• The Korean Journal of Pain
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• 제18권1호
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• pp.60-63
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• 2005

This report describes the successful treatment of spontaneous intracranial hypotension (SIH) with multiple cerebrospinal fluid (CSF) leaks using 10 applications of epidural blood patches (EBP). A forty year old female who suffered with a postural headache was diagnosed as having SIH. On the cisternography, multiple CSF leaks were noted at the thoracic and lumbar area. Her headache was not improved with conservative treatments such as bed rest, hydration and NSAIDS. So, she underwent treatment with EBPs. After 10 applications of site-directed EBPs, her headache was resolved gradually and completely without any complications.

• Journal of Korean Neurosurgical Society
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• 제55권3호
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• pp.160-163
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• 2014

Uncontrolled cerebrospinal fluid (CSF) leakage after transsphenoidal surgery (TSS) for pituitary adenoma can lead to meningitis. Intracranial mycotic pseudoaneurysm is a rare complication in central nervous system infection. Large single pseudoaneurysm is more uncommon. Most mycotic aneurysms occur due to endocarditis. The present patient had no heart problem and was infected by CSF leakage after transsphenoidal surgery. We present a case of large ruptured mycotic pseudoaneurysm as a complication of cerebral infection after TSS for pituitary macroadenoma.

• Journal of Yeungnam Medical Science
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• 제33권1호
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• pp.64-67
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• 2016

We report on a 64-year-old man with leptomeningeal metastasis (LM) from an epidermal growth factor receptor (EGFR)-mutated adenocarcinoma of the lung. He was treated with paclitaxel, cisplatin. After completion of chemotherapy, he complained of headache, nausea, and vomiting. EGFR-mutated tumor cells were identified from the cerebrospinal fluid (CSF). Second-line therapy with gefitinib, methotrexate was started. After receiving gefitinib for 4 weeks, he had no more headaches or vomiting. Eleven months after initiation of gefitinib, he developed headache and nausea. Chest computed tomography showed aggravation of bone metastasis. Third-line therapy was started with gemcitabine and carboplatin. Two weeks later, he experienced disorientation. After a fourth relapse within the central nervous system, the therapy was switched to erlotinib and significant improvement of LM was achieved. This case shows that LM can be diagnosed by detecting EGFR mutation in CSF and EGFR tyrosine kinase inhibitors are effective for LM from EGFR mutant non-small cell lung cancer.

• Journal of Korean Neurosurgical Society
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• 제29권9호
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• pp.1204-1208
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• 2000

Objectives : At the closure of the transsphenoidal approach(TSA), the proper sellar floor reconstruction plays an important role in preventing postoperative complications. The septal cartilage, perpendicular plate of nasal septum, and the sphenoid sinus bone are usually used to repair the sellar floor as a bone splint. The authors evaluate the usefulness of a silicone plate as a substitute for bone splint to close a defect of the sellar floor. Materials and Methods : A silicone plate was used to repair the sellar floor in 7 patients with sellar lesions which included four pituitary adenomas, two Rathke's cleft cysts and one metastatic tumor. Among seven cases, five cases underwent a standard TSAs and two received a extended TSAs. The trajectories of the approach were sublabial in four cases and endonasal routes in three cases. The silicone plate for implantation was cut to a size of slightly larger than that of bone window and inserted with a three-pronged fork, and then adjusted precisely. Results : In six patients, there were no complications which related to sellar floor reconstruction. A postoperative cerebrospinal fluid(CSF) rhinorrhea was observed in one patient with pituitary macroadenoma. Conclusions : From the authors' experience, the advantages of the silicone plate are its simplicity of molding to fit any size of sellar floor defects, and easy detection of previously created bone window at reoperation.

• Clinical and Experimental Pediatrics
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• 제58권3호
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• pp.102-107
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• 2015

