자발성 뇌출혈의 치료 : Medical versus Surgical Therapy for Spontaneous Intracerebral Hemorrhage

김태호,정신,이제혁,박종근,김재휴,김수한,강삼석 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.2

The results of treatment for 248 patients with spontaneous intracerebral hemorrhage are described. Spontaneous intracerebral hemorrhage are classified into primary(215 patients) and secondary(33 patients) hemorrhages. Most of the secondary hemorrhages were located in the subcortical area(64%). In the Non-treated group, eighty patients died immediately after diagnosis. In the treated group, the overall mortality was 5% in primary hemorrhage and 15% in secondary hemorrhages, and the percentages of hypertensive intracerebral hemorrhage patients returning to full-time work or independent life without disability or with minimal disability were 30% in putaminal hemorrhages, 86% in caudate hemorrhages, 44% in thalamic hemorrhages, 61% in subcortical hemorrhage, 78% in cerebellar hemorrhages and 40% in brainstem hemorrhages respectively. This study showed that surgical treatment did not give better result over conservative treatment in the management of hypertensive supratentorial and brainstem hemorrhage. However hypertensive caudate and cerebellar hemorrhage were associated with favorable outcomes regardless of the mode of therapy chosen in severe hemorrhages, surgery may improve the length of survival, but the quality of life remains poor. The authors have shown again that aspiration surgery for hypertensive cerebellar hemorrhage is a valuable alternative to craniotomy.

Case Report : Cerebellar hemorrhage after spine fixation misdiagnosed as a complication of narcotics use

( Ki Hwan Yang ),( Jeong Uk Han ),( Jong Kwon Jung ),( Doo Ik Lee ),( Sung Il Hwang ),( Hyun Kyoung Lim ) 대한마취과학회 2011 Korean Journal of Anesthesiology Vol.60 No.1

Cerebellar hemorrhage occurs mainly due to hypertension. Postoperative cerebellar hemorrhage is known to be associated frequently with frontotemporal craniotomy, but quite rare with spine operation. A 56-year-old female received spinal fixation due to continuous leg tingling sensation for since two years ago. Twenty-one hours after operation, she was disoriented and unresponsive to voice. Performed computed tomography showed both cerebellar hemorrhage. An emergency decompressive craniotomy was carried out to remove the hematoma. On the basis of this case, we reported this complications and reviewed related literature. (Korean J Anesthesiol 2011; 60: 54-56)

소뇌 출혈 환자에 대한 ICF Tool을 적용한 중재전략의 증례

강태우,박영시 대한고유수용성신경근촉진법학회 2013 PNF and Movement Vol.11 No.2

Purpose : The purpose of this study was to describe the Intervention strategy applied ICF Tool about patient with cerebellar hemorrhage. Methods : The data was collected by patient with cerebellar hemorrhage. We applied the ICF Tool for patient with cerebellar hemorrhage. Parameters of result were collected for using the Timed up and go test, Berg balance scale and ICF assessment sheet. Results : Significant differences were observed the patient for Timed up and go test, Berg balance scale and ICF assessment sheet. patient with cerebellar hemorrhage improved all test. Conclusion : ICF Tool applied Intervention about patient with cerebellar hemorrhage is very useful and effective. It is effective in clinical practice. .

Cerebellar Hemorrhage due to a Direct Carotid-Cavernous Fistula after Surgery for Maxillary Cancer

Kamio, Yoshinobu,Hiramatsu, Hisaya,Kamiya, Mika,Yamashita, Shuhei,Namba, Hiroki The Korean Neurosurgical Society 2017 Journal of Korean neurosurgical society Vol.60 No.1

Infratentorial cerebral hemorrhage due to a direct carotid-cavernous fistula (CCF) is very rare. To our knowledge, only four such cases have been reported. Cerebellar hemorrhage due to a direct CCF has not been reported. We describe a 63-year-old female who presented with reduced consciousness 3 days after undergoing a maxillectomy for maxillary cancer. Computed tomography showed a cerebellar hemorrhage. Magnetic resonance angiography showed a left-sided direct CCF draining into the left petrosal and cerebellar veins through the left superior petrosal sinus (SPS). Her previous surgery had sacrificed the pterygoid plexus and facial vein. Increased blood flow and reduced drainage could have led to increased venous pressure in infratentorial veins, including the petrosal and cerebellar veins. The cavernous sinus has several drainage routes, but the SPS is one of the most important routes for infratentorial venous drainage. Stenosis or absence of the posterior segment of the SPS can also result in increased pressure in the cerebellar and pontine veins. We emphasize that a direct CCF with cortical venous reflux should be precisely evaluated to determine the hemodynamic status and venous drainage from the cavernous sinus.

