Chinese Journal of Stroke

Trace the Origins

WANG Yong-Jun

2018, 13(03): 203-204. DOI: 10.3969/j.issn.1673-5765.2018.03.001

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Correctly Understand the Relationship Between Headache and Stroke

LU Ming

2018, 13(03): 205-208. DOI: 10.3969/j.issn.1673-5765.2018.03.002

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Relationship between Headache and Characteristics of Cerebral Small Vessel Disease Imaging in Young Stroke#br# Patients

ZHANG Ying-Shuang, LU Ming, CHEN Lu, SUN A-Ping, LIU Xiang-Yi, HUANG Xiao, WANG Ao-Nan, YANG Li-Peng, SHEN Shen, ZHAO Jia-Ling, FAN Dong-Sheng

2018, 13(03): 209-214. DOI: 10.3969/j.issn.1673-5765.2018.03.003

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Objective The study aimed to investigate the prevalence of cerebral small vessel disease (SVD), the prevalence of headache, and the relationship between SVD and headache in non-hereditary young stroke patients. Methods A retrospective analysis was made upon 200 patients who were hospitalized in department of neurology of Peking University Third Hospital due to first-ever ischemic stroke during January 2006 and January 2015. All patients were aged 18 to 45 years old, who underwent MR imaging (MRI) and MR angiography (MRA) within 7 days after stroke onset. Patients were divided into two groups: those with headache and those without headache. The prevalence of ischemic SVD in 2 groups, including asymptomatic lacunar infarcts (ALAs), white matter lesions (WMLs), and enlarged perivascular spaces (EPVS), were compared to study headache associated factors.

Results Of the 200 patients, male had higher prevalence (male vs female=6.41:1). Of all, 32.5% (65/200) had ALAs, 25.5% (51/200) had WMLs, and 30.5% (61/200) had EPVS. There were 11% (22/200) had headache during acute stroke onset. ALAs and EPVS were less frequently associated with headache (P =0.045 and P =0.021 respectively). The percentage of Non-large artery atherosclerosis type in Trial of Org 10 172 in Acute Stroke Treatment (Toast) was significantly higher in headache group than that in non-headache group [63.6% (14/22) vs 26.4%(47/178), P =0.001]. The lesions located under the tentorium (brain stem or cerebellum) were significantly higher in headache group than that in non-headache group [63.6% (14/22) vs 26.4% (47/178), P< 0.001]. Culprit vessels in the posterior circulation were significantly higher in headache group than that in non-headache group [68.2% (15/22) vs 37.6% (67/178), P =0.006]. Conclusion Our data suggest that the lesions in young patients with headache onset during acute stroke mainly located under the tentorium (brain stem or cerebellum) and culprit vessels mostly in the posterior circulation. Onset of headache is significantly lower in the SVD group. Headache is significantly higher in the non- large artery atherosclerosis type in TOAST.

Characteristics Analysis of Headache in Cerebral Venous Sinus Thrombosis

ZHAO Hai-Yan, ZHANG Hui, LU Ming

2018, 13(03): 215-219. DOI: 10.3969/j.issn.1673-5765.2018.03.004

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Objective To analyze the characteristics of headache in cerebral venous sinus thrombosis (CVST) through case report, so as to increase the understanding of CVST. Methods Cases of CVST who came to Peking University third hospital between January 2007 and December 2016 were collected. Retrospective review was made upon the characteristics of headache, clinical manifestations, clinical medical records, and neuroimaging studies. And the relevant literatures were reviewed for discussion. Results A total of 18 patients were enrolled into study. Transverse sinus was the most common site of thrombosis (77.8%, 14/18), followed by sigmoid sinus (61.1%, 11/18) and the superior sagittal sinus (50%, 9/18). There were 14 cases (77.8%) had involvement of multiple sinuses. Headache was the first symptom in all patients, including 7 cases (38.9%) with headache as the only symptom. There were 11 cases complicated with other symptoms, including epilepsy (38.9%, 7/18), vomiting (44.4%, 8/18), limb numbness (11.1%, 2/18), limb weakness (16.7%, 3/18), eye symptoms (22.2%, 4/18), and disturbance of consciousness (11.1%, 2/18). Headache was located in one side in 9 cases (50%), and 8 cases (88.9%, 8/9) had ipsilateral CVST. The mean of visual analogue scale/score (VAS) was 7 points (3-10 points). The onset of headache was acute in 5 cases (27.8%), subacute in 12 cases (66.7%), and chronic in 1 case (5.6%). Conclusion Headache was the most common symptom of CVST. Venous sinus thrombosis located in the same side of headache in CVST patients with unilateral headache. Young patients with subacute headache should be alert to the possibility of CVST.