Purpose: Human parechovirus (HPeV) and enterovirus (EV) are causative agents of a sepsis-like illness in neonates and of infections of the central nervous system in young children. The objectives of this study were to assess the prevalence of HPeV3 and EV infection in young children with a sepsis-like illness or with meningitis in Jinju, Korea. Methods: Cerebrospinal fluid (CSF) samples were collected from 267 patients (age range, 1 day to 5 years) and assessed for HPeV and EV by performing reverse transcription polymerase chain reaction assay. Amplification products of the VP3/VP1 region of HPeV and of the VP1 region of EV were sequenced to identify the virus type. Results: HPeV and EV were detected in 3.4% and 7.5% of the total CSF samples assessed, respectively. The age distribution of EV-positive patients (median age, 1.4 months) had a significantly broader range than that of HPeV-positive patients (median age, 7.8 months). The peak seasons for HPeV and EV infection were spring and summer, respectively. The clinical symptoms for HPeV and EV infection were similar, and fever was the most common symptom. Pleocytosis was detected in 22.2% of HPeV-positive patients and 35.5% of EV-positive patients. The VP3/VP1 gene sequence of the nine Korean strains clustered most closely with the Japanese strain (AB759202). Conclusion: The data indicate that HPeV infection is predominant in young infants (<6 months) and that meningitis without pleocytosis was caused by both HPeV and EV infection in children.

• Brain Tumor Research and Treatment
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• 제6권2호
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• pp.54-59
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• 2018

Background Leptomeningeal metastasis (LM) is an uncommon, but devastating complication of advanced cancer and has no standard treatment. Herein, we analyzed the clinical characteristics and outcomes of patients with solid tumors who were diagnosed with LM. Methods Between January 2007 and December 2017, we retrospectively analyzed the medical records of patients with solid tumors who were diagnosed with LM. Results A total of 58 patients were enrolled in this study. The median age of patients was 51 years (range, 27-72 years), and 62.1% had a poor Eastern Cooperative Oncology Group (ECOG) performance status (PS) (>2). The common types of primary tumor were breast cancer (39.7%), gastric cancer (25.9%), and non-small cell lung cancer (20.7%). Forty-two patients (72.4%) were diagnosed with LM by MRI of the brain and/or spine and cerebrospinal fluid (CSF) analysis, 14 were diagnosed by CSF analysis alone, and 2 were diagnosed by MRI alone. Treatments for LM were performed in 53 patients (91.4%), and best supportive care was provided for 5 patients (8.6%). Intrathecal chemotherapy, radiotherapy, and systemic chemotherapy were administered in 43 (74.1%), 17 (29.3%), and 24 (41.4%) patients, respectively. The median overall survival of the entire cohort was 2.4 months (95% confidence interval, 1.0-3.7). In the analysis of prognostic factors for survival, a good ECOG PS (${\leq}2$), administration of systemic chemotherapy after LM diagnosis, and a prior history of brain radiation were associated with prolonged survival. Conclusion Although the prognosis of LM in patients with solid tumors is poor, systemic chemotherapy might improve survival in selected patients with a good PS.

• 대한의용생체공학회:의공학회지
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• 제40권5호
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• pp.189-196
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• 2019

We investigated differences in ventricular and hippocampal volumes between CSF tap test (CSFTT) responders and non-responders in idiopathic normal-pressure hydrocephalus (INPH) patients and compared these parameters in INPH patients with that of age- and gender-matched healthy controls. We also evaluated relationships between ventricular and hippocampal volumes and clinical profiles in INPH patients. We enrolled 48 patients with INPH and 29 healthy controls. Ventricular and hippocampal volumes were measured on MRI, including 3-dimensional volumetric images. INPH patients, when compared to healthy controls, had significantly larger ventricular and smaller hippocampal volumes. No difference in ventricular and hippocampal volumes was found between CSFTT responders and non-responders in INPH patients. And hippocampal volumes showed significant negative correlations with Clinical Dementia Rating Scale scores, INPH grading scale cognitive scores, Timed Up and Go Test scores, and Unified Parkinson's Disease Rating Scale motor scores in INPH patients. Volumetric assessment of ventricular and hippocampal regions may have no predictive value in differentiating between CSFTT responders and non-responders in INPH patients. Our findings may help us understand the potential pathophysiology of unique symptoms associated with INPH.

• 대한영상의학회지
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• 제85권1호
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• pp.24-35
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• 2024

자발두개내압저하(spontaneous intracranial hypotension)은 기립성 두통을 특징으로 하는 질환이며, 영상기법의 발달과 질환에 대한 인식이 높아짐에 따라 발견 빈도가 점차 증가하고 있는 추세이다. 이전에는 이 질환에서의 특징적인 뇌 자기공명영상 소견들이 많이 알려져 있었다. 그러나 최근에는 척추에서의 뇌척수액 누출이 원인으로 알려짐에 따라 척추 자기공명영상 소견이 주목받고 있다. 또한 뇌척수액 누출 부위를 정확히 확인할 수 있는 초고속 CT 척수조영술(ultrafast CT myelography), 디지털 감산 척수조영술(digital subtraction myelography) 등이 개발되었다. 이 종설에서는 자발두개내압저하의 진단, 척추 자기공명영상 소견, 최신 영상검사법과 치료에 대해 다루고자 한다.

