Chinese Journal of Stroke

Convenient Application

WANG Yong-Jun

2016, 11(08): 613-615.

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High Resolution Magnetic Resonance Imaging of Intracranial Vessel Disease –– a Beginning of Recognition of Cerebrovascular Disease

XU Wei-Hai

2016, 11(08): 617-618.

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Stroke Mechanisms of Middle Cerebral Artery Plaque in Different Stenosis Rate: a High Resolution Magnetic Resonance Imaging Study

2016, 11(08): 619-625.

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Objective To explore the mechanism of stroke in different middle cerebral artery (MCA) stenosis rate, by understanding the association of MCA stenosis rate, MCA plaque morphology and infarct pattern in stroke patients. Methods Patients with ischemic stroke in MCA territory within 2 weeks in Peking Union Medical College Hospital from 2009 to 2014 were consecutively collected. Patients with MCA plaque on high-resolution magnetic resonance imaging (HRMRI) were included, and patients with cardioembolic, extracranial large artery atherosclerotic stroke and other causes of stroke were excluded from the study. The infarct lesions were classified into penetrating artery, cortical, watershed (or border zone) and mixed infarction, and then the infarct volume on diffusion weighted image (DWI) was calculated. On sagittal HRMRI, the stenosis rate of MCA M1 segment, plaque distribution, length, thickness, signal and surface discontinuity were assessed. Patients with stenosis rate >50%were severe stenosis group, and patients with stenosis rate ≤50% were mild stenosis group. Results One hundred and two patients were analyzed, of whom, 39 patients were in severe stenosis group and 63 in mild stenosis group. Severe stenosis group had 14 cases of penetrating artery infarction (35.9%), 9 cortical infarction (23.1%), 4 watershed infarction (10.3%) and 12 mixed infarction (30.8%); mild stenosis group had 44 penetrating artery infarction (69.8%), 8 cortical infarction (12.7%), 3 watershed infarction (5.8%) and 8 mixed infarction (12.7%). The proportion of two groups had significant difference (P =0.014). The severe stenosis group had longer (P <0.001) and thicker (P <0.001) plaques, and more mixed-signal plaques (P <0.001). The plaque thickness (P <0.001, OR 87.792, 95%CI 13.120-587.453) and mixed-signal of plaque (P =0.007, OR 7.358, 95%CI 1.725-31.382) were independent predicting factors of MCA stenosis >50%. In severe stenosis group, the infarct volume was related to plaque surface discontinuity (P =0.004).In mild stenosis group, the infarct pattern was related to plaque surface discontinuity (P =0.002) and plaque thickness (P =0.002). The plaque discontinuity was the independent predicting factor of embolic infarction (P =0.003, OR 5.778, 95%CI 1.788-18.672) in mild stenosis group. Conclusion Patients with MCA stenosis >50% or ≤50% have different proportion of infarct pattern and plaque morphological markers. The surface discontinuity of plaques with stenosis ≤50% is the independent risk factor of embolic infarction, indicating the potential stroke mechanism of mild stenotic MCA.

The Association between Dynamic Changes of MCA Stenosis and Its Surrounding Small Vessels in Brain

ZHENG Bo-Wen, XU Yu-Yuan, LI Ming-Li, et al.

2016, 11(08): 626-630.

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Objective To analyze the relationship between the stenotic or occluded middle cerebral artery (MCA) and a newly discovered imaging phenomenon, which called small vessels around stenotic or occluded site (SVSOS), in patients with multiple high-resolution magnetic resonance imaging (HRMRI) examinations. Methods Retrospectively reviewed 20 patients with multiple HRMRI examinations for MCA stenosis or occlusion in Peking Union Medical College from July 2007 to March 2015, and analyzed the relationship between stenotic or occluded MCA and SVSOS. Results Seven patients’ MCA changed from stenosis to occlusion with multiple HRMRI examinations (35.00%), while 13 patients’ MCA remained stenotic. Six cases with SVSOS were witnessed in patients with MCA change (85.71%), while 3 patients without MCA change had SVSOS (23.08%). There was significant difference in two groups (P =0.02). Conclusion Small vessels around stenotic or occluded site (SVSOS) might be associated with the aggravation of stenosis degree.

Preliminary Study of Immunological Vascular Damage of Cerebral Amyloid Angiopathy Related Hemorrhage

GU Xiao-Hua, XU Jun, CHENG Xin-Xin, et al.

2016, 11(08): 631-635.

