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Objective:To investigate the relationship between the degree and location of cerebral microbleeds (CMBs) and the early neurological deterioration (END) within 72 h after admissionin in patients with acute small artery occlusive stroke (SAO).Methods:Patients with first-onset SAO hospitalized in Changzhou Second People′s Hospital from July 2020 to January 2021 were retrospectively enrolled. All patients completed the head magnetic resonance imaging including susceptibility weighted imaging. Collected baseline data, and evaluated the National Institutes of Health Stroke Scale (NHISS) scores before admission and within 72 h after onset. Patients were divided into END group and no END group according to whether NIHSS scores increased by ≥3 within 72 h after admission. The baseline characteristics were compared between these two groups. Moreover, the correlation between the degree and location of CMBs and END were analyzed by multivariate Logistic regression.Results:A total of 163 first-episode SAO patients were enrolled. There were 47 patients (28.83%) with END. In END group, there were 35 patients (74.47%) with CMBs which was higher than those in non-END group [42 patients (36.21%)]. In END group, there were 21 patients (44.68%) with severe CMBs, 11 patients (23.41%) with basal ganglia CMBs, 16 patients (34.04%) with mixed CMBs, which were all higher than those in non-END group [5 patients (4.31%) with severe CMBs, 9 patients (7.76%) with basal ganglia CMBs, and 13 patients (11.21%) with mixed CMBs]. The difference was statistically significant ( P<0.05). After adjusting for triglyceride, location of infarcated lesions, and the degree of WMHs, further Logistic regression analysis revealed that severe CMBs ( OR = 6.139, 95% CI 1.377 - 27.375, P = 0.017), basal ganglia CMBs ( OR = 5.253, 95% CI 1.105 - 24.975, P = 0.037) and mixed CMBS ( OR = 5.098, 95% CI 1.197 - 21.704, P = 0.028) were independent risk factors of END in SAO patients. Conclusions:The location and degree of CMBs are closely related to the occurrence of END in patients with SAO. Severe CMBs, basal ganglia CMBs and mixed CMBs may be the effective predictors of END in patients with SAO.
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Cerebral small vessel disease (CSVD) is one of the main causes of cognitive impairment and decreased the quality of daily life in the elderly. Researches have shown that CSVD is closely associated with autonomic nervous function. Patients with CSVD may be accompanied by cardiovascular, endocrine, gastrointestinal, urination, sleep disorders and other autonomic dysfunction.
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Intracranial arterial dolichoectasia (IADE), also known as dilated cerebral artery disease, is manifested as an increase in the length and diameter of one or more intracranial arteries, the affected arteries being enlarged and dilated significantly, or even with winding and tortuosity. The diagnosis and prognostic evaluation of IADE are mainly based on the diameter and curvature of the intracranial artery. IADE can be manifested as ischemic stroke, transient ischemic attack, hydrocephalus, and hemorrhagic stroke. The review focuses on IADE, including the concept, diagnostic criteria, etiology, pathogenesis, pathology, clinical manifestations, treatment, and prognosis.
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Objective:To investigate the relationship between renal function and the total cerebral small vessel disease(CSVD)score in elderly patients with a mild stroke.Methods:Patients with a mild stroke(National Institutes of Health Stroke Scale score≤3)and aged 60 years and above hospitalized in our hospital from March to December 2019 were consecutively enrolled.Total CSVD scores were evaluated based on enlarged perivascular spaces, cerebral microbleeds, white matter hyperintensities of presumed vascular origin and lacunes of presumed vascular origin.The estimated glomerular filtration rate(eGFR)was derived by using the formula of chronic kidney disease epidemiology collaboration based on serum creatinine(CKD-EPI Scr). The relationship between eGFR and the total CSVD score was analyzed. Results:Of the 152 patients enrolled, 35, 38, 39, 28 and 12 had total CSVD scores of 0, 1, 2, 3 and 4, respectively.The age of patients increased and eGFR decreased with the increase of total CSVD scores(CSVD from 0 to 4, [(67.43±6.59), (68.42±6.83), (72.18±7.94), (76.46±7.75) vs.(79.92±6.17)years old, F=12.018, P<0.001]; [(92.94±12.45)ml·min -1·1.73m -2, (90.52±8.62)ml·min -1·1.73m -2, (89.45±8.48)ml·min -1·1.73m -2 and(83.90±7.19)ml·min -1·1.73m -2vs.(79.16±7.77)ml·min -1·1.73m -2, F=7.210, P<0.001]. Spearman correlation analysis showed that eGFR was negatively correlated with the total CSVD score( r=-0.399, P<0.001). After adjusting for risk factors including age, gender and hypertension, multivariate ordinary regression analysis showed that decreased eGFR was an independent risk factor for the total CSVD score( OR=0.957, 95% CI: 0.924-0.990, P=0.012). Conclusions:In elderly patients with a mild stroke, eGFR is an independent risk factor for the total CSVD score, which shows an increased burden as eGFR decreases.
