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Objective：Although prediction of functional recovery after lacunar infarction is challenging, quantitative evaluation of brain imaging may be promising. In this article, we investigate association of the amount of corticospinal tract (CST) injury on Computed Tomography (CT) and functional recovery of lacunar infarction in the corona radiata.Methods：In 24 patients with lacunar infarction of the corona radiata, we investigated association of the amount of virtual CST injury with upper and lower limb motor function at 90 days after the stroke onset. The optimal area of the virtual CST to predict motor function was also determined. Finally, we evaluated whether the quantitative CST injury predicted practical motor function regarding activities of daily living.Results：The amount of virtual CST injury, evaluated with Hounsfield unit value of CT, was significantly associated with upper and lower limb function at 90 days after stroke onset. Among them, 6 mm radius CST circle for upper limb had the highest regression coefficient to predict Brunnstrom stage for the upper extremity (R2＝0.69), grip strength (R2＝0.52) and Simple Test for Evaluating Hand function (R2＝0.75). Also, 7 mm radius CST circle for lower limb had the highest regression coefficient to predict Brunnstrom stage for the lower extremity (R2＝0.51), weight bearing index (R2＝0.53) and Berg Balance Scale (R2＝0.52). These virtual CSTs predicted practical function including practical upper limb and ambulation.Conclusion：Quantitative evaluation of CST on CT predicted functional recovery after lacunar infarction of the corona radiata.
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Objective: To explore the patterns of cerebral structural abnormalities and cognitive function alterations in end-stage renal disease (ESRD) patients undergoing maintenance hemodialysis, and the underlying correlative factors. Methods: Thirty-seven ESRD patients undergoing maintenance hemodialysis without prior stroke in Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine were selected. All patients underwent brain magnetic resonance imaging (MRI) and assessment of cognitive function by using Mini-Mental State Examination (MMSE). Patients were divided into lacunar infarction group (n=33) and non-lacunar infarction group (n=4), or white matter hyperintensities (WMH) group (n=14) and non-WMH group (n=23). The difference of demographic characteristics, past history, blood parameter and dialysis adequacy between patients and their controls were analyzed by t test, Mann-Whitney U test, χ2 test and Fisher exact test. Spearman correlation analysis were performed to explore the relationship between clinical features, cerebral structural abnormalities and cognitive function. Results: Nineteen male and eighteen female patients participated in the study. The mean age was (59.4±12.3) years. The incidences of lacunar infarction and WMH were 89.2% and 37.8%, respectively. 24.3% of the participants were diagnosed as cognitive impairment. Patients with lacunar infarction were elder, who had lower level of hemoglobin, hematocrit, serum albumin and serum total protein, while parathyroid hormone (PTH), erythrocyte sedimentation rate, tumor necrosis factor-α and interleukin-6 were elevated. Patients with WMH were also significantly elder, lower in transferrin saturation and higher in PTH. The differences between the two groups were statistically significant (all P<0.05). Spearman correlation analysis showed MMSE score had a negative correlation with age (r=-0.471, P=0.003) and had positive correlations with education status (r=0.355, P=0.031) and hypertension (r=0.358, P=0.030). The study did not find the relationship among lacunar infarction, WMH and MMSE score; however, recall function was found negatively correlated with lacunar infarction (r=-0.357, P=0.030). Conclusion: ESRD patients undergoing maintenance hemodialysis have a high prevalence of cerebrovascular disease and cognitive impairment. Older age, anemia, inflammation status, chronic kidney disease-mineral and bone disorder may be the influencing factors of the cerebral structural abnormalities and cognition decline.
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Objective To analyze the clinical,radiological features and risk factors of diplopia in patients with acute lacunar infarction (ALI).Methods Retrospectively retrieved patients of ALI (lesion diameter was less than 1.5 cm in DWI sequence)diagnosed by MR and clinical.We further summarized 13 ALI patients with diplopia and randomly selected 13 ALI patients without diplopia as the control group. SPSS22.0 statistical software was used for statistical analysis.The general clinical data such as sex and age was compared by Ch-i square test and t-test.The risk factors were primarily analyzed by one-way ANOVA and then the risk factors with statistical significance were brought into the logistic regression model for multivariate analysis.Results The incidence of diplopia in ALI patients was about 2.7%(13/489). The infarct sites were all located in the brain stem of the oculomotor-related brain nucleus and the dorsolateral medulla oblongata.Hypertension and hematocrit were negatively correlated with diplopia after infarction (P＜0.05 ).Conclusion The incidence of diplopia is low in ALI patients.The medial longitudinal tract of the dorsolateral medulla is an important area causing diplopia.Hypertension and hematocrit are non-risk factors for diplopia after ALI.
