The relationship between bruits over the carotid arteries in the neck and occlusive lesions of the extracranial carotid arteries has been recognized. The diagnostic implication of carotid bruits as an indicator of extracranial arterial lesion has been emphasized. However, less attention has been paid to the bruits over the subclavian artery. In the present study, nine patients with bruits over the subclavian artery were examined to study the significance and the difference from carotid bruits.
From angiographical findings of the subclavian artery, two patients had stenosis of more than fifty percent. Six patients had wall irregularity. One patient had normal findings.
From angiographical findings of the internal carotid artery, two patients had stenosis of more than fifty percent. Two patients had stenosis of less than fifty percent. Two patients had wall irregularity. Three patients had normal findings.
In six patients with wall irregularity of the subclavian artery, bruits over the subclavian artery were always audible in one patient. Bruits were sometimes audible in five patients.
In four patients with stenosis of less than fifty percent or wall irregularity of the internal carotid artery, bruits over the internal carotid artery were sometimes audible in one patient. Bruits were not audible in three patients.
Bruits over the subclavian artery were more frequently audible in patients with more mild lesions of the subclavian artery than those of the internal carotid artery. In addition, the chances of bruits over the subclavian artery were more variable.
It is suggested that these results are due to the differences of anatomical constitution, flow velocity and hemodynamics of the subclavian artery and the internal carotid artery

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In evaluating the hemodynamic status of the brain in patients with ischemic cerebro-vascular disorders, the use of an invasive method may occasionally be precluded by patient's old age and the presence of complications. In such an instance we electively use RI angiography with ^99mTc-HSA as a less invasive method of evaluating cerebral hemody-namics.
This procedure was performed in a total of 30 patients at our department, 22 inpatients with ischemic cerebrovascular disorders and $ with headache who served as controls.
Time activity curves constructed from RI angiograms thus obtained were classified into 5 types according to their pattern. The pattern of time activity curve had no correlation with the size of infarcted area but was found to correlate with the length of time elapsing from the onset (disease stage) and hence was thought to be of prognostic value.
The mean transit time, half time and appearance time to peak time were estimated for each type of time activity curve. However, values of these parameters for any type of the curve were not significantly different from control values. It was thus considered that comparing the curves, as they were, from the healthy and affected sides of the patient's brain was the simplest and most useful method of understanding the existing status of ischemic cerebrovascular disorders

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Two hundred and two patients with subarachnoid hemorrhage (SAH) due to ruptured intracranial aneurysms admitted to our clinic, of which 40 cases were observed without radical operations, and were investigated in this paper. Average age of this group was older than other group significantly. In the cases of over 70 years old, radical operation should be indicated properly. Aneurysms of vertebro-basilar system were found in 7 cases (15%). Vertebro-basilar aneurysms were not operated during acute stage, because many perforating arteries around basilar top aneurysm cannot be identified in the dense suba-rachnoid clot. However vertebral aneurysms, which do not have important perforating arteies around itself, will be operated during acute stage in the future.
In patients who were transfered to our clinic within 24 hours after the onset of the disease, several cases with no operative indication showed sevee CT grade, intracerebral hematomas and/or subdural hematomas. But in patients who were transfered over 24 hours after the onset of the disease, some cases were not indicated for the operation because of angiospasm on angiogram, though they showed mild SAH in CT scan or the patients were in good level of consciousness.
All patients of ruptured intracranial aneurysms should be transfered to the clinics in which neurosurgeons are available on full-time basis