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With the aging of population, cerebral small vessel disease has attracted more and more attention. A growing body of literature has confirmed that retinal vascular changes can be used as a potential marker for the prediction of cerebral small vessel disease. The retina is recognized as a window into cerebrovascular and systemic vascular conditions. Combining traditional fundus photograph and fundus fluorescein angiography with optical coherence tomography angiography, the retinal vascular system of patients with cerebral small vessel disease can be comprehensively analyzed. This paper summarizes and analyzes the application of retinal angiography technology in different image types of cerebral small vessel disease and makes a review, in order to provide reference for the early diagnosis and prevention of cerebral small vessel disease.
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Intracranial arterial dolichoectasia (IADE), also known as dilated cerebral artery disease, is a kind of disease in which the diseased arteries are lengthened, enlarged, and tortuous due to various reasons. Cerebral small vessel disease (CSVD) refers to a series of clinical, imaging and pathological syndromes caused by various etiologies affecting cerebral arterioles, venules and capillaries. Its main imaging manifestations include lacunar infarction, cerebral microbleeds, enlargement of perivascular space, white matter hyperintensities, and brain atrophy. In recent years, more and more studies have shown that IADE is closely associated with the occurrence and development of CSVD. This article reviews the correlation between IADE and CSVD.
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Objective:To investigate the relationship between enlarged perivascular space (EPVS) and retinal vessel abnormalities in transient ischemic attack (TIA) and mild stroke patients.Methods:TIA and mild cerebral infarction (National Institutes of Health Stroke Scale score≤3) patients were enrolled from March to August 2019 in Changzhou Second People′s Hospital. Magnetic resonance imaging and retinal fundus photography were performed in all patients. Retinal arteriovenous diameter was semi-automatically measured, and retinal arteriosclerosis grades, vascular curvature, hemorrhages, microangioma, hard exudation, soft exudation, arteriovenous nicking and venous beads were assessed. Patients were divided into two groups according to the existence of EPVS: EPVS group and non-EPVS group. The baseline data of the two groups were compared and further multivariate Logistic regression was carried out. After normal transformation of the number of EPVS, the correlation between the grades of EPVS and converted EPVS was analyzed. The relationship between the number of converted EPVS and the grades and retinal fundus vascular lesions was further analyzed.Results:A total of 123 patients were included, including 99 patients with cerebral infarction, 24 patients with TIA; 52 patients without EPVS and 71 patients with EPVS. The EPVS group was more than the non-EPVS group in age ((68.61±12.71) years and (63.37±13.53) years, t=-2.198, P=0.030), history of hypertension (52 (73.2%) and 25 (48.1%), χ 2=8.118, P=0.004), hemangioma (17 (23.9%) and 5 (9.6%), χ 2=4.196, P=0.041), arteriovenous nicking (50 (70.4%) and 8 (15.4%), χ 2=36.488, P<0.05) and arteriosclerosis grades (1 (1, 2) and 0 (0, 1), Z=-7.454, P<0.05), and less than the non-EPVS group in central retinal artery equivalent (CRAE; (106.31±15.02) mm and (113.89±11.86) mm, t=3.014, P=0.003) and arteriole-to-venule ratio (AVR; 0.54±0.07 and 0.59±0.05, t=4.553, P<0.05). Multivariate Logistic regression analysis showed arteriosclerosis grades ( OR=7.781, 95 %CI 2.876-21.055, P<0.05) and hypertension ( OR=3.203, 95 %CI 1.049-9.777, P=0.041) were related factors for EPVS. Adjusting for age, sex, hypertension and diabetes, the normally transformed EPVS was found positively correlated with arteriovenous nicking ( B=0.556, 95 %CI 0.203-0.910, P=0.003) and arteriosclerosis grade ( B=0.417, 95 %CI 0.259-0.576, P<0.05), and negatively correlated with AVR ( B=-4.213, 95 %CI-6.712--1.714, P=0.001). The grades of EPVS were positively correlated with arteriosclerosis ( r=0.764, P<0.05), and negatively correlated with CRAE ( r=-0.287, P<0.05) and AVR ( r=-0.422, P<0.05). Conclusions:Hypertension and retinal arteriosclerosis are related factors of EPVS in mild stroke and TIA patients. EPVS is correlated with retinal vessel abnormalities. The more serious of EPVS is, the more serious of retinal arteriosclerosis is, the higher ratio of arteriovenous nicking is, the smaller of CRAE and AVR are.
