Delayed appearance of a traumatic intracranial aneurysm. Case report and review of the literature.

Giant traumatic intracranial aneurysms are rare, and thus their incidence and clinical behavior are poorly understood. In most cases, traumatic aneurysms develop and become symptomatic within months following injury. The authors present the case of a 46-year-old war veteran, in whom a giant internal carotid artery aneurysm developed as a result of a penetrating cranial shrapnel injury sustained 25 years earlier during the Vietnam war. The aneurysm had not been evident on previous imaging studies. At surgery, a piece of shrapnel was found embedded in the dome of the aneurysm. The presentation, diagnosis, management, and treatment options related to this lesion are discussed.

Temperature distributions in porcine orbital tissues following the use of CO2 and Nd:YAG lasers.

Temperature distributions in the orbital tissues of a live porcine model were obtained during and immediately following the application of CO2 and Nd:YAG (both contact and noncontact) laser irradiation to muscle tissue adjacent to the optic nerve. Temperatures were measured with thermocouples and an infrared-sensitive thermographic camera system. Significant thermal spread was observed only in the case of the contact Nd:YAG laser, along with histologic evidence of damage to the optic nerve. After the laser was switched off, the target cooled with a time constant on the order of 10 seconds.

Major cerebral vessels injury caused by a seatbelt shoulder strap: case report.

Major cerebral arterial injury may result from penetrating or blunt trauma. In blunt trauma, clinical suspicion of such injury may not be raised, especially if the cranial CT scan is negative. We report a case of a seatbelt shoulder strap to the neck resulting in injury to three major cerebral vessels as demonstrated by cerebral angiography. Although the initial cranial CT scans were negative, a cerebral infarction ultimately developed. The patient was managed conservatively and recovered most of her functions. The importance of clinical suspicion and cerebral angiography is stressed.

Acute cervical spondylytic myelopathy.

Myelopathy is a common consequence of cervical spondylosis. Typically, the syndrome develops gradually over a long period. Rapidly progressive deterioration in the absence of trauma or other precipitating factors is exceptional. We report a case of a rapidly progressive acute myelopathy secondary to cervical spondylosis without identifiable precipitating cause. The importance of recognizing this syndrome lies in the fact that rapid operative intervention may result in significant neurological recovery. The value of magnetic resonance imaging preoperatively and postoperatively is emphasized.

MR imaging in the diagnosis of spontaneous spinal epidural hematomas.

Three patients with spontaneous (idiopathic) spinal epidural hematomas were diagnosed with magnetic resonance (MR) imaging. Magnetic resonance is an accurate, rapid method of localizing and characterizing the hematomas. We believe that MR (where available) should be the primary method of diagnosis in cases in which spinal epidural hematoma is suspected.