We evaluated lesions at the common carotid artery bifurcation and in the internal carotid artery of patients with carotid stenosis employing carotid ultrasonography, multidetector-row CT (MDCT) and magnetic resonance angiography (MRA). We calculated the degree of stenosis with both the area methods and the North American Symptomatic Carotid Endarterectomy Trial (NASCET) methods. The findings of MDCT and MRA were analyzed with reconstruction images as the multiplanar reconstruction (MPR) and maximum intensity projection (MIP). In the short axis area method, we recognized a strong correlation in stenosis rates between MDCT and MRA, and between MRA and ultrasonography. In the NASCET methods, a correlation of stenosis rates was noted only between MDCT and MRA. We recognized a correlation only between MRA and ultrasonography by the short axis area method in the calcification group. It is inferred that MDCT is as useful as the other two methods.

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To assess the relationship between neurological severity on admission and outcome at discharge in hy-peracute ischemic stroke, we analyzed 4, 019 patients who were admitted to hospital within 3 hours after stroke onset among 16, 922 patients registered at the central office of Japan Multicenter Stroke Investigators' Collaboration (J-MUSIC). We examined the association between NIHSS score on admission and mRS score at discharge. The frequency of a good outcome (mRS score of 0-1), poor outcome (score of 4-5), and death was 75.2%, 5.1%, and 1.0% in patients with an admission NIHSS score of 0-4; 41.0%, 22.7%, and 2.4% in those scored at 5-9; 19.6%, 46.0%, and 8.3% at a score of 10-14; 8.3%, 58.7%, and 18.4% at a score of 15-20; and 4.2%, 50.8%, and 39.6% at a score of ≥21, respectively. In patients with an NIHSS score of 0-4, the frequency of a good outcome was highest in lacunar stroke (P=0.0004), and among those with a score of 5-9, cardioembolic stroke patients revealed the best outcome among the various stroke subtypes (P= 0.0300). On the other hand, the death rate was highest in cardioembolic stroke among the stroke subtypes in those with a score of 15-20 and 21 or more (P=0.0354). As regards the effect of age on outcome, the frequency of a good outcome was higher in patients at-64 years old than in those at 65-74, and ≥75 years old, who presented an NIHSS score of 0-4, and 5-9 (P<0.0001 for each group). In conclusion, the NIHSS score on admission was a strong predictor for patient's outcome at discharge. However, stroke subtype as well as patient's age also contrib-utes to outcome in patients with acute ischemic stroke.

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A 56-year-old woman was admitted to our hospital because of sudden onset of pain in the lower back and gait disturbance. On admission, she showed a minimal degree of paraplegia, hyperreflexia in the lower extremities, a positive Babinski's sign on the left side, sensory impairment of the right femoral region, and urinary incontinence. Thoracic T₂-weighted MRI revealed a mass with a mixture of predominantly low and focally high intensity at the posterior aspect of the spinal cord at the 10th and 11th thoracic vertebral level. An intramedullary high intensity area was also noted. There were no flow voids in the mass which compressed the spinal cord. The mass was in the intradural perimedullary space and was enhanced irregularly on imaging after administration of gadolinium. At the time of surgery, a hematoma occupied the subarachnoid space at the 10th thoracic vertebral level. Following removal of the hematoma, an elliptical mass connected by two vessels was found behind the spinal cord. One of the two vessels was a posterior radicular artery. Histolopa-thological examinations of the removed mass demonstrated a mixture of dilated abnormal veins and an abnormal artery. She was diagnosed as having perimedullary spinal AVM based on the operative and histopathological findings. The intramedullary high intensity area on T₂-weighted MRI was considered to be congestion and edema because this finding disappeared after the operation. Our patient displayed a sudden onset of myelopathy. Such an onset was atypical because spinal AVM usually exhibits a chronic progressive myelopathy. We speculate that the myelopathy in our patient was due to compression of the spinal cord by the hematoma, and intramedullary congestion and edema. Spinal AVM should be considered when a patient displays acute-onset myelopathy with lower back pain, even if MRI fails to show typical flow voids in the spinal mass lesion.

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A 75-year-old right-handed man was admitted to our hospital because of progressive disturbance o speech and clumsiness of the right hand. Before admission, the blood pressure (systolic/diastolic) of the pa tient had been kept under 120 mmHg/70 mmHg with antihypertensive drugs. Over 10 months, despite thf administration of antiplatelet drug, his language function and dexterity of the right hand had deteriorated in stepwise fashion. Brain MRI revealed fresh infarction in the left frontal lobe and old infarction in the lef parieto-occipital watershed territory. MRA demonstrated severe stenosis of the left internal carotid artery SPECT showed a decrease in left hemispheric perfusion, particularly in the anterior and posterior watershec territories. The Standard Language Test of Aphasia identified a decrease of spontaneous speech and distur bance of auditory comprehension, objective naming and repetition, indicative of mixed type aphasia. Neuropsychological examinations disclosed limb-kinetic apraxia and ideomotor apraxia, predominantly on the right side. Discontinuance of the antihypertensive drugs resulted in improvement of the aphasia and apraxia On the basis of the clinical course and findings of neuroimaging, the progressive aphasia and apraxia appearec to be caused by the sequential occurrence of hemodynamic infarctions due to excessive antihypertensive therapy. We conclude that physicians should pay careful attention to fluctuations of higher brain functions it patients with stenosis or occlusion of the main vessels during antihypertensive therapy.

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A 72-year-old woman was admitted to our hospital because she felt weakness of the first and second fin-gers of her left hand. She had non-insulin dependent diabetes mellitus and was managed with oral antidiabetic drugs (glibenclamide and voglibose). A diffusion weighted image of brain MRI on the day revealed a spotty high intensity lesion in her right frontal subcortical area. Transesophageal echocardiography and RI venography demonstrated patent foramen ovale and deep venous thrombosis. She was diagnosed as having paradoxical brain embolism and was started on oral warfarin (3 mg daily) on 12 July 2002 to prevent subsequent stroke. On the day, she suffered hypoglycemic attacks in the evening, and despite glucose transfusion, hypoglycemia occurred frequently. Before starting warfarin, she had never experienced hypoglycemia. After glibenclamide administration was stopped, she no longer had hypoglycemic attacks. Although interactions between glibenclamide and warfarin have been recognized, only a few reports have described hypoglycemia caused by the interaction of glibenclamide and warfarin. Attention should be paid to this problem in the case of patients who need both warfarin and glibenclamide.

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The discovery of the neurogenesis, migration and differentiation of neural stem cells in experimental models of stroke reveals a potential new facet of recovery after stroke that may translate into new treatments for stroke and other neurological disorders. New neurons are regenerated and functional recovery is enhanced with neural stem cell transplantation in stroke. In this review, we summarize the recent experiences about intravenous transplantation of human neural stem cells in various stroke models.

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