• Journal of the Korean Society of Radiology
• /
• v.83 no.5
• /
• pp.1147-1152
• /
• 2022

Presumed idiopathic intracranial hypertension (IIH) is a disorder of elevated intracranial pressure with unknown etiology, and 10% of cases occur secondarily to cerebral venous sinus thrombosis (CVST). CVST may be underestimated when findings of IIH are missed in a normal-weight patient without risk factors of coagulopathy. Here, we present a case of CVST that mimics a neurogenic tumor in the hypoglossal canal in a normal-weight patient without risk factors of coagulopathy.

• Journal of Korean Neurosurgical Society
• /
• v.40 no.5
• /
• pp.377-380
• /
• 2006

Intradiploic epidermoid cysts of the cranium are rare, benign and slow growing lesion. However, these cysts may cause neurologic deficits due to mass effect. Intradiploic epidermoid cysts are thought to be derived from persistent ectodermal remnants present in the cranial bones during embryogenic development. Here, we report a case of an occipital intradiploic epidermoid cyst with posterior fossa extension. The patient developed intracranial hypertension associated with hydrocephalus due to aqueductal stenosis, and venous congestion secondary to compression of the torcular and the transverse sinus. The imaging studies included a computerized tomography[CT] venogram, which is essential for determining the pathophysiological mechanism of the clinical spectrum and for surgical planning. Near total removal was accomplished and the postoperative course was uneventful. Postoperative imaging studies demonstrated a reversal of the neural structures, but no patency of the sinus, which was presumably indicative of prolonged sinus stenosis. The patient gradually improved and was discharged free of symptoms.

• Journal of Yeungnam Medical Science
• /
• v.21 no.1
• /
• pp.96-100
• /
• 2004

Behcet's disease is a chronic, relapsing multisystem disorder, that may develop into variable neurological manifestations. They include vascular and parenchymal involvement. Vascular involvement is dominated by cerebral venous sinus thrombosis marked by benign intracranial hypertension. Cerebral venous sinus thrombosis can present with all the classical criteria for idiopathic intracranial hypertension, including normal brain CT findings with normal CSF content. But brain MRI is a useful diagnostic method in this situation to confirm the presence of cerebral venous sinus thrombosis. We experienced a case of raised intracranial pressure in a 21-year-old man, caused by cerebral venous sinus thrombosis. We disclosed his symptoms and signs thus fulfilling the diagnostic criteria for Behcet's disease.

• Journal of Korean Neurosurgical Society
• /
• v.42 no.1
• /
• pp.20-26
• /
• 2007

Objective : We present the difference of histopathologic changes of the internal elastic lamina (IEL) and collagen III in the superficial temporal artery (STA) between aneurysmal patients and non-aneurysmal patients. Also, the pathologic data with clinical features by comparative methods to validate the risk factor of the intracranial aneurysm are presented. Methods : Samples of the STA were harvested form 38 patients including aneurysmal and non-aneurysmal patients undergoing craniotomy. Paraffin-embedded sections were examined, using hematoxylin and eosin, van Giebson and mouse anti-collagen III staining techniques. Histopathological observations were ana lysed and correlated with clinical features such as presence of aneurysm, hypertension, age, and sex. Results : Twenty-seven patients had the intracranial aneurysm. Of these 24 patients were 50 years old or older. Nineteen patients had a history of hypertension. Twenty patients were female. Histopathological study demostrated the derangement of IEL and the deficiency of type III collagen were prominent in aneurysmal patients (p < 0.05). Fifty years old or older patients did not show correlation with the deficiency of type III collagen, but with the derangement of IEL (p < 0.05). The female sex was not correlated with the derangement of IEL but with the deficiency of type III collagen (p < 0.05). However, Hypertension was not correlated with these pathologic data. Conclusion : Patients with intracranial aneurysms have severe histopathologic changes of the arterial wall showing the derangement of IEL and the deficiency of type III collagen. In the clinico-pathologic study, the advanced age and female sex were considered as risk factors of the intracranial aneurysm.

• Journal of Korean Neurosurgical Society
• /
• v.51 no.2
• /
• pp.86-90
• /
• 2012

Objective : Life-threatening hemispheric stroke is associated with a high mortality and morbidity. Decompressive hemicraniectomy has been regarded as an effective treatment option for refractory intracranial hypertension. Here, we reported the clinical course of 5 children with decompressive craniectomy and duroplasty after non-traumatic refractory intracranial hypertension. Methods : Four toddlers and one preschool-girl were included in this study; there were 3 boys and 2 girls with a mean age of 34.6 months (range 17-80). Decompressive craniectomy including duroplasty was performed in cases of dilatation of pupil size after intensified standard medical therapy had proven insufficient. All children had a Pediatric Glasgow Coma Scale score <8 at pre-operation state. The mean time-point of craniectomy after stroke attack was 12 hours (range 4-19). Results : During the long-term follow-up period (mean 47.6 months), no children died. One year later, when we checked their Glasgow Outcome Scale scores, only one toddler received a score of 4 (moderate disability). But the others had good recoveries although they had minor physical or mental deficits. According to the Pediatric Cerebral Performance Category Scale, 4 children received a score of 2 (mild disability). Conclusion : Despite our small cases, we suggest that decompressive hemicraniectomy and duroplasty is an acceptable and life-saving treatment for refractory intracranial hypertension after unilateral hemispheric stroke in toddlers and preschool children.

