Sonographic diagnosis of a corpus callosum lipoma with extracranial extension in an infant.
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Brain↗
Biomedical subjects
T N Lui
Publications and source records attributed to T N Lui.
Surgical treatment for ossification of the posterior longitudinal ligament of the cervical spine.
Ossification of the posterior longitudinal ligament (OPLL) is a degenerative disease of the spine, usually found in the cervical vertebrae. Most symptomatic patients present with a myelopathy or myeloradiculopathy. Surgical decompression is the preferred treatment. The choice of operative approach, anterior or posterior, is still controversial. From January 1986 to June 1992, 20 patients with this condition received operations at Chang Gung Memorial Hospital. The clinical manifestations and the results of treatment are analysed. The ideal surgery seems to be the anterior approach with bone fusion. If, however, the OPLL involves more than three segments, the posterior approach with an expansive laminoplasty would be the better alternative technique.
Adult↗
Citrobacter meningitis in adults.
Citrobacter meningitis is an uncommon infection of neonates and young children. It is rarely seen in adults. We describe a 46-year-old man with a mixed bacterial meningitis caused by C. diversus and Klebsiella oxytoca and a 64-year-old woman with C. freundii meningitis. Review of the English-language literature revealed only 2 adult patients with C. diversus meningitis and another 2, with C. freundii meningitis. The ages of these 6 aforementioned patients ranged from 31 to 84 years. Multiple facial fractures, neurosurgical procedures, alcoholism and diabetes mellitus were predisposing conditions. Among the 5 patients whose outcome was known, antibiotic therapy was successful in 4 but failed in 1. This study emphasizes that almost any of the gram-negative bacilli can cause serious infection of the central nervous system in adults in the proper setting.
Adult↗
Epidural hematomas in the posterior cranial fossa.
A review of 89 cases of posterior fossa epidural hematoma (PFEDH) is presented. The mortality rate was 17.9%. In 44 cases (49.4%) there were associated intracranial hematomas. In 30 cases the hematoma was localized within the boundary of the foramen magnum and the transverse and sigmoid sinuses ("pure" PFEDH). In 59 cases the hematoma extended beyond the sinuses to the occipital area ("mixed" PFEDH). In the pure PFEDHs, the bleeder could be identified in only six cases and in five cases the source was a bleeding transverse sinus. The bleeders disclosed in the mixed PFEDHs were a torn transverse sinus in 28 cases, a meningeal artery in three cases, and a bony fracture in three cases. The possibility of a PFEDH should be kept in mind when evaluating patients who have suffered an occipital blow resulting in a frontal or temporal hematoma. In our series, patients with the pure PFEDHs with no associated intracranial hematomas had the best prognoses. Nine patients developed a PFEDH after surgery for a supratentorial hematoma. In 14 cases the PFEDH was treated at the subacute or chronic stage. All but one patient survived with a good recovery. Children generally had better prognoses.
Adolescent↗
The expectant treatment of "asymptomatic" supratentorial epidural hematomas.
Seventy-four patients with a traumatic epidural hematoma (EDH) and a Glasgow Coma Scale score of more than 12 received expectant treatment; 14 subsequently underwent surgical evacuation of the EDH. A patient with initial brain computed tomograms (CT) showing an EDH volume of more than 30 ml, a thickness of more than 15 mm, and a midline shift beyond 5 mm tended to require surgery within 3 days of the injury when the brain had exhausted its compensatory mechanism and yielded to the expanding EDH. After the 3-day period, in the absence of neurological symptoms, the presence of the EDH may not be an indication for surgical evacuation or hospitalization beyond 7 days. In our patients, the presence of a skull fracture in the temporal bone, the heterogeneous density of the EDH in the CT scan, or the 6-hour period between the CT study and the injury did not significantly increase the failure rate of nonsurgical treatment. Although a zero mortality was achieved in this series, these guidelines may not be applicable to the management of an infratentorial EDH.
Adult↗
Features of spinal cord injury in Taiwan (1977-1989).
