Chinese Journal of Stroke

A Happy Leap Year for CHANCE Study

WANG Yong-Jun

2017, 12(05): 381-386. DOI: 10.3969/j.issn.1673-5765.2017.05.001

Asbtract ( )

PDF (1805KB) ( )

References | Related Articles | Metrics

Immune Response after Ischemic Stroke

SUN Lin, WANG Jia-Wei

2017, 12(05): 387-389. DOI: 10.3969/j.issn.1673-5765.2017.05.002

Asbtract ( )

PDF (1419KB) ( )

References | Related Articles | Metrics

The Dynamic Changes of T Lymphocyte Subsets in Peripheral Blood in Patients with Stroke and Their Influence on Infection after Stroke

ZHAO Bo, YANG Bin-Bin, WANG Jia-Wei

2017, 12(05): 390-395. DOI: 10.3969/j.issn.1673-5765.2017.05.003

Asbtract ( )

PDF (1852KB) ( )

References | Related Articles | Metrics

Objective To observe the dynamic changes of CD3+T cells, CD3+CD4+T cells, CD3+CD8+T cells and CD4+CD25+FoxP3+ regulatory T cells (Tregs) in peripheral blood of patients with acute stroke, and explore the immune state and its influence on infection after stroke. Methods There were 32 acute stroke patients in stroke group, and 23 age- and gender-matched healthy ones in control group. According to infection occurring within 1 week after stroke or not, 32 stroke patients were divided into infection group (n =8) and non-infection group (n =24). The levels of CD3+T cells, CD3+CD4+T cells, CD3+CD8+T cells and Tregs were determined serially on day 1, 3 and 7 after stroke onset in 32 stroke patients and 23 controls. Results ①Comparing with the control group, CD3+CD4+T cells and Tregs increased on day 7 after onset (P =0.02 and 0.03, respectively), CD3+CD8+T cells decreased on day 1 and 3 after onset (P =0.01 and 0.03, respectively) and restored to a normal level on day 7 in non-infection group. A significant

fall of CD3+T cells, CD3+CD4+T cells, CD3+CD8+T cells and Tregs were observed on day 1 (P <0.001, <0.001, 0.03 and <0.001, respectively), 3 (P <0.001), and 7 (P <0.001, 0.01, 0.01 and 0.01, respectively) after onset in infection group. ②Comparing with non-infection group, CD3+T cells, CD3+CD4+T cells, and Tregs were all significantly lower on day 1 (P =0.01, <0.001 and <0.001, respectively), 3 (P <0.001, <0.001 and 0.04, respectively) and 7 (P <0.001) after onset in infection group. There was no significant difference in CD3+CD8+T cells between the two stroke groups on day 1, while this type of T cells in infection group significantly decreased on day 3 (P <0.001) and 7 (P =0.02) after onset than that of in non-infection group. Conclusion CD3+T cells, CD3+CD4+T cells, CD3+CD8+T cells and Tregs may involve in pathophysiological process in the acute phase of stroke. The dynamic changes of T lymphocytes may induce to immunodepression, and involve in infection after stroke.

Clinical Analysis of Symptoms Associated with Cerebral Parenchyma Injury in Vogt-Koyanagi-Harada Syndrome

LI Lin, WANG Jia-Wei

2017, 12(05): 396-399. DOI: 10.3969/j.issn.1673-5765.2017.05.004

Asbtract ( )

PDF (1804KB) ( )

References | Related Articles | Metrics

Objective To summarize the clinical characteristics of the nervous system symptoms in patients with Vogt-Koyanagi-Harada syndrome. Methods Clinical materials of the inpatients with Vogt-Koyanagi-Harada syndrome were retrospectively analyzed. The clinical features, nervous system symptoms, results of lab tests and magnetic resonance imaging (MRI), treatment and prognosis were descriptively analyzed. Results Thirty-six cases were collected, of which 30 (83.33%) cases presented with nervous system symptoms, and headache was the most common (29 cases, 80.56%). Stroke-like symptoms included limbs and facial numbness (1 case, 2.78%), walking unstable (1 case, 2.78%), conscious disturbance (1 case, 2.78%). Demyelination sign can be seen on the MRI of the patients with stroke-like symptoms, yet without new infarction lesion. Conclusion Symptoms associated with cerebral parenchyma injury are uncommon in patients with Vogt-Koyanagi-Harada syndrome, presenting demyelination sign on MRI.

