The amount of norepinephrine (NE) and epinephrine (E) in the urine of 160 stroke patients were measured both at the acute stage and at the chronic stage (31 days or later) of the diseases and a CT scan was taken simultaneously. The urinary NE and E were separated by the high performance liquid chromatography and measured by trihydroxyindole method. Forty five healthy subjects were employed as a control group.
The results were as follows :
1) In subarachnoid hemorrhage and intracerebral hemorrhage the NE and E and in cerebral infarction the NE were significantly increased in the acute stage. But, when divided by CT scan findings, the group of intracerebral hemorrhage without perforation into the ventricles showed increases of NE only and those without deviation of midline showed no significant increase of the NE and E. In cases of large cerebral infarction, both NE and E were significantly increased. It is supposed that not only the type of the disease but also the facfors such as its size, perforation into the ventricles and deviation of the midline may change activities of secretion of NE and E.
2) The NE/E ratio was significantly low in the group of intracerebral hemorrhage with perforation into the ventricles (p<0.001) and the ratio was significantly lower in the thalamic hemorrhage than in the putaminal hemorrhage (p<0.02). The rate of perforation into the ventricles was significantly higher in the thalamic hemorrhage (78.6%) than that of the putaminal hemorrhage (10.5%).
3) In the chronic stage of the stroke, the NE and E (especially E) were decreased and showed a high NE/E. ratio.

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Whole blood viscosity, RBC defomability index (D.I.) and plasma fibrinogen (fbg.) were measured in 98 cases of ischemic cerebral infarcts and its clinical implication was investigated.
The cases were divided in two groups as 38 cases of cortical infarcts and 60 cases of perforating branch infarcts from the clinical profiles with particular references to CT and angiographic findings.
1) The whole blood viscosity as corrected for hematocrit (Ht) showed a significantly higher value than that of normal controls (p<0.01).
2) D.I. of cerebral infarcts was found to be statically significantly low as compared with D.I. of normal controls (p<0.01).
3) The level of serum fbg. of cerebral infarcts in acute stage was significantly higher than those of normal controls (p<0.01).
4) The results implies that an increase of whole blood viscosity in cerebral infarcts in not necessarily dependent on an increase of Ht.
5) There were no significant differences of whole blood viscosity and D.I. between the groups of cerebral infarcts in acute chronic stages.
6) In cerebral infacts regardless of cortical and perforating branch infarcts, an elevation of whole blood viscosity and a decrease of D.I. were found bo te statistically significant as compared with normal controls.
It is concluded from these results that an elevation of whole blood viscosity is attributed to both increased level of fbg. and decreased D.I. in cerebral infarcts.

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RBC deformability index (D.I.) and whole blood viscosity were investigated in three groups of patients with ischemic cerebrovascular diseases as classified by (1) multiple infarcts, (2) main truncal artery occlusions, and (3) perforating branch occlusions. The mean value of D.I. in 18 cases of multiple infarcts were 0.687 ± 0.150 ml/min., which was significantly lower than that of normal controls (0.896 ± 0.163 ml/min. p<0.01). The mean value of D.I. in multi-infarct dementia (MID) was found to be markedly reduced to 0.514±0.160 ml/min. The mean value of D.I. in 31 cases of perforating branch occlusion was 0.776 ± 0.180 ml/min, which was a statistically significantly low value as compared with that of normal controls (p<0.01) but significantly higher than that of multiple infarcts (p<0.05). There were no statistically significant differences in D.I. between patients with main truncal artery occlusion and normal controls. These groups were further studied for D.I. in acute and chronic stages but no significant difference was found in this aspect. Whole blood viscosity was analyzed by the viscosity-hematocrit regression line and it was found that the regression line of multiple infarcts was compatible with that of acute stage including all the groups of ischemic cerebrovasuclar diseases. It is postulated from these results that D.I. together with whole blood viscosity are related with the pathogenesis of ischemic cerebral infarcts especially with that of multiple infarcts.

