Table of Content

20 August 2019, Volume 14 Issue 08

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Theory Glows from Pracitce

WANG Yong-Jun

2019, 14(08):  743-744.  DOI: 10.3969/j.issn.1673-5765.2019.08.001

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Improve the Accuracy of Patients Death Outcome in Stroke Cohort Study by Database Matching

LYU Wei,JIANG Yong, MENG Xia, HUANG Xin-Ying, ZHOU Mai-Geng

2019, 14(08):  745-749.  DOI: 10.3969/j.issn.1673-5765.2019.08.002

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Objective To explore the data matching profile between stroke cohort in large multicenter study and the administrative data, and to provide new ideas and methods for data quality control in similar clinical studies. Methods The data of 12 112 inpatients with ischemic stroke who completed the 90-day followup from multicenter clinical trial from 2015 to 2017 were selected. The selected data were matched with all the deaths in the China National Disease Surveillance Points System from 2015 to 2017. The differences in regional and hospital distribution and patients characteristics were compared and analyzed between the group of unmatched patients with no death information in stroke cohort study while who had died as shown in China National Disease Surveillance Points System and the group of matched patients with the same death information in the two data. Results There were no statistically significant differences in regional and hospital distribution and patients characteristics between the two groups. However, according to the data trend, the unmatched rate of death information in the patients with NIHSS ≤3 on admission was higher than that in the patients with NIHSS >3 on admission (11.36% vs 6.56%), and the unmatched rate of death information in the patients living alone was higher than that in the patients living with family (13.16%vs 7.65%). Conclusions It is more difficult to obtain accurate death outcome information in patients with relatively mild neurologic impairment and patients living alone after discharge. The database matching method can make up for the lack of follow-up information in large multicenter cohort studies, which can provide accurate death outcome information of patients for stroke cohort studies.

Characteristics of Symptomatic Intra- and Extracranial Atherosclerotic Plaques in Anterior Circulation Based on Multi-contrast Magnetic Resonance Vascular Wall Imaging

XU Yi-Lan, LI Rui, CUI Yuan-Yuan,ZHENG Zhuo-Zhao, ZHAO Xi-Hai

2019, 14(08):  750-755.  DOI: 10.3969/j.issn.1673-5765.2019.08.003

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Objective To compare the characteristics of intra- and extracranial plaques using 3D multi-contrast magnetic resonance vessel wall imaging in patients with symptomatic intra- and extracranial atherosclerotic diseases. Methods The data of patients with symptomatic intra-and extracranial carotid artery culprit plaques identified by MR vessel wall imaging were retrospectively analyzed. The distribution, burden and components of plaques were analyzed. The plaque burden including the maximum wall thickness (Max WT), plaque length and vessel stenosis were measured. Plaque components such as lipid-rich necrotic core (LRNC), intraplaque hemorrhage (IPH) and calcification on MRI were evaluated. The imaging characteristics of plaques between intracranial and extracranial arteries were compared. Results In total, 45 patients were recruited and 203 atherosclerotic plaques were detected, including 156 extracranial plaques (76.8%) and 47 intracranial plaques (23.2%). Max WT [(3.2±1.0) mm vs (1.9±0.4) mm, P <0.001] and plaque length [10.7 (7.5-13.7) mm vs 4.3 (2.6-6.3) mm, P <0.001] of extracranial plaques were significantly larger than that of intracranial plaques. Stenosis degree [28.0 (20.0-38.5)% vs 18.8 (10.8-30.5)%, P <0.001] of intracranial plaques were significantly larger than that of extracranial plaques. Compared with intracranial plaques, extracranial plaques showed more higher rate of LRNC (66.0% vs 21.3%, P <0.001) and lower rate of IPH (13.5% vs 27.7%, P =0.027). Conclusions For patients with atherosclerotic culprit plaques and symptomatic intracranial and extracranial artery diseases, extracranial plaques commonly have greater Max WT, higher rate of LRNC, less severe stenosis and lower rate of IPH than intracranial plaques.

