Search

A 52-year-old woman was admitted to our hospital with sudden diplopia, right ophthalmalgia, and occipital pain. The nature of her headache was continuous, and changing her position provided no relief. Three weeks before her admission, she experienced continuous cough and rhinorrhea during a few days. On admission, her neurological examination revealed right abducens paralysis, and right lateral gaze aggravated diplopia. Brain magnetic resonance imaging scan demonstrated diffuse pachymeningeal enhancement by gadolinium. Radioisotope cisternography showed a leak of cerebrospinal fluid from near the third lumbar vertebra. The first lumbar puncture revealed an initial pressure of 0 mm H2O. She was given a diagnosis of spontaneous intracranial hypotension due to a leak of the cerebrospinal fluid. During her hospitalization, she complained of vertigo and nausea. We found horizontal gaze nystagmus to left side and sensorineural deafness in her left ear, which improved in a few days. After treatment by a lumbar epidural continuous infusion of saline and a lumbar epidural blood patch, her headache and abnormal MRI findings had improved. The continuous cough before her admission may be the cause of the leak of cerebrospinal fluid. We had difficulty in diagnosis only by the history and clinical examination, because she had no history of orthostatic headache.

The intramedullary nailing method described by Küntscher is used widely now as an excellent treatment of the fracture of the long bone. However, it is well known from clinical experience that fracture fixation of the clover leaf nail is not so strong and especially rotational fixation is very poor. For the purpose of re-evaluating fracture fixation mechanism with Küntscher's nail, the following studies were performed. Osteotomized human cadaveric femur was fixed with the clover leaf nail in an ordinary manner. This osteosynthesis model was imbedded in plastic resin (RIGOLAC) in situ. Afterwards this model was cut into specimens 1.5 cm in thickness. The contact area between the bone and the nail was investigated macroscopically and roentgenographically on each specimen. Stress distribution in cross section of some commercially available clover leaf nails was investigated by the technique of photoelastography. Total expansive force of the clover leaf nail was obtained by the calculation based on the measured values. From these investigations the author concludes that the clover leaf nail does not fix the fracture by the expansive spring mechanism only, as was originally claimed by Küntscher.