Risk factors for ischemic stroke: differences between cerebral small vessel and large artery atherosclerosis aetiologies.

The treatment for large artery atherosclerosis (LAA) stroke is also important for patients with cerebral small vessel disease (SVD). Our aim is to clarify the risk factors for ischemic cerebral SVD and to evaluate the different risk factor profiles of the two ischemic stroke subtypes, namely, ischemic cerebral SVD and LAA. A total of 353 patients with acute ischemic stroke were assigned to two groups according to the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria: the ischemic cerebral SVD group and the LAA group. A total of 70 non-stroke patients admitted during the same period served as the control group. Clinical variables were collected, including age, sex, blood pressure, blood glucose, triglycerides, low-density lipoprotein, total cholesterol (TC), smoking history, drinking history, coronary atherosclerotic heart disease and family history of a high-risk disease. Multivariate logistic regression (MLR) analyses were performed. MLR analysis showed that risk factors for LAA stroke included hypertension, diabetes mellitus, high low-density lipoprotein, hypertriglyceridemia and smoking compared with the control group. The analysis also showed that the risk factors for cerebral SVD stroke were hypertension, diabetes mellitus, high TC, hypertriglyceridemia and smoking. In terms of the factors distinguishing LAA and cerebral SVD, MLR demonstrated that high TC played prominent roles in cerebral SVD. Hypertension, diabetes mellitus, high total cholesterol, hypertriglyceridemia and smoking are independent risk factors for cerebral SVD stroke. Compared with the LAA stroke group, patients with cerebral SVD stroke were more likely to have a high level of TC.

Case Report: Four Cases of Cortical/Brainstem Encephalitis Positive for Myelin Oligodendrocyte Glycoprotein Immunoglobulin G.

AIM: Despite a significant improvement in the number of studies on myelin oligodendrocyte glycoprotein (MOG)-immunoglobulin G (IgG)-associated disorder (MOGAD) over the past few years, MOG-IgG-associated cortical/brainstem encephalitis remains a relatively uncommon and less-reported presentation among the MOGAD spectrum. This study aimed to report the clinical course, imaging features, and therapeutic response of MOG-IgG-associated cortical/brainstem encephalitis. METHODS: Data of four patients who suffered from cortical encephalitis with epileptic seizures and/or brainstem encephalitis during the course of the disease were retrospectively collected and analyzed. RESULTS: In this study, three male patients and one female patient, with a median age of onset of 21 years (ranging 20-51 years) were enrolled. An epileptic seizure was the main symptom of cortical encephalitis in these patients, while the manifestations of brainstem encephalitis were diverse. Cranial MRI demonstrated abnormal signals in unilateral or bilateral cortical or brainstem. Cerebrospinal fluid studies showed normal or mildly elevated leukocyte counts and protein levels, and a cell-based assay detected positive MOG-IgG in the serum of all patients. Two patients were misdiagnosed at the first attack, and both experienced a relapse. All of them accepted the first-line immunotherapy after a confirmed diagnosis and had a good outcome. CONCLUSION: Early suspicion of MOG-IgG-associated encephalitis is necessary for any patient with sudden onset of seizures or symptoms of brainstem damage, especially with lesions on unilateral/bilateral cortical or brainstem on brain MRI.