• Journal of Korean Neurosurgical Society
• /
• v.30 no.sup1
• /
• pp.115-119
• /
• 2001

Objective : The cause and clinical outcome of cerebral hemorrhage in patients on maintenance hemodialysis have been poorly studied in korea. The purpose of this paper is to clarify the clincal features and the outcome of cerebral hemorrhage in patients on maintenance hemodialysis. Method : We analyzed clincal features and the outcome of cerebral hemorrhage in 14 patients on maintenance hemodialysis. Hematomas were reviewed and evaluated for location, size, and intraventricular extension by the one of the authors without any prior informations. The axial slice of CT film that the hematoma was appeared in maximal dimension was chosen for evaluations. Result : Hypertension was found in 71.4%(10 cases) and motality rate was 78.5%(11 cases). Basal ganglia hemorrhage was found in 50%(7 cases), subcortex in 28.5%(4 cases), pons in 14.2%(2 cases). Size of hematoma in patients on maintenance hemodialysis was significantly larger than that of hypertensive cerebral hemorrhage patients(p=0.0061). The 4 cases of basal ganglia hemorrhage without intraventricular hemorrhage and subarachnoid hemorrhage were good mental state at the onset of stroke because of small mass effect relative to the size of hematoma. The duration of hemodialysis treatment prior to strokes ranged from 1 to 107 months. Strokes developed within 6 hours of the previous hemodialysis are 5 cases. Average serum albumin concentration was 3.4g/dl. The use of heparin is less responsible for the development of cerebral hemorrhage in patients on maintenance hemodialysis Conclusion : Cerebral hemorrhage in patients on maintenance hemodialysis is more severe in terms of hematoma size and clinical outcome. Therefore, the prevention and treatment of cerebral hemorrhage in patients on maintenance hemodialysis should be more aggressive.

• Journal of Korean Neurosurgical Society
• /
• v.58 no.3
• /
• pp.291-293
• /
• 2015

Anterior communicating artery (ACoA) aneurysms sometimes present with visual symptoms when they rupture or directly compress the optic nerve. Giant or large ACoA aneurysms producing bitemporal hemianopsia are extremely rare. Here we present an unusual case of bitemporal hemianopsia caused by a large intracranial aneurysm of the ACoA. A 41-year-old woman was admitted to our neurosurgical department with a sudden-onset bursting headache and visual impairment. On admission, her vision was decreased to finger counting at 30 cm in the left eye and 50 cm in the right eye, and a severe bitemporal hemianopsia was demonstrated on visual field testing. A brain computed tomography scan revealed a subarachnoid hemorrhage at the basal cistern, and conventional cerebral catheter angiography of the left internal carotid artery demonstrated an $18{\times}8mm$ dumbbell-shaped aneurysm at the ACoA. Microscopic aneurysmal clipping was performed. An ACoA aneurysm can produce visual field defects by compressing the optic chiasm or nerves. We emphasize that it is important to diagnose an aneurysm through cerebrovascular study to prevent confusing it with pituitary apoplexy.

• Journal of Korean Neurosurgical Society
• /
• v.45 no.4
• /
• pp.240-242
• /
• 2009

Oculomotor nerve palsy (ONP) with subarachnoid hemorrhage (SAH) occurs usually when oculomotor nerve is compressed by growing or budding of posterior communicating artery (PcoA) aneurysm. Midbrain injury, increased intracranial pressure (lCP), or uncal herniation may also cause it. We report herein a rare case of ONP associated with SAH which was caused by middle cerebral artery (MCA) bifurcation aneurysm rupture. A 58-year-old woman with clear consciousness suffered from headache and sudden onset of unilateral ONP. Computed tomography showed SAH caused by the rupture of MCA aneurysm. The unilateral ONP was not associated with midbrain injury, increased ICP, or uncal herniation. The patient was treated with coil embolization, and the signs of oculomotor nerve palsy completely resolved after a few days. We suggest that bloody jet flow from the rupture of distant aneurysm other than PcoA aneurysm may also be considered as a cause of sudden unilateral ONP in patients with SAH.

• Journal of Korean Neurosurgical Society
• /
• v.44 no.2
• /
• pp.63-66
• /
• 2008

Objective : The purpose of this study is to investigate the correlation between various transcranial Doppler (TCD) ultrasonography parameters and clinical vasospasm after aneurysmal subarachnoid hemorrhage (SAH). Methods : This study enrolled 40 patients presented with aneurysmal SAH between September 2006 and August 2007. We measured differences of mean blood flow velocity (BFVm), highest systolic blood flow velocity (BFVh), and Lindegaard ratio (LR) in the middle cerebral artery on TCD examination. These parameters were evaluated for correlation with clinical vasospasm by univariate analysis and the receiver operating characteristic analysis. Results : Twelve patients (30%) developed clinical vasospasm. The best TCD parameters for the detection of clinical vasospasm were revealed to be differences of BFVm, BFVh, and LR values between $1^{st}$ TCD test and $3^{rd}$ TCD (7 cm/s. 11.5 cm/s, 0.45 respectively). The positive predictive value of anyone of three parameters was 60% and the negative predictive value was 100%. Conclusion : TCD is still considered a useful tool for screening clinical vasospasm. To confirm the predictive value of the above parameters. further prospective study will be needed.

