Effects of " acupuncture on cerebral blood flow in patients with high risk of cerebral ischemic stroke based on ASL and PWI technique / 中国针灸

OBJECTIVE@#To observe the effects of "" acupuncture on cerebral blood flow in high-risk patients of cerebral ischemic stroke based on arterial spin labeling (ASL) and perfusion-weighted imaging (PWI), and to evaluate the clinical efficacy.@*METHODS@#A total of 180 patients with transient ischemic attacks (TIA) / minor ischemic stroke (MIS) were randomly divided into an acupuncture A group, an acupuncture B group and a medication group, 60 cases in each group. The patients in the acupuncture A group were treated with "" acupuncture at Baihui (GV 20), Fengfu (GV 16), Yamen (GV 15), Dazhui (GV 14), Shenzhu (GV 12), Zhiyang (GV 9), Mingmen (GV 4), Yaoyangguan (GV 3) and Jingjiaji (EX-B 2), once a day; the patients in the acupuncture B group were treated with identical acupoints but was given once every other day; the patients in the medication group were treated with oral administration of nimodipine tablets, 30 mg, three times daily. All the three groups were treated for four weeks. ASL and PWI, including relative cerebral blood volume (rCBV), relative cerebral blood flow (rCBF), relative mean transit time (rMTT) and relative time to peak (rTTP), were conducted before and after treatment; the changes of the test indexes were compared before and after treatment. The clinical efficacy of the three groups was compared.@*RESULTS@#Compared before treatment, the numbers of ASL normal perfusion in the 3 groups were significantly increased after treatment (all 0.05). Compared before treatment, rCBV and rCBF in the 3 groups were significantly increased after treatment (all 0.05). The total effective rate was 88.3% (53/60) in the acupuncture A group, 73.3% (44/60) in the acupuncture B group and 90.0% (54/60) in the medication group; the total effective rate in the acupuncture A group was superior to that in the acupuncture B group (0.05).@*CONCLUSION@#"" acupuncture could effectively improve the hypoperfusion of cerebral blood flow in patients with high risk of cerebral ischemic stroke, reduce the incidence of severe CIS; acupuncture for once a day is better than once every other day.

Role of Perfusion-Weighted Imaging in a Diffusion-Weighted-Imaging-Negative Transient Ischemic Attack

BACKGROUND AND PURPOSE: The absence of acute ischemic lesions in diffusion-weighted imaging (DWI) in transient ischemic attack (TIA) patients makes it difficult to diagnose the true vascular etiologies. Among patients with DWI-negative TIA, we investigated whether the presence of a perfusion-weighted imaging (PWI) abnormality implied a true vascular event by identifying new acute ischemic lesions in follow-up magnetic resonance imaging (MRI) in areas corresponding to the initial PWI abnormality. METHODS: The included patients underwent DWI and PWI within 72 hours of TIA and also follow-up DWI at 3 days after the initial MRI. These patients had visited the emergency room between July 2009 and May 2015. Patients who demonstrated initial DWI lesions were excluded. The initial PWI abnormalities in the corresponding vascular territory were visually classified into three patterns: no abnormality, focal abnormality, and territorial abnormality. RESULTS: No DWI lesions were evident in initial MRI in 345 of the 443 TIA patients. Follow-up DWI was applied to 87 of these 345 DWI-negative TIA patients. Initial PWI abnormalities were significantly associated with follow-up DWI abnormalities: 8 of 43 patients with no PWI abnormalities (18.6%) had new ischemic lesions, whereas 13 of 16 patients with focal perfusion abnormalities (81.2%) had new ischemic lesions in the areas of initial PWI abnormalities [odds ratio (OR)=15.1, 95% confidence interval (CI)=3.6–62.9], and 14 of 28 patients with territorial perfusion abnormalities (50%) had new lesions (OR=3.7, 95% CI=1.2–11.5). CONCLUSIONS: PWI is useful in defining whether or not the transient neurological symptoms in DWI-negative TIA are true vascular events, and will help to improve the understanding of the pathomechanism of TIA.

