• Journal of Korean Neurosurgical Society
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• 제60권6호
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• pp.730-737
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• 2017

Objective : Postoperative hydrocephalus is a common complication following craniectomy in patients with traumatic brain injury, and affects patients' long-term outcomes. This study aimed to verify the risk factors associated with the development of hydrocephalus after craniectomy in patients with acute traumatic subdural hemorrhage (tSDH). Methods : Patients with acute traumatic SDH who had received a craniectomy between December 2005 and January 2016 were retrospectively assessed by reviewing the coexistence of other types of hemorrahges, measurable variables on computed tomography (CT) scans, and the development of hydrocephalus during the follow-up period. Results : Data from a total of 63 patients who underwent unilateral craniectomy were analyzed. Postoperative hydrocephalus was identified in 34 patients (54%) via brain CT scans. Preoperative intraventricular hemorrhage (IVH) was associated with the development of hydrocephalus. Furthermore, the thickness of SDH (p=0.006) and the extent of midline shift before craniectomy (p=0.001) were significantly larger in patients with postoperative hydrocephalus. Indeed, multivariate analyses showed that the thickness of SDH (p=0.019), the extent of midline shift (p<0.001) and the coexistence of IVH (p=0.012) were significant risk factors for the development of postoperative hydrocephalus. However, the distance from the midline to the craniectomy margin was not an associated risk factor for postoperative hydrocephalus. Conclusion : In patients with acute traumatic SDH with coexisting IVH, a large amount of SDH, and a larger midline shift, close follow-up is necessary for the early prediction of postoperative hydrocephalus. Furthermore, craniectomy margin need not be limited in acute traumatic SDH patients for the reason of postoperative hydrocephalus.

• Journal of Korean Neurosurgical Society
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• 제64권1호
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• pp.51-59
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• 2021

Objective : Several studies have reported inconsistent findings among countries on whether off-hour hospital presentation is associated with worse outcome in patients with acute stroke. However, its association is yet not clear and has not been thoroughly studied in Korea. We assessed nationwide administrative data to verify off-hour effect in different subtypes of acute stroke in Korea. Methods : We respectively analyzed the nationwide administrative data of National Emergency Department Information System in Korea; 7144 of ischemic stroke (IS), 2424 of intracerebral hemorrhage (ICH), and 1482 of subarachnoid hemorrhage (SAH), respectively. "Off-hour hospital presentation" was defined as weekends, holidays, and any times except 8:00 AM to 6:00 PM on weekdays. The primary outcome measure was in-hospital mortality in different subtypes of acute stroke. We adjusted for covariates to influence the primary outcome using binary logistic regression model and Cox's proportional hazard model. Results : In subjects with IS, off-hour hospital presentation was associated with unfavorable outcome (24.6% off hours vs. 20.9% working hours, p<0.001) and in-hospital mortality (5.3% off hours vs. 3.9% working hours, p=0.004), even after adjustment for compounding variables (hazard ratio [HR], 1.244; 95% confidence interval [CI], 1.106-1.400; HR, 1.402; 95% CI, 1.124-1.747, respectively). Off-hours had significantly more elderly ≥65 years (35.4% off hours vs. 32.1% working hours, p=0.029) and significantly more frequent intensive care unit admission (32.5% off hours vs. 29.9% working hours, p=0.017) than working hours. However, off-hour hospital presentation was not related to poor short-term outcome in subjects with ICH and SAH. Conclusion : This study indicates that off-hour hospital presentation may lead to poor short-term morbidity and mortality in patients with IS, but not in patients with ICH and SAH in Korea. Excessive death seems to be ascribed to old age or the higher severity of medical conditions apart from that of stroke during off hours.

• Korean Journal of Radiology
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• 제2권4호
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• pp.183-191
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• 2001

Objective: To document the signal characteristics of intracerebral hemorrhage (ICH) at evolving stages on diffusion-weighted images (DWI) by comparison with conventional MR images. Materials and Methods: In our retrospective study, 38 patients with ICH underwent a set of imaging sequences that included DWI, T1-and T2-weighted imaging, and fluid-attenuated inversion recovery (FLAIR). In 33 and 10 patients, respectively, conventional and echo-planar T2^* gradient-echo images were also obtained. According to the time interval between symptom onset and initial MRI, five stages were categorized: hyperacute (n=6); acute (n=7); early subacute (n=7); late subacute (n=10); and chronic (n=8). We investigated the signal intensity and apparent diffusion coefficient (ADC) of ICH and compared the signal intensities of hematomas at DWI and on conventional MR images. Results: DWI showed that hematomas were hyperintense at the hyperacute and late subacute stages, and hypointense at the acute, early subacute and chronic stages. Invariably, focal hypointensity was observed within a hyperacute hematoma. At the hyperacute, acute and early subacute stages, hyperintense rims that corresponded with edema surrounding the hematoma were present. The mean ADC ratio was 0.73 at the hyperacute stage, 0.72 at the acute stage, 0.70 at the early subacute stage, 0.72 at the late subacute stage, and 2.56 at the chronic stage. Conclusion: DWI showed that the signal intensity of an ICH may be related to both its ADC value and the magnetic susceptibility effect. In patients with acute stroke, an understanding of the characteristic features of ICH seen at DWI can be helpful in both the characterization of intracranial hemorrhagic lesions and the differentiation of hemorrhage from ischemia.

