Vessel flow void sign and hyperintense vessel sign on FLAIR images distinguish between MELAS and AIS.

OBJECTIVE: This study aimed to evaluate the sensitivity and specificity of the vessel signs, including the Vessel Flow Void Sign (VFVS) and the Hyperintense Vessel Sign (HVS) in Fluid Attenuated Inversion Recovery (FLAIR) images during the differentiation of Mitochondrial Encephalopathy, Lactic Acidosis, and Stroke-like Episodes (MELAS) in Acute Ischemic Stroke (AIS). METHODS: Magnetic Resonance Imaging (MRI) scans of 13 MELAS and 20 AIS patients were obtained during the acute stage of the diseases (median time to scan <1 day from symptom onset). To evaluate VFVS and HVS on the FLAIR images, Logistic Regression was used to analyze their correlation with MELAS. Then, a new scale of scoring, involving two aspects (VFVS and HVS) on FLAIR images was established. Receiver operating characteristic (ROC) curves were used to evaluate the efficacy of the developed criterion. RESULTS: FLAIR images from 12 of the 13 MELAS patients exhibited VFVS while none exhibited HVS. Moreover, FLAIR images from 3 of the 20 AIS patients exhibited VFVS while 17 exhibited HVS. Logistic Regression showed that VFVS and the absence of HVS (NoHVS) were independent MELAS predictors. If there were VFVS, the patient scored 2 points, while there were NoHVS, the patient scored 1 point. Patients with >1.5 scores were prone to be MELAS, while patients with <1.5 scores were prone to be AIS. Sensitivity was found to be 92.3%, specificity was 85%, with an AUC of 0.94. CONCLUSION: We have established a new scoring criterion, with a high sensitivity and specificity, for differentiating between MELAS and AIS in patients during the acute stage.

[Diffusion-weighted imaging hyperintensity is reversible in large middle cerebral artery infarction following thrombectomy:a case report].

Diffusion-weighted imaging (DWI) is currently the most sensitive technique to diagnose early ischemic stroke. DWI signal hyperintensity is usually considered to suggest irreversible infarct core, but recent studies demonstrated that DWI hyperintensity signal could be reversible on small embolic lesions. Herein we present a case in a 63-year-old male patient, who was admitted to the emergency department with altered mental status and complaint of weakness in the left arm and leg 6.8 h prior to the admission. Emergency cranial magnetic resonance imaging (MRI) and angiography (MRA) revealed occlusion of his right middle cerebral artery (MCA) and large lesions on DWI. The patient underwent intra-artery thrombectomy after evaluation in spite of the large volume of the DWI lesions up to 91.5 mL at the baseline. His right MCA was recanalized at 8.5 h from symptom onset. One week after the procedure, the patient showed reduced DWI lesion volume to 11.58 mL. In this case we observed the reversibility of a large lesion of the anterior artery circulation presenting with hyperintensity on DWI, suggesting that the clinical implication of DWI hyperintensity should be interpreted with caution, and a large volume of baseline DWI hyperintensity may not be a contraindication to thrombectomy. This conclusion, however, awaits further validation by future large-scale randomized controlled trials.

[Mismatch of ASPECTS based on arterial spin labeling and diffusion-weighted imaging as an indicator for mechanical thrombectomy in patients with wake-up stroke].

OBJECTIVE: To retrospectively analyze the outcomes of wake-up stroke (WUS) patients with occlusion of large vessel occlusion (LVO), who were selected for mechanical thrombectomy according to the mismatch of Alberta Stroke Program Early CT Score (ASPECTS) based on arterial spin labeling (ASL) and diffusion-weighted image (DWI) on admission magnetic resonance (MR) scans. METHODS: Twelve consecutive WUS patients with acute LVO of the anterior circulation undergoing MR scans with ASL and DWI prior to thrombectomy were retrospectively evaluated. The mismatch of ASPECTS was defined as the difference between ASL-ASPECTS and DWI-ASPECTS, and a higher score indicates a greater mismatch. RESULTS: The procedures led to successful reperfusion in all the cases (Thrombolysis in Cerebral Infarction Grade 2b-3). Eleven patients (91.7%) had significantly decreased National Institute of Health Stroke scale (NIHSS) score at discharge.AmRS score of ≤2 at 90 days was achieved in 8 of the 12 patients (66.7%). CONCLUSIONS: The mismatch between ASPECTS assessed based on ASL and DWI can detect a true mismatch in patients with acute LVO of the anterior circulation, and can be used for rapid screening of patients eligible for thrombectomy.

