Japanese Journal of Stroke
Online ISSN : 1883-1923
Print ISSN : 0912-0726
ISSN-L : 0912-0726
Volume 9, Issue 1
Displaying 1-12 of 12 articles from this issue
  • Itsuro Kobayashi, Shinichiro Uchiyama, Reiko Sato, Takashi Nagayama, S ...
    1987 Volume 9 Issue 1 Pages 1-5
    Published: February 25, 1987
    Released on J-STAGE: September 03, 2009
    JOURNAL FREE ACCESS
    We examined a quantitative relationship between platelet aggregation and ATP release reaction using 182 subjects including healthy control, cerebral thrombosis and TIA. We determined the released amount of ATP on luminescence curve which was obtained by an addition of 10μM of authentic ATP. The above value was compaired to the intensity of platelet aggregation.
    Significant positive correlations were observed between the maximum aggregation (M%) and the time which reached maximum aggregation (Tm) and the amount of released ATP induced by 4μM ADP. The amount of released ATP, M (%) and Tm in cerebral thrombosis and TIA were increased statisfically significant (p<0.010.05) compared with healthy control. ASA (0.30.7 g/day) and ticlopidine (100 and 200 mg/day) treatment were decreased the amount of released ATP, M (%) and Tm statistically significant (p<0.010.05).
    These data suggests that the enhancement of platelet released ATP reaction and aggregation in cerebral thrombosis and TIA is tend to release the ATP easily and to make a thrombogeneis.
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  • Soemu Kuroki, Tadashi Kitahama, Tokuzo Miyazaki, Atsushi Nagazumi, Aki ...
    1987 Volume 9 Issue 1 Pages 6-13
    Published: February 25, 1987
    Released on J-STAGE: January 22, 2010
    JOURNAL FREE ACCESS
    It is important to know cerebral blood dynamics of cerebral infarcts. Intra-arterial Digital Subtraction Angiography (IADSA) is widely used in cerebrovascular diseases because of its superority in high sensitivity of time and contrast medium, and time-density curves of any area can be given easily at real time by A/D converter.
    Brain mean transit time (t) (which means time from internal carotid artery to internal jugular vein) and partial brain mean transit time (tp) (which means time from internal carotid artery to cortical area in the middle cerebral artery) were calculated in the damaged hemisphere and non-damaged one by time-density curves using Hamilton's dye dilution method in 84 middle cerebral artery infarcts. We discussed clinical application of t and tp to CT groups divided by lesion and low density area, and Activity of Daily Living (ADL). The larger the low density area is, the longer t becomes prolonged both in the damaged hemisphere and the opposite one. t was mutually correlated in all CT groups and was measured over 6.0 sec except normal group that showed 4.32 ± 0.45 sec. However tp wasn't mutually correlated in CT groups and ADL ones. t is clinically useful compared to tp because of the former reflecting physical conditions of arterial and venous vessels. The better ADL is, the shorter t becomes. Excellent prognostic group and bad ones can be classified whether t indicates below 6.0 sec or not.
    We concluded that t is one of the valuable parameters which reflects cerebral blood flow and can be useful to determine prognosis of cerebrovascular patients.
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  • Relations between the site of arterial occlusive change and the autoregulation of cerebral blood flow
    Takaji Kaneko, Tohru Sawada, Yoshihiro Kuriyama, Hiroaki Naritomi, Har ...
    1987 Volume 9 Issue 1 Pages 14-21
    Published: February 25, 1987
    Released on J-STAGE: September 03, 2009
    JOURNAL FREE ACCESS
    The range of autoregulation of cerebral blood flow (CBF) was investigated by the stepwise lowering of blood pressure with head-up tilting and/or with infusion of trimetaphan camsilate in the 52 patients with cerebral infarction of old stage. Changes of CBF were calculated by the method of cerebral arterio-venous oxygen difference. Fifty-two cases included 24 patients (Group N) which had no occlusion in the major cerebral arteries, 17 cases (Group E) which had one or more complete extracranial arterial occlusions, and the other 11 cases (Group M) which had occlusions in the stem of middle cerebral artery. CBF measurements were made at least more than a month after the onset.
    Results obtained were as follows :
    1) The ranges of autoregulation of CBF (control mean blood pressure (MABP) minus MABP at the lower limit of autoregulation) were 21.2 mmHg in Group N, 16.9 in Group E, and 12.0 in Group M respectively. There was a statistically significant difference between Group N and M (p<0.005).
