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To investigate the relationship between prognosis of aphasia and neuronal damage in the cerebral cortex, we evaluated the distribution of central-type benzodiazepine receptor (BZR) binding in post-stroke aphasics with [123I]iomazenil and SPECT. We performed iomazenil SPECT in six aphasic patients (aged from 45 to 75 years; all right-handed) with unilateral left cerebral infarction. Three patients showed signs of Broca's aphasia and the other three Wernicke's aphasia. Cerebral blood flow (CBF) imaging was performed with [123I]iodoamphetamine (IMP). The regions of interest (ROIs) on both images were set in the cerebral cortex, cerebellar cortex and language-relevant area in both hemispheres. Three patients were classified in the mild prognosis group and the other three in the moderate prognosis group. The left language-relevant area was more closely concerned with the difference in aphasic symptoms than the right one in both BZR and CBF distribution, but the ipsilateral to the contralateral ratio (I/C ratio) in the language-relevant areas in the BZR distribution was significantly lower in the moderate prognosis group than in the mild prognosis group, although no difference was seen for these values between the two groups in the CBF distribution. These results suggest that BZR imaging, which makes possible an increase in neuronal cell viability in the cerebral cortex, is useful not only for clarifying the aphasic symptoms but also for evaluating the prognosis of aphasia in patients with cerebral infarction. [ABSTRACT FROM AUTHOR]

Gait initiation is a useful surrogate measure of supraspinal motor control mechanisms but has never been evaluated in a cohort following concussion. The aim of this study was to quantify the preparatory postural adjustments (PPAs) of gait initiation (GI) in fifteen concussion patients (4 females, 11 males) in comparison to a group of fifteen age- and sex-matched controls. All participants completed variants of the GI task where their dominant and non-dominant limbs as the 'stepping' and 'support' limbs. Task performance was quantified using the centre of pressure (COP) trajectory of each foot (computed from a force plate) and a surrogate of the centre of mass (COM) trajectory (estimated from an inertial measurement unit placed on the sacrum). Concussed patients exhibited decreased COP excursion on their dominant foot, both when it was the stepping limb (sagittal plane: 9.71mm [95% CI: 8.14-11.27mm] vs 14.9mm [95% CI: 12.31-17.49mm]; frontal plane: 36.95mm [95% CI: 30.87-43.03mm] vs 54.24mm [95% CI: 46.99-61.50mm]) and when it was the support limb (sagittal plane: 10.43mm [95% CI: 8.73-12.13mm] vs 18.13mm [95% CI: 14.92-21.35mm]; frontal plane: 66.51mm [95% CI: 60.45-72.57mm] vs 88.43mm [95% CI: 78.53-98.32mm]). This was reflected in the trajectory of the COM, wherein concussion patients exhibited lower posterior displacement (19.67mm [95% CI: 19.65mm-19.7mm]) compared with controls (23.62mm [95% CI: 23.6-23.64]). On this basis, we conclude that individuals with concussion display deficits during a GI task which are potentially indicative of supraspinal impairments in motor control., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background: The aim of this study was to quantify postural control ability in a group with concussion compared with a healthy control group., Method: Fifteen concussion patients (4 females, 11 males) and a group of fifteen age- and sex-matched controls were recruited. Participants were tested during the performance of the three stance variants (bilateral, tandem and unilateral) of the balance error scoring system standing on a force place, while wearing an inertial measurement unit placed at the posterior aspect of the sacrum., Findings: The area of postural sway was computed using the force-plate and the '95% ellipsoid volume of sway' was computed from the accelerometer data. Concussed patients exhibited increased sway area (1513mm 2 [95% CI: 935 to 2091mm 2 ] vs 646mm 2 [95% CI: 519 to 772mm 2 ]; p=0.02) and sway volume (9.46m 3 s -6 [95% CI: 8.02 to 19.94m 3 s -6 ] vs 2.68m 3 s -6 [95% CI: 1.81 to 3.55m 3 s -6 ]; p=0.01) in the bilateral stance position of the balance error scoring system. The sway volume metric also had excellent accuracy in identifying task 'errors' (tandem stance: 91% accuracy [95% CI: 85-96%], p<0.001; unilateral stance: 91% accuracy [95% CI: 86-96%], p<0.001)., Interpretation: Individuals with concussion display increased postural sway during bilateral stance. The sway volume that was calculated from the accelerometer data not only differentiated a group with concussion from a healthy control group, but successfully identified when task errors had occurred. This may be of value in the development of a pitch-side assessment system for concussion., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