• Journal of Korean Neurosurgical Society
• /
• v.57 no.5
• /
• pp.379-385
• /
• 2015

Chronic subdural hematomas mainly occur amongst elderly people and usually develop after minor head injuries. In younger patients, subdural collections may be related to hypertension, coagulopathies, vascular abnormalities, and substance abuse. Different techniques can be used for the surgical treatment of symptomatic chronic subdural hematomas : single or double burr-hole evacuation, with or without subdural drainage, twist-drill craniostomies and classical craniotomies. Failure of the brain to re-expand, pneumocephalus, incomplete evacuation, and recurrence of the fluid collection are common complications following these procedures. Acute subdural hematomas may also occur. Rarely reported hemorrhagic complications include subarachnoid, intracerebral, intraventricular, and remote cerebellar hemorrhages. The causes of such uncommon complications are difficult to explain and remain poorly understood. Overdrainage and intracranial hypotension, rapid brain decompression and shift of the intracranial contents, cerebrospinal fluid loss, vascular dysregulation and impairment of venous outflow are the main mechanisms discussed in the literature. In this article we report three cases of different post-operative intracranial bleeding and review the related literature.

• Journal of Korean Neurosurgical Society
• /
• v.45 no.1
• /
• pp.43-45
• /
• 2009

A 75-year-old female presented with subarachnoid hemorrhage. Angiography revealed a partial duplication (fenestration) in the proximal $A_1$ segment and a ruptured aneurysm at the distal end of $A_1$ fenestration. This congenital anomaly accompanying an aneurysm was associated with duplicated ipsilateral middle cerebral artery (MCA). Congenital defect of the arterial wall and hemodynamic factors at the fenestrated $A_1$ are considered to play a significant role in the development of this aneurysm. The present case is peculiar because not only the ruptured $A_1$ aneurysm was related with the anterior and middle cerebral artery duplication but also the location of $A_1$ fenestration and the origin of $A_1$ aneurysm in a fenestration are quite unusual.

• Journal of Korean Neurosurgical Society
• /
• v.61 no.5
• /
• pp.653-659
• /
• 2018

Objective : Surgical obliteration of ruptured aneurysm of the proximal posterior inferior cerebellar artery (PICA) is challenging because of limited surgical accessibility. In recent years, coil embolization is the first-choice treatment for these lesions. However, coil embolization is not always easy in ruptured PICA aneurysm owing to the variable anatomical diversity of its shapes, its relationship to the parent artery, its low incidence, and accordingly, lesser neurointerventionist experience. Methods : The parent artery and microcatheter for easier navigation and the embolization technique for stable coiling were identified. Results : This study aimed to identify the more appropriate approach route, microcatheter, and strategies for an easier and safer, and more durable coil embolization in the treatment of lesions in the proximal PICA. Conclusion : Coil embolization for aneurysmal subarachnoid hemorrhage due to a ruptured proximal PICA remains a challenge, but with the appropriate coiling plan, it can be treated successfully.

• Journal of Korean Neurosurgical Society
• /
• v.50 no.4
• /
• pp.327-331
• /
• 2011

Objective : The aim of this study is to investigate the clinical outcomes of surgery and coiling and analyze the predicting factors affecting the clinical outcomes of ruptured posterior inferior cerebellar artery (PICA) aneurysms. Methods : During the last 15 years, 20 consecutive patients with ruptured PICA aneurysms were treated and these patients were included in this study. The Fisher's exact test was used for the statistical significance of Glasgow Outcome Scale (GOS) according to initial Hunt-Hess (H-H) grade, treatment modalities, and the presence of acute hydrocephalus. Results : Eleven (55%) and nine (45%) patients were treated with surgical clipping and endovascular treatment, respectively. Among 20 patients, thirteen (65.0%) patients had good outcomes (GOS 4 or 5). There was the statistical significance between initial poor H-H grade, the presence of acute hydrocephalus and poor GOS. Conclusion : In our study, we suggest that initial H-H grade and the presence of acute hydrocephalus may affect the clinical outcome rather than treatment modalities in the ruptured PICA aneurysms.

• Journal of Acupuncture Research
• /
• v.20 no.1
• /
• pp.35-50
• /
• 2003

In order to study the effect of Bee venom(BV) on the subarachnoid hemorrhage animal model, the autologous whole blood was applied to the vicinity of the sprague dawley rat right femoral artery. Following periarterial application of autologous whole blood(PAB) and intraperitoneal injection of BV(1:5,000 nd 1:500), the vasomotor responses to BV(from 1:500,000 to 1:500) were identified and the histological changes, neovascularized blood vessel were observed. We have shown that alterations in vasomotor and histological findings are elicited following application of periarterial blood and i.p. injection of BV(1:5,000 and 1:500) induced heavy vasospasm and neovascularization on the subarachnoid hemorrhage like model form peripheral artery.

• The Journal of the Korea Contents Association
• /
• v.11 no.3
• /
• pp.302-308
• /
• 2011

The aim of this study is to compare reference levels for radiation dose in angiography and interventional radiology. Proposed reference levels for various procedures and classification of diseases are provided by fluoroscopy time and kerma area product(KAP) rate normalizing the body habitus focusing the cerebrum. Subarachnoid hemorrhage(SAH) represents the highest KAP-rates and aneurysm represents the lowest KAP-rates. According to these types of procedures, internal carotid artery(ICA), common carotid artery(CCA), and vertebral artery(VA) show the highest KAP-rates and guglielmi detachable coil shows the lowest KAP-rates. Therefore, the present study can suggested reference levels for patient radiation dose and is expected to be further useful in the field of radiation dose education and management of angiography and interventional radiology.