Table of Content

20 December 2020, Volume 15 Issue 12

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China Stroke Statistics 2019 (3)

WANG Yong-Jun, LI Zi-Xiao, GU Hong-Qiu, ZHAI Yi, JIANG Yong,ZHAO Xing-Quan, WANG Yi-Long, YANG Xin, WANG Chun-Juan, MENG Xia, LI Hao, LIU Li-Ping, JING Jing,WU Jing, XU An-Ding, DONG Qiang, David Wang

2020, 15(12):  1251-1263.  DOI: 10.3969/j.issn.1673-5765.2020.12.001

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Review on Highlights on Imaging Research of Cerebral Small Vessel Disease  

XU Qun

2020, 15(12):  1264-1266.  DOI: 10.3969/j.issn.1673-5765.2020.12.002

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Cerebral Small Vessel Disease: Cognition and Imaging

XU Qun

2020, 15(12):  1267-1267. 

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Functional Network Connectivity in Patients with Early Cognitive Impairment due to Cerebral Small Vessel Disease

LU Pei-Wen, YANG Jie, DENG Qiu-Qiong, YU Ling, CAO Wen-Wei, DU Jing, WANG Yao, ZHOU Yan,XU Qun

2020, 15(12):  1268-1275.  DOI: 10.3969/j.issn.1673-5765.2020.12.003

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Objective To investigate the changes of the resting state network (RSN) connection pattern in patients with early cognitive impairment due to cerebral small vessel disease (CSVD). Methods From July 2015 to December 2018, non-dementia CSVD patients were consecutively recruited from the stroke clinic. They were divided into two groups: no cognitive impairment (NCI) and mild cognitive impairment (MCI). The baseline demographic, sociological data and vascular risk factors were collected. Detailed neuropsychological assessments and multimodal MRI were performed. The functional network connectivity (FNC) was compared between the two groups, and the correlation between FNC and cognitive function of patients was analyzed. Results (1) A total of 185 CSVD patients were enrolled in this study, including 117 (63.2%) in MCI group and 68 (36.8%) in NCI group, with a mean age of 64.6±7.2 years old and 86 males (78.4%). Compared with the NCI group, the MCI group had fewer males (P =0.035) and education years (P =0.003). There was no statistical difference in age and vascular risk factors between the two groups. (2) After adjusting for age, gender and education years, at RSN level, the functional connection between executive control network (ECN) and right frontoparietal network (RFPN) in MCI group was weaker than that in NCI group (P <0.05). At the level of independent component (IC), compared with NCI, the functional connections among some ICs involving auditory network (AN), default mode network (DMN), ECN and RFPN in MCI group weakened (all P <0.05), while the functional connections among ICs involving DMN, AN and visual network (VN) enhanced (all P <0.05). (3) Except for FNC among AN-13 and DMN-16, RFPN-26 and ECN-19, the FNCs were all correlated with general cognition, attention, executive and visuospatial function (all P <0.05). Conclusions In CSVD patients with early cognitive impairment, the functional connection between ECN and RFPN weakened. FNCs of ICs significantly weakened involving AN, DMN, ECN and RFPN, and enhanced involving DMN, AN and VN. FNCs were correlated with cognitive function. FNCs may become a new neural network marker for cognitive impairment due to CSVD.

Correlation between the Total Cerebral Small Vessel Disease Load and Cognitive Function, Brain Atrophy and Cerebral Perfusion in Patients with Memory Loss

