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We analysed the predictive factors for relatively good prognosis in the patients with total anterior circulation infarction (TACI) defined by the Oxfordshire Community Stroke Project. One hundred patients with first-ever ischemic stroke within 6 hours of onset were enrolled. Outcomes were assessed at 3 months using the modified Rankin Scale (mRS), and rated as good if the mRS was 0 to 3, and as bad if the mRS was 4 or 5, or the patient was dead. These two groups were compared in terms of their clinical background, risk factors, vital signs, laboratory data, and cranial CT at the time of hospitalization and repeated CT at 24 to 48 hours after onset. There were 36 patients with good prognosis and 64 patients with bad prognosis. In univariate analysis, the patients with good prognosis were younger, had lower scores in the National Institutes of Health Stroke Scale (NIHSS, both total score and the score of consciousness sub-item), had fewer rates of deterioration within 7 days than the patients with bad prognosis. In the first cranial CT within 6 hours, the patients with good prognosis had fewer early CT signs including hyperdense middle cerebral artery sign, and brain swelling, as well as infrequent hypodensity more than 33% of total MCA territory, than the patients with bad prognosis. In the second CT during 24 to 48 hours, the patients with good prognosis had smaller lesions than the patients with bad prognosis. In multivariate analysis with logistic regression revealed that age70 years, low NIHSS scoreor = 15, no deterioration in the acute phase, and small lesion on the second CT were independent predictors of good prognosis.

A 27-year-old woman was admitted to our hospital because of headache, fever and right neck pain. Neurological examination revealed mild meningeal signs, and hyper-reflexia in all extremities. In the laboratory tests, white-cell count was 13,000/mm3, rheumatoid factor(RF) and C-reactive protein(CRP) were positive. The cerebro-spinal fluid showed pleocytosis (56/mm3, neutorophils and lymphocytes were 26 and 28, respectively). Thus, she was diagnosed as aseptic meningitis. A few days later, she had weakness and dysesthesia of the right face and the left extremities. Pulse therapy with intravenous methylprednisolone was started. A magnetic resonance imaging (MRI) of the brain showed a hemorrhagic infarction in the right parietal lobe. In hemostatic markers, thrombin-antithrombin III complex(TAT; 106 ng/dl), D-dimer 1234 ng/dl, prothrombin fragment 1 + 2(F1 + 2; 2.36 nmol/L), beta-thromboglobulin (beta TG; 4,300 ng/dl) and platelet factor 4 (PF-4; 1,770 ng/dl) were extremely elevated. On duplex ultrasonography, a low echo lucent plaque was observed at the right internal carotid artery and the mean blood flow velocity in the right carotid artery was decreased. She was placed on oral prednisolone and warfarin for suspected stroke due to hypercoagulability associated with vasculitis. Afterwards, she discharged from our hospital. Two months later, she was readmitted to our hospital because of irregular menses and vaginal bleeding. Endometrial uterus biopsy was conducted, which revealed a grade I endometrioid adenocarcinoma. She was under total uterectomy without tumor recurrence. After the radical operation, white-cell count, RF, CRP, TAT, D-dimer, F1 + 2, and beta TG were normalized, and the mean flow velocity of the right common carotid artery was increased. Thereafter, she did not experience stroke recurrence. Therefore, we speculated that she had stroke due to hypercoagulability in association with malignancy, that is Trousseau's syndrome. We also assumed that aseptic meningitis, brainstem encephalitis associated with vasculitis in this patient are other clinical variants of paraneoplastic syndrome through immunological mechanisms associated with malignancy. We emphasize that patients with Trousseau's syndrome can be associated with other paraneoplastic manifestations such as vasculitis as seen in this patient.

