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    20 June 2013, Volume 8 Issue 06
    Flower in Mist
    WANG Yong-Jun
    2013, 8(06):  419-421. 
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    Controversy and Inspiration of Neuroscience Research in Cerebral Small Vessel Disease
    ZHANG Zai-Qiang, WANG Yong-Jun
    2013, 8(06):  423-425. 
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    A Clinical, Neuro-imaging, Pathological and Gene Analysis of a Patient with Hereditary Angiopathy with Nephropathy, Aneurysm and Cramps Syndrome
    WEI Na, NIU SongTao, LI Wei, ZHANG Zai-Qiang.
    2013, 8(06):  426-431. 
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    【Abstract】 Objective To investigate the clinical manifestation, histopathology, and genotype in a patient with hereditary angiopathy with nephropathy, aneurysm and cramps (HANAC) syndrome. Methods The medical history, family history, neuro-imaging, biopsy of skin and kidney, and COL4A1 gene analysis of the patient were collected. Results A 50-year-old female presented with leukoencephalopathy, nephropathy, and muscle cramps. Histological analysis revealed complex basement-membrane defects in kidney and skin small vessels. Genetic analysis showed COL4A1 mutations localized in exon 1 (A1A/G) which is heterozygous mutation in the start codon. Conclusion The phenotype of COL4A1 mutation in the start codon of exon 1 was HANAC syndrome.

    Study of Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy:MRI, Notch3 Gene and Clinical Features
    LI Wei*, LI ShaoWu, LI Yu-Xiang, NIU Song-Tao, WANG Yong-Jun, ZHANG Zai-Qiang.
    2013, 8(06):  432-436. 
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    【Abstract】 Objective To investigate the MRI and clinical features of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). Methods A retrospective study about 11 inpatients suffered CADASIL was carried out in Beijing Tiantan Hospital from August 2010 to November 2012, which included magnetic resonance imaging (MRI), clinical features, direct sequencing of Notch3 gene and/or skin biopsies of patients. Results The clinical features showed headache was 45.45% (5/11 cases); memory decline was 45.45% (5/11 cases); presence of anxiety and/or depression was 57.14% (4/7 cases). The MRI showed the pontine lesion was 63.63% (7/11 cases); the damage of temporal pole was 54.54% (6/11 cases). Five patients were performed with direct sequencing of Notch3 gene, in which four mutations occurred in exon 4 and one mutation in exon 3. Conclusion The migraine is an important clinical feature of CADASIL patients. Pons is a common damage location in CADASIL patients involved brain stem.

    Association between Uric Acid Level and Intracranial Artery Stenosis
    WAN Xin*, DAI Cheng-Bo, CAO Yu-Min, ZHANG Xiong, ZHANG Yu-Hu, MA Gui-Xian, WANG Shuo, WANG Li-Juan.
    2013, 8(06):  437-442. 
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    【Abstract】 Objective To discuss the association between uric acid (UA) and intracranial artery stenosis in patients with cerebrovascular disease. Methods Clinical data of 509 patients undergoing cerebral angiography were analyzed, and they were separated into four groups according to the findings of cerebral angiography:Intracranial artery stenosis group included 198 patients who had at least one intracranial large artery stenosis more than 50%; Extracranial artery stenosis group included 107 patients who had at least one extracranial large artery stenosis more than 50%; Cerebral artery stenosis group included 55 patients who had both intracranial and extracranial large artery stenosis more than 50%; and the control group included 149 patients who had none cerebral large artery stenosis. The relationship between UA level and intracranial artery stenosis was explored. Results The UA level of intracranial artery stenosis group was significantly higher than that of the control group (P<0.001), and the intracranial artery stenosis group had a marked higher rate of patients who had abnormal UA level (χ2=7.388, P=0.007). The proportion of intracranial artery stenosis patients increased significantly with the increase of UA level (χ2=9.230, P=0.026). Logistic regression analysis shows that UA level is one of the independent risk factors of intracranial artery stenosis (odds ratio[OR]=1.005, P=0.001). The relationship between extracranial artery stenosis and UA was negative. Conclusion The elevated UA level correlates with intracranial artery stenosis and it is an underlying independent risk factor of intracranial artery stenosis.

