[Case report of traumatic hemorrhage from the anterior choroidal artery].

Traumatic hemorrhage from the anterior choroidal artery is very rare. A 74-year-old male was admitted to our hospital immediately after a traffic accident. CT on admission showed right intracerebral hematomas in the posterior limb of the internal capsule and the upper part of the right cerebral peduncle. Neurological examination revealed that the patient had left hemiparesis and transient mute, pseudobulbar sign and peduncular hallucination. The absence of hypertensive asymptomatic microbleeds in other basal ganglia supported the verdict of traumatic injury of the anterior choroidal artery. The tear mechanism of the anterior choroidal artery might have been caused by an impact to the parietal region directed toward the tentorium.

[Isolated trigeminal sensory neuropathy due to pontine infarction of the root entry zone--report of two cases].

Secondary trigeminal neuralgia and isolated trigeminal neuropathy due to ischemic lesion of the pons are very rare. We report 2 patients with pontine infarct transecting the central trigeminal pathways resulting in trigeminal neuropathy and/or neuralgia. Case 1: A 48-year-old female presented with lancinating pain and paresthesia and hypesthesia in the right V2 and V3 distributions. Magnetic resonance imaging (MRI) of the brain demonstrated a wedge-shaped infarct at the root entry zone (REZ) of the right trigeminal nerve in the pons. Case 2: A 66-year-old female presented with paresthesia and hypesthesia in the right V1, V2 and V3 distributions. MRI demonstrated a small wedge-shaped infarct at REZ. This infarction of the REZ may have led to produce the isolated trigeminal neuralgia and trigeminal neuropathy.

[Rapid disappearance of acute epidural hematoma by percutaneous aspiration of subperiosteal hematoma--case report].

We present the case of an 8-year-old boy who was injured in a bicycle accident and was admitted with a right frontal skull fracture, an acute epidural hematoma, a right frontal laceration, and a subperiosteal hematoma on admission. After the frontal cutaneous suture, the subperiosteal hematoma was aspirated by the percutaneous needle. Two hours later, a CT scan revealed that the epidural hematoma was disappeared. It is speculated that the subperiosteal and epidural hematoma communicated via the skull fracture thus necessitating the evacuation of the epidural hematoma by subperiosteal aspiration.

[Conjugate deviation in ischemia of medial medullary oblongata--report of three cases].

Medial medullary infarct (MMI) is a rare type of brain stem infarction. Its clinical picture was characterized by contralateral hemiparesis, deep sensory disturbance, and ipsilateral hypoglossal paresis, but conjugate deviation or nystagmus is uncommon as initial symptom. Case 1: A 73-year-old man developed vomiting and vertigo. Examination revealed right conjugate deviation and horizontal nystagmus beating toward the left side, and numbness on his right upper limb,but no hypoglossal nerve palsy. Cranial MRI demonstrated an infarction in the left paramedian region of the upper medulla and thrombus of the left vertebral artery. Case 2: A 74-year-old man suffered from dizziness and nausea. He showed left conjugate deviation and right-beating horizontal nystagmus without Horner syndrome or hypoglossal nerve palsy. MRI disclosed an infarction in the right upper medial medulla. MRA revealed the right dissecting vertebral artery. Case 3: A 71-year-old man developed vertigo when watching at TV. He showed transient left conjugate deviation and transient motor paresis on the left upper limb. MRI showed the thickened wall of the right vertebral artery but no abnormal ischemic lesion. Digital subtraction angiograms revealed the dissecting right vertebral artery. All ischemic events limited to the upper third of the medulla were caused by the vertebral artery lesions, and prognosis was good. The unilateral MMI lesion in the nucleus prepositus hypoglossi and/or the medullary reticular formation caused contralesional shift of the eyes and ipsilesional nystagmus. The upper MMI will be characterized by a triad of contralateral hemiparesis, deep sensory disturbance and abnormal ocular motor findings.

[Paradoxical worsening ocular movement in idiopathic carotid-cavernous fistula without conjunctival congestion--case report].

We report a case of carotid-cavernous fistula(CCF) without conjunctival congestion and showing radiographically paradoxical worsening ocular movement. A 71-year-old woman suffered from mild double vision. The first carotid angiogram revealed left CCF, which was supplied by dural branches of the internal and external carotid arteries and drained out well via only the superior orbital vein to the angular vein. We did not perform intravascular intervention because of spontaneous improving of her symptom. However, three weeks after her discharge, her symptom began worsening and she was readmitted because of left complete ophthalmoplegia, but without conjunctival congestion. Contrary to our expectation the second left carotid angiogram demonstrated that the shunt flow to the angular vein of CCF was much less than that seen previously. After transvenous embolization of the left cavernous sinus, her symptom completely improved and CCF did not recur.