• Journal of Korean Neurosurgical Society
• /
• v.50 no.2
• /
• pp.126-129
• /
• 2011

Bilateral traumatic carotid-cavernous fistulae (TCCFs) is rarely encountered neurovascular disease. For treatment of TCCF, detachable balloons have been widely used. Nowadays, transarterial and/or transvenous coil embolization with placement of covered stents is adopted as another treatment method. We experienced a patient with a bilateral TCCFs who was successfully treated with covered stents. However, cerebral hemorrhage occurred in the bed of previous infarction one day after treatment. Hyperperfusion syndrome was considered as a possible cause of the hemorrhage, so that barbiturate coma therapy was started and progression of hemorrhage was stopped. We emphasize that cerebral hyperperfusion hemorrhage can occur even after successful endovascular treatment of TCCF.

• Parasites, Hosts and Diseases
• /
• v.51 no.6
• /
• pp.755-757
• /
• 2013

Gnathostoma spinigerum can cause subarachnoid hemorrhage (SAH). The detection of specific antibodies in serum against G. spinigerum antigen is helpful for diagnosis of neurognathostomiasis. There is limited data on the frequency of G. spinigerum infection in non-traumatic SAH. A series of patients diagnosed as non-traumatic SAH at the Srinagarind Hospital, Khon Kaen University, Thailand between January 2011 and January 2013 were studied. CT or MR imaging of the brain was used for diagnosis of SAH. Patients were categorized as aneurysmal subarachnoid hemorrhage (A-SAH) or non-aneurysmal subarachnoid hemorrhage (NA-SAH) according to the results of cerebral angiograms. The presence of specific antibodies in serum against 21- or 24-kDa G. spinigerum antigen was determined using the immunoblot technique. The detection rate of antibodies was compared between the 2 groups. Of the 118 non-traumatic SAH patients for whom cerebral angiogram and immunoblot data were available, 80 (67.8%) patients had A-SAH, whereas 38 (32.2%) had NASAH. Overall, 23.7% were positive for specific antibodies against 21- and /or 24-kDa G. spinigerum antigen. No significant differences were found in the positive rate of specific antibodies against G. spinigerum in both groups (P-value=0.350).

• Journal of Korean Neurosurgical Society
• /
• v.55 no.4
• /
• pp.222-225
• /
• 2014

Traumatic intracranial aneurysms (TICAs) are rare and are associated with high rates of morbidity and mortality. TICAs usually result from head injuries caused by traffic accidents, industrial accidents, or gunshots. We report a traumatic aneurysm of the callosomarginal artery-cortical artery junction arising from a penetrating injury by scissors. A 51-year-old woman was admitted to our hospital after suffering a penetrating injury caused by scissors. Computed tomography (CT) and CT-angiography demonstrated a right orbital roof fracture, subarachnoid hemorrhage, frontal lobe hemorrhage, intraventricular hemorrhage, and a traumatic aneurysm of the right callosomarginal artery-cortical artery junction. We trapped the traumatic aneurysm and repositioned a galeal flap. Postoperative CT showed a small infarction in the left frontal lobe. Follow-up angiography two months later showed no residual aneurysm. We suggest that an aggressive surgical intervention be performed whenever TICA is diagnosed.

• Journal of Korean Neurosurgical Society
• /
• v.39 no.2
• /
• pp.125-129
• /
• 2006

Objective : The purpose of this study is to identify any differential point in computerized tomographic[CT] findings between aneurysmal subarachnoid hemorrhage[ASAH] and traumatic subarachnoid hemorrhage[TSAH], which sometimes make us not confident in differentiation. Methods : CT of 142 ASAH and 82 TSAH patients over the last 2 years were retrospectively reviewed. We evaluated the thickness of SAH, the laterality of sylvian cisternal hemorrhage, the location, the number of involved cisterns, and the associated other lesions between two types of SAH. Results : Suprasellar cisterns and sylvian cisterns were most prominently and frequently involved cisterns in ASAH but cortical sulci and sylvian cisterns were most frequently involved in TSAH. Intraventricular and intracerebral hemorrhage were frequently seen in ASAH. Thickness of SAH over 1mm, bilateral sylvian SAH, multiple cisternal SAH were in favor of ASAH. The number of involved cisterns were more frequently seen in ASAH than in TSAH. In ASAH, bilateral sylvian hemorrhages were more frequently seen than in TSAH. Skull fracture, subdural hematoma, subgaleal hematoma, and hemorrhagic contusion were frequently associated with TSAH. Conclusion : As a result of our study, the authors conclude that when IVH, hydrocephalus, thick SAH > 1mm bilateral sylvian SAH, and multiple cisternal SAH are seen in CT, immediate angiography should be performed to rule out cerebral aneurysms whether associated with other traumatic lesions or not.

