Neurogenic myocardial dysfunction related to pulsatile compression of medulla by aneurysm.
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Adult↗
Biomedical subjects
Dae Hee Han
Publications and source records attributed to Dae Hee Han.
Moyamoya disease associated with Graves disease: special considerations regarding clinical significance and management.
OBJECT: In moyamoya disease (MMD), ischemic events are usually precipitated by activities associated with hyperventilation or physical strain. The authors report on four patients with a rare combination of Graves disease-associated thyrotoxicosis and MMD, whose cerebrovascular ischemic events occurred while in a thyrotoxic state. The clinical correlation between MMD and Graves' thyrotoxicosis, and outcome after surgical intervention are described. METHODS: Four young women, ages 22 to 25 years, presented with profound cerebrovascular ischemic accidents. They had clinical and radiological features consistent with the diagnosis of MMD and were in the active thyrotoxic state of Graves disease. To prevent a future ischemic event, patients underwent superficial temporal artery-middle cerebral artery anastomosis combined with encephalomyosynangiosis or encephaloduroarteriosynangiosis after normalization of their hormonal conditions. All patients have been neurologically stable since revascularization procedures and lead a normal daily life. In patients with MMD, cerebrovascular ischemic events may be precipitated by thyrotoxicosis. One possible pathomechanism of cerebrovascular ischemic aggravation in the thyrotoxic state may be a hemodynamic compromise induced by an excessive increase in the cerebral metabolism and oxygen demand over the compensation of the cerebral blood flow deficit through collateral supply in MMD. CONCLUSIONS: Surgical revascularization after optimal control of thyrotoxicosis is thought to be an appropriate treatment in patients with MMD concurrent with Graves disease for the prevention of further ischemic events, especially in those with impaired cerebral perfusion and cerebral ischemic symptoms.
Adult↗
Gamma knife surgery of superficially located meningioma.
OBJECT: The authors analyzed tumor control rates and complications in patients with superficially located meningiomas after gamma knife surgery (GKS). METHODS: Between 1998 and 2003, GKS was performed in 23 patients with 26 lesions in whom follow-up imaging for 1 year or more was available. The male/female ratio was 1:22. The mean age was 59 years. The median tumor volume was 4.7 cm3, and the mean margin dose was 16 Gy at the 50% isodose line. Peritumoral edema was revealed on magnetic resonance (MR) imaging in four patients before GKS. Magnetic resonance imaging and clinical examinations were performed every 6 months after GKS. The mean follow-up duration was 32 months. The tumor shrank in eight cases, was stable in 17, and enlarged in one; thus 25 (95%) of 26 tumors were controlled. A peritumoral high signal on T2-weighted MR images was found in eight lesions and preexisting edema was aggravated in three lesions after GKS. Ten of these 11 patients complained of severe headache, and three patients experienced neurological deficits at the same time after a mean latency of 3 months; however, high signal was not demonstrated on imaging before 6 months on average. Steroid agents, when required, gave relief to all patients. The complication rate was 43% (10 of 23 cases). High signal disappeared in nine patients and decreased in the remaining two. High signal was associated with a high integral dose and a large tumor volume. Tumor shrinkage at the last follow-up examination was more prominent in the patients with symptomatic high signal (p = 0.03). CONCLUSIONS: There was a good tumor control rate with a high complication rate. Longer follow up of more patients is needed. Adjusting the dose-volume relationship should be considered to reduce complications.
Adult↗
Diagnostic and therapeutic problems of pulmonary tuberculosis in elderly patients.
To identify differences in the clinical, radiologic, and microbiologic features of pulmonary tuberculosis (TB) in the young (<64 yr) and elderly (> or =65 yr), we performed a retrospective analysis of the medical charts and chest radiographs of 207 young and 119 elderly pulmonary TB patients. Hemoptysis and a febrile sense were more frequent in the young, whereas weakness, dyspnea, anorexia, and mental change were more frequent in the elderly. Elderly patients showed higher frequencies of cardiovascular and chronic lung diseases, whereas the young showed a higher proportion of underlying liver disease. In addition, chest radiography showed a significantly higher frequency of mid or lower lung involvement by TB lesions in the elderly (10.6% vs. 22.7%, p<0.05). Lesions were frequently misdiagnosed as pneumonia or lung cancer in the elderly. However, there was no difference between these two groups in terms of sputum acid-fast bacilli positivity. The elderly showed a higher frequency of adverse drug reactions (18.5% vs. 40.7%, p<0.05), and higher TB-related mortality (1.3% vs. 11.1%, p<0.05). In conclusion this study showed that young and elderly pulmonary TB patients have similar microbiologic features; however, the elderly showed higher frequencies of atypical clinical and radiologic presentations, adverse drug reactions, and higher TB-related mortality.