This paper presents an initial overview of insights gained into how older adults mobilize in the home and community, based on data from inertial sensors which were worn by study participants over a 7-day period. The addition of a wearable camera provided additional contextual information which can be used to assess mobility and understand the factors that influence it in the free living environment. Seven days of data collected from a group of older adults who had experienced one or more falls in the previous six months was compared to that of a control group with no history of falling. Results showed that both groups spent relatively little time walking in challenging environmental conditions, and that the fallers spent significantly less time walking under regular conditions (no effect on gait) and outdoors. Analysis of gait metrics showed that the fallers were slightly slower in general, and more noticeable differences were observed when the participants were regrouped according to mobility levels determined from baseline assessments using traditional methods.

This paper describes three retrospective case studies to illustrate the potential clinical value of a system capable of capturing objective gait metrics and environment data from older adults with a history of falls while they go about their daily lives. Participants in this study wore an inertial sensor above each ankle and a wearable camera around their neck for seven consecutive days. Selected metrics are presented to illustrate scenarios where the data collected by the system could be of clinical value. Evidence suggests that obtaining objective gait metrics and environment data from older adults may not only allow healthcare professionals to assess gait more accurately, but also to design treatment plans and falls prevention strategies that are more specifically tailored to each individual.

Background: Cerebral revascularization surgery (CRS) is increasingly recognized as an important component in the treatment of complex cerebral vascular disease and tumors. CRS requires that the incidence of perioperative neurological complications should be minimized, because CRS for ischemic disease is often not the goal of treatment, but rather a prophylactic surgery. CRS carries the risk of focal postoperative neurological deficits. Little has been established concerning mechanisms of post-CRS ischemia. We used 3.0-T diffusion-weighted magnetic resonance imaging (DWI) and magnetic resonance angiography (MRA) to analyze the incidence and mechanism of ischemic lesions., Methods: We studied the anterior circulation territory after 20 CRS procedures involving 33 vascular anastomosis procedures (13 double anastomoses and 7 single anastomoses) in 12 men and 8 women between June 2007 and October 2011. The operations included single or double superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis to treat internal carotid artery/MCA occlusions or severe MCA stenosis. A combined STA-MCA anastomosis and indirect bypass were performed for moyamoya disease. Postoperative DWI and MRA were obtained in all patients between 24 and 96 h after surgery to detect thromboembolism, hypoperfusion, or procedural ischemic complications and vasospasms of the donor STA., Results: Follow-up DWI and MRA were carried out 1.8±0.6 days after CRS (range, 1-4 days). Temporary occlusion time for anastomoses averaged 18.9 min (range, 16-32 min). Asymptomatic new hyperintensities occurred in the ipsilateral hemisphere of 2 patients on postoperative DWI (10% patients/6.0% anastomoses), and 1 moyamoya patient (5.0% patients/3.0% anastomoses) developed a symptomatic hyperintensity in the ipsilateral occipital lobe in response to the operation. Two abnormal small (<5 mm) cortical DWI lesions were caused by sacrifices of a small branch of the recipient MCA., Conclusion: This study is the first postoperative 3.0-T DWI study of CRS and related clinical events. The incidence of symptomatic postoperative DWI abnormalities was restricted to 1 moyamoya patient representing 5.0% of total patients and 3.0% anastomoses. Although some postoperative DWI abnormalities occurred, CRS was found to be safe with a low risk of symptomatic ischemia., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Aim: Early computed tomography (CT) signs are crucial to predict the onset of hemorrhagic transformation (HT) and are preventive to avoid a fatal hematoma after thrombolysis. In the present study, we retrospectively reviewed the clinical records of patients receiving heparinization to investigate the correlation between early CT signs and the frequency of HT., Methods: We reviewed 96 patients with cardiogenic cerebral embolism. These patients were admitted within 24 h of the onset and were subsequently given 5000-15,000 units of heparin per day for 3 days. Owing to CT on admission, early CT changes were evaluated. Patient characteristics were also estimated, including evidence of hypertension, diabetes mellitus, hyperlipidemia, coronary heart disease and history of smoking. The probability of hemorrhagic transformation, or good outcome and independence was assessed by backward stepwise logistic regression analysis based on the maximum likelihood ratio., Results: Higher baseline National Institutes of Health Stroke Scale (NIHSS) score, early CT signs and absence of hyperlipidemia diversely correlated with the occurrence of HT. Also, the presence or absence of early CT signs was significantly related to HT classification (χ(2)-test; P < 0.05). It was statistically significant that a higher baseline NIHSS score (OR 8.51; 95% CI 3.11-27.75) affected the outcome without showing a significant relationship to early CT signs., Conclusions: Presence of early CT signs correlated more strongly with HT than with the interval from symptom onset to hospital arrival. We might extend the therapeutic time for thrombolytic therapy, only if the early CT sign does not appear., (© 2011 Japan Geriatrics Society.)

