ABSTRACT
Acute ischemic stroke has become one of the important causes of death and disability in human beings, especially in elderly patients. Intravenous thrombolysis with alteplase is an important treatment. However, there are many underlying diseases and poor overall conditions in elderly patients, which increase the risk of intracranial hemorrhage. Intracranial hemorrhage transformation makes the patient′s condition worse, which is the most serious complication of alteplase intravenous thrombolysis, and also one of the important reasons for the low treatment rate of alteplase intravenous thrombolysis in elderly patients. Therefore, we need to pay close attention to the occurrence mechanism and risk factors of intracranial hemorrhage transformation after alteplase intravenous thrombolysis in elderly patients, so as to reduce the risk of intracranial hemorrhage transformation, improve the prognosis and reduce the risk of morbidity and mortality.
ABSTRACT
Objective:To investigate the correlation between the imaging markers of cerebral small vessel disease (CSVD) and early hematoma expansion (HE) in patients with spontaneous intracerebral hemorrhage (sICH).Methods:Patients with sICH admitted to the Department of Neurology, the Affiliated Hospital of Qingdao University between January 1, 2015 and December 31, 2019 were enrolled retrospectively. All patients received noncontrast CT (NCCT) within 6 h after onset. Within 24 h after the initial NCCT examination, they were reexamed to determine whether HE occurred, and brain MRI examination was completed within 48 h after onset. HE was defined as the increase of hematoma volume on NCCT reexamination by >33% or >6 ml compared with the baseline. NCCT was used to evaluate the abnormal morphology and density signs, including blend sign, swirl sign, black hole sign, island sign, and satellite sign. MRI was used to evaluate CSVD imaging markers, including lacunar infarcts (LIs), enlarged perivascular space (EPVS), white matter hyperintensities (WMHs), cerebral microbleeds (CMBs), and cortical superficial siderosis (CSS). Multivariate logistic regression analysis was used to determine independent risk factors for HE. The receiver operator characteristic (ROC) curve was used to evaluate the predictive ability of imaging markers for HE in patients with sICH. Results:A total of 216 patients with sICH were included. Their age was 57±15 years, 113 (61.6%) were male, 88 (40.7%) had HE, 123 (56.9%) had NCCT signs, 122 (56.5%) had CMBs, 143 (66.2%) had WMHs, 44 (20.4%) had CSS, 25 (11.6%) had LIs, and 31 (14.4%) had EPVS. The baseline hematoma volume, blood calcium, the modified Rankin Scale score and the National Institutes of Health Stroke Scale score at admission, and detection rates of NCCT signs, CMBs, WMHs and CSS in the HE group were significantly higher than those in the non-HE group (all P<0.05). Multivariate logistic regression analysis showed that the blood calcium (odds ratio [ OR] 0.040, 95% confidence interval [ CI] 0.004-0.238; P=0.001), any NCCT signs ( OR 3.275, 95% CI 1.492-7.188; P=0.003), CMBs grade 4 ( OR 3.591, 95% CI 1.146-11.250; P=0.028), CSS ( OR 3.008, 95% CI 1.214-7.452; P=0.017), NCCT signs+ CMBs grade 3 ( OR 3.390, 95% CI 1.035-11.102; P=0.044), NCCT signs+ CMBs grade 4 ( OR 5.473, 95% CI 1.352-22.161; P=0.017), and NCCT signs+ CSS ( OR 3.544, 95% CI 1.215-10.336; P=0.021) were the independent risk factors for HE in patients with sICH. ROC curve analysis showed that the sensitivity of NCCT signs, CMBs and CSS for predicting HE were 81.8%, 64.8% and 34.1%, respectively, and the specificity were 60.2%, 60.9% and 89.1%, respectively. The predictive sensitivity of NCCT signs+ CMBs and NCCT signs+ CSS (59.1% and 30.7%, respectively) was lower than that of single imaging marker, while the specificity (78.1% and 93.7%, respectively) was higher than that of single imaging marker. Conclusions:The imaging markers of CSVD are closely associated with the risk of HE in patients with sICH. Severe CMBs and CSS are the independent risk factors for HE in patients with sICH. The specificity of NCCT signs combined with CSVD imaging markers for predicting HE is increased but the sensitivity decreased.
ABSTRACT
Cerebral microbleeds are a research focus in the field of cerebrovascular disease in recent years.Cerebral microbleeds have important influence on recurrent stroke,hemorrhagic transformation,cognitive impairment,and treatment options in patients with ischemic stroke.The article reviews the above aspects.
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Capsular warning syndrome (CWS) is a subtype of recurrent stereotyped transient ischemic attacks that heralds a subsequent stroke.The mainly presumed mechanism is repeated bursts of ischemia in the region of penetrating arteries,since the structural changes of large arteries is rare in series of imaging examinations.The majority of the infarct is located in the internal capsule or pontine.CWS is usually therapeutically resistant to simple traditional antithrombotic treatment,while combined antiplatelet treatment,thrombolysis,endovascular intervention and antiepileptics may protect part of the patients from developing into permanent infarcts.
ABSTRACT
he blood supply of corpus callosum is rich, its function is complex, and the incidence of infarction is low. The risk factors and etiology for callosal infarction do not have any difference with the infarction in other parts of the brain. The clinical manifestations of the disease are complex and diverse. The two classical clinical manifestations are callosal disconnection syndrome and frontal-type gait disorder, but hemiplegia, monoplegia, apraxia, and mental retardation are common in clinical practice. The positive rate of CT scan is lower. MRI has higher sensitivity and specificity for callosal infarction. The diagnosis of callosal infarction is not difficult according to the history and imaging examination, however, it needs to be differentiated with other diseases that likely involve corpus callosum. Most of the patients with callosal infarction have good prognosis.
ABSTRACT
We analysed the therapeutic effect and laboratory findings in the patients of a-cute cerebral infarction treated with PGMS and PSS. The results show that the efficient rate of PGMS group was obtained to 95. 6% and 70. l%,and was better than that of PSS group, but there was no statistic significance. The laboratory findings show the i both of them had the effect of anticogau ant and decreasing blood viscosity and serum co tents of lipids. But PGMS had a slight anticoagulant effect and could obviously decrease olood viscosity and serum contents of lipids. here was no side effects in the PGMS group. So PGMS is considered to be a prospective drug for treating acute cerebral infarction.