Moyamoya syndrome complicated with bilateral posterior cerebral artery embolism: a case report and literature review / 中华神经科杂志

No case of moyamoya syndrome with bilateral posterior cerebral artery (PCA) occlusion has been reported in China so far as this disease is extremely rare. The case shown in this article is a middle-aged women who has a history of atrial fibrillation, hypertension and type 2 diabetes acutely attacked by this syndrome. The main clinical manifestations included binocular blindness, right limb weakness. Imaging findings showed bilateral acute cerebral infarction in the parietal occipital lobe, bilateral anterior cerebral artery and middle cerebral artery smoke angiogenesis, bilateral PCA occlusion with distal smoke angiogenesis. Considering the medical history of the patient, the cause of the disease was diagnosed as embolic stroke of undetermined source. The patient′s consciousness has been recovered and the limb weakness has been improved after active symptomatic treatment. However, the blindness did not see any improvements. This case report aims to improve clinicians′ understanding of bilateral PCA embolization in patients with moyamoya syndrome so the occurrence of cerebral infarction can be effectively prevented.

The effectiveness of serum S100B, TRAIL, and adropin levels in predicting clinical outcome, final infarct core, and stroke subtypes of acute ischemic stroke patients / Eficacia de los niveles séricos de S100B,TRAIL y adropina para predecir el resultado clínico, el núcleo del infarto final y los subtipos de ataque cerebrovascular de los pacientes con accidente cerebrovascular isquémico agudo

Introduction: More than half of all worldwide deaths and disabilities were caused by stroke. Large artery atherosclerosis is identified as a high etiological risk factor because it accounts for 20% of ischemic stroke. Objectives: To identify the significance of TRAIL and adropin release and the relative changes related to S100B levels, as well as the relationship between these biomarkers and the final infarct core, the clinical outcome, and the presence of large artery atherosclerosis in acute stroke patients. Materials and methods: Over a one-year period, demographic, clinical, and neuroimaging findings of 90 consecutive patients with acute ischemic stroke were evaluated. Results: The mean age of participants was 69.28 ± 10 and 39 patients were female. The increased level of S100B and the decreased levels of sTRAIL with adropin were significantly associated with moderate to severe neurologic presentation (p=0.0001, p=0.002, p=0.002, respectively). On the control CT, a large infarct core was significantly associated with decreased serum levels of sTRAIL and adropin (p=0.001 and p=0.000, respectively); however, the levels of S100B were not significantly associated with good ASPECTS score (p=0.684). Disability and an unfavorable outcome were significantly related to the decreased level of sTRAIL and adropin (p=0.001 and p=0.000 for THRIVE score>5, respectively). Decreased sTRAIL and adropin levels and an increased S100B level were correlated with the presence of large artery atherosclerotic etiologic factors (p=0.000, p=0.000, p=0.036, respectively). Conclusion: TRAIL and adropin serum levels were associated with poor clinical outcomes and greater infarcted area in acute ischemic stroke patients.

Introducción. Más de la mitad de todas las muertes y discapacidades en todo el mundo fueron causadas por accidentes cerebrovasculares. La aterosclerosis de las grandes arterias se identifica como un factor de alto riesgo etiológico debido a que representa el 20 % de los accidentes cerebrovasculares isquémicos. Objetivo. Determinar la importancia de la liberación de TRAIL y adropina y los cambios relativos relacionados con los niveles de S100B, así como la relación entre estos biomarcadores y el núcleo final del infarto, el resultado clínico y la presencia de aterosclerosis de arterias grandes en pacientes con accidente cerebrovascular agudo. Materiales y métodos. Durante un año, se evaluaron los hallazgos demográficos, clínicos y de neuroimágenes de 90 pacientes con accidente cerebrovascular isquémico agudo. Resultados. La edad media de los pacientes fue de 69,28 ± 10 y 39 eran mujeres. El aumento del nivel de S100B y la disminución de los niveles de sTRAIL y adropina se asociaron significativamente con una presentación neurológica moderada a grave en los pacientes (p=0,0001, p=0,002 y p=0,002, respectivamente). En la TC de control, un gran núcleo de infarto se asoció significativamente con una disminución del nivel sérico de sTRAIL y adropina (p=0,001 y p=0,000, respectivamente); sin embargo, los niveles de S100B no se asociaron significativamente con una buena puntuación en el ASPECT (p=0,684). La discapacidad y el resultado desfavorable se relacionaron significativamente con la disminución de los niveles de sTRAIL y adropina (p=0,001 y p=0,000 para una puntuación >5 en el THRIVE, respectivamente). La disminución de los niveles de sTRAIL y adropina y el aumento del nivel de S100B, se correlacionaron con la presencia de un factor etiológico aterosclerótico de arterias grandes entre la población de estudio (p=0,000, p=0,000 y p=0,036, respectivamente). Conclusiones. Los niveles séricos de TRAIL y adropina se asociaron con un resultado clínico deficiente y una mayor área infartada en pacientes con ataque cerebrovascular isquémico agudo.

