miR-22 and cerebral microbleeds in brainstem and deep area are associated with depression one month after ischemic stroke

In this study, we aimed to explore the relationship among miR-22, deep cerebral microbleeds (CMBs), and post-stroke depression (PSD) 1 month after ischemic stroke. We consecutively recruited 257 patients with first-ever and recurrent acute cerebral infarction and performed PSD diagnosis in accordance with the Diagnostic and Statistical Manual IV criteria for depression. Clinical information, assessments of stroke severity, and imaging data were recorded on admission. We further detected plasma miR-22 using quantitative PCR and analyzed the relationship among miR-22, clinical data, and PSD using SPSS 23.0 software. Logistic regression showed that deep (OR=1.845, 95%CI: 1.006-3.386, P=0.047) and brain stem CMBs (OR=2.652, 95%CI: 1.110-6.921, P=0.040), as well as plasma miR-22 levels (OR=2.094, 95%CI: 1.066-4.115, P=0.032) were independent risk factors for PSD. In addition, there were significant differences in baseline National Institutes of Health Stroke Scale scores (OR=1.881, 95%CI: 1.180-3.011, P=0.007) and Widowhood scores (OR=1.903, 95%CI: 1.182-3.063, P=0.012). Analysis of the receiver operating curve (AUC=0.723, 95%CI: 0.562-0.883, P=0.016) revealed that miR-22 could predict PSD one month after ischemic stroke. Furthermore, plasma miR-22 levels in brainstem and deep CMBs patients showed an upward trend (P=0.028) relative to the others. Patients with acute ischemic stroke, having brainstem and deep cerebral microbleeds, or a higher plasma miR-22 were more likely to develop PSD. These findings indicate that miR-22 might be involved in cerebral microvascular impairment and post-stroke depression.

Magnetic resonance imaging in brainstem ischemic stroke

To evaluate the efficacy of magnetic resonance imaging in brainstem stroke, we studied 21 cases of clinically definite brainstem ischemic stroke with brain magnetic resonance imaging (MRI) and conventional computed tomography (CT). MRI demonstrated brainstem lesions in 79% of the cases (16.5 out of 21), while CT revealed 33% (7 out of 21) when cases with suspicious lesions counted as 0.5. Although MRI was done a few days later than CT in most cases, MRI was superior to CT in detecting the number and the size of ischemic lesions, with clear delineation of anatomy and visualization of the status of the blood flow in the vertebral-basilar artery. Disappearance of the flow signal void in the basilar artery can be an important clue in diagnosing occlusion or thrombus of the basilar artery. By delineating the extent and the location of the infarction, MRI findings allowed an interpretation of whether the ischemic vessel is a small basilar branch or a large vessel vertebral or basilar artery.

Benign brainstem hemorrhage simulating transient ischemic attack

A 48-year-old hypertensive man had sudden onset of symptoms suggesting vertebrobasilar insufficiency, which were transient in nature lasted for only 4 hours. Brain computed tomography revealed a small hematoma in the pontomedullary junction. This is an uncommon presentation of benign brainstem hemorrhage simulating transient ischemic attack. We propose that computed tomographic scan using thin slices of 3mm to 5mm thickness at the level of brainstem is required before starting anticoagulation therapy for vertebrobasilar transient ischemic attack.

Infartos del tronco encefálico: estudio patológico de 24 casos / Infarctions of the brain stem: pathologic study of 24 cases

Se realizó un estudio patológico en 24 fallecidos con lesiones isquémicas del tronco encefálico. Los hallazgos demostraron la presencia de infartos en las 3 partes del tronco encefálico, con predominio de las lesiones en la protuberancia y el mesencéfalo. Los infartos múltiples fueron más frecuentes que las lesiones aisladas. Se observaron 22 oclusiones arteriales: 5 vertebrales, 10 de la basilar y 7 de la vertebrobasilar. En 19 ocasiones el fenómeno oclusivo fue por trombosis y en 3 por embolismo. En 2 casos no se pudo precisar la obstrucción arterial. El 85 de los casos presentó diferentes grados de ateromatosis y en el 60 se observó infartos en los hemisferios cerebrales