Predictive factors and prognosis of post-stroke seizures / 中华行为医学与脑科学杂志

Objective:To assess the predictive factors and prognosis of post-stroke seizures.Methods:A total of 315 inpatients with acute anterior circulation cerebral infarction from January 2018 to December 2018 were retrospectively collected, including 95 patients with PSS as observation group and 220 patients without PSS as control group.Clinical characteristics of the patients were recorded, including gender, age, lesion specificity, imaging features, past history, and the time and type of seizures.The Alberta stroke program early CT score (ASPECTS) was used to assess the extent of infarction, the national institutes of health stroke scale (NIHSS) and the modified rankin scale (MRS) were used to assess the severity and prognosis of cerebral infarction.The hemorrhage transformation of cerebral infarction was graded according to the European cooperative acute stroke study Ⅲ(ECASS Ⅲ) classification system.SPSS 21.0 software was used for data analysis.Chi-square test was used for categorical variables and t-test or non-parametric test was used for continuous variables. Results:The observation group had lower ASPECTS scores compared with the control group (5(4, 7), 7 (5, 8)), the presence of atrial fibrillation, hemorrhage transformation, laminar necrosis(LN) and hemosiderin deposition (31.6%, 45.3%, 24.2%, 26.3%) were higher than those of control group (20.9%, 28.2%, 9.1%, 16.4%), and the differences were statistically significant (all P<0.05). In multivariate analysis, ASPECTS score ( OR=0.658, 95% CI=0.556-0.778, P<0.001), hemorrhage transformation ( OR=2.307, 95% CI=1.311-4.059, P=0.004), LN ( OR=2.530, 95% CI=1.250-5.123, P=0.010) and hemosiderin deposition ( OR=2.308, 95% CI=1.201-4.436, P=0.012) were the influencing factors of PSS.Partial secondary generalized seizures was the most common type of seizures, and in this group it accounted for 42.1% (40/95), simple partial seizures and complex partial seizures accounted for 12.6% (12/95)respectively, and generalized seizures accounted for 32.6% (31/95). The mean follow-up time of the two groups was 24.1 months and 24.6 months, respectively.The scores of MRS at the last follow-up and discharge (3(2, 4), 2(1, 4)) of the observation group were better than those of the control group (2(1, 3), 1(1, 3)), and the differences were statistically significant(both P<0.05). Conclusions:PSS after cerebral infarction can affect the prognosis of patients, and the large infarction scope, hemorrhage transformation, LN and hemosiderin deposition are the high risk factors of PSS.

Identification and significance of cortical laminar necrosis after acute cerebral infarction / 中华神经科杂志

Objective:To observe the clinical and imaging features of cortical laminar necrosis (CLN) after acute cerebral infarction, and to explore its possible mechanism.Methods:Five hundred and three patients were recruited into study with acute anterior circulation cerebral infarction confirmed by magnetic resonance imaging in People′s Hospital of Zhengzhou University from June 2019 to June 2020. They were divided into 24 patients with CLN (CLN group) and 479 patients without CLN (NCLN group). The general information and clinical manifestations of the patients were recorded. National Institutes of Health Stroke Scale (NIHSS) and Montreal Cognitive Assessment Scale (MoCA) scores and cranial magnetic resonance imaging characteristics were compared between the two groups, and the possible mechanism was discussed.Results:After acute cerebral infarction, the incidence of CLN was 4.77% (24/503). CLN group had more cognitive impairment (MoCA total score 15.17±2.67; NCLN group 18.12±2.49) and less neurological impairment (NIHSS total score 6.93±3.63; NCLN group 8.86±3.26),and there were significant differences between the two group ( t=-5.58, t=-2.75; P<0.05). In the CLN group, the proportion of perfusion-weighted imaging showing hyper-perfusion in the laminar necrosis area (increased relative cerebral blood volume) was 87.5% (21/24), while in the NCLN group, the proportion of hyper-perfusion was lower [1.25% (6/479)]. There was statistically significant difference in the perfusion between the two groups (χ2=143.06, P<0.01). In the CLN group, CT angiography or magnetic resonance angiography showed common atherosclerotic stenosis or occlusion of the large intracranial arteries. Conclusion:CLN after cerebral infarction is relatively rare in clinical practice, and its occurrence may be related to local cortical hyper-perfusion.

