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Restenosis after carotid endarterectomy (CEA) is one of most significant complications. There is no previous report about MRI findings of restenotic lesions and preoperative plaques. The purpose of this study was to evaluate the initial and recurrent plaques in patients with restenosis after CEA by using black-blood MRI (BB-MRI). Three patients who underwent carotid artery stenting for restenosis after CEA were included in this study. The relative signal intensities (rSI) of the initial and recurrent plaques were calculated with reference to the sternocleidomastoid muscle on T1-weighted images (T1WI) and the submandibular gland on T2-weighted images (T2WI). This study investigated the rSI characteristics and morphology of the initial and recurrent plaques. All patients had restenosis within 1 year after CEA. The rSI values of the preoperative lesion were not high on T1WI and were high on T2WI in all cases (T1WI/T2WI: 0.63/2.43 in Case 1, 1.00/1.29 in Case 2, and 1.13/1.70 in Case 3). The morphology of the initial plaques was eccentric in 2 cases and concentric in 1 case. The rSI values of restenosis were high on T2WI in all cases (T1WI/T2WI: 1.09/1.20 in Case 1, 1.31/1.50 in Case 2, and 1.23/1.70 in Case 3). The morphology of restenotic lesions was concentric in all cases. The high rSI on T2WI and concentricity of the restenosis after CEA suggest early restenosis (intimal hyperplasia). The low-iso rSI on T1WI and high rSI on T2WI of the preoperative plaques are associated with restenosis after CEA. BB-MRI may be useful to evaluate and predict restenosis after CEA. (Received: May 7, 2012, Accepted: September 10, 2012).

The Stroop test has been already applied to many children with attention deficit/hyperactivity disorder (AD/HD). There are, however, differences in the measurement of the Stroop test, and also in the background conditions of the patients, such as the status of comorbidity with learning disorder (LD), medication and the level of Intelligence Quotient (IQ), and presumably as a result, the outcome of the Stroop test shows a diversity. This study was undertaken to compare the performances of children with AD/HD to normal controls using the modified Stroop test according to the subtypes of AD/HD. Subjects in this study were 23 unmedicated children with AD/HD, ranging from 6 to 14 years of age, and 69 normal controls who were matched on sex and age. Children with AD/HD whose verbal IQ and performance IQ were above 80 showed significant differences in such indices as Incongruent Color Naming time (ICN) and the resulting index of subtracting Color Naming time (CN) from ICN (ICN-CN). As to the analysis according to the subtypes excluding 8 cases with comorbid LD, both the predominantly inattentive type and the group putting together the predominantly hyperactive-impulsive type and the combined type showed significant differences in ICN--CN compared with the normal controls. These results suggest that the inattentiveness relevant factor affects the performance of the interference task in children with AD/HD.

The Stroop test was originally invented by Stroop to measure selective attention and cognitive flexibility and various versions of this test have been developed by many other researchers. Since the Stroop test requires the examinee's sustained efforts, it is not readily applicable to children with developmental disorders. In order to overcome this weakness, a modified Stroop test by reducing the total number of stimulations from 300 to 72 was proposed for clinical use. This study was performed to obtain the standard value of the modified Stroop test, and also to clarify the developmental changes in indices of interference effect. Two hundred eighty one normal children and adults, ranging from 6 to 20 years of age were examined. A simple regression analysis was performed to examine the relation between age and the score of indices such as Incongruent Color Naming (ICN), ICN--Color Naming (CN), ICN/CN. The results from this analysis showed significant age-related changes. Subjects between sixteen and seventeen showed the best score in each index. These findings suggest that a brain region and/or functional system of late maturation might participate in the execution of the interference task.

An 18-year-old male admitted to our hospital suffered left temporal subcortical hemorrhage. No abnormality was demonstrated on carotid or vertebral angiography at that time. On the day following the onset, left frontotemporal craniotomy was performed and the subcortical hematoma was evacuated. No vascular malformation was found despite careful investigation. On 30th day after the onset, the repeat cerebral angiography was performed but failed to show any vascular abnormalities. After discharge he was in good health, and had had some follow up, CT were normal except for the hematoma cavity. Just two years after the first operation he suffered a second left temporal hemorrhage. Cerebral angiography was repeated and a temporal arteriovenous malformation (AVM) was found with feeding vessels from the M-1 and M-2 portion of the left middle cerebral artery and from the left anterior choroidal artery, and draining veins to vein of Rosenthal and the straight sinus. One month after the second hemorrhage, left frontotemporal craniotomy was performed and complete excision of the AVM was carried out. Only five cases of AVMs in patients with normal angiograms several years before have been reported previously in the literature. But there are no cases in which surgery has been performed. Differently to those cases, in this case it was investigated operatively whether there was a vascular abnormality at the first hemorrhage. We didn't think, however, that the AVM demonstrated at the second hemorrhage had developed spontaneously because there had been a hemorrhage of unknown origin previous to it. It was assumed that a small angiographically occult AVM connected to the hematoma cavity existed at the time of the first hemorrhage but it was too small to be found even during surgical procedure. Such an angiography occult AVM had been growing for two years, and its growth had probably been facilitated by the presence of the hematoma cavity left after the first operation.

