Search

A small number of neurons in the nucleus accumbens of the rat showed tyrosine hydroxylase-like immunoreactivity (TH-LI). These TH-LI neurons had medium-sized cell bodies with several spiny dendrites. When a lesion was produced in the ventral tegmental area of the midbrain by injecting 6-hydroxydopamine, TH-LI neurons in the nucleus accumbens, as well as those in the olfactory bulb, were increased in number on the side ipsilateral to the lesion. The results indicated that expression of TH might be enhanced in some neurons deprived of dopaminergic afferent fibers.

✓ The authors review their 2-year experience with a rhinoseptal transsphenoidal approach to skull-base tumors of various pathologies involving both the sphenoid and cavernous sinuses. Eight patients with cranial nerve palsies attributable to compression of the contents of the cavernous sinus and/or optic canal are included in this report. Among these patients, a total of 17 cranial nerves were affected. Postoperative normalization was achieved in eight nerves, significant improvement in seven nerves, and no improvement in two nerves. There were no operative complications of aggravation of cranial nerve palsies in this series. In spite of the limited operating field, the results demonstrate the effectiveness and safety of this approach. The authors recommend that this approach be considered before more aggressive surgery is undertaken.

Seven patients with histologically proven primary intracerebral malignant lymphoma, characterized by a fluctuating nature with both transient regression and spatial evolution of the tumors without contiguity to the initial lesion, are presented. Although the overall outcome was unfavorable, two cases had a long-term survival of 3 years or more and one of them showed a good quality of life. Correlation among characteristic clinical presentations, computed tomography scans, and prognostic factors after management with surgery, radiation, and chemotherapy, including steroids, is discussed.

The origins and overall distribution of perivascular nerve fibers showing calcitonin gene-related peptide-like immunoreactivity (CGRP-LI) in the major cerebral arteries were investigated immunohistochemically in the dog by using whole-mount preparations of the arterial trees around the circle of Willis. Perivascular nerve fibers with CGRP-LI were seen most abundantly in the basilar artery, vertebral artery, common anterior cerebral artery, proximal part of the anterior cerebral artery, and terminal part of the internal carotid artery. They were far less numerous in the middle cerebral artery, posterior cerebral artery, superior cerebellar artery, and distal part of the anterior cerebral artery. Neuronal cell bodies with CGRP-LI were observed in the trigeminal, nodose, superior cervical, and dorsal root ganglia. CGRP-LI fibers in the large pial arteries in the circle of Willis were eliminated ipsilaterally after unilateral transection of the ophthalmic division of the trigeminal nerve, and slightly reduced in number ipsilaterally after unilateral transection of the maxillary division of the trigeminal nerve. They did not show any noticeable changes after unilateral transection of the mandibular division of the trigeminal nerve. On the other hand, CGRP-LI fibers in the basilar and vertebral arteries did not show any appreciable changes after unilateral transection of the trigeminal nerve, but they were eliminated after bilateral ganglionectomy of the dorsal root ganglia of the first, second, and third cervical nerves. After ganglionectomy of the ciliary, pterygopalatine, otic, nodose, or superior cervical ganglion, no changes were observed in perivascular nerve fibers with CGRP-LI in the major cerebral arteries. The data indicate that perivascular nerve fibers with CGRP-LI in the large pial arteries forming the circle of Willis originate mainly from the ophthalmic division of the trigeminal nerve, and partly from the maxillary division of the trigeminal nerve, and that CGRP-LI fibers in the basilar artery and distal part of the vertebral artery originate mainly from the dorsal root ganglia of the upper cervical nerves.