• Biomolecules & Therapeutics
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• 제11권2호
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• pp.126-132
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• 2003

Efficacy and in vivo bioassay of recombinant human erythropoietin (rh-EPO, DWP413) was investigated. Efficacy studies on erythropoiesis were conducted in normal, cisplatin-induced anemic rats and acute hemorrhage - induced anemic rats. Animals were treated intravenously with DWP413 for 5 days, the changes in the number of red blood cells (RBC), hematocrit value (Hct), hemoglobin concentration (Hb) and reticulocyte were examined. In normal rats, at the doses of 50, 250, and 1250 IU/kg/day, in cisplatin-induced anemic rats, at the doses of 50, 100 and 200 IU/kg/day, RBC, Hb, Hct and reticulocyte were increased dose-depen-dently. And in acute hemorrhage-induced anemic rats, DWP413 (150, 450 and 1350 IU/kg/day) significantly increased RBC, Hb, Hct and reticulocytes. In histopathological findings of kidney, cisplatin alone treated rats expressed severe glomerulus and tubular damage. But in the DWP413 treated rats after cisplatin treatment, these were not remarkable compared to cisplatin alone treated rats. In vivo bioassay, DWP413 had 102.43% of bioactivity compared to erythropoietin BRP(Biological Reference Product, European Directorate for the Quality of Medicines). These results suggest that DWP413 might be useful for the therapy of anemia induce by renal failure and acute blood loss.

• Investigative Magnetic Resonance Imaging
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• 제20권1호
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• pp.71-74
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• 2016

Wernicke's encephalopathy (WE) is an acute neurological disorder resulting from thiamine deficiency. Early diagnosis and treatment of WE is important to avoid persistent brain damage. Although histopathologic examination usually demonstrates pin-point hemorrhages in affected brain parenchyma, secondary hemorrhage is a rare but serious complication of WE. We experienced a rare case of intracranial hemorrhage related to WE in a 56-year-old male patient with malnourishment.

• Investigative Magnetic Resonance Imaging
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• 제25권1호
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• pp.43-46
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• 2021

Arachnoid cysts are benign lesions that are formed between the inner and outer layers of the arachnoid, accounting for 1% of all intracranial space occupying lesions. Usually, arachnoid cysts are asymptomatic. It can be symptomatic in case of complication such as intracystic hemorrhage or acute cyst expansion. We present a case of incidentally prediagnosed arachnoid cyst which undergone intracystic hemorrhage combined with ipsilateral SDH in a young male.

• Investigative Magnetic Resonance Imaging
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• 제19권2호
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• pp.107-113
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• 2015

Purpose: Susceptibility weighted imaging (SWI) is a new magnetic resonance technique that can exploit the magnetic susceptibility differences of various tissues. Intracranial hemorrhage (ICH) looks a dark blooming on the magnitude images of SWI. However, the pattern of ICH on phase images is not well known. The purpose of this study is to characterize hemorrhagic lesions on the phase images of SWI. Materials and Methods: We retrospectively enrolled patients with ICH, who underwent both SWI and precontrast CT, between 2012 and 2013 (n = 95). An SWI was taken, using the 3-tesla system. A phase map was generated after postprocessing. Cases with an intracranial hemorrhage were reviewed by an experienced neuroradiologist and a trainee radiologist, with 10 years and 3 years of experience, respectively. The types and stages of the hemorrhages were determined in correlation with the precontrast CT, the T1- and T2-weighted images, and the FLAIR images. The size of the hemorrhage was measured by a one- directional axis on a magnitude image of SWI. The phase values of the ICH were qualitatively evaluated: hypo-, iso-, and hyper-intensity. We summarized the imaging features of the intracranial hemorrhage on the phase map of the SWI. Results: Four types of hemorrhage are observed: subdural and epidural; subarachnoid; parenchymal hemorrhage; and microbleed. The stages of the ICH were classified into 4 groups: acute (n = 34); early subacute (n = 11); late subacute (n = 15); chronic (n = 8); stage-unknown microbleeds (n = 27). The acute and early subacute hemorrhage showed heterogeneous mixed hyper-, iso-, and hypo-signal intensity; the late subacute hemorrhage showed homogeneous hyper-intensity, and the chronic hemorrhage showed a shrunken iso-signal intensity with the hyper-signal rim. All acute subarachnoid hemorrhages showed a homogeneous hyper-signal intensity. All parenchymal hemorrhages (> 3 mm) showed a dipole artifact on the phase images; however, microbleeds of less than 3 mm showed no dipole artifact. Larger hematomas showed a heterogeneous mixture of hyper-, iso-, and hypo-signal intensities. Conclusion: The pattern of the phase value of the SWI showed difference, according to the type, stage, and size.

