Cerebral angiography is now applied not only in cerebro-neuralgical fields but also by general clinicians and considered as very effective intracranial diagnostic method.
The authors performed this method to many patients in our hospital and the result of our experiences are as follows:
1) The method of carotid and vertebral angiography are described shortly.
2) For past seven years 152 cases were examined by this method and 508 pictures were taken.
3) Sex: The numbers of male patients were two times than female ones.
Age: The youngest was 5 years old, the oldest are 68 years old.
4) Cerebral tumor cases were most frequently examined, then head injuries and cebrovascular diseases.
5) There were two cases of complications: one was permanent and another was temporary hemiparesis. The incidence rate was 1.3% in patient cases and 0.4% in injection numbers.
6) Fifty % Hypaque was regarded as best opaque material by literature, but we believe 60% Urografin has the least complications.
7) Sixty % Urografin for angiovascular opaque injection is safe and effective, therefore we expect this method will be applied more generally and commonly in this diagnostic field.

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The problems involved in the diagnosis and treatment of cerebral vascular disorders were investigated on the patients who were seen at the Neurological Service of Nagoya National Hospital since 1961, and their various data including autopsy, operative, cerebral angiographic, and other clinical findings were available.
The problems of differential diagnosis, interpretation of cerebral angiographic findings and EEG findings, clinical observations including physical findings and their development, and interrelationship between these findings were reviewed on the material, Moreover, the indication of surgical approach for cerebral vascular disorders was discussed.

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For the purpose of studying of the structure of the brain blood vessels and the pathologic changes of them simultaneously, a new method using barium sulphate has been carried out.
This method is effective not only for observation of the extracranial large vessels but also the capillaries of the brain. Relation between quantity of barium sulphate and radiological finding of brain capillaries depends on the pressure & speed of injection and the vessel to be injected dye.

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Lots of hemiplegic patients has been visiting our hospital for the purpose of receiving balneotherapy. Now I would like to report the plan and effect of their treatment.
In order to avoid various accidents, first of all, the patients should be checked for the function of heart, kidney and blood vessels of retina. Next, muscle strength, range of motion, activities of daily lives (ADL-test) and psychiatric and psychological conditions must be evaluated. Then we could decide the procedure of treatment by refering the above examinations.
In practice, we use splints, sandbags and pillows for the prevention of deformities of limbs. As soon as the signs of acute distress disappear, we move their limbs (for a short time) several times a day. About 10 days after the onset we usually begin massage. The affected limbs should be exercised with the help of non-affected limbs in order to protect from the contracture.
When the patient starts to move the affected limbs by himself, various exercises such as getting up, standing up or walking should be added. But most of our patients had to waste many days prior to admission, so that we usually perform physio- and balneotherapy from the beginning of admission, and certainly these therapies combined with adequate exercises increase the effect of rehabilitation.
In hydrotherapy we usually use tepid water-bath, which does not elevate blood pressure, so we can use that at about 1 month after the onset, By bathing, the stiffness and pain diminish by the improvement of blood circulation, and in water we can move more easily by its buoyancy. From these reasons we use Hubbard tank-bath, airbubble bath, orthopedic pool, hand- and foot-bath for hemiplegic patients.
We treated 56 hemiplegic patients in 6 years (from 1957 through 1962), and we would like to show some statistics about them.
1) Most of them (especially cerebral hemorrhage and thrombosis) were 50 to 70-years-old.
2) Improvement of physical conditions are found in 38 patients (about 68% of all).
3) In a few patients, improvement was remarkable at the 3rd or 4th day of treatment, but many of them showed improvement after a couple of months. After three months of treatment, usually the grade of improvement becomes poor, so we guess the therapies at home are more suitable than that in hospital thereafter. But in fact, many of the patients have been staying in our hospital for 1 or 6 months.
4) Those who entered the hospital over 1 year after the onset, the effect of therapies was less remarkable than others.
5) Our therapies were non-effective for the following cases.
a) One patient who didn't like to move by himself.
b) Five patients who couldn't perform the exercises because of heart or kidney trouble.
c) Nine patients whose symptoms were stationary because they were too late to come to our hospital.
d) Five patients who were psychotic due to cerebral arteriosclerosis.

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Recently head injury, especially the severe cases, are increasing. Because of the requirement of quick diagnosis and adequate treatment for neurological diseases, the specialization of Neurology-neurosurgery clinic is now establishing in Japan. In our clinic also we founded the “Center for Neurological Diseases” since 1963. The anthers reported the statistical studies of head injuries and the results are as follows:
1) Out-patient of head injury is increasing; this shows that people payed increasing attention to this kind of disease.
2) Head injury by traffic accident is increasing.
3) Severe case of head injury is increasing and sequelae are also increasing.
4) Funduscopic examination, vestibural test and cerebral angiography become principle tests for head injury.
5) Urea, Mannitol, Centrophenoxine and Kymopsine become important drugs for head injury.
6) Total operations are 26 cases: and of 11 cases of acute hemorrhage 5 deceased, of 15 patients of subacute hemorrhage no deceased case.
7) Nine patients are treated by hypothermia; of 6 operated cases 2 deceased and of 3 conservatively treated patients 1 deceased. In all cases hypothermia was very effective.

