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Biomedical subjects

H G Bae

Publications and source records attributed to H G Bae.

13 recordsLinked to original sources

Delayed central cord syndrome after a handstand in a child: case report.

We report a case of a central cord syndrome in a 7 year-old girl. After several handstands, with sudden upper thoracic back pain and weakness of the legs 2 to 3 h later, then rapidly progressive tetraplegia with apnea. Plain X-rays and CT myelography of the cervical spine revealed no abnormalities. Although the initial neurological deficit was severe enough to require the child to be placed on a mechanical ventilator, she recovered to be able to walk on the 24th hospital day. Since the development of a central cord syndrome after handstands is exceptional in a child with a normal cervical spine, we report here briefly.

Apnea

Hydrothorax from intrathoracic migration of a ventriculoperitoneal shunt catheter.

BACKGROUND: The intrathoracic complications of the ventriculoperitoneal (VP) shunt are very rare. We report an unusual case of VP shunt complication with intrathoracic migration, associated with pleural effusion in a 55-year-old man. METHODS: We reviewed the seven cases reported in the literature and the mechanism of shunt-tip migration and preventive measures are presented. RESULTS: The patient was successfully managed with revision. The catheter was retrieved and replaced in the peritoneal cavity. CONCLUSIONS: With VP shunting, it is important to keep in mind the possibility of peritoneal shunt-tip migration into the chest. To prevent this kind of complication, we stressed precise location of a subcutaneous tunneling device above the ribs during subcutaneous passage.

Catheters, Indwelling

Brain abscess from a ganglionic hemorrhage--a case report.

We present a unique case of a brain abscess that occurred secondary to a ganglionic hemorrhage in a 64-year-old man. This abscess appeared to be metastatic after septicemia. Aspiration with antibiotics eliminated this infection.

Basal Ganglia Diseases

Rapid expansion of hypertensive intracerebral hemorrhage.

We report a series of 10 patients who had a rapid expansion of a hypertensive intracerebral hemorrhage (HICH). It occurred in approximately 3% of 320 patients who sought treatment for HICH during the past 2 years. The site of hemorrhage was the putamen in 6 patients and the thalamus in 4 patients. Neurological deterioration occurred in a mean time of 40 hours after the onset of symptoms (range, 5.5-109 h). Fifty percent of all patients deteriorated within 24 hours. Persistent hypertension was recorded in all patients. Repeat computed tomography showed an increase of hematoma volume that was twice as large in thalamic hemorrhage and about three times as large in putaminal hemorrhage. Six patients died, whereas 3 survived with severe disability and 1 survived with moderate disability. This study indicates that continued or subsequent bleeding can occur in HICH. If those lesions are not detected early and microsurgically evacuated, they are almost always fatal. Early stereotactic evacuation with urokinase irrigation is considered more dangerous than open craniotomy by microsurgical techniques. We stress the need for attention to this problem during the acute phase of HICH.

Adult

Small-sized acute subdural hematoma: operate or not.

A retrospective study of 90 cases of small-sized (less than 3 mm on the printed CT film) acute (within 24 hours) subdural hematoma (SASDH) is presented. From March 1985 to December 1986, the SASDH were immediately operated on (operation rate: 86.0%). From January 1988 to December 1989, we attempted to treat them conservatively (operation rate: 49.1%). The patient population for this study consisted of 38 surgically-treated patients in the first period (Group I), 26 surgically-treated patients in the second period (Group IIs), and 26 conservatively-treated patients in the second period (Group IIc). We compared the clinical features, radiologic findings, and outcome of these 3 groups. The clinical features of Group I, including age, sex, Glasgow Coma Scale (GCS) score on admission, pupillary status on arrival, and interval from injury to the CT, did not differ significantly from those of Group II (P greater than 0.01). The only difference was the timing of the operation. In Group I, 20 patients (52.6%) received an operation within 4 hours, while in Group IIs, only 7 patients (26.9%) underwent surgery within 4 hours (P less than 0.05). The radiologic findings of Group I, including the thickness and volume of the hematoma, the degree of midline shift, and the frequency of skull fracture, also did not differ from those of Group II (P greater than 0.1). However, the outcome of Group II strikingly differed from that of Group I. The mortality rate was 76.3% in Group I, while it was 44.2% in Group II (P less than 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease

Clinical course of spontaneous gangliothalamic hemorrhage in the acute period--who requires surgical removal?

