두부손상 환자의 뇌신경손상에 대한 임상적 분석

유장수,한용표,김헌주,홍순기,허철 대한신경외과학회 1991 Journal of Korean neurosurgical society Vol.20 No.1-3

The clinical analysis of cranial nerve injuries was performed on 435 cases with cranoicrerbral trauma. This prospective study included the correlation between cranial nerve injuries and risk factors such as intracranial hematoma, initial Glasgow Coma Scale(GCS) score, pneumocephalus, and other combined injuries. The results were revealed as follows : 1) 133 cranial nerve injuries(on 97 patients) were noted among 435 craniocerebral trauma victims(91/435= 22.2%). 2) The order of frequent cranial nerve injuries was facial nerve(7.3%), olfactory nerve(6.9%), oculomotor nerve(4.4%), abducens nerve(3.9%), optic nerve(3.2%), etc. 3) Bilateral involvment of cranial nerve injuries was noted in 16.5% (22/133). 4) The incidence of immediate onset of cranial nerve injuries was 66.9% (89/133) 5) The incidence of cranial nerve injuries was significantly high in patients with pneumocephalus and low initial GCS score. 6) The functional recovery of injured cranial nerve within 3 months was noted in 30.1% (40/133).

Concomitant Injury of Vagus and Hypoglossal Nerves Caused by Fracture of Skull Base: A Case Report and Literature Review

이상훈,오재상,김도의,김윤태 대한신경손상학회 2020 Korean Journal of Neurotrauma Vol.16 No.2

Injury of lower cranial nerves (CNs) by skull base fracture afer head trauma can occursometimes. However, selectively different CN damage on either side is extremely rare. A 53-year-old man had difculty of swallowing, phonation, and articulation afer fallingoff his bicycle. In physical examination, a deviated tongue to the right side was shown. Brain computed tomography showed a skull base fracture involving bilateral jugularforamina and right hypoglossal canal. Lef vocal cord palsy was confrmed by laryngoscopy. Electromyography confrmed injury of lef superior laryngeal nerve, recurrent laryngealnerve, and right hypoglossal nerve. Video fluoroscopic swallowing study revealed largeamounts of remnant in vallecula and pyriform sinus without opening of upper esophagealsphincter due to dysfunction of cricopharyngeus muscle. Afer constant rehabilitation fordysphagia, he was allowed to eat a general diet with compensatory techniques at dischargeand further recovery afer 3 months. Injury of lower CNs afer fracture of the skull base cancause severe morbidity. However, the prognosis of such injuries can be favorable with earlyrehabilitation treatment by identifying the injured CN. A careful and accurate examination oflower CN injury in skull base fracture is essential for planning a treatment strategy

두개저부 골절에 대한 임상적 분석

장수찬,박철완,한기수,이상구,김영보,이언,정환영 대한신경외과학회 1997 Journal of Korean neurosurgical society Vol.26 No.5

A case report of “minor” trauma leading to a major disability: whiplash-associated dysphagia, dysphonia, and dysgeusia

( Ami Schattner ),( Yair Glick ) 대한외상학회 2022 大韓外傷學會誌 Vol.35 No.2

“Whiplash”-type injuries are commonly encountered and often cause neck pain, neck stiffness, and headaches. However, these injuries can have rare and poorly recognized complications, such as the development of a prevertebral hematoma leading to acute respiratory failure in the emergency department, followed by severe, life-threatening dysphagia and recurrent aspirations. In the patient described herein, a whiplash injury was accompanied by vocal cord paralysis and dysphonia (vagus nerve), dysgeusia (glossopharyngeal nerve, vagus nerve), and upper esophageal spasm (cricopharyngeal muscle, vagus nerve). It is unlikely that this was a complication of cervical fusion surgery. Instead, a combined stretch-induced lower cranial nerve injury, possibly on the exit of these nerves through the jugular foramen, seems to be a likely, but underappreciated mechanism occurring in rare instances of whiplash injuries.

