Chinese Journal of Stroke

Keep a Watchful Eye on Secondary Damage

WANG Yong-Jun

2017, 12(03): 203-204. DOI: 10.3969/j.issn.1673-5765.2017.03.001

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The Prognosis of Stroke Patients Must Pay Attention to Post-stroke Complications

HE Li

2017, 12(03): 205-206. DOI: 10.3969/j.issn.1673-5765.2017.03.002

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Study on Effects of Neuromuscular Electrical Stimulation on Dysphagia in Post-stroke Patients

LI Bing-Jie, ZHANG Tong, LI Fang

2017, 12(03): 207-213. DOI: 10.3969/j.issn.1673-5765.2017.03.003

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Objective To clarity the effects of neuromuscular electrical stimulation (NMES) on swallowing function of post-stroke patients from kinematic research of swallowing by video fluoroscopy swallowing study (VFSS). Methods Patients with dysphagia were recruited and randomly allocated to the study group and the control group. VFSS was performed before treatments. Patients in the study group received real NMES, and patients in the control group received sham NMES. Different interventions were applied for 20 min per time, 5 times per week, for 4 weeks. All the patients received traditional swallowing therapy at the same time. The evaluation was performed by using VFSS before and after treatment. Rosenbek Penetration-Aspiration scale (PAS) of 3 ml liquid barium food, 10 ml liquid barium food, semisolid barium food and solid barium food, pharyngeal transit time (PTT), pharyngeal delayed time (PDT), maximal extent of forward laryngeal movement and upward laryngeal movement, maximal extent of forward hyoid movement and upward hyoid movement

were obtained. The differences between two groups before and after treatment were identified respectively. Results A total of 43 patients were enrolled into study including 23 cases in study group and 20 cases in control group. After treatments, the scores of PAS of swallowing of 4 kinds of food in both groups were significantly reduced, and PDT and PTT were shorter compared with those before treatment (All P <0.05). There were no significant differences between two groups in the scores of PAS, PTT and PDT before and after treatment. Before treatment, there was no significance in difference in forward laryngeal movement, upward laryngeal movement, forward hyoid movement and upward hyoid movement between two groups. After treatment, upward laryngeal movement and upward of hyoid movement of study group were significantly increased compared with those of the control group (All P <0.05), however, there were no significant differences in forward laryngeal movement and forward hyoid movement between two groups. Conclusion NMES and traditional swallowing therapy can improve the swallowing function of stroke patients. The application of NMES could improve the upward movement of hyolaryngeal complex better.

Study on the Influential Factors of the Cerebral Venous Sinus Thrombosis in Early-onset Seizures

YAN bin, ZHU Ming-Zhen, LIU Yuan-Hong, et al.

2017, 12(03): 214-218. DOI: 10.3969/j.issn.1673-5765.2017.03.004

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Objective To study the correlative factors of the cerebral venous sinus thrombosis (CVST) in early-onset seizures. Methods The patients with cerebral venous sinus thrombosis were selected as subjects and were divided into early onset epilepsy group and the control group according to the criteria of whether there were epileptic seizures within 2 weeks after the onset. Retrospective analysis of patients was made upon clinical data including acute clinical manifestation, imaging and electroencephalogram (EEG), etc. Single factor analysis and binary logistic regression analysis were made to study the factors that might influence the early onset of epilepsy of CVST. Results A total of 64 patients with CVST were enrolled, among whom, there were 19 cases in early onset epilepsy group (29.7%) and 45 cases in the control group (70.3%). By the single factor analysis of early-onset epilepsy group, the puerperal women during pregnancy (52.6% vs 20.5%, P =0.01), disturbance of consciousness (31.6% vs 8.89%, P =0.02), the multiple lobes lesion (52.6% vs 24.4%, P =0.03), cerebral infarction merger of vein bleeding (52.6% vs 11.1%, P =0.01), abnormal EEG (73.7% vs 46.6%, P =0.01) were significantly higher than that of control group, with significant difference statistically. Binary logistic regression analysis showed that more cerebral lobe lesions

[(odds ratio (OR) 12.89, 95% confidence interval (CI) 2.12-78.41], cerebral infarction merger of vein bleeding (OR 12.92, 95%CI 12.92-99.25), EEG anomalies (OR 2.19, 95%CI 2.19-4.49) were risk factors for early onset seizures in CVST. Conclusion Multiple cerebral lobe lesions, vein cerebral infarction with bleeding and abnormal electroencephalogram (EEG) were independent risk factors for CVST early-onset seizures.

The Usage Rate of Clopidogrel in Combination with Aspirin in Ischemic Stroke Patients in 2012-2014

YANG Cheng, WEI Chen-Lu, TIAN Yao-Hua, et al.