    2) Ratios of the MABP at lower limit of autoregulation to the control value of MABP were 82.7%, 85.3%, and 88.7% in groups N, E and M, respectively.
    3) Dysautoregulation of CBF was most frequently encountered in Group M (45%).
    From these observations, it is suggested that the adequate range at the time of the relatively rapid blood pressure reduction for hypertensive patients with ischemic cerebrovascular diseases is preferable within 20% in cases with no arterial occlusion and 10% in cases of occlusions in the middle cerebral arteries.
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  • Tomohisa Okada, Yoshihisa Kida
    1987 Volume 9 Issue 1 Pages 22-27
    Published: February 25, 1987
    Released on J-STAGE: September 03, 2009
    JOURNAL FREE ACCESS
    Two rare cases of intracerebral hemorrhage occurring immediately after evacuation of a chronic subdural hematoma via burr hole were encountered. In Case 1, a 64-year-old man was aggravated immediately after evacuation of a chronic subdural hematoma and a CT scan revealed the presence of a large subcortical hemorrhage subjacent to the subdural hematoma. In Case 2, an 85-year-old woman who had bilateral chronic subdural hematomas progressively deteriorated in coma about 25 hours after unilateral evacuation of a chronic subdural hematoma and a CT scan revealed the presence of a large subcortical hemorrhage in the temporal lobe contralateral to the burr hole.
    Eleven similar cases, nine of which had been reported in other papers and two of which were the present ones, were summarized and the features of this complication were stated based on them. The etiopathogenesis of this complication is not clearly known but rapid surgical decompression of the chronically compressed brain or a sudden increase in the systemic blood pressure which disturbs an autoregulation may cause an increase in the local cerebral blood flow in the area which has damage to parenchymal vessels and in part be responsible for the postoperative intracerebral hemorrhage as encountered in the present cases. Thus, this devasting complication can be avoided if a chronic subdural hematoma is slowly removed with keeping normotension during and after the surgery.
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  • Takaji Kaneko
    1987 Volume 9 Issue 1 Pages 28-36
    Published: February 25, 1987
    Released on J-STAGE: September 03, 2009
    JOURNAL FREE ACCESS
    The purpose of the present study was to know the correlation between cerebrovascular CO2 reactivity and the hypertensive organ changes in cases of cerebrovascular disease.
    The subjects of the present study were 45 patients with cerebral infarction confirmed by CT scan and cerebral angiogram. Of 45 patients, 31 cases (Group N) had no occlusion in the major cerebral arteries, and the other 14 cases (Group M) had occlusions in the stem of the middle cerebral artery. Measurements of cerebrovascular CO2 reactivity were made at least more than a month after the attack.
    The cerebral blood flow (CBF) was determined by using the Argon inhalation method. The changes of CBF during hyperventilation, 3% CO2, 5% CO2 and 7% CO2 inhalations, were estimated by using the method of cerebral arteriovenous oxygen difference. The individual CBF-PaCO2 relationship curves of the patients were calculated by the following equations by Olesen et al.
    In CBF=K·PaCO2+A
    The cerebrovascular CO2 reactivity was represented as K value which was a slope index of the In CBF-PaCO2 relationship curve.
    The severities of hypertensive and arteriosclerotic involvements in organs were estimated according to the classification of hypertension severity (IKEDA et al, 1984).
    Results were summarized as follows :
    1) There was a strong negative correlation between K values and the scores of the hypertension severity in Group N (r=-0.86, p<0.001). Although, no significant correlation was seen in Group M.
    2) There was negative correlation between K values and the cerebrovascular resistance (CVR) in Group N (r=-0.46, p<0.01).
    From these observations, it was suggested that the decline of cerebrovascular CO2 reactivity in Group N was reflected in the arteriolosclerotic chages due to sustained hypertension. Then, the cerebrovascular CO2 reactivity in Group M might be influenced by pathophysiological factors, such as. the quality of the collateral circulation, the changes of vascular beds or vascular tones and so on, in addition to arteriolosclerotic change.
    Moreover, we discussed a propriety to use the K value as an index of a cerebrovascular CO2 reactivity rather than a conventional 5% CO2 reactivity.
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  • Yoko Tsuzuki, Fumio Gotoh, Atsuo Koto, Norihiro Suzuki, Ryukichi Senda
    1987 Volume 9 Issue 1 Pages 37-42
    Published: February 25, 1987
    Released on J-STAGE: September 03, 2009
    JOURNAL FREE ACCESS
    In order to examine the effect of experimental subarachnoid hemorrhage (SAH) on the autonomic nervous system of the cerebral arteries, changes in the diameter of the vesicles were investigated in the perivascular nerve terminals.
