• Journal of Korean Neurosurgical Society
• /
• v.48 no.3
• /
• pp.213-218
• /
• 2010

Objective : Pituitary apoplexy (PA) is described as a clinical syndrome characterized by sudden headache, vomiting, visual impairment, and meningismus caused by rapid enlargement of a pituitary adenoma, We retrospectively analyzed the clinical presentation and surgical outcome in PA presenting with cranial neuropathy. Methods : Twelve cases (33%) of PA were retrospectively reviewed among 359 patients diagnosed with pituitary adenoma, The study included 6 males and 6 females, Mean age of patients was 49,0 years, with a range of 16 to 74 years, Follow-up duration ranged from 3 to 20 months, with an average of 12 months, All patients were submitted to surgery, using the transsphenoidal approach (TSA). Results : Symptoms included abrupt headache (11/12), decreased visual acuity (12/12), visual field defect (11/12), and cranial nerve palsy of the third (5/12) and sixth (2/12) Mean height of the mass was 29.0 mm (range 15-46) Duration between the ictus and operation ranged from 1 to 15 days (mean 7.0) The symptom duration before operation and the recovery period of cranial neuropathy correlated significantly (p = 0.0286) TSA resulted in improvement of decreased visual acuity in 91.6%, visual field defect in 54.5%, and cranial neuropathy in 100% at 3 months after surgery. Conclusion : PA is a rare event, complicating 3.3% in our series, Even in blindness following pituitary apoplexy cases, improvement of cranial neuropathy is possible if adequate management is initiated in time, Surgical decompression must be considered as soon as possible in cases with severe visual impairment or cranial neuropathy.

• The Journal of the Society of Stroke on Korean Medicine
• /
• v.22 no.1
• /
• pp.21-30
• /
• 2021

■ Background Patients with posterior cerebral artery infarction could complain of visual field defects or prosopagnosia that does not recognize a person's face. However, there has been no standardized treatment for these symptoms. ■ Case report A 57-year-old male patient complained homonymous hemianopia and prosopagnosia after posterior cerebral artery infarction. After combined Korean medicine treatment for 49 days, subjective visual field was improved and the discomfort associated with visual field defect and the disability of recognizing people was decreased. Evaluations were took place by assessing visual field using Automated Perimetry and Confrontation visual field exam. Discomfort caused by visual field defects or prosopagnosia was evaluated by visual analog scale. The patient was treated with acupuncture, moxibustion, and herbal medications. ■ Conclusion The present case report suggests that combined Korean medicine treatment might be effective to resolution of homonymous hemianopia and prosopagnosia after stroke.

• Journal of Korean Neurosurgical Society
• /
• v.29 no.6
• /
• pp.815-821
• /
• 2000

Parasplenial arteriovenous malformations(AVMs) are rare vascular malformations which have distinct clinical and anatomical features. They are situated at the confluence of the hippocampus, isthmus of the cingulate gyrus and the gyrus occipitotemporalis medialis. These lesions are anterior to the calcarine sulcus and their apex extends towards the medial surface of the trigonum. Posterolaterally, these lesions are in close proximity to the visual cortex and optic radiation. The objectives in the surgery of parasplenial AVMs are complete resection of the lesions and preservation of vision. These objectives must be achieved with comprehensive understanding of the following anatomical features :1) the deep central location of the lesions within eloquent brain tissue ; 2) the lack of cortical representation of the AVMs that requires retraction of visual cortex ; 3) deep arterial supply ; 4) deep venous drainage ; 5) juxtaposition to the choroid plexus with which arterial supply and venous drainage are shared. A 16-year-old female student presented with intraventricular hemorrhage from a right parasplenial-subtrigonal AVM. The lesion, fed by posterior cerebral artery and drained into the vein of Galen, was successfully treated by the inter-hemispheric parietooccipital approach. To avoid visual field defect a small incision was made on precuneus anterior to the calcarine sulcus. In this report, the authors describe a surgical approach with special consideration on preservation of visual field.

• Annals of Clinical Neurophysiology
• /
• v.22 no.1
• /
• pp.48-49
• /
• 2020

• Archives of Plastic Surgery
• /
• v.34 no.5
• /
• pp.663-666
• /
• 2007

Purpose: Autologous fat injection into the facial area is a frequently used technique in aesthetic plastic surgery for augmentation of the soft tissue. Fat injection is a very safe procedure because of the advantage of being autologous tissue. Minimal foreign body reaction or infections are noted after fat injection. However, there may be some complications including those as severe as blindness. There have been some case reports on visual disturbances after autologous fat injection reported in the literature. Methods: A 21-year-old female patient underwent autologous fat injection into left eyebrow area to correct depression of soft tissue. Immediately after injection of autologous fat, she complained sudden visual loss on the left eye. She had come to our emergency room and ophthalmologic evaluation showed that the patient could only recognize hand motion. There was no abnormality of the optic nerve on magnetic resonance imaging. Suspecting an ischemic optic neuritis from fat embolism of the central retinal artery, the patient was treated conservatively with occular massage, antiglaucomatic agent, anti-inflammatory drugs and antibiotics. Visual field examination showed visual defect of half the lower hemisphere. Results: While maintaining antiglaucomatic agents and non steroidal anti inflammatory drugs, fundoscopic examination showed no abnormalities on the second day of admission. Visual field examination showed an improvement on the fourth day along with decreased eyeball pain. Significant improvement of vision was noted and the patient was discharged on the fifth day of admission. The patient was followed-up 2 days afterwards with improved vision and visual field defect. Conclusion: We describe an unusual case of sudden unilateral visual disturbance following autologous fat injection into periorbital area.

