Chinese Journal of Stroke

The Doctor's Degree

WANG Yong-Jun

2013, 8(08): 597-598.

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Preventive Strategy for Hypertension:up to the Standard and the Management of Blood Pressure

SUN Ning-Ling

2013, 8(08): 599-602.

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Association of Morning Blood Pressure Surge with Carotid Artery Plaque Ulceration in Ischemic Stroke Patients with Pathogenesis of Artery to Artery Embolism

CHENG Wei*, BAO Yan-Er, NIE Li, LI Wan-Qiu, QIAO Xiang-Liang, CHENG Xiao-Ling.

2013, 8(08): 603-607.

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【Abstract】 Objective To investigate the association of morning blood pressure surge (MBPS) with carotid artery plaque ulceration (CAPU) in ischemic stroke (IS) patients. Methods One hundred and twenty IS patients diagnosed with artery to artery embolism based on Chinese Ischemic Stroke Subclassification (CISS) were enrolled in this study. MBPS was monitored by ambulatory blood pressure monitoring within 24 hours, and CAPU was examined by carotid ultrasonography. The association of MBPS with CAPU was evaluated by the Logistic regression model. Results The mean age of the total 120 IS patients was (62.6±12.8) years old, and 36.8% was female. Compared with the MBPS- group (n=72), the MBPS+ group (n=48) did not have higher detection rate of CAPU (31.3% vs 30.6%, P=0.84). After separation of ipsilateral CAPU and contralateral CAPU, we found the detection rate was higher in MBPS+ group than MBPS- group (27.1% vs 19.4%, P=0.008). The multivariate analysis showed that MBPS was associated with ipsilateral CAPU (odds ratio[OR], 1.42; 95%confidence interval[CI], 1.09~4.22) after adjusting for age and sex. The association still existed after further adjusting for other risk factors (OR 1.23; 95%CI 1.02~3.46). Conclusion MBPS is associated with ipsilateral CAPU in the IS patients with pathogenesis of artery to artery embolism, which implies that higher MBPS may contribute to the fall of plaque that led to the occurrence of artery to artery embolism.

Analysis of Diffusion-weighted Imaging Abnormality in Acute Spontaneous Intracerebral Hemorrhage

LIU Yan-Fang, BIAN Li-Heng, ZHANG Ning.

2013, 8(08): 608-613.

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【Abstract】 Objective To determine the prevalence of diffusion-weighted imaging (DWI) abnormality in a cohort of spontaneous intracerebral hemorrhage (sICH) patients and to analyse its effects on clinical outcomes of 90 days. Methods In our prospective cohort study, patients with sICH within 24 hours were enrolled and had done magnetic resonance imaging (MRI) within 72 hours, and their clinical, imaging and laboratory data were collected. Multivariate Logistic regression analysis was used to analyse the risk factors of signal abnormalities in DWI and the associations between signal abnormalities in DWI and clinical outcomes of 90 days. Results There were totally 93 patients with sICH enrolled in our study. Eleven patients (11.8%) had abnormal signal in DWI, and located at the cortex, subcortex, or asymptomatic (accounting for 90.9%). The risk factors associated with signal abnormalities in DWI were: the number of microbleeds (odds ratio[OR] 1.08; 95% confidence interval[CI] 1.00~1.17; P=0.04), position of hemorrhage (OR 5.84; 95%CI 1.27~26.96; P=0.02), and higher mean arterial pressure (MAP) at 72 hours (OR 0.94; 95%CI 0.88~0.99; P=0.04). The occurrence of signal abnormalities in DWI in acute phase of sICH had no relationship with short-term (90 days) outcomes (P=0.74). Conclusion Signal abnormalities in DWI can occur in acute phase of sICH. Positions of hemorrhage, microbleeds and MAP within 72 hours are associated with it, but it has no relationship with short-term (90 days) outcomes.

Diffusion Tensor Imaging Analysis of Association Fibers in Patients with Subcortical Ischemic Vascular Disease and Correlations with Cognitive Function

LIN Lin, XUE Yun-Jing, DUAN Qing, KANG Zheng-Wu, LIN Hai-Long, SUN Bin.

2013, 8(08): 614-621.