두개저 골절 환자의 임상적 고찰

이용성,송시헌,김성호,김관태,김윤 대한신경외과학회 1994 Journal of Korean neurosurgical society Vol.23 No.9

The authors analyzed 147 cases of basal skull fracture which were treated in the Department of Neurosurgery, Chungnam National University Hospital from Janwuy 1989 to December 1992. These fractures are difficult to diagnose by ordinary X-ray examination and are freguently inferred by clinical signs. The clinical features and radiological findings were reviewed. The results of the analysis are summarized as follows 1) The basal skull fractures were more common in men than women-the ratio being 6 1 1. 2) In decreasing order of cause of basal skull fractures were traffic accident~(77%), fall down, assault and slipping. 3) The minor head injury, Glasgow Coma Scale Score(GCS) of 13 to 15, was 79 cases(54%), the moderate head injury 40 cases(27%) and the severe head injury 18 cases(1996). 4) In decreasing order of clinical features were otorrhea(71 I) rhinorrhea(4856) and raccoon eye(33%) etc. 5) In decreasing order of the combined pathologies were skull fracture(55I 1, subdural hema-toma(l7%), epidural hematoma(l6%) and intraerebral hematoma(l2I) etc. 6) The facial nerve, vestibulocochlear nerve and optic nerve were the most commonly injured cranial nerve. 7) CSF leakage was noted in 139 cases and among them immediate type was far more common(%%) than the delayed type. 8) The incidence of meningitis was 5.4% and most of them associated with CSF leakage and the prophylatic antibiotic treatment has no effect to decrease infection rate. 9) In decreasing order of the frequency associated injuries were facial bone fracture (47%), clavicle fracture(19%), lower extremitics fracture(9%) and upper extremcties fracture(7%) etc.

Collet-Sicard Syndrome in a Patient with Jeff erson Fracture

Hee Chung Kwon,김태욱,Dae Kyung Cho,Yoon Young Jang,이성재,현정근 대한재활의학회 2011 Annals of Rehabilitation Medicine Vol.35 No.6

Collet-Sicard syndrome is a rare condition characterized by the unilateral paralysis of the 9th through 12th cranial nerves. We describe a case of a 46-year-old man who presented with dysphagia after a falling down injury. Computed tomography demonstrated burst fracture of the atlas. Physical examination revealed decreased gag reflex on the left side, decreased laryngeal elevation, tongue deviation to the left side, and atrophy of the left trapezius muscle. Videofl uoroscopic swallowing study (VFSS) revealed frequent aspirations of a massive amount of thick liquid and incomplete opening of the upper esophageal sphincter during the pharyngeal phase. We report a rare case of Collet-Sicard syndrome caused by Jeff erson fracture.

경미한 두부외상에 의한 단독 외전신경 마비

김문연(Moon-Yeon Kim),김일만(Ealmaan Kim) 대한두개저학회 2014 대한두개저학회지 Vol.9 No.2

Cranial nerve lesions often accompany closed and open head trauma. Nevertheless, isolated involvement of abducens nerve (AN) without any cervical or cranial fracture is rare. A case of acute AN palsy caused by mild temporal blow is herein described with high-quality reconstructed magnetic resonance images. The authors discuss the current knowledge of the relevant neuroanatomy, the proposed mechanism of nerve injury, and the treatment outcome in patients with isolated AN palsy following minor head trauma.

Isolated Spinal Accessory Nerve Palsy from Volleyball Injury

Cole A. Holan,Brent M. Egeland,Steven L. Henry 대한성형외과학회 2022 Archives of Plastic Surgery Vol.49 No.3

Spinal accessory nerve (SAN) palsy is typically a result of posterior triangle surgery and can present with partial or complete paralysis of the trapezius muscle and severe shoulder dysfunction. We share an atypical case of a patient who presented with SAN palsy following an injury sustained playing competitive volleyball. A 19-year-old right hand dominant competitive volleyball player presented with right shoulder weakness, dyskinesia, and pain. She injured the right shoulder during a volleyball game 2 years prior when diving routinely for a ball. On physical examination she had weakness of shoulder shrug and a pronounced shift of the scapula when abducting or forward flexing her shoulder greater than 90 degrees. Manual stabilization of the scapula eliminated this shift, so we performed scapulopexy to stabilize the inferior angle of the scapula. At 6months postoperative, she had full active range ofmotion of the shoulder. SAN palsy can occur following what would seem to be a routine volleyball maneuver. This could be due to a combination of muscle hypertrophy from intensive volleyball training and stretch sustained while diving for a ball. Despite delayed presentation and complete atrophy of the trapezius, a satisfactory outcome was achieved with scapulopexy.