Nine Cases of Cerebral Venous Sinus Thrombosis Associated with Behcet's Disease

ZHU Li-Ping,WANG Jia-Wei, LAI Chun-Tao

2017, 12(05): 400-403. DOI: 10.3969/j.issn.1673-5765.2017.05.005

Asbtract ( )

PDF (1626KB) ( )

References | Related Articles | Metrics

Objective To investigate the clinical features, thrombosis location, treatment and prognosis in patients with intracranial venous sinus thrombosis (CVST) associated with Behcet's disease (BD). Methods We performed a retrospective analysis of clinical data of 9 inpatients with CVST associated with BD in Beijing Tongren hospital of Capital Medical University from January 2014 to August 2016. Results Nine patients (age range 21-47 years, mean age 35.9 years) with CVST associated with BD were collected, of which 2 (22.2%) cases were male. The results of clinical features showed as follows: 1 acute onset (11.1%) and 8 chronic onset (88.9%); 4 headache (44.4%), 1 dizziness (11.1%), 3 paroxysmal amaurosis (33.3%), 5 decreased binocular vision (55.6%), 9 papilledema (100%), 3 diplopia (33.3%) and only 1 tinnitus (11.1%); 7 sigmoid sinus thrombosis (77.8%), 5 transverse sinus thrombosis (55.6%), 1 straight sinus thrombosis (11.1%), 1 inferior sagittal sinus thrombosis (11.1%) and 2 internal jugular vein thrombosis (22.2%); 4 cases involving only 1 sinus (44.4%) and 5 ones involving 2 and more than 2 sinus (55.6%). All patients were given with oral methazolamide 50 mg bid, and glucocorticoids impact treatment for 3 cases (33.3%), of which 1 case (11.1%) combined with warfarin anticoagulant therapy and the other two (22.2%) undergoing lumbar cistern - celiac bypass surgery. After follow-up of 1- 32 months, all patients obviously improved after treatment. Conclusion BD can cause CVST, one or more than one venous sinuses can be involved, and the possibility of BD should be excluded in CVST patients.

Analysis of Relationship of Plasma Homocysteine Level and Polymorphism of Methylenetetrahydrofolate Reductase with Ischemic Stroke

ZHANG Lu, CUI Xiao-Yan, ZHANG Bo-Ai

2017, 12(05): 404-409. DOI: 10.3969/j.issn.1673-5765.2017.05.006

Asbtract ( )

PDF (1856KB) ( )

References | Related Articles | Metrics

Objective To investigate the relationship of the plasma homocysteine (Hcy) level and the polymorphism of methylenetetrahydrofolate reductase C667T (MTHFR C667T ) gene with ischemic stroke (IS) in China, and analyze the correlation between Hcy and folate, VitB12. Methods The levels of plasma Hcy in 217 patients with IS and 223 matched controls were detected by enzymatic recycling method, and the MTHFR C667T genotype of the two groups by the method of polymerase chain reaction (PCR)-gene chip, then the level of plasma Hcy, the genotype frequency and the alleles distribution in two groups were compared. The levels of serum folate and VitB12 were detected by immunoassay method in 88 patients with IS and 125 controls who had not taken drugs containing folic acid or VitB12, and the correlation between folate, VitB12 and Hcy were analyzed. Results The plasma Hcy concentration in the IS group was higher than that in control group

([23.95±12.13] μmol/L vs [17.31±7.20] μmol/L, t =29.61, P <0.001); however, the frequency of homozygous and heterozygous MTHFR mutation between the two groups had no significant difference (χ 2=3.59, P =0.166), the frequency of allele C and T in the IS group were 36.6% and 63.4%, respectively, 42.8% and 57.2% in control group, there was also no significant difference in the two groups (χ 2=3.52, P =0.061). There was a significant difference in the corresponding plasma Hcy level of CC, CT, TT genotype, the plasma Hcy level of TT genotype ([25.19±12.53]μmol/L, n =162) was significantly higher than that of CT ([18.21±8.08] μmol/L, n =206) and CC ([16.65±6.90] μmol/L, n =72) genotype, and that of CT genotype was significantly higher than CC genotype (all P <0.001). The Hcy level was negatively correlated with VitB12 in the two groups (the IS: r =-0.431, the control: r =-0.507, both P <0.001) and also negatively correlated with folate(the IS: r = -0.489, the control: r =-0.446, both P <0.001). Conclusion The plasma homocysteine level of IS patients was higher than that of healthy people. The mutation of MTHFR C677T and the declined level of folic acid and VitB12 may contribute to the elevation of homocysteine level. The MTHFR gene mutation may be irrelevant to ischemic stroke.

