No shinkei geka. Neurological surgery
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The authors presented a case of a subacute epidural hematoma of the posterior fossa, for which we never thought of a head injury at the admission. We discussed the diagnosis (the clinical pictures and X-ray findings), stressing that CT plays an important role especially in diagnosing posterior fossa diseases. Our case could probably not be diagnosed correctly without CT, because the conventional X-ray examinations did not reveal clearly the space--occupying lesion in the posterior fossa, before CT was done. ⋯ These findings were due directly to the compression of the epidural hematoma. CT can promptly not only a posterior fossa hematoma, but also accompanied supratentorial lesions (concrecoup injury etc) simultaneously, therefore one can expect that there are not errors any more with CT to overlook the supratentorial contrecoup injury. Posterior fossa hematomas have usually a venous bleeding origin, from the transverse sinus, torcular Herophilli, emissary veins, bridging vein etc. therefore, present a slowly progressive and intermittent neurological signs, as the hematomas grow slowly.
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Eighteen examinations of acute head trauma have been performed using computerized tomography (CT), EMI scanner, before and after operation in our department since September, 1975. Diagnostic findings in CT before emergency operations of 5 cases including epidural hematoma (1), subdural hematoma (2), intracerebral hematoma (1), and combined hematoma (1) were presented and the diagnostic value of this new method was compared with that of cerebral angiography. CT was proved to be highly valuable in the diagnosis of not only intracranial hematomas but also cerebral edema, cerebral contusion and other abnormalities of the brain structures in head injury.
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Out of 60 consective cases with hydrocephalus of pediatric age group, 8 cases were found to be so-called "compensated" hydrocephalus and their clinical features were reported. "Compensation" of hydrocephalus in our cases was probably induced by increased ventricular absorption of cerebrospinal fluid since moderate to severe ventricular dilatation was present in all cases. Such "compensation" of hydrocephalus is apparently made at the expense of normal development of the brain function. Therefore, such "compensation" of hydrocephalus is not the condition to be aimed for, but to be avoided for preservation of normal brain function. ⋯ Unrolling of the anterior cerebral artery was found even in such cases whose cerebrospinal fluid pressure was normal, head circumference did not show any increase, and IQ test was normal. In one case, "compensated" hydrocephalus became later "decompensated" with apparent signs of increased intracranial pressure. Other supplementary tests for cerebrospinal fluid dynamic such as saline infusion test or RISA cisternography were also discussed.