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Because the brain and kidneys share a common basis for small vessel lesions, the related research on cerebral microbleeds (CMBs) in patients with chronic kidney disease (CKD) is gradually increasing. The development of neuroimaging technology has significantly increased the detection rate of CMBs, but there is still controversy over whether CKD will increase the incidence of CMBs. This article reviews the relationship between CKD and CMBs, pathogenesis, biomarkers, and treatment.
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Objective:To investigate the correlation of fluid-attenuation inversion recovery (FLAIR) vascular hyperintensity (FVH) and clinical outcome in patients with middle cerebral artery M1 occlusive stroke.Methods:Patients with acute middle cerebral artery M1 occlusive stroke admitted to the Department of Neurology, the Second Affiliated Hospital of Anhui Medical University from June 2018 to September 2019 were enrolled retrospectively. The demographic and clinical data were collected. Diffusion-weighted imaging (DWI)-Alberta Stroke Program Early CT Score (ASPECTS) and FVH score were performed with MRI images. The modified Rankin Scale (MRS) was used to evaluate the clinical outcome at 90 d after onset. 0-2 was defined as good outcome, and >2 was defined as poor outcome. Multivariate logistic regression analysis was used to determine the independent correlation between FVH and the outcome. Results:A total of 65 patients with acute middle cerebral artery M1 occlusive stroke were enrolled, including 37 males (56.9%). Their age was 64.35±12.13 years. Twenty-nine patients (44.6%) had a good outcome, and 36 (55.4%) had a poor outcome. There were significant differences in triglyceride ( P=0.037), antihypertensive drug treatment ( P=0.037), baseline National Institutes of Health Stroke Scale (NIHSS) score ( P<0.001), DWI-ASPECTS ( P=0.017) and FVH score ( P<0.001) between the poor outcome group and the good outcome group. Multivariate logistic regression analysis showed that FVH score (odds ratio 6.477, 95% confidence interval 1.570-26.716; P=0.010) and NIHSS score (odds ratio 1.869, 95% confidence interval 1.326-2.635; P<0.001) were significantly independently correlated with the poor outcome. However, there was no significant independent correlation between DWI-ASPECTS and the outcome (odds ratio 0.451, 95% confidence interval 0.068-2.988; P=0.410). Conclusions:FVH score is an independent risk factor for poor outcome in patients with acute middle cerebral artery M1 occlusive stroke.
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Objective:To investigate the correlation between basilar artery (BA) dolichosis and clinical outcome of patients with acute isolated pontine infarction.Methods:Consecutive patients with acute isolated pontine infarction within 7 d after onset admitted to the Department of Neurology, the Affiliated Hefei Hospital of Anhui Medical University were enrolled. The demographic, clinical and MRI data were collected. The modified Rankin Scale was used to evaluate the clinical outcome at 3 months after the onset. 0-2 was defined as good outcome, and >2 was defined as poor outcome. A binary multivariate logistic regression model was used to analyze the correlation between BA dolichosis and clinical outcome of the patients. Results:A total of 116 patients with acute isolated pontine infarction were enrolled. There were 69 (59.5%) males and 47 (40.5%) females, with a median age of 65 years (interquartile range: 57-76 years). There were 39 patients (33.6%) in BA dolichosis group and 77 (66.4%) in non-BA dolichosis group. The BA diameter ( P=0.021), theoretical length (basilar artery length, BAL) ( P<0.001), bending length (BL) ( P<0.001) and the proportion of patients with BA bending ( P<0.001) in the BA dolichosis group were significantly higher than those of the non-BA dolichosis group. There were 93 (80.2%) patients in good outcome group and 23 (19.8%) in poor outcome group. The baseline National Institute of Health stroke scale (NIHSS) score ( P<0.001), approximate length of BA ( P=0.007), BAL ( P=0.020), BL ( P=0.005) and the proportion of patients with BA dolichosis ( P=0.002) and bending ( P=0.008) in the poor outcome group were significantly higher than those in the good outcome group. Spearman correlation analysis showed that the approximate length of BA was significantly positively correlated with BL ( r=0.597, P<0001). Multivariate logistic regression analysis showed that BA dolichosis (odds ratio 5.441, 95% confidence interval 1.814-16.320; P=0.003) and the higher baseline NIHSS score (odds ratio 1.696, 95% confidence interval 1.291-2.228; P<0.001) were the independent risk factors for poor outcomes in patients with acute isolated pontine infarction. Conclusion:BA dolichosis is common in patients with acute isolated pontine infarction. BA dolichosis may be an independent risk factor for poor outcome in patients with acute isolated pontine infarction at 3 months after onset.
