Etiological analysis of single small subcortical infarction with different imaging features / 中华神经科杂志

Objective:To investigate the etiological mechanism in single small subcortical infarction (SSSI) with different imaging features.Methods:The patients registered in a database of ischemic stroke in the Department of Neurology of the First Affiliated Hospital of Zhengzhou University from January 2016 to December 2019 were analyzed. According to the lowest slice (LS) and the total number of involved slices (TNS) on diffusion-weighted imaging, the SSSI was divided into 3 types: proximal SSSI (pSSSI; LS≤2), distal and large SSSI (dl-SSSI; LS>2, TNS>2) and distal and small SSSI (ds-SSSI; LS>2, TNS≤2). The clinical and imaging features among 3 different lesion patterns were compared by using χ 2 test, Kruskal-Wallis H test and multiple Logistic regression analysis, etc. Results:In the 3 groups of ds-SSSI ( n=205), dl-SSSI ( n=157) and pSSSI ( n=166), the prevalences of parent artery disease (PAD)[10.7% (22/205) , 19.1% (30/157) , 42.8% (71/166), respectively, χ 2=54.89, P<0.001], coronary artery disease [8.3% (17/205), 14.0% (22/157), 16.9%(28/166), respectively, χ 2=6.44, P=0.040] and severe white matter hyperintensities (sWMHs)[58.0% (119/205), 43.3% (68/157), 41.0% (68/166), respectively, χ 2=12.94, P<0.001], the level of serum homocysteine (Hcy)[18.01 (13.54, 25.56), 16.03 (12.50, 21.09), 14.72 (11.12, 19.14) μmol/L, respectively, H=19.36, P<0.001], and the National Institutes of Health Stroke Scale (NIHSS) score[2(1, 3), 3(1, 4), 3(2, 6), respectively, H=39.53, P<0.001] showed statistically significant differences. Multiple Logistic regression analysis showed that compared with dl-SSSI patients, the lesion pattern of patients with higher proportion of PAD ( OR=3.12, 95% CI 1.86-5.24, P<0.001) was closer to pSSSI; the lesion pattern of patients with higher serum Hcy level ( OR=1.02, 95% CI 1.00-1.04, P=0.046) or higher proportion of sWMHs ( OR=1.79, 95% CI 1.12-2.86, P=0.015) was closer to ds-SSSI, and the lesion pattern of patients with higher proportion of PAD ( OR=0.50, 95% CI 0.27-0.93, P=0.029) or higher NIHSS score ( OR=0.84, 95% CI 0.77-0.92, P<0.001) was closer to dl-SSSI. Conclusions:The pathogenesis of ds-SSSI tends to be cerebral small vessel disease. The pathogenesis of pSSSI is related to atherosclerosis. The patients with dl-SSSI have the intermediate characteristics of pSSSI and ds-SSSI and may be unstable.

Clinical features and gene mutation analysis of a male case of subcortical band heterotopia caused by mosaic mutation of DCX gene / 中华神经科杂志

Objective:To investigate the clinical phenotype and genotype of a male case of subcortical band heterotopia caused by mosaic mutation of DCX gene.Methods:The clinical data and magnetic resonance imaging (MRI) features of a male case of subcortical band heterotopia diagnosed in the Department of Neurology, Children′s Hospital Affiliated to Zhengzhou University in August 2020 were analyzed retrospectively. At the same time, the whole exon sequencing of the families was performed by next generation sequencing method, the suspicious mutation was verified by polymerase chain reaction Sanger sequencing, and their genetic mutation characteristics were analyzed.Results:The proband, one male, aged 5 years and 1 month, was hospitalized in August 2020 with the complaint of intermittent convulsions for 4 years and six months. Clinical features included that limb muscle tension was slightly high, intellectual and motor development was backward, and head circumference was 48 cm. MRI of his head showed diffuse thick subcortical band heterotopia. The detection of whole exon sequencing in his family showed that there was hemizygous mosaic mutation in DCX gene (mosaic ratio 44%), c.148A>G (p.k50E). The mosaic ratios of oral mucosa and urinalysis were 38.2% and 44.8% respectively. His parents were wild-type, The mutation found in this patient has not been reported at home and abroad.Conclusions:The mosaic variation of DCX gene can cause subcortical band heterotopia in males. The variation of DCX gene c.148A>G (p.k50E) may be the possible cause of the proband, which expands the variation spectrum of subcortical band heterotopia.