✓ The vascular relaxation effects of calcitonin gene-related peptide (CGRP) and vasoactive intestinal polypeptide (VIP) on the dog basilar artery after experimentally produced subarachnoid hemorrhage (SAH) were examined in vitro by an isometric tension recording method. Both CGRP and VIP induced dose-dependent relaxations in ring segments of the intact basilar artery of control dogs. The vasorelaxant action of CGRP was more potent than that of VIP. The single-injection model of SAH was produced by injection of fresh autologous arterial blood ( 1 ml/kg body weight) into the cisterna magna on Day 0 of the post-SAH period, and the double-injection model was produced by two injections of blood (0.5 ml/kg each) on Days 0 and 2. Narrowing of the basilar arteries on vertebral angiograms was most prominent on Day 3 or 7 in the single- or double-injection model, respectively. Relaxation of the basilar artery induced by CGRP and VIP was to some extent decreased on Days 3 and 7 of the post-SAH period in the single-injection model, and on Days 7 and 14 in the double-injection model. However, the vasorelaxant effects of CGRP and VIP were significantly enhanced on Day 14 of the post-SAH period in the single-injection model, and on Days 28 and 42 in the double-injection model. Subsequently, these effects returned to control levels by Days 28 or 63 in the single- or double-injection model, respectively.

(-)-Biopterin (1) was synthesized from 5-deoxy-L-ribose (6) which was derived from commercially available D-ribose (2) employing the highly stereoselective Grignard reaction of 2,3-O-cyclohexylidene-D-ribose (3) with methylmagnesium iodide.

✓ A case of Cobb's syndrome, which is characterized by spinal and vertebral angiomas and a skin nevus at the same metameric level, is reported. The spinal angiomas were treated with liquid embolization using ethylene vinyl alcohol.

We have recently shown that exogenous expression of the mouse interferon-gamma (IFN-gamma) gene augmented the cell-killing potential of a line of cytotoxic T lymphocytes (CTLs) specific against a murine glioma line (203-glioma). In the present work, we further investigated the in vivo antitumor effects of the E gamma-6 and E gamma-9 sublines of this CTL line transfected with the IFN-gamma gene. Using the Winn assay to test the neutralization of subcutaneous gliomas, we determined that these CTL sublines were more effective than the E-4 parent CTL line and that suppression of the tumor growth was dependent on the number of effector cells (CTLs). Moreover, intravenous injection of E gamma-9 cells was more effective in suppressing the tumor growth than intravenous injection of E-4 cells. These results suggest that transfection of antitumor effector cells with the IFN-gamma gene could improve the efficacy of adoptive immunotherapy against cancer.

The synthesis of (-)-biopterin (1) was accomplished by employing (1S,2S)-1-(2-furyl)-2-(trityloxy)-1-propanol (6), derived from ethyl (S)-lactate, as building block for the side chain. Synthese von (-)-Biopterin Fur die Synthese von (-)-Biopterin (1) dient das aus (S)-Milchsaure-ethylester gebildete (1S,2S)-1-(2-Furyl)-2-(trityloxy)-1-propanol (6) als Baustein fur die Seitenkette.

Using dynamic PET mode and 18FDG, glucose transport in patients with gliomas were investigated. The values for transfer rate constants kl*, k2*, k3*, and glucose consumption were found to be low in the low-grade glioma as compared to those of the high-grade glioma and the contralateral cerebral cortex. The differences were statistically significant with the exception of k2*. There were no statistically significant differences between the high-grade glioma and the contralateral cerebral cortex. In contrast, the distribution volumes k1*/ k2* and k1*/(k2*+k3*) were low in high-grade glioma and the difference between the high-grade glioma and the contralateral cerebral cortex was statistically significant. A difference in k1*/ (k2*+k3*) was noted between the low-grade and the high-grade gliomas. Thus, the distribution volumes are most sensitive for differentiation between high-grade glioma and cerebral cortex.

Several operative procedures have previously been documented for the surgical treatment of cerebrovascular moyamoya disease (1–9). The postoperative improvement in motor or speech impairment can be attributed to improved perfusion in the middle cerebral artery (MCA) distribution following these surgical treatments. However, progressive occlusive lesions are not confined to the MCA in moyamoya disease. They also occur in the internal carotid artery (ICA), the anterior cerebral artery (ACA), and the posterior cerebral artery (PCA) (1,8). Thus cerebral ischaemia in the ACA or PCA distribution results in such symptoms as visual disturbances and motor weakness in the lower extremities in some patients with moyamoya disease. Since most of the current documented operative procedures cannot directly revascularize these regions, omental grafts were performed in 14 cases with ischaemic symptoms in the ACA or PCA areas.

