In order to evaluate the usefulness of spectrum analysis for stenotic internal carotid artery disease, quantitative frequency spectrum analysis was used to study internal and common carotid artery disease from 22 control subjects-34 vessels and 31 patients-43 stenotic vessels which were diagnosed angiographically. Continuous wave directional Doppler ultrasound device and Doppler frequency spectrum analyzer were used for ultrasonic studies. Peak systolic frequency (PSF) and peak diastolic frequency (PDF) of carotid artery in normal subjects proved by angiography were constant along the vessel from common carotid to internal carotid artery at four points, and the values of PSF were between 1.4 and 4.4 KHz. The maximum PSF with stenotic internal carotid artery was regionally increased above 2.4 KHz and PSF ratio between internal carotid artery and common carotid artery (PSF-ratio (ICA/CCA)) was above 1.33. The sensitivity of PSF above 4.0 KHz for stenotic internal carotid artery disease was 72.1% and the specificity was 94.1%. The sensitivity of PSF-ratio (ICA/CCA) above 1.50 was 62.8% and its specificity was 82.3%. In the stenotic group, the % stenosis of internal carotid artery was correlated significantly (p<0.05-0.01) with PSF of stenotic portion and with PSF-ratio respectively. There is a positive linear correlation between the % stenosis of internal carotid artery (X) and PSF of stenotic portion (Y) and this is expressed as follows; Y=0.052X + 2.79, r=0.586, (p<0.001). And there is also a positive linear correlation between the % stenosis of internal carotid artery (X) and PSF-ratio (ICA/CCA) (Y) as follows; Y=0.025X + 1.11, r=0.503, (p<0.001) until about 80% stenosis. The localized elevation of PSF more than 4.0 KHz in internal carotid artery and PSF-ratio (ICA/CCA) more than 1.50 were found to have diagnostic value for stenotic cervical internal carotid artery disease. And PSF of internal carotid artery and PSF-ratio are quantitatively useful parameters for stenotic cervical internal carotid artery disease and these can be used for the detection of stenotic lesions in carotid artery disease clinically

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The effects of hyperglycemia at the time of admission and glucose intolerance on the prognosis of thrombotic internal carotid artery (ICA) occlusion were studied. Subjects and methods : Judging from the results of oral glucose tolerance test (OGTT) in the chronic stage or preictal period, the 100 subjects with thrombotic ICA occlusion were devided into the two groups. One the normal glucose tolerance group (Group A : N=38), the other the glucose intolerance (DM or IGT) group (Group B : N=45). The glucose tolerance was not determined in the 17 remainder because the OGTT was not performed. Among these subjects, 47 subjects were admitted into our hospital within 48 hr of ICA occlusion and plasma glucose were determined on admission. In these 47 subjects, relationship between plasma glucose on admission and size of infarction were studied.
Prognosis of the subjects was evaluated from the size of infarction and functional outcome on discharge. The size of infarction was determined by brain CT at the chronic stage of infarction and was calculated from the following formula : area of maximum low density/area of maximum hemisphere on CT. Functional outcome was graded upon the degree of disability on walking. In some cases, rCBF was also measured in chronic stage of infarction. The size of infarction, functional outcome and rCBF were compared between group A and group B.
1) There was no significant relationship between plasma glucose on admission and size of infarction.
2) The size of infarction in group B was significantly larger than that in group A (p<0.02). The rCBF in group B was significantly lower than that in group A (p<0.02) and there was a significant relationship between rCBF and the size of infarction (p<0.02).
3) The functional outcome in group B was significantly poorer than that in group A (p<0.02).
The adverse effects of high plasam glucose on the prognosis of cerebral ischemia was not confirmed in the present study. The outcome of ischemic cerebrovascular disease may depend upon the degree of intracranial atherosclerotic changes due to the longstanding diabetes or glucose intolerance. These results suggest that preexist glucose intolerance may give more extensive effects on the prognosis of thrombotic ICA occlusion than high plasma glucose concentration on admission.