• Journal of Korean Neurosurgical Society
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• 제54권2호
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• pp.145-147
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• 2013

We present a case of acute hydrocephalus secondary to cervical spinal cord injury in a patient with diffuse ossification of the posterior longitudinal ligament (OPLL). A 75-year-old male patient visited the emergency department with tetraparesis and spinal shock. Imaging studies showed cervical spinal cord injury with hemorrhage and diffuse OPLL from C1 to C4. We performed decompressive laminectomy and occipitocervical fusion. Two days after surgery, his mental status had deteriorated to drowsiness with dilatation of the right pupil. Findings on brain computed tomography revealed acute hydrocephalus and subarachnoid hemorrhage in the cerebellomedullary cistern, therefore, extraventricular drainage was performed immediately. Acute hydrocephalus as a complication of cervical spine trauma is rare, however, it should be considered if the patient shows deterioration of neurologic symptoms.

• The Korean Journal of Physiology and Pharmacology
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• 제6권4호
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• pp.199-205
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• 2002

The role of peripheral vestibular receptors in acute hypotension was investigated in anesthetized rats. Acute hypotension was induced by either intravenous infusion of sodium nitroprusside (SNP) or by experimental hemorrhage, and electrical activity and expression of cFos-like immunoreactive (cFL) protein were measured in the medial vestibular nuclei (MVN). Blood pressure decreased proportionately to the does of intravenous SNP and to the volume of the hemorrhage. Blood pressure decreased 10, 30, 50% for the 5, 10, $15{\mu}g/kg$ SNP injection, respectively, and also decreased 30 and 50% after 1- and 2-ml blood loss, respectively, due to hemorrhage. In animals with intact labyrinths, acute hypotension induced by either intravenous infusion of SNP or hemorrhage produced different electrical activities with three different patterns in type I and II neurons of MVN. The responses of type I neurons showed excitatory in 2/3 of recorded neurons and inhibitory or no change in 1/3 of neurons, while the responses of type II neurons showed inhibitory in 2/3 of recorded neurons and excitatory or no change in 1/3 of neurons. In unilateral labyrinthectomized animals, 2/3 of type I neurons ipsilateral to the lesion showed an inhibitory response, and 2/3 of contralateral type I neurons showed an excitatory response after the induction of acute hypotension. The response patterns of type II neurons were opposite from those of the type I neurons. After 30% decrease in blood pressure, cFL protein expressed in the bilateral vestibular nuclei of control animals with intact labyrinths. Expression of cFL protein increased significantly proportionately to the reduction of blood pressure. The unilateral labyrinthectomized animals with acute hypotension produced expression of cFL neurons in contralateral vestibular nuclei to the lesion side, but not in ipsilateral vestibular nuclei. However, cFL protein was not expressed in bilateral vestibular nuclei after acute hypotension in bilateral labyrinthectomized animals. These results suggest that the peripheral vestibular receptors might play a significant role in controlling blood pressure following acute hypotension via activation of type I neurons and inhibition of type II neurons in the vestibular nuclei.

• Journal of Korean Neurosurgical Society
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• 제29권5호
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• pp.644-649
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• 2000

저자들의 방법으로 급성 수두증이 지속되는 환자를 치료한다면 첫째, 뇌압이 상승된 환자에서 요추지주막하 배액의 가장 우려되는 합병증인 탈뇌의 가능성을 미리 예측 할 수 있고 둘째, 뇌실외배액을 뇌실염 발생 이전에 요추지주막하배액으로 대치하여 뇌실염을 예방할 수 있으며 셋째, 뇌실외배액으로 인하여 뇌실염이 이미 발생한 경우에는 요추지주막하 배액으로 치환하여, 이물질(foreign body)로 작용하여 감염치료를 저해하는 뇌실내 카테터를 제거할 수 있고 동시에 경막내 항생제 투여로 뇌실염의 치료를 기대할 수 있으며 넷째, 요추지주막하 배액은 뇌실외배액에 비해 반복적 시술에 따른 두개강내 출혈, 경련 등의 위험으로부터 안전하며 천자가 가능한 부위가 많아 기간이 오래되거나 혹은 천자가 실패하여 다른 부위로 옮겨야할 때 위치 변경이 용이하다는 등의 장점이 기대된다. 본 교실에서는 여러 가지 원인으로 인하여 발생한 급성 수두증이 조기에 해결되지 않고 잔존혈괴나 감염 등의 이유로 단락술을 바로 시행할 수도 없는 경우에 간단한 시험을 통하여 탈뇌의 가능성을 배제한 다음 뇌실외배액을 요추지주막하 배액으로 치환하여 치료함으로써 좋은 결과를 얻었기에 이러한 곤란한 경우의 치료법의 한가지 대안으로 제안하고자 한다.