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Objective:To investigate the etiological mechanism in single small subcortical infarction (SSSI) with different imaging features.Methods:The patients registered in a database of ischemic stroke in the Department of Neurology of the First Affiliated Hospital of Zhengzhou University from January 2016 to December 2019 were analyzed. According to the lowest slice (LS) and the total number of involved slices (TNS) on diffusion-weighted imaging, the SSSI was divided into 3 types: proximal SSSI (pSSSI; LS≤2), distal and large SSSI (dl-SSSI; LS>2, TNS>2) and distal and small SSSI (ds-SSSI; LS>2, TNS≤2). The clinical and imaging features among 3 different lesion patterns were compared by using χ 2 test, Kruskal-Wallis H test and multiple Logistic regression analysis, etc. Results:In the 3 groups of ds-SSSI ( n=205), dl-SSSI ( n=157) and pSSSI ( n=166), the prevalences of parent artery disease (PAD)[10.7% (22/205) , 19.1% (30/157) , 42.8% (71/166), respectively, χ 2=54.89, P<0.001], coronary artery disease [8.3% (17/205), 14.0% (22/157), 16.9%(28/166), respectively, χ 2=6.44, P=0.040] and severe white matter hyperintensities (sWMHs)[58.0% (119/205), 43.3% (68/157), 41.0% (68/166), respectively, χ 2=12.94, P<0.001], the level of serum homocysteine (Hcy)[18.01 (13.54, 25.56), 16.03 (12.50, 21.09), 14.72 (11.12, 19.14) μmol/L, respectively, H=19.36, P<0.001], and the National Institutes of Health Stroke Scale (NIHSS) score[2(1, 3), 3(1, 4), 3(2, 6), respectively, H=39.53, P<0.001] showed statistically significant differences. Multiple Logistic regression analysis showed that compared with dl-SSSI patients, the lesion pattern of patients with higher proportion of PAD ( OR=3.12, 95% CI 1.86-5.24, P<0.001) was closer to pSSSI; the lesion pattern of patients with higher serum Hcy level ( OR=1.02, 95% CI 1.00-1.04, P=0.046) or higher proportion of sWMHs ( OR=1.79, 95% CI 1.12-2.86, P=0.015) was closer to ds-SSSI, and the lesion pattern of patients with higher proportion of PAD ( OR=0.50, 95% CI 0.27-0.93, P=0.029) or higher NIHSS score ( OR=0.84, 95% CI 0.77-0.92, P<0.001) was closer to dl-SSSI. Conclusions:The pathogenesis of ds-SSSI tends to be cerebral small vessel disease. The pathogenesis of pSSSI is related to atherosclerosis. The patients with dl-SSSI have the intermediate characteristics of pSSSI and ds-SSSI and may be unstable.
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Objective To investigate the association among cerebral lesions, mild cognitive impairment and artery stenosis.Methods In 685 cases which seek medical care in our hospital in recent years, we studied the cortical infarction lesions in this study, analysis of subcortical infarction in patients with cognitive impairment as well as the composition of the artery stenosis conditions were conducted .Results in this study, subcortical infarct patients with mild disturbance of consciousness accounted for 9.20%, while blood supply stenosis cases accounted for 49.34%.Elder than 70 years, long course of subcortical infarction, family history of alcohol consumption and dementia were associated with cortical (P <0.05), the incidence of subcortical infarct and mild cognitive disturbance were 2.138 times for infarct and mild disturbance of consciousness patients.Multivariate regression analysis showed that family history of hypertension and cerebrovascular disease were also risk factors.In addition, mild cognitive impairment can increase the risk of subcortical infarct and the incidence of vascular stenosis, OR was 2.077;elder than 70 years of age, subcortical infarct length, hypertension and family history of cerebrovascular disease were risk factors for subcortical infarction and stenosis of blood supply.In multivariate regression analysis, mild cognitive impairment, long duration of subcortical infarct, overweight and obesity, and hypertension showed to be risk factors of subcortical infarct and blood supply stenosis.Conclusion The artery stenosis and subcortical infarction with mild cognitive impairment show a positive correlation, while the presence of mild cognitive impairment and subcortical infarction and artery stenosis and an increased risk of an association, are related to each while age, duration and associated subcortical infarcts family history and other factors also affect the potential relationship between them .
