The ability of facial thermography to detect disease in the internal carotid artery was evaluated. Unilateral forehead cooling of 0.7°C or greater was observed in 57% of 30 cases with angiographically proved stenosis. Two provocative tests, facial cooling and a head clamp, increased the sensitivity rate to 83% The greatest overall sensitivity and specificity was obtained by using a head clamp especially designed to bilaterally occlude superficial temporal arteries. Facial thermography is a useful screening device in detecting carotid occlusive disease. However, the necessity to use a provocative test to increase the sensitivity to acceptable levels will probably limit its use to the screening of high-risk asymptomatic patients. It does not appear to be economically feasible in the mass screening of healthy individuals.

Thirty-five cases of thoracic outlet syndrome complicating whiplash or cervical strain injury were studied. Thirty cases had confirmation by the demonstration of slowed ulnar nerve conduction velocity (UNCV) through the thoracic outlet. Two distinct groups of patients were found. An acute group, seen an average of 3 1/2 months post injury, had severe neck pain with often mild or incidental thoracic outlet syndrome. A chronic group, with symptoms persisting more than 2 years after cervical injury, often had thoracic outlet symptoms as the predominant complaint. This study suggests that the arm aches and parethesias seen in association with both acute and chronic cervical strain injury are most often secondary to thoracic outlet syndrome.

SUMMARY This is a report of spontaneous posterior fossa subdural haematoma associated with anticoagulation therapy. The possibility of posterior fossa lesions related to spontaneous haemorrhage is suggested by the combination of severe headache and increasing disturbance of consciousness associated with signs of brain-stem decompensation. A thorough neurological evaluation including appropriate contrast studies will help rule out a supratentorial lesion. This is a neurological emergency which can be successfully treated by early detection and prompt surgical decompression. This is the second reported case of spontaneous subdural haematoma of the posterior fossa occurring during anticoagulant therapy.

in 1964, described the application of the new technique of medical thermography to the study of carotid occlusive disease. He and others1-4 have reported an 80% to 90% association between a "positive" thermogram and significant carotid narrowing. The studies so far published were performed largely on patients with symptomatic cerebrovascular disease. The test itself was used in certain instances to select patients for cerebral angiography.These selective factors may well have resulted in establishing a falsely high sensitivity rate for the procedure.Despite these encouraging initial reports, thermography has had limited use thus far as a diagnostic tool in the field of cerebrovascular disease. This is not unexpected when one considers the high cost of equipment, and the fact that there are available other methods of evaluating carotid competency such as ophthalmodynamometry and carotid compression with electroencephalogram monitor. A more valuable role for facial thermography may lie in mass population screening where a need exists for a fast, innocuous, and technically simple test to identify patients likely to have future carot¬ id occlusions. A sensitive and reasonably specific screening test for carotid occlusive disease could alert the physician to obtain a more directed history and physical examina¬ tion, and also contribute to our knowledge of the natural history of the disorder.The application of facial thermography to an asymptomatic population, however, might Fig 1.-Head clamp with adjustable head straps, rigid aluminum frame, and screw-controlled rubber pressure pads.

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