The purpose of the present study is to investigate the effects of hypochlorhydria induced by proton pump inhibitor (PPI) administration and intake of a dairy product fermented by lactobacilli (DFL) on bone metabolism in growing rats. Male rats, aged 3 weeks, were divided into two groups: a control group fed a casein-based diet and a group fed a DFL-based diet. Each group was fed its respective experimental diets for 9 d. At day 5 of the feeding period, each group was divided into two subgroups: one that received a saline injection and one that received a PPI injection. Rats were subcutaneously administered saline or PPI for 5 d. Faecal Ca excretion was determined from day 6 to day 9. At the end of the experiment, plasma and femurs were collected. Administration of PPI significantly decreased bone mineral density (shown by X-ray computerised tomography) and bone strength (shown by a three-point bending test) in the control group. Plasma osteocalcin, type I collagen C-telopeptides, 1,25-dihydroxyvitamin D and parathyroid hormone concentrations were elevated by PPI administration in the control group. Faecal Ca excretion and urinary P excretion in the control group were remarkably increased by PPI administration. On the other hand, these adverse effects of PPI were not observed in the DFL group. These results suggest that hypochlorhydria-induced bone loss may result from high bone turnover induced by secondary hyperparathyroidism due to Ca malabsorption and that DFL intake cancels these adverse effects probably via improving Ca malabsorption in growing rats.

Objective: We investigated whether a correlation exists between insulin resistance and the severity of cerebral white matter lesions among non-diabetic patients with ischemic stroke., Methods: The subjects were 105 consecutive patients without diabetes who were hospitalized due to non-cardioembolic stroke. The insulin resistance was evaluated by a homeostasis model assessment of insulin resistance (HOMA-IR). The degrees of periventricular hyperintensity (PVH) and deep and subcortical white matter hyperintensity (DSWMH) were evaluated by the brain MRI. The HOMA-IR values >or=2.5 were indicative of the insulin resistance., Results: The presence of PVH and DSWMH were 86.7 and 83.8%, respectively. The ratio of insulin resistance increased with higher grades of PVH and DSWMH. The HOMA-IR level in grade 3 PVH was significantly higher than those in grades 0 and 1. The HOMA-IR level in grade 3 DSWMH was significantly higher than those in grades 0-2. Multiple linear regression analysis showed that HOMA-IR was significantly associated with PVH or DSWMH., Conclusion: It was found that insulin resistance correlated with white matter lesions among non-diabetic patients with non-cardiogenic ischemic stroke.

Background: Poststroke depression is one of the most frequent and important complications of stroke. Although many studies of depression after stroke have been reported, clinical association between the risk of depression after stroke and the lesion location remains unclear. The presence of depression after stroke reportedly confers a poor prognosis; however, early recognition of depressive symptoms may improve outcomes. We examined the relation between lesion location and presence of depressive symptoms 1 month after ischemic stroke, with a view toward early management of depressive symptoms., Methods: In all, 134 consecutive patients with ischemic stroke were followed up to determine whether depression was present 1 month after stroke onset. Depressive symptoms were assessed by means of the Zung Self-rating Depression Scale. The lesion location was determined on magnetic resonance or computed tomography images., Results: The incidence of depressive symptoms 1 month after stroke onset was 34.3%. Backward stepwise logistic regression analysis showed hypertension, education, and the presence of a left lenticulocapsular infarct, in particular, to be independent predictors of depressive symptoms., Conclusions: Patients with ischemic stroke, particularly in the left lenticulocapsular area, should be carefully evaluated for early detection and treatment of depressive symptoms, which may greatly influence outcome., (Copyright (c) 2010 National Stroke Association. Published by Elsevier Inc. All rights reserved.)

