• Journal of Korean Neurosurgical Society
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• v.53 no.2
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• pp.108-111
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• 2013

Burr hole drainage has been widely used to treat chronic subdural hematomas (SDH), and most of them are easily treated by simple trephination and drainage. However, various complications, such as, hematoma recurrence, infection, seizure, cerebral edema, tension pneumocephalus and failure of the brain to expand due to cerebro-cranial disproportion may develop after chronic SDH drainage. Among them, intracerebral hemorrhage after evacuation of a recurrent chronic SDH is very rare. Here, we report a fatal case of delayed intracerebral hemorrhage caused by coagulopathy following evacuation of a chronic SDH. Possible pathogenic mechanisms of this unfavorable complication are discussed and a review of pertinent literature is included.

• The Journal of Internal Korean Medicine
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• v.23 no.2
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• pp.260-267
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• 2002

Chronic Myeloblastic Leukemia(CML) is characterised by excessive production of neoplastic myeloid cell, reciprocal translocation between chromosome 9 and 22 called 'Philadelphia chromosome'. This one case of CML with Intracerebral Hemorrhage(ICH) patient is thought of Kidney-Yin and Yang deficiency, by the first clinical symptoms, at admission. So the nourishing Yin and Tonifying kidney, warming and tonifying kidney-yang is used. After the incresing of WBC count, the nourishing Yin and Tonifying kidney, invigorating-Yin and reducing fire is used for treatment of the essence-of-life and blood deficiency, fever due to Yin deficiency.

• Journal of Korean Neurosurgical Society
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• v.54 no.2
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• pp.125-127
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• 2013

Here, we report a rare case of an anaplastic astrocytoma masquerading as a hypertensive basal ganglia hemorrhage. A 69-year-old woman who had been under medical management for hypertension during the past 3 years suddenly developed right hemiparesis with dysarthria. Brain computed tomography (CT) scans with contrast and CT angiograms revealed an intracerebral hemorrhage (ICH) in the left basal ganglia, without an underlying lesion. She was treated conservatively, but underwent a ventriculoperitoneal shunt operation 3 months after the initial attack due to deteriorated mental status and chronic hydrocephalus. Three months later, her mental status deteriorated further. Magnetic resonance imaging (MRI) with gadolinium demonstrated an irregular enhanced mass in which the previous hemorrhage occurred. The final histological diagnosis which made by stereotactic biopsy was an anaplastic astrocytoma. In the present case, the diagnosis of a high grade glioma was delayed due to tumor bleeding mimicking hypertensive ICH. Thus, a careful review of neuroradiological images including MRI with a suspicion of tumor bleeding is needed even in the patients with past medical history of hypertension.

• Journal of Korean Neurosurgical Society
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• v.54 no.4
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• pp.296-301
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• 2013

Objective : We conducted a retrospective study examining the outcomes of intracerebral hemorrhage (ICH) in patients with chronic kidney disease (CKD) to identify parameters associated with prognosis. Methods : From January 2001 to June 2008, we treated 32 ICH patients (21 men, 11 women; mean age, 62 years) with CKD. We surveyed patients age, sex, underlying disease, neurological status using Glasgow Coma Scale (GCS), ICH volume, hematoma location, accompanying intraventricular hemorrhage, anti-platelet agents, initial and 3rd day systolic blood pressure (SBP), clinical outcome using the modified Rankin Scale (mRS) and complications. The severity of renal functions was categorized using a modified glomerular filtration rate (mGFR). Multifactorial effects were identified by regression analysis. Results : The mean GCS score on admission was $9.4{\pm}4.4$ and the mean mRS was $4.3{\pm}1.8$. The overall clinical outcomes showed a significant relationship on initial neurological status, hematoma volume, and mGFR. Also, the outcomes of patients with a severe renal dysfunction were significantly different from those with mild/moderate renal dysfunction (p<0.05). Particularly, initial hematoma volume and sBP on the 3rd day after ICH onset were related with mortality (p<0.05). However, the other factors showed no correlation with clinical outcome. Conclusion : Neurological outcome was based on initial neurological status, renal function and the volume of the hematoma. In addition, hematoma volume and uncontrolled blood pressure were significantly related to mortality. Hence, the severity of renal function, initial neurological status, hematoma volume, and uncontrolled blood pressure emerged as significant prognostic factors in ICH patients with CKD.