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Objective To investigate the effect of repeated application of low-frequency transcranial magne-tic stimulation ( rTMS) when combined with hyperbaric oxygen ( HBO) in the treatment non-fluent aphasia after a stroke. Methods Forty-eight stroke survivors with non-fluent aphasia were randomly assigned to a control group, an HBO group or an observation group, each of 16. All received conventional rehabilitation therapy consisting of drug therapy, speech training and conventional physical exercises, while the HBO and observation groups were additionally given HBO and rTMS combined with HBO respectively. The 1 Hz rTMS was applied over the Broca's homologues of the unaffected hemisphere. Before and after 4 weeks of treatment, the Western Aphasia Battery ( WAB) was used to evaluate the subjects' language function and the Modified Barthel Index ( MBI) was used to assess their ability in the activities of daily living. Results There was no significant difference in the average WAB scores among the three groups before the treatment. After 4 weeks of treatment the average WAB and MBI scores of the HBO group and the observation group had improved significantly, and there was then a significant difference among the three groups. The observation group was performing significantly better than the HBO group and the control group in spontaneous speech, auditory comprehension, repetition, naming, AQ score and MBI score. Pairwise comparisons showed that the observation group's average WAB score, spontaneous speech, auditory comprehension, repetition, naming, AQ score and MBI score were the best, followed by those of the HBO group and then those of the control group. All of the differences were statistically significant. Conclusions Low-frequency rTMS combined with HBO can significantly improve the language function and the quality of life of patients with non-fluent aphasia. Such combined therapy is worthy of clinical promotion and application.
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The incidence of ischemic stroke in the middle cerebral artery (MCA )territory is high.Despite intravenous thrombolytic therapy with recombinant tissue type plasminogen activator (rt-PA )can be used at the early stage ,the patients seldom gain benefits from that ,and the morbidity and mortality stay high. In order to provide evidence for optimizing early identification and clinical treatment of patients at high risk of ischemic stroke ,this article reviewed the current state of science and technology regarding prognosis-influencing factors for ischemic stroke of the middle cerebral artery territory ,such as stroke pathogenesis ,the length and site of vessel occlusion ,the collateral circulation and lesion patterns ,initial symptoms and clinical intervention ,and other related indexes after thrombolysis.
