• Journal of Korean Neurosurgical Society
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• 제57권4호
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• pp.307-310
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• 2015

We report a case of a paradoxical response of a tuberculoma in the brain mimicking a brain tumor. A 76-year-old woman presented with a 2 week history of headache, dysarthia, and orthopnea. Brain magnetic resonance images (MRI) revealed two rim-enhancing lesions on the pons and occipital lobe, and chest computed tomography showed randomly distributed miliary nodules. The tentative diagnosis was tuberculosis (TB) of the brain and lung. She complained of right hemiparesis and worsening general weakness after taking the anti-TB medication. On the monthly follow-up images, the enhanced lesions were enlarged with increased perfusion and choline/creatinine ratio, suggesting a high grade glioma. A surgical resection was completed to diagnose the occipital lesion, and the tuberculoma was pathologically confirmed by a positive TB-polymerase chain reaction. The anti-TB medication was continued for 13 months. A follow-up MRI showed decreased size of the brain lesions associated with perilesional edema, and the clinical symptoms had improved. Brain tuberculoma could be aggravated mimicking brain malignancy during administration of anti-TB medication. This paradoxical response can be effectively managed by continuing the anti-TB drugs.

• Journal of Korean Neurosurgical Society
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• 제50권2호
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• pp.99-102
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• 2011

Objective : The purpose of this retrospective study was to evaluate the outcome of gamma knife radiosurgery (GKRS) and/or whole brain radiation therapy (WBRT) for the treatment of small cell lung carcinoma (SCLC) metastasis to the brain. Methods : From 2000 to 2010, 50 patients underwent GKRS for metastatic brain lesions originating from SCLC. Among these patients, 11 received prophylactic cranial irradiation (PCI) before the development of metastatic lesions (PCI group), and GKRS was performed as an initial treatment for newly diagnosed lesions in 12 patients who had not received PCI (primary GKRS group). In addition, GKRS was performed as a salvage treatment for progressive lesions after WBRT in 27 patients (salvage GKRS group). The medical records and imaging data of all patients were retrospectively analyzed. Results : The overall survival of the 50 patients was 20.8 months (range 1-53) after the diagnosis of primary tumor and 12.0 months (range 1-47) after the development of cerebral metastasis. Median survival after GKRS was 4.8 months (range 1-15) in the PCI group, 4.6 months (range 0-18) in the primary GKRS group, and 7.6 months (range 0-33) in the salvage GKRS group. Further treatment for progressive lesions after GKRS was necessary in 15 patients, after a mean interval of 3.8 months. Causes of death were systemic organ failure in 15 patients, deterioration of neurological state in 13 patients, and unknown or combined causes in 16 patients. The local control rate of the lesions treated with GKRS was 76.4% (decreased in 13 patients and stable in 16 patients at the final imaging follow-up (mean 5.60 months). Conclusion : GKRS is an effective local treatment for brain metastasis from SCLC both as an initial treatment for newly diagnosed lesions after PCI and as a salvage treatment for recurrent or progressive lesions. However, the survival benefit is not significant because most patients die of systemic multi-organ failure with a short life expectancy.

• 대한자기공명의과학회:학술대회논문집
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• 대한자기공명의과학회 2003년도 제8차 학술대회 초록집
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• pp.100-100
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• 2003

In brain MR imaging, contrast-enhanced study is important in the detection and characterization of lesions. As a postcontrast brain MR imaging, conventional T1 weighted imaging has been usually used. Magnetization transfer imaging has been used to increase conspicuity of enhancing lesions. In addition, fat-suppression imaging can be used as in other parts of the body. Recently, FLAIR sequence has been reported to be useful in detecting subarachnoid, meningeal, and subdural abnormalities. In this exhibit, we demonstrate basic principles and typical appearances of various pulse sequences that can be used as a postcontrast brain MR imaging in children. Furthermore, we discuss imaging strategies to increase clinical usefulness of postcontrast brain MR imaging for specific abnormalities. The advantages and disadvantages of each pulse sequence are also discussed.

• Journal of Korean Neurosurgical Society
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• 제65권1호
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• pp.145-150
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• 2022

Lesions occurring simultaneously in the somatosensory or motor cortex of the brain and the cervical spine are rare. Brain tumors can cause similar symptoms to cervical lesions which can lead to confusion in treatment priorities. Moreover, if cervical disease is noticeably observed in radiologic findings of a patient complaining of cervical radiculopathy with non-specific electromyography results, it is common to no longer perform further evaluation. Here we introduce two cases where the cause of cervical radiculopathy was first considered to be the result of a degenerative cervical disease but was later discovered to be a result of a brain tumor.