Adult↗
Surgical management of an unruptured dural arteriovenous fistula of the anterior cranial fossa: natural history for 7 years.
BACKGROUND: Anterior cranial fossa dural arteriovenous fistulas (DAVFs), unlike those in other locations, form a distinct subgroup because of a high incidence of intracerebral hemorrhage and their unique anatomy. We surgically obliterated an unruptured anterior cranial fossa DAVF because the venous aneurysm in the DAVF increased in size during the follow-up period and we present the clinical symptoms, the natural history for a 7-year period before operation, the radiologic findings, and surgical management. This is the first case report in which the growth of a preexisting venous aneurysm in an anterior fossa DAVF was identified. The possible pathogeneses of the rupture of anterior cranial DAVFs are discussed. CASE DESCRIPTION: A 68-year-old man presented with diplopia, retro-orbital headache, and loss of consciousness. Cerebral angiography revealed an anterior cranial fossa DAVF. The primary source of arterial supply was from the ipsilateral anterior ethmoidal artery in combination with the contralateral anterior ethmoidal artery and other less prominent feeding vessels from the external carotid artery (ECA). Venous drainage was through the superior sagittal sinus via dilated pial veins. In addition, a subfrontal pial vein drained toward the region of the sphenoparietal and cavernous sinuses. The detection of the growth of a venous aneurysm 7 years after the initial evaluation prompted an aggressive therapeutic decision on considering a future catastrophic rupture risk. The vascular malformation was approached via a low-frontal craniotomy. A venous aneurysm with a dural feeder was encountered near the site of the anastomosis. The vascular connection between the dura of the cribriform plate and the pial vessels was completely occluded. Postoperative angiography confirmed the complete obliteration of the DAVF. CONCLUSION: In this case, we confirmed an increase in the size of a venous aneurysm of an anterior cranial fossa DAVF. Our findings support the belief that the catastrophic intracranial hemorrhage in an anterior cranial fossa DVAF may occur in the setting of increased hemodynamic pressure of its draining venous channel.
Central Nervous System Vascular Malformations↗
Involuntary movement induced by cerebral ischemia: pathogenesis and surgical outcome.
OBJECT: Involuntary movement is an uncommon manifestation of a transient ischemic attack. It may be induced by cerebral hemodynamic insufficiency, which is associated with several cerebral ischemic diseases. The authors present three cases of limb shaking due to moyamoya disease (MMD) or radiation-induced middle cerebral artery stenosis, and three additional cases of choreic movement due to MMD. Neuroimaging studies and surgical outcomes in these patients were retrospectively analyzed to investigate the pathological mechanism underlying the symptoms and to provide guidance for the management of involuntary movement disorders in cases of ischemic cerebral disease. METHODS: The patient population included two children and four adults with ages at presentation ranging between 7 and 50 years. The initial presenting symptoms were involuntary movements in all six cases. A magnetic resonance imaging finding common in all cases was a small infarct in the frontal corona radiata, which did not extend to the cortex or basal ganglia. A perfusion defect in the frontoparietal cortical and subcortical regions was demonstrated by single-photon emission computerized tomography in all patients. Improved hemodynamic circulation in the frontoparietal cortical and subcortical regions occurred in parallel with clinical improvement following indirect or direct bypass surgery. CONCLUSIONS: Ischemic dysfunction of the frontal cortical and subcortical motor pathways rather than that of the basal ganglia was suspected to be the cause of the observed contralateral involuntary movements. Direct and indirect bypass surgery can be used effectively to treat involuntary movements in patients with cerebral ischemic diseases such as MMD and in those with stenosis of an intracranial major artery.
Adolescent↗
Postoperative 3D angiography in intracranial aneurysms.
BACKGROUND AND PURPOSE: Postsurgical evaluation of patients with intracranial aneurysms is important because there is a risk of regrowth and subarachnoid hemorrhage from residual aneurysms. We assessed the role and value of 3D angiography in this evaluation. METHODS: Images from both 3D angiography and digital subtraction angiography (DSA) were preoperatively obtained in 71 consecutive patients with 88 intracranial clipped aneurysms. We analyzed the incidence of postoperative residual aneurysms and compared the 3D angiographic and DSA images in these patients. RESULTS: With 3D angiography, 37 residual aneurysms were found among 88 clipped aneurysms. These comprised 12 large residual necks and 25 small, dog-eared remnants. DSA demonstrated 12 large, residual necks and only six small, dog-eared remnants. 3D angiography also demonstrated the clips, aneurysms, and parent arteries simultaneously, enabling us to appreciate the clip-aneurysm configuration completely. CONCLUSION: 3D angiography allowed us to detect more residual aneurysms after surgical clip placement than did conventional DSA, although none of those detected on only 3D angiography were judged to require additional treatment. 3D angiography may provide baseline data for the long-term follow-up of postsurgical aneurysms.