    Application of 110 mm Volume Helical Shuttle Scanning in Whole Brain Perfusion and Cerebral Vascular Joint Imaging
    GU Wei-Bin*, GAO Pei-Yi, XUE Jing, LIU Yang.
    2013, 8(06):  443-448. 
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    【Abstract】 Objective To discuss the value of GE Discovery CT750 HD 110 mm volume helical shuttle scanning in whole brain perfusion and cerebral vascular joint imaging. Methods Using GE Discovery CT750 HD, after contrast agent injection, volume helical shuttle scanning to the range of 110 mm from the base to top of the head was applied. Whole brain perfusion and cerebral vascular image of 56 patients were constructed. At the same time in the same machine through the conventional scan model, 100 cases of cerebral artery reconstruction, 25 cases of cerebral venous 3D reconstruction imaging, and 80 cases of brain perfusion were selected. All the cases of image mentioned above were used to establish database respectively. For the volume helical scan model, 20 cases of cerebral perfusion images were selected randomly, 20 cases of cerebral arteries reconstructed 3D images and cerebral arteries thin-layer maximum intensity projection(MIP) images were randomly selected in accordance with the random from 44 patients without moyamoya disease, 15 cases were selected from 17 cases of cerebral venous reconstruction images, these images were respectively compared on image quality to the images with the same amount and types selected from the conventional scan model. Then value of application of GE Discovery CT750 HD 110 mm volume helical shuttle scanning in whole brain perfusion and cerebral vascular joint imaging was discussed. Results As to image quality, the difference of brain perfusion and vein reconstruction of volume helical shuttle scanning and conventional scanning pattern had no statistical significance, the scores and statistics results respectively were:brain perfusion image:4.00(3.00, 4.00) vs 4.00(3.00, 4.00), P=0.477, cerebral venous reconstruction image:5.00(4.00, 5.00) vs 4.00(4.00, 5.00), P=0.119. The image quality of cerebral artery thin-section MIP images of volume helical shuttle scanning was better than the conventional scanning mode, the scores and statistics results respectively were:4.00(4.00, 5.00) vs 4.00(4.00, 4.00), P=0.016. The image quality of cerebral artery reconstruction image of volume helical shuttle scanning was worse than the conventional scanning mode, the scores and statistics results respectively were:3.00(3.00, 4.00) vs 4.00(4.00, 5.00), P<0.001. Conclusion GE Discovery CT750 HD 110 mm volume helical shuttle scanning could be effectively used for comprehensive imaging evaluation of cerebrovascular disease patients.

    Cerebrovascular Reactivity Changes in Healthy Adults Rapidly Ascending to High Altitude
    GAO Yan-Qing*, ZHANG Shu-Kun, WU Shi-Zheng.
    2013, 8(06):  449-453. 
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    【Abstract】 Objective To investigate the cerebrovascular reactivity (CVR) changes of healthy individuals after rapidly ascending to high altitude and its underlying mechanisms. Methods CVR of healthy adults who rapidly ascended from 2200 meters above the sea level to 3800 meters was evaluated by transcranial Doppler ultrasound; The plasma level of nitric oxide (NO) was determined by nitrate reduction method; The plasma level of endothelial nitric oxide synthase (eNOS) was determined by enzyme linked immune absorption methods. Results A total of 46 cases were analyzed in our present study. CVR was significantly increased after rapidly ascending to high altitude than before (before ascending to high altitude CVR 1.43± 0.46, cerebrovascular reserve index [CVRI] 1.82± 0.71; after rapidly ascending to high altitude CVR 2.36 ±0.74, CVRI 2.56± 0.89, P<0.001); Plasmic NO (μmol/L) and eNOS (pg/ml) were significantly increased after rapidly ascending to high altitude than before (before ascending to high altitude NO 34.45± 2.86, eNOS 209.73± 14.34; after rapidly ascending to high altitude NO 44.97± 0.68, eNOS 274.81± 13.68, P<0.001); Mean cerebral blood flow velocity of bilateral middle cerebral artery (MCAv) (cm/s) was significantly increased during regular breathing after rapidly ascending to high altitude than before (before ascending to high altitude MCAv 80.85±11.14, after ascending to high altitude MCAv 93.78± 11.67, P<0.001). Conclusion Our study reveals that CVR, plasmic NO, eNOS, and MCAv in healthy adults are increased after they rapidly ascend to high altitude, which are adaptive strategies of brain in high altitude hypoxic environment

