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Shigeki Yamada, Masatsune Ishikawa, Kazuo Yamamoto, Tadashi Ino, Toru Kimura, Shotai Kobayashi and Japan Standard Stroke Registry Study Group


The present study aimed to investigate aneurysm locations and treatments for ruptured cerebral aneurysms associated with secondary normal-pressure hydrocephalus (sNPH) after subarachnoid hemorrhage (SAH) by using comprehensive data from the Japanese Stroke DataBank.


Among 101,165 patients with acute stroke registered between 2000 and 2013, 4693 patients (1482 men, 3211 women) were registered as having had an SAH caused by a ruptured saccular aneurysm. Of them, 1448 patients (438 men and 1010 women; mean age 61.9 ± 13.4 years) who were confirmed to have or not have coexisting acute hydrocephalus and sNPH were included for statistical analyses. Locations of the ruptured aneurysms were subcategorized into 1 of the following 4 groups: middle cerebral artery (MCA; n = 354), anterior communicating artery and anterior cerebral artery (ACA; n = 496), internal carotid artery (ICA; n = 402), and posterior circulation (n = 130). Locations of 66 of the ruptured aneurysms were unknown/unrecorded. Treatments included craniotomy and clipping alone in 1073 patients, endovascular coil embolization alone in 285 patients, and a combination of coiling and clipping in 17 patients. The age-adjusted and multivariate odds ratios from logistic regression analyses were calculated after stratification using the Fisher CT scale to investigate the effects of the hematoma volume of SAH.


Acute hydrocephalus was confirmed in 593 patients, and 521 patients developed sNPH. Patients with a ruptured ACA aneurysm had twice the risk for sNPH over those with a ruptured MCA aneurysm. Those with an ACA aneurysm with Fisher Grade 3 SAH had a 9-fold-higher risk for sNPH than those with an MCA aneurysm with Fisher Grade 1 or 2 SAH. Patients with a ruptured posterior circulation aneurysm did not have any significant risk for sNPH. Clipping of the ruptured aneurysm resulted in twice the risk for sNPH over coil embolization alone.


Patients with low-grade SAH caused by a ruptured MCA aneurysm had a low risk for the development of sNPH. In contrast, patients with high-grade SAH caused by a ruptured ACA aneurysm had a higher risk for sNPH. Endovascular coiling might confer a lower risk of developing sNPH than microsurgical clipping.

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5-Hydroxytryptamine innervation of vessels in the rat cerebral cortex

Immunohistochemical findings and hydrogen clearance study of rCBF

Toru Itakura, Hideyoshi Yokote, Hiroshi Kimura, Ichiro Kamei, Kazuo Nakakita, Yutaka Naka, Kunio Nakai, Harumichi Imai and Norihiko Komai

✓ The role of the central 5-hydroxytryptamine (5-HT) neuron system in cerebral microcirculation of the rat was examined by immunohistochemical and hydrogen clearance methods. Immunohistochemical studies demonstrated 5-HT-immunoreactive nerve fibers along intraparenchymal blood vessels (arterioles, capillaries, and venules). Ultrastructural observation revealed that 5-HT-immunoreactive terminal boutons (0.3 to 1.0 µm in diameter) made contact with the basement membrane of the capillaries. After an intracerebral injection of 5,7-dihydroxytryptamine (5,7-DHT), a neurotoxin to the 5-HT neuron system, no 5-HT-immunoreactive nerve fibers were found around the injection site with immunohistochemical techniques. With the hydrogen clearance method, the 5,7-DHT-injected cortex showed no significant change in regional cerebral blood flow (rCBF) in the presence of normocapnia, but a significant increase in rCBF with hypercapnia, compared with the untreated cortex. These facts strongly suggest that the central 5-HT neuron system has an important role in carbon dioxide reactivity of the cerebral blood vessels.