Sirs, Zonisamide (ZNS) was originally used as an anti-epileptic agent. ZNS has recently been shown to exert beneficial effects in patients with Parkinson s disease (PD) [1–6] and anti-tremor effects in patients with essential tremor and in tacrine-induced tremulous jaw movements in rats [7–11]. We report herein that intractable resting and re-emergent tremor [12] (resting tremor that re-emerges after a variable delay while maintaining posture) in patients with PD improved dramatically by ZNS. This case was a 73-year-old woman with PD who developed resting tremor and mild postural tremor on the right hand at the age of 68 years. The patient first took pramipexole, but the dosage could not be increased because of adverse effects of sleepiness, and so was kept at 1.5 mg/day. After 2 years, resting tremors expanded to all extremities, and postural tremor appeared on both upper hands. Levodopa/carbidopa at 500 mg/day, cabergoline and amantadine showed no efficacy against tremors. Trihexyphenidyl at 2 mg/day decreased tremors (Video S1), but induced somnolence. Alotinolol could not be used, as the patient was asthmatic. After 4 years, activities of daily living deteriorated because of severe resting and re-emergent tremors on both upper hands, as well as jaw and tongue tremors (Video S1). She was unable to change clothes or eat meals by herself even using daily doses of pramipexole at 1.5 mg, levodopa/carbidopa at 500 mg and trihexyphenidyl at 4 mg. ZNS was added at 50 mg/day, and tremors diminished slightly. Resting and re-emergent tremors improved markedly with ZNS at 100 mg/day (Video S2). Although mild sleepiness was observed, no severe additional adverse effects were noted during treatment with ZNS. Her

Alterations of platelet, coagulation, and fibrinolysis markers were investigated to determine the indications for antithrombotic therapy in patients with different clinical categories of acute cerebral infarction. Marked platelet activation was observed in platelet function tests, including measurements of platelet-specific proteins and platelet survival, platelet scintigraphy in the brain, and platelet fibrinogen binding assay, in patients with atherothrombotic stroke. Among patients with atherothrombotic stroke, increases of thrombin-antithrombin III complex (TAT) and D-dimer were frequent in addition to the findings of platelet activation in patients showing progressing stroke. Patients with cardioembolic stroke demonstrated marked elevation of coagulation markers, TAT and fibrinopeptide A, and fibrinolysis markers, D-dimer and plasmin-alpha2-plasmin inhibitor complex, as well as platelet activation. In contrast, neither activation was seen in patients with lacunar stroke. On the basis of these findings, antiplatelet therapy is indicated for stable or improving stroke, whereas anticoagulant therapy is indicated for progressing stroke among patients with atherothrombotic stroke. In patients with cardioembolic stroke, anticoagulant therapy should be started as soon as possible, or should be followed by thrombolytic therapy in the hyperacute phase. However, further investigation appears necessary for recommendations for patients with lacunar stroke.