Intraoperative somatosensory evoked potentials (SEPs) were measured in 17 patients during 21 extracranial revascularization and related procedures. The operations included 13 carotid endarterectomies (CEAs), two cervical internal carotid ligations, one vertebral artery (VA) clipping, one VA-common carotid artery (CCA) transposition, and four temporary balloon occlusion tests (TBOTs). Three of the 13 CEAs (23%) showed reduced amplitude and delayed latency of primary cortical SEPs during clamping of the carotid artery, followed by their recovery after emplacement of the internal shunt. Flattening of SEPs during clamping of the CCA was observed in the case of VA-CCA transposition; however, SEPs returned to normal immediately after insertion of a balloon indwelling shunt into the CCA. One of the four TBOTs showed alteration of SEPs during balloon occlusion of the subclavian artery proximal to the origin of the VA. In the others, SEPs remained stable during the entire procedure. Only one transient intraoperative ischemic complication was encountered among the cases of CEA. It was detected through flattening of SEPs, which led to the discovery of an internal shunt obstruction. Carotid stump pressure was also measured in 12 CEAs and two TBOTs, and seven of these 14 had pressure less than or equal to 50 mmHg. Four of the seven had carotid stump pressure less than or equal to 30 mmHg, and three of these four also showed altered SEPs. SEPs remained stable if the collateral flow was sufficient during vascular occlusion and showed obvious alteration when the blood flow was reduced to below the threshold. The authors conclude that monitoring of SEPs during extracranial revascularization is very useful.

The association of pituitary adenoma and adjacent cerebral aneurysm is not uncommon and acute hemorrhage into a pituitary adenoma is also a well recognized condition. However, the simultaneous occurrence of pituitary apoplexy with intracranial aneurysm is very rare. Such a case demonstrates the diagnostic difficulty in distinguishing between pituitary apoplexy and rupture of an aneurysm. We reported a patient with subarachnoid hemorrhage in whom a hemorrhage into the pituitary adenoma and a carotid-ophthalmic aneurysm was proven, and discussed the differential diagnosis and treatment. A 41-year-old man, who developed sudden severe headache with nausea and vomiting, was admitted to our hospital. Examination disclosed a mildly stuporous man with bilateral defects of upper lateral visual fields and lumbar puncture revealed subarachnoid hemorrhage. Plain radiographs of the skull showed an enlarged and eroded sella turcica. Carotid angiography revealed a left carotid-ophthalmic aneurysm. A plain CT scan demonstrated an acute suprasellar hematoma. A transsphenoidal operation was performed and postoperative course was uneventful.

The identification of intermediate filaments within immature cells is valuable as a means to investigate neuronal and glial differentiation. The purpose of this study is to investigate the time of appearance of neuron and glia within rat embryo by identifying cell-specific intermediate filaments. Pregnant rat were daily sacrificed from day 9-20 of pregnancy. Rat embryos were fixed with 100% ethanol and then we have made the paraffin section. We have stained the specimens for vimentin in accordance with ABC method and for GFAP in accordance with PAP method. We have performed Bodian stain. The neural plate of day 9 rat embryo is composed with vimentin positive immature cells which are disposed with pseudostratified arrangement. In midbrain of day 13 rat embryo, immature cells and their fibers are vimentin positive which are spanning from ventricular surface to marginal layer. NFP is detectable in immature cells and fibers of marginal layer. But GFAP positive cells and fibers are not identified in the same region. In anterior column of day 18 rat embryo, GFAP positive fibers are detectable. Summarizing of these results, we can display first: immature cells composing of neural plate are vimentin positive at day 9, second: NFP positive fibers and cells appear at day 13, third: NFP positive cells are vimentin positive, too, forth: GFAP positive fibers appear at day 18 and they are vimentin positive, too.