Lower serum uric acid and impairment of right cerebral hemisphere structural brain networks are related to depressive symptoms in cerebral small vessel disease: A cross-sectional study.

Cerebral small vessel disease (SVD) may be associated with an increased risk of depressive symptoms. Serum uric acid (SUA), an antioxidant, may be involved in the occurrence and development of depressive symptoms, but the mechanism remains unknown. Moreover, the relationship between structural brain networks and SUA has not been explored. This study examined the relationship between SUA and depressive symptoms in patients with SVD using graph theory analysis. We recruited 208 SVD inpatients and collected fasting blood samples upon admission. Depressive symptoms were assessed using the 24-item Hamilton Depression Rating Scale (HAMD-24). Magnetic resonance imaging was used to evaluate SVD, and diffusion tensor images were used to analyze structural brain networks using graph theory. Patients with depressive symptoms (n = 34, 25.76%) compared to those without (334.53 vs 381.28 µmol/L, p = 0.017) had lower SUA levels. Graph theoretical analyses showed a positive association of SUA with betweenness centrality, nodal efficiency, and clustering coefficients and a negative correlation with the shortest path length in SVD with depressive symptoms group. HAMD scores were significantly associated with nodal network metrics in the right cerebral hemisphere. Our findings suggested that lower SUA levels are significantly associated with disrupted structural brain networks in the right cerebral hemisphere of patients with SVD who have depressive symptoms.

Risk Factors and Prognosis of Early Neurological Deterioration after Bridging Therapy.

BACKGROUND: Early neurological deterioration (END) after bridging therapy (BT) of acute ischemic stroke (AIS) patients is associated with poor outcomes. OBJECTIVE: We aimed to study the incidence, risk factors and prognosis of END after BT. METHODS: From January to December 2021, the clinical data of AIS patients treated by BT (intravenous thrombolysis with alteplase prior to mechanical thrombectomy) from three comprehensive stroke centers were analyzed. Patients were divided into non-END group and END group according to whether they developed END within 72 hours of symptom onset. Modified Rankin scale (mRS) was used to assess the patient's prognosis at 90 days, and favorable outcomes were defined as mRS≤2. The incidence of END was investigated, and binary logistic regression analysis was used to explore its associated factors. RESULTS: The incidence of END after BT was 33.67%. The eligible 90 patients included 29 cases in the END group and 61 cases in the non-END group. Multivariate Logistic regression analysis showed that increase of systolic blood pressure (SBP) (OR=1.026, 95%CI:1.001-1.051, p =0.043), higher level of blood glucose at admission (OR=1.389, 95%CI:1.092-1.176, p =0.007) and large artery atherosclerosis (LAA) subtype (OR=8.009, 95%CI:2.357-27.223, p =0.001) were independent risk factors of END. Compared with the non-END group, the END group had significantly lower rates of good outcomes (6.90% versus 65.57%, p =0.001) while higher rates of mortality (44.83% versus 4.92%, p =0.001). CONCLUSION: It was found that the incidence of END after BT in AIS patients was 33.67%. An increase in SBP, higher glucose levels at admission, and LAA were independent risk factors of END that predicted a poor prognosis.

Plaque characteristics associated with failure of primary balloon angioplasty for intracranial atherosclerotic stenosis: a retrospective study.

BACKGROUND: Primary balloon angioplasty (PBA) is an alternative treatment approach for intracranial atherosclerotic stenosis (ICAS); however, its efficacy may be compromised by arterial dissection or early elastic recoil after balloon dilation. This study aimed to explore the association between plaque characteristics on high-resolution magnetic resonance vessel wall imaging (HR-VWI) and failure of PBA for ICAS. METHODS: We conducted a retrospective analysis of 113 patients with ICAS who underwent HR-VWI before endovascular treatment. Based on the presence of arterial dissection or early elastic recoil post-balloon dilation, patients were classified into the failed PBA (FPBA) group or the successful PBA (SPBA) group. Clinical and baseline HR-VWI characteristics were compared between the two groups. Multivariable analysis was used to investigate plaque features associated with the failure of PBA. RESULTS: The FPBA and SPBA groups comprised 74 and 39 patients, respectively. Plaque eccentricity (83.78% vs 46.15%, P<0.001), negative remodeling (90.54% vs 48.72%, P<0.001), remodeling index (median 0.73 vs 0.90, P=0.001), and intraplaque hemorrhage (31.08% vs 5.13%, P=0.002) differed significantly between the FPBA and SPBA groups. Multivariable analysis indicated that higher frequency of plaque eccentricity (OR 14.03, 95% CI 3.42 to 57.62, P<0.001) and negative remodeling (OR 6.11, 95% CI 1.22 to 30.71, P=0.028) were independently associated with failure of PBA. CONCLUSION: Our findings showed that failure of PBA was associated with plaque eccentricity and negative remodeling. Analysis of plaque characteristics on baseline HR-VWI holds potential value for identifying arterial dissection or early elastic recoil after angioplasty in patients with ICAS.