Fabry disease is an X-linked lysosomal storage disease resulting from deficient activity of the enzyme alpha-galactosidase (alpha-Gal) A. It has been postulated that the accumulation of globotriaosylceramide in the endothelial cells of blood vessels may lead to thrombosis of the brain and other tissues. Recently, enzyme replacement therapy (ERT) for Fabry disease is available. A high incidence of thrombotic accidents in Fabry disease has been postulated. However, a systemic study on thrombosis in cases of Fabry disease has not been undertaken. To clarify the incidence of thrombosis in Fabry disease, we screened 65 patients with Fabry disease (49 hemizygotes and 16 heterozygotes) from 39 unrelated Japanese families. We found that ten patients with Fabry disease (7 hemizygous males and 3 heterozygous females) had experienced thrombotic accidents, under 45-years-old in 8 cases. These 10 patients showed the gene mutations of classical Fabry disease. Nine of these thrombotic patients developed brain infarctions, one man who had the complication of recurrent thrombophlebitis, and the remaining woman showed central retinal artery occlusion and thrombophlebitis. We demonstrated a high incidence of thrombosis in Fabry disease (15%). ERT should be performed in patients not only in hemizygous males but also in heterozygous females and started at their early ages.

Free radicals are known to activate coagulation and inhibit fibrinolysis. Edaravone, a free radical scavenger, protects vascular endothelial cells and neurons during acute brain ischemia in in vitro models. Hemorrhagic transformation and treatment outcomes were retrospectively examined in 76 patients with acute cardiogenic embolism treated with edaravone in addition to routine treatment within 24 hours of the onset of symptoms. Hemorrhagic transformation was categorized according to European Cooperative Acute Stroke Study-II. Patient characteristics were also evaluated, including evidence of hypertension, diabetes mellitus, hyperlipidemia, coronary heart disease, history of smoking, National Institutes of Health Stroke Scale on arrival, and modified Rankin scale at 3 months post-onset. Edaravone administration was one of the factors that contributed to increased frequency of hemorrhagic transformation, but had showed no significant relationship with the outcome. The present study showed that edaravone administration increased the frequency of hemorrhagic transformation with heparin in patients with cardiogenic embolism. Free radical scavenging may have promoted the coagulating conditions. Edaravone administration may allow reduction of the dose of heparin and tissue plasminogen activator in patients with acute ischemic stroke.

Background: Arteriosclerosis obliterans (ASO) is a serious complication in patients with end-stage renal disease (ESRD) caused by diabetic nephropathy. Adsorption of low-density lipoprotein (LDL) has been performed to treat ASO. While efficacy of this treatment has been reported in limb ischemia, the mechanism underlying the benefit remains unclear. We investigated how LDL adsorption affected soluble adhesion molecules; P-selectin, an endothelial and platelet activation marker; inflammatory cytokines such as interleukin (IL)-1beta, IL-6 and tissue necrosis factor (TNF)-alpha; and lipids in serum., Methods: Selective LDL adsorption by dextran sulfate columns (LDL apheresis) was performed weekly for 10 weeks to treat eight hemodialysis patients with ASO, ESRD, and type 2 diabetes mellitus. Serum was sampled before and immediately after apheresis., Results: LDL apheresis was performed safely. After LDL apheresis lipid concentrations were significantly reduced and clinical findings, such as Fontaine's classification and ankle brachial pressure index values, were improved. Pretreatment concentrations of soluble intercellular and vascular cell adhesion molecules (sICAM-1 and sVCAM-1) and also P-selectin were higher in patients than healthy controls. After apheresis these decreased, especially P-selectin. IL-1beta, IL-6, and TNF-alpha concentrations before apheresis were similar to those in controls and were unaffected by treatment., Conclusion: Effectiveness of LDL apheresis against ASO may involve decreased endothelial cell and platelet activation.

A thrombolytic agent, recombinant tissue plasminogen activator (rt-PA), was recently approved in Japan for use on patients within 3 hrs of the onset of cerebral infarction. In order to salvage cerebral tissue after an ischemic insult, it is crucial to detect the ischemic lesion before it becomes irreversible and to detect the core and penumbra areas of the lesion for guidance in selecting the suitable therapy. In this symposium we discuss the detection of ischemic lesions using plain CT, perfusion CT, and MRI. In the section on plain CT, we present a typical case with early CT signs. In the section on perfusion CT, we report on the feasibility and limitation of the technique for the diagnosis of acute cerebral infarction. In the section on MRI, we study the usefulness of DWI for the early and highly reliable detection of ischemic stroke.

