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R Kwak

Publications and source records attributed to R Kwak.

71 records · Page 4Linked to original sources
PubMed1975

[Four cases of ectopic pinealoma with ipsilateral cerebral hemiatrophy (author's transl)].

The 6 cases of brain tumor with ipsilateral cerebral hemiatrophy in which 4 cases were experienced in our institute and 2 cases were found in literature were studied in this paper. The specific character which was common in 6 cases were observed in their clinical course and the findings of clinical examinations. The histopathological study was proceeded with a autopsy case to observe the correlation between brain tumor and the ipsilateral cerebral hemiatrophy. As the result of it, we discussed the mechanism of appearance of the ipsilateral cerebral hemiatrophy due to brain tumor in the thalamic region. 1) All six cases were very young in which the age of onset was between 8 to 14 years old, 11 years 8 months old in average. 2) Their clinical course was relatively chronic. The period from onset to first admission was between 1 year 2 months to 4 years, 2 years and 1 month in average. 3) The declining of school work and hemiparesis were recognized as the primary sign of their onset. Main symptoms were hemiparesis, dementia, character and emotional change, and abnormal behavior, but sign of increased intracranial pressure was not observed. 4) The findings of carotid angiogram and pneumoence-phalogram showed ipsilateral hemiatrophy on the tumor side. 5) The brain tumor localized in the thalamic region and its surroundings which was common with all six cases. 6) Histopathological diagnosis was pinealoma, and 3 autopsy cases were ectopic pinealoma and the other 3 cases were suspected too as ectopic pinealoma. 7) In our autopsy case, ipsilateral cortical and subcortical atrophy with ectopic pinealoma was observed. As the pathological findins, degeneration and destruction of ganglion cells, demyelination in the subcortex and damage of axon were observed. These findings suggested that the ipsilateral cerebral hemiatrophy was induced by Waller's and retrograde degeneration as the result of the secondary damages of the thalamic ganglion cells and the afferent and efferent nerve fibers, due to invasive tumor into thalamic region.

Atrophy↗
PubMedDate not supplied

A microsurgical anterior osteophytectomy for cervical spondylotic myelopathy.

Cervical spondylotic myelopathy was treated by a microsurgical anterior approach removing osteophytes completely. Follow-up results of 43 patients showed that 39 patients (91%) exhibited overall improvements of either 1, 2, or 3 grades on Nurick's grading. Four (9%) remained unchanged. Even severely affected myelopathic patients exhibited neurologic recovery. Cases that also had narrow cervical canals were treated by the same anterior osteophytectomy, and they showed similar responses. Six out of ten patients who had osteophytectomies without fusion developed neck and arm pain postoperatively, although the presence or absence of an interbody fusion did not affect the postoperative recovery from myelopathy.

Adult↗
PubMedDate not supplied

Factors affecting the prognosis in thalamic hemorrhage.

The present study deals with the factors affecting the prognosis in the acute stage of 29 cases with hypertensive thalamic hemorrhage diagnosed by CT scan. It was thought that the following factors were significantly related to the outcome of the patients who were unable to lead daily life, remained in vegetative state or died: (1) consciousness level was below 10 in the so-called 3-3-9 formula, (2) bilateral Babinski's signs were observed, (3) localization of the hematoma was all the thalamic nuclei type, (4) hematoma volume was above 10 ml, (5) the maximum dimension of hematoma was over 30 or 35 mm, maximum width over 30 mm, maximum length over 25 mm and maximum height over 30 or 40 mm, and (6) the ventricles were dilatated. The prognosis had no significant relationship with the age of the patients, the side of the hematoma, the presence or the absence of ventricular penetration of the hematoma, or the existence of midline shift. We believe that in the acute stage of hypertensive thalamic hemorrhage, the prognosis can be forecasted by neurological findings, accurate calculation of the hematoma volume and size, localization of the hematoma and presence or absence of ventricular dilatation as determined by CT scan.

Activities of Daily Living↗
PubMedDate not supplied

Brain tumor with ipsilateral cerebral hemiatrophy in children.

A series of six cases of cerebral tumor with ipsilateral cerebral hemiatrophy, including four cases admitted at our institute, were studied. Various common clinical features were noted in these six cases. The mechanism whereby ipsilateral hemiatrophy of the cerebrum arises from brain tumor has been discussed on the basis of symptomatologic and clinicopathologic findings noted in these 6 cases. 1) The onset of the disease was between 8 and 14 years of age with a mean of 11 years and 8 months; thus all the 6 patients being juvenile. 2) Presenting symptoms developed from 1 year and 2 months to 4 years before admission, with an average of 2 years and 1 month. The clinical course was therefore relatively chronic in every case. 3) Presenting symptoms were: decline of school work, hemiparesis and loss of consciousness. These symptoms were all progressive throughout the course. The principal symptoms were hemiparesis, hemihypoesthesia, character and emotional changes, deterioration of mental faculties and behavioral abnormalities. No sign or symptom of significant increase of intracranial pressure were observed in any case. 4) Ipsilateral cerebral hemiatrophy on the tumor side was evidenced by carotid angiography and by pneumoencephalography. 5) The common site of tumor in this series was the thalamus and its surrounding areas. 6) The tumor was invariably a pinealoma which seemed to be ectopic in every case. 7) The obtained histopathological findings suggest that the ipsilateral cerebral hemiatrophy was due to thinning of the cerebral cortex with degeneration and disappearance of ganglion cells, demyelination in the subcortex and destruction of axons. Our speculated mechanism of ipsilateral cerebral hemiatrophy due to thalamic tumor is that thalamic tumor causes the degeneration and disappearance of thalamic ganglion cells and nerve fibers, consequently occurring secondary Waller's degeneration of afferent and projecting fibers from the thalamus as well as retrograde degeneration of efferent fibers, thus resulting in an extensive atrophy of the cerebral cortex and subcortical tissue.

Atrophy↗