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Objective To investigate the relationship between cerebral atrophy and total burden of cerebral small vessel disease in patients with recent small subcortical infarct(RSSI).Methods A total of 194 elderly RSSI patients admitted to Department of Neurology of Changzhou Second People's Hospital Affiliated to Nanjing Medical University from September 2021 to November 2022 were recruited in this study.All patients completed cranial MRI examination and were divid-ed into a non-mild group 1(97 cases)and a moderate to severe group 1(97 cases)based on the to-tal burden of cerebral small vessel diseases(CSVD)imaging.Visual assessment scale was used to assess the severity of brain atrophy in the whole brain and various regions of the brain.According to the global cortical atrophy scale(GCA)score,all patients were divided into a non-mild group 2(88 cases)and a moderate to severe group 2(106 cases).Brain atrophy in various regions,medial temporal lobe atrophy(MTA)score,frontal temporal lobe atrophy(FTA)score,and posterior cortical atrophy(PA)score were evaluated.Their general clinical and imaging data were collected,multivariate logistic regression analysis was employed to analyze the relationship between GCA score and total burden of CSVD imaging in RSSI patients,and Spearman correlation analysis was further adopted to explore the correlation of GCA score and different parts of brain atrophy with total burden of CSVD imaging.Results When compared with the non-mild group 1,the moderate to severe group 1 had significantly larger proportions of having GCA score of 2-3 points,PA score of 2-3 points,MTA score of 2-4 points and FTA score of 2-4 points(P＜0.01).The ra-tio of having 2-4 points in total imaging burden score of CSVD was obviously higher in the mod-erate to severe group 2 than the non-mild group 2(P＜0.01).Multivariate logistic regression anal-ysis showed that age and total burden of CSVD imaging were independent risk factors for brain atrophy in RSSI patients(OR=1.184,95％CI:1.099-1.276,P=0.000;OR=3.537,95％CI:1.664-7.518,P=0.001).Spearman correlation analysis revealed that the total burden score of CSVD imaging was positively correlated with GCA,MTA,FTA and PA scores in RSSI patients(r=0.518,r=0.382,r=0.471,r=0.388,P=0.000).Conclusion The total burden of CSVD is an independent risk factor for GCA in elderly RSSI patients.The more serious the total burden of CSVD is,the higher the grade of GCA is.The total burden of CSVD is related to the whole brain and brain atrophy in other different regions of the brain.
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Objective To explore the relationship between optic nerve tissue thickness and enlarged perivascular space(EPVS)in patients with recent small subcortical infarct(RSSI).Methods A total of 72 RSSI patients admitted to Department of Neurology of Changzhou Second People's Hospital affiliated to Nanjing Medical University from November 2021 to December 2022 were re-cruited in this study.All patients underwent cranial MRI,optical coherence tomography(OCT)and fundus photography.The thickness of retinal nerve fiber layer(RNFL)and ganglion cell-inner plexiform layer(GCL-IPL)were measured by software semi-automatic segmentation,and fundus lesions such as fundus hemorrhage and exudation were observed through fundus photography.The severity of EPVS was graded by visual quantitative evaluation,and then the patients were divided into no to mild EPVS group(32 cases)and moderate to severe EPVS group(40 cases).Basal gan-glia EPVS(BG-EPVS)and semioval center EPVS(CSO-EPVS)were further graded and grouped into no to mild BG-EPVS group(31 cases)and moderate and severe BG-EPVS group(41 cases),and no to mild CSO-EPVS group(39 cases)and moderate and severe CSO-EPVS group(33 cases).The clinical data of each group were compared separately.Results There were statistical differences in age,ratio of hypertension and thicknesses of RNFL and GCL-IPL between the no to mild EPVS group and the moderate to severe EPVS group(P＜0.05,P＜0.01),between the no to mild BG-EPVS and the moderate to severe BG-EPVS group(P＜0.01).Multivariate logistic re-gression analysis showed that age(OR=1.207,95％CI:1.028-1.416,P=0.021),hypertension(OR=7.264,95％CI:1.079-11.929,P=0.042),RNFL thickness(OR=0.753,95％CI:0.617-0.915,P=0.004)and GCL-IPL thickness(OR=0.848,95％CI:0.758-0.949,P=0.004)were independent factors of BG-EPVS grade.Spearman correlation analysis indicated that the thicknes-ses of RNFL and GCL-IPL were negatively correlated with BG-EPVS grade(r=-0.571,r=-0.649,P＜0.01).Conclusion RNFL and GCL-IPL thicknesses are independent factors for BG-EPVS grade and negatively correlated with BG-EPVS grade.OCT has important clinical value in assessing the severity of EPVS lesions in RSSI patients.
