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Table of Content

    20 July 2011, Volume 6 Issue 07
    主编手记
    Open the Window of Your Heart
    WANG Yong-Jun
    2011, 6(07):  503-504. 
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    会议报道
    Summary of Tiantan International Stroke Conference 2011
    LENG Xin-Yi;QIN Hai-Qiang;BIAN Li-Heng;et al
    2011, 6(07):  505-508. 
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    述评
    Vascular Neuro-Ophthalmology
    ZHANG Xiao-Jun;TIAN Guo-Hong
    2011, 6(07):  509-513. 
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    论著
    Clinical Features of Brainstem Infarction Dominantly Presented as Ophthalmoplegia
    MENG Chao;JIANG Han-Qiu;TIAN Guo-Hong;et al
    2011, 6(07):  514-518. 
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    Objective To describe the clinical features, magnetic resonance imaging(MRI) findings,pathogenesis and risk factors of stroke progression of brainstem infarction dominantly manifestedas ophthalmoplegia.Methods Thirty-two patients presenting with ophthalmoplegia with or without minimalaccompanied neurological sings were studied. To analysis the types of ophthamopoegia,accompanied neurological symptoms, responsible blood vessel and focus, pathogenesis and risks ofstroke progression.Results In 32 cases included, four types of ophthalmolegia were classified:sub-nuclear(2 cases),nuclear(21 cases), inte-rnuclear(4 cases) and mixed ophthalmoplegia(5 cases). Vertigo was the mostcommon accompanied symptom. Nine patients had multiple lesions. Vascular occlusion or stenoseswere found in 11 patients:8 at the posterior cerebral circulation, 3 at the anterior cerebral circulation.Vascular risk factors were more common in progressive stroke group than non-progressive groups.Multiple infarction lesion and accompanied neurological signs were statistically correlated withstroke progression.Conclusion Clinical features of ophthalmoplegia caused by brainstem infarction varies, in whichnuclear oculomotor nerve ophthalmoplegia was the most common type. The responsible arteryincluded both large and small blood cerebral vessels, patients with Essen Stroke Risk Score(ESRS)>3 score, multiple infarction lesions and accompanied positive neurological signs showedhigher possibilities of progression, suggesting a more aggressive prevention.
    Comparison of Risk Factors in Patients with Retinal and Hemisphere Ischemic Event
    WANG QIAN;JIA Nan;LU Ning;et al
    2011, 6(07):  519-523. 
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    Objective To compare the differences of risk factor between acute retinal ischemic event(ARIE)and acute hemisphere ischemic event(AHIE).Methods Single center, cross-section descriptive study. Consecutive cases of acute ischemicretinopathy patients(ARIE) and acute ischemic cerebrovascular disease patients(AHIE) werecollected prospectively from January 2008 to January 2009. Clinical data were recorded and databetween ARIE and AHIE were compared and statistically analyzed by SPSS11.5 software.Results Totally 124 ARIE cases and 126 AHIE patients were included. ARIE patients(53±16yearsold) were statistically younger than AHIE patients(67±12 years old)(P <0.01). No statisticallysignificant difference regard to gender, smoking, alcohol, hyperlipidemia, ischemic heart diseasewas found between ARIE and AHIE(P >0.05). Hypertension(P <0.01), diabetes mellitus(P =0.016),valvular heart diseases(P =0.048), stroke(P =0.001) and atrial fibrillation(P =0.007) were statisticallymore common in AHIE patients than in ARIE patients, while severe carotid artery stenosis/occlusion was statistically more common in ARIE than in AHIE[ARIE versus AHIE:odds ratio(OR),2.3; 95% confidence interval(CI), 1.110 to 4.682, P =0.025].Conclusion History of Hypertension, diabetes mellitus, valvular heart diseases, cerebral strokeand atrial fibrillation were more common in AHIE while carotid artery stenosis/occlusion wasstatistically more common in ARIE.
