Japanese Journal of Stroke
Online ISSN : 1883-1923
Print ISSN : 0912-0726
ISSN-L : 0912-0726
Volume 4, Issue 1
Displaying 1-10 of 10 articles from this issue
  • Part 1. Hemodynamics at the center of the focal cerebral infarction following recirculation
    Akira Ogawa, Hirohumi Seki, Takashi Yoshimoto, Jiro Suzuki
    1982 Volume 4 Issue 1 Pages 1-9
    Published: March 25, 1982
    Released on J-STAGE: September 03, 2009
    JOURNAL FREE ACCESS
    The pathophysiology at the center of foci of cerebral infarction was investigated in terms of cerebral blood flow, EEG and histological study. The experimental model for focal cerebral infarction was the thalamic infarction model in the dog. The rCBF was measured using the hydrogen clearance method, simultaneously with recording of thalamic EEG from the same site. Dogs were subjected to temporary vascular occlusion for 30, 60, of 120 minutes, and both rCBF and EEG were recorded for 24 hours after recirculation.
    The rCBF of the thalamus was found to be 33±9 ml/min/100g under mild pentobarbital anesthesia. Due to occlusion there was a fall in rCBF to below about 9±2ml/min/100g in the portion of the thalamus showing diminution of fast wave components with attenuation of voltage in EEG recordings. In the dogs with 30 minute temporary occlusion, one showed a transient increase following recirculation but it returned quickly to the control level and was maintained thereafter. Histologically, no infarction was found. In contrast, in the dogs with 60 and 120 minutes temporary occlusion, all showed rCBF values 2-4 times higher than those of controls. Those values decreased with time, but remained high for 24 hours Recovery of thalamic EEG was not seen and histological examination revealed an infarction confined to the thalamus.
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  • Part 2. Hemodynamics in and around the focal cerebral infarction following recirculation
    Akira Ogawa, Hirohumi Seki, Takashi Yoshimoto, Jiro Suzuki
    1982 Volume 4 Issue 1 Pages 10-17
    Published: March 25, 1982
    Released on J-STAGE: September 03, 2009
    JOURNAL FREE ACCESS
    Using the canine thalamic infarction model, recirculation was allowed after two hours of occlusion. Changes in rCBF and EEG activity were determined at three locations in and around the infarctic focus, i.e., in the center of the focus, within its outer border and just outside the outer border.
    Severe ischemia developed at the center of the focus due to vascular occlusion and there was attenuation of voltage and decreased fast wave components in the EEG. In the peripheral region of the infarction, there were no notable changes in the rCBF, but decreases in fast wave components and the appearance of slow waves was seen. In the region just external to the focus, there was slowly increasing hyperemia, but no changes in electrical activity of the brain were apparent.
    Subsequent to recirculation, a long-lasting hyperemia arose at the center and periphery of the focus, and an abnormal CO2 response was found. The EEG showed gradual flattening of electrical activity. The hyperemia which appeared during occlusion at sites external to the focus recovered rapidly following recirculation, and no abnormalities in the CO2 response were seen in this region. Notable changes were not seen in the EEG.
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  • Timing and effect of operation in occlusion of the circle of Willis in children
    Youko Kato, Kazuhiro Katada, Youichi Shinomiya, Hirotoshi Sano, Tetsuo ...
    1982 Volume 4 Issue 1 Pages 18-24
    Published: March 25, 1982
    Released on J-STAGE: September 03, 2009
    JOURNAL FREE ACCESS
    There have been many papers about occlusion of circle of Willis since 1956, when Kudo et al. reported the first case. However its causal genesis and treatment are still controversial. Therefore, an investigation was made in order to clarify the indication and timing of the operation for occlusion of circle of Willis considering from cerebral angiograms, CT findings and pre-and-post operative clinical symptoms.
    Eight infantile cases out of eighteen cases of occlusion of the circle of Willis were operated in our university hospital from 1977 to 1980. These cases were classified into 3 types. Type 1 means early stage of occlusion of circle of Willis. Occlusive lesion is still confined in the anterior half of the circle of Willis and development of Moyamoya vessels or collateral circulation is incomplete. CT reveals within normal limits or mild hemiatrophy.