Comparison of Anxiety and Depression between Patients with Benign Paroxysmal Positional Vertigo and Vestibular Migraine

SHEN Yuan, ZHU Cui-Ting, LI Yi-Qing, JU Yi

2019, 14(08):  756-759.  DOI: 10.3969/j.issn.1673-5765.2019.08.004

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Objective To compare the incidence and charateristics of anxiety and depression between the patients with benign paroxysmal positional vertigo (BPPV) and vestibular migraine (VM). Methods 100 outpatients diagnosed with BPPV (n =50) and VM (n =50) at Beijing Tian Tan Hospital from September 2016 to December 2017 were included in the analysis. Dizziness handicap inventory (DHI) and hospital anxiety and depression scale (HADS) were used to evaluate the emotional state of the two groups. Results In BPPV group: the incidence of significant dizziness handicap, depression and anxiety were 64% (32/50) and 30% (15/50) before treatment respectively, and reduced to 6% (3/50) and 4% (2/50) after treatment respectively, and the differences before and after treatment had statistical significance (P <0.001 and P =0.001, respectively). In VM group: the incidence of significant dizziness handicap, depression and anxiety were 76% (38/50) and 56% (28/50) before treatment respectively, and reduced to 24% (12/50) and 16% (8/50) respectively, and the differences before and after treatment had statistical significance (P <0.001 and P <0.001, respectively). Before treatment, the DHI [55.00 (44.00-70.00) vs 31.00 (20.00-45.00), P <0.001] and HADS scores [13.50 (6.00-20.00) vs 6.00 (3.75-10.00), P =0.001] were both higher in VM group than that in BPPV group and what’s more, the scores in functional, emotional and physical items were all significantly higher in VM group than that in BPPV group. After treatment, the scores of DHI [22.00 (12.00-34.00) vs 0 (0-4.00), P <0.001] and HADS scores [7.50 (2.00-10.50) vs 0 (0-3.00), P <0.001] in VM group were still higher than that in BPPV group, and similarly, the scores in functional, emotional and physical items were all higher in VM group than that in BPPV group, and the above differences all had statistical significance. Conclusions The incidence and severity of anxiety and depression were both higher in VM patients than that in BPPV patients, and the incidence greatly declined in VM and BPPV patients after treatment.

Relationship of Post-stroke Depression and Anxiety with Cognitive Impairment

2019, 14(08):  760-764.  DOI: 10.3969/j.issn.1673-5765.2019.08.005

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Objective To explore the relationship of post-stroke depression and anxiety with cognitive impairment. Methods 98 patients with first ischemic stroke who were admitted to the First Hospital of Handan from January 2017 to March 2018 were selected. 50 inpatients with non-stroke in the same period were chosen as control group.The patients of the two groups were assessed using the following scales within 2 days after hospitalization, including Hamilton anxiety scale (HAMA), Hamilton depression scale (HAMD), activity of daily living scale (ADL), Montreal cognitive assessment (MOCA) and NIHSS. The cognitive impairment, anxiety and depression in both groups were analyzed. The correlation analysis of ADL, MoCA, NIHSS and HAMA, HAMD scores were performed. Results 62 (63.3%) patients in stroke group were diagnosed with cognitive dysfunction, 53 (54.1%) patients with anxiety, and 42 (42.9%) patients with depression; while in control group, 14 (28%) cases with cognitive dysfunction, 17 (34.0%) ones with anxiety, and 9 (18.0%) ones with depression. The MoCA and ADL scores in stroke group were both lower than that in control group, and the differences were statistically significant. The correlation analysis of HAMA and ADL, MoCA, NIHSS score showed that the correlation coefficients r =-0.526 (P <0.001), r =- 0.592 (P <0.001) and r =0.412 (P <0.001), respectively; the correlation coefficients of HAMD score and ADL, MoCA, NIHSS were r =-0.490 (P <0.001), r =-0.571 (P <0.001) and r =0.606 (P <0.001), respectively. The correlation coefficients of ADL, MoCA and NIHSS were r =0.933 (P <0.001) and r =-0.842 (P <0.001). The correlation coefficient of MoCA and NIHSS was r =-0.911 (P <0.001). Conclusions The incidence of anxiety and depression after ischemic stroke were higher, and they were both correlated with cognitive impairment. The more severe post-stroke anxiety and depression, the more serious the neurological deficit and the worse the activity of daily living.

