Superficial siderosis (SS) in central nervous system is a rare, slowly progressive disease and usually misdiagnosed or diagnosed too late when the patient is chronically devastated. A 55-year-old man with deafness and gait disturbance for ten years was referred from otorhinologist for evaluation of brain. Magnetic resonance image (MRI) showed symmetric hypointense rim partially delineated the bilateral hemisphere on gradient-recalled-echo T2-weighted image, and it was diagnosed as hemosiderin deposition in subarachnoid and subpial meningeal layer. The correct diagnosis of cerebral superficial siderosis can be achieved by careful neurological examination and MRI because computed tomography findings and symptoms are ambiguous. Serial follow-up of imaging study and education for patient are necessary to prevent progression of SS.
Chorea is uncommon clinical presentation in moyamoya disease (MMD); it can be present in 3% to 6% of patients [1]. Although the mechanism of development of chorea is unclear, ischemia of the basal ganglia, which could lead to post stroke abnormal movements is considered a dominant mechanism. A majority of chorea symptoms improve within 1 year of surgical revascularization of the ischemic region. However, it is very rare that chorea develops after surgical revascularization. We report two adolescent cases of new-onset hemichorea after diagnosis of MMD and bilateral bypass surgery. An 11-year-old boy (Patient A) had undergone bilateral bypass surgery for MMD. Four years after the bypass surgery, the patient was referred to our department for new-onset hemichorea. Intermittent tremors began in the right arm and gradually worsened to become sporadic irregular, dance-like movements of hemichorea, which resulted in twisting movements. One week later, the hemichorea progressed to involve the right leg, which made walking difficult. A 16-year-old girl (Patient B) had undergone bilateral bypass surgery for MMD. Two years after the bypass surgery, she developed new trem
ObjectiveCerebrovascular disease (CVD) was the third most common cause of death in South Korea in 2014. Evidence from abroad suggests that comprehensive stroke centers play an important role in improving the mortality rate of stroke. However, surgical treatment for CVD is currently slightly neglected by national policy, and there is still regional imbalance in this regard. For this reason, we conducted a survey on the necessity of, and the requirements for, establishing regional comprehensive cerebrovascular surgery centers (CCVSCs).MethodsThis investigation was performed using the questionnaire survey method. The questionnaire was consisted with two sections. The first concerned the respondent’s opinion regarding the current status of demand and the regional imbalance of cerebrovascular surgery in South Korea. The second section asked about the requirements for establishing regional CCVSCs. We sent the questionnaire to 100 board members of the Korean Society of Cerebrovascular Surgeons.ResultsMost experts agreed that cerebrovascular surgery patients were concentrated in large hospitals in the capital area, and 83.6% of respondents agreed that it was necessary to alleviate the regional imbalance of cerebrovascular surgery. With regards to personnel, over 90% of respondents answered that at least two neuro-vascular surgeons and two neuro-interventionists are necessary to establish a CCVSC. Regarding facilities, almost all respondents stated that each CCVSC would require a neuro-intensive care unit and hybrid operating room. The survey asked the respondents about 13 specific neurovascular surgical procedures and whether they were necessary for a regional CCVSC. In the questions about the necessity of cerebrovascular surgical equipment, all seven pieces of equipment were considered essential by all respondents. A further five pieces of equipment were considered necessary on site: computed tomographic angiography, magnetic resonance angiography, conventional angiography, surgical microscope, and surgical navigation. Our results may provide a basis for future policy regarding treatment of cerebrovascular disease, including surgery.ConclusionRaising the comprehensiveness of treatment at a regional level would lower the national disease burden. Policies should be drafted regarding comprehensive treatment including surgery for cerebrovascular disease, and related support plans should be implemented.
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