Clinical Study on the Intracranial Aneurysms and Arteriovenous

It is well known that approximately 35-50 per cent of all patients with a spontaneous subarachnoid hemorrhage die in the first attack and about 40 per cent of the survivors expire due to recurrent attacks some time within the following five years. These hemorrhages occur principally from ruptured aneurysms located on the great vessels at the base of the brain, and some from ruptured arteriovenous malformations. The purpose of this report is to present the results of clinical observations and treatments in 62 patients with intracranial aneurysms and 25 patients with intracranial arteriovenous malformations, durng period from September, 1957 to August, 1971 at the Department of Neurosurgery, Seoul National University, Seoul, Korea. There were 119 cases of spontaneous subarachnoid hemorrhage among 312 patients of cerebrovascular diseases, of which 58 cases (48%) were due to ruptured intracranial aneurysms and 14 cases (12%) were due to arteriovenous malformations. Unruptu• red aneurysms were found in 4 patients (6.5% of all aneurysm cases) and unruptured arteriovenous malformations in 11 patients (44% of all A. V. M. cases). There were 36 males (58%) and 26 females (42%) among aneurysm cases, and 19 males (76%) and 6 females (24%) among arteriovenous malformation cases. The highest age incidence was found in fourth and fifth decades in aneurysriJ.ai groups, and in third and fourth decades in arteriovenous malformation group. The site of a single aneurysm was on the internal carotid artery in 46. 2 per cent; anterior cerebral artery complex in 25.4 per cent; middle cerebral artery in 22.4 per cent and vertebrobasilar system in 6. 0 per cent. Multiple aneurysms were found in 8 per cent and all were associated with the internal carotid artery aneurysms. All unruptured aneurysms were located on the internal carotid artery, three of them were in the intracavernous portion and one at the bifurcation of the posterior communicating artery. Nineteen cases (76%) of 25 arteriovenous malformations were angiomatous malformations, 4 cases (16%) were carotid•cavernous fistulas and 2 cases (8%) were combined intracranial-extracranial arte• riovenous malformations. The parietal area was the most prevalent site of supratentorial angiomatous malformations, and infratentorial arteriovenous malformations were only three cases (12%) . Main feeding arteries to these arteriovenous malformations were the middle cerebral artery in 40 per cent, anterior cerebral artery 24 per cent and internal carotid artery in 20 per cent, while the main draining veins were the sagittal sinus in 36 per cent, internal cerebral veins in 36 per cent and other cortical veins in 32 per cent. The size of aneurysms varied as follows: 3-5 mm in 43.5 per cent, 6-10 mm in 47.1 per cent, and over 10 mm in 9.4 per cent. Angiographically, generalized arterial spasm was found in 38. 7 per cent of 58 ruptured aneurysm cases, localized arterial spasm in 25. 8 per cent, spasm only in parent artery in 19.4 per cent. UsuallY cerebral angiography was performed when the patient's condition was good but when intracerebral hematoma or subdural hematoma was suspected in ruptured aneurysms, angiography was done immediately. In 78 per cent of aneurysm cases, angiography was performed within 3 weeks. Bilateral or triple angi ography was done in 43. 6 per cent of intracranial aneurysms and unilateral was done in 56.4 per cen

An Experimental Study of Total Hemispherectomy in the Cat

Cerebral hemispherectomy, since its first application by Dandy (1928), has been a radical procedure applied to patients with infiltrating gliomas of one cerebral hemisphere, intractable convulsive seizures due to unilateral cerebral atrophy, Sturge-Weber syndrome or diffuse cerebral paragonimiasis. In these operations the caudate nucleus, thalamus and subthalamic structures have usually been spared. Although many fundamental contributions have been made in the field of experimental neurology through study of animals in which large portions of cerebrum had been removed or destroyed, few experiments have been performed to define the limit of [cerebral resection compatible with maintenance of consciousness and survival. The purpose of this study is to present the physiological and anatomical observations on the effect of total cerebral hemispherectomy in the cat. In this study, twenty healthy cats of both sexes weighing five to nine lbs. were subjected to one stage removal of all cerebral cortex, basal ganglia, and thalamus from one side of the brain. In ten cats total hemispherectomy was performed on the right side and in the other ten on the left. These experimental animals were clinically observed for periods varying from five to thirty eight days. All twenty cats that had total hemispherectomy survived the initial operative procedure, but five of these cats subsequently died within a week due to intracranial hemorrhage or infection. Five of the surviving fifteen cats were sacrificed within the fourteenth postoperative day and the other ten were sacrificed during the period from three to five weeks postoperatively. The brain stem and spinal cord was stained with the Marchi staining method to observe secondary degenerative changes of nerve fibers. The postoperative physiological findings were as follows: In spite of the extensive removal of the unilateral cerebrum including the thalamus, .all of these animals demonstrated early and rapid return of consciousness, giving evidence of awareness of environment by noting objects in their remaining homonymous visual' field. After recovery from anesthesia, the totally hemispherectornized cats demonstrated marked flaccid paralysis. of contralateral extremities but good motor function on the ipsilateral side. The contralateral flaccid paralysis recovered slightly in the forelimb on the second postoperative day and hindlimb improvement began on the third postoperative day. Although the cats usually could get up and walk within a few days and showed aJrrost ncrmal motor function within a week, the distal musculature of the contralateral extremities showed the least recovery. Following unilateral total hemispherectomy including the thalamus, these experimental animals were unable to respond to painful stimuli on the contralateral side when they awoke from anesthesia. However, painful stimulation was perceived over the contralateral face and extremities in twenty four hours, and maximum return of sensory function was accomplished by the third postoperative day

