Experience of Triage During an A/H1N1 Influenza Pandemic in After-Hours Emergency Centers.

During the 2009 A/H1N1 influenza pandemic in Sendai, two primary emergency clinics, which are after-hours emergency centers managed by the Sendai Emergency Medical Service Foundation, were inundated with many influenza patients. In the course of the pandemic, from August 1, 2009 to March 31, 2010, a total of 47,831 internal medicine and pediatric patients visited the two clinics and rapid influenza tests were performed in 17,167 of patients, in which 6,697 patients tested A-positive. Consequently, 10,743 patients were diagnosed with influenza, which included 1,447 patients that tested negative, and 2,599 patients that were not tested.

[Hemorrhagic infarction complicated by obliteration of the superior sagittal sinus by depressed skull fracture after a hammer injury: a case report].

The authors have encountered a case of compound depressed skull fracture in a 59 year-old-man complicated by occlusion of the anterior 1/3 part of the superior sagittal sinus (SSS). He was hit by a hammer at the midline of the frontal region, and transferred to our emergency care unit. On admission, there was laceration of skin at the midline of the forehead, but the patient had no neurological deficit.

JSNT-Guidelines for the Management of Severe Head Injury (Abridged edition).

The aim of this article is to introduce the principal part of the JSNT-guidelines for the management of severe head injury in adults. The JSNT-guidelines were developed in 2000 by the Guidelines Committee of the Japan Society of Neurotraumatology (JSNT) based on the results of literature review and the Committee consensus. The guidelines updated in 2006 consist of 7 topics pertaining not only to prehospital care, initial, ICU and surgical management, but also the management of pediatric and geriatric patients.

Acute epidural hematoma of the posterior fossa--cases of acute clinical deterioration.

Purpose: Posterior fossa epidural hematoma (PFEDH) is an uncommon complication of head injury, which is sometimes associated with acute clinical deterioration (ACD) without significant warning symptoms and may results in death. We investigated clinical characteristics of PFEDH with ACD to identify the process of ACD.

Methods: A retrospective case-control review of all patients admitted with a diagnosis of PFEDH between September 1989 and February 1999 was performed.

Thrombosed vertebral artery aneurysm presenting with hemorrhage and bulbar compression: report of two cases.

Bulbar compression by vertebral artery (VA) aneurysm is extremely rare and only reported in a few cases. We report two cases with thrombosed VA aneurysm compressing medulla oblongata; one presented with bulbar apoplexy hemorrhage and the other with subarachnoid hemorrhage (SAH). A 61-year-old male (case 1) presented with consciousness disturbances, left hemiplegia, and subsequent respiratory arrest.

Cerebral infarction in the caudate nucleus associated with acute epidural hematoma and diffuse brain injury in a child after severe head injury.

Case Report: A 6-year-old boy was admitted to our hospital 20 min after receiving a direct impact to his head in an automobile accident. He was semi-comatose on admission and computed tomography showed acute epidural hematoma in the right supratentorial region. Three hours later, his consciousness deteriorated due to the enlargement of the hematoma.

Hydrocephalus due to cerebrospinal fluid overproduction by bilateral choroid plexus papillomas.

Case Report: A 10-month-old boy, with congenital deafness and blindness associated with chromosomal deletion [46XY, del(13)(q32)], presented with intractable ascites 9 months after ventriculo-peritoneal shunting for congenital hydrocephalus. Revision of the ventriculo-atrial shunt resulted in shunt failure 1 month later. External ventricular drainage revealed cerebrospinal fluid (CSF) overproduction (2,000 ml/day).

A distal anterior cerebral artery aneurysm in infant: disappearance and reappearance of the aneurysm.

The incidence of intracranial aneurysms in childhood is rare, especially in infancy. Spontaneous thrombosis of a cerebral aneurysm in a child is very rare, particularly in a non-giant aneurysm. We report a case of a 1-month-old girl with a distal anterior cerebral artery aneurysm which disappeared spontaneously after subarachnoid hemorrhage and reappeared 6 months later.

[Two cases of impending herniation due to multiple traumatic acute subdural hematomas: combination of burr hole evacuation and craniotomy].

A contralateral extra-axial hematoma sometimes occurs during an operation on an acute subdural hematoma and may become fatal. Using a combined procedure of burr hole evacuation and craniotomy, we treated 2 cases of multiple traumatic acute subdural hematomas. Our policy for such cases is first to perform a burr hole evacuation for the acute subdural hematoma in the emergency room, while simultaneously preparing the operation room for a possible further operation.

[A case of vertebral artery occlusion following heading play in soccer].

A 13-year-old boy suffered from cerebeller infarction due to right vertebral artery occlusion after heading a ball during a rainy soccer game. Dissection of the vertebral artery after trivial head trauma is well known, but heading as the cause has not been reported. We speculated in this present case that excessive impact force to the young boy's neck due to the heavy rain-soaked ball might have caused right vertebral artery dissection and occlusion.

Unruptured carotid-duplicated middle cerebral artery aneurysm: case report.

We demonstrate the first case with unruptured carotid-duplicated middle cerebral artery (IC-Dup MCA) aneurysm combined with ruptured opposite carotid aneurysm. Eleven IC-Dup MCA aneurysm reported until now had all ruptured. It is noteworthy that 8 patients of the 11 were Japanese.

Growth of small unruptured intracranial aneurysm: case report.

Magnetic resonance angiography (MRA) revealed silent but rapid growth of a small unruptured intracranial aneurysm until it was surgically treated to prevent rupture. Modern neuroimaging methods such as MRA and 3-dimensional computed tomography have increased opportunity to detect small unruptured cerebral aneurysms. Strict follow up is an option for the incidentally discovered small intact aneurysms using these methods.

Symptom changes caused by movement of a calcified lateral ventricular meningioma: case report.

Large calcified psammomatous meningioma in the left lateral ventricle with a long silent interval of 16 years was presented. The symptoms varied by its moving not enlargement, which was described by sequential images of the brain computer tomography. Combined approaches of transcallosal and transinferior temporal sulcus routes were superior to prevent injury of the speech center in the dominant hemisphere.

Single burr hole evacuation for traumatic acute subdural hematoma of the posterior fossa in the emergency room.

A 57-year-old man and a 55-year-old man presented with acute subdural hematoma of the posterior cranial fossa due to trauma. Both were comatose preoperatively. Emergent single burr hole evacuation in the posterior cranial fossa was performed in the emergency room immediately after computed tomography.