• Journal of Korean Neurosurgical Society
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• v.48 no.3
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• pp.288-290
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• 2010

The common etiologies of pneumocephalus, presence of air in the intracranial cavity, are trauma and cranial surgery. Pneumocephalus after spinal surgery is an unusual postoperative complication. We report the case of a male 59-year-old man who developed a pneumacephalus after posterior lumbar surgery for spinal stenosis. Intraoperatively, a cerebrospinal fluid leak following a dural tear was noted and immediately repaired. The next day, the patient complained of headache and dizziness. Head and lumbar computed tomography scans revealed significant air in the frontal region, several cisterns, intraventricle, and extra-dural area in the spine canal. Symptoms were spontaneously resolved within 2 weeks with conservative management.

• Journal of Korean Neurosurgical Society
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• v.54 no.1
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• pp.68-70
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• 2013

A 39-year old female presented with chronic spinal subdural hematoma manifesting as low back pain and radiating pain from both legs. Magnetic resonance imaging (MRI) showed spinal subdural hematoma (SDH) extending from L4 to S2 leading to severe central spinal canal stenosis. One day after admission, she complained of nausea and severe headache. Computed tomography of the brain revealed chronic SDH associated with midline shift. Intracranial chronic SDH was evacuated through two burr holes. Back pain and radiating leg pain derived from the spinal SDH diminished about 2 weeks after admission and spinal SDH was completely resolved on MRI obtained 3 months after onset. Physicians should be aware of such a condition and check the possibility of concurrent cranial SDH in patients with spinal SDH, especially with non-traumatic origin.

• Journal of Korea Association of Health Promotion
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• v.1 no.1
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• pp.21-25
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• 2003

Vomiting in pediatric patient is frequently encountered problem in emergency room or outpatient clinic. In differential diagnosis, age of the patient or accompanying symptoms should be considered in the differential diagnosis. Accurate diagnosis is very important because surgical treatment is necessary in some of the conditions. Imaging diagnosis of conservative modality such as upper gastrointestinal series or colon study is still important radiological examination in the initial differential diagnosis, but recently ultrasonography offers accurate diagnosis in many situations. The cause of vomiting in pediatric are diverse according to the age group :neonatal sepsis, necrotizing enterocolitis, or hypertrophic pyloric stenosis in neonates : gastroesophageal reflux, viral enteritis, or intussusception in infant: midgut volvulus, appendicitis, metabolic disorders, or increased intracranial pressure also an be the cause. knowledge of radiological findings of normal gastrointestinal tract is important to recognize abnormalities. A discussion of radiological findings in variable surgical conditions to present as vomiting in pediatric patients is offered.

• The Korean Journal of Pain
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• v.26 no.2
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• pp.199-202
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• 2013

Epiduroscopic laser discectomy and neural decompression (ELND) is known as an effective treatment for intractable lumbar pain and radiating pain which develop after lumbar surgery, as well as for herniation of the intervertebral disk and spinal stenosis. However, various complications occur due to the invasiveness of this procedure and epidural adhesion, and rarely, cranial nerve damage can occur due to increased intracranial pressure. Here, the authors report case in which double vision occurred after epiduroscopic laser discectomy and neural decompression in a patient with failed back surgery syndrome (FBSS).

• Journal of Yeungnam Medical Science
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• v.26 no.1
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• pp.70-73
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• 2009

A 78-year-old woman presented with weakness of the extremities, dysarthria, dizziness, and sensory impairment. Magnetic resonance imaging showed acute bilateral medial medullary infarction. Contrast enhanced magnetic resonance angiography demonstrated stenosis or occlusion of both intracranial vertebral arteries. We present a rare case of bilateral medullary infarction seen on diffusion-weighted imaging.

