Chinese Journal of Stroke

The Application of Alteplase via Vein in the Treatment of Acute Ischemic Stroke

CHEN Sheng-Yun, WANG Dan-Dan, YANG Zhong-Hua, et al.

2016, 11(10): 821-823.

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The Recanalization and Prognosis of Acute Cerebral Infarction Patients with Middle Cerebral Artery Occlusion after Intravenous Thrombolytic Treatment

LIAO Xiao-Ling, WANG Yi-Long,PAN Yue-Song, et al.

2016, 11(10): 824-828.

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Objective To investigate the association between recanalization and prognosis of acute cerebral infarction patients with middle cerebral artery (MCA) occlusion after intravenous thrombolytic treatment. Methods The data of acute cerebral infarction patients with MCA occlusion who received intravenous thrombolytic treatment were retrospectively analyzed. The recanalization rate after thrombolysis was analyzed. The safety and efficacy outcome between recanalization group and no recanalization group were compared. Results A total of 67 patients were included. The rate of recanalization of MCA was 55.2%. For the functional independence outcome at 90 days, recanalization group (n =37) was significantly better than no recanalization group (n =30) (72.97% vs 43.33%, OR=3.5, P =0.014). For the excellent recovery outcome at 90 days, the former was also significantly better than the latter (64.86% vs 26.67%, OR=5.1, P =0.002). There were no significant differences for the symptomatic intracranial hemorrhage and mortality between the two groups. Conclusion The recanalization rate of acute cerebral infarction patients with MCA occlusion is relatively high, and recanalization is strongly associated with prognosis. For these patients, bridgetreatment is the optimal choice.

The Evaluation of Clinical Effect and Efficiency of Endovascular Treatment for Acute Ischemic Stroke Treatment

DENG Yi-Ming, HUO Xiao-Chuan, GAO Feng, et al.

2016, 11(10): 829-835.

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Objective To evaluate the clinical effect and efficiency of endovascular treatment of acute ischemic stroke through utilization of stroke prognosis specific and non-specific as well as health economics evaluation system. Methods Patients who were eligible for acute ischemic stroke endovascular treatment and admitted to Beijing Tiantan Hospital, Capital Medical University from January to April in 2015 were divided into the endovascular treatment group and control group. The main criteria for evaluation were: ①Specific indicators: 14 days National Institute of Health Stroke Scale (NIHSS) score after admission, 90 days after the modified Rankin scale (mRS) rating, 90 days and 1 year of stroke incidence; ②Non-specific indicators: 1 year incidence of nosocomial infection, acute myocardial infarction and symptomatic intracerebral hemorrhage; ③Health economics indicators: 1 year total health care costs, the total cost of drugs, hospital days in hospital cumulative intensive care unit

(ICU) length of stay. Results The endovascular treatment group had a better prognosis than the control group at 14 days NIHSS score after admission (P <0.01); 90 days (P <0.01) and one year (P <0.05) incidence of stroke (by χ 2 test) were both lower than the control group. There was no difference in the incidence of 1 year nosocomial infections, acute myocardial infarction and symptomatic intracerebral hemorrhage rate by χ 2 test. The 90 d mRS rating used rank sum test. The number of no disability or mild disability (grade 0-1), moderate disability (grade 2-3), severe disability (grade 4-5) and death of the control group and endovascular treatment group were 3 vs 17, 15 vs 12, 23 vs 3, 4 vs 5, respectively. And there was no difference in the 1 year cost with the control group. Compared with the control group, the endovascular treatment group decreased significantly in the number of hospitalizations per year (P <0.01), medicine (P <0.05) and ICU length of stay (P <0.01). Conclusion Endovascular treatment for acute ischemic stroke patients can improve the prognosis of patients, improving quality of care at the same time. It doesn’t increase the expense of hospitalization and can reduce the cost for patient's hospitalization and medication.

Study on Intracranial Pressure Changes with Transcranial Doppler Ultrasound in Patients with Intracerebral Haemorrhage

WU Jian-Wei, JIA Jiao-Kun, DING Ze-Yu, et al.

2016, 11(10): 836-841.