• The Journal of Internal Korean Medicine
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• v.40 no.4
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• pp.730-741
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• 2019

Objective: The aim of this study was to report the effectiveness of traditional Korean medicine treatment with rehabilitation exercise on a chronic intracerebral hemorrhage patient with a severe gait disturbance. Method: The patient was treated with Korean herbal medicine (Gami-sibjeondaebo-tang) along with acupuncture, moxibustion, and rehabilitation exercise. The treatment effect was evaluated through the Manual Muscle Test (MMT) and the Korean version of the Modified Barthel Index (K-MBI). The gait of the patient was evaluated by Functional Ambulatory Category (FAC) and the Timed Up and Go (TUG) test. The spatiotemporal parameters were evaluated by a walkway system (GAITRite(R) system) and gait symmetry was evaluated by Symmetry Criterion (SC). Results: After 111 days of traditional Korean medicine treatment, the spatiotemporal parameters and symmetry of the patient's gait improved. Conclusion: This study suggested that traditional Korean medicine treatment with rehabilitation exercise could be effective for gait disturbance in patients with chronic intracerebral hemorrhage.

• Journal of Korean Neurosurgical Society
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• v.38 no.3
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• pp.211-214
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• 2005

Objective : Post-traumatic hydrocephalus is a complication of head injury and can present with several different clinical symptoms. However, the developing factors of post-traumatic hydrocephalus and treatment are still not well known. The authors design the study to focus on incidence, causing diseases and treatment of post-traumatic hydrocephalus. Methods : The 789patients of traumatic head injury followed by admission treatment over 7days from Jan. 1997 to Dec. 2001, were divided shunt group and shunt free group. We analyzed age, sex, causing diseases, developing time of hydrocephalus and effects of shunt operation in post-traumatic hydrocephalus. Results : The incidence of post-traumatic hydrocephalus for requiring shunt was 9.2% [64cases]. Chronic hydrocephalus which developed after 14days of injury was higher incidence [51cases]. We found following variables were significantly related to shunt-dependent hydrocephalus : low GCS score at admission, initial CT finding of traumatic subarachnoid hemorrhage and intracerebral hemorrhage [including intraventricular hemorrhage]. The effect of shunt operation was not related with the spinal pressure, but had statistically significant correlation with the response of lumbar drainage. Conclusion : We conclude that development of hydrocephalus after head trauma is related to low GCS score, intracerebral hemorrhage [including intraventricular hemorrhage] and subarachnoid hemorrhage. The effect of preoperative lumbar drainage has a significant role in predicting the result of shunt operation in patient with post-traumatic hydrocephalus.

• Journal of Korean Neurosurgical Society
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• v.43 no.4
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• pp.177-181
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• 2008