Machine Learning for Predicting Motor Improvement After Acute Subcortical Infarction Using Baseline Whole Brain Volumes.

Background. Neuroimaging biomarkers are valuable predictors of motor improvement after stroke, but there is a gap between published evidence and clinical usage. Objective. In this work, we aimed to investigate whether machine learning techniques, when applied to a combination of baseline whole brain volumes and clinical data, can accurately predict individual motor outcome after stroke. Methods. Upper extremity Fugl-Meyer Assessments (FMA-UE) were conducted 1 week and 12 weeks, and structural MRI was performed 1 week, after onset in 56 patients with subcortical infarction. Proportional recovery model residuals were employed to assign patients to proportional and poor recovery groups (34 vs 22). A sophisticated machine learning scheme, consisting of conditional infomax feature extraction, synthetic minority over-sampling technique for nominal and continuous, and bagging classification, was employed to predict motor outcomes, with the input features being a combination of baseline whole brain volumes and clinical data (FMA-UE scores). Results. The proposed machine learning scheme yielded an overall balanced accuracy of 87.71% in predicting proportional vs poor recovery outcomes, a sensitivity of 93.77% in correctly identifying poor recovery outcomes, and a ROC AUC of 89.74%. Compared with only using clinical data, adding whole brain volumes can significantly improve the classification performance, especially in terms of the overall balanced accuracy (from 80.88% to 87.71%) and the sensitivity (from 92.23% to 93.77%). Conclusions. Experimental results suggest that a combination of baseline whole brain volumes and clinical data, when equipped with appropriate machine learning techniques, may provide valuable information for personalized rehabilitation planning after subcortical infarction.

Impact of stroke center certification on rt-PA thrombolysis after acute ischemic stroke in South China from 2015 to 2020.

BACKGROUND AND PURPOSE: In China, stroke center certification was launched in 2015, but little is known about its impact on intravenous thrombolysis. This study aimed to evaluate the effects of stroke center certification on the use of intravenous thrombolysis during a five-year period in South China. METHODS: We retrospectively collected data regarding the use of recombinant tissue plasminogen activator (rt-PA) in 21 cities of Guangdong from 2015 to 2020. The annual thrombolysis rate was defined as the number of patients who underwent intravenous rt-PA therapy divided by the number of those who had acute ischemic stroke within the same year. The density of stroke centers was calculated as the number of stroke centers divided by the corresponding residents. Spearman's correlation analysis was used to determine the correlations between the annual thrombolysis rates and the number/density of stroke centers. Paired t-test was used to compare differences in growth in annual thrombolysis rates before and after having stroke centers. RESULTS: From 2015 to 2020, the annual rt-PA thrombolysis rates of Guangdong increased from 1.4% to 7.2%, which was accompanied by an increase in the number of stroke centers from 0 to 82 and density of stroke centers from 0.00 to 0.71 per million population. The average annual rt-PA use in stroke centers was higher than that in non-stroke centers from 2016 to 2020 (all P < 0.05). There was a positive correlation of annual thrombolysis rates with the number of stroke centers (r = 1.00, P = 0.0028) and with the density of stroke centers in the 21 cities from 2018 to 2020 (all P < 0.05). The growth in annual thrombolysis rates significantly accelerated at the city-level after having stroke centers (1.55%/y vs. 0.77%/y, P < 0.001). CONCLUSIONS: Stroke center certification may partially drive the increased use of rt-PA thrombolysis. Stroke center certification should be continually promoted to facilitate access to intravenous thrombolysis for patients with acute ischemic stroke.

Longitudinal changes in the inferior cerebellar peduncle and lower limb motor recovery following subcortical infarction.

