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A patient with a right internal capsule and thalamic hemorrhage showed ipsilateral hemiplegia. MRI at 10 months after the cerebral hemorrhage demonstrated Wallerian degeneration, which could be traced to the ipsilateral anterior funiculus at the cervical level. The findings of motor evoked potentials and somatosensory evoked potentials indicate a predominantly ipsilateral innervation of motor and sensory systems in this particular patient.

A 66-year-old male presented with a left frontal intracerebral arteriovenous malformation (AVM) fed by the anterior ethmoidal artery. The nidus was located intracerebrally, although the feeder was a dural artery, and was drained by the ascending frontal vein which showed varicose dilatation. The AVM was associated with an unruptured right anterior choroidal artery aneurysm. The AVM was removed and the aneurysm was clipped in a two-stage operation. The etiology of AVMs fed by the ethmoidal artery is still uncertain, but is probably due to a disturbance in normal embryonic development. The association with aneurysm seemed to be incidental.

Acute cerebrovascular congestion after a closed head injury is significantly related to intracranial hypertension. As an indirect method of cerebral blood flow measurement; transcranial doppler sonography (TCD) provides a rapid and noninvasive assessment of cerebral haemodynamics, including hyperaemic conditions. TCD examinations was serially performed in 35 patients with severe head injury with intact cerebral circulation; i.e. the mean flow velocity (MFV) patterns of the middle cerebral artery (MCA) did not show signs of cerebral circulatory arrest such as systolic spike, to and fro, or no flow. The results showed that the MFV of the MCAs and ipsilateral extracranial internal carotid arteries (ICAs) in 9 of these patients increased sharply and pulsatility index (PI) decreased during 48-96 hours after the injury. This was soon followed by patterns of high intracranial resistance, consistent with elevated intracranial pressure (ICP) in monitored patients and acute brain swelling on repeated computed tomographic (CT) scans. The correlation between increased MFVs, decreased PIs, and cerebral haemodynamic changes leading to acute brain swelling is discussed. The number of patients who ended with severe disability, vegetative state, or death was 66% in this group of 9 patients, compared to only 34% for the 35 patients overall with severe head injury. Though the morbidity and mortality rates largely depend on the primary injury, the presence of acute cerebral swelling aggravate the grave course in these patients. And the ability of TCD to monitor the hyperaemic state prior to oedema should lead us to adjust the therapy in order to minimize the secondary insult related to intracranial hypertension.

Recurrence of hypertensive intracerebral hemorrhage confirmed by computed tomography scan has rarely been reported. The authors have experienced nine cases of recurrent hemorrhage among 494 cases of hypertensive intracerebral hemorrhage. Recurrence rate was 1.8%. There were eight males and one female with an average age of 60.5 years. Six cases had their first and second attacks in ganglionic regions. Among them, three cases had the second attack in the ipsilateral side, and the other three cases had the second attack in the contralateral side. Two cases had the first attack in the thalamic and the second in the cerebellar regions. One case had the first attack in the pontine and the second in the putaminal regions. Intervals between the first and second attacks were within 6 months for ipsilateral ganglionic attacks and over 4 years for contralateral ganglionic attacks. In all cases systemic blood pressure was normalized or well controlled by antihypertensive agents after the first attack. The mechanism of rebleeding has not been clarified.

There has been no report available for determining surgical indications in hypertensive subcortical hemorrhage based on functional prognosis. The authors then studied the clinical results of hypertensive subcortical hemorrhage for evaluating the surgical indication in relation to functional prognosis. Sixty-five patients with hypertensive subcortical hemorrhage diagnosed by CT scan who were hospitalized to Matsue Red Cross Hospital from January 1980 up to December 1986 were studied. The 44 male and 21 female patients ranged in age from 37 to 86 years, and 38 of them were operated on. The results were as follows: 1) Patients with grade I (Kanaya's neurological grading) or a volume of hematoma less than 30 ml should be treated with conservative therapy. Those with grade II and III or a volume of hematoma = 30 - 50ml should be treated in accordance with proper therapeutic method, taking into consideration the site of the hematoma. Patients with more than grade IVa or a volume of hematoma greater than 50ml would be in danger of losing their lives unless surgical therapy was performed. 2) The follow up study of the patients' long-term prognosis after discharge revealed the majority of the patients showed aggravation of the illness and/or death due to cerebral apoplexy-like attack and re-bleeding. It is necessary to follow up these cases with careful systemic control, including monitoring of blood pressure.

Four cases of intracranial hemorrhage associated with pregnancy are reported. They were a ruptured anterior communicating aneurysm, a ruptured AVM of cerebellar hemisphere, a lt-thalamic and putaminal hemorrhage and brain stem hemorrhage. As the mode of hemorrhage, one case was a subarachnoid hemorrhage, one case was a subarachnoid hemorrhage combined with a cerebellar hemorrhage and other two cases were intraparenchymal hemorrhage. The mean age of these 4 cases was 29.5 years of age from 25 to 35. One case was occurred the intracranial hemorrhage during the first trimester but other 3 cases was occurred during the third trimester. It was, thus, considered the intracranial hemorrhage associated with pregnancy was more frequently occurred during the third trimester. Primigravida and multigravida were equally occurred on each two cases. It was not related to parity. Consciousness levels were drowsiness; one case, semicoma; two cases and deep coma; one case. A case of ruptured anterior communicating aneurysm underwent neck clipping of aneurysm through the rt-fronto-temporal craniotomy on the first day of the attack. This case fully recovered, but the other three cases of severely impaired consciousness level were dead. Maternal prognosis was related to consciousness level. We mentioned the preferred neurosurgical and obstetrical management to the intracranial hemorrhage associated with pregnancy.

There have been a few reports available for determining surgical indications in hypertensive cerebellar hemorrhage based on volume of hematoma on computerized tomography (CT). The authors then studied the clinical results of hypertensive cerebellar hemorrhage, and the surgical indication based on clinical findings and volume of hematoma on CT scan was considered. Forty-five patients with hypertensive cerebellar hemorrhage diagnosed by CT scan who were hospitalized to Matsue Red Cross Hospital from January 1980 up to December 1986 were studied. The 25 male and 20 female patients ranged in age from 52 to 85 years, and 16 of them were operated on. The results were as follows: 1) The Kanaya's neurological grading tended to be high in the patients with cerebellar vermis hemorrhage or a large volume of hematoma (greater than or equal to 30 ml). 2) In patients with grade I or II and a moderate volume of hematoma (15-30 ml), the patient complicated with hydrocephalus should be treated with ventricular drainage. The patients with grade III and IVa should be treated with surgical therapy (suboccipital craniectomy and evacuation of the hematoma). The patients with cerebellar vermis hemorrhage should be treated with surgical therapy. The patients with a large volume of hematoma (greater than or equal to 30 ml) should be treated with surgical therapy. The patients with grade IVb and V should not be treated actively because the prognosis is bad.(ABSTRACT TRUNCATED AT 250 WORDS)

Four cases of pituitary adenoma with intratumoral hemorrhage were studied endocrinologically. 1) It would be suggested that ACTH and TSH secretion of these cases was strongly impaired but LH, FSH and PRL secretion was fairly preserved immediately after hemorrhagic episode. 2) Two of these four cases revealed normal TSH secretion and normal thyroid function following the period of excessive TSH secretion and impaired thyroid function.