ABSTRACT
Enlarged perivascular spaces (EPVS) are one of the early characteristic imaging manifestations of cerebral small vessel disease. Studies have shown that EPVS may be an early independent risk factor for post-stroke cognitive impairment (PSCI), and it plays an important role in the occurrence and development of cognitive impairment. This article reviews the correlation between EPVS and PSCI.
ABSTRACT
Cerebral hyperperfusion syndrome is a rare but life-threatening complication after carotid endarterectomy and carotid artery stenting. If it is not identified and adequately treated in time, it may cause severe neurological impairment or even death due to cerebral edema or cerebral hemorrhage. This article reviews the risk factors, pathophysiological mechanisms, clinical manifestations, imaging diagnosis and treatment of cerebral hyperperfusion syndrome.
ABSTRACT
Silent cerebral small vessel disease is a series of imaging and pathological syndromes caused by intracranial small vessel disease. It is named for the lack of clinically recognizable stroke symptoms. Its imaging characteristics are mainly cerebral microbleeds, white matter hypertensities, lacune, and enlarged perivascular space. Recent studies have shown that patients with intracerebral hemorrhage often have varying degrees of cerebrovascular disease imaging changes, which seriously affect the clinical outcome of patients. This article reviews the relationship between silent small vessel disease and outcome in patients with intracerebral hemorrhage.
ABSTRACT
Objective To investigate the relationship between the total burden of cerebral small vessel disease (CSVD) and the outcomes in patients with large artery atherosclerotic (LAA) stroke.Methods From June 2016 to January 2018,patients with LAA stroke treated at the Department of Neurology,the Affiliated Hospital of Qingdao University were enrolled retrospectively.The overall burden of CSVD was evaluated according to MRI findings.The National Institute of Health Stroke Scale (NIHSS) was used to evaluate theseverity of stroke.The modified Rankin scale (mRS) was used to evaluate the outcomes at day 90 after the onset.The mRS score 0-2 was defined as good outcome,and ＞2 was defined as poor outcome.Results A total of 148 patients with LAA stroke were enrolled,including good outcome in 72 (48.65％) and poor outcome in 76 (51.35％).There were significant differences in the proportions of hypertension (69.44％ vs.85.52％;x2 =5.519,P =0.019),taking antihypertensive drugs before the onset (48.61％ vs.69.74％;x2 =6.845,P =0.009),white matter hyperintensity (18.06％ vs.39.47％;x2 =8.228,P =0.004),enlarged perivascular space (33.33％ vs.60.53％;x2 =10.968,P =0.001),as well as the baseline NIHSS scores (3.00 [2.00-4.00] vs.7.0 [5.0-10.0];Z =-8.159,P =0.001),baseline systolic blood pressure (149.40± 15.80mmHgvs.157.21± 14.05mmHg;t=3.180,P=0.002;1 mmHg=0.133 kPa),fasting glucose (5.91 ±2.06 mmol/L vs.6.92 ±2.65 mmol/L;t =2.595,P =0.010),and the proportions of total CSVD scores 0,1,2,3,and 4 (Z =-4.927,P =0.001) between the 2 groups.After adjustment for the confounding factors,such as hypertension and fasting glucose,multivariate regression analysis showed that the total CSVD score (odds ratio 4.457,95％ confidence interval 1.768-11.236;P =0.002) and baseline NIHSS score (odds ratio 2.070,95％ confidence interval 1.580-2.710;P ＜ 0.001)were the independent risk factors for the poor outcomes in patients with LAA stroke.Conclusions The total CSVD burden was closely associated with the outcomes in patients with LAA stroke.Higher CSVD total score and baseline NIHSS scores were independently associated with the poor outcome at 90 d in patients with LAA stroke.
