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20 children with tuberous sclerosis were examined by computertomography (CCT). The test is useful to detect cerebral involvement with great certainty. The method is especially helpful in the early diagnosis of the disease. This offers the possibility of giving an early genetic advice. Characteristic CCT scan abnormalities in tuberous sclerosis are multiple densities in the walls and the roof of lateral ventricles. This specific finding can already be seen prior to the occurrence of calcifications in standard roentgenograms.

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Persisting embryonic vessels of the head and neck generally are rare anomalies, and usually t h e y are of no clinical consequences. In our case of a traumatic carotico-cavernous fistula an accidentally discovered hypoglossal artery became very iInportant for surgical treatment.Case R e p o r t G.Z., a ~5-year-old white male, was injured in a motorcycle accident. Iu an unconscious state he was admitted to a general hospital, and a mild hemorrhage from the left ear was noticed. After almost 1 day of unconsciousness he became restless for ~ days. Later on he vomited several times and when he awoke he complained of severe headaches.The physical and neurologic findings were normal. Roentgenograms of the skull revealed no fracture. Shortly thereafter, a mild protrusion of the right eyeball occurred, and in the following days the protrusion increased more and more. Also the patient started having a hissing sound in his head, synchronous with the rate of his pulse. Thirteen days after the accident the patient was transferred to the Ophthalmic Itospital of the Wtirzburg University for further observation.Examination there revealed a severe hematoma of the right eyelids, which could not be closed over the protruded eyeball. The palpebral fissure could be closed up to 3 ram., and opened for about 5 ram. There was a marked chemosis, and the swollen conjunctiva overlapped the margin of the lower lid ( Fig. 1). A small fistula was seen in the nasal part of the overlapping conjunctival flap, and a mild hemorrhagic discharge was noticed twice from that fistula. There was a protrusion of the right eyeball, measuring 14 mm., as compared to the left eye. No movements of the right eye were possible. The right pupil was dilated slightly and did not react to light. There was no lesion or opacity of the cornea, of the aqueous chamber, or of the crystalline lens, and there was no irritation of the iris. In the vitreous body there was some mild turbidness. The eyegrounds appeared normal. The visual acuity was diminished in the right eye (5/~25), and normal in the left eye (5/4). The visual field, tested with hand perimeter and color squares of ~.0 cmY, proved to be normal on both sides.In spite of an absent visible pulsation of the eye, a carotico-cavernous fistula was diagnosed, and the patient was transferred to the Neurosurgical Division of the Wtirzburg University, ~6 days after the accident. Examination. There was slight weakness of the lower portion of the face on the left, but there were no other Received for publication March 15, 1963. FIG. 1. Patient before operation.abnormalities. The patient continued having a hissing sound in his head. A pulse-synchronous aneurysmal murmur was heard distinctly in the temporal areas, more on the right than on the left. The electroencephalogram was interpreted as abnormal, with increasingly occurring slow waves in the right frontoprecentral region.Carotid angiograms were performed on both sides. Eight films were taken in each angiography, 4 ill lateral, and 4 in sagittal view. In either projec...