Headache and Nontraumatic Convexity Subarachnoid Hemorrhage

ZHAO Hai-Yan, ZHANG-Hui, LU Ming

2018, 13(03): 220-225. DOI: 10.3969/j.issn.1673-5765.2018.03.005

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Objective To analyze the characteristics of headache and the possible cause of convexity subarachnoid hemorrhage (cSAH), so as to increase the understanding of cSAH. Methods A total of 14 cases of cSAH who came to Peking University third hospital between January 2010 and December 2014 were enrolled. Retrospective review was made upon the characteristics of headache, clinical manifestations, clinical medical records, and neuroimaging studies. Results Among 14 patients, acute headache (n =8, 57.1%) was the most common clinical manifestations, including 6 cases (75%) for unilateral. And 4 cases (50%) had a transient headache, usually lasting no longer than half an hour. There were 12 cases (85.7%) with clear etiology; there were 8 cases (57.1%) with severe stenosis or occlusion in ipsilateral internal carotid artery system of cSAH; and there were 4 cases: one with intracranial venous sinus thrombosis, one with cerebral arteriovenous malformation, one using anticoagulant and one with suspected cerebral amyloid vascular degeneration, respectively. Conclusion In the present study, acute headache was the most common clinical manifestation of cSAH. The patients with transient headache or with mild to moderate headache should be aware of the possibility of cSAH. Severe atherosclerotic stenosis or occlusion in the main branch of ipsilateral internal carotid artery system was an important cause of cSAH.

Clinical and Imaging Features of Ischemic Stroke in Middle Cerebral Artery Territory and Risk Factors for Recurrence

ZHANG Chang-Qing, WANG Yi-Long, WANG Chun-Xue, LIU Li-Ping, ZHAO Xing-Quan, WANG Yong-Jun

2018, 13(03): 226-231. DOI: 10.3969/j.issn.1673-5765.2018.03.006

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Objective To analyze the clinical and imaging features of noncardiogenic Ischemic Stroke (IS) in middle cerebral artery (MCA) territory, and risk factors of recurrent IS. Methods Noncardiogenic IS patients in MCA territory with onset of symptoms <7 days were enrolled consecutively. Demographic information, risk factors for vascular diseases, main admission symptoms and signs, topographical distribution of acute infarcts, number and topographical distribution of acute infarcts, and stenosis degree of responsible MCA were assessed. Multivariate logistic regression analysis was used to identify risk factors associated with recurrent IS or TIA within the year following IS. Results A total of 926 patients were enrolled into study. Patients (n =447) with ≥70% degree stenosis in MCA most often had multiple acute infarcts (n =338, 75.6%) and watershed infarcts (n =317, 70.9%), while patients (n =479) without obvious stenosis or with <70% degree stenosis in MCA most often had single infarct (n =247, 55.3%) in the territory of MCA penetrating artery. Multivariate Logistic regression analysis identified history of coronary heart disease [odds ratio (OR) 7.55, 95% confidence interval (CI) 2.85-20.0, P <0.001], history of IS (OR 3.49, 95%CI 1.52-8.01, P =0.003), repeated TIAs within 3 months before the stroke (OR 22.7, 95%CI 8.35-61.6, P <0.001), and newly onset multiple acute infarcts (OR 5.26, 95%CI 1.33-20.8, P =0.018) as independent predictors of recurrent IS or TIA. Conclusion For patients with noncardiogenic IS, topographical distribution of acute infarcts is related with stenosis degree in MCA, and patients with multiple acute infarcts and history of ischemic cardiovascular or cerebrovascular disease had a higher recurrence risk of IS or TIA within 1 year.