Surgical clipping of ruptured posterior communicating artery aneurysms originating from fetal-type posterior cerebral artery via lateral supraorbital approach / 国际脑血管病杂志

Objective:To investigate the therapeutic effect of surgical clipping ruptured posterior communicating artery aneurysms (PCoAA) originating from fetal-type posterior cerebral artery (FPCA) via lateral supraorbital approach and the influencing factors of the outcomes.Methods:Patients with ruptured PCoAA originating from FPCA underwent surgical clipping via lateral supraorbital approach in the Cerebrovascular Center of Foshan Hospital of Traditional Chinese Medicine from January 2017 to May 2020 were retrospectively enrolled. The Glasgow Outcome Scale was used to evaluate the outcomes of patients at 6 months after operation. 4-5 points were defined as good outcome, and 1-3 points were defined as poor outcome. Multivariable logistic regression analysis was used to determine the risk factors for poor outcomes. Results:A total of 119 patients were enrolled, including 98 females (82.35%), aged 61.59±11.52 years old (range 32-78 years). Thirty patients (25.21%) had poor outcomes. Multivariable logistic regression analysis showed that age (odds ratio [ OR] 2.935, 95% confidence interval [ CI] 2.117-5.391; P=0.012), hypertension ( OR 2.016, 95% CI 1.568-4.335; P=0.023), Hunt-Hess grade ( OR 2.408, 95% CI 1.326-5.068; P<0.001), modified Fisher grade ( OR 3.034, 95% CI 2.201-5.517; P<0.001), aneurysm size ( OR 1.793, 95% CI 1.427-2.622; P=0.009), preoperative intracranial hematoma volume ( OR 1.246, 95% CI 1.055-2.153; P=0.011) and surgical timing ( OR 2.152, 95% CI 1.316-3.240; P=0.006) were the independent risk factors for poor outcomes of the patients. Conclusions:Surgical clipping via lateral supraorbital approach can effectively treat the ruptured PcoAA with FPCA. Patients with age >65 years, with a history of hypertension, high Hunt-Hess grade, high modified Fisher grade, aneurysms >7.65 mm, preoperative intracranial hematoma volume >19.02 ml, and late surgery need to strengthen postoperative management to improve outcomes.

FLAIR vascular hyperintensities in patients with posterior cerebral artery infarction: influencing factors and impacts on outcomes / 国际脑血管病杂志

Objective:To investigate the influencing factors of fluid attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH) and its impacts on outcomes in patients with posterior cerebral artery infarction.Methods:Consecutive patients with posterior cerebral artery infarction admitted to the Department of Neurology, Fuyang Hospital of Anhui Medical University from January 2019 to December 2021 were retrospective enrolled. Demographic and clinical data of patients were collected. The modified Rankin Scale (mRS) score was used to evaluate the outcomes at 3 months after the onset. 0-2 were defined as good outcomes, and >2 were defined as poor outcomes. Multivariate logistic regression analysis was used to determine the independent influencing factors of FVH and poor outcomes. Results:A total of 65 patients (46 males [70.8%], aged 71.25±10.06 years) with posterior cerebral artery infarction were enrolled. There were 14 patients (21.5%) in FVH positive group and 51 (78.5%) in FVH negative group; 45 (69.2%) had a good outcome, and 20 (30.8%) had a poor outcome. There were significant differences in hypertension, history of previous stroke or transient ischemic attack, pre-onset mRS score >1, and etiology of stroke between the FVH positive group and the FVH negative group. Multivariate logistic regression analysis showed that there was a significant independent correlation between the pre-onset mRS score >1 and FVH positive (odds ratio 6.206, 95% confidence interval 1.463-26.328; P=0.013). There were significant differences in age, atrial fibrillation, history of previous stroke or transient ischemic attack, baseline National Institutes of Health Stroke Scale score, FVH positive, and anticoagulant use between the good outcome group and the poor outcome group. Multivariate logistic regression analysis showed that there was a significant independent correlation between FVH positive and poor outcomes (odds ratio 5.761, 95% confidence interval 1.477-22.466; P=0.012). Conclusion:The pre-onset mRS score >1 is independently associated with FVH positive, while FVH positive is independently associated with poor outcomes in patients with posterior cerebral artery infarction.

