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Objective:To investigate the clinical and imaging features of Wallerian degeneration in adults with stroke.Methods:Adult stroke patients with Wallerian degeneration admitted to Shengjing Hospital of China Medical University from October 2018 to September 2019 were enrolled retrospectively. Combined with the related literature, the clinical and imaging features of Wallerian degeneration after stroke were investigated.Results:A total of 4 patients with Wallerian degeneration after stroke were enrolled, including 3 males and 1 female, aged 56-63 years. The main clinical symptoms were dysarthria ( n=3), poor physical activity ( n=3), dysphagia ( n=1), and dizziness ( n=1). The National Institutes of Health Stroke Scale score was 1-6. The initial MRI and CT findings after stroke were consistent with the diagnosis of acute cerebral infarction. During the follow-up of 3 to 7 months after the onset, MRI revealed Wallerian degeneration, which showed hyperintensities along nerve fibers on T 2 and Fluid-Attenuation Inversion Recovery (FLAIR) sequence images. Diffusion-Weighted Imaging (DWI) in almost all cases also found hyperintensities along nerve fibers. Conclusions:After acute stroke (including ischemic and hemorrhagic stroke) in the territory of the internal carotid artery, ipsilateral pyramidal tract damage may occur, affecting the long-term motor function of patients. After unilateral pontine stroke, bilateral pontine arm damage may occur, affecting ataxia and balance function of the patients. Wallerian degeneration after stroke is a special neurodegenerative process. Its imaging manifestations are similar to those of new cerebral infarction. Correct understanding of this phenomenon can avoid misdiagnosis.
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Although there is no definite definition,the stroke that has no abnormalities before going to sleep and finds a neurological deficit after waking up are classified as wake-up strokes (WUS) in most of the literature.WUS account for 15％ ～30％ of all stroke cases,and little is known about its pathogenesis.Studies have shown that there is no significant difference in risk factors,clinical features,especially initial severity and outcome between WUS and non-WUS.The current research focuses on the benefits and risks of intravenous thrombolysis and endovascular treatment in WUS.
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Perihematomal edema (PHE) is the key factor to lead to the secondary brain injury after intracerebral hemorrhage,and it can affect the outcomes of patients.This article reviews the pathophysiological mechanisms and treatment strategies of PHE.
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Objective To investigate the associations of serum soluble CD40 ligand (sCD40L) levels with stroke risk,severity,and infarct volume.Methods Consecutive inpatients with acute ischemic stroke were recruited as a patient group.Healthy subjects were used as a control group.The demographics,vascular risk factors,and clinical data were collected from the patient group and control group.The serum sCD40L levels were measured by enzyme linked immunosorbent assay.According to the baseline National Institutes of Health Stroke Scale (NIHSS) scores,they were divided into a mild stroke group (＜ 8) and a moderate to severe stroke group (≥ 8).According to the median of infarct volume,the patients with ischemic stroke were divided into either a large infarction group or a small infarction group.Results A total 106 patients with acute ischemic stroke were recruited,including 47 females (44.3％) and 59 males (55.7％),and the mean age was 71.31 ± 11.27 years.There were 86 healthy subjects in the control group,including 41 females (47.7％) and 45 males (52.3％),the mean age was 73.56±9.32 years;there were.41 patients (38.7％) in large infarction group (≥1.8 cm3) and 65 (61.3％) in the small infarction group (＜1.8 cm3);there were 69 patients (65.1％) with mild stroke and 37 (34.9％) with moderate to severe stroke.The baseline serum sCD40L level in the patient group was significantly higher than that in the control group (5.61 ± 1.68 mg/L vs.3.56 ± 1.32 mg/L;t =9.236,P ＜0.01),the serum sCD40L level at day 14 after admission (4.19 ± 1.45 mg/L) in the patient group was significantly lower than the baseline level (P ＜0.01),but it was still higher than the control group (P ＜ 0.01).Multivariate logistic regression analysis showed that the higher low-density lipoprotein cholesterol (odds ratio [OR] 3.358,95％ confidence interval [CI] 2.681-4.056;P＜0.001) and serum sCD40L (OR 5.103,95％ CI 2.317-8.903;P＜0.001) levels were the independent risk factors for ischemic stroke;the higher serum sCD40L level (fourth vs.first quartile,OR 4.017,95％ CI 1.608-10.037;P =0.003),large atherosclerotic stroke (OR 2.321,95％ CI 1.014-5.314;P =0.046),cortical-subcortical infarcts (OR 2.679,95％ CI 1.111-6.460;P =0.028),and larger infarct volume (OR 3.216,95％ CI 1.398-7.395;P=0.006) were the independent risk factors for moderate to severe stroke;the higher serum sCD40L level (fourth vs.first quartile,OR 3.142,95％ CI 1.274-7.745;P =0.013),large atherosclerotic stroke (OR 2.956,95％ CI 1.299-6.767;P =0.010),cortical-subcortieal infarcts (OR 4.750,95％ CI 1.909-11.818;P ＜0.001),and baseline NIHSS score ≥8 (OR 8.509,95％ CI 3.432-21.094;P ＜ 0.001) were the independent risk factors for large infarction.Conclusion The serum sCD40L levels are closely associated with the risk,severity and infarct volume of ischemic stroke.