자발성 후두와 출혈의 예후인자

최상준,고삼규,김오룡,지용철,조수호 대한신경외과학회 1992 Journal of Korean neurosurgical society Vol.21 No.12

We analyzed 66 posterior fossa hemorrhage for evaluation of contributing factors to the patient prognosis. Among them 41 patients were cerebellar hemorrhage and 25 were pontine hemorrhages. We analyzed the effect of 7 contributing variables to the patient prognosis with multiple logistic regression methods for eliminating the compound effect of mutiple factors. In cerebellar hemorrhages, we found that the significant contributing factors toward positive prognosis were a good initial mentality, the location of the hemorrhages in the hemisphere, an absence of intraventricular hemorrhages, an absence of midline shifting and an absence of quadrigeminal cistern obliteration. In the treatment methods, the prognosis of stereotaxically treated cases were better than other methods. In pontine hemorrhages, a small sized hemorrhage or an absence of intraventricular hemorrhage were significant factors in determining a posivitive prognosis although the number of theses cases was small.

임상 및 뇌단층촬영 소견에 따른 자발성 소뇌 출혈의 예후 인자

여만수,박화성,김상용,이동열 대한신경외과학회 1992 Journal of Korean neurosurgical society Vol.21 No.12

Generally, the incidence of spontaneous cerebellar hemorrhage is about 16% of all cases of intracerebral hemorrhage, at our hospital 8.4%. Characteristics of spontaneous cerebellar hemorrhage included association with high incidence of hypdrocephalus(about 70%), high risk of mortality, and frequent occurrence of hydrocephalus. We analyzed 52 cases retrospectively using clinical findings. The cases with lower GCS on admission(esp. below 8), presence of hypertension, and brain stem compression signs showed poor prognosis. By analysis of brain CT findings, the cases with midline, large diameter of hematoma(esp. above 3㎝), severe hydrocephalus, associated extended ventricular hemorrhage, effacement or hemorrhage within quadrigeminal cistern, and presence of brain stem low density showed poor prognosis. We concluded that clinical and CT parameters will be used to predict the prognosis of spontaneous cerebellar hemorrhage.

Remote Cerebellar Hemorrhage after Intradural Disc Surgery

Yoo, Je Chul,Choi, Jeong Jae,Lee, Dong Woo,Lee, Sangpyung The Korean Neurosurgical Society 2013 Journal of Korean neurosurgical society Vol.53 No.2

We report a rare case of remote cerebellar hemorrhage after intradural disc surgery at the L1-2 level. Two days after the spine surgery, patient complained unexpected headache, dizziness, nausea and vomiting. From the urgently conducted brain CT, it was reported that the patient had cerebellar hemorrhage. Occipital craniotomy and hematoma evacuation was performed, and hemorrhagic lesion on the right cerebellum was effectively removed. After occipital craniotomy, the patient showed signs of improvement on headache, dizziness, nausea and vomiting. He was able to leave the hospital after two weeks of initial operation without any neurological deficit. Remote cerebellar hemorrhage following spinal surgery is extremely rare, but may occur from dural damage of spinal surgery, accompanied with cerebrospinal fluid leakage. Early diagnosis is particularly important for the optimal treatment of remote cerebellar hemorrhage.

Remote Cerebellar Hemorrhage after Supratentorial Aneurysmal Surgery : Report of Six Cases

Jang, Jae-Won,Joo, Sung-Pil,Kim, Jae-Hyoo,Kim, Soo-Han The Korean Neurosurgical Society 2006 Journal of Korean neurosurgical society Vol.39 No.5

The case of postoperative hemorrhage occurring apart from the operative site as a complication of intracranial surgery is a rare malady, especially when it involves the cerebellum after supratentorial aneurysm surgery. In a review of the literature, the possible etiologies for cerebellar hemorrhage are: coagulopathy, intraoperative urokinase irrigation, excessive head rotation on positioning, brain shift due to excessive cerebrospinal fluid[CSF] and epidural hemovac drainage. We experienced six cases of cerebellar hemorrhage after supratentorial aneurysm surgery, and all of the patients were improved by instituting conservative medical treatment. The possible mechanism for the remote cerebellar hemorrhages seen in our series is probably a multifactorial effect, such as excessive epidural hemovac and CSF drainage, and jugular venous compression due to the operative position. The purpose of this report is to alert neurosurgeons to the existence of this syndrome and to suggest several ways of minimizing the possibility of their patients developing remote cerebellar hemorrhage.

