Goro Araki

Carotid Plaque and Intima-Media Thickness Assessed by B-Mode Ultrasonography in Subjects Ranging From Young Adults to Centenarians

UNLABELLED BACKGROUND AND PURPOSE-To investigate relationships among plaque formation, increasing intima-media thickness, and age, we examined ultrasonographically carotid arteries of subjects who had no major atherosclerotic risk factors and who ranged in age from young adults to centenarians. METHODS We studied 319 healthy subjects (154 men, 165 women; age range, 21 to 105 years) with no history of hypertension, diabetes mellitus, or atherosclerotic disease. Mean intima-media wall thickness (IMT) of common carotid arteries at plaque-free sites and prevalence of plaques were evaluated by B-mode ultrasound. RESULTS Mean common carotid IMT increased in a linear manner with age for all decades of life, including centenarians [IMT=(0.009xAge)+0.116] (r=0.83). In centenarians (n=30), intima-media complexes were diffusely thickened (mean IMT, 1.01 mm). Plaque prevalence increased up to the tenth decade of life (83.3%, n=30) but decreased in centenarians (60.0%). IMT and plaque prevalence were closely associated in the seventh and eighth decades of life but not at older ages. CONCLUSIONS The present study indicates that increased IMT is a physiological effect of aging that corresponds to diffuse intimal thickening, especially in very elderly persons, and that IMT is distinct from pathological plaque formation.

Topographic Electroencephalographic Study of Cerebral Infarction Using Computed Mapping of the EEG

Computed mapping of the electroencephalogram (CME) is a newly developed method using a microcomputer system that displays the scalp topograph as the square roots of the average power spectra over each EEG frequency band on a color television screen. This new device has been employed in an examination of functional lesions in 20 patients with aphasia due to cerebral infarction. The results were compared with those of computed tomography (CT) and regional cerebral blood flow (rCBF) studies using intracarotid 133Xe. A high-voltage focus of slow components and an asymmetrical distribution of alpha activity were regarded as signs of functional lesions on CME. Twelve patients showed high-voltage foci and six showed asymmetrical alpha activity on CME, which correlated well with the lesions on CT and/or rCBF studies. Especially in patients with motor aphasia, CME demonstrated the abnormality in advance of the appearance of a low-density area on CT. Compared with conventional EEG interpretation, CME is very useful in topographic and objective diagnosis of functional lesions, although the source of the data is the same as for the conventional EEG.

Is angiographic spasm real spasm

SummarySystematic morphological study of the cerebral arteries was made in six autopsy cases of ruptured aneurysms. The time course of the arterial luminal narrowing was observed by repeated angiograms, and segments of the narrowed arteries were studied histologically.Various histological changes were found consistent with the angiographic findings. We have devided these into three stages according to the duration of the disease.In the acute stage (less than one day) the contraction of the medial smooth muscle cells may be the main cause of the luminal narrowing. In the subacute stage, arteries showed a reduction in lumen size with medial thickening, marked corrugation of the internal elastic lamina, and thrombus formation attached to the endothelial surface. If vasoconstriction remained localized to the same segment for several days, the intimai or medial thickening and thrombus might produce the luminal narrowing consistent with the angiographic narrowing. In the chronic stage (more than two weeks), most cases showed dilatation of the arterial lumen on angiography. These arteries showed frank necrosis of the smooth muscle cells histologically. In a case which demonstrated progressive luminal narrowing on angiograms over 2 weeks, the arterial wall showed luminal narrowing with cellulofibrous thickening of the intima and organization of the thrombus.The presence of these structural changes in the narrowed arteries seen at angiography seems to be very important for proper understanding and treatment of vasospasm.

Arteriographically Visualized Extravasation in Hypertensive Intracerebral Hemorrhage

Seven cases are reported in which extravasation of contrast medium from the lateral lenticulostriate artery was observed on cerebral angiography performed in the early stage of hypertensive intracerebral hemorrhage. We advance the theory that continuous bleeding from the ruptured artery with mechanical destruction and displacement of cerebral tissue is the cause of massive hematoma formation, and discuss the possibility of surgical treatment of the acute stage of hypertensive intracerebral hemorrhage.

CT and arteriographic comparison of patients with transient ischemic attacks--correlation with small infarction of basal ganglia.