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To clarify the action of enkephalin on cerebral circulation, the effect of (D-Ala²-Met⁵) -enkephalinamide on the response of pial vessels to electrical stimulation of superior cervical ganglion (SCG) was investigated in 8 cats.
Two cranial windows were placed in the unilateral parietal skull at the distance of 3 mm. The pial vessels were visualized by the video camera system and the diameters were measured by the width analyzer continuously. The intensity of scattering light, which mainly reflected the change in blood volume was measured by silicon photodiode attached to another window. The ipsilateral SCG was stimulated electrically (3-8 V, 300 usec, 100 Hz) for 5 minutes.
Pial arteries (113±11 μm) showed a significant decrease in diameter of 5.1-7.5% during SCG stimulation. Pial veins (87 ± 18 μm) also constricted significantly (0.9-6.0%), but to a lesser degree. Immediately after intravenous administration of enkephalin, no significant change of diameter was found in pial vessels, but the MABP decreased by 20 mmHg, and gradually returned to the initial value. Thirty minutes after the administration of enkephalin, pial arteries constricted 0.9-2.4% during SCG stimulation, but no significant constriction was observed in pial veins. The maximum constriction rates of pial arteries before and after administration of enkephalin were 9.1±1.3% and 3.4 ± 0.9 respectively with statistical significance.
The vasoconstrictive response of pial vessels to SCG stimulation was found to be diminished by the administration of enkephalin.
In conclusion, the observed elimination of vascular response may be attributable to the sympathetic inhibition mediated by the presynaptic opiate receptor of the cerebral vessels.

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Early postoperative (within three weeks) clinical course was analyzed in 25 cases of moyamoya disease on which 49 operations of encephalo-duro-arterio-synangiosis (EDAS) have been carried out as indirect EC-IC anastomosis. At high ratio of 12 out of 25 cases, early postoperative ameliorations in preoperative symptoms, which were comprised of 9 motor disturbance, 2 speech disturbance, 2 psycointellectual disturbance, 2 headache, 1 involuntary movement, 1 swallowing difficulty was noted. Though age, sex, EEG finding and usage of steroid did not correlate with the amelioration, brain atrophic finding on CT scan correlated. This result suggested that the brain scarcely functioning at critical blood supply without cerebral infarction was best imporved in the symptoms and most compatible finding with the brain on preoperative CT scan was not normal but brain atrophy. Based on the experimental result using rabbits, which consist of early postoperative dilatation of cortical arteries and communicating network formation by the neovessels in the granulation tissue formed between the cortical arteries and the scalp artery, mechanism of early postoperative amelioration of the symptoms seemed to be caused by the early revascularization during wound healing period, which resulted in cerebral blood flow increase through the transplanted donor artery.

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A case with acute-onset dementia due to left anterior paramedian thalamic infarct was reported.
The case was a 82-year-old right handed woman. She presented acute onset of memory disturbance, abulia, disorientation and dyscalculia.
CTscan showed a low density spot in the left anteromedial part of the thalamus, which included the anterior part of the dorsomedial nucleus, a part of the anterior, ventro-anterior, intralaminal and central nuclei and a part of the mamillothalamic tract.
Disorientation and dyscalculia improved moderately. But amnesia, abulia and personality change were stable over 6 months. The case was regarded as dementia due to the antero-medial thalamic lesion in the dominant hemisphere.

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This study demonstrates the serial alteration in local cerebral blood flow (LCBF) by the hydrogen clearance method, which was generated by electrolysis, in the parietal cortex, and lateral and medial parts of the striatum in rats during the proximal middle cerebral artery (MCA) occlusion. There was severe reduction of LCBF immediately after MCA occlusion with the eraly recovery in the ipsilateral parietal cortex and lateral part of the striatum. The previous reports showed that significant decrease in LCBF was still recognized 30 minutes or 60 minutes after the proximal MCA occlusion in the ipsilateral parietal cortex and lateral part of the striatum in rats. The difference between the results of the present study and those of the previous ones resulted probably from difference in the method of MCA occlusion. In the present study, MCA was occluded by ligation with a 10-0 monofilament nylon suture (22 μm in diameter), on the other hand, in the previous study, it was occluded by the clipping with a small clip or by the coagulation with bipolar cautery. The present method of MCA occlusion harmed less perforating arteries (lenticulostriate branches) than the previous ones. This early recovery of LCBF occurred probably because of the increase in circulation through the intact perforating arteries or the collateral arteries. This model of transient ischemia is reliably useful for investigation of collateral flow and reperfusion phenomena.