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Patients with ischemic cerebrovascular disease take such varied clinical courses that it has long been difficult to predict, especially in the acute stages, the prognosis precisely and to evaluate the effectiveness of any kind of treatment. Recent development in drugs with protective effects on the ischemic brain and in surgical methods for revascularization under the administration of such substances have necessitated the analysis of the socalled “natural course” of this type of stroke.
In this study, the clinical courses of 104 patients with internal carotid artery occlusion, confirmed by cerebral angiography, were prospectively analyzed. They were selected from 1000 cases with ischemic cerebrovasuclar disease collected in a cooperative study which was organized at the Eighth Annual Meeting of the Japan Stroke Society in 1983. Patients were all admitted within 24 hours from onset and were evaluated sequentially for two months, treated neither by surgery nor with such special therapeutics as barbiturates. The level of consciousness and motor function were graded using the “III-3 formula” and DeJong's criteria, respectively. Prognosis at the second month was evaluated in five grades.
Of the 104 patients, the prognosis was excellent in 5 (4.8%), good in 6 (5.8%), fair in 11 (10.6%), poor in 31 (29.8%), and 51 patients died (49.0%). The prognosis of patients over the age of 60 was worse than that of those under 60. The site of occlusion, extra- or intracranial, had no significant relation with the prognosis. Among the 104 patients, 30 had thrombosis and 55 had embolism' the prognosis of the latter being significantly worse than that of the former. The lower the level of consciousness on admission, the worse the prognosis. Among the patients in a grade II or III state of consciousness, about 75% died. It was also found that the lower the grade of motor function on admission, the worse the prognosis. Among the patients with a grade 2 motor function or worse, almost none of the patients returned to social life.
According to the size of low density areas (LDAs) in CT scans, patients were divided into four groups. The larger the size of LDA, the worse the prognosis. When the LDA covered the whole territory fed by the middle cerebral artery, no patients returned to social life. Among those in whom the LDA extended over the area fed by two or more main trunks, 90% died. Hemorrhagic infarction was detected in the CT scans of 19 patients, but the prognosis was unaffected by its presence or absence. Hemorrhagic infarction occurred within the first week in 7 patients, among whom 6 died of cerebral infarction and one died from pneumonia.
Finally, 51 patients died during the two month follow-up period. Dead cases were older than survivors. Among the 51 dead cases, 40 died of cerebral infarction in the early stage, mostly within the first two weeks with a peak on the 4th day and 11 died of systemic complications at various times during the follow-up period. The mean age of the latter was higher than that of the former.

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Regional cerebral blood flow (rCBF) was measured using N-isopropyl-p- [¹²³I] Iodoamphetamine and single photon emission computed tomography in patients with stroke. During the acute stage (N=6) the area of reduced rCBF was larger, often including the cortex, compared with the relatively limited area of the low density on CT scan. During the chronic stage (N=3) the reduction of rCBF corresponded well to the zone of the low density on CT scan. Among 4 patients with TIA or RIND, 2 patients showed the reduction of rCBF during the symptom-free period. Two patients with Moya-moya disease with a history of TIA also showed reduced rCBF in the clinically suspected regions. Two patients with stroke during the acute phase showed focal hyperemia in or around the CT low density.
The hemodynamic change in the ischemic tissue after stroke was evaluated by correlating the qualitative analysis of rCBF with the clinical, CT and angiographic findings.