    Type 2 means typical cases of occlusion of circle of Willis with Moyamoya vessels or transdural anastomosis. CT reveals watershed infarction or cortical atrophy. Transit type means cases resemble to adult type. Cases of type 1 with operation (STAMCA anastomosis +EMS) improved well immediately after operation, and postoperative angiogram revealed marked increase of blood flow in MCA territory. However, cases of type 1 without operation became type 2. Cases of transit type were not improved well by operation. Therefore, timing and indication of the operation for occlusion of circle of Willis are good during the stage of type 1.
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  • Clinical investigation of the acute cerebrovascular disease Part 4. Questions to the surgical indication of hypertensive intracerebellar hemorrhage
    Fuyuki Mitsuyama, Kazuhiro Katada, Youichi Shinomiya, Hirotoshi Sano, ...
    1982 Volume 4 Issue 1 Pages 25-29
    Published: March 25, 1982
    Released on J-STAGE: September 03, 2009
    JOURNAL FREE ACCESS
    Recently the most of the reported papers concerning to the indication for the hematoma removal of the cerebellar hemorrhage, indicate that hematoma larger than 3 cm in diameter must be removed.
    However, in this paper, the authors presented 4 cases who survived and showed relatively satisfactory recovery course with some cerebellar dysfunction in conservative treatment.
    Therefore, the authors suggested that the conservative treatment for the cerebellar hemorrhage could be worth to reconsider as a first choice of the treatment.
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  • Part I : Reproducibility of regional and mean hemispheric CBF values
    Yukito Shinohara, Shigeharu Takagi, Keitaro Kobatake
    1982 Volume 4 Issue 1 Pages 30-37
    Published: March 25, 1982
    Released on J-STAGE: January 22, 2010
    JOURNAL FREE ACCESS
    The purpose of this investigation was to clarify the reproducibility of the values of cerebral blood flow (CBF) measured by the 133Xe inhalation method. Two measurements of regional CBF were made at 13 locations in each hemisphere in 19 subjects with an age range of 19 to 83 years (mean age 51), with an interval of 10 to 70 minutes between the serial runs in each subject. The blood flow of the fast compartment (gray matter) of the brain (F1) was calculated as well as the initial slope index (ISI), the relative weight (W1) and the fractional flow (FF1) of the fast compartment. Because it was found that the maximal count rate per 5 seconds recorded from the region (MC) is an important factor for good reproducibility, only the data obtained from detectors with values of MC in the both measurements of 1000 counts or more were analyzed in this study.
    The mean value of hemispheric F1 of the second measurement was significantly smaller (-7.6 ml) than that of the first measurement (79.3±18.4 ml per 100 gm brain per minute). The mean value of ISI of the second measurement was also significantly smaller (-5.7) than that of the first measurement (57.3±13.8). This decrease of the mean hemispheric F1 or ISI was especially large in young subjects or subjects with high flow values. There was actually no difference of W1 and FF1 between the two measurements. There was no significant difference in PaCO2 or mean arterial blood pressure in the serial measurements. The reasons why F1 and ISI decreased are discussed.
    The values of variation coefficient (V.C.) of the change of mean hemispheric value from the first to the second measurement were 7.6% (F1), 13.9% (ISI), 4.1% (FF1), and 6.4% (W1). The V.C. of the changes of regional values were 13.8% (F1), 14.6% (ISI), 5.4% (FF1), and 9.3% (W1). The intermeasurement correlation coefficients of mean hemispheric F1 and ISI were 0.95 and 0.85, respectively. Analysis of the intermeasurement correlations of regional F1 and ISI also revealed significant correlations, though the degrees of correlation (F1 0.82, ISI 0.78) were less than those of the mean hemispheric values. From these data we conclude that the large variation of regional CBF values as measured by the 133Xe inhalation method must be taken into account, especially in assessing the effects on CBF of various factors, such as activation, sleep or vasoactive agents.
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  • Part II : Factors influencing CBF reproducibility
    Shigeharu Takagi, Yukito Shinohara, Keitaro Kobatake
    1982 Volume 4 Issue 1 Pages 38-43
    Published: March 25, 1982
    Released on J-STAGE: January 22, 2010
    JOURNAL FREE ACCESS
    The reproducibility of the cerebral blood flow (CBF) values measured by the non-invasive 133xenon inhalation method was reported in our previous article. The purpose of this investigation was to clarify the effects of various factors upon the reproducibility of this method. Two measurements of regional CBF were made at 13 locations in each hemisphere by the 133Xe inhalation method in 19 subjects with an age range of 19 to 83 years (mean age 51), with an interval of 10 to 70 minutes between the serial runs in each subject. The blood flow of the fast compartment (gray matter) of the brain (F1) was calculated as well as the initial slope index (ISI), as a flow index of predominantly gray matter, the relative weight (W1) and the fractional flow (FF1) of the fast compartment.