WCN 2013 No: 1177 Topic: 3 — Stroke Cilostazol plus aspirin versus aspirin alone in patients with symptomatic intracranial arterial stenosis: Results of catharsis S. Uchiyama, N. Sakai, S. Toi, M. Ezura, Y. Okada, M. Takagi, Y. Nagai, K. Miyakoda, K. Minematsu, N. Suzuki, N. Tanahashi, W. Taki, I. Nagata, M. Matsumoto The CATHARSIS Study Group Department of Neurology, Tokyo Women's Medical University, Tokyo, Japan; Department of Neurosurgery, Kobe City General Hospital, Kobe, Japan; Department of Neuroendovascular Therapy, Tohoku University, Sendai, Japan; National Hospital Organization Kyushu Medical Center, Fukuoka, Japan; Department of Neurology, Saiseikai Central Hospital, Tokyo, Japan; Translational Research Informatics Center, Kobe, Japan; National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology, Keio University, Tokyo, Japan; Saitama Medical University International Medical Center, Saitama, Japan; Department of Neurosurgery, Mie University, Tsu, Japan; Department of Neurosurgery, Nagasaki University, Nagasaki, Japan; Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Hiroshima, Japan Background: The Cilostazol–Aspirin Against Recurrent Stroke with Intracranial Artery Stenosis (CATHARSIS) (Clinicaltrials.gov identifier: NCT00333164) was an investigator-driven nationwide multicenter cooperative randomized controlled trial to compare cilostazol plus aspirin with aspirin alone in patients with symptomatic intracranial artery stenosis (IAS). Methods: Subjects were patients at age of 45–85 years with ischemic stroke after two weeks to six months from onset and N50% stenosis in responsible intracranial arteries on MRA. They were randomly allocated to either group of cilostazol 200 mg/day plus aspirin 100 mg/day (CA group) or aspirin 100 mg/day alone (A group), whowere followed up for two years. Results: A total of 165 patients (109 males, average 68 years) were randomized. There was no difference in the progression of IAS between both groups (9.6% in CA group and 7.6% in A group, p = 0.5326). Stroke recurrence occurred in 2.4%/year in CA group (ischemic 4, hemorrhagic 0) and 5.5%/year in A group (ischemic 6, hemorrhagic 2). After correction with background characteristics, rates of stroke plus silent brain infarct (5.8% vs 12.5%, HR 0.34, 95% CI 0.12–0.96, p = 0.04) and all vascular events plus silent brain infarct (10.7% vs 25.0%, HR 0.37, 95% CI 0.14–0.97, p = 0.04) were significantly lower in CA than A group. Conclusion: There was no difference in the progression of IAS between two groups. Rates of stroke plus silent brain infarct and all vascular events plus silent brain infarct were lower in CA than A group. doi:10.1016/j.jns.2013.07.781 Abstract — WCN 2013 No: 1368 Topic: 3 — Stroke Nonhemiplegic hand strength is weaker in those with deglutition problems at initial one month after stroke WCN 2013 No: 1368 Topic: 3 — Stroke Nonhemiplegic hand strength is weaker in those with deglutition problems at initial one month after stroke H. Choi, S. Im, G.Y. Park, J.H. Park, Y.J. Lee. Catholic University of Korea Bucheon St. Mary's Hospital, Bucheon, Republic of Korea Background: Dysphasic stroke patients with nasogastric feeding tubes (NGT) are at high risk of malnutrition, which may lead to prolonged hospital stay and poor functional recovery. Hand grip strength (HGS) is a useful marker of patients' nutritional status at an early stage. Objective: The objective is to determine if HGS of the nonhemiplegic side at one month post-stroke is significantly different in patients with NGT compared to those without NGT and to assess if HGS measurements correlated to serum markers and functional status. Patients and method: We retrospectively reviewed medical record of 218 patients admitted to our department from September 2010 to April 2012. Material and method: We recorded patients' serum markers (albumin), modified Barthel index scores (MBI), mini mental status examination (MMSE), and Berg balance scale (BBS). Correlations analysis of hand strength to biochemical markers was performed using independent t-test. Result: Mean ± SD values of MBI, BBS, MMSE albumin, with NGT (n = 151)/without NGT (n = 67) were 12.5 ± 20.0/51.3 ± 31.3, 6.26 ± 12.2/27.6 ± 20.9, 10.0 ± 10.1/19.1 ± 8.0, and 6.7 ± 0.7/7.4 ± 6.7. The mean lateral pinch and grip strength (lb) of these two groups were 6.5 ± 7.0/11.7 ± 5.3 and 20.1 ± 23.5/42.3 ± 20.6, respectively and all these values showed statistically significant differences (P b 0.05). Conclusion: NGT patients showed weaker grip and lateral pinch strength in nonhemiplegic hand and this correlated to functional status and serum markers. Initial assessment of grip and lateral pinch strength of the contralateral hand may be useful to evaluate the functional nutritional status in those with prolonged NGT from an early stage. doi:10.1016/j.jns.2013.07.782 Abstract — WCN 2013 No: 1373 Topic: 3 — Stroke On the question of the application of silver nanoparticles in antithrombotic therapy WCN 2013 No: 1373 Topic: 3 — Stroke On the question of the application of silver nanoparticles in antithrombotic therapy A.I. Fedin, A. Babushkin, A.V. Chekanov, O.A. Baranova, O.P. Mironova, E.Y. Solovyeva. Neurology, Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia Platelets play a key role in the development of thrombotic lesions. Urgent action to prevent platelet activation affecting the process of fibrin polymerization and slowing clot formation. Objective: To study the effect of silver nanoparticles with 10, 20, 70 nm on the systemof cellular and plasmahemostasis in vivo. For the study of platelet aggregation, we used the method of scanning electron microscopy. Silver nanoparticles were pre-incubated with platelet-rich plasma of human blood in the presence of ADP in the control units. The particles do not exceed the diameter of 2.9–3.2 mm. Addition of 60 mM and d= 70 nm nanoparticles in platelet rich plasma, caused the formation of aggregates a diameter of 3.5–4.2 mm. It caused the decrease in prothrombine time, which indicates additional aggregation and thrombus formation. By chemiluminescence, registered superweak glow and intense bursts are accompanied by activation of blood neutrophils in the presence of luminol by adding nanoparticles of d70 nm at a concentration of 0.064 × 10−11 M, indicating an inflammatory action. When added to the plasma particles 10 and 20 nm, it manifested an anti agregational effect — formed units 1.8–2.5 mm, prothrombin time did not change. Adding 10–20 nm silver nanoparticles in a concentration of 10 to 100 mM prevented fibrin polymerization. Conclusion: Nanosilver, d = 20 nm or less, reduces platelet aggregation, practically does not activate neutrophils and prevents fibrin polymerization. The data suggest that nanosilver d = 20 nm or less is Abstracts / Journal of the Neurological Sciences 333 (2013) e152–e214 e194