Adult↗
Posterior fossa hemorrhage caused by dural arteriovenous fistula: case reports.
BACKGROUND: Relatively few reports are available on dural arteriovenous fistulas (AVFs) accompanied by posterior fossa hemorrhage. We now report upon two such cases and discuss the differential diagnosis and imaging findings. CASE DESCRIPTION: A 36-year-old man was admitted after experiencing sudden headache. Computerized tomography (CT) showed vermian and fourth ventricular hematoma, and magnetic resonance imaging (MRI) revealed an abnormal signal void. Angiography demonstrated a dural AVF in the region of foramen magnum. The second case, a 57-year-old man, was also admitted for the evaluation of headache. CT scan revealed tentorial subdural, subarachnoid and vermian hemorrhage. MRI showed vermian hematoma and an abnormal signal void below the tentorium. Angiography demonstrated a dural AVF in the tentorium. The first case underwent transarterial embolization, after which the dural AVF disappeared completely. The second case underwent craniotomy immediately after failure of endovascular therapy. Postoperative angiography demonstrated no remaining dural AVF. CONCLUSIONS: Dural AVF should be considered as a causative lesion in cases with posterior fossa hemorrhage with no other definitive cause.
Adult↗
Clinical characteristics of dural arteriovenous fistula.
Intracranial dural arteriovenous fistula (DAVF) is an uncommon neurosurgical condition; in particular, it has been infrequently reported in Korea. To understand the general clinical characteristics of DAVFs, the authors reviewed 53 cases and analyzed factors affecting DAVF hemorrhage of and treatment outcome. Since 1980 we have encountered 480 pial and 53 DAVFs, a ratio of 9.1 to 1. The age of these patients ranged from 1 month to 71 years, the most common being in the 6th decade, and females exceeded males by 1.65 to 1. All lesions except three were single, and symptoms were related to location and the venous drainage pattern. The most common location was the cavernous sinus, accounting for about 64% of cases, with the result that the most common clinical symptoms of DAVFs were ocular, namely proptosis and chemosis. The next was tinnitus also found in transverse-sigmoid sinus DAVFs. Intracranial hemorrhage was seen in eight cases,(15%) the primary cause of hemorrhage was retrograde intracranial venous drainage (P=0.017), and one hemorrhage was observed in cases with no intracranial venous drainage. Intracranial hemorrhage was more frequently in transverse-sigmoid than cavernous sinus DAVFs (P=0.049), and this proved to be so even where there was intracranial venous drainage. However, two of 34 patients with cavernous DAVFs became blind in one eye, demonstrating that in such patients, the clinical course could be aggressive. Thirteen patients were treated conservatively. The conservative treatment group was comprised of 13 patients, two of three patients with transverse-sigmoid sinus DAVF expired, and 7 of 10 with cavernous sinus DAVF experienced a clinical improvement or cure. Surgical excision was performed in only two patients. A total of 39 patients underwent embolization; clinical cure was achieved in 13, improvement of symptoms in 12, an unchanged or aggravated result occurred in 9, one died, and four were lost to follow up. During intervention, there was one hemorrhagic complication, owing to obstruction of the venous outflow with embolic materials. In this study, the most common location of DAVFs was the cavernous sinus. The cortical venous drainage remains the primary determinant of intracranial hemorrhage. Common indications for treatment include hemorrhage and neurological deficit. Endovascular treatment is preferred in the majority of cases except tentorial DAVF. The goal of embolization in cavernous DAVF is the alleviation of symptoms, not angiographic cure. But transverse-sigmoid sinus DAVF with venous restriction and leptomeningeal drainage should be treated aggressively.
Adolescent↗
Growth of basilar artery aneurysm after ventriculo-peritoneal shunt.
We report upon two cases of obstructive hydrocephalus produced by giant basilar artery aneurysms. They initially presented with symptoms of increased intracranial pressure, and were managed by a ventriculo-peritoneal (VP) shunt with good symptomatic improvement. With time, however, both showed a gradual deterioration of clinical symptoms due to increased aneurysm size. One, with a basilar tip aneurysm was treated by direct neck-clipping of the aneurysm, and was able to return to work. In the other patient, with a basilar trunk aneurysm, endovascular occlusion of one vertebral artery was attempted in an effort to decrease the aneurysm size, but the aneurysm enlarged precipitating brain stem failure. In conclusion, these cases reveal the risk of the VP shunt, which may induce aneurysmal growth, leading to clinical devastation, and emphasize the importance of definitive treatment for giant cerebral aneurysms whenever possible.