2017, 12(03): 219-222. DOI: 10.3969/j.issn.1673-5765.2017.03.005

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Objective To analyze the usage rate of clopidogrel in combination with aspirin through big data analysis. Methods Using the Beijing Medical Insurance Database for Employers, patients with the primary diagnosis of ischemic stroke or transient ischemic attack (TIA) and related syndrome from January 1, 2012 to December 31, 2014 were identified as the study subjects and were divided into two subsets according to International Classification of Diseases-10 (ICD), with June, 2013 as the cutoff point. The two subsets both covered 18-month long period. Descriptive analysis was applied to compare the difference in the usage rate of clopidogrel in combination with aspirin between the two subsets. Subgroup analysis was also conducted in ischemic stroke patients and TIA patients separatively. Results A total of 6 296 188 cases and 101 587 subjects were included during study period. During July, 2013 to December, 2014, 876.9 (±129.8) cases used clopidogrel in combination with aspirin each month, accounting for 14.7% of the total cases. And the number was 649.9 (±129.8) from January, 2012 to June, 2013, accounting for 12.3% of the total cases. The usage rates were 14.5% and

9.1% in patients with primary diagnosis as ischemic stroke and TIA each month before June, 2013, respectively. The usage rates became higher after June, 2013 (20.2% and 11.1% for ischemic stroke and TIA, respectively). Before June, 2013, 18.3% of the participants used clopidogrel in combination with aspirin. Afterwards, the proportion rate increased up to 22.2%. Conclusion Among the patients with ischemic stroke and TIA of Beijing Medical Insurance Database, the usage rate of clopidogrel in combination with aspirin after June, 2013 was higher than that of before June, 2013.

Effects of Repetitive Peripheral Magnetic Stimulation on Submandibular Muscles in Post-stroke Patients with Dysphagia

WANG Jie, YAN Wen-Jing, HU Luo-Man, et al.

2017, 12(03): 223-227. DOI: 10.3969/j.issn.1673-5765.2017.03.006

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Objective To study the effect of repetitive peripheral magnetic stimulation (rPMS) on the submandibular muscles in post-stroke patients with dysphagia during subacute stage. Methods Forty subacute post-stroke patients with dysphagia were selected in the study which were randomly allocated into treatment group and control group. The treatment group was given conventional swallowing treatment combined with rPMS, and the control group was given conventional swallowing treatment only. Severity of the swallow disorders (STSD), saitoh seven stage scale (SSSS), and the surface electromyographic signals were performed before and after treatment. The change of swallowing function of 2 groups were compared 2 weeks later to observe the changes of Severity of STSD, SSSS, and the surface electromyographic signals, and the swallowing duration and maximal amplitude. Results The swallowing function of both groups got improved after 2 weeks of therapy. The intragroup comparison showed that the STSD and the SSSS improved (P <0.05) and the amplitude increased and the swallow duration shortened in each group (P <0.05), which had significant difference. The intergroup comparison showed that STSD score in treatment group was significantly

higher than that of control group (P =0.043); the SSSS score in treatment group was significantly improved than in control group (P =0.028); and the swallowing duration in treatment group were significantly shortened than that in control group (P =0.005). However, there was no significant difference in the change of the maximal amplitude between treatment group and the control group. Conclusion The treatment of rPMS combined with conventional swallowing treatment can help post-stroke patients with dysphagia improve the function of swallowing. It may be chosen as a good new method in regulating the harmony and flexibility of the swallowing muscles by clinical doctors.

Study on Unilateral Venous Sinus Stent Implantation in the Treatment of Idiopathic Intracranial Hypertension

WANG Wei, ZHANG Jia-Liang, FU Ji-Di, et al.

2017, 12(03): 228-232. DOI: 10.3969/j.issn.1673-5765.2017.03.007

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Objective To investigate the impact of sinus disease on idiopathic intracranial hypertension and the feasibility of endovascular stent placement. Methods The retrospective study recruited intracranial-hypertensive patients hospitalized between 2012 and 2015 and given the stent angioplasty for venous sinus stenosis. Data on clinical symptoms, fundus examination, measurement of intracranial pressure, cerebral angiography, efficacy and safety of operation were collected. Results A total of 7 patients with idiopathic intracranial hypertension were treated with the retrograde angiography manometry of cerebral venous sinus and the implantation of the venous sinus stent. Among 7 patients, 4 patients had headache, and 1 patient experienced rhinorrhea. These symptoms were improved after operation. Visual acuity decrease occurred in 7 patients. Of 7 patients, 6 had improvement of visual acuity after operation. Conclusion Patients with idiopathic intracranial hypertension should be treated with retrograde venography and venous sinus pressure. Stent implantation is an alternative treatment for patients with symptoms of venous sinus stenosis.

Significance and Change in Prominent Vessel Sign on Susceptibility-weighted Imaging before and after Thrombolysis in Acute Ischemic Stroke

XUE Jing, WANG Hao, GAO Pei-Yi, et al.