BACKGROUND: The cerebellum receives afferent signals from spinocerebellar pathways regulating lower limb movements. However, the longitudinal changes in the spinocerebellar pathway in the early stage of unilateral supratentorial stroke and their potential clinical significance have received little attention. METHODS: Diffusion tensor imaging and Fugl-Meyer assessment of lower limb were performed 1, 4, and 12 weeks after onset in 33 patients with acute subcortical infarction involving the supratentorial areas, and in 33 healthy subjects. We evaluated group differences in diffusion metrics in the bilateral inferior cerebellar peduncle (ICP) and analyzed the correlation between ICP diffusion metrics and changes to the Fugl-Meyer scores of the affected lower limb within 12 weeks after stroke. RESULTS: Significantly decreased fractional anisotropy and increased mean diffusivity were found in the contralesional ICP at week 12 after stroke compared to controls (all P < 0.01) and those at week 1 (all P < 0.05). There were significant fractional anisotropy decreases in the ipsilesional ICP at week 4 (P = 0.008) and week 12 (P = 0.004) compared to controls. Both fractional anisotropy (rs = 0.416, P = 0.025) and mean diffusivity (rs = -0.507, P = 0.005) changes in the contralesional ICP correlated with changes in Fugl-Meyer scores of the affected lower limb in all patients. CONCLUSIONS: Bilateral ICP degeneration occurs in the early phase of supratentorial stroke, and diffusion metric values of the contralesional ICP are useful indicators of affected lower limb function after supratentorial stroke.

Late-onset MADD in Yemen caused by a novel ETFDH mutation misdiagnosed as ADEM.

We report a case of late-onset multiple acyl-CoA dehydrogenase deficiency (MADD) with recurrent abdominal pain, vomiting, and impaired consciousness as the initial symptoms in Yemen; the case showed distinctive characteristics from those of Asian or Caucasian patients. Initially, he was misdiagnosed with pancreatitis, acute disseminated encephalomyelitis(ADEM), and fatty liver. Final diagnosis was further confirmed by electromyography, muscle biopsy, uric organic acid analysis, and a novel missense mutation in exon 7 (c.807A>C) of ETFDH was identified by next-generation sequencing. To our knowledge, we report this mutation in an adult MADD patient as well as late-onset MADD in a Middle East country for the first time. MADD is characterised by varied genotypes and broad spectrum of clinical manifestations among different populations and ages, which requires more attention and awareness in the clinic.

Predisposing factors and radiological features in patients with internal carotid artery dissection or vertebral artery dissection.

BACKGROUND: Cervicocerebral artery dissection is an important cause of ischemic stroke in young and middle-aged individuals. However, very few studies have compared the differential features between internal carotid artery dissection (ICAD) and vertebral artery dissection (VAD), including both cervical and intracranial artery dissections. We conducted a study to investigate the predisposing factors and radiological features in patients with ICAD or VAD. METHODS: All cases diagnosed with cervicocerebral artery dissection, ICAD, or VAD were identified through a medical records database, between January 2010 and January 2020. Baseline characteristics, predisposing factors, and radiological features of ICAD versus VAD were compared. RESULTS: A total of 140 patients with cervicocerebral artery dissection were included in the study, including 84 patients in the ICAD group and 56 in the VAD group. The mean age of patients in the ICAD and VAD groups was 43.37 ± 14.01 and 41.00 ± 12.98 years old, respectively. Patients with ICAD were more likely to be men compared with VAD (85.71% vs. 67.86%, p = 0.012). The frequency of hypertension, diabetes, smoking, drinking, and cervical trauma did not differ between ICAD and VAD. Dissections of ICAD were more frequently at the extracranial portions of the artery compared with those of VAD (70.24% vs. 44.64%, p = 0.003). In contrast, dissections of VAD were more common in the intracranial artery (55.36% vs. 29.76%, p = 0.003). Radiologically, double lumen (36.90% vs. 19.64%, p = 0.029) and intimal flap (11.90% vs. 1.79%, p = 0.029) were more frequently observed in ICAD than in VAD, and dissecting aneurysms were less frequent (13.10% vs. 26.79%, p = 0.041). CONCLUSIONS: The distributions of cervical and intracranial artery dissections were different between ICAD and VAD. The frequencies of radiological features detected in patients with ICAD and VAD also differed.

Glucose-6-phosphate dehydrogenase deficiency and stroke outcomes.

