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.