WANG Jie-Qun, WU Yi-Tai, WANG Xing, XU Sheng, LI Ren-Ren,NIE Zhi-Yu, LI Yun-Xia

2020, 15(12):  1276-1280.  DOI: 10.3969/j.issn.1673-5765.2020.12.004

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Objective To investigate the correlation between the total cerebral small vessel disease (CSVD) load and cognitive function, brain atrophy and cerebral perfusion in patients with memory loss. Methods The outpatients with memory loss in the Department of Neurology and Memory Clinic of Tongji Hospital were retrospectively included in this study. The collected data included the general information and imaging results, cognitive assessment (MoCA score), the total CSVD load, the atrophy score of the whole brain and each lode, and cerebral blood flow (CBF) of the whole brain and each lobe. Spearman correlation analysis was used to analyze the relationship between the total CSVD load and cognitive function, brain atrophy and CBF. Results A total of 200 patients were included, with a mean age of 69.16±9.44 years old and 99 males (49.5%). The total CSVD load was negatively correlated with MoCA score (r =-0.202, P =0.004), and CBF of the whole brain (r =-0.234, P =0.001), frontal lobe (r =-0.252, P <0.001), parietal lobe (r =-0.253, P <0.001), and occipital lobe (r =-0.224, P =0.001). The total CSVD load was positively correlated with the atrophy scores of the whole brain (r =0.313, P <0.001), frontal lobe (r =0.393, P<0.001) and parietal lobe (r =0.237, P =0.001). Conclusions The higher the CSVD load, the worse the cognitive function, the lower cerebral perfusion, and the more severe the brain atrophy.

Advances in Machine Learning-based Neuroimaging Studies on Cognitive Impairment due to Cerebral Small Vessel Disease

LU Pei-Wen, XU Qun

2020, 15(12):  1281-1286.  DOI: 10.3969/j.issn.1673-5765.2020.12.005

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Cerebral small vessel disease (CSVD) is the main cause of cognitive impairment. Some neuroimaging studies have found many changes in brain structure and function related to cognitive impairment due to CSVD at group level. However, it is hard to make individual evaluation for cognitive impairment and prognosis prediction according to these neuroimaging changes. In recent years, machine learning has been gradually applied to cerebrovascular disease field, and machine learning-based neuroimaging data analysis can be used to predict disease progression and find potential imaging biomarkers.

Progress of Perivascular Spaces in Cerebral Small Vessel Disease

GONG Ling-Yu, Xu Qun

2020, 15(12):  1287-1291.  DOI: 10.3969/j.issn.1673-5765.2020.12.006

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Perivascular spaces (PVS) are potential spaces filled with fluid around cerebral small vessels. Enlarged perivascular spaces (ePVS) have become one of the recognized imaging markers of cerebral small vessel disease (CSVD). The quantification of PVS depends on MRI, and the difficulty lies in the differentiation between ePVS and lacuna. Previous studies have shown that PVS is associated with age, hypertension, other CSVD imaging markers, cognitive impairment, and systematic inflammation. However, the long-term cohort studies in different populations still lack. To study the relationship between ePVS and the course of CSVD is helpful for early detection and risk prediction of CSVD.

Multi-language-task Functional Magnetic Resonance Imaging Guides the Resection of Arteriovenous Malformations in Chinese Language Area

DENG Xiao-Feng, CAI Hu-Su-Le, WANG Pei-Jiong, WANG Bo, ZHANG Dong,WANG Shuo, CAO Yong, ZHAO Ji-Zong, ZHANG Yan

2020, 15(12):  1292-1298.  DOI: 10.3969/j.issn.1673-5765.2020.12.007

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Objective To observe the protection effect of the multi-language-task functional MRI (fMRI) guided resection of arteriovenous malformations (AVM) involving the language (mainly Chinese) on language function. Methods From December 2017 to December 2019, the data of a total of 31 patients with AVM involving the language area who were admitted to Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University were prospectively collected. Multi-language-task (including synonymous word judgment, single word reading, listening comprehension) fMRI was performed before surgery in all patients. SPM12 was used to map the activation areas of each task and the relationship between the lesions and activation areas was analyzed (including the distance between them and the presence of lateralization functional remodeling in activation areas). The Brainlab system was used to guide the operation. Western aphasia battery (WAB) was used to evaluate language function before and one week after surgery. Results All patients had effective language area mapping. Synonym judgment task mainly activated the left middle gyrus (24/31, 77.4%), and 1 patient (3.2%) showed right-hemisphere dominance in language area. single word reading task mainly activated the posterior part of left inferior frontal gyrus (23/31, 77.2%), and 7 patients (22.6%) showed right-hemisphere dominance in language area. listening comprehension task mainly activated the posterior part of left superior temporal gyrus (30/31, 96.8%), and 6 patients (19.4%) showed right-hemisphere dominance in language area. The distance between lesions and language area was 5.5±3.4 mm. The overall WAB score (38.51±2.84) after surgery did not decrease significantly compared with that before surgery (39.32±0.64, P =0.135), and language dysfunction after surgery occurred in only 2 patients (6.4%). Conclusions The multi-language-task fMRI can guide the resection of AVM with language area (mainly Chinese) involvement and effectively protect the language function.