ABSTRACT
Objective To investigate the changes of cognitive impairment with disease progression in patients with minor stroke/transient ischemic attack (TIA).Methods Consecutive patients with minor stroke/TIA were enrolled prospectively.Montreal Cognitive Assessment (MoCA) was used to conduct the cognitive function assessment within 7 d of the onset (baseline),at 1 and 3 months,respectively.Compared with the baseline,the total scores of MoCA in patients increased by ≥2 at 3 months were cognitive function improvement and increased <2 were no cognitive function improvement.Multivariate logistic regression analysis was applied to identify the independent risk factors for no cognitive improvement.ResultsA total of 112 patients with minor stroke/TIA were enrolled in the study,including 63 patients (56.2%) with TIA and 49 (43.8%) with minor stroke.At baseline,1 month,and 3 months,77 (68.8%),72 (64.3%) and 60 (53.6%) patients had cognitive impairment.At 3 months after the onset,the cognitive function of 25 patients (22.3%) were improved,in which 19 (76.0%) and 6 (24.0%) patients had TIA/minor stroke respectively;87 (77.7%) did not have any improvement.Compared with the improvement group,the level of education was significantly lower (3.29±3.48 years vs.5.63±4.26 years;t=2.814,P=0.006),the level of glycosylated hemoglobin was significantly higher (6.35%±1.26% vs.7.21%±1.26%;t=-3.088,P=0.003) in the no improvement group,and the proportions of patients with minor stroke (49.4% vs.24.0%;χ2=5.101,P=0.024),hypertension (52.9% vs.24.0%;χ2=6.509,P=0.011),hyperlipidemia (51.7% vs.24.0%;χ2=6.019,P=0.014),diabetes (41.4% vs.16.0%;χ2=5.448,P=0.020),and coronary heart disease (32.2% vs.8.0%;χ2=5.792,P=0.016) were significantly higher.Multivariate logistic regression analysis showed that the level of education (odds ratio [OR] 1.364,95% confidence interval [CI] 1.059-1.756;P=0.016),atrial fibrillation (OR 2.509,95% CI 1.020-6.167;P=0.045),and higher glycosylated hemoglobin level (OR 1.586,95% CI 1.021-2.034;P=0.030) were the independent risk factors for no cognitive function improvement at 3 months after the onset of minor stroke/TIA.As time went on,the MoCA score and visual spatial execution,memory,abstract and directional scores were increased significantly (P<0.001),while there were no significant differences in naming,attention,and language scores.Conclusion s About 2/3 patients with minor stroke/TIA had cognitive impairment,and as time went on,they were improved.The lower education level,atrial fibrillation and higher baseline glycated hemoglobin were the independent risk factors for affecting no cognitive impairment improvement after monor stroke/TIA.
ABSTRACT
Circle of Willis is the most important intracranial collateral circulation system,it has many types of variation.Circle of Willis variants reduce intracranial blood perfusion and increase the risks of ischemic cerebrovascular diseases and white matter lesions.White matter lesions are white matter damage caused by a variety of causes.With the wide application of neuroimaging technology,the detection rate of white matter lesions is significantly higher,and it is closely associated with the ischemic cerebrovascular disease.This article reviews the correlation between circle of Willis variants and white matter lesions.
ABSTRACT
Benign paroxysmal positional vertigo (BPPV) is the most common kind of vertigo,which can be divided into idiopathic and secondary types.Head trauma,surgery,and inner ear diseases may induce the secondary BPPV,but the etiology and pathogenesis of idiopathic BPPV is still unknown.Recent studies indicate that multiple factors are associated with idiopathic BPPV;in this article we will review the risk factors of idiopathic BPPV.
ABSTRACT
Objective To investigate the incidence,characteristics and risk factors of cognitive impairment in patients with transient ischemic attack(TI A) or minor stroke.Methods Montreal cognitive assessment(MoCA) was carried out in 279 patients with TIA or minor stroke and 150 healthy controls to assess their cognitive function.Results (1) Compared with the healthy controls,the TIA/minor stroke patients scored significantly lower on MoCA total score((23.98±2.55) vs (26.60±0.99),t=12.084,P＜0.01) and subtests including visuoexecutive function((3.68±0.94) vs (4.41±0.64),t=8.483,P＜0.01),digital span ((1.81±0.40) vs (1.95±0.23),t=3.771,P＜0.01),attention((0.84±0.37) vs (0.95±0.23),t=3.357,P＜ 0.01),repetition((1.59±0.62) vs (1.89±0.37),t=5.496,P＜0.01),verbal fluency((0.88±0.33) vs (0.95 ± ±0.23),t=2.286,P＜0.05),abstraction((1.55±0.64) vs (1.91±0.34),t=6.357,P＜0.01) and recall ((2.87±1.13) vs (3.18±0.41),t=3.281,P＜0.01) were significantly decreased.(2) Of 279 TIA/Minor stroke patients,213 (76.3％) suffered from cognitive impairment.The incidence of cognitive impairment was positively correlated with the gender,age,educational level,smoking,course,leukoaraiosis,comorbidities such as hypertension,diabetes mellitus(P＜0.05),and negatively correlated with hyperlipidemia(P＞0.05).Conclusion Extensive impairments of cognitive functions occur along with the incidence of TIA or minor stroke.It is thus suggested that cognitive assessment and interventions may be carried out at an early stage.