Objective : Hydrocephalus is a common sequelae of aneurysmal subarachnoid hemorrhage (SAH) and patients who develop hydrocephalus after SAH typically have a worse prognosis than those who do not. This study was designed to identify factors predictive of shunt-dependent chronic hydrocephalus among patients with aneurysmal SAH, and patients who require permanent cerebrospinal fluid diversion. Methods : Seven-hundred-and-thirty-four patients with aneurysmal SAH who were treated surgically between 1990 and 2006 were retrospectively studied. Three stages of hydrocephalus have been categorized in this paper, i.e., acute (0-3 days after SAH), subacute (4-13 days after SAH), chronic (${\geqq}14$ days after SAH). Criteria indicating the occurrence of hydrocephalus were the presence of significantly enlarged temporal horns or ratio of frontal horn to maximal biparietal diameter more than 30% in computerized tomography. Results : Overall, 66 of the 734 patients (8.9%) underwent shunting procedures for the treatment of chronic hydrocephalus. Statistically significant associations among the following factors and shunt-dependent chronic hydrocephalus were observed. (1) Increased age (p < 0.05), (2) poor Hunt and Hess grade at admission (p < 0.05), (3) intraventricular hemorrhage (p < 0.05), (4) Fisher grade III, IV at admission (p < 0.05), (5) radiological hydrocephalus at admission (p < 0.05), and (6) post surgery meningitis (p < 0.05) did affect development of chronic hydrocephalus. However the presence of intracerebral hemorrhage, multiple aneurysms, vasospasm, and gender did not influence the development of shunt-dependent chronic hydrocephalus. In addition, the location of the ruptured aneurysms in posterior cerebral circulation did not show significant correlation of development of shunt-dependent chronic hydrocephalus. Conclusion : Hydrocephalus after aneurysmal subarachnoid hemorrhage seems to have a multifactorial etiology. Understanding predisposing factors related to the shunt-dependent chronic hydrocephalus may help to guide neurosurgeons for better treatment outcomes.

• Korean Journal of Radiology
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• v.2 no.4
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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.

• Korean Journal of Adult Nursing
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• v.17 no.3
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• pp.464-473
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• 2005

Purpose: The purpose of this study was to evaluate and compare the predictive ability of three mortality scoring systems; Acute Physiology and Chronic Health Evaluation(APACHE) III, Simplified Acute Physiology Score(SAPS) II, and Mortality Probability Model(MPM) II in discriminating in-hospital mortality for intensive care unit(ICU) patients with spontaneous intracerebral hemorrhage. Methods: Eighty-nine patients admitted to the ICU at a university hospital in Daejeon Korea were recruited for this study. Medical records of the subject were reviewed by a researcher from January 1, 2003 to March 31, 2004, retrospectively. Data were analyzed using SAS 8.1. General characteristic of the subjects were analyzed for frequency and percentage. Results: The results of this study were summarized as follows. The values of the Hosmer-Lemeshow's goodness-of-fit test for the APACHE III, the SAPS II and the MPM II were chi-square H=4.3849 p=0.7345, chi-square H=15.4491 p=0.0307, and chi-square H=0.3356 p=0.8455, respectively. Thus, The calibration of the MPM II found to be the best scoring system, followed by APACHE III. For ROC curve analysis, the areas under the curves of APACHE III, SAPS II, and MPM II were 0.934, 0.918 and 0.813, respectively. Thus, the discrimination of three scoring systems were satisfactory. For two-by-two decision matrices with a decision criterion of 0.5, the correct classification of three scoring systems were good. Conclusion: Both the APACHE III and the MPM II had an excellent power of mortality prediction and discrimination for spontaneous intracerebral hemorrhage patients in ICU.

• The Journal of Internal Korean Medicine
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• v.38 no.2
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• pp.164-171
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• 2017

Objectives: The purpose of this case report is to describe the efficacy of Saenggan-tang-gagam treatment in a patient with immune-tolerant chronic hepatitis B who converted to the immune active phase during hospitalization for Intracerebral hemorrhage. Methods: A 61-year-old male patient with chronic hepatitis B was hospitalized from July 21, 2016 to October 24, 2016. On September 5, the patient showed fatigue and dyspepsia, and his urine was dark. These symptoms were accompanied by a dramatic elevation of aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and gamma-glutamyl transferase (GGT) levels. Saenggan-tang-gagam was administered three times a day until the patient was discharged from the hospital. Results: After the Saenggan-tang-gagam treatment, AST and ALP levels decreased significantly, below the upper limit level. In addition, the levels of ALT and GG were significantly decreased. In addition, the fatigue, dyspepsia, and dark urine induced by hepatitis improved after the Saenggan-tang-gagam treatment. Conclusion: This case report suggests that traditional Korean medicine has a beneficial effect on the immune active phase of chronic hepatitis B.