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Abstract Background Ischemic stroke is an important cause of death in the world. The malignant middle cerebral artery infarction (MMCAI) has mortality as high as 80% when clinically treated. In this setting, decompressive craniectomy is a life-saving measure, in spite of high morbidity among survivors. Objective To evaluate the outcomes of patients with MMCAI treated with decompressive craniectomy in a Brazilian academic tertiary stroke center. Methods A prospective stroke database was retrospectively evaluated, and all patients treated with decompressive craniectomy for MMCAI between January 2014 and December 2017 were included. The demographics and clinical characteristics were evaluated. The functional outcome, measured by the modified Rankin Scale (mRS), was assessed at hospital discharge, after 3-months and 1-year of follow-up. Results We included 53 patients on the final analysis. The mean age was 54.6 ± 11.6 years and 64.2% were males. The median time from symptoms to admission was 4.8 (3-9.7) hours and the mean time from symptoms to surgery was 36 ± 17 hours. The left hemisphere was the affected in 39.6%. The median NIHSS at admission was 20 (16-24). The in-hospital mortality was 30.2%. After a median of 337 [157-393] days, 47.1% of patients had achieved favorable outcome (mRS ≤ 4) and 39.6% had died. Conclusion Decompressive craniectomy is a life-saving measure in the setting of MMCAI, and its effects remains important in the scenario of a middle-income country in real-world situations.
Resumo Antecedentes O acidente vascular cerebral (AVC) isquêmico é uma causa importante da morte em todo o mundo. O infarto maligno da artéria cerebral média (IMACM) tem mortalidade de até 80% quando tratado clinicamente. Nesse contexto, a craniectomia descompressiva é uma medida salvadora de vidas, apesar da alta morbidade entre os sobreviventes. Objetivo Avaliar os desfechos dos pacientes com IMACM tratados com craniectomia descompressiva em um centro acadêmico terciário de AVC no Brasil. Métodos Um banco de dados prospectivo de AVC foi avaliado retrospectivamente e todos os pacientes tratados com craniectomia descompressiva para IMACM entre janeiro de 2014 e dezembro de 2017 foram incluídos. As características clínicas e demográficas foram avaliadas. Os desfechos funcionais, medidos pela escala modificada da Rankin (mRS), foram avaliados na alta hospitalar, após 3 meses e após 1 ano de seguimento. Resultados Foram incluídos 53 pacientes na análise final. A idade média foi 54,6 ± 11,6 anos e 64,2% eram homens. A mediana do tempo dos sintomas à admissão foi 4,8 (3-9,7) horas e o tempo médio dos sintomas à cirurgia foi 36 ± 17 horas. O hemisfério esquerdo foi o afetado em 39,6%. A pontuação na escala de AVC do National Institute of Health (NIHSS) à admissão foi 20 (16-24). A mortalidade hospitalar foi 30,2%. Após uma mediana de 337 (157-393) dias, 47,1% dos pacientes tinham atingido um desfecho favorável (mRS ≤ 4) e 39,6% tinham morrido. Conclusão Craniectomia descompressiva é uma medida salvadora de vidas no contexto do IMACM e seus efeitos permanecem importantes no cenário de um país em desenvolvimento em situação de vida real.
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Abstract Background Brain edema is the leading cause of death in patients with malignant middle cerebral artery (MCA) infarction. Midline shift (MLS) has been used as a monohemispheric brain edema marker in several studies; however, it does not precisely measure brain edema. It is now possible to directly measure hemisphere brain volume. Knowledge about the time course of brain edema after malignant middle cerebral artery infarction may contribute to the condition's management. Objective Therefore, our goal was to evaluate the course of brain edema in patients with malignant MCA infarction treated with decompressive craniectomy (DC) using hemispheric volumetric measurements. Methods Patients were selected consecutively from a single tertiary hospital between 2013 and 2019. All patients were diagnosed with malignant middle cerebral artery infarction and underwent a decompressive craniectomy (DC) to treat the ischemic event. All computed tomography (CT) exams performed during the clinical care of these patients were analyzed, and the whole ischemic hemisphere volume was calculated for each CT scan. Results We analyzed 43 patients (197 CT exams). Patients' mean age at DC was 51.72 [range: 42-68] years. The mean time between the ischemic ictus and DC was 41.88 (range: 6-77) hours. The mean time between the ischemic event and the peak of hemisphere volume was 168.84 (95% confidence interval [142.08, 195.59]) hours. Conclusion In conclusion, the peak of cerebral edema in malignant MCA infarction after DC occurred on the 7th day (168.84 h) after stroke symptoms onset. Further studies evaluating therapies for brain edema even after DC should be investigated.