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Objective To investigate the influence of moderate to severe leukoaraiosis (LA) on hemorrhagic transformation and prognosis of patients after intravenous recombinant tissue plasminogen activator thrombolysis for acute ischemic stroke and analyze influencing factors of the clinical prognosis.Methods We consecutively collected patients with acute infarct on anterior circulation (n =78) in Department of Neurology or Emergency of our hospital between January 2014 and March 2017,and all patients received intravenous thrombolysis therapy within the 4.5-hour time window.All patients processed brain MRI after intravenous thrombolysis therapy.According to the degree of LA,all subjects were classified into two groups;LA group (moderate to severe) vs no LA group (absent to mild).Clinical data were obtained and compared among patients with different grades of LA.Logistic regression analysis was used to confirm the relevant factors of prognosis 90 days after stroke.Results Among 78 enrolled patients,24 (30.8％) were classified as LA and 54 (69.2％) as no LA.In the group of LA,33.3％ (8/24) patients conducted hemorrhagic transformation,whereas 11.1％ (6/54) patients also underwent hemorrhagic transformation in the group of no LA.There was a significant difference between the two groups (x2 =5.571,P =0.018).But symptomatic intracranial hemorrhage accounted for 16.7％ (4/24) and 5.6％ (3/54) respectively in the two groups without significant difference (x2 =2.304,P =0.129).Three-month recurrence of stroke in the groups of LA and no LA was 20.8％ (5/24) and 5.6％ (3/54) respectively,also without significant difference between the two groups (x2 =3.850,P =0.050).Age ((73.7 ± 6.7)years vs (61.3 ± 10.6) years,t =6.567,P =0.012),90 d Fugl-Meyer Scale (FMS) score (92.3 ± 3.4 vs 72.9 ± 7.8,t =22.345,P ＜ 0.01) and proportion of 90 d modified Rankin Scale score 0-2 (83.3％(45/54) vs 50.0％ (12/24),x2 =9.383,P =0.002) were significantly different between the two groups.Follow-up 90-day after onset showed that the good outcome was found in 57 cases (73.1％),poor outcome in 21 patients (26.9％) and death in six cases (7.7％).The grade of LA (57.1％ (12/21) vs 21.1％ (12/57),x2 =9.383,P =0.002),silent lacunar infarction (66.7％ (14/21) vs 35.1％ (20/57),x2 =6.224,P =0.013),age ((72.8 ± 7.9) vs (61.5 ± 11.7) years,t =4.423,P =0.039),proportion of thrombolysis within 3.0-4.5 hours (71.4％ (15/21) vs 38.6％ (22/57),x2 =6.634,P =0.010),vascular occlusion size (66.7％ (14/21) vs 38.6％ (22/57),x2 =4.865,P =0.027),infarction size (52.4％ (11/21) vs 12.3％ (7/57),x2 =14.053,P =0.001) and baseline NIHSS score (16.9 ±6.7 vs 9.5 ± 4.5,t =5.426,P =0.022) were significantly different between the two groups.After adjusting for age,thrombolysis time,baseline NIHSS score,infarction size,vascular occlusion size and silent lacunar infarction,multivariate analysis revealed that moderate to severe LA (OR =4.564,95％ CI 1.199-67.724,P =0.033) was risk factor for worse outcome of patients after intravenous thrombolysis.Conclusions Acute ischemic stroke patients with moderate to severe LA have high hemorrhagic transformation after intravenous thrombolysis and may have poor 90-day FMS score.And moderate to severe LA was found to be an independent risk factor for prognosis in cerebral infarction patients with intravenous thrombolysis.
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Objective To investigate the effect of the location of middle cerebral artery (MCA) occlusion on outcomes after intravenous thrombolysis with recombinant tissue plasminogen activator (rtPA) in patients with acute ischemic stroke.Methods The consecutive patients with stroke of acute MCA occlusion treated with rtPA intravenous thrombolysis within 4.5 h after onset were included.The locations of MCA occlusion were divided into either a proximal MCA segment (proximal M1 segment) or a distal MCA segment (distal M1 segment,M2 segment and more distally).Early neurological improvement was defined as National Institutes of Health Stroke Scale (NIHSS) score improvement ≥4 points from baseline or NIHSS 0 point at 24 h after thrombolysis.They were divided into a good outcome group (0-2) and a poor outcome group (3-6) according to the modified Rankin Scale (mRS) scores.Results A total of 70 patients with MCA occlusion were enrolled in the study,including 22 (31.4％) with proximal MCA occlusion and 48 (68.6％) with distal MCA occlusion;52 (74.3％) with good outcome and 18 (25.7％) with poor outcome.The proportion of atrial fibrilhtion (x2 =4.541,P =0.033),the NIHSS scores on admission (t =5.192,P =0.026) and 24 h after thrombolysis (t =5.365,P =0.024) in the proximal MCA occlusion group were higher than those in the distal MCA occlusion group.The proportion of early neurological improvement in the proximal MCA occlusion group was significantly lower than that in the distal MCA occlusion group (x2 =9.434,P =0.002),and the incidence of symptomatic intracranial hemorrhage (x2 =9.563,P =0.002)and the mortality rate within 7 d (x2 =14.491,P ＜0.001) were significantly higher than those in the distal MCA occlusion group.The time from onset to thrombolysis (t =6.346,P =0.014),NIHSS scores on admission (t =4.498,P =0.038) and at 24 h after thrombolysis (t =4.866,P =0.028),and the proportion of proximal MCA occlusion (x2 =18.710,P ＜0.001) in the poor outcome group were significantly longer or higher than those in the good outcome group.Multivariatelogistic regression analysis showed that the proximal MCA occlusion (odds ratio [OR] 14.385,95％ confidence interval [CI] 2.525-81.925;P =0.003),longer time from onset to thrombolysis (OR 12.927,95％ CI 2.624-61.748;P =0.002),higher NIHSS score at 24 h after thrombolysis (OR 3.492,95％ CI 1.027-11.880;P=0.045) were the independent predictors for poor outcome at 90 d.Conclusions There are differences in the outcomes after intravenous thrombolysis in patients with MCA occlusion at different locations.The locations of MCA occlusion,time from onset to thrombolysis,and NIHSS score at 24 h after thrombolysis,and age are the independent predictors for the outcomes after intravenous thrombolysis in patients with acute MCA ischemic stroke.
