Arteriosclerosis of intracerebral arteries in Japanese people is more severe compared to that of American or European people in which sclerosis of extracranial cerebral arteries (carotid arteries) is more advanced. This causes a different mechanism of transient ischemic attack and different incidences of vascular dementia. In the aged average 80 years old, macroscopic cerebral vascular pathology is found in 83.9% by autopsy, and low density on CT was noted in 19.6% in apparently healthy cases.
I propose a new classification of ischemic cerebral diseases, because it is not reasonable that the same vascular pathology is called by different disease entities, such as cerebral infarction and RIND, according to the severity of pathology. It may be adequate to name cerebral infarction -0, cerebral infarction-1, or -2, depending upon the existence of clinical symptoms or CT (MRI) findings. In this classification, the name of disease suggests the grade of pathology, clinical symptoms or prognosis, in some degree. In early stage of acute severe brainstem hemorrhage and severe ischemia, EEG shows special findings called as α-coma & β-coma, respectively. EEG is moderately asymmetric in cases with aphasia.
The number and size of macroscopic infarction is paralleled significantly with the incidence of dementia. It may be worth while to study prevention of senile demention by administration of cerebral vasodilators or cerebral metabolic activators in aged volunteers.

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In this essay we consider Kakusho Tachibana's image of older people in the age of total war. Tachibana is the most famous researcher of this time. However, there has not been a study of Tachibana's works untill now. The aim is to explain the image of older people is clearly from his activities in yokuhukai in the age of total war

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Impairments of the lower limbs, observed in patients with hemiplegia after cerebral apoplexy, are mainly caused by the inhibitive factors such as loose-type and spastic-type hemiplegia, sensory impairments, or articular contracture. Among these factors, spastic hemiplegia is the major target of physical therapy in this disease. There is atendency to show a typical position of the limbs peculiar to cerebral apoplexy, with flexion of the upper limb and extension of the lower limb, this being called Wernicke-Mann. In the standing position, however, some cases were observed where the lower limb was flexed, and the patients were unable to walk dre to the superiority of the flexor muscle. A study of this inexplicable phenomenon suggested that it was different to the knee-flexion involved in the loose-type hemiplegia in its mechanism of onset, as well as its difference from foot flexion and spastic paraplegia. The authors therefore evaluated six patients during the period from July 1977 to December 1982 (four male and two female patients), included were four patients with right hemiplegia and two with left hemiplegia. As a result, symptoms such as decrease in the will to move (with normal conversation and symptom different from akinetic mutism), nervousness upon movement (a sense of anxiety), acceleration of tendon reflex, contracture and sensory impairment. These patients received dynamic, long ower-limb orthoses (including Type-PP LLB), with knee pads to help them walk with the assistance of a T-cane. However, only one case could reduce the short lower-limb orthosis or Walk without assistance. All other patients showed poor results.

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Generally, the crevat and and sling have been used for shoulder articulation, subluxation, pair, edema, shoulder-hand syndrome, etc. Which are equally attributable to hemiplegia due to cerebral apoplexy. However, since immobilization of the upper limbs not only promotes secondary disorders such as poor limb level and articular contracture but also badly affects gait, the compatibility of equipment has become a topic of descussion. The development of the "Functional Arm Sling Brace" has solved these problems to some extent, however, depending on the severity limb disturbance, it is necessary to fully adjust an elbow joint. Thus, we have classified upper limb disturbances in (1) flacoid, (2) flexer synegy, (3) extensor synergy and (4) mixing synergy types, and used Klenzak elbow joint system arm brace for the upper limbs in 10 typical cases. As a result, extension of the width of the rubber used improved articulation, subluxation pain, etc. The adjustment of the flexor and extensor directions of polypropylene type elbow joint system arm brace prevented co-movement of the upper limbs and the tonicity of cervical and pectoralis major muscle. Moreover, ipsilateral and contralateral association responses were successfully blocked. We also improved not only posture but also gait to a certain extent. However, despite the shoulder joints being in a normal condition, an arm brace is required when a patient is highly spasmodic. It is necessary to adjust the whole of the upper limbs by elbow pad, hand-finger splint, etc. and to enhibit spasmodic conditions by using the arm leg braces.

