Terson's Syndrome due to Subarachnoid Hemorrhage after Rupture of MCA Bifurcation Aneurysm

In the literature, Terson's syndrome most commonly co-occurs with subarachnoid hemorrhage(SAH) secondary to rupture of an A-com or ICA aneurysm. It is usually observed bilaterally and the prognosis is poor. The authors report two rare cases of unilateral Terson's syndrome after rupture of MCA bifurcation aneurysm rupture. In both cases, retinal hemorrhage was noticed after early aneurysmal clipping ; after these were conservatively treated, the visual acuity of one patient improved slightly and that of the other showed no change. For early detection and proper management of retinal hemorrhage after subarachnoid hemorrhage, early and periodic fundoscopic examination appears to be important.

Clinical Analysis of Axis Fracture

This retrospective analysis describes the clinical characteristics, treatment, and long-term outcome of 30 patients with axis fracture admitted to our institution between January 1991 and December 1995. The incidence of axis fracture was 27.2% in the 110 cervical spine fractures. Among these, odontoid process fracture was the most common type, 19 cases(63%) followed by 8 hangmans fractures(27%), 3 miscellaneous fractures(10%). Hangman's fractures, odontoid type III fractures and miscellaneous fractures were treated with external immobilization devices. Remaining 11 odontoid type II fractures, and six patients with dens dislocation of 6 mm or greater were initially treated by early surgical stabilization. Individuals with dens dislocated less than 6 mm were treated by external immobilization only. Among the nonoperative group of acute axis fractures, there was no fusion failure. In the early operated group, all patients were stable clinically or radiologically. But three patients with posterior wiring and bone graft complained of their neck motion limitation.

Clinical Analysis of Anterior Approach with the Several Types of Cervical Plate for the Lower Cervical Lesions

The surgical approach to the lower cervical lesions, especially in traumatic injuries, has been controversial. Some authors advocated posterior fusion for such lesions, while others disagreed and reported good operative results with anterior approach using several types of cervical plates. We analysed 28 patients with lower cervical spine traumatic as well as pathological lesions who underwent 32 anterior surgical interventions with cervical plates during the period of August, 1991 and December, 1993. A successful postoperative vertebral stability was obtained in 5 patients(89.3%) and in 19 patients(87.5%) who had predominent posterior ligamentous injuries. Serious complications such as esophageal perforation and postoperative angulation were seen in 5 patients(17.3%) that were related to the process of reduction. With our clinical experiences, we support anterior fusion with cervical plates particularly for lower cervical lesions even though posterior fusion has ben preferred for traumatic posterior ligamentous complex injuries.