Myung Hyun Kim

Delayed occurrence of spinal arachnoiditis following a caudal block

Abstract Context Spinal arachnoiditis is a rare disease caused by fibrosis and adhesion of the arachnoid membrane due to chronic inflammation. The causes of arachnoiditis are infection, spinal surgery, intraspinal injection of steroid or myelography dye, and spinal anesthesia. Method Case report. Findings A 60-year-old woman presented with progressive weakness and sensory change of both legs and urinary symptoms. She had received a single caudal block 6 months before symptom onset. Magnetic resonance imaging of the thoraco-lumbar spine showed an intradural extramedullary tumor at the T5–T7 level. She underwent laminectomy and tumor resection. The pathological finding was arachnoiditis. After surgery, a rehabilitation program of strengthening exercises of both lower extremities and gait training was started. At 2-month follow-up, she was able to walk with orthoses and performed daily activities with minimal assistance. Conclusion Symptoms of spinal arachnoiditis occurred 6 months after a single caudal block in this woman. Clinicians should be aware of this possible delayed complication.

Trans-Cranial Doppler and Peripheral Sensory Threshold Tests for Carbon Disulfide Poisoning

Trans‐Cranial Doppler and Peripheral Sensory Threshold Tests for Carbon Disulfide Poisoning: Eunil Lee, et al. Department of Preventive Medicine, School of Medicine, Korea University—Trans‐cranial doppler (TCD) and sensory threshold (vibration, pain and discrimination) tests, which are safe and inexpensive techniques, were applied to detect cerebral vasoreactivity or neuropathic changes between carbon disulfide (CS2) poisoning cases and two control groups respectively. The cases were 31 male CS2poisoning workers, and the first control group for the TCD test consisted of eight healthy men, and the second group for the threshold test were 21 healthy male workers. In the TCD test, the blood flow velocity in both middle cerebral arteries and the CO2 content of expired air were measured to evaluate CO2 reactivity. The vibration and pain perception threshold were measured on both the 2nd and 5th fingers. The CS2 poisoning cases showed higher rates of abnormal CO2 reactivity above the cut‐off value than healthy controls (80.081.8% vs 0%). Among the threshold tests, the proportions of abnormal pain threshold of both the 2nd and 5th fingers were higher in poisoning cases than in the controls (77.8%‐88.9% vs 11.1‐33.3%) among over 45 yr old subjects. CO2 reactivity and pain threshold test showed the possibility to detect changes in cerebral vessels and the sensory threshold in CS2 exposure cases, but there should be further study to apply these tests to workers exposed to CS2 before the development of CS2 poisoning, with large number of control subjects.

Neurosurgical aspects of sedimentation levels in acute intracerebral haematoma.

We describe the neurosurgical aspects of sedimentation levels that are rarely found in acute intracerebral haematomas (ICH). We had four patients with acute ICH whose cerebral computed tomography revealed sedimentation levels. Two patients had received thrombolytic therapy for ischaemic heart disease and one for ischaemic stroke. Another patient, who was diagnosed later as having a coagulation disorder, did not have any medical history on admission. All patients had emergency ICH drainage under local anaesthesia. In the immediate postoperative period, we observed dramatic improvement in all the patients, without surgical complications. The sedimentation level in an ICH should be identified as a specific indicator of a coagulation defect and a thorough search for possible underlying coagulopathy is warranted. We believe that simple ICH drainage should be performed as the haematoma is in a liquid form.

Cine MR CSF Flow Study in Hydrocephalus: What are the Valuable Parameters?

To evaluate the changes of intracranial cerebrospinal fluid (CSF) dynamics in hydrocephalus, we studied the various parameters of cine phase contrast (PC) magnetic resonance (MR) CSF flow images in cases of acutely progressive hydrocephalus, comparing them with those in normal CSF circulation. The MR images were obtained with 1.5 T unit using the 2 dimensional cine PC sequence with cardiac gating in 10 non-obstructive hydrocephalus (NOH), 3 obstructive hydrocephalus (OH), and 10 controls. The temporal velocity information from the anterior and posterior cervical pericord spaces, third and fourth ventricles, and aqueduct were plotted as wave form. The wave forms were analyzed for configurations, amplitude parameters (Smax, Smin, Sdif), and temporal parameters (R-S, R-SMV, R-D, R-DMV). The statistical significance of each parameter was examined with paired t-test. All patients with OH underwent endoscopic thrid ventriculostomy, whereas all NOH underwent shunting procedures. In 5 ROIs, distinct reproducible configuration features were obtained at aqueductal and cervical pericord spaces. Statistically significant differences between control and hydrocephalus only in temporal parameters were determined. In NOH, the graph showed R-DMV shortening (p < 0.01) at anterior cervical pericord space. In OH, there were R-DMV shortening (p < 0.05) at anterior cervical pericord space, R-SMV shortening (p < 0.02) at posterior cervical pericord space. Also the level of obstructions could be determined in all OHs. The analysis of MR CSF flow images may give us valuable information on the site of obstruction, explaining the cause of hydrocephalus, thus deciding the necessity of shunting procedures using in vivo images.