    The mean value of hemispheric F1 or ISI of the second measurement was significantly smaller than that of the first measurement.
    The variation coefficient (V.C.) of the change of regional F1 or ISI value was closely related to the geometric mean (MC) of maximal count rate per 5 seconds recorded from the same region in the first and second measurements.
    The values of V.C. of the changes of regional F1 and ISI from regions with MC of 1000 or more were 15.6 and 14.6, respectively. Those from regions with MC of 1400 or more were 11.6 and 10.4, respectively. These values were smaller than the V.C. of the changes of regional F1 (19.1) and ISI (15.2) from all regions. The correlation coefficient of regional F1 in the first and the second measurements from regions with MC of 1400 or more was 0.86, whereas that of regional F1 from all regions was 0.76.
    From these data, it appears that a high count rate of 1000 to 1400 counts or more per 5 seconds is essential if good reproducibility is to be obtained.
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  • Takeshi Saito, Takamaru Tanabe, Seiji Morii, Hiroshi Takagi, Kenzoh Ya ...
    1982 Volume 4 Issue 1 Pages 44-53
    Published: March 25, 1982
    Released on J-STAGE: January 22, 2010
    JOURNAL FREE ACCESS
    The present study was designed to define the effect of hyperdynamic state produced by infusion of a large amount of human albumin upon neurological manifestations caused by cerebral vasospasm. No other drugs which have vasomotor effects were administered.
    Eight patients, including six preoperative patients, who developed neurological deficits associated with angiographically proven cerebral vasospasm were subjected to this study.
    Standard dose of albumin infused in this series was 1.5 g/kg/day to 2.0. Duration of the treatment ranged from 6 days to 16 days with an average of 10 days. Average amount of fluid infused during the treatment was 3, 200 ml/day.
    During the therapy, Swan·Ganz catheter was employed to monitor intravascular volume and cardiac function. Colloid. osmotic pressure (COP) was measured with IL 186 oncometer at regular interval. Intracranial pressure was monitored continuously by subdural balloon method.
    All the cases showed marked improvement of the neurological status following to the treatment. Finally, seven of the eight cases recovered completely without any neurological deficits.
    During this hyperdynamic treatment, COP elevated significantly, which led to hypervolemia. Cardiac index increased markedly while systemic arterial pressure remained unchanged. No elevation of intracranial pressure was observed by the infusion of a large amount of albumin. None of the patients developed cardiac or pulmonary dysfunction despite of marked increase of intravascular volume estimated by significant elevation of cardiac index and pulmonary artery wedge pressure.
    The authors believe that the hyperdynamic treatment by giving only a large amount of albumin is the most effective and a safe method in treating neurological manifestations caused by vasospasm due to subarachnoid hemorrhage.
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  • Analysis of 48 cases in the acute stage
    Jun-ichiro Choki, Takenori Yamaguchi, Yutaka Hirata, Mikio Tashiro, To ...
    1982 Volume 4 Issue 1 Pages 54-62
    Published: March 25, 1982
    Released on J-STAGE: September 03, 2009
    JOURNAL FREE ACCESS
    In order to reestablish the precise clinical image of cerebral embolism by comparing with those of nonembolic cerebral infarction, 48 cases of cerebral embolism were selected from 274 consecutive cases of cerebral infarction who were admitted within one week after the onset. The diagnosis of cerebral embolism was made by the following criteria; 1) abrupt onset and completion of focal cerebral symptoms and signs, 2) presence of embolic sources, and 3) evidence of systemic embolism.
    Patients with cerebral embolism showed more severe symptoms than those of nonembolic cerebral infarction. Disturbances of consciousness of various degrees were seen in more than one half of the cases with cerebral embolism. Eleven patients died during admission, and 15 were disabled at the time of discharge.
    Forty-six cases had cerebral lesions in the territory of the internal carotid artery, while only one case in regions supplied by the vertebro-basilar artery system and one in both systems. There was no difference in the incidence of involved sides.
    Among 42 patients in whom cerebral angiography was performed, 38 cases had arterial occlusions, and four cases showed normal angiograms. Eleven lesions were found in the internal carotid artery (ICA), eight in the stem of the middle cerebral artery (MCA), 18 in the branches of MCA, four in the anterior cerebral and one in the vertebral artery (VA). Radiolucent shadows which were thought to be emboli were frequently seen in large cerebral arteries, in eight of 11 cases with ICA occlusion, in four of eight MCA stem occlusion and in one VA occlusion. Only four out of 18 MCA branch occlusion showed emboli on cerebral angiogram.
