• Journal of Korean Neurosurgical Society
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• v.57 no.3
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• pp.204-207
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• 2015

We are reporting an unusual case of dural arteriovenous fistula (AVF) of the superior sagittal sinus (SSS) after tamoxifen treatment for breast cancer. A 30-year-old female arrived at the emergency room with a sudden headache and left sided weakness and sensory loss. In her past medical history, she was diagnosed with breast cancer 1 year prior, and subsequently underwent a breast conserving mastectomy with whole breast radiation and adjuvant chemotherapy with tamoxifen. At the time of admission, computed tomography showed a small acute intracerebral hemorrhage at the right parietal cortex, and magnetic resonance imaging showed that a dural AVF at the SSS with a prominent and tortuous venous enhancement along the centrum semiovale was present. Cerebral angiography showed that the dural AVF at the mid-portion of the SSS with meningeal arterial feeding vessels entering the wall of the SSS, then draining through the dilated cortical veins. Our patient had no signs of active malignancy or any abnormalities in her coagulation profile, so it can be concluded that the tamoxifen was the likely cause of the SSS thrombosis and dural AVF. The dural AVF was treated by an endovascular coil embolization for the arterialized segment of the SSS. The patient dramatically recovered favorably from left side motor and sensory deficit. The best clinical approach is to screen potential patients of tamoxifen hormonal therapy and educate them on the sign and symptoms of life threatening thromboembolic events while taking tamoxifen.

• Journal of Korean Neurosurgical Society
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• v.44 no.3
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• pp.159-162
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• 2008

Stenting is a useful alternative treatment modality in carotid artery stenosis patients who are too high-risk to undergo carotid endarterectomy (CEA). We report a case of contralateral cerebral infarction after stenting for extracranial carotid stenosis. A 78-year-old woman was admitted to the hospital with left-sided weakness. Based on magnetic resonance imaging (MRI) of the brain and conventional angiography, she was diagnosed with an acute watershed infarct of the right hemisphere secondary to severe carotid stenosis. Stenting was performed for treatment of the right carotid artery stenosis after a one-week cerebral angiogram was completed. Thirty minutes after stent placement, the patient exhibited a generalized seizure. Four hours later, brain MRI revealed left hemispheric cerebral infarction. Complex aorta-like arch elongation, tortuosity, calcification, and acute angulation at the origin of the supra-aortic arteries may increase the risk of procedural complications. In our case, we suggest that difficult carotid artery catheterization, with aggressive maneuvering during stenting, likely injured the tortuous, atherosclerotic aortic arch, and led to infarction of the contralateral cerebral hemisphere by thromboemboli formed on the wall of the atherosclerotic aorta.

• The Korean Journal of Pain
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• v.9 no.1
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• pp.210-214
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• 1996

Thoracic sympathetic ganglion block(TSGB) with alcohol is a traditional method for treating a variety of disease at pain clinics. But it is a difficult block to perform requiring both skill and experience. Therefore, we performed a thoracic endoscopic cauterization to evaluate the efficacy of this method. A patient suffering sever forearm and hand pain due to radius fracture of the right arm, one and half years earlier, was referred to several different orthopaedic department of various hospitals with continued aggravated symptoms. He was then admitted to our hospital's orthopaedic department. Our diagnosis, confirmed by thermography, revealed reflex sympathetic dystrophy. Patients was therefore referred to the pain clinic where treatment consisted of endoscopic thoracic sympathetic cauterization under general anesthesia. Patient was intubated with Robertashow 37 Fr. double lumen tube left sided. Left lateral and slight head up position was applied to make lesion side up. Incisions were made to penetrate trocas 5 mm diamether on 4 th intercostal space along mid axillary line and midclavicular line. Negative pressure suction on ipsilateral lung and CO2 insufflation under 10 mmHg was applied to reduce lung size. Cauterization on thoracic sympathetic chain at T3 level was done under endoscoic guide. 24 Fr. chest tube was inserted. Patient's symptoms cleared and he was satisfied with the results of this treatment.

• Journal of Chest Surgery
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• v.15 no.4
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• pp.402-408
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• 1982

The primary cardiac tumor was considered as a form of disease with poor prognosis in the past and it was hardly diagnosed before post mortem autopsy. But recent development of diagnostic procedure and the cardiac surgery using extracorporeal circulation increased the accuracy of diagnosis and the opportunity of successful treatment. The authors present two cases of left atrial myxoma which experienced during recent 4 years between 1979 and 1982. A 33 year old woman admitted with severe shortness of breath, generalized edema, ascites and the evidence of hepatopathy resulted from right sided heart failure. Preoperatively, the patient was treated with conservative medication to improve general condition for a few days. The tumor mass was removed successfully under the cardiopulmonary bypass. She, however, died of myocardial dysfunction showing low blood pressure. The tumor mass weighed 22gm and measured 5.2x4.5x3.6 cm in size. A 60 year old man admitted with shortness of breath on exertion and an episode of fainting. Following the removal of tumor mass under the cardiovascular bypass, the clinical course was satisfactory with no complication. The tumor mass weighed 105gm and measured 9x4x5 cm in size.

