• Tuberculosis and Respiratory Diseases
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• 제51권3호
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• pp.260-264
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• 2001

연구배경 : 역설적 두개강내 결핵종이란 항결핵 치료 중 발생하거나 커지는 결핵종을 말한다. 그러나 이 병의 자연경과나 치료법등은 잘 알려져 있지 않다. 연구방법 : 항결핵 치료 후 두개강내 결핵종이 발견되었거나 결핵종이 커진 10명의 환자를 대상으로 후향적 연구를 시행하였다. 결 과 : 역설적 두개강내 결핵종은 항결핵제 치료 시작 후 평균 67.9일 후 발견 되었다. 결핵종은 발견 후 평균 102.3간의 악화소견을 보였으며 165.4일후 호전되는 양상을 보였다. 뇌 척수액 소견은 결핵종 발견당시 악화되었다가 결핵종이 호전되면서 같이 호전 되었다. 결 론 : 역설적 두개강내 결핵종은 특별한 증상 없이도 발생할 수 있다. 이 결핵종은 독립된 하나의 질병 혹은 반응이 아니라 두개강내 결핵종 혹은 결핵에서 치료에 대한 자연경과 이던지 치료에 약간 반응이 떨어지는 경우일 것일 수 있다.

• Radiation Oncology Journal
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• 제17권4호
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• pp.293-298
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• 1999

선양낭포암의 두개내 침습은 매우 드물게 보고되어 있고 구개 선양낭포암이 두개내로 침습된 경우는 국내에서 보고된 바 없다. 침습 기전으로는 직접적인 침습, 신경주위 전이, 혈행성 전이 등 세 가지 경로가 알려져 있다. 본 증례는 35세 여자 환자로 우측 구개 선양낭포암으로 수술과 방사선치료를 받고 3년 10개월 후에 우측 삼차 신경의 안신경가지와 상악 신경가지 부위에 감각이상을 호소하였으나 CT상 재발소견이 보이지 않았다. 이후 우측 안검하수증과 안구마비 증세가 차례대로 발생되어 2차 수술을 받았으며, 종양이 삼차 신경을 따라 두개내 갓세르 반월신경절(Gasserian ganglion)을 거쳐 해면 정맥동과 안와내로 침습됨을 시사했다. 또한 7년 6개월 후에 측두골과 접형골 및 접형동을 통해 우측 측두엽으로 직접 침습된 소견이 발견되어 3차 수술을 받았다. 그 후 폐 전이가 진단된 상태로서, 일차 수술후 9년 5개월동안 생존하여 있다.

• Journal of Yeungnam Medical Science
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• 제29권1호
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• pp.42-44
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• 2012

Plasma cell myelomas generally manifest as bone or soft-tissue tumors with variable mass effects, pain, and infiltrative behavior. Extramedullary involvement occurs most commonly in the spleen, liver, lymph nodes, and kidneys, but intracranial involvement in plasma cell myeloma is a rare extramedullary manifestation. These authors recently encountered a case of intracranial involvement of plasma cell myeloma. A 69-year-old man was hospitalized for headache and mental changes. Brain CT showed subdural hemorrhage caused by plasma cell myeloma. Plasma cell myeloma with intracranial involvement has poor prognosis, and the patient in this case died from acute complications, such as subdural hemorrhage. Based on this case report, it is suggested that more effective treatment regimens of plasma cell myeloma with intracranial involvement be developed. Moreover, a screening method and decision on the appropriate time for intracranial involvement are needed for plasma cell myeloma patients.

• Journal of Korean Neurosurgical Society
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• 제50권1호
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• pp.6-10
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• 2011

Objective : Spontaneous acute subdural hematomas (aSDH) secondary to ruptured intracranial aneurysms are rarely reported. This report reviews the clinical features, diagnostic modalities, treatments, and outcomes of this unusual and often fatal condition. Methods : We performed a database search for all cases of intracranial aneurysms treated at our hospital between 2005 and 2010. Patients with ruptured intracranial aneurysms who presented with aSDH on initial computed tomography (CT) were selected for inclusion. The clinical conditions, radiologic findings, treatments, and outcomes were assessed. Results : A total of 551 patients were treated for ruptured intracranial aneurysms during the review period. We selected 23 patients (4.2%) who presented with spontaneous aSDH on initial CT. Ruptured aneurysms were detected on initial 3D-CT angiography in all cases. All ruptured aneurysms were located in the anterior portion of the circle of Willis. The World Federation of Neurosurgical Societies grade on admission was V in 17 cases (73.9%). Immediate decompressive craniotomy was performed 22 cases (95.7%). Obliteration of the ruptured aneurysm was achieved in all cases. The Glasgow outcome scales for the cases were good recovery in 5 cases (21.7%), moderate disability to vegetative in 7 cases (30.4%), and death in 11 cases (47.8%). Conclusion : Spontaneous aSDH caused by a ruptured intracranial aneurysm is rare pattern of aneurysmal subarachnoid hemorrhage. For early detection of aneurysm, 3D-CT angiography is useful. Early decompression with obliteration of the aneurysm is recommended. Outcomes were correlated with the clinical grade and CT findings on admission.