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Objective To investigate the associations of left atrial enlargement and the severity and lesion patterns of cardioembolic stroke in patients with nonvalvular atrial fibrillation (NVAF).Methods The patients with NVAF diagnosed as cardiogenic stroke within 48 h after onset were enrolled.The National Institutes of Health Stroke Scale (NIHSS) was used to evaluate the severity of stroke,and ≥ 10 was defined as moderate to severe stroke,and ＜ 10 was defined as mild stroke.Transthoracic echocardiography was used to measure the left atrial diameter.The patients were divided into normal group,mild,moderate,and severe left atrial enlargement groups.According to the lesion patterns revealed by the diffusion weighted imaging,they were divided into either a multiple infarctions group or a single infarction group.Results A total of 137 patients were enrolled,including 86 patients with mild stroke (62.8％),51 with moderate to severe stroke (37.2％),69 with multiple infarctions,and 68 with single infarction (49.6％).Left atrial enlargement was found in 103 cases,in which 35 (25.5％) were mild enlargement,40 (29.2％) were moderate enlargement,and 28 (20.4％) were severe enlargement.Multivariate logistic regression analysis showed that the risk of severe stroke in patients with mild (odds ratio [OR] 15.662,95％ confidence interval [CI] 1.821-134.677;P =0.012),moderate (OR 26.435,95％ CI 3.201-218.319;P =0.002),and severe (OR 75.763,95％ CI 8.536-672.441;P＜0.001) left atrial enlargement were increased significantly,and there were no significant differences in the lesion patterns among the different severity of left atrial enlargement groups (x2 =7.050,P =0.07).Conclusions Left atrial enlargement may be independently associated with the severity of cardiogenic stroke in patients with NVAF,but it is not associated with the lesion patterns.
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ObjectiveTo investigate the associations of fetal-type posterior cerebral artery (FTP) with infarction distribution and stroke severity in patients with acute ischemic stroke.MethodsThe patients with acute ischemic stroke were enrolled.They were divided into either a FTP group or a non-FTP group according to the results of magnetic resonance imaging.The former group was further divided into complete FTP (cFTP) and partial FTP (pFTP).According to the results of diffusion-weighted imaging, the infarction distribution was divided into the territory of the anterior cerebral artery (ACA), middle cerebral artery (MCA), posterior cerebral artery (PCA), and vertebrobasilar artery.According to the National Institutes of Health Stroke Scale (NIHSS), the stroke severity was assessed, <8 was defined as mild stroke, and ≥8 was defined as moderate to severe stroke.Multivariate logistic regression analysis was used to determine the associations of FTP with infarction distribution and stroke severity.ResultsA total of 647 patients with acute ischemic stroke were enrolled, and 201 (31.1%) had FTP, including 162 (25.0%) cFTP and 39 (6.0%) pFTP.Multivariate logistic regression analysis showed that cFTP and pFTP were the independent risk factors for MCA infarction (cFTP: odds ratio [OR] 24.714, 95% confidence interval [CI] 10.952-45.766, P<0.001;pFTP: OR 14.526, 95% CI 6.832-25.931, P<0.001), and the independent protective factors for PCA infarction (cFTP: OR 0.214, 95% CI 0.022-0.531, P<0.001;pFTP: OR 0.326, 95% CI 0.018-0.739, P<0.001), they were also the independent risk factor for the severity of acute ischemic stroke (cFTP: OR 22.138, 95% CI 12.492-64.067, P<0.001;cFTP: OR 19.510, 95% CI 8.956-23.514, P<0.001).ConclusionscFTP and pFTP are the independent risk factors for MCA infarction, and the independent protective factors for PCA infarction, and at the same time, they were also the independent risk factors for the moderate to severe stroke.FTP is associated with the infarction distribution and the stroke severity in acute ischemic stroke.