High-temperature requirement A serine peptidase 1-related cerebral small vessel disease / 中华神经科杂志

The high-temperature requirement A serine peptidase 1 (HTRA1) gene mutation results in cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy and autosomal dominant cerebral small vessel disease (CSVD). This article described the definition, clinical features, magnetic resonance imaging manifestations, genetic and pathological examinations and treatment plans of HTRA1 related CSVD and highlighted the distinction between HTRA1 related CSVD and other inherited disorders with white matter involvement, and proposed a diagnostic pathway for timely recognition of HTRA1 related CSVD in a routine clinical environment. Ultimately, in addition to the conventional treatment of CSVD, effective targeted treatment methods still need to be established.

Selective Aberrant Functional–Structural Coupling of Multiscale Brain Networks in Subcortical Vascular Mild Cognitive Impairment / 神经科学通报·英文版

Subcortical vascular mild cognitive impairment (svMCI) is a common prodromal stage of vascular dementia. Although mounting evidence has suggested abnormalities in several single brain network metrics, few studies have explored the consistency between functional and structural connectivity networks in svMCI. Here, we constructed such networks using resting-state fMRI for functional connectivity and diffusion tensor imaging for structural connectivity in 30 patients with svMCI and 30 normal controls. The functional networks were then parcellated into topological modules, corresponding to several well-defined functional domains. The coupling between the functional and structural networks was finally estimated and compared at the multiscale network level (whole brain and modular level). We found no significant intergroup differences in the functional–structural coupling within the whole brain; however, there was significantly increased functional–structural coupling within the dorsal attention module and decreased functional–structural coupling within the ventral attention module in the svMCI group. In addition, the svMCI patients demonstrated decreased intramodular connectivity strength in the visual, somatomotor, and dorsal attention modules as well as decreased intermodular connectivity strength between several modules in the functional network, mainly linking the visual, somatomotor, dorsal attention, ventral attention, and frontoparietal control modules. There was no significant correlation between the altered module-level functional–structural coupling and cognitive performance in patients with svMCI. These findings demonstrate for the first time that svMCI is reflected in a selective aberrant topological organization in multiscale brain networks and may improve our understanding of the pathophysiological mechanisms underlying svMCI.

The Amygdala Responds Rapidly to Flashes Linked to Direct Retinal Innervation: A Flash-evoked Potential Study Across Cortical and Subcortical Visual Pathways / 神经科学通报·英文版

Rapid detection and response to visual threats are critical for survival in animals. The amygdala (AMY) is hypothesized to be involved in this process, but how it interacts with the visual system to do this remains unclear. By recording flash-evoked potentials simultaneously from the superior colliculus (SC), lateral posterior nucleus of the thalamus, AMY, lateral geniculate nucleus (LGN) and visual cortex, which belong to the cortical and subcortical pathways for visual fear processing, we investigated the temporal relationship between these regions in visual processing in rats. A quick flash-evoked potential (FEP) component was identified in the AMY. This emerged as early as in the LGN and was approximately 25 ms prior to the earliest component recorded in the SC, which was assumed to be an important area in visual fear. This quick P1 component in the AMY was not affected by restraint stress or corticosterone injection, but was diminished by RU38486, a glucocorticoid receptor blocker. By injecting a monosynaptic retrograde AAV tracer into the AMY, we found that it received a direct projection from the retina. These results confirm the existence of a direct connection from the retina to the AMY, that the latency in the AMY to flashes is equivalent to that in the sensory thalamus, and that the response is modulated by glucocorticoids.

Van der Knaap disease: a case report

Van der Knaap disease or megalencephalic leukoencephalopathy with subcortical cysts (MLC) is a rare autosomal recessive degenerative disorder characterized by megalocephaly, cerebral leukoencephalopathy, and motor deterioration. Most cases reported with this disease are from our country India, belong to Agarwal community, who have high rates of consanguinity. We report a 4 and 1/2year old boy, with a history of delayed motor milestones, ataxia, increasing head circumference and abnormal body movements, who is belonging to the Bhat family of Handwara town of Kupwara district of Jammu and Kashmir, India.

