Measurement of optic nerve sheath diameter on computed tomography for the differentiation of transient ischemic attacks

SUMMARY OBJECTIVE: The objective of this study was to investigate whether the measurement of mean optic nerve sheath diameter in patients with transient ischemic attack could be used to distinguish between control groups, the acute ischemic stroke group, and subgroups within the acute ischemic stroke category. METHODS: Retrospectively, the mean optic nerve sheath diameters of patients aged 18 years and older belonging to control, transient ischemic attack, acute ischemic stroke, and subgroups within the acute ischemic stroke category were measured with initial computed tomography conducted in the emergency department. RESULTS: Out of the 773 patients included in the study, 318 (41.1%) were in the control group, 77 (10%) had transient ischemic attack, and 378 (49%) were categorized as stroke patients. The average mean optic nerve sheath diameter was significantly higher in both the stroke and transient ischemic attack groups compared with the control group (p<0.001 for both comparisons). Furthermore, the mean optic nerve sheath diameter in the stroke subgroups was significantly higher than in both the transient ischemic attack and control groups (p<0.001 for all comparisons). In transient ischemic attack patients, the mean optic nerve sheath diameter showed a significant ability to predict transient ischemic attack (AUC=0.913, p<0.001), with a calculated optimal cutoff value of 4.72, sensitivity of 94.8%, and specificity of 73.9%. CONCLUSION: The mean optic nerve sheath diameter of patients in the transient ischemic attack group was lower compared with those in the stroke subgroups but higher compared with the control group.

Value of multiparameter MRI in predicting acute cerebral infarction secondary to transient ischemic attack / 中华神经医学杂志

Objective:To investigate the value of multiparameter MRI in predicting secondary acute cerebral infarction in patients with transient ischemic attack (TIA).Methods:A total of 358 patients with TIA admitted to Department of Neurology, Affiliated Hospital of Chengde Medical College from April 2020 to May 2022 were selected. They were divided into cerebral infarction group ( n=114) and non-cerebral infarction group ( n=244) according to whether they had secondary acute cerebral infarction within 3 months of follow up. Differences in multiparameter MRI (number of unstable plaques, reference vessel area/plaque area, internal carotid artery stenosis rate, intracranial arterial stenosis rate, ratio of unstable plaques, lumen area of the most stenotic responsible vessel, and wall area of the most stenotic responsible vessel) at the consultation time were collected and compared between the 2 groups; correlations of multiparameter MRI with secondary acute cerebral infarction was evaluated by partial regression analysis; value of multiparameter MRI in predicting secondary acute cerebral infarction in TIA patients was evaluated by receiver operating characteristic (ROC) curve. Results:Reference vessel area/plaque area, intracranial arterial stenosis rate, ratio of unstable plaques and wall area of the most stenotic responsible vessel in the infarction group were significantly higher/larger than those in the non-cerebral infarction group, and lumen area of the most stenotic responsible vessel in the infarction group was significantly smaller than that in the non-cerebral infarction group ( P<0.05). After adjusting for age and gender, reference vessel area/plaque area, intracranial arterial stenosis rate, ratio of unstable plaques and wall area of the most stenotic responsible vessel were positively correlated with secondary acute cerebral infarction, while lumen area of the most stenotic responsible vessel was negatively correlated with secondary acute cerebral infarction ( P<0.05); AUC of the combination of above parameters was 0.900, which was significantly greater than that of reference vessel area/plaque area (0.724), intracranial arterial stenosis rate (0.751), unstable plaque occurrence rate (0.812), lumen area of the most stenotic vessel (0.771), and wall area of the most stenotic vessel (0.763), respectively ( P<0.05). Conclusion:Multiparameter MRI analyzing reference vessel area/plaque area, intracranial arterial stenosis rate, ratio of unstable plaques, lumen area of the most stenotic responsible vessel, and wall area of the most stenotic responsible vessel can effectively predict secondary acute cerebral infarction in TIA patients.

Neuronal intranuclear inclusion disease presented with stroke-like onset: a case report / 中华神经科杂志

Neuronal intranuclear inclusion disease (NIID) is a neurodegenerative disease, characterized by eosinophilic transparent inclusions in the central and peripheral nervous systems, and internal organs. NIID clinical characteristics are varied, including cognitive impairment, muscle weakness, episodic symptoms, movement disorders and autonomic dysfunction. This article reports a patient with NIID who manifested with episodes of aphasia, dysgraphia and dyslexia without fever, headache, nausea and vomiting confirmed by genetic testing. The patient was a 62-year-old female with acute onset who was diagnosed with transient ischemic attack. This article aims to improve the knowledge of NIID with stroke-like onset by this case presentation and avoid misdiagnosis.

