Chinese Journal of Stroke

Advances in Drugs Treatment of Cognitive Dysfunction after Intracerebral Hemorrhage of Different Etiologies

HUANG Yan, HUANG Ying, ZOU Liang-Yu

2021, 16(04): 321-325. DOI: 10.3969/j.issn.1673-5765.2021.04.001

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Progress of Relationship between Cerebral Microbleeds and Alzheimer's Disease

LIAO Yi-Fei, ZHANG Hui,ZOU Liang-Yu

2021, 16(04): 327-330. DOI: 10.3969/j.issn.1673-5765.2021.04.002

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Cerebral microbleed (CMB) is a circular or elliptical low-density lesion with a diameter of 2-10 mm, with no edema around the lesion, which can be found by T2 * GRE or SWI. CMB is a pathological change of cerebral small vessel disease. With the development of imaging technology, the detection rate of CMB in Alzheimer's disease (AD) is increasing. The incidence of CMBs in AD patients is higher than that in the healthy and dementia patients, and the CMBs in AD patients mainly located in brain lobes. CMBs play a role in the progression of AD by involving intracranial amyloidosis and neuronal degeneration, being associated with APOE gene, and affecting the blood-brain barrier.

Dementia due to Bilateral Thalamic Lesions Caused by Thalamic Arteriovenous Malformation: A Case Report

ZHANG Hui, LIAO Yi-Fei, SHI Xue, ZOU Liang-Yu

2021, 16(04): 331-334. DOI: 10.3969/j.issn.1673-5765.2021.04.003

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Correlation between Cerebral Microbleeds and the Volume of Basal Ganglia Nuclei in Community-based Population

SU Ning, WANG Quan, LIANG Xin-Yu, HAN Fei, ZHOU Li-Xin, YAO Ming, CUI Li-Ying, GONG Gao-Lang, ZHU Yi-Cheng, NI Jun

2021, 16(04): 335-342. DOI: 10.3969/j.issn.1673-5765.2021.04.004

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Objective To investigate the association of the burden and anatomical location of cerebral microbleeds (CMBs) with the volume of basal ganglia (BG) nuclei in community-dwelling population. Methods An epidemiological survey on neurovascular disease was performed in five villages of Shunyi district in Beijing from June 2013 to April 2016. The general demographic information and risk factors of cerebrovascular disease were collected. The volume of the whole brain was collected, and the volume of BG nulei (caudate nucleus, globus pallidus, putamen and thalamus) were automatically segmented and extracted by 3T MRI. Meanwhile, the burden and location of CMBs were evaluated by neurologists. Multivariate linear model was used to analyze the correlation of the burden and distribution of CMBs (the absence of CMBs, 1-2 strictly lobar CMBs, ≥3 strictly lobar CMBs, 1-2 deep/mixed CMBs, ≥3 deep/mixed CMBs) with the volume of BG nuclei. Results A total of 997 subjects were included, with an average age of 56.7±9.3 years old and 346 males (34.7%). The percentage of the volume of BG, globus pallidus, putamen and thalamus in the whole brain in CMBs group were all significantly lower than that in no CMBs group. With the increasing burden of CMBs, the percentage of the volume of BG, globus pallidus, putamen and thalamus in the whole brain decreased (all P <0.05). There was statistical difference in the percentage of the volume of BG, globus pallidus, putamen and thalamus in the whole brain among the three CMBs subgroups. Multivariate linear analysis showed that ≥3 deep/mixed CMBs was negatively correlated with pallidal volume (β =-0.014, P =0.0027). Conclusions In community-dwelling population, higher deep/mixed CMBs burden was closely related to the smaller pallidal volume.