Reproducibility analysis of quantitative susceptibility mapping of cerebral subcortical nuclei in healthy adults / 南方医科大学学报

OBJECTIVE@#To investigate the intra- and inter-scanner reproducibility of quantitative susceptibility mapping (QSM) of cerebral subcortical nuclei in healthy adults.@*METHODS@#QSM was performed in 21 healthy adults on two different 3.0T MR scanners, and the region of interest (ROI) method was used to measure the magnetic susceptibility value of the left subcortical nuclei (the head of the caudate, putamen, globus pallidus, thalamus, substantia nigra and red nucleus). The intraclass correlation coefficient (ICC) and Bland-Altman method were used to evaluate the inter-scanner and intra-scanner reliability.@*RESULTS@#The ICCs of the susceptibility value ranged from 0.90 to 0.99 for all the subcortical gray nuclei except for the head of the caudate nucleus measured on the same MR scanner by the same observer. Bland-Altman analysis revealed that the points with susceptibility differences for all the subcortical gray nuclei except for substantia nigra located in the 95% CI of limits of agreement for the same MR scanner. The ICCs of the susceptibility value for the inter-scanner was 0.49 (0.08-0.75) for the head of the caudate nuleus, 0.80 (0.57-0.91) for the putamen, 0.77 (0.51-0.90) for the globus pallidus, 0.78 (0.54-0.91) for the thalamus, 0.80 (0.56-0.91) for the substantia nigra and 0.93 (0.83-0.97) for the red nucleus. The points with susceptibility difference (95.2%, 20/21) located in the 95% CI of limits of agreement for the putamen and the thalamus measured on two different MR scanners.@*CONCLUSIONS@#The intra-scanner reproducibility of QSM of the subcortical gray nuclei is superior to the inter-scanner reproducibility in healthy adults.

Myotonic dystrophy type 1 with anterior temporal white matter changes mimicking cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy

@#Myotonic dystrophy type 1 is the most common type of muscular dystrophy in adults characterized by progressive myopathy, myotonia, and occasional systemic involvement. This is a case of myotonic dystrophy type 1 with cognitive decline showing brain magnetic resonance image abnormality mimicking cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL).

Van der Knaap disease

Van der Knaap disease is a rare form of leukodystrophy, phenotypically characterized by megalencephaly, early-onset ataxia, pyramidal features, cognitive impairment, with an autosomal recessive inheritence. MRI Brain shows T1 and FLAIR hypointense subcortical cysts in mostly temporal lobes and in fronto-parietal subcortical areas. Authors report a 20 yr. girl with typical features.

Detection of Microhemorrhages in Cerebral Amyloid Angiopathy by Susceptibility Weighted MR Imaging – An Observational Study

Introduction: Cerebral amyloid angiopathy (CAA) is acause for approximately 10-20% of spontaneous intracerebralhaemorrhage in elderly population. Susceptibility weightedimaging (SW1) is a new imaging method is clinically usefulfor evaluating the presence of chronic blood products in thebrain, especially clinically silent microbleeds associatedwith cerebral amyloid angiopathy. Aim of this study was todetermine the advantages of Susceptibility weighted imaging(SW1) over conventional gradient echo (GRE) technique in aprobable diagnosis of Cerebral amyloid angiopathy.Material and Methods: All patients more than 55 yrspresented with neurological signs and symptoms referredfor neuroimaging, were subjected to image with MRI usingT1W, T2W, FLAIR. AXIAL 2D MERGE, Diffusion weightedimaging (DWI) including apparent diffusion coefficient(ADC) and Susceptibility weighted imaging (SWI). Thosecases having multiple macro and micro haemorrhagesinvolving cortical and sub cortical region detected by eithergradient or SWI included in the study.Results: Sudden onset of neurological deficit was the mostcommon symptom which accounted for 37% of cases.Cortical and sub cortical regions are most commonly involvedsites. On comparison between gradient and SWI, 11 caseshaving micro hemorrgages detected only by SWI and absentin gradient.Conclusion: GE - T2* MR imaging is currently the “ standard”for identifying microhemorrhages and diagnosing cerebralamyloid angiopathy based on number and distribution of microhaemorrhages. SW1 identified many more microhemorrhagesthan conventional T2* weighted GE magnitude technique andmay lead to earlier diagnosis of patients with CAA.