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Susceptibility-weighted imaging (SWI) is a tool that uses the intrinsic nature of local magnetic fields to enhance image contrast in order to improve the visibility of various susceptibility sources. SWI has blood oxygen levels dependent effect and is sensitive to the change of the cerebral oxygen saturation. This imaging method is applied to various diseases with abnormal deoxyhemoglobin concentration, such as ischemic stroke and cerebral arteriovenous malformation. Patients with acute ischemic stroke have elevated levels of deoxygenated hemoglobin in the affected area, so the ischemic area can show abnormal venous imaging on SWI images. SWI could recognize penumbra and guide the management of patients with acute stroke. Besides, SWI also could evaluate the severity of symptoms, predict prognosis and future surviving state. This paper reviews the research progress of the prominent hypointense vessels sign and its application in acute ischemic stroke.
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Susceptibility-weighted imaging (SWI) is a tool that uses the intrinsic nature of local magnetic fields to enhance image contrast in order to improve the visibility of various susceptibility sources.SWI has blood oxygen levels dependent effect and is sensitive to the change of the cerebral oxygen saturation.This imaging method is applied to various diseases with abnormal deoxyhemoglobin concentration,such as ischemic stroke and cerebral arteriovenous malformation.Patients with acute ischemic stroke have elevated levels of deoxygenated hemoglobin in the affected area,so the ischemic area can show abnormal venous imaging on SWI images.SWI could recognize penumbra and guide the management of patients with acute stroke.Besides,SWI also could evaluate the severity of symptoms,predict prognosis and future surviving state.This paper reviews the research progress of the prominent hypointense vessels sign and its application in acute ischemic stroke.
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Vertebrobasilar dolichoectasia (VBD) is a rare posterior circulation vascular variant disease.Studies have shown that VBD has an effect on the outcome of ischemic stroke.This article reviews the relationship between VBD and ischemic stroke.
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Objective To investigate the correlation between ipsilateral posterior cerebral artery laterality (PCAL) and the outcomes in patients with ischemic stroke in the middle cerebral artery (MCA) territory. Methods From June 2015 to December 2016, patients with acute ischemic stroke in the MCA territory admitted to the Second People's Hospital of Hefei were enrolled. Magnetic resonance angiography (MRA) was used to assess PCAL. The outcome was evaluated by the modified Rankin scale at 3 months after onset. 0-2 was defined as good outcome and > 2 was defined as poor outcome. Multivariate logistic regression analysis was used to determine the independent influencing factors of clinical outcome. Results A total of 111 patients with ischemic stroke in MCA territory were enrolled, including 47 (42. 3％) PCAL and 30 (27. 0％) poor outcomes. The baseline NIHSS score in the PCAL group was significantly lower than that in the non-PCAL group (5. 13 ± 3. 29 years vs. 7. 03 ± 5. 676 years, t = 2. 058; P = 0. 042). There were significantly differences in the proportion of diabetes mellitus (29. 6％ vs. 10. 0％; χ2 = 4. 583, P = 0. 032), PCAL (51. 9％ vs. 16. 7％;χ2 = 11. 101, P = 0. 001) and smoking (25. 9％ vs. 13. 3％; χ2 = 4. 943, P = 0. 026), as well as age (63. 9 ± 11. 8 years vs. 71. 0 ± 6. 7 years; t = 2. 688, P = 0. 007), baseline diastolic blood pressure (89 ± 13 mmHg vs. 82 ± 10 mmHg; t = -2. 249, P = 0. 025; 1 mmHg = 0. 133 kPa) and baseline NIHSS score (5. 02 ± 3. 67 vs. 9. 47 ± 6. 20; t = 3. 883, P < 0. 001) between the good outcome group and the poor outcome group. Multivariate logistic regression analysis showed that PCAL was associated independently with good outcome (odds ratio [OR] 0. 272, 95％ confidence interval [CI] 0. 083-0. 888; P = 0. 031), while advanced age (OR 1. 088, 95％ CI 1. 022-1. 157; P = 0. 008) and high baseline NIHSS score (OR 1. 224, 95％ CI 1. 077-1. 391; P = 0. 002) were associated independently with poor outcome. Conclusion PCAL is associated independently with good outcome in patients with ischemic stroke in MCA territory.
