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We report two cases of spontaneous epidural hematoma associated with the hemorrhagic diathesis and the paranasal sinusitis. Case 1: A 31-year-old man with a history of subtotal gastrectomy because of gastric cancer. He complained of headache at left temporal region, but CT scan showed no abnormal finding. After about 12 hours, he was found in comatose state. Emergency CT scan showed left epidural hematoma. He had the thrombocytemia and hemorrhagic diathesis which were supposed to be the side effect of the chemotherapy or DIC. Although the epidural hematoma was removed at emergency, he died 5 days after the operation, because of severe brain swelling. Case 2: A 34-year-old woman with a history of paranasal sinusitis. At 3 weeks after her fourth delivery, she had a headache and a right orbital swelling. She was admitted to the otorhinolaryngologist under the diagnosis of the acute paranasal sinusitis and orbital phlegmone. After admission, the level of consciousness became worse, she was given neurosurgical consultation. Angiogram showed right temporal mass lesion. At operation, the epidural hematoma was found and evacuated. She was discharged without any neurological deficits.

We experience sometimes an infantile skull fracture which is followed by the skull fracture line and bulging of the fractured area day by day after the head injury. Since John Howship reported the case of the partial absorption of the right parietal bone, arising from a blow on the head in a child aged 9 month in 1816, this phenomenon was variously described meningocele spuria, traumatic cephalohydrocele, leptomeningeal cyst, fibrosing osteitis, cerebrocranial erosion, traumatic meningocele, die wachsende Schädelfrakture, growing skull fracture, etc. So called "growing skull fracture" has generally the triad of the symptoms which are the parietal skull fracture in infancy or childhood, traumatic dural tears, and subsequent enlargement of the fractures. And it is said that the dural tear is an indispensable condition for the developing of the "growing skull fracture". But we recently had the case of a 14 day old male infant who had neither traumatic dural tear nor subdural hematoma, but the progressive enlarging of the fracture line in the left parietal bone. The authors suggest that there should be the difference between the growing skull fracture (with the dural teat) and the enlarging skull fracture (without the dural tear).

This is a report of a rare case of pineal metastasis from gastric adenocarcinoma. A 75-year-old male with a previous medical history of subtotal gastrectomy for cancer of the cardia was diagnosed as having hydrocephalus 6 months later. After undergoing a V-P shunt operation, he was transferred to Kyoto First Red Cross Hospital. The patient had neurological abnormalities: bilateral paralysis of upward eye movement, and bilateral sluggish reflex to light. Ten days later the patient suddenly fell into a coma due to intratumoral hemorrhage. The patient soon regained consciousness and received Cobalt-therapy. However he died two months later of pulmonary malfunction due to pulmonary metastasis. An autopsy revealed a pineal tumor metastasized from gastric adenocarcinoma. The tumor involved the body of the pineal gland, and was expanded having a sharply defined margin which extended to the posterior portion of the third ventricle and the bilateral basal ganglia.

It is well known that a Bernasconi-Cassinari artery is an important finding at diagnosis of the abnormality in tentorium. Since Bernasconi and Cassinari reported the artery in 1956, many reports have been presented and showed that the artery arose from the intracavernous portion of the internal carotid artery. We presented a 54-year-old female with tentorial meningioma. In selective external carotid angiography, the artery feeding the tumor was revealed arising from the accessory meningeal artery, which came off the internal maxillary artery and passed into the carnium through the foramen ovale, and took the same course of "Bernasconi-Cassinari artery". This angiographic finding suggests that it is possible for marginal tentorial artery to arise from an external carotid arterial system. It is said in the anatomical studies, when the trunk of primitive maxillary artery which is one of maxillo-carotid anastomotic arteries in fetus regresses, "marginal tentorial artery" usually remains linked to the internal carotid artery. But, if this transition of "the artery" from the external to the internal carotid artery failed, it is easily conceived the artery results in the origin of accessory meningeal artery, a branch of the external carotid artery.

A case of a patient with the syndrome of chronic hypernatremia and hypodispia due to hypothalamic tumor was studied to evaluate the change of ADH response to plasma osmolality during the clinical course. A 23-year-old man was admitted for investigation of anorexia, hypodipsia and gait disturbance. Examination showed memory disturbance and generalized muscle weakness. Investigation showed marked hypernatremia (177 mEq/l) and hypopituitarism. Water loading test showed that ADH was not stimulated by hyperosmolality but continued to be secreted at a more or less constant level approximating normal basal state. CT scan revealed hypothalamic tumor. The tumor was suspected to be germinoma due to its radiosensitivity and high serum hCG level. After irradiation, the tumor lesion disappeared. ADH secretion came to be responsive to changes in osmolality but the response of the system was markedly reduced compared with the normal response, and hypodipsia and hypernatremia still remained. We conclude that the adipsia and complete destruction of the osmoreceptor in the patient caused marked hypernatremia and the destruction of ADH osmostat improved partially after irradiation. We believe it very useful for analyzing the disturbance of osmoregulatory system to evaluate the relationship of plasma ADH to plasma osmolality.