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Background: Hearing is essential for learning in school, and untreated hearing loss may hinder quality education and equal opportunities. Detection of children with hearing loss is the first step in improving the learning situation, but effective interventions must also be provided. Hearing aids can provide great benefit for children with hearing impairment, but this may not be a realistic alternative in many low- and middle-income countries because of the shortage of hearing aids and hearing care service providers. Objective: In this study, alternative solutions were tested to investigate the potential to improve the learning situation for children with hearing impairment. Method: Two technical solutions (a personal amplifier with and without remote microphone) were tested, in addition to an approach where the children with hearing impairment were moved closer to the teacher. A Swahili speech-in-noise test was developed and used to assess the effect of the interventions. Results: The personal sound amplifier with wireless transmission of sound from the teacher to the child gave the best results in the speech-in-noise test. The amplifier with directive microphone had limited effect and was outperformed by the intervention where the child was moved closer to the teacher. Conclusion: This study, although small in sample size, showed that personal amplification with directive microphones did little to assist children with hearing impairment. It also indicated that simple actions can be used to improve the learning situation for children with hearing impairment but that the context (e.g. room acoustical parameters) must be taken into account when implementing interventions. Contribution: The study gives insight into how to improve the learning situation for school children with hearing impairment and raises concerns about some of the known technical solutions currently being used.

Abstract Intellectual disability (ID) affects approximately 1% of the population. Some patients with severe or profound ID are essentially non-communicating and therefore risk experiencing pain and distress without being able to notify their caregivers, which is a major health issue. This real-world proof of concept study aimed to see if heart rate (HR) monitoring could reveal whether non-communicating persons with ID experience acute pain or distress in their daily lives. We monitored HR in 14 non-communicating participants with ID in their daily environment to see if specific situations were associated with increased HR. We defined increased HR as being > 1 standard deviation above the daily mean and lasting > 5 s. In 11 out of 14 participants, increased HR indicated pain or distress in situations that were not previously suspected to be stressful, e.g. passive stretching of spastic limbs or being transported in patient lifts. Increased HR suggesting joy was detected in three participants (during car rides, movies). In some situations that were previously suspected to be stressful, absence of HR increase suggested absence of pain or distress. We conclude that HR monitoring may identify acute pain and distress in non-communicating persons with ID, allowing for improved health care for this patient group.

Bakgrunn: Muntlig rapport har lang tradisjon i helsetjenesten. Elektronisk journaldokumentasjon er tilgjengelig, og det argumenteres for at skriftlig informasjon kan erstatte den muntlige overleveringen av pasientinformasjon. Noen steder er muntlig rapport erstattet med stille rapport for å spare tid og ressurser. Hensikt: Hensikten er å utvikle kunnskap om hvilke tema helsepersonell snakker om under rapportmøter i helsetjenesten. Metode: Kvalitativ tilnærming, Krippendorffs innholdsanalyse. Sykepleierstudenter samlet data fra rapportmøter i sykehus, sykehjem og hjemmetjeneste. Resultat: Organisatoriske forhold og drift, pleie og behandling ble mest omtalt. Faglige forhold og personalets bekymring og frustrasjon ble ofte omtalt. Privat prat opptok liten del av rapportmøtene. Konklusjon: Rapportmøtene inneholder mer enn formidling av pasientopplysninger, og må få større fokus mens videreutvikling av elektronisk pasientjournal (EPJ) pågår. Effektivisering av helsetjenesten, uten konsekvensutredning av reduksjon i rapport-tiden, kan medføre kvalitetsforringelse av sykepleietjenesten og pasientsikkerheten. Sykepleiernes organiseringsvirksomhet kan kamufleres i begrepet rapport.