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Elevated plasma concentrations of fibrinopeptide A (FPA) and fibrinopeptide Bβ_15-42 (FPBβ) are direct evidence for enhanced thrombin and plasmin activities in plasma respectively. Plasma FPA and FPBβ levels were measured serially following stroke by specific radioimmunoassays in 19 patients with cerebral hemorrhage and 30 patients with cerebral infarction. Based on the findings of cranial computerized tomography, patients with cerebral infarction were divided into 2 subtypes : main trunk artery type and deep branch artery type infarction.
In patients with cerebral hemorrhage, FPA levels were greatly elevated and exceeded FPBβ levels immediately following stroke. This was followed by a rapid increase in FPBβ levels, with peak FPBβ levels occurring on the 1st day after ictus.
In patients with main trunk artery type infarction, FPBβ levels were mildly to moderately elevated and exceeded FPA levels immediately following stroke. FPA levels increased gradually and peaked on the 3rd day after ictus only in patients with stroke progression. In contrast, FPA levels did not increase with time in patients who remained stable.
In patients with deep branch artery type infarction, no significant changes in both FPA and FPBβ levels were observed following stroke.
These results suggest that the pattern of plasmin activity following thrombin activity after cerebral hemorrhage may represent a common hemostatic response to injury, and also that the pattern of gradual increase of thrombin activity after main trunk artery type infarction may represent stroke progression closely associated with development of thrombus formation.

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It has been reported that frontal subcortical involvement was important in multi-infarct dementia (MID), and the multifocal reduction of the regional cerebral blood flow (rCBF) has been reported. To investigate these points, localization of the lesions on CT scan and the patterns of rCBF were examined in fifteen MID patients, and compared with twenty-nine non-demented lacunar stroke patients.
Both Hasegawa's intelligence score and Hachinski's ADL score were correlated with rCBF and brain atrophy only in MID.
There was no significant difference in localization of the lesions between the two groups. Brain atrophy in MID was significantly severe than that of non-demented patients.
Mean rCBF in MID was significantly lower than that in non-demented lacunar stroke patients. The significant reduction of rCBF was observed in bilateral fronto-parietal regions in MID.
Conclusions; These results suggested that brain atrophy is more important than localization of the lesions, frontoparietal rCBF reduction is charactaristic in multi-infarct dementia.

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In order to evaluate the effects of therapeutic methods which have recently been performed for patients with cerebral infarction in acute stage, it seems essential to clarify the clinical course of cerebral infarction from acute stage after onset.
In the present study, clinical course in 188 cases of middle cerebral artery occlusion admitted within 24 hours after onset was investigated.
The prognosis in 183 cases at 2 months after the onset was as follows : excellent in 16 cases (8.5%), good in 23 cases (12.2%), fair in 49 cases (26.1%), poor in 74 cases (39.4%), dead in 26 cases (13.8%). In died 26 cases, 14 cases were dut to the complications, and 12 cases died from cerebral infarction directly without any complications, in which 7 of 12 died of hemorrhagic infarction.
The relationship between the prognosis and the occlusive lesions revealed that the prognosis of the occlusion at the origin of middle cerebral artery was poorest, and it is better at the more distal site of occlusion.
By classification into embolism and thrombosis, 90 were classified as embolism, 44 thrombosis and 54 unknown. The prognosis of patients with embolism was significantly worse than that with thrombosis. In addition, all patients with thrombosis died of complications.
Hemorrhagic infarction was observed in 49 cases. The prognosis of hemorrhagic infarction was significantly poorer than that of non-hemorrhagic infarction. In 99 cases of embolism, hemorrhagic infarction was observed in 33 in tis rate as high as 37%, but it was also observed in 6 (14%) out of 44 cases with thrombosis.
Neurological symptoms at the admission were closely related with the prognosis. 40% of patients with the consciousness level “O” (alert) at admission showed excellent or good prognosis, and were possible to return to the social life 2 months after onset. While the severer disturbance of consiousness resulted in poorer prognosis, and in cases of Grade III, nearly 90% of cases died, for which, there was significant difference.
In 162 survived cases after 2 months, about 80% cases of slight motor disturbance over grade 4 at admission showed the recovery up to the favorable motor function with grade 4-grade 5, while its degree became 40% in the moderate disturbance grade 3-grade 2 at admission. Only 10% casse with severe disturbance of grade 1-grade 0 at admission showed favorable recovery. Dead cases were distributed widely from slight to severe motor distubances at admission and no distinct difference was observed.