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The aspiration of intracerebral hematoma (ICH) through burr hole is recently perfomed in stead of removing ICH by craniotomy. Stereotactic technique is usually used to aspirate hematoma. But authors simplified the operations by using free bands. Burr hole was made, orientating from CT finding, i. e., distance from Orbito-Meatal Line and midline of forehead. Hematoma was taped and aspirated. Irrigation or drainage of ICH was not performed.
These methods were carried out in three cases of putaminal hematoma and four cases of thalamic hematoma. The result of operation was excellent in all putaminal cases and good in only two cases of thalamic hematoma. Because primary damage of the brain was severe in the thalamic hemorrhage.
Our protocol of the treatment of ICH is described below. When ICH is larger than 6cm in diameter, craniotomy is immediately performed and hematoma is removed. When ICH is larger than 3cm and the patient exhibits hemiplegia, craniotomy is immediately performed. If the patient exhibits mild or moderate hemiparesis, conservative treatment is recommended. If the conservative therapy is continued more than one week and clinical signs are not improved, then aspiration of ICH is performed

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In order to elucidate the cerebral circulation before and after shunt in patients with normal pressure hydrocephalus(NPH), a comparative study of 12 cases was performed using dynamic CT.
In the effective shunt group, blood flow in the frontal gray matter and PVL was improved. The improvement in PVL was particularly marked. On the other hand, in the non-effective group, blood flow in the frontal gray matter was reduced compared with that before operation.
In regard to predicting the effectiveness of the shunt from the features of preoperative dynamic CT study in NPH, it is suggested that blood flow in the frontal gray matter was lower in the effective shunt group than in the non-effective group.
This cerebral circulation study using dynamic CT, which can be easily manipulated, is non-invasive, and is thought to be a useful method when highly reproducible parameters are chosen

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To study the relationship between activity of daily living (ADL) and serum lipo-proteins in patients with cerebral thrombosis (CT), serum lipids and lipoproteins were measured in 29 cases of healthy person, 41 cases of CT (21 cases of well ADL, 20 cases of poor ADL who are the bed ridden patients in need of constant nursing care) and 10 cases of cerebral hemorrhage (poor ADL).
The results were as follows.
(1) HDL cholesterol (CH) in the poor ADL group with CT was lower than that in healthy persons and well ADL group.
(2) Atherogenic Index (AI) in the poor ADL group with CT was higher than that in healthy persons and well ADL group.
The possibilities for the cause of decreased serum HDL-CH and increased AT in the poor ADL patients with CT might be considered to be as follows

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A 25-year-old male sustained head injury and was admitted to our hospital about two hours later. CT scan on admission showed traumatic intracerebral hematoma in the right basal ganglia without mass effect and its ventricular rupture was also found. Skull plain film showed no fracture. Follow-up CT scan about 19 hours after injury showed enlargement of the hematoma with minimal perifocal edema. Right carotid angiogram performed just after the initial CT scan showed extravasation of the contrast medium. Clinically he was comatose and decerebrated. He died about 21 hours after head injury.
It is a matter of common knowledge that we can sometimes find extravasation of the contrast medium on cerebral angiogram, but extravasation of the contrast medium into the traumatic intracerebral hematoma is relatively rare and minimal.
In this case, intracerebral extravasation of the contrast medium was considered to be the radiological feature of active hemorrhage, because the enlargement of hematoma on CT scan performed both just before and after the cerebral angiography was recognized

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A 7-year-old girl first noticed slight difficulty in gait and pes equinovarus. Later the symptoms gradually worsened. Neurological examination revealed spastic gait, exagger ated deep tendon reflexes, pes equinovarus, rigidity, postural and action tremor of upper limbs. In the morning the neurological examination was normal. In the afternoon she had a tendency to fall. CT-scan showed mild frontal lobe atrophy. Because of clinical features, L-DOPA therapy was started. L-DOPA produced a dramatic improvement of symptoms. Although HPD might reflect the functional disturbance of the striatum, CT-findings suggested that the pathogenesis of HPD might be linked with frontal lobe atrophy