Objective: To determine whether relapses of neuromyelitis optica (NMO) are associated with pregnancy. Background The risk of multiple sclerosis (MS) relapse is known to decrease markedly during pregnancy, particularly in the third trimester, and increase again in the first 3 months postpartum. However, little is known about the influence of pregnancy on the clinical course of NMO. Design/Methods: We retrospectively studied pregnant patients with NMO seen at Tokyo Women9s University Hospital, Tohoku University Hospital, or Juntendo University Hospital and diagnosed according to AQP4 antibody-positive findings and the revised criteria. We analyzed disease onset and/or relapse associated with pregnancy and investigated each trimester during pregnancy (1st, DP1; 2nd, DP2; 3rd, DP3) and each trimester postpartum (1st, PP1; 2nd, PP2; 3rd, PP3; 4th and over, PP4). Results: Among total 51 pregnant women diagnosed with NMO, we extracted 14 NMO patients (mean age at disease onset, 30.4±8.5 years; mean age at pregnancy, 32.6±6.6 years; these mean ages were lower than those of the general age at onset for NMO [39 years]). Total number of relapses was 17 among our patients. For each period, the number of relapses was 3 for DP1, 2 for DP2, 1 for DP3, 5 for PP1, 3 for PP2, 1 for PP3, 1 for PP4, and 1 immediately after elective abortion. NMO appeared to be associated with pregnancy in 6 patients, and the time of disease onset was more frequently postpartum (n=6) than during pregnancy (n=2) in these patients. Almost all of these patients delivered healthy babies. Conclusions: Our results suggest that NMO patients of childbearing age need to be aware of the potential for disease exacerbation and may be at a higher risk of relapse/disease onset postpartum compared to during pregnancy. The influence of pregnancy on NMO might bear some resemblance to MS. Supported by: A Health and Labour Sciences Research Grant on Intractable Diseases (Neuroimmunological Diseases) from the Ministry of Health, Labour and Welfare of Japan. Disclosure: Dr. Shimizu has received personal compensation for activities with Bayer Yakuhin, Biogen Idec Japan, Teijin Pharma, and Novartis. Dr. Shimizu has received royalty payments for the Quick Reference Guide for Management. Dr. Ohashi has received personal compensation for activities with Bayer Yakuhin, Biogen Idec Japan, Teijin Pharma, and Novartis Pharma. Dr. Maruyama has nothing to disclose. Dr. Nakashima has received personal compensation for activities with Bayer Schering, Novartis, and Biogen Idec. Dr. Nakashima has received research support from Mitsubishi Chemical Medience Corporation and the Ministry of Education, Science, and Technology of Japan. Dr. Yokoyama has personal compensation for activities with Bayer Yakuhin, Biogen Idec Japan, Mitsubishi Tanabe Pharma, Teijin Pharma, Asteras Pharma, Daiichi Sankyo, Cosmic Corporation, Takeda Pharma, and AstraZeneca Pharmaceuticals. Dr. Fujihara has received personal compensation for Bayer Schering Pharma, Biogen Idec, Merck Serono, Biogen Idec, Eisai Inc., Mitsubishi Tanabe Pharma Corporation, Astellas Pharma Inc., Takeda Pharmaceutical Company Limited, and Asahi Kasei Kuraray Medical Co., Ltd. Dr. Fujihara has received personal compensation in an editorial capacity for Clinical and Experimental Neuroimmunology. Dr. Fujihara has received research support from Bayer Schering Pharma, Biogen Idec Japan, Asahi Kasei Kuraray Medical Co., The Chemo-Sero-Therapeutic Research Institute, Teva Pharmaceutical K.K., Mitsubishi Tanabe Pharma Corporation, Teijin Pharma, Eisai Inc., and Kyowa Pharmaceuticals America, Inc. Dr. Uchiyama has received personal compensation for activities with Sanofi-Aventis Pharmaceuticals, Inc., Otsuka, Novartis, Boehringer Ingelheim Pharmaceuticals, Inc., and Daiichi Sankyo.

