We evaluated the termination of the abdominal aorta in relation with the vertebral column in 142 cases, finding it between middle 1/3 of the L3 vertebra and L5-S1 intervertebral disc. At the level of the L4 vertebra the abdominal aorta ends in 71 of the cases, following, in the order of the frequency, the L4-L5 intervertebral disk with 40 cases, the L5 vertebra with 14 cases, the L3-L4 intervertebral disc with 10 cases, the L3 vertebra with 6 cases and only in one case at the L5-S1 intervertebral disc. The aortic termination above the L4 vertebra was considered a high termination, 11.27% of cases, and the origin below the L4-L5 intervertebral disc was considered a low termination, 10.56% of cases. The bifurcation of the aorta in relation to mid-vertebral line was assessed on 138 cases, with 79 cases on the left, 38 on the midline and in 21 cases the aortic bifurcation was right to the midline. The distance between the aortic bifurcation and the sacro-vertebral joint (promontory) was between 40 - 82 mm. The aortic bifurcation related to the origin of the inferior vena cava was assessed on 38 cases, finding that most frequently, in 27 cases, the bifurcation was above the level of origin of the inferior vena cava, with a distance of between 2 - 3 mm and up to 45 mm. In 7 cases it was located below the origin of the inferior vena cava and in 4 cases the aortic bifurcation was located at the same level with the origin of the inferior vena cava.

Encephalitis is a rare complication of cervical - cranial zoster infection. Myelitis is a similar, severe complication of thoracic zoster. They occur in patients with immune deficiencies, in 5-21 days after the rash and progress in the same time frame. We are presenting the case of a 54 year old male with rapid evolution of an ascending encephalomyelitis with onset at 17 days after a left cervical-thoraco-brachial zoster episode. Neurologic examination: lower limb paresthesia, ascending to the trunk, unstable gait, which becomes impossible with closed eyes, absent deep tendon reflexes, bilateral Babinski sign. After 48 hours, left cerebellar syndrome appears, in one week the patient had asymmetrical tetraparesis and in 11 days he becomes paraplegic, left side more affected than the right one. After 16 days, the clinical state stabilizes, he begins moving his right lower limb. Lumbar puncture on admission: CSF albumin 1220 mg% (after 3 days it becomes normal); 81 cells/mm3, 100% mononuclear cells, 50 cells after 3 days and after a week 23 cells/mm3. Cervical and thoracic spine MRI performed on the 3rd day from admission was normal but after repeating it in 10 days it showed T2, STIR and FLAIR hyper intense intraspinal, infra- and supratentorial lesions, well contoured, with homogenous gadolinium enhancement: demyelinating lesions. He received Acyclovir, Solumedrol, Insulin and symptomatic treatment. After 2 weeks from leaving the hospital with symptomatic treatment and kinetic therapy, he returns in a septic state, with deep bed sores, positive blood cultures (Fusobacterium nucleatum, Staphylococcus Epidermidis) and urine cultures (Klebsiella). The outcome was death in 4 days. Differential diagnosis – polyradiculoneuritis, paraneoplastic syndrome, cerebral and vertebral metastases. Pathology exams: low grade acinary adenocarcinoma of the pancreatic head, invasive, with a solid pattern. The particularity of the case: the severity of the acute ascending encephalomyelitis, the fulminant evolution of the pancreatic cancer, the disruption of the blood-brain barrier by an inflammatory and tumoral mechanism, showed on spine and brain contrast MRI.

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The transverse diameter of the abdominal aorta was measured above the origin of the celiac trunk on a number of 82 cases, in male finding a caliber range of 18 to 31.8 mm, in one case, the aorta having a diameter of 31.8 mm. In females, the aorta was between 12.4 to 23.4 mm in caliber, most commonly, in 24 cases, being present a caliber range from 14.8 to 19.7 mm. At the level of the celiac trunk, on a number of 74 cases, the aorta had a diameter of between 12.9 to 28.6 mm in females and 11.4 to 21.8 mm in males. In males, on 20 cases, the caliber was 20 to 25 mm while in females, on 42 cases, we found a caliber range from 11.4 to 21.8 mm and in 20 cases being 19.4 to 2.18 mm. At the level of the superior mesenteric artery, we studied the aortic diameter on a number of 86 cases. In males it had a diameter between 12.9 to 26.4 mm, but in one case with 12.9 mm. In 26 cases, it had a diameter of between 20.1 to 26.4 mm. In females we found a range of 12.5 to 20.4 mm, most commonly with the diameter of 18-20 mm in 19 cases. Next to the renal arteries we studied the aortic diameter on a number of 118 cases, finding abdominal aortic diameters of 10.3 to 27.4 mm. In males it ranged from 10.9 to 27.4 mm diameter while in females had a diameter between 10.3 to 20.4 mm; in one case we met a caliber of 20.4 mm. The diameter of the abdominal aorta at the level of the inferior mesenteric artery was evaluated on 80 cases; in males the diameter ranged from 13.9 to 25.9 mm and in females was 10.6 to 19.3 mm.

Generally, according to international literature, cerebral ischemia is a secondary posttraumatic lesion produced by direct compression in the context of a cerebral herniation syndrome or indirect by vasospasm produced by posttraumatic subarachnoid, subdural or intraventricular hemorrhages. We present the case of a patient with an acute MCA ischemia with severe head injury due to a fall with subsequent intracranial acute intracerebral and subdural hematoma which evolved with acute left uncal, parahipocampal and subfalcinecerebral herniation (coma, GCS 6, left mydriasis, right severe hemiparesis). Surgical emergency aspiration of the hematomas was performed. Postoperative treatment of cerebral ischemia and residual hematomas was properly done. We consider important and underdiagnosed the association of cerebral ischemia and secondary posttraumatic brain injuries. Abbreviations: MCA-middle cerebral artery, GCS-Glasgow Coma Scale, ICA-internal carotid artery, PCA-posterior cerebral artery, ACA-anterior cerebral artery. Conclusion: We present a case of a patient with an acute MCA ischemia with secondary head injury due to a fall with subsequent intracranial acute intracerebral and subdural hematomas. Surgical emergency aspiration of the hematomas was performed. The treatment was performed for both lesions (cerebral ischemia and posttraumatic hematomas) with vitamins B, neurotrophycs, pain killers, antibiotics. Unfortunately, due to aggravation of the Mendelson syndrome, the patient died 7 days later.