腦實質內血腫의 臨床的 分析

車喜中,崔雲成,高鶴鍾,沈輔星 대한신경외과학회 1975 Journal of Korean neurosurgical society Vol.4 No.2

Seventy cases of intracerebral hematomas were analysed, forty-six of spontaneous origin and remainder of traumatic one, which had been experienced in Seoul National University Hospital between March 1970 and June, 1975. The results were as follows: A. Among forty-six cases of spontaneous intracerebra1 hematomas, twenty-six cases (52%) were primary intracerebral hematomas, normotensive or hypertensive, seven aneurysmal ruptures (15%), seven arteriovenous malformations (15%), two cerebral rete mirabiles, one tumor bleeding, one leukemia, one idiopathic thrombocytopenic purpura and one due to other blood dyscrasia. 1. Among twenty-six cases of primary intracerebral hematomas, angiography was performed in all and fourteen cases were operated. The sites of hemorrhage were as follows: a. Putaminal hemorrhage: 17 cases (65%) (two cases associated with intraventricular hematoma) b. Thalamic hemorrhage: 5 cases (19%) (two cases associated with intraventricular hematoma) c. Subcortical hemorrhage: 4 cases (16%) 2. Overall mortality among twenty-six cases was forty-six per cent; operative mortality was forty-three per cent, and non-operative, fifty per cent. 3. Age, mode of onset, level of consciousness at the time of surgery and the site of hematoma were all important factors for surgical result. Surgical intervention seemed to be most favorable in patients who had verbal communication with subcortical or localized putaminal hematoma. 4. Normotensive group was worse than hypertensive one with conservative treatment, but the former was more benefited than the latter with surgery. 5. Intracerebral hematomas due to aneurysmal rupture, arteriovenous malformation and others were also influenced with above mentioned factors, but the nature of underlined disease was of prime importance. B. Among twenty-four operated cases of traumatic intracerebral hematomas: 1. Five cases(21%) showed classical lucid interval with variable duration from thirty minutes to forty-eight hours. 2. Tempora1 lobe was most frequently involved (63%). 3. Lateral blow was Predominant than axial blow, and contrecoup than coup lesion. 4. Overall mortality was twenty-nine percent. 5. Age, lucid interval, preoperative level of consciousness and associated cerebral contusion or subdural hematoma were important factors for prognosis, but the preoperative level of consciousness was of prime importance.

Hutchinson형 신경아세포종 1예

차희중,고학종,최길수 대한신경외과학회 1976 Journal of Korean neurosurgical society Vol.5 No.1

Metastasis of neuroblastoma into the central nervous system is well known, but, in fact rare clinically. Recently we had experienced one such case, which was characterized by sudden onset of paraplegia and blindness and delayed appearance of radiologic findings. A 7 years old Korean boy was admitted to the pediatric ward of the Seoul National University. Hospital on September 28, 1975 due to sudden onset of paraplegia. All physical, laboratory and simple thoracic spine X-ray findings were normal except for albuminocytologic dissociation in the C.S.F. Guillain Barre syndrome was suspected and steroid therapy was recommended. On November 10, 1975, he was readmitted due to sudden loss of visual acuity bilaterally. At first all radiologic examinations revealed no clue to the lesion. After 4 months from the onset, there appeard typical pedicular destruction of the thoracic spine and confirmed it as neuroblastoma by surgery.

외상성 뇌척수액 비루에 수반된 기류 2례 보고

차희중,황성남,한대희,심보성 대한신경외과학회 1977 Journal of Korean neurosurgical society Vol.6 No.1

We have experienced two cases of intracerebral aerocele combined by persistent traumatic cerebrospinal fluid rhinorrhea. All of two cases were diagnosed incidentally during observation in simple skull X-ray films. We performed craniotomy for the repair of the dural fistula and treated successfully. Authors discussed the possible mechanisms of the intracerebral aerocele briefly.