Recent evidence has suggested that shear-induced platelet aggregation is an important mechanism of thrombosis at arterial bifurcations or stenoses. We measured shear-induced platelet aggregation with a new apparatus in patients with cerebral ischemia and also studied correlations with other hemostatic parameters as well as the effect of antiplatelet agents. The subjects were 75 patients with cerebral ischemia and 26 control subjects. Platelet aggregation was induced in citrated platelet-rich plasma by a high shear stress (108 dynes/cm2) that was applied by means of a cone-plate streaming chamber based on turbidimetry. We studied the correlation of test results with hemostatic parameters and also the effects of antiplatelet agents. Compared with the control subjects, an increase of shear-induced platelet aggregation was observed in 21 patients with atherothrombotic stroke and 12 with transient ischemic attacks, but not in 11 with cardioembolic stroke or 31 with lacunar stroke. There was no significant correlation of shear-induced platelet aggregation with platelet count, agonist-induced platelet aggregation, fibrinogen level, or beta-thromboglobulin level. The extent of shear-induced aggregation was not correlated with von Willebrand factor antigen levels but was significantly correlated with the amounts of larger von Willebrand factor multimers. Oral aspirin (81 mg/d) did not inhibit shear-induced platelet aggregation, whereas oral ticlopidine (200 mg/d) significantly inhibited it. These results indicate that shear-induced platelet aggregation is increased in patients with atherothrombotic stroke and transient ischemic attacks, is correlated with the increase of larger von Willebrand factor multimers, and is corrected by ticlopidine but not by low-dose aspirin.

Objectives The objective of this study was to examine clinical factors associated with depressive state in patients with myasthenia gravis (MG). Design Cross-sectional study. Setting and participants We evaluated 287 consecutive cases of MG seen at six neurological centres located in Eastern Japan. Outcome measures All MG patients completed the Japanese version of the Beck Depression Inventory–Second Edition (BDI-II). Disease severity was determined according to the MG Foundation of America (MGFA) quantitative MG score, MG activities of daily living scale and MG composite scale (MG composite). Clinical state following treatment was categorised according to MGFA postintervention status. Associations between detailed clinical parameters of MG and BDI-II score were then examined statistically. Results Mean BDI-II score for patients with MG (11.0±8.1) did not differ substantially from and overlapped with that reported as the Japanese standard (8.7±6.4). The mean +2 SDs for the Japanese standard is 21.5, approximately equal to the cut-off level indicative of moderate or worse depression (>20 points) in the original English version. We thus defined BDI-II >21.5 as depressive state, with a frequency of 13.6% in patients with MG. Multivariate logistic regression analysis revealed current dose of oral prednisolone (OR 1.09, 95% CI 1.02 to 1.17; p=0.01), unchanged MGFA postintervention status (OR 3.55, 95% CI 1.18 to 10.71; p=0.02), time since onset (OR 0.93, 95% CI 0.87 to 0.99; p=0.03) and MG composite (OR 1.16, 95% CI 1.00 to 1.34; p=0.046) as factors independently associated with depressive state in MG. Conclusions Dose of oral corticosteroids appears to represent the major factor associated with depressive state in MG. Unchanged status despite treatment and early disease stage are also significant background factors for depressive state, along with disease severity., Article summary Article focus Background factors associated with depressive state in MG were statistically examined. Key messages Dose of oral corticosteroids appears to represent the major factor associated with depressive state in MG. Unchanged status despite treatment and early disease stage are also significant background factors for depressive state, along with disease severity. Achieving early improvement of disease by adequate MG therapy without long-term use of higher dose oral corticosteroids may be important to avoiding depressive state in patients with MG. Strengths and limitations of this study Strength: this study probably is the first to systematically and statistically examine the associations between detailed disease-related parameters of MG and depressive state. Limitation: predictive modelling cannot be strictly performed on this cross-sectional sample. Weakness: the absence of social factors as variables.

