Acute cerebral embolism continues to be a major cause of stroke morbidity in children and young adults. A variety of drugs including steroids, dextran, barbiturates, and anticoagulants are used in the management of cerebral ischemia, despite controversy over their benefits in clinical and experimental situations. The operative treatment includes microsurgical cerebral embolectomy and cerebral revascularization. Middle cerebral artery embolectomies which have been carried out in human with variable results, have been reported by different authors. In order to define a time limit for cerebral embolectomies before irreversible brain damage has been incurred, the canine middle cerebral artery was embolized by means of a gutta percha cylinder, 4 mm long by 1.5 mm in diameter, via the internal carotid artery. It was observed that embolectomy of the middle cerebral artery performed between 4 and 5 hours postembolism could prevent the expected cerebral infarction effectually. Middle cerebral artery embolectomy beyond 5-hour periods invariably resulted in severe hemorrhagic infarction with concomitant neurological impairment.
Anticoagulants ; Barbiturates ; Brain ; Brain Ischemia ; Carotid Artery, Internal ; Cerebral Infarction ; Cerebral Revascularization ; Child ; Dextrans ; Embolectomy* ; Gutta-Percha ; Humans ; Infarction ; Intracranial Embolism ; Middle Cerebral Artery ; Steroids ; Stroke ; Young Adult

This study has been made to stress the importance of fracture pattern of the posterior fossa for recognition of traumatic lesions in the posterior fossa. Included in the series are all the cases of clinically significant verified lesions in the posterior fossa due to posterior fossa fractures. The classification of posterior fossa fractures introduced here by author has been based on the linear fracture involving the transverse sinus groove and/or the foramen magnum in Towne's projection. Five types of pattern have occurred. In type I, a linear fracture involves the transverse sinus groove and the foramen magnum. In type II, a linear fracture involves the transverse sinus groove but not the foramen magnum. In type III, a linear fracture involves the lambdoid suture, the transverse sinus groove and the foramen magnum. In type IV, a linear fracture involves the lambdoid suture and the transverse sinus groove, but not the foramen magnum. In type V, a linear fracture of the suboccipital bone involves the foramen magnum, but not the transverse sinus groove. In a total of 33 cases of posterior fossa fracture, 13 cases(39.3%) are of type I, 7 cases(21.2%) are of type II, 5 cases(15.2%) are of type III, 5 cases(15.2%) are of type IV, 3 cases(9.1%) are of type V. It has been shown that the cerebellar hematomas have been verified in type I, epidural and subdural hematomas verified in all the types without regard to the fracture patterns, and subdural hygromas verified in type I, III and V.
Classification ; Foramen Magnum ; Hematoma ; Hematoma, Subdural ; Subdural Effusion ; Sutures

Although a great deal has been written about porencephaly during the past 100 years, there is much that remains obscure. The clinical recognition of porencephaly is important because it occurs with sufficient frequency to require consideration in the differential diagnosis of focal cerebral lesions. The authors considered and discussed to fulfill the pathogensis for this case.
Diagnosis, Differential

In an attempt to evaluate cranioplasty, author reviewed 53 cases of head injuries with cranial defect repaired by cranioplasty. Materials used for cranioplasty were acrylic resin in 42 cases, tantalum in 6 cases and iliac bone in 5 cases. Adequate follow-up observations were obtained in all cases for at least 4 years. The results were as follows; 1) The majority of head injuries were caused by vehicle accident. 2) The majority of skull defects were in the frontal and parietal bones. 3) The interval between primary craniectomy and secondary cranioplasty was from 3 to 4 months in the majority of cases and cranioplasty was performed after fixation of permanent neurologic defect. 4) The indications for the cranioplasty were based upon criteria recommended by Grant and Norcross. 5) Postoperative complications were observed in 3 cases(5.7%).
Craniocerebral Trauma ; Financing, Organized ; Follow-Up Studies ; Parietal Bone ; Postoperative Complications ; Skull ; Tantalum