• Parasites, Hosts and Diseases
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• 제30권2호
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• pp.83-90
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• 1992

Toxoplasma증의 혈청학적 진단에 있어서 민감도를 증가시키기 위해 간접 latex 응집반응의 결과와 비교하면서 ELISA를 개발하였으며, 뇌척수액의 검사 시료로서의 가능성을 검토하였다. 아울러 중추신경계 질환환자로부 터기생충질환을 감별하기 위하여 1986년부터 1991년까지 전국 카 병원에서 채취한 혈청과 뇌척수액에 대하여 간접 latex 응집반응(ILA)과 ELISA를 실시하여 Toxoplasma 항체 보유 양상을 비교 검토하였다. 전체 2,016 건의 혈청에 대해 ILA를 실시하여 76건(3.8%)의 양성 (1:32이상의 titer)을 얻었다. 그러나 양성 혈청환자에서 채취한 뇌척수액에서는 낮은 titer의 반응은 있었으나 양성은 나타나지 않았다. 이들 양성 혈청의 양성 혈청 및 음성 혈청에 대하여 ELISA로 항체검사를 실시한바 ILA의 titer가 1 : 32인 군에서 통계적으로 유의한 차이를 나타내는 항체값을 얻었으며, 그 흡반도는 0.40이었다. 뇌척수액에 대한 ELISA로는 ILA의 1 : 64 titer군에서 통계 적으로 유의한 차이가 나타났고 그때의 흡광도 0.27을 양성 판단의 기준으로 사용하였다. ELISA에 의한 항체 검사상 전체 혈청에서 7.0%의 양성을 검출하여 ILA보다 약 2배 정도의 높은 민감도를 보였으며, 뇌척수액에서 는 5.6%의 양성률을 보여 ELISA는 뇌척수액에서의 항체 검출시 유용한 방법이라고 판단하였다. ILA에 비하여 ELISA는 약 2배 정도 높은 양성률을 내었고 양성률은 나이에 마라 40대 이후 급격한 증가를 보였으며, 여성보 다는 남성에서 약 2배 정도 양성률이 높게 나타났다. ELISA에 의한 뇌척수액의 항체 검사에서는 양성률의 성별 차이를 나타내지 않았다. 이상의 결과로 판단할 때, ELISA가 ILA보다 Toxoplasma 항체 검출의 민감도가 높았으며, 뇌척수액은 ELISA의 좋은 검사시료가 되며, 특히 중추신경계 Tocxoplnsma증의 진단에 있어 뇌척수액에 대한 항체 검사에서 ELISA가 유용하다고 판단하였다.

• Journal of Korean Neurosurgical Society
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• 제38권1호
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• pp.1-11
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• 2005

Objective : The purpose of this study is to evaluate the correlation of the ICAM-l levels in serum and CSF with cerebral vasospasm in early aneurysmal subarachnoid hemorrhage [SAH] patients. Methods : A prospective analysis was performed in thirty consecutive patients who underwent early surgery for intracranial aneurysmal SAH. The serum and CSF were obtained daily through the indwelling arterial lines and intraoperative ventriculostomy, or cisternal drain for 4 consecutive days after surgery. The ICAM-1 levels in serum and CSF samples were measured via quantitative enzyme-linked immunosorbent assay. Results : The mean concentration of serum in aneurysmal SAH patients was 207.89ng/ml compared with 132.25ng/ml in controls. The mean concentration of CSF in aneurysmal SAH patients was 76.39ng/ml compared with 3.96ng/ml in controls. There were no significant differences between serum and CSF ICAM-1 level with regards to clinical characteristics in patients with aneurysmal SAH [P>0.05]. However, CSF ICAM-1 levels increased significantly in patients with vasospasm compared with those without vasospasm [P<0.05]. Conclusion : The major result of this study shows that ICAM-1 is increased in CSF after early aneurysmal SAH and that this increase in ICAM-1 has correlation with cerebral vasospasm. Further study is needed to determine whether ICAM-1 levels may be indicator in the pathogenesis of important events leading to cerebral vasospasm.