Fifty patients presenting clinically with TIAs were examined angiographically. Twenty one patients (42%) had no abnormality. Twenty patients (40%) had stenosis or occlusion in the MCA, ACA or intracranial carotid, whereas 11 (22%) had involvement of their extracranial internal carotid artery. Seven of the 28 CTs performed showed basal ganglia infarcts. This suggests that the cause for the TIA was an infarct in the vascular territory of a lenticulostriate artery.

Topographic Electroencephalographic Study of Ischemic Cerebrovascular Disease

Publisher Summary Presence of the slow wave components and slowing, or amplitude depression of background activity on the ischemic side suggest a relationship between cerebral ischemia and the resulting electroencephalographic abnormalities. Polymorphic delta activity and an asymmetrical distribution of background activity are thought to be unilateral signs of the EEG abnormalities in ischemic cerebrovascular disease. The incidences of the resulting EEG abnormalities have differed widely in various studies; these unilateral EEG abnormalities are found in 67.6% of the patients with unilateral cerebral infarction, in 85.7% of those with occlusive cerebrovascular disease, and in 90.3% who had an infarct in the carotid or middle cerebral arterial territory. These variations in the results are considered to depend on some basic factors. The three important factors influencing the resulting EEG abnormalities in cerebral ischemia are as follows: (1) localization of the ischemia area, (2) the duration of the ischemia, and (3) the interval between the onset of ischemia and the recording of the EEG.

Regional cerebral blood flow correlates of aphasia outcome in cerebral hemorrhage and cerebral infarction.

The relationship between recovery from aphasia and regional cerebral blood flow (CBF) was compared in 87 patients, 44 with cerebral hemorrhage and 43 with non-embolic cerebral infarction. CBF values correlated poorly with aphasia outcome in patients with cerebral hemorrhage whereas a tight correlation was demonstrated in patients with non-embolic cerebral infarction. A marked variability of CBF values in the acute and subacute stage might account for the poor correlation between CBF and aphasia outcome in patients with cerebral hemorrhage. On the other hand, a sharp discrimination was achieved between those with a good recovery from aphasia and those with a poor recovery by the dimensions of the hematoma on CT. In non-embolic cerebral infarction, a relative frontal ischemia was associated with motor aphasia while a relative temporal ischemia was associated with sensory aphasia. This dichotomy was not demonstrated in the regional CBF values in patients with cerebral hemorrhage.

Surgical treatment of primary intracerebral hemorrhage- Part 1: new angiographical classification.

A new angiographical classification of primary intra* cerebral hemorrhage is presented. We have clarified the predilection sites of intracerebral hemorrhage and the advancing direction of the hematoma by studying autopsy cases. Furthermore, we tried to detect the presence or absence of destruction of the internal capsule and ventricular ventricular rupture by means of angiography. Our classification, introducing the idea of dynamic changes of hematoma advancement from localized to advanced type, can be applied to clinical practice. This classification, along with the patients level of consciousness, is felt to be the most important indication for operation.

Comparative angiographic and histological evaluations of intracranial atherosclerosis in hypertensive and normotensive subjects.

Cerebral atherosclerosis without luminal narrowing has been found macroscopically and by angiographic examinations in some patients with cerebral hemorrhage. In order to clarify the histology of non-stenotic atherosclerosis of the cerebral vessels, we examined cleared specimens and serial sections of the main trunks of the cerebral arteries. The middle cerebral artery was selected in 20 cases of cerebral hemorrhage and 7 cases of cerebral infarction. Non-stenotic atherosclerosis was found frequently in cases of cerebral hemorrhage, while most patients with cerebral infarction showed stenotic cerebral atherosclerosis. We counted the numbers of medial smooth muscle cells in 10 autopsied cases of cerebral hemorrhage and 6 of cerebralinfarction. The mean numbers of smooth muscle cells per unit area in the patientwith cerebral hemorrhage were less than those in cerebral infarction. In cerebral hemorrhage, the main trunks of the cerebral arteries were dilated, probably as a result of the damage to medial muscle cells and higher blood pressure during the course of intimal thickening. It is considered that arterial hypertension spreads to the peripheral, small arteries through the main trunks without luminal narrowing of the cerebral vessels.