    Visual Function Disturbance as Initial Manifestation of Stroke-Report of Fifty Cases
    TIAN Guo-Hong;JIANG Han-Qiu;WANG Qian;et al
    2011, 6(07):  524-528. 
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    Objective To evaluate the clinical features among stroke patients whose initial symptom werevisual loss or/and visual fields defect.Methods a retrospective study was used to analysis patients with initial visual disturbancediagnosed as stroke in department of neurology, Beijing Tongren Hospital from Jan. 2008 to Dec.2009.Results Fifteen patients were included in this study. There were 11 males and 4 females. Themean age is 55±14years. The initial manifestation included bilateral visual loss sequently, suddenmonocular visual loss, simultaneous bilateral visual loss, homonymous hemianopia defects. Thediagnosis included moyamoya disease(n=2), occlusion of the internal carotid artery(n=1), cerebralvascular malformation(n=1) anterior vascular stroke(n=1) and posterior vascular stroke(n=10).Among the posterior vascular stroke patients, seven cases were unilateral or bilateral occipitaland temporal lobes infarction, one top of the basilar artery syndrome, two cases were brain steminfarction.Conclusion The monocular visual disturbance is a topical sign of carotid artery ischemic. Thesudden bilateral visual loss was always attribute to vertebrobasilar system embolism. Some visualaura might be the early stage of devastating progressed posterior cerebral vascular disease.【Key Words】 Cerebral vascular disease; Visual disorders; Visual fields; Hemianopsia
    Clinical Analysis of Related Ophthalmologic Signs Caused by Carotid Cavernous Fistula
    QU Yuan-Zhen;YANG Liu;FANG Min;et al
    2011, 6(07):  529-532. 
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    Objective To analyse the ocular changes of carotid cavernous fistula (CCF) and to avoidmisdiagnosis.Methods The clinical data of 39 patients with CCF treated at department of interventionalneuroradiology of Beijing Tiantan Hospital were analyzed retrospectively.Results Pulsating exophthalmos and intracalvarium strepitus occurred in 21 cases (53.85%),respectively. Twenty cases (51.28%) had suffered from conjunctival congestion and fundus changes,respectively. Nineteen patients (48.72%) had decline of visual acuity.Conclusion Many ocular changes may occur in CCF, and the most common change is pulsatingexophthalmos and intracalvarium strepitus.
    ABCD2 Score Predicts Severity of Early Recurrent Events After Transient Ischemic Attack
    LI Ling;ZHANG Jin-Li;SONG Yang
    2011, 6(07):  533-538. 
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    Objective To assess the predictive accuracy of the ABCD2 score for the severity of early recurrentevents after transient ischemic attack (TIA).Methods We completed a prospective, hospital-based study of 488 consecutive patients presentingwith TIA. Recurrent TIA, minor stroke, and major stroke (National Institutes of Health Stroke Scalescore>3) were identified within 7 days after TIA. Predictive value was expressed as the area underthe receiver operating characteristic curve (AUC).Results Of 488 patients with TIA were involved in study, 49 had a recurrent TIA (10.04%; 95%CI ,6.78% to16.12%), 23 had a recurrent minor stroke (4.71%; 95%CI , 1.96% to 6.37%) and 25 hada recurrent major stroke (5.12%; 95%CI , 2.68% to 8.08%) within 7 days. The ABCD2 score washighly predictive of major recurrent stroke (AUC=0.76; 95%CI ,0.67 to 0.85, P <0.01), weaklypredictive of minor stroke (AUC=0.57; 95%CI , 0.42 to 0.70, P =0.18), and inversely related to riskof recurrent TIA (AUC=0.34; 95% CI , 0.22 to 0.59, P <0.01) (overall heterogeneity, P <0.001).Conclusion The ABCD2 score predicts severity of recurrent events after TIA, high scores beingassociated with major recurrent stroke and low scores with high rates of recurrent TIA.
    Characteristic Anylisis of Cognitive Impairment of Mild Cognitive Impairment Patients with
    JIN Xiang-Lan;ZHENG SHuo;ZHANG Yun-Ling;et al
    2011, 6(07):  539-542. 