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The incidence of variation of cerebrovascular structure is higher in population.Previous studies have shown that the variation of the cerebrovascular structure is an independent risk factor for ischemia stroke.This article reviews the common cerebrovascular variation and its relationship with ischemic stroke.
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Objective To investigate the correlations of P2Y1 and ITGB3 single nucleotide polymorphisms (SNP) with aspirin resistance (AR) in patients with large atherosclerotic stroke (LAA) in a Chinese Han population.Methods Patients with first-ever LAA from Anhui stroke registration system were enrolled.Thrombus elasticity diagram was used to detect the platelet function.TaqMan technology was used to detect the P2Y1 and ITGB3 genotypes.Results A total of 206 patients with LAA were enrolled.Thirty-one patients (15.0％) had AR and 175 (85.0％) were aspirin sensitive (AS).The frequency of P2Y1 rs701265 G allele in the AR group was significantly higher than that in the AS group (43.5％ vs.26.9％;x2 =7.074,P=0.008).The frequency of P2Y1 rs701265 AA genotype in the AR group was significantly lower than that in the AS group (32.3％ vs.53.7％;x2 =4.850,P=0.028).There were no significant significances in the frequencies of P2Y1 rs1065776 and ITGB3 rs5918 alleles and genotypes between the AR group and the AS group.Multivariate logistic regression analysis showed that P2Y1 rs701265 G allele was an independent risk factor for AR in patients with LAA (odds ratio 2.186,95％ confidence interval 1.190-4.016;P=0.012).Conclusion The P2Y1 rs701265 polymorphism is associated with AR in Chinese Han patients with LAA,while the P2Y1 rs1065776 and ITGB3 rs5918 polymorphisms are not.