Preserved repetition in thalamic afasia. A pathophysiological hypothesis / Preservação da repetição na afasia talâmica. Uma hipótese fisiopatológica

ABSTRACT. The ability to repeat words is almost always preserved in thalamic aphasia. The pathophysiology of both thalamic aphasia and preservation of repetition are not fully understood. In a case of severe aphasia with preserved repetition after a left thalamic hemorrhage, MRI disclosed left thalamic lesion and loss of fractional anisotropy in the left centrum semiovale. FDG-PET showed severe hypometabolism in the left cerebral hemisphere, except for superior and transverse temporal gyri, calcarine fissure and frontopolar regions. Primary sensory function may be less functionally dependent on thalamic connections than heteromodal and paralimbic areas, which have connections with several thalamic nuclei. The extensive cortical hypometabolism due to diaschisis may have been responsible for the severity of the aphasia, whereas the less severe reduction of metabolism in the superior and transverse temporal gyri, and also, albeit less evident, in Broca's area, might explain the preservation of repetition.

RESUMO. A capacidade de repetir palavras é quase sempre preservada na afasia talâmica. A fisiopatologia da afasia talâmica assim como a da preservação da repetição não são totalmente compreendidas. Em um caso de afasia grave com repetição preservada após hemorragia talâmica esquerda, a RM revelou lesão talâmica esquerda e perda de anisotropia fracionada no centro semioval. O FDG-PET revelou hipometabolismo grave no hemisfério cerebral esquerdo, exceto nos giros temporais superiores e transversos, fissura calcarina e regiões frontopares. A função sensorial primária pode ser menos funcionalmente dependente das conexões talâmicas do que as áreas heteromodais e paralímbicas, que têm conexões com vários núcleos talâmicos. O hipometabolismo cortical extenso devido à diasquise pode ter sido responsável pela gravidade da afasia, enquanto a redução menos severa do metabolismo nos giros temporal superior e transverso, e também, embora menos evidente, na área de Broca, poderia explicar a preservação da repetição.

Effect of levodopa on frontal-subcortical and posterior cortical functioning in patients with Parkinson's disease

INTRODUCTION@#Parkinson's disease (PD) is associated with cognitive decline but little is known about frontal-subcortical and posterior cortical cognitive functioning in patients with PD. The present study was designed to: (a) compare frontal and posterior cognitive functioning between patients with PD and healthy controls; (b) determine the effect of levodopa (L-dopa) on frontal-subcortical and posterior cortical cognitive functions; and (c) identify predictors of cognitive functions in patients with PD.@*METHODS@#50 patients diagnosed with PD from April 2016 to May 2017 at Civil Hospital, Bahawal Victoria Hospital, Bahawalpur, and Nishter Hospital Multan, Pakistan, and 50 healthy individuals from the community participated in our study. Patients had two testing sessions - first, at the time of diagnosis before taking L-dopa medication to determine baseline scores; and second, after at least three months of L-dopa medication. Participants completed the Parkinson's Disease-Cognitive Rating Scale.@*RESULTS@#Patients with PD showed impaired performance on frontal-subcortical and posterior cortical functions in contrast with the control group. L-dopa medication had beneficial effects on frontal-subcortical and posterior cortical functioning in patients with PD. Disease duration was a significant predictor of cognitive performance in patients with PD.@*CONCLUSION@#L-dopa medication improves frontal-subcortical and posterior cortical cognitive functioning in patients with PD. Disease duration is a marker of cognitive decline in PD.

