This is a report of a patient who developed sharp intercostal pain and Brown-Séquard syndrome. Displacement of the spinal cord toward an extradural mass was noted at the T4-5 vertebral level on iophendylate myelography and metrizamide computerized tomography myelography. Multiple meningeal diverticular lesions of congenital origin were also found. Surgical correction of the spinal cord, which had herniated into a laterally located extradural arachnoid cyst and become incarcerated, resulted in a complete neurological recovery.

Twenty-six cases of infantile acute subdural hematoma treated between 1972 and 1983 were reviewed. The series was limited to infants with acute subdural hematoma apparently due to minor head trauma without loss of consciousness, and not associated with cerebral contusion. Twenty-three of the patients were boys, and three were girls, showing a clear male predominance. The patients ranged in age between 3 and 13 months, with an average age of 8.1 months, the majority of patients being between 7 and 10 months old. Most of the patients were brought to the hospital because of generalized tonic convulsion which developed soon after minor head trauma, and all patients had retinal and preretinal hemorrhage. The cases were graded into mild, intermediate, and fulminant types, mainly on the basis of the level of consciousness and motor weakness. Treatment for fulminant cases was emergency craniotomy, and that for mild cases was subdural tapping alone. For intermediate cases, craniotomy or subdural tapping was selected according to the contents of the hematoma. The follow-up results included death in two cases, mild physical retardation in one case, and epilepsy in one case. The remaining 23 patients showed normal development. The relationship between computerized tomography (CT) findings and clinical grading was analyzed. Because some mild and intermediate cases could be missed on CT, the importance of noting the characteristic clinical course and of funduscopic examination is stressed.

Whether and when unruptured aneurysms or aneurysmal rests following incomplete surgery result in subsequent bleeding are major concerns for neurosurgeons. By calculating the annual growth rate of aneurysms in long-term follow-up angiography (partly supplemented with MR-imaging and/or MR-angiography), we attempted to determine the surgical indications for these aneurysms. Long-term follow-up angiography ranging from one to 20 years was carried out on five patients whose ruptured aneurysms had been incompletely occluded, six patients with multiple aneurysms, of which the ruptured ones had been completely obliterated at operation and the small unruptured aneurysms, missed or misdiagnosed, and eight patients with unruptured aneurysms which were asymptomatic or symptomatic. The correlation of annual aneurysm growth rate to subsequent bleeding was investigated. Four out of six fast-growing aneurysms with high annual growth rates (more than 8% increase per year) resulted in subsequent bleeding whereas none of the fourteen slow-growing aneurysms with low annual growth rates (less than 8% increase per year) led to bleeding (Fisher's exact test; p < 0.01). Hypertension, patient age and aneurysmal location showed no significant correlation to the annual growth rate (Fisher's exact test; p > 0.05). This study suggests that aneurysmal rests after incomplete surgery and missed or misdiagnosed multiple or incidental aneurysms which are fast growing have a high possibility of subsequent bleeding and should be operated on as soon as possible.

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