In order to establish an etiological and statistical base for spinal cord injuries, 1,617 spinal cord injured patients admitted to the Chang Gung Memorial Hospital in Taiwan during the period of 1977 to 1989 were reviewed. The most common causes of injury were pedestrian (29.31%) and motorcycle (28.88%) accidents. The greatest incidence of injury was in the 26-35 year age group. The complete tetraplegic patients had the highest mortality rate (26.5%). Additional features studied were the time of occurrence and pattern of injury. Information gathered from this study suggest the need to establish a Spinal Cord Injury Prevention Program, to develop a Prehospital Care System and set up comprehensive Spinal Cord Injury Units in Taiwan. We expect this study to be adaptable to other similar developing countries.
Adolescent↗
Eosinophilic granuloma of the skull--report of four cases.
Eosinophilic granuloma is a benign form of the three clinical variants of histiocytosis-X. It is an uncommon, localized granulomatous process, forming solitary or multiple lytic skeletal lesions, and primarily involving male children and young adults. We studied 4 cases, three boys and one girl, aged 4, 8, 27 and 12 years, in Chang Gung Memorial Hospital from 1981 to 1990. Their common presentation was the rapidly growing, painful, and protruding scalp masses without neurological deficits. En bloc excisions of these lesions were performed. Then radiotherapy was given postoperatively in two cases, chemotherapy in one, and no adjuvant treatment in one. During their follow-up period of 2 to 10 years, all 4 patients were well, without evidence of recurrence.
Adult↗
Surgical treatment of type I Chiari malformation with syringomyelia in adults.
The surgical treatment of six adult patients with Type I Chiari malformation associated with syringomyelia is reported. Two patients presented with acute respiratory insufficiency, which is common in Type II and rare in the Type I anomaly. One patient initially appeared with unilateral vocal cord palsy that was followed by wasting and fasciculation of the tongue and limb muscles. Two patients had a typical central cord syndrome and the last patient had hemiparesis and gait disturbance. The first patient was diagnosed clinically. Two patients were studied by computed tomographic metrizamide myelogram (CTMM). The last three patients were diagnosed by magnetic resonance imaging (MRI) scan. All patients were operated on with a modified 'Gardner procedure'. Symptoms related to cervico-medullary compression improved satisfactorily. Signs of central cord syndrome, however, remained stationary event though the follow-up MRI examinations revealed good resolution of the syringomyelia. One patient died within one week of surgery. MRI makes the diagnosis of this anomaly much easier and is the ideal tool for follow-up study. Clinicians should include this malformation in the differential diagnosis when considering cases of syringomyelia.
Adult↗
Bilateral glossopharyngeal neuralgia after excision of a solitary cervico-medullary haemangioblastoma: case report.
A man presenting with sleep apnoea was found to have a haemangioblastoma at the cervico-medullary junction. The associated hydrocephalus and syringomyelia resolved after excision of the tumour. Postoperatively the patient developed transient bilateral glossopharyngeal neuralgia, presumably due to surgical damages to the tractus solitarius. To the best of our knowledge this is the first reported case with transient bilateral glossopharyngeal neuralgia following resection of a haemangioblastoma of the cervico-medullary junction.
Adult↗
Acute paraplegia resulting from haemorrhage into a spinal neurofibroma.
Acute paraplegia due to the intratumour haemorrhage of spinal neurofibroma is a rare condition. We describe 2 patients with this unusual presentation. Surgical treatment was successful in both patients. These 2 cases are reported, and the literature is reviewed.
Acute Disease↗
Early seizures after mild closed head injury.