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Objective To retrospectively analyze the prevalence of cerebral amyloid angiopathy (CAA) in the patients with spontaneous intracerebral hemorrhage (ICH) who received surgical treatment, and related the immune vascular factor co-expressions as to explore the possible immunological vascular damage of CAA-ICH. Methods Surgical samples of 46 ICH patients from 2010 to 2011 were enrolled, including 27 male patients and 19 female patients. The average age was 56±15 years old. The co-expression of amyloid β (Aβ), glycosylation end products (RAGE) and low-density lipoprotein receptor related protein-1 (LRP1) protein in the samples was detected by immunofluorescence and immunohistochemistry. Results Among 46 cases of ICH patients, 8 patients (17.39%, 5 males and 3 females) were diagnosed with CAA by pathology. The co-expression (positive rate 100%) of Aβ, LRP1 and RAGE proteins were detected in the patients with CAA, while others patients did not show co expression of Aβ, LRP1 and RAGE proteins. Compared with that in others patients, the level of LRP1 expression was significantly lower in the patients with CAA (P =0.031), while the level of RAGE expression was significantly higher (P =0.015). Conclusion CAA is one of the key reasons leading to the disease of ICH. The abnormal expression of RAGE and LRP1may play a vital role in the pathogenesis of CAA associated ICH.

Effect of Tumor Necrosis Factor-like Weak Inducer of Apoptosis on Lectin-like Oxidized Low-density Lipoprotein Receptor-1 Expression of Human Umbilical Vein Endothelial Cells

LI Jia-Wei, WANG Li

2016, 11(08): 636-641.

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Objective To investigate the effect of tumor necrosis factor-like weak inducer of apoptosis (TWEAK) in human umbilical vein endothelial cells (HUVECs) on lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) expression. Methods In vitro cultured HUVECs were taken intervention by final concentration of 0, 10, 50, 100 ng/ml of recombinant human TWEAK (rhTWEAK) for 24 h, and fluorescence quantitative polymerase chain reaction (PCR) technology was used to detect the relative expression of TWEAK group LOX-1 mRNA detection of different doses. Meanwhile, after HUVECs cells were intervened with by previously having added final concentration 0.2, 1, 10 μmol/L atorvastatin for 24 h, then coupled with a concentration of 100 ng/ml TWEAK incubated for 24 h, followed by PCR to detect the relative expression of LOX-1 mRNA; and enzyme-linked immunosorbent assay (ELISA) method was used to detect the cell supernatant LOX-1 protein expression. At the same time, morphological changes in each group were observed by fluorescence microscopy. Results LOX-1 mRNA 2-△△Ct values of final concentration of 0, 10, 50, 100 ng/ml TWEAK

intervention group and the relative expression of LOX-1 protein of the supernatant of each group were compared with the control group, which had statistically significant difference (P <0.001). TWEAK increased with increasing concentration of LOX-1 expression levels in different dose groups, which had significant difference (P <0.001); final concentration 0.2, 1, 10 μmol/ L atorvastatin intervention group after the intervention significantly inhibited the expression of LOX-1 mRNA and protein compared with 100 ng/ml TWEAK group, which had significant difference (P <0.001); and there were significant differences of inter-group comparison of different concentrations of atorvastatin group (P <0.001). Conclusion TWEAK can induce increased expression of human umbilical vein endothelial cells LOX-1, which may correlate with atherosclerosis. Atorvastatin could inhibit LOX-1 expression, which may be one of the mechanisms to play the anti-inflammatory and anti-atherosclerosis role.

The Multi-factors Analysis of Early Neurological Deterioration in Patients with Unilateral Isolated Basal Ganglia Lacunar Cerebral Infarction and the Correlation Study of Ischemia Tolerance

MAN Hong-Hao, BI Yu-Hua, YU Yong-Peng, et al.

2016, 11(08): 642-648.

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Objective To investigate the related factors of early neurological deterioration (END) in patients with unilateral isolated basal ganglia lacunar cerebral infarction and the related mechanism of brain ischemic tolerance (BIT) and END. Methods Retrospective analysis were made upon clinical data of 167 patients who were diagnosed with unilateral isolated basal ganglia lacunar cerebral infarction confirmed by magnetic resonance imaging (MRI) excluding artery stenosis diagnosed. According to the score of National Institutes of Health Stroke Scale (NIHSS) of the stroke within 1 week, 167 patients were divided into two groups: positive END and negative END. Multivariate logistic regression analysis was associated to analyze factors related to the early neurologic deterioration of cerebral infarction. Results Among 167 patients, 42 (25.15%) patients suffered END and 125 patients didn’t have END. Multiple factor analysis indicated that lesions located in the internal capsule hind legs radial posterior lateral ventricle were independent risk factors for END and there were significant difference between two groups (P <0.01). The age of onset, history of cerebral infarction, history of diabetes, systolic

blood pressure at admission and lesions of cerebral white matter were associated with END, which had significant differences (P <0.05). Single factor and multi-factors analysis of with or without diabetes and difference lesion location at different layer and inter-layers showed that with or without diabetes and difference lesion location didn’t affect the association between age, history of stroke, white matter and positive ENT. END correlates with previous history of stroke, pathological changes of white matter, and age of onset, which had significant difference (P <0.05). Conclusion END in patients with unilateral isolated basal ganglia lacunar cerebral infarction is closely related to the lesion, other related factors such as lesions of cerebral white matter, history of cerebral infarction, history of diabetes and age, etc. Age of 65 years old and above, systolic hypertension, history of stroke, and lesions cerebral white matter are protective factors for positive END. Brain ischemia intolerance is the main mechanism for END.