Cervical Artery Dissection: Imaging Feature and Prognostic Analysis

FANG Ya-Lan, CHANG Jun-Sen, NIU Xiao-Yuan

2018, 13(03): 232-236. DOI: 10.3969/j.issn.1673-5765.2018.03.007

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Objective To explore the imaging feature of cervical artery dissection (CAD), and analyze the influential factors of prognostic assessed by ultrasound follow-up. Methods From June 2013 to October 2015, inpatients with acute stroke or transient ischemic attack (TIA) following vascular occlusion or stenosis due to CAD admitted to department of neurology, first hospital of Shanxi medical university were consecutively enrolled. All the patients were evaluated by neurovascular ultrasound at 3rd and 6th month respectively after discharge. At 6th month, neurological deficits were assessed using the modified Rankin Scale (mRS). Results Among 42 patients with CAD, 35 cases (83%) were internal carotid artery dissection and the rest of 7 cases (17%) were vertebral artery dissection. 27 cervical artery occlusion cases (64%) were diagnosed by ultrasound, which were all finally confirmed by computed tomography angiography (CTA) or digital subtraction angiography (DSA). The most typical sign of vascular imaging for the cervical artery occlusion was the "dual-chamber sign" (26,63%), followed by "flame sign" (7,17%). There was no significant difference in the proportion of vascular recanalization between good prognosis group and poor prognosis group. The proportion of limb weakness (92.3% vs 45.8%), basal ganglia involvement (69.2% vs 25%) and vertebral artery dissection (100% vs 70.8%) in poor prognosis group were all higher than that in good prognosis group, and the difference was statistically significant.

Conclusion The prognosis of cerebral artery dissection is related to limb dysfunction, the position of cerebral infarction, and the type of dissection, but not the recanalization rate.

Correlation between Serum Uric Acid and Vascular Mild Cognitive Impairment in Patients with Cerebral Small Vessel Disease

LI Yan-Fang, GAO Ming, ZHANG Zhi-Chao, LI Xue-Mei

2018, 13(03): 237-241. DOI: 10.3969/j.issn.1673-5765.2018.03.008

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Objective To investigate the correlation between serum uric acid (UA) and vascular mild cognitive impairment (VaMCI) in patients with cerebral small vessel disease (CSVD). Methods Between October 2015 and June 2017, 87 patients with CSVD and 44 healthy individuals were enrolled from department of neurology of the affiliated hospital of weifang medical university. According to the Montreal cognitive assessment (MoCA) scale, the patients with CSVD were divided into the VaMCI group (n =47) and normal cognition group (n =40). The association between serum UA and VaMCI in patients with CSVD was analyzed by Logistic regression analysis and Pearson correlation analysis. Results Compared with the control group [(269.66±40.21) μmol/L], serum UA levels in the normal cognition and VaMCI groups [(315.15±56.76) μmol/L, (363.32±42.58) μmol/L] were increased (all P <0.001). Serum UA level was higher in the VaMCI group than that in the normal cognition group (P <0.001). Serum UA level was negatively correlated with MoCA total score, subscores on visuospatial ability and executive function, recall, and language ability (r =-0.351, P =0.015; r =-0.456, P =0.001; r =-0.408, P =0.004, r =-0.329, P =0.024). Logistic regression analysis showed that serum UA level [odds ratio (OR) 1.020, 95% confidence interval (CI) 1.009-1.032, P =0.01) was independent risk factor of vascular mild cognitive impairment in patients with CSVD . Conclusion Serum UA level was significantly increased in the VaMCI group, and UA level might be a risk factor of VaMCI in patients with CSVD. Serum UA level was negatively correlated with MoCA total score, subscores on visuospatial ability and executive function, recall, and language ability.

