• Journal of Korean Neurosurgical Society
• /
• 제58권1호
• /
• pp.76-78
• /
• 2015

This report details a case of unexpected, severe post-operative cerebral edema following cranioplasty. We discuss the possible pathological mechanisms of this complication. A 50-year-old female was admitted to our department with sudden onset of stuporous consciousness. A brain computed tomography (CT) revealed a subarachnoid hemorrhage with intracranial hemorrhage and subdural hematoma. Emergency decompressive craniectomy and aneurysmal neck clipping were performed. Following recovery, the decision was made to proceed with an autologous cranioplasty. The cranioplasty procedure was free of complications. An epidural drain was placed and connected to a suction system during skin closure to avoid epidural blood accumulation. However, following the procedure, the patient had a seizure in the recovery room. An emergency brain CT scan revealed widespread cerebral edema, and the catheter drain was clamped. The increased intracranial pressure and cerebral edema were controlled with osmotic diuretics, corticosteroids, and antiepileptic drugs. The edema slowly subsided, but new low-density areas were noted in the brain on follow-up CT 1 week later. We speculated that placing the epidural drain on active suction may have caused an acute decrease in intracranial pressure and subsequent rapid expansion of the brain, which impaired autoregulation and led to reperfusion injury.

• Journal of Korean Neurosurgical Society
• /
• 제57권5호
• /
• 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
• /
• 제58권2호
• /
• pp.137-140
• /
• 2015

The most common neurologic manifestations of polycythemia vera (PV) are cerebral infarction and transient ischemic attacks, while cerebral hemorrhage or intracranial dissection has been rarely associated with PV. Here we report the first case of a 59-year-old patient with intracranial supraclinoid internal carotid artery (ICA) dissection causing cerebral infarction and concomitant subarachnoid hemorrhage due to pseudoaneurysm rupture as clinical onset of PV. This case report discusses the possible mechanism and treatment of this extremely rare condition.

• Journal of Korean Neurosurgical Society
• /
• 제30권12호
• /
• pp.1427-1429
• /
• 2001

Traumatic intracranial aneurysms are rare, compromising less than 1% of intracranial aneurysms. The case of 20-year-old man suffered from delayed frontal intracerebral hematoma, subarachnoid hemorrhage and intraventricular hemorrhage from traumatic pericallosal aneurysm 12 days after head injury is presented. Traumatic pericallosal artery aneurysm is always near the falcine edge, is unrelated to arterial branching point. Sudden movement of brain and artery causes vessel wall injury against the stationary edge of the falx. Because of high mortality rate of ruptured traumatic aneurysm, clinical suspicion must be focused on the prompt diagnostic work-up and early treatment.

• 한국임상수의학회지
• /
• 제31권4호
• /
• pp.337-340
• /
• 2014

An 11-year-old male Maltese dog was presented with sudden onset of convulsion and right sided circling. On neurological examination, left side proprioception and menace reflexes were delayed. Blood examinations indicated severe thrombocytopenia and increased hepatic enzymes. On brain magnetic resonance imaging, lesions were founded on the left lateral subarachnoid space area. Those lesions showed hyperintense on T1-weighted images, hyperintense on T2-weighted images and hyperintense on fluid attenuated inversion recovery images. Cerebrospinal fluid analysis revealed xanthochromia and erythrophagocytosis. Coagulation test results demonstrated that fibrin degradation product and D-dimer concentrations were higher than normal range. The patient expired few hours after presentation. This case report demonstrates intracranial hemorrhage with disseminated intravascular coagulation in a dog.

• Journal of Korean Neurosurgical Society
• /
• 제45권6호
• /
• pp.386-389
• /
• 2009

On rare occasions, percutaneous vertebroplasty (PV) may be associated with adverse spinal and extraspinal events. Subarachnoid hemorrhage (SAH) has not been reported complication following a PV. This is a report of two elderly women with spine compressions who developed idiopathic SAH after injecting polymethylmethacrylate into the thoracolumbar region transcutaneously. PV was performed as an usual manner on prone position under local anesthesia for these patients. During the interventions, two patients complained of a bursting nature of headache and their arterial blood pressure was jumped up. Computed tomography scans revealed symmetric SAH on the both hemispheres and moderate degree of hydrocephalus. Any intracranial vascular abnormalities for their SAH were not evident on modern neuroangiography modalities. One patient received a ventricular shunt surgery, but both fully recovered from the procedure-related SAH. The pathophysiologic mechanism that induce SAH will be discussed, with suggesting the manner that prevent and minimize this rare intracranial complication after PV.

• Journal of Korean Neurosurgical Society
• /
• 제50권5호
• /
• pp.457-459
• /
• 2011

A rare case of spontaneous subarachnoid hemorrhage from newly developed cerebral aneurysm in glioblastoma patient is presented. A 57-year-old man was presented with headache and memory impairment. On the magnetic resonance image and the magnetic resonance angiography, a large enhancing mass was found at right frontal subcortex and intracranial aneurysm was not found. The mass was removed subtotally and revealed as glioblastoma. He took concurrent PCV chemotherapy and radiation therapy, but the mass recurred one month later after radiotherapy. He was then treated with temozolomide for 7 cycles. Three months after the completion of temozolomide therapy, he suffered from a subarachnoid hemorrhage due to a rupture of a small de novo aneurysm at distal anterior cerebral artery. He underwent an aneurysm clipping and discharged without neurologic complication.

• Journal of Korean Neurosurgical Society
• /
• 제62권2호
• /
• pp.136-143
• /
• 2019

Moyamoya disease (MMD) is a progressive cerebrovascular disease with unknown etiology, characterized by bilateral steno-occlusive changes at the terminal portion of the internal carotid artery and an abnormal vascular network formation at the base of the brain. MMD has an intrinsic nature to convert the vascular supply for the brain from internal carotid (IC) system to the external carotid (EC) system, as indicated by Suzuki's angiographic staging. Insufficiency of this 'IC-EC conversion system' could result not only in cerebral ischemia, but also in intracranial hemorrhage from inadequate collateral anastomosis, both of which represent the clinical manifestation of MMD. Surgical revascularization prevents cerebral ischemic attack by improving cerebral blood flow, and recent evidence further suggests that extracranial-intracranial bypass could powerfully reduce the risk of re-bleeding in MMD patients with posterior hemorrhage, who were known to have extremely high re-bleeding risk. Although the exact mechanism underlying the hemorrhagic presentation in MMD is undetermined, most recent angiographic analysis revealed the characteristic angio-architecture related to high re-bleeding risk, such as the extension and dilatation of choroidal collaterals and posterior cerebral artery involvement. We sought to update the current management strategy for hemorrhagic MMD, including the outcome of surgical revascularization for hemorrhagic MMD in our institute. Further investigations will clarify the optimal surgical strategy to prevent hemorrhagic manifestation in patients with MMD.

• Journal of Korean Neurosurgical Society
• /
• 제67권1호
• /
• pp.130-132
• /
• 2024

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