The anatomical pattern of the dural venous sinuses in the vicinity of their confluence was examinaed in 54 cases of human fetus. The classification introduced here by author was based upon the presence or absence of bifurcation of the superior sagittal and straight sinuses without regard to their sizes or to those of the transverse sinuses. Four types of pattern occurred;common pool type, double bifurcation type, straight sinus bifurcation type and superior sagittal sinus bifurcation type. In a total of 54 anatomical dissections, 28 cases(51.8%) were of the first type(common pool), 5 cases(9.3%) of the second(double bifurcation), 6 cases(11.1%) of the third(straight sinus bifurcation) and 15 cases(27.8%) of the fourth(superior sagittal sinus bifurcation) .
Classification ; Fetus ; Humans ; Superior Sagittal Sinus ; Transverse Sinuses

The authors report a case of cirsoid aneurysm in which diagnosis is reached by carotid angiography. To clarify the confusion regarding this rare lesion, the definition, origin and pathogenesis of the lesion are discussed.
Aneurysm* ; Angiography ; Diagnosis ; Scalp*

The author describes a case of traumatic cervical fracture-dislocation without spial cord syndrome in which Cloward anterior approach was performed under the operating microscope, and satisfactory stabilization and restoration of normal contour of the cervical spine were obtained by a dowel-shaped interbody bone graft. Cervical fracture-dislocation / spinal cord syndrome / Cloward technique / surgical microscope / dowel-shaped bone graft / anterior fusion / Crutchfield traction.
Spinal Cord* ; Spine ; Traction ; Transplants

The penicillin produces seizures when applied directly to cerebral cortex and, in some instances, when given systemically in large amounts. Most studies with this agent have had as their goal the elucidation of neurophysiological mechanisms underlying seizure activity. The present study was undertaken to explore the biochemical events which take place in the presence of an epileptogenic agent and, in particular, to see whether this agent has a direct effect on passive or active cation transport or an effect on energy production within neural tissues. The penicillin-induced seizure activity has been produced by direct injection of an aqueous penicillin G sodium into the cerebral subarachnoid space in rat. It is assumed that penicillin-induced seizure results from the leakage of potassium ions from intracellular compartment and alteration of firing properties of neurons with prolonged depolarization, and disturbances in activities of enzyme involved in glutamine metabolism. Diphenylhydantoin may stimulate cation pumping with activation of (Na+-K+)-ATPase enzyme system and this action may be relevant to its anticonvulsant activity.
Animals ; Cation Transport Proteins ; Cerebral Cortex ; Fires ; Glutamine ; Ions ; Metabolism ; Neurons ; Penicillin G ; Penicillins ; Phenytoin ; Potassium ; Rats ; Seizures* ; Subarachnoid Space

A geometrical method for estimating the normal position of the angiographic sylvian point in the lateral angiographic projection is described. The position of the angiographic sylvian point is determined by the base and the height of a right-angled triangle formed by the line from the anterior clinoid process to the angiographic sylvian point and the perpendicular line from the angiographic sylvian point to the clino-occipital line. The 95% confidence limits for mean value of the base are 37.13+/-.05mm and of the height 43.95+/-.95mm.

A method for determining the normal position of the angiographic sylvian point in the lateral angiographic projection has been devised by author. The position of the angiographic sylvian point has been determined by the angle between two lines from the anterior clinoid process to internal occipital protuberance and to angiographic sylvian point, and the quotient of the measured distance from the anterior clinoid process to angiographic sylvian point to that from the anterior clinoid process to inner table of parietal bone. The 95% confidence limits for mean vlaue of the angle are 50.09+/-.90 and of the quotient 0.47+/-.008. The angiographic sylvian point seems to become lower with advancing age, but remains stationary after growth is completed. The quotient value calculated is independent of skull dimensions. It is assumed that the author's method for estimating the position of the angiographic sylvian point is relatively accurate since the position is determined by the dual components of angle and quotient.
Parietal Bone ; Skull