Evaluación morfológica y variaciones del circulo arterial cerebral: un estudio con material cadavérico en una muestra de población colombianas / Morphological evaluation and variations of the cerebral arterial circle: a study with cadaveric material in a Colombian population sample

RESUMEN: El círculo arterial cerebral (CAC) mencionado también como polígono de Willis es una red de anastomosis vascular situado en la base del cerebro, constituido por ramas de la arteria carótida interna (ACI) y del sistema vertebro-basilar. Este estudio evaluó la morfología de las arterias que conforman el CAC en una muestra de individuos colombianos. Previa canalización de la ACI y de la arteria vertebral (AV), se perfundió con resina poliéster (palatal 85 % y estireno 15 %) los lechos vasculares del CAC de 70 encéfalos extraídos de cadáveres a quienes se les practicó necropsia en el Instituto de Medicina Legal de Bucaramanga, Colombia. La arteria comunicante anterior (ACoA) se observó en 68 encéfalos (97,1 %), con ausencia en 2 de las muestras (2,9 %); en promedio su diámetro fue de 1,91?1,04 mm y su longitud 2,21?0,97 mm respectivamente. Asimismo, se encontró hipoplasia en 6 muestras (8,4 %). La arteria comunicante posterior (ACoP) estuvo ausente en 2 de las muestras (5,7 %); su longitud fue 11,63?2,12 mm, mientras que su calibre fue de 1,21?0,58 mm, siendo ligeramente mayor en el lado derecho, sin diferencias estadísticamente significativas con relación al lado de presentación (p= 0,763). Se encontró hipoplasia de la ACoP en forma bilateral en 19 de las muestras (27,1 %) y unilateral en 15 muestras (21,4 %). En 8 muestras (20 %) de 35 CAC evaluados se observó configuración fetal. La incidencia de hipoplasia de la ACoP y de configuración fetal encontrados en el presente estudio, se ubican en el segmento superior de lo reportado en la literatura. Estas expresiones morfológicas han sido consideradas como coadyuvantes en el desarrollo de accidentes cerebro-vasculares (ACV).

SUMMARY: The cerebral arterial circle (CAC), also referred to as the polygon of Willis is a network of vascular anastomoses located at the base of the brain, consisting of branches of the internal carotid artery (ICA) and the vertebrobasilar system (VBS). This study evaluated the morphology of the arteries forming the CAC in a sample of Colombian individuals. After cannulation of the ICA and the vertebral artery (VA), the vascular beds of the ACC of 70 brains extracted from cadavers at the Institute of Legal Medicine of Bucaramanga, Colombia, were perfused with polyester resin (85 % palatal and 15 % styrene). The anterior communicating artery (ACoA) was observed in 68 brains (97.1 %), with absence in 2 of the samples (2.9 %); on average its diameter was 1.91?1.04mm and its length 2.21?0.97mm respectively. Likewise, hypoplasia was found in 6 samples (8.4 %). The posterior communicating artery (ACoP) was absent in 2 of the samples (5,7 %); its length was 11.63?2.12mm, while its caliber was 1.21?0.58mm, being slightly larger on the right side, with no statistically significant differences in relation to the side of presentation (p= 0.763). Hypoplasia of the ACoP was found bilaterally in 19 of the samples (27.1 %) and unilaterally in 15 samples (21.4 %). Fetal configuration was observed in 8 samples (20 %) of 35 CACs evaluated. The incidence of ACoP hypoplasia and fetal configuration found in the present study are in the upper segment of those reported in the literature. These morphological expressions have been considered as coadjuvants in the development of cerebrovascular accidents (CVA).

Neuropsychiatrie symptoms as the only acute manifestation of a stroke in the left hemisphere. Case report / Alteraciones neuropsiquiátricas como única manifestación de accidente cerebrovascular en hemisferio izquierdo. Reporte de caso

ABSTRACT We report the case of a 60-year-old female patient with a history of hypertension and dyslipidemia, who suddenly presented with a clinical picture of emotional lability, disorientation, complex visual hallucinations and persecutory delusions. There were no associated neurological findings in her initial physical examination. At a local hospital she was initially diagnosed with late-onset bipolar disorder and a manic episode with psychotic features, then referred to the mental health unit, where nuclear magnetic resonance (NMR) imaging of the brain revealed an acute ischemic stroke in the territory of the left posterior cerebral artery (PCA) with haemorrhagic reperfusion to the occipital cortex. Complete and spontaneous resolution of her clinical condition was achieved after approximately 15 days.

RESUMEN Se presenta el reporte de caso de una mujer de 60 anos de edad con antecedente de hipertensión arterial y dislipidemia, quien presenta cuadro clínico de inicio súbito consistente en labilidad emocional, desorientación alopsíquica global, alucinaciones visuales complejas e ideación delirante de tipo persecutorio, sin hallazgos neurológicos asociados en el examen físico inicial. Se enfocó en hospital local como un trastorno bipolar de inicio tardío con episodio actual maníaco con características psicóticas y es remitida a unidad de salud mental. Posteriormente hallazgos de resonancia magnética nuclear (RMN) cerebral revelaron una lesión correspondiente a ataque cerebrovascular (ACV) isquémico agudo en territorio de la arteria cerebral posterior (ACP) izquierda con reperfusión hemorrágica a nivel de corteza occipital. Se alcanzó una resolución espontánea completa de su cuadro clínico en un curso aproximado de 15 días.