C-reactive protein/albumin ratio predicting early death in patients with acute ischemic stroke / 国际脑血管病杂志

Objective To investigate the predictive value of C-reactive protein/albumin ratio (CAR) for 30 d survival status in patients with acute ischemic stroke.Methods Patients with acute ischemic stroke admitted to the Neurological Intensive Care Unit (NICU),Nanfang Hospital,Southern Medical University were selected from 2013 to 2016.They were divided into a survival group and a death group according to the 30 d survival status.The clinical data of both groups were compared and analyzed.Multivariate logistic regression analysis was used to determine the independent risk factors for 30 d survival status.The predictive value of the variables was analyzed using the receiver operating characteristic (ROC) curve.Results A total of 236 patients were enrolled in the study,including 64 (27.12％) in the death group and 172 (72.88％) in the survival group.The baseline National Institutes of Health Stroke Scale score,procalcitonin,C-reactive protein,CAR,and onset to NICU time in patients of the survival group were significantly lower or shorter than those of the death group,and the serum albumin level of the survival group was higher than that of the death group (all P ＜0.05).Pearson's correlation analysis showed that C-reactive protein (r =0.647,P ＜ 0.001),CAR (r =0.632,P ＜ 0.001),and onset to NICU time (r =0.596,P ＜ 0.001) were closely associated with the 30 d survival status in patients with acute ischemic stroke.Multivariate logistic regression analysis showed that CAR was an independent risk factor for 30 d mortality in patients with acute ischemic stroke (odds ratio 1.895,95％ confidence interval 1.573-2.282;P ＜ 0.001).ROC curve analysis showed that the area under the curve of CAR was 0.873 (95％ confidence interval 0.815-0.931),the optimal cut-off value was 2.197,the sensitivity of predicting 30 d death risk was 82.8％,and the specificity was 87.8％.Conclusion CAR is an independent risk factor for 30 d death in patients with acute ischemic stroke and can be used for 30 d survival assessment in patients with acute ischemic stroke.

Predictive value of serum procalcitonin for acute stroke patients with bacterial pneumonia:a retrospective case series study / 国际脑血管病杂志

Objective To investigate the risk factors for bacterial pneumonia and the predictive value of early serum procalcitonin (PCT) level for bacterial pneumonia and sepsis classification in patients with acute stroke. Methods The patients with acute stroke in neurological intensive care unit were enroled retrospectively and divided into either a bacterial pneumonia group or a non-infection group according to whether they had bacterial pneumonia or not. The former was redivided into a non-severe sepsis subgroup and a severe sepsis subgroup according to the sepsis classification. The demographics, baseline clinical data, and PCT level (the bacterial pneumonia group was the PCT level when infection occurred, the non-infection group was the PCT level within 24 h of admission) were compared. Multivariate logistic regression analysis was used to identify the independent risk factors for bacterial pneumonia. Receiver operator characteristic (ROC) curve was used to analyze the predictive value of serum PCT level for bacterial pneumonia and sepsis classification. Results A total of 164 patients with acute stroke were enroled in the study, including 114 in the bacterial pneumonia group (66 in the non-severe sepsis subgroup and 48 in the severe sepsis subgroup) and 50 in the non-infection group. There were significant differences in age, fasting blood glucose level, Glasgow coma scale (GCS) score, and PCT level between the bacterial pneumonia group and the non-infection group (P < 0. 05 ). Multivariate logistic regression analysis showed that fasting blood glucose level ≥7 mmol/L (odds ratio [ OR] 8. 488, 95% confidence interval [ CI] 2. 739 - 26. 300; P < 0. 01), GCS score ≤8 (OR 11. 361, 95% CI 2. 175 - 59. 352; P < 0. 01), and PCT level ≥0. 050 ng/ml (OR 16. 715, CI 5. 075 - 55. 049; P < 0. 01) were the independent risk factors for bacterial pneumonia. In the bacterial pneumonia group, the PCT level (median; interquartile range) in the severe sepsis subgroup was significantly higher than that in the non-severe sepsis subgroup (0. 835 [ 0. 164 - 1. 715 ] ng/ml vs. 0. 114 [0. 073 - 0. 275 ] ng/ml; Z = 4. 818, P < 0. 01 ). ROC curve analysis showed that PCT ≥0. 070 ng/ml could better predict the occurrence of bacterial pneumonia in patients with acute stroke, with sensitivity of 84. 2% , specificity of 74. 0% and the area under the ROC curve of 0. 865 (CI 0. 806 - 0. 924, P < 0. 01); PCT 0. 669 ng/mlcould better predict the occurrence of severe sepsis in acute stroke patients with bacterial pneumonia, with sensitivity of 56. 3% , specificity of 92. 4% and the area under the ROC curve of 0. 765 (CI 0. 672 - 0. 858; P < 0. 01). Conclusions The early PCT level ≥0. 050 ng/ml was an independent risk factor for occurring bacterial pneumonia in patients with acute stroke, its level had certaln predictive value for bacterial pneumonia and the severity of infection.