Background: Fabry disease is an X-linked lysosomal storage disease resulting from deficient activity of the enzyme alpha-galacotsidase A. Accumulation of glycosphingolipids, especially globotriaosylceramide, leads to renal damage in Fabry disease. In patients with Fabry disease, the urinary sediment contains excreted glycosphingolipids. With enzyme replacement therapy for Fabry disease now currently available, we examined whether the urinary sediment could be used to noninvasively monitor effectiveness of enzyme replacement therapy., Methods: Four male patients with hemizygous classical Fabry disease received recombinant alpha-galactsidase A biweekly, and urinary sediments were assessed at 3-month intervals., Results: The morphologic and immunohistochemical changes in urinary sediment at 6 and 18 months suggested that accumulations of glycosphingolipids in renal tissues were cleared by enzyme replacement., Conclusion: Examination of urinary sediments could serve as noninvasive monitoring of the effect of therapy in patients with Fabry disease.

The effect of edaravone as an inhibitor of ischemic brain damage in addition to routine treatment was retrospectively examined in 70 patients with lacunar infarction who were admitted within 24 hours of symptom onset. Clinical status was assessed using the National Institutes of Health Stroke Scale (NIHSS). The modified Rankin Scale (MRS) was used to assess clinical outcomes at 3 months after onset, with a good outcome defined as MRS score < or =2. Risk factors were also evaluated, including evidence of hypertension, diabetes mellitus, hyperlipidemia, coronary heart disease, and a history of smoking longer than 2 months. The probability of a good outcome and independence at 3 months was assessed by backward stepwise logistic regression analysis based on the maximum likelihood ratio. Administration of edaravone yielded an odds ratio with multivariate adjustment of 6.49 (95% confidence interval, 1.35 to 50.32; p < 0.05) for a good outcome at 3 months. Higher baseline NIHSS score and higher age also adversely affected the outcome at 3 months (p < 0.005). Administration of edaravone improves the outcome of patients with lacunar infarction.

A 34-year-old Japanese man admitted to hospital with pneumonia had previously undergone surgery for paranasal sinusitis and also for the clipping of an aneurysm at the origin of the anterior choroidal artery after subarachnoid hemorrhage. Laboratory tests performed at the present admission showed renal insufficiency and serological findings of raised proteinase 3 antineutrophil cytoplasmic antibody level. A renal biopsy was performed that showed diffuse necrotizing glomerulonephritis with fibrocellular crescents. The diagnosis of Wegener's granulomatosis(WG) was confirmed on the basis of the clinical picture, laboratory findings, and biopsies of renal tissues. The disease responded to prednisolone and cyclophosphamide. The association of WG with a ruptured intracranial aneurysm is rare and has not previously been confirmed.

Background and Purpose: Crossed cerebellar diaschisis (CCD) refers to reduced metabolism and blood flow in the cerebellar hemisphere contralateral to a cerebral lesion. Many cortical areas have been reported to cause CCD without consideration of confounding factors. We performed single-photon emission computed tomography (SPECT) in patients with cortical infarction to identify regions independently related to CCD, controlling for possible confounding effects., Methods: Patients with unilateral cortical infarction (n=113; 75 male, 38 female; mean+/-SD age, 66+/-13 years) underwent SPECT of the brain with N-isopropyl-p-[(123)I]iodoamphetamine ((123)I-IMP). Regional cerebral blood flow was measured autoradiographically. Asymmetry indices (AIs) were calculated on the basis of ratios representing symmetrical regional cerebral blood flow in the cerebellum and 16 cerebral regions. CCD was defined as AI for cerebellum >0.1. AIs for 16 cortical regions were considered for both dichotomous and continuous variables for analysis of CCD occurrence by means of backward logistic regression., Results: For dichotomized variables, hypoperfusion of postcentral (odds ratio [OR]=7.607; 95% CI, 2.299 to 25.174) and supramarginal (OR=3.916; 95% CI, 1.394 to 11.003) regions independently influenced CCD. For continuous variables, hypoperfusion of postcentral (OR=1.044; 95% CI, 1.019 to 1.068) and supramarginal (OR=1.021; 95% CI, 1.001 to 1.041) regions (and, as a negative factor, medial occipital regions; OR=0.942; 95% CI, 0.895 to 0.991) independently influenced CCD., Conclusions: Many cortical areas apparently do not contribute to CCD. Correspondence of CCD between dichotomized and continuous analyses suggests that location of a lesion, not severity, is the main determinant of CCD.