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Objective To further verify the correlation between intracranial pressure (ICP) and blood flow parameters of transcranial Doppler ultrasound (TCD) in patients with cerebral hemorrhage. The optimal mathematical models of intracranial pressure were established, which were predicted quantitatively by blood flow parameters of TCD, and then evaluated the accuracy. Methods According to the inclusion and exclusion criteria, demographic data, major neurological function scores and characteristics of lesions of 22 patients with cerebral hemorrhage were registered. The intracranial pressure monitor was used to monitor the intraparenchymal pressure continuously at the bedside. TCD detection was reviewed daily. The blood flow parameters of MCA and ICA, the instant ICP values, temperature, blood pressure, heart rate, and oxygen saturation were recorded. The analyses of multiple linear regression were completed to establish the optimal mathematical model of ICP evaluated by TCD parameters, and then evaluate the accuracy for the diagnosis of intracranial hypertension (ICP>15 mmHg). Results The correlation analysis of PI and ICP showed positive correlation, and the correlation coefficient was r =0.66 (P <0.01). The mathematical model was ICPe=-16.8+26.8×PI+0.12×Vm, adjusted R2=0.46; When ICP>15 mmHg, the area under curve of ICPe was 0.93, and 95% confidence interval was 0.88-0.97.Conclusion PI is positively correlated with ICP, and is the most important predictive indicator of the ICP evaluation. ICPe=-16.8+26.8×PI+0.12×Vm (adjusted R2=0.46) could predict the ICP to diagnose the intracranial hypertension (ICP>15 mmHg) with high accuracy.

Efficacy Evaluation of Decompressive Hemicraniectomy Surgery in Large Cerebral Infarction

ZHANG Xu, LIANG Jun, SANG Ben

2016, 11(10): 842-846.

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Objective To investigate the clinical effect of medical treatment and decompressive craniectomy in treatment of massive cerebral infarction. Methods Decompressive craniectomy was performed in 41 patients with massive cerebral infarction from January 2012 to January 2015 in Xuzhou Medical University Affiliated Hospital. The data of these 41 patients and 30 patients who received conservative medical treatment after massive cerebral infarction were retrospectively studied. The changes of Glasgow Outcome Scale (GOS) of functional recovery at 3 and 12 months after surgery and mortality rates between two groups were compared retrospectively. Results Comparing the operative patients and medical treatment patients, the mortality of operative patients was lower, and overall prognosis of operative patients was better (χ 2=4.522, P =0.02). The mortality of operative patients above the age of 60 was higher than those under 60 (χ 2=5.634, P =0.04). The comparison between operative patients and medical treatment patients were categorized according to the GOS classification 3 months later and 12 months later after discharge. The comparison between operative patients and medical treatment patients in 3 months later and 12 months later: overall prognosis was better and the disability rate of survivors was lower (χ 2=6.437, P =0.03). Conclusion Comparing the surgical therapy with medical treatment in the massive hemispheric infarction patients, the surgical therapy decreases mortality and improves the quality of life.

Case Analysis and Study on Screening Method of the Cryptogenic Stroke Caused by Pulmonary Arteriovenous Fistula

DONG Pei, KUI Dong-Mei, BAI Ya-Qiu, et al.

2016, 11(10): 847-851.

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Objective To analyze the clinical features of the patients with cryptogenic stroke caused by pulmonary arteriovenous fistula (PAVF), and compare the characteristics of different diagnostic methods to find preliminary screening method. Methods Detailed clinical data of 2 patients with cryptogenic stroke were collected. Transesophageal echocardiography (TEE) and contrast transcranial Doppler (cTCD) were performed. Results cTCD in 2 patients showed the following characteristics of microemboli signals: late appearance, large number, long duration, and the number was not influenced by Valsalva maneuver (VM). TEE showed that there were no abnormal CDFI and large number of microbubbles appeared in the left atrium at 5th cardiac cycle after VM. Conclusion Ischemic stroke is the most common extra-pulmonary manifestation of PAVF, influenced by the diameter of feeding artery and quantity of PAVF. cTCD combined with arterial blood gas analysis is useful for preliminary screening, efficacy evaluation and follow-up for PAVM.

The Influence of Nursing Intervention Based on Roy Adaption Theory on Improving Mood Disorder and Neurological Deficit in Patients with Stroke

DU Yue

2016, 11(10): 852-856.

