5 research outputs found
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. Unruptuโข
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 carotidโขcavernous fistulas and 2 cases
(8%) were combined intracranial-extracranial arteโข
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
ใf 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. 1ยฑ7. 6
% in acute carbon monoxide intoxication with 0.5%
CO for 45 min. exposure and then rapidly degraded
to 20. 2ยฑ9. 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