[Clinical course in poor grade patients with ruptured intracranial aneurysms and extensive subarachnoidal clot].

Three hundred and eight cases with ruptured intracranial aneurysms and variable amounts of subarachnoidal clot were evaluated clinically with special emphasis on the natural course of poor grade patients. Clinical severity was classified according to the Glasgow Coma Scale (GCS); severe cases (score 3-8) and mild cases (score 9-15). Patients were further divided into four groups based on the preoperative clinical course, and on whether radical surgery was performed or not.

Sequential changes in cerebral blood flow and metabolism in patients with subarachnoid haemorrhage.

Haemodynamic and metabolic sequences were investigated in nine patients having subarachnoid haemorrhage (SAH) up to 3 months following aneurysmal rupture, using positron emission tomography (PET). In the pre-spasm stage (2-4 days after SAH) cerebral blood flow (CBF, ml/100 ml/min) was 45 +/- 11, the cerebral metabolic rate of oxygen (CMRO2, ml/100 ml/min) was 2.68 +/- 0.

The basal interhemispheric approach for acute anterior communicating aneurysms.

We reviewed the surgical outcome in 85 patients with ruptured anterior communicating artery (ACoA) aneurysms, who were operated on within 72 hours of onset via a basal interhemispheric (BIH) approach (Group 1, N = 48), or an anterior interhemispheric (AIH) approach (Group 2, N = 37). The age, sex ratio and pre-operative grade (Gr) were similar for both groups. The outcome at the time of discharge was as follows for group 1: excellent or good 88%; fair, 6%; vegetative state, 2% and death 4%.

STA-MCA bypass surgery for internal carotid artery occlusion--comparative follow-up study.

Sixty-three patients with internal carotid artery occlusion manifesting as transient ischemic attack or minor stroke received superficial temporal artery-middle cerebral artery bypass surgery and medical treatment (n = 27) or medical treatment only (n = 36). Long-term follow-up showed that there was no significant difference in the outcomes. However, positron emission tomography studies suggested that patients with misery perfusion in the chronic stage benefited from extracranial-intracranial bypass surgery.

Ruptured anterior communicating artery aneurysm causing bilateral abducens nerve paralyses--case report.

A rare case of bilateral abducens nerve paralyses after rupture of an anterior communicating artery (AcoA) aneurysm occurred in a 56-year-old female after sudden onset of severe headache. Bilateral abducens nerve paralyses were present without additional neuro-ophthalmological signs. Computed tomography revealed subarachnoid hemorrhage (SAH).

[Problems of surgical treatment for multiple intracranial aneurysms].

A series of 105 patients presenting with multiple aneurysms and subarachnoid hemorrhage (SAH) were operated on for ruptured and unruptured aneurysms between 1976 and 1984. Clinical factors other than the severity of SAH affecting the outcomes included: 1) Misdiagnosis of the location of a ruptured aneurysm among multiple aneurysms resulted in poor outcomes because of multiple surgical approaches or rebleeding during the acute period. 2) Combinations of aneurysmal locations requiring multiple surgical approaches, such as interhemispheric and transsylvian, during the acute stage caused worse outcomes than with multi-stage surgeries.

[Magnetic resonance imaging of aneurysmal subarachnoid hemorrhage].

Magnetic resonance imaging of subarachnoid hemorrhage (SAH) due to aneurysm rupture was evaluated in relation to CT findings in nine patients. Six patients were studied within 3 days and the other three patients were studied 4 to 6 days from the ictus of SAH using a 0.5 Tesla superconducting unit.

The effect of distraction upon bone, muscle, and periosteum.

Bone lengthening was achieved on rabbit tibias by means of callus distraction (callotasis) using a dynamic external fixator. The periosteum and the muscle fascia were labeled with metal markers; changes in position of these markers during slow progressive distraction were monitored by soft radiography. During the waiting period before commencing distraction, the periosteal markers around the osteotomy site were elevated from the bone surface by newly formed external callus.