• Journal of Korean Neurosurgical Society
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• 제47권1호
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• pp.7-10
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• 2010

Objective: In this study, we present a simple closed head injury model as a two-stage experiment. The height of the weight drop enables gradation of head trauma severity. Methods: The head injury device consists of three parts and there are three adjustable parameters-weight (100-600 g). height of fall (5-100 cm) and elasticity of the springs. Thirty male Wistar rats underwent monitoring of intracranial pressure with and without induction of the head injury. Results: The weight drop from 45 to 100 cm led to immediate seizure activity and early death of the experimental animals. Severe head injury was induced from 40 cm weight drop. There was 50% mortality and all surviving rats had behavioral deterioration. Intracranial pressure was 9.3${\pm}$3.76 mmHg. Moderate head injury was induced from 35 cm, mortality decreased to 20-40%, only half of the animals showed behavioral pathology and intracranial pressure was 7.6${\pm}$3.54 mmHg. Weight drop from 30 cm caused mild head injury without mortality and neurological deterioration. Intracranial pressure was slightly higher compared to sham group- 5.5${\pm}$0.74 mmHg and 2.9${\pm}$0.81 mmHg respectively. Conclusion: This model is an eligible tool to create graded brain injury with stepwise intracranial pressure elevation.

• 대한약리학회지
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• 제13권2호
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• pp.19-34
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• 1977

1) 마취가토(痲醉家兎) 및 묘(猫)에서 경뇌막외강(硬腦膜外腔)을 통(通)한 가압방법(加壓方法)으로 두개내압상승(頭蓋內驅上昇)과 혈압(血壓) 및 심박(心搏)과의 관계(關係)를 조사(調査)하였다. 2) 양동물(兩動物)에서 두개내압(頭盞內壓)을 상승(上昇)시켜 두개내압(頭蓋內壓)과 혈압(血壓)의 차(差)가 아주 적어지면 현저(顯著)한 혈압상승(血壓上昇)이 나타났다. 3) 양동물(兩動物)에서 두개내압(頭盞內壓)이 혈압(血壓)보다 높아지면 현저(顯著)한 혈압하강(血壓下降)과 현저(顯著)한 일시적(一時的)인 심박감소(心搏減少)가 나타났다. 4) Reserpine 처리동물(處理動物)에서는 두개내압상승(頭蓋內驅上昇)은 혈압하강(血壓下降), 심박감소(心搏減少)를 일으켰다. 5) 6-Hydroxydopamine 처리(뇌내)동물(處理(腦內)動物)에서는 두개내압상승(頭蓋內驅上昇)에 의한 혈압상승(血壓上昇)은 비처리동물(非處理動物)에 비(比)하여 약(弱)하였다. 6) Reserpine 처리동물(處理動物)의 측뇌실내(側腦室內)에 norepinephrine을 투여(投與)한 후(後)에는 두개내압상승(頭蓋內驅上昇)은 현저(顯著)한 혈압상승(血壓上昇)을 일으켰다. 7) 두개내압상승(頭蓋內驅上昇)에 의한 혈압상승(血壓上昇)은 두개내압상승(頭蓋內驅上昇)으로써 뇌내(腦內) noradrenergic neuron이 자극(刺戟)되여 norepinephrine 유리(遊離)가 증가(增加)한 결과(結果) 일어나는 것으로 추리(推理)하였다.

• Neonatal Medicine
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• 제15권2호
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• pp.160-165
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• 2008

목 적: 두혈종과 두개내 혈종의 연관성을 조사하여 두혈종이 있는 신생아에 대한 뇌영상의 필요성에 대하여 알아보고자 하였다. 방 법 : 2002년 1월부터 2006년 6월까지 경북대학교 병원 신생아집중치료실에 입원한 신생아 중 두혈종이 있어 두부 전산화단층촬영술이나 자기공명영상을 시행하였던 18명을 대상으로 후향적 의무기록 분석을 시행하였다. 결 과 : 뇌영상 검사상 18명 중 6명(33.3%)에서 두개내 혈종이 관찰되었고 이 중 4례는 경막외 혈종, 2례는 경막하 혈종이었다. 두개내 혈종이 있었던 6례 중 2례는 신경학적 증상과 함몰 골절이 없었다. 두개내 혈종이 있던 신생아와 혈종이 없던 신생아 사이에 재태주령, 출생시 체중, 두위 및 두혈종의 크기 및 분만력에 유의한 차이가 없었다. 또한 신경학적 증상과 숫구멍 융기 소견의 발현 빈도에도 차이를 보이지 않았으며 황달, 빈혈의 빈도 역시 차이를 보이지 않았다. 결 론 : 두혈종이 있는 신생아에서는 두개내 혈종, 특히 경막외 혈종이 문헌에 보고된 발생 빈도보다 많이 발견되었다. 또한 신경학적 증상이나 함몰 골절이 없는 경우에도, 다른 원인이 없는 황달, 빈혈 등의 소견이 두혈종과 동반된 경우 두혈종에 합병된 두개내 혈종에 대한 임상의 관심이 요구되며 적절한 뇌영상 검사를 고려할 필요가 있을 것으로 생각된다.