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Twenty-eight cases of intracranial arachnoid cysts in children aged 3 months to 16 years (mean 4 years) have been studied and the location of cysts and clinical symptoms were correlated. Twenty-two patients were male, and six were female. In twenty-two patients, the cysts were located in the middle cranial fossa, and there was a higher incidence on the left side (16 case…s86%); 3 in the posterior fossa, and 3 in the convexity.
A rare case of the middle fossa arachnoid cyst was presented. A 6-year-old-boy had proptosis from birth and many cafe au lait spots. The optic fundus was normal, as was visual acuity. Computed tomographic scan showed left parasellar cystic collection with thinning of sphenoid wing and mild proptosis of the left eye.
The other congenital anomalies were associated with arachnoid cysts in nine of 28 cases, which were cutaneous, cardiac, and skeletal disorders. Most frequent clinical symp-toms were convulsions, and delayed motor and mental development

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There have been very few reports of venous angiomas of the posterior fossa. Since 1977 only 14 cases including our case have been reported.
We experienced a case of venous angioma of the right cerebellar hemisphere with intra-cerebellar hematoma. The patient was a 41-year-old man, complaining of occipitalgia, diplopia and gait disturbances. Neurological examination revealed the paralysis of the right 6th, 7th, 8th, 9th, 10th and 11th cranial nerves, right limb ataxia, truncal ataxia, nystagmus and slurred speech. Plain CT showed high density area (HDA) in the right cerebellar hemisphere. Enhanced CT showed cord-like high density between the HDA in the right cerebellar hemisphere and the right sigmoid sinus. Serial vertebral angiogram showed “umbrella-like” abnormal veins in the right cerebellar hemisphere which converged centripetally into a single large vein draining into the right sigmoid sinus.
We tried to remove the hematoma surgically, but the operative procedure was discon-tinued after finding a large superficial red vein on the right cerebellar hemisphere.
We discussed clinical features, diagnosis and treatment of the venous angioma of the posterior fossa

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On June 15, 1982, a 74-year-old man was admitted to our hospital complaining of vertigo, headache and tinnitus. A pulsatile bruit was audible at the left mastoid region. The left carotid angiogram revealed a dural arteriovenous malformation (AVM) in the region of the left transverse-sigmoid sinus. Feeders of the dural AVM were the dural branches of the occipital arteries, muscles and the meningeal branches of the vertebral artery and the ascending cervical artery. The draining veins were transverse-sigmoid sinus. Many kinds of surgical treatments were carried out; 1) intra-arterial embolization by silicone spheres via the left occipital artery 2) Bucrylate and Aron Alpha A were injected through the occipital artery 3) ligation of the bilateral external carotid arteries 4) separation of periosteum from the occipital bone.
After the operation, vertigo, headache and tinnitus disappeared. He had had no com-plaints during the ensuing two years. The reports in the literature were reviewed

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Two cases with giant aneurysm of the cavernous carotid artery were directly operated upon.
Case 1: A 68-year-old female was admitted on Nov. 12, 1981, complaining of double vision on left lateral gaze. Neurological examination revealed left abducens palsy and hypesthesia on the left forehead. A CT scan revealed a parasellar mass lesion. Left carotid angiography demonstrated obstruction of the left internal carotid artery in the cavernous portion.
Case 2: A 56-year-old male was admitted complaining of headache, nausea, vomiting, left ptosis, and double vision. On neurological examination left total ophthalmoplegia and hyperesthesia on the left forehead and cheek were found. A CT scan revealed a parasellar mass lesion. Left carotid angiography showed complete obstruction of the left internal carotid artery in the cavernous portion.
IC trapping was carried out in both cases with concomitant incision of the lateral wall of the cavernous sinus and evacuation of the aneurysmal contents. In case 1, simultaneous EC-IC bypass operation was also performed. In both cases postoperative course was favorable without any complications or neurological disturbances.
The objectives of the surgical treatment of infracrinoid giant aneurysms are: (1) to eliminate mass effects and pressure on adjacent structures, (2) to prevent aneurysmal rupture, and (3) to maintain or enhance the circulation to the brain. Our operative technique is described with particular emphasis on its safety and effectiveness