Correlation of Intra-and Extracranial Arteriostenosis and Hypertension and Diabetes in Patients with Ischemic Stroke

PANG Jin-Jing, SONG Li-Yan, XU Li-Hong, SUN Xiao-Yan, MA Bin-Bin

2018, 13(03): 242-246. DOI: 10.3969/j.issn.1673-5765.2018.03.009

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Objective To investigate the characteristics of intra-and extracranial arteriostenosis in patients with ischemic stroke (IS) and its relationship with course and control levels of hypertension and diabetes. Methods The data of hospitalized patients with atherosclerotic acute ischemic stroke (AIS) who had intracranial and extracranial artery stenosis and concomitant hypertension or diabetes were retrospectively analyzed. Hypertension patients were divided into long-course group (>5 years) and short-course group (≤5 years), blood pressure well controlled and badly controlled groups. Diabetic patients were also divided into long-course group (>5 years) and short-course group (≤5 years), blood glucose well controlled group and badly controlled group. The distribution situation of intracranial and extracranial arteriostenosis and hemadostenosis degree were compared in different groups. Results A total of 216 patients with IS were enrolled into study, including 57 extracranial arteriostenosis patients, 105 intracranial arteriostenosis patients, and 54 intracranial and extracranial arteriostenosis patients. Among which, there were 73 mild arteriostenosis patients, 101 moderate arteriostenosis patients, 42 severe arteriostenosis and occlusion patients. There were 140 hypertensive patients in total. The commonest arterostenosis in long-course group was in intracranial artery (54.5%) and short-course group was in extracranial artery (51.3%), which had statistical significance in difference (P <0.001). Besides, the difference in the degree of arterial stenosis between two groups also had statistical significance. There were 76 diabetic patients in total. The commonest arterostenosis in long-course group was in intracranial artery (72.2%) and short-course group was in extracranial artery (65%), which had statistical significance in difference. The difference in the degree of arterial stenosis between two groups also had statistical significance. The probability of severe stenosis or occlusion in badly controlled hypertension group was higher than that of well controlled group (20.7% vs 8.6%). The probability of severe stenosis or occlusion in blood glucose badly controlled group was higher than that of well controlled group (40.9% vs 6.3%). Conclusion With the course of hypertension lengthening, the incidence of intracranial artery stenosis in IS patients was increasing, and moderate stenosis was the commonest. The proportion of severe stenosis or occlusion in blood pressure badly controlled patients was high. With the course progression of diabetes, the incidence of intracranial artery stenosis was increasing, and moderate stenosis was the commonest. Similarly, the proportion of severe stenosis or occlusion in blood glucose badly controlled group was high.

Analysis of Clinical Curative Effect of Dl-3-n-butyphthalide Injection in Treatment of Acute Cerebral Infarction and Quantitative Electroencephalogram

CHEN Xiao-Min, ZHOU Xiao-Li, DING Yan-Bing

2018, 13(03): 247-250. DOI: 10.3969/j.issn.1673-5765.2018.03.010

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Objective To observe the clinical curative effect of dl-3-n-butyphthalide injection in treatment of patients with acute cerebral infarction and the monitoring significance of quantitative electroencephalogram (EEG). Methods A total of 80 patients with acute cerebral infarction were randomly divided into treatment group and control group. The treatment group were given dl-3-n-butyphthalide injection on the basis of conventional treatment. The National Institute of Health Stroke Scale (NIHSS) score, Barthel index score and quantitative electroencephalogram (QEEG), Deltaratio, Symmetry theta/ alpha+beta rate (DTABR) were compared in two groups before and after treatment respectively. Results After 14 days of treatment, the change of the NIHSS score [(3.58±2.72) vs (6.33±2.63)], the Barthel index score [(68.20±26.83) vs (66.12±24.45)], and DTABR [(2.83±1.20) vs (4.10±1.72)] in treatment group were superior to control group, the difference of which had statistical significance. Conclusion The clinical curative effect dl-3-n-butyphthalide injection treatment in patients with acute cerebral infarction is distinct and the monitoring of QEEG in patients with acute cerebral infarction is of great value.