Correlation between Total Cholesterol / High Density Lipoprotein Cholesterol Ratio and Recurrent Stroke in Patients with Acute Ischemic Stroke

WANG Lin-Yu, HAN Kun-Qiang, GUAN Sheng, LI Zhen-Dong

2019, 14(08):  765-769.  DOI: 10.3969/j.issn.1673-5765.2019.08.006

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Objective To investigate the correlation between TC/HDL-C ratio and recurrent stroke within 90 days after onset in patients with acute ischemic stroke (AIS). Methods The data of 3605 patients from the Study on Oxidative Stress in Patients with Acute Ischemic Stroke (SOS-Stroke) were selected. Multivariate logistic regression analysis was used to analyze the influence factors for recurrent stroke within 90 days after onset in patients with AIS. Results Recurrent stroke within 90 days occurred in 231 patients (6.40%). Logistic regression analysis showed that age (OR 1.02, 95%CI 1.00-1.03, P =0.011), history of diabetes (OR 1.44, 95%CI 1.00-2.07, P =0.048) were the risk factors of recurrent stroke, and taking lipid-lowering drugs during hospitalization (OR 0.60, 95%CI 0.40-0.90, P =0.012) was the protection factor of recurrent stroke. Conclusions TC/HDL-C ratio can’t predict the risk of recurrent stroke within 90 days after onset in AIS patients.

Diagnostic Value of Transcranial Contrast-enhanced Ultrasound and Digital Subtraction Angiography for Middle Cerebral Artery Stenosis

ZHANG Hui-Qin, WANG Li-Shu, TIAN Feng-Lan, WANG Kun, XU Dong-Juan, HE Wen

2019, 14(08):  770-774.  DOI: 10.3969/j.issn.1673-5765.2019.08.007

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Objective To investigate the diagnostic value of transcranial contrast-enhanced ultrasound (t-CEUS) and digital subtraction angiography (DSA) for middle cerebral artery (MCA) stenosis or occlusion. Methods A total of 197 patients with suspected MCA stenosis or occlusion from December 2017 to April 2019 were enrolled. A total of 225 stenostic or occluded MCAs were diagnosed by t-CEUS and DSA, according to the degree of MCA stenosis, the MCAs were divided into four groups: mild (30%-50%), moderate (50%-69%), severe (70%-99%) and occlusion (100%). Taking DSA diagnosis as the golden standard, the specificity, sensitivity, and accuracy of t-CEUS diagnosis were analyzed by comparing the results of ultrasound imaging. Results Of all the 197 patients, 132 male and 65 female, with the average age (58.4+4.6) years and the range 43 to 72 years. Of 225 MCAs diagnosed by DSA, 16 MCAs were mild, 70 were moderate, 121 were severe, and 18 were occluded. Of 224 MCAs diagnosed by t-CEUS, 18 were mild, 76 were moderate, 112 were severe, and 18 were occluded. The diagnosis of MCA stenosis/occlusion using t-CEUS and DSA had a high consistency (Kappa=0.91). The sensitivity, specificity and accuracy of t-CEUS for the diagnosis of mild MCAs were 80%, 80%, and 91%, respectively; the sensitivity,specificity and accuracy of t-CEUS for the diagnosis of moderate MCAs were 83%, 93%, and 97%, respectively; the sensitivity, specificity and accuracy of t-CEUS for the diagnosis of severe MCA were 83%, 96%, and 96%, respectively. Conclusions t-CEUS can clearly show mild, moderate and severe stenosis and occlusion in MCAs, and it is suitable for the diagnosis of patients with MCA stenosis and occlusion, especially for the patients with suspected MCA stenosis and who are not suitable for DSA.