Correlation between serum fibrinogen albumin ratio and ischemic cerebrovascular disease / 中风与神经疾病杂志

@#Objective The aim of this study was to analyze the relationship between serum fibrinogen to albumin ratio(FAR) and the main types of ischemic cerebrovascular disease(IVD):lacunar infarction(LI) and transient ischemic attack(TIA) before treatment. Methods Two hundreds and twenty-six IVD patients who were admitted to our hospital from January 2018 to November 2021 were collected,including 109 in Li group and 117 in TIA group. According to the average value of FAR,the two groups were divided into LILow FAR group(≤0.11,n=61),LI High FAR group(>0.11,n=48),TIA Low FAR group(≤0.11,n=68) and TIA High FAR group respectively(>0.11,n=49);Thirty-three healthy patients in the same period were selected as the control group. Pre-treatment FAR levels were analyzed in the five groups of patients,the FAR levels of the five groups were analyzed,the correlation between FAR levels and LI and TIA was analyzed by multivariate logistic regression,and the predictive value of FAR to LI and TIA was evaluated by ROC curve. Results Compared with the control group and Low FAR group,FAR in LI and TIA groups was increased(P≤0.05). Multivariate logistic regression analysis showed that FAR is an independent risk factor for LI,not for TIA. ROC curve analysis shows that the FAR can be a predictor of LI. Conclusion FAR is an independent risk factor for LI. It has good predictive value for LI,andit can be used as a predictor of LI.

Coexisting Coronary and Carotid Artery Disease: What We Did, What Happened

ABSTRACT Introduction: There is no complete consensus on the three surgical methods and long-term consequences for coexisting coronary and carotid artery disease. We retrospectively evaluated the surgical results in this high-risk group in our clinic for a decade. Methods: Between 2005 and 2015, 196 patients were treated for combined carotid and coronary artery disease. A total of 50 patients were operated on with the staged method, 40 of which had carotid endarterectomy (CEA) priority, and 10 had coronary artery bypass grafting (CABG) priority. CABG and CEA were simultaneously performed in 82 patients; and in 64 asymptomatic patients with unilateral carotid artery lesions and stenosis over 70%, only CABG was done (64 patients). Results were evaluated by uni-/multivariate analyses for perioperative, early, and late postoperative data. Results: In the staged group, interval between the operations was 2.82±0.74 months. Perioperative and early postoperative (30 days) parameters did not differ between groups (P-value < 0.05). Postoperative follow-up time was averaged 94.9±38.3 months. Postoperative events were examined in three groups as (A) deaths (all cause), (B) cardiovascular events (non-fatal myocardial infarction, recurrent angina, congestive heart failure, palpitation), and (C) fatal neurological events (amaurosis fugax, transient ischemic attack, and stroke). When group C events were excluded, event-free actuarial survival rates were similar in all three methods (P=0.740). Actuarial survival rate was significantly different when all events were included (P=0.027). Neurological events increased markedly between months 34 and 66 (P=0.004). Conclusion: Perioperative and early postoperative event-free survival rates were similar in all three methods. By the beginning of the 34th month, the only CABG group has been negatively separated due to neurological events. In the choice of methodology, "most threatened organ priority'' was considered as clinical parameter.

Pre-induction Jerky limb movements on operation table – Is it transient ischemic attack

Transient ischemic attack (TIA) is a diagnostic challenge for all physicians due to the temporariness of symptoms and the absence of any definitive diagnostic test. There is a very high risk of TIA being followed by an ischemic stroke, hence require urgent investigation and preventive strategies. At the same time, it is also important to distinguish TIA from other close differentials, to avoid wrong diagnoses leading to harmful, misdirected medical management. In this report, we will discuss the case of a middle-aged male patient with stable pre-operative vitals who was posted for total parotidectomy and suddenly developed jerky movement of the upper limb and transient aphasia on the operation theater table along with raised blood pressure. This is a very rare presentation of TIA that needs to be differentiated from other close differentials as this form is mostly associated with severe carotid occlusive disease and, hence, carries a high risk of stroke.