The 40 Hz auditory steady-state response predicting the malignant process of middle cerebral artery territory infarction: a retrospective case series study / 国际脑血管病杂志

Objcctive To investigate the predictive value of the 40 Hz auditory steady-state response (ASSR) in patients with the malignant process of middle cerebral artery territory infarction.Methods The40 Hz ASSR and brainstem auditory evoked potential (BAEP) were performed within 72 hours after patients with middle cerebral artery terrtory infarction admitted in the neuro-intensive care unite (NICU).At the same time,the National Institutes of Health Stroke Scale (NIHSS) scores were assessed.Multivariable logistic regression analysis was used to deterrmine the influencing factors of the malignant process.The relevant indicators of the malignant process were analyzed by the receiver operating characteristic(ROC) curve in order to clear the predictive value of 40 Hz ASSR in the malignant process of middle cerebral artery territory infarction.Results A total of 104 patients with supratentorial middle cerebral artery territory infarction were included.They were divided into the malignant process group (n=59) or the non-malignant process group (n=45).There were significant differences in the baseline NIHSS scores (17.25 ± 7.23 vs.20.40 ± 8.09; t =- 2.055,P =0.043),infarct volume (105.85 ± 73.37 mm3 us.179.15 ± 144.38 mm3; t =-3.011,P =0.004),leukocyte count ([ 10.26 ±3.14] × 109/L vs.[ 13.45 ±5.42] × 109/L; t =-3.336,P =0.001),40 Hz ASSR (Z =-3.237,P =0.001),and short-latency somatosensory evoked potentials (Z =-3.130,P =0.002) grade between the malignant process group and the non-malignant process group.Multivariate logistic regression analysis showed that the40 Hz ASSR (odds ratio [OR] 3.347,95％ confidence interval [CI] 1.630 -6.872; P=0.014),infarct volume (OR 1.006,95％ CI 1.001 - 1.012,P=0.003),and leukocyte count (OR 1.277,95％ CI 1.074 - 1.402; P =0.001) were the independent predictors in patients with the malignant process of middle cerebral artery territory infarction.When the 40 Hz ASSR was grade 3,the sensitivity and specificity of predicting malignant process were 39.5％ and 94.4％.Conclusions The 40 Hz ASSR has an important predictive value in patients with the malignant process of middle cerebral artery territory infarction.

Prognostic predictive value of quantitative electroencephalography for patients with large middle cerebral artery infarction / 国际脑血管病杂志

Objective To study the prognostic predictive value of quantitative dectroencephalography (qEEG)for patients with large middle cerebral artery infarction (LMCAI).Methods The scores of routine electroencephalography (EEG),qEEG and the Glasgow Coma Scale (GCS) of the patients within 72 hours after symptom onset were recorded.The short-term prognosis (death or survival) was evaluated at 1 month after the onset.The long-term prognosis (good or poor) was evaluated at 3 months after the onset.All the observed data in each prognostic group were compared.Results A total of 105 patients were included in the study.There were significant differences in the margin of amplitude integrated electroencephalogram (aEEG) (upper margin:19.11 ± 7.80 μV vs.11.87 ±6.41 μV;t =2.392,P =0.019; lower margin:11.90 ± 4.78 μV vs.7.58 ± 4.15 μV; t =3.327,P =0.022),Synek-classification (x2 =48.114,P =0.000) between the short-term survival group and the death group; in patients with left LMCAI,there were significant differences in the absolute energy of the β-activity (13.16 ±12.66 μV2 vs.19.20 ±17.96 μV2;t =-2.781,P =0.039),spectral edge frequency 95％ (SEF95％) (9.17 ± 3.24 Hz vs.10.36 ± 3.76 Hz; t =-5.614,P =0.002) between the short-term survival group and the death group.There were significant differences in the age (59.33 ±13.67 years vs.68.87± 10.473 years; t =-3.215,P =0.002),GCS scores (10.86±2.80 vs.9.21 ±2.51;t =2.511,P =0.015),SEF95％ (13.80 ±5.40 Hz vs.10.93 ±4.68 Hz; t ＝2.311,P =0.024) and sides of infarction (x2 =4.737,P =0.030) between the long-term good prognosis group and the poor prognosis group.Conclusion qEEG can be used as an effective means of monitoring for evaluating the prognosis of patients with LMCAI.