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Objective:To apply 13N-ammonia PET/CT cerebral blood perfusion imaging combined with methazolamide challenge for cerebrovascular reserve (CVR) evaluation in ischemic cerebrovascular diseases. Methods:From January, 2014 to December, 2016, 56 ischemic stroke patients with serious stenosis of unilateral internal carotid artery or middle cerebral artery accepted basal and stress PET/CT with methazolamide challenge. The patients were divided into normal-CVR group (n = 29) and reduced-CVR group (n = 27) according to the results of CVR, and followed up for 24 months. The ischemic cerebrovascular events and cerebral blood flow were observed. Results:The incidence of transient ischemic attack was more in the reduced-CVR group than in the normal-CVR group (χ2 = 4.389, P < 0.05), while the incidence of ischemic stroke increased a little with no significant difference between the two groups (P > 0.05). The CBF was improved in normal-CVR group after treatment (t = 2.409, P < 0.05), and the improvement was not significant in reduced-CVR group (t = 0.648, P > 0.05). Conclusion:13N-ammonia PET/CT cerebral blood flow perfusion imaging combined with methazolamide challenge can be used to evaluate CVR to predict the outcome for patients with cerebral ischemic disease, which is helpful for early intervention.
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Las enfermedades cerebrovasculares constituyen la tercera causa de muerte en Europa y la sexta y novena en Cuba en los grupos etarios de 25 a 34 y 15 a 25 años, respectivamente. Entre estas, la forma isquémica de presentación suele ser la de mejor pronóstico cuando se evitan las secuelas neurológicas y los pacientes son tratados precozmente; sin embargo, su diferenciación mediante el método clínico no puede ser lo único que se utilice para diagnosticar un cuadro de isquemia, pues se asemeja mucho a otros procesos morbosos de ese mismo grupo y también a algunos de carácter neurológico, por lo cual se impone acudir a diferentes mecanismos en búsqueda de la certeza. Su confirmación temprana resulta crucial para poder aplicar oportunamente la terapéutica con trombolíticos, que debe iniciarse antes de las 3 horas de presentarse los síntomas y signos de la afección; razones que justifican determinar cuál es el medio de diagnóstico más eficaz, anticipado, menos costoso e invasivo para generalizar en las instituciones sanitarias del país.
The cerebrovascular diseases constitute the third cause of death in Europe and the sixth and ninth cause in Cuba in the age groups 25 to 34 and 15 to 25 years, respectively. Among these, the ischemic form is usually that of better prognosis when the neurological sequels are avoided and the patients are early treated; however, its differentiation by means of the clinical method cannot be the only element used to diagnose an ischemic pattern, because it resembles very much to other morbid processes of that same group and also to some of neurological character, reason why it is necessary to look for different mechanisms searching accuracy. Their early confirmation is crucial to apply appropriately the thrombolytic therapy that should begin 3 hours before the signs and symptoms of the disorder are presented; reason that justifies to determine which is the most effective, early, less expensive and invasive diagnostic mean to be generalized in the domestic health institutions.
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@#ObjectiveTo investigate the clinical application of transcranial Doppler (TCD) in patients with ischemic cerebrovascular diseases (ICVD). MethodsPatients complaining hemiplegia (n=38) or dizziness (n=35) after ICVD were detected with TCD and magnetic resonance angiography (MRA). ResultsThe incidence of abnormal intracranial large arteries detection was similar in patients complaining hemiplegia (χ2=1.03,P>0.05) between TCD and MRA, but different in patients complaining dizziness(χ2=10.76,P<0.05). ConclusionIn the patients with ICVD, TCD can be used in those complaining hemiplegia as a screening test before vascular interventional therapy, but be worthless in those complaining dizziness.
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To observe whether plasma levels of lysophosphatidic acid (LPA) can be decreased in patients with cerebrovascular diseases after the treatment with aspirin. Methods:A total of 1,400 patients were recruited. Among them,803 patients were diagnosed as probable ischemic stroke,and 343 patients were diagnosed as ischemic stroke. Thirty-four health volunteers were used as control subjects. The levels of LPA were measured by chromatography with the combination of inorganic phosphorus quantitative method. Results: The levels of LPA in the ischemic cerebrovascular group (3.11 ± 1.55 μmol/L) were significantly higher than those in the control group (1.77 ± 1.04 μmol/L) (P < 0.001). Taking aspirin (80 mg,qd) for one month significantly decreased the levels of LPA. After stopping aspirin for one month,the level of LPA re-elevated (3.90 ± 1.09 μmol/L),was higher than that during administration of aspirin (1.93 ±0.85 μmol/L(P <0.001). Conclusions: There are close correlations between the increased levels of LPA and the platelet activation. Aspirin decreases the level of plasma LPA;this may be one of the mechanisms of aspirin in prevention against ischemic stroke.
