Single-photon emission computed tomography (SPECT) was used for the measurement of regional cerebral blood volume (CBV) and hematocrit (Hct) in normal healthy human volunteers (mean age 30 +/- 8 years). Regional cerebral red blood cell (RBC) volume and plasma volume were determined separately and their responses to carbon dioxide were investigated. Ten right-handed healthy volunteers were the subjects studied. SPECT scans were performed following intravenous injection of the RBC tracer (99mTc-labeled RBC) and plasma tracer (99mTc-labeled human serum albumin) with an interval of 48 h. Regional cerebral Hct was calculated as the regional ratio between RBC and plasma volumes and then was used for calculating CBV. Mean regional CBV in the resting state was 4.81 +/- 0.37 ml/100 g brain, significantly greater in the left hemisphere compared with the right by 3.8% (p less than 0.01). Mean regional RBC volumes (1.50 +/- 0.09 ml/100 g brain) were less than mean regional plasma volumes (3.34 +/- 0.28 ml/100 g brain), and mean regional cerebral Hcts were 31.3 +/- 1.8%, which was 75.9 +/- 2.1% of the large-vessel Hct. During 5% CO2 inhalation, increases in plasma volume (2.48 +/- 0.82%/mmHg PaCO2) were significantly greater than for RBC volume (1.46 +/- 0.48%/mmHg PaCO2). Consequently, the cerebral-to-large-vessel Hct ratio was reduced to 72.4 +/- 2.2%. Results emphasize the importance of cerebral Hct for the measurement of CBV and indicate that regional cerebral Hcts are not constant when shifted from one physiological state to another.

Objective Recent studies have demonstrated gender differences in functional outcome after stroke. However, the underlying reasons for differences have been inconsistent. The present study examined whether gender differences in long-term functional outcomes exist among surviving patients with first-ever ischemic stroke and with individual subtypes of stroke. Methods A total of 997 patients (654 men, 343 women) were followed for 5 years after discharge. Patients were assigned to 4 subtypes of ischemic stroke (atherothrombotic, lacunar, cardioembolic and unclassified infarction

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Serum dopamine-beta-hydroxylase (DBH) activity was measured during headache-free intervals in 17 patients with migraine and during the headache interval in 16 patients with muscle contraction headache, as well as in 40 normal subjects. The DBH activity was significantly higher in the migraine patients (46.5+/4.5 units) than in the controls (24.9+/2.4 units), whereas no significant difference was observed between the patients with muscle contraction headache (29.4+/4.5 units) and the controls.

Regardless of degree of independence of patients' ADLs, caregiver burden was severe. To decrease caregiver burden, it is necessary to use care services, reduce care time, and allow caregivers free time. In addition, it is possible to continue long-term home care by maintaining their relationships.

Background:To determine whether differences in health-related quality of life (HRQOL) exist between male and female stroke patients and, if present, to identify factors influencing these differences. Methods:A questionnaire assessing HRQOL, measured by the EuroQol questionnaire, and functional outcome was mailed to 792 stroke patients and responded by 604 patients 39.6 ± 18.4 (mean ± standard deviation) months after stroke onset. A total of 480 patients who lived at home after discharge were considered eligible for the analysis. Results:The mean quality of life (QOL) utility score for men (0.79 ± 0.22) was significantly higher than that for women (0.69 ± 0.26; P < 0.001). At discharge, men had a significantly better ability to walk than women (P < 0.001). The ability to perform activities of daily living (ADL) was also better among men than women after discharge (P < 0.01). A close relationship was observed between QOL utility scores and performance of ADL in both genders. A higher proportion of women were found to be in a state of anxiety or depression. Multiple regression analysis revealed that the QOL utility scores for men and women were influenced by functional changes, and the ADL items walking and dressing ability after discharge. In addition, the score for women was influenced by walking ability at discharge.Conclusions: HRQOL among men was significantly better than that among women. The difference in QOL scores appears to be influenced by the poorer outcome of ADL and the higher proportion of post-stroke anxiety and depression among women.

SUMMARY Regional cerebellar blood flow was measured in a patient with left-sided ataxic hemiparesis, using single-photon emission computed tomography and N-isopropyl-p-[1Z3 I]Iodoamphetamine. X-ray computed tomography revealed a small infarct in the paramedian portion of the right upper basis pontis. Blood flow was markedly reduced in the contralateral cerebellar hemisphere corresponding to the side of ataxia. The present study emphasizes the value of the three-dimensional functional imaging of the cerebellum to Investigate the responsible lesion for ataxia and to study function of the cerebro-cerebellar circuits. Stroke Vol 17, No 5, 1986 IN 1978, Fisher 1 reported a pathological study of three patients with sudden onset of weakness and cerebellar ataxia of the same side. He suggested that this unusual combination of ipsilateral hemiparesis and ataxia is caused by a lacunar infarct in the upper basis pontis, and he proposed that the designation "ataxic hemiparesis" should be used to supplant the previously designated "homolateral ataxia with crural paresis" which he himself reported in 1967.2 In subsequently reported cases of ataxic hemiparesis, however, the location of CT lesions were rather diverse including not only the basis pontis 3 but also the internal capsule/ 5 corona radiata 6 and midbrain. 7 Based on these variable localizations of CT lesions, some authors 89 speculate that there are several regions where a small lesion may damage both the pyramidal tract and the cerebro-cerebellar circuit. However, it has been a difficult question to settle whether the ataxia or dysmetria on the side of weakness is actually due to cerebellar dysfunction.We report a case of ataxic hemiparesis in which a lacunar infarct was confirmed in the basis pontis by CT scan and the reduction of contralateral cerebellar blood flow was measured by single-photon emission computed tomography and N-isopropyl-p-[123 I]Iodoamphetamine. Report of a CaseA 70-year-old, right handed, diabetic woman experienced three episodes of transient and mild weakness of the left arm and leg for two days prior to admission. The first episode was associated with slurred speech and the third with nausea. She was able to walk but tended to fall to the left. On the day of admission, she From the Departments of Medicine, and Radiology,* School of Medicine, Kitasato University, 1-15-1 Kitasato, Sagamihara, Kanagawa-ken 228, Japan.Nihon Medi-Physics Co., Ltd. in Japan provided the N-isopropylp[123 I]Iodoamphetamine. Address correspondence to: Fumihiko Sakai, M.D., Department of Medicine, School of Medicine, Kitasato University, 1-15-1 Kitasato, Sagamihara, Kanagawa-ken 228, Japan.Received September 4, 1985; accepted November 22, 1985. woke unable to walk without falling and there was severe clumsiness of the left arm. On examination she was alert, oriented, with intact recent and remote memory, and was not aphasic. Her blood pressure was 166/92 mmHg, and the pulse was 76/min and regular. She was moderately dysarthric with mild weakness of the left lowe...