ABSTRACT
Vascular cognitive impairment has been a research hotspot in the field of neurology in recent years.The Montreal Cognitive Assessment is a rapid screening tool for detecting mild cognitive impairment.Now it has been widely used in the evaluation of vascular cognitive impairment.This article reviews the content,features,application status,and development prospects of the Montreal Cognitive Assessment.
ABSTRACT
ObjectiveToinvestigatetherolesofbrain-derivedneurotrophicfactor(BDNF)and tyrosine receptor kinase B (TrkB) in ischemic postconditioning. Methods Wistar rats w ere randomly assigned to three groups:a sham operation (9 rats), an ischemic postconditioning, and an ischemia-reperfusion group. According to the reperfusion time, the latter 2 groups w ere redivided into 6, 12, 24, 48, and 72 h subgroups (9 rats in each subgroups). A middle cerebral artery occluded by suture method for a cerebral ischemia-reperfusion model. Triphenyl tetrazolium staining w as used to detect infarct volume (P=4). Immunohisto-chemical staining w as used to detect the expression levels of BDNF and TrkB proteins (P=5). Results The infarct volumes in the ischemic postconditioning group w ere reduced significantly compared w ith those in the ischemia-reperfusion group (6 h:143.3 ±8.7 mm3 vs.166.8 ±7.5 mm3, t=4.104, P=0.006;12 h:151.7 ±7.8 mm3 vs.171.6 ±9.1 mm3, t=3.314, P=0.016; 24 h: 159.2 ±9.3 mm3 vs.177.1 ± 7.6 mm3, t=3.000, P=0.024;48 h:166.9 ±9.6 mm3 vs.184.9 ±9.0 mm3, t=2.732, P=0.034;72 h:172.0 ±9.1 mm3 vs.198.1 ±8.2 mm3, t=2.640, P=0.039), and the positive cel numbers of BDNF (6 h:23.98 ±4.07 vs.18.63 ±2.5, t=2.479, P=0.038;12 h:27.64 ±3.18 vs.22.01 ±3.14, t=2.817, P=0.023;24 h:34.82 ±4.17 vs.28.46 ±4.05, t=2.446, P=0.040; 48 h:34.30 ±3.27 vs.26.29 ± 3.26, t=3.872, P=0.005;72 h:28.77 ±3.53 vs.23.64 ±3.54, t=2.297, P=0.051) and TrkB (6 h:33.83 ±3.90 vs.21.51 ±3.86, t=5.012, P<0.001; 12 h:38.59 ±4.84 vs.23.41 ±3.67, t=5.586, P<0.001;24 h:46.07 ±3.06 vs.28.78 ±3.61, t=8.169, P<0.001; 48 h:47.90 ±3.30 vs.29.51 ± 3.81, t=8.160, P<0.001; 72 h:42.78 ±4.07 vs.27.46 ±3.19, t=6.623, P<0.001) per high-pow er field at each time point in the ischemic postconditioning group w ere significantly more than those in the ischemia-reperfusion group. Conclusions Ischemic postconditioning upregulates the expressions levels of BDNF and TrkB proteins after ischemia-reperfusion and reduces cerebral infarct volumes. BDNF/TrkB may play an important neuroprotective effect in ischemic postconditioning.
ABSTRACT
Vascular cognitive impairment in patients with severe stroke has attracted wide attention of clinicians in recent years,and the cognitive impairments of transient ischemic attack (TIA) and minor stroke are often overlooked because of their mild symptoms and short duration.This article reviews the advances in research on cognitive impairment in patients with TIA and minor stroke in recent years in order to increase the degree of attention of clinicians and improve the overall prognosis of patients.
ABSTRACT
The optimal therapeutic regimen for patients with asymptomatic carotid artery stenosis (ACS) has been controversial.Early research suggests that carotid endarterectomy (CEA) is effective for the treatment of patients with severe ACAS.In recent years,as a minimally invasive treatment,carotid artery stenting (CAS) is as effective as CEA.It has a trend of replacing CEA.In recent 10 years,medicine standardized treatment has made great progress.Recent studies have shown that the risk of stroke is lower using the optimal medical treatment in patients with ACAS compared with CEA and CAS.The key of choosing optimal therapeutic regimen is to identify the high risk patients with stroke.
