• Journal of Korean Neurosurgical Society
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• 제46권5호
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• pp.501-504
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• 2009

Remote cerebellar hemorrhage (RCH) is rare but potentially lethal as a complication of spinal surgery. We recently experienced a case of RCH in a 61-year-old man who showed mental deterioration after lumbar spinal surgery. There was dural tearing with subsequent cerebrospinal fluid (CSF) loss during the surgery. Brain computed tomography scan revealed cerebellar hemorrhage, 3rd and 4th ventricular hemorrhage and pneumocephalus. He underwent suboccipital craniectomy and hematoma removal. The most important pathomechanism leading to RCH after spinal surgery has been known to be venous bleeding due to caudal sagging of cerebellum by rapid leak of large amount of CSF which seems to be related with this case. Dural repair and minimizing CSF loss after intraoperative dural tearing would be helpful to prevent postoperative RCH.

• Journal of Korean Neurosurgical Society
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• 제42권5호
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• pp.410-412
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• 2007

Pleomorphic xanthoastrocytoma (PXA) has been considered as a low grade tumor of adolescents and young adults. Although this tumor often shows cystic component, the hemorrhage within the cyst is extremely rare. The authors report a rare case of cystic PXA with a hemorrhage within the cyst and the mural nodule in the left frontal lobe. A 64-year-old male presented with a week history of the right side hemiparesis. After gross total resection of the tumor, the patient was fully recovered from neurological deficit. It is suggested that this typically benign tumor could be presented with hemorrhage, causing a rapid neurological deterioration. Prompt surgical intervention, especially total removal of the tumor can provide an excellent functional recovery.

• Journal of Korean Neurosurgical Society
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• 제41권4호
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• pp.272-274
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• 2007

Bilateral traumatic hemorrhage of the basal ganglia is an extremely rare neuropathologic entity. This report describes a 50year-old man with bilateral basal ganglia hemorrhage with occipital fracture of the skull after head trauma. The mechanism of development of traumatic hemorrhage of the basal ganglia has been not clear. But, it is presumed to be secondary to rupture of the lenticulostriate or anterior choroidal artery by shearing as a result of acceleration/deceleration forces. We briefly summarize our uncommon case and discuss its possible mechanisms.

• Journal of Korean Neurosurgical Society
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• 제41권4호
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• pp.261-263
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• 2007

Subdural hygromas are easily treated by trephination and drainage. Therefore, most neurosurgeons do not consider subdural hygromas seriously. However, various complications including intracerebral hemorrhage may develop after rapid drainage of subdural hygroma although rare. Postoperative intracerebral hemorrhage presents with a rapid deterioration of consciousness and focal neurological deficits occurring immediately after drainage of the subdural hygroma. The authors present an unfortunate massive intracerebral hemorrhage and pneumocephalus following drainage of the bifrontal subdural hygroma. The patient subsequently died. To prevent this disastrous complication, close neurosurgical observation and gradual drainage under a closed system seem mandatory. Possible pathogenic mechanisms for this unfavorable complication is discussed with a review of pertinent literatures.

• Journal of Korean Neurosurgical Society
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• 제43권3호
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• pp.162-164
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• 2008

Post-clipping intraparenchymal hemorrhage of the contralateral hemisphere is a very unusual phenomenon in a patient with aneurysmal subarachnoid hemorrhage, unless there is an underlying condition. We report a complicated case of 47-year-old man, who underwent uneventful clipping of ruptured aneurysm and experienced vasospasm two weeks later. Vasospasm was treated by intra-arterial nimodipine and systemic hyperdynamic therapy. One week thereafter, he became unconscious due to intraparenchymal hemorrhage on the anterior border-zone of contalateral hemisphere, but intraoperative and pathologic findings failed to disclose any vascular anomaly. We suggest that the anti-spastic regimens cause local hemodynamic redistribution through the vasodilatory effect and in turn, resulted in such an unexpected bleeding.