• Journal of Korean Neurosurgical Society
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• 제44권6호
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• pp.358-363
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• 2008

Objective : This study was performed to assess the efficacy of GKS in patients with ten or more brain metastases. Methods : From Aug 2002 to Dec 2007, twenty-six patients (13 men and 13 women) with ten or more cerebral metastatic lesions underwent GKS. The mean age was 55 years (32-80). All patients had Karnofsky performance status (KPS) score of 70 or better. According to recursive partitioning analysis (RPA) classification, 3 patients belonged to class I and 23 to class II. The location of primary tumor was lung (21), breast (3) and unknown (2). The mean number of the lesions per patient was 16.6 (10-37). The mean cumulated volume was 10.9 cc (1.0-42.2). The median marginal dose was 15 Gy (9-23). Overall survival and the prognostic factors for the survival were retrospectively analyzed by using Kaplan Meier method and univariate analysis. Results : Overall median survival from GKS was 34 weeks (8-199). Local control was possible for 79.5% of the lesions and control of all the lesions was possible in at least 14 patients (53.8%) until 6 months after GKS. New lesions appeared in 7 (26.9%) patients during the same period. At the last follow-up, 18 patients died; 6 (33.3%) from systemic causes, 10 (55.6%) from neurological causes, and 2 (11.1 %) from unknown causes. Synchronous onset in non-small cell lung cancer (p=0.007), high KPS score (${\geq}80$, p=0.029), and controlled primary disease (p=0.020) were favorable prognostic factors in univariate analysis. Conclusion : In carefully selected patients, GKS may be a treatment option for ten or more brain metastases.

• Clinical and Experimental Pediatrics
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• 제62권9호
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• pp.334-339
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• 2019

Kawasaki disease (KD) is a systemic vasculitis in infants and young children. However, its natural history has not been fully elucidated because the first case was reported in the late 1960s and patients who have recovered are just now entering middle age. Nevertheless, much evidence has raised concerns regarding the subclinical vascular changes that occur in post-KD patients. KD research has focused on coronary artery aneurysms because they are directly associated with fatality. However, aneurysms have been reported in other extracardiac muscular arteries and their fate seems to resemble that of coronary artery aneurysms. Arterial strokes in KD cases are rarely reported. Asymptomatic ischemic lesions were observed in a prospective study of brain vascular lesions in KD patients with coronary artery aneurysms. The findings of a study of single-photon emission computed tomography suggested that asymptomatic cerebral vasculitis is more common than we believed. Some authors assumed that the need to consider the possibility of brain vascular lesions in severe cases of KD regardless of presence or absence of neurological symptoms. These findings suggest that KD is related with cerebrovascular lesions in children and young adults. Considering the fatal consequences of cerebral vascular involvement in KD patients, increased attention is required. Here we review our understanding of brain vascular involvement in KD.

• Clinical Nutrition Research
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• 제11권1호
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• pp.20-31
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• 2022

Through a survey on dietary intake of children and adolescents with brain lesions, the present study aimed to analyze the current status of nutrient intake and examine the effect of high-protein nutrient drink on their nutritional and muscle statuses. The study participants were 90 juvenile participants aged 8-19 years, with brain lesions. The participants were provided with a protein nutrient drink for 12 weeks and a questionnaire survey on dietary intake was performed to analyze the level of nutrient intake before and after ingestion. The physical measurements were taken to determine the improvements in nutrient and muscle statuses. The results showed that, before the intake of protein nutrient drink as a supplement, the participants exhibited lower height, weight, and body mass index than those of the standard levels of healthy individuals, and the level of nutrient intake through diet was lower than those of the required and recommended levels of nutrient intake for Koreans. Conversely, after the intake of protein nutrient drink for 12 weeks, the level of nutrient intake and physical statuses such as weight showed significant improvements. In addition, the muscle status had undergone approximately 10% of change during the intervention with no significant difference. Thus, to ensure an adequate level of nutrient supply to children and adolescents with brain lesions, there is an urgent need to develop a guideline of nutrient intake. The findings in this study are expected to serve as the basic data for such guidelines.