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Objective To investigate the effect of basilar artery hypoplasia (BAH) on the outcomes in patients with acute ischemic stroke.Methods Consecutive patients with acute ischemic stroke admitted to hospital within 7 d after onset were enrolled.The modified Rankin Scale was used to assess the functional outcomes at discharge and 90 d after onset,and 0-2 was defined as a good outcome.BAH was defined as the basilar artery uniform and fine and its diameter ＜2 mm in the level of pons.Demography,vascular risk factors,vascular variation,baseline clinical data,and laboratory examinations were compared between the good outcome group and the poor outcome group.Multivariate logistic regression analysis was used to determine the independent influencing factors of outcomes in patients with acute ischemic stroke.Results A total of 334 patients with acute ischemic stroke were enrolled,including 112 (33.5％) females and 222 (66.5％) males,with an average age of 67.3 ± 12.0 years;28 (8.4％) patients had BAH,260 (77.8％) had good outcomes at discharge,258 (77.2％) had good outcomes at 90 d after onset.The age,baseline National Institutes of Health Stroke Scale (NIHSS) score,fasting blood glucose level,and the proportions of atrial fibrillation,anterior circulation infarction,and non-BAH in the poor outcome group were significantly higher than those in the good outcome group at discharge (all P ＜ 0.05).Multivariable logistic regression analysis showed that the higher baseline NIHSS score (odds ratio [OR] 1.170,95％ confidence interval [CI] 1.088-1.258;P ＜ 0.001) and fasting blood glucose (OR 1.155,95％ CI 1.049-1.272;P =0.004) were the independent risk factors for poor outcome,and BAH (OR 0.190,95 ％ CI 0.039-0.920;P =0.039) was an independent predictor of good outcome at discharge.The age,fasting blood glucose,low-density lipoprotein cholesterol,baseline NIHSS score,and the proportions of smoking,atrial fibrillation,anterior circulation infarction,and non-BAH in the poor outcome group were significantly higher than those in the good outcome group at 90 d after onset (all P ＜0.05).Multivariate logistic regression analysis showed that higher baseline NIHSS score (OR 1.172,95％ CI 1.089-1.262;P ＜0.001) and higher fasting blood glucose (OR 1.156,95％ CI 1.048-1.275;P =0.004) were the independent risk factors for poor outcome,and BAH (OR 0.195,95％ CI 0.040-0.940;P =0.042) was an independent predictor of good outcome at 90 d after the onset.Conclusion BAH is the independent predictor of good outcome in patients with acute ischemic stroke.
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Objeetive To investigate the clinical and imaging features in patients with clinically confirmed acute ischemic stroke and negative diffusion-weighted imaging (DWI).Methods The clinical and imaging data in patients with clinically confirmed acute ischemic stroke and initial negative DWI were collected retrospectively.According to the repeat DWI findings,they were divided into either a persistentnegative DWI group or a faise-negative DWI group.The demographics,and data of clinical and imaging at baseline between the 2 groups were compared,and the causes of the initial negative DWI were analyzed.Results A total of 15 patients with clinically confirmed acute ischemic stroke and initial negative DWI were enrolled,including 9 in the persistent-negative DWI group (9/15,60.0％) and 6 in the false-negative DWI group (6/15,40.0％),and 8 with minor stroke (National Institute of Health Stroke Scale score ≤3;8/15,53.3％).The time from onset to admission ranged from 1 to 48 h.The time from onset to initial DWI examination ranged from 5 to 65 h.The time from onset to repeat DWI ranged from 38 to 190 h.There were no significant differences in demographics,and data of clinical and imaging at baseline between the 2 groups.In 6 patients with false-negative DWI findings,5 were posterior circulation stroke (5/6,83.3％) and 1 was anterior circulation stroke (1/6,16.7％);1 might have a second infarct,1 might be associated with shorter examination time (5 h after onset),1 was associated with not reaching the diffusion limited threshold and the influence of MRI artifact before symptom aggravation,and the remaining 3 might be associated with smaller lesions and locating in the posterior circulation.The causes of 9 patients with persistent-negative DWI ffndings were unknown.Conclusions There were no significant differences in features of clinical and imaging at baseline between persistent-negative and false-negative DWI findings.False-negative DWI findings in acute ischemic stroke can be mainly seen in patients with posterior circulation stroke and minor stroke.