ABSTRACT
Minor stroke is characterized by the mild symptom and rapid recovery,and does not easily cause disability,but a part of patients with minor stroke are the high risk population of recurrent stroke,and can cause disability,cognitive impairment,and emotional disorders.Early prediction of the prognosis in patients with minor stroke,screening for the high risk population of recurrent stroke and disability,and giving appropriate treatment may prevent recurrent stroke and improve the prognosis of patients.This article reviews the predictors of prognosis in patients with minor stroke.
ABSTRACT
Patients with asymptomatic carotid stenosis (ACS) are the potentially high-risk population of stroke.Screening for high-risk patients with ACS and giving them appropriate interventions may have great significance for the prevention of the occurrence of stroke.This article reviews the advances in research of ACS screening in recent years.
ABSTRACT
Objective To investigate the effect of cerebral ischemic preconditioning (IP) on the expressions of angiopoietin-1 (Ang-1) and its receptor Tie-2 mRNA in cerebral ischemia in rats.Methods Ninety-nine Wistar rats were randomly assigned to three groups:sham operation (n =9),non-ischemic preconditioning (NIP) (n =45),and IP (n =45).The latter two groups were redivided into 5 subgroups:ischemia-reperfusion 1,3,7,14,and 21 days (n =9 in each group).A model of transient middle cerebral artery occlusion (MCAO) was induced by the intraluminal suture method for focal IP (ischemia for 10 minutes and restoring perfusion).Infarct volume was determined by 2,3,5-triphenyltetrazolium staining.The expression levels of Ang-1/Tie-2 mRNA were detected by in situ hybridization.Results The infarct volumes in the 1 -,3-,and 7-day subgroups of the IP group were significantly smaller than those in the relative subgroups of the NIP group (all P＜ 0.05).The expression of Ang-1 mRNA in the 3- and 7-day subgroups of the IP group and the expression of Tie-2 mRNA in the 1-,3-,and 7-day subgroups of the NIP group were upregulated significantly (all P ＜ 0.05).The infarct volume in the 3-day subgroup of the IP group was reduced most significantly (P ＜ 0.05).The expression of Ang-1 mRNA in the 7-day subgroup was upregulated significantly,and the peak expression of its receptor Tie-2 mRNA appeared at day 3 after IP and continued to day 7.Pearson correlation analysis showed that the expression levels of Ang-1/Tie-2 mRNA were significantly negatively correlated with infarct volume (P ＜0.01).Conclusions The expression of Ang-1/Tie-2 mRNA in the IP group was upregulated within the time window of ischemic tolerance (1 - 7 days after preconditioning),in which Ang-1 may mainly act on the later stage of the cerebral ischemic tolerance.
ABSTRACT
Objective To investigate the effects of ischemic postconditioning (IP) on interleukin-1β (IL-1β) and tunor necrosis factor-α (TNF-α) expression in focal cerebral ischenia/reperfusion in rats in order to clarify the rnechanism of neuroprotective effect of IP.Methods One hundred and ten healthy adult male Sprague-Dawley rats were randomized into sham operation (n =10),ischemia/reperfusion and IP groups.The latter two groups were redivided into 6-,12-,24-,48- and 72-hour subgroups (n =10 in each subgroup) according to their reperfusion time.A focal cerebral ischemia/reperfusion model was induced by the middle cerebral artery intraluminal suture method.After middle cerebral artery occlusion for 2 hours,reperfusion for 15 seconds was conducted using the IP method,and this was repeated for 3 times.The neurobehavioral scores of the rats were evaluated in each group.The infarct volume was measured with 2,3,5-triphenyltetrazolium chloride staining.The expression of TNF-α and IL-1β protein in brain tissue was detected by immunohistochemistry assay.The expression of IL-1β and TNF-αmRNA was determined by in situ hybridization.Results Compared with the ischemia/reperfusion group,the neurobehavioral score and and cerebral infarct volume in the IP group decreased significantly (all P ＜0.05).Expressions of IL-1 β,TNF-o protein and mRNA were slight in the frontoparietal cortex in the sham group; however,they were apparent in ischemia/reperfusion group and IP groups,and began to increase at 6 hours and reached the peak at 24 hours (compared to other time points all P ＜0.05),then decreased gradually.There was the same dynamic change trend in the IP group,and the expression at each time point was significantly lower than that in the ischemia/reperfusion group (all P＜0.05).Conclusions IP significantly down-regulates the expressions of IL-1 β and TNF-α and reduces the infarct volume of the ischemia/reperfusion in rats.These findings indicate that IP may play a neuroprotective role by inhibiting the inflammatory response in brain tissue after ischemia/reperfusion.