Hemodynamic force may be an important factor to develop cerebral aneurysm since its early change often occurs at the cerebral artery bifurcation [1]. In previous studies [2,3], we proved that a cerebral aneurysm could be induced successfully in rats. The scanning electron microscopic observation on the aneurysm showed early changes of the endothelial cell just distal to the apex of the cerebral artery bifurcation [4]. This suggested that the endothelial change might be closely connected with flow near the apex [3].

A long-term assessment was performed to determine the posttreatment clinical course of 113 patients with moyamoya disease. All patients sustained cerebral ischemic attacks and underwent superficial temporal artery-middle cerebral artery anastomosis with or without temporal muscle grafting. The follow-up duration was 3 to 24 years (mean 14.4 ± 5.8 [standard deviation]). Complete cessation of the ischemic episodes was obtained in 110 of 113 patients. One hundred patients were able to return to independent acitvities of daily living. Intellectual delays prevented 24 patients from engaging in an independent social life. Although intracranial bleeding is one of the common manifestations in moyamoya disease, hemorrhage was not detected in the 113 patients who underwent cerebral revascularization.

Between 1977 and 1993, we treated 47 patients with histologically verified primary intracerebral non-Hodgkin's lymphoma of B-cell origin. The cases of four of these patients (8.5% of the total) with long-term survival with high quality of life for more than 5 years are presented. Three have remained relapse-free for between 8.5 and 12 years after completion of original treatment; the fourth obtained complete remission for more than 5 years before death from tumor recurrence. All four patients were treated with our institutional therapeutic regimen, which includes radiotherapy consisting of 50–60 Gy to the tumor and 30–40 Gy to the whole brain, followed by four to six cycles of chemotherapy with cyclophosphamide, vincristine, adriamycin, and prednisolone at 4- and 8-week intervals. No further treatment was performed after remission had been obtained. No factors—including patient sex, age, tumor location, multiplicity of lesions, histology, or treatment modality—proved to be specific predictors of therapeutic success. The administration of chemotherapy beginning at the conclusion of radiotherapy in order to enhance the radiation antitumor effect may, however, have contributed to therapeutic success. The finding that all four patients had an immediate response to radiation may be related to their relatively high rate of survival. Histologic examination disclosed small non-cleaved cell lymphoma (high-grade malignancy) in one patient; diffuse large cell lymphoma (intermediate malignancy) in two patients; and small lymphocytic lymphoma (low-grade malignancy) in one patient. Posttherapeutic management during follow-up observation is discussed.

We examined the expression of fibroblast growth factor receptor-1 (FGFR-1), namely FLG, in tissues of 18 human gliomas, 10 human meningiomas, 3 human metastatic brain tumors, and 2 normal human brains by means of immunohistochemistry. All tissues were positively stained for FGFR-1. Primary brain tumors were more abundantly immunoreactive than normal brain tissues (Mann-Whitney U test, P < 0.05). There was significant correlation between the expression level of basic fibroblast growth factor (basic FGF) and that of FGFR-1 in tissues of human glioma (Spearman's test, P < 0.05). The expression level of FGFR-1 of tumor cells increased in correlation with that of endothelial cells in glioma tissues (Spearman's test, P < 0.001). We previously reported that basic FGF is produced in more than 90% of human glioma and meningioma tissues. Together with these data, it is suggested that basic FGF is involved in autonomous cell growth and tumorigenesis of gliomas and meningiomas as an autocrine growth factor in vivo.