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Objective To investigate the intracranial vascular lesions in patients with subcortical infarction-induced vascular cognitive impairment(VCI), and to investigate the etiology and mechanisms of VCI. Methods Inpatients with subcortical infarction in our hospital were enrolled in this study from Nov. 2012 to Feb. 2014, with those unable to complete the cognitive evaluation eliminated. According to the diagnostic criteria of VCI the patients were divided into two groups: 49 with cognitive impairment (VCI group) and 42 without cognitive impairment (NVCI group). The clinical data, physical examinations, laboratory tests, and the Montreal Cognitive Assessment (MoCA) scale scores were collected. Cerebral blood vessels were assessed by CT angiography or magnetic resonance angiography (MRA). Results The results showed that, according to TOAST classification, VCI group had 24 (48.98%) patients with large artery atherosclerosis (LAA) and NVCI group had 22 (52.38%), showing no significant difference between the two groups. CTA or MRA indicated that 37 (75.51%) patients in VCI group had vascular stenosis, with 75.25% of the 37 patients having intracranial vascular stenosis and 28.71% with middle cerebral artery stenosis. Patients with single cerebral artery stenosis accounted for 18.37% and those with the multiple artery stenosis accounted for 57.14%. CTA or MRA indicated that 34 (80.95%) patients in NVCI group had vascular stenosis, with 60% having intracranial vascular stenosis, including 32% with middle cerebral artery stenosis, 26.19% with single cerebral artery stenosis, and 54.76% with the multiple artery stenosis, with the latter two data being significantly different from the VCI group (P s=-0.283, P <0.05). Conclusion Different from the common causes of small blood vessels, LAA is the most common etiology of subcortical VCI, which implied that exploring the LAA causes of small lesions is crucial for the prevention of VCI in Chinese patients.
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Objective To investigate the cognitive behavioral characteristic longitudinally of the patients after subcortical infarction engaged in feature and binding working memory tasks.Methods The behavioral performances were recorded from 28 patients after subcortical infarction at the 1 st week (W1),3 rd moth (M3) and 6th month (M6) while performing color,location,and color-location binding delayed match-to-sample working memory task.25 healthy volunteers(controls) were investigated once using the same task protocol during the study period.Computer recorded the behavior reaction time and accuracy.Single factor variant analysis of repeated measurement was adopted.Results The accuracy of three memory tasks of M3 ((64.92 ± 5.47) ％ ; (92.88 ± 2.98) ％ ;(82.35 ±7.44)％) was improved than that of W1 ((61.06 ±7.78)％; (90.59 ±2.95)％; (77.06 ±5.58) ％) and the difference had statistically significant (P ＜ 0.05).But the reaction time of M3 ((868.31 ±118.91)ms; (833.37 ± 120.99) ms; (918.72 ± 101.28) ms) was shortened than that of W1 ((914.02 ±110.53) ms; (859.89 ± 139.94) ms; (1150.17 ± 92.02) ms) and the difference also had statistically significant (P ＜ 0.05).In the location-memory task,the correct rate of M6 ((93.91 ± 2.86) ％) was improved than that of M3 ((92.88 ± 2.98) ％) and the reaction time of M6 ((813.24 ± 119.54) ms) was shortened than M3 ((833.37 ±120.99) ms).M6 and M3 to be compared in the color memory task,the correct rate ((64.50 ± 4.49) ％ ; (64.92 ± 5.47) ％) and the reaction time ((866.47 ± 123.87) ms; (868.31 ± 118.91) ms) had no significant difference (P ＜ 0.05).But in the color-location binding task,the correct rate of M6 ((78.49 ± 7.85) ％) and M3 ((82.35 ± 7.44)％) to be compared had significant decreased nearly the level ((77.06 ± 5.58)％) of the stroke beginning.All behavioral performances of patients were worse than that of control subjects except the compare result of location-memory task in M6((93.91 ± 2.86) ％ ; (813.24 ± 119.54) ms).Conclusion Feature memory and binding memory had been damaged in different degrees in the patient after subcortical infarction.The binding memory had the secondary damage what might be related to the secondary nerve fiber degeneration after infarction.