2017, 12(03): 233-238. DOI: 10.3969/j.issn.1673-5765.2017.03.008

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Objective To evaluate the significance and change in prominent vessel sign (PVS) on susceptibility-weighted imaging (SWI) before and after thrombolysis in acute ischemic stroke. Methods A total of 34 acute ischemic stroke patients with large vessel occlusion or severe stenosis who underwent SWI examination before and after thrombolytic therapy were enrolled in the study. The patients were divided into recanalization group and non-recanalization group. The SWI-PVS grade and Alberta Stroke Program Early Computed Tomography (ASPECT) Score of the two groups were evaluated before and after treatment. Mann-Whitney U rank sum test was used to compare the statistical difference of SWI-PVS in recanalization group and non-recanalization group before and after thrombolytic therapy, and the statistical difference of SWI-PVS between the two groups after thrombolytic therapy, respectively. Results The difference of the SWI-PVS grade and ASPECT score before and after thrombolytic therapy in recanalization group (22 cases) was statistically significant (Z =3.852, P <0.001; Z =3.852, P <0.001). The difference in non-recanalization group (12 cases) was not statistically significant (Z =3.852, P <0.001 and Z =3.852, P <0.001). The difference of SWI-PVS score and ASPECT score

between the two groups after thrombolytic therapy was not statistically significant (Z =3.901, P <0.001; Z =3.978, P <0.001). Conclusion The PVS on SWI can be indicative and reflect hypo-perfusion status in acute ischemic stroke patients with large vessel occlusion or severe stenosis. It can be used to evaluate the reperfusion status after thrombolytic therapy.

Clinical Research of Endovascular Angioplasty and Stenting in Symptomatic Middle Cerebral Artery Stenosis

MI Yu-Xia, ZHANG Guang-Yu, ZHANG Cai-Xia, et al.

2017, 12(03): 239-243. DOI: 10.3969/j.issn.1673-5765.2017.03.009

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Objective To probe into the endovascular stent angioplasty in the treatment of symptomatic middle cerebral artery stenosis, and evaluate its safety and therapeutic effect. Methods A retrospective analysis of the patients with middle cerebral artery stenosis who had received endovascular stent angioplasty treatment from May 2008 to December 2015 in Neurology Department, Cangzhou City People's Hospital was made to observe the success rate of endovascular stent, surgical complication rate, preoperative and postoperative stenosis stent rate, and follow-up the therapeutic effect of patients who had endovascular stent angioplasty. Results A total of 98 patients who have been successfully implanted brackets were enrolled into the group. The preoperative stenosis rate was (83.8±7.9)% on average, and postoperative residual stenosis rate was (21.9±4.2)%. There was 1 case (1.0%) of subacute thrombus which happened 3 days after the operation, with the restenosis rate of 12.9%. The 1 year follow-up cumulative incidence of endpoint events (onset of ischemic stroke at 30 d after operation, hemorrhagic stroke and operation associated death, ischemic stroke within the lesion region after 30 d) was 14.3%. Conclusion Endovascular stent angioplasty shows good therapeutic effect and safety, high success rate of the operation, and low incidence of 1 year restenosis.

Research Advances of Statin Treatment for Ischemic Stroke

ZHANG Bei, ZHOU Xin

2017, 12(03): 245-250. DOI: 10.3969/j.issn.1673-5765.2017.03.010

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Ischemic stroke is one of major causes of affecting disability adjusted life year. Statin, as an inhibitor of hydroxymethyl glutaric acyl coenzyme A reductase, has been widely used in primary and secondary prevention of ischemic stroke according to the guideline by many countries. This paper reviewed the curative effect, possible mechanism and safety of statin treatment in ischemic stroke for clinical discussion

Research Status and Advances of Post-stroke Seizure and Post-stroke Epilepsy

GUO Yi-Jia, HE Li,ZHOU Dong

2017, 12(03): 251-255. DOI: 10.3969/j.issn.1673-5765.2017.03.011

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Definition of post-stroke seizure and epilepsy remains inconsistent so far. The reported incidence of seizures after ischemic infarction varies greatly from 3% to 30%, which may exert adverse effects on clinical prognosis in stroke patients. The intervention strategies include management of stroke risk factors, stroke recurrence prevention and antiepileptic treatment. Some studies indicated that the effect of new antiepileptic drugs was superior to traditional medications, and statins might also lower the risk of occurrence. For now, there is no definite consensus or guideline for the diagnosis and treatment of post-stroke seizure and epilepsy, which requires further research to provide more evidence-based findings.

JAMA: Statins vs Non-Statins in the Prevention of Severe Vascular Events

YANG Zhong-Hua

2017, 12(03): 256-256. DOI: 10.3969/j.issn.1673-5765.2017.03.012

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Neurology: Can Statin Increase the Risk of Cerebral Hemorrhage?

YANG Zhong-Hua

2017, 12(03): 257-257. DOI: 10.3969/j.issn.1673-5765.2017.03.013

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Traditional Chinese Medicine Serves as a Predecessor in the Treatment of Stroke IV —— Baopu Taoist Temple

John H.Zhang

2017, 12(03): 258-259. DOI: 10.3969/j.issn.1673-5765.2017.03.014

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