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Objective To investigate the early warning effect of glomerular filtration rate on cerebralmicrobleeds (CMBs) in patients with lacunar infarction. Methods A retrospective study was performed. One hundred and sixty-eight patients with lacunar infarction from January 2015 to January 2018 were selected in Tai′an Central Hospital. The CMBs group and non-CMBs group were classified according to susceptibility weighted imaging. The estimated glomerular filtration rate (eGFR) was obtained. According to the MDRD formula, the indicators of renal dysfunction in patients with different degrees of cerebral microbleeds were compared, and the related risk factors of cerebral microbleeds were analyzed by single factor and multivariate analysis. Results The blood high sensitive C-reactive protein (hs-CRP) was significantly higher in CMBs group than that in non-CMBs group: (4.29 ± 3.86) mg/L vs. (2.58 ± 2.74) mg/L, P < 0.01. The proportion of patients with elevated eGFR in CMBs group was significantly higher than that in non-CMBs group: 40.7%(33/81) vs. 11.4%(10/88), P<0.01. There were significant differences in the proportion of hypertension history [83.3% (50/60) vs. 52.4% (11/21), χ2＝6.947,P＝0.008], serum creatinine(SCr) value[(113.75 ± 71.23) μmol/L vs. (75.38 ± 38.36) μmol/L, t＝－2.346,P＝0.021] and eGFR value [(91.58 ± 31.87) ml/(min·1.73 m2) vs. (109.95 ± 29.47) ml/(min·1.73 m2),t＝2.316,P＝0.023] between CMBs groups with different distribution (P < 0.05). Multivariate Logistic regression analysis showed that the history of hypertension ( OR＝5.408; 95% CI 1.518-19.267, P＝0.008) was the risk factor of CMBs in deep/ subtentorial group.The urea nitrogen (BUN)value increased (χ2＝28.150, P < 0.01), SCr value (χ2＝47.610, P < 0.01) increased, and eGFR value (χ2＝39.067,P<0.01) decreased with the severity of CMBs, and the differences were statistically significant. The proportion of CMBs in patients with eGFR decreased group(76.7% , 33/43) was significantly higher than that in normal eGFR group (38.1%, 48/126), and the difference was statistically significant (χ2＝19.188, P < 0.01). Logistic regression analysis of multiple factors affecting cerebral microbleeds showed that history of hypertension ( OR＝3.135; 95% CI 1.343-7.321, P＝0.008), elevated hs-CRP( OR＝1.233; 95% CI 1.098-1.385, P < 0.01), eGFR decreased ( OR＝1.025; 95% CI 1.002-1.048, P＝0.033) were risk factors for cerebral microbleeds. The area under the ROC curve of eGRF was 0.694 (P＝0.042). Conclusions A history of hypertension is a risk factor for deep/infratentorial CMBs. Decreased glomerular filtration rate is an independent risk factor for cerebral microbleeds. Therefore, reminding clinicians to actively diagnose and treat patients with glomerular filtration rate decline has important clinical significance for preventing the occurrence and development of cerebral microbleeds.