Cerebral Angiography↗
Intraosseous dural arteriovenous fistula of the skull base associated with hearing loss. Case report.
The most common clinical presentations of dural arteriovenous fistulas (DAVFs) are bruit, headache, increased intracranial pressure, and intracranial hemorrhage. In particular locations, such as the cavernous sinus or middle cranial fossa, cranial nerve involvement due to dural arterial steal or venous occlusion may develop. A case in which a DAVF is associated with hearing loss, however, has not previously been reported. The authors report a case in which an intraosseous DAVF and associated hearing loss probably resulted from cochlear nerve or vascular compression caused by the draining vein or nidus of the DAVF.
Adolescent↗
Intraarterially administered abciximab as an adjuvant thrombolytic therapy: report of three cases.
The intravenous administration of abciximab can be used as an adjuvant therapy to facilitate thrombolysis for acute cerebrovascular occlusion. However, to our knowledge, the intraaterial administration of abciximab has not been reported. We recently treated three patients with acute thrombosis of the cerebral arteries by using an intraarterial infusion of urokinase and abciximab. Even with small doses, we achieved rapid and complete recanalization without complications. We believe that the intraarterial infusion of abciximab may be promising for effective and safe recanalization of acute thrombotic occlusion of cerebral arteries.
Abciximab↗
Radiosurgical treatment of a cerebral arteriovenous malformation in a patient with moyamoya disease: case report.
OBJECTIVE AND IMPORTANCE: A case of a cerebral arteriovenous malformation (AVM), which was treated with gamma knife surgery, in a patient with moyamoya disease is described. This is the first report of radiosurgical treatment of a cerebral AVM in a patient with moyamoya disease; the outcome was satisfactory. CLINICAL PRESENTATION: The patient presented with frequent episodes of transient ischemic attacks and seizures. INTERVENTION: Staged encephaloduroarteriosynangiosis was performed on both sides, with an interval of 10 months. Postoperative cerebral angiography demonstrated augmented cerebral perfusion, which increased the size of the AVM nidus. The patient subsequently underwent gamma knife surgery, and the AVM completely disappeared 2 years later. CONCLUSION: Radiosurgery may be a good treatment option for AVMs accompanying moyamoya disease, allowing the preservation of collateral vessels and the prevention of possible misery perfusion.
Adult↗
Technical problems associated with new designs of Guglielmi detachable coils.
BACKGROUND AND PURPOSE: Recently, we experienced several technical problems that were directly related to new designs of Guglielmi detachable coils (GDCs). We herein present cases involving those problems and propose probable causes. METHODS: We reviewed the clinical and angiographic data of 269 consecutive patients with intracranial aneurysms who had been treated with GDCs between May 1996 and October 2001. We focused on newly encountered technical problems: spontaneous premature coil detachment, backward slipping of the coil into the microcatheter lumen after detachment, and undesirable detachment of the coils at the parent artery. The occurrence and clinical consequences of the problems were investigated before and after the introduction of a new GDC (SynerG) design. Additionally, to confirm the potential causal relationship, in vitro observations and simulation tests were performed. RESULTS: Of the 269 patients, 69 underwent embolization between March and October of 2001. Among those, we encountered technical problems in 10 (14.5%) cases. The overall number of events was 12, including spontaneous detachment (n = 5), backward slipping of the coil into the microcatheter lumen after detachment (n = 4), and undesirable coil detachment with a segment of the coil remaining at the parent artery (n = 3). No similar problems occurred among the 200 patients treated during the period between May 1996 and February 2001, when the new design coil had not yet been introduced. In vitro observations suggested that the long and stiff segment of the SynerG coil, especially the SR type, was a highly probable cause of these technical problems. CONCLUSION: Our clinical experience showed a high incidence of technical problems, and in vitro observations suggested that the new GDC designs could be responsible for them. For safe aneurysm treatment, details of embolization techniques should be modified.
Adult↗
Treatment of a sequential giant fusiform aneurysm of the basilar trunk.
We report an exceptional case of a de novo giant fusiform aneurysm of the basilar trunk, which developed shortly after the therapeutic occlusion of the right internal carotid artery for a fusiform carotid aneurysm. It would appear to be appropriate to call this entity a sequential giant fusiform aneurysm. The patient was successfully treated with endovascular occlusion of the giant basilar trunk aneurysm following bypass surgery.
Adult↗