The therapeutic effect of the synthetic serine protease inhibitor, FUT-175, on cerebral vasospasm after subarachnoid hemorrhage (SAH) was investigated. Twenty-three patients with severe SAH who were admitted between February and July 1990 and who underwent surgery within 48 hours of the initial aneurysmal rupture were treated with an intravenous administration of FUT-175 soon after the operation. The patients were divided randomly into three groups, each receiving a different dose of FUT-175 (Group A, 20 mg every 12 hours for 4 days; Group B, 20 mg every 6 hours for 4 days, Group C, 40 mg every 6 hours for 4 days). The results were compared with another group of twenty-two patients with severe SAH who were admitted before February 1990 and received equivalent treatment, except they were not treated with FUT-175. In 64% of all the patients treated with FUT-175 (Groups A, B, C), and in 85% of those treated with higher doses of FUT-175 (Groups B and C), there was no spasm or only mild vasospasm on the angiogram. The incidence of a delayed ischemic neurological deficit significantly decreased from 55% in the control group to 13% in all patients treated with FUT-175 and to 7% in the patients treated with higher doses (P less than 0.05). The incidence of cerebral infarction resulting from vasospasm significantly decreased from 43% in the control group to 9% in patients treated with FUT-175. In the patients treated with higher doses of FUT-175 (Groups B and C), none developed cerebral infarction.(ABSTRACT TRUNCATED AT 250 WORDS)

Five cynomolgus monkeys treated with unilateral carotid ligation, renal hypertension, and β-aminopropionitrile feeding were studied repeatedly by cerebral angiography to clarify the growth process of saccular cerebral aneurysms. Repeated angiography demonstrated saccular cerebral aneurysms in three of five monkeys; two aneurysms were found 15 months and a third 12 months after the operation. At autopsy, one saccular aneurysm was found to be bilocular in shape, and the others were unilocular. Fusiform aneurysms were also observed in four monkeys. Microscopic studies revealed the walls of the saccular aneurysms were very thin and consisted of fibrous tissue. In one aneurysm, the aneurysmal sac was almost obstructed by a well-organized thrombus. No evidence of intramural hemorrhage was found in any of the saccular cerebral aneurysms. The conversion of early aneurysmal changes into saccular aneurysms was found in any of the abruptly, and no consistent growth rate was noted. The multiloculation of saccular aneurysms was closely related to the size of an aneurysm. The present study indicates that a saccular cerebral aneurysm may grow abruptly from one of several different kinds of early aneurysmal changes.

A case of an unruptured giant aneurysm of the cavernous portion of the left internal carotid artery associated with a persistent primitive trigeminal artery (PTA) is presented. The usual surgical approach to giant aneurysms at this site. including ligation of the ipsilateral internal carotid artery (ICA) and an extracranial-intracranial (EC-IC) bypass, was inadequate because of continued blood supply to the aneurysm via the PTA from the vertebrobasilar system. The patient was successfully treated with a combination of EC-IC bypass surgery, ICA ligation, and simultaneous intravascular balloon obliteration of the ICA just distal to the junction of the PTA and immediately proximal to the aneurysmal neck. Follow-up radiological investigations showed thrombosis of the aneurysm.

Local cortical blood flow (LCBF) was measured during extracranial-intracranial (EC-IC) bypass surgery in 14 hemispheres of 12 patients with moyamoya disease, 8 hemispheres of 8 patients with occlusion or stenosis of the internal carotid or middle cerebral artery, and 2 hemispheres of 2 patients with an unruptured internal carotid aneurysm. Measurement of LCBF was performed with the clearance method of hydrogen gas generated by electrolysis (H2-method) and the heat clearance method (heat-method), using the plate type probe in both methods. LCBF measured by the H2-method was distinctly lower in all the patients with occlusive lesions before the EC-IC bypass, than in one patient without occlusive lesions. LCBF after bypass was increased in the territory of the recipient artery of all the patients with occlusive lesions, including moyamoya disease, except for one patient with stenosis of the middle cerebral artery. LCBF was not always increased after bypass in the area apart from the recipient artery, or the area on the opposite side of the Sylvian fissure of the patients with moyamoya disease. The LCBF measured by the heatmethod was hardly decreased by the clamping of the recipient artery in the part near the recipient artery before the bypass. The LCBF measured by the heat-method was promptly decreased by the clamping of the donor artery and increased by the release of the clamp after bypass. According to this evidence, the patency of the anastomosis and the surface area fed by the donor artery were confirmed after bypass. CO2 reactivity was studied by the heat-method in patients with moyamoya disease. In many of them, LCBF was not increased during hypercapnia but was decreased during hypocapnia. In the patients with unruptured internal carotid aneurysm, the heat-method was useful for determining the influence of clamping of the internal carotid artery on the LCBF before permanent ligation of the internal carotid artery. The H2-method is quantitative but interrupted, whereas the heat-method is continuous qualitative. It is quite possible that simultaneous LCBF measurements by both methods during bypass surgery are useful not only for the study of the cerebral hemodynamics but also for the monitoring system during operation.

