• The Korean Journal of Pain
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• 제14권2호
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• pp.276-279
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• 2001

Epidural steroid injection is one method of releiving chronic back pain. However, problems with the loss of resistance to air technique include the possible subarachnoid or subdural injection of air resulting in headache, venous air embolism, and the introduction of air bubbles into the epidural space. Pneumocephalus is a rare complication of epidural block for epidural steroid injection. We report a case of a 58-year-old woman who developed a severe headache and posterior nuchal pain with incomplete oculomotor palsy due to pneumocephalus occuring after an epidural steroid injection.

• Journal of Oral Medicine and Pain
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• 제43권3호
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• pp.92-96
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• 2018

A 39-year-old male presented with severe pain in right posterior mandibular teeth and temporal area. Initially, the pain in the mandibular teeth was moderate, but the concomitant headache was unbearably severe. His medical history was non-contributory. The clinical and radiographic examination failed to reveal any pathology in the region. There was no tenderness to palpation in the temporalis and masseter muscles or temporomandibular joints. The clinical impression was migraine. The pain in the teeth and headache were aborted using ergotamine tartrate and sumatriptan succinate. Atenolol prevented further pain, while amitriptyline and imipramine had no effect. Migraine can present as non-odontogenic pain in the mandibular teeth, although not as frequently as in the maxillary teeth. A correct diagnosis is essential to avoid unnecessary dental treatments and to manage pain effectively. Clinicians should be able to identify migraine with non-odontogenic dental pain and establish a proper diagnosis through a comprehensive evaluation.

• Journal of Trauma and Injury
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• 제26권1호
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• pp.30-33
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• 2013

A 55-year-old woman was seen in the emergency department with posterior neck pain and a headache after a traffic accident. Physical examination revealed tenderness on palpation over the posterior skull and a midline spinous process of the cervical spine without neurologic deficit. A plain radiograph of the cervical spine demonstrated the absence of the lateral portion of the posterior arch of the atlas and very lucent shadowing of the anterior midline of the atlas, suggesting a fracture of the anterior arch. On three-dimensional computed tomography (CT) of the cervical spine, anterior and posterior bony defects of the atlas were noted. Well-corticated defects were noted with sclerotic change and with no evidence of soft tissue swelling adjacent to the bony discontinuities, consistent with a congenital abnormality. With conservative therapy, the patient gradually showed a lessening of the midline tenderness. Careful investigation with radiography or CT is needed for these patients to avoid confusion with a fracture, because these patients seldom need surgical treatment.

• 대한물리의학회지
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• 제10권1호
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• pp.115-120
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• 2015

PURPOSE: Vertebrobasilar insufficiency (VBI) should be carefully assessed in patient for whom manipulation of the cervical spine is to be undertaken. The purpose of this study was to investigate the changes in posterior cerebral artery blood flow velocity following head and body positioning by transcranial doppler ultrasonography (TCD) in healthy subjects. METHODS: Twenty two healthy female (mean age $20.77{\pm}1.30yrs.$) participants volunteered to participate in the study. None of the participants had a history of neck pain or headache within the last 6 months. To evaluate the cerebral blood flow, we measured the mean flow velocity of the posterior cerebral artery unilaterally (right side). The blood flow velocity was measured under 3 different head positions (in a neutral head position, ipsilateral head rotation and contralateral head rotation position) and 2 different body conditions (supine position and sitting position). RESULTS: The mean blood flow velocity of posterior cerebral artery was decreased in body positioning from supine to sitting (p<.05), but the decreased rate of blood flow velocity in posterior cerebral artery did not change significantly between ipsilateral head rotation and contralateral head rotation (p>.05). CONCLUSION: These result of our study show that body positioning (sitting and supine) affect the blood flow velocity in posterior cerebral artery.

• The Korean Journal of Pain
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• 제20권2호
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• pp.235-239
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• 2007

Spontaneous intracranial hypotension (SIH) is believed to be a benign disease. However, numerous studies have reported serious complications related to SIH, including subdural hematoma. In this case report, a 54-year-old male patient visited the emergency room with orthostatic headache. A brain magnetic resonance imaging (MRI) study showed diffuse mild thickening and enhancement of pachymeninges, with a suspicious minimal amount of subdural fluid collected in the left posterior parietal area. His orthostatic headache showed no improvement with conservative treatment; but his pain was almost completely relieved after two trials of cervical epidural blood patch. On the 74th day after the onset of his pain, the patient showed a drowsy mental status and slurred speech when he visited the pain clinic. Brain computerized tomography indicated a left subdural hemorrhage, and he underwent emergency operation to drain the SDH. In conclusion, pain clinicians should pay attention to abrupt changes in mental status as well as continuous headache, for the early diagnosis of SDH in SIH patients.