Before the completion of visual development, visual deprivation impairs synaptic elimination in the visual cortex. The purpose of this study was to determine whether the distribution of central benzodiazepine receptor (BZR) is also altered in the visual cortex in subjects with early-onset blindness. Positron emission tomography was carried out with [(15)O]water and [(11)C]flumazenil on six blind subjects and seven sighted controls at rest. We found that the CBF was significantly higher in the visual cortex for the early-onset blind subjects than for the sighted control subjects. However, there was no significant difference in the BZR distribution in the visual cortex for the subject with early-onset blindness than for the sighted control subjects. These results demonstrated that early visual deprivation does not affect the distribution of GABA(A) receptors in the visual cortex with the sensitivity of our measurements. Synaptic elimination may be independent of visual experience in the GABAergic system of the human visual cortex during visual development.

Immunoadsorption plasmapheresis (IAPP) is a method of removing circulating immune factors that is used to treat Guillain-Barré syndrome (GBS). We retrospectively analyzed the data on our GBS patients. In 21 patients treated with IAPP, linear regression analysis showed that the time from the onset of symptoms to the initiation of IAPP was correlated with the time required for improvement by one Hughes functional grade. We investigated the critical day for initiating treatment, which we defined as the day when initiation of IAPP was significantly more likely to improve function by at least one Hughes grade when compared with the outcome in patients receiving supportive therapy (non-IAPP group). The critical day was found to be day 6 after the onset of GBS.

Background: The optimal hematocrit (Hctopt) in hemodialysis (HD) patients has yet to be determined based on the etiology and complications of their endstage renal disease (ESRD). To investigate this problem, we compared regional cerebral oxygen supply (rCOS) in diabetic (DM group) and non-diabetic HD patients (non-DM group) with data from subjects without renal disease or DM (control group), Methods: Regional cerebral blood flow (rCBF) was measured with single-photon emission computed tomography (SPECT) by the N-isopropyl-p-[(123)I]-iodoamphetamine ((123)I-IMP)-autoradiographic (ARG) method, and both the O2 content (O2CT) of arterial blood and hematocrit (Hct) were evaluated. Using the regression lines of rCBF vs Hct and O2CT vs Hct, we established a convex curve between rCOS and Hct. The peak of the curve indicates the maximum rCOS (rCOSmax) and Hctopt for rCOSmax, Results: The rCBF in both the DM and non-DM groups was lower than that of the control group at the same Hct level, and the DM group had the lowest values. The rCOSmax values in the DM and non-DM groups were nearly equal, but both were lower than in controls. The Hctopt in the DM group was lower than that in the non-DM group by 6.3%±3.3%, Conclusions: Although the difference in Hctopt values in the DM and non-DM groups was 6.3%, the rCOSmax values in both groups were nearly equal. This suggests that differences in the Hctopt may depend on complications or causes of ESRD. The optimal Hct in the DM group was 22.6%±1.9%, and that for the non-DM group was 29.0%±1.8%

Objective: We performed single-photon emission computed tomography (SPECT) to investigate the influence of renal transplantation on cerebral blood flow (CBF)., Patients and Methods: Fifteen renal transplant recipients and twelve normal subjects underwent cerebral SPECT with N-isopropyl-p -[123I] iodoamphetamine (123I-IMP). All transplant recipients received prednisolone and cyclosporine (CyA). Regional CBF (rCBF) was measured by defining regions of interest in the cerebral cortex, deep white matter, striatum, thalamus, and cerebellum. In transplant recipients, correlations to the mean overall cortical CBF were assessed using the interval from transplantation to measurement of SPECT, as well as the serum creatinine concentration. Moreover, to investigate the influence of CyA on CBF, the correlation between mean overall cortical CBF and CyA trough concentrations was assessed., Results: In all regions, CBF in renal transplant recipients was significantly lower than in normal subjects. No significant correlation was seen between serum creatinine, interval from transplantation, or CyA trough concentrations and mean overall cortical CBF., Conclusion: Renal transplant recipients demonstrated a decrease in CBF, that can have an associated secondary pathology. Therefore, renal transplant recipients may benefit from post-operative MRI or CT.