Cryptococcal Meningitis Simulating a Posterior Fossa Tumor

Cryptococcal meningitis, also known as Torula meningitis and yeast meningitis, is caused by an infection of Cryptococcus Neoformans (Torula Histolytica), and is the most common form of mycotic infection of the central nervous system. Since the first report of this disease by Busse in 1894. many cases have been reported in the literature. A few cases of cryptococcal meningitis have been reported ill Korea. A thirteen-years old Korean boy had severe occipital headache. mental change and decreased vision. and was admitted to Seoul National University Hospital on December 14, 1968. On neurological examination. bilateral papilledema. right 6th nerve palsy. right-sided hemiparesis and trunkal ataxia were found. Skull films showed evident suture separation along with so-called silver-beaten appearance. Carotid angiogram and ventriculogram showed a marked symmetrical. bilateral dilatation of ventricular system suggesting an obstruction of the CSF pathways in the posterior fossa. Examination of cerebrospinal fluid showed a slight pleocytosis. elevated protein and decreased sugar content. Exploring the posterior fossa, an enlarged cisterna magna and thickened basal meninges coated with yellowish necrotic debris or sediments were demonstrated. A diffuse or more localized opacity of meninges and obliteration of subarachnoid space over the cerebellar hemispheres. particularly. the portion of vallecula. were encountered. Microscopic findings was acute and chronic inflammatory changes in different stages with well encapsulated cryptococcus in loose connective tissue. On the 10th postoperative day the patient died. No amphotericin B therapy was done. Postmortem examination could't be done

Cytopathologic Study of Cerebellar Purkinje Cells on the Effect of Acute Carbon Monoxide Intoxication in Rats

An experimental study was performed to observe the cytopathologic effects of acute carbon monoxide intoxication in lapse on the cerebellar Purkinje cells 。f rats by means of cytologic, enzyme cytochemical methods using light and electron microscope attem' pting to explore the pathogenesis related to ultrastr uctural features and enzyme cytochemistry. Experimental animals(125 Wister rats , 300-350gm.) were devided into control and exposure groups which were exposed by 0.5%CO for 45 min. And thereafter left to fresh air in 15 minutes through 30 days past to acute carbon monoxide intoxication. Cytopathologic investigation around the stainability, changes of Nissl substances and ultrastructural study on Purlinje cells of rat cerebellum were made. and enzyme activities of succinic dehydrogenase, NADH diaphorase, lactic dehydrogenase, acid phosphatase and thiamine pyrophosphatase in them were observed by appropriate enzyme cytochemical stainings. Results obtained were as follows: 1. The blood CO-Hb concentration was 89. 1±7. 6 % in acute carbon monoxide intoxication with 0.5% CO for 45 min. exposure and then rapidly degraded to 20. 2±9. 4% in 60 min. past the intoxication to leave in fresh air and reached to normal range in 4 hours past 2. Histologic sections of Nissl stainings revealed moderate decrease of stainability in chromatophilia of Nissl substances of cerebellar Purkinje cells and mild eloudy swelling of them with occasional central chromatolysis in rats of acute carbon monoxide intoxication. These findings were aggravated as far as 2 hours past the intoxication and thereafter arnended gradually in 6 hours through 24 hours pas t. 3. a) Mitochondrial SDH and NADH diaphorase activities of cerebellar Purkinje cells were moderately decreased in acute carbon monoxide intoxication, and their activities were gradually increased in 60 min. through 24 hours past the intoxication and thereafter reached to normal activities as control, to be more or less distinct changes in the midzonal area of their cytoplas