• Journal of Korean Neurosurgical Society
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• 제57권5호
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• pp.371-375
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• 2015

Spontaneous spinal subdural hematoma is reported at a rare level of incidence, and is frequently associated with underlying coagulopathy or those receiving anticoagulant or antiplatelet agents; some cases accompany concomitant intracranial hemorrhage. The spontaneous development of spinal subdural hemorrhage (SDH) is a neurological emergency; therefore, early diagnosis, the discontinuation of anticoagulant, and urgent surgical decompression are required to enable neurological recovery. In this report, we present a simultaneous spinal subdural hematoma and cranial subarachnoid hemorrhage, which mimicked an aneurysmal origin in a female patient who had been taking warfarin due to aortic valve replacement surgery.

• Journal of Korean Neurosurgical Society
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• 제45권1호
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• pp.46-49
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• 2009

Developmental venous anomalies (DVAs) are hemodynamically low flow, low resistance vascular malformations without clinical significance. Although most DVAs are asymptomatic and are found incidentally, sometimes they can be symptomatic with intracerebral hemorrhage, many of which are usually caused by associated cavernous malformations (CMs) rather than the DVAs themselves. Only a few cases have been reported in the literature where an intracerebral hemorrhage has been caused by a DVA alone. This report describes a case of an intracerebral hemorrhage due to DVA alone with review of the literature.

• Journal of Korean Neurosurgical Society
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• 제53권1호
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• pp.59-61
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• 2013

Authors report a rare case of acute intracranial subdural and intraventricular hemorrhage that were caused by intracranial hypotension resulted from cerebrospinal fluid leakage through an unidentified dural tear site during spinal surgery. The initial brain computed tomography image showed acute hemorrhages combined with preexisting asymptomatic chronic subdural hemorrhage. One burr hole was made over the right parietal skull to drain intracranial hemorrhages and subsequent drainage of cerebrospinal fluid induced by closure of the durotomy site. Among various methods to treat cerebrospinal fluid leakage through unidentified dural injury site, primary repair and spinal subarachnoid drainage are well known treatment options. The brain imaging study to diagnose intracranial hemorrhage should be taken before selecting the treatment method, especially for spinal subarachnoid drainage. Similar mechanism to its spinal counterpart, cranial cerebrospinal fluid drainage has not been mentioned in previous article and could be another treatment option to seal off an unidentified dural tear in particular case of drainage of intracranial hemorrhage is needed.

• Journal of Korean Neurosurgical Society
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• 제47권3호
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• pp.210-212
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• 2010

Sildenafil citrate ($Viagra^{(R)}$ Pfeizer US Pharmaceutical Group, New York, NY, USA) is a potent vasodilating agent to treat male erectile dysfunction. Among its adverse effects, hemorrhagic stroke has not been widely reported yet. We present a case of a 33-year-old healthy man who ingested 50 mg sildenafil a half hour before onset of headache, nervousness and speech disturbance. Head computed tomogram of this stuporous man showed huge intracerebral hemorrhage and thick subarachnoid hemorrhage, but angiography failed to disclose any vascular anomalies. Subsequent surgical procedure was followed, and rehabilitation was provided thereafter. Sildenafil seems to act by redistributing arterial blood flow, and concurrent sympathetic hyperactivity, which lead to such hemorrhagic presentation. Extreme caution should be paid on even in a young adult male patient wven without known risk factors.

• Journal of Korean Neurosurgical Society
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• 제47권3호
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• pp.213-216
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• 2010

Spontaneous intracerebral hemorrhage (ICH) is a common condition that often leads to death or disability. Accurate prediction of the outcome and decisions regarding the treatment of ICH patients are important issues. We report a case of thalamic hemorrhage with an intraventricular hemorrhage that was suddenly migrated into the third and fourth ventricles in its entirety 8 hours after symptom onset. To our knowledge, this case is the first report of spontaneous migration of thalamic ICH into ventricles, and we suggest a possible mechanism for this case with a brief review of the literature.