Influencing factors of hematoma enlargement after spontaneous intracerebral hemorrhage / 国际脑血管病杂志

Objective To investigate the influencing factors of hematoma enlargement after spontaneous intracerebral hemorrhage. Methods The patients with spontaneous intracerebral hemorrhage were enrolled retrospectively in the study. The demographics, vascular risk factors, and baseline clinical data of the patients were collected. Hematoma enlargement was defined as CT scan within 48 h showed that the increased hematoma volume was more than >1/3 of the baseline. The demographics, vascular risk factors, and baseline clinical data of the hematoma enlargement group and the non-hematoma enlargement group were compared. Multivariate logistic regression analysis was use to identify the risk factors for hematoma enlargement. Results A total of 121 patients with spontaneous intracerebral hemorrhage were enrolled, including 69 males and 52 females, their ages were 24 to 89 years (mean 59.16 ±12.68). Forty-five patients (37.2%) had combined hypertension, 5 (4.1%) had diabetes, and 11 (9.1%) had hyperlipoidemia. Thirty patients (24.79%) had hematoma enlargement within 48 h. The time from ictus to the first CT scan was 4.21 ±1.57 h and the time from ictus to CT scan again was 34.78 ±6.90 h. Univariate analysis showed that the proportion of patients drinking alcohol (46.7% vs.26.4%; χ2 =4.313, P =0.038), as well as systolic blood pressure (174.53 ±20.02 mmHg vs.160.63 ±19.79 mmHg, t = -3.327, P = 0.001; 1 mmHg = 0.133 kPa), fasting blood glucose (7.67[6.70-9.47]mmol/L vs.6.78[5.81- 7.79]mmol/L; Z = -2.266, P =0.023), National Institutes of Health Stroke Scale (NIHSS) score (10.00[8.00-12.00] vs.5.00[3.00-8.00]; Z = -5.468, P < 0.001) in the hematoma enlargement group were significantly higher than those in the non-hematoma enlargement group, while low-density lipoprotein cholesterol (2.60[2.10- 2.91]mmol/L vs.3.00[2.60-3.41]mmol/L; Z = -3.905, P <0.001) was significantly lower than that in the nonhematoma enlargement group. Multivariate logistic regression analysis showed that baseline systolic blood pressure (odds ratio [OR] 1.036, 95% confidence interval [CI] 1.007-1.065; P =0.014) and NIHSS score (OR 1.310, 95% CI 1.111-1.544; P =0.001) were the independent risk factors for hematoma enlargement, while low –density lipoprotein cholesterol (OR 0.279, 95% CI 10.105-0.742; P =0.011) was the independent protective factor for hematoma enlargement. Conclusions Systolic blood pressure and NIHSS score were the independent risk factors for hematoma enlargement after spontaneous intracerebral hemorrhage, while low -density lipoprotein cholesterol was the independent protective factor for hematoma enlargement.

Advances in mechanical embolectomy for acute ischemic stroke / 国际脑血管病杂志

As a direct vascular recanalization method, safety and efficacy of mechanical embolectomy in acute ischemic stroke have been controversial. This article reviews the safety and efficacy of mechanical embolectomy in acute ischemic stroke via summarizing the development process of mechanical devices and the latest clinical trial results of mechanical embolectomy.

Carotid atherosclerotic plaque predicts poor short-term outcomes of cerebral embolism due to non-valvular atrial fibrillation / 中华老年医学杂志

Objective To investigate the impact of carotid atherosclerotic plaque on short-term outcomes of cardioembolic stroke due to non-valvular atrial fibrillation (NVAF).Methods A total of 288 patients with acute cerebral embolism due to NVAF were recruited in this study.All patients underwent carotid ultrasonography screening to estimate carotid intima-medium thickness (IMT) and atherosclerotic plaque.The short-term outcomes were assessed.The correlation between carotid atherosclerotic plaque and short-term outcomes of cardioembolic stroke due to NVAF were determined by partial correlation analysis.Results Among the 288 patients,carotid atherosclerosis occurred in 202 cases (70.1％) of the patients,poor outcomes in 113 cases (39.1％),worsening neurological function in 43 cases(14.9％),and stroke recurrence in 24 cases(8.3％).Carotid atherosclerosis plaque was positively associated with neurological worsening (r =0.247,P =0.000) and poor outcomes (r=0.139,P=0.018).The use of aspirin was negatively correlated with both neurological worsening (r=-0.235,P=0.000) and recurrence of stroke (r=-0.177,P=0.003).The use of statin was negatively correlated with recurrence of stroke (r =-0.223,P =0.000),neurological worsening (r=-0.147,P=0.013) and poor outcomes (r=-0.286,P=0.000).Conclusions Carotid atherosclerotic plaque is an independent predictive factor for poor short-term outcomes of cardioembolic stroke due to NVAF,and the aggressive management for carotid plaque can improve the poor short-term outcomes.

The episodic memory monitoring in patients with white matter lesions / 中华神经科杂志

Objective To investigate the episodic memory monitoring in patients with white matter lesions (WML) and explore the relevance of episodic memory disorder and memory monitoring and the possible mechanism.Methods The feeling of knowing-episodic memory (FOK-EM) paradigm was adopted and subsequently administered in 30 WML patients and 30 control participants who were matched in age and educational level.Results Compared with control group (cued recall 4.37 ± 1.59;recognition 8.73 ± 1.05),the episodic memories of WML patients were significantly impaired on the cued recall performance (3.30 ± 1.51,t =2.666,P ＜ 0.05) and recognition performance (7.23 ± 0.77,t =6.306,P ＜ 0.01).Furthermore,the accuracy of FOK judgment (-0.13 ± 0.31),the correct judgment and correct recognition of FOK-EM (23.16％ ±5.96％) and the correct judgment and false recognition of FOK-EM (34.26％ ± 7.65％) in the WML patients group were significantly different compared with the control group (the accuracy of FOK judgment:0.34 ± 0.27,t =6.280,P ＜ 0.01;the correct judgment and correct recognition:35.12％ ± 6.82％,t =7.234,P ＜ 0.01;the correct judgment and false recognition:19.27％ ±6.50％,t =-8.174,P ＜ 0.01).In addition,the correct judgment and false recognition performance were positively correlated with the severity of periventricular lesions and deep white matter lesions in the WMLpatients group (r=0.716,P＜0.01;r=0.598,P＜0.01).Conclusions The WML patients demonstrated an overestimation of their recognition ability of episodic memory.Moreover,this impairment of memory monitoring was correlated with the deficit of executive function caused by the damage of the prefrontal-subcortical circuit,indicating that this mechanism could be an influential factor of episodic memory disorder in WML.