A perplexing case report of an imaging negative acute ischemic stroke

Magnetic resonance imaging (MRI) is often seen as the gold standard when dealing with an acute ischemic stroke. Despite its unique ability to quickly diagnose acute stroke with diffusion-weighted imaging, there is enough evidence to suggest that MRI has failed to diagnose acute ischemic stroke in a minority of patients. We, hereby, present a case of a 55-year-old gentleman who presented with symptoms consistent with an acute ischemic event, but concurrent computed tomography and MRI were normal. However, the treatment regime for stroke was commenced despite normal imaging. It was only on the 3rd day of admission when the MRI revealed a significant finding which consolidated our diagnosis of ischemic stroke.Through this case report, we aim to help clinicians avoid misdiagnosis or delay in the treatment strategies, especially intravenous thrombolysis in patients with a clinical diagnosis of acute stroke with normal neuroradiological imaging. This is a testament to the fact that clinical assessment still retains priority until a diagnostic tool offers 100% sensitivity and specificity

Multiple Mild Stimulations Reduce Membrane Distribution of CX3CR1 Promoted by Annexin a1 in Microglia to Attenuate Excessive Dendritic Spine Pruning and Cognitive Deficits Caused by a Transient Ischemic Attack in Mice / 神经科学通报·英文版

A transient ischemic attack (TIA) can cause reversible and delayed impairment of cognition, but the specific mechanisms are still unclear. Annexin a1 (ANXA1) is a phospholipid-binding protein. Here, we confirmed that cognition and hippocampal synapses were impaired in TIA-treated mice, and this could be rescued by multiple mild stimulations (MMS). TIA promoted the interaction of ANXA1 and CX3CR1, increased the membrane distribution of CX3CR1 in microglia, and thus enhanced the CX3CR1 and CX3CL1 interaction. These phenomena induced by TIA could be reversed by MMS. Meanwhile, the CX3CR1 membrane distribution and CX3CR1-CX3CL1 interaction were upregulated in primary cultured microglia overexpressing ANXA1, and the spine density was significantly reduced in co-cultured microglia overexpressing ANXA1 and neurons. Moreover, ANXA1 overexpression in microglia abolished the protection of MMS after TIA. Collectively, our study provides a potential strategy for treating the delayed synaptic injury caused by TIA.

Efficacy and safety of generic and branded atorvastatin in patients with ischemic stroke/transient ischemic attack: A real-world study / 中国临床药理学与治疗学

AIM: In this study, we assessed the safety and efficacy of generic and branded atorvastatin in patients with ischemic stroke/transient ischemic attack in real-world practice. METHODS: Patients admitted for ischemic stroke/transient ischemic attack between January 1, 2018 and March 31, 2021 who continually received atorvastatin for ≥6 months after diagnosis were included. Safety and efficacy endpoints in patients receiving the generic atorvastatin were compared with those of patients receiving the branded medication. Propensity score matching was applied to control con-founders. RESULTS: There were 665 patients in our final analysis, 302 in the branded group and 363 in the generic group. After propensity score matching, patients who received generic atorvastatin did not show a greater incidence of Ischemic Stroke/transient ischemic attack recurrence or onset of coronary heart disease. Similar changes in NIHSS and mRS scores were observed between the generic and branded groups. Consistent results were found in rates of hepatobiliary laboratory abnormalities and the compound adverse event profile of an elevated creatine kinase level, elevated aspartate aminotransferase/alanine aminotransferase levels, and intracranial hemorrhage. Results were consistent before and after propensity score matching. CONCLUSION: Both generic and branded atorvastatin are equally effective in preventing stroke recurrence and improving neurological deficits in patients with ischemic stroke/ transient ischemic attack. Both treatments are generally well tolerated by patients.