Regional cerebral blood flow (rCBF), oxygen extraction fraction (rOEF), cerebral metabolic rate for oxygen (rCMRO2) and cerebral blood volume (rCBV) in nine cases of moyamoya disease in adults were studied with positron emission CT (PET) scan, using 15O steady-state methods. Three cases showed ischaemic symptoms and the other six cases showed haemorrhagic symptoms. PET scan was performed during the chronic stage. Control data were obtained from eight normal volunteers. Regional cerebral blood flow and other physiological parameters in cerebral gray matter, white matter and basal ganglia were compared with normal controls. All nine cases of Moyamoya disease showed decreased rCBF, though not significant, in cerebral gray matter, white matter and basal ganglia. Reduction of rCBF was significant in the cerebral cortex of six haemorrhagic cases. This significant decrease was considered to be due to diaschisis and also brain atrophy caused by the cerebral haemorrhage. There was a significant increase in rCBV in white matter of the both ischaemic and haemorrhagic cases. The calculated value of CBF/CBV is considered to be an index of perfusion pressure. This value was significantly decreased in all three regions, though rOEF was not significantly increased in moyamoya disease. Hence the cerebral circulation in adults with moyamoya disease appears to be characterized by a mild decrease in perfusion pressure and prolonged circulated time.

Ultrasonography was attempted to be utilized intraoperatively in 14 patients with medically intractable epilepsy. In nine of these 14 patients, epileptogenic foci were identified directly by intraoperative ultrasonogra-phy. All of the lesions with cystic components were clearly demonstrated. However, intraoperative ultrasonography could not depict satisfactorily all of the calcified lesions which had been demonstrated distinctly on preoperative CT and MRI. Even if ultrasonography could not demonstrate epileptogenic lesions, it was useful for determining localization of the lesions intraoperatively by three dimensional measurements of their location and extent by referring to sonographically identifiable structures, such as the ventricles, choroid plexus, falx, cerebellar tentorium and so on. Ultrasonography is considered to be useful as an intraoperative complement of structural studies in the surgical treatment of epilepsy.

In an investigation of the changes in cerebral blood flow (CBF) in subarachnoid hemorrhage, CBF was monitored in 14 patients who underwent surgery within 3 days of the onset of hemorrhage. On admission, one patient was neurological grade I, one was grade II, seven were grade III, and five were grade IV. Computed tomography showed diffuse, thick subarachnoid hemorrhage with or without intracerebral hematoma in all patients, strongly indicating the possibility of cerebral vasospasm. CBF monitoring was performed by the thermal diffusion technique, in which a small flow probe, 7 mm in diameter and 4 mm in height and containing a Peltier stack, is used. The probe was implanted in the subdural space in the frontotemporal region during surgery. Epidural intracranial pressure was also monitored. Local CBF was measured continuously for 7 to 19 days after surgery. Immediately after surgery, CBF was low in grade IV patients (mean, 25 ml/100 g/min), whereas a variety of CBF rates were observed in grade III patients. Minimal decreases in CBF were noted in the grades I and II patients (mean, 41 ml/100 g/min). The sequential changes in CBF were well correlated with outcome. The two grades I and II patients, who had no appreciable decrease in CBF, had excellent outcomes. In the five (of seven) grade III patients who showed good or excellent recovery, CBF was maintained with only a slight decrease. In two grade III patients, substantial depression of CBF occurred several days after the onset of subarachnoid hemorrhage; one had a poor outcome, and one died. Good recovery of CBF was observed in one grade IV patient, who showed excellent postoperative recovery. The remaining four patients, had moderate to substantial decreases in CBF, with poor postoperative results, including two deaths. These observations indicate that a decrease in CBF due to vasospasm or other causes can be detected early through CBF monitoring. In addition, the outcome of subarachnoid hemorrhage can be predicted on the basis of sequential changes in CBF.