The Characteristics of Vestibular Autorotation Test in Patients with the Posterior Circulation Transient Ischemic Attacks / 听力学及言语疾病杂志

Objective To study the characteristics of vestibular autorotation test (VAT) in patients with the posterior circulation transient ischemic attacks(PCTIA) ,further reveal the pathogenesis vestibular function damage because of PCTIA .Methods VAT was performed on 41 patients with posterior circulation transient ischemic at‐tacks(PCTIA group) and 30 healthy controls(control group) .Parameters analyzed included gains ,phases and a‐symmetry of VAT .The positive result of the test could be defined if any of the paramaeters was abnormal .Results In the PCTIA group and control group ,gains were enhanced without being reduced as showed in 25 (62 .5% ,25/40) cases and 5(16 .7% ) ,respectively (χ2 =7 .09 ,P<0 .01) ,gains were enhanced with reduced as showed in 10(25% ) cases and 0(0% ) ,respectively (χ2 =8 .78 ,P<0 .01) .Conclusion The results of VAT in patients with the PCTIA can show gains enhanced with reduced in different frequency .VAT can provide valuable reference on positioning as‐sessment of vestibular system damage in patients with PCTIA .

Relationship between Duration of Transient Ischemic Attacks and Prognosis:36 Case Report / 中国康复理论与实践

@#ObjectiveTo explore the relationship between the duration, MRI characters and prognosis in transient ischemic attack (TIA). Methods36 TIA cases were retrospectively analyzed according to the duration and Magnetic Resonance Imaging Diffusion Weighted Imaging(MRI-DWI). They were divided into two groups, Group A (13 cases) in which TIA continued within 1 h and Group B (23cases) in which TIA continued for 1～24 h. The patients were followed up 3 months and 12 months later. ResultsMRI abnormalities could be found with MRI-DWI in 2 cases in Group A, but 17 cases in group B(χ2=11.416,P=0.001). 1 case in Group A and 14 cases in Group B occurred cerebral infarction within a year(χ2=9.663,P=0.004). ConclusionThe longer TIA duration, the worse the prognosis.

Recurrent Sensory Transient Ischemic Attacks treated by Urgent Endovascular Revascularization

A 47-year-old man presented with recurrent transient right hemiparesthesia and right homonymous hemianopsia. The transient ischemic attacks (TIAs) may be related to hemodynamic disturbance caused by acute occlusion of the internal carotid artery with severe stenosis of the ipsilateral posterior cerebral artery. After urgent endovascular revascularization of the internal carotid artery, there were no further attacks. Our case suggests that repetitive sensory TIAs can be induced by a hemodynamic disturbance caused by a large artery stenosis, which can be prevented with urgent endovascular treatment.

Effect of batroxobin on the levels of neuron-specific enolase and endothelin in plasm of patients with transient ischemic attacks and its significance / 临床神经病学杂志

Objective To investigate the effect and significance of batroxobin on the levels of neuron-specific enolase(NSE) and endothelin(ET) in plasm of patients with transient ischemic attacks(TIAs).Methods 120 cases of carotid territory TIAs(

The profile of transient ischemic attacks in younger patients / 中国实用内科杂志

Objective To evaluate the profile of transient ischemic attacks in younger patients compared with older patients effectively.Methods We study 75 younger patients(≤45 years)compared with 90 older patients(≥65 years).History of presenting transient ischemic attacks,etiology,clinical feature and lab investigation were compared on the basis of the above age groups.Results Overweight、hypercholesterolemia、insomnia and vascular disease family history being more common in the younger group and Hypertension,ischemic heart disease,long-term history of smoking being more common in the elder group.Diabetes and high serum uric acid occurred high frequently in both groups.Conclusion A significant correlation existed between etiologies contribution and adverse life custom,the early management should be take up to prevent TIA occurrence.