    SAH was induced by injection of autologous blood into the cisterna magna of 15 cats. The animals were divided into three groups (each consisting of 5 cats) and were sacrificed at 6 hours, 1 week and 2 weeks following SAH by perfusion of 2.5% glutaraldehyde 15 minutes after injection of 5-hydroxydopamine (5 mg/kg). Sections were taken from the middle cerebral artery (MCA) and the vertebral artery (VA) and were prepared for electron microscopic examination. The diameter of two types of vesicles, i.e., dense cored and clear vesicles, was measured by means of an image analyzer. Fifteen sham-operated cats were treated in the same way and served as a control groups.
    After SAH the size of both dense cored and clear vesicles decreased significantly as compared with those in the control group both in MCA and in VA. This change was particularly prominent at 6 hours and 2 weeks after SAH. These findings suggest that SAH affects the autonomic nervous system controlling the cerebral arteries and that neurogenic factors may contribute to the emergence of pathological conditions such as cerebral vasospasm.
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  • Seisho Abiko, Hideo Aoki, Shinichi Inoue, Tomomi Okamura
    1987 Volume 9 Issue 1 Pages 43-47
    Published: February 25, 1987
    Released on J-STAGE: September 03, 2009
    JOURNAL FREE ACCESS
    A case of ruptured cerebral aneurysm in a patient with systemic lupus erythematosus (SLE) was reported.
    A 47-year-old woman complained of a severe headache, vomiting and consciousness disturbance on November 4th, 1983 and was admitted to the internal medicine ward, at Yamaguchi University Hospital.
    A CT scan performed on the first day on admission showed a subarachnoid hemorrhage, so she was immediatly transferred to our clinic. She had a past history of subarachnoid hemorrhage 7 years previously, and a cerebral angiogram performed at that time showed a tiny aneurysm at the distal anterior cerebral artery.
    She was medically treated at that time because she was known to have had SLE for the previous 5 years.
    On admission, she was in a drowsy state and appeared cushingoid and in moderate discomfort from headache with stiff neck but showed no paresis and sensory distrubance on limbs.
    A four-vessel angiogram performed via the femoral route showed a saccular aneurysm at the junction of the pericallosal artery and the callosomarginal artery which had increased in size to about 4 mm in diameter.
    The patient's consciousness level markedly improved after intravenously administered glycerol, so she was operated on November 10th, 1983. The operative course was uneventful and a postoperative angiogram showed complete obliteration of the aneurysm.
    This is the first report in which a radical operation on confirmed cerebral aneurysm in SLE was performed. The pathogenesis of cerebral aneurysm in a SLE is discussed.
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  • Mikio Tashiro
    1987 Volume 9 Issue 1 Pages 48-53
    Published: February 25, 1987
    Released on J-STAGE: September 03, 2009
    JOURNAL FREE ACCESS
    It is generally accepted that an increase in whole blood viscosity (WBV) in a range of low shear rates is due mainly to the aggregation of red blood cells (RBC), but that at the shear rates over 55-60/sec, the aggregation of RBC has little concern with WBV. At the higher shear rates, WBV is regulated by hematocrit (Ht), plasma viscosity (PV) and RBC deformability. Therefore, it appears to be possible to estimate an index of RBC deformability by eliminating the participation of Ht and PV from WBV.
    The purpose of the present study was to obtain indices of RBC deformability by calculating from the values of WBV, PV and Ht. WBV and PV were measured in 40 healthy subjects and 17 patients with cerebral infarction with a cone-plate viscometer (Tokyo Keiki Co.) at the shear rates of 75.5 and 377.5/sec. Ht was measured with the capillary tube method. In order to apply the RBC-deformability index to a wide range of Ht and PV, the following procedures were performed : Ht in each sample was altered by removing or adding autologous plasma (PV being constant), and PV was changed by partial replacement of the plasma with physiological saline by two steps (Ht being constant).
