The Clinical Observation on the Acute Epidural Hematoma

Acute epidural hematoma is the one which neurosurgeons encounter commonly in severe head injuries and needs emergency operation. But the fact that the mortality of it is still very high(20-50%), is disheartening to all neurosurgeons. In my country, the acute epidural hematoma has been recognized and treated since the 1950th by neurosurgeons. Nevertheless, the report of the collected acute epidural hematoma is rarely seen. The reason is felt that the illness is quite common around us but the mortality is so high to make the report be delayed. The authors have treated 60 cases of surgically confirmed acute epidural hematoma during 24 months from April 1969 to March 1971 and have observed clinically. Following are the results: 1) Sex incidence showed male(50), female(10), and age incidence ranged 2 years of age to 60 yrs. But it was most common in 2nd decade to 4th decade. 2) Most common mode of injury was traffic accident(33 cases) and there were 15 cases of falling down accident and 12 cases of direct batting over the head by blunt materials. 3) There were lucid interval in 13 cases. Most common papillary change was ipsilateral mydriasis(23 cases). Bilateral mydriasis were in 4 cases & other showed miotic or normal pupils. Bilateral positive Babinski's sign were noted in 22 cases and there were 14 cases of unilateral Babinski's sign. 4) Site of hematoma;Most common site of the hematoma was temporoparietal region but there were 8 cases of confined frontal pole and 3 cases of posterior fossa region. In 42 cases of 60, the site of hematoma was confirmed by carotid angiography & on the rest, direct surgery was performed without carotid angiography. 5) Mortality; 47 cases of 60, have survived. The age, level of consciousness, other intracranial associated injuries, time of operation, bilateral positive Babinski's sign, volume of hematoma were felt to be the influencing factors to mortality. In 5 cases of 13 which expired, have died 4 weeks after surgery and the causes of death were pulmonary edema, pneumonia, septicemia, tracheal bleeding & renal shut down. In survivals, hemiplegia, hydrocephalus, oculomotor nerve palsy and mental confusion were observed which improved gradually except 4 cases, & 43 cases of 60 which have survived could remain to return to his usual daily activity.

Acute Paraplegia as the Initial Symptom of Acute Leukemia

Metastatic involvement of the central nervous system during the course of leukemia is an increasingly frequent occurrence because of the longer survival time brought about by the efficacious cytotoxic therapy available today. The onset of acute leukemia may be abrupt with a great variety of clinical manifestations. Most commonly, such as vomiting, headache, papilledema, lethargy and vertigo, are referable to increased intracranial pressure caused by infiltration of the cortex and meninges. The acute paraplegia as the initial symptom of acute leukemia is very rare. A case in which acute paraplegia occurred as the initial symptom of acute leukemia in a 15-year-old boy is reported.

Acute Paraplegia as the Initial Symptom of Acute Leukemia

Metastatic involvement of the central nervous system during the course of leukemia is an increasingly frequent occurrence because of the longer survival time brought about by the efficacious cytotoxic therapy available today. The onset of acute leukemia may be abrupt with a great variety of clinical manifestations. Most commonly, such as vomiting, headache, papilledema, lethargy and vertigo, are referable to increased intracranial pressure caused by infiltration of the cortex and meninges. The acute paraplegia as the initial symptom of acute leukemia is very rare. A case in which acute paraplegia occurred as the initial symptom of acute leukemia in a 15-year-old boy is reported.