Prevalence and Extent of Right-to-left Shunt in Chinese Patients with Migraine in a National Multicenter Study

WANG Si-Bo, LIU Kang-Ding, YANG Yi, LI Ya-Jie, HU Ming-Yi, LIN Pan, GUO Rong, TIAN Qian, YOU Yong, CUI Ying-Hua, ZHANG Guan-Ling, DONG Zhao, GAO Yong-Sheng, XING Ying-Qi

2018, 13(03): 251-256. DOI: 10.3969/j.issn.1673-5765.2018.03.011

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Background The association between Right-to-left shunt (RLS) and migraine was still controversial. The aim of this study was to investigate the prevalence, grade and volume of RLS in Chinese patients with migraine and to evaluate the relationship between RLS and migraine. Methods It was a multi-center case-control study with North America Clinical Study Registration No. NCT02425696, and underwent jointly by 9 sunb-centers in China. The patients, aged between 18 years old to 65 years old, who received consultation services in sub-centers and were diagnosed as migraine according to The International Classification of Headache Disorders 3rd Edition Beta Version (ICHD-3 β) during June 2015 to August 2016, were consecutively enrolled into migraine group. There were 931 patients in migraine group, among which, there were 695 cases of female. There were 240 cases of migraine with aura and 691 cases of migraine without aura. There were 282 healthy adults in control group. Results The prevalence of RLS were 63.7% and 39.9% in the migraine with aura group (MA+) and migraine without aura group (MA-), respectively, which were significantly higher than that of healthy group (29.4%, P <0.001; P <0.001). The positive rate of large RLS in the MA+ group and MA- group were 32.1% and 16.5%, respectively, which were significantly higher than healthy group (6.4%, P <0.001; P <0.001). There was no difference among groups in terms of mid-size volume ratio and small size volume ratio of RLS. Conclusion That the positive rate of RLS in migraine patients with and without aura is higher than that of normal control group, which mainly have large RLS. There are no difference in mid-size volume, small size volume and types of RLS between migraine group and the control group. There is an association between RLS and migraine, especially when the shunt is large.

Migraine and Youth Stroke

JIANG Xiao-Han, LIU Li, XING Ying-Qi

2018, 13(03): 258-262. DOI: 10.3969/j.issn.1673-5765.2018.03.012

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Migrainous Infarction

WANG Wei-Wei, HU Hong-Tao

2018, 13(03): 263-266. DOI: 10.3969/j.issn.1673-5765.2018.03.013

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Cerebral Vascular Disease Related Headache

DU Wan-Liang, WANG Yong-Jun

2018, 13(03): 267-271. DOI: 10.3969/j.issn.1673-5765.2018.03.014

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Headache diagnosis should be based on the International Classification of Headache Disorders (ICHD). In the latest version of ICHD, cerebral vascular disease-related headaches belong to "6. headache attributed to cranial or cervical vascular disorder", including definite diagnostic criteria and clear classification entries. Thunderclap headache may be caused by cerebral vascular disease, intracranial non-vascular disease, infectious diseases or systemic diseases. To find and diagnose the primary disease is the fundamental of correct diagnosis. Headache at stroke onset is associated with stroke types. Headache history is associated with increased risk of stroke.

AJNR: Transient Perivascular Inflammation Syndrome of the carotid Artery

YANG Zhong-Hua

2018, 13(03): 272-273. DOI: 10.3969/j.issn.1673-5765.2018.03.015

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Short Story about Stroke: Despire and Hope of Translational Study on Stroke

John H.Zhang

2018, 13(03): 274-275. DOI: 10.3969/j.issn.1673-5765.2018.03.016

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