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Studies have shown that cerebral small vessel diseases can affect the mechanisms such as neural circuits,local cerebral blood flow changes,and neuroendocrine changes through brain damage,causing sleep disorders,and poststroke depression and brain atrophy caused by cerebral small vessel diseases may be associated with sleep disorders.In return,sleep disorders can damage the blood-brain barrier and cerebrovascular autoregulation function,and increase the risk of the occurrence of cerebrovascular disease.Both of them are interrehted,reciprocal causation,and commonly affect the prognosis and quality of life in patients.
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Objective To evaluate the effect and mechanism of rt-PA combined with high pressure oxygen (HPO)on cerebral ischemia-reperfusion injury in rats.Methods The model of cerebral ischemia-reperfusion injury was constructed by using middle cerebral artery occlusion.The neurological function score;brain index,water content and infarction volume;SOD;LDH;NOS;MDA;LD;NO and NOS were measured.The protein and mRNA expressions of iNOS,BDNF,p75NTR and TrkB were also detected by RT-PCR and Western blot to evaluate and compare the protective effect of rt-PA combined HPO therapy. Results rt-PA combined HPO could significantly decrease the neurological function score;brain index,water content,and infarction volume;SOD;NOS;MDA;LD;NO and NOS but increase LDH content and the weight of rats,compared with rt-PA.In addition,rt-PA combined HPO could increase BNDF and TrKB expressions and downregulate the expressions of iNOS and p75NTR,compared with rt-PA (P<0.05).Conclusion The rt-PA combined HPO therapy has a greater protective effect than rt-PA therapy and its mechanism might be related to having antioxidant effects, increasing the expressions of BDNF and TrKB,and decreasing the expressions of iNOS and p75NTR.
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Objective To explore the relationship between reduction of regional cerebral blood flow in the normal appearing white matter (NAWM) and the extent of age-related white matter lesions (WML).Methods We used Fazekas scale to divide all participants into four groups (normal,mild,moderate,severe) according to the extent of the lesions showed on MRI.Regional cerebral blood flow (rCBF) in the area of WML and NAWM was measured by xenon contrast CT examination.Results A total of 56 cases were selected.The average rCBF (ml · 100 g-1 · min-1) in the lesions (WML) around ventricle,in right centrum ovale and in left centrum ovale respectively was 20.33 ± 2.52,21.27 ± 1.02,21.03 ± 1.83 for mild; 16.33 ±2.03,15.55 ±1.71,15.91 ±0.98 for moderate; 14.05 ±2.63,14.46 ±2.17,14.23 ± 1.95 for severe.The average rCBF (ml · 100 g-1 · min-1) in the NAWM around ventricle,in right centrum ovale and in left centrum ovale respectively was 20.79 ± 2.78,22.26 ± 1.9,22.15 ± 2.4 for normal; 21.12 ± 2.95,22.17 ± 1.50,22.25 ± 2.13 for mild,18.02 ± 2.41,19.45 ± 1.94,19.62 ± 1.54for moderate; 16.38 ± 3.22,18.18 ± 2.84,16.74 ± 2.97 for severe.The decrease of rCBF in the severe and moderate lesion areas was more serious than that in the mild lesion areas and reached statistic significance (P ＜ 0.05) ; The decrease of rCBF in the severe and moderate lesion areas was more serious than that in the area of NAWM in the same grade and reached statistic significance (P ＜ 0.05).The decrease of rCBF in the area of NAWM around severe and moderate lesion areas was more serious compared with that around mild lesion areas or normal areas (P ＜ 0.05) ; But the difference of rCBF in the area of NAWM around mild lesion areas and normal areas did not show any statistic significance.Conclusions Chronic ischemia was found to be existed not only in the lesions (WML) but also in the area of NAWM around the lesions,and was related to the extent of the lesions.Chronic ischemia may play a key role in the mechanism of aged-related WML.