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Objective To investigate the effect of the location of middle cerebral artery (MCA) occlusion on outcomes after intravenous thrombolysis with recombinant tissue plasminogen activator (rtPA) in patients with acute ischemic stroke.Methods The consecutive patients with stroke of acute MCA occlusion treated with rtPA intravenous thrombolysis within 4.5 h after onset were included.The locations of MCA occlusion were divided into either a proximal MCA segment (proximal M1 segment) or a distal MCA segment (distal M1 segment,M2 segment and more distally).Early neurological improvement was defined as National Institutes of Health Stroke Scale (NIHSS) score improvement ≥4 points from baseline or NIHSS 0 point at 24 h after thrombolysis.They were divided into a good outcome group (0-2) and a poor outcome group (3-6) according to the modified Rankin Scale (mRS) scores.Results A total of 70 patients with MCA occlusion were enrolled in the study,including 22 (31.4％) with proximal MCA occlusion and 48 (68.6％) with distal MCA occlusion;52 (74.3％) with good outcome and 18 (25.7％) with poor outcome.The proportion of atrial fibrilhtion (x2 =4.541,P =0.033),the NIHSS scores on admission (t =5.192,P =0.026) and 24 h after thrombolysis (t =5.365,P =0.024) in the proximal MCA occlusion group were higher than those in the distal MCA occlusion group.The proportion of early neurological improvement in the proximal MCA occlusion group was significantly lower than that in the distal MCA occlusion group (x2 =9.434,P =0.002),and the incidence of symptomatic intracranial hemorrhage (x2 =9.563,P =0.002)and the mortality rate within 7 d (x2 =14.491,P ＜0.001) were significantly higher than those in the distal MCA occlusion group.The time from onset to thrombolysis (t =6.346,P =0.014),NIHSS scores on admission (t =4.498,P =0.038) and at 24 h after thrombolysis (t =4.866,P =0.028),and the proportion of proximal MCA occlusion (x2 =18.710,P ＜0.001) in the poor outcome group were significantly longer or higher than those in the good outcome group.Multivariatelogistic regression analysis showed that the proximal MCA occlusion (odds ratio [OR] 14.385,95％ confidence interval [CI] 2.525-81.925;P =0.003),longer time from onset to thrombolysis (OR 12.927,95％ CI 2.624-61.748;P =0.002),higher NIHSS score at 24 h after thrombolysis (OR 3.492,95％ CI 1.027-11.880;P=0.045) were the independent predictors for poor outcome at 90 d.Conclusions There are differences in the outcomes after intravenous thrombolysis in patients with MCA occlusion at different locations.The locations of MCA occlusion,time from onset to thrombolysis,and NIHSS score at 24 h after thrombolysis,and age are the independent predictors for the outcomes after intravenous thrombolysis in patients with acute MCA ischemic stroke.