Cerebral cortical laminar necrosis in children: imaging findings and clinical features / 实用放射学杂志

Objective To evaluate the imaging features and causes of cerebral cortical laminar necrosis(CLN) in children,to improve understanding this sign.Methods The imaging and clinical data of 33 children diagnosed with CLN were analyzed retrospectively.The imaging features of CT and MRI were summarized and compared according to their etiologies.Results Children cerebral CLN involved multiple lobes of bilateral hemicerebrum, including the cortical region, subcortical region and basal ganglia region, and linear or gyral shape,patchy shape and punctate shape abnormal density or signal were demonstrated.The typical imaging features were high-signal intensity over the lateral cortical surfaces or along the gyri on T1WI and FLAIR.Diffusion weighted imaging(DWI) showed high signal with restricted diffusion on acute-stage, and Gd-DTPA enhancement demonstrated linear or gyrate enhanced appearance on early-stage.The extent of CLN of cerebral infarction was relatively limited.Acute anoxic encephalopathy showed an early imaging change and extensive involvement.While chronic anoxic encephalopathy and inflammatory encephalopathy showed a late imaging change and a longer existence.Conclusion Children cerebral CLN may have various causes and imaging features,and show characteristic chronological signal changes on imaging studies.The different causes result in the different patterns for CLN in distribution and time distribution.

Acute Hepatic Encephalopathy Presenting as Cortical Laminar Necrosis: Case Report

We report on a 55-year-old man with alcoholic liver cirrhosis who presented with status epilepticus. Laboratory analysis showed markedly elevated blood ammonia. Brain magnetic resonance imaging (MRI) showed widespread cortical signal changes with restricted diffusion, involving both temporo-fronto-parietal cortex, while the perirolandic regions and occipital cortex were uniquely spared. A follow-up brain MRI demonstrated diffuse cortical atrophy with increased signals on T1-weighted images in both the basal ganglia and temporal lobe cortex, representing cortical laminar necrosis. We suggest that the brain lesions, in our case, represent a consequence of toxic effect of ammonia.

The clinical significance of cortical laminar necrosis on diffusion-weighted imaging at acute stage of cerebral infarction / 中华行为医学与脑科学杂志

Objective To evaluate the clinical significance of cortical laminar necrosis (CLN) on diffusion-weighted imaging at acute stage of cerebral infarction.Methods 41 patients were retrospectively investigated who were diagnosed acute cerebral infarction in area of middle cerebral artery,and they got diffusion weighted imaging ( DWI ),magnetic resonance angiography ( MRA ) and colored ultrasonic inspection of cervical arteries within 48 hours after onset,with exclusion of cardioembolism,and 5 patients also had digital subtraction angiography (DSA).The patients were classified into CLN positive group or negative group.The stenosis or occlusion of ipsolateral MCA,intracranial and extracranial ICA were compared between the two groups.Results 9 patients'DWI had CLN,among whom 7 patients present moderate or more severe stenosis of feeding artery,and 5 patients who only had CLN signal presented severe stenosis or occlusion.32 patients'DWI had not CLN,among whom 12 patients present moderate or more severe stenosis of feeding artery.The CLN positive group had a high incidence of ipsilateral intracranial ICA and(or) MCA moderate or severe stenosis or occlusion(55.6％ vs 21.9％,x2 =3.85,P ＜ 0.05 ).The 5 patients who only had CLN signal had ipsilateral feeding artery severe stenosis.A positive correlation was found between CLN and moderate or severe stenosis or occlusion of ipsilateral intracranial ICA and(or) MCA(OR:4.5,95％ CI:1.0 ～ 20.2).Conclusion Patients with acute cerebral infarction and CLN on DWI were more likely to suffer from moderate or severe stenosis or occlusion of feeding large artery,and these patients should be evaluated vessel condition.

Cortical Laminar Necrosis in an Infant with Severe Traumatic Brain Injury

Cortical laminar necrosis appears as hyperinense lesions with a laminar pattern on T1 weighted magnetic resonance (MR) imaging, without signs of hemorrhage or calcification on T2 weighted MR imaging or computed tomography. It has been reported to be associated with hypoxia, metabolic disturbances, drugs, and infections. We present a 12 month-old male infant who suffered diffuse brain injuries following car accident and showed laminar necrosis of cortex.

Cortical Laminar Necrosis associated with Osmotic Demyelination Syndrome

Cortical laminar necrosis has been rarely observed in osmotic demyelination syndrome. We report a 32-year-old female patient who became comatose after the rapid correction of hyponatremia. There were high signal intensities in the pons and bilateral deep gray nuclei on T2-weighted MRI images, and linear hyperintensities along the cerebral cortices on T1-weighted images with a diffuse gyriform enhancement. MR spectroscopic findings showed a decrease of the N-acetyl aspartate peak and an increase in those of the lipid and lactate complex. The case demonstrates that a severe form of osmotic demyelination syndrome accompanying cortical laminar necrosis can result from the rapid correction of hyponatremia.