Risk Factors of Preoperative Rebleeding of Ruptured Intracranial Aneurysms

XING Xia, PI Hong-Ying,JI Huan-Huan

2019, 14(08):  775-779.  DOI: 10.3969/j.issn.1673-5765.2019.08.008

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Objective To explore the risk factors of preoperative rebleeding of ruptured intracranial aneurysms, to provide reference for preventing aneurysm rebleeding. Methods This is a retrospective case-control study. A total of 450 cases diagnosed with ruptured intracranial aneurysm patients were included. According to whether or not there was rebleeding before surgery, all the patients were divided into non-rebleeding group and rebleeding group. Multivariate logistic regression analysis was used to analyze the risk factors of aneurysm rebleeding. Results The rate of preoperative rebleeding of ruptured intracranial aneurysms reached up to 23.56% (106/450). Logistic regression analysis showed that the following factors of hypertension (OR 4.221, 95%CI 2.969-5.472, P <0.001), cerebral angiospasm (OR 2.015, 95%CI 1.274- 2.756, P =0.005), epilepsy (OR 3.093, 95%CI 1.980-4.206, P <0.01), DSA examination (OR 1.684, 95%CI 1.103-2.265, P =0.002), irregular shape of aneurysm (OR 2.465, 95%CI 1.887-3.042, P <0.001), aneurysm diameter ≥10 mm (OR 3.046, 95%CI 2.060-4.031, P <0.001), severe cough (OR 3.594, 95%CI 2.447-4.741, P <0.001), abnormal mood fluctuation (OR 2.756, 95%CI 1.928- 3.585, P =0.002), earlier moving or out-of-bed activity (OR 4.226, 95%CI 2.769-5.683, P <0.001), forced defecation (OR 2.451, 95%CI 1.810-3.092, P <0.001) and Hunt-Hess grade (OR 1.073, 95%CI 1.031-1.114, P <0.001) were all dependent risk factors of rebleeding of ruptured intracranial aneurysm before surgery. Conclusions The incidence of rebleeding of ruptured intracranial aneurysm before surgery was still high, and there were many independent risk factors affecting aneurysm rebleeding. According to the risk factors, intervention measures should be taken to prevent the occurrence of aneurysm rebleeding.

Value of Brainstem Auditory Evoked Potential in the Diagnosis of Post-circulation Cerebral Infarction

JIANG Qing-Qing, ZHAO Yu-Wu, LU Kai-Li, ZHANG Xiao-Jie

2019, 14(08):  780-785.  DOI: 10.3969/j.issn.1673-5765.2019.08.009

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Objective Based on the characteristics of brainstem auditory evoked potentials (BAEP) in acute and chronic post-circulation cerebral infarction, to explore the clinical value of BAEP in early identification and diagnosis of post-circulation cerebral infarction. Methods The patients with posterior circulation infarction from Department of Neurology of Shanghai Sixth People’s Hospital from August, 2018 to March 2019 were included in this study. According to cerebral MRI, all the patients were divided into acute infarction group and chronic infarction group, and the patients without cerebrovascular diseases in the same period are selected as control group. The characteristics of peak latency (PL) of BAEP Ⅰ, Ⅲ, and V wave, and the inter-peak latency (IPL) of BAEP Ⅰ-Ⅲ, Ⅲ-V and I-V wave, and Ⅲ-V/Ⅰ-Ⅲ IPL ratio in the three groups were compared. Results Finally, 36 patients in acute infarction group, 32 patients in chronic infarction group, and 32 ones in control group. The BAEP Ⅲ and V wave PL in acute infarction group were longer than that in chronic infarction group (P <0.001 and P =0.005) and control group (both P <0.001). The BAEP V wave PL in chronic group was significantly longer than that in control group (P <0.001). The BAEP Ⅰ-Ⅲ wave (P <0.001), Ⅲ-V wave (P =0.006) and Ⅰ-V wave (P <0.001) IPL in acute infarction group were all longer than that in control group; and the Ⅰ-Ⅲ wave (P <0.001) and Ⅰ-V wave (P =0.029) IPL in acute infarction group than that in chronic infarction group; and the Ⅲ-V wave (P =0.003) IPL in chronic infarction group was longer than that in control group. There were 9 cases (25.0%) with abnormal Ⅲ-V/Ⅰ-Ⅲ wave IPL ratio in chronic infarction group, and 2 cases (6.3%) in acute infarction group, the difference between the two groups was statistically significant (P =0.001). Conclusions The abnormal electrophysiological changes of auditory sense pathway in patients with acute and chronic post-circulation infarction can be detected by BAEP examination. The BAEP Ⅲ and V wave PL, Ⅰ-Ⅲ and Ⅰ-V wave IPL were all prolonged in acute infarction group, especially Ⅲ wave PL and Ⅰ-Ⅲ wave IPL; and the prolonged potentials were mainly the V wave PL and Ⅲ-V wave IPL in chronic infarction group.