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    Objective To explore mild cognitive impairment with impairment characteristics ofleukoaraiosis(LACI), and to provide the reference for clinical diagnosis and treatment.Methods Seventy-seven patients with LACI and 74 leukoaraiosis(LA) patients without cognitiveimpairment(control group) were tested by Montreal cognitive assessment(MoCA) scale and otherpsychological scales.Results The total score of MoCA(20.84± 3.04) in LACI group was lower than that in the controlgroup(27.38 + 1.25)(P < 0.01).There was significant difference between the two groups in the spaceand execution, depending on-named ability, attention, language ability, abstract ability, delayedmemory ability and directional power of seven cognitive domains(P <0.01). The correlation analysisbetween the total score of the MoCA scores and secondary types showed that except for the namingand language ability, there was a positive correlation between the other five secondary types and thetotal scores, according to high-and-low ranking in the correlation coefficient, which in turn dependson the space and executive function for delay, memory, attention, abstract ability, directional power.Conclusion LACI patients have different damage levels on visual space, execution, named ability,attention, language ability, abstract ability, delayed memory ability, directional power and some othercognitive domains, and visual space and executive function, delayed memory, attention, abstract,directional power ability may be obvious cognitive domains in the earlier damage, the three key linkin the process of memory such as encoding, storage, extraction have existed in the damage.
    Influence of Atorvastatin on Serum Matrix Metalloproteinase-9 in Patients with Acute Cerebral Infarction in Anterior Circulation
    CHEN Xin-Ping;YU Feng-Chun;LIU Wei;et al
    2011, 6(07):  543-546. 
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    Objective To observe the influence of atorvastatin on serum matrix metalloproteinases-9(MMP-9)in patients with acute cerebral infarction.Methods One hundred and twenty-eight patients with acute cerebral infarction in anteriorcirculation were divided into three subgroups according to the characteristic of carotid arteriesatherosclerotic(AS) plaques, which were assessed by color doppler ultrasonography:stable plaquegroup(51 cases), vulnerable plaque group(46 cases) and no plaque group(31 cases). All patientsreceived oral atorvastatin of 20 mg daily for 2 weeks. The levels of serum MMP-9 before and aftertreatment in patients were measured respectively. Statistic analysis was performed with SPSS11.5.Results ①The level of serum MMP-9 in vulnerable plaque group was (419.93±113.12)μg/L and in stable plaque group was (271.45±80.34)μg/L before the treatment, it was significantlyhigher than (147.36±23.62)μg/L in no plaque group, and the level in vulnerable plaque groupwas also significantly higher than in stable plaque group(P <0.01, respectively). ②At the end ofthe two weeks after treatment with atorvastatin, the level of serum MMP-9 in three groups were(242.58±101.63)μg/L, (191.36±79.28) μg/L and (126.72±22.86)μg/L, it was significantly lowerthan the level in the same group before treatment (P <0.01, respectively).Conclusion The level of the serum MMP-9 in patients with acute cerebral infarction in anteriorcirculation is associated with the occurrence and stability of the carotid atherosclerosis plaques;Atorvastatin has effects on a marked reduction in MMP-9 level in patients with acute cerebralinfarction in anterior circulation.
    Analysis of Causes of 67 Elderly Syncope Cases
    WANG Ji-Yun;WANG Shu-Min;ZHANG Jie
    2011, 6(07):  547-551. 
