Background and purpose: Chronic inflammation plays a major role in atherosclerosis, and high-sensitivity C-reactive protein (HSCRP) is a strong predictor of cardiovascular disease. It is well known that statin therapy can improve inflammatory markers in coronary heart disease. We examined the inflammatory markers and lipid profiles in stroke patients and estimated the stroke subtypes and effects of statin therapy. Methods: The subjects comprised 189 chronic stroke (cerebral infarction and intracerebral hemorrhage; S group) patients after more than 6 months from onset, 41 asymptomatic infarction patients (A group) and 61 controls (C group). Cardioembolic infarction and acute/chronic inflammatory diseases were excluded. We measured and evaluated the plasma levels of HSCRP, interleukin-6 (IL-6), white blood cells (WBC), fibrinogen and lipid profiles. Results: The mean concentration of IL-6 was significant lower in the patients receiving sta-tin agents than in those without. Analysis of the subjects not receiving statin agents revealed that HSCRP, IL-6 and WBC were significantly higher, while high-density lipoprotein was significantly lower in the S group as compared to the controls. Conclusions: Inflammatory markers tend to be higher in chronic stroke patients than in controls, and statin agents can improve the plasma level of IL-6. Treatment of inflammation due to car-diovascular disease clearly represents a new target in preventing stroke.

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We studied the long-term outcome of hemorrhagic moyamoya disease in an attempt to clarify the natural course of this disease. Sixteen patients admitted to Aomori Prefectural Hospital were followed up for 1-161 months (mean 61 months). The outcome before rebleeding was GR (good recovery) in 6 cases, MD (moderate disability) in 3 cases, SD (severe disability) in 1 case, VS (vegetative state) in 2 cases, and D (dead) in 4 cases. Seven of the 16 patients suffered rebleeding 2-161 months later, and one patient suffered a third bleeding at 41 months after rebleeding. The rate of good recovery fell from 38 to 19% after rebleeding and the mortality rate rose from 25 to 69% after rebleeding. The causes of death were rebleeding in 9 cases, pneumonia in 1 case and renal failure in 1 case. In none of the 3 cases which underwent non-anastomotic bypass surgery could rebleeding be prevented. Thus, patients with hemorragic moyamoya disease often suffered rebleeding, and non-anastomotic bypass surgery was considered not to be effective.

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We evaluated how diagnostic imaging was undertaken in acute stroke patients. For the survey, we selected the training hospitals (1, 227 hospitals) of the Japan Neurosurgical Society or Japanese Association of Acute Medicine and sent out questionnaires to them. In total, 431 hospitals (35.1%) responded to the survey. The diagnostic imaging procedures that were performed on the acute stroke patients included CT (96%), MRI (77%), SPECT (9%), and carotid sonography (19%). For acute stroke patients, 17 hospitals carried out only MRI, and 39 hospitals performed MRI first, and then CT. The pulse sequences of the MRI for the stroke patients were very variable for each hospital. 94 hospitals (22.5%) did not own an MRI machine that could provide diffusion-weighted images. 209 hospitals (50%) operated their MRI 24 hours a day. CT and MRI were mainly performed for stroke patients, but the imaging strategy could be different at each hospital.

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In 2003, the Japan Stroke Scale-Depression Scale (JSS-D) was estabished by the Japan Stroke Society for evaluating mood disorders after stroke, especially post-stroke depression (PSD). In order to determine a strategy for the appropriate and easy diagnosis of PSD, 50 consecutive patients, who were hospitalized at Dokkyo University Hospital, were examined in terms of the prevalence and validity of evaluation at the subacute stage of stroke. We employed several different depression scales for the evaluation of PSD including the international neuropsychiatric interview based on DSM-IV (MINI), Hamilton Depression Scale (HAM-D) and JSS-D. In addition, we used the Zung Self-Rating Depression Scale (SDS), Beck Depression Inventory (BDI) and Geriatric Depression Score (GDS) as self-reported depression scales which have been applied traditionally for bedside diagnosis. As a result, the prevalence of PSD as estimated using the MINI and HAM-D was around 16% at the subacute stage, and the strongest correlation was between the JSS-D and HAM-D in comparison with other depression scales. As a marker for the diagnosis of PSD, JSS-D was thus recognized as the best scale for diagnosing PSD due to its satisfactory reliability in comparison with other scales. Our data suggested that the JSS-D should be employed firstly for the clinical diagnosis of PSD. In addition, selected items of the SDS may also be useful for the diagnosis of PSD, since the SDS has the advantage of being a pure questionnaire.

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The patient was a 57-year-old man. Twelve years ago, he was subjected to radiotherapy of both the mediastinum and apical segment of his right lung, as well as its extirpation, for the treatment of lung cancer. Subsequently, 7 years ago, he suffered from onset of left cerebral infarction, evolving into the occurrence of various sequelae including right hemiplegia and dysphasia. At this time, he was admitted to our department due to an unconsciousness attack. Upon admission, angiography verified occlusion at the origin of the left common carotid artery, stenosis at the origin of the right common carotid artery, and occlusion at the origin of the right subclavian artery. All of these multi-occlusive vascular lesions were limited to the irradiated segments, and were therefore diagnosed as radiation-induced vasculopathy (RIV). In order to prevent complication with serious cerebral circulation disorders attributable to progress of stenosis of the right common carotid artery, intravascular stenting was performed for the treatment of the above-mentioned stenosis. To our knowledge, there is no previous report documenting RIV in patients with lung cancer; however, the present case suggests that long survivors with lung cancer after radiotherapy should be regarded as a stroke high-risk group, besides being recognized as subjects for whom early detection of signs indicative of stroke and prevention of recurrence are warranted.