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【Abstract】 Objective To investigate microstructure changes of association fibers in subcortical ischemic vascular disease (SIVD) patients using atlas-based analyses (ABA) of diffusion tensor imaging (DTI) and clinical correlations of ischemic changes. Methods Forty SIVD patients (18 vascular cognitive impairment [VCI] patients and 22 non-cognitive impairment [NCI] patients) and 20 normal controls were performed with neuropsychological tests and 3-Tesla magnetic resonance imaging (MRI) including DTI scans. The rating score of white matter change, ABA of the fractional anisotropy (FA) and mean diffusivity (MD) were computed. The correlation between DTI parameters and Montreal Cognitive Assessment (MoCA) scores were evaluated. Results Compared with NCI group, VCI group patients had lower FA value and higher MD value in bilateral sagittal stratum (inferior longitudinal fasciculus/inferior fronto-occipital fasciculus), cingulate gyrus (cingulum), hippocampus (cingulum), superior longitudinal fasciculus, superior fronto-occipital fasciculus, uncinate fasciculus. However, the rating score of white matter change showed no significant difference. In addition, MoCA scores of SIVD patients positively correlated with FA values and negatively correlated with MD values of association fibers, including bilateral sagittal stratum (inferior longitudinal fasciculus/inferior fronto-occipital fasciculus), cingulate gyrus (cingulum), superior longitudinal fasciculus, superior fronto-occipital fasciculus, uncinate fasciculus and left hippocampus (cingulum). Conclusion FA values increase and MD values decrease in association fibers of SIVD patients. Moreover, it is significantly related with cognitive function.

Nature History and Predictive Factors of Perihematomal Edema after Intracerebral Hemorrhage

WANG Wen-Juan, LU Jing-Jing, BIAN Li-Heng, ZHAO Xing-Quan.

2013, 8(08): 631-636.

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【Abstract】 Objective To evaluate the nature history of perihematomal edema (PHE) in intracerebral hemorrhage (ICH) patients using X-ray computed tomography (CT), to analyze the predictive factors of the severity of initial and peak PHE, and to explore the relationship between PHE and clinical outcome. Methods It was a retrospective study of consecutive patients with ICH admitted to Beijing Tiantan Hospital from October 2009 to November 2011. Medical records, laboratory data, and CT scan were performed at admission. On (12±2) days after ICH, CT angiography and venography were given to analyze peak edema and cerebral vascular system. Neurologic assessments were performed at admission, patient discharge and 3 months after ICH. Results Among 51 patients enrolled, there were 36 cases of basal ganglia hemorrhage, 7 cases of thalamus hemorrhage and 8 cases of lobar hemorrhage. According to our study, baseline hematoma volume was the only correlation factor of baseline edema volume (r=0.799, P＜0.001) and antiplatelet use on admission is associated with more severe relative baseline edema (r=-2.456, P=0.014). Peak edema volume had a positive correlation with both baseline edema (r=0.720, P＜0.001) and hematoma volume and peak hematoma volume (r=0.788, P＜0.001). Peak edema index is only related with baseline edema index (r=0.357, P=0.010). This study revealed significant relationship between the baseline/peak edema volume and acute clinical deterioration/modified Rankin Scale (mRS) and National Institutes of Health Stroke Scale (NIHSS) on discharge and 90 days of onset, but failed to find correlations between baseline/peak edema index and clinical outcomes. Conclusion Antiplatelet use on admission is associated with more severe relative baseline edema. Acute clinical deterioration and long-term functional outcome after ICH are only correlated to initial absolute PHE severity.

Effects of Large Doses of Hyperbaric Oxygen on Nuclear Factor-κB Activity of Brain Tissue of Acute Permanent Middle Cerebral Artery Occlusion in Rats

LIU Ya-Ling*, WANG Chun-Juan, ZHANG Hong-Xia,YU Qiu-Hong, XUE Lian-Bi.

2013, 8(08): 637-642.

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【Abstract】 Objective To investigate the effects of large doses of hyperbaric oxygen (HBO) on acute permanent middle cerebral artery occlusion (PMCAO) in rats and to examine whether hyperbaric oxygen treatment (HBOT) could influence NF-κB deoxyribonucleic acid (DNA) binding activity of peri-infarction region of brain tissue. Methods Sprague-Dawley rats were randomized to HBO group, control group, and sham group (n=32). HBO group and control group underwent PMCAO surgery. HBOT began 5 h after surgery. HBOT was delivered at a dose of 2 absolute atmosphere (ATA) for 90 min. Control animals were exposed to air at ambient room pressure. Other rats underwent sham surgery. Neurological outcome was measured at 24 h and 5 d after surgery using Garcia score. 2, 3, 5-triphenyltetrazolium chlorid (TTC) pathological staining and Image J software were used to determine infarction volume at the point of 24 h, 5 d after surgery. NF-κB DNA binding activity of brain tissue was investigated at 24 h, 5 d after surgery using electrophoretic mobility shift assay (EMSA). Results Garcia score of HBO group at the point of 24 h after PMCAO was significantly higher than that of control group ([13.33±1.53] vs [10.33±0.58], P<0.001). Infarction volume of HBO group at the point of 24 h was smaller than that of control group ([139.73±33.59] vs [203.02±57.66], P=0.008). The gray level of NF-κB of HBO group at 5 d after PMCAO was lower than that of control group ([16.01±4.56] vs [50.28±9.13], P=0.035). Conclusion Large doses of hyperbaric oxygen could protect ischemic brain tissue at 24 h after surgery. Large doses of hyperbaric oxygen could decrease NF-κB DNA binding activity of periinfarction region of brain tissue.

Hypertension Management in Stroke

2013, 8(08): 642-642.

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