OBJECTIVE: To assess the risk of glucose-6-phosphate dehydrogenase (G6PD) on stroke prognosis, we compared outcomes between patients with stroke with and without G6PD deficiency. METHODS: The study recruited 1,251 patients with acute ischemic stroke. Patients were individually categorized into G6PD-deficiency and non-G6PD-deficiency groups according to G6PD activity upon admission. The primary endpoint was poor outcome at 3 months defined by a modified Rankin Scale (mRS) score ≥2 (including disability and death). Secondary outcomes included the overall mRS score at 3 months and in-hospital death and all death within 3 months. Logistic regression and Cox models, adjusted for potential confounders, were fitted to estimate the association of G6PD deficiency with the outcomes. RESULTS: Among 1,251 patients, 150 (12.0%) were G6PD-deficient. Patients with G6PD deficiency had higher proportions of large-artery atherosclerosis (odds ratio [OR] 1.53, 95% confidence interval [CI] 1.09-2.17) and stroke history (OR 1.93, 95% CI 1.26-2.90) compared to the non-G6PD-deficient group. The 2 groups differed significantly in the overall mRS score distribution (adjusted common OR 1.57, 95% CI 1.14-2.17). Patients with G6PD deficiency had higher rates of poor outcome at 3 months (adjusted OR 1.73, 95% CI 1.08-2.76; adjusted absolute risk increase 13.0%, 95% CI 2.4%-23.6%). The hazard ratio of in-hospital death for patients with G6PD-deficiency was 1.46 (95% CI 1.37-1.84). CONCLUSIONS: G6PD deficiency is associated with the risk of poor outcome at 3 months after ischemic stroke and may increase the risk of in-hospital death. These findings suggest the rationality of G6PD screening in patients with stroke.

Regional Shape Abnormalities in Thalamus and Verbal Memory Impairment After Subcortical Infarction.

Background. Subcortical infarcts can result in verbal memory impairment, but the potential underlying mechanisms remain unknown. Objective. We investigated the spatiotemporal deterioration patterns of brain structures in patients with subcortical infarction and identified the regions that contributed to verbal memory impairment. Methods. Cognitive assessment and structural magnetic resonance imaging were performed 1, 4, and 12 weeks after stroke onset in 28 left-hemisphere and 22 right-hemisphere stroke patients with subcortical infarction. Whole-brain volumetric analysis combined with a further-refined shape analysis was conducted to analyze longitudinal morphometric changes in brain structures and their relationship to verbal memory performance. Results. Between weeks 1 and 12, significant volume decreases in the ipsilesional basal ganglia, inferior white matter, and thalamus were found in the left-hemisphere stroke group. Among those 3 structures, only the change rate of the thalamus volume was significantly correlated with that in immediate recall. For the right-hemisphere stroke group, only the ipsilesional basal ganglia survived the week 1 to week 12 group comparison, but its change rate was not significantly correlated with the verbal memory change rate. Shape analysis of the thalamus revealed atrophies of the ipsilesional thalamic subregions connected to the prefrontal, temporal, and premotor cortices in the left-hemisphere stroke group and positive correlations between the rates of those atrophies and the change rate in immediate recall. Conclusions. Secondary damage to the thalamus, especially to the left subregions connected to specific cortices, may be associated with early verbal memory impairment following an acute subcortical infarct.

Axial diffusivity changes in the motor pathway above stroke foci and functional recovery after subcortical infarction.

BACKGROUND: Secondary degeneration of the fiber tract of the motor pathway below infarct foci and functional recovery after stroke have been well demonstrated, but the role of the fiber tract above stroke foci remains unclear. OBJECTIVE: This study aimed to investigate diffusion changes in motor fibers above the lesion and identify predictors of motor improvement within 12 weeks after subcortical infarction. METHODS: Diffusion tensor imaging and the Fugl-Meyer (FM) scale were conducted 1, 4, and 12 weeks (W) after a subcortical infarct. Proportional recovery model residuals were used to assign patients to proportional recovery and poor recovery groups. Region of interest analysis was used to assess diffusion changes in the motor pathway above and below a stroke lesion. Multivariable linear regression was employed to identify predictors of motor improvement within 12 weeks after stroke. RESULTS: Axial diffusivity (AD) in the underlying white matter of the ipsilesional primary motor area (PMA) and cerebral peduncle (CP) in both proportional and poor recovery groups was lower at W1 compared to the controls and values in the contralesional PMA and CP (all P < 0.05). Subsequently, AD in the ipsilesional CP became relatively stable, while AD in the ipsilesional PMA significantly increased from W4 to W12 after stroke (P < 0.05). In all of the patients, changes in the FM scores were greater in those with higher changes in AD of the ipsilesional PMA. Only initial impairment or lesion volume was predictive of motor improvement within 12 weeks after stroke in patients with proportional or poor recovery. CONCLUSION: Increases of AD in the motor pathway above stroke foci may be associated with motor recovery after subcortical infarction. Early measurement of diffusion metrics in the ipsilesional non-ischemic motor pathway has limited value in predicting future motor improvement patterns (proportional or poor recovery).