Assessment of Collateral Circulation in Ischemic Stroke Using Transcranial Doppler Ultrasound

LIU Wei,LU Shuo, LIU Zun-Jing

2019, 14(08):  786-791.  DOI: 10.3969/j.issn.1673-5765.2019.08.010

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Cerebral collateral circulation is crucial for the prognosis of patients with acute ischemic stroke (AIS). The assessment of cerebral collateral circulation can guide the selection of treatment strategy. TCD is a convenient and effective method of evaluating collateral circulation. TCD can detect cerebral hemodynamic indexes in real-time, in addition, it has non-invasive, repeatable, convenient operation and low-priced advantages. Therefore, TCD plays an important role in diagnosis and treatment of AIS. This article reviewed the detection methods and clinical value of TCD for primary and secondary collateral circulation and cerebrovascular reactivity in ischemic stroke, to provide some reference for diagnosis and treatment of AIS.

Application of High-resolution Magnetic Resonance Imaging in the Evaluation of Symptomatic Intracranial Atherosclerotic Diseases

LIU Cui-Cui, LI Wen-Jun, JIA Ya-Nan, LIU Jun-Yan

2019, 14(08):  792-796.  DOI: 10.3969/j.issn.1673-5765.2019.08.011

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The vulnerability of intracranial atherosclerotic plaques is closely related to symptomatic intracranial atherosclerotic diseases (sICAD). High-resolution magnetic resonance vessel wall imaging can visually show the structure of intracranial artery wall, the distribution and characteristics of atherosclerotic plaques, vessel wall remodeling index and enhancement features and etc., which are very helpful for the differential diagnosis, stroke risk assessment and treatment evaluation of sICAD.

Application of Neuroimaging Evaluations of Cerebrovascular Reactivity in Intra-extracranial Arterial Stenosis

XU Yu-Zhu, XUE Hong-Lian, LIU Jun-Yan

2019, 14(08):  797-802.  DOI: 10.3969/j.issn.1673-5765.2019.08.012

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Good cerebrovascular reactivity (CVR) is an important compensatory pathway during cerebral hemodynamic decompensation in patients with intra-extracranial arterial severe stenosis or occlusion. CVR assessment can be used to predict the risk and prognosis of ischemic stroke, and evaluate the efficacy of vascular reconstruction. The detection method of CVR as follows: firstly cerebral small vessels are induced to dilatating by CO2 stimulation test or tilt table test, then the cerebral hemodynamic changes before and after vasodilatation are detected by neuroimaging examination. At present, CVR detection techniques include direct detection techniques, such as CTP, PWI, single photon emission computed tomography, Xenon CT, positron emission tomography, blood oxygen level dependent-functional MRI, and arterial spin labeling, and indirect detection techniques such as TCD.

Imaging Evaluation of Post-stroke Hemorrhagic Transformation

LI Wen-Jun, LIU Jun-Yan

2019, 14(08):  803-808.  DOI: 10.3969/j.issn.1673-5765.2019.08.013

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Hemorrhagic transformation (HT) is one of the most severe complications after endovascular revascularization or intravenous thrombolysis in patients with acute ischemic stroke. Identifying ischemic stroke patients who are at high risk of HT is crucial for guiding therapeutic strategies. Currently, there are a variety of neuroimaging techniques such as brain CT, CTA, MRI, DWI, SWI and perfusion imaging and etc. The information of stroke category, core infarct volume, vascular lesions, the perfusion state of ischemic lesion and perilesional area, the permeability of culprit vessel wall and so on can be rapidly obtained by the above imaging examination, which can be used to assess the risk of HT. In a word, the evaluation of HT risk is very helpful for clinicians to make optimal therapeutic strategy for stroke patients, to improve the prognosis of patients.