• Journal of Korean Neurosurgical Society
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• v.65 no.4
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• pp.603-608
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• 2022

Vertebral artery (VA) occlusion is frequently encountered, usually without acute ischemic injury of the brain. However, when it is accompanied by hypoplasia or stenosis of the opposite VA, brain ischemia may develop due to insufficient collateral supply. Both hemodynamic instability and embolic infarction can occur in VA occlusion, which may cause severe symptoms in a patient. Extracranial carotid-VA bypass should be considered for symptomatic VA occlusion patients, especially when the patient has repeated ischemic brain injuries. In this report, the cases of three extracranial carotid-VA bypass patients are introduced, along with a brief description of the surgical techniques. All three cases were treated with different bypass methods according to their disease location.

• Korean Journal of Radiology
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• v.23 no.3
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• pp.333-342
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• 2022

Objective: Intracranial atherosclerotic stroke occurs through various mechanisms, mainly by artery-to-artery embolism (AA) or branch occlusive disease (BOD). This study evaluated the spatial relationship between middle cerebral artery (MCA) plaques and perforating arteries among different MCA territory infarction types using vessel wall magnetic resonance imaging (VW-MRI). Materials and Methods: We retrospectively enrolled patients with acute MCA infarction who underwent VW-MRI. Thirty-four patients were divided into three groups according to infarction pattern: 1) BOD, 2) both BOD and AA (BOD-AA), and 3) AA. To determine the factors related to BOD, the BOD and BOD-AA groups were combined into one group (with striatocapsular infarction [BOD+]) and compared with the AA group. To determine the factors related to AA, the BOD-AA and AA groups were combined into another group (with cortical infarction [AA+]) and compared with the BOD group. Plaque morphology and the spatial relationship between the perforating artery orifice and plaque were evaluated both quantitatively and qualitatively. Results: The plaque margin in the BOD+ group was closer to the perforating artery orifice than that in the AA group (p = 0.011), with less enhancing plaque (p = 0.030). In the BOD group, plaques were mainly located on the dorsal (41.2%) and superior (41.2%) sides where the perforating arteries mainly arose. No patient in the AA group had overlapping plaques with perforating arteries at the cross-section where the perforator arose. Perforating arteries associated with culprit plaques were most frequently located in the middle two-thirds of the M1 segment (41.4%). The AA+ group had more stenosis (%) than the BOD group (39.73 ± 24.52 vs. 14.42 ± 20.96; p = 0.003). Conclusion: The spatial relationship between the perforating artery orifice and plaque varied among different types of MCA territory infarctions. In patients with BOD, the plaque margin was closer and blocked the perforating artery orifice, and stenosis degree and enhancement were less than those in patients with AA.

• Journal of Korean Neurosurgical Society
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• v.65 no.3
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• pp.422-429
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• 2022

Objective : Extracranial supra-aortic dissections (ESADs) with severe stenosis, occlusion and/or pseudoaneurysm presents potential risk of stroke. Endovascular stenting to reconstruct non acute phase ESADs (NAP-ESADs) is an alternative to anticoagulant or antiplatelet therapy. However, its feasibility, safety and efficacy of stenting in NAP-ESADs is unclear. This study aims to investigate the long-term outcomes of the feasibility, safety and efficacy of stenting in NAP-ESADs. Methods : Seventy-four patients with 91 NAP-ESAD vessels with severe stenosis, occlusion and/or pseudoaneurysm presents potential risk of stroke who underwent stent remodeling were enrolled into this respective study from December 2008 to March 2020. Technical success rate, complications, clinical and angiographic results were harvested and analyzed. Results : Success rate of stent deployment was 99% (90/91) with no procedural mortality or morbidity. Transient ischemic attack occurred in three patients during operation (4.1%, 3/74). Asymptomatic embolisms of distal intracranial vessels were found in two patients (2.7%, 2/74). One hundred and forty-two stents deployed at 85 carotid (135 stents) and six vertebral (seven stents) vessels. Six stent types (Wingspan, 28/135, 20.7%; Solitaire, 10/135, 7.4%; Neuroform, 8/135, 5.9%; LVIS, 2/135, 1.5%; Precise, 75/135, 55.6%; Acculink, 12/135, 8.9%) were deployed at carotid arterial dissection while two types (Wingspan, 5/7, 71.4%; Solitaire 2/7, 28.6%) at vertebral arterial dissection. Digital subtracted angiography (56%, 51/91), computational tomography angiography (41.8%, 38/91) and high resolution magnetic resonance imaging (2.2%, 2/91) were adopted for follow up, with a mean time of 17.2±15.4 months (5-77). All patient modified Rankin Scale scores showed no increase at discharge or follow-up. Angiographically, dissections in 86 vessels in 69 patients (94.5%, 86/91) were completely reconstructed with only minor remnant dissections in four vessels in four patients (4.4%, 4/91). Severe re-stenosis in the stented segment required re-stenting in one patient (1.1%, 1/91). Conclusion : Stent remodeling technique provides feasible, safe and efficacious treatment of ESADs patients with severe stenosis, occlusion and/or pseudoaneurysm.

