In cases with occlusion of the middle cerebral artery (MCA) or the internal carotid artery (ICA), the size or distribution of cerebral infarction varies widely. The purpose of this study is to reveal several factors which influence the size of cerebral infarction in MCA and ICA occlusion.
One hundred and seventeen patients, 68 with ICA occlusion and 49 with MCA stem occlusion, were examined. Occlusion were confirmed angiographically in 40 cases, and by autopsy in the remaining 77 cases.
The relationship between the size or distribution of cerebral infarction and collateral circulation on angiography, changes of blood hematocrit values and blood pressure in acute stage. In most cases only ipsilateral collateral cir-culation were studied, because four-vessels study could not be performed for elderly patients.
The results were as follows :
1) Ipsilateral collateral circulation were poorer in cases with massive infarctions than in those with small in-farctions in deep areas or borderzone areas.
2) Blood pressure in acute stage was significantly lower in cases with small infarction in the deep areas or in borderzone areas than in cases with massive infarction.
3) More than 5% increase of hematocrit values was found more frequently in cases with large infarctions than in cases with small infarctions.
It is suggested that the size or distribution of cerebral infarction in ICA or MCA stem occlusion is determined not only by the degree of collateral circulation, but also by blood pressure in acute stage, and the rate of increase in the hematocrit values between before and after stroke.

View full abstract

In children with occulsion of the circle of Willis, so called Moyamoya disease (MMD), the most common clinical manifestation is transient ischemic attacks (TIAs). TIAs are often encountered during crying, blowing balloons or eating hot foods seemingly relating with hyperventilation. Occurrence of TIAs is most frequent in the first decade, and somehow attacks tend to cease after advance of age. The purpose of this study is to clarify whether age factor is participated with frequent occurrence of TIAs in MMD children.
Materials and Methods : Thirteen MMD children with ages ranging from 3 to 16 years were subjected in this study. These children had recurrent TIAs since 2 to 10 years of age but no neurological deficit at the time of study. In these children, regional cerebral blood flow (rCBF) was measured by ¹³³Xe inhalation methods during resting state and/or hyperventilation; and relationships of age, rCBF and frequency of TIAs were analyzed. The rCBF was measured also in 29 adult controls who had TIAs but no MMD.
Results : At the time of this study, all MMD children below 10 years of age had frequent repetition of TIAs, while 3 of 5 older children had no TIA for the last 6 months to 6 years. Thus, the lower the age, the more frequent the occurrence of TIAs. In 12 children, TIAs were often precipitated by hyperventilatory behaviors, such as crying. In 3 children with 5 to 7 years of age, TIAs occurred during voluntary hyperventilation which was performed at the time of EEG recording.
The rCBF (ISI) values in MMD children measured during resting state were 64.3 ± 10.2, and those in adult TIA patients were 45.2 ± 4.3. The former was significantly higher than the latter (p<0.001). Among children the youngest case had the highest rCBF, and there was a negative correlation between age and rCBF (r=-0.77, p<0.01). When measured during hyperventilation, rCBF was 50.0 ± 12.2 in children (n=6) and 32.8 ± 4.3 in adults (n=10). Thus, rCBF during hyperventilation was still higher in MMD children than adults (p<0.005). Here again, a negative correlation was seen between age and rCBF among MMD children (r=-0.94, p<0.01).
Comments : The present study showed that MMD children below 10 years of age had higher rCBF level compared to older children or adult TIA patients both during resting state and hyperventilation. Despite such a flow condition, these children frequently showed TIAs during hyperventilatory behaviors, such as crying or blowing balloons. Adult TIA patients never showed ischemic symptoms during hyperventilation.
It is considered likely that young children are more susceptible to ischemic anoxia compared to adults. Cerebral oxygen metabolism is known to be much greater in the first decade of life than in later decades, and hence, higher level of rCBF may be needed in this low age period to maintain normal cerebral function. Frequent occurrence of TIAs in young MMD children may be partly attributed to such a hypersusceptibility of juvenile brain.

View full abstract

In the past six years 257 patients with cerebral aneurysm were treated, and carotid-choroidal aneurysm was observed in 13 cases (5%) of them. Direct method-clipping was carried out on all the patients. In one week after opreation, cerebral angiography was conducted, and the disappearance of the a. choroidal artery was observed in high frequency, i.e. 7 of 13 cases. In 5 cases out of them post-operative disturbance of consciousness, mental symptoms in various kinds, contralateral hemiplegia and sensory disturbances, and homonynous hemianopia were observed, and infarction foci were proved in the dominant field of the a. choroidal artery in CT scanning. These seven cases are divided into the following
1) In the two cases cerebral aneurysm was broken, causing great hemorrhage, and was clipped unavoidably under impossible condition of detachment of ant. choroid. art. from aneurysm.
2) In the three cases cerebral aneurysm was relatively large, having a broad neck, and detouching was difficult, and therefore these wee obliged to clip.
3) In the remaining two cases the patients were asymptomatic.
The prognosis of these neurological symptoms was very bad, and accordingly discreet attention should be paid to keep the a. choroidal artery in the operation of carotid-choroidal aneurysm.

View full abstract

Twenty one patients with hypertensive intracerebral hematoma admitted within 8 hours after the onset were examined by contrast enhancement CT scan.
In 7 cases out of 21, diffuse contrast enhancement effect was observed in the bilateral cerebral cortex. In 4 cases contrast enhancement effect was observed in only the affected side of cerebral henisphere. In other ten cases, contrast enhancement effect was not observed.
In cases without enhancement, the consciousness disturbance was mild and the volume of hematoma was 38 ml on average. In cases with unilateral enhancement, disturbance of consciousness was moderate and the volume of hematoma was 50 ml. In cases with bilateral enhancements, 6 cases out of 7 were in comatous state and the volume of hematoma was 114 ml on average. Thus the appearance of this contrast enhancement effect was significantly correlated with the level of consciousness and the volume of hematoma.
The pathogenesis of this contrast enhancement effect was discussed.

View full abstract

Twenty six cases of hypertensive pontine hemorrhage were experienced in our clinic from June, 1978 to April, 1982. They consisted of 20 males and 6 females between 33 to 68 years old.
The size of hematoma was measured by CT taken within 24 hours after the onset. And the relation between the size of hematoma, neurological findings and prognosis was studied.
On admission, the level of consciousness was clear in five cases, somnolent or semicomatous in seven cases and comatous in 14 cases. Thirteen patients fell into comatous state within two hours after the onset. The transverse diameter of hematoma was 13.8 ± 2.9 mm (mean ± SD) in clear patients, 16.7 ± 6.4 mm in somnolent or semicomatous patients and 25.5 ± 4.0 mm in comatous patients.
Out of 16 cases of which the transverse diameter of hematoma was more than 21 mm, 11 cases died, three cases became vegetative state and two cases improved. On the contrary, nine cases improved and one case died of GI bleeding out of 10 cases of which the diameter of hematoma was less than 20 mm.
Findings suggesting good prognosis are as follows : no or mild distrubance of consciousness, normal pupil, transverse diameter of hematoma is less than 20 mm. Most of the cases which showed poor prognosis fell into comatous state within two hours after the onset. Their pupils were delated bilaterally, pinpoint, or anisocoric. And the transverese diameter of hematoma was more than 21 mm.

View full abstract