Heparin versus danaproid for prevention of venous thromboembolism after hip surgery.

PURPOSE: To compare the prevalence of deep vein thrombosis (DVT), pulmonary thromboembolism (PTE), and bleeding complications in patients receiving heparin or danaproid after hemiarthroplasty or osteosynthesis for hip fractures. METHODS: 37 men and 138 women aged 47 to 100 (mean, 80) years underwent either hemiarthroplasty or osteosynthesis for hip fractures; 5 patients with dementia were excluded. All patients received preoperative elastic stocking and postoperative intermittent pneumatic compression. They were divided into 3 groups based on their admission period: controls (n=71), unfractionated heparin (n=44), and danaproid sodium (n=55). Drugs were administered from postoperative day 1 to 7. At day 7, all patients undertook radioisotope venography of the legs and lung perfusion scintigraphy. RESULTS: In the control, heparin, and danaproid groups respectively, the DVT rates were 31%, 9.1%, and 5.5%, and the PTE rates were 5.6%, 4.5%, and 1.8%. Only the DVT rate in the control group was significantly higher than that in the heparin and danaproid groups. In the heparin group, one patient had gastrointestinal bleeding, 5 developed wound haematomas, and one had leakage from the drain site for 2 weeks. CONCLUSION: Danaproid sodium appeared more effective and safer than heparin, with no bleeding complications occurred.

Total hip arthroplasty with a sliding iliac graft for acetabular dysplasia.

We describe a new technique of reconstruction of the deficient acetabulum in cementless total hip arthroplasty. The outer iliac table just above the deficient acetabulum is osteotomised and slid downwards. We have termed this an iliac sliding graft. Between October 1997 and November 2001, cementless total hip arthroplasty with an iliac sliding graft was performed on 19 patients (19 hips) with acetabular dysplasia. The mean follow-up was 3.4 years (2 to 6). The mean pre-operative Harris hip score was 45.1 which improved significantly to 85.3 at the time of the final follow-up. No patient had post-operative abductor dysfunction. Incorporation of the graft was seen after two to three months in all patients. Resorption of the graft and radiolucencies were infrequent. This technique is a useful alternative to femoral head autografting when the patient's own femoral head cannot be used.

Atlantoaxial dislocation associated with neurofibromatosis. Report of three cases.

Atlantoaxial dislocation was found in three patients with neurofibromatosis. Roentgenographic findings included marked reduction of sagittal diameter at the C-1 vertebral level, and cervical spine abnormalities associated with mesodermal dysplasia, such as posterior scalloping of the cervical spinal bodies with dural ectasia and vertebral body deformity (vertebral body dysplasia). Although the relationship of the atlas and axis did not change with neck position, all three patients had progressive neurological deficits and were treated by decompressive surgery combined with fusion. The pathogenesis of atlantoaxial dislocation associated with neurofibromatosis is discussed.

Focal eosinophilic myositis.

Idiopathic hypereosinophilic syndrome (HES) is a heterogeneous group of disorders with the common features of prolonged eosinophilia of underdetermined cause and multiple organ system dysfunction. Focal eosinophilic myositis is an uncommon manifestation of HES. We report a case of focal eosinophilic myositis with tender muscle swelling followed by proximal weakness, but without non-systemic symptoms and muscle trophism in the lower limbs. Muscle biopsy specimen showed acute myositis with eosinophil infiltration. Electromyographic features were typical of myositis. The clinical and biochemical response to corticosteroids was excellent, and a relapse that occurred because the steroid dose was not lowered, responded well.

Histologic analysis of the tibial bone tunnel after anterior cruciate ligament reconstruction using solvent-dried and gamma-irradiated fascia lata allograft.

Anterior cruciate ligament (ACL) reconstruction using free tendon graft requires biologic fixation in the bone tunnel. This report describes the intratunnel histology retrieved from a 47-year-old woman who underwent high tibial osteotomy 17 months after ACL reconstruction using a hybrid graft (a solvent-dried and gamma-irradiated fascia lata allograft as a core wrapped with iliotibial autograft). The patient underwent revision because of pain resulting from osteoarthrotic change, and the graft appeared to be taut and healthy on second-look arthroscopy. The sample was taken from the site of the metaphyseal osteotomy site. Histologic examination of the samples was performed with a light microscope (H&E and Masson trichrome stain). Biologic fixation of the graft to the bone was evident from observation of collagen fiber continuities, resembling Sharpey fibers. Integration of the autograft and allograft seemed to have occurred; the junction between the allograft and the autograft could not be determined. However, there was a difference in ligamentization depending on location. In the peripheral region of the graft (the autograft region), the collagen fibers showed a distinct crimped pattern; the fibroblasts were arranged regularly along the major axis of the collagen fiber bundle. In the central part of the graft (the allograft region), remodeling seemed to be delayed. There were acellular, bubbly or myxoid degeneration areas in which the fiber bundles were less oriented and there was increased vascularity.