• Investigative Magnetic Resonance Imaging
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• 제22권3호
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• pp.150-157
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• 2018

Purpose: To assess associations between morphological characteristics of intracranial arteries in time-of-flight MR angiography (TOF-MRA) and atherosclerotic risk factors. Materials and Methods: From January 2014 to October 2015, a total of 129 patients (65 men and 64 women) without intracranial arterial stenosis > 50% were included in this study. All MRIs were performed using a 3T machine with 3D TOF-MRA sequences. We evaluated irregularity, tortuosity, and dilatation of intracranial arteries in maximal intensity projection (MIP) of TOF-MRA. Subjects' risk factors for atherosclerosis including history of hypertension and diabetes were collected by reviewing their medical records. Associations between morphological characteristics and each known atherosclerosis risk factor were examined using univariate regression analysis. Multivariate regression models were built to determine combined association between those risk factors and morphologic changes of intracranial arteries. Results: In multivariate analysis, hypertension (coefficient [95% CI]: 0.162 [0.036, 0.289], P = 0.012) and absence of diabetes (coefficient [95% CI]: -0.159 [-0.296, -0.023], P = 0.022) were associated with large diameter of intracranial arteries. Males (coefficient [95% CI]: 0.11 [-0.006, 0.23], P = 0.062) and higher age (coefficient [95% CI]: 0.003 [-0.001, 0.008], P = 0.138) had marginal association with increased diameter. Tortuosity was associated with old age (OR: 1.04 [1.02, 1.07], P < 0.001). Irregular contour of intracranial arteries was significantly associated with old age (OR: 1.05 [1.02, 1.09], P = 0.004), presence of diabetes (OR: 2.88 [1.36, 6.15], P = 0.0058), and previous ischemic stroke (OR: 3.91 [1.41, 11.16], P = 0.0092). Conclusion: Morphological characteristics (irregularity, tortuosity, dilatation) of intracranial arteries seen in TOF-MRA might be associated with atherosclerotic risk factors in subjects with no or mild stenosis.

• Journal of Korean Neurosurgical Society
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• 제44권2호
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• pp.101-104
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• 2008

Intracranial pial arteriovenous fistula (AVF) is a rare cerebrovascular lesion that has only recently been recognized as a distinct pathological entity. A 41-year-old woman (Patient 1) presented with the sudden development of an altered mental state. Brain CT showed an acute subdural hematoma. A red sylvian vein was found intraoperatively. A pial AVF was revealed on postoperative angiography, and surgical disconnection of the AVF was performed. A 10-year-old boy (Patient 2) presented with a 10-day history of paraparesis and urinary incontinence. Brain, spinal MRI and angiography revealed an intracranial pial AVF and a spinal perimedullary AVF. Endovascular embolization was performed for both lesions. The AVFs were completely obliterated in both patients. On follow-up, patient 1 reported having no difficulty in performing activities of daily living. Patient 2 is currently able to walk without assistance and voids into a diaper. Intracranial pial AVF is a rare disease entity that can be treated with surgical disconnection or endovascular embolization. It is important for the appropriate treatment strategy to be selected on the basis of patient-specific and lesion-specific factors in order to achieve good outcomes.

• Journal of Korean Neurosurgical Society
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• 제41권4호
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• pp.217-223
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• 2007

Objective : The apparent increase in the incidence of the intracranial meningiomas in the elderly is due in part to improved diagnostic tools and improved span of life. The authors carried out a retrospect study to validate the use of the Clinical-Radiological Grading System [CRGS] as a clinical tool to orientate surgical decision making in elderly patients and to explore prognostic factors of survival. Methods : From January 1997 to January 2006, the authors consecutively recruited and surgically treated 20 patients older than 65 years of age with radiologic findings of intracranial meningiomas and a preoperative evaluation based on the CRGS. Results : High CRGS score was associated with a higher probability of good outcome [p=0.004] and a lower probability of postoperative complications [p=0.049]. Among the different subset items of the CRGS score, larger maximum tumor diameters [$D{\geqq}4cm$] and the presence of a severe peritumoral edema were associated with incidence rate of postoperative poor outcome and complications [p<0.05]. Additionally, the critical location of the tumor was also correlated with poor outcome [p<0.05]. Conclusion : A CRGS score higher than 13 is a good prognostic indication of survival. The CRGS score is a useful and practical tool for the selection of elderly patients affected by intracranial meningiomas as surgical candidates.