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Five cases of familial intracranial aneurysms occurring in two families are reported. Family A
Case 1 : A 64-year-old female experienced subarachnoid hemorrhage, and a left carotid angiogram demonstrated a saccular aneurysm of the left internal carotid artery. Case 2 : Her elder sister, aged 67, also suffered from subarachnoid hemorrhage, and a saccular aneurysm at the A₃ portion of the right anterior cerebral artery was revealed in an angiogram. Neck clippling was successfully carried out in both these cases. Family B
Case 3 : A 63-year-old male was admitted with subarachnoid hemorrhage. An angiogram demonstrated a saccular aneurysm of the right middle cerebral artery. Neck clipping was successfully performed and the postoperative course was uneventful. Case 4 : A 50-year-old female, younger sister of Case 3, also suffered from subarachnoid hemorrhage. A carotid angiogram revealed two saccular aneurysms. The right middle cerebral artery was the location of one and the left internal carotid artery was the location of one and the left internal carotid artery the other. Both were successfully clipped. Case 5 : A 35-year-old male, the son of Case 4, was admitted with subarachnoid hemorrhage. A carotid angiogram demonstrated a saccular aneurysm at the anterior communicating artery. The patient died 19 days after onset as a result of severe vasospasm. Neck clipping had not been performed.
An investigation of familial intracerebral aneurysm by the authors revealed 161 cases in 70 families to have been reported in literature. Statistically, the mean age of patients with aneurysms in familial cases is lower than that in non-familial cases. Also, the distribution by site of aneurysms in familial cases differs from that in non-familial cases. The incidence of aneurysms of the middle cerebral artery in familial cases (26.9%) is statistically higher than that of the general population (19.8%), and 17.3% of aneurysms in familial cases are located at the anterior cerebral artery as compared with 28% for the general population. In several reports, the asymtomatic members of such families were investigated and some found to have aneurysms. These findings suggest that elective angiography should be recommended in the case of certain families.

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To evaluate the antithrombogenic activity of endothelium, we injected heparin (60 U/kg) intravenously into patients with cerebral thrombosis and healthy controls, and measured blood levels of both plasma platelet factor 4 (PF4) and β-thromboglobulin (β-TG). Plasma PF4 increased transiently after 5 minutes of heparin injection, while β-TG did not. This may suggest that PF4 was released from the heparin-like molecules on endothelium. As the heparin exerts its anticoagulant activities by potentiating the antithrombin III against the proteinases of the coagulation system, further increase in amounts of PF4 released from endothelium can neutralize more heparinlike molecules on the endothelium and decrease the antithrombogenic activities of endothelium.
We designated the heparin-releasable PF4 as ΔPF4 andβ-TG just before heparin injection as pre-βTG respectively. It is assumed that ΔPF4 is one of a marker of the endothelial antithrombogenic activity and pre-βTG is the platelet function in vivo. Plotting pre-BTG on an ordinate and ΔPF4 on an abscissa, we divided the subjects into four groups, type 1 (high pre-βTG with high ΔPF4), type 2 (low pre-βTG with high ΔPF4), type 3 (high pre-βTG with low ΔPF4) and type 4 (low pre-βTG with low ΔPF4). According to this analysis, nineteen healthy controls out of 22 (86%) were plotted on type 4 dimension. However, 23 patients with cerebral thrombosis out of 44 (53%) showed abnormal profiles based on the level of pre-βTG and ΔPF4. Namely, 25% was type 1, 16% was type 2 and 11% was type 3. Furthermore, 9 out of 12 patients with recurrent cerebral thromboses were plotted in type 1, 2 or 3. These patients with abnormal profiles showed the tendency of recurrent cerebral thromboses. In the acute stage of cerebral thrombosis, further decrease in antithrombogenic activity of endothelium was revealed, in accordance with the improvement after the ictal course.
We conclude that the heparin injection test, simultaneously measuring both heparin-releasable PF4 and β-TG, is an useful method to evaluate the endothelial antithrombogenic activity. The decreased antithrombogenic activity, revealed by this heparin injection test, may play a role in the pathogenesis of cerebral thrombosis.