Follow-up study on metastatic cerebellar tumor surgery--characteristic problems of surgical treatment.

Recently, the incidence of metastatic cerebellar tumors has increased. The authors operated on 12 cases of metastatic cerebellar tumors, with total or subtotal removal of nodules in brain metastases. Surgical complications observed as a result of postoperative investigation are presented. 1) Some cases developed carcinomatous meningitis within a short period. During removal of a tumor on the superior cerebellar surface attention should be paid to the prevention of dissemination to the cerebral cisterns adjacent to the tumor. 2) Some cases demonstrated peritoneal metastasis probably due to dissemination via the ventriculoperitoneal shunt tube, suggesting that great care should be taken during a shunt operation after removal. 3) Both carcinomatous meningitis occurring after removal and remote metastasis via the shunt tube were related to recurrence after removal of the cerebellar metastatic lesion, raising the issue of whether or not total macroscopic removal should be included in the indications for surgical treatment of cerebellar metastasis. Those cases in which surgery is indicated should also be routinely treated by postoperative irradiation.

Clinicopathological study of multiple gliomas--report of three cases.

Three cases of multiple gliomas with postmortem findings including a rare case of multicentric glioma are presented. A 59-year-old female was hospitalized with decreased mental activity and gait disturbance. Computed tomographic (CT) scans and magnetic resonance (MR) images showed two independent mass lesions in the left frontal and the right temporal lobes, shown by postmortem to have no communication. Histologically, they were a gemistocytic astrocytoma and an anaplastic astrocytoma, respectively. Therefore, multicentric glioma was diagnosed. A 66-year-old male was admitted with slow mentation and gait disturbance. CT scans and MR images demonstrated two mass lesions; one overriding the bilateral frontal lobes through the corpus callosum and the other in the left temporal lobe. Postmortem examination showed that both lesions were glioblastoma and the left temporal tumor was accompanied by subarachnoid dissemination. A 29-year-old male was hospitalized with gustatory hallucination and convulsions of the right upper extremity. CT scans revealed two mass lesions in the right frontal and the left temporal lobes. MR images demonstrated communication between the two lesions through the corpus callosum. The left temporal tumor developed into the occipital lobe and another new lesion appeared in the right temporal lobe despite chemotherapy and irradiation. Postmortem examination revealed communication between the three masses through the corpus callosum. Histologically, all three tumors were glioblastoma. Multicentric gliomas have been reported at various incidences from 2.3 to 9.1%. However, multicentric gliomas with multiple tumors of different histologies are very rare and only 16 cases have been reported. MR imaging is more valuable than CT scanning to detect communication between two or more lesions.

[Evaluation of recurrent metastatic brain tumor of lung cancer origin].

The authors examined numerous clinical features in 15 patients in whom brain metastases from lung cancer recurred after total or subtotal removal. The incidence of recurrence after initial removal of brain nodules was 46.9% (15 of 32 cases). There was no significant correlation between the incidence of recurrence and the histology of the lung cancer, the site of brain nodules, or age. Recurrent brain nodules were the cause of or contributed to death in 60% of recurrent cases. Recurrence was within 3 months of initial removal of brain nodules in 10 of the 15 patients. Brain metastasis recurred only at the initial site in 11 cases (73.3%). Three patients developed carcinomatous meningitis and one had multiple metastases in addition to recurrence or regrowth at the original site. The primary lung cancer was relatively stable at the time of recurrence of brain nodules in 60% of the patients. Tumor removal and radiotherapy are highly recommended for prevention of early recurrence following initial removal of brain metastases. Removal of metastatic tumor is advised in the event of recurrence after 1 year from initial surgery, since the outcome after second surgery tends to be fair. However, tumor removal and radiotherapy are sometimes capable of inducing recurrence of brain nodules. Therefore, it is hoped that more effective cancer chemotherapy will be developed in the near future.