Abstract 1066 Poster Board I-88 Introduction: Edoxaban (the free base of DU-176b) is an oral, selective, reversible, direct factor Xa inhibitor in clinical development for the prevention of stroke in patients with non-valvular atrial fibrillation (AF). There is evidence that asymptomatic intracranial hemorrhage (ICH) may be a risk factor for symptomatic ICH in anticoagulated patients. A phase IIb study in Japanese AF patients compared the incidence of asymptomatic ICH with edoxaban and warfarin use. Patients and Methods: This was a multicenter, randomized, dose comparison study. Patients aged ≥20 years with CHADS2 score ≥1 were randomly assigned to receive 1 of 3 doses of edoxaban (30 mg, 45 mg, or 60 mg QD) or open-label warfarin dose-adjusted to a target international normalized ratio (INR) of 2.0 to 3.0 inclusive for patients aged Results: There were no clinically relevant differences in patient demographics and baseline characteristics between treatment groups. Overall, the time within the target INR range was 83% and 73% for patients aged ≥70 years and aged Disclosures: Yasaka: Nippon Boehringer lngelheim Co., Ltd.: Consultancy; Pfizer Japan Inc.: Consultancy; Daiichi Sankyo Co., LTD.: Consultancy. Kawai:Toyama Chemical: Consultancy; DaiichiSankyo: Consultancy. Yamaguchi:Mitsubishi Tanabe Pharma: Consultancy; Otsuka Pharmaceutical: Consultancy. Uchiyama:Bayer Yakuhin, LTD. : Consultancy; Nippon Boehringer lngelheim Co., Ltd.: Consultancy; Astellas Pharma Inc.: Consultancy. Ogawa:TEIJIN PHARMA LIMITED: Consultancy; Pfizer Japan Inc.: Consultancy; Bayer Yakuhin, LTD.: Consultancy; Astellas Pharma : Share Holder; Sanofi-aventis : Paid Instructor. Koretsune:Daiichi Sankyo: Consultancy, National Lead Investigator. Yamashita:Novartis: Consultancy; DaiichiSankyo: Consultancy, National Lead Investigator; Otsuka Pharmaceutical: Paid Instructor; Sanofi-aventis: Paid Instructor; TEIJIN PHARMA: Paid Instructor.

Lumi-aggregometerを用いて血小板より放出されるATP量を求め, 虚血性脳血管障害におけるATP放出能と凝集能との関係ならびに抗血小板剤の効果について検討した.抗血小板剤未投与の脳血栓症, TIAのATP放出量はそれぞれ3.88±2.24μM, 4.97±4.11μMであった.最大凝集率 (M%) はそれぞれ66.3±11.1%, 77.1±11.6%, 最大凝集までの時間 (Tm) はそれぞれ288.5±86.9sec, 301.8±78.8sec, 解離率 (D%) はそれぞれ, 6.2±11.5%, 3.4±5.1%であった.これらの値は, 健康成人ならびにASA (0.3～0.7g/日), ticlopidine100mg/日または200mg/日の治療群と比べ有意 (p

Currently we developed a new in vitro test of hemostasis, the filter bleeding time (FBT), which is based on progressive decrease of flow rate of citrated blood through a disk filter of Woven Dacron under controlled pressure as platelet aggregates occlude the filter. FBT is defined as the time when the blood drop rate has fallen to less than 1/30sec. There was a high correlation (r=-0.91) between FBT and platelet count below 105/μl in dogs made thrombocytopenia by estradiol. There was a significant correlation (r=0.65) between FBT and Ivy Bleeding Time (IBT) in 59 patients referred because of a suspected bleeding disorder. FBT was prolonged in 3 of 3 patients with Glanzmann's thrombasthenia, 5 of 6 with von Willebrand disease and normal in 6 of 6 with hemophilia. FBT was more sensitive than IBT in detecting abnormal platelet aggregation in response to collagen, epinephrine or arachidonate. A monoclonal platelet antibody (HP1-1D), which is a specific antibody for platelet membrane glycoprotein IIb and IIIa, increased FBT in a dose dependent manner. FBT was prolonged by adding 0.1μM prostaglandin I2 and an ADP scavenge system, CP/CPK/ATP but not by adding thromboxane synthetase inhibitor, UK-37, 248 or UK-38, 485. Thromboxane synthetase inhibitors had, however, a synergistic effect on FBT when added with CP/CPK/ATP. Oral ticlopidine 250mg b. i. d. for 7 days increased FBT as well as IBT and Template bleeding time. Additional increase in FBT and skin bleeding times was produced by simultenous taking of 650mg aspirin b. i. d. for 7 days.FBT was significantly shorter in smokers than in non-smokers. It is suggested from these observations that FBT is a useful test of platelet function and has certain advantages over skin bleeding time methods.

