Although, we should mind the limitations of this study design because of case selection bias, different treatment protocols and incomplete follow-up of patients, this study led the following results and suggestive conclusions. Tumor hemorrhage and progressive extraneural and cerebrospinal fluid metastasis were characteristic clinical problems of PICCC/GCTs with HL-HCG. In the cases with extremely elevated levels of HCG, biopsy for histological diagnosis may be no longer needed. Initial biopsy and radiotherapy may lead to tumor hemorrhage. To prevent tumor hemorrhage, gross tumor removal followed by radiotherapy and chemotherapy should be aimed for. A few courses of chemotherapy before surgery may prevent metastasis. Stereotactic radiotherapy and high dose chemotherapy may be promising options for treatment.
Thirty-nine cases of primary intracranial arachnoid cyst in the elderly, including one case of our own, were analyzed. Clinical characteristics in these patients were as follows. (1) The number of patients decreased with age, but there were no differences according to sex. (2) Clinical manifestations were similar to those of chronic subdural haematoma or normal pressure hydrocephalus including dementia, urinary incontinence, and hemiparesis. General symptoms such as headache and seizures were also present. (3) Surgery was performed in most patients with generally good outcome regardless of operative procedures (capsular resection vs. shunt). (4) In some cases of advanced age, disease manifestation may have been due to slight head injuries.
The clinical course and computed tomographic (CT) findings of 23 patients with brain tumors manifesting as tumoral hemorrhage were reviewed. The most common symptoms were headache and clouding of consciousness. A CT finding of a lesion located next to a solid or irregular clot indi cated intratumoral hemorrhage. Precontrast CT demonstrating an indent on the hematoma surface was a valuable indicator of tumoral hemorrhage.A CT finding of accumulated levels of blood⁄ fluid or a hyperdense mass containing small hematoma indicated intratumoral hemorrhage, and ob scure hyperdensity indicated intratumoral hemorrhagic infarction. Such findings were often difficult to distinguish from spontaneous intracerebral hemorrhage due to other factors. The incidence of rebleeding from residual tumors was high, carrying a very poor prognosis, so radical removal of brain tumors with hemorrhage is very important.
We report four cases of acute subdural hematoma (ASDH) in which the hematoma rapidly resolved. Three of the four hematomas were traumatic. The outcome was good in three cases and fair in one. Spontaneous resolution of ASDH is rare.
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