Resumo Antecedentes O edema cerebral é a principal causa de morte em pacientes com infarto maligno de artéria cerebral média. O desvio da linha média tem sido utilizado como marcador de edema cerebral mono-hemisférico em alguns estudos; porém, ele não mede de forma precisa o edema cerebral. Atualmente é possível mensurar diretamente o volume do hemisfério cerebral. O conhecimento sobre a evolução temporal do edema cerebral após infartos malignos da artéria cerebral média pode contribuir para o cuidado clínico desta condição. Objetivo Nosso objetivo é avaliar o edema hemisférico ao longo do tempo, em pacientes com infarto maligno da artéria cerebral média, tratados com craniectomia descompressiva. Métodos Os pacientes foram selecionados de forma consecutiva, em um hospital terciário, entre 2013 e 2019. Todos os pacientes apresentavam diagnóstico de infarto maligno de artéria cerebral média e foram submetidos a craniectomia descompressiva. Todas as tomografias computadorizadas de crânio destes pacientes foram analizadas, e o volume do hemisfério cerebral infartado foi mensurado. Resultados Analisamos 43 pacientes (197 tomografias de crânio). A idade média dos pacientes na craniectomia descompressiva foi 51,72 (42-68) anos. O tempo médio entre o ictus e a craniectomia descompressiva foi 41,88 (6-77) horas. O tempo médio entre o ictus e o pico do volume hemisférico foi 168,84 (142,08-195,59) horas. Conclusão O pico do volume cerebral em pacientes com infarto maligno de artéria cerebral média submetidos a craniectomia descompressiva ocorreu no 7o dia (168,84 horas) após o infarto. Mais estudos avaliando terapêuticas direcionadas ao edema cerebral seriam úteis neste contexto.
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Objective:To analyze the prehospital predictors of large-vessel occlusion (LVO) in acute ischemic stroke.Methods:This study recruited patients who had developed LVO for less than 24 hours and had a National Institute of Health Stroke Scale (NIHSS) score ≥ 8 and who received treatment in Lu'an People's Hospital from December 2018 to November 2020. The included patients were divided into LVO and LVO-free groups according to the presence of a large-vessel occlusion determined by magnetic resonance angiography, CT angiography, and digital subtraction angiography. Baseline data (sex, age, disease history, life history, and medication history), NIHSS subscale score, and blood pressure at admission were compared between LVO and LVO-free groups. The efficacy of the factors that were screened for predicting LVO in acute ischemic stroke were compared with the that of commonly used scales.Results:A total of 761 patients with acute ischemic stroke who had an NIHSS score ≥ 8 were included in the final analysis. Among them, 228 patients had an LVO and 533 patients had no LVO. There were significant differences in the proportions of patients with atrial fibrillation ( OR = 5.230, 95% CI = 3.400-8.043, P < 0.001) and systolic blood pressure ≤ 170 mmHg ( OR = 5.181, 95% CI = 3.327-8.068, P < 0.001) between the two groups. Conclusion:Atrial fibrillation and systolic blood pressure ≤ 170 mmHg are greatly associated with the presence of large-vessel occlusion in acute ischemic stroke.
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Objective: To observe the effects of electroacupuncture (EA) pretreatment on motor function, cerebral blood flow, cerebral infarction volume, and vascular endothelial growth factor (VEGF) level in middle cerebral artery occlusion (MCAO) model rats. Methods: Twenty-four male Sprague-Dawley rats were randomly divided into a normal group, a model group, and an EA group, with eight rats in each group. The middle cerebral artery ischemia-reperfusion model was established by the suture-occluded method in the model group and the EA group, while not in the normal group. The EA group was pretreated with EA at bilateral Fengchi (GB20) before model preparation, once a day for 30 min each time for a total of 7 d. The changes in the CatWalk gait parameters, modified Bederson neurological deficit score, cerebral blood flow, cerebral infarction volume after ischemia, and VEGF level in the brain tissue of rats in each group were observed. Results: Compared with the normal group, the modified Bederson neurological deficit score in the model group and the EA group increased after modeling (P<0.05), and the CatWalk gait parameters (one-leg stance duration, gait cadence, and gait cycle) were all changed (P<0.05). Compared with the model group, the modified Bederson neurological deficit score in the EA group decreased (P<0.05), and the CatWalk gait parameters improved (P<0.05). Immediately after ischemia, the cerebral blood flow in the normal group was greater than that in the model group and the EA group (P<0.05); after reperfusion, the cerebral blood flow in the EA group was greater than that in the model group (P<0.05). Compared with the normal group, the cerebral infarction volume in the model group and the EA group increased (P<0.05). Compared with the model group, the cerebral infarction volume in the EA group decreased (P<0.05). The expression level of VEGF-positive cells in the rat brain tissue in the model group was higher than that in the normal group (P<0.05), and was higher in the EA group than in the model group (P<0.05). Conclusion: EA pretreatment improves the limb motor function in MCAO model rats, alleviates the symptoms of neurological deficits, promotes the recovery of cerebral blood flow, reduces the cerebral infarction area after MCAO modeling, and increases the VEGF expression in the brain tissue.
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Middle cerebral artery dissection is an uncommon cause of ischemic stroke in young adults, which is extremely rare in the case that it occurs in HIV-infected patients. This article reported a 26-year-old acute cerebral infarction patient with HIV antigen/antibody-positive who started with capsular warning syndrome and progressed to right basal ganglia cerebral infarction. The high-resolution vessel wall imaging showed the characteristic findings of middle cerebral artery dissection including "double luminal" and "intimal flap" signs. The coexistence of HIV-associated vasculopathy and hypertension with high blood pressure variability contributed to the occurrence of middle cerebral artery dissection in the patient. Combined with literature reports, this paper will further explore the relationship between HIV infection and cerebrovascular disease and the possible mechanism of middle cerebral artery dissection.