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Objective To study the predictive value of lipoprotein-associated phospholipase A2 ( Lp-PLA2)for early neurological deterioration (END) in patients with lacunar infarction. Methods Between January 2016 and July 2018,281 consecutive patients with first-ever acute lacunar infarction admitted to the Department of Neurology, the Second People's Hospital of Lianyungang were enrolled retrospectively. They were divided into END group (n = 75 ) and non-END group ( n = 206) depending on whether END occurred or not. The general data ( age, sex, body mass index,past medical history) ,clinical data (National Institute of Health stroke scale [ NIHSS score] ) , onset to admission time,imaging data (white matter lesion score,cerebral microhemorrhage score and branch atherosclerosis) , treatment methods and laboratory findings such as neutrophil to lymphocyte ratio, total cholesterol,low- density lipoprotein cholesterol, fasting blood glucose, hypersensitive C-reactive protein, homocysteine, and Lp-PLA2 were compared in patients between the two groups. Immunoturbidimetry was used to determine the level of Lp-PLA2 in blood. SPSS 22. 0 software was used to analyze and process the data. Multivariate logistic regression was used to analyze the risk factors for affecting the occurrence of END in patients with lacunar cerebral infarction. Receiver operating characteristic (ROC) curve was used to analyze the value of Lp-PLA2 in predicting the occurrence of END in lacunar infarction. Results Univariate analysis showed that NLR (2. 5 ± 0. 5 vs. 2. 3 ± 0. 5, t = 2. 996) , low-density lipoprotein cholesterol (2. 6 ± 0. 8 mmol/L vs. 2. 3 ± 0. 7 mmol/L, t = 3. 056), NIHSS score on admission ( 3.4 ± 1.5 vs. 3.0 ± 1.4, l = 2. 080), and the proportion of patients with branch atherosclerosis (21. 3% [ 16/75] vs. 7. 3% [ 15/206] #=1 1-061) in the END group were higher than those in the non-END group (240 ± 26 jxg/L vs. 180 ±23 p,g/L, I = 9. 032) ,and the difference was statistically significant (all P <0. 05). Multivariate logistic regression analysis showed that the increased level of NLR (0/,3.927,95% CI 2.918 -5.016,P = 0.020),Lp-PLA2 (OR, 1.026,95% 67 1.019-1.034, P <0.01), low-density lipoprotein cholesterol (OR, 2.715,95% CI 2.193 -3.273, P =0.025) , NIHSS score on admission (OR,2. 831 ,95% CI 2.412 -3. 197, P = 0.028) , and branch atherosclerosis ( OR,4. 552 ,95% CI 2. 934 -7. 017 , P = 0. 002) were the independent risk factors for lacunar infarction occurring END. Receiver operating characteristic ( ROC) curve analysis showed that the area under the curve of Lp-PLA2 predicting END was 0. 799 (95% CI 0. 728 -0. 833 ,P< 0. 01 ) ;the optimal cut-off value was 189 jtg/L, the sensitivity for predicting END was 92. 3% ,and the specificity was 55. 4%. Conclusion The increased level of serum I.p-PLA2 is an independent risk factor for lacunar infarction occurring END,and it has certain predictive value for END.
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Objective To explore the changes of serum visfatin and thrombus precursor protein (TpP) levels in patients with lacunar infarction,and the relationship with carotid atherosclerotic plaque ,and to determine the values of the two factors to predict lacunar infarction .Methods Carotid atherosclerosis plaques were detected in 95 cases with lacunar infarction,including 56 cases in unstable plaque group,39 cases in stable plaque group,and another 70 healthy persons were selected as control group .Serum visfatin,high-sensitivity C reactive protein (hs-CRP), interleukin-6(IL-6) and TpP levels were measured.The carotid atherosclerotic plaque was examined by color Doppler ultrasonography.Results The levels of visfatin,hs-CRP and IL-6 in the unstable plaque group and stable plaque group were higher than those in the control group (t =10.886,9.180,11.889,4.990,5.084,9.703,all P <0.05).The levels of visfatin,hs-CRP and IL-6 in the unstable plaque group were (29.10 ±8.85)μg/L,(6.15 ± 2.78)mg/L and (5.98 ±2.66) pg /mL,respectively, which were higher than those in the stable plaque group [(21.47 ±8.39)μg/L,(4.37 ±2.09)mg/L and (4.64 ±2.03)pg/mL,t =4.222,3.385,2.652,all P <0.05]. Pearson linear correlation analysis and multiple linear stepwise regression analysis showed that serum visfatin levels were positively correlated with hs-CRP and IL-6.The TpP levels of 3h,6h and 12h after cerebral infarction in the unstable plaque group and stable plaque group were higher than those in the control group (t =17.342,21.770, 18.138,11.228,15.245,14.306,all P <0.05).The TpP levels of 3h,6h and 12h after cerebral infarction in the unstable plaque group were (18.52 ±6.43)mg/L,(25.95 ±7.98)mg/L,(18.43 ±6.10)mg/L,respectively,which were higher than those in the stable plaque group [(12.40 ±5.37) mg/L,(20.81 ±8.60) mg/L, (13.86 ± 5.04)mg/L,t =3.282,2.991,3.850,all P <0.05].Conclusion The serum levels of visfatin and TpP are highly specific,can be used as important indicators for prediction and diagnosis of lacunar infarction ,and they are related to the stability of carotid atherosclerotic plaque .