We analyzed the clinical courses of 93 consecutive patients with gangliothalmic hemorrhage for the first three weeks after the ictus and investigated the factors affecting the clinical course and the final outcome. The clinical status was assessed daily using the Glasgow Coma Score (GCS) and patients were divided into two groups according to the clinical course; Group I included those who improved and Group II consisted of patients who deteriorated. There were 44 patients (47.3%) in Group I and 49 patients (52.7%) in group II. Each group was subdivided into the conservative group and the surgical group. In Group I only eight patients (18.2%) received surgery while twenty-five patients (51.0%) received surgery in Group II. Clinical features and computed tomography characteristics of these four groups were compared. Our results suggested that the surgery is rarely required for patients 1) whose GCS values are 12 or more without deterioration; 2) with hematomas smaller than 3 cm in diameter or 20 ml in volume; 3) with midline shifts of less than 3 mm, and 4) whose subtypes of the hematomas are P1, P2a, T1, T2a, and T2b. For proper comparison of the results of medical and surgical treatment, the patient population should include the patients 1) who became deteriorated progressively regardless of initial GCS values; 2) whose GCS values are below 12; 3) with hematomas larger than at least 3cm in diameter or 20ml in volume; 4) with midline shift of more than 3mm, and 5) whose subtypes of the hematoma are P2b or GT.

Adult

Lymphomatoid granulomatosis with isolated involvement of the brain--case report.

Lymphomatoid granulomatosis usually presents as a primary lung affliction with secondary metastatic spread to the central nervous system(CNS), and its initial manifestation purely as a CNS disease is rare. A 57-year-old man with histologically proven lymphomatoid granulomatosis of the brain as the sole manifestation of the disease is presented.

Brain Neoplasms

Recurrent intracerebral hemorrhage due to hypertension.

We report a series of 14 patients who had recurrent intracerebral hemorrhage due to hypertension. These patients comprise 2.7% of all those admitted to the Soonchunhyang University Chonan Hospital for hypertensive intracerebral hemorrhage from 1985 to 1988. Women outnumbered men by 13 to 1. The mean age of the patients was 54.5 years at the time of the first hemorrhage and 55.4 years at the time of the second hemorrhage. The mean interval between attacks was 13.1 months. All patients were hypertensive on admission, and in 10 patients hypertension had been diagnosed previously. None of the patients had received regular antihypertensive therapy, even after the first hemorrhage. Hemiplegia was the most common deficit seen after both the first and second attacks. The site of the first hemorrhage was ganglionic in 9 patients, cerebellar in 3 patients, and lobar in 2 patients. The site of the second hemorrhage was ganglionic in 9 patients and lobar in 5. The site of recurrent hemorrhage was different from the initial site in all patients except one. The most common pattern of recurrence was "ganglionic-ganglionic." The "lobar-lobar" pattern was noted in only 1 patient. The hypertensive changes of the cerebral arteries are considered to be the major cause of these recurrent hemorrhages. We believe that recurrent intracerebral hemorrhages in hypertensive patients are not rare as previously thought. Possible reasons for the increased frequency of recurrent intracerebral hemorrhage are discussed.

Aged

Recurrent alternating stroke.

Recurrent alternating stroke, i.e., one time ischemic and the other hemorrhagic or vice versa, is an uncommon event. We report a series of eight patients who had recurrent alternating strokes, which were diagnosed by CT scans during the last four years. Infarcts preceded hemorrhage in six patients. In the remaining two patients, hemorrhage developed first and infarct followed. All ischemic strokes were the lacunar infarcts. The lesions of the two attacks were located in different sites in all cases except one. The mean age of the patients was 56.6 years at the time of the first attack and 57.5 years at the time of the second. The mean interval between attacks was 11.8 months. All patients were hypertensive on admission. After the first attack, the outcome was favorable in all patients. However, after the second attack the outcome deteriorated to moderate disability in three, severe disability in one and death in four. We discuss some possible reasons for the rarity of recurrent alternating stroke.

Brain Ischemia

Bilateral proptosis from a subgaleal hematoma. Case report.

A case of bilateral proptosis due to orbital extension of a subgaleal hematoma is reported. It was produced by a compressive dressing applied for treatment of the hematoma. Orbital entry seemed to be via the lateral canthal region.

Adolescent