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Objective:To investigate the correlation of fluid-attenuation inversion recovery (FLAIR) vascular hyperintensity (FVH) and clinical outcome in patients with middle cerebral artery M1 occlusive stroke.Methods:Patients with acute middle cerebral artery M1 occlusive stroke admitted to the Department of Neurology, the Second Affiliated Hospital of Anhui Medical University from June 2018 to September 2019 were enrolled retrospectively. The demographic and clinical data were collected. Diffusion-weighted imaging (DWI)-Alberta Stroke Program Early CT Score (ASPECTS) and FVH score were performed with MRI images. The modified Rankin Scale (MRS) was used to evaluate the clinical outcome at 90 d after onset. 0-2 was defined as good outcome, and >2 was defined as poor outcome. Multivariate logistic regression analysis was used to determine the independent correlation between FVH and the outcome. Results:A total of 65 patients with acute middle cerebral artery M1 occlusive stroke were enrolled, including 37 males (56.9%). Their age was 64.35±12.13 years. Twenty-nine patients (44.6%) had a good outcome, and 36 (55.4%) had a poor outcome. There were significant differences in triglyceride ( P=0.037), antihypertensive drug treatment ( P=0.037), baseline National Institutes of Health Stroke Scale (NIHSS) score ( P<0.001), DWI-ASPECTS ( P=0.017) and FVH score ( P<0.001) between the poor outcome group and the good outcome group. Multivariate logistic regression analysis showed that FVH score (odds ratio 6.477, 95% confidence interval 1.570-26.716; P=0.010) and NIHSS score (odds ratio 1.869, 95% confidence interval 1.326-2.635; P<0.001) were significantly independently correlated with the poor outcome. However, there was no significant independent correlation between DWI-ASPECTS and the outcome (odds ratio 0.451, 95% confidence interval 0.068-2.988; P=0.410). Conclusions:FVH score is an independent risk factor for poor outcome in patients with acute middle cerebral artery M1 occlusive stroke.
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Objective:To investigate the risk factors for different types of single subcortical infarction (SSI) in middle cerebral artery territory and the risk factors for early neurologic deterioration (END).Methods:Patients with SSI in middle cerebral artery territory admitted to the Department of Neurology, People's Hospital Affiliated to Jiangsu University from January 2020 to April 2021 were enrolled retrospectively. According to the distribution of infarction, the patients were divided into proximal SSI (pSSI) and distal SSI (dSSI). The demographics, vascular risk factors and baseline clinical data were collected. END was defined as new signs and/or symptoms of neurological deficit or aggravation of any neurological deficit within 2 weeks after onset. Multivariate logistic regression analysis was used to determine the independent risk factors for pSSI and END. Results:Seventy-six patients with acute SSI in the middle cerebral artery territory were included, 41 patients (53.9%) in the pSSI group, 35 (46.1%) in the dSSI group; 13 (17.1%) in the END group, and 63 (82.9%) in the non-END group. There were no significant differences in age, gender, vascular risk factors and baseline National Institutes of Health Stroke Scale score between the pSSI group and the dSSI group. The total cholesterol, fasting blood glucose levels and the ratio of pSSI in the END group were significantly higher than those in the non-END group ( P<0.05), while the high-density lipoprotein cholesterol level was significantly lower than that of the non-END group ( P<0.05). Multivariate logistic regression analysis showed that pSSI was an independent risk factor for the occurrence of END in patients with SSI (odds ratio 6.75, 95% confidence interval 1.26-36.23; P=0.026). Conclusion:There was no significant difference in risk factors between pSSI and dSSI, but patients with pSSI were more prone to END.
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Objective To investigate the effect of Danhong injection combined with edaravone in the treatment of patients with acute cerebral infarction,and its influence on cytokines,cerebral hemodynamics and vascular endothelial function.Methods From March 2018 to March 2019,142 patients with acute cerebral infarction treated in the People's Hospital of Yuhuan were randomly divided into treatment group and control group according to the digital table,with 71 cases in each group.The treatment group was treated with Danhong injection combined with edaravone,while the control group was only treated with edaravone.Both two groups were treated for 2 weeks.The therapeutic effects,changes of cytokines,cerebral hemodynamics,vascular endothelial function,activity of daily living index(Barthel index) and neurological deficit score(NIHSS score) before and after treatment were compared between the two groups.Results The total effective rate of the treatment group was 90.14％ (64/71),which was higher than 74.65％ (53/71) of the control group,the difference was statistically significant(x2 =5.874,P ＜ 0.05).After treatment,the serum levels of CRP [(5.43 ± 1.20) mg/L] and IL-6 [(32.15 ± 7.39) ng/L] in the treatment group were lower than those in the control group [(9.38 ± 1.74) mg/L and (67.43 ± 10.29) ng/L] (t =15.747,23.465,all P ＜0.05).After treatment,the Vp [(69.83 ± 3.24) v ·-1 · s-1] and Vm [(35.24 ± 2.10) v ·-1 · s-1] in the treatment group were higher than those in the control group [(63.81 ± 2.68) v ·-1 · s-1 and (32.18 ± 1.73) v ·-1s-1],while the PI in the treatment group [(0.72 ± 0.04)] was lower than that in the control group [(0.83 ±0.07)],the differences were statistically significant (t =12.064,9.477,11.497,all P ＜ 0.05).After treatment,the serum level of ET-1 [(60.17 ± 5.46) mg/L] in the treatment group was lower than that in the control group[(73.21 ±6.78)mg/L],while the NO level in the treatment group[(72.15 ±7.39) ng/L] was higher than that in the control group [(61.43 ± 10.29) ng/L],the differences were statistically significant (t =12.622,7.130,all P ＜0.05).After treatment,the Barthel index score of the treatment group [(68.93 ± 7.83) points] was higher than that of the control group [(54.57 ± 7.38)points],while the NIHSS score of the treatment group [(9.34 ± 1.97)points] was lower than that of the control group [(14.54 ± 2.89) points],the differences were statistically significant (t =11.246,12.528,all P ＜ 0.05).Conclusion Danhong injection combined with edaravone in the treatment of acute cerebral infarction is effective,which can alleviate inflammation and improve cerebral hemodynamics and vascular endothelial dysfunction.
