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Retropharyngeal hematomas are uncommon, but they may rarely cause occlusion of the upper airway and threaten life. Retropharyngeal hematomas often occur due to head or neck injury;they rarely occur due to iatrogenic causes such as insertion of a gastric tube or anticoagulant therapy. It has been found that patients receiving anticoagulant therapy are more likely to experience potentially severe retropharyngeal hematomas. We report the case of a patient with retropharyngeal hematoma with cervical cord damage. A 75-year-old man was transferred to our hospital after he sustained a fall and damaged his face. CT showed a massive retropharyngeal hematoma, but he did not complain of any breathing issues. Therefore, we selected conservative therapy. However, after approximately 4 hours, he suddenly complained of breathing problems and suffered from loss of consciousness. We performed intubation and provided sedation. After one week, his condition clearly improved and he was extubated.

Among 104 cases of intracranial aneurysms, 64 were operated under hypervolemic hypotension (HVH) and Trimethaphan induced hypotensive anesthesia. Of the remaining 40 cases, 14 were operated under normotensive anesthesia, 12 were treated by common carotid clamp, and 14 were found not compatible to surgical treatment because of recurrent bleeding, vasospasm and other serious complications. The advantages and surgical results of HVH, including morbidity, mortality, and complications are discussed and compared with several other reports of induced hypotensive anesthesia. The benefits of the HVH are as follows : 1) Cerebral metabolism is maintained within normal range during the prolonged induced hypotension by hypervolemic perfusion. 2) The dissection and clipping of aneurysm are considerably easier and premature rupture occurring during surgical manipulation of the aneurysm can be handled without difficulty. 3) The hypervolemic hypotension may diminish the danger of postoperative cerebral swelling and edema, and improve the prognosis and long-term survival of the intracranial aneurysm patients.

Divided 3, 284 patients of the head injuries into three age groups, the children, the adults, and the aged, and investigated the relationship of their clinical pictures, X-ray evidences, and EEG abnormality.1) EEG abnormality of the head injuries most frequently appeared in the children (49%), less frequently in the aged (35%), and least frequently in the adults (24%).2) As to the relationship between the consciousness disturbance and EEG abnormality, 10 mins interval of the unconsciousness became a borderline; the abnormal EEG more frequently appeared, when the unconsciousness was more than 10 mins.3) The diffuse abnormality frequently appeared in the children, and the frequent focal abnormality was found in the aged.4) About half of the patients of skull fracture showed the abnormal EEG.5) As to burst, theta waves frequently appeared in the children; alpha range wave in the adults; and delta waves in the aged.6) Spike, spike and wave complex, and sharp wave were mainly found in the children.7) The slowing trend like diffuse slow wave, posterior half slowing, and such was found in the aged.8) Slow wave of high amplitude like posterior half random δ, θ waves were found many in the children.9) Abnormal wave activated by the hyperventilation and photic stimulation was observed frequently in the children and rarely in the aged.

Statistical evaluation of 218 patients with closed head injury in advanced age over 60 was conducted, obtaining the following results:1) In terms of the causes of the head injuries, traffic accidents with auto-mobiles shared 61.9% of the total, of which the accidents while walking on foot shared 50.9%. Falling also shared a relatively high percentage of 17.0%.2) No significant difference could be seen between the senile patients and adult patients in lower age in terms of the period of unconsciousness, 3) The main subjective symptoms experienced (lasting for more than a week) were headache, dizziness, head heaviness, fatigability, forgetfulness, tinni-tus, emotional variability, and so on in this decremental order.4) Of all the frequent objective symptoms experienced, pyramidal symptoms and cranial nerve paralysis or paresis were most frequent among other neuro-logical symptoms, and dimentia, changes in characters, and loss of memory were most frequent among other psychic symptoms.5) The results of the accessory diagnosis demonstrated that skull fractures in senile patients shared 5.9% of all the patients we evaluated; this was some-what higher than that of the adult patients in lower age. The frequency of ab-normal electroencephalographic patterns was more markedly frequent than that of the adult patients in lower age.Our acknowledgments are due Prof. Tatsuyuki Kudo for his revision of this report.