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ABSTRACT Background: Diagnosis of silent lacunar infarcts is complicated in remote rural areas where MRI is not available. Hospital series have suggested an association between the pulsatility index of intracranial arteries - as assessed by transcranial Doppler - and some neuroimaging signatures of cerebral small vessel disease. We aimed to assess the reliability of cerebral pulsatility indices to identify candidates for MRI screening in population-based studies assessing prevalence of silent lacunar infarctions. Methods: A random sample of stroke-free Atahualpa residents aged ≥60 years investigated with MRI underwent transcranial Doppler for calculating the pulsatility index (PI) of the middle cerebral artery (MCA). For each person, mean PI was obtained by averaging both MCAs. Using conditional logistic regression for matched pairs data, we evaluated whether the pulsatility index of both MCAs correlate with silent lacunar infarcts. Results: Silent lacunar infarcts were noticed in 28 (12%) of 234 scanned persons. Six of them were excluded due to poor insonation through transtemporal windows. The remaining 22 participants were considered case-patients and were matched 1:1 with individuals free of infarcts (controls). Moderate-to-severe white matter hyperintensities were noticed in 12 (55%) case-patients and 7 (32%) controls (p=0.228). The mean MCA PI value in the 44 participants was 1.15 ± 0.21, with no difference found across case-patients and controls, after adjustment for white matter hyperintensities (β coefficient: 3.361, 95% C.I.: -0.693 to 7.417, p=0.104). Conclusions: Cerebral PI should not be used to identify candidates for MRI screening in population-based studies assessing the burden of silent lacunar infarcts.
RESUMEN Antecedentes: El diagnóstico de infartos lacunares silentes es complicado en áreas rurales donde no se dispone de IRM. Series hospitalarias han sugerido una asociación entre el índice de pulsatilidad (IP) de las arterias intracraneales -evaluadas mediante Doppler transcraneal- y algunas de las imágenes sugestivas de enfermedad cerebral de pequeños vasos. Nuestro objetivo fue evaluar la confiabilidad del IP para identificar candidatos para la práctica de IRM en estudios poblacionales que evalúen prevalencia de infartos lacunares. Métodos: Una muestra aleatoria de residentes de Atahualpa sin evidencia de ictus, con edad ≥60 años e investigados con IRM, fueron sometidos a Doppler transcraneal, para calcular el IP de las arterias cerebrales medias. El IP medio se obtuvo promediando el IP de ambas arterias cerebrales medias. Usando regresión logística condicional, se evaluó si el IP de las arterias cerebrales medias se correlacionó con la presencia de infartos lacunares. Resultados: Se detectaron infartos lacunares silentes en 28 (12%) de 234 personas exploradas. Seis de ellos fueron excluidos debido a mala insonancia a través de ventanas transtemporales. Los 22 participantes restantes se consideraron casos y se emparejaron 1: 1 con individuos libres de infartos (controles). Se observaron hiperintensidades de sustancia blanca de moderada a grave en 12 (55%) pacientes y 7 (32%) controles (p = 0.228). El valor medio de IP en los 44 participantes fue de 1,15 ± 0,21, sin diferencias entre pacientes y controles, después del ajuste para hiperintensidades de sustancia blanca (coeficiente β: 3,361, 95% C.I.: -0,693 a 7,417, p = 0,104). Conclusiones: El IP cerebral no se debe utilizar para identificar candidatos para el cribado de IRM en estudios poblacionales que evalúen la presencia de infartos lacunares silentes.