뇌도수관 폐쇄로 인한 수두증 4예

차희중,고학종,김현집,최길수 대한신경외과학회 1976 Journal of Korean neurosurgical society Vol.5 No.2

Aqueductal obstruction has been an interesting entity among hydrocephalic patients because of its possible permanent cure by interventriculostomy alone, eliminating the need of external shunt problem. Recently we have experienced four such cases as following. Case 1: A 21 years old female was admitted due to headache and deteriorating visual acuity. Positive neurologic findings were bilateral papilledema and rapidly deteriorating visual acuity. Conray ventriculogram revealed bilateral symmetrical hydrocephalus with obstruction at the distal portion of the aqueduct. Suboccipital craniectomy was performed. Cistema magna and fourth ventricle were dried. With 3.5 cm upwards advancement of Nelaton tube from the orbex, resistence was felt. And with further advancement, giving sensation of membrane rupture was felt. We confirmed good passage of C. S. F. and closed without the tube remained. The patient was discharged two weeks later with much improvement clinically. Case 2: A 20 years old male was admitted due to sudden onset of coma. Positive neurologic findings were bilaterally dilated pupil, increased DTRs, and positive toe signs. Conray ventriculogram revealed marked hydrocephalic pattern with cupping like obstruction at the distal portion of the cerebral aquedct. Operative findings were the same as in case 1, but rubber catheter was remained in the cerebral aqueduct. Post-operative course revealed high fever due to pneumonia, but much clinical improvement was achieved until discharge. Case 3: A 6 years old girl was admitted due to unsteady gait and headache. Neurologic findings were bilateral papilledema,'hyperactive DTRs, positive toe signs and generally disturbed cerebellar function. Radiologic and surgical findings were the same as in case 1, but a tube was remained in situ. Post-operative state revealed satisfactory. Case 4: A 14 years old boy was admitted due to headache and unsteady gait. Positive neurologic findings were hyperactive DTRs, positive toe signs and disturbed 1t. cerebellar function. Conray ventriculogram revealed marked hydrocephalus and obstruction at the mid-portion of aqueduct. Proximal aqueduct was markedly dilated. Suboccipital craniectomy was performed, when 3.7 cm adavancement of the tube, resistance was felt, but giving sensation of membrane rapture was not felt. So the tube was remained in situ. Post-operative state revealed drowsy consiousness, right lateral gaze palsy and transient C.S.F. leakage. Surgical mortality was zero, and the. complications of case 4 were supposed due to inadequate placement of the tube. From these, we feel that simple membraneous puncture' without catheter tube placement may be better if surgeon feels the giving sensation of membrane puncture when the tube advancement to make C. S. F. passage. Otherwise, the catheter may be well left in situ.

馬尾腔後方으로 脫出된 腰椎間核脫出症 1例

車喜中,金國起,高鶴鍾,沈輔星 대한신경외과학회 1975 Journal of Korean neurosurgical society Vol.4 No.2

Recently we had experienced a case of posterior migration of herniated lumbar nucleus pulposus over the cauda equina, simulating a cord tumor clinically and radiologically. But we could hardly find any previous case report on it. A 35 years old man was admitted to our ward due to paraparesis on July 17, 1975. He had a history of back sprain five years ago with intermittently appearing mild lumbago. Two weeks prior to admission, there appeared severe left leg pain and soon resulted in paraparesis. Preoperative positive neurologic findings were paraparesis with left side foot drop, hypesthesia on the left L 4,5 and S 1 dermatome and bilaterally decreased ankle and knee jerks. Myelogram revealed complete block at L2-3 with suspicious indentation filling defect at left L4-5 interspace. C.S.F. protein value marked 738㎎%. On operation, the dural sac was compressed by a posteriorly overriding mass on it at the L2-3 level. The mass was traced to its origin from the left side of the L2-3 interspace and into the ruptured posterior longiturdinal ligament with a narrow pedicle. L4-5 interspace revealed a typically protruding type disc lesion. These were composed of degenerated nucleus pulposus on histological examination.

Tetralogy of Fallot 에 수반된 뇌농양

차희중,손효정,조병규,채진,최길수,심보성 대한신경외과학회 1975 Journal of Korean neurosurgical society Vol.4 No.1

The incidence of brain abscess in congenital heart disease marks 4~6%. Of these, tetralogy of Fallot is the most common congenital heart disease. We had experienced 2 cases of brain abscess associated with tetralogy of Fallot among 32 cases Of brain abscess from March-' 57 tc September-' 74. Case 1; A 10 years old boy was admitted to our hospital in March-'66 because of headaches and vomiting. He had a history of Potts' operation under the impression of tetralogly of Fallot at the age of 5. Findings of clinical examination and diagnostic studies gave us an impression of a huge cystic mass in the right posterior temporo-occipital area. We aspirated about 80cc of pus, but no microorganisms were noted on direct smear and culture. Case 2; A 7 years old boy was admitted to our hospital in August-' 74 because of headaches and fever. He had been suffered from tetralogy of Fallot from the age of 3 without any surgical intervention. We made a burr hole on the right anterior temporal area under the impression of right posterior fronto-temporal mass, and aspirated about l5cc of pus. Multiple Gram positive cocci were noted on direct smear, but nothing on culture.