Hydroxy Safflower Yellow in Acute Cerebral Infarction with Myocardial Ischemia: A Randomized, Open Label and Controlled Study

WEI Wei, ZHANG Xiang-Jian, XIAO Bao-Guo, TAI Li-Wen, MA Xing-Guang, HUANG Yong-Hua,WANG Hai-Xia, YANG Qian, ZHANG Wei-Wei

2021, 16(04): 343-347. DOI: 10.3969/j.issn.1673-5765.2021.04.005

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Objective To observe the efficacy of hydroxy safflower yellow in acute cerebral infarction with myocardial ischemia. Methods This prospective multicenter study enrolled the hospitalized patients with acute cerebral infarction and myocardial ischemia who were admitted to Department of Neurology of Chinese PLA General Hospital No.7 Medical Center and the Second Hospital of Hebei Medical University from April 2016 to December 2017. All the patients were randomizely divided into the observation group (conventional treatment and hydroxy safflower yellow) and control group (conventional treatment). The primary outcomes included mRS score at 14 and 90 days and electrocardiogram (ECG) myocardial ischemia improvement. Secondary outcomes included NIHSS score at 14, 28 and 90 days after enrollment. Results A total of 144 cases were enrolled, and 122 cases were included in the final analysis, including 62 cases in observation group and 60 cases in control group. The mRS at 14 days (P <0.0001) and 90 days (P <0.0001) in observation group was better than that in control group. The improvement rate of ECG at 14 days (92.7% vs 75.0%, P =0.0113) and 90 days (90.3% vs 58.3%, P <0.001) in observation group was higher than that in control group. There was no statistical difference in the NIHSS score at 14 days between the two groups (P =0.0001) , while the NIHSS at 28 and 90 days in observation group were lower than that in control group. Conclusions Hydroxy safflower yellow injection combined with conventional treatment had a definite clinical effect on acute cerebral infarction with myocardial ischemia.

Analysis of Feasibility of Endovascular Therapy for Non-acute Intracranial Anterior Circulation Large Vessel Occlusion

LI Guang-Wen, LIU Peng, GONG Wen-Tao, LIU Tong-Hui, SUN Yu-Jie, ZHANG Xian-Jun, ZHANG Yong

2021, 16(04): 348-353. DOI: 10.3969/j.issn.1673-5765.2021.04.006

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Objective To explore the feasibility and effectiveness of endovascular therapy for symptomatic non-acute intracranial anterior circulation large artery occlusion. Methods The data of patients with non-acute intracranial anterior circulation large artery occlusion who underwent endovascular treatment in Department of Neurology of the Affiliated Hospital of Qingdao University from January 2016 to October 2019 were retrospectively analyzed. The recanalization rate, postoperative complications, clinical prognosis (including mRS score, restenosis and ischemic events) were evaluated. Results A total of 22 patients were included. 20 cases (90.9%) achieved successfully recanalization. 3 cases (13.6%) had postoperative complications, including one case with intraoperative subarachnoid hemorrhage, one case with hemorrhagic transformation and one case with epileptic seizure. For the patients who achieved successful recanalization, 7 patients underwent balloon angioplasty, and the rate of moderate residual stenosis was 12.4% (8.6%-20.5%); 10 patients underwent balloon angioplasty and self-expanding stenting, and the rate of moderate residual stenosis was 10.4% (6.2%-17.8%); there was no statistical difference in the rate of residual stenosis between the two treatment methods. After successful recanalization, the clinical symptoms improved in 8 cases (40.0%) and no change in 12 cases (60.0%) and no worsen case. 12 cases (60.0%) had a mRS score of 0-1 within the follow-up of 19 (12-29) months, 1 case (5.0%) had recurrent TIA due to in-stent restenosis, and the symptoms improved after balloon dilatation. Conclusions Endovascular therapy for symptomatic non-acute intracranial anterior circulation large artery occlusion is safe and feasible, which can improve ischemic symptoms and reduce the risk of recurrent stroke.