• Pediatric Infection and Vaccine
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• 제22권2호
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• pp.113-116
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• 2015

가역적 후두부 뇌병증 증후군은 다양한 원인에 의하여 생기는 발생하는 질환으로 갑자기 생기는 두통, 정신상태의 변화, 시력장애, 경련 등이 주증상이다. 영상의학 검사에서는 후두부 백질의 부종이 양측성 혹은 일측성으로 나타난다. 저자들은 A군 사슬알균 감염 후 가역적 후두부 뇌병증 증후군을 보인 환자를 경험하였고 고혈압을 조절한 후 환자는 빠른 시간 내에 신경학적인 회복을 보였다.

• Journal of Korean Neurosurgical Society
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• 제41권3호
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• pp.196-199
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• 2007

Dissecting aneurysms frequently involve the vertebral arteries and their branches, but those involving the posterior inferior cerebellar artery [PICA] and not vertebral artery at all are extremely rare. We present a case of an isolated dissecting aneurysm of the PICA without involvement of vertebral artery. A 54-year-old man presented with dizziness and headache. MR imaging of the brain showed a cerebellar infarction of the left PICA territory. MR angiographic and cerebral angiographic studies revealed a dissecting fusiform aneurysm involving the left proximal PICA. Subsequently, the patient underwent GDC embolization. A postembolization angiogram demonstrated complete obliteration of the aneurysm. In this report, the treatment modalities for this rare condition is described with review of the literature.

• Journal of Korean Neurosurgical Society
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• 제40권4호
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• pp.293-295
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• 2006

Infundibular dilatation is funnel-shaped symmetrical enlargement that occurs at the origin of cerebral arteries and which is apparent on 7 to 25% of normal angiograms. Infundibular dilatation is frequently considered a normal anatomic variation of no pathologic significance. The authors report a case in which an aneurysm developed on an infundibular dilatation of the posterior communicating artery [PComA]. A 72-year-old woman presented with severe headache, nausea, and vomiting. Digital subtraction angiography showed a saccular aneurysm arising from the origin of the left PComA. Operative findings revealed the aneurysm and infundibular widening of the right PComA. The aneurysm was successfully obliterated. Whether infundibular dilatation is a pre-aneurysmal state or a benign dilatation is controversial. However, we believe infundibular dilatation of the PComA in this case may have served as a pre-aneurysmal lesion.

• Journal of Korean Neurosurgical Society
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• 제42권6호
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• pp.475-477
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• 2007

Choroid plexus papillomas (CPPs) are typically considered as benign tumors, with a favorable long-term prognosis. Drop metastasis of CPP into the spinal subarachnoid space is rare. We report a 42-year-old woman who presented with headache and back pain 6 years after removal of a posterior fossa CPP. Magnetic resonance imaging revealed mass lesions in the lumbosacral subarachnoid space and recurrent intracranial tumor. The lesions were resected and histologically diagnosed was CPP. We consider that CPP can spread via cerebrospinal fluid pathways and cause spinal drop metastasis. Therefore, it is necessary to evaluate the whole spinal axis and to perform periodic follow-up examinations in patients with CPP.

• Journal of Korean Neurosurgical Society
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• 제37권4호
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• pp.310-312
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• 2005

We report a case of endodermal cyst of the posterior fossa. A 44-year-old man presented with headache for three months. Computed tomography and magnetic resonance imaging revealed a $6{\times}2.5{\times}2cm$ sized extra-axial non-enhancing cystic lesion on the ventral aspect to brain stem. To avoid retraction injury to brain stem, far lateral transcondylar approach was selected. Right suboccipital craniotomy and partial removal of occipital condyle with resection of C-1 and C-2 hemilaminae exposed the extra-axial cyst well. The cyst has a whitish thick membrane. It was not adherent to brain stem and lower cranial nerves. Total removal of the cyst was done without difficulty. Histological analysis disclosed a layer of pseudostratified columnar epithelium with basement membrane. The result of immunohistochemical study was consistent with endodermal cyst.