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The influence of hypertensive intracerebral hemorrhage on systemic blood pressure (SBP) was investigated in a series of 57 cases with thalamic hemorrhage (Th-H) and 23 cases with putaminal hemorrhage (P-H).
There were no differences in mean values of systemic blood pressure during Day 1 to 3 between Th-H and P-H (181/106 mmHg and 171/104 mmHg, respectively). Systemic blood pressures on Day 7 were significantly lower than those of Day 1-3 in both groups, and blood pressure still continued to decrease until Day 30.
The difference in systemic blood pressure between acute (Day 1-3) and chronic (Day 30) stage (%Δ SBP) was significantly larger in Th-H than in P-H.
Neither the systemic blood pressure in acute stage nor that in chronic stage appeared to be influenced by the hematoma size in both groups.
Among Th-H, blood pressure in patients presenting Homer's sign tended to be lower, and was more frequently normalized in chronic stage than those without Homer's sign.
The fact that there were some differences in changes of blood pressure during the course of illness between Th-H and P-H may be partly due to difference in effects on the hypothalamus. The hypothalamus has been known to play a role in regulating autonomic nervous system as the central level. A large number of studies has revealed the function of each hypothalamic nuclei, where the stimulation of the posterior and lateral region increase the sympathetic activity, while that of anterior region does the parasympathetic activity. In Th-H, effect of hematoma on the hypothalamus is thought to be larger than in P-H. The posterior region of the hypothalamus is more easily stimulated by the hematoma than the anterior region because of the anatomical localization. Then, an increase of the blood pressure in acute stage could have been larger than that of P-H.
In patients presenting Homer's sign, the sympathetic activity must have been decreased by direct invasion or destructive effect of hematoma. When the hematoma causes hypofunction of the posterior region, Homer's sign may appear and the blood pressure does not increase significantly.

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The influence of rebleeding due to ruptured cerebral aneurysm on results of their treatment was investigated.
The study included 414 cases of ruptured aneurysms admitted to our clinic within 48 hours after the last bleeding. They were divided into two groups : admitted after “Initial bleeding”, 278 cases and “Rebleeding” 136 cases. In these two groups the patient's condition on admission, the results of treatment and the timing of rebleeding were investigated.
As the results, the patient's condition on admission (Hunt and Kosnik's grading) was better in “Initial bleeding” group than in “Rebleeding” group significantly. Operative and overall results were better in “Initial bleeding” group also. There was no significant difference of results of treatment between two groups in cases of same condition.
In “Rebleeding” group the timing of rebleeding was analysed and many rebleeding (71%) occured within 24 hours, especially (55%) within 6 hours after the initial bleeding.
It is concluded that the prevention of rebleeding in ultra-early stage is the most important in the treatment of ruptured cerebral aneurysms.

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Arterial bruit was auscultated over the eyeball, carotid and femoral areas in 1050 patients aged 40 to 88 years (average 63 years) and the relationship between ocular bruit and ischemic stroke and other atherosclerotic diseases was studied. Ocular bruit was detected in 43 of the 1050 patients (4%) and in 25 of 300 patients aged 70 or more (8%). Not only ischemic stroke but ischemic heart disease, intermittent claudication, hypertension and diabetes mellitus were significantly more prevalent in patients with ocular bruit than in those without. The incidence of carotid or femoral bruit and roentgenologic calcification of the aortic arch, abdominal aorta and carotid sinus were also significantly higher in patients with ocular bruit than in those without.
Dynamic responses of ocular bruits to various maneuvers were evaluated by recording them with a phonocardiograph. Leg-raising, paperbag rebreathing, contralateral carotid compression or inhalation of amyl nitrite resulted in augmentation of the bruits in over 70% of patients. Arrhythmias such as ectopic beats or atrial fibrillation induced a beat-to-beat change of the bruits.
In conclusion, ocular bruits were not rare in older patients and there was a close relationship between the bruits and generalized atherosclerosis. Ocular auscultation is useful not only in the evaluation of neurologic patients, but also in the recognition of asymptomatic cerebral atherosclerosis.

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