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Objective To investigate the relationship between the level of serum cystatin C (CysC) and cognitive function in patients with acute cerebral lacunar infarction caused by small vessel disease . Methods One hundred twen-ty-three patients with acute cerebral lacunar infarction were divided into 3 groups according to serum cystatin C level. Patients were further divided into normal group (n=64), vascular mild cognitive impairment (VaMCI) group(n=36),and vascular dementia( VaD) group (n=23). The CysC, estimated glomerular filtration rate (eGFR), serum creatinine (Scr), TC, TG, HDL, LDL, fast glucose, HbA1C, NIHSS, MMSE, ADAS-cog score were compared between the 3 groups. Multivari-able logistic regression analysis was used to examine the association of serum CysC with cognitive function. Results Sub-jects with higher CysC levels tended to have lower MMSE score(21.98 ± 6.08 vs. 25.02 ± 4.69 vs. 25.10 ± 3.95 )and higher ADAS-cog score(17.73±14.23 vs. 12.51±10.39 vs. 10.67±7.53). The higher CysC was, the higher SCr and lower eGFR were. Subjects with severer cognition impairment tended to have higher CysC(0.93 ± 0.21 vs. 1.10 ± 0.45 vs. 1.34 ± 0.58). Multivariable logistic regression showed the regression coefficient was 7.06(P<0.05). Conclusion Elevated Serum CysC is one of the risk factors of cognitive dysfunction and associated with the severity in patients with small vessel disease-re-lated acute lacunar cerebral infarction.
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Objective:To observe the diagnosis effect about the MRI and CT examination for the patients with lacunar cerebral infarction(LAC).Methods: 82 cases early LAC patients during April 2014- June 2016 were diagnosed by two methods, MRI and CT, respectively. And the application effect of the two methods were compared based on image result.Results: In 82 cases of LAC 742 lesions confirmed by MRI and only 145 lesions confirmed by CT, and there was statistical significant between the two methods; especially in front lobe and thalamic, lesions detection rate using MRI was higher than CT, and there was statistical significant between the two methods(x2=6.59,x2=5.64,x2=6.42;P0.05);Conclusion: Both of CT and MRI can be used in early diagnosis of LAC, and MRI examination is more accurate for early or micro lesions and lesions happened in the frontal lobe, thalamus, capsula internal than CT. Therefore, MRI can be used as first choice eximination method in early diagnosis of LAC.
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Objective To observe the surface electromyography (sEMG) characteristics of pharyngeal swallowing muscles in different swallowing modes in asymptomatic lacunar infarction (LI) patients. Methods From January, 2015 to January, 2017, a total of 32 asymptom-atic LI patients (LI group) aged over 60 years were consecutively collected, and 30 normal old subjects matched with age and gender (nor-mal group) were also enrolled. The amplitudes of sEMG activity of infrahyoid muscles and submental muscles in different swallowing modes were recorded, and the root mean square (RMS) was analyzed. Results Significant difference was found in both muscle groups in dif-ferent swallowing modes in both groups (F>110.67, P0.05). In the 20 ml water swallowing mode, the RMS was lower in the submental muscles in the LI group than in the normal group (t=3.334, P0.05). In the 100 ml continuous drinking mode, the RMSs were significantly lower in both two muscle groups in LI group than in the normal group (t>3.118, P<0.01). Conclusion Swallow abilities decrease in asymptomatic LI. sEMG could be used to evaluate their swallowing function.
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Objective To explore the independent risk factors and distribution of intracranial arterial stenosis in young pa‐tients with acute lacunar infarction .Methods We retrospectively reviewed the clinical data of 30-45 year‐old young patients with lacunar infarction who were admitted to the Third Affiliated Hospital of Xinxiang Medical University .The patients were divided in‐to two groups according to their skull blood vessel examination :intracranial arterial stenosis group and intracranial arterial stenosis group .Results There were 28 cases of intracranial large artery stenosis and 17 cases without stenosis in 45 young patients ,it was found that the levels of triglyceride ,low density lipoprotein cholesterol and carotid artery plaque in the intracranial arterial stenosis were significantly less than those of the intracranial artery stenosis (P0 .05) .Simple ante‐rior circulation stenosis in 12 cases ,simple posterior circulation stenosis in 8 cases ,only the anterior and posterior circulation in‐tracranial artery stenosis ,vascular risk factors were not statistically significant ( P> 0 .05 ) .Binary Logistic regression analysis showed that LDL cholesterol was an independent risk factor of intracranial arterial stenosis .Conclusion With intracranial artery stenosis in young patients with lacunar cerebral infarction prone to progressive stroke ,young patients with cerebrovascular infarc‐tion should be examined .