• 한국산학기술학회논문지
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• 제13권5호
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• pp.2267-2277
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• 2012

본 연구는 배변 문제가 있는 뇌 병변 장애 입원 환자에게 자원봉사자들이 주 3회의 아로마 복부경락마사지 중재(7분/1회)를 4주간 적용하여 변비완화에 미치는 효과를 검정하고자 시도되었다. 연구 설계는 단일군 전후설계의 원시실험연구이며, 연구대상은 5개월 이상 입원중이며 배변문제가 있는 뇌 병변 장애환자 38명이었다. 연구기간은 2011년 5월 9일부터 6월 19일까지 총 6주간 이었다. 변비완화 효과는 좌약 또는 관장 적용 횟수, 배변 횟수, 배변 양으로 측정 하였으며, 수집된 자료를 SPSS 19.0을 이용하여 기술통계와 Repeated Measures ANOVA로 분석한 결과는 다음과 같다. 첫째, 시간의 경과에 따라 좌약 또는 관장횟수가 감소한 것으로 나타났으나 통계적으로 유의하지 않았다(F=1.03, p=.361). 둘째, 시간의 경과에 따라 배변 횟수가 증가한 것으로 나타났으나 통계적으로 유의하지 않았다(F=2.14, p=.133). 셋째, 시간의 경과에 따라 배변 양이 유의하게 증가한 것으로 나타났다(F=3.56, p=.033). 시점 간을 비교 분석한 결과 사전시기 보다 중재 1-2주(p<.05)와 중재 3-4주(p<.01)에 배변 양이 증가하여 유의한 차이가 있었다. 이상의 결과를 통해 자원봉사자에 의한 주 3회의 아로마 복부경락마사지는 입원 뇌 병변 장애 환자의 변비완화에 효과가 있는 비 침습적인 간호중재라고 결론지을 수 있으며, 간호실무 현장에서 아로마 복부경락마사지 중재를 적용할 수 있는 경험적 근거와 지침을 제공한 점에서 그 의의가 있다. 추후 본 연구결과의 확산을 위해 다양한 대상자에게 반복 연구를 실시하여 경험적 증거를 축적할 것을 제언한다.

• Journal of Korean Neurosurgical Society
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• 제58권2호
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• pp.163-166
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• 2015

The prophylactic use of phenytoin during and after brain surgery and cranial irradiation is a common measure in brain tumor therapy. Phenytoin has been associated with variety of adverse skin reactions including urticaria, erythroderma, erythema multiforme (EM), Stevens-Johnson syndrome, and toxic epidermal necrolysis. EM associated with phenytoin and cranial radiation therapy (EMPACT) is a rare specific entity among patients with brain tumors receiving radiation therapy while on prophylactic anti-convulsive therapy. Herein we report a 41-year-old female patient with left temporal glial tumor who underwent surgery and then received whole brain radiation therapy and chemotherapy. After 24 days of continous prophylactic phenytoin therapy the patient developed minor skin reactions and 2 days later the patient returned with generalized erythamatous and itchy maculopapuler rash involving neck, chest, face, trunk, extremities. There was significant periorbital and perioral edema. Painful mucosal lesions consisting of oral and platal erosions also occurred and prevented oral intake significantly. Phenytoin was discontinued gradually. Systemic admistration of corticosteroids combined with topical usage of steroids for oral lesions resulted in complete resolution of eruptions in 3 weeks. All cutaneous lesions in patients with phenytoin usage with the radiotherapy must be evoluated with suspicion for EM.

• Journal of Korean Neurosurgical Society
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• 제47권5호
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• pp.325-331
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• 2010

Objective : We retrospectively evaluated the survival outcome of patients with brain metastasis from hepatocellular carcinoma (HCC). Methods : Between 1991 and 2007, a total of 20 patients were diagnosed as having brain metastasis from HCC. The mean age of the patients was 55 ${\pm}$ 13 years, and 17 (85.0%) were men. Seventeen (85.0%) patients had already extracranial metastases. The median time from diagnosis of HCC to brain metastasis was 18.5 months. Fourteen (70.0%) patients had stroke-like presentation due to intracerebral hemorrhage (ICH). Ten (50.0%) patients had single or solitary brain metastasis. Among a total of 34 brain lesions, 31 (91.2%) lesions had the hemorrhagic components. Results : The median survival time was 8 weeks (95% CI, 5.08-10.92), and the actuarial survival rates were 85.0%, 45.0%, 22.5%, and 8.4% at 4, 12, 24, and 54 weeks. Age < 60 years, treatment of the primary and/or extracranial lesions, and recurrent ICH were the possible prognostic factors (p = 0.044, p < 0.001, and p = 0.111, respectively). The median progression-free survival (PFS) time was 3 months (95% CI, 0.95-5.05). Conclusion : The overall survival of the patients with brain metastasis from HCC was very poor with median survival time being only 8 weeks. However, the younger patients less than 60 years and/or no extracranial metastases seem to be a positive prognostic factor.