Chinese Stroke Association Guidelines for Clinical Management of Cerebrovascular Disorders (Excerpts)——Clinical Management of Intracerebral Hemorrhage

CAO Yong, ZHANG Qian, YU Tao, LIU Yan-Fang, SUN Zheng-Hui, YU Song-Lin, ZHAO Meng, WANG Wen, ZHAO Ji-Zong, the Writing Committee of Chinese Stroke Association Guidelines for Clinical Management of Cer

2019, 14(08):  809-813.  DOI: 10.3969/j.issn.1673-5765.2019.08.014

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Chinese Stroke Association Guidelines for Clinical Management of Cerebrovascular Disorders (Excerpts)——Clinical Management of Subarachnoid Hemorrhage

DONG Yi, GUO Zhen-Ni, LI Qi, NI Wei, GU Hong-Qiu,GU Yu-Xiang, DONG Qiang, the Writing Committee of Chinese Stroke Association Guidelines for Clinical Management of Cerebrovascular Disorders

2019, 14(08):  814-818.  DOI: 10.3969/j.issn.1673-5765.2019.08.015

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Chinese Stroke Association Guidelines for Clinical Management of Cerebrovascular Disorders (Excerpts)——Clinical Management of Cerebral Venous Thrombosis

FAN Yu-Hua, CHEN Hong-Bing, YU Jian, DUAN Jian-Gang, MO Da-Peng, ZHU Wen-Hao, WANG Bo, ZENG Jin-Sheng

2019, 14(08):  819-822.  DOI: 10.3969/j.issn.1673-5765.2019.08.016

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Chinese Stroke Association Guidelines for Clinical Management of Cerebrovascular Disorders (Excerpts)——Management of Stroke Rehabilitation

ZHANG Tong, ZHAO Jun, BAI Yu-Long, LI Xue-Ping, QU-Yun, WANG Bao-Jun, LI Bing-Jie, the Writing Committee of Chinese Stroke Association Guidelines for Clinical Management of Cerebrovascular Disorders

2019, 14(08):  823-831.  DOI: 10.3969/j.issn.1673-5765.2019.08.017

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Evacuation of Intracerebral Hematomas: Gains and Losses

John H.Zhang

2019, 14(08):  832-841.  DOI: 10.3969/j.issn.1673-5765.2019.08.018

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Advance in Detection of Ischemic Penumbra in Acute Ischemic Stroke Using Multimodal Magnetic Resonance Imaging

HE Hao-Ran, ZU Zhong-Liang, LIU Yong

2019, 14(08):  842-847.  DOI: 10.3969/j.issn.1673-5765.2019.08.019

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Ischemic penumbra (IP) in acute ischemic stroke (AIS) has always been the focus of imaging evaluation in acute endovascular treatment. Because multimodal MRI can provide many pathophysiological parameters, using multimodal MRI to evaluate IP is promising. This article introduced the characteristics and limitation of different MRI sequence for assessing IP, with emphasis on the new technology amide proton transfer (APT) imaging, which can properly evaluate IP through accurate determination of intracellular pH value in cerebral ischemia region. Although APT is rarely used in clinical examination at present, it is believed that APT will become an important imaging technique for the diagnosis and treatment of AIS patients in the future, with the improvement of imaging technology.

Research and Practice of Continuing Medical Education of National Key Discipline —— Continuing Medical Education Management of Vascular Neurosurgery

LIU Yi-Jie, WANG Shuo

2019, 14(08):  848-850.  DOI: 10.3969/j.issn.1673-5765.2019.08.020

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The standardized and scientific management of continuing medical education (CME) of national key discipline, and the advantages and current problems in vascular neurosurgery CME management at Beijing Tian Tan Hospital were introduced and analyzed in this article. According to the actual problems, the innovative improvement measures were made and carried out, which greatly enhanced the efficiency and efficacy of CME and made CME management more standardized and scientific, and all the above promoted the sustained and healthy development of CME management and enhanced social benefits.