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Objective To investigate the correlation between the changes of serum neuron specific enolase(NSE) and hypersensitive C-reactive protein (hs-CRP) levels and the degree of neurological deficit (NIHSS)score in patients with cerebral infarction.Methods From January 2017 to January 2019,63 patients with cerebral infarction admitted to Lishui Central Hospital were selected.According to NIHSS score,they were divided into 13 mild cases,30 moderate cases and 20 severe cases.According to infarction area,they were divided into large area group(16 cases),small area group (27 cases) and lacunar infarction group (20 cases).Another 60 cases underwent health examination in our hospital from January 2017 to January 2019 were selected as the control group.Enzyme-linked immunosorbent assay (ELISA) was used to determine the content of NSE,and immunoturbidimetric assay was used to determine the content of hs-CRP.The changes of serum NSE and hs-CRP levels in the cerebral infarction group and control group,serum NSE,hs-CRP levels and NIHSS scores in different severity and infarction area,and the correlation between serum NSE and hs-CRP changes and NIHSS scores were compared.Results The serum levels of NSE [(21.34 ± 3.27) ng/mL] and hs-CRP [(10.48 ± 2.14) mg/L] in the cerebral infarction group were significantly higher than those in the control group [(6.23 ± 1.08) ng/mL,(2.83 ± 0.46) mg/L] (t =34.061,27.095,all P ＜ 0.05).The serum levels of NSE [(26.98 ± 3.64) ng/mL],hs-CRP [(15.36 ± 2.57) mg/L] and NIHSS score[(38.49 ±3.25) points] in the severe group were higher than those in the moderate group and mild group,which in the moderate group [(20.98 ± 3.21) ng/mL,(10.25 ± 2.09) mg/L and (22.18 ± 3.48) points]were higher than those in the mild group [(12.64 ± 2.78) ng/mL,(5.47 ± 1.40) mg/L and (7.38 ± 2.56)],the differences were statistically significant (F =14.975,9.132,15.873,all P ＜ 0.05).The serum levels of NSE[(25.43 ± 3.35) ng/mL],hs-CRP [(16.54 ± 2.71) mg/L] and NIHSS score [(37.34 ± 3.75) points] in the large area group were higher than those in the small area group and lacunar infarction group,which in the small area group [(21.67 ± 3.12) ng/mL,(10.86 ± 2.21) mg/L and (21.25 ± 3.26) points] were higher than those in the lacunar infarction group [(13.45 ± 2.97) ng/mL,(4.79 ± 1.35) mg/L and (8.49 ± 2.15) points],the differences were statistically significant (F =13.241,9.893,17.482,all P ＜ 0.05).The serum levels of NSE and hs-CRP were positively correlated with NIHSS score (r =0.829,0.713,all P ＜ 0.05).Conclusion The levels of serum NSE and hs-CRP in patients with cerebral infarction increase with the progression of the disease,and there is a linear positive correlation between NSE and hs-CRP and NIHSS score.It is considered that NSE and hs-CRP are of great value in evaluating the degree of neurological impairment,the severity of the disease and the size of the infarct.