흰쥐 대뇌 Guanine Aminohydrolase의 정제 및 특성에 관한 연구

차희중,정희원,고영초,심보성,박주배,김승원 대한신경외과학회 1984 Journal of Korean neurosurgical society Vol.13 No.4

Guanine aminohydrolase(GAH; EC 3. 5. 4. 3.) was partially purified 122-fold from rat cerebrum to a specific activity of 7.22 inits per mg protein with a recovery of 7.47% by fractionation with ammonium sulfate, chromatography on. DEAE-cellulose and hydroxyapatite, gel filtration on Sephadex G-200, and isoelectric focusing (pH 4-6). The molecular weight of partially purified rat cerebral guanine aminohydrolase was estimated to be 110,000. But, in the cerebral cytosol, a rather higher molecular weight form of the enzyme was identified. The activity of the higher molecular weight form of guanine aminohydrolase was increased by dialysing the cytosol, and it was converted into the lower molecular weight form (M.W. 110,000 ) by addition of 2-mercaptoethanol. The reaction velocity of partially purified guanine aminohydrolase of rat cerebrum disclosed a hyperbolic curve, with its K_(M) being 6.0 uM at pH 8.0. The preparation showed high substrate specificity : among the purine nucleotides, nucleosides and bases with amino group, only guanosine and guanine were deaminated by the enzyme, and the reaction rate of the enzyme displayed by guanosine was less than 10% of that by guanine. When observed under the equimolar concentration of the substrate, hypoxanthine as well as inosine inhibited the activity of the rat cerebral guanine aminohydrolase by 9.4 and 7.8%, respectively, while 5-aminoimidazole-4-carboxamide inhibited the activity of it by 38%. The activity was inhibited by p-hydroxymercuric benzoate as well. Complete loss of its activity was observed after 30 minutes incubation at 60℃, suggesting the preparation was heat labile.

척추 및 뇌낭미충증의 혼합형 1예

김현집,차희중,신동휘,최길수 대한신경외과학회 1976 Journal of Korean neurosurgical society Vol.5 No.1

Cerebral cysticercosis is relatively common along the regional distribution of the world, but spinal cysticercosis is extremely rare. Furthermore combined forms of the two are not ever reported in the literature. Recently we have experienced a case, which was characterized by mental confusion, gait disturbance and urinary and fecal incontinence of 6 years' duration in 45 years old woman. We found these simultaneous two lesions by myelography and conray ventriculography and carried out surgical removal of the two lesions successfully.

Dumb-bell 모양의 요추 Ganglioneuroblastoma 일예 보고

고학종,차희중,최길수,심보성 대한신경외과학회 1975 Journal of Korean neurosurgical society Vol.4 No.2

The ganglioneuroblastoma is a rare tumor originating form the sympathetic chain. Both cytologically and biologically it is intermediate between the highly malignant neuroblastoma and the benign gauglioneurinoma. The predilection site of neoroblastoma is adrenal medulla, but ganglioneuroblastoma and ganglioneurinoma are frequently located in the retropreitoneum and mediastinum. We have recently experienced the dumb-bell shaped ganglioneuroblastoma at L-2 and 3 level. A 2 year-old-girl was admitted to Seoul National University hospital on May-1975 with complaints of lumbar back pain and kyphosis for 6 months. She had normal motor and spincter function. Neurological examination showed normal. Simple lumbar spine x-ray showed the widening of interpedicular distance and erosion of the pedicle at L-2 and L-3. On lateral view scalloping of posterior herder of L-2 was found. Lumbar puncture and myelography were failed. Total laminectomy at L-2, L-3 was done. Dumb-bell shaped mass was seen half in the extradural intraspinal space and half in the extraspinal space with pedicle in the widened intervertebral foramen. The mass was adult thumb-tip sized, dark greyish tan color, modular surfaced, and well encapsulated. The tissue diagnosis was ganglioneuroblastoma. Post-operatively urinary secretion of vanyl-mandelic acid level was normal limit.

시신경 손상없이 좌측 시신경공을 통과한 이물(알미늄제 젓가락)의 1예

정희원,차희중,한대희,심보성 대한신경외과학회 1976 Journal of Korean neurosurgical society Vol.5 No.2

A 20-year-old, male patient was admitted to the Department of Neurosurgery, Seoul National University Hospital, complaining- of painful swelling of the left orbit. Two days before admission, patient sustained piercing of an aluminium chopstick at his left upper eyelid by his friend accidentally. Fluttered friend tried to pull out the chopstick manually but only broke its proximal portion. On neurologic and ophthalmologic exam, he was fully conscious and free from neurologic deficits at all. His visual acuity was as usual and examination of fundi, extraocular muscle functions, visual field and pupillary light reflex were all within normal limit. Subconjuctival hemorrhage and chemosis were positive findings. Skull X-rays including optic foramen, view revealed broken distal part of the chopstick, about 7 ㎝ in length, which passed through the left lateral orbit and left optic foramen to reach sellar region across the midline. Emergency Kro¨nlein-Berke's lateral orbitotomy was performed and the chopstick was removed without difficulty. Postoperatively patient showed good recovery and presented quite normal and usual eve function.