Background and AimsPhotochemical internalization (PCI) is a technology for inducing release of endocytosed antigens into the cell cytosol via a light-induced process. Preclinical experiments have shown that PCI improves MHC class I antigen presentation, resulting in strongly enhanced CD8+ T-cell responses to polypeptide antigens. In PCI vaccination a mixture of the photosensitizing compound fimaporfin, vaccine antigens, and an adjuvant is administered intradermally followed by illumination of the vaccination site. This work describes an open label, phase I study in healthy volunteers, to assess the safety, tolerability, and immune response to PCI vaccination in combination with the adjuvant poly-ICLC (Hiltonol) (ClinicalTrials.gov Identifier: NCT02947854).MethodsThe primary objective of the study was to assess the safety and local tolerance of PCI mediated vaccination, and to identify a safe fimaporfin dose for later clinical studies. A secondary objective was to analyze the immunological responses to the vaccination. Each subject received 3 doses of HPV16 E7 peptide antigens and two doses of Keyhole Limpet Hemocyanin (KLH) protein. A control group received Hiltonol and vaccine antigens only, whereas the PCI groups in addition received fimaporfin + light. Local and systemic adverse effects were assessed by standard criteria, and cellular and humoral immune responses were analyzed by ELISpot, flow cytometry, and ELISA assays.Results96 healthy volunteers were vaccinated with fimaporfin doses of 0.75–50 µg. Doses below 17.5 µg were safe and tolerable, higher doses exhibited local tolerability issues in some study subjects, mainly erythema, and pain during illumination. There were few, and only mild and expected systemic adverse events. The employment of PCI increased the number of subjects exhibiting a T-cell response to the HPV peptide vaccine about 10-fold over what was achieved with the antigen/Hiltonol combination without PCI. Moreover, the use of PCI seemed to result in a more consistent and multifunctional CD8+ T-cell response. An enhancement of the humoral immune response to KLH vaccination was also observed.ConclusionsUsing PCI in combination with Hiltonol for intradermal vaccination is safe at fimaporfin doses below 17.5 µg, and gives encouraging immune responses to peptide and protein based vaccination.

Personer med kognitiv svikt og orienteringsvansker kan ha nytte av lokaliseringsteknologi (GPS) for å kunne bevege seg trygt omkring på egen hånd. Denne artikkelen beskriver brukeres refleksjoner over det å være bærer av en GPS-enhet. Hvordan opplever de forholdet mellom trygghet og bevegelsesfrihet, og hva er viktig for dem? Knytter de bruken av GPS til det som er viktig i eget liv? Artikkelen bygger på dybdeintervjuer med fem personer med kognitiv svikt og orienteringsvansker. Det er viktig selv å bestemme når man vil gå ut, hvor lenge man skal være ute, og hvor man skal gå. Å balansere mellom trygghet og bevegelsesfrihet handler om å håndtere risiko knyttet til å være ute alene. Lokaliseringsteknologi kan være et godt hjelpemiddel dersom den støtter brukerens identitet, verdier og ønsker. Mestring kan økes ved grundig opplæring gjennom praktiske øvelser i realistiske situasjoner. Lokaliseringsteknologi (GPS) griper inn i personers mulighet for å leve et liv med selvbestemmelse og bevegelsesfrihet, og den kan påvirke muligheten for å bevege seg omkring på egen hånd utenfor andres innsyn og kontroll. Teknologien aktualiserer dermed en rekke spørsmål knyttet til autonomi og trygghet. De senere årene har mange kommuner gjennomført prosjekter der de har prøvd ut lokaliseringsteknologi for personer med kognitiv svikt og orienteringsvansker, og det er høstet lovende erfaringer. Resultatene bygger i alt vesentlig på fagpersoners og pårørendes tilbakemeldinger. I denne artikkelen konsentrerer vi oss om brukernes opplevelser. Nøkkelord Demens, Lokaliseringsteknologi, Brukererfaringer

A new methodology for long-term monitoring of climate change impacts on historic buildings and interiors has been developed. This paper proposes a generic framework for how monitoring programs can be developed and describes the planning and arrangement of a Norwegian monitoring campaign. The methodology aims to make it possible to establish a data-driven decision making process based on monitored decay related to climate change. This monitoring campaign includes 45 medieval buildings distributed over the entirety of Norway. Thirty-five of these buildings are dated to before 1537 and include wooden buildings as well as 10 medieval churches built in stone while the remaining 10 buildings are situated in the World Heritage sites of Bryggen, in Bergen on the west coast of Norway, and in Røros, which is a mining town in the inland of the country. The monitoring is planned to run for 30 to 50 years. It includes a zero-level registration and an interval-based registration system focused on relevant indicators, which will make it possible to register climate change-induced decay at an early stage.