    Application of Magnetic Resonance Imaging on Ischemia-reperfusion Rat Models
    HAN Wei*, QING Wen, XUE Rong, YU Chun-Shui, ZHANG Yun-Ting.
    2013, 8(06):  454-458. 
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    【Abstract】 Objective To screen the stable middle cerebral artery occlusion (MCAO) model by magnetic resonance angiography (MRA) and T2 scan, to analyze the characteristics of apparent diffusion coefficient (ADC), fractional anisotropy (FA) change after ischemia-reperfusion injury. Methods The MCAO model of SD rat was made. Those rats were divided into sham-operation group, permanent middle cerebral artery occlusion (pMCAO) group, and transient middle cerebral artery occlusion (tMCAO) group according to cerebral artery reperfusion and occlusion. Each experiment group has nine rats, and the control group has 2 rats. MRA T2, diffusion weighted imaging (DWI), diffusion tensor imaging (DTI) by 3.0-T magnetic resonance imaging (MRI) clinical scanner were applied when the unilateral middle cerebral artery was occluded and reopened. After scanning, reconstruct the cerebral vessel and calculate the relative ADC value and FA value, and compare relative ADC value and FA value of two groups. Results The occlusion and reperfusion of rat's cerebral vessel was clearly demonstrated by MRA and subarachnoid hemorrhage was observed on T2. Intensity signal in maps of ADC and FA of pMCAO was higher than that of tMCAO(0.657±0.140 vs 0.588±0.132, trADC=2.27, P=0.048; 1.010±0.143 vs 0.915+0.111, trFA=2.89, P=0.02). Conclusion The stable MCAO model can be screened out by MRA and T2, and rADC value and rFA values of pMCAO group are higher than those of tMCAO group.

    Clinical Analysis of the Relationship between Vascular Cognitive Impairment and Infarction Locations and White Matter Lesions at Early Stages of Acute Cerebral Infarction
    ZHANG Juan, LI Jian, CHEN Wen-Rui, MENG Xiang-Yu, HU Wen-Li.
    2013, 8(06):  459-463. 
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    【Abstract】 Objective To analyze the influences of infarction locations and white matter lesions on vascular cognitive impairment (VCI) of acute cerebral infarction patients at their early stages. Methods Consecutive acute cerebral infarction patients underwent Clinical Dementia Rating (CDR), Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). Analyses were performed to study the association between cognitive impairment and infarction locations including cortical infarction, subcortical critical site infarction, subcortical non-critical site infarction and white matter lesions including leukoaraiosis and non-leukoaraiosis. Results The mean age of cognitive impaired patients was significantly higher than that of normal cognition patients (67.31 10.88 vs 57.09 9.91, P=0.015). The mean score of National Institute of Health Stroke Scale (NIHSS) of cognitive impaired patients was significantly higher than that of normal cognition patients (3.0[2.0~4.0] vs 1.0[1.0~2.0], P=0.012). The mean score of Barthel index of cognitive impaired patients was significantly lower than that of normal cognition patients (81.67 23.55 vs 95.91 12.00, P=0.029). There was significant difference in infarction locations between two groups of patients (P=0.042). Cortical infarction was more popular in vascular cognitive impaired patients. The mean score of the domain of visuospatial executive function in the cortical stroke patients was significantly lower than that of subcortical non-coritical site stroke ones (1.5[0.0~3.0] vs 3.0[2.0~4.0], P=0.016). White matter lesions have no significant relationship with VCI. Conclusion Age, severe neurological deficits, cortical infarcton and ability of daily life were highly related with cognitive impairment of the acute cerebral infarction patients.