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Objective To investigate the imaging characteristics, clinical features and outcomes of penetrating ar-tery disease (PAD) cerebral infarction. Methods One hundred cases of cerebral infarction were divided into 44 cases of PAD group and 56 cases of LAA (large artery atherosclerosis ) group by brain MRI and neck CTA, or DSA neck artery ultrasound. The clinical features, imaging characteristics, outcome and progressive motor deficits(PMD) were compared between PAD cerebral infarction and large artery atherosclerosis (LAA) cerebral infarction. Results There were For-ty-four (44%) cases of PAD cerebral infarction, 56 (56%) cases of LAA cerebral infarction according to 2011 Chinese ischemic stroke subclassification (CISS). The smoking, drinking and TIA histories was significantly less in PAD group (27.27%) than in LAA group (50%) (P=0.021,0.023 and 0.025 respectively,);compared with LAA group, PMD occured in PAD group more frequently. (56.82% vs. 30.36%, P=0.008); lesions were located in the lateral ventricles in most PAD group which was significantly different from LAA group (52.27% vs. 21.43%, P=0.001). Modified Rankin Scale, (mRS) was not significantly different between two groups (1.43 ± 1.17 vs. 1.43 ± 1.45, P=0.99) at 3 months. Conclu-sions Patients with PAD cerebral infarction have PMD at early stage but have good prognosis at three months.
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Cerebral small vessel diseases refer to small intracranial vascular lesions caused ischemic or hemorrhagic disease.Although researches have performed a large number of studies for its pathogenesis,it remains unclear now.This article reviews the pathogenesis of cerebral small vessel diseases from endothelial dysfunction,blood-brain barrier damage,ischemic and hypoperfusion,amyloid deposition,and genetic factor.
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Objective To investigate the relationship among carotid atherosclerosis,plasma homocysteine and D-dimer level in patients with acute cerebral infarction.Methods Two hundred and eightyseven cases of patients with acute cerebral infarction treated in Pudong Hospital,Shanghai from January 2011 to March 2012 were enrolled into the observation group and 287 cases of healthy people not suffering from cerebral infarction or other patients had nothing to do with cerebrovascular disease were selected into the control group.The serum levels of plasma homocysteine were determined by fluorescence polarization immunoassay (FPIA) and D-dimer level by double antibody clip method.At the same time,neck vascular artery ultrasound were performed by MycoCardR Reader Ⅱ.The relationship of carotid atherosclerosis with plasma homocysteine and D-dimer were compared between these two groups.Results There were significant differences on total cholesterol ((4.25 ± 0.92) mmol/L vs (4.98 ± 0.88) mmol/L,t =3.244,P ＜ 0.05),triacylglycerol ((1.48 ±0.82) mmol/L vs (1.78 ± 1.09) mmol/L,t =3.564,P ＜ 0.05),low density lipoprotein ((2.52-0.76) mmol/L vs (2.92 ± 0.73) mmol/L,t =2.987,P ＜ 0.05),high-density lipoprotein ((1.38 ± 0.26) mmol/L vs (1.06± 0.29) mmol/L,t =3.964,P ＜ 0.05),systolic pressure ((130.28 ± 14.78) mm Hg vs (152.98 ± 20.45) mm Hg,t =3.264,P ＜ 0.05),diastolic pressure ((78.45 ± 16.02) mm Hg vs (93.81 ± 16.88) mm Hg,t =2.785,P ＜0.05) and common carotid artery IMT(left:(0.86 ±0.41)mm vs (1.18 ±0.25)mm,t =2.164,P ＜0.05;right:(0.87 ± 0.39)mm vs (1.12 ± 0.29)mm,t =2.254,P ＜ 0.05) between observation group and control group.Homocysteine concentration and the D-dimer level of patients with carotid atherosclerosis were significant higher than that without carotid atherosclerosis (homocysteine concentration:(12.89 ± 6.56) μnol/L vs (3.17 ± 0.12) μnol/L,t =2.324,P ＜ 0.05 ; D-dimer level:(1.53 ± 0.59) mg/L vs (0.33 ± 0.23) mg/L,t =2.753,P ＜ 0.05).Conclusion The plasma homocysteine concentration and the D-dimer levels are correlated with carotid atherosclerosis in patients with acute cerebral infarction.