Características anatómicas del origen de las arterias cerebelares / Anatomical features of the origin of the cerebellar arteries

RESUMEN Fundamento: las arterias cerebelares han sido descritas como variables en su anatomía, característica importante por su valor en la terapéutica endovascular y las complicaciones quirúrgicas. Objetivo: caracterizar anatómicamente el patrón común y las variantes del origen de las arterias cerebelares. Métodos: se realizó un estudio descriptivo en 50 encéfalos obtenidos de Medicina Legal del Hospital Universitario Amalia Simoni en la provincia Camagüey, se disecó cada sistema arterial cerebelar. Resultados: la arteria cerebelar posteroinferior se originó de la vertebral en el 90 %, como variantes cinco se originaron de la basilar y cinco ausentes. La media de su grosor externo fue 1,6 mm. La cerebelar anteroinferior se originó en todos los casos de la basilar, con asimetría en el nivel de origen y doble en el 10 %. El grosor presentó una media de 1,39 mm. La cerebelar superior se originó de la basilar en el 94 % y de la arteria cerebral posterior en el 6 %, se presentó doble en un 17 %. El grosor tuvo una media de 1,73 mm. Conclusiones: el patrón común se caracteriza por el origen de la arteria cerebelar posteroinferior en la arteria vertebral, y de las arterias cerebelar posteroinferior y superior en la arteria basilar. Como variantes, la cerebelar posteroinferior se origina en la basilar o está ausente; la anteroinferior es doble y con asimetría y la superior parte de la cerebral posterior o se presenta doble. La media de los grosores externos de cada uno de los tres sistemas arteriales cerebelares presenta valores menores de dos milímetros.

ABSTRACT Background: the cerebellar arteries have been described as variable in terms of anatomy; which is quite relevant due to the impact on endovascular therapeutic and surgical complication. Objective: to characterize the common pattern and anatomical variants of the origin of cerebellar arteries. Methods: a descriptive study was conducted on 50 human brains obtained from the Legal Department of Amalia Simoni Teaching Hospita, in Camagüey. The cerebellar arterial system of each brain was further dissected. Results: the back-inferior cerebellar artery arose from the vertebral one in 90 % of samples; variants included five that arose from the basilar artery and five absent; its outer diameter average was 1.6 mm. The anteroinferior cerebellar artery arose from the basilar in all cases, asymmetrical at its origin level and 10 % was double; its outer diameter average was 1.39 mm. The superior cerebellar artery arose from the basilar in 94% of cases and from the posterior cerebral artery in 6%, 17 % was double; and its outer diameter average was 1.73 mm. Conclusions: the anatomical origin of the posteroinferior cerebellar artery is from the vertebral artery as common pattern while the anteroinferior and superior cerebellar arteries arise from basilar artery. Anatomical variants includes the origin of the posteroinferior cerebellar artery from the basilar or being absent; double or asymmetric anteroinferior cerebellar artery and superior cerebellar artery with origin at the posterior cerebral artery and/or double. The average of the outer diameter of each cerebellar arteries is less than two millimeters.

Early Functional Connectivity Predicts Recovery from Visual Field Defects after Stroke / 대한뇌졸중학회지

BACKGROUND AND PURPOSE: We aimed to assess whether early resting-state functional connectivity (RSFC) changes measured via functional magnetic resonance imaging (fMRI) could predict recovery from visual field defect (VFD) in acute stroke patients. METHODS: Patients with VFD due to acute ischemic stroke in the visual cortex and age-matched healthy controls were prospectively enrolled. Serial resting-state (RS)-fMRI and Humphrey visual field (VF) tests were performed within 1 week and at 1 and 3 months (additional VF test at 6 months) after stroke onset in the patient group. The control group also underwent RS-fMRI and a Humphrey VF test. The changes in RSFCs and VF scores (VFSs) over time and their correlations were investigated. RESULTS: In 32 patients (65±10 years, 25 men), the VFSs were lower and the interhemispheric RSFC in the visual cortices was decreased compared to the control group (n=15, 62±6 years, seven men). The VFSs and interhemispheric RSFC in the visual cortex increased mainly within the first month after stroke onset. The interhemispheric RSFC and VFSs were positively correlated at 1 month after stroke onset. Moreover, the interhemispheric RSFCs in the visual cortex within 1 week were positively correlated with the follow-up VFSs. CONCLUSIONS: Interhemispheric RSFCs in the visual cortices within 1 week after stroke onset may be a useful biomarker to predict long-term VFD recovery.