A 50-year-old woman treated for breast cancer with mitomycin C developed severe hypertension, followed by deep coma 3 days later. Computed tomography of the brain showed frontoparietal intracranial hemorrhage accompanied by subarachnoid hemorrhage. The patient was diagnosed additionally with hemolytic uremic syndrome (HUS) based on hemolytic anemia with schistocytosis, thrombocytopenia, and acute renal failure. The patient underwent hemodialysis and plasmapheresis with no improvement. We present the pathologic findings of the general vessels, which has been reported rarely. This case represents the first reported intracranial hemorrhage in HUS following mitomycin C administration. We emphasize the need to control blood pressure in patients with HUS.

A 33-year-old right-handed man with intermittent headache was found to have agenesis of the corpus callosum. He underwent magnetic resonance imaging, positron emission tomography (PET), and detailed neuropsychologic tests, including a Wada test. There was bilateral representation of language, and a PET activation study with word repetition revealed bilateral areas of activation that were not completely symmetric. These findings and the literature concerning agenesis of the corpus callosum are discussed as is the possible compensatory mechanism for absence of the corpus callosum, which is important for cross-communication.

The effect of prostaglandin E1 (PGE1) on cerebral blood flow (CBF) was studied in 10 patients with chronic cerebral infarction. Regional cerebral blood flow (rCBF) was measured by single photon emission computed tomography before and after they received PGE1 120 microg daily for 2 weeks. The rCBF of the brainstem, cerebellum, and frontal, temporal, and parietal lobes increased significantly after PGE1 administration. PGE1 also significantly increased the rCBF of the non-infarcted area adjacent to infarction. The results indicate that PGE1 increases the CBF of patients with chronic cerebral infarction without causing the intracerebral steal phenomenon.

The purpose of this study was to investigate the functional relation between the thalamus and other cortical regions in patients with thalamic stroke from the view of cerebral blood flow (CBF) and the cerebral metabolic rate of oxygen (CMRO2) using positron emission tomography (PET). Twenty patients with thalamic stroke (right lesion = 8, left lesion = 12) and 7 normal controls were studied. Five patients were diagnosed as having thalamic infarction, and 15 (patients were diagnosed) as having thalamic hemorrhage by X-CT and/or MRI scan. Regional cerebral blood flow and cerebral metabolic rate of oxygen were measured by PET using C15O2 and 15O2 steady state inhalation technique. In the left thalamic stroke group, CMRO2 was significantly decreased in the left cingulate, superior frontal, superior temporal, middle temporal, medial occipital, and thalamic regions, compared with the normal control group. In the right thalamic stroke group, CMRO2 was decreased in the left cingulate, medial occipital, right hippocampal, thalamic, and the bilateral cerebellar regions, compared with the normal control group. In the left thalamic stroke group. CBF was decreased significantly in the left cingulate, middle temporal, hippocampal, thalamic, and right cerebellar regions, compared with the normal control group. In the right thalamic stroke group, CBF was significantly decreased in the right hippocampal, thalamic and left cerebellar regions compared with the normal control group. These results indicate that CBF and CMRO2 decrease in some distant regions from thalamic lesions, perhaps due to a disconnection of neuronal fiber. Especially in the left thalamic stroke group, CMRO2 was decreased in the ipsilateral temporal regions. This result suggests that there are more intimate functional fiber connections between the thalamus and temporal cortex in the left hemisphere than in the right hemisphere.

During early embryogenesis, anastomoses are formed between the carotid artery and the basilar or the vertebral artery, and subsequently, these anastomoses regress. In some cases, these anastomoses remain as persistent carotid-basilar or carotid-vertebral anastomoses. Atrial septal defect (ASD), a communication between the atria at the septal level, is a congenital heart anomaly. Intrahepatic venous shunts between the portal and hepatic veins are very rare and only some are considered congenital. We present the first case report of a patient with an ASD, a persistent primitive hypoglossal artery, and congenital portahepatic shunts.

We describe a 66-year-old man with a 20-year history of ataxic gait who suddenly developed diplopia on rightward gaze. Neurologic examination revealed right hemi-ataxia and hemi-hypesthesia, and left internuclear ophthalmoplegia. MRI showed a cavernous angioma in the left tectum, mild right cerebellar atrophy, and left interior olivary hypertrophy. Single photon emission computed tomography (SPECT) imaging demonstrated contralateral cerebellar diaschisis. We discuss the findings and review the literature concerning contralateral cerebellar diaschisis.