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Objective To investigate the effects of butylphthalide on serum S-100 beta protein,NSE and neurological deficits in patients with cerebral infarction and reperfusion.Methods From January 2016 to January 2018,104 patients with early cerebral infarction admitted to the People's Hospital of Feicheng were divided into two groups according to different treatment methods.The control group (n =52) was given routine treatment,while the observation group (n =52) was given butylphthalide treatment on the basis of the control group.The degree of neurological deficit,serum NSE and S-100 beta protein levels were compared between the two groups before and after thrombolysis.Results The NIHSS scores of the two groups before thrombolysis were (10.27 ± 1.32) points and(10.28 ± 1.30) points,respectively,the difference between the two groups was no statistically significant(t =0.038,P ＞ 0.05).The NIHSS scores of the two groups were decreased at 24h and 7d after thrombolysis,which of the observation group at 24h and 7d after thrombolysis were (8.32 ± 1.37)points and (4.25 ± 1.54)points,respectively,which were significantly lower than those of the control group [(9.24 ± 1.40) points and (9.50 ± 1.24) points],the differences were statistically significant (t =3.396,19.147,all P ＜ 0.05).The serum NSE levels of the two groups before thrombolysis were (22.56 ± 5.78) U/mL and (22.58 ± 5.77) U/mL,respectively,the difference between the two groups was no statistically significant (t =0.017,P ＞ 0.05).At 24h and 7d after thrombolysis,the serum NSE levels of the two groups were decreased.The serum NSE levels of the observation group at 24h and 7d after thrombolysis were (15.08 ± 9.35) U/mL and (13.25 ± 6.47) U/mL,respectively,which were significantly lower than those in the control group [(18.96 ± 10.14)U/mL and (16.98 ± 7.11) U/mL],the differences were statistically significant(t =2.028,2.79,all P ＜ 0.05).The serum S-100β protein levels in the two groups before thrombolysis were(1.26 ± 0.71)μg/L and (1.27 ± 0.70)μg/L,respectively,and the difference was not significant (t =0.0723,P ＞0.05).At 24h and 7d after thrombolysis,the serum S-100β protein levels were decreased in both two groups,which in the observation group were (1.13 ± 0.62) μg/L and (0.53 ± 0.48) μg/L,respectively,which were significantly lower than those in the control group [(1.40 ± 0.64) μg/L,(0.87 ± 0.32) μg/L],the differences were statistically significant (t =2.185,4.25,all P ＜ 0.05).Conclusion Butylphthalide injection for patients with cerebral infarction and reperfusion can effectively promote the recovery of neurological function,improve the levels of serum NSE and S-100 beta protein,and help patients recover as soon as possible.
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Objective To study the effect of electric stimulation combined with Ai salt bag on shoulderhand syndrome after cerebral infarction.Methods A total of 188 patients with shoulder-hand syndrome after cerebral infarction admitted to Taizhou Central Hospital from September 2015 to August 2018 were enrolled in the study,they were randomly divided into study group (n =94) and control group (n =94) according to the random number table method.The control group was given uplink electrical stimulation treatment based on the conventional treatment for cerebral infarction and rehabilitation training,the study group was given Ai salt bag treatment on the basis of the control group.The clinical treatment effect,pain and edema VAS score,Fugl-Meyer motor function score and ADL score were observed and compared between the two groups.Results After 28 days of treatment,the total effective rate was 88.30％ (83/94) in the study group and 76.60％ (72/94) in the control group,the difference between the two groups was statistically significant (x2 =4.447,P ＜ 0.05).The VAS score of edema degree and pain degree in the study group decreased from (4.13 ± 1.40) points,(3.43 ± 2.20) points to (1.70 ± 1.36) points,(1.52 ±1.22) points,which in the control group decreased from (4.10 ± 1.46) points,(3.40 ± 2.17) points to (2.79 ±1.58) points,(2.52 ± 1.18) points,there were statistically significant differences between the two groups after treatment (t1 =5.712,t2 =5.069,all P ＜ 0.05).The Fugl-Meyer motor function score and ADL score of the study group increased from (19.91 ± 13.32) points,(42.34 ± 15.57)points to (54.21 ± 11.71) points,(86.02 ±16.62)points,which in the control group increased from (20.74 ± 11.30) points,(45.84 ± 14.44) points to(45.44 ± 12.61) points,(78.84 ± 17.79)points,there were statistically significant differences between the two groups after treatment (t1 =4.941,t2 =2.859,all P ＜ 0.05).Conclusion Electrical stimulation combined with Ai salt bag in the treatment of shoulder-hand syndrome after cerebral infarction has significant clinical effect,which can effectively alleviate the pain symptoms and swelling of the affected limb,promote the activities of daily living and improve the function of the affected limb,and is worthy of clinical application.
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Objective To observe the clinical efficacy of Eureklin in the treatment of progressive cerebral infarction in young and middle-aged people outside the thrombolytic time window (the onset time was more than 6h).Methods From March 2016 to March 2019,120 young and middle-aged patients with progressive brain infarction who admitted to the neurology department of Chaonan Minsheng Hospital were selected and all patients were confirmed by cranial CT or MRI.They were divided into two groups by random drawing method.Clinical conventional therapy was applied in the control group (60 cases),and on the basis of conventional treatment,Eureklin intravenous drips was used in the treatment group (60 cases).Before and after treatment 14d,the national institutes of health stroke scale(NIHSS),daily living ability scale(ADL) were used to assessment of neurological impairment and Barthel index in patients.At the same time,the drug side effects and adverse reactions were observed.Results After treatment,the NIHSS score in the conventional treatment group[(3.4 ± 0.3)points] was lower than that in the Eureklin group[(4.1 ± 0.4) points],and the ADLscore in the conventional treatment group [(67.5 ± 24.8) points] was higher than that in the Eureklin group[(57.8± 26.7) points],the difference was statistically significant(t =0.014,0.003,all P ＜ 0.05).The total effective rate of the treatment group [83.33％ (50/60)] was higher than that of the control group [71.67％ (43/60)],the difference was statistically significant (x2 =3.596,P ＜ 0.05).At the same time,no serious adverse reactions were found in the Eureklin treatment group.Conclusion For young and middle-aged patients with progressive cerebral infarction outside the thrombolytic time window,the application of Eureklin can improve the patients' symptoms of neurological dysfunction,improve the ability of daily life,and without serious adverse events such as bleeding,which is worthy of clinical application.