Bilateral Occipital Lobe Infarction Presenting as Bilateral Inferior Altitudinal Defects

PURPOSE: Horizontal visual field defects are generally caused by lesions before the optic chiasm, but we report a case with bilateral inferior altitudinal defects secondary to bilateral occipital lobe infarction. CASE SUMMARY: A 57-year-old male with a history of diabetes and hypertension presented with a month of blurring in the inferior visual field. His corrected visual acuity was 1.0 in the right eye and 0.63 in the left eye, and the intraocular pressure was normal in each eye. Pupillary response, ocular movement, and color vision tests were normal in both eyes. There was no specific finding of the optic disc and macula on fundus examination. Visual field examination revealed an inferior congruous homonymous hemianopia with horizontal meridian sparing and a left incongruous homonymous quadrantanopia. Optical coherence tomography for peripapillary retinal nerve fiber layer thickness revealed a mild decrease in the inferior disc of both eyes. Brain magnetic resonance imaging confirmed the presence of an acute infarction confined with upper medial calcarine fissures of bilateral occipital lobe and the right splenium of the corpus callosum, which were consistent with inferior altitudinal hemianopia and left superior incongruous quadrantanopia, respectively. Brain magnetic resonance angiography showed multiple stenosis of bilateral posterior cerebral arteries. CONCLUSIONS: The altitudinal visual field defects could be caused by the occipital lesion medial to the calcarine fissure, and unusual visual defects could be due to a combination of multiple lesions.

Correlation between ipsilateral prominent posterior cerebral artery laterality and white matter hyperintensity in patients with severe internal carotid artery stenosis / 国际脑血管病杂志

Objective To investigate the correlation between ipsilateral prominent posterior cerebral artery laterality (PCAL) and white matter hyperintensities (WMHs) in patients with severe internal carotid artery (ICA) stenosis. Methods From April 2016 to December 2017, patients with unilateral ICA stenosis≥70% (including occlusion) and contralateral ICA stenosis <50% or no stenosis admitted to the Department of Neurology, Liaoning Provincial People's Hospital were enrolled. According to the presence or absence of PCAL on the ipsilateral side of ICA stenosis, they were divided into positive group and negative group, and the severity of WMHs was compared between the 2 groups. The patients were grouped according to the severity of overall WMHs and deep WMHs (DWMHs) and periventricular WMHs (PWMHs) on the ipsilateral side of ICA stenosis. Multivariate logistic regression analysis was used to determine the independently relevant factors of WMHs. Results A total of 131 patients were enrolled, 65 of them (49.62% ) had ipsilateral PCAL positive. The proportion of severe DWMHs in this group was significantly lower than that in the ipsilateral PCAL negative group (38.46% vs. 59.09% ; χ2 =5.578, P=0.018 ). Multivariate logistic regression analysis showed that advanced age (odds ratio [ OR] 2.196, 95% confidence interval [ CI] 1.278-3.773; P=0.004), hypertension (OR 3.279, 95% CI 1.107-9.709; P=0.032), and high systolic blood pressure (OR 1.027, 95% CI 1.002-1.053; P=0.031) were independently associated with severe overall WMHs; advanced age (OR 1.957, 95% CI 1.141-3.358; P=0.015) and hypertension (OR 4.739, 95% CI 1.570-14.286; P=0.006) were independently correlated with ipsilateral severe DWMHs, ipsilateral PCAL (OR 0.340, 95% CI 0.135-0.856; P=0.022 ) was independently correlated with ipsilateral mild DWMHs; advanced age (OR 1.805, 95% CI 1.175-2.775; P=0.007) and high systolic blood pressure (OR 1.030, 95% CI 1.007-1.053; P=0.010) were independently correlated with ipsilateral severe PWMHs. Conclusion Ipsilateral PCAL is an independent protective factor for ipsilateral DWMHs in patients with severe ICA stenosis.

Paradoxical Motor and Cognitive Function Recovery in Response to Zolpidem in a Patient with Hypoxic-ischemic Brain Injury: A Case Report

We report an extremely rare case of a patient with hypoxic-ischemic brain injury who recovered consciousness and motor and cognitive functions due to paradoxical response after zolpidem administration. A 32-year-old woman who had attempted suicide by hanging was admitted. The patient had stabilized in a state of drowsy mentality, quadriparesis, dysphagia, and impaired cognition. Brain magnetic resonance imaging was suggestive of hypoxic ischemic brain injury and unilateral infarction in the right posterior cerebral artery territory. Due to sleep disturbance, zolpidem was administered, and paradoxically consciousness level and function returned to near-normal during the duration of the drug-effect. In addition to previous reports, our case characteristically showed remarkable motor and cognitive function recovery, not only consciousness level. The drug-effect time was gradually decreased after 18 months and absent after 3 years. We have reviewed related literature and discussed possible neuropharmacological and neurobiological mechanism.

