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@#In the absence of symptoms, silent cerebral infarction can be discovered incidentally during an imaging or neuropathological examination. After cardiovascular surgery with cardiopulmonary bypass, the morbidity is high, and it may contribute to neurocognitive dysfunction, symptomatic cerebral infarction and increased risk of death. The embolus caused by various operations intraoperatively are closely associated with this progress. However, controversies over the prevention still persist. As a result, an overall summary of silent cerebral infarction after cardiovascular surgery with cardiopulmonary bypass will be presented in this review.
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Abstract: Background: Diabetes accelerates the atherosclerotic process in blood vessels, leading to micro- and macro vascular complications, stroke being one of these. Carotid artery atherosclerosis in patients with Diabetic nephropathy is found to be associated with Silent cerebral infarction (SCI). Present study was carried to found any relationship between carotid intima media thickness and silent cerebral infarction in patients with type 2 diabetic nephropathy.Methods: The study was done in 50 DN patients admitted in medicine ward of tertiary care hospital. Subjects were evaluated based on detailed clinical data like symptoms, signs, and associated illnesses, general and systemic examination. Subjects were diagnosed with silent cerebral infarct based on MRI Findings. Each subject had undergone MRI to find out incidence of SCI.Results: Maximum (54%) was in age group of 61-70yrs and very few (6%) were below age of 50yrs. M: F was 1.6:1. Around 44% had duration of diabetes in 1-5yrs of duration and very few (6%) had diabetes >15yrs. On USG scan of carotid vessels it was found that 86% had increased carotid intimal media thickness either or side of vessel. On MRI brain there was incidence of silent cerebral ischemia among 30% study subjects.Conclusion: Both CIMT and SBI showed rise in incidence with corresponds to increase in age, duration of diabetes and urine albumin level among study subjects.
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Objective To observe the impairment effect of retinol binding protein 4(RBP4) on neurocognitive function in diabetic nephropathy(DN) patients with silent cerebral infarction(SCI) and to explore its mechanism.Methods Sixty patients with newly diagnosed DN and 30 healthy volunteers were selected as the study subjects and the DN cases were divided into the complicating SCI group(SCI,n=30) and non-complicating SCI group(NSCI,n=30) according to the imaging results.The degrees of neurological function deficit and Montreal cognitive assessment(MoCA) were evaluated.Serum RBP4 level was determined by ELISA and expressions of Lp-PLA2 and C-X-C chemokine receptor type 4(CXCR4) were determined by Western blot.Results Compared with the NSCI group,the neurocognitive function in the SCI group was subsided,the expression levels of RBP4,Lp-PLA2 and CXCR4 were increased(P＜0.05).The RBP4 level was positively correlated with the neurocognitive function impairment in SCI patients,moreover,there existed a regression correlation between them.Conclusion Serum RBP4 may serve as the predictive factor of DN complicating SCI and is positively correlated with neurocognitive dysfunction.Lp-PLA2/CXCR4 pathway activation may be one of its pathogenesis.
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Objective To explore the characteristics of selective attention function in patients with silent cerebral in-farction (SCI) and depression, the relationship between depression, selective attention and cognitive dysfunction. Methods Eighty-two patients with SCI and 82 normal subjects were selected and evaluated by using Hamilton Depression Rating Scale (HAMD), Montreal cognitive assessment (MoCA) and Stroop color-word test (CWT). Patients with SCI were further classified into depression subgroup and no-depression subgroup based on the score of HAMD. Results The score of MoCA was lower in SCI group (23.11 ± 5.41) and was much lower in depression subgroup (20.31 ± 5.44) compared with control group (28.70 ± 2.18) (all P<0.01). Compared with control group, the reaction times of card A, B, C and Stroop interference effects (SIE) were prolonged in SCI group. The reaction time of card A, B, C and SIE were (33.25±14.10);(42.45±15.18);(104.68 ± 25.08) and (62.24 ± 21.53) in depression subgroup, respectively. The error counts of card B, C and SIE were in-creased (P<0.05) in SCI group. The error counts of card B,C and SIE were (3.59±2.14), (15.67±7.20) and (12.08±6.46) in depression subgroup, respectively. The scores of MoCA were negatively correlated with the reaction time and error counts of SIE (r=-0.429,r=-0.500,all P<0.01).The location of infarction was correlated with the score of HAMD and error counts of SIE to some degree: both of the scores were higher in patients with left infarction compared with right infarction and were higher in patients with cortex infarction compared with subcortex infarction. Conclusion The present study revealed that patients with SCI and depression have selective attention deficit which is closely correlated with the level of cognitive function.
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Objective: To observe the prevalence, image findings and risk factors of silent cerebral infarctions (SCI) in healthy subjects undergoing physical examination. Methods: A total of 1, 008 consecutive subjects, who underwent brain MRI as part of their routine health check from May 2006 to March 2010, were included in the present study. The prevalences of SCI were compared in subjects of different ages and sexes, and the imaging features of the ischemic lesions were summasized. Statistical analysis was performed to assess the association of SCI with common risk factors. Results: We identified 328 subjects who had SCI on MRI, with the prevalence being 32.5%, and we also found that 83.4% of the ischemic lesions were lacunar infarcts and mainly located in the frontal lobe, centrum semiovale, basal ganglia, and periventricular white matter. Univariate and multivasiate logistic analyses showed that the age, hypertension, diabetes mellitus, low-density lipoprotein cholesterol, lipoprotein α, uric acid and carotid intima-media thickness were statistically significant between SCI and non-SCI patients, and they were the independent factors of SCI. Conclusion: SCI is common in Chinese population, and more attention is needed for control of its risk factors.
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Objective:To analyze the correlation between intra-extracranial arterial stenosis and silent cerebral infarction(SCI) in the elder with essential hypertension(EH). Methods:The results of color duplex ultrasonography(Duplex) and digital subtraction angiography(DSA) examination of 86 patients with essential hypertension complicated silent cerebral infarction were analyzed.The incidence of intra-and extracranial arterial stenosis and arthrosclerosis plaque were calculated.The comparative value of Duplex and DSA for evaluating atherosclerosis of extracranial carotid artery was analyzed using statistic methods. Results:The incidence of arthrosclerosis plaque was higher in SCI group than that in normal control group(62.79%,24%,P
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Objective:To explore the effective treatment to the depression after silent cerebral infarction(SCI).Methods:Seventy-three patients suffering from depression after SCI were treated for three moths with a mono-blind experiment.Results:There was significant difference between the effect of antidepressant and the effect of nonantideressant( P