Background: Mortality rates from injuries are higher for people from poorer economic backgrounds than those with higher incomes (according to the World Health Organization [WHO]), and health care professionals and organisations dealing with people with disabilities experience that individuals with spinal cord injury (SCI) in low income countries face serious challenges in their daily lives. Objectives: The aims of this study were to explore life expectancy (life expectancy is the average remaining years of life of an individual) and the situation of persons living with SCI in low income settings. Method: Literature studies and qualitative methods were used. Qualitative data was collected through semi-structured interviews with 23 informants from four study sites in Zimbabwe representing persons with SCI, their relatives and rehabilitation professionals. Results: There are few publications available about life expectancy and the daily life of persons with SCI in low income countries. Those few publications identified and the study findings confirm that individuals with SCI are experiencing a high occurrence of pressure sores and urinary tract infections leading to unnecessary suffering, often causing premature death. Pain and depression are frequently reported and stigma and negative attitudes are experienced in society. Lack of appropriate wheelchairs and services, limited knowledge about SCI amongst health care staff, limited access to health care and rehabilitation services, loss of employment and lack of financial resources worsen the daily challenges. Conclusion: The study indicates that life expectancy for individuals with SCI in low income settings is shorter than for the average population and also with respect to individuals with SCI in high income countries. Poverty worsened the situation for individuals with SCI, creating barriers that increase the risk of contracting harmful pressure sores and infections leading to premature death. Further explorations on mortality and how individuals with SCI and their families in low income settings are coping in their daily life are required to provide comprehensive evidences.

Background and Purpose: To measure the magnitude of the effect of the infarct location measured using the posterior circulation Alberta Stroke Program Early Computed Tomographic Score (pc-ASPECTS) on the functional outcome at 90 days in patients with basilar artery (BA) occlusion undergoing endovascular therapy (EVT)., Methods: Of the acute ischemic stroke patients undergoing EVT for acute posterior circulation large vessel occlusion enrolled in the multicenter observational registry from December 2013 to February 2021, patients with BA occlusion were included. A favorable outcome was defined as achieving a modified Rankin Scale score of 0-3 at 90 days. The effect of pc-ASPECTS including the distribution on favorable outcomes was evaluated., Results: One hundred patients were analyzed. Fifty-one patients (51%) achieved favorable outcome. Patients achieving a favorable outcome were younger, had a lower National Institutes of Health Stroke Scale score before EVT, and had a higher pc-ASPECTS before EVT than those not achieving a favorable outcome. Multivariable logistic analysis showed a significant association between higher pc-ASPECTS and a favorable outcome (odds ratio [OR] 1.24; 95% confidence interval [CI] 1.02-1.52; P = 0.028). Considering the infarct location, bilateral cerebellar infarction was significantly associated with a lower frequency of favorable outcomes than those without cerebellar infarction (OR 0.16; 95% CI 0.04-0.51; P = 0.002)., Conclusions: A higher pc-ASPECTS before EVT could be a predictor of a favorable outcome after EVT for BA occlusion. In particular, the presence of bilateral cerebellar infarction before EVT was significantly associated with a lower likelihood of a favorable outcome., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Patients with diffuse axonal injury (DAI) may initially present with prominent physical impairments, but their cognitive dysfunctions are more persistent and are attributable to later unemployment. In this study, we analyzed how the findings of early and delayed neuropsychological assessments correlated with employment outcome of patients with DAI. A total of 56 patients with DAI without motor or visual dysfunction were included in this study. The neuropsychological battery consisted of the Wechsler Adult Intelligent Scale - Revised (WAIS-R), Wechsler Memory Scale - Revised (WMS-R), Trail Making Test (TMT), Wisconsin Card Sorting Test (WCST), and Word Fluency Test (WFT). This battery of tests was administered twice in early stage after injury and in later stage. The results of all of the neuropsychological tests improved significantly (P <0.001) between the early and later assessments. All scores other than TMT part A and B improved to the normal range (Z-score ≥ 2). The patient characteristics (age, gender, initial Glasgow Coma Scale, and duration of posttraumatic amnesia) had no relationship to the outcome. The results of TMT part B, however, were significantly correlated with employment outcome in both the early and later assessments (P = 0.01, 0.04). Given that TMT evaluates visual attention, we surmise that a lack of attention may be the core symptom of the cognitive deficit and cause the re-employment failure in patients with DAI. TMT part B in both early and later assessments has the potential to accurately predict chronic functional outcome.