• Journal of Medicine and Life Science
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• v.17 no.1
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• pp.16-20
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• 2020

Spontaneous hemopneumothorax is a rare disease, and it can cause life threatening condition. It is characterized by the accumulation of more than 400 mL of blood and air in the pleural cavity without any other apparent causes. A previously healthy 22-year-old female patient presented with acute chest pain and dyspnea. Chest X-ray and computed tomography revealed a massive hemopneumothorax in the left hemithorax. The images showed a completely collapsed left lung with right-sided tracheal deviation, several pleural adhesion bands, and fluid collection with air-fluid level. We emergently performed a closed thoracostomy, and then 560 mL of fresh bloods were initially drained. We considered an emergent video-assisted thoracoscopic surgery for pulmonary wedge resection and bleeding control because of the massive hemothorax. However, the patient's vital signs were stabilized after blood transfusion and supportive cares for re-expansion pulmonary edema. The patient discharged from the hospital on 11^th in-hospital day after removal of the chest tube, and there had not been any recurrence of the pneumothorax for 10 months. We suggest that treatment strategy should be decided upon individually based on the patient's condition and clinical course of the disease.

• Archives of Plastic Surgery
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• v.32 no.5
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• pp.653-655
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• 2005

Epithelial-myoepithelial carcinoma (EMC) of the salivary gland is a rare tumor that comprises approximately 1% of all salivary gland tumors. It has a distinctive histological appearance comprising ductal structures with an inner epithelial cell component and an outer layer of myoepithelial cells. We report a case of EMC of the parotid gland in a 41- year-old man. He presented left-sided subauricular swelling developed 3-month earlier. Neck CT scans revealed a well-defined mass in the left superficial parotid gland. He underwent superficial parotidectomy and was diagnosed as EMC. He was taken postoperative radiotherapy. There was no evidence of recurrence during a follow-up period of 12 months. A EMC is a low grade malignant tumor which can cause diagnostic confusion during workup and also frequently misdiagnosed as other benign or malignant tumor.

• Journal of Korean Neurosurgical Society
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• v.59 no.1
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• pp.58-61
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• 2016

Choroid plexus papillomas (CPPs) are relatively rare neuroectodermal tumors that develop from choroid plexus epithelial cells and are usually restricted to the ventricles. Extraventricular CPPs are very unusual and can be difficult to diagnose and treat. A 50-year-old male patient was admitted to our clinic complaining of headache and visual deterioration. Neurological examination found no abnormalities except decreased light perception and secondary optic atrophy in the left eye. Endocrine testing revealed normal levels of hormones produced by the pituitary and target glands. Magnetic resonance imaging of the brain revealed a huge regular-shaped lesion in the sellar-suprasellar region occupying the sella turcica and extending into the suprasellar cistern and planum sphenoidale. The lesion was completely excised by microsurgery via an ordinary left-sided pterional approach. Histopathology identified the lesion as a choroid plexus papilloma. Following the case report, literature on the origin, differential diagnosis, and treatment of this rare tumor is reviewed.

• Sleep Medicine and Psychophysiology
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• v.3 no.1
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• pp.68-78
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• 1996

Objective : The Mini-Mental State Examination(MMSE) and Brief Cognitive Rating Scale(BCRS) are frequently using screening tests fur evaluating the cognitive function in clinical practice and research. The authors tried to evaluate the clinical usefulness of these tests for the patients with non-traumatic subcortical cerebrovascular disease. Method : We administered the MMSE and BCRS to 85 patients and 195 normal control group. In order to compare the test results according to the lesion site, we divided patients into left sided lesion group(21 patients), right sided lesion group(31 patients) and both sided lesion group(13 patients). Their cognitive function was evaluated by the BNA and daily living functional activity was examined by the IADLs(Instrumental Activities of Daily Living Scale)and GERRI(Geriatric Evaluation by Relative's Rating Instrument). Results : The results are as follows : 1) In the BNA, the patients scored significantly lower than control group at all items(except Right-Left Orientation and Motor Impersistence), but there were no difference in the MMSE(total score and all 5 items), and only 2 items(recent memory and self-care) were significantly different between two groups in the BCRS. 2) In the comparison by lateralization, there were significant differences among three groups at 3 items(Left Tactile Form Perception, Left Finger Localization and Right Finger Localization) in the BNA. But, there were no difference in the MMSE and BCRS. 3) In the correlation between daily living functioning and the MMSE/BCRS, control group showed no relation(except item of cognitive functioning), but patient group was significantly correlated with 3 items(social functioning, instrumental activities of daily living and cognitive functioning). Conclusions : These findings suggest that MMSE and BCRS are not useful as the test for cognitive function and discrimination of lateralization in patients with non-traumatic subcortical cerebrovascular disease. However, scores of these tests may be related with the functional level(such as daily living function) of patients.

• Journal of Korean Neurosurgical Society
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• v.59 no.2
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• pp.168-171
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• 2016

Choroidal fissure cysts are often incidentally discovered. They are usually asymptomatic. The authors report a case of growing and hemorrhagic choroidal fissure cyst which was treated surgically. A 22-year-old female presented with headache. Cranial MRI showed a left-sided choroidal fissure cyst. Follow-up MRI showed that the size of the cyst had increased gradually. Twenty months later, the patient was admitted to our emergency department with severe headache. MRI and CT showed an intracystic hematoma. Although such cysts usually have a benign course without symptoms and progression, they may rarely present with intracystic hemorrhage, enlargement of the cyst and increasing symptomatology.

• Archives of Plastic Surgery
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• v.45 no.2
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• pp.171-176
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• 2018

Central venous stenosis is a rare cause of unilateral breast edema occurring in hemodialysis patients that needs to be differentiated from other differential diagnoses, including, but not limited to, inflammatory breast carcinoma, mastitis, lymphedema, and congestive heart failure. All reports of similar cases in the available literature have described improvement or resolution of the edema after treatment. Herein, we report and discuss the pathophysiology of breast edema formation in a patient who presented with massive left-sided breast edema 7 years after being diagnosed with central venous stenosis. Medical and minimally invasive therapy had not been successful, so she underwent reduction mammoplasty to relieve the symptoms.