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Objective Toexploretheclinicalvalueofcombiningapplicationofthreedimensionalpseudocontinuousarterialspin labeling (3D-pCASL)andsusceptibilityweightedimaging (SWI)inpredictingtheoutcomsofcerebralischemia.Methods Thirty-two patientswithmoderatetoseverestenosisofunilateralmiddlecerebralartery(MCA)and16healthyvolunteers(asacontrolgroup) underwenttheexaminationsoftheroutineMRI,MRA,3D-pCASL (PLD:1525ms,2525ms)andSWI.Thepatientsweredividedinto twogroups:lowperfusiongroupandequal/highperfusiongroupaccordingtotherCBFof3D-pCASLwithPLD:2525ms.OnSWI, theparametersofdeepmedullaryvein(DMV)includedratioofquantity,totallengthinbilateralunitareaandsubjectivescoreofischemic side.ThedifferencesofthevaluesofDMV parametersamongthegroupswerecompared,andthecorrelationsbetweenrCBFand DMVparameterswereanalyzed.Thereexaminationswereperformed6monthslaterandtheincidenceofinfarctionwascomparedbetween thelowperfusiongroupandtheequal/highperfusiongroup.ThecorrelationbetweenvaluechangeofrCBFandDMV,andthetransformation tendencyfromtheischemiclesiontocerebralinfarctionwerealsoanalyzed.Results Inthelowperfusiongroup,allDMVparameters werehigherthanthoseinthecontrolgroupandtheequal/highperfusiongroup,andthedifferencesbetweengroupswerestatistically significant(P＜0.05),buttherewerenosignificantdifferencesbetweenthevaluesofthecontrolgroupandtheequal/highperfusion group (P＞0.05).Thereexaminationresultsof6monthslatershowedthat4caseswithcerebralinfarctionwereallfromthelowperfusion group.Theincidenceofthecerebralinfarctioninthelowperfusion groupwas25%andwassignificantlyhigherthanthat(0%)in theequal/highperfusiongroup (P＜0.05).Theincidencewas positivelycorrelatedwiththeratioofquantity,totallengthinbilateral unitareaandsubjectivescoreofischemicsideofDMV (r＝0.512,0.43,0.449,P＜0.05),whilenegativelycorrelatedwithrCBF (r＝－0.501,P＜0.05).Conclusion TherearesomechangesofrCBFandDMVincerebralischemicarea,andthereisacorrelationbetween rCBFandDMV.3D-pCASLandSWIcanshowcerebralbloodflowperfusionandDMVinischemicarea,andplayanimportantrolein studyingtheoutcomesofcerebralischemiclesions.
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Objective Toinvestigatethecorrelationbetweentheredbloodcelldistributionwidth (RDW)and in-hospital prognosis in elderly patients with cerebral infarction and severe hemiplegia. Methods Atotalof209consecutiveelderlypatientswithcerebralinfarctionandhemiplegiadiagnosedat the Emergency Department,Central Hospital of Jiading District in Shanghai from January 2012 to December 2013 were enrolled retrospectively. All patients were divided into an L-RDW group (n=73 ),an M-RDW group (n=56),and an H-RDW group (n=80)according to the RDW trisection level. A single factor analysis of variance was used to compare the differences of clinical data,laboratory indexes,and mortality during hospitalization among the three groups. The patients were redivided into either a survival group (n=170)or a death group (n=39)according to their clinical outcomes. Its differences of RDW levels in the acute phase were compared. Logistic regression analysis was used to analyze the independence risk factors for the death of patients,and the risk ratio (OR)was calculated. Spearman correlation analysis was used to analyzeRDWandtheNationalInstitutesofHealthStrokeScale(NIHSS)scores.Results Themortality of the M-RDW group was significantly lower than that of the L-RDW and the H-RDW groups (1. 8%[n=1] vs. 12. 3%[n=9]and 36. 2%[n=29],all P<0. 01). the RDW level of the death group was significantly higher than that of the survival group (14.2 [13.3,15.1]vs.12.5 [11. 9,13. 5];P =0. 002). The H-RDW level (OR,12. 164,95%CI 2.544-58.181,P=0.002)and the NIHSS score (OR,1. 136, 95%CI 1. 056-1. 221,P=0. 001)were the independence risk factors for the death of the elderly patients with severe hemiplegia cerebral infarction;the RDW level was positively correlated with the NIHSSscore(r=0.167,P=0.016).Conclusion ThemortalityofdifferentRDWlevelsinelderly patients with cerebral infarction and severe hemiplegia showed aU shape. The mortality of the H-RDW is the highest. The RDW level has an important reference value for identifying the prognosis in elderly patients with cerebral infarction and severe hemiplegia.