    Results were summarized as follows; 1) From the measurements in normal subjects, an extremely significant correlation was obtained between Ht and relative viscosity (WBV/PV) with an equation of Y=e0.0286X-0.0094 (n=112, r=0.992, p<0.001). Since WBV/PV expresses the contribution of the red cells (Ht and RBC deformability) to blood viscosity, the deviation of measured relative viscosity from this regression line in percent was thought to be an index of red cell deformability (% (WBV/PV)). 2) When plasma of each sample was diluted with physiological saline, WBV was lineally decreased in every case. A significant positive correlation (n=80, r=0.949, p<0.001) was also obtained between PV and %WBV, which was the percent deviation of individual WBV from the point of same Ht on the standard exponential curve obtained from the healthy subjects (n=112, r=0.988, p<0.001). The deviation from the regression line of this correlation was regarded as another index of RBC deformability (RD-Index), since the contribution of Ht and PV was mathematically eliminated from WBV. 3) The multiple regression analysis on the contribution of the rheologic factors to WBV showed that both the coefficients of determination of Ht, PV and % (WBV/PV), and Ht, PV and RD-Index to WBV were close to 1.0 (0.996 0.998) in both healthy subjects and patients with cerebral infarction. 4) The correlation of these two indices of red blood cell deformability was significant not only in healthy subjects (n=40, r=0.917, p<0.001) but in patients with cerebral infarction (n=17, r=0.944, p<0.001). 5) There was a significant correlation between MCHC (mean corpuscular hemoglobin concentration) and RD-Index, i.e. the higher the MCHC, the poorer the RBC-deformability was.
    The results obtained from the present study suggest that these two indices appropriately indicate the RBC deformability.
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  • -With special reference to age, type of infarction and collateral circulation-
    Mikio Tashiro
    1987 Volume 9 Issue 1 Pages 54-61
    Published: February 25, 1987
    Released on J-STAGE: September 03, 2009
    JOURNAL FREE ACCESS
    Whole blood viscosity (WBV) and its major determinants (hematocrit (Ht), plasma viscosity (PV) and indirect deformability of red blood cells (RD-Index)) were measured in 40 normal subjects and 325 cases with cerebral infarction (91 cases with perforator thrombosis, 152 with cortical artery thrombosis and 82 with cerebral embolism). WBV and PV were measured with a cone-plate viscometer (Tokyo Keiki Co.) at the shear rates of 75.5 and 377.5/sec. These rheologic factors were analysed in relation to age, subtypes of cerebral infarction and the time elapsed from onset (stage).
    PV was higher than normal in all but one subgroup irrespective of age and stage. In the group of perforator thrombosis, patients under the age of 60 years old showed an increased RD-Inedx (high RD-Index indicates poor RBC deformability) during both acute (within Day 7) and subacute (after Day 8) stages, but Ht was increased only in acute stage. In patients over 60 years old of the same group, however, RD-Index was increased only in acute stage, and Ht was not higher than normal throughout the course.
    RD-Indices in patients with cortical artery thrombosis were not increased even when they were divided into subgroups by age and stage. Ht was higher than normal controls in acute stage of the younger age group (<60 years old). In cerebral embolism, no significant abnormalities of these rheologic factors were detected except for PV.
    When the patients with thrombotic major cerebral artery occlusion (internal carotid and middle cerebral artery trunk, 208 cases) were divided into two subgroups by the grade of availability of transcortical collateral circulation, Ht in patients with poor collaterals was significantly higher in acute stage than normal and other subgroups. RD-Index in this group also tended to be higher in acute stage than others, but the difference was significant only in subacute stage.
    In contrast, patients with thrombotic occlusion having good collaterals and those with embolic occlusion showed no abnomal values of rheologic factors except for an increased PV.
    In summary, abnormalities of blood rheologic factors were most frequently found and most apparent in patients with perforator thrombosis, followed by those with thrombotic major cerebral artery occlusion and embolic occlusion, respectively. From the above results, it is suggested that these rheologic factors may play one of the important roles in promoting the occurrence of thrombotic cerebral infarction, especially in regions of perforating arteries. Impairment of RBC deformability might have been present before the onset of stroke, and an increment of Ht by any reasons may have induced a circulatory disturbance in such small vessels as perforating arteries.
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  • Jun Miyagi, Fumihito Yamamoto, Minoru Shigemori, Shinken Kuramoto, Toh ...
    1987 Volume 9 Issue 1 Pages 62-67
    Published: February 25, 1987
    Released on J-STAGE: September 03, 2009
    JOURNAL FREE ACCESS
    It is uncommon that cerebral aneurysm is determined as thromboembolic origin and produces ischemic cerebrovascular accident. These events rarely occurs in the territory of posterior cirsulation and only five such cases have been reported.