The Association of Cerebral Autoregulation Function after Endovascular Treatment with Clinical Outcome in Acute Anterior Circulation Ischemic Stroke

ZHANG Zhe, PU Yue-Hua, YU Lei, DUAN Wan-Ying, MI Dong-Hua,LIU Li-Ping

2020, 15(12):  1299-1305.  DOI: 10.3969/j.issn.1673-5765.2020.12.008

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Objective Using transfer function analysis (TFA) and Spearman correlation analysis to calculate cerebral autoregulation (CA) after endovascular treatment (EVT) in acute anterior circulation ischemic stroke, and to compare the correlation between the CA calculated by the two methods and clinical outcome. Methods The data of acute anterior circulation ischemic stroke patients who received endovascular treatment were prospectively collected. Within 48 hours after EVT, the bilateral middle cerebral artery flow velocity (FV) by TCD and non-invasive arterial blood pressure (ABP) were continuously recorded, TFA was used to calculate phase shift and gain of FV and ABP (including different frequency: very low 0.02-0.07 Hz, low 0.07-0.20 Hz, high 0.20-0.50 Hz), and Spearman correlation analysis was used to calculate mean flow velocity index (Mx). Good prognosis was defined as a mRS score of 0-2. The association of the above CA parameters by two methods with clinical prognosis (including 90-day mRS, NIHSS score decrease at 7 days, pre-EVT infarction volume and infarction volume increase at 48 hours post-EVT) were analyzed. Results A total of 52 patients were included. 18 patients had 90-day good prognosis. The Mx of the patients with poor prognosis was higher than that of the patients with good prognosis [0.40 (0.18, 0.50) vs 0.26 (0.05, 0.36), P =0.012], while there were no statistical differences in phase shift and gain in each frequency band between the two groups. Mx was positively correlated with the NIHSS score improvement at 7 days post-EVT (r =0.299, P =0.031), 90-day mRS score (r =0.382, P =0.005), pre-EVT infarct volume (r =0.561, P <0.001), and infarct volume growth at 48 hours post-EVT (r =0.286, P =0.040). Very low frequency phase shift was negatively correlated with pre-EVT infarct volume (r =-0.282, P =0.043) and 90-day mRS score (r =-0.276, P =0.048). Multivariate regression analysis showed that Mx was independently associated with 90-day poor prognosis (OR 132.69, 95%CI 5.71-3081.96, P =0.002). Conclusions For acute anterior circulation cerebral infarction patients who underwent EVT, good CA function early after EVT was associated with good prognosis. Compared with phase shift and gain, Mx has a stronger correlation with clinical outcome.

Clinical Analysis of 49 Cases of Takayasu Arteritis Complicated with Cerebral Infarction

KONG Fang, HUANG Xu, WEI Lian, SU Li, LIAO Qiu-ju, LIU Hong-Jun, ZHAO Yi

2020, 15(12):  1306-1312.  DOI: 10.3969/j.issn.1673-5765.2020.12.009

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Objective To summarize the clinical features of Takayasu arteritis (TA) complicated with cerebral infarction (CI), and analyze the related factors for recurrent cerebral infarction in TA patients. Methods The clinical data of 49 patients with TA and CI who were followed up for more than 3 years from January 2010 to June 2020 were retrospectively analyzed. Results A total of 49 eligible patients were included. The median age at the first CI onset was 30.0 (22.0-45.0) years old, and the median follow-up time was 3.4 (3.2-3.7) years. Recurrent cerebral infarction occurred in 11 cases (22.4%), and the median time between the two CI was 8.0 (5.0-88.0) months. The proportion of diabetes mellitus (27.3% vs 2.6%, P =0.031) and the elevated triglyceride level during the follow-up after CI (3.65±0.96 mmol/L vs 1.14±0.54 mmol/L, P =0.001) in patients with recurrent CI were significantly higher than that in those without recurrent CI. The most involved artery in TA was common carotid artery (48/49, 98%), followed by vertebral artery (40/49, 81.6%), stenosis (49/49, 100%) and occlusion (36/49, 73.5%) were the most common lesions in these involved arteries. The incidence of artery occlusion (100% vs 65.8%, P =0.024) and thrombosis (45.5% vs 13.2%, P =0.033) in patients with recurrent CI were significantly higher than that in those without recurrent CI. The patients with recurrent CI had lower proportion of receiving antiplatelet therapy (63.6% vs 97.4%, P =0.007) and revascularization (27.3% vs 68.4%, P =0.033) than those without recurrent CI. Conclusions Diabetes mellitus, poor lipid control, occlusion in branches of aortic arch and thrombosis were correlated with recurrent CI risk in patients with TA and CI.