• Investigative Magnetic Resonance Imaging
• /
• v.22 no.3
• /
• pp.150-157
• /
• 2018

Purpose: To assess associations between morphological characteristics of intracranial arteries in time-of-flight MR angiography (TOF-MRA) and atherosclerotic risk factors. Materials and Methods: From January 2014 to October 2015, a total of 129 patients (65 men and 64 women) without intracranial arterial stenosis > 50% were included in this study. All MRIs were performed using a 3T machine with 3D TOF-MRA sequences. We evaluated irregularity, tortuosity, and dilatation of intracranial arteries in maximal intensity projection (MIP) of TOF-MRA. Subjects' risk factors for atherosclerosis including history of hypertension and diabetes were collected by reviewing their medical records. Associations between morphological characteristics and each known atherosclerosis risk factor were examined using univariate regression analysis. Multivariate regression models were built to determine combined association between those risk factors and morphologic changes of intracranial arteries. Results: In multivariate analysis, hypertension (coefficient [95% CI]: 0.162 [0.036, 0.289], P = 0.012) and absence of diabetes (coefficient [95% CI]: -0.159 [-0.296, -0.023], P = 0.022) were associated with large diameter of intracranial arteries. Males (coefficient [95% CI]: 0.11 [-0.006, 0.23], P = 0.062) and higher age (coefficient [95% CI]: 0.003 [-0.001, 0.008], P = 0.138) had marginal association with increased diameter. Tortuosity was associated with old age (OR: 1.04 [1.02, 1.07], P < 0.001). Irregular contour of intracranial arteries was significantly associated with old age (OR: 1.05 [1.02, 1.09], P = 0.004), presence of diabetes (OR: 2.88 [1.36, 6.15], P = 0.0058), and previous ischemic stroke (OR: 3.91 [1.41, 11.16], P = 0.0092). Conclusion: Morphological characteristics (irregularity, tortuosity, dilatation) of intracranial arteries seen in TOF-MRA might be associated with atherosclerotic risk factors in subjects with no or mild stenosis.

• Journal of Korean Neurosurgical Society
• /
• v.59 no.3
• /
• pp.197-203
• /
• 2016

Craniosynostosis is defined as the premature fusion of one or more cranial sutures resulting in skull deformity. Characteristically, this disorder can cause diverse neurosurgical problems, as well as abnormal skull shape. Intracranial hypertension, hydrocephalus, Chiari malformation and neuropsychological dysfunction are the major neurosurgical concerns in children with craniosynostosis. In this review article, we investigate pathophysiology, characteristics and proper neurosurgical management of these neurosurgical issues, respectively.

• Journal of Korean Neurosurgical Society
• /
• v.59 no.5
• /
• pp.449-457
• /
• 2016

Objective : Subarachnoid hemorrhage (SAH) caused by rupture of an internal carotid artery (ICA) or vertebral artery (VA) dissecting aneuryesm is rare. Various treatment strategies have been used for ruptured intracranial dissections. The purpose of this study is to compare the clinical and angiographic characteristics and outcomes of endovascular treatment for ruptured dissecting aneurysms of the intracranial ICA and VA. Methods : The authors retrospectively reviewed a series of patients with SAH caused by ruptured intracranial ICA and VA dissecting aneurysms from March 2009 to April 2014. The relevant demographic and angiographic data were collected, categorized and analyzed with respect to the outcome. Results : Fifteen patients were identified (6 ICAs and 9 VAs). The percentage of patients showing unfavorable initial clinical condition and a history of hypertension was higher in the VA group. The initial aneurysm detection rate and the percentage of fusiform aneurysms were higher in the VA group. In the ICA group, all patients were treated with double stent-assisted coiling, and showed favorable outcomes. In the VA group, 2 patients were treated with double stent-assisted coiling and 7 with endovascular trapping. Two patients died and 1 patient developed severe disability. Conclusion : Clinically, grave initial clinical condition and hypertension were more frequent in the VA group. Angiographically, bleb-like aneurysms were more frequent in the ICA group and fusiform aneurysms were more frequent in the VA group. Endovascular treatment of these aneurysms is feasible and the result is acceptable in most instances.

• The Journal of Korean Medicine
• /
• v.18 no.1
• /
• pp.72-81
• /
• 1997

The causes of stroke are presumed hypertension, atherosclerosis,. cardiac disease, diabetes mellitus and old age and risk factors of stroke are suggested hypertension, hyperlipidemia. obesity, smoking and drinking etc. Especilly, hypertension is one of the most important cause and risk factor of stroke, therfore without therapy hypertension leads to stroke. The frequence of hypertension is significantly higher in hemorrhage patients of intracranial hemorrhage and subarachnoid hemorrhage. Antihypertensive therapy has an impact not only on the primary prevention of stroke but also on stroke recurrence and the declining of stroke motality has been attributed to the widespread availability and use of antihypertensive therapy. The goals of antihypertensive therapy decrease the complications and motalitv of cardiovascular system and prevent the promoting arteriosclerosis. In this study, we observed the blood pressure change of cb-hemorrhagic patients with hypertension who were hospitalized from 1996. 3. 1 to 1997. 2 .26 in Wonkwang Oriental Hospital. These patients had no antihypertensive therapy and were supplied herb med(Jaum sikpoongtang, Chungrijagamtang, Gojinumja) in medication. Our results suggested as follows. 1. Systolic and diastolic average BP at admission is $150.71{\pm}15.61mmHg$ and $95.00{\pm}8.8mmHg$ and this is hypertension state defining WHO 2. During one week in admission, the blood pressure demostrated a marked declination by SBP 8.97mmHg and DBP 6.22mmHg. 3. During two week in admission, the declination of SBP was significant in paired t-test(p<0.05) but, the declination of DBP was non-significant in paired t-test. 4. The blood pressure during third and fourth weeks gradually declined but, non-significant in test. According to the above results, we suggested that the BP declination Was affected by $Jamyang{\cdot}Jaum$ prescriptions in acute stage of cerebral hemorrhage.

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