A case of transient ischemic attack during acupuncture therapy / 全日本鍼灸学会雑誌

[Objective] We report a case in which we unexpectedly encountered a patient with a transient ischemic attack (TIA) caused by severe stenosis of the left middle cerebral artery (MCA) during the course of acupuncture treatment.Patient: A 79-year-old man suffered from bilateral shoulder pain. He was diagnosed with a frozen shoulder at the orthopedic department and was referred to the acupuncture department.[Results] During the course of acupuncture treatment, the subject occasionally exhibited subtle behavioral features, such as difficulty in speech, holding incoherent conversations, and forgetting where he put things. The symptoms were observed repeatedly during treatment, so the acupuncturist referred the patient to the neurosurgical department for a consultation. Magnetic resonance imaging (MRI) of the brain showed an old cerebral infarction in the watershed area in the left paraventricular region, and MR angiography (MRA) revealed left middle cerebral artery stenosis. Single photon emission computed tomography showed decreased blood flow in the left MCA area. The symptoms could be considered TIA with motor and sensory aphasia. The administration of aspirin was started, and the symptoms disappeared.[Discussion and Conclusion] The acupuncturist has more opportunities to obtain information about the patient due to the longer time spent in acupuncture therapy compared to general outpatient treatment. Acupuncture can play an important role in medical partnership. It is also important that the acupuncturist has sufficient medical knowledge.

Accidente cerebrovascular isquémico en un adulto joven

RESUMEN Presentamos caso de un varón de 39 años con antecedentes de varios accidentes isquémicos transitorios que siempre resolvieron rápida y espontáneamente. Fue sometido a varios estudios cardiovasculares, neurovasculares y de neuro y angioimagen que resultaron normales. El paciente se presentó a consulta con una paresia facio-braquial derecha y disartria. Sin embargo, el cuadro cedió en el transcurso de horas a pesar de manifestarse una isquemia en los estudios neurovasculares. Por todo lo anterior se decidió estudiar trombofilias presentándose el resultado de una mutación del gen G20210A de la protrombina. Al alta, en tratamiento con anticoagulantes orales, el paciente se presenta asintomático con monitoreo mensual continuo.

ABSTRACT We present the case of a 39-year-old man with a history of several transient ischemic attacks that always resolved quickly and spontaneously. He underwent several cardiovascular, neurovascular, and neuro and angioimaging studies that were normal. The patient presented for consultation with a right faciobrachial paresis and dysarthria. However, the condition subsided within hours despite ischemia manifested in neurovascular studies. For all the above, it was decided to study thrombophilias, finding the prothrombin G20210A mutation. Upon discharge, on treatment with oral anticoagulants, the patient is asymptomatic with continuous monthly monitoring.

Analysis of the efficacy of tirofiban in the treatment of transient ischemic attack with high risk of recurrence / 中风与神经疾病杂志

@#Objective　To investigate the efficacy of tirofiban on transient ischemic attack with high risk of recurrence.Methods　156 patients with non-cardiogenic transient ischemic attack with ABCD2 score ≥ 4 points were hospitalized at the Department of Neurology,Sinopharm Tongmei General Hospital from Jan 2019 to Mar 2021.Eight patients were excluded due to incomplete data or drop-off from follow-up.The remaining 148 patients were randomly divided into two groups,78 in the observation group and 70 in the control group.The observation group was given tirofiban treatment (loading tirofiban via a micropump,and continuous intravenous pumping for 48 hours) and intensive lipid-lowering therapy.The control group was given intensive anti-platelet aggregation therapy with Aspirin enteric-coated tablets,hydroclopidogre and intensive lipid-lowering therapy.We made a comparative analysis between two groups about efficacy,safety and short-term stroke incidence.Results　In the observation group,57 cases were cured,14 cases were effective,and 7 cases were ineffective;6 cases (7.69%) had a stroke (cerebral infarction) within 7 days,7 cases (8.97%) had a stroke within 30 days,and 7 cases (8.97%) had a stroke within 90 days.In the control group,39 cases were markedly effective,15 cases were effective,and 16 cases were ineffective;in the control group,13 cases (18.57%) had a stroke (cerebral infarction) within 7 days,15 cases (21.43%) had a stroke within 30 days,16 cases (22.86%) had a stroke within 90 days.No intracerebral hemorrhage occurred in either group within 90 days.The two groups had statistical significance in terms of effective treatment rate (P<0.05).However,there was no significant difference in the number of stroke cases between the observation group and the control group in the short-term 7 days,30 days,and 90 days (P>0.05).There was no significant difference in coagulation,platelet,liver and kidney function between the two groups after 48 hours of treatment (P>0.05).Conclusion　For patients with transient ischemic attack at high risk of recurrence,tirofiban treatment can effectively control TIA attacks,but it cannot reduce the risk of stroke.