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Foix-Chavany-Marie Syndrome (FCMS) is characterized by anarthria and bilateral facio-pharyngo-glosso-masticatory paralysis with an automatic-voluntary dissociation, which usually develops in bilateral opercular lesions. We present a case of FCMS caused by unilateral subcortical lesion. A 54-year-old man was admitted due to acute right hemiparesis with anarthria. He had voluntary facial paresis but automatic-involuntary facial movements were preserved. MRI showed an acute left corona radiata infarction and PET revealed decreased glucose metabolism in left basal ganglia and fronto-parietal lobe.
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Humans , Middle Aged , Basal Ganglia , Cerebral Infarction , Cranial Nerve Diseases , Cranial Nerves , Dissociative Disorders , Facial Paralysis , Glucose , Infarction , Paralysis , ParesisABSTRACT
BACKGROUND: Diffusion tensor MRI (DTI) is a new imaging technique and enables us to analyze the structural damage of fiber pathways and to monitor the time course of Wallerian degeneration of the pyramidal tract in stroke patients. We used DTI to investigate structural changes of the infarct area and the associated descending corticospinal tract in patients with subcortical infarct. METHODS: We examined 24 consecutive patients who presented with acute single cerebral infarct in the subcortical area and who also had undergone an MRI study within 7 days after symptom onset. Clinical outcome was assessed using the National Institutes of Health Stroke Scale (NIHSS) at admission, 7 days, 14 days and 30 days and modified Rankin Scale (mRS) at admission and 30 days. Each of the indices was achieved by post processing the acquired DTI data and correlated with the NIHSS. RESULTS: In infarct region, fractional anisotropy (FA) was significantly decreased compared with matched-contralateral regions (0.39 vs. 0.53, p<0.001). In the distal to the infarct, FA was significantly decreased at internal capsule (0.62 vs. 0.64, p=0.019), not at pons (0.51 vs. 0.53, p=0.103). The decrease of anisotropy at infarct region correlated positively with the NIHSS at 7, 14 and 30 days and mRS at 30 days after stroke, but the decrease of anisotropy at internal capsule did not correlate with the NIHSS. CONCLUSIONS: This study shows the potential of DTI to detect and monitor the structural degeneration of fiber pathways and to establish the prognosis in patients with acute subcortical cerebral infarct.
Subject(s)
Humans , Anisotropy , Cerebral Infarction , Diffusion , Internal Capsule , Magnetic Resonance Imaging , Pons , Prognosis , Pyramidal Tracts , Stroke , Wallerian DegenerationABSTRACT
Cerebral autosomal dominant arteriopathy with subcortical infarcts and lecukoencephalopathy (CADASIL) is a recently described neurovascular disease affecting young to middle aged individuals. The disease is caused by mutations in the Notch3 gene located in the long arm of chromosome 19. The disease clinically is characterized by migrainous headaches ,mood disturbances, focal neurologic deficits, transient ischemic attaches, strokes and dementia. Pathologically, the disease is characterized by a stereotypic degeneration of the arterial walls with deposition in the media of a nonatheromatous,(nonamyloidotic) substance that under the electron microscope (EM) appears as a granular osmiophilic material (GOM). A review of current literature is presented concerning the clinical, radiological, pathologic and genetic feature of CADASIL.
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BACKGROUND: Diffusion-weighted MR imaging (DWI) was designed to detect the random molecular otion of water in tissue. DWI has gained increasing interest recently because it can demonstrate yperacute stroke earlier than any other imaging methods so far. The purpose of our study was to etermine the clinical usefulness and significance of DWI compared with those of Fast Spin Echo T2-weighted image (SE T2WI) and Fluid Attenuated Inversion Recovery (FLAIR) image in acute and subacute ischemic stroke. METHOD: Twenty-five adult patients with clinical diagnoses of acute or subacute cerebral infarctions were imaged with fast SE T2WI, FLAIR and DWI using a 1.5-T image. RESULTS:All the patients had areas of high signal intensity indicating acute or subacute lesions on DWI and these lesions provide an excellent clinicoanatomic correlation. CONCLUSIONS: DWI is most useful in the diagnosis and localization of acute or subacute lacuna or subcortical infarction in patients with preexisting chronic infarctions or white matter hyperintensity showing high signal intensity similar to acute or subacute infarctions on T2WI or FLAIR image.