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    Objective To summarize common etiology and characteristics of syncope among elderly patientswith the aim of correcting diagnosis and management of elderly syncope, and improving theirsurvival and quality of life in the future.Methods Sixty-seven inpatient and outpatient elderly patients, aged≥60 years old from Jan. 2007to Dec. 2010 were envolled. Detailed medical history and completed physical examinatin wereobtained, corresponding syncope appraisal process were performed, adding specific exams whennecessary to analyse the causes of elderly syncope patients.Results Mean age is 74±8 years old. Forty-four cases are male(65.67%), twenty-three cases arefemale(34.32%). Twenty cases out of 67 were diagnosed with neurally-mediated syncope(29.95%),among which 11 cases are vasovagal syncope, 5 cases are due to cough and micturition, and 4 casesare caused by carotic sinus syndrome. Arrhythmias induced 22 cases of syncope(32.83%), of whichpersistent ventricular tachycardia is accounted for 2 cases, high grade and complete heart blockare the cause for 10 cases, 4 syncope cases are due to sick sinus syndrome, fast-slow syndromewith atrial fibrillation are the cause for 3 cases, fast atrial fibrillation induced syncope are 3 cases.Syncope related to coronary ischemia are 5 cases(7.24%). Pulmonary embolism related syncopeare 10 cases(14.92%), 3 of which is relevant to post surgery and malignant tumor. Orthostatichypotension are 10 cases(14.92%), 6 of which is induced by medication.Conclusion Although the most common etiology of elderly syncope is neurally-mediated. Elderlysyncope attributed to arrhythmias, pulmonary embolism, and orthostatic hypotension is not rare.Syncope caused by severe acute coronary heart disease is very likely in elderly patents with multiplecardiovascular diseases risk factors.
    专题论坛
    Oculomotor Nerve Palsy and Unruptured Intracranial Aneurysm
    JIANG Han-Qiu
    2011, 6(07):  553-557. 
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    Etiology of Cortical Blindness
    TIAN Guo-Hong;ZHANG Xiao-Jun
    2011, 6(07):  558-563. 
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    病例讨论
    Comprehension to a Complex Case of Takayasu Arteritis Diagnosed with Three Dimensional Contrast Enhanced Magnetic Resonance Angioryaphy
    CHEN Wen-Huo;CHEN Yue-Hong;WU Zong-Zhong;et al
    2011, 6(07):  564-567. 
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    指南与规范
    National Stroke Association Recommendations for Systems of Care for Transient Ischemic Attack
    CHEN Yu;DU Wan-Liang
    2011, 6(07):  568-572. 
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    综述
    Importance of Oxidative Stress in Diabetes Increasing the Risk of Ischemic Stroke
    ZHAO Min
    2011, 6(07):  573-577. 
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    The risk of stroke in patients with diabetes is higher than non-diabetic patients, and patients withdiabetes are easily suffered from stroke earlier and severer. Diabetes mellitus patients are oftenat a higher level of oxidative stress. Oxidative stress is a key mediating link in the mechanismof diabetes increasing the risk of stroke and worsening the prognosis of stroke. Antioxidants caneffectively reduce the risk of vascular events in patients with diabetes.
    Related Hot Issues in Guidelines for Stroke Prevention from American
    LU Zu-Neng.
    2011, 6(07):  578-585. 
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    Ten risk factors are associated with 90% of the risk of stroke. Healthy lifestyle must be thecornerstone of all physician recommendations for stroke prevention. Recent clinical trials havedemonstrated that there are numerous opportunities to improve stroke prevention strategies. Forpatients with diabetes mellitus and for those with previous strokes or transient ischemic attacks, ithas become evident that aggressive low-density lipoprotein lowering with statins will decrease therisk for total and fatal strokes. Optimal anticoagulation and antiplatelet therapy for primary andsecondary stroke prevention in atrial fibrillation is being carefully defined; Dabigatran has beenapproved by Food and Drug Administration(FDA) for secondary prevention in selected patients,and the guideline has been updated. The study findings offer conflicting views on future role ofcarotid angioplasty and stenting(CAS), and CAS is more risky than carotid endarterectomy(CEA);completion of long-term follow-up is needed to establish the efficacy of CAS compared withCEA; CEA should remain the treatment of the first choice for patients suitable for surgery. As tohypertension and stroke prevention, the results of recent studies might set the foundation for a majorchange in the clinical practice.
    教学园地
    Improving the Resident’s Clinic Thinking in Neurophthalmologic Disease with Problem-Basedn Learning Method
    LU Wen;TANG Yang;YANG Liu;et al
    2011, 6(07):  586-589. 
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