Analysis of bleeding characteristics and risk factors caused by aspirin combined with ticagrelor in the treatment of IS/TIA / 中风与神经疾病杂志

@#Objective To investigate characteristics of bleeding caused by combination of aspirin with ticagrelor in the treatment of Ischemic stroke (IS) and Transient Ischemic Attack (TIA),and analyze the risk factors influencing the occurrence of bleeding. Methods 501 patients with IS and TIA who were treated with aspirin combined with ticagrelor were included. And baseline and clinical data of the subjects were collected on the first day after admission,and the occurrence of bleeding events within one year was followed up. Patients were divided into two groups according to whether there was bleeding. Baseline and clinical data of the two groups were compared,and risk factors of bleeding events were analyzed by logistic regression. Results After 1 year of follow-up,a total of 89 patients were found to have bleeding,with a total bleeding rate of 17.76%,a fatal bleeding rate of 5.39% and a non-fatal bleeding rate of 12.38%. In 5.19% of patients,ticagrelor was discontinued due to bleeding,while in 7.58% of patients,the dosage of ticagrelor was halved due to bleeding. Logistic regression analysis found that age,smoking history,history of myocardial infarction,history of peptic ulcer and CRUSADE score≥41 are risk factors for bleeding events (P<0.05). Conclusion 17.76% of IS and TIA had bleeding events during aspirin combined with ticagrelor,and age,smoking history,history of myocardial infarction,history of peptic ulcer disease,and higher CRUSADE score were risk factors for bleeding.

Ataque isquémico transitorio como manifestación inicial de arteritis de células gigantes: reporte de caso / Transient ischemic attacks initial manifestation of giant cell arteritis: case report

RESUMEN La arteritis de células gigantes es la vasculitis sistémica de medianos y grandes vasos más frecuente en adultos mayores de 50 años. Afecta de manera preferencial a las ramas de las arterias carótidas y vertebrales, pero también se han visto involucradas las arterias axilares, las femorales y las iliacas. Se reporta el caso de un paciente adulto que debutó con clínica de accidente isquémico transitorio asociado con cefalea frontotemporal de moderada intensidad persistente. A la exploración física se encontraba con arterias temporales prominentes y dolorosas, pero no refería síntomas o signos de claudicación mandibular ni de polimialgia reumática. Se confirmó el diagnóstico de arteritis de células gigantes mediante biopsia de arteria temporal y se instauró corticoterapia de forma temprana con buena respuesta al tratamiento. Los eventos isquémicos cerebrovasculares son una presentación relativamente poco frecuente y se han descrito clásicamente cuando ya se han iniciado síntomas de vasculitis. En este caso se presentó como manifestación inicial del periodo activo de la enfermedad, lo cual conlleva un reto diagnóstico que es importante tener en cuenta para iniciar las medidas terapéuticas de manera precoz y disminuir las complicaciones potencialmente graves asociadas. Dentro de tales medidas es preciso destacar el uso de agentes biológicos como el tocilizumab que como terapia adyuvante reduce el riesgo de recaída y la exposición acumulativa de corticoides, en comparación con la monoterapia con corticoides en ciertos casos de arteritis de células gigantes con complicaciones.

SUMMARY Giant cell arteritis is the most common systemic vasculitis of medium and great vessels in adults over 50 years of age. This involvement preferentially the branches of the carotid and vertebral arteries, but the axillary, femoral and iliac arteries have also been involved. The case of an adult patient who debuted with a transient ischemic accident clinic who associated manifestation of moderate persistent frontotemporal headache and the physical examination with prominent and painful temporal arteries is reported. No symptoms or signs of mandibular claudication or polymyalgia rheumatica are reported. The diagnosis of giant cell arteritis was confirmed by temporal artery biopsy and corticosteroid therapy was instituted early with a good response to treatment. Cerebrovascular ischemic events are a relatively rare presentation and have been classically described when symptoms of vasculitis have started, in this case they presented as the initial manifestation of the active period of the disease, which denotes a diagnostic challenge that is important to consider. to initiate therapeutic measures early and reduce associated potentially serious complications. Among these therapeutic measures, the use of biological agents such as Tocilizumab, which as adjuvant therapy reduces the risk of relapse and cumulative corticosteroid exposure compared to corticosteroid monotherapy in cases of giant cell arteritis with complications, should be highlighted.