The authors review the seizure incidence in 4232 adult patients with mild closed head injury who did not receive prophylactic anticonvulsant agents. One hundred patients (2.36%) experienced seizures within 1 week after head injury; 43 of these (1.02% of the series) had seizures within 24 hours after trauma. Most of the seizures (84%) that developed during the 1st week after injury were of the generalized tonic-clonic type. The incidence of generalized tonic-clonic seizures was higher than that of partial seizures with motor symptoms both within 24 hours (91% vs. 9%) and during the Day 2 to 7 period (79% vs. 21%). No definite intracranial pathological findings were detected by computerized tomography (CT) in 53% of patients with early posttraumatic seizures; six patients had intracranial hemorrhage without intracranial parenchymal damage (three with epidural hematoma and three with subarachnoid hemorrhage). The most common positive CT findings in the early posttraumatic-seizure group were intracerebral hemorrhage (24%), followed by acute subdural hematoma with intracerebral hemorrhage (17%). Intracerebral parenchymal damage could be identified on CT scans in 41 (48.8%) of 84 patients with generalized tonic-clonic seizures and five (31%) of 16 patients with partial seizures with motor symptoms. The intracerebral parenchymal damage was most commonly detected in the frontal lobe (21%) and the temporal lobe (19%). Seven patients with early posttraumatic seizures received emergency craniotomy to remove an intracranial hematoma (epidural in three, subdural and intracerebral in four) because the mass effect resulted in significant midline shift as seen on CT scans. This review suggests that early posttraumatic seizures after mild closed head injury have a high incidence (53%) in patients with normal CT scan findings. Although the possibility of surgically correctable intracranial hemorrhage is low (7%), the condition may be devastating if not treated properly.
Adolescent↗
The simultaneous use of electrocochleogram, brainstem auditory evoked potential and facial muscle EMG in cerebellopontine angle tumor removal.
In six cases of acoustic neurilemmoma, electrocochleogram (ECOchG), brainstem auditory evoked potentials (BAEP) and facial muscle electromyograms (EMG) were recorded to monitor facial nerve and brainstem function. Under isoflurane and nitrous oxide anesthesia, we recorded ECOchG from the tympanic membrane, BAEP from the scalp needle, and facial muscle EMG from the mentalis muscle. During surgery, the body temperature was kept above 36.5 degrees C, and PaCO2 above 30 mmHg. In all cases, the peak N1 of ECOchG and wave I of BAEP had identical latencies throughout the monitoring period. The response was faster and the amplitude was higher in the ECOchG recordings. For calculation of the I-III or I-V interpeak latency of BAEP, the wave I of BAEP could be confirmed more quickly and precisely by the peak N1 of ECOchG. During tumor removal, the embedded facial nerve pathway in the tumor was identified by electric stimulation of the intracranial facial nerve, followed by evoked facial muscle EMG. Facial nerve function was confirmed by nerve traction or direct electric stimulation after total removal of the tumor. No facial palsy or other neurologic sequelae was found after the operations.
Adult↗
Delayed intracranial haemorrhage in patients with multiple trauma and shock-related hypotension.
During an 11 year period, 10 cases of delayed traumatic intracranial haematomas, following the correction of shock, were discovered. The intracranial haematomas were not present on initial computerized tomography (CT) scans after stabilization of the vital signs. Skull fractures were found in six patients; five of them had epidural haematomas at the site of their skull fracture. Four patients developed intracranial haematomas during general anaesthesia for extracranial surgery. All the delayed intracranial haemorrhages (seven epidural haematomas and three delayed intracranial haematomas) occurred within 12 hours after initial resuscitation. Seven out of eight patients made a good recovery after surgical removal of their intracranial haematoma. The initial hypotension may have acted as a protective mechanism, obscuring the intracranial haemorrhage. Awareness of this possibility, and a high degree of suspicion in those patients who deteriorate following correction of their shock, is important. We suggest that, even with a negative initial CT scan the duration of extracranial surgery in the acute period should be as short as possible in patients with suspected head injury. If these patients fail to wake up as expected following anaesthesia or new neurologic deficits develop, an urgent follow up CT scan should be performed.
Adolescent↗
Acute post-traumatic intraventricular hemorrhage analysis of 25 patients with emphasis on final outcome.
A series of 25 patients suffering acute post-traumatic intraventricular hemorrhage (IVH) after closed head injury is reviewed. Post-traumatic IVH was associated with other brain lesion in most cases; intracerebral lesions with contusion, subdural hematoma, and epidural hematoma coexisted with post-traumatic IVH in ten, three, and one instance, respectively. In six cases, no CT abnormality other than IVH was noted. The final outcome in this series is poor, only 10 (40%) patients made a functional survival. Four different groups of IVH were proposed according to the CT scan findings: deep nuclei hemorrhage, brain stem injury, white matter hemorrhage and isolated IVH. The group of isolated IVH usually got a good outcome. The abnormal motor response, abnormal pupil reaction and impaired oculocephalic response were reliable parameters for poor prognosis.