• Journal of Korean Neurosurgical Society
• /
• v.58 no.3
• /
• pp.291-293
• /
• 2015

Anterior communicating artery (ACoA) aneurysms sometimes present with visual symptoms when they rupture or directly compress the optic nerve. Giant or large ACoA aneurysms producing bitemporal hemianopsia are extremely rare. Here we present an unusual case of bitemporal hemianopsia caused by a large intracranial aneurysm of the ACoA. A 41-year-old woman was admitted to our neurosurgical department with a sudden-onset bursting headache and visual impairment. On admission, her vision was decreased to finger counting at 30 cm in the left eye and 50 cm in the right eye, and a severe bitemporal hemianopsia was demonstrated on visual field testing. A brain computed tomography scan revealed a subarachnoid hemorrhage at the basal cistern, and conventional cerebral catheter angiography of the left internal carotid artery demonstrated an $18{\times}8mm$ dumbbell-shaped aneurysm at the ACoA. Microscopic aneurysmal clipping was performed. An ACoA aneurysm can produce visual field defects by compressing the optic chiasm or nerves. We emphasize that it is important to diagnose an aneurysm through cerebrovascular study to prevent confusing it with pituitary apoplexy.

• The Journal of the Society of Stroke on Korean Medicine
• /
• v.24 no.1
• /
• pp.25-40
• /
• 2023

Background: Although not clarified, the overall prevalence of visual field loss after stroke was estimated at 52% of stroke survivors and for visual acuity loss, at 70% of them. Among visual field loss patients after stroke, homonymous hemianopia is the most common symptom. Visual defect degrades the quality of life by disrupting independent life and affecting the survival of the patients, but highly-evidenced treatment has not been found until now. ■Case report A 51-year-old female with left-side homonymous hemianopia and central vision loss by a right occipital-temporal hemorrhage was treated with Hyeolbuchukeo-tang, Ikgibohyeol-tang, acupuncture, electroacupuncture, and moxibustion. We used a confrontation visual field exam, automated perimetry and visual analog scale, and visual acuity test to observe changes in the patient's symptoms and evaluate the efficacy of the treatment. After 61 days of such interventions, the patient's subjective discomfort lessened, followed by positive changes in the scales of tests mentioned above. ■Conclusion This case suggests that combined Korean medicine treatment might be an effective tool for treating post-stroke homonymous hemianopia and central vision loss. More studies should be conducted to support the effectiveness of the treatment.

• Journal of Korean Neurosurgical Society
• /
• v.57 no.1
• /
• pp.23-31
• /
• 2015

Objective : The aims of this study were to investigate the quantitative relationship between pituitary macroadenoma size and degree of visual impairment, and assess visual improvement after surgical resection of the tumor. Methods : The medical records of patients with pituitary adenoma, who had undergone trans-sphenoidal adenectomy between January 2009 and January 2011, were reviewed. Patients underwent an ocular examination and brain MRI before and after surgery. The visual impairment score (VIS) was derived by combining the scores of best-corrected visual acuity and visual field. The relationship between VIS and tumor size/tumor type/position of the optic chiasm was assessed. Results : Seventy-eight patients were included (41 male, 37 female). Thirty-two (41%) patients experienced blurred vision or visual field defect as an initial symptom. Receiver operating characteristic curve analysis showed that tumors <2.2 cm tended to cause minimal or no visual impairment. Statistical analysis showed that 1) poor preoperative vision is related to tumor size, displacement of the optic chiasm in the sagittal view on MRI and optic atrophy, and 2) poorer visual prognosis is associated with greater preoperative VIS. In multivariate analysis the only factor significantly related to VIS improvement was increasing pituitary adenoma size, which predicted decreased improvement. Conclusion : Results from this study show that pituitary adenomas larger than 2 cm cause defects in vision while adenomas 2 cm or smaller do not cause significant visual impairment. Patients with a large macroadenoma or giant adenoma should undergo surgical resection as soon as possible to prevent permanent visual loss.

• Journal of the Korean Society for Nondestructive Testing
• /
• v.34 no.2
• /
• pp.135-140
• /
• 2014

Pressure vessels are used in various industrial fields. If a defect occurs on the inner or outer surface of a pressure vessel, it may cause a massive accident. A defect on the outer surface can be detected by visual inspection. However, a defect on the inner surface is generally impossible to detect with visual inspection. Nondestructive testing can be used to detect this type of defect. Laser speckle shearing interferometry is one nondestructive testing method that can optically detect a defect; its advantages include noncontact, full field, and real time inspection. This study evaluated the detectable size for an internal defect of a pressure vessel. The material of the pressure vessel was ASTM A53 Gr.B. The internal defect was detected when the pressure vessel was loaded by internal pressure controlled by a pneumatic system. The internal pressure was controlled from 0.2 MPa to 0.6 MPa in increments of 0.2 MPa. The results confirmed that an internal defect with a 25 % defect depth could be detected even at 0.2 MPa pressure variation.

• Journal of the Korean neurological association
• /
• v.36 no.4
• /
• pp.413-414
• /
• 2018