No shinkei geka. Neurological surgery
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Case Reports
[Neurogenic pulmonary edema following severe head injury--case report (author's transl)].
A case of severe head injury associated with fulminant pulmonary edema considered as neurogenic which developed within short time after the injury was presented. A five-year-old boy who had no previous history of cardiopulmonary disease was struck on his right frontal region by car accident at 15.30 PM on July 5 of 1979. Immediately after the impact he lost his consciousness and subsequently transferred to a local hospital where bilateral dilated pupil and flaccid paralysis of the limbs were noted. ⋯ From these clinical findings the pulmonary edema was concluded as neurogenic. Direct or indirect injury to the hypothalamic efferent pathway at the level of lower brain stem seemed to be important as the cause of neurogenic pulmonary edema in this case. The possible pathophysiology of neurogenic pulmonary edema associated with brain stem injury and intracranial hypertension was discussed with other related literature.
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Case Reports
[Traumatic posterior fossa epidural hematoma--especially the value of CT scan (author's transl)].
Epidural hematoma in the posterior fossa is a rare clinical entity which requires the early diagnosis and treatment, and the difficulty of the diagnosis has been pointed out. However, more recently CT scan began to use to make the valuable diagnostic method for traumatic posterior fossa hematomas. Epidural hematoma may be classified as acute, subacute and chronic, according to the time of free interval or lucid interval after injury. ⋯ Liquor cavity in the posterior fossa which is thought to serve as a buffer action of hematoma is about 20 ml, so we discuss about the volume of hematoma, especially of 20 ml, associated with clinical course and prognosis. Volume of epidural hematoma is one of the most important factors affecting clinical course and prognosis. In summary of these our experiences, we again emphasize the value of CT scan as the rapid, noninvasive, accurate radiological examination in the diagnosis of traumatic posterior fossa epidural hematoma.
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A rare case of duplication of the middle cerebral artery with a ruptured aneurysm on its origin during pregnancy was reported. A 29-year-old woman, primipara, was admitted to our clinic at 17 weeks' gestation on June 26, 1979 with a history of sudden onset of severe headache and vomiting, followed by unconsciousness fit for 30 minutes. The patient displayed typical features of subarachnoid hemorrhage. ⋯ Postoperative course was excellent. Three months postoperatively, the patient went into spontaneous labor, at 40 week's gestation, and delivered a healthy infant. Clinical management of subarachnoid hemorrhage in pregnancy and the relationship between anomaly of the middle cerebral artery and aneurysm were discussed with the literature.