Whether the intentional antihypertensive therapy recommended by the American Heart Association/American Stroke Association (AHA/ASA) guidelines has clinical benefit for patients who have acute spontaneous intracerebral hemorrhage (ICH) has yet to be proven. We retrospectively reviewed the clinical charts of 175 patients with putaminal or thalamic ICH with acute hypertension to examine the correlation between the efficacy of antihypertensive therapy within 3 hours of onset, hematoma expansion (HE) after hospitalization and clinical outcome. The aim of the antihypertensive therapy was to achieve and maintain a systolic blood pressure of 120 mm Hg to 160 mm Hg until the second CT scan. The mean arterial pressure (MAP) after admission was the average MAP values measured every hour for the first 3 hours of hospitalization or until the second CT scan, if this was performed within the same timeframe. Thirty-two (18.3%) patients were found to have HE. Prior to the second CT scan, antihypertensive medications were administered to all patients without any major complications. A multiple logistic regression analysis revealed that a MAP of >110 mm Hg after admission was the only variable independently associated with HE (odds ratio [OR] = 3.455; 95% confidence interval [CI] = 1.510-8.412; p = 0.004). Modified Rankin Scale scores of < or = 3 on day 30 were significantly more common in those patients without HE (p = 0.002). Our findings suggest that there are clinical benefits, by the prevention of subsequent HE, in maintaining a MAP level lower than that recommended by the AHA/ASA (110 mm Hg) after hospitalization for patients who have ICH., (Copyright 2010 Elsevier Ltd. All rights reserved.)

An 81-year-old male presented with weight loss and hyponatremia. A baseline endocrinological examination revealed anterior pituitary dysfunction. A computed tomography and MRI revealed a large, unruptured intrasellar aneurysm protruding from the right internal carotid artery and pushing the pituitary stalk leftward. The patient developed polyuria and polydipsia from 10 days after commencing corticosteroid supplementation and was diagnosed with partial central diabetes insipidus (DI). Balloon assisted endosaccular embolization was performed about one month after the posterior pituitary dysfunction was identified. The unruptured aneurysm was successfully embolized with Guglielmi detachable coils (GDCs) without narrowing of the parent vessel. DI resolved completely and the posterior pituitary dysfunction improved soon after endosaccular embolization. The remission of DI after coil embolization suggested that the DI might have been induced by the progressive mass effect of the aneurysm rather than by the steroid. An endocrinological evaluation and cerebral angiography confirmed partial recovery of anterior pituitary dysfunction and almost complete obliteration of the aneurysm, respectively at 1 year after the operation. We report a case of hypopituitarism secondary to the large intrasellar aneurysm. This aneurysm was embolized with GDCs, resulting in partial recovery of anterior pituitary dysfunction and complete recovery of posterior pituitary dysfunction.

