A case of spontaneous cervical epidural hematoma in an elderly patient was reported. An 82-year-old male was referred to our department because of right hemiparesis. He was diagnosed as cerebral thrombosis and treated conservatively. He complained of neck pain and CT scanning on the second day showed a high dense area at the level of dorsal C2 and C4. MRI revealed iso-low intense area in T1WI and T2WI, and the lesion was diagnosed as spontaneous cervical epidural hematoma. On the third day after the onset, C2-C4 laminectomy and evacuation of the hematoma was performed. No vascular anomaly was recognized in the lesion on histopathological examination. Postoperatively, his hemiparesis alomost fully recovered within one week and he was discharged on the 14th day after the operation. In a review literature, elderly patients whose hematoma was evacuated within 36 hours of the lesion being detected in the thoracic region showed a good prognosis. Especially in elderly patients, prompt diagnosis and treatment are essential for good quality of life.
Emergency surgical repairs were performed successfully in two cases of blunt traumatic rupture of the thoracic aorta. Case 1 was a 32 year-oldman, and case 2 was a 50 year-old man. Two patients were injured in separate traffic accidents and suffered aortic ruptures just distal to the isthmus. The diagnoses were made only by enhanced helical CT. Aortic repairs were accomplished with the aid of left heart bypass. Intraoperative transesophageal echocardiogrphy, which was done in case 2, was very useful in delineating the site of rupture and coincident aortic dissection. Prosthetic graft interpositions were performed. There were no postoperative paraplegia in either case. Rapid diagnosis and urgent definitive surgical repair are crucial for the successful outcome of blunt traumatic rupture of the thoracic aorta.