• Journal of Korean Neurosurgical Society
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• v.29 no.8
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• pp.1063-1068
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• 2000

Objectives : To determine the contribution of cranial magnetic resonance angiography(MRA) for the evaluation of patients with ischemic cerebrovascular accident. Methods : Magnetic resonance image(MRI) and MRA studies performed on 34 patients with ischemic stroke were retrospectively reviewed with the clinical records. Results : There were 9 transient ischemic attacks and 25 completed strokes in our series. Twenty-three of 34 MRA examinations(68%) were positive for stenosis or occlusion. The distribution of stenotic or occlusive vascular lesions were correlated with the location of infarction in 22 of the 23 positive cases(96%). MRA provided additional information not obtained from the MRI in 19 cases(56%). Conclusions : Vascular lesions demonstrated on intracranial MRA show a high correlation with infarct distribution. MRA provided information adjunctive to conventional MRI in a majority of cases. We conclude that MRA is an important noninvasive component of the complete evaluation of ischemic stroke.

• The Journal of Korean Physical Therapy
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• v.14 no.4
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• pp.119-130
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• 2002

The purpose of this study was to evaluate hemodynamics of intracranial blood flow for obtain clinically useful reference values and assess cerebral hemodynamics change with aging. 81 normal Korean subjects(age, 14$\thicksim\∼\thicksim$70 years) examined who han no history of neurologic disease and the subjects divided into group A(age, 14$\∼$39 years), group B(age, 40$\∼$59 years) and group C(age, 60$\∼$70 years). Transcranial doppler was use for measured the maximum velocity(Vmax), mean velocity(Vmean), pulsatility index(PI), resistive index(RI), stenosis index(SI) and depth of sample volume. Vmax was 99.1 1cm/s, Vmean was 63.57cm/s, PI was 0.85, RI was 0.56, SI was 31.94 and depth of sample volume was 52.35 in middle cerebral artery. Vmax was 85.54cm/s, Vmean was 52.52cm/s, PI was 0.82, RI was 0.55, SI was 34.48 and depth of sample volume was 73.62 in anterior cerebral artery. Vmax was 75.45cm/s, Vmean was 45.60cm/s, PI was 0.82, RI was 0.58, SI was 36.14 and depth of sample volume was 62.35 in posterior cerebral artery. Vmax was 70.44cm/s, Vmean was 47.07cm/s, PI was 0.87, RI was 0.58, SI was 29.83 and depth of sample volume was 75.23 in basilar artery Vmax was 63.92, Vmean was 42.42, PI was 0.89, RI was 0.58, SI was 29.89 and depth of sample volume was 66.65 in vertebral artery. Vmax and Vmean was significantly decreased with increasing age in middle cerebral artery, anterior cerebral artery, posterior cerebral artery, basilar artery and vertebral artery And PI and RI was significantly increased with increasing age in basilar artery and vertebral artery. And I suggest that transcranial doppler sonography can be used as one of useful clinical tool for detection of cerebral hemodynamics.