[The clinical efficacy of imipenem/cilastatin sodium in orthopedic infections and drug levels in the bone tissue].

We evaluated the clinical efficacy of imipenem/cilastatin sodium (IPM/CS--a carbapenem antibiotic) against orthopedic infections, and the drug levels of the bone tissues were determined. The clinical efficacies for 6 patients in the infection group were good in 3 cases, and fair in the other 3; giving an efficacy rate of 50%. Bacteriologically, 8 strains were isolated from patients with the infection and an eradication rate of 87.5% was obtained upon the treatment. In 39 patients that were given the drug prophylactically, no postoperative infections occurred. Mean IPM levels in the bone and the bone marrow at 1 hour after administration in 5 patients of the prophylactic group were 17.3 micrograms/ml and 5.9 micrograms/g, respectively. The ratio of concentrations the bone to those in the bone marrow was 34.6%. The results of this study suggest that IMP/CS reaches to the bone tissue providing sufficient concentrations and that the drug is efficacious for the prophylaxis and the treatment of orthopedic infections.

[A clinical survey of cerebellar astrocytoma--comparison between childhood and adult cases (author's transl)].

The symptomatological investigations on 20 cases of cerebellar astocytoma were carried out. These cases, observed and treated in Hokkaido University Hospital from 1959 to 1978, were divided into two groups, such as childhood group (under 15 years old) and adult group (over 16 years old). The following conclusions were obtained: (1) The youngest was 2 years old and the oldest was 64 years old. The age distribution showed higher incidence in younger age group under the age of 30, especially in the first decade. (2) The most frequent symptoms were vomiting, headache and unsteady gait in all cases, but vomiting was constantly seen in childhood cases. (3) The average length of history in children was 2.4 months in childhood, and 17.6 months in adult cases. (4) Neurological signs on admission could be summarized as follows. The signs indicating increased intracranial pressure was most frequent, and the next common findings were ataxia of the limbs and trunk. Impairment of the cranial nerves and brainstem were uncommon. On neurological signs there was little difference between in children and in adults. (5) The total cases of complete removal of the tumor were many, but in adults there were not a few cases in which incomplete removal of the tumor was accomplished. (6) The majority of cerebellar astrocytoma were cystic and laterally placed in the cerebellum especially in children. (7) Microscopically in children, the frequent type was pilocytic astrocytoma of juvenile type. (8) The result of surgical removal of cerebellar astrocytoma was excellent, and the long-term survivours were found frequently and the quality of survival was good. The follow-up results in children were better than those in adults.

[Multiple cerebral infarction by blood-borne tumor emboli in carcinoma of the mid-pharynx: an autopsy case].

In May, 1989, a-54-year old man was admitted complaining of sore throat and tumor of the neck which had persisted for 2 months. Mid-pharyngeal tumor was diagnosed as poorly differentiated squamous cell carcinoma (stage, T3N2M0) and the patient was treated with radiation (Co 65Gy) from May 30 to July 24 and chemotherapy (UFT), which therapies were effective. On Aug. 16, sudden onset of consciousness disturbance and hemiparesis was revealed, and MRI showed small cerebral infarction. He died on Oct. 23, of pneumonia. Pathological diagnosis revealed a case of carcinoma of the mid-pharynx with wide-spread tumor embolism. Multiple cerebral and myocardial infarctions, thrombus in pulmonary arteries and congestion of kidneys with tumor emboli, due to "disseminated intravascular carcinomatosis" were noticed. A direct cause of death was dyspnea due to multiple lung metastases, pneumonia and tumor embolism in the pulmonary and coronary arteries.

[Lateral ventricle tumors (Part 1)--clinical manifestations on 30 cases (author's transl)].

The clinical investigations especially on symptomatology of 30 cases of the tumors of the lateral ventricle are carried out. For the clinical analysis, in agreement with Koos and Laubichler, the tumors of the lateral ventricle are classified into 2 groups, as follows: 1. Intraventricular tumors group (11 cases). 2. Paraventricular tumors group (18 cases). The following points are emphasized in the clinical features excluding radiological findings. 1. Because of symptomatologically no difference between the intraventricular tumors group and paraventricular tumors group, paraventricular tumors are included into the tumors of the lateral ventricle. 2. On neurological signs and symptoms, we contrast "false" localising signs which are common in patients with objective evidence of raised intracranial pressure and intermittent symptoms which occur more frequently with tumors in the ventricular system. 3. The results of surgical removal of the tumors are not always good. The diversity of results probably reflects the grade of malignancy and growth of the tumors, and skillfulness of operative technique is required, not to do damage to essential neurological elements and vital structures neighbouring the lateral ventricle.