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Objective To evaluate the influence of antiplatelet therapy prior to intravenous thrombolysis (IVT) on acute ischemic stroke (AIS) patients receiving IVT with recombinant tissue type plasminogen activator (rt-PA).Methods Researches about the safety of pre-existing antiplatelet treatment on AIS patients undergoing rt-PA IVT published before 31st December 2013 were retrieved based on internet databases.A meta-analysis of included clinical trials was performed by RevMan 5.2 and Stata 12.0 software.Simultaneously,funnel plot and Egger's test were used to evaluate the publication bias.Results A total of 10 papers were included.Eight researches based meta-analysis showed that pre-existing antiplatelet therapy increased the risk of symptomatic intracranial hemorrhage (SICH ; OR =1.67,95％ CI 1.44-1.93,P ＜ 0.01),6 researches based analysis suggested pre-existing antiplatelet therapy increased the risk of any intracranial hemorrhage (ICH ; OR =1.23,95％ CI 1.04-1.47,P ＜ 0.05) and 3 trials based analysis indicated the functional independence of patients receiving antiplatelet treatment was a bit worse than control group (OR =0.86,95％ CI0.80-0.93,P ＜0.01).Funnel plots and Egger' s test showed that there was no significant publication bias (P ＞ 0.05).Conclusions Antiplatelet therapy might increase the risk of post thrombolysis SICH and ICH,and their 3-month function independence is not so satisfied as those who had no antiplatelet agents before IVT.However,this review has limitations and the above results should be validated in future large prospective clinical studies.
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Objective To investigate the prevalence and risk factors of atherosclerotic renal artery stenosis (ARAS) in patients with ischemic stroke (IS).Methods A total of 596 consecutive patients with ischemic stroke underwent cerebrovascular and renal angiography at our hospital from January 2008 to March 2013.Renal artery stenosis was defined as at least one of renal artery narrowing ≥ 50％ of luminal diameter.Multivariate logistic regression analysis was performed to investigate the association of the clinical variables with ARAS.Results Intracranial arterial stenosis (ICAS) was identified in 203 patients (34.1％),including 108 cases (18.5％) with arteriostenosis ≥ 50％.Extracranial arterial stenosis (ECAS) was identified in 250 patients (41.9％),including 149 cases (25.0％) with arteriostenosis ≥ 50％.The prevalence of ECAS was higher than that of ICAS(x2 =7.86,P ＜ 0.05).ARAS was identified in 77 patients (12.9％),and the prevalence of ARAS in patients with ECAS ≥50％ was higher than that in with ICAS ≥50％ (30.2 ％ vs.18.5％,x2 =4.52,P ＜0.05).Multivariate analysis showed that the age≥ 60 y (OR:2.48,P ＜ 0.05) and ECAS ≥ 50％ (OR:5.37,P ＜ 0.05) were independent risk factors for prevalence of ARAS.Conclusion ARAS is a relatively common finding among patients with ischemic stroke,suggesting that renal angiography should be performed in elderly IS patients,especially for those combined with severe ECAS.
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Objective To investigate the effects of the low-osmolar nonionic contrast media on renal function in elderly patients suffering from ischemic cerebral vascular disease and undergoing angiography.To study the incidence and risk factors for contrast-induced nephropathy (CIN).Methods 276 elderly patients who were going to receive selective cranial angiography and bilateral renal angiography were included.The 0.9 ％ sodium chloride (1 ml · kg-1 · h-1) was administered in all patients 6 hours before and 12 hours after contrast media administration.No patients suffered from obviously congestive heart failure.The levels of serum creatinine (Scr) and serum urea nitrogen (SUN) were measured 3 days before and at day 1,2,6 after the administration of contrast media respectively.Then creatinine clearance rate (Ccr) was calculated.Multivariate predictors of contrastinduced nephropathy were determined by logistic regression.Results Among the 276 patients,CIN occurred in 19 patients (6.9％),among whom 4 patients suffered from severe renal artery stenosis and received percutaneous transluminal renal angioplasty (PTRA) at 1 week after undergoing angiography.The renal function in the other 15 cases with CIN were recovered to baseline 1evel 3 months after the use of contrast media.No patients underwent a maintenance hemodialysis.In the 19 patients with CIN,the levels of SUN and Scr were higher and Ccr was lower at day 1 and 2 after angiography than before the procedure (all P ＜ 0.05),but the parameters were decreased to preoperative level at day 6 after angiography (all P＞0.05).Logistic regression analysis showed that renal dysfunction,diabetes mellitus and severe renal artery stenosis were the major risk factors for contrast-induced nephropathy.Conclusions Low-osmoiar nonionic contrast used in angiography is safe for elderly patients if adequately hydrated with 0.9 ％ sodium chloride.The clinical risk factors for CIN are renal dysfunction,diabetes mellitus and severe renal artery stenosis.