Microsurgical Treatment of Posterior Cerebral Artery Aneurysm (P2P Segment): Case Report and Review of the Literature

Introduction Aneurysms of the posterior cerebral artery (PCA) represent 1% of all intracranial aneurysms and usually present with subarachnoid hemorrhage. Objective The aimof the present study is to describe the case of an adult man presenting a saccular aneurysm of the right PCA at the posterior half of the postcommunicating (P2P) segment, and to discuss the technical nuances of the approach and of the clipping process. Case Report An investigation of a chronic headache in a 55-year-old man found a saccular aneurysm located just posterior to the most lateral portion of the right cerebral peduncle. A digital subtraction arteriography revealed a 7.8 mm 5.6 mm 4.8 mm posterior-medial projecting aneurysm of the right PCA at the P2P segment. A subtemporal approach was performed with partial aspiration of the right parahippocampal gyrus for a better exposure of the vascular structures. A proximal temporary occlusion of the PCA was performed at the anterior half of the postcommunicating P2A segment. The aneurysm was clipped with two semi-curved clips. The patient presented an uneventful recovery and was discharged from the hospital on the third postoperative day without any additional neurological deficits. Conclusion Aneurysms of the PCA are an uncommon vascular disease that challenges the ability of the neurosurgeons due to their many anatomical nuances, to their vast number of perforators, and to the risk of bleeding. However, the operative management of aneurysms of the PCA is technically feasible, safe and effective when performed respecting microsurgical principles.

A Clinical Study On Topographical Analysis Of Vascular Territories In Stroke With Clinical And Etiopathogenesis

Stroke incidence is currently increasing in India, compared to Western countries. Mostly it’s attributed to risk factors like hypertension, diabetes, smoking, and dyslipidemia and alcohol consumption. Risk factors are poorly controlled with insufficient infrastructure and inadequate public awareness, poor rehabilitation services contributes for increasing prevalence of the stroke with disability. This clinical study focussed on topographical analysis of vascular territories involved in stroke with clinical and etipathogeneis contributing stroke.

Infarto talámico bilateral secundario a oclusión de la arteria de Percherón / Bilateral thalamic infarct secondary to Percheron's artery occlusion

Resumen: La arteria de Percherón es una variante vascular que se caracteriza por una arteria tálamo-perforante dominante originada en el segmento P1 de la arteria cerebral posterior y se bifurca para irrigar a ambos tálamos en su porción paramedial. Su obstrucción se traduce en infartos talámicos bilaterales en el sitio paramedial. Se comunica el caso de un paciente de 85 años de edad con alteraciones en el estado de conciencia, con poca interacción con el medio y parálisis vertical de la mirada, al que se le realizó una resonancia magnética que evidenció infartos talámicos bilaterales. Las lesiones talámicas bilaterales son poco frecuentes. Los infartos talámicos representan 11% de los eventos vasculares y los bilaterales de 22 a 35% de los eventos vasculares talámicos; generalmente son de origen embólico y en raras ocasiones se asocian con hipoperfusión. La tríada típica incluye alteraciones del estado de conciencia, alteraciones de la memoria y parálisis vertical de la mirada. Aunque es una enfermedad infrecuente, es importante considerar la realización de estudios de imagen en pacientes con alteraciones del estado de conciencia que permitan descartar infartos talámicos como parte del diagnóstico diferencial.

Abstract: The Percheron's artery is a vascular variant characterized by the presence of a dominant thalamic-perforating artery originated in the P1 segment of the posterior cerebral artery; it forks to irrigate both thalamus in its paramedial portion. Its obstruction results in bilateral thalamic infarcts in the paramedial site. This paper reports the case of an 85-year-old man evaluated for alterations in the state of consciousness, associated with little interaction with the environment and vertical paralysis of the gaze. MRI evidenced bilateral thalamic stroke. The presentation of bilateral thalamic lesions is rare. The thalamic infarcts represent 11% of the vascular events, and the bilateral events 22 to 35% of the thalamic vascular events; they usually have an embolic origin and they are rarely associated with hypoperfusion. The typical triad includes alterations of the state of consciousness, alterations of the memory and vertical paralysis of the gaze. Although this is an infrequent disease, it is important to consider the performance of imaging studies in patients with alterations of the state of consciousness that allow to discard thalamic infarctions as part of the differential diagnosis.

Correlation between ipsilateral posterior cerebral artery laterality and outcome in patients with acute ischemic stroke in the middle cerebral artery territory / 国际脑血管病杂志