Motor Recovery Prediction With Clinical Assessment and Local Diffusion Homogeneity After Acute Subcortical Infarction.

BACKGROUND AND PURPOSE: Initial clinical assessment or conventional diffusion tensor imaging parameters alone do not reliably predict poststroke recovery of motor function. Recently, local diffusion homogeneity (LDH) has been proposed to represent the local coherence of water molecule diffusion and can serve as a complementary marker for investigating white matter alterations of the brain. We aimed to determine whether a combination of initial clinical assessment and LDH could predict motor recovery after acute subcortical infarction. METHODS: Standard upper extremity Fugl-Meyer assessment and diffusion tensor imaging were performed 1, 4, and 12 weeks after onset in 50 patients with subcortical infarction. Proportional recovery model residuals were used to assign patients to proportional recovery and poor recovery groups. Tract-based spatial statistics analysis was used to compare diffusion differences between proportional and poor recovery outcomes. Multivariate logistic regression model was used to identify the predictors of motor improvement within 12 weeks after stroke. RESULTS: The poor recovery group had lower LDH than the proportional recovery group, mainly in the ipsilesional corticospinal tract in the superior corona radiate and posterior limb of internal capsule 1 week after stroke (P<0.005; family-wise error corrected). Multivariate logistic regression analysis indicated that both initial Fugl-Meyer assessment and LDH in the ipsilesional corticospinal tract in the superior corona radiate and posterior limb of internal capsule were predictors of motor improvement within 12 weeks after stroke (G=47.22; P<0.001). Leave-one-out cross-validation confirmed a positive predictive value of 0.818, a negative predictive value of 0.833, and an accuracy of 0.824 (P<0.00 001; permutation test). CONCLUSIONS: These results suggest that a combination of clinical assessment and LDH in the ipsilesional corticospinal tract in the acute phase can accurately predict resolution of upper limb impairment within 12 weeks after subcortical infarction.

Relationship between visible branch arteries distal to the stenosis on magnetic resonance angiography and stroke recurrence in patients with severe middle cerebral artery trunk stenosis: a one-year follow up study.

BACKGROUND: To evaluate the relationship between the flow signal intensity of branch arteries distal to the stenosis on 3-dimensional (3D) time-of-flight (TOF) magnetic resonance angiography (MRA) and the risk of stroke recurrence in patients with severe middle cerebral artery (MCA) trunk stenosis. METHODS: We prospectively recruited 153 patients (mean age 62.9 ± 13.0 years, 106 males) with a first ischemic stroke or transient ischemic attack caused by a severe MCA trunk stenosis (70 % to 99 %) confirmed by 3D TOF MRA and followed them for one year to determine the stroke recurrence. The MCA branch signal intensity distal to the site of stenosis on 3D TOF MRA was classified as either good (grade A) or poor [mild reduction (grade B) or severe reduction (grade C)] according to the extent to which the MCA could be visualized. The patients were divided into groups A (35), B (58), or C (60) based on the MRA grading of the MCA branch signal intensity distal to the site of stenosis. RESULTS: Poor MCA branch signal intensity was associated with internal border-zone infarction (p < 0.05). The risk of stroke recurrence in the ipsilateral MCA in the first year was 18.3 %. The 1-year cumulative incidence of recurrence was higher in the patients in group C (30 %) than in groups B (12.1 %) or A (8.6 %) (Log rank, p = 0.007). Multivariate analyses via Cox proportional hazard regression demonstrated that only a grade C classification of the signal intensity of the MCA branches was an independent predictor of stroke recurrence in the ipsilateral MCA (hazard ratio = 3.0, 95 % confidence interval = 1.3-7.4, p = 0.014). CONCLUSIONS: This study demonstrated that MCA branch signal intensity as assessed via 3D TOF MRA may be a useful and simple tool to stratify the risk of stroke recurrence in patients with severe MCA trunk stenosis.