Headache Characteristics of Cerebral Venous Thrombosis Patients with Headache as the Sole Presentation

XU Li, YUAN Dan, GONG Zhong, WANG Ying-Peng, LI Dong-Hua, WANG Hai-Peng

2020, 15(12):  1313-1316.  DOI: 10.3969/j.issn.1673-5765.2020.12.010

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Objective To describe the characteristics of headache in cerebral venous thrombosis (CVT) patients with headache as the sole presentation. Methods The data of CVT patients presenting with only headache admitted to Department of Neurology of Beijing Aerospace General Hospital between January 2012 and December 2018 were retrospectively analyzed. All the included patients met the following criteria: (1) CVT was confirmed by MRI/MRV; (2) presenting with only headache, in absence of the signs suggesting intracranial hypertension; (3) normal cerebrospinal fluid pressure; (4) no subarachnoid hemorrhage based on neuroimaging or cerebrospinal fluid examination on admission. The headache characteristics (location, headache pattern, evolution and severity) in these patients were described in detail. Results A total of 8 patients were included, with the median age of 40 years old and 6 females (75%). The most involved venous sinus was lateral sinus (7/8, 87.5%). Only the left lateral sinus was involved in 4 patients, and the 4 patients presented with ipsilateral headache. In the other 4 patients, the middleline sinuses (superior sagittal sinus and/or straight sinus) were involved and these 4 patients presented with bilateral headache. Other characteristics of headache were as follows: progressive headache in 7 patients and thunderclap in 1 patient; persistent headache in 7 patients and intermittent in 1 patient; severe headache in 7 patients and moderate in 1 patient. Conclusions For some CVT patients with only headache and without intracranial hypertension and subarachnoid hemorrhage, the lateral sinus was often involved, especially the left lateral sinus. The headache site was consistent with the involved venous sinus.

Clinical Features and Prognosis of Capsule Warning Syndrome

YU Yi-Jiao, LIU Li, DU Juan, LI Wei, LIN Tian,LU Dong-Xu, CAI Yi-Ling

2020, 15(12):  1317-1321.  DOI: 10.3969/j.issn.1673-5765.2020.12.011

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Objective To investigate the clinical and imaging features and prognosis of capsular warning syndrome (CWS). Methods The data of patients with CWS admitted in Department of Neurology of PLA Strategic Support Force Characteristic Medical Center from January 2013 to December 2018 were retrospectively analyzed. Results There were 12 patients including 8 males (66.67%), with the median age of 60 years old. There were 9 (75.0%) cases with hyperlipidemia, 8 (66.67%) with hypertension, 4 (33.33%) with diabetes, 3 (25.0%) with tumor history. There were 4 (33.33%) with a pure motor dysfunction, 4 (33.33%) with motor dysfunction and dysarthria, 3 (25.00%) with motor and sensory dysfunction, 1 (8.33%) with pure sensory dysfunction. 6 cases (50%) had new cerebral infarction in lenticulostriate artery territory. All patients were given oral dual antiplatelet therapy, of whom 3 cases with repetitive symptoms were also given with intravenous thrombolysis and antiplatelet therapy. At the 3-month follow-up, all patients had no recurrent symptoms, 10 patients had a mRS score of 0, and 2 patients had a mRS score of 4 and 3, respectively. Conclusions CWS patients mainly presented with repetitive episodes of motor dysfunction. The common cause of CWS is atherosclerosis. Dual antiplatelet therapy for CWS in our series of cases was effective, and intravenous thrombolysis was uncertain.