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Objective To investigate the influence of combined spinal-epidural anesthesia and general anesthesia on short-term cogni-tive function of elderly patients with lacunar infarction after surgery.Methods A total of 50 patients with lacunar infarction who underwent abdominal surgery in our hospital from June 2012 to December 2013 were selected as the research object,who were divided into spinal-epi-dural anesthesia group (combined group)and general anesthesia group (general group).The incidence of postoperative cognitive dysfunction of two groups were observed and compared.The mini-mental state examination(MMSE)and Montreal cognitive Assessment(MoCA)were used to evaluated the cognitive function before and postoperative 1 day.Results The probability of postoperative cognitive dysfunction (POCD)of combined group and the general group were 12% and 32%,respectively,and the POCD probability of combined group was lower than that of general group,the difference was significant(P <0.05).The MMSE score and MoCA score at postoperative 1 day of two groups were lower than those before anesthesia,the difference was significant(P <0.05).The MMSE score and MoCA score of combined group at postoperative 1 day were lower than that of general group,the difference was significant(P <0.05).Conclusion The anesthesia can cause a certain cognitive dysfunction for elderly patients with lacunar infarction,while the spinal-epidural anesthesia can reduce the incidence rate of POCD compared anesthesia.
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Objective:To observe the clinical efficacy and safety of piracetam tablets combined with butylphthalide soft capsules in the treatment of patients with lacunar infarction(LI) complicated with vascular cognitive impairment(VCI). Methods:Totally 87 cases of patients with LI and VCI were selected and randomly divided into the control group(44 cases)and the treatment group(43 cases). The control group was only treated with piracetam tablets(1. 2 g,tid),while the treatment group was treated with piracetam tablets(1. 2 g,tid)and butylphthalide soft capsules(0. 2 g,qid),and the treatment course was 30 days. The changes of MMSE score,serum of SOD level and adverse drug reactions were observed and compared in the two groups. Results:Compared with those before the treatment,the mini-mental state examination(MMSE)score and serum level of SOD of the two groups were increased(P < 0. 01)after the treatment,and the increase in the treatment group was more notable than that in the control group(P < 0. 01and P < 0. 05). The effective rate of the treatment group was 86. 05% ,which was higher than that of the control group(75. 00% ,P < 0. 05). Conclusion:Piracetam combined with butylphthalide soft capsules can effectively improve the cognitive impairment of the patients with LI and VCI,and the effect may be related with increasing the level of SOD.
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Objective Toinvestigatethechangesofcognitiveimpairmentandcerebralhemodynamics inpatientswithacutelacunarcerebralinfarctionwithin2weeksafteronset.Methods Nineteenpatients with lacunar cerebral infarction (a patient group)were consecutive enrolled in the study. Twenty-three sex-and age-matched inpatients without ischemic cerebrovascular disease or healthy volunteers of outpatient department over the same period were used as a control group. The cerebral hemodynamic features were evaluated with transcranial Doppler (TCD)breath-holding test and single photon emission computed tomography (SPECT)resting + adenosine stress imaging. Simultaneously,the neuropsychological tests were performed,the Montreal cognitive assessment (MoCA)was performed including executive capacity, structural capacity,memory (including auditory memory,visual memory,and logic memory ),information processing speed,and visual-spatial ability. Results (1 )There were no significant differences in the years of education,hypertension,diabetes,hyperlipidemia,coronary heart disease,and smoking between the 2 groups (all P>0. 05). Compared with the control group,there were significant differences in the MoCA score,visual memory,executive function,structural capacity,and information processing speed of the patient group (all P<0. 05). (2)19 patients completed the SPECT resting + load test (12 in the control group and 7 in the patient group). There were significant differences in the uptake ratio (UR)in the right basal ganglia (8. 91[-2. 48 - 5. 87]and -6. 21 [-10. 39 - 5. 42 respectively])and left frontal lobe UR (11. 62 [2. 93-16. 87]and 1. 04 [-10. 17- 3. 82]respectively)between the patient group and the control group (P<0. 05). (3)26 patients completed the breath-holding test + head-up tilt table test (n=13 in each group]. The vascular motor reactivities were 13 ± 5 on the left and 21 ± 7 on the right, and the breath-holding indexes were 0. 66 ± 0. 26 on the left and 1. 0 ± 0. 4 on the right in the patient group;the vascular motor reactivities were 24 ± 11 on the left and 30 ± 9 on the right,and the breath-holding indexes were 1. 21 ± 0. 57 on the left and 1. 5 ± 0. 4 on the right in the control group. There were significant differencesbetweenthe2groups(P<0.05).Conclusion Attheearlystageoflacunarinfarction,the patients have presented varying degrees of cognitive impairment and the changes of cerebral hemodynamics.