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Objective The aim of this study was to examine the association between plasma Pentraxin 3(PTX3) levels with acute ischemic stroke and carotid artery atherosclerosis.Methods We enrolled 103 patients with acute ischemic stroke (AIS)and 83 control subjects.The levels of plasma PTX3 were measured by using Enzyme-linked immunosorbent assay (ELISA) at admission and after 7 days treatment in the AIS group.The carotid artery plaques in the AIS group were detected by using Color Doppler Ultrasound.Patients with AIS were divided into two groups according to the stability of carotid artery atherosclerosis plaques.The association between plasma PTX3 levels with acute ischemic stroke and the stability of carotid artery atherosclerosis plaques was examined.Results ① The plasma PTX3 levels were significantly higher in the AIS group than in the control group (P＜0.05).After 7 days standard treatment,the plasma PTX3 levels in AIS group were significantly decreased (P＜0.05),but still higher than those in control group (P＜0.05).Multivariable logistic regression suggested that the plasma PTX3 levels had a close relationship with AIS (OR=15.043,95％CI:3.46～65.45,P＜0.001).② In the AIS group,the plasma PTX3 levels before and after treatment were significantly higher in unstable plaque group than in no plaque and stable plaque group(P＜0.05).Conclusion The plasma PTX3 levels are higher in patients with acute ischemic stroke.The plasma PTX3 levels are significantly higher in AIS group with unstable plaque.The plasma PTX3 levels are closely associated with acute ischemic stroke.
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Endovascular therapy is another revascularization therapy after intravenous thrombolysis, but it is strictly limited by the time window as with the venous thrombolysis.For patients exceeding the time window, there is a tendency to use imaging means to assess their benefits and risks to guide decisions, which are particularly important for the assessment of collateral circulation. This article reviews collateral circulation assessment and its application in endovascular treatment of acute ischemic stroke.
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Nontraumatic convexal subarachnoid hemorrhage is a rare type of nonaneurysmal subarachnoid hemorrhage.Its etiologies and clinical manifestations are diverse.This article reviews nontraumatic convexal subarachnoid hemorrhage from the aspects of etiology, clinical manifestation, imaging, diagnosis, treatment, and prognosis.
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Objective To investigate the correlation between thyroid antibody level and carotid atherosclerotic plaque in patients with acute ischemic stroke.Methods Consecutive patients with acute ischemic stroke were enrolled retrospectively.They were divided into a non-plaque group and a plaque group according to the findings of carotid artery color-Doppler ultrasonography.The plaque group was redivided into a stable plaque subgroup and a non-stable plaque subgroup.Chemiluminescence method was used to measure the serum thyroperoxidase antibodies (TPOAb) and thyroglobulin antibodies (TGAb) levels and they were compared.Results A total of 383 patients were enrolled in the study,including 116 (30.3％) did not have plaque and 267 (69.7％) had plaque,68 of them had unstable plaque,and 199 had stable plaque.The level of TGAb in the plaque group was significantly higher than that in the non-plaque group (Z =-4.826,P ＜0.001).Multivariate logistic regression analysis showed that the level of TGAb might be an independent risk factors for carotid plaque (odds ratio 1.007,95％ confidence interval 1.001-1.012;P =0.016).The serum level of TPOAb in the stable plaque group was significantly higher than that in the unstable plaque group (Z =-2.114,P=0.035),but multivariate logistic regression analysis showed that it was not the independent risk factor for unstable plaque (odds ratio 1.001,95％ confidence interval 0.996-1.006;P =0.786).Conclusions The level of serum thyroid antibodies increased in patients with acute ischemic stroke,especially the increased level of TGAb might be associated with the occurrence and development of carotid atherosclerotic plaque,however,it was not associated with the plaque stability.