The Role of Th17 in Stroke in Patients with Acute Atherosclerotic Cerebral Infarction

REN Qing-Qing,QIAN Wei-Dong

2017, 12(05): 410-414. DOI: 10.3969/j.issn.1673-5765.2017.05.007

Asbtract ( )

PDF (1839KB) ( )

References | Related Articles | Metrics

Objective To explore the role of T helper cell 17 (Th17) in stroke evolving by detecting the level of Th17 in peripheral blood and its relationship with carotid artery intima-media thickness (IMT) in patients with acute atherothrombotic ischemic stroke. Methods Patients with first-ever acute atherosclerosis cerebral infarction were included in the stroke group, and the baseline characteristics matched healthy people as control. The levels of Th17 in peripheral blood between the two groups were compared. According to the National Institute of Health Stroke Scale (NIHSS) score at admission, the patients in stroke group were divided into light stroke, medium stroke and severe stroke subgroups. The level of Th17 between the two groups and among the three subgroups were compared. The relationship between the level of Th17 and risk factors of the patients such as age, gender, hypertension, diabetes, hyperlipidemia were analyzed. The correlation between Th17 and carotid artery intima-media thickness (IMT) was also analyzed. Results All the subjects from the stroke group (n =45) and control group (n =32) were investigated. The level of Th17 in stroke group was significantly higher than that in control group ([7.41±1.93]% vs [2.8±0.64]%, P <0.001). The percentage of Th17 in peripheral blood mononuclear cells in light stroke (4.97±0.89)%, medium stroke (7.06±1.33)% and severe stroke subgroup (8.65±1.71)% were all significantly higher than that in control group (all P value<0.001). The level of Th17 in medium

stroke subgroup was higher than that in light stroke subgroup (P =0.003). The level of Th17 in severe stroke subgroup were higher than that in medium (P =0.002) and light stroke subgroup (P =0.002). There was a significantly positive correlation between the level of Th17 and IMT (r =0.68, P <0.001). Conclusion Elevated level of Th17 may enhance vascular inflammation and accelerate atherosclerotic cerebral infarction, and Th17 may involve in the pathogenesis of stroke.

Current Status of Diagnosis and Treatment of Embolic Stroke of Undetermined Source

WANG Heng-Heng, XIA Zhi-Wei, FAN Dong-Sheng

2017, 12(05): 415-420. DOI: 10.3969/j.issn.1673-5765.2017.05.008

Asbtract ( )

PDF (1830KB) ( )

References | Related Articles | Metrics

Objective To investigate the current status of diagnosis and treatment of embolic stroke of undetermined source (ESUS) in patients hospitalized for ischemic stroke in China. Methods A retrospective review of clinical data of inpatients for ischemic stroke in Peking University Third Hospital between Jan 2011 and Dec 2012 was conducted. Patients who did not receive 24-hour Holter monitoring, yet had completed the other evaluations and met ESUS diagnostic criteria of ESUS International Working Group were defined as “suspected ESUS” (sESUS), while those who completed all relative evaluations (including 24-hour Holter monitoring) and met the diagnostic criteria of ESUS were defined as “definite ESUS” (dESUS). All the above patients were enrolled into ESUS group, and the other subtypes of stroke as control. The baseline charateristics, risk factors and clinical features were compared between the two groups. Secondary prevention and stroke recurrence of these ESUS patients (including sESUS and dESUS) after discharge were followed up. Results Finally, 900 patients with ischemic stroke were enrolled in this study, of which 9 dESUS (1.0%) and 95 sESUS (10.6%), the 104 ESUS patients accounted for 11.6% (104/900) of all subjects,

and the remaining 796 patients were divided into non-ESUS group. Clinical features of two groups as follows: 85 onset during physical activities (81.7%), 58 ones with fluctuating symptoms (55.8%) and the mean score of National Institutes of Health Stroke Scale (NIHSS) was 2.0 (0, 4.0) in ESUS group; the corresponding in control group was 538 (67.6%) , 245 (30.8%) and 3.0 (1.3, 5.0), respectively; there was significant difference in any of the three between two groups (P =0.010, P <0.001, P <0.001, respectively). Analyzing the usage of antithrombotic drugs in acute phase and after discharge in ESUS patients, we found that all ESUS patients had taken antiplatelet agents, and 6 dESUS and 10 sESUS patients experienced recurrent stroke during the first year after discharge. Conclusion Patients diagnosed as ESUS is very common in patients with ischemic stroke. Comparing with non-ESUS patients, there were more fluctuating symptoms and less neurologic deficit in ESUS ones. 24-hour Holter monitoring in ESUS patients is necessary and very helpful for determing the cause of stroke.