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Objective:To identify the influencing factors for cognitive impairment in patients with recent small subcortical infarct (RSSI), and explore the relationship between enlarged perivascular space (EPVS) and executive function in patients with RSSI.Methods:From February to December 2021, 115 patients with RSSI accepted treatment in Department of Neurology, Changzhou Second People's Hospital Affiliated to Nanjing Medical University were enrolled. According to Montreal cognitive assessment (MoCA) scores, these patients were divided into normal cognitive function group (MoCA scores≥26, n=45) and cognitive impairment group (MoCA scores<26, n=70); univariate analysis was used to analyze the differences of general clinical data and EPVS volume between the two groups; multivariate Logistic regression analysis was used to identify the independent influencing factors for RSSI combined with cognitive impairment. Patients were further divided into EPVS non-mild group and EPVS moderate-severe group according to EPVS visual assessment; the differences of scores of different executive function domains were compared between the two groups; Spearman correlation analysis was used to observe the relationships of EPVS grading and volume with executive function. Results:Patients in the cognitive impairment group had significantly older age, significantly higher serum creatinine level, proportion of patients with moderate-severe basal ganglia EPVS (BG-EPVS) and BG-EPVS volume, and significantly lower years of education as compared with those in the normal cognitive function group ( P<0.05). Multivariate Logistic regression analysis showed that BG-EPVS volume ( OR=1.421, 95%CI: 1.028-1.965, P=0.034) was an independent risk factor for RSSI combined with cognitive impairment. MoCA total scores, scores of visual space and executive function domains in patients of the BG-EPVS moderate-severe group were significantly lower than those in patients of the BG-EPVS non-mild group, while Z-scores of Stroop color word test (SCWT) and trail making test (TMT), and total Z-scores of executive function were significantly higher than those in patients of the BG-EPVS non-mild group ( P<0.05). Spearman correlation analysis showed that BG-EPVS grading and volume were positively correlated with total Z-scores of executive function in RSSI patients with cognitive impairment ( r=0.439, P=0.001; r=0.410, P=0.001). Conclusion:BG-EPVS volume is an independent risk factor for cognitive impairment, and both BG-EPVS grading and volume are correlated with impairment degrees of executive function in cognitive function in RSSI patients.
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Objective:To evaluate the visibility of intracranial deep medullary vein (DMV) by sensitivity weighted imaging (SWI), and explore its correlation with recent small subcortical infarct (RSSI).Methods:From March 2021 to May 2022, 277 patients with cerebral small vascular disease (CSVD) confirmed by cranial MRI in Department of Neurology, Third Hospital of Hebei Medical University, were consecutively enrolled. These patients were divided into RSSI group ( n=128) and non-RSSI group ( n=149) according to RSSI presence or not within one week of onset. According to the DMV scores, these patients were divided into mild-moderate DMV group (0-12 scores, n=199) and severe DMV group (13-18 scores, n=78). The clinical and imaging data of these groups were analyzed retrospectively and compared. Multivariate Logistic regression analysis was used to determine the correlation between DMV and RSSI, as well as the independent influencing factors for DMV grading. Results:The cerebral microbleed (CMB), periventricular white matter hyperintensity (WMH) scores, deep WMH scores, total WMH scores, total CSVD burden scores, and DMV scores in patients of the RSSI group were significantly higher than those in the non-RSSI group ( P<0.05); and patients in the RSSI group had significantly younger age and significantly lower high density lipoprotein cholesterol (HDL-C) level than those in the non-RSSI group ( P<0.05). Multivariate Logistic regression analysis showed that DMV score ( OR=1.142, 95%CI: 1.026-1.271, P=0.016) was an independent influencing factor for RSSI after adjusting for HDL-C and deep WMH scores. The severe DMV group had significantly older age, statistically higher percentages of patients having history of hypertension, CMB, lacuna and moderate to severe EPVS in basal ganglia, and significantly higher periventricular WMH scores, deep WMH scores, total WMH scores, and total CSVD burden scores as compared with the mild-moderate DMV group ( P<0.05). Multivariate Logistic regression analysis showed that age ( OR=1.101, 95%CI: 1.060-1.143, P<0.001) and total CSVD burden scores ( OR=3.589, 95%CI: 2.506-5.141, P<0.001) were independent influencing factors for DMV scores. Conclusion:DMV is involved in the mechanism of RSSI, and DMV visibility can be used as an indicator to diagnose RSSI and evaluate RSSI progression.