Recently ethanol intoxication has been recognized as a risk factor of cerebral thrombosis in the young adults.The purpose of this study is to elucidate the effects of ethanol on blood coagulability, fibrinolytic activity, platelet aggregability, blood viscosity, and serum protein and lipids. Each comparative study was made before and after the oral administration of beer in nine young, healthy male volunteers. Beer was taken in the total amount of 1899ml containing about 4.5% ethanol (total ethanol volume: about 85g) over 3 hours.The results of this study were as follows:(1) Elevated hepaplastintest (p

Antiplatelet effects by combination therapy with aspirin and ticlopidine were investigated in comparison with single aspirin or ticlopidine therapy in 62 patients with cerebral thrombosis and transient ischemic attack. The 14, 21 and 27 patients were given orally 300mg aspirin, 200mg ticlopidine and 81mg aspirin with 100mg ticlopidine, respectively. Aspirin inhibited platelet aggregation (PA) to ADP and arachidonic acid (AA) but not to PAF, while ticlopidine inhibited PA to ADP and PAF but not to AA. In contrast, aspirin with ticlopidine inhibited PA to all the 3 agonists. Aspirin decreased plasma thromboxane (TX) B2 but not plasma β-thromboglobulin (βTG) or platelet factor (PF) 4, while ticlopidine decreased βTG and PF 4 but not TXB2. In contrast, aspirin with ticlopidine decreased TXB2 as well as βTG and PF 4. Platelet survival and lysis remained unaltered after aspirin or ticlopidine alone, whereas platelet survival was longer and percent platelet lysis was lower in 4 patients treated with both aspirin and ticlopidine than in 3 non-treated patients. Hemorrhagic complications were observed in 2, 3 and 8 patients treated with aspirin, ticlopidine and both, respectively. The results above indicate that combination therapy with aspirin and ticlopidine is a potential antithrombotic strategy, although further investigaton appeared necessary to determine optimal doses for minimizing hemorrhagic complications.

脳塞栓症を生じて入院した特発性心筋症 (ICM) 8症例について臨床的検討を加えた.ICMの病型の内訳は拡張型3例, 肥大型4例, 肥大型閉塞性1例で, 肥大型の多いことが従来の報告と異なっていた.肥大型も心房細動や心不全を合併する病期になると拡張型と同様に塞栓症を併発しやすくなると考えられた.ICMによる脳塞栓症の特徴は右内頚動脈系に多く, 頻回に再発をくり返し, 意識障害はないか軽度なことであった.凝血学的には血小板放出因子 (β-TG, PF4) の増加と血液粘度の上昇が高率に認められ, 心腔内の血流異常や血栓形成との関連が示唆された.ICMによる脳塞栓症の再発予防に抗血小板剤療法は有効とは云い難く, 抗凝固療法が試みられるべぎである.

Background and Purpose— After carotid endarterectomy (CEA) or carotid artery stenting (CAS) in patients with transient ischemic attack or minor ischemic stroke, recurrent stroke risk falls to a low rate on modern medical treatment. Methods— We used data from 4583 patients with recent transient ischemic attack or minor stroke enrolled in the TIAregistry.org to perform a nested case–control analysis to evaluate pre- and post-CEA/CAS risk. Cases were defined as patients with a CEA/CAS during the 1-year follow-up period. For each case, 2 controls with a follow-up time greater than the time from qualifying event to CEA/CAS were randomly selected, matched by age and sex. Primary outcome was defined as major vascular events (MVE, including stroke, cardiovascular death, and myocardial infarction). Results— The median delay from symptom onset of qualifying event to CEA/CAS was 11 days (interquartile range, 6–23). Overall, patients with CEA/CAS had a higher 1-year risk of MVE than other patients (14.8% versus 5.8%; adjusted hazard ratio, 2.40; 95% confidence interval, 1.61–3.60; P P =0.03). In the postprocedural period, the risk of MVE was also higher in cases than in controls (adjusted P Conclusions— Patients with CEA/CAS had a higher 12-month risk of MVE, as well as during pre- and postprocedural periods. These results suggest that patients in whom CEA/CAS is anticipated are likely to be an informative population for inclusion in studies testing new antithrombotic strategies started soon after symptom onset.