Objective To investigate the correlation between ipsilateral posterior cerebral artery laterality (PCAL) and the outcomes in patients with ischemic stroke in the middle cerebral artery (MCA) territory. Methods From June 2015 to December 2016, patients with acute ischemic stroke in the MCA territory admitted to the Second People's Hospital of Hefei were enrolled. Magnetic resonance angiography (MRA) was used to assess PCAL. The outcome was evaluated by the modified Rankin scale at 3 months 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 influencing factors of clinical outcome. Results A total of 111 patients with ischemic stroke in MCA territory were enrolled, including 47 (42. 3％) PCAL and 30 (27. 0％) poor outcomes. The baseline NIHSS score in the PCAL group was significantly lower than that in the non-PCAL group (5. 13 ± 3. 29 years vs. 7. 03 ± 5. 676 years, t = 2. 058; P = 0. 042). There were significantly differences in the proportion of diabetes mellitus (29. 6％ vs. 10. 0％; χ2 = 4. 583, P = 0. 032), PCAL (51. 9％ vs. 16. 7％;χ2 = 11. 101, P = 0. 001) and smoking (25. 9％ vs. 13. 3％; χ2 = 4. 943, P = 0. 026), as well as age (63. 9 ± 11. 8 years vs. 71. 0 ± 6. 7 years; t = 2. 688, P = 0. 007), baseline diastolic blood pressure (89 ± 13 mmHg vs. 82 ± 10 mmHg; t = -2. 249, P = 0. 025; 1 mmHg = 0. 133 kPa) and baseline NIHSS score (5. 02 ± 3. 67 vs. 9. 47 ± 6. 20; t = 3. 883, P < 0. 001) between the good outcome group and the poor outcome group. Multivariate logistic regression analysis showed that PCAL was associated independently with good outcome (odds ratio [OR] 0. 272, 95％ confidence interval [CI] 0. 083-0. 888; P = 0. 031), while advanced age (OR 1. 088, 95％ CI 1. 022-1. 157; P = 0. 008) and high baseline NIHSS score (OR 1. 224, 95％ CI 1. 077-1. 391; P = 0. 002) were associated independently with poor outcome. Conclusion PCAL is associated independently with good outcome in patients with ischemic stroke in MCA territory.

Association between leptomeningeal collateral circulation and cerebral infarction in patients with middle cerebral artery stenosis / 中华老年心脑血管病杂志

Objective To study the association between leptomeningeal anastomosis (LMA) collateral circulation and cerebral infarction in patients with middle cerebral artery (MCA) M1-segment stenosis by observing the compensatory characteristics of LMA collateral circulation.Methods One hundred and fourteen MCA M1-segment stenosis patients were divided into cerebral infarction group (n=68) and cerebral infarction-free group (n=46).The hemilateral phenomenon of homolateral anterior cerebral artery (ACA) stenosis and posterior cerebral artery stenosis was assessed and its effect on the incidence of cerebral infarction was studied according to its magnetic resonance angiography.Results The ACA score and MCA stenosis severity were significantly different between cerebral infarction group and cerebral infarction-free group (P＜0.05).Multivariate logistic regression analysis showed that low ACA score and MCA M1-segment stenosis were two independent risk factors for cerebral infarction (OR =0.390,95％ CI:0.154-0.987;OR =2.421,95％CI:1.324-4.428,P＜0.01).Conclusion The incidence of cerebral infarction is low in MCA M1-segment stenosis patients with good ACA collateral circulation.

Association between vertebral artery hypoplasia and acute posterior circulation ischemic stroke / 中华老年心脑血管病杂志

Obective To study the association between vertebral artery hypoplasia (VAH) and acute posterior circulation ischemic stroke (APCIS).Methods Of the 718 patients admitted to our hospital for carotid artery ultrosonography and head MRI included in this study,381 with unilateral or bilateral VAH served as an observation group and 337 without unilateral or bilateral VAH served as a control group.The incidence of APCIS in two groups was retrospectively analyzed.The risk factors for APCIS were analyzed by multivariate logistic stepwise regression analysis.Results The incidence of embryonal posterior cerebral artery hypoplasia was significantly higher in observation group than in control group (48.03％ vs 15.13％,P=0.000).No significant difference was found in the incidence of APCIS between the two groups (14.16％ vs 10.00％when the age was ≤ 55 years,7.84％ vs 11.24％ when the age was＞＞55 years,xMH2 =0.310,P=0.578).Hypertension and hyperlipidaemia were the risk factors for APCIS (OR=1.913,P=0.019;OR=1.875,P=0.015).Conclusion VAH is rather common in APCIS patients.However,its accomplanied embryonal posterior cerebral artery hypoplasia does not incease the risk of APCIS.

Changes of blood flow in posterior cerebral artery in fetus with complete transposition of great arteries by pulsed Doppler ultrasound / 中华超声影像学杂志

Objective To study the changes of blood flow in posterior cerebral artery ( PCA ) in complete transposition of great arteries (CTGA) through the application of the pulsed Doppler . Methods Twenty CTGA fetuses ( CTGA group) and 20 healthy control fetuses ( control group) were involved ,the blood flow indexes peak systolic velocity ( Vs) ,end-diastolic velocity ( Vd) ,pulsatility index ( PI) ,resistance index ( RI) ,velocity-time integral ( VTI) of PCA-S1 ,PCA-S2 and MCA of the fetuses in the two groups were detected by pulsed Doppler . The differences in blood flow indexes between CTGA fetuses and healthy controls were analyzed by independent t -test . The rates of abnormal resistance in PCA-S1 and MCA in CTGA fetuses were compared through Chi-square test ( χ2 test) . Results Compared with control group ,the MCA-PI ,MCA-RI ,PCA-S1-PI and PCA-S1-RI of CTGA group decreased significantly( all P < 0 .05) ,MCA-VTI ,PCA-S1-VTI ,PCA-S2-VTI increased significantly ( all P < 0 .05) ,but no significant difference was found in PCA-S2-PI ,PCA-S2-RI ,Vs and Vd of the MCA and the PCA ( all P > 0 .05 ) . The rate of abnormal resistance in the MCA was significantly lower than that in the PCA-S1 in CTGA group ( P <0 .05) . Conclusions The pulsed Doppler can be used to study the changes of blood flow in PCA of CTGA fetuses and the differences of specific hemodynamic alterations may occured in different segments of the PCA in CTGA fetuses ,indicating a tendency to protect the PCA-supplying areas of the brain when ischemia and hypoxia .