Association of Homocysteine with Mild Cognitive Impairment in Hypertension Patients

SONG Yan-Li, LIN Jie,XIA Wen-Jing, XUE Bin, WU Yi-Ping

2020, 15(12):  1322-1326.  DOI: 10.3969/j.issn.1673-5765.2020.12.012

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Objective To explore the association of homocysteine with mild cognitive impairment in hypertension patients. Methods Data of primary hypertension patients from Department of Neurology of Handan First Hospital between January 2017 and February 2018 were retrospectively analyzed. According to the level of plasma homocysteine (Hcy), the patients were divided into 2 groups: none-H-type hypertension group (Hcy<15 μmmol/L) and H-type hypertension group (Hcy≥15 μmmol/L). The MMSE and MoCA score were used to evaluate the cognitive function of these patients. Spearman correlation analysis was used to determine the relationship between plasma Hcy and MMSE and MoCA, and logistic regression analysis was used to determine the influencing factors for mild cognitive impairment. Results 113 subjects were included, with 49 cases in none-H-type hypertension group and 64 cases in H-type hypertension group. In comparison to none-H-type hypertension group, H-type hypertension group had lower MMSE score (24.94±1.83 vs 27.96±1.54, P <0.001) and MoCA score (23.45±2.47 vs 27.24±1.80, P <0.001). The correlation analysis showed that Hcy level was negatively correlated with the MMSE score (r =-0.513, P <0.001) and MoCA score (r =-0.500, P <0.001). Logistic analysis showed that higher age (OR 1.236, 95%CI 1.124-1.361) and H-type hypertension (OR 22.218, 95%CI 8.243-59.654) were the independent risk factors for cognitive impairment. Conclusions Higher plasma Hcy level was the independent risk factor for mild cognitive impairment in hypertension patients.

Reporting Guidelines for Clinical Trial Reports for Interventions Involving Artificial Intelligence: the CONSORT-AI Extension

Translator: LI Zi-Xiao, XIONG Yun-Yun, DING Ling-Ling, WANG Chun-Juan, WANG Chun-Xue, ZHAO Xing-Quan, WANG Yong-Jun

2020, 15(12):  1327-1336.  DOI: 10.3969/j.issn.1673-5765.2020.12.013

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A Case of Persistent Primitive Hypoglossal Artery Diagnosed by Vascular Ultrasound with Stroke Onset

AN Li-Si, QU Kai, XING Ying-Qi

2020, 15(12):  1337-1341.  DOI: 10.3969/j.issn.1673-5765.2020.12.014

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Advances in Branch Atheromatous Disease

ZHOU Li-Xin, NI Jun

2020, 15(12):  1342-1351.  DOI: 10.3969/j.issn.1673-5765.2020.12.015

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Branch atheromatous disease (BAD), was supposed as one of the important etiology for acute isolated subcortical infarction, especially in Asian population. Compared with classic lacuna infarction due to cerebral small vessel disease, the diameter and morphological distribution of BAD related infarction have certain characteristics. Patients with BAD are more liable to have a fluctuating symptoms or experience early neurological deterioration and may have early poor prognosis. However, due to the fact that the existing imaging techniques cannot depict small vessel changes, the clinical diagnosis and research of BAD are facing challenges. Recently, the application of high resolution and high field magnetic resonance imaging can simultaneously depict the vessel wall of parent artery and the morphology of penetrating artery, which is expected to break through the bottleneck of the research on pathogenesis of BAD. This article reviewed the clinical and imaging features of BAD, diagnosis standards and treatment strategy for BAD, to raise the awareness of this disease for neurologists.

A Review on Risk Factors Associated with Poor Prognosis after Intravenous Thrombolysis in Ischemic Stroke Patients

HUANG Li-Hong, LIU Guang-Wei

2020, 15(12):  1352-1359.  DOI: 10.3969/j.issn.1673-5765.2020.12.016

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Clinical prognosis in patients treated with intravenous thrombolysis is affected by multiple factors, such as: stroke severity, onset to needle time, cerebral small vessel disease, blood sugar level, neutrophil count, platelet count, reperfusion injury and hemorrhage transformation after intravenous thrombolysis. We reviewed the literatures on epidemiology of intravenous thrombolysis, pre- and post-thrombolysis risk factors affecting the prognosis, and related prediction models, to provide theoretical basis and reference for clinical practice.

Analysis on the Teaching Model of Refresher Cerebrovascular Disease Physicians

YE Yu-Mei, XU-Rong,REN-Yi

2020, 15(12):  1360-1362.  DOI: 10.3969/j.issn.1673-5765.2020.12.017

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Advanced education training is an important part of continuing medical education for physicians. Beijing Tiantan Hospital of Capital Medical University attracts a large number of nationwide refresher cerebrovascular disease physicians every year. With the rapid development of new technologies, traditional teaching methods can't meet the clinical needs, many new teaching models have emerged and new technologies have been applied in the teaching.