Plasma fibronectin (FN) were measured by means of immuno-turbidimetry using laser nepherometer in 124 patients with ischemic cerebrovascular disease (ICVD, 75 with cerebral infarction and 49 with TIA) and 75 agematched controls having neurological disorders except for cerebrovascular disease. In patients with cerebral infarction, 15 patients were at acute stage (within a month from the onset of stroke) and 60 were at chronic stage (over a month after onset).FN was 26.3±4.9mg/dl (x±SD) in the patient controls, in whom there was a significant correlation between FN and age (r=+0.462, p

In order to study a relationship between blood viscosity and miscelaneous blood components in patients with cerebrovascular disease (CVD), whole blood and serum viscosity, hematocrit, γ-globulin, total protein, albumin and lipids were measured in 113 patients with CVD (cerebral thrombosis 90, TIA 23) and 31 patients with non-CVD neurological diseases served as control.1) Whole blood viscosity, especially at the shear rate of 18.75 and 376sec-1, was correlated with hematocrit (r=0.52).2) γ-globulin was correlated with plasma viscosity (r=0.52) and whole blood viscosity (r=0.36 at 18.75sec-1 and r=0.31 at 75.2sec-1). Thus serum γ-globulin was thought to be another factor for increasing blood viscosity.3) Thrombosis of carotid system and TIA were associated with the increase of whole blood viscosity and hematocrit. However thrombosis of vertebrobasilar system were not associated with them.4) It is suggested that the increased blood viscosity plays a role on thrombosis of carotid system but not of vertebrovasilar system.

慢性進行性小脳症状を呈したクリプトコッカス髄膜脳炎の1例を報告した.症例は61才女性で,めまい,悪心,難聴で発症し,さらに歩行障害,構音障害,頭痛,微熱,尿失禁が順次出現した.入院時,四肢・躯幹失調を認め,髄液にてリンパ球増加と糖減少,培養にて莢膜陰性のCryptococcus neoformansが証明された. Amphotericin B, 5FC併用療法にて髄液所見,小脳症状は改善した.

We compared combination therapy with low-dose aspirin plus ticlopidine to therapy with aspirin alone or ticlopidine alone in patients suffering transient ischemic attack or cerebral infarction. In 17, 24, and 23 patients, respectively, 300 mg/day aspirin, 200 mg/day ticlopidine, and 81 mg/day aspirin plus 100 mg/day ticlopidine were administered orally. Aspirin alone markedly inhibited platelet aggregation induced by arachidonic acid, partially inhibited platelet aggregation induced by adenosine diphosphate, and did not inhibit platelet aggregation induced by platelet activating factor. Ticlopidine alone inhibited platelet aggregation induced by adenosine diphosphate and platelet activating factor, but did not inhibit platelet aggregation induced by arachidonic acid. Combination therapy with aspirin plus ticlopidine markedly inhibited platelet aggregation induced by all three agonists. Plasma concentrations of beta-thromboglobulin and platelet factor 4 remained unchanged by aspirin alone, were slightly reduced by ticlopidine alone, and were markedly reduced by aspirin plus ticlopidine. Plasma concentration of thromboxane B2 was reduced by aspirin alone or with ticlopidine, but not by ticlopidine alone. The level of 6-ketoprostaglandin F1 alpha was reduced only by aspirin alone. Bleeding time was significantly prolonged by aspirin alone and by ticlopidine alone, although the greatest prolongation was produced by aspirin plus ticlopidine. Our results indicate that the combination of aspirin plus ticlopidine is a potent antiplatelet strategy, although the clinical importance of the changes observed need to be determined by a properly designed and controlled prospective study.

症例は56才,女性.昭和59年3月,失語症が出現し,左前頭側頭葉に梗塞所見があり入院した.その後外来で血小板凝集抑制薬を投与し経過観察中, 6月に再び失語症が出現し, CTで新たに左側頭葉に梗塞所見があり再入院した.脳血管造影を施行後, 3日自と12日目に2回の脳梗塞再発作が出現した.この間血液凝固学的には慢性DICの所見を呈し,原因を検索した結果,卵巣癌が発見された.急性DICに脳血管障害が合併する事は良く知られているが,慢性DICによる脳血管障害の報告は少なく,本例を含め6例の報告しかない.一方本症例では,特に脳血管造影後に慢性DICの急性増悪を示し脳梗塞再発の誘因になったと考えられた.

症例は22才,男性で, 20才時ヘルペス脳炎に罹患し軽快したが, 15カ月後再び発熱,意識障害が出現.単純ヘルペスウイルス(HSV)抗体価上昇より再発性HSV脳炎と診断した.免疫不全はなく再発の原因として弱毒HSVの再感染,またはHSVの潜伏感染が考えられた.頭部CTでは両側前頭葉の低吸収域のみ認めたが, MRIではさらに両側頭頂葉,右側頭葉にも異常信号域を認め, HSV脳炎の病巣検出にMRIは有用と考えられた.