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Pentraxin (PTX) 3 is a typical long PTX. As an inflammatory marker, the plasma PTX3 level is elevated in atherosclerosis, cardiovascular disease, infection, inflammation, autoimmune disease and tissue injury. Recently studies have shown that the plasma PTX3 level rapidly increased during the acute phase of ischemic cerebrovascular disease. Detection of plasma PTX3 level may be contribute to the diagnosis, treatment and prognostic judgment of acute cerebral infarction.
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Objective The purpose of this study was to explore the effect of FVIII(factor VIII,FVIII)and VWF (von Willebrand factor,VWF)elevation on the severity, prognosis and inpatient complications such as infections and neuroworsening in patients with acute ischemic stroke. Methods Ninety patients with acute ischemic stroke and 50 pa?tients without ischemic stroke were recruited from affiliated Shengjing hospital of China Medical University between De?cember 2014 and March 2015 . We tested FVIII and VWF levels of all the patients. Patients with acute ischemic stroke were divided into 4 groups:both FVIII and VWF within normal range(FVIII-/VWF-);elevated FVIII, but normal VWF (FVIII↑/VWF-); FVIII within normal range, but elevated VWF(FVIII-/VWF↑); and elevation of both FVIII and VWF(FVIII↑/VWF↑). Results The median of VWF was higher in the case group (1521.88 U/L) than in the control group (1281.77U/L)(P=0.023). Compared with patients with both FVIII and VWF within normal range, patients with ele? vation of both FVIII and VWF had more severe neurological dysfunction(NIHSS at admission>5)(OR=3.643,95%CI:1.258~10.549,P=0.017)and poorer prognosis(mRS>2 at the point of 3 months after stroke)(OR=7,95%CI:2.304~21.266,P=0.001), higher proportion of mRS>2 at discharge(OR=3.797,95%CI:1.346~10.713,P=0.012),and more in?patient complications such as infections(OR=3.913,95%CI:1.115~13.729,P=0.033)and neuroworsening(OR=5.538, 95%CI:1.099~27.908,P=0.038). After additional adjustment for various confounding factors, elevation of both FVIII and VWF was an independent predictor of poor prognosis in patients with acute ischemic stroke(OR=4.495,95%CI 1.012~19.957,P=0.048). Conclusions The elevation of FVIII and VWF is positively associated with the severity and prognosis in patients with acute ischemic stroke, which may serve as an independent predictor of poor prognosis.
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Fetal-type posterior cerebral artery is a common embryonic derivation type of the Willis.This article reviews the definition and typing of the fetal-type posterior cerebral artery,and its relationship with collateral circulation,ischemic stroke,and intracranial aneurysm,etc.
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Left atrial enlargement is an independent risk factor for ischemic stroke and other cardiovascular adverse events. It can affect stroke severity and increase the risk of recurrence. The mechanisms associated with left atrial enlargement and ischemic stroke are not yet clear. It may be associated with atrial thrombosis or co-morbidity, such as atrial fibrillation and hypertension. How to conduct primary and secondary prevention of stroke patients with left atrial enlargement still need further clinical trials to determine.
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von Willebrand factor (vWF) and factor Ⅷ (FⅧ) exist in a complex form in blood.After being activated,they mediated platelet adhesion and aggregation,and play an important role in the course of thrombosis.The levels in blood of both of them were affected by a variety of factors.vWF and FⅧ are closely associated with the risk,etiological type,severity and outcome of acute ischemic stroke.Studies on the corresponding antagonistic drugs have made a breakthrough,and these drugs may become more advantageous antithrombotic s.
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Endothelialprogenitorcels(EPCs)arethepluripotentstemcelsofvascularendothelial cels. They have self-differentiation and proliferation ability. A large number of animal experiments and preliminary clinical studies have show n that EPCs have broad prospects of clinical application. This article review s the research status of EPCs and their application in the clinical treatment of ischemic stroke.
