Table of Content

20 May 2011, Volume 6 Issue 05

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主编手记

Grassroots Heroesr

WANG Yong-Jun

2011, 6(05):  341-342. 

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述评

Discussion of

GAO Shan

2011, 6(05):  343-350. 

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Afterword to the Discussion of "Lacunar Infarct"

GAO Shan

2011, 6(05):  351-352. 

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Birth and Development of Chinese Ischemic Stroke Subclassfication

GAO Shan

2011, 6(05):  353-358. 

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论著

The Reliability of Ischemic Stroke Subtype Classification Using the A-S-C-O Criteria, TOAST Criteria and CISS Criteria

LI Xiao-Lei;LI Qing-Jing;LI Tie;et al

2011, 6(05):  359-365. 

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Objective To assess the reliability of ischemic stroke subtype classification using the A-S-C-Ocriteria, Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria and Chinese IschemicStroke Subclassfication (CISS) criteria.Methods A hundred acute ischemic stroke patients were consecutively recruited into this study.Two raters were invited to assess the etiological subclassification using the A-S-C-O criteria,TOAST criteria and CISS criteria. The data was analyzed by the statistics software of SPSS 17.0.Results The value of Kappa about the A-S-C-O classification’s reliability was 0.504, (P <0.001).The value of Kappa about the TOAST classification’s reliability was 0.769, (P <0.001). The value ofKappa about the CISS classification’s reliability was 0.710, (P <0.001).Conclusion The reliability of the A-S-C-O classification was moderate, the reliability of theTOAST classification and the CISS classification were both good.

Analysis of Cerebral Infarction and Collateral Flow in Patients with Unilateral Carotid artery Occlusion

LI Rao;HE Jin-Tao;WU Ji-Xing;et al

2011, 6(05):  366-370. 

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Objective To investigate the cerebral infarction by computer tomography (CT) and magneticresonance imaging (MRI) ipsilateral to carotid artery occlusion in patients with unilateral carotidartery occlusion and the association between ischemic brain lesions and intracranial collateral bloodflow. To promote our understanding of the pathophysiology of cerebral ischemia.Methods Forty-three patients with unilateral carotid artery occlusion confirmed by coratidultrasound were included. The numbers of infarction were compared in each of five cerebralanatomic regions ipsilateral to the occlusion. The five regions were territory cortical region ofmiddle cerebral artery (MC), anterior watershed cortical region (AWS), posterior watershedcortical region (PWS), internal watershed region (IWS), and perforating artery region (PA). Theassociations between collateral blood flow pattern and infarction in five regions were analyzed.Results The frequency of IWS infarcts in the hemisphere ipsilateral to the occluded carotid arterywas higher (n=17, 44.2%). Six of eight AWS infarcts coexisted with IWS infarcts. The presenceof Posterior communicating artery (PCoA) was a protective factor associated with a reduction inprevalence of IWS infarcts (odd ratio (OR ) =0.226, 95% confidence interval (CI ): 0.058-0.833,P =0.027).Conclusion Higher frequency of IWS infarcts and most of AWS infarcts coexisted with IWSinfarcts suggested a hemodynamic mechanism for stroke with occlusive coratid disease. PCoA wasa protective factor associated with a reduction in prevalence of IWS infarcts.

Risk Factors and Prognosis in Patients with Acute Cerebral Stroke Complicated by Stress Ulcer Bleeding

FENG Rui-Jing;ZHAO Xing-Quan;SONG Hong-Jie

2011, 6(05):  371-375. 

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Objective To observe the independent risk factors of stress ulcer bleeding (SUB) caused by acutecerebral stroke, to analyze the clinical features of SUB, and to assess its influence to the prognosis.Methods Patients of acute stroke hospitalized in our hospital from Mar. 2009 to Mar. 2010were chosen. We investigated the state of SUB within 14d from development of disease, and theimpossible risk factors were monofactorial and multifactorial analyzed. Modified Ranking Scale(mRS) was used to estimate and comparative study the 90d prognosis of SUB group and non-SUBgroup.Results Altogether 216 cases of acute stroke were registered in our study, 40 cases were diagnosedSUB, the incidence was 18.5%. The independent risk factors of SUB include admission toneurologic intensive care unit (NICU) (OR=23.582, 95%CI 6.287～88.458) and the thalamus stroke(OR=11.389, 95%CI 4.5～28.828). SUB mostly occurred within the first week after stroke (92.5%).In the 40 cases of SUB, 20 patients (50%) died at discharge, and among the 176 cases without SUB,12 patients (6.8%) died. The mortality is significantly different between two groups (x2=48.157,P <0.01). 90 days after stroke, 29/40 (72.5%) patients with SUB had bad consequence (mRS 4～6),compared to 51/176 (28.9%) patients without SUB, the difference has statistical significance(x2=26.475, P <0.001).Conclusion The thalamus stroke and admission to NICU maybe the independent predictivefactors of acute cerebral stroke complicated by stress ulcer bleeding. Once SUB occurs, it oftendemonstrates the deterioration and bad consequence.

