The present study deals with the factors affecting the prognosis in the acute stage of 29 cases with hypertensive thalamic hemorrhage diagnosed by CT scan. It was thought that the following factors were significantly related to the outcome of the patients who were unable to lead daily life, remained in vegetative state or died: (1) consciousness level was below 10 in the so-called 3-3-9 formula, (2) bilateral Babinski's signs were observed, (3) localization of the hematoma was all the thalamic nuclei type, (4) hematoma volume was above 10 ml, (5) the maximum dimension of hematoma was over 30 or 35 mm, maximum width over 30 mm, maximum length over 25 mm and maximum height over 30 or 40 mm, and (6) the ventricles were dilatated. The prognosis had no significant relationship with the age of the patients, the side of the hematoma, the presence or the absence of ventricular penetration of the hematoma, or the existence of midline shift. We believe that in the acute stage of hypertensive thalamic hemorrhage, the prognosis can be forecasted by neurological findings, accurate calculation of the hematoma volume and size, localization of the hematoma and presence or absence of ventricular dilatation as determined by CT scan.

In 296 cases with a single aneurysm of the anterior communicating artery (ACoA), fenestration or the presence of more than two ACoA's was observed in 17 cases (5.7%), and abnormal vessels of ACoA origin, such as a median artery of the corpus callosum, were observed in 13 cases (4.4%). As more than one anomaly was found in some of these cases, anomalies of the ACoA were found in total of 26 cases (8.8%). This occurrence rate was no higher than that observed in other cerebral aneurysm cases and in the control cases, which were reported previously. There was no significant increase of hypoplasia of the A1 portion if the ACoA aneurysm was complicated by other arterial anomalies.

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Two cases of moyamoya disease associated with persistent primitive trigeminal artery (PTA) are reported. The first patient was a 44-year-old man who experienced a sudden severe headache brought about by an intracerebral hematoma in the left temporoparietal lobe. Four-vessel study showed a right-sided PTA and moyamoya disease. The second patient was a 56-year-old woman with similar symptoms and a hematoma in the right temporoparietal lobe. Four-vessel study showed a left-sided PTA and moyamoya disease. Among the 212 PTA cases reported in the literature, none has been associated with moyamoya disease. Moreover, there are no cases of moyamoya disease among the 119 cases of persistent primitive hypoglossal artery (PHA), which is thought to be a vascular anomaly fundamentally similar to PTA. None of the 907 cases of moyamoya disease reported in Japan has been associated with either PTA or PHA. Nonetheless, the embryonic stage when PTA or PHA normally disappears partially overlaps that period when moyamoya-like vascular anomalies have been thought to arise. The possible developmental relationship between these two varieties of vascular abnormality is discussed.

A case of cerebral tumor with ipsilateral cerebral hemiatrophy is presented and five previously reported cases are reviewed. The etiology of this entity is discussed on the basis of the symptomatological and clinicopathological findings noted in these six cases. It is suggested that ipsilateral cerebral hemiatrophy is due to thinning of the cerebral cortex with degeneration and disappearance of ganglion cells, demyelination in the subcortex, and destruction of axons. The mechanism proposed for ipsilateral cerebral hemiatrophy due to thalamic tumor is that thalamic tumor causes degeneration and disappearance of thalamic ganglion cells and nerve fibers, with consequent secondary Wallerian degeneration of afferent and projecting fibers from the thalamus as well as retrograde degeneration of efferent fibers, thus resulting in extensive atrophy of the cerebral cortex and subcortical tissue.