[The coexistence of basal epidermoid tumor and trigeminal neurinoma within the posterior fossa].

Recently we encountered one case with basal epidermoid tumor originated in the cerebellopontine angle, associated with a trigeminal neurinoma of the Gasserian ganglion and trigeminal root within both middle and posterior fossa. We wish to present the case with an analytical review of the reported cases of multiple intracranial tumors. The patient was a 49-year-old man who noted the onset of left facial nerve palsy in March, 1974, which lasted for several years. In April 1976, he developed unsteadiness of gait which was not worsening. He noted left facial pain and paresthesias of tongue in October, 1981 and was pointed out as having left hearing disturbance by a physician. He was admitted to our hospital on December 11, 1981. Neurological examination showed hypalgesia and hypesthesia on his left face, left VII cranial nerve palsy and left-sided hearing loss. The IX and X cranial nerves were also involved with absent gag reflexes on the left side and swallowing difficulty. Tongue was deviated to the right on protrusion. He had mild ataxia of the left limbs, ataxic gait and horizontal gaze nystagmus to the right. He had neither café-au-lait spot nor subcutaneous tumor suggestive of von Recklinghausen's disease. CT scan revealed water density lesion in the prepontine and cerebellopontine cisterns which seemed to distort brainstem posteriorly. Metrizamide CT cisternography showed a large fungated mass filling the basal cistern. These findings strongly suggested the presence of an epidermoid tumor. A left suboccipital craniectomy was performed on May 13, 1982. A large pearly mass filling the basal cistern was removed.(ABSTRACT TRUNCATED AT 250 WORDS)

[Lateral ventricle tumors. (Part 2) -Neuroradiological analyses of 30 cases- (author's transl)].

In the first report, the clinical manifestations of 30 cases of the lateral ventricle tumor were reviewed. This report summarizes neuroradiological findings of the same 30 cases, in which 26 cases were examined by cerebral angiograms and 3 cases by CT scan. For the radiological analyses, the tumors of the lateral ventricle are classified into two groups, as follows: 1. Intraventricular tumors arise in the projection of the choroid plexus, the tela and the ependyma and grow in the lateral ventricle. 2. Paraventricular tumors arise from the wall of the neuroglia not only bulge into ventricle, but in addition infliltrate the substance of the surrounding brain. Following conclusions are obtained. (1) Unilateral hydrocephalus, which is shown clearly by vascular displacements in subependymal veins, is demonstrated in both tumors groups. (2) There are different findings on the feeding arteries, the draining veins and the tumor stains between two tumors groups. (3) In the intraventricular tumors groups, the anterior choroidal artery supplying the tumor is its the plexal segments and atrial segments. (4) On the other hand, the paraventricular tumors group, the anterior choroidal artery supplying the tumor is its the superior penetrating branch to the cerebral parenchyma. (5) Cerebral angiograms can reveal the definite signs of the intraventricular mass, but it is sometimes difficult to evaluate whether its space occupying lesions infiltrates the cerebral substance below the wall of the lateral ventricle, or not. (6) CT scan is useful neuroradiological method in the different diagnosis between two tumor groups, and CT scan provides and anantomical diagnosis rather than a histological one. (7) The accurate diagnosis of the tumors of the lateral ventricle can be demonstrated by both cerebral angiograms and CT scan.

[Vertebral angiography of cerebellar astrocytoma-tumor stain, tumor circulation, CT and angiography in diagnosis (author's transl)].