The Evaluation of Cranial and Cervical Arteries and the Brain in TIA Patients with MRA and DWI / 实用放射学杂志

Objective To evaluate magnetic resonance angiography(MRA) and diffusion weighted imaging(DWI) features of transient ischemic attacks(TIA).Methods 40 patients with TIA were chosen as study subjects,and 34 healthy adults and 36 cases with brain infarction were randomly chosen as control subjects.MRA and DWI was performed with a superconductive GE 1.5T system.The relationship between TIA and the degree and distribution of stenosis of cranial and cervical arteries,the development of the vessels,DWI findings of the brain was analyzed.Results There were significant differences among the three groups in the number and the degree of stenosis of cranial and cervical arteries(P=0.006).The stenosis and occlusion of arteries were severe in the patients with TIA and brain infarctions than that in healthy adults(P=0.004,0.015),but there were no significant differences between TIA and brain infarctions(P=0.148).The incidence of dysplasia of unilateral vertebral arteries(VA) in TIA was higher than that in the normal subjects(P=0.039).The internal carotid artery(ICA)system supplying to the regions of brain tended to show more ischemic focus on DWI(4/8,50%) in the cases with TIA.Conclusion Severe stenosis or occlusion and irregular filling defects of cervical and cranial arteries in patients with TIA might be one of the risk factors for severe ischemia stroke.The hypoplastic VA was one of predisposing factor for TIA.

Anesthetic Management of Carotid Endarterectomy: A case report / 대한마취과학회지

Carotid endarterectomy is the preferred treatment for a patient with transient ischemic attacks (TIAs) in whom carotid artery stenosis is present. This patient was a 58-year-old male associated with 60 kg in body weight and 172 cm in height. He was scheduled for elective carotid endarterectomy in ASA physical status III. For premedication, he was administered triflupromazine (Veprin ) 10 mg and glycopyrrolate 0.2 mg IM 1 hour prior to induction. Induction was established with thiopental sodium, succinylcholine after preoxygenation. N2O/O2 (2:1), isoflurane and pancuronium were administered for maintenance. For monitoring, ECG, EEG, direct arterial pressure, ETCO2, CVP and rectal temperature were performed. A primary goal of the intraoperative management is the prevention of the cerebral ischemia. He was challenged to maintain adequate cerebral perfusion without causing myocardial ischemia. The EEG is the reliable indication of cortical function during general anesthesia. No signs of the cerebral ischemia were occurred at the time of the carotid occlusion. Minute ventilation was kept mild hypo-or normocapnia. He had no new neurologic deficits and myocardial ischemia, and discharged on 14 day postoperation.

Anesthetic Management of Carotid Endarterectomy: A case report / 대한마취과학회지

Carotid endarterectomy is the preferred treatment for a patient with transient ischemic attacks (TIAs) in whom carotid artery stenosis is present. This patient was a 58-year-old male associated with 60 kg in body weight and 172 cm in height. He was scheduled for elective carotid endarterectomy in ASA physical status III. For premedication, he was administered triflupromazine (Veprin ) 10 mg and glycopyrrolate 0.2 mg IM 1 hour prior to induction. Induction was established with thiopental sodium, succinylcholine after preoxygenation. N2O/O2 (2:1), isoflurane and pancuronium were administered for maintenance. For monitoring, ECG, EEG, direct arterial pressure, ETCO2, CVP and rectal temperature were performed. A primary goal of the intraoperative management is the prevention of the cerebral ischemia. He was challenged to maintain adequate cerebral perfusion without causing myocardial ischemia. The EEG is the reliable indication of cortical function during general anesthesia. No signs of the cerebral ischemia were occurred at the time of the carotid occlusion. Minute ventilation was kept mild hypo-or normocapnia. He had no new neurologic deficits and myocardial ischemia, and discharged on 14 day postoperation.