CADASIL with clinical manifestations of lumbago, hunchback and Parkinson’s syndrome / 中华医学遗传学杂志

Objective@#To report a patient with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) manifesting as lumbago, hunchback and Parkinson’s syndrome.@*Methods@#A 49-years-old male CADASIL patient was reported. Results of clinical examination, neuroimaging and genetic testing were analyzed. His family members were also subjected to genetic testing. Related literature was reviewed.@*Results@#The patient had no typical symptoms of CADASIL such as headache, repeated stroke, dementia and emotional disorders, but progressive Parkinson’s syndrome, late onset lumbago, hunchback, dysphagia, and diplopia. Brain MRI showed left basal ganglia and external capsule lacunar infarction. Genetic testing revealed a point mutation c. 1630C>T (p.R544C) in exon 11 of the NOTCH3 gene. A heterozygous mutation was detected in the same gene in his mother, elder sister and younger brother, all of whom showed different clinical phenotypes.@*Conclusion@#The clinical features of CADASIL are heterogeneous. Lumbago, humpback, and Parkinson’s syndrome may be a rare clinical phenotype of CADASIL.

Relationship between clinical phenotype and NOTCH3 genotype in patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy / 第二军医大学学报

Objective To explore the relationship between exon mutations of NOTCH3 gene and clinical phenotype in patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). Methods We consecutively included 30 CADASIL patients with clinical symptoms in 15 pedigrees, who visited Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine from May 2015 to Dec. 2017, and collected the clinical data and genetic analysis results. Furthermore, we analyzed the relationship between the exon mutations of NOTCH3 gene and clinical phenotypes, including age at onset, first clinical symptoms and frequency of symptomatic ischemic stroke. Results Twelve mutation sites of NOTCH3 gene were detected in the 15 pedigrees. Seven of them were located in exon 4, 3 in exon 11, 1 in exon 19, and 1 in exon 20. The onset age of the patients carrying exon 11 mutations was the latest ([53.6±13.3] years, n＝7), followed by the patients carrying exon 4 mutations ([42.7±5.7] years, n＝15). The onset age of 8 patients with mutations in other exons (exon 19 and 20) was (33.5±7.5) years, which was significantly earlier compared with the patients with exon 4 and 11 mutation (P0.01 and P0.05). Most of the patients with mutations of exon 4 had motor and speech disorders (11/15, 73.3%), while ones with mutations of exon 19 and 20 had cognitive impairment (7/8, 87.5%). Most of the patients (11/15, 73.3%) carrying mutations in exon 4 had motor and speech disorders at onset, while 7 of 8 patients (87.5%) with mutations in exon 19 and exon 20 had impaired cognition at onset. The times of symptomatic ischemic stroke in patients with mutations in exon 4 was 3 (median) and in patients with mutations in exon 11 was 2 (median), and no symptomatic ischemic stroke occurred in the patients with mutations in exon 19 and 20. Conclusion Exon 4 and exon 11 of NOTCH3 gene are hotspots of mutations in the cohort of CADASIL cases, and the mutations in different exons are associated with onset age, first symptoms and symptomatic ischemic stroke.

Analysis of clinical characteristics and gene mutations of megalencephalic leukoencephalopathy with subcortical cysts in a family / 中华实用儿科临床杂志

Objective To analyze the clinical characteristics and genetic variation of megalencephalic leu-koencephalopathy with subcortical cysts(MCL),then to explore the genetic characteristics so as to help families by pro-viding genetic counseling. Methods The clinical data of the children and their family members were collected,and the peripheral blood DNA of the children and family members were extracted. Then,the MLC1 gene mutation in the children was detected by using the target sequence capture high-throughput sequencing technology and Sanger sequencing tech-nology. Results (1)MCL often presented abnormal head circumference in infants as the first symptom. The main clini-cal manifestations were hypoevolutism in motor development,retrogression of early school age,then the movement disor-der progressed and finally paralyzed;epilepsy was common in early childhood;head magnetic resonance imaging showed white matter in bilateral cerebral hemisphere diffusing abnormal signal with temporal lobe cystic change in the early stage,and then showed brain atrophy. (2)The gene results showed that the 2 girls with MLC had both c. 368C >T (p. Thr123Ile)and c. 353C > T (p. Thr118Met)complex heterozygous variation,which existed in the MLC1 gene. The girls′ father and a sister carried c. 368C > T (p. Thr123Ile),while the mother carried c. 353C > T (p. Thr118Met) heterozygous variation,all of whom were normal phenotypes. Conclusions MCL is one cause of hypoevolutism in motor development in children and abnormal head circumference of infants is usually the first symptom. The MLC1 gene c. 368C> T(p. Thr123Ile)is a pathogenic mutation for MLC,and may be another new pa-thogenic mutation.