[Risks of surgical treatment for unruptured intracranial aneurysms].

The risks of surgical treatment for unruptured intracranial aneurysms, as well as the significance of evaluating cerebral blood flow (CBF), are here reported. Out of 72 patients who underwent unruptured aneurysm surgery without such complications as occlusion of the main trunk or perforating arteries, or brain contusion, and who according to CT scans, did not have new lesions related to the operations, 18 patients (25%) developed neurological deficits postoperatively. In 17 of these 18 patients, postoperative neurological deficits (frontal sign: 7, paresis: 4, and seizure: 6 cases) disappeared within 2 weeks following the operations.

[Clinical study of growing up aneurysms: report of 25 cases].

Twenty-five cases of patients with growing up aneurysms are reported. Growth of the aneurysm was confirmed by repeated angiography within 1 month in 11 cases (short-term group), and for over 1 month in the other 14 cases (long-term group) following the initial angiography. Clinical history, shape and growth pattern of aneurysms, as well as hemodynamic factors that effect the growth were investigated in each group.

[A case of adult pilocytic astrocytoma in the right temporal lobe].

A case of adult pilocytic astrocytoma in the right temporal lobe is reported here. The patient was a twenty-four year old man, who came to the neurological division of our hospital on October 6, 1987 because of repeated consciousness-loss attacks accompanied with uncinate fit. He had no neurological deficits.

[Treatment for serious cases of ruptured intracranial aneurysms with severe subarachnoid clot].

Forty-one serious cases of ruptured intracranial aneurysms with severe subarachnoid clot were clinically analyzed, with special emphasis on the prognosis, pathophysiology, and surgical indications. All cases had thick subarachnoid clot without concurrent intracerebral hematoma and/or intraventricular hematoma causing mass signs on the CT scan. In this series, 23 cases underwent radical surgery while in the acute stage, 18 cases were treated conservatively (including 5 cases treated only by continuous ventricular drainage).

Comparison of the clinical results of STA-MCA anastomosis and the medical treatment in the cerebral low perfusion patients with viable brain tissue.

The long-term clinical results of STA-MCA anastomosis as well as the medical treatments were compared in cases that were confined as having a focal cerebral perfusion deficit with viable brain tissue, based on either the drug induced EEG and evoked potential test (DEE test) and/or by positron emission tomography (PET). The criteria for viable cerebral tissue was determined by the following four conditions: (1) functional reversibility could be confirmed by the DEE test; (2) a haemodynamic process could be found in the DEE test; (3) a haemodynamic compromise could be confirmed in the PET study; (4) misery perfusion could be confirmed in the PET study. From 1975 to 1989, 55 cases were confirmed as having viable brain tissue according to the DEE test and the PET study.

Clinical value of PET with 18F-fluorodeoxyglucose and L-methyl-11C-methionine for diagnosis of recurrent brain tumor and radiation injury.

We studied 15 patients clinically suspected to have recurrent brain tumor or radiation injury, using positron emission tomography (PET) with 18F-fluorodeoxyglucose (18FDG) and L-methyl-11C-methionine (11C-Met). PET with 11C-Met (Met-PET) clearly delineated the extent of recurrent brain tumor as focal areas of increased accumulation of 11C-Met, and was useful for early detection of recurrent brain tumor. PET with 18FDG (FDG-PET) showed focal 18FDG-hypermetabolism in one patient with malignant transformation of low grade glioma, and demonstrated its usefulness for evaluation of malignant transformation.

[A case of Klippel-Feil syndrome with crossed renal ectopia with fusion and unilateral vertebral artery occlusion].

A case of Klippel-Feil syndrome with crossed renal ectopia with fusion and unilateral vertebral artery occlusion is reported. A 61-year-old female was admitted because of having developed myelopathy, gait and sensory disturbance. The physical examination on admission revealed spastic gait and hypesthesia of the lower extremities.

Multiple medullary venous malformations decreasing cerebral blood flow: case report.