Twelve cases of cerebellar astrocytoma experienced in the Department of Neurosurgery, Hokkaido University School of Medicine were examined primarily for tumor stain and pathological tumor circulation by angiography. In addition, comparison on neuroradiological findings between cerebellar astrocytoma and hemispheric supratentorial astrocytoma (low-grade) was carried out, and neuroradiological differential diagnosis of cerebellar astrocytoma and cerebellar hemangioblastoma was discussed on the basis of the present results and those which were already reported by other investigations and the authors. The results are as follows: 1) Tumor stain was observed in only one case. A tumor was demonstrated as an avascular mass in the remaining 12 cases. 2) Demonstration of cerebellar astrocytoma as hypovascular or avascular masses was related to their low-grade malignancy in histology and cystic nature in gross appearance, as already pointed out. Furthermore, the present study suggested that mural nodules of cystic lesions should have certain weight and sizes so that they could be demonstrated as tumor stain. 3) Abnormal findings concerning tumor circulation were mostly limited to the cases with tumor stain. Early filling veins were not found in any case. Neither feeding artery nor draining vein was clearly identified in some cases. In addition, the abnormal vessels lacked hypertrophic and tortuous changes. 4) In the supratentorial region, five of the 12 low-grade astrocytoma exhibited abnormal tumor stain and tumor circulation by cerebral angiogram and we think that supratentorial and posterior fossa astrocytoma must usually exhibit different pathological tumor circulation by cerebral angiogram, since each group has distinctive clinical and biological characteristics. 5) CT was performed in 7 of 13 cases. It appeared to be more useful than cerebral angiography in the morphological diagnosis Especially in cystic tumors, CT produced minute information concerning peritumoral edema, enhancement of margin of cystic astrocytoma after intravenous contrast medium, and marginal enhancement with layering in the dependent part of the cyst. 6) Neuroradiological different diagnosis of cerebellar astrocytoma and cerebellar hemangioblastoma by CT was difficult in our cases of cystic tumors. However, both tumors were differentiated from each other with ease by tumor stain and tumor circulation in cerebral angiography, since cerebellar astrocytoma was lacking in abnormal vessels, whereas cerebellar hemangioblastoma was marked by many abnormal vessels. Thus, we concluded that cerebral angiography is superior to CT in differential diagnosis between cerebellar astrocytoma and cerebellar hemangioblastoma.

[Computed tomographic metrizamide myelography in spinal disease (author's transl)].

METHODS: Either EMT Head Scanner, CT 1010 (slice thickness 10mm) or EMI Body Scanner, CT 5005 (slice thickness 13mm) was used. The concentration of metrizamide was 170-250 mgI/microliter and the amount was 7-10 microliters. Either lumbar puncture or lateral C puncture was made. MATERIALS: 26 cases were included in this study. 1) disc disease: 11 cases, 2) spinal cord tumor: 6 cases, 3) Arnold-Chiari malformation: 3 cases, 4) atlantoaxial dislocation: 3 cases, 5) ossification of the posterior longitudinal ligament (associated with ossification of the ligamentum flavum): 2 cases (1 case), 6) spinal foreign body (acupuncture needle): 1 case. RESULTS: 1) CT metrizamide myelography visualizes the subarachnoid space and makes it possible to know the lesion in the spinal canal in relation to the spinal cord in transverse plane. 2) It is difficult to determine the exact level of the lesion in axial plane. 3) The present technique does not allow to visualize the root sleeves. 4) It is difficult to delineate a compression of the subarachnoid space by small localized lesions (esp., disc diseases) due to overlapping the patent adjacent subarachnoid space within a slice 10 mm to 13 mm thick.

[Vertebral angiography of cerebellar hemangioblatoma -tumor stain, tumor circulation, CT and angiography in diagnosis(author's transl)].

Tumor "stain" and pathological tumor circulation were investigated mainly by cerebral angiography in 8 patients of cerebellar hemangioblastoma who were hospitalized in the Hokkaido University Hospital and considered to be suitable for this study. The results are presented with some speculation in this paper. (1) Tumor stain was found in all of the 8 cases. (2) Histologically all 8 cases were composed of endothelial cells with numerous vascular channels. The characteristic tumor "stain" in cerebellar hemangioblastoma was supposed to be closely related to the histologic features. (3) Review of the reports published on tumor stain indicates that tumor staining patterns have been classified into 3 to 5 types. Similar items were established in all the classifications. (4) The 8 cases were divided into 4 types: cystic type, cystic and solid type, solid type, and multiple type based on macroscopic natures of the tumor. Tumor staining patterns in angiography were also tentatively classified into types 1 to 4 according to the natures of the tumor. (5) Concerning pathological tumor circulation, (a) the time of appearance of tumor "stain" was long; (b) early filling veins in the tumor were found in 4 of the 8 cases; (c) almost all feeding arteries had one or two branches; (d) arteries originating from meningeal vessels were enlarged in 2 cases and angiography of the external carotid artery was useful for their identification; and (3) draining veins were enlarged more markedly than feeding arteries and were mostly a single superficial vein. (6) CT was performed in 4 of the 8 cases. It was compared with vertebral angiography regarding diagnostic capability in consideration of the published reports. Vertebral angiography was superior to CT in (a) verification of the presence of multiple lesions in cerebellar hemangioblastoma and (b) differential diagnosis between cerebellar astrocytoma and hemangioblastoma.