Vitamin B 12: the hidden ingredient of stroke

Background: Study aimed to evaluate the relationship between vitamin B12 and acute cerebral stroke in this study.Methods: Blood samples drawn within 24 hours after the stroke from hospitalized patients (n=100) and from 100 control cases matched for age, sex and other modifiable risk factors of stroke were analyzed. With a competitive, ECLIA, serum levels of vitamin B12 were measured. The quantitative data of the groups was compared using Analysis of Varience and Tukeys HSD post hoc test for comparison. Chi-square tests were used.Results: Median serum vitamin B12 levels were significantly lower in the patients than in the control subjects, 188.71 and 256.25 pg/ml respectively (p=0.0001). This difference was independent from other risk factors. The mean age in case group was 62.49 (SD: 12.45 years) and 56.62 (SD: 13.05 years) in control group with p=0.001. Therefore, prevalence of stroke is more between 6th and 7th decade of life. Mean serum vitamin B12 levels were lower in males (201.8pg/ml) than the females (268.pg/ml) in the case group.Conclusions: Low vitamin B12 is associated with an increased risk of stroke, and its relationship is independent from the other known modifiable stroke risk factors.

Complicaciones cerebrovasculares luego de angiografía coronaria en contexto de infarto agudo de miocardio. Estudio de cohorte / Cerebrovascular complications after invasive percutaneous coronary procedure for acute myocardial infarction in a patient cohort / Complicações cerebro-vasculares após procedimento coronário invasivo percutâneo para infarto do miocárdio aguda em um coorte do paciente

Resumen: Introducción: los eventos cerebrovasculares son una complicación grave, pero infrecuente, de los procedimientos coronarios invasivos. La angioplastia coronaria aumenta el riesgo de presentarla en 17 veces. Los pacientes que la sufren tienen más complicaciones agregadas y mayores tasas de mortalidad. Objetivo: determinar las características clínicas y evolutivas de los pacientes que desarrollaron un evento cerebrovascular luego de una angiografía coronaria de urgencia en el contexto de un infarto agudo de miocardio (IAM). Secundariamente, analizar la relación temporal entre ambos eventos e identificar factores previos asociados al desarrollo de la complicación neurológica. Método: cohorte retrospectiva de pacientes que sufrieron un evento cerebrovascular de cualquier tipo dentro de los 30 días posteriores a un procedimiento coronario por IAM en el Centro Cardiovascular Universitario, entre 2008 y 2017. Se analizaron características demográficas, del procedimiento coronario y del evento cerebrovascular. Resultados: 24 pacientes, 54,2% hombres; 1/3 del total tenía ataque cerebrovascular (ACV) previo. El 66,7% sufrió IAM sin elevación del segmento ST. Todos los eventos cerebrovasculares fueron isquémicos; la mayoría sobre la circulación anterior. El 62% ocurrió en las primeras 48 horas luego del procedimiento coronario, asociándose a mayor duración del procedimiento y número de vasos tratados. En tres casos se utilizó activador tisular del plasminógeno recombinante para reperfusión del evento neurológico. La mediana de NIHSS (National Institute of Health Stroke Scale) fue de 4 puntos (IQ 2-8) en IAM sin elevación del ST, y 8 puntos (IQ 3-20) en IAM con elevación del ST (p=0,20). El 79% de los pacientes sufrió complicaciones adicionales durante la hospitalización; cinco fallecieron. Conclusiones: entre quienes sufrieron complicaciones cerebrovasculares luego de angiografía coronaria pos-IAM existió una proporción similar de ambos sexos y un porcentaje elevado de pacientes con antecedentes de ACV. La forma de presentación del evento cardiovascular fue predominantemente IAM sin elevación del ST. Los eventos cerebrovasculares fueron isquémicos, en su mayoría de la circulación cerebral anterior y ocurrieron en las primeras 48 horas. El ACV/AIT (ataque isquémico transitorio) en este contexto podría asociarse a una mayor estancia hospitalaria y mortalidad.