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@# ObjectiveTo investigate the changes of the serum level of insulin-like growth factor-1 (IGF-1) and lipid as well as their correlation in aged patients with ischemic cerebrovascular diseases(ICVD).MethodsSerum level of IGF-1, Lipoprotein(a) [LP(a)], total cholesterol (TC), triglyceride (TG) and low density lipoprotein cholesterol (LDL-C) were detected in 130 cases of aged ICVD, as well as in 43 cases of healthy aged control.ResultsIGF-1 level in aged ICVD group was remarkably lower than that in control(P<0.05), and the levels of LP(a),TC, TG and LDL-C in aged ICVD group were significantly higher than that in control (P<0.05). The serum IGF-1 level in TIA patients with infarction was mower than those without infarction (P<0.05). In aged ICVD group, the serum IGF-1 level was negatively correlated with LP(a),TC, TG and LDL-C level (P<0.01). ConclusionIGF-1 decreased in the patients of aged ICVD, which shows a close relationship about the disorder of lipid metabolism, and may play a certain role in the course of occurrence and development of aged ICVD.
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Antiplatelet therapy is a major strategy with a growing body of evidence in management of ischemic cerebrovascular diseases.This article introduces the mechanism of currently available antiplatelet drugs as well as their practice guidelines and evidence from clinical trials.There is currently no robust evidence to support the use of venous antiplatelet agents.Aspirin is the sole evidence-based antiplatelet drug for treatment of acute ischemic stroke.Aspirin,dipyridamole and clopidogrel are effective in secondary stroke prevention.Combination therapy using aspirin plus extended-release dipyridamole is the only combination approach to demonstrate additive benefit.
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BACKGROUND: The etiologies of ischemic cerebrovascular diseases are various-thrombosis or artery to artery embolism, cardiogenic embolism and lipohyalinosis. In the past embolic cerebral infarct was thought to occur uncommonly. But these days substantial portion of patients have been found to have potential embolic sources by transesophageal echo cardiography and carotid duplex doppler. As transesophageal echocardiography has a high yield for identification of potential sources of cardiac embolism in patients with ischemic cerbrovascular diseases, its use has been increasing. In Korea an increasing number of patients with ischemic cerebrovascular diseases have been examined by transesophageal echocardiography since 1990. But in all the previous studies transesophageal echocardiographic evaluation has been confined to the patients with high probability of embolic cerebral infarct. All kinds of ischemic cerebrovascular diseases patients have never been examined by transesophageal echocardiography and carotid duplex doppler and the prevalence of potential embolic sources in Korean ischemic cerebrovascular disease patients is not known. The aim of this study was to evaluate the prevalence of potential cardiovascular embolic sources by transesophageal echocardiography and carotid duplex doppler in unselected patients with ischemic cerebrovascular diseases. METHODS: We evaluated all kinds of ischemic cerebrovascular diseases patients admitted from 1994. 9. 1. until 1995 9. 31. to the Departments of Neurology and Internal Medicine of Kangnam General Hospital. We evaluated them by transesophageal echocardiography, carotid doppler, brain CT(or brain MRI). A significant carotid stenosis was defined as a duplex scandetected lesion producing at least 50% vessel narrowing. The following echocardiographic findings were defined prospectively as potential cardiac sources of embolism : atrial appendage or left atrial cavity thrombus, spontaneous echocardiographic contrast, atrial septal aneurysm, interatrial shunt, ventricular aneurysm, ventricular thrombus, myxomatous mitral valve and protruding atherosclerotic plaque in the ascending aorta or transverse aortic arch. RESULTS: Of 64 patients admitted during the study period, 30 were excluded(Three patients were critically ill, and twenty seven patients refused diagnostic work-up.). Thorough diagnostic work-up was performed in 34 patients. Transesophageal echocardiographic positive findings were present in six patients(17.6%). Of them four(4/34, 11.7%) had spontaneous echo contrast, two(2/34, 5.8%) had left atrial thrombi, one(1/34, 2.9%) had ascending aorta atheroma. Eleven patients(11/34, 32.3%) had abnormalities in carotid doppler study. Five patients(5/34, 14.7%) had abnormalities both in transesophageal echocardiography and carotid doppler study. CONCLUSIONS: The results suggest that among ischemic cerebrovascular diseases patients substantial portion of patients have potential embolic sources. The prevalence of potential embolic sources in Korea may be higher than previously expected. Because the relative small number of the patients studied make it difficult to generalize the results, further studies with a large number of patients are needed.