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Objective To investigate the factors influencing expansion of Virchow-Robin spaces (VRS) in basal ganglia and central semiovale.Methods One hundred and ninety-six patients with acute single lacunar infarction were analyzed retrospectively from June 2015 to June 2019 in Fukuang General Hospital of Liaoning Health Industry Group (Seventh Clinical College of China Medical University).Among them,108 patients with basal ganglia infarction and 88 patients with central semiovale infarction were included.MRI was used to evaluate the extent of VRS expansion.Univariate analysis and multivariable Logistic regression analysis were used to analyze the related factors affecting VRS expansion in basal ganglia and central semiovah.Results Univariate analysis showed that there were significant differences in the female,proportion of hypertension,systolic blood pressure and body mass index (BMI) between the mild enlarged group (48 cases) and the severe enlarged group (148 cases) of VRS expansion in basal ganglia:22 cases vs.40 cases,35.4％(17/48) vs.78.4％(116/148),(138.7 ± 14.2)mmHg (1 mmHg=0.133 kPa) vs.(150.3 ± 12.0) mmHg and (26.7 ± 2.5) kg/m2 vs.(24.1 ± 2.2) kg/m2,and there were statistical differences (P＜0.05 or ＜0.01);and there were significant differences in the proportion of hypertension,diabetes mellitus and BMI between the mild enlarged group (79 cases) and the severe enlarged group (117 cases) of VRS expansion in central semiovale (P＜0.05).Multivariable Logistic regression analysis showed that hypertension (OR=6.383,95％ CI 1.942 to 18.204,P=0.005),BMI (OR=0.768,95％ CI 0.620 to 0.938,P=0.010) significantly affected the expansion of VRS expansion in basal ganglia,while BMI significantly affected the expansion of VRS expansion in central semiovale (OR=0.784,95％ CI 0.642 to 0.921,P=0.003).Conclusions Hypertension is the independent risk factor of VRS expansion in basal ganglia,and BMI is the protective factor of VRS expansion in basal ganglia and central semiovale.
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Embolic stroke secondary to cardiac tumors is uncommon. However, 25-30% of cardiac tumors may cause systemic emboli. We report a 29-year-old male consulting for a sudden episode of aphasia and right hemiparesis, compatible with infarct of the left middle cerebral artery territory. Transthoracic echocardiography reported an ovoid tumor of 8 × 7 × 7 mm in relation to the sub valvular apparatus of the mitral valve. After neurologic stabilization, surgical treatment was performed. Approached by median sternotomy and in cardiopulmonary bypass, the mitral valve was explored. A macroscopic tumor consistent with a papillary fibroelastoma curled in sub valvular chordae was found. It was deployed and resected from its base, while the anterior mitral leaflet was preserved intact. Histopathological examination confirmed the intraoperative macroscopic diagnosis. The patient recovered uneventfully postoperatively and was discharged on the fifth day after surgery. He currently is in functional capacity I without cardiovascular symptoms at five years follow-up.
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Humans , Male , Adult , Infarction, Middle Cerebral Artery/etiology , Fibroma/complications , Heart Neoplasms/complications , Heart Valve Diseases/complications , Papillary Muscles , Echocardiography , Sternotomy , Fibroma/surgery , Fibroma/pathology , Fibroma/diagnostic imaging , Heart Neoplasms/surgery , Heart Neoplasms/pathology , Heart Neoplasms/diagnostic imaging , Heart Valve Diseases/surgery , Heart Valve Diseases/diagnostic imaging , Mitral ValveABSTRACT
Objective To investigate the effects of butylphthalide combined with edaravone on cerebral hemodynamics,vascular endothelial function and cytokines in elderly patients with acute cerebral infarction.Methods From May 2017 to May 2018,82 elderly patients with acute cerebral infarction admitted to the First People's Hospital of Wenling were selected and randomly divided into two groups according to the digital table,with 41 cases in each group.The patients in the control group were treated with edaravone,while the patients in the treatment group were treated with butylphthalide on the basis of the control group.The two groups were treated for 2 weeks.The neurological deficit scale (NIHSS),cerebral hemodynamics,vascular endothelial function and cytokines were compared between the two groups before and after treatment.Results The NIHSS score of the treatment group was (18.49 ±1.87)points,which was lower than (22.17 ± 1.32)points of the control group at 2 weeks after treatment (t =10.294,P＜0.05).The mean flow velocity [(31.70 ±3.25)cm/s],vascular resistance index (0.79 ±0.12) and maximum peak flow velocity [(54.21 ± 2.65)cm/s] in the treatment group were higher than those in the control group [(26.91 ± 4.39) cm/s,(0.61 ± 0.05) and (43.76 ± 3.10) cm/s] (t =5.615,8.866,16.407,all P ＜0.05).The contents of NO [(71.27 ± 6.58) μmol/L] and eNOS [(66.37 ± 3.65) U/mL] in the treatment group were higher than those in the control group [(62.30 ±2.71) μmol/L and (57.89 ±4.08) U/mL] (t =8.071,9.919,all P ＜ 0.05).After 2 weeks of treatment,the contents of IL-6 [(27.36 ± 2.71) pg/mL],CRP [(2.87 ±0.76) mg/L] and TNF-α[(98.24 ± 10.48) ng/mL] in the treatment group were lower than those in the control group [(43.25 ±4.10) pg/mL,(4.59 ±0.91) mg/L and (160.27 ± 15.42) ng/mL] (t =20.702,9.289,21.303,all P ＜ 0.05).The total effective rate of treatment group (90.24％) was higher than that of control group (68.29％)(x2 =6.011,P ＜ 0.05).Conclusion Butylphthalide combined with edaravone can improve cerebral hemodynamics,vascular endothelial function and alleviate cellular inflammatory reaction in elderly patients with acute cerebral infarction,and the curative effect is significant,which is worthy of clinical study.