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Stereotactic hematoma aspiration was performed in 68 cases. Thirty seven patients were male and 31 patients were female. Their mean age was 59 years, ranging from 16 to 84 years. Rebleeding occurred in 3 cases. In case 1, surgery was performed 2 days after the onset of hemorrhage, and bleeding occurred during the operation. Fortunately rebleeding stopped almost instantly. The cause of rebleeding was considered to be due to poor control of blood pressure during the operation. In case 2, surgery was performed 5 hours after the onset of hemorrhage, and bleeding seemed to continue during the operation. CT scan, on admission, showed irregular shaped hematoma. In case 3, rebleeding occurred 7 days postoperatively. The cause of rebleeding was thought to be due to negative pressure too high for aspiration.
We think that this technique should not be performed on superacute cases because there is danger of further hemorrhage. In case of threatened herniation signs, regular surgery with total evacuation of the hematoma at one time may be preferable.
We recommend the following :
1) CT scan, laboratory data, angiography (if necessary) should be evaluated preoperatively.
2) The pressure for aspiration of the hematoma should not be high.
3) Blood pressure should be controlled pre, intra and post-operatively. The patient should rest in bed until drainage tube has been removed.

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Fifty adults cats were subjected to the study to evaluate the role of eicosanoids in cerebral vasopasm. Experimental cerebral vasospasm was produced as follows : Three days after the injection of 3 ml of autologous blood into the cisterna magna, the basilar artery was exposed transclivally and continuously irrigated with the mixture of blood and CSF incubated for 3 days at 37°C. The caliber of basilar artery and rCBF of pontine tegmental region were measured simultaneously by microphotography and heat-and hydrogen clearance method.
Cats were divided into 3 groups : non-treated cats, and cats treated with thromboxane A₂ (TXA₂) antagonists : ONO-3708, ONO-1270, (100 μg/kg/min), and prostacyclin (PGI₂) analogues : OP-41483, (75 ng/kg/min), OP-2507, (100 ng/kg/min). In fifteen nontreated cats, the caliber of basilar artery decreased 29.2 ± 4.4% (mean ± SE) of its original diameter 10 minutes after the irrigation of blood-CSF mixture and remained unchanged as long as it was irrigated. Ten minutes after the irrigation, rCBF was 24.4 ± 1.5 ml/100 g/min and gradually decreased further to the level of 18.6 ± 1.4 ml/100 g/min. In treated cats, basilar artery became spastic as well. The gradual reduction in rCBF, however, could be prevented even in animals with severe cerebral vasospasm. Both TxA₂ antagonists and PGI₂ analogues markedly inhibited platelet aggregation. The adhesion of platelets and red blood cells to the folded luminal surface was also inhibited scanning-electron-microscopically in both treated groups.
These results suggest that the accumulation of TxA₂ or the deficiency of PGI₂ in the cerebral vessel wall, if it should occur after subarachnoid hemorrhage, may not have an important role in the development and progression of cerebral vasospasm in the major vessels but significantly decrease the cerebral blood flow by increasing platelet aggregation.

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A case of intracranial fibromuscular dysplasia (FMD) with transient ischemic attack (TIA), which had a family history, was reported.
A 39-year-old female, who had juvenile hypertension, sufferd from transient left-sided numbness and hemiparesis on May 27th 1986. Her blood pressure was 140/100, neurological examinations on admission revealed no abnormalities, and head CT revealed normal. Carotid angiography showed the “string of beads” at the C5 portions of the bilateral internal caortid arteries, the she was diagnosed as FMD. The TIA disappeared after the administration of aspirin.
Her mother also had juvenile hypertension, and had admitted to our hospital because of cerebral infarction at age 55 (1982). Right carotid angiography showed “tubular stenosis” -like appearance at the M2 portion of the middle cerebral artery. She died from pneumonia on 1985, but autopsy was not done.
The etiology of cervical and cranial FMD has not been elucidated. This case is an interesting case which suggests the importance of genetic factor.

