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Objective To assess cerebrovascular reserve ( CVR) function in patients with internal border zone infarction(IBZI) induced by severe middle cerebral artery (MCA) stenosis, and investigate the impact on progression and outcome of the disease .Methods A total of 84 patients with unilateral severe MCA stenosis were selected . Hypercapnia was induced by holding breath .The change of blood flow velocity in MCA was measured by transcranial Doppler ( TCD ) to calculate CVR .According to CVR , patients were divided into impaired regional CVR group ( CVR 0.05 ) .Conclusion Impaired regional CVR may be predictive of subsequent progressive cerebral infarction and poor clinical outcomes in patients with IBZI induced by severe MCA stenosis .
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Objective To investigate clinical significance and related factors of fluid-attenuated inversion recov?ery vascular hyperintensities (FVH) in transient ischemic attack (TIA) of carotid system. Method Data including general information and TIA risk factors was continuously collected from 142 patients with carotid system TIA from the depart?ment of neurology of Sheng jing Hospital affiliated China Medical University from January 2012 to February 2014.All pa?tients completed brain MRI including FLAIR and diffusion-weighted imaging (DWI)and MRA examinations within 72 hours after TIA. All patients were followed up for one month. Risk factors and FVH situations were analyzed based on clinical manifestations and DWI results. Result There were 87 male cases (61.27%)and FVH positive 57 cases (40.14%) among 142 cases with carotid system TIA (mean age 63.2±11.5). Logistic regression analysis revealed that the large intra?cranial carotid artery stenosis≥50%(OR=2.44,95%CI:1.09~5.49, P=0.03) and prior history of ischemic stroke (OR=3.88,95%CI:1.04~14.5, P=0.04) were independently associated with positive FVH. At one month followed-up, 40 cas?es (28.17%) of 142 patients progressed to acute cerebral infarction. Vulnerable plaque number in the contralateral carot?id artery (P=0.018), contralateral intracranial large vessel stenosis in MRA≥50%(P=0.007) and contralateral FVH oc?currence rate (P=0.001) were significantly higher in cerebral infarction group than in non-cerebral infarction group. Con?clusion FVH is common in carotid TIA patients, which is associated with intracranial carotid artery stenosis ischemic and previous history of ischemic stroke. Vulnerable plaque number of contralateral carotid artery, contralateral intracranial large vessel stenosis≥50%and the rate of occurrence of contralateral FVH may be associated with short-term progress leading TIA to acute infarction.
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Objective To describe the clinical and radiological characteristics, the etiology, clinical course and MRI findings and prognosis of reversible splenial lesion syndrome ( RESLES) are analyzed.Methods Clinical and MRI findings of adult patients who presented with RESLES were retrospectively reviewed.Corresponding to severity of disability using Modified Oxford Handicap Scale ( MOHS ) , patients were classified into favorable outcome group (MOHS≤2)and poor outcome group(MOHS≥3),clinical and neuroimaging features between two outcome groups were compared.Results Eight patients fulfilled the criteria were included, who suffered from a broad spectrum of disorders, including mild encephalitis/encephalopathy, Marchiafava-Bignami disease and antiepileptic drug withdrawal.MRI found a high signal lesion in the splenium with or without the other parts of corpus callosum and extracallosal involved.The hyperintensity disappeared or lapsed comfirmed by repeated MRI.There is an significant difference on symptoms of severe disturbance of consciousness during clinical course and MRI showed extracallosal lesions between two groups (P<0.05).Conclusions RESLES is a rare entity with wide clinicoradiological spectrum due to varied diseases and conditions.Although overall symptoms of patients with RESLES trend to relieve, the prognosis of patients with severe disturbance of consciousness and extracallosal lesions are unlikely to be favorable.
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Objective Toinvestigatethecorrelationofsmallvesseldisease(CSVD)causedacute lacunarinfarctionandurinemicroalbumin.Methods Theclinicaldataof136patientswithacutelacunar infarction admitted to the Department of Neurology,Shengjing Hospital of China Medical University from November 2012 to April 2014 were analyzed retrospectively. They were divided into either a CSVD group (n=72)or a cerebral large vessel disease (CLVD)group (n=64)according to their carotid artery color Doppler ultrasound and head magnetic resonance angiography findings. The levels of urinary microalbumin in both groups were observed and compared. SAS 9. 1 software was used to conduct statistic analysis. A Logistic regression analysis was used to determine the independent risk factors for CSVD caused acute lacunarinfarction.Results TheconcentrationofurinemicroalbuminoftheCSVDgroup(22±13mg/L) was significantly lower than (29 ± 14 mg/L)that of the CLVD group. There was significant difference (P<0.05). There was significant difference in the increased urine microalbumin levels between the CSVD group and the CLVD group (P<0. 01). There was an increasing trend for the proportion of patients with urine microalbumin concentration 10- <30 mg/L (56. 9%[41/72])in the CSVD group compared with the CLVD group (26. 6%[17/64]). Logistic regression analysis showed that the slightly increased microalbuminuria was associated with CSVD caused acute lacunar infarction (OR,3. 130,95%CI 1. 481-6.618;P<0.01).Conclusion Theslightlyincreasedmicroalbuminuriaisanindependentriskfactorfor CSVD caused acute lacunar infarction.