    This 53-year-old man admitted because of a sudden onset of vertigo, nausea and vomiting on Jan 7, 1983. Neurological examination revealed bilateral horizontal nystagmus and ataxia of left upper and lower extremities. A CT scan on admission revealed no particular finding, but a low density area of the left cerebellar hemisphere with internal hydrocephalus was noted on CT taken at three days later. The brachial angiogram showed no abnormal feature in the region of extracranial vertebral and subclavian arteries. But on the left vertebral artery, an aneurysm of the left posterior inferior cerebellar aetery (PICA) and obstruction of the left tonsillo-hemisheric branch of PICA were disclosed. At 8 weeks after onset, an exploratory suoccipital craniectomy was performed. The operation confirmed that the aneurysm on the left PICA was not saccular but fusiform in the shape and it was adhered to ventral surface of the medulla oblongata. The separation of the adhesions and trapping of PICA were impossible because of several perforating arteries originating from the PICA to the brain stem. The coating of fusiform aneurysm with Biobond was then perfimed. No additional neurological deficit was noted postoperatively. On April 28, 1983, the patient became almost asymptomatic and returned to the normal activity.
    In this case, the cerbellar infarction was possibly by thromboembolism originated from the fusiformaneurysm because there were no cardiogenic factor nor extracranial embolic source. The principle of management for the aneurysm presenting as a thromboembolic event was discussed with reviewing the literature.
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  • -From the analysis of 4 surgically and 2 medically treated cases-
    Koichi Kitami, Hiromi Tsuchida, Tsutomu Sohma, Izumi Hamajima, Tamotsu ...
    1987 Volume 9 Issue 1 Pages 68-77
    Published: February 25, 1987
    Released on J-STAGE: September 03, 2009
    JOURNAL FREE ACCESS
    Six cases of primary pontine hemorrhage were reported and each of their clinical test results were compared from the standpoint of making the indication for radical operation. Four cases were performed the surgical removal of the hematoma. In three of them, surgery was done in the acute phase (2-4 days), the other one got the surgery in the subacute phase (19 days). Their preoperative consciousness were worse than semicoma, with disturbance of respiration and decerebrate posture. In all surgical cases, the respiratory care became much easier after the operation, and amelioration in consciousness were obtained in three cases. Although one case expired of myocardial infarction, none of them died of surgical insults. In one surgical case, auditory brainstem response (ABR) and continuous intracranial pressure (ICP) recording suggested the enlargement of hematoma with marked obstructive hydrocephalus, and clearly showed the timing for the radical operation. Two cases were treated medically. One case showed normal ABRs on one side and made the dramatic recovery from coma to alertness. But his activity of daily life was not so satisfactory even 6 months later. Another case was a typical fulminant type, who died of brainstem damage one month after the onset. In conclusion, the surgical indication for pontine hemorrhages was thought as below. I : Life saving indication -When deterioration in ABR and/or enlargement of hematoma in CT occur which cause secondary ischemic damage to the residual brainstem function. II : Functional indication -When ABRs are normal on at least one side and tendency of recovery in consciousness appeares. The operative procedure (craniotomy or burr-hole irrigation like CT-guided method) was thought to be controversial. Among the diagnostic tests, ABR and ICP monitoring were considered mostly valuable methods on managing the treatment of pontine hemorrhages.
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  • Naoki Fujimoto, Tadao Miyahara, Atsushi Murai, Hideo Shio, Masakuni Ka ...
    1987 Volume 9 Issue 1 Pages 78-84
    Published: February 25, 1987
    Released on J-STAGE: January 22, 2010
    JOURNAL FREE ACCESS
    Fatty acid compositions of plasma, erythrocytes, and platelets were determined in cerebral infarction (CI) to elucidate the relation of these to atherosclerosis and platelet aggregability. Based on the findings of both CT and cerebral angiography, CI patients were divided into two subgroups; CI of cortical type (CI-C) with atherosclerosis of the major cervical and intracranial arteries and CI of perforating type (CI-P) with no significant angiographic changes. In both subgroups, the relative amount of palmitic acid was higher and that of linoleic acid was lower than these in the control. Serum level of HDL cholesterol (HDL-C) in CI-C was lower than that in the control and CI-P. It is likely that, in the CI-C subgroup, a combination of fatty acid abnormalities and reduced serum HDL-C accelerates the atheroma formation in the major cervical and intracranial arteries.
    Abnormalities of the fatty acid composition in platelets were strongly related to platelet aggregability. In highly aggregating platelets, frequently seen in CI-P, the arachidonic acid was lower and eicosapentaenoic acid was higher than these in normally aggregating platelets. We suggest that these abnormal fatty acid composition in platelets may be a risk factor in CI-P through enhanced platelet aggregability.
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