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We report two cases of brain infarction due to basilar artery dissection. The first case was a 41-year-old woman who suddenly suffered from headache, visual loss, and loss of consciousness when she played badminton. Diffusion weighted brain MRI revealed high intensity in the left cerebellum and left occipital lobe. An intramural hematoma in the basilar artery was observed on T1 weighted imaging. Left vertebral angiography showed stenosis in the left vertebral artery which progressed to occlusion in 3 weeks. The second case was a 74-year-old woman who developed sensory disturbance on the right side after headache. Brain MRI revealed high intensity on T2 and diffusion weighted images in part of the left thalamus and occipital lobe. An intimal flap was also evident in the basilar artery. Although left occipital artery occlusion was found by conventional angiography, the basilar, artery was normal. The patients' symptoms and signs improved gradually resulting in a benign clinical course. It is suggested that MRI is a useful procedure for the detection of basilar artery dissection. There is a subgroup of basilar artery dissection presenting brain infarction with a good clinical recovery. The clinical outcome of such cases might be determined by the site of dissection, ventral or dorsal in the basilar artery.

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We report the case of a 30-year-old man who experienced beauty parlor stroke syndrome resulting in brainstem infarction. Over the previous 3 years, he had dried his hair with a drier every day in a hanging head-hyperextended position while lying down on a sofa. He developed headache and vertigo after performing neck rotation in the same head position. Neurological examinations on admission revealed gaze nystagmus, dysarthria, dysphagia and left limb ataxia. T2 weighted MRI on day 2 disclosed a high intensity area in the left lateral medulla. Intramural hematoma of the left vertebral artery at the V3 portion was also found. Cerebral angiography on day 5 demonstrated string signs of the left vertebral artery in the same portion. The patient was diagnosed as having lateral medullary infarction caused by dissection of the vertebral artery. Beauty parlor stroke syndrome, i. e. stroke that occurs following assumption of a hanging headhyperextended position, is one of the potential risks that face even the younger generation.

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The recent development for a treatment of hypertensive brain hemorrhage (ICH) is described.
1) Patients with brain hemorrhage are selected for surgical treatment on the basis of their response to hyperbaric oxygen (H.B.O). Patients who show clinical improvement with hyperbaric oxygen therapy and undergo surgery show a significantly improved outcome. On the other hand, patients who do not show any clinical improvement with hyperbaric oxygen demonstrate a poor outcome even if surgery is performed.
There are some similarities between the effects of H.B.O and hematoma evacuation. Both these procedures decrease intracranial pressure and improve the marginal regional cerebral blood flow (r-CBF) and acidosis. However, there is one significant difference. The effect of H.B.O therapy does not last for longer than 24 hrs. Any clinical improvement returns to the pretreatment level the following mornig. Therefore, H.B.O does not offer a permanent treatment for hypertensive ICH. On the other hand, the effect of hematoma evacuation is more permanet. We therefore, postulated that patients who demonstrate clinical improvement with H.B.O would benefit more permanently from surgery.
The long-term outcome of 216 patients verified this approach. Patients with moderate brain hemorrhage for surgery based on H.B.O clearly showed a significantly better long-term outcome compared with control.
This comparative study verified the usefulness of hyperbaric oxygen therapy for selection of patients with ICH selection for surgery.
2) CT-guided intervention has been a common procedure for the last 10 years, but the real-time monitoring with CT image has not been available yet. We have developed the real-time CT-fuluoroscopy of which initial trial was reported in 1993. This paper deals with the clinical experience with its system in surgery for brain hemorrhage. A third-generation scanner equipped with a slip-ring (TOSHIBA) was used. Images were reconstructed and displayed at a rate of 6 per second with 0.83-second delay time using a newly designed array processor. These results suggest that CT-fuluoroscopy offers improved accuracy and safety in surgery for brain hemorrhage as a new neuro-navigation system and makes it possible to do free-hand puncture without stereotactic procedures.
3) Neuroendoscopy has become more popular in neurosurgery. It used to be difficult to use it for hematoma evacuation, because the surgical field was bloody which made the complete evacuation more difficult. However, since a new sheath around the tip of the endoscopy was developed, the evacuation becomes easier, and more accurate.

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In April 2003, I was nominated 4th President of the Japan Stroke Society (JSS), following Dr. Fumio Gotoh. Now, Professor Tetsuo Kanno, chairman of this annual meeting, has suggested I should speak about the present status and aims of the JSS, as the new president. In the first year, we have already resolved several issues, including 1) alliance of JSS with the Japan Medical Association, 2) establishment of the system of JSS-verified stroke specialists, 3) reorganization of various committees, 4) framing the homepage and the publicity committee, and 5) establishment and publication of the guidelines for stroke management.
Other issues which we have to settle in the near future are 1) changing JSS to a limited liability, non-profit organization ("chukan hojin" in Japanese), 2) establishment of an age-limit system in JSS, 3) increasing the number of JSS members, 4) cooperation with other stroke-related societies and associations, 5) promoting the Journal of Stroke and CVD, 6) promoting clinical trials by the JSS, and 7) developing a mass-education campaign concerning the risk of stroke in Japan.
There is much to do to ensure that the Society plays its proper role in the 21st century, so I look forward to your kind cooperation.

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