Analysis of the correlation between thyroid function and cognitive function ients with subcortical arteriosclerotic encephalopathy / 中国综合临床

Objective To explore the correlation between thyroid function and cognitive ability in patients with subcortical arteriosclerotic encephalopathy.Methods Montreal cognitive assessment scale (Montreal Cognitive Assessment,MoCA) was used to evaluate the cognitive function of SAE patients with normal thyroid function and hypothyroidism.And the difference in the risk factors of SAE cognitive ability in patients with different thyroid functions was analyzed.Results There were no significant differences in gender,age,risk factors of hypertension,cerebral infarction,diabetes and smoking between the two groups (P＞0.05).The levels of FT3,FT4,TSH,MoCA and ADL in patients with hypothyroidism were (2.92±0.35) pmol/L,(15.61±2.76) pmol/L,(13.05± 1.64) mU/L,(12.73±5.75) points,(45.64±25.77) points,respectively.The levels of FT3,FT4 and TSH in normal thyroid function group and MoCA,ADL scores were (4.27±0.55)pmol/L,(16.74 ± 2.35) pmol/L,(2.73 ± 0.38) mU/L,(18.15 ± 5.35) points,(62.17 ± 26.72) points,respectively.The data of the hypothyroidism group was significantly lower than thst in the normal thyroid function group,and the difference was statistically significant (t =3.591,3.012,12.753,8.967,15.442,P＜0.05).FT3 levels in SAE patients were positively correlated with MoCA score and ADL score (r=0.518,0.617,P=0.026,0.018),while there was no significant correlation between FT4 level and MoCA and ADL score (r =0.015,0.007,P =0.852,0.074).MoCA score and ADL score were negatively correlated with TSH level (r=-0.651,-0.582,P=0.016,0.005).Conclusion Thyroid function is significantly correlated with cognitive ability of SAE patients.Thyroid function may be a clinical index for patients with subcortical arteriosclerosis,and provide a basis for rational drug use in patients with subcortical arteriosclerosis.

Prediction of white matter lesions and subcortical atrophy for cognitive impairment in patients with ischemic stroke / 中华行为医学与脑科学杂志

Objective To investigate the predictive role of cerebral white matter lesions (WML) and subcortical atrophy on cognitive function in patients with acute ischemic stroke (AIS) after 3 months.Methods 233 cases of AIS patients admitted to hospital continuously from September 2016 to March 2018 were enrolled and all of them underwent brain MRI.The degree of WML on FLAIR was evaluated according to the Fazekas grading standard.The linear measurement of subcortical atrophy on T1WI was carried out on the subcortical brain atrophy index,including EVANS ratio (ER),inverse cella media index (iCMI),caudate head index (CHI) and basal cistern index (BCI).Demographic,clinical and imaging data of all patients were also recorded.Mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) were conducted at 3 months after AIS.The patients were divided into normal cognitive function (NCI) group and post stroke cognitive impairment (PSCI) group according to evaluation results of MMSE and MoCA.Multivariate logistic regression analysis was used to screen the independent risk factors of cognitive impairment.Results Univariate analysis showed that age (t=-4.233,P=0.000),sex (x2 =7.501,P=0.006),education (H=21.188,P=0.000),NHISS score (H =5.791,P=0.016),history of atrial fibrillation (x2 =6.484,P=0.011),TIA (x2 =9.015,P=0.003),smoking history (x2 =6.943,P=0.008),Fazekas WML score (x2 =27.885,P=0.000),EVANS ratio (H =31.129,P =0.000),inverse cella media index (H =9.434,P =0.002),caudate head index (H=15.148,P=0.000),basal cistern index (t=-1.979,P=0.049) and baseline cognitive function (x2=136.994,P=0.000) were related to cognitive impairment in patients with AIS after 3 months (P＜0.05).Multivariate logistic regression analysis showed that WML score (OR=3.416,P=0.047,95％CI:1.017-11.482),EVANS ratio (OR=1.245,P=0.038,95％CI:1.012-1.531) and caudate head index (OR =1.187,P=0.040,95 ％ CI:1.008-1.397) were risk factors for cognitive impairment in AIS patients after 3 monfths adjusting for age,education,disease severity and baseline cognitive function.Conclusion WML,EVANS ratio and caudate head index can predict short-term cognitive function in patients with AIS.