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Objective To investigate the executive function features of different subtypes of vascular cognitive impairment (VCI). Methods Sixty-four subjects with subcortical ischaemic vascular disease (SIVD) presumed by medical history and neuroimaging (cranial MRI) were recruited. The clinical and neuropsychological features of the 4 groups were compared: cognitive normal control (n=25), simple executive impairment of VCI-ND (s-VCI-ND, n=16), multi-domain impairment of VCI-ND (m-VCI-ND, n=26) and vascular dementia (VaD) patients (n=22). All participants underwent neuropsychological tests covering global cognitive function, executive function, memory function, language function and visual spatial skills. The executive tests included 15 independent subtest reflect set shifting, inhibition of prepotent responses, working memory, concept formation and fluency. Results Tower of Hanoi, self ordered pointing test and paced auditory serial addition test were not suitable for identification of VCI-ND because their finish rates were less 50%. Performance of trail making test (216.5±69.3 vs 137.4±37.9), Stroop color words test (115.4±30.1 vs 72.9±17.5), California cards sorting test-Chinese version (1.9±1.4 vs 2.7±1.2)and animal category fluency test(14.2±2.3 vs 17.7±4.4) had significant difference between s-VCI-ND group and cognitive normal control group (t=4.73, 5.72, 2.04 and 3.53, all P<0.05) and these tests were applicable and sensitive assessment tools in all executive tests. Time-consuming index showed more sensitivity than correct index in executive function. Neuropsychological deficits of m-VCI-ND patients showed lower than that of s-VCI-ND group and better than that of VaD patients. It was likely that the m-VCI-ND was a transition state between normal aging and VaD. Conclusion Executive dysfunction of VCI caused by SIVD is short of specificity. Some tests may appear earlier in screening of VCI-ND.
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Objective To set up and verify a new scoring system of clock drawing test(CDT).Methods CDT and other neuropsychological tests were applied to 180 normal individuals.170 subjects with mild cognitive impairment(MCI),and 31 patients with mild Alzheimer's disease(AD).The first step of the 30-score system of CDT was to anchor the 4 points of"12-3-6-9".totaling a score of 4 which was the "30-score system A(Anchoring)part";and the other 13 items reflecting the drawing results and totaling a score of 26 made up the so called"30-score system C(Clockfaee)part".the two together had a total score of 30.Thirty-eight subjects underwent Xe-enhanced computed tomography(Xe-CT)scanning for quantitively measuring regional cerebral blood flow(rCBF)of 26 regions of brain.Results Correlations coefficients of the scores of 14 items with the total score in 30-score system of CDT were in the range of 0.48to 0.71(P＜0.01).30-score system C part was closely correlated with indicators of visuospatial and executive function,while 30-score system A part with memory indicators.The sensitivity and specificity of the 30-score system A part score≤2 for detecting MCl were 70.6%and 73.9%.respectively.The sensitivity the specificity of 30-score system C part score≤17 for mild AD were 75.3%and 75.9%.respectively.In the regression equation of 30-score system A and C part.the combined independent variables were the CBF of left frontal cortex and right white matter,respectively.Conclusion The 30-score system A and C part have difierent meanings:30-score system C part could be used to identify AD while 30-score system A part is helpful for identiring MCI.
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Objective To evaluate the effects of statins on the cerebral haemodynamics of ischemic stroke patients with transcranial Doppler(TCD). Methods 70 inpatients with acute ischemic stroke were divided into two groups according whether they had taken statins after stroke.The change of the cerebral haemodynamics was studied in the two groups with TCD three months after stroke. Results Three months later,the systolic flow velocities and mean flow velocities of bilateral middle cerebral arteries in the statins groups significantly increased (P＜0.05). The pulse index of bilateral middle cerebral arteries in statins group significantly decreased (P＜0.05).The flow velocities and pulse index of bilateral middle cerebral arteries in control group don't change significantly(P＞0.05). Conclusions Statins may have the effects of improving the situation of cerebral haemodynamics of patients with ischemic stroke.
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Objective To investigate the regional cerebral blood flow (rCBF) in amnestic mild cognitive impairment (aMCI) and vascular cognitive impairment-no dementia (VCI-ND) subjects. Methods Sixteen normal elders, 10 patients of aMCI, 12 patients of VCI-ND who were aged from 50 to 80 years old and received an education of middle school or higher. All participants finished cranial CT or MRI. Xe-CT was used to evaluate rCBF of different cerebral regions of all participants. Results The distribution of rCBF of basal ganglia, the cortex and white matter was (76. 4 ± 8. 6), (48.0 ± 7. 1) and (20. 5 ± 1.7) ml· 100 g-1 ·min-1, respectively. When compared in 3 groups, the temporal and parietal lobe rCBF had a decreasing tendency in aMCI group, while in VCI-ND group, the most dominant decreasing parts were mainly concentrated in white matter region ((17. 7±2. 3) ml·100 g-1·min-1, F = 5. 740, P = 0. 002). Whatever the depth or the width was, beth periventricular and subeortical deep white matter, anterior and posterior ventricular regions were all involved. There are no dominant difference of rCBF in caudate nucleus, lentiform nucleus and thalamus. Conclusion The difference in rCBF reflects the pathological difference between aMCI and VCI-ND.