Adolescent↗
Early postoperative seizures after posterior fossa surgery.
A review is reported of the seizure incidence in 726 patients who underwent 740 posterior fossa operations via a suboccipital craniectomy without prophylactic anticonvulsant agents. Thirteen patients (1.8%) experienced seizures within 2 weeks postoperatively. Five of these patients (0.7% of the series) had seizures within 24 hours after operation. The incidence was highest for patients with medulloblastoma (7.2%) followed by those with astrocytoma (2.3%). Also, a higher percentage was found in patients with preoperative ventriculoperitoneal shunt or intraoperative ventriculostomy (2.7%) than in those without (1%), but the difference was not statistically significant. Metabolic acidosis (80%) and hyponatremia (20%) were the major causes of the seizures that developed within 24 hours after operation. Follow-up computerized tomography showed no definite lesion in these patients. Hydrocephalus (75%) and supratentorial hemorrhage remote from the operative site (25%) were detected in the patients who developed seizures between the 2nd and 14th postoperative day. Two of these patients also had postoperative bacterial meningitis. This review suggests that seizures are a possible complication in the early postoperative period after suboccipital craniectomy for posterior fossa lesions.
Adolescent↗
[Adenoid cystic carcinoma of the nasopharynx with intracranial metastasis--a case report].
Adenoid cystic carcinoma of the nasopharynx is an occurrence with only 44 previously reported cases in the English literature. We report herein one additional case. This 62-year-old female patient suffered from right facial numbness for 1 year. A CT scan of the brain showed tumor shadow in right C-P angle. Subsequently, the patient underwent a temporal craniotomy. A mass was noted in medial temporal fossa, encasing the trigeminal nerve. The tumor was totally removed and pathologic examination showed a picture of metastatic adenoid cystic carcinoma. High resolution CT scan of nasopharynx after surgery revealed bulging of fossa of Rosenmüller, although no gross abnormality was found in the mirror examination of nasopharynx. Thus, nasopharyngeal biopsy was done resulting in a diagnosis of adenoid cystic carcinoma which was considered to be the primary site of origin. The patient received radiotherapy and she was followed up in our clinic.
Brain Neoplasms↗
Features of head injury in a developing country--Taiwan (1977-1987).
Certain features of head-injured patients admitted to the Chang Gung Memorial Hospital in Taiwan during the period 1977 to 1987 were reviewed. The most common causes of injury were motorcycle accidents (56.3%) and street accidents with pedestrian injury (29.47%). The age groups with the greatest incidence of injury were aged 16-20 years, 21-25 years, and 25-30 years. The pedestrian group involving the highest incidence of injury was less than 10 years of age. Overall mortality was 17.26%. The injured pedestrian group had the highest mortality (19.1%). Initial clinical assessment was recorded using the Glasgow Coma Scale. Head-injured patients with a GCS less than 8 had a mortality in the injured pedestrian group of 46%, whereas the mortality rate in the motorcycle accident group was 41%. Additional features studied were time of occurrence of injury and pattern of injury. Information gathered from this study would suggest the need to establish a Head Injury Prevention Program in Taiwan. This of course implies major cooperation among the providers of health care delivery, the medical profession, legislators, and the government at all levels.
Adolescent↗
Upper lumbar disc herniation.
Herniations of the upper lumbar disc have often been overlooked due to a relatively low incidence we had 457 lumbar disc surgeries from January 1978 to June 1987. Twenty-two of them were of the upper three lumbar discs. We analyzed these patients according to their clinical syndromes, radiological findings and surgical results. The characteristic features of anterior thigh pain from upper lumbar disc herniation were different from the more commonly seen fourth and fifth lumbar disc herniation which resulted in sciatica. The incidence of cauda equina syndrome was relatively high in our series (36%). All the 22 cases had correlated X-ray findings. Satisfactory operative results for upper lumbar disc herniation were achieved in 20 of 22 (90%).
Cauda Equina↗