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Objective To investigate the distribution and severity of cerebral artery stenosis and the prognosis in elderly patients with acute cerebral infarction using digital subtraction angiography (DSA). Methods The 432 elderly patients with acute cerebral ischemia infarction underwent DSA,and they were divided into two groups: elderly group (n= 320) and non-elderly group (n= 112). The characteristics of distribution and severity of cerebral artery stenosis, the relationship between artery stenosis and relative risk factors, and the prognosis of acute cerebral infarction were analyzed.Results In elderly group, 270 cases (84.3%) had intra- and extra- cranial artery stenosis, of which 98 patients (30.6%) with pure extracranial arterial stenosis, 132 patients (41.3%) with combined extra- and intra-cranial artery stenosis. They were both significantly higher than the corresponding data in non-elderly group [23 cases (20.5%) and 28 cases (25%), P＜0.05 and 0.01]. The prevalences of moderate and severe cerebral artery stenosises were higher in elderly group than in nonelderly group [224 locations (52.1%) vs. 51 locations (40.8%), P＜0. 05]. The number of patients with previous history of cerebrovascular disease was much more and the prognosis was much worse in elderly group than in non-elderly group (both P＜0.05), Conclusions The elderly patients with cerebral infarction have severer cerebral artery stenosis, increased proportion of multivessel disease and poor prognosis. So it is very important to take aggressive treatment as soon as possible, and to make secondary prevention and effective rehabilitation so as to improve their prognosis.
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@#ObjectiveTo explore the effect of system reading therapy on alexia after stroke.Methods104 stroke patients with alexia were divided into two groups: observation group(51) and control group(53). General speech training were used for the two groups, while the observation group received system reading training at the same time, all for 30 minutes, once a day for 1 month. Chineses Standard Aphasic Examination was applied to assess the reading ability before and 1 month after treatment.ResultsThere are three kinds of alexia in the patients: frontal alexia, alexia with agaphia, and subcortical aphasic alexia. Reading ability improved in the two groups (P<0-01), but the observation group was better than the control group(P<0-05).ConclusionSystem reading therapy is very helpful to improve reading ability of stroke patients with alexia.
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Objective To investigate the changes of vertebral-basal artery and regional cerebral blood flow(rCBF) in patients with olivopontocerebellar atrophy(OPCA).Methods 10 patients with OPCA were examined by digital subtraction angiography(DSA) and single-photon-emission-computed tomography(SPECT),and compared with the control group(patients with vertigo or transient ischemic attack).Results In OPCA group,there were 5 cases with small vertebral artery(50%),4 cases with single vertebral artery(40%),9 cases with small and little vessels(90%),10 cases with poor stain in later arterial phase(100%) could be seen by DSA.The lower rCBF in cerebellum and brain stem were seen in 8 cases(80%)by SPECT.In control group,there were 3 cases(15%),4 cases(20%),4 cases(20%),3 cases(15%) and 7 cases(35%) respectively.There were significant differences between the two groups(all P
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Objective To observe the changes of nitric oxide(NO), nitric oxide synthase(NOS),and endothelin(ET) contents in plasma after acute cerebral infarction(ACI), And to evaluate the therapeutic effect of nimodipine on their changes.Methods 110 cases with ACI were randomly divided into Nimodipine therapeutic group(Nimodipine is used with general therapy,Nimodipine group) and general therapeutic group(general group). NO, NOS and ET contents in plasma at different time after ACI were observed, while control group was set up.Results ET content in plasma after ACI increased significantly until recovery. NO and NOS contents in plasma rise at the beginning, then they declined. ET contents had significant difference between Nimodipine group and general group( P 0.05).Conclusion NO, NOS and ET interfered with the complex process of pathologic after acute cerebral infarction. Nimodipine had therapeutic action on ACI partly depended on affecting content of ET in plasma.
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Objective To study the relationship between helicobacter pylori (HP)infection and hemicrania.Methods The serum HP IgG level and ~ 14 C expiration test were detected in patients with HP infected. The patients with hemicrania, health and at attack stage or interval stage or any degree attack stage of hemicrania were observed the condition of HP infection. The curative effect of HP patients treated with traditional method and plus with three combined anti-HP infection treatment was observed.Results The positive rate of HP infected in patients with hemicrania was higher than that of control(81.0% vs 30.96%, P