The Application of Intermittent Oro-Esophageal Tube Feeding in Acute Stroke Patients with Dysphagia

LIU Yao,QIAO Li, LIU Heng-Jun, HE Fei, XU Peng

2021, 16(04): 354-359. DOI: 10.3969/j.issn.1673-5765.2021.04.007

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Objective To evaluate the application effacy of intermittent oro-esophageal tube feeding (IOE) in acute stroke patients with dysphagia. Methods This prospective randomized controlled trial enrolled acute stroke patients complicated with dysphagia who were admitted to Department of Emergency of Nanjing Drum Tower Hospital from January 2018 to September 2020. All the patients were randomly divided into nasogastric feeding group and IOE group. Water swallow test and standardized swallowing assessment (SSA) were used to evaluate the swallowing function of all the patients at admission and discharge. The BMI, hemoglobin (Hb), albumin (ALB) and prealbumin (PA) of all the patients were collected. Meanwhile, the length of stay, aspiration pneumonia, peptic ulcer, constipation, diarrhea, vomiting and mucosa injury of mouth and nose were compared between the two groups. Results 126 acute stroke patients were included for analysis finally, with 62 cases in nasogastric feeding group and 64 in IOE group. Although the number of patients with dysphagia grade 1 and 2 in IOE group was higher than that in nasogastric feeding group at discharge, there was no statistical difference. The improvement of SSA score in IOE group was better than that in nasogastric feeding group (24.88±3.07 vs 28.87±3.04, P <0.001). For nutritional state, the level of ALB (37.40±4.40 g/L vs 35.31±3.32 g/L, P =0.003), PA (0.28±0.04 g/L vs 0.24±0.03 g/L, P <0.001) and Hb (127.60±6.93 vs 124.76±6.69 g/L, P =0.021) were all higher in IOE group than in nasogastric feeding group at discharge; the incidence of aspiration pneumonia (4.69% vs 22.58%, P =0.007), vomiting (3.13% vs 25.81%, P =0.001) and mucosa injury of mouth and nose (0 vs 17.74%, P =0.001) and the length of stay (median: 15 days vs 17 days, P =0.029) in IOE group were all lower than that in nasogastric feeding group. Conclusions IOE could provide appropriate nutrition support and improve swallowing function in acute stroke patients with dysphagia, and reduce the incidence of the complications of aspiration pneumonia, vomiting and mucosa injury of mouth and nose.

Prognosis and Recurrence of Ischemic Stroke under Stroke Management Model Guided by Stroke Health Manager

PAN Xin, GUO Na-Na, XUE Wei, LI Yi-Cai, LIU Jun-Ling, LI Xue-Mei

2021, 16(04): 360-365. DOI: 10.3969/j.issn.1673-5765.2021.04.008

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Objective To explore the effect of stroke management model guided by stroke health managers based on patients' needs on the prognosis and recurrence of mild to moderate ischemic stroke. Methods The patients with mild to moderate ischemic stroke from January to June 2019 were randomly divided into control group and observational group. The routine stroke management was adopted in control group, and the stroke health manager-guided management model based on patient’s needs was adopted in observational group. The blood pressure, fasting blood glucose, LDL-C level, NIHSS score, stroke recurrence rate, basic self-care rate (modified Barthel index>80) rate and good prognosis (mRS≤2) rate were compared between the two groups at 12-month follow-up. Results Finally, 101 cases in control group and 105 ones in observational group were included. There was no statistical difference in baseline data between the two groups. At the 12-month followup, the systolic blood pressure (P <0.001), diastolic blood pressure (P =0.002), fasting blood glucose (P <0.001) and LDL-C level (P <0.001) in observational group were all lower than those in control group, while NIHSS score (median, 2 vs 3, P =0.041) and stroke recurrence rate (8.6% vs 18.8%, P =0.032) were lower than that in control group. In addition, the basic self-care rate (87.6% vs 75.2%, P =0.022) and good prognosis rate (81.9% vs 69.3%, P =0.035) in observational group were higher than that in control group. Conclusions The stroke health manager-guided management model based on patient’s needs can better control stroke risk factors, significantly improve the prognosis of patients with mild to moderate ischemic stroke, and reduce the disability rate and stroke recurrence rate.