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Objective The predictive indexes which affect early neurological deterioration ( END) of patients with acute la-cunar stroke still remain unclear .The purpose of the article was to investigate the correlation between the location and numbers of cere -bral microbleeds (CMBs) and END in patients with first-onset lacunar stroke. Methods 217 patients with acute lacunar stroke hos-pitalized in Anhui Provincial Hospital within 24 hours after occurrence from Mar 2009 to May 2012 were prospectively enrolled .All pa-tients underwent susceptibility-weighted imaging MRI right after admission , followed by the investigation on the relationship of the loca-tion and numbers of CMBs and END . Results END occurred in 76 (35.0%) patients.Among these patients, there were 33 positive cases with CMBs (43.3%).There were no significant difference in END incidence between positive group and negative group (P=0.173).In the comparison of the numbers of CMBs foci , patients with more than 5 foci were more prone to END (P=0.005).Logistic regression analysis showed there was relation between CMBs foci numbers>5 and END (OR=3.14, 95% CI: 1.22 ~8.13), and there was no relation between CMBs foci numbers≤5 and END ( OR=1.12, 95%CI:0.53~2.37)as to CMBs negative patients.No signifi-cant relationship was found in CMBs location and END occurrence ( P>0.05). Conclusion The distribution of CMBs foci has nothing to do with early neurological fluctuation .However , more than 5 CMBs foci might be the independent prediction cause of END .
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Recent studies suggest that lacunar infarction is a high risk ischemic cerebrovascular disease highly correlated with the time, which optimistic prognosis is not as good as previously thought.In addition, the role of macrovascular diseases has not been paid attention, it is not conducive to secondary prevention and early intervention for the etiology of lacunar infarction.This review focu-ses on application of imaging diagnosis of lacunar infarction, the etiology of non-lacunar infarct, and differential diagnosis of lacunar in-farction.
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BACKGROUND: Patients with lacunar infarction often show neurological deterioration during the acute period of stroke. The aim of this study was to identify the predictors for early neurological deterioration (END) in patients with lacunar infarction using clinical variables and the findings of diffusion-weighted imaging (DWI). METHODS: This study involved 104 consecutive patients with acute lacunar infarction in the lenticulostriate artery territory who were admitted within 24 hours after onset between January 2010 and October 2014. END was defined as a decrease of > or =1 point in the National Institutes of Health Stroke Scale (NIHSS) motor score or > or =2 points in the total NIHSS score during the first 7 days after stroke onset. Clinical characteristics including initial NIHSS score, vascular risk factors, laboratory parameters, and DWI findings including the size, location, and shape of the lacunar infarction were evaluated to identify predictors for END. RESULTS: END occurred in 25 (24%) patients with lacunar infarction. The initial NIHSS score (odds ratio, 1.47; p=0.01), number of infarct slices (odds ratio, 1.95; p<0.01), and infarction with an irregular shape (odds ratio, 2.87; p=0.048) were independently associated with END in multivariable logistic regression analysis. In receiver operating characteristic curve analysis, the best threshold for predicting END was an NIHSS score of 4 points (sensitivity, 72%; specificity, 68%) and an infarct slice number of 3 (sensitivity, 84%; specificity, 62%). CONCLUSIONS: This study suggests that the initial NIHSS score, number of infarct slices, and an irregular lesion shape are independent predictors for END.