Diagnosis and Treatment of 48 Cases of Cerebral Venous Sinus Thrombosis

WEI Bo-Ping;YUAN Min-Shao;WAGN Xin-Gao

2011, 6(05):  376-380. 

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Objective To analyze the features of cerebral venous sinus thrombosis (CVST), and to assess thetherapeutic effect.Methods To retrospectively analyze the clinical data of cerebral venous sinus thrombosis thatcomes from Beijing Tiantan Hospital and People's Hospital of Jimo.Results From 2006 to 2010, 48 cases of definite cerebral venous sinus thrombosis were treatedin both hospitals, 24 (50.0%) cases were subacute onset, mainly for intracranial hypertensionsyndrome, 8 (16.7%) cases were complicated with limb movement disorder. Eight (16.7%) casesoccurred disturbance of consciousness. The head magnetic resonance venography (MRV) showeddifferent degrees of cerebral venous sinus occlusion. Etiological treatment, anticoagulant therapy,symptomatic and supportive treatment are the main measures. Thrombolytic therapy combinedwhen necessary. Fifteen (31.3%) cases recovered, 30 (62.5%) cases improved, 3 (6.25%) casesinvalid.Conclusion The lack of specific clinical manifestations of CVST, magnetic resonance imaging(MRI) should be the first line as soon as possible, the first MRI diagnosis and prompt treatment iscritical, anticoagulant therapy is the first-line treatment for CVST. If received treatment, the diseasehas relative good prognosis.

Effects of Mirror Therapy on Hemiplegic Upper Extremity Motor Recovery in Stroke Patients

ZHANG Hong-Cui;YU Da-Jun;LIU Zhi-Hua;et al

2011, 6(05):  381-387. 

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Objective To observe the effects of mirror therapy (MT) compared with the conventional trainingtherapy (CTT) on hemiplegic upper extremity recovery after stroke.Methods Thirty sub-acute patients with upper limb paralysis were randomly divided into twogroups: MT group and CTT group. All 30 patients received physical treatment for a period of 4weeks. All patients were assessed with Fugl-Meyer motor assessment (FMA), motor assessmentscale (MAS), the action research arm test (ARAT), the modified Ashworth scale, visual analoguescore (VAS) and the modified Barthel index before treatment and after 4 weeks.Results After 4 weeks, FMA, MAS, ARAT and Barthel index scores in the two groups hadimproved (P <0.01), and the FMA, ARAT scores in the MT group were significantly higher thanthose of the control group (P <0.05), but the scores of MAS, Barthel index had no significantdifference between the two groups (P> 0.05). After 4 weeks, VAS had decreased in the MT group(P <0.05), but it had no difference in CTT group. In two groups, there were no significant differencesof the modified Ashworth scale after treatment (P> 0.05).Conclusion Mirror therapy can improve the functional performance of the upper extremity ofstroke patients.

Cortical electrical stimulation combined with rehabilitative training enhance forelimb motorfunction and synaptic plasticity following focal cortical ischemia in rats

ZHENG Jian;YAGNLi-Jun;XIE Rui-Lu;et al

2011, 6(05):  388-394. 