A rare case of multiple medullary venous malformations in the right cerebral hemisphere is reported. The literature review yielded only one case of multiple medullary venous malformations. Computed tomography scan showed multiple calcified lesions with linear contrast enhancement representing abnormal dilated vessels and mild atrophic change of the right cerebral hemisphere.

Effects of a Ca2+ entry blocker (nilvadipine) on acute focal cerebral ischemia in rats.

The effects of nilvadipine, a Ca2+ entry blocker, on focal cerebral ischemia were investigated in rats having unilateral middle cerebral artery occlusion. All rats had 24 h ischemia, and were divided into three groups (ten rats per group). Groups 1 and 2 received 1.

Attenuated neuropathology by nilvadipine after middle cerebral artery occlusion in rats.

We investigated the effects of nilvadipine, a calcium antagonist, on cerebral ischemia in rats. Under halothane anesthesia, 30 rats had a 3-0 nylon suture introduced through the extracranial internal carotid artery to occlude the left middle cerebral artery. Nilvadipine was dissolved in polyethylene glycol 400.

Rat middle cerebral artery occlusion using an intraluminal thread technique.

A modification of the previous methods of producing cerebral ischaemia in rats (Koizumi et al., Longa et al.), using an intraluminal thread technique, is described.

[Intraventricular hematomas associated with hypertensive intracerebral hemorrhages: with special reference to third ventricular hematoma].

Intraventricular hematoma (IVH) is often associated with many kinds of intracranial hemorrhage; for example, hypertensive intracerebral hemorrhage, subarachnoid hemorrhage, and so on. In this paper we discuss the clinical significance of IVH in the third ventricle, as well as the effects of surgical treatment. Forty-five patients were treated in our hospital because of massive IVH associated with small or mode-rate-size (hematoma volume less than or equal to 15 ml) thalamic or caudate-head hemorrhage between April, 1983 and April, 1988.

Contrast medium extravasation during cerebral angiography for ruptured intracranial aneurysm--clinical analysis of 26 cases.

Since 1976, the authors performed angiography on 837 patients with ruptured intracranial aneurysm, among which extravasation (EV) of contrast medium occurred in 26. Eleven patients underwent radical surgery within 3 hours after the EV, and four recovered well. The other 15 patients were conservatively treated, and all died.

[Combination of serial transcranial Doppler examinations and cerebral blood flow studies in the management of cerebral vasospasm after subarachnoid hemorrhage].

In 13 patients who had ruptured intracranial aneurysms, serial transcranial Doppler (TCD) and cerebral blood flow (CBF) examinations were performed in order to evaluate the degree of cerebral vasospasm. All patients showed some extent of vasospasm on angiography, which was performed between Day 7 and 10. The flow velocities of either the middle cerebral arteries or the anterior cerebral arteries, measured by TCD, began to increase on post hemorrhage Day 5, and maximum flow velocities were recorded between Day 9 and 13, with normalization occurring within the following 2 weeks.

[Regional effects of craniotomy on cerebral circulation and metabolism: PET study on the un-ruptured aneurysmal surgery].

Regional effects of craniotomy on cerebral circulation and metabolism, such as regional cerebral blood flow (rCBF), regional cerebral oxygen consumption (rCMRO2), regional oxygen extraction fraction (rOEF), and regional cerebral blood volume (rCBV) were examined by a PET (positron emission tomography) study concerning surgery that was performed on unruptured aneurysm patients. Eight patients with intracranial un-ruptured aneurysms were studied pre- and post-operatively by the 15O labelled-gas steady-state method, using HEADTOME-III. All patients underwent aneurysmal surgery performed by the transsylvian approach.

Therapeutic effects of hyperbaric oxygenation on acute focal cerebral ischemia in rats.

The effects of hyperbaric oxygenation on acute focal cerebral ischemia in rats were investigated. All rats suffered 4-hour middle cerebral artery occlusion. Nontreated controls had a 27.