[Atlantoaxial dislocation in neurofibromatosis.--Report of three cases--].

Atlantoaxial dislocation has received little attention in many studies of spinal deformity in neurofibromatosis. The only four cases of atlantoaxial dislocation associated with neurofibromatosis has been previously reported in the literature. We reported three rare cases of atlantoaxial dislocation associated with neurofibromatosis. These characteristics in roentgenogram were as follows; (1) marked narrowing of sagittal diameter at C1 level without instability (instability index 0%) (2) association with other mesodermal dysplasia, such as posterior vertebral body scalloping, vertebral body dysplasia, dural ectasia etc. Neurofibromatous tissue was found around the anterior region of the odontoid process in one of our three patients. We speculate that atlantoaxial dislocation in neurofibromatosis may be due to mesodermal dysplasia. On the other hand, a neurofibroma was found around the anterior region of the odontoid process in our third case. Therefore, there is a possibility that atlantoaxial dislocation in the instance was caused by the neurofibroma involving transverse atlantal ligament.

[Computed tomography in developmental anomalies of craniocervical junction].

We reviewed 27 patients with developmental anomalies in craniovertebral junction, and special attention was paid to computed tomography (CT) findings in congenital atlantoaxial dislocation (AAD), basilar invagination and Chiari malformations. In ADD, CT clearly demonstrated the relationships of the atlas to the axis in axial plane. Four major types were distinguished; anteroposterior (6 cases), transverse (0 case), anteroposterior-transverse (4 cases) and rotatory (5 cases) dislocations. It was feasible by CT to analyse the pathomechanics in each individual with AAD. Soft tissue wad was shown on the posterior aspect of the odontoid in 7 out of 15 patients with AAD. Those two features, pathomechanics of AAD and intraspinal soft tissue wad, were felt to be important for patient's symptomatology. Basilar invagination presented in no patient as a single deformity and was always associated with other bony and neural abnormalities in 14 patients. Basilar invagination might be suggested of its existence in such a case as CT showing; (1) the odontoid at or above the level of the foramen magnum, (2) distinctive margin of the foramen magnum above the bottom of the posterior fossa, and (3) the posterior arch of the atlas at the same level as foramen magnum. Nevertheless, it is essential to confirm occipital hypoplasia by using either reformatting CT images in coronal and sagittal plane or conventional tomography; whereas high resolutional CT machine provides new dimension for demonstration of bony details. In Chiari malformations, plain CT scanned by high resolutional machine often makes it possible to delineate caudal migration of the cerebellar tonsils, so that it may be a choice of examination as a screening of the anomaly. In addition, metrizamide CT clearly demonstrated caudal migration both of cerebellar tonsils and medulla oblongata. Therefore, CT apparently exceeds other diagnostic modalities in evaluating this anomaly.

[Cerebral infarction and subarachnoid hemorrhage caused by dolichoectasia; report of a case].

Dolichoectasia usually causes neurological symptoms because of the pressure it exerts on adjacent intracranial structures and/or impaired circulation distal to ectasia. However, it rarely induces subarachnoid hemorrhage. The authors report just such a rare case of dolichoectasia, which caused subarachnoid hemorrhage following extensive cerebral infarction distal to ectasia. On October 18, 1982, a 47-year-old man came to our hospital with dementia which had started 7 days before, as his chief complaint. Neurological examinations revealed no positive findings. However, plain CT scan showed the presence of small multiple low density areas with a round-shaped high density area at the tip of the right temporal lobe. Angiogram taken on February 18, 1983, revealed that all main cerebral arteries, especially the C1 portion of the right internal carotid artery, and the M1 portion of the right middle cerebral artery were abnormally tortuous and distended. There was also pooling of contrast medium in the distal part of the M1 portion of the right middle cerebral artery which corresponded to the site of high density area on the plain CT scan. On January 31, 1987, he was admitted to our hospital with his chief complaint being the sudden onset of weakness in his left extremities. On admission, he was confused (II-10 on the Japan Coma Scale), dysarthric, and hemiparetic on the left side. Plain CT scan showed extensive cerebral infarction of the right middle cerebral artery territory distal to the ectasia.(ABSTRACT TRUNCATED AT 250 WORDS)