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Objective To assess the behavioral and synaptic plasticity effects of combining epidural corticalelectrical stimulation with motor skills training following unilateral sensorimotor cortex (SMC)lesions in adult male rats.Methods Prior to lesion/electrode implantation surgeries, rats were pre-trained on the ‘singlepellet retrieval task’ to a minimum criterion of 30% success rate for two consecutive days. Thenthese rats received partial unilateral SMC lesions and implantation of electrodes over the remainingSMC. Fourteen days later, rats received daily reach training concurrent with anodal or cathodal100 Hz or no stimulation for 14 days. Performance was measured as the percent of successes outof the total number of reach attempts [(total successes/total reach attempts)*100]. Conventionalavidin biotinylated enzyme complex (ABC) immunohistochemical method was used quantify theexpression and distribution of microtubule-associated protein 2 (MAP-2) and growth associatedprotein 43 (GAP-43) in motor cortical area underlying the electrode.Results There was no statistical significance between the two groups on the 14th day of preoperativetraining (P=0.546). The stimulation group had significantly greater rates of improvementwith the impaired forelimb in comparison to control group (49.12% vs 21.67%, P =0.004). Theexpression and distribution of MAP-2 and GAP-43 in the stimulating group were better than thosein control group (GAP-43: 0.3338 vs 0.3056, P=0.008; MAP-2: 0.4825 vs 0.4327, P=0.027).Conclusion These data indicate that cortical stimulation greatly improves the efficacy ofrehabilitative reach training following SMC damage and raise the possibility that CS-inducedfunctional improvements may be mediated by promoting the expression of MAP-2 and GAP-43 inperilesion cortex, and thus improve synaptic plasticity in cerebral ischemic rats.

专题论坛

Aortic Atherosclerotic Stroke Should Be Classified as Cardioembolism Stroke

TIAN Cheng-Lin;HAO Yong-Gang

2011, 6(05):  396-398. 

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Etiological Analysis of Ischemic Stroke Caused by Aortic Arch Atherosclerosis

WU Yin-Yan;YIN Hong-Bing

2011, 6(05):  399-402. 

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病例讨论

Outcome of Severe Systemic Hypoperfusion in Patients with Stroke Resulting from LargeArtery Atherosclerois

BAI Jing;TIAN Cheng-Lin

2011, 6(05):  403-406. 

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指南与规范

Evidence-Based Guideline: the Role of Diffusion and Perfusion MRI for the Diagnosis of cute Ischemic Stroke—Report of the Therapeutics and Technology Assessment ubcommittee of the American Academy of Neurology

DUAN Wan-Ying;JIA Qian;MA Li

2011, 6(05):  407-413. 

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快讯

Stroke Institute: Loam,Platform,Starting point and Bridge

TIAN Cheng-Lin

2011, 6(05):  414-415. 

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综述

Classification of Ischemic Stroke Subtypes——From Original TOAST to ASCO

CHEN Pei-Hao;GAO Shan

2011, 6(05):  416-422. 

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【Abstract】 The fundamental goal of ischemic stroke classification is to generate correctdiagnosis and treatment in subgroups with discrete features. It is critical to both basic research andclinical practice. The Trial of Org10172 in Acute Stroke Treatment (TOAST) classification systemhas become the most widely accepted tool to categorize stroke subtype in recent literature. Withthe advances in stroke imaging and epidemiological studies, several classification systems, such asSTOP Stroke Study (SSS)-TOAST and Korean TOAST, have been devised to enhance the accuracyof original TOAST. The newly developed ASCO (A for atherosclerosis, S for small vessel disease,C for cardiac source, O for other cause) classification is tried to identify the most likely etiologywithout neglecting mixed phenotypes. Therefore, the ASCO system is probable a suitable toolfor evaluating secondary stroke prevention and conducting clinical trials. Until now, there is noperfect ischemic stroke classification system. This review article highlights the major classificationsystems that have benefits and limitations in etiologic stroke evaluation. On the basis of the currentunderstanding, we are looking forward to an innovative classification system that fits to the Chinesepopulations.

Research of Drug Treatment of Vascular Dementia

LUO Di;BI Qi

2011, 6(05):  423-426. 

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【Abstract】 Vascular dementia is a kind of cognitive dysfunction clinical syndrome causedby cerebrovascular diseases. Relevant drug therapy includes anticholinesterase, N-aspartic acidmethyl-D-receptor inhibitors, Nimodipine, statins and nicergoline etc. The effect of donepezil iscontroversy; galanthamine is effective to the dementia caused by both Alzheimer disease (AD) andcerebrovascular diseases; rivastigmine in vascular dementia those who are old and may have ADhas the obvious effect in cognitive; memantine in mild to moderate vascular dementia has goodcurative effect and tolerability; most tests show nimodipine in vascular cognitive dysfunction isan effective treatment, and have good safety; simastatin and atorvastatin are effective; nicergolinecan improve cognitive functions in vascular dementia patient. At present, there is no evidence thatantiplatelet agents and antihypertensive drugs have positive treatment function.