A 48-year-old female was referred to our hospital for the management of a ruptured 22-mm-diameter internal carotid aneurysm, located immediately distal to the ophthalmic artery. The right internal carotid artery was completely involved in the aneurysm. Because the right carotid siphon was relatively nontortuous stent-assisted coiling of the aneurysm was attempted 4 days after subarachnoid hemorrhage. A new coil-type coronary stent, a DRIVER stent, was deployed after microcatheter insertion into the aneurysm dome under systemic heparinization, followed by dome packing using Guglielmi detachable coils. Systemic heparinization was continued for 18 hours postoperatively, and aspirin (100 mg/day) was administered orally immediately after the embolization. However, 4 hours after heparin administration cessation, left hemiparesis became apparent. Immediate magnetic resonance angiography revealed a right internal carotid artery occlusion. Diffusion-weighted images demonstrated ischemic spots in the watershed zones of the right cerebral hemisphere. Following an immediate thrombolysis of the right internal carotid artery, systemic heparinization was continued for 5 days, and aspirin and ticlopidine were administrated orally. The patient was discharged on day 37, following the recovery from left hemiparesis within ten days. A DRIVER stent is a low profile coil-type coronary stent, which can be used for the stent-assisted coiling of large internal carotid aneurysms, located distal to the carotid siphon. It seems necessary to continue systemic heparinization for more than 2 days and to administer increased dose or two types of antiplatelet after the stent-assisted coiling of large cerebral aneurysms.

The authors examined the correlations between cerebral blood flow (CBF) during the stage of vasospasm following subarachnoid hemorrhage and four parameters, namely, cardiac output (cardiac index), mean arterial blood pressure, age, and the Glasgow coma scale score. Forty-two patients who were diagnosed to have subarachnoid hemorrhage were included in this study, and 50 measurements were performed between day 5 and 12 following the subarachnoid hemorrhage. The CBF was measured by stable xenon-enhanced CT and the mean values of four CBF maps were corrected for a PaCO2 of 34 mm Hg (CBF34). The cardiac output and cardiac index were continuously monitored during the CBF measurement. The correlation coefficients of cardiac index, mean arterial blood pressure, age, and GCS against CBF34 were, respectively, 0.436, 0.227, 0.037, and 0.225, and the p values were, respectively, 0.002, 0.074, 0.789, and 0.087. The CBF34 was positively correlated with only the cardiac index and not with any of the other three parameters. Therefore, an increase in the cardiac output is apparently associated with an increase in the CBF during the stage of vasospasm following subarachnoid hemorrhage. Furthermore, we measured the CBF and cerebral perfusion pressure before and after increasing cardiac output in three patients during the stage of vasospasm. The CBF increased by 22.5% +/- 2.9 (SD), with a 42.0% +/- 16.4 increase in the cardiac index, however, no significant change in cerebral perfusion pressure was observed. Therefore, the increase in CBF associated with the increase in cardiac output seems to be attributable to a reduction in the cerebrovascular resistance.

The relationship between traumatic extra-axial hematomas and cerebral atrophy was investigated in 42 adult patients aged between 15 and 50 years who required removal of extra-axial hematomas. These patients were followed up by serial computed tomography for more than 6 months after head injury. Nine of these patients developed cerebral atrophy. Their Glasgow Coma Scale score on admission was 6.4 +/- 2.8 (mean +/- SD). The score of the patients without cerebral atrophy was 9.6 +/- 3.3 (p < 0.01). These patients had three extradural and six subdural hematomas. All patients with cerebral atrophy had cerebral swelling postoperatively, more prominent in the hemisphere ipsilateral to the hematoma in seven patients. This swelling was associated with global hypodensity and persisted for 10.4 +/- 2.9 days. The severity of cerebral atrophy was more prominent in the hemisphere ipsilateral to the hematoma in five of these seven patients. Extra-axial hematoma in patients with severe head injury can induce hemispheric cerebral atrophy in the underlying cerebral hemisphere.