Analysis of Effect Difference of Hypertension on Hemodynamics and Wall Thickness of Bilateral Carotid Arteries

JIANG Fan, LU Liu-Xi, JIANG Zhong-Bi, et al

2017, 12(05): 421-424. DOI: 10.3969/j.issn.1673-5765.2017.05.009

Asbtract ( )

PDF (1809KB) ( )

References | Related Articles | Metrics

Objective To investigate the effect difference of hypertension on the hemodynamics and wall thickness of bilateral carotid arteries. Methods All subjects were divided into two groups: fifty-two hypertension patients in hypertension group and forty-six healthy people as control. The pulsatility index (PI), resistance index (RI), peak systolic velocity (PSV), end diastolic velocity (EDV), and intima-media thickness (IMT) of bilateral common carotid arteries of all subjects were detected by color Doppler ultrasound. The above indexes were compared to analyze the difference between left and right carotid artery in two groups, and ipsilateral difference between the two groups. Results In hypertension group: the PI (P =0.019), RI (P =0.012) and IMT (P =0.043) of common carotid artery were greater on the left side than that on the right side, while there was no significant difference in blood flow velocity (PSV, EDV) between both sides (P >0.05). In healthy group: there were no significant difference in all the indexes of carotid artery between two sides (P >0.05). Comparing the two groups, the results were that IMT and RI of common carotid artery in hypertension group were higher than that of ipsilateral artery in healthy group (left IMT: P =0.002; right IMT: P =0.017; left RI: P =0.023; right RI: P =0.024), while the PI difference was only found on the left side (hypertension group > healthy group: P =0.011). There were no significant difference in EDV and PSV between the two groups (P >0.05).

Conclusion The influence of primary hypertension on the hemodynamics and wall thickness of carotid artery on the left side was greater than on the right side.

Immune Mechanism and Progress of Immune-modulating Therapy after Ischemic Stroke

ZHAO Bo,WANG Jia-Wei

2017, 12(05): 426-431. DOI: 10.3969/j.issn.1673-5765.2017.05.010

Asbtract ( )

PDF (1651KB) ( )

References | Related Articles | Metrics

In recent years, immunity and inflammation in the pathophysiological process of ischemic stroke gradually draw more attention. After ischemic stroke, the natural immune and adaptive immune system will be activated. Stroke will break the balance between the nervous system and immune system, and cause homeostasis unbalance. Immune modulators can be taken as auxiliary medicine, which open a new way for the treatment of stroke.

Stroke in Behçet's Disease

YANG Qing-Lin, WANG Jia-Wei, LAI Chun-Tao

2017, 12(05): 432-435. DOI: 10.3969/j.issn.1673-5765.2017.05.011

Asbtract ( )

PDF (1626KB) ( )

References | Related Articles | Metrics

Behçet's syndrome (BD) is a immune-mediated small-vessel systemic vasculitis. Neuro-Behçet's disease (NBD), involving central nervous system damage in 2.5%-49% of BD cases, is an important factor resulting in poor outcome of BD. It is usually classified as parenchymal and non-parenchymal NBD, the latter also known as vascular NBD. In vascular NBD, besides common cerebral venous sinus thrombosis, other forms of vascular damage such as ischemic or hemorrhagic stroke, intracranial artery dissection, aneurysm and ischemic optic neuropathy have been reported, and the lesions have involved in brain parenchyma, beyond the range of vascular NBD in traditional definition. Advances in clinical characteristics and diagnosis of stroke related to different types of BD are reviewed in this article.

Neurology: Pseudotumoral Presentation of Cerebral Amyloid Angiopathy-related Inflammation

YANG Zhong-Hua

2017, 12(05): 436-437. DOI: 10.3969/j.issn.1673-5765.2017.05.012

Asbtract ( )

PDF (1457KB) ( )

References | Related Articles | Metrics

Stroke: Added Value of Vessel Wall Magnetic Resonance Imaging in the Differentiation of Moyamoya Vasculopathies in a Non-Asian Cohort

YANG Zhong-Hua

2017, 12(05): 438-439. DOI: 10.3969/j.issn.1673-5765.2017.05.013

Asbtract ( )

PDF (1451KB) ( )

References | Related Articles | Metrics

Traditional Chinese Medicine Serves as a Predecessor in the Treatment of Stroke VI —— Qingren Corrected Errors

John H.Zhang

2017, 12(05): 440-441. DOI: 10.3969/j.issn.1673-5765.2017.05.014

Asbtract ( )

PDF (1495KB) ( )

Table of Content