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1) The contribution of hypertension to risk of cerebral hemorrhage, cerebral infarction and myocardial infarction was examined in 427 elderly autopsied cases. The diastolic hypertensive group had significantly higher incidence rates of severe cerebral sclerosis, cerebral infarction, cerebral hemorrhage, severe coronary sclerosis, hearts above 350gm, and moderately large myocardial scar and myocardial infarction than the normotensive group below 160mmHg systolic and 90mmHg diastolic. Between the normotensive group and the systolic hypertensive group (systolic pressure>160mmHg) a definite difference was noted only in the incidence of severe cerebral arteriosis. Except for cerebral infarction, significant differences were observed between the systolic hypertensive group and the diastolic hypertensive group. In comparison to the group with a diastolic blood pressure from 90mmHg to 110mmHg that with a diastolic blood pressure≥110mmHg had a significantly greater incidence rate of cerebral hemorrhages.
2) In our previous reports vascullar permeability factors were demonstrated in the renal cortex. These factors ware quite different from renin and the intravenous injection of the factors resulted in the development of small cerebral hemorrhages in rats. The blood level of these factors were measured by the use of hemagglutination inhibition test. Cases of fresh cerebral hemorrhage had higher blood levels of the permeability factor than those with old cerebral hemorrhage.
3) Membrane potential of rat muscle immediately decreased when the permeability factor prepared from rat kidney was added to the medium. This was not the case for inactivated permeability factor. From these data it is concluded that hypertension accelerates arteriosclerosis and that the renal permeability factor is an important factor contributing to the manifestation of cardiovascular complications and the development of arterischerosis.

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脳梗塞と他臓器障害との関連を剖検例について検討した.対象は過去約20年における病院の連続剖検例2,193例 (男720例, 女1,473例) であり年齢は60～99歳, 平均80.0±7.0歳 (男78.4±7.0歳, 女80.8±6.9歳) である.対象となった脳梗塞は454例 (60～98歳, 平均78.8±7.1歳), 脳出血は215例 (61～95歳, 平均76.6±6.8歳) である.
大脳梗塞は年代の進むにつれて減少傾向を示し, 中等大脳梗塞は年代の進むにつれて増加する.一方, 多発性脳梗塞は年代の進むにつれて明らかに減少する.脳出血では大出血, 中等大出血とも年代の進むにつれて減少を示し, とくに大出血で明らかである.1960年連続剖検例の約10%を占めていた致死的大出血は1970年約6%, 1980年約1%と激減している.剖検脳においてもかつては梗塞巣とともに散在していた小出血, 点状出血巣も稀なものとなってきており, 脳自体が変ったとしかいいようのない状態である.この原因は明らかではない.病院では20年前既に現在と同じような高血圧の管理を行っており, とくに変っていない.

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Ascending aortas, abdominal aortas and pulmonary arteries were collected from 36 cadavers of old men, and amounts of water content, total nitrogen, reduced substance, hexosamine, sulfuric radical, metachromasic substance, cholesterol, Na, Ca and P, all of which are fractions easily extractable with water contained in the walls of these arteries, were determined to seek relation between arteriosclerosis and change in these values, with the following results:
1) There was no remarkable difference between the ascending and abdominal aorta in the values of total nitrogen, hexosamine, and reduced substance, and these values were lower in the pulmonary artery than in the two aortas. No significant difference in sulfuric radical was observed between the three.
2) Water content was found decreased in sclerotic part as compared with non-sclerotic part.
3) Total nitrogen, hexosamine, reduced substance, sulfuric radical and metachromasic substance were all decreased in sclerotic part.
4) Cholesterol value was increased in sclerotic part.
5) In sclerotic part, Ca content was increased, but Na content was contrarily decreased.
6) In sclerotic part, total P and acid-soluble P were found increased, but change in inorganic p and lipid P was indistinct.
7) Significant correlation was observed between hexosamine and sulfuric radical in arterial wall which were determined by the acid hydrolysis method.

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