The means of the cerebral blood flow (CBF) values obtained by the stable xenon enhanced CT (Xe/CT) method using two different CT scanners were compared with global CBF value obtained by the Kety-Schmidt (N2O) method as a reference. Xe/CT CBF values were obtained using a GE CT9200 (31 patients, 2 flow maps, 120 kV, absorption constant of 0.040) as well as a GE ProSeed Accell (38 patients, 4 flow maps, 80 kV, absorption constant of 0.028). The protocol of inhalation in the Xe/XT method consisted of 4 min wash-in and 4-min wash-out of 35% stable xenon. In the Kety-Schmidt method, 15% N2O gas was inhaled for 10 min. The N2O content of blood samples was measured using a van Slyke-Neill blood gas analyzer. We corrected all obtained CBF values for a PaCO2 of 34 mmHG (CBF34). The global CBF34 values obtained by the Kety-Schmidt method were linearly correlated with the CBF34 values obtained using the CT9200 and with those obtained using the ProSeed Accell, and the regression line equations were, respectively, Y = 0.64X + 13.7 (X: CT9200, Y: Kety-Schmidt, r = 0.666, p < 0.01) and Y = 0.99X + 11.2 (X: ProSeed Accell, Y: Kety Schmidt, r = 0.756, p < 0.01). Since the CBF values obtained by the Xe/CT method using different CT scanners are not always the same as the global CBF values obtained by the Kety-Schmidt method, CBF values obtained by the Xe/CT method should be corrected referring to the regression line obtained by applying both methods for each patient.

Among nine infants aged less than 4 years with acute subdural hematoma admitted between 1980 and 1991, five required evacuation of a hematoma. Eight of them survived longer than 1 month and the remaining patient who had a hematoma removal died 3 days postoperatively. The four infants who required evacuation of a hematoma and survived longer than 1 month had prolonged hemispheric swelling ipsilateral to the hematoma lasting for 2 weeks postoperatively. Intracranial pressure was higher than 25 mm Hg during this period. Diffuse high density was observed in the affected hemisphere in one patient 12 days after injury, which was assumed to be hemorrhagic infarction. Subsequently, these four infants developed atrophy of the cerebral hemisphere ipsilateral to the hematoma. The pathophysiology of the atrophy of the cerebral hemisphere ipsilateral to the acute subdural hematoma is discussed.

We examined the effectiveness of high colloid oncotic pressure (COP) therapy to suppress and/or reduce brain edema associated with putaminal hemorrhage of patients whose clinical grades were grade 3 or 4a classified according to the Japanese neurological grading for putaminal hemorrhage. In the treated group of 11 patients, 25% albumin solution was intravenously administered (50-100 ml/day) with additional use of furosemide (20-40 mg/day) following hematoma removal. The serum COP was maintained at 25-30 mmHg for 2 weeks. In the untreated group of 11 patients, the COP therapy was not applied following hematoma removal. The serum COP was 20-25 mmHg for 2 weeks thereafter. During the 2-week observation period, serum osmolality, electrolyte, and hematocrit levels did not significantly differ between the two groups. The midline structure shift on CT of the treated group was 4.5 mm, which was significantly smaller than that of the untreated group (p < 0.05). The numbers of patients either in the vegetative state or death were 0 and 3, respectively, in the treated and the untreated groups. We concluded that high COP therapy for 2 weeks following hematoma removal was effective to suppress and/or reduce brain edema associated with putaminal hemorrhage, and that this therapy could be continued for 2 weeks without systemic complications.