Summary: Introduction: cerebrovascular events are serious but infrequent complications of invasive percutaneous coronary procedure. Coronary angioplasty increases the risk 17 times. Patients suffering this complication have higher morbidity and mortality rates. Objective: to determine the clinical and evolutionary characteristics of the patients who developed a cerebrovascular event after an emergency coronary angiography in the context of an acute myocardial infarction. Secondly, analyze the temporal relationship between both events and identify previous factors associated with the development of neurological complications. Methods: demographic, characteristics of the angiographic procedure, and cerebrovascular features of a population of patients with stroke occurring within 30 days after of invasive percutaneous coronary procedure for myocardial infarctions are described. Data was retrospectively collected from the Cardiovascular University Center (Hospital de Clínicas, Montevideo, Uruguay) between 2008-2017. Results: 24 patients, 54.2% were men; 1/3 had prior stroke; 66.7% presented non ST segment elevation myocardial infarction. All of the cerebrovascular events were ischemic, most were from the anterior circulation. 62% occurred in the first 48 hours after invasive percutaneous coronary procedure, having this group a higher percentage of percutaneous coronary angioplasty and longer procedures. In three patients recombinant tissue plasminogen activator was used for stroke treatment. NIHSS median was 4 points (IQ 2-8) in patients without ST-segment elevation myocardial infarction and 8 points (IQ 3-20) in patients with ST-segment elevation myocardial infarction (p=0.20). 79% of patients had complications during the hospitalization, and 5 died. Conclusions: there was a similar proportion of men and women, and a high percentage of patients with a history of stroke. The presentation of the cardiovascular events was predominantly non ST myocardial infarction. All the cerebrovascular events were ischemic, it occurred for most patients in the first 48 hours after invasive percutaneous coronary procedure, and the anterior brain circulation was most commonly affected. Stroke/transient ischemic attack after invasive percutaneous coronary procedure could be associated with longer hospital stays and death.

Resumo: Introdução: o acidente vascular cerebral é uma complicação séria, mas pouco frequente, da procedimiento coronário invasivo percutâneo. Angioplastia coronariana aumenta o risco 17 vezes. Pacientes que sofrem dessa complicação têm mais complicações e maiores taxas de mortalidade. Objetivo: determinar as características clínicas e evolutivas dos pacientes que desenvolveram um evento cerebrovascular após uma angiografia coronária de emergência no contexto de um infarto agudo do miocárdio. Em segundo lugar, analise a relação temporal entre os dois eventos e identifique os fatores anteriores associados ao desenvolvimento de complicações neurológicas. Métodos: uma coorte retrospectiva dos pacientes que sofreram um acidente vascular cerebral nos primeiros 30 dias de um procedimento coronário para o infarto agudo do miocárdio, e a análise dos seus dados demográficos e características de processo coronária e acidente vascular cerebral é realizada é descrito. Dados do Centro Cardiovascular Universitário do Hospital de Clínicas de Montevidéu, Uruguai, foram obtidos retrospectivamente a partir das datas entre 2008 e 2017. Resultados: 24 pacientes; 54,2% eram homens; 1/3 haviam sofrido um ataque cerebrovascular prévio; 66,7% apresentavam infarto agudo do miocárdio sem supradesnivelamento do segmento ST. Todos os eventos cerebrovasculares foram isquêmicos, a maioria era da circulação anterior. 62% dos eventos cerebrovasculares ocorreram nas primeiras 48 horas após o procedimento coronário, tendo encontrado nesse grupo procedimentos mais longos e com mais angioplastias coronarianas realizadas. Em 3 pacientes, a ativador do plasminogênio tissular recombinante foi usada para tratar o acidente vascular cerebral. O NIHSS mediana foi de 4 pontos (IQ 2-8) no infarto agudo do miocárdio, sem elevação do segmento ST, e 8 pontos (IQ 3- 20) no infarto agudo do miocárdio com elevação do segmento ST (p = 0,20) . 79% dos pacientes sofreram complicações durante a internação e 5 morreram. Conclusões: houve uma proporção semelhante de ambos sexos e uma alta porcentagem de pacientes com história de acidente vascular cerebral. A apresentação do evento cardiovascular foi predominantemente IAM sem supradesnivelamento do segmento ST. O ataque cerebrovascular foi isquêmico, ocorreu mais freqüentemente nas primeiras 48 horas e afetou principalmente a circulação cerebral anterior. Acidente vascular cerebral após intervenção coronária percutânea poderia estar associada a uma permanência hospitalar mais longa e mortalidade.

