ABSTRACT
Objective:To investigate the neuroimaging features of hemorrhagic transformation (HT) after intravenous thrombolysis in patients with acute ischemic stroke.Methods:Patients with acute ischemic stroke received intravenous thrombolysis with a standard dose of alteplase in the Department of Neurology, Ninghe District Hospital from April 2018 to May 2022 and had HT within 24 h after treatment were retrospectively included. Demography, clinical data and neuroimaging findings of HT were recorded. The clinical data of symptomatic intracerebral hemorrhage (sICH) group and asymptomatic intracerebral hemorrhage (asICH) group, as well as HT in the infarct group and HT outside the infarct group were compared. Multivariate logistic regression analysis was used to determine independent risk factors for HT types. Results:A total of 63 patients with HT were enrolled (40 males and 23 females, aged 73.5±8.95 years). There were 42 patients with sICH (66.7%), 21 (33.3%) with asICH, 37 (58.7%) with HT in the infarct (ECASS classification: hemorrhagic infarction [HI]-1, 5 cases [7.9%]; HI-2, 6 cases [9.5%]; parenchymal hematoma [PH]-1, 11 cases [17.5%]; PH-2, 15 cases [23.8%]), 17 (27.0%) with HT outside the infarct, and 9 cases (14.3%) with HT both inside and outside the infarct. Heidelberg classification: 1a HI-1, 5 cases (7.9%); 1b HI-2, 6 cases (9.5%); 1c PH-1, 11 cases (17.5%); 2, 15 cases (23.8%); 3a, 14 cases (22.2%); 3b, 6 cases (9.5%); 3c, 4 cases (6.3%); and 3d, 2 cases (3.2%). Multivariate logistic regression analysis showed that lower baseline National Institutes of Health Stroke Scale (NIHSS) score (odds ratio [ OR] 1.413, 95% confidence interval [ CI] 1.216-1.447; P=0.001), small vessel occlusion ( OR 1.378, 95% CI 1.134-1.429; P=0.002), minor stroke ( OR 1.447, 95% CI 1.120-1.467; P<0.001), and HT outside the infarct ( OR 1.335, 95% CI 1.131-1.363; P=0.007) were independently associated with sICH. Higher baseline NIHSS scores ( OR 1.737, 95% CI1.102-1.801; P<0.001), cardiogenic embolism ( OR 1.789, 95% CI 1.095-1.881; P<0.001), and severe stroke ( OR 1.648, 95% CI 1.110-1.672; P<0.001) were independently associated with HT in the infarct. Conclusions:The most common neuroimaging feature of HT after intravenous thrombolysis in patients with acute ischemic stroke is PH in the infarct, while HT outside the infarct and HT both inside and outside the infarct are rare. For patients with cardiogenic embolism with higher baseline NIHSS score, the HT after thrombolysis was mostly asICH, and its imaging features were mostly multiple punctuate hemorrhage in the infarct. In patients with small vessel occlusion with lower baseline NIHSS score, most of the HT after thrombolytic therapy is sICH, and their imaging features are mostly PH outside the infarct.
ABSTRACT
Objective:To investigate the outcomes and its influencing factors of ischemic stroke patients with lung cancer.Methods:Patients with acute ischemic stroke complicated with lung cancer admitted to the Department of Neurology, Ninghe District Hospital of Tianjin from January 2017 to December 2020 were retrospectively enrolled. The demographic and baseline clinical data were collected. The main outcome measure was the clinical outcome evaluated by the modified Rankin Scale at 90 days after the onset of ischemic stroke. 0-2 was defined as a good outcome, and 3-6 was defined as a poor outcome. The secondary outcome measures were bleeding events within 90 d after the onset of ischemic stroke, including hemorrhagic transformation and hemoptysis.Results:A total of 37 patients were enrolled, including 25 males (68%) and 12 females (32%); age 72.6±8.0 years; 23 patients (62.2%) had a good outcome and 14 (37.8%) had a poor outcome. The baseline National Institutes of Health Stroke Scale (NIHSS) score and the proportions of patients with stage Ⅳ lung cancer, cerebral infarction due to other causes, moderate and severe stroke, anterior + posterior circulation cerebral infarction, bilateral cerebral infarction and multiple cerebral infarction in the poor outcome group were significantly higher than those in the good outcome group, while the proportion of patients with minor stroke, stage Ⅲ lung cancer and intravenous thrombolysis were significantly lower than those of patients with good outcomes (all P<0.05). Multivariate logistic regression analysis showed that the high baseline NIHSS score (odd ratio [ OR] 1.342, 95% confidence interval [ CI] 1.219-1.586; P=0.018], stage Ⅳ lung cancer ( OR 1.180, 95% CI 1.088-2.187; P=0.042), severe stroke ( OR 1.216, 95% CI 1.008-2.136; P=0.037) and multiple cerebral infarction ( OR 1.508, 95% CI 1.005-1.516; P<0.001) were independently associated with the poor outcomes, while intravenous thrombolytic therapy ( OR 0.572, 95% CI 0.262-0.802; P=0.001) was independently associated with the good outcomes. In addition, the incidence of hemorrhagic transformation and hemoptysis in intravenous thrombolytic patients was significantly higher than that in the non-intravenous thrombolytic patients (all P<0.05). Conclusions:Higher baseline NIHSS scores, multiple cerebral infarction and advanced lung cancer are associated with the poor outcomes in patients with lung cancer and ischemic stroke; intravenous thrombolytic therapy is associated with good outcomes, although it increased the risk of bleeding.
ABSTRACT
Intracranial aneurysms are mainly caused by the local arterial wal defects and the increased intraluminal pressure. Usualy, the unruptured smal aneurysms are asymptomatic, and the ruptured aneurysms can cause subarachnoid hemorrhage. So far, the etiology and pathogenesis of intracranial aneurysms are not fuly understood. A lot of evidence has showed that intracranial aneurysms are a complex disease of environmental factors and multi-gene interaction. This article reviews the correlation between polymorphisms of elastin and colagen type Ⅰ α2 genes and intracranial aneurysm.