Analysis of Risk Factors for Ischemic Stroke-associated Pneumonia

SUN Yue, CHEN Yi-Tong, LI Xing, ZHANG Run-Hua

2021, 16(04): 366-370. DOI: 10.3969/j.issn.1673-5765.2021.04.009

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Objective To analyze the risk factors for stroke-associated pneumonia. Methods The patients with acute ischemic stroke (AIS) who were consecutively admitted to Beijing Tiantan Hospital from May 2014 to May 2016 were included in this retrospective study. According to whether they developed new-onset pneumonia within 7 days of stroke onset, all the patients were divided into stroke-associated pneumonia group and non-pneumonia group. The vascular risk factors and NIHSS at admission were compared between the two groups, and multivariate logistic regression analysis was used to analyze the risk factors for stroke-associated pneumonia. Results A total of 1129 patients were included, including 1043 patients in non-pneumonia group and 86 patients in stroke-associated pneumonia group. Multivariate analysis showed that elder age (OR 1.084, 95%CI 1.047-1.122, P <0.0001), NIHSS at admission (OR 1.192, 95%CI 1.133-1.254, P <0.0001), increased white blood cells count (OR 1.269, 95%CI 1.134-1.420, P <0.0001) and long hospital stay (OR 1.146, 95%CI 1.087-1.208, P <0.0001) were independent risk factors for strokeassociated pneumonia. Conclusions Acute ischemic stroke-associated pneumonia were associated with elder age, severe neurological impairment, increased white blood cells count and long hospital stay.

Correlation between Serum Brain Derived Neurotrophic Factor Level and Cognitive Impairment due to Cerebral Small Vessel Disease

MENG Li-Fang, PENG Xue, LIU Hao, WANG Jin, LIU Jun-Li, JIA Xiang-Lei, ZHAO Pan-Pan,WANG Fan, WANG Chao-Wei, ZHANG Li-Jun, LI Qing, JI Si-Bei, YUAN Bin, CAI Rui-Yan, YANG Ru, LI Shao-Min,ZHAO Jian-Hua

2021, 16(04): 371-375. DOI: 10.3969/j.issn.1673-5765.2021.04.010

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Objective To explore the relationship between the level of serum brain derived neurotrophic factor (BDNF) and cognitive impairment due to cerebral small vessel disease (CSVD). Methods The prospective study enrolled the patients with CSVD who were consecutively admitted to the First Affiliated Hospital of Xinxiang Medical University from April 2019 to April 2020. According to the MMSE score, all the patients were divided into normal cognitive function group (27-30 points), mild cognitive impairment group (21-26 points) and moderate cognitive impairment group (10-20 points). The baseline data and serum BDNF level were compared among the three groups, and the correlation between the level of serum BDNF and cognitive function was analyzed. Results A total of 60 patients with CSVD were included, with an average age of 60.6±10.5 years old and 38 males (63.3%), and including 21 (35.0%) cases with normal cognitive function, 24 (40.0%) with mild cognitive impairment and 15 (25.0%) with moderate cognitive impairment. There were statistical differences in age, education attainment and the level of serum BDNF among the three groups. The Pearson correlation analysis showed that the level of serum BDNF and educational attainment were both positively correlated with MMSE score (r =0.499, P =0.043; r =0.516, P <0.001), while the age was negatively correlated with MMSE score (r =-0.577, P <0.001). Conclusions The level of serum BDNF was correlated with cognitive impairment due to cerebrovascular disease. The lower the serum BDNF level, the more severe the cognitive impairment.

Experts Consensus on Post-stroke Cognitive Impairment Management 2021

Chinese Society of Vascular Cognitive Impairment

2021, 16(04): 376-389. DOI: 10.3969/j.issn.1673-5765.2021.04.011

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WHO Guidelines on Physical Activity and Sedentary Behaviour

Translator: WANG Rui-Qing, KONG Xian-Fei,ZHANG Hua, FANG Jun, ZHANG Long-You, WANG Chun-Xue, ZHENG Hua-Guang, YANG Hai-Bin, WANG Yong-Jun

2021, 16(04): 390-397. DOI: 10.3969/j.issn.1673-5765.2021.04.012

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