A multi-center double blind study for the clinical evaluation of TCUK was carried out on 115 patients with cerebral thrombosis.The administration of TCUK was done continuously in doses of 60, 000 I. U. for 7 days under comparison with negative placebo.The study was performed according to the protocol, shown in Table 1-6 and the effects of TCUK were judged by the grade of improvement of apparent subjective complaints, disturbances of consciousness, motorius and sensorial disorders of extremities and comprehensive daily life activities. The total scoring of improvements in individual disorders and their comprehensive evaluation were made for judgement of the global improvement and availability of the drugs, obtaining the following conclusions:(1) The availability, particularly the global improvement of TCUK were better than those of placebo in their statistical significance (Table 10).(2) In the serial evaluations, the clinical effects were more significant in patient groups of mild or moderate grades in the severity of disorders, of ages between 40-69, without histories of brain damages and without simultaneous infusions of large amount of solutions.(3) The side effects of TCUK were rare (Table 11) with only two exceptional cases with disturbance of liver functions (Table 18), but the relationship between this liver function disturbance and administration of TCUK was obscure and no cases of hemorrhagic infarction were found in connection with TCUK administration in this study.

✓ Eleven lymphocyte clones were established from the peripheral blood lymphocytes of a patient with gliosarcoma by means of autologous tumor stimulation and the limiting-dilution technique with recombinant interleukin-2. Ten of the 11 clones were cytotoxic against the autologous tumor cell line GI-1. Seven of the 10 clones were also cytotoxic against allogeneic brain-tumor lines and HeLa cells, one clone was cytotoxic against several target cells, and two clones were specifically cytotoxic against GI-1 and allogeneic brain-tumor cells. One of the 11 clones was not cytotoxic against any target cells tested. Lymphokine-activated killer cells induced by recombinant interleukin-2 alone exhibited cytotoxic activity against all target tumor cells tested. Surface phenotypic analysis revealed that all lymphocyte clones expressed CD3 antigen, some expressed CD4 antigen, and others expressed CD8 antigen. These clones seemed to be antigen-specific cytotoxic T lymphocyte clones. Analysis with these antigen-specific cytotoxic T lymphocyte clones may be useful in the elucidation of tumor-specific or tumor-associated antigens on autologous tumor cells.

Noninvasive measurement of human spinal cord blood flow (SCBF) has not yet been established. The authors successfully measured human SCBF by using xenon and a CT scanner (Shuttle method). This method was clinically applied in 10 patients without spinal cord pathology. Mean SCBF of the normal adult at the C5 level was 42.3 ± 6.3 ml/ 100 g/min. CO2 reactivity in SCBF was also detected. This method may well be used in the clinical study of human SCBF.

小児もやもや病患者12名についてジアゼパムーフェンタニル麻酔下にPaCO2を変化させて全脳および大脳皮質の脳血流量の変化を測定し, 同時に Anesthesia and Brain activity Monitor によるEEGを記録した. PaCO2 53mmHgの hypercapnia 時脳血流量は全脳では平均32%, 大脳皮質では平均12%の有意でない増加傾向を示したが, 減少する例も見られた. 平均PaCO2 33mmHgの hypocapnia 時は全脳では平均28%, 大脳皮質では平均20%の有意な減少を示した. 脳血流量の変化とEEG平均周波数および平均振幅の変化との間に一定の傾向はみられなかった. 小児もやもや病の麻酔管理に際しては hypocapnia をさけるのは当然であるが hypercapnia よりも normocapnia が好ましい.

