호
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• pp.301-306
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• 1994

The purpose of this study was to compare Tc-99m-HMPAO SPECT with MRI after acute and subacute closed-head injury. There were thirty two focal lesions in all cases of these. Fifteen lesions(47%) were seen on both MRI and SPECT. Fourteen lesions(44%) were seen only on MRI. Three lesions(9%) were seen only on SPECT. Of the 14 lesions seen only on MRI, one was epidural hematoma, two were subdural hematoma, three were subdural hygroma, one was intracerebral hematoma, four were contusion, and three were diffuse axonal injuries. SPECT detected 52% of the focal lesions found on MRI. For the detection of lesions, MRI was superior to SPECT in fourteen cases, while SPECT was superior to MRI in three cases. In conclusion, there was a tendency that detection rate of the traumatic lesions was higher on MRI, but the SPECT could delineate more wide extent of lesion.

• Journal of Korean Neurosurgical Society
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• 제54권2호
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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.

• 대한임상독성학회지
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• 제14권2호
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• pp.151-154
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• 2016

Increased plasma insulin levels are often observed in exogenous insulin overdose patients. However, plasma insulin level may decrease with time. We report a case of low plasma insulin level hypoglycemia after insulin lispro overdose. The patient was a 37-year-old man with no previous medical history who suspected insulin lispro overdose. Upon arrival, his Glasgow coma scale was 3 points and his blood sugar level (BSL) was 24 mg/dl. We found five humalog-quick-pen (insulin lispro) in his bag. There was no elevation of glucose level, despite an initial 50 ml bolus of 50% glucose and 150 cc/hr of 10% dextrose continuous intravenous infusion. He also suffered from generalized tonic-clonic seizure, which was treated with lorazepam and phenytoin. We conducted endotracheal intubation, after which he was admitted to the intensive care unit (ICU). There were recurrent events of hypoglycemia below BSL<50 mg/dl after admission. We repeatedly infused 50 ml 50% glucose 10 times and administered 1 mg of glucagon two times. The plasma insulin level was 0.2 uU/ml on initial blood sampling and 0.2 uU/ml after 5 hours. After 13 hours, his BSL stabilized but his mental status had not recovered. Diffuse brain injury was observed upon magnetic resonance imaging (MRI) and severe diffuse cerebral dysfunction was found on electroencephalography (EEG). Despite 35 days of ICU care, he died from ventilator associated pneumonia.