Among 86 patients with aneurysms arising from the vertebral artery or its branches, 24 had dissecting aneurysms. The patients with dissecting aneurysms were characteristically relatively young males. Twenty-one patients presented with subarachnoid hemorrhage (SAH) and three with ischemia. Severe headache or neck pain occurred in all three patients with ischemia. Five of the 21 patients with SAH and all three patients with ischemia experienced recurrent episodes. Angiography typically showed fusiform dilatation and proximal and/or distal narrowing of the affected artery. The difficulty of diagnosing this disorder is pointed out. Surgery was performed in 19 patients, the most common technique being clip-occlusion of the proximal vertebral artery. There were no postoperative deaths or rebleeding; a lateral medullary syndrome developed in three patients. The observation at surgery of intramural clot with characteristic discoloration was limited to the cases operated on within 36 days after the ictus. After this period, the aneurysm was whitish gray in color and had become firm. Of 36 other cases of vertebral dissecting aneurysm reported in the literature, 20 were operated on. The indications for surgery are discussed.

SummaryIt has been our observation that in the presence of concave deformity of the skin flap following large decompressive craniectomy, unexpected neurological deterioation would occur independently of the primary disease or natural improvement would be unduly impaired, and that such unfavorable phenomena were reversed by cranioplasty. In order to know the true incidence and the nature of this phenomenon, 33 consecutive cases were analyzed. Nine of 30 patients (30%) with flat or sinking skin flap showed prompt improvement following cranioplasty. The best 'candidates' for maximum benefit of cranioplasty were those with moderate grade neurological deficits in addition to the presence of concave deformity of skin flap (successful rate of 88%; 7 among 8 patients).Other factors influencing the results were primary disease (favorable to meningioma), time elapse from the decompressive craniectomy, presence of shunt system, CSF pressure and EEG changes before and after cranioplasty. EEG changes had well coincided with clinical course.The characteristic phenomenon would be described as "the syndrome of the sinking skin flap," considering that neurological deterioration may be due solely to effect of concave deformity of the skin flap upon the underlying brain tissue.

It has been hypothesized that language functions are more strongly lateralized to the left hemisphere in males than in females. Previous anatomical data and patient studies have suggested that the posterior language areas should exhibit sex differences. However, neuroimaging studies to date have only provided support for differences in the anterior language areas. To look for differences in the posterior language areas, functional magnetic resonance imaging scans were obtained while male and female subjects listened attentively to a story read aloud and to the same story replayed in reverse. Comparing activation in the superior and the middle temporal gyri during a story to activation during reverse replay of the story showed lateralization to the left in males but not in females. There was no lateralization in either sex when comparing activation during random fragmentation of the story to reverse replay. In the angular and the supramarginal gyri, however, activation was lateralized to the left hemisphere in both sexes, unlike the sex-dependent activation of the posterior temporal lobes. We infer that females use the posterior temporal lobes more bilaterally during linguistic processing of global structures in a narrative than males do.

The biological features of gliomas, which are characterized by highly heterogeneous biological aggressiveness even in the same histological category, would be precisely described by global gene expression data at the protein level. We investigated whether proteome analysis based on twodimensional gel electrophoresis and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry can identify differences in protein expression between high-and low-grade glioma tissues. Proteome profiling patterns were compared in 85 tissue samples: 52 glioblastoma multiforme, 13 anaplastic astrocytomas, 10 atrocytomas, and 10 normal brain tissues. We could completely distinguish the normal brain tissues from glioma tissues by cluster analysis based on the proteome profiling patterns. Proteome-based clustering significantly correlated with the patient survival, and we could identify a biologically distinct subset of astrocytomas with aggressive nature. Discriminant analysis extracted a set of 37 proteins differentially expressed based on histological grading. Among them, many of the proteins that were increased in high-grade gliomas were categorized as signal transduction proteins, including small Gproteins. Immunohistochemical analysis confirmed the expression of identified proteins in glioma tissues. The present study shows that proteome analysis is useful to develop a novel system for the prediction of biological aggressiveness of gliomas. The proteins identified here could be novel biomarkers for survival prediction and rational targets for antiglioma therapy.

BackgroundBecause circulating antibodies against a variety of antigens have been detected in patients with coronary heart disease, carotid atherosclerosis and those who have suffered a stroke, it is suspected that immune response may be one of the mechanisms of atherogenesis The objective of this study is to identify novel antibodies in ischemic stroke patients by screening the expressed recombinant proteins using a human cDNA library (SEREX).MethodsTo identify the candidate antigens, cDNA library was screened by SEREX using plasma from ten patients with ischemic stroke. Subsequently, via ELISA using recombinant proteins and synthetic peptides, the serum antibody levels were measured in two independent patient/healthy donor (HD) cohorts (142 and 78 in the 2nd screening and a validation cohort, respectively).ResultsThe initial screening resulted in the identification of six candidate antigens. Of these antigens, replication protein A2 (RPA2) was determined to be the antigen associated with stroke (P < 0.05) by ELISA with 2nd screening and validation cohort. Multifactorial logistic regression analysis showed that the increased levels of the RPA2 antibodies (RPA2-Abs) associated with stroke independent of other risk factors for stroke (P < 0.05). Receiver operating curve analysis demonstrated that the area under the curve from ELISA using GST fusion RPA2 and synthetic peptides (bRPA2-132) were 0.867 (95% CI: 0.798-0.936) and 0.971 (95% CI: 0.940-1.00), respectively. If the cut-off value of the bRPA2-132-Ab level was determined to be 0.334, the sensitivity and specificity of the antibody level as the diagnostic marker for stroke were 0.323 (95% CI: 0.209-0.453) and 1.00 (95% CI: 0.713-1.00), respectively.ConclusionsSEREX identified RPA2 as the antigen associated with ischemic stroke and serum auto-antibodies against RPA2 elevates in stroke patients. RPA2-Abs could become a biomarker for the evaluation of ischemic stroke at risk.