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Objective To investigate the influence of nursing intervention based on Roy adaption theory on improving mood disorder and neurological deficit in patients with stroke. Methods A total of 82 patients diagnosed with stroke admitted in our hospital from Jun. 2014 to Feb. 2015 were chosen as subjects with two-month nursing intervention, and divided into conventional group and Roy group according to their date of admission. Conventional group received conventional medical care and general rehabilitation exercise, and Roy group added psychological intervention comprehensive care based on Roy adaption theory, including psychological support, cognitive therapy, psychological suggestion, music therapy, etc. Then to compare the scores of Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS) and Clinical Nerve Function Limitation Score (CNS) between two groups pre/post-nursing intervention. Results There was no significant difference in SAS, SDS, and CNS between conventional group and Roy group before nursing intervention (P >0.05), after nursing intervention, the scores of SAS, SDS, and CNS of the Roy group was significantly lower than those of the conventional group (P <0.05). Conclusion The psychological intervention comprehensive care based on Roy adaption theory can significantly improve stroke patients mood disorder and neurological deficit, which is worth to be popularization.

Effectiveness of Cognitive Behavioral Therapy with Antidepressants on Post-stroke
Depression: a Systematic Review

LI Li-Jun, HU Wei-Jiang, GAO Ya-Kun, et al.

2016, 11(10): 857-862.

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Objective To assess the effectiveness of cognitive behavioral therapy with antidepressants on poststroke depression. Methods All published research about randomized controlled trials (RCTs) focusing on cognitive behavioral therapy with antidepressants on post-stroke depression on PubMed, Cochrane library, CNKI, VIP, Wanfang Standards Database were searched. Meta-analysis was conducted by RevMan 5.3 software based on data which was eligible for inclusion criteria. The improvement condition of Hamilton Depression Scale (HAMD) and rehabilitation status of neuro-function by Fugl-Meyer Motor-Function Scale were analyzed to compare the effectiveness of two therapies. Results A total of 9 RCTs were included, involving 584 post-stroke depression patients. The results of meta-analysis of the subgroup of early phase (4 weeks, 8 weeks) and long-term phase (12 weeks, 21 weeks, 52 weeks) revealed that cognitive behavioral therapy with antidepressants was more effective in decreasing depression score than control group (4 weeks WMD -1.42, 95% confidence interval [CI ] [-2.02,-0.78], P <0.001; 8 weeks WMD -3.74, 95%CI [-5.50,-1.99], P <0.001; 12 weeks WMD -1.86,95%CI [-2.55,-1.17], P <0.001; 21 weeks WMD -2.20, 95%CI [-3.09,-1.30], P <0.001; 52 weeks WMD -3.73, 95%CI [-4.75,-2.70], P <0.001), and the results also showed that cognitive behavioral therapy with antidepressants was more effective in motor function rehabilitation than control group (WMD -0.32, 95%CI [-0.60, -0.04], P =0.03). Conclusion Cognitive behavioral therapy with antidepressants on post-stroke depression is more effective in decreasing depression score, and promotes the motor functional recovery of patients.

Primary Central Nervous System Vasculitis (8 Cases Report and Literature Review)

LEI Ai-Di, ZHANG Xing-Hu, ZHOU Heng

2016, 11(10): 863-867.

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Objective To analyze and compare the diagnosis method of primary central nervous system vasculitis (PCNSV) according to the international standard. Methods A total of 8 cases who were admitted to Department of Neuro-infection and Immunology of Neurological Disease Center of Beijing Tiantan Hospital, Capital Medical University during Jan.1st, 2012 to Dec.31st, 2015 and diagnosed with PCNSV were reviewed. Their clinical descriptions, laboratory examinations, neuroimaging and pathological characteristic were analyzed. Results The most common clinical symptoms were: chronic headache, seizures, stroke like focal neurological deficits, mental and behavioral abnormalities and symptoms of the external pyramidal system. No specific blood biochemical and cerebral spinal fluid (CSF) abnormalities were found in all patients. Intracranial abnormal signal was seen in magnetic resonance imaging (MRI). Magnetic resonance angiography (MRA) and digital subtraction angiography (DSA) were not significantly abnormal. Brain biopsy was performed in 8 patients and the pathologic results were consistent with PCNSV expression. Conclusion The diagnosis of PCNSV should consider the patient's clinical manifestations, laboratory tests and imaging findings. The extensive development of brain biopsy is helpful to improve the diagnostic rate of the disease.

Inventor of Cerebral Angiography

John H.Zhang

2016, 11(10): 868-868.

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