It is well known that cerebral vasospasm following ruptured cerebral aneurysm affects the prognosis very seriously after direct surgery. However, the pathogenesis of cerebral vasospasm remains obscure. Furthermore, the precise brain damage following it has not been made clear histopathologically. The histopathological postmortem studies of intracranial arteries with angiographycally demonstrated arterial narrowing have been carried out in 44 cases. The cerebral arterial wall corresponding to the angiographic vasospasm showed various structural changes, which could be divided into five groups according to histological findings. In Group 1, the intraluminal size of arterial wall was reduced even though the medial thickening, marked corrugation of the internal elastic lamina and intimal edema were demonstrated. In Group 2, necrosis of smooth muscle cells in the tunica media, partial break of internal elastic lamina and the profuse deposition of acid mucopolysaccharides were seen. In Group 3, marked intimal thickening and the medial atrophy were seen. In Group 4, dilatation of luminal size with improvement of the intimal thickening and the remarkable medial atrophy were noted. In Group 5, regeneration of smooth muscle cell in the tunica media was observed. These histological findings suggest the time course of cerebral arterial spasm from onset to remission.

Cerebral rCBF, rOEF, rCMRO2, and rCBV in moyamoya disease were studied by means of positron emmission tomography (PET), using 15O as a tracer. Steady-state methods with C15O2 and 15O2 were used to obtain the functional images of rCBF, rCMRO2, and rOEF. The 15O single-inhalation method was used to obtain the rCBV image. Five children (two boys and three girls) with mean age of 11 years and eight normal volunteers with mean age of 31 years were included in the study. The symptoms of moyamoya disease were due to cerebral ischemia, such as transient ischemic attack (TIA), reversible ischemic neurological deficit (RIND), and minor stroke. The interval between the latest ictus and PET scan ranged from 3 days to 3 years 6 months. Physiological parameters (rCBF, rCMRO2 etc.) in cerebral gray matter, cerebral white matter and basal ganglia were calculated from the single functional images. Any, low density areas appearing in X-ray-CT performed just prior to the PET study were carefully excluded from the analysis. The parameters of moyamoya disease were statistically compared with normal control parameters. Though the value of rCBF was slightly higher in moyamoya disease, this difference was not statistically significant. On the other hand, in moyamoya disease rCBV increased significantly in gray matter, white matter, and basal ganglia. The ratio of CBF to CBV is considered to be the index of perfusion pressure and reciprocal of cerebral mean transit time under the normal autoregulation of CBF. This ratio was calculated and compared with the normal value for each tissue. The ratio was significantly decreased in each tissue in moyamoya disease, indicating the presence of a low perfusion pressure in the moyamoya brain. In general, when the reduction of perfusion pressure becomes profound the decrease in the CBF-to-CBV ratio is followed by an increase in rOEF. In spite of the reduction in the CBF-to-CBV ratio there was no significant increase in rOEF in moyamoya disease. Thus, the cerebral circulation in childhood moyamoya disease of ischemic type was characterized by a mild decrease in perfusion pressure and a prolonged circulation time.

A simple method was developed to measure in vivo local oxygen consumption quantitatively in the brain cortex. Reflectance spectra of tissue hemoglobin at the brain's surface were measured for assessment of both local tissue hemoglobin content and its oxygen saturation. Local oxygen consumption was calculated from the spectral changes of tissue hemoglobin during complete cessation of blood flow by compression of the cortical surface in the suprasylvian gyrus with the tip of an optic probe. This procedure was performed without any brain damage and only took ∼5 s. The calculated local oxygen consumption during this short period of compression remained constant for a few seconds. Then, it decreased rapidly, although the local tissue hemoglobin was not completely deoxygenated. The value of local cerebral oxygen consumption obtained by this method was 3.02 ± 0.61 mL O2/100 g brain/min; it was not influenced by the change in systemic blood pressure. The effect of pentobarbital on cerebral oxygen consumption was also studied. At the stage of burst and suppression on electrocorticogram, cerebral oxygen consumption decreased significantly (p < 0.001) to 1.03 ± 0.07 mL O2/100 g brain/min.