    Follow-up angiography was performed in 21 cases, and 18 of them showed the reopening of previously occluded arteries.
    Hemorrhagic infarction occured in 12 of 36 cases in which CT and/or cerebrospinal fluid examination were done at the appropriate time. Deterioration of consciousness was observed in only four cases of 12 hemorrhagic infarction. It seems that hemorrhagic infarction does not necessarily worsen the symptoms in the majority of cases.
    Twenty-one recurrent embolic events occurred in 16 cases during admission not only in the brain but in various parts of the body. They tended to occur frequently within two weeks after the onset of cerebral embolism. When embolic episodes which occured before the admission were included, 88 events occured in 48 patients in total; 66 events occured in the brain, nine in the extremities, seven in the abdominal organs and one in the ophthalmic artery.
    In summary, clinical manifestation of cerebral embolism were variable and much more severe than those of cerebral thrombosis. The incidence of reopening of the occluded arteries was extremely high as it is mentioned in the literatures, although that of hemorrhagic infarction was somewhat lower than that reported in the pathological studies. It seems necessary to differentiate the cases of cerebral embolism from those of nonembolic infarction and to treat them differently, since cerebral embolism has such specific features in its clinical manifestation.
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  • Comparison of embolic with nonembolic cerebral artery occlusion
    Kazuo Minematsu, Takenori Yamaguchi, Jun-ichiro Choki, Tohru Sawada, M ...
    1982 Volume 4 Issue 1 Pages 63-70
    Published: March 25, 1982
    Released on J-STAGE: January 22, 2010
    JOURNAL FREE ACCESS
    We reported earlier that bilateral carotid ligation in hyprertensive rats caused much more pronounced ischemia than in normotensive rats. Results of the study suggested that hypertension may predispose to production of larger cerebral infarcts when the main cerebral arteries are occluded.
    In order to elucidate the role of hypertension in production of cerebral infarcts in humans, 80 patients with definite embolic cerebral infarction (ECI) and 69 with nonembolic cerebral infarction (NECI) admitted within two weeks after onset were analyzed in the present study. Diagnosis of ECI was made only when the patient met at least two of the following criteria; 1) abrupt onset and completion of focal cerebral symptoms and signs, 2) presence of embolic source, and 3) evidence of systemic embolism. Arterial occlusion and/or reopening of occluded artery were confirmed by cerebral angiography in the majority of cases. The ratio of the largest low Vat area to the largest hemispheric area in CT films (expressed in %) was used to represent the size of the infarct (Infarct-Index).
    When the Infarct-Index in the ECI-group was plotted against the mean arterial blood pressure (MABP) at 0, 7, 28 and 60 days after the onset, a significant positive correlation was obtained at each stage. In the NECI-group, no correlation was present at all.
    When the ECI-group was further divided according to the site of occlusion, i.e. the internal carotid, the middle cerebral artery (MCA) stem and MCA branch occlusion, significant positive correlations were obtained only in patients with embolic occlusion of MCA stem and branch at the chronic stage (28 and 60 days after the onset). As blood pressure is unlikely to be modified by an event that occurred in the brain one or two months before, the level of blood pressure in the chronic stage may well reflect the habitual blood pressure before the stroke. Thus, the above evidence that the correlation was highly significant 60 days after the onset of ECI, strongly suggests the importance of longstanding hypertension in production of larger infarct when the main cerebral artery is abruptly occluded.
    To clarify the speculation mentioned above, Infarct-Index was related to MABP before the onset of stroke in patients whose blood pressure had been periodically checked at the outpatient clinic. The correlation was again significant at 5% level in the ECI-group.
    Further, patients with history of hypertension showed a higher mean Infarct-Index, and worse outcome than those without history of hypertension. Those differences were significant only in the ECI-group, but not in the NECI-group.
    From the result of the present study, it is concluded that longstanding hypertension may not only be the most important risk factor of stroke, but also play an imprtant role in production of more severe and larger ischemia especially when the main cerebral artery is abruptly occluded.
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  • 1982 Volume 4 Issue 1 Pages 71
    Published: 1982
    Released on J-STAGE: September 03, 2009
    JOURNAL FREE ACCESS
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