The Effect of Cerebral Asymmetry on the Infarct Volume and Behavior Function of Focal Cerebral Ischemia in the Rats

ZHAI Zhi-Yong, ZHAO Gui-Feng, FENG Juan

2016, 11(08): 649-653.

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Objective To investigate the effect of different side middle cerebral artery occlusion (MCAO) model at different time point on the infarct volume and neurological function in the rats by application of Zea-longa method. Methods Middle cerebral artery occlusion (MCAO) was induced in rats by filament insertion for 1.5 h according to Zea-Longa method. A total of 36 Sprague-Dawley rats were randomly divided into left MCAO and right MCAO groups. Behavior scores, trapezoid balance bar experiment and Morris water maze experiment were all carried out to evaluate the recovery of neural function and infarct volume of the brains were measured at the 1st, 3rd, 7th day after operation respectively. Results Compared with the right MCAO group, the motor function, balancing function of the left MCAO group all decreased at the 1st, 3rd, 7th day after cerebral ischemia-reperfusion, however, memory function was obviously higher than that of right MCAO group, especially at 7th day after I/R. Total infarction volume was the largest at 3rd day after I/R, and smallest at 7th in the two groups. There was no significant difference in infarct volume of the two groups at the 1st and 3rd day after I/R. But at 7th day, infarct volume in left MCAO group was significantly larger than that in the right MCAO group. Conclusion Whether the left or the right MCAO model does not much affect the infarct volume at early stage. However, the infarct volume of left MCAO was larger than that of right MCAO at later stage. More serious movement is caused in the left MCAO group and more serious memory impairments is caused in the right MCAO group. These findings suggest there may be structural and functional asymmetry in hemispheres of rat, which affects the outcome of the focal cerebral ischemia.

Diagnoses and Treatment as Well as Literature Review of Developmental Venous Anomalies

KANG Shuai, YE Xun, ZHAO Yuan-Li, et al.

2016, 11(08): 654-658.

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Objective To analyze the pathological characteristics, clinical manifestation, diagnosis and treatment of venous malformations (VMs), and to improve the clinical significance of its recognition. Methods A retrospective study and a literature study to review 10 patients with VMs from our hospital were performed. Results A total of 10 patients with VMs could be identified: intracerebral hemorrhage (n =7), seizures (n =2), non-neurological indication (n =1). Seven patients received conservative therapy and 3 patients were found associated cavernoma, among whom, two received operations and one VMS was resected. Those who received conservative therapy had no further disease progress and those who received operation had good prognosis. Conclusion Although VMs should be considered benign and clinically silent, coexisting cavernomas are found having a defined bleeding potential and should be treated independently of the VMS after overall evaluation.

Association of HbA1c Levels with Carotid Plaque in Community-based Population with Type 2 Diabetes

ZHANG Run-Hua, LIU Gai-Fen, WANG Yi-Long, et al.

2016, 11(08): 659-664.

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Objective To evaluate the association of HbA1c and carotid plaque in community-based type 2 diabetes. Methods Form the cross-sectional study, information of community-dwelling adults was collected by investigators who were trained uniformly, including demographics, behavior and life style, disease history, medicine condition, HbA1c level, as well as carotid ultrasound. A total of 552 subjects, who self-reported be with type 2 diabetes or had glucose-lowering agents and ≥40 years old, were included. The association of HbA1c level and carotid plaque was explored by using the methods of univariate and multivariate logistic regression models. In addition, stratified analysis was used to evaluate the risk of HbA1c level and carotid plaque in population with different characteristics. Results There were 218 men and 334 women in this study, of which the prevalence of carotid plaque was 41.9% and the mean level of HbA1c was (7.25±1.53)%. In the univariate logistic

regression model, the odds ratio of carotid plaque was 1.10 (95%CI 0.98-1.22, P =0.108) for per 1% increase. The OR was 1.13 (95%CI 1.00-1.26, P =0.047) when adjusting age and gender. After disease history, smoking status, drinking, total cholesterol, triglyceride, low-density lipoprotein (LDL), high-density lipoprotein (HDL), statins, BMI, physical exercises, medicine treatment, sleep duration, and family history of stroke have been taken into consideration, the OR was 1.16 (95%CI 1.02-1.33, P =0.025) for per 1% increase. When the level of HbA1c was classified as low group, middle group, and high group, serving low group as reference, the OR of high group was 1.71 (95%CI 1.06-2.76, P =0.028), and the OR of middle group was 1.40 (95%CI 0.87-2.25, P =0.170). Stratified by age, BMI, and hypertension, the population of <60 years or BMI≥24 or with hypertension were found tending to have relative high risk of association of HbA1c and carotid plaque. Conclusion HbA1c level is significantly associated with carotid plaque in the community-dwelling with type 2 diabetes.

Brief History of Stroke

John H.Zhang

2016, 11(08): 665-667.

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