No shinkei geka. Neurological surgery
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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.
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Case Reports
[Ipsilateral exophthalmos in chronic extradural fluid-hematoma, case report (author's transl)].
A case of chronic extradural hematoma with liquid contents that had showed ipsilateral exophthalmos was reported. A 10-year-old girl fell and struck on her head. Neurological examination, on admission to our hospital on tenth day after the injury, revealed left exophthalmos and slight right hemiparesis. ⋯ The small hematoma might have enlarged by a process similar to that postulated in chronic subdural hematoma. Thus a huge extradural hematoma with liquid contents might have been produced. There may be two factors as causes of exophthalmos. 1) Blood from the frontal extradural hematoma through the fracture of orbital roof into the orbit is postulated to have compressed the periorbita. 2) Direct pressure by the frontal hematoma on the cavernous sinus and the superior ophthalmic vein produced venous circulatory disturbance of the orbit and was postulated to have caused the ipsilateral exophthalmos.