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Thirty-five patients with hemiplegia due to cerebrovascular accidents were studied with regared to the muscle wastings before and after rehabilitation training. Hemiplegics were composed of 12 improved and 23 non-improved patients. The CT scan was carried out at the midportion of the thigh and largest-diameter section of the calf. Muscle size of each cross-sectional area was measured on CT image and the increase of size (ΔS) in each muscle after training was calculated.
The ΔS of quadriceps femoris was correlated with that of whole cross-section of the thigh. The gracilis in non-affected side was not correlated with that of whole muscles. In both legs, there was an increase in leg muscle size after training. These changes were nost marked in the non-affected side of the improved patients. After training the difference between the two limbs remained unchanged.
Recovery of muscle wasting in both legs was seen first in the quadriceps in thigh and flexors in calf. Gracilis was relatively unchanged in comparison with other muscles. Remarkable increase of muscle size in non-affected side was worthwhile to note.

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Mean transit time was calculated using an intraarterial digital subtraction aortography performed in 9 patients with normal computed tomography and carotid and vertebral angiogram (contral group) and 5 patients with cerebral infarction and with severe stenosis or occlusion of internal carotid or middle cerebral artery (occlusive group). Data were obtained for right and left middle cerebral arteries (MCA). Raw data of time-DSA number curve in the region of interest set in bilateral MCA territories were analyzed by the gamma variated curve fitting technique to obtain the mean transit time (MTT) defined as ∫^∞₀t·C (t) dt/∫^∞₀C (t) dt (C (t) : DSA number at time t). There were no significant difference between the MTTs of right and left middle cerebral arteries in the control group but the MTT of the stenotic or occlusive side was significantly longer than that of angiographically normal side in the occlusive group. In the occlusive group there was no significant difference between the MTTs of right and left side after superficial temporal artery-middle cerebral artery anastomosis (STA-MCA anastomasis) resulting in their normalization compared to the control group.
In summary, analysis of MTT using DSA system and gamma variate fitting techniques is of use in evaluation of cerebral vascular hemodynamics in pre- and post-operative neurosurgical patients with STA-MCA anastomosis.

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Eight patients, aged 4378 years, with occlusion or stenosis of intracranial cerebral arteries at their main trunks were treated with intraarterial urokinase infusion within 5 hours after onset. Intracranial hemorrhage was excluded and low density area were absent on the first CT examination. Three of eight patients were diagnosed as embolism because of the sudden onset and coexisted atrial fibrillation. Middle cerebral artery (MCA) occlusion was disclosed in 5 cases. MCA stenosis, internal carotid artery (ICA) occlusion and ICA stenosis were revealed in each one case by angiography. 2472 × 10⁴units of urokinase was infused manually into the common or internal carotid artery through the catheter for angiography within 1050 minutes. Anticoagulants were not used exept in one case.
Four patients were immediately improved after urokinase infusion and discharged without any significant sequelae. Patients with mild or moderate disability due to thrombosis recovered and those with severe symptoms due to embolism scarcely improved. The follow-up CT scans revealed hemorragic infarction in only one case (embolism of MCA), although symptoms did not deteriorate.
After infusion of 48 × 10⁴units of urokinase for 50 minutes, fibrinogen and α₂-antiplasmin (α₂AP) decreased to 34% and 21% of the original values, respectively. Although the decrease of fibrinogen level is a disadvantage in this therapy, the decrease in the level of α₂ AP near the clot is probably indispensable for the fibrinolytic effect. If the endothelial damage of ischemic arteries still remain mild and reversible, hemorrhagic complication after reperfusion may rarely take place. It is suggested that intraarterial urokinase infusion is a relatively safe and effective therapy of cerebral artery occlusion and stenosis in strictly selected cases.

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