Recent advance in relation betweent intracranial artery calcification and ischemic stroke / 中华神经医学杂志

Vascular calcification is often observed in the angiographic examination of patients with cardiovascular and cerebrovascular diseases, especially in the elderly. There are many researches on the relation between intracranial artery calcification (ICA) and ischemic stroke (IS) in clinic, but the conclusions of these researches have not been unified yet. In this article, the researches on progression of relation between ICA and IS are used as a clue to review, and try to clarify the correlation between ICA and IS in the current researches, so as to provide a new strategy for the treatment of IS in clinic.

Effect of intensive rosuvastatin calcium combined with clopidogrel and aspirin on patients with high risk of transient ischemic attack / 中风与神经疾病杂志

@#Objective　To explore the clinical efficacy of intensive rosuvastatin calcium combined with clopidogrel and aspirin on patients with high risk of transient ischemic attack （TIA）,and the influence of treatment on carotid artery intima-media thickness,blood lipid and platelet parameter.Methods　One hundred and ten patients with high risk of TIA were randomly divided into control group and treatment group.The control group was given rosuvastatin 10 mg/d combined with 100 mg/d aspirin (withdraw at day 21) and 75 mg/d clopidogrel,while the treatment group was initiated with a loading dose of 20 mg/d for 14 days followed by 10 mg/d combined with 100 mg/d aspirin (withdraw at day 21) and 75 mg/d clopidogrel.The primary efficacy end point is the percentage of patients with any stroke,the influence on carotid artery intima-media thickness,blood lipid and platelet parameter 3 months later.Results　Stroke occurred in 5.2% of patients in the treatment group and 11.5% in the control group,the difference was statistically significantly (P<0.05).Total cholesterol (TC),triglyceride (TG),and low density lipoprotein-C (LDL-C) were significant lower in treatment group compared with those in control group,and the difference was statistically significantly (P<0.05).The carotid artery intima-media thickness was lower in the treatment group (P<0.05).Besides,the platelet (PLT) count and the mean platelet volume (MPV) was lower after treatment (P<0.05).Moreover,MPV were significantly lower in treatment group compared to that in control group 3 months later (P<0.05).Conclusion　Intensive rosuvastatin calcium combined with clopidogrel and aspirin can reduce the blood lipid level and has a significant effect on the prevention of patients with high risk of TIA to cerebral infarction,reduce the carotid artery intima-media thickness,PLT and MPV.

The predictive value of TOAST and Lp-PLA2 for early recurrence of ischemic cerebrovascular disease after transient ischemic attack and minor ischemic stroke of anterior circulation / 中风与神经疾病杂志

@#Objective　To investigate the predictive value of TOAST（Trial of Org 10172 in Acute Stroke Treatment） and lipoprotein-associated phospholipase A2（Lp-PLA2） for early recurrence of ischemic cerebrovascular disease after transient ischemic attack（TIA）and minor ischemic stroke of anterior circulation. Methods　A total of 190 patients with TIA and minor ischemic stroke of anterior circulation were selected and the general information and supplementary examinations were recorded. The patients were classified etiologically into large-artery atherosclerotic stroke（LAA） group and non-LAA group according to TOAST. According to the recurrence of ischemic cerebrovascular disease within 30 days，the patients were divided into positive event group and negative event group，and the differences between the two groups were compared. ROC curve was used to determine the best cutoff value of Lp-PLA2 for predicting positive event. Multivariate analysis was performed to identify potential predictors of recurrence. Finally，ROC curve was used to analyze the predictive value of Lp-PLA2 and LAA alone or in combination for recurrent ischemic cerebrovascular disease in the early stage of TIA and minor ischemic stroke of anterior circulation. Results　For positive event group，the age，proportion of TIA or cerebral infarction history，proportion of LAA and the level of Lp-PLA2 were higher than those of negative event group（P<0.05）.The best cutoff value of Lp-PLA2 was 304.50 ng/ml（sensitivity and specificity were 0.645 and 0.711 respectively）. LAA and Lp-PLA2 ≥ 304.50 ng/ml were independent risk factors for recurrent ischemic cerebrovascular disease within 30 days after TIA and minor ischemic stroke of anterior circulation. The area under ROC curve of LAA，Lp-PLA2≥ 304.50 ng/ml and combination of both were 0.671，0.678 and 0.729 respectively. The area under ROC curve of combined prediction of LAA and Lp-PLA2 was the largest. Conclusion　LAA combined with Lp-PLA2≥304.50 ng/ml could predict the risk of early recurrence of ischemic cerebrovascular disease in TIA and minor ischemic stroke of anterior circulation.