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Objective Toinvestigatetherelatedriskfactorsofneurologicaldeterioration(ND)in patientswithacutecerebralinfarction.Methods Atotalof446patientswithacutecerebral infarction admitted to the Department of Neurology,Zhongda Hospital,Southeast University from January 2012 to December 2013 were analyzed retrospectively. ND was defined as the reevaluation of the National Institutes of Health Stroke Scale (NIHSS)scores at any time for the increased admission baseline score 2 (ND2)or 4 (ND4)within the first 72 hours. All subjects were divided into a ND2 group (n=107)and a non-ND2 group (n=339)or a ND4 group (n=62)and a non-ND4 group (n=384 ). The differences of general demography,vascular risk factors,imaging,and hematological dataamongthedifferentgroupswerecompared.Results Ofthe446patients,107cases(24.0%) were diagnosed as ND2 and 62 cases (13. 9%)were diagnosed as ND4. The result of univariate analysis showed that there were significant differences in the length of hospital stay,age,baseline NIHSS score,baseline systolic blood pressure on admission,guilty artery occlusion,and the levels of leukocyte,fasting glucose,and C-reactive protein between the ND2 patients and the non-ND2 patients (all P<0. 05). There were significant differences in sex,age,atrial fibrillation,baseline NIHSS score, baseline systolic blood pressure on admission,guilty artery occlusion,and the level of C-reactive protein between the ND4 patients and the non-ND4 patients (all P<0. 05). After adjustment for the confounding factors,the results of Logistic regression analysis showed that the baseline NIHSS score (OR,1.114, 95%CI 1. 0481-1.185,P=0. 001),C-reactive protein (OR,1. 014,95%CI 1. 004-1. 024,P=0. 004), and guilty artery occlusion (OR,2. 303,95%CI 1. 152-4. 606,P=0. 018)were independently correlated with ND2;while the age (OR,1. 040,95%CI 1. 011-1. 070,P=0. 006),systolic blood pressure (OR, 1.015,95%CI 1. 003-1. 027,P=0. 018),C-reactive protein (OR,1. 016,95%CI 1. 005-1. 026,P=0.003),and guilty artery occlusion (OR,2. 845,95%CI 1. 291-2. 269,P =0. 009)were independently correlatedwithND4.Conclusion TheearlyonsetofNDinpatientswithacutecerebralinfarctionare closely associated with age,stroke severity,baseline systolic blood pressure,C-reactive protein,and occlusion of guilty artery. In the clinical diagnosis and treatment,detecting the above indicators timely may contribute to identify the patients with acute cerebral infarction and early progressive deterioration.
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Objective To provide theoretic support for preventing traumatic arterial and venous cerebral infarction after craniocerebral trauma by probing into the related risk factors.Methods The clinical data of 154 pateints with moderate or severe craniocerebral trauma treated by decompressive craniectomy were studied retrospectively.Univariate analysis was carried out on 13 related factors including gender,age,Glasgow Coma Score(GCS)on admission,pupil status,morphological changes of ambient cisterns,brain midline,associated injury,blood pressure,traumatic superficial cerebral veins injury,platelet count,plasma D-dimer value,dosage of dehydrating agent and perioperative fluid balance.Then,the logistic multiple regression analysis was made on significant indexes with SPSS 10.0.Results Univariate analysis showed that seven factors including pupil status,GCS on admission,age,associated injury,perioperative blood pressure,morphological changes of ambient cisterns and brain midline were significantly correlated with traumatic arterial cerebral infarction(P ＜ 0.05)and that three factors including traumatic superficial cerebral veins injury,plasma D-dimer value and associated injury were significantly correlated with traumatic venous cerebral infarction(P ＜ 0.05).Logistic multi-factors regression analysis showed that mydriasis and hypotension might be the independent risk factor of traumatic arterial cerebral infarction and that traumatic superficial cerebral veins injury might be the independent risk factors of traumatic venous cerebral infarction.Conclusion The pupil status,GCS on admission,age,associated injury,perioperative blood pressure,morphological changes of ambient cisterns and brain midline are the risk factors of traumatic arterial cerebral infarction,with mydriasis and hypotension as independent risk factors.Traumatic superficial cerebral veins injury,plasma D-dimer value and associated injury are the risk factors of raumatic venous cerebral infarction,with traumatic superficial cerebral veins injury as independent risk factor.
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Objective To investigate the relationship of character of atherosclerotic plaque in carotid artery and serum CRP level. Methods The atherosclerotic plaques in carotid arteries were confirmed by multislice CT angiography(MSCTA),in which serum CRP level were detected in 28 patients with cerebral thrombosis,24 patients with lacunar infarction and 19 patients with TIA in internal carotid artery system in order to analysis the relationship between character of plaque and serum CRP level. Results (1)Mixed plaque and soft plaque were mainly found in cerebral thrombosis and TIA groups, while rigidity plaque was mostly found in lacunar infarction group, there were significance difference in plaques distribution among three groups(all P0.05).(3) CRP level in different groups was (4.546?2.720)mg/L in soft plaque group, (3.951?1.863)mg/L in mixed plaque group respectively,those were both higher than that of the rigidity plaque group[(2.762?1.323)mg/L],and there was significance difference between them(all P