ABSTRACT
The incidence of cerebral watershed infarction is higher.At present,the correlation studies of cerebral watershed infarction and cerebral vascular stenosis are mostly limited to the guilty vascular lesions,and the atherosclerotic disease is a chronic systemic inflammatory response.It often exists multiple vascular stenosis.This article elaborates cerebral watershed infarction from the aspects of carotid artery complicated with other parts of the arterial stenosis,middle cerebral artery complicated with other parts of the artery stenosis and collateral circulation in order to improve the awareness of the correlation between watershed cerebral infarction and multiple cerebral artery stenosis.
ABSTRACT
Objective To investigate the effects of ischemic preconditioning (IP) on blood-brain barrier permeability and matrix metalloproteinase-9 expression after cerebral ischemia reperfusion in rats.Methods A total of 154 Wistar rats were randomly divided into sham operation (n = 14),non-ischemic preconditioning (NIP,n = 70),and IP (n = 70) group.The latter two groups were redivided into 5 subgroups (n = 14 in each subgroup).A middle cerebral artery occlusion model was induced by intraluminal suture method.After 10 minutes IP,re-ischemia for 2 hours and reperfusion for 22 hours were performed at day 1,3,7,14,and 21,respectively.The infarct volume was detected using 2,3,5-triphenyltetrazolium chloride (TTC)staining.The BBB permeability were evaluated by measuring the content of the extravascular exudation of Evan's blue (EB).The degree of cerebral edema was evaluated using the wet-dry weight method.MMP-9 protein and mRNA expression were detected by immunohistochemical staining and in situ hybridization.Results Compared to the corresponding subgroups in the NIP group,the neurological deficit scores,infarct volume,EB content,and brain water content were decreased significantly,and MMP-9 protein and mRNA expression were down-regulated significantly in the day 1,3,and 7 subgroups in the IP group (P ＜ 0.05 or P ＜ 0.01 ).The infarct volume and MMP-9 mRNA expression of the day 1,3,7 subgroups in the IP group were more significantly reduced or down-regulated than those of the day 14 and21 subgroups in the IP group.The EB content,brain water content,and MMP-9 protein expression of the day 3 and 7 subgroups were more significantly lower than those in other subgroups.Among them,they were decreased most significantly in the day 3 subgroup (P ＜ 0.05).Conclusions The changes of IP-induced BBB permeability and the down-regulated MMP-9 expression may play important roles in cerebral ischemic tolerance.
ABSTRACT
The mild cognitive impairment and vascular cognitive impairment no dementia are the early stages for Alzheimer's disease and vascular dementia proposed in recent years.They both not only have some differences,but also have many crosses and contacts in concepts,diagnostic criteria,epidemiology,pathology,neuropsychology,and biological markers,etc.This article reviews the recent progresses and problems facing in recent years.
ABSTRACT
Objective To investigate the clinical significances of thyroid function changes in patients with post-stroke depression(PSD). Methods Sixty two cases with acute cerebral infarction (CI) were stratified into two groups by Zung self-rating depression scale, single cerebral infarct patients group (CI group) and PSD group. Serum levels of FT3, FT4 and TSH of the patients were detected on 2 days,7days,14 days and 21days after admission. Results ①On each time point after admission, FT3 levels in PSD group were lower than those in CI group. FT3 levels in the two groups on the 7 days were higher than those on 2 days(2.04±0.53 vs 1.28±0.19, 1.43±0.91 vs 1.07±0.37, P <0.05).On the 14 and 21 days, levels of FT3 in the PSD group were continuously increased.②On the 2 days and 7 days after admission, FT4 levels in PSD group were higher than those in CI group. FT4 levels in the two groups on the 14 days were lower than those on 7 days(1.52±0.18 vs 2.09±0.26, 1.57±0.31 vs 2.28±0.38, P <0.05). ③On the 2 days after admission,the TSH level in the PSD group were lower than that in CI group(2.02±0.36 vs 2.27±0.49,P <0.05). Conclusion The results indicated that the hypothalamic-pituitary-thyroid axis plays important role in the pathogenesis of PSD.