Correlation between Blood Flow Signal of Magnetic Resonance Imaging and Short-term Outcome in Patients with Symptomatic Severe Stenosis or Occlusion of Middle Cerebral Artery M1 segment / 中山大学学报(医学科学版)

[Objective] To investigatethe correlation between blood flow signal on three dimensional time-of-flight magnetic resonance angiography (3D-TOF-MRA) and short-term outcome in patients with symptomatic middle cerebral artery (MCA) severe stenosis or MCA occlusion.[Methods] We retrospectively reviewed consecutive patients with symptomatic MCA severe stenosis or MCA occlusion.General information,clinical data and cranial imaging data were collected.Characteristics of blood flow signal on 3D-TOF-MRA for each patient were analyzed,which included:(1) blood flow signal of MCA distal to stenosis/occlusion lesion;(2) laterality of posterior cerebral artery (PCA).The correlation between characteristics of blood flow signal and short-term outcome was analyzed.[Results] Three hundred and twenty-eight patients were included in this study.There were 154 patients with symptomatic MCA severe stenosis and the rest of them had symptomatic MCA occlusion.Poor blood flow signal of distal MCA independently correlated with poor shortterm outcome in patients with severe MCA stenosis.[Odds Ratio (OR) 0.32,95％ Confident Interval (CI) 0.14～0.72].PCA laterality was not related with short-term outcome in these patients (OR,2.28,95％ CI,0.85～6.15).PCA laterality independently correlated with poor short-term outcome in patients with MCA occlusion.(OR,3.54,95％ CI,1.32～ 9.78).Blood flow signal of distal MCA was not related with short-term outcome in these patients (OR,0.58,95％ CI,0.22～1.48).[Conclusion] Blood flow signal on 3D-TOF-MRA correlates with short-term outcome in patients with symptomatic MCA severe stenosis or occlusion but the characteristics differs between severe MCA stenosis and occlusion patients.Anterograde blood flow (blood flow signal of MCA distal to stenosis lesion) for patients with severe MCA stenosis and retrograde blood flow (PCA laterality) for patients with MCA occlusion correlates with shot-term outcome.

Associations of fetal-type posterior cerebral artery with infarction distribution and stroke severity in patients with acute ischemic stroke / 国际脑血管病杂志

ObjectiveTo investigate the associations of fetal-type posterior cerebral artery (FTP) with infarction distribution and stroke severity in patients with acute ischemic stroke.MethodsThe patients with acute ischemic stroke were enrolled.They were divided into either a FTP group or a non-FTP group according to the results of magnetic resonance imaging.The former group was further divided into complete FTP (cFTP) and partial FTP (pFTP).According to the results of diffusion-weighted imaging, the infarction distribution was divided into the territory of the anterior cerebral artery (ACA), middle cerebral artery (MCA), posterior cerebral artery (PCA), and vertebrobasilar artery.According to the National Institutes of Health Stroke Scale (NIHSS), the stroke severity was assessed, <8 was defined as mild stroke, and ≥8 was defined as moderate to severe stroke.Multivariate logistic regression analysis was used to determine the associations of FTP with infarction distribution and stroke severity.ResultsA total of 647 patients with acute ischemic stroke were enrolled, and 201 (31.1%) had FTP, including 162 (25.0%) cFTP and 39 (6.0%) pFTP.Multivariate logistic regression analysis showed that cFTP and pFTP were the independent risk factors for MCA infarction (cFTP: odds ratio [OR] 24.714, 95% confidence interval [CI] 10.952-45.766, P<0.001;pFTP: OR 14.526, 95% CI 6.832-25.931, P<0.001), and the independent protective factors for PCA infarction (cFTP: OR 0.214, 95% CI 0.022-0.531, P<0.001;pFTP: OR 0.326, 95% CI 0.018-0.739, P<0.001), they were also the independent risk factor for the severity of acute ischemic stroke (cFTP: OR 22.138, 95% CI 12.492-64.067, P<0.001;cFTP: OR 19.510, 95% CI 8.956-23.514, P<0.001).ConclusionscFTP and pFTP are the independent risk factors for MCA infarction, and the independent protective factors for PCA infarction, and at the same time, they were also the independent risk factors for the moderate to severe stroke.FTP is associated with the infarction distribution and the stroke severity in acute ischemic stroke.