A 48-year-old Japanese woman from Kyushu was admitted to the Nippon Medical School First Hospital with complaints of numbness in both legs, gait disturbance, and urinary problems. On examination, her lower extremities were spastic with increased reflexes and positive Babinski sign. Sensation was absent below the T4 spinal level. The cerebrospinal fluid contained HTLV-I antibodies and she was diagnosed with HTLV-I associated myelopathy. Her symptoms were resolved with prednisolone, but six months later a visual disturbance of the left eye edema developed. Orbital CT scans showed that left optic nerve was edematous. T2 enhanced MRI revealed a high intensity lesion of the left optic nerve. ERG was normal and no VEP was detected in response to flashing stimulation to the left eye. The HTLV-I antigen titer of CBF was very high. Her optic neuritis improved following oral administration of prednisolone and retrobulbar injections of dexamethasone. This is the first case report of HTLV-I associated myelopathy complicated by optic neuritis.

We quantitatively measured regional cerebral blood flow (rCBF) in 37 patients with dementia of Alzheimer type (DAT) to investigate the clinical utilities of the N-isopropyl-p-[123I]iodoamphetamine autoradiographic method (IMP ARG method) that is a quantitative method more simplified and less invasive for IMP-SPECT developed by Iida et al. A given standard input function and a given value of distribution volume (Vd) used for the rCBF measurement of this method were calculated from the dynamic study by six normal volunteers. Mean values [SD] of rCBF (ml/ 100 g/min) in the Cerebral Cortex were 49.0 [6.0] in the controls (n = 20), 42.6 [5.9] in mild DAT group (n = 14), 36.7 [5.5] in moderate DAT group (n = 12), and 26.4 [7.5] in severe DAT group (n = 11), respectively. These values were significantly different between each neighboring group. Moreover, the correlations between the score by the Hasegawa dementia scale (HDS-R) and each rCBF were significant in the temporal, parietal, and frontal cortex. These findings suggest that the rCBF measurement in IMP-SPECT using this method is useful for the diagnosis of the clinical severity in patients with DAT.

This study was designed to investigate benzodiazepine receptors (BZR) and cerebral blood flow (CBF) in patients with early Alzheimer's disease. Imaging of BZR and measurement of CBF were performed by SPECT using 123I-Iomazenil (IMZ) and 123I-IMP respectively, in seven patients with early Alzheimer's disease and five patients with unilateral left cerebral infarction as controls. The values for the normal cerebral hemisphere (ratio to the contralateral cerebellum) in patients with cerebral infarction were adopted as control values. In patients with Alzheimer's disease, the CBF (ratio to cerebellum) decreased significantly in the frontal cortex and the parietal cortex compared with the control values. There was no significant difference in late IMZ SPECT counts (ratio to cerebellum) and washout (the ratio of late-to-early IMZ SPECT counts) between patients with Alzheimer's disease and the controls. However, the late IMZ SPECT counts and washout decreased in one patient with moderate dementia. There was a significant correlation between the severity of dementia and the late IMZ SPECT counts in the temporal cortex and the parietal cortex. These results suggest that benzodiazepine binding sites are relatively well preserved in patients with early Alzheimer's disease, and reduction of the CBF is caused by neuronal dysfunction rather than by neuronal loss. IMZ SPECT study is useful and necessary for clarifying the pathophysiological state in Alzheimer's disease.

In order to investigate the laterality of cerebellar ataxia and its influence for the cerebral cortex in spinocerebellar degeneration (SCD), regional cerebral blood flow (r CBF) was measured using positron emission tomography (PET) in 10 patients with sporadic olivopontocerebellar atrophy (sOPCA), 7 patients with hereditary SCD (h SCD), and 10 age matched control subjects. The laterality of cerebellar ataxia was evaluated by the total score of the difference between left and right limbs of three limb-coordination tests. The lateralities of rCBF were calculated by asymmetry indices (AIs) of each region of interest in the cerebellum, thalamus, caudate, putamen, cerebral cortices. The laterality of cerebellar ataxia was significantly correlated with AI in the cerebellum in patients with sOPCA. Furthermore, significant negative correlations were observed between AI in the cerebellum and each AI in the thalamus, frontal cortex in patients with sOPCA. However, no correlations were observed between AI in the cerebellum and the other AIs in controls and patients with h SCD. Duration of illness in patients with sOPCA with laterality is shorter than that in patients without laterality. These results suggest that the existence of crossed cerebello-cerebral diaschisis (CCCD) resulting from transneuronal deactivation through cerebello-thalamo-cerebral pathway in patients with the early stage of sOPCA with laterality.