Intracranial versus Extracranial Symptomatic Carotid Atherosclerosis in Chinese Patients: Risk Factors, Stroke Mechanisms, and Long-Term Prognosis.

OBJECTIVES: This study aims to investigate the clinical-radiological features and stroke mechanisms of symptomatic intracranial internal carotid artery (IICA) atherosclerosis and prognoses of patients with IICA atherosclosis, and compare these data with those from patients with symptomatic extranial carotid artery (EICA) atherosclerosis. METHODS: We prospectively recruited 155 patients with symptomatic IICA or EICA atherosclerosis (stenosis ≥50% or occlusion) from 1968 Chinese patients with a first-ever ischemic stroke or transient ischemic attack. The patients were followed up for stroke recurrence, cardiovascular events, and death. RESULTS: There were 80 and 75 patients in the IICA and EICA groups, respectively. Multivariate logistic regression analyses showed that the patients in the IICA group were associated with hypertension (odds ratio [OR], 5.980; 95% confidence interval [CI], 1.790-19.976) and asymptomatic intracranial atherosclerosis (OR, 2.564; 95% CI, 1.222-5.377), while the patients in the EICA group were associated with smoking (OR, 2.397; 95% CI, 1.150-4.998) and contralateral EICA disease (OR, 4.742; 95% CI, 1.455-15.455). Hemodynamic stroke alone was more common in the IICA group; artery-to-artery embolism was identified more often in the EICA group (P <.05). The cumulative incidences of ipsilateral stroke recurrence, stroke recurrence and cardiovascular events, and death at 5 years were 43.5%, 52.4%, and 27.3%, respectively, in the patients of the IICA group, which did not differ from those of the EICA group. CONCLUSIONS: IICA atherosclerosis as well as EICA atherosclerosis is an important cause of stroke in Chinese patients. Patients with symptomatic IICA atherosclerosis had unique clinical-radiological features and stroke mechanisms compared with those with symptomatic EICA atherosclerosis; their long-term prognosis was poor.

Risk factor differences between type 2 diabetes patients with ischemic cerebrovascular versus coronary heart diseases at admission.

AIMS: Type 2 diabetes mellitus (T2DM) is a major risk factor, and shares many common risk factors with ischemic cerebrovascular diseases (ICVD) and coronary heart diseases (CHD). Few studies have directly compared the differences in common risk factors between T2DM patients with ICVD and CHD at admission. METHODS: In this cross-sectional study, T2DM patients with or without first-ever ICVD or CHD admitted to our hospital over 3 years were enrolled. Patients' data were retrospectively collected and compared using multivariate logistic regression analyses. RESULTS: In total, 1208 T2DM patients were enrolled (57.5% men). The median age was 59 years (interquartile range [IQR] 51-69), and duration of diabetes was 7 years (IQR 3-10). Two hundred and two patients (16.7%) were diagnosed with ICVD, 345 (28.6%) with CHD, and 661 (54.7%) had neither ICVD nor CHD. Compared with T2DM patients without ICVD or CHD, ICVD and CHD patients had higher systolic blood pressure (SBP) and older age but lower high-density lipoprotein cholesterol levels (all p<0.01), whereas reduced estimated glomerular filtration rate was only associated with CHD (p<0.05). Furthermore, ICVD patients had higher SBP (every 10-mmHg increase, OR=1.38, 95% CI: 1.26-1.51) and HbA1c levels (OR=1.18, 95% CI: 1.06-1.31) than CHD patients. CONCLUSIONS: T2DM patients with ICVD and CHD have differences in common risk factors at admission. Higher systolic blood pressure and HbA1c levels may indicate ICVD.

Intracranial versus extracranial artery dissection cases presenting with ischemic stroke.