뇌출혈로 발현한 척추기저동맥의 동맥경화성 폐색 일례

남병극,이재홍,이순금,이명종 울산대학교 의과대학 1996 울산의대학술지 Vol.5 No.1

Background : There have been some reports of intracranial hemorrhage which were attributed to atherosclerotic occlusive disease of major intracranial arteries, mostly the carotid system. The vertebrobasilar system very rarely presents hemorrhage as a result of occlusion or stenosis. We report a case of cerebellar and subarachnoid hemorrhage with vertebrobasilar atherosclerotic occlusion. Case report : A patient with severe vertigo, diplopia and ataxia of sudden onset was managed with intraarterial thrombolytic therapy for the left vertebral artery occlusion. After that, the arterial occlusion and the neurologic deficits resolved rapidly. Four years later, he developed a sudden headache and vertigo. Brain CT revealed right cerebellar hemorrhage with adjacent subarachnoid hemorrhage. Follow-up angiography showed occlusion of the right vertebral artery with fine collateral vessels. Rupture of small collateral vessels secondary to the atherosclerotic occlusion of the distal vertebral artery was postulated as the underlying cause of hemorrhage. Conclusion : Atherosclerotic occlusive disease of the vertebrobasilar system may bring about intracranial hemorrhage just like moyamoya disease does in the carotid system. The same pathomecha-nism seems to play in these clinical situations.

자발성 뇌교, 소뇌 출혈의 예후 인자

구일권,조수호,김성호,배장호,김오룡,최병연 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.12

1983년 5월부터 1994년 12월까지 본 교실에 내원하여 전산화단층촬영상 자발성 소뇌 혹은 뇌교 출혈로 진단되어 입원가료한 소뇌출현 62례와 뇌교출혈 38례 대상으로 임상경과와 방사선학적 소견, 치료의 방법과 예후를 조사분석 하였다. 소뇌출혈과 관계된 예후인자를 보면, 내원 당시 의식장애가 없을수록, 혈종량이 적을수록, 소뇌반구 혈종일수록, 사구체조 폐쇄와 수두증이 없을수록 좋은 예후를 나타내었다. 혈종량이 적고 사구체조의 폐쇄와 수두증이 동반되지 않을 경우 재출혈등의 합병증이 없다면 보존적 요법만으로 좋은 결과를 볼 수 있었다. 즉, 예후를 추정하고 수술의 적응을 잡는 도구로서 혈종량만을 고려하는 것은 의미가 없으며, 뇌간 압박 소견인 사구체조 폐쇄와 수두증의 합병증 유무가 더 중요하였다. 뇌교 출혈과 관계된 예후인자는 내원 당시의 의식상태가 좋을수록, 혈종량이 적을수록, 사구체조 폐쇄 없을수록 좋은 예후를 나타내었고, 혈종의 위치는 기저·피개 혼합부를 모두 침범한 경우가 가장 나쁜 예후를 나타내었다. The author studied 62 consecutive patients with spontaneous cerebellar hemorrhage and 38 patients with spontaneous pontine hemorrhage diagnosed by computerized tomography scanning from May 1983 to December 1994 and assessed the relationship of outcome to initial GCS score, CT findings, and treatment modality. In cerebellar hemorrhage, good outcome was achieved in patients with high initial GCS score(>13), small hematoma, patent quadrigsminal cistern, absent hydrocephalic change, and the location of the hemorrage in the hemisphere. Although the size of hematoma was an important prognostic factor it had no constant bearing on the level of consciousness, degree of quadrigeminal cistern obliteration, and outcome. Absence of quadrigeminal cistern obliteration predicted a good outcome whether the hematoma was evacuated or not as long as obstructive hydrocephalus, if present. was relieved early. However, partial obliteration of the quadrigeminal cistern was a predictor of good outcome if the hematoma was evacuated within 48 hours after the onset of hemorrhage. Total obliteration of the quadrigeminal cistern inevitably predicted an unfavorable outcome. In pontine hemorrhages a good outcome was achieved in patients with high initial GCS score(<13), small size hematoma(<5cc) and patent quadrigeminal cistern. Especially, the size of the hematoma was an important prognostic factor and guideline for the determination of surgical candidates. Small hematomas(<5cc) responded more positively to conservative management than to surgery. However, early hematoma evacuation(<48hr) had improved the outcome in moderate sized hematomas(5-l0cc). Large hematomas(>10cc) inevitably showed an unfavorable outcome.