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Humans , Arteries , Infarction , Logistic Models , Risk Factors , ROC Curve , Sensitivity and Specificity , Stroke , Stroke, LacunarABSTRACT
Chronic kidney disease, defined by a decreased glomerular filtration rate or albuminuria, is recognized as a major global health burden, mainly because it is an established risk factor for cardiovascular and cerebrovascular diseases. The magnitude of the effect of chronic kidney disease on incident stroke seems to be higher in persons of Asian ethnicity. Since the kidney and brain share unique susceptibilities to vascular injury due to similar anatomical and functional features of small artery diseases, kidney impairment can be predictive of the presence and severity of cerebral small vessel diseases. Chronic kidney disease has been reported to be associated with silent brain infarcts, cerebral white matter lesions, and cerebral microbleeds, independently of vascular risk factors. In addition, chronic kidney disease affects cognitive function, partly via the high prevalence of cerebral small vessel diseases. Retinal artery disease also has an independent relationship with chronic kidney disease and cognitive impairment. Stroke experts are no longer allowed to be ignorant of chronic kidney disease. Close liaison between neurologists and nephrologists can improve the management of cerebral small vessel diseases in kidney patients.
Subject(s)
Humans , Albuminuria , Arteries , Asian People , Brain , Cerebral Small Vessel Diseases , Dementia , Glomerular Filtration Rate , Kidney , Kidney Diseases , Prevalence , Renal Insufficiency, Chronic , Retinal Artery , Risk Factors , Stroke , Stroke, Lacunar , Vascular System InjuriesABSTRACT
BACKGROUND: Contrary to the initial hypothesis, there is accumulating evidence that the pathogenesis of lacunar infarction (LI) is heterogeneous. LI is often accompanied by intracranial stenosis, and while the clinical significance of severe stenosis of the intracranial parent artery in LI has been demonstrated, that of mild stenosis in LI has not been. Thus the aim of this study was to determine the clinical relevance of mild intracranial stenosis in LI. METHODS: Ninety-three consecutive patients with acute LI were enrolled between March 2011 and December 2013. The patients were divided according to the presence of intracranial stenosis in the parent artery into pure LI (PLI) and LI with mild intracranial stenosis (<50% stenosis, BAD). Various clinical and laboratory characteristics were compared between the two groups. RESULTS: PLI group were older and, had a less frequent history of smoking, a larger infarct, lower likelihood of a favorable outcome, and higher National Institute of Health Stroke Scale score at discharge in the univariate analysis. After adjusting for confounding factors, BAD was associated with older age at onset [odds ratio (OR) = 1.113, 95% confidence interval (95% CI) = 1.056-1.172, p<0.001), no history of previous statin medication (OR = 13.362, 95% CI = 1.014-176.062, p=0.049), and nonsignificant stenosis in the parent artery was associated with larger infarct (beta=0.296, p=0.01) in the multivariate analyses. CONCLUSIONS: LI with mild parent-artery disease was demonstrated to have distinct clinical characteristics compared to LI without parent artery disease. Thus, even mild branch atheromatous disease in LI should be evaluated thoroughly and treated via a planned and systematic approach.
Subject(s)
Humans , Arteries , Constriction, Pathologic , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Intracranial Arteriosclerosis , Multivariate Analysis , Parents , Smoke , Smoking , Stroke , Stroke, LacunarABSTRACT
Objective To explore relationship between magnetic resonance imaging (MRI) performance and lipid levels in pa-tients with lacunar infarction (LI) .Methods 68 patients with LI were retrospectively analyzed ,62 cases patients without heart ce-rebrovascular disease in the same period were choosen as control group ,the multivariate logistic regression was used to analyze the relationship between MRI performance ,the changed level of lipid .Results A total of 299 lacunar lesions were detected by MRI ,in which there were 58(19 .40% )in the left cerebral hemisphere ,26(8 .70% ) in the right hemisphere ,73(24 .41% ) in the bilateral basal ganglia ,27 (9 .03% ) in thalamus ,54 (18 .06% ) in the lateral ventricles corona radiata ,39 (13 .04% ) in brainstem ,and 22 (7 .36% ) in cerebellum .TC ,TG ,LDL-C and Ox-LDL levels in LI patients were significantly higher than the controls (P<0 .05) , while HDL-C levels were significantly lower than the controls (P<0 .05) .Multivariate Logistic regression analysis showed that relative risk of TC ,TG ,LDL-C ,HDL-C and Ox-LDL to LI were 1 .56 ,1 .27 ,1 .39 ,1 .46 and 1 .44 .Conclusion The MRI manifestations and lipid levels of LI have a certain degree of correlation ,and elevated blood lipid levels may be important risk factors for LI .