Subcortical Ischemic Change as a Predictor of Driving Cessation in the Elderly

OBJECTIVE: Motor, perceptual, and cognitive functions are known to affect driving competence. Subcortical ischemic changes on brain magnetic resonance imaging (MRI) can reflect reduction in cognitive and motor performance. However, few studies have reported the relationship between subcortical ischemic changes and driving competence of the elderly. Thus, the objective of this study was to investigate the association between subcortical ischemic changes on MRI and driving abilities of the elderly. METHODS: Participants (n=540) were drawn from a nationwide, multicenter, hospital-based, longitudinal cohort. Each participant underwent MRI scan and interview for driving capacity categorized into ‘now driving’ and ‘driving cessation (driven before, not driving now)’. Participants were divided into three groups (mild, n=389; moderate, n=116; and severe, n=35) depending on the degree of white matter hyperintensity (WMH) on MRI at baseline. Driving status was evaluated at follow-up. Statistical analyses were conducted using χ2 test, analysis of variance (ANOVA), structured equation model (SEM), and generalized estimating equation (GEE). RESULTS: In SEM, greater baseline degree of WMH was directly associated with driving cessation regardless of cognitive or motor dysfunction (β=-0.110, p < 0.001). In GEE models after controlling for age, sex, education, cognitive, and motor dysfunction, more severe change in the degree of WMH was associated with faster change from ‘now driving’ state to ‘driving cessation’ state over time in the elderly (β=-0.508, p < 0.001). CONCLUSION: In both cross-sectional and longitudinal results, the degree of subcortical ischemic change on MRI might predict driving cessation in the elderly.

Advance in Localization of Brain Injury for Post-stroke Anomic Aphasia (review) / 中国康复理论与实践

@#The most important characteristic of post-stroke anomic aphasia is disorder in nomenclature, but the location of brain injury has been unclear. In recent years, it was found that, based on T1WI of MRI, the location is uncertain in chronic anomic aphasia after stroke, but it is mostly in temporal lobe of the dominant hemisphere in acute stage. Based on diffusion tensor imaging, the subcortical white matter, especially the left subfrontal white matter plays an important role in the naming process. The fMRI studies found that anomic aphasia is related to the destruction of the connections among some specific gray matter brain regions, named brain network theory. The cognitive psychology theory suggested that language processing can be further divided into different steps, each step is responsible for different brain regions; for different kinds of words, such as verbs and nouns, the processing involves different regions.

Mechanism of Subcortical Aphasia: A Diffusion Tensor Imaging Study / 中国康复理论与实践

@#Objective To explore the connection of fibers among functional language areas in the normals and the patients with subcortical aphasia using diffusion tensor imaging (DTI) and diffusion tensor fiber tractography (DT-FT). Methods From June, 2016 to May, 2017, 20 healthy subjects and three stroke patients whose lesion located in subcortical structures were included. There were two patients with Broca's aphasia and one with conductive aphasia from the Western Aphasia Battery. They were scanned with DTI and DT-FT, while the fractional anisotropy (FA) of functional language areas and contralateral mirror areas were measured, and the relevant fibers were observed. Results The structures of functional language areas were complicated and extensively connected with other cortex and subcortical structures in healthy subjects, with few differences among individuals. FA was lower in the functional language areas and arcuate fasciculus than in the mirror regions in patients, and the fibers were damaged, distorted or shifted.Conclusion Structures related to language are very complicated, which involve cortex, lots of white matter tracts, subcortical structure and others. The damage, transformation or transposition of fibers in functional language areas may be the mechanism of subcortical aphasia.