To evaluate the risk of tonsillar herniation, the caudal pole of the cerebellar tonsil in posterior fossa mass lesions and anomalies was investigated with magnetic resonance imaging. The cerebellar tonsil was clearly demonstrated in relation to the surrounding structures on T1-weighted images in the paramedian or midline sagittal plane. In 78% of a control group of 50 cases, the tonsil was located just on or close to the upper border of the posterior lip of the foramen magnum. It was close to the line of the foramen magnum in 4 cases (8%), but displacement below this line was not observed in any case. In 18 cases of posterior fossa mass lesions, the tonsil tended to be in a lower position than in the control group, and tonsillar displacement below the foramen magnum was noted in 3 cases. Two of these cases had anterior medullary displacement with loss of the cerebrospinal fluid (CSF) space anterior to the tonsil; these patients had either rapid clinical deterioration or severe papilledema. In the remaining case and in 3 additional cases of Chiari malformation, the tonsils were displaced into the cervical canal with preservation of the CSF space, and the patients showed no signs of rapid clinical deterioration or increased intracranial pressure. The present study suggests that tonsillar displacement through the foramen magnum with associated anterior medullary displacement and loss of the CSF space anterior to the tonsil can be regarded as a sign of tonsillar herniation.

The CT findings of 19 children under 16 years of age with primary brain tumors in the cerebral hemisphere were investigated with special reference to the existence of cerebral hemiatrophy ipsilateral to the side of the tumor. "Ipsilateral cerebral hemiatrophy" was observed in four of 19 cases (21%). These included two cases with germinoma in the basal ganglia and two with low-grade astrocytoma in the frontal and occipital cortex. This peculiar CT finding was not specific to the location or histology of the tumor. The four cases were characterized by slow progression, which contrasted with the rapid progression of tumors shown in seven cases with a mass effect on CT.

Experimental cerebral aneurysms in monkeys induced by treating them with unilateral carotid ligation, renal hypertension, and beta-aminopropionitrile feeding were studied macroscopically and with light microscopy. Macroscopically, 13 cerebral aneurysms were observed in six of seven monkeys. Microscopically, the elastic lamina and the media ended around the beginning of the aneurysms. The thin aneurysmal walls consisted of fibrous connective tissues. All findings were generally in accordance with spontaneous lesions in humans. The induced cerebral aneurysms in primates are thought to be a suitable experimental model to clarify the pathogenesis of the disease.

✓ This study examines the relaxant effect of calcitonin gene-related peptide (CGRP), a 37-amino acid peptide with a potent vasodilator action, on cerebral arterial spasm after subarachnoid hemorrhage (SAH). The spasm was induced by injecting autologous arterial blood percutaneously into the cisterna magna in adult mongrel dogs. The single-injection model of SAH was produced by injection of 1.0 ml/kg body weight of blood (on Day 0), and the double-injection model involved two successive injections of 0.5 ml/kg body weight of blood made 48 hours apart (on Day 0 and Day 2). On vertebral angiograms, arterial narrowing of the major cerebral arteries was most prominent on Day 3 after SAH in the single-injection model and on Day 7 in the double-injection model. When 10−10 mol/kg of CGRP was administered intracisternally in the single-injection model on Day 3, the diameter of the spastic cerebral arteries, as determined by angiography, recovered to normal. After intracisternal administration of 10−11 to 2 × 10−10 mol/kg of CGRP on Day 7 in double-injection models, spastic cerebral arteries dilated in a dose-dependent manner. The dilatory effect of CGRP continued for a few hours after administration. The results suggest that CGRP injected intracisternally may reverse cerebral arterial spasm after SAH.