키아리 1형 기형을 동반한 고도 척추 측만증에서 수술 전 Halo-Pelvic 견인 후 발생한 6번 뇌신경(외전신경) 마비

황재광(Jae-Kwang Hwang),이춘성(Choon Sung Lee),최신우(Shin Woo Choi),김정환(Chung-Hwan Kim) 대한정형외과학회 2020 대한정형외과학회지 Vol.55 No.6

고도 척추 측만증의 치료는 척추외과 의사에게 어려운 과제로 남아있다. 고도 척추 측만증의 수술 시 급격한 교정은 신경학적 손상이나 기구 실패 등의 수술 중 합병증의 위험을 증가시킬 수 있다. 이러한 합병증을 최소화하기 위해 최종 수술을 시행하기에 앞서 부분 교정을 얻기 위한 다양한 수술 전 견인법들이 사용되고 있다. 하지만 이전 연구에 의하면 halo 견인과 관련한 합병증의 하나로 뇌신경 마비가 발생할 수 있으며 대표적으로 6번 뇌신경(외전신경)의 마비가 가장 흔하게 나타난다. 이러한 합병증을 줄이기 위해 견인 무게의 점진적 증량이나 세심한 신경학적 검진이 필요하며 특히 이전에 뇌수술이나 경추부 수술을 시행한 경우에는 더욱 주의가 필요할 수 있다. 저자들은 이전에 키아리 1형 기형과 관련하여 감압술을 시행했던 고도 척추 측만증에서 수술 전 halo-pelvic 견인에 의한 6번 뇌신경 마비의 증례를 경험하였기에 문헌 고찰과 함께 보고하고자 한다. The management of severe scoliosis remains a challenge to spine surgeons. The rapid intraoperative correction of severe scoliosis may increase the risk of perioperative complications, such as neurological compromise and implant failure. To minimize these risks, various preoperative traction methods have been employed to achieve partial correction before performing definitive corrective surgery. On the other hand, some studies have shown that one of the complications associated with halo traction could lead to cranial nerve palsy, with the sixth nerve (abducens nerve) being most commonly affected. To reduce the complications, gradual increases in the traction weight and detailed neurological examinations are needed, particularly for patients who have previously undergone brain or cervical surgery. The authors report a case of sixth cranial nerve palsy by preoperative halo-pelvic traction in patients with severe scoliosis who underwent previous decompression surgery for a Chiari I malformation with a review of the relevant literature.

Outcomes after Transverse-Incision ‘Mini’ Carotid Endarterectomy and Patch-Plasty

Sidhartha Sinha,Matthew Fok,Aaron Goh,Vijay Gadhvi 대한혈관외과학회 2019 Vascular Specialist International Vol.35 No.3

Purpose: Traditional longitudinal incision for carotid endarterectomy (CEA) can be painful, aesthetically displeasing, and associated with a high incidence of cranial nerve injury (CNI). This study describes the outcomes of CEA performed through small (<5 cm long), transversely oriented incisions located directly over the carotid bifurcation, as identified by color-enhanced duplex ultrasound. Materials and Methods: Patient demographics and operative data were collected retrospectively from an in-house database of consecutive vascular patients undergoing CEA with a small transversely oriented incision for both symptomatic and asymptomatic carotid artery stenoses. Results: A total of 52 consecutive patients underwent CEA between 2012 and 2016 (median age, 73.5 years; interquartile range, 67-80.3; male/female ratio, 40:12). CEA was performed under regional/local anesthesia (LA) in 48 (92.3%) patients, with 4 (7.7%) being performed under general anesthesia. One patient under LA experienced intraoperative neurological dysfunction intraoperatively (manifesting as an inability to count out loud) that resolved with insertion of shunt. One patient experienced a transient neurological event (expressive dysphasia) within the immediate postoperative period, which resolved within 6 hours. No in-hospital death or perioperative major adverse cardiovascular events were noted. Follow-up data were available for a median period of 3.1 years and for all patients. Three patients experienced strokes following discharge (2 strokes contralateral to the operated side and 1 transient ischemic attack ipsilateral to the operated side). No persistent CNIs nor bleeding complications necessitating re-exploration were reported. Conclusion: Small, transversely orientated incisions, hidden within a neck skin crease can be safely performed in the majority of patients undergoing CEA.