Nineteen patients, who developed symptomatic vasospasm due to subarachnoid hemorrhage, were treated by hypervolemic-hyperdynamic therapy. The object of this treatment was to increase cardiac output and cerebral blood flow as a result of hypervolemia and the administration of beta-stimulants. During the treatment, if cerebral infarction occurred followed by brain edema, we applied oncotic therapy. As the parameters of therapy, we measured serum colloid oncotic pressure and cardiac functions in all of these patients. Nineteen patients were divided into two groups: group A, 9 patients, who did not develop brain edema, and group B, 10 patients, who developed brain edema. All patients underwent acute neck clipping surgery and plasma volume expansion by the infusion of albumin and/or low molecular weight dextran (LMWD). If symptomatic vasospasm occurred, a Swan-Ganz catheter was inserted and cardiac output was measured until it increased to 1.5 times the value of pretreatment. In group B, we also used oncotic therapy, raising serum oncotic pressure higher than 25 mmHg by increasing the amount of albumin and/or LMWD and administering furosemide. By this treatment, the percentage of patients who showed neurological improvement in at least one deficit was 100% in group A, and 89% in group B. In Glasgow outcome scale scores, 89% of group A and 70% of group B had disability not lower than moderate. Serum colloid oncotic pressure was maintained at around 20-25mmHg in group A, and 25-30mmHg in group B. Although pulmonary artery diastolic pressure in group B tended to be lower than that in group A, cardiac indices in both groups were high, approximately 5.0 L/min/m2.(ABSTRACT TRUNCATED AT 250 WORDS)

Incorporation of plasma [14C]palmitate into the hippocampus was measured using quantitative autoradiography and a ratio method of analysis between 10 min and 7 days after 5 min of bilateral occlusion of the common carotid arteries in awake gerbils. One day after carotid occlusion, relative palmitate incorporation was elevated by 16% and 20%, respectively (p less than 0.01), in the CA4 pyramidal cell layer and dentate gyrus of the hippocampus as compared with sham-operated animals. At 3 days, significant elevations of this magnitude were found in the CA3 and CA4 cell layers, and relative incorporation was reduced by 26% in the CA1 pyramidal cell layer. At 7 days, the only significant difference from control was a 15% elevated incorporation in the CA3 pyramidal cell layer. The results suggest that the turnover of palmitate-containing lipids is retained in the CA1 pyramidal layer of the gerbil hippocampus for 1 day and then reduced at 3 days after 5-min ischemia and that lipid synthesis is stimulated in hippocampal regions affected by but recovering from an ischemic insult (CA3, CA4, dentate gyrus).

A rare case with coexistent extracranial congenital arteriovenous malformation and aneurysms of the occipital artery is presented. A 32-year-old man visited Tachikawa National Hospital with the complaints of occasional dizziness and a gradually growing pulsatile mass in the left occipital region. The patient had had no head trauma. Neurological examination revealed no abnormality. Physical examination showed a round and pulsating tumor measuring 4 cm x 7 cm in the retroauricular region on the left side, which lost its pulsation and consistency upon compressing the left common carotid artery. Left selective external carotid angiography demonstrated a tortuous and locally enlarged occipital artery with venous drainage around the artery and an arteriovenous malformation (AVM) in the retroauricular region and neck. The patient was successfully treated by surgical embolization of the feeding arteries with ligation of the left external carotid artery and partial excision of aneurysms under general endotracheal anesthesia. The postoperative course was uneventful. Fourteen months after the operation there is no evidence of recurrence of the pulsatile mass and the preoperative symptoms. Microscopic examination of the excised artery and aneurysms showed partial disappearance of the internal elastic lamina and muscle layer of the artery. Capillary nevi noted over the ear, retroauricular region, neck, and shoulder on the left side without history of head trauma and angiographic findings suggest that the AVM was congenital. In addition, we think that the aneurysms of the left occipital artery on the side ipsilateral to the AVM may have originated from the site of the arterial wall lacking the internal elastic lamina and developed due to hemodynamic mechanism associated with the AVM. Although the treatment of choice for extracranial, congenital and traumatic, AVMs is ideally total excision, careful embolization of the nidus with ligation of the feeders seems to be the most opportune procedure of choice as the second-best treatment in cases in which the nidus of the AVM occupies extensive areas of the head or face and which have little chance of developing serious signs and symptoms such as massive hemorrhage.