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Objective To investigate the effects of brain ischemic preconditioning (BIP) on peripheral blood EPCs and neovascularization in ischemic brain tissue in rats with cerebral ischemia reperfusion injury (IRI). Methods One hundred and eight male SD rats were randomly divided into three groups:SO group (n=36), MCAO group (n=36) and BIP group (n=36). Neurological function assessment was conducted at 0 h before MCAO-reperfusion, 3 h, 24 h and 3 d, 5 d as well as 7 d after MCAO-reperfusion (n=6 for each group in each time point). Flow cytometry was used to calculate the number of EPCs. Immunohistochemical staining was used to detect the capillary density. Results ①Although neurologi?cal deficit scores were significantly decreased in both BIP and MCAO groups after 3 h following MCAO-reperfusion, the scores were much lower in BIP group than in MCAO group(5 d:1.00±0.63;7 d:1.00±0.63, P<0.05).②The numbers of EPCs were decreased in MCAO group while was increased in BIP group at 3 h after MCAO-reperfusion. The numbers of EPCs were significantly higher in BIP group than in MCAO group(24 h:0.58±0.07;3 d:0.80±0.10;5 d:0.68±0.05;7 d:0.52 ± 0.03, P<0.01). ③ The new blood vessels could be detected at 3 d in BIP group and 5 d in MCAO group after MCAO-reperfusion. The numbers of new blood vessels were significantly higher in BIP group than MCAO group(5 d:14.53 ± 3.44; 7 d: 41.40 ± 5.62, P<0.01). ④ Pearson analysis showed a positive correlation between EPCs and capillary density (5 d: r=0.855, P<0.01; 7 d: r=0.946, P<0.01). Conclusion BIP can improve EPCs mobilization and function, which may contribute to neovascularization in the ischemic brain tissue.
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Background To investigate the expression of the early growth response gene-1 ( Egr-1 ) mRNA after focal cerebral ischemia / reperfusion in rats.Methods Ten healthy male SD rats weighing 200 ～ 250 g were used to create model of focal cerebral ischemia. The expression of Egr-1 after focal cerebral ischemia/reperfusion in rats was determined using in situ hybridization and RT-PCR.Results (1) The result of the in situ hybridization: A trace amount of Egr-1 mRNA expressed in the neurons and the glial cells in the sham operated group. The expression of Egr-1 mRNA at the ischemic side increased dramatically following ischemia and reached peaks after 4 hours' reperfusion. Egr-1 expression started to subside following 22 hours' reperfusion and further decreased following 166 hours' reperfusion, which was still significantly higher than that in the sham operated group. (2) The result of RT-PCR: The expression of Egr-1 mRNA at the ischemic side was significantly higher than that in the sham operated group at all time points after ischemia/reperfusion in the rats(P ＜0. 01). Expression of Egr-1 increased 2 h after ischemia and reached the peak 4 h following reperfusion, and then decreased dramatically at 46 h after reperfusion which was still higher than that in the sham operated group (P ＜ 0. 01). As the ischemia/reperfusion period prolonged, the expression of Egr-1 mRNA increased gradually, but still detectable even 166 h following reperfusion. The expression of Egr-1 was significantly higher than that in the sham operated group at all time points (P ＜0. 01).Conclusions The expression of Egr-1 mRNA increase in the neurons and the glial cells after ischemia/reperfusion, which may have protective effects on ischemic brain tissues.
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Objective To study the clinical and imaging characteristics of cerebral venous sinus thrombosis(CVST).Methods Clinical data of 9 cases with CVST were retrospectively analyzed.Results All patients had headache,nausea and vomiting; 5 patients had epilepsy; 3 patients had focal neurological deficits; 3 patients had fever; 3 patients had palilledema; 3 patients had disturbance of consciousness. CSF examination showed prominent high intracranial pressure, but conventional and biochemical examinations were normal. 8 patients did CT scan, but the diagnosis was not clear. All patients first MRI showed venous sinus and related brain areas long T1 and T2 signal; MRV showed that the involved venoussinus had non-visualized signal. MRI in chronic phase showed slightly higher T1 and T2 signal; MRV showed sinus enhancement.The outline of uncomplete reconalzation was unclear. Conclusions The common high intracranial pressure is unspecific sign and symptom of patients with CVST. CSF examination show that the intracranial pressure is prominent high, but conventional and biochemical examination are normal. MRI can show that the normal flow void of the dural sinus is disappeared, instead of abnormal high or equality intensities. The characters of CVST in MRV are those the blood flow signal of involved venous sinus be disappeared or showed anormalism.