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BACKGROUND: Acute ischemic stroke patients with malignant infarct cores were primarily treated with neurocritical care based on reperfusion and hypothermia. We evaluated the predictors for malignant progression and functional outcomes. METHODS: From January 2010 to March 2015 ischemic stroke patients with large vessel occlusion of the anterior circulation with infarct volume >82 mL on baseline diffusion weighted image (DWI) within 6 hours from onset, with National Institutes of Health Stroke Scale ≥15 were included. All patients were managed with intent for reperfusion and neurocritical care. Malignant progression was defined as clinical signs of progressive herniation. Predictive factors for malignant progression and outcomes of decompressive hemicraniectomy (DHC) were evaluated. RESULTS: In total, 49 patients were included in the study. Among them, 33 (67.3%) could be managed with neurocritical care and malignant progression was observed in the remainder. Decompressive surgery was performed in nine patients (18.4%). Factors predictive of malignant progression were initial DWI volumes (odds ratio [OR], 1.01; 95% confidence interval [CI], 1.00 to 1.02; P=0.046) and parenchymal hematoma (OR, 6.77; 95% CI, 1.50 to 30.53; P=0.013) on computed tomography taken at Day 1. Infarct volume of >210 mL predicted malignant progression with 56.3% sensitivity and 90.9% specificity. Among the malignant progressors, 77.7% resulted in grave outcomes even with DHC, while all patients who declined surgery died. CONCLUSION: Acute ischemic stroke patients with malignant cores between 82 to 209 mL can be primarily treated with neurocritical care based on reperfusion and hypothermia with feasible results. In patients undergoing surgical decompression due to malignant progression, the functional outcomes were not satisfactory.
Subject(s)
Humans , Brain Edema , Critical Care , Decompression, Surgical , Decompressive Craniectomy , Diffusion , Hematoma , Hypothermia , Hypothermia, Induced , Infarction, Middle Cerebral Artery , Reperfusion , Sensitivity and Specificity , Stroke , ThrombectomyABSTRACT
Malignant middle cerebral artery infarction (mMCAI) is a critically ill neurological disease, which often leads to the rapid deterioration of neurological function, resulting in consciousness disturbance and even death. Therefore, early identification and judgment of mMCAI to determine the need for lateral craniectomy decompression is essential to improve the survival rate of patients. With the development of neuroimaging technology, some CT and MRI parameters have been able to predict mMCAI. This article reviews the predictive value of CT and MR related parameters to mMCAI.
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Objective@#To investigate the effects of Shuxuening injection combined with edaravone on neurological function, serum vascular endothelial growth factor (VEGF) and soluble vascular cell adhesion molecule-1 (sVCAM-1) in patients with cerebral infarction.@*Methods@#A total of 112 patients with cerebral infarction admitted to Zhejiang Provincial Armed Police Hospital from August 2016 to August 2018 were enrolled in the study.They were divided into observation group and control group according to the digital table, with 56 patients in each group.The two groups were given routine symptomatic treatment.On the basis of this, the control group was given edaravone treatment, and the observation group was given Shuxuening injection combined with edaravone.The changes of NIHSS, GCS score, serum NSE, NGF, NTF, VEGF and sVCAM-1 levels before and after treatment were compared between the two groups, and the clinical efficacy was compared.@*Results@#After treatment, the effective rate of the observation group was 92.86%(52/56), which was higher than that of the control group 73.21%(41/56), the difference was statistically significant (χ2=7.669, P<0.05). After treatment, the NIHSS score, NSE, sVCAM-1 of the two groups were decreased, which of the observation group were lower than those of the control group[(3.27±1.16)points vs.(6.32±2.12)points, (13.15±1.14)μg/L vs.(17.64±1.89)μg/L, (648.56±134.67)ng/mL vs.(1 078.36±131.23)ng/mL], while the GCS score, NGF, NTF, VEGF levels of the two groups were elevated, which of the observation group were higher than those of the control group[(13.64±3.86)points vs.(11.89±3.41)points, (76.13±8.72)μg/L vs.(68.24±7.25)μg/L, (5.14±0.36)μg/L vs.(3.74±0.29)μg/L, (831.51±91.67)ng/L vs.(752.83±91.24)ng/L], the differences were statistically significant (t=9.414, 2.543, 15.223, 5.205, 22.663, 4.552, 15.672, all P<0.05).@*Conclusion@#Shuxuening injection combined with edaravone can improve the curative effect of patients with cerebral infarction, improve neurological function, effectively improve serum VEGF level and decrease sVCAM-1 level.It is worthy of clinical application.