    Ultrasound Characteristics of Left Atrium in Stroke of Undetermined Cause
    DU Li-Juan, HE Wen, HUANG Wen-Yang, ZHANG Hui-Qin, WEI Dong-Mei.
    2013, 8(06):  464-468. 
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    【Abstract】 Objective To investigate the left atrial (LA) structure and function in stroke of undetermined cause by echocardiography. Methods Thirty-six consecutive patients with stroke of undetermined cause and thirty-five healthy cases were involved. LA size, area, LA ejection fraction and LA pressure were measured and compared between both groups by echocardiography. Results There were no statistical differences in LA diameter and LA size between both groups (P=0.811 and P=0.542, respectively). LA ejection fraction of stroke group was lower than that of the control group ( [61.13 ±11.42]% vs [65.15± 10.12]%, P=0.043). LA pressure in stroke group was higher than that in the control group ([98.76± 21.89]mmHg vs [75.37 ±26.98] mmHg, P=0.0414), while LA central blood flow velocity was lower than that of the control group ([57.50 ±4.03] cm/s vs [66.56± 10.59] cm/s, P=0.035). Conclusion Abnormal function of the left atrium exists in stroke of undetermined cause.

    Speical Reviews: Cerebral Small Vessel Disease
    2013, 8(06):  469-469. 
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    Vascular Pathology and its Sequelae in Cerebral Small Vessel Disease
    ZHANG Zai-Qiang
    2013, 8(06):  470-476. 
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    Intracranial Arterial Dolichoectasia Combined with Small-Vessel Disease:a Case Report
    DUAN Wan-Ying, ZHANG Zai-Qiang
    2013, 8(06):  477-480. 
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    Guidelines for the Early Management of Patients With Acute Ischemic Stroke (Part 2)
    BAO Huan, HU Hui, WANG Xuan, et al.
    2013, 8(06):  481-485. 
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    Monogenic Hereditary Cerebral Vascular Disease:A Multisystem Genetic Disease
    LI Wei*, ZHANG Zai-Qiang, LI Shao-Wu, LI Yu-Xiang, WANG Yong-Jun.
    2013, 8(06):  486-490. 
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    【Abstract】 Monogenic cerebral small vessel disease is a kind of single-gene inherited disease which manifests clinical spectrums involving multiple systems, and cerebral small vessel disease is a common characteristic. The pathogenic genes, mutations, gene phenotypes and clinical spectrums of the major single-gene hereditary cerebral small vessel diseases are the key to diagnosis, and the comprehensive understanding of those elements is the basis to further study these diseases.

    Progress of Clinical Research of Leukoaraiosis
    ZHAO Ping, WANG Chun-Xue, ZHANG Yu-Mei, SHI Qing-Li
    2013, 8(06):  491-495. 
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    【Abstract】 The previous studies suggested that leukoaraiosis(LA) may be associated with older age, hypertension, diabetes, hyperhomocysteinemia and other risk factors. There is no clear conclusion about specific correlation. Researches on the pathogenesis of LA mainly focus on low perfusion, destruction of blood-brain barrier, while studies about the gene of LA are also one of the hot spots. But all of this lack of recognized and positive findings. This article reviews the advances and controversies of risk factors and pathogenesis of LA.

    Name Evolution of Posterior Circulation Ischemia and Its Treatment Progress
    JIANG Wei*, ZHAO Xiao-Feng, MENG Zhi-Hong.
    2013, 8(06):  496-500. 
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    【Abstract】 The concept of posterior circulation ischemia(PCI) is gradually accepted by clinical physicians and they pay more attention to its treatment. But it is still lack of large sample randomized controlled studies for PCI. In addition to the routine drug treatment, patients with PCI can benefit from thrombolysis and interventional therapy. But no more research reports on surgical treatment. We searched large number of literature to review the name evolution of PCI and summarize its new development treatment.

    Teaching Method of “Problem-Based Learning” Practicng in Community Hospital
    WANG De-Zhao
    2013, 8(06):  501-502. 
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