• Journal of Korean Neurosurgical Society
• /
• v.41 no.5
• /
• pp.336-339
• /
• 2007

Traumatic intracranial aneurysm rarely occurs after a head injury. The authors report a case of a 51-year-old man in whom subarachnoid hemorrhage was developed as a result of delayed traumatic aneurysmal rupture of the distal portion of the middle cerebral artery following a minor, closed-head injury. The unruptured aneurysm had been evident on the magnetic resonance image taken two days prior to onset of the subarachnoid hemorrhage. The clinical presentation and possible underlying mechanism are discussed with a review of pertinent literature.

• Journal of Korean Neurosurgical Society
• /
• v.56 no.6
• /
• pp.531-533
• /
• 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
• /
• v.49 no.1
• /
• pp.49-52
• /
• 2011

Traumatic intracranial aneurysms are rare, comprising 1% or less of all cerebral aneurysms. The majority of these aneurysms arise at the skull base or in the distal anterior and middle cerebral arteries or their branches following direct mural injury or acceleration-induced shearing force. We present a 50-year-old patient in whom subarachnoid hemorrhage (SAH) was developed as a result of traumatic aneurysm rupture after a closed craniofacial injury. Through careful evaluation of the three-dimensional computed tomography and conventional angiographies, the possible mechanism of the traumatic internal carotid artery trunk aneurysm is correlated with a hit injury by the bony protuberances on the anterior and posterior clinoid processes. This traumatic aneurysm was successfully obliterated with clipping and wrapping technique. The possibility of a traumatic intracranial aneurysm should be considered when patient with SAH demonstrates bony protuberances on the clinoid process as a traumatic aneurysm may result from mechanical injury by the sharp bony edges.

• Journal of Korean Neurosurgical Society
• /
• v.46 no.4
• /
• pp.365-369
• /
• 2009

Objective : Susceptibility-weighted image (SWI) is a sensitive magnetic resonance image (MRI) technique to detect cerebral microbleeds (MBLs). which would not be detected by conventional MRI. We performed SWI to detect MBLs and investigated its usefulness in the evaluation of mild traumatic brain injury (MTBI) patients. Methods : From December 2006 to June 2007, twenty-one MTBI patients without any parenchymal hemorrhage on conventional MRI were selected. Forty-two patients without trauma were selected for control group. According to the presence of MBLs, we divided the MTBI group into MBLs positive [SWI (+)] and negative [SWI (-)] group. Regional distribution of MBLs and clinical factors were compared between groups. Results : Fifty-one MBLs appeared in 16 patients of SWI (+) group and 16 MBLs in 10 patients of control group [control (+)], respectively. In SWI (+) group, MBLs were located more frequently in white matters than in deep nucleus different from the control (+) group (p<0.05). Nine patients (56.3%) of SW (+) group had various neurological deficits (disorientation in 4, visual field defect in 2, hearing difficulty in 2 and Parkinson syndrome in 1). Initial Glasgow Coma Scale (GCS)/mean Glasgow Outcome Scale (GOS) were $13.9{\pm}1.5/4.7{\pm}0.8$ and $15.0{\pm}0.0/5.0{\pm}0.0$ in SWI (+) and SWI (-) groups, respectively (p<0.05). Conclusion : Traumatic cerebral MBLs showed characteristic regional distribution, and seemed to have an importance on the initial neurological status and the prognosis. SWI is useful for detection of traumatic cerebral MBLs, and can provide etiologic evidences for some post-traumatic neurologic deficits which were unexplainable with conventional MRI.

• Journal of Korean Neurosurgical Society
• /
• v.42 no.5
• /
• pp.416-418
• /
• 2007

Hematomas caused by ruptured traumatic pseudoaneurysms of the middle meningeal artery (MMA) usually present with extradural hematomas, whereas intradural intraparenchymal hematomas are extremely rare. We report a case of traumatic pseudoaneurysm of the MMA giving rise to an intracerebral hematoma after head trauma. A 70-year-old man suffered a massive intracerebral temporoparietal hemorrhage after a head injury. CT angiogram of the brain revealed a large hematoma in the right middle cranial fossa extending to the right sylvian fissure. Cerebral angiogram also revealed a pseudoaneurysm of the MMA, which was successfully treated surgically. Although traumatic MMA pseudoaneurysm producing intracerebral hematoma (ICH) is rare, it should be considered as a possible cause of intracerebral hematoma.

• Journal of Korean Neurosurgical Society
• /
• v.46 no.4
• /
• pp.417-420
• /
• 2009

The purpose of this report is to describe our surgical experiences in the treatment of cerebral decompression with in situ floating resin cranioplasty. We included in this retrospective study 7 patients who underwent in situ floating resin cranioplasty for cerebral decompression between December 2006 and March 2008. Of these patients, 3 patients had traumatic brain injury, 3 cerebral infarction, and one subarachnoid hemorrhage due to aneurysmal rupture. In situ floating resin cranioplasty for cerebral decompression can reduce complications related to the absence of a bone flap and allow reconstruction by secondary cranioplasty without difficulty. Furthermore, it provides cerebral protection and selectively eliminates the need for secondary cranioplasty in elderly patients or patients who have experienced unfavorable outcome.