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Objective@#To analyze the risk factors affecting the poor prognosis of progressive cerebral infarction.@*Methods@#The clinical data of 326 patients with cerebral infarction admitted to Dermatology and Venereal Disease Prevention and Cure Hospital of Zaozhuang from January 2013 to March 2017 were retrospectively analyzed.The patients were divided into poor prognosis group(n=148) and good prognosis group(n=178) according to their prognosis during hospitalization.Univariate analysis and multivariate logistic regression analysis were used to explore the risk factors affecting prognosis.@*Results@#Statistical analysis showed that there were no statistically significant differences in sex composition, average age, diastolic blood pressure, LDL, anterior cerebral artery stenosis, posterior cerebral artery stenosis and vertebral basilar artery stenosis between the two groups (all P>0.05). The incidence rates of hypertension history (60.81% vs. 48.88%, χ2=1.683, P=0.031), diabetes history (41.89% vs. 30.90%, χ2=4.244, P=0.039), hyperlipidemia history (62.84% vs. 49.44%, χ2=5.875, P=0.015) in the poor prognosis group were higher than those in the good prognosis group.The systolic blood pressure in poor prognosis group was lower than that in the good prognosis group [(144±17)mmHg vs. (150±22)mmHg, t=2.928, P=0.004]. The body temperature[(38.10±0.22)℃ vs. (38.03±0.34)℃, t=2.240, P=0.026], FPG[(7.85±1.95)mmol/L vs. (6.91±1.77)mmol/L, t=4.558, P=0.000], TC[(5.21±1.66)mmol/L vs. (4.84±1.55)mmol/L, t=2.708, P=0.039], TG[(2.49±0.79 mmol/L vs. (2.30±0.54)mmol/L, t=2.483, P=0.014], HDL [(1.30±0.51)mmol/L vs. (1.17±0.44)mmol/L, t=2.470, P=0.014] and FIB[(4.37±1.67)g/L vs. (3.79±1.42)g/L, t=3.339, P=0.001], stenosis of internal carotid artery (31.08% vs. 20.79%, χ2=4.636, P=0.031), stenosis of middle cerebral artery(39.86% vs. 29.21%, χ2=4.083, P=0.043), and plaque of internal carotid artery (48.65% vs. 36.52%, χ2=4.882, P=0.027) in the poor prognosis group were higher than those in the good prognosis group.Multivariate regression analysis showed that history of hypertension, diabetes, hyperlipidemia, fever, decreased blood pressure, elevated TC, elevated TG, elevated HDL and elevated FIB were the risk factors for the prognosis of progressive cerebral infarction.@*Conclusion@#There are many risk factors affecting the poor prognosis of progressive cerebral infarction, and the physiological mechanism is complex.In clinical treatment, attention should be paid to patients' past diseases, prevention and treatment should be carried out according to different mechanisms.
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A case of middle-age-onset mitochondrial encephalomyopathy,lactic acidosis and stroke-like episodes (MELAS) type mitochondrial myopathy was retrospectively analyzed, and clinical features and diagnostic criteria of MELAS with multiple cerebrovascular stenosis in the middle-aged were summarized. The patient was a middle-aged woman who suffered from repeated headaches and limb convulsions and admitted by Xuanwu Hospital Capital Medical University. She had various risk factors of atherosclerosis. Related examination revealed multiple intracranial vascular stenosis. The lesions could be caused by the stenotic vessels. Therefore, the first diagnosis was ' acute cerebral infarction' after admission. But the clinical symptoms were characterized by ' relapse-remission'. The patient also suffered from headaches, seizures, and cognitive decline. There was past history of ' neurological deafness' and hearing loss in both ears. Magnetic resonance imaging (MRI) showed that ischemic lesions were distributed in the cortex. So further examinations were conducted. She was diagnosed as MELAS-type mitochondrial myopathy by head MR, magnetic resonance spectroscopy (MRS) and genetic examination. Neurotrophic factors, mitochondria-protection,anti-epilepsy,and relief therapy were given. The genetics and clinical manifestations of MELAS-type of mitochondrial myopathy are broadly heterogeneous. For middle-age-onset patients who have various atherosclerotic risk factors and stroke-like symptoms, doctors should be cautious about the mitochondrial disease by dynamically observing patient's clinical symptoms and head MRI, and perform pathology and gene mutation examination for comprehensive analysis. Only in this way,can we timely consider the possibility of mitochondrial encephalomyopathy and correctly make diagnosis as early as possible.