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The barbiturate-induced coma has been studied experimentally and used clinically to protect the brain from the various damages. In the present clinical study, barbiturate was used in five patients with severe head injury and eleven patients with severe cerebro vascular diseases.
The therapy was started with intravenous infusion of 500-1000mg (15mg/kg) of thiamylal, then the continuous intravenous administration of 5mg/kg/hr thiamylal was carried out. Depth of induced coma was maintained at the level of burst and suppression pattern on EEG. High-dose barbiturate therapy was continued in all patients for at least 72 hours, and mannitol and steroids were continued in patients under controlled respiration and circulatory monitoring. Four of the five patients with severe head injury returned to a productive life and one remained moderately disabled. Two of the six patients with ruptured aneurysm, who fell under the clinical grade of IV or V by Hunt and Kosnik, returned to a productive life, one was severely disabled and three died. One of the two patients with arteriovenous malformation became excellent and the other died. One of the two patients with cerebellar hematoma and a patient with pontine hemorrhage returned to a productive life.
Barbiturates were useful in the treatment of uncontrolled intracranial hypertension and severely brain-injured patients, but dosage, indication and duration of administration were clinically not clear. The use of high-dose barbiturate was suggested as an indication for patients who were unresponsive to other forms of therapy

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It is well known that phenytoin (DPH) has an adverse effect on cerebellar function. Epileptic patients receiving large doses of DPH are reported to show diffuse degeneration and loss of Purkinje cells, and atrophy and gliosis of the molecular layer in autopsied brain tissue. The aim of the present study was to investigate the effects of DPH on mouse Purkinje cells in infantile and adult normal mice.
Materials and Methds:
Weaning (groups A, B, C, D and H) and adult (groups E, F, G and I) mice of ddY strain were used. DPH was administered intraperitoneally in 0.5% traganth solution and control animals were given 0.5% traganth solution alone.
The DPH administration schedule was as follows:
Groups A (N=6) and B (N=6); From 20 days after birth, 5mg/kg. b. wt (A) or 10mg/kg. b. wt (B) of DPH was administered daily for 20 days.
Groups C (N=7) and D (N=5); From 10 days after birth, 10mg/kg. b. wt (C) or 50mg/kg. b. wt (D) of DPH was administered daily for 20 days.
Groups E (N=6), F (N=6) and G (N=5); 5 mg/kg. b. wt (E), 10mg/kg. b. wt (F) or 50mg/kg. b. wt (G) of DPH was administered daily for 20 days.
Group H (N=4); On 20 days after birth, 100mg/kg. b. wt of DPH was given as a single injection.
Group I (N=5); 100mg/kg. b. wt of DPH was given as a single injection.
Groups A, B, C, D, E, F and G were decapitated next day after the last injection and groups H and I were decapitated 20 days after that. After fixing the brains were weighed. The degeneration and loss of Purkinje cells were examined histologically by hematoxylin-eosin and phosphotungustic acid-hematoxylin stainings.
Results:
In the groups given a small dose (A, B, C, E and F), the weight of brain did not change but degeneration and loss of Purkinje cells were recognized in infantile mice. Infantile mice receiving a large dose, i. e. group D, showed not only weight loss of the brain, but also changes of Purkinje cells, although adult mice in group G showed only changes of Purkinje cells, the weight of the brain remaining unchanged. In the group with single injection, a loss of brain weight and changes of Purkinje cells were not recognized.
Conclusion:
It is possible to conclude that long term administration of DPH causes a prominent disturbunce of cerebellar function, especially in the infantile period

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We evaluated 35 stroke in-patients by method of Manifest Anxiety Scale to know their psychological problems. Anxiety scores shown by many of the patients were higher than normal range, so we analysed the relationship between their scores and 21 variables which were thought of the factors influencing their psychological state, by means of multivariate analysis and analysis on each factor.
The results of multivariate analysis were as follows:
1) The anxiety scores shown by the patients who had had occupations before their attack, were significantly low.
(Especially male patients showed this tendency. )
(2) The anxiety scores shown by the patients who had ataxia or hemianopsia, were significantly high.
The result of analysis on each factor was as follows:
3) Sex determination significantly influenced on the anxiety scores.
(Female showed higher scores.)

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