BACKGROUND: To compare the clinical and radiologic characteristics, possible stroke mechanisms, and prognosis of intracranial artery dissections (IADs) with those of extracranial artery dissections (EADs) presenting with cerebral infarction. METHODS: Among 3250 adult patients with acute ischemic stroke (cerebral infarction), we prospectively recruited and categorized patients with cerebral infarction secondary to spontaneous cerebral artery dissection into IAD or EAD groups. The clinical and radiologic characteristics, possible stroke mechanisms according to the distributions of the infarctions based on diffusion-weighted imaging, and prognosis were analyzed for both groups. RESULTS: There were 48 and 50 patients experiencing IAD and EAD, accounting for 1.5% and 1.5% of all ischemic stroke patients, respectively. Compression of the perforating artery was the most common possible stroke mechanism (33.3%) in IADs; thromboembolism was more common in EADs than that in IADs (36 of 50 versus 12 of 48; P < .001). Magnetic resonance imaging and angiography were used to investigate the arterial dissections in all IAD patients and 46 EAD patients. Based on magnetic resonance imaging and angiography, the IADs more frequently displayed dissecting aneurysm (6 of 48 versus 0 of 46; P = .027) and intimal flap or double lumen (21 of 48 versus 4 of 46; P < .001) than EADs. For the clinical characteristics and prognosis, there was no significant difference between the 2 groups. CONCLUSIONS: These results indicate that IAD is an important cause of ischemic stroke, and it displays unique radiologic characteristics and specific stroke mechanisms compared with EAD.

The clinical characteristics and risk factors of cerebral venous sinus thrombosis complicated by cerebral hemorrhage / 中国神经精神疾病杂志

Objective To analyze the characteristics of clinical manifestations, risk factors, therapies and acute outcomes in patients with cerebral venous sinus thrombosis complicated by cerebral hemorrhage. Methods Seventy-five patients with cerebral venous sinus thrombosis were included in the study. According to the radiological findings on the brain image, patients were divided into two subgroups:cerebral hemorrhage group and non-hemorrhage group. The demo?graphic data, potential risk factors, clinical manifestations, radiological features, therapeutic strategies and acute out?comes were compared between two subgroups, and high risk factors were also analyzed. Results There were seventy-five patients with cerebral venous sinus thrombosis in the present study. Twenty-eight patients of them (37.2%) had cerebral hemorrhage whereas the remaining forty-seven patients (62.7%) did not have cerebral hemorrhage. Pregnancy/puerperi?um were significantly higher in patients with cerebral hemorrhage (with vs without;28.6%vs. 6.4%, P=0.015), while in?fection was markedly higher in patients without cerebral hemorrhage (with vs without;7.1% vs. 29.8%, P=0.021). Head?ache (92.9% vs. 70.2%, P=0.021), unconsciousness (25.0% vs. 6.4%,P=0.034), seizures (53.6% vs. 19.1%, P=0.002) and motor deficits (35.7% vs. 12.8%, P=0.019) were more common in patients with cerebral hemorrhage. Moreover, mul?tiple sinus involvement (1.4% vs. 44.7%, P=0.024) was significantly higher and the acute outcomes(mRS≥3: 46.4%vs.17.0%, P=0.006)were poorer in patients with cerebral hemorrhage. Binary Logistic analysis showed that pregnancy/pu?erperium (P=0.004) and multiple sinus involvement were positively, whereas infection was negatively correlated with cere?bral venous sinus thrombosis and hemorrhage ( P=0.007;P=0.03). Conclusions Pregnancy/puerperium, headache, uncon?sciousness, seizures, motor deficits and multiple sinus involvement are more frequently in patients with cerebral venous sinus thrombosis and hemorrhage, and the acute outcomes are poorer in patients with cerebral venous sinus thrombosis complicated by cerebral hemorrhage.

[Prevalence of asymptomatic intracranial artery stenosis in middle-aged and elderly population in the community of Foshan city, Guangdong province: a cross-sectional study].