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Objective To investigate the correlation between lesion pattern and etiological mechanism in acute isolated pontine infarction.Methods The clinical data in patients with acute isolated pontine infarction were collected retrospectively. Diffusion weighted imaging (DWI) was used to identify the lesion patterns. The correlation between the lesion pattern and etiological subtype was analyzed. Results A total of 146 patients with acute isolated pontine infarction were enrolled in the study, including 136 unilateral infarctions and 8 bilateral infarctions. The DWI lesion pattern analysis showed that there were 98 patients with paranasal infarction, 11 with anterolateral infarction, 18 with tegmentum infarction, and 19 with multiple infarction. Among all the etiological subtypes, basilar artery branch disease (BABD) accounted for the greatest proportion (n = 72, 49.3%), followed by large arterial occlusive disease ( n = 32, 21.9%), small arterial occlusive disease ( n = 25, 17.1%), and other causes/unknown causes ( n = 12, 8.2%). Cardioembolism was minimal (n =5, 3.4%). The distribution patterns of DWI lesions in acute isolated pontine infarction were significantly correlated with the etiological subtypes (C = 0.516, P < 0.001). Among them, 60 patients with paramedian infarction ( χ2 =16.915, P <0.001), 1 with anterolateral infarction ( χ2 =7.701, P = 0.006), 1 with tegmentum infarction ( χ2 =17.401, P <0.001) were closely associated with BABD; 9 patients with paramedian infarction ( χ2 =12.534, P <0.001), 6 with anterolateral infarction ( χ2 =24.365, P <0.001), and 10 with tegmentum infarction ( χ2 =18.312, P < 0.001) were significantly associated with small arterial occlusive disease. Conclusions There are significant correlation between the lesion pattern and etiological mechanism in acute isolated pontine infarction. The cause of acute isolated pontine infarction can be predicted in early stage by DWI revealed infarction distribution characteristics.
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Cystatin C is a cysteine protease inhibitor. It is widely found in the nucleated cells and body fluids of various tissues. It is a low molecular weight basic non-glycosylated protein. Previous studies have confirmed that cystatin C is an ideal endogenous marker reflecting early renal damage. Recent studies have shown that cystatin C is involved in the pathophysiological processes of a various cardiocerebrovascular diseases.This article reviews the correlation between cystatin C and cardiocerebralvascular diseases.
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Objective To investigate the predictive factors of progressive motor deficits (PMD) after isolated pontine infarction. Methods Consecutive patients with isolated pontine infarction admitted to hospital within 48 hours after onset were enroled. They were divided into either a PMD group (increase ≥1 within 7 days) or a non-PMD group according to the clinical course and the changes of motor scores of the National Institutes of Health Stroke Scale (NIHSS). The pontine infarction patterns were classified as basal surface infarction and deep infarction, the sides were divided into left and right, the infarct levels were divided into upper, middle, and lower according to diffusion-weighted imaging. The demographics, baseline clinical data, and imaging features were compared between the two groups. Multivariable logistic regression models were used to analyze the predictive factors of PMD after isolated pontine infarction. Results A total of 101 patients with isolated pontine infarction admitted to hospital within 48 h of onset were enroled, including 16 in the PMD group and 85 in the non-PMD group. The proportions of pontine infarction involving the basal surface (87. 5% vs. 47. 1% , χ2 = 8. 851, P = 0. 003), the infarcts on the middle levels (56. 2% vs. 24. 7% , χ2 = 4. 851, P = 0. 028), and basilar artery stenosis or occlusion (62. 5% vs. 27. 1% ,χ2 = 7. 689, P = 0. 006) of the PMD group were significantly higher than those of the non-PMD group, while the proportions of the infarcts on the left sides (18. 8% vs. 56. 5% , χ2 = 7. 664, P = 0. 006) and the infarcts on the upper levels (37. 5% vs. 72. 9% , χ2 = 7. 689, P = 0. 006) of the PMD group was significantly lower than those of the non-PMD group. Multivariate logistic regression analysis identified that pontine infarction involving the basal surface (odds ratio 5. 650, 95% confidence interval 1. 011 - 31. 580, P = 0. 049) and basilar artery stenosis or occlusion (odds ratio 4. 075, 95% confidence interval 1. 127 - 14. 741, P = 0. 032) were the independent risk factors for PMD after isolated pontine infarction. Conclusions Infarction involving the basal surface and basilar artery stenosis or occlusion may be the predictors for PMD after isolated pontine infarction.