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A 28-years-old man was admitted on April 16, 1983, with the chief complaint of loss of right eyesight 3 hours after the accident.
The fractures of right optic canal was observed, decompression of the right optic canal was curried out 8 days later.
Twelve hours after the surgery he obtained a little recovery of visual acuity, but thereafter remained in the same degree.
At any rate, authors believe, decompression of the optic canal for the optic nevre injuries due to fractures of the optic canal should be performed for the purpose of diagnostic aid and therapeutic procedure as soon as possible.

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The author described techniques and effects of therapeutic hypothermia in neurosurgical practice at The 1st Tokyo National Hospital.
The techniques used are artificial hibernation and mild hypothermia. For the former “lytic cocktial M₁” after Laborit (Wintermin 1, Pyrethia 1, Opistan 2), for the latter placing the patient in contact with several bags containing ice at head, neck, axillary groove and inguinal region are used. The degree of hypothermia obtained varies from a restoration of normal temperature to a lowering general body temperature to 35.5°C to 36°C of rectal one.
Fifteen cases of severe head injury, 10 cases of immediate postoperative dysfunction of brain tumor and each one cases of apoplexy, encephalitis and brain damage due to anoxia during general anesthesia, were treated with this procedure.
All severe head injury cases had neuro-vegetative signs due to compressing brain stem (unconsciousness, hyperthermia etc.). They recovered from the cerebral trauma with our hypothermia except one boy of six years old who had hemorrhagic diathesis.
Immediate postoperative unconsciousness and hyperthermia of brain tumor patients were treated by our hypothermia with sucess. This patientY had been critically ill previously.
A patient with apoplexy who recovered well without hyperthermia by our hypothermia.
A patient with encephalitis was treated with our procedure for 60 days keeping her rectal temperature around 36.5°C. Her hyperthermia disappeared with improving her consciousness, and she recovered without sequellae.
A patient with brain damage after anesthesia passed through dangerous period with our hypothermia.

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This is the clinical report on the congenital abnormalities, which contain hydrocephalus, craniostenosis, cranial and spinal dysraphism, congenital brain cyst, cleidocranial dysostosis and pericranial sinus.
Six cases among 14 hydrocephalus and 11 cases among 12 craniostenosis were used instrument at birth or experienced prolonged delivery.
In the craniostenosis, 7 cases among 12 were early closing of coronal suture and closing of lamboid, then sagittal sutur were followed. As the clinical symptoms of the craniostenosis, characteristic deformity of the skull, visual disturbance or papilledema, motor palsy of extremities and epileptic seizure were observed.
In the 14 hydrocephalus cases, 12 were non-obstructed and 2 were obstracted one. Subarachnoid-peritoneal shunt formation for non-obstructive hydrocephalus and ventriculoauricular shunt for obstructive one were performed.
Most important point in neurosurgical care of the congenital abnormality is early diagnosis and treatment.

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is is the clinical observation on the 177 confirmed cases by the neurosurgical procedure and necropsy.
Among them, 95 males and 82 females, two third were 20 to 50-years-old of age. Main diagnostic procedure was cerebral angiography.
The pathological classification showed almost same frequency in the gliomatous group, meningioma and others. The localization of the tumor at the brain is closely related with pathological classification.
Post-operatively 40% of cases survived for 3 years or longer.

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We evaluated neurosurgical cases at our hospital from 1959 through 1962 and examined post-operative death cases.
1) They were 19 cases of intracranial tumors 215 cases of head injuries and 7 cases of others.
2) Mortality rate after surgery of intracranial tumors was 29%; 10% in supratentorial and 75% in infratentorial tumors.
3) A case of pinealoma was treated by radiotherapy, which was so effective that the symptome had completely disappeared for a short time, but later on the patient died.
4) In cases of metastatic tumor from carcinoma of the lung, as it tends to occur inn many places, we should remove main tumor and at the same time use other treatment such as chemotherapeutic agent for cancer.
5) In two cases of acoustic neurinomas we attempted to remove completely, but both of them died, so we felt keenly importance of choice of technique.
6) In cases of head injury we operated 15 cases and 3 cases died. That mortality rate was 20%, but all of them were complicated cases in acute distress and had had severe damage in the brain already.
7) On operating cases such as serious head injury, we should proceed as soon as possible and apply hypothermia before operation, through and after.
8) We operated 5 cases of the other intracranial lesion and one died. That mortality rate was 20%.

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Activated vitamines administered to the cases of multiple sclerosis, amyotrophic lateral sclerosis and chorea with favorable results by B-1, while little effect with vitamine B-6 and B-12.
For numbness, pain, vertigo, etc., we gave also activated vitamine B-1 with some effect.
It may be emphasized that the dosis is not so important, but the duration of administra-tion is rather important.

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This is a case of cerebellar abscess that originated from cholesteatomatous otitis media. The patient was 19-years-old female, who showed an acute sign of otitis media. After removal of cholesteatoma a tympanoplasty was performed.
A few days later, she developed a typical sign of cerebellar dysfunction and a cerebellar abscess was confirmed by several tests including a puncture of abscess.
The patient recovered completely without any residue after operation.

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