OBJECTIVE: To investigate the prevalence and risk factors of asymptomatic intracranial artery stenosis in middle-aged and elderly population in the community of Foshan city, Guangdong province. METHODS: Subjects from residential communities were chosen through Cluster sampling method. Physical data and history were collected. Serum fasting glucose, total cholesterol and triglycerides concentrations were tested with venous blood samples. Intracranial artery stenosis was diagnosed by transcranial Doppler (TCD). Data was analyzed by the software SPSS 18.0. RESULTS: 1405 subjects met the inclusive criteria, among which 163 (11.6%) were found one (7.4%) or more (4.2%) stenotic arteries, and the standardized rate was 10.3%. 9.89% of the SICA, and 3.05%, 2.29%, 1.59%, 1.38%, 0.89% of basilar artery, middle cerebral artery, anterior cerebral artery, vertebral artery, posterior cerebral artery were found stenotic respectively. Data from the age-stratified analysis showed that the prevalence in these above 70 (27.8%) was significantly higher than that under age 70 (7.5%) (P = 0.000). Single factor and logistic regression analysis demonstrated the history of diabetes mellitus and elevated systolic pressure present were significantly different between stenotic group and the non-stenotic group (P = 0.000, P = 0.000), which were the independent risk factors of asymptomatic stenosis of intracranial arteries (OR = 2.362, 95%CI: 1.194 - 4.674;OR = 1.024, 95%CI: 1.016 - 1.031). CONCLUSION: Comparatively high prevalence of asymptomatic intracranial artery stenosis in middle-aged and aged community population was found in the Southern part of China, especially among the age group above 70. History of diabetes and elevated systolic pressure seemed to be the independent risk factors of asymptomatic stenosis of intracranial arteries.

[Role of abdominal obesity in asymptomatic intracranial arterial stenosis: a community-based study].

OBJECTIVE: To investigate the relationship between abdominal obesity and intracranial artery stenosis and the underlying mechanism. METHODS: By cluster sampling, 1405 adult Han people were selected from the residential communities. Among them, 1035 people conformed to the inclusion criteria. Medical history was documented and body height, body weight, waist circumference, hip circumference and blood pressure were measured. Venous blood samples were collected to detect the serum concentrations of fasting glucose, total cholesterol and triglycerides. Serum nitric oxide (NO) level was determined by cadmium reduction method. Middle cerebral artery stenosis (MCAS) was diagnosed by transcranial Doppler. The SPSS 11.0 software package was used for data analysis. RESULTS: MCA stenosis was found in 66 subjects (6.4%). Univariate analysis showed history of hypertension, history of ischemic heart disease, systolic blood pressure and diastolic blood pressure were the risk factors for MCAS and waist-to-hip ratio (WHR) was a risk factor only in males. Logistic regression demonstrated history of hypertension was an independent risk factor for MCAS both in males and females (P = 0.011, P = 0.009) and WHR for MCAS only in males (P = 0.030). Among males and females over 55 years old, the NO levels were higher in people with a higher WHR and the difference was statistically significant (P = 0.042, P = 0.016); however the NO levels for people with a varying WHR showed statistically insignificant difference among females under 55 years old (P = 0.228). CONCLUSION: Hypertension and abdominal obesity are important risk factors for MCAS. Endothelial cell dysfunction and an elevated level of oxidative stress may be involved in the atherogenetic mechanism of abdominal obesity while estrogen may play a protective role in it.

[Study on the correlation between hypertension and the indexes of vascular endothelial function among people living in the community].

OBJECTIVE: To study the features of hypertension and vessel endothelium functional parameter in people living at the community level as well as the risk factors of hypertension. Differences of angiotensin II (Ang II ), prostacyclin (PGI2) and nitric oxide (NO) among normal group and three hypertension groups were also studied. METHODS: By cluster sampling, 1134 adult Han people were selected from the residential communities. Medical history was documented and measurements of body height, body weight, waist circumference, hip circumference and blood pressure were performed. Serum NO levels were determined by cadmium reduction method while plasma Ang II and PGI2 concentration were determined by radioimmunoassay. SPSS 13.0 was used for data analysis. RESULTS: The total ratio of hypertension from people living at the community was 44.5%, with the standardized prevalence of hypertension as 15.3%. With the increase of age, the prevalence of hypertension also increased. Overweight and obesity seemed to be independent risk factors for hypertension. History of smoking and drinking and gender did not enter the logistic equation for hypertension. The amount of plasma Ang II concentration of the three hypertension groups was significantly lower than that in the normal group while the lowest group appeared to from the one that hypertension was under control. The NO and PGI2 levels of the two groups whose hypertension had been known were significantly higher than in the normal group while the difference between the group whose hypertension had not been measured and the normal group was not found. CONCLUSION: The prevalence of hypertension had been increasing. Control of body weight seemed to be a useful way for prevention of hypertension. We assumed that the negative feedback regulation of renin-angiotonin-aldosterone system in hypertension patient still existed which called for the research on the mechanism of hypertension.