Chinese Journal of Stroke

Like Wakening from a Dream

WANG Yong-Jun

2013, 8(09): 689-691.

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Research Status of Relationship between Sleep Apnea Hypopnea Syndrome and Stroke

YU Feng-Chun

2013, 8(09): 693-696.

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Discussion about the Relationship of Obstructive Sleep Apnea Hypopnea Syndromes with the Recurrence of Non-cardiac Ischemic Stroke

ZHOU Zheng-Hong, YU Feng-Chun, MENG Xiao-Mei, LIU Yong-Zhen.

2013, 8(09): 697-702.

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【Abstract】 Objective To explore the relationship of the recurrence of non-cardiac ischemic stroke with the severity of obstructive sleep apnea-hypopnea syndromes (OSAHS). Methods In our prospective observational study, we enrolled 227 patients hospitalized in the Department of Neurology, Beijing Haidian Hospital from March 2008 to July 2011. According to apnea hypopnea index (AHI), these patients were divided into four groups:pure non-cardiac ischemic stroke group (group Ⅰ, n=52), non-cardiac ischemic stroke combined with mild OSAHS group (group Ⅱ, n=60), non-cardiac ischemic stroke combined with moderate OSAHS group (group Ⅲ, n=59), and non-cardiac ischemic stroke combined with severe OSAHS group (group Ⅳ, n=56). Then we collected the baseline information, recorded other related risk factors (such as hypertension, smoking history), and kept the results of polysomnography. The patients were followed up after 12 months. The amounts of ischemic stroke recurrence events and the influencing factors were compared with the results taken previously among different groups using Logistic regression analysis. Results The recurrence rates of pure non-cardiac ischemic stroke group, non-cardiac ischemic stroke combined with mild OSAHS group, non-cardiac ischemic stroke combined with moderate OSAHS group, non-cardiac ischemic stroke combined with severe OSAHS group after one year were 3.8%, 5.0%, 11.9%, and 16.4%, respectively. The statistics results show that the number of non-cardiac ischemic stroke combined with severe OSAHS group's ischemic stroke recurrence events is with significant difference compared with both pure non-cardiac ischemic stroke group and non-cardiac ischemic stroke combined with mild OSAHS group (P=0.033, 0.046). While there is no significant difference observed among the other groups (P=0.768, 1.177, 0.490, 0.123). According to the Logistic regression analysis, it shows that body mass index (BMI) (odds ratios [OR] 3.126, 95% confidence interval [CI] 2.079~4.700, P<0.001), hypertension (OR 3.258, 95%CI 1.308~8.111, P=0.011), AHI(OR 1.071, 95%CI 1.038~1.105, P<0.001), SaO2 (OR 0.907, 95%CI 0.848~0.969, P=0.004) are related with the recurrence of ischemic stroke, which are also the independent risk factors at the same time. Conclusion OSAHS, obesity and hypertension are the possible independent risk factors led to the recurrence of non-cardiac ischemic stroke.

Management and Variables Associated with Case Fatality of Intracerebral Haemorrhage in China

WANG Wen-Juan, WANG Chun-Xue, YANG Zhong-Hua, LIU Li-Ping, LU Jing-Jing, WANG An-Xin, ZHAO Xing-Quan.

2013, 8(09): 703-711.

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【Abstract】 Objective To systematically analyze the risk factors associated with 3-month, 1-year case fatality of intracerebral hemorrhage in China. Methods China National Stroke Registry (CNSR) is a national prospective registry study. A total of 132 hospitals representing 27 provinces, 4 municipalities and Hong Kong in China have been selected as the study sites. From September 2007 to August 2008, ICH patients presenting within 14 days after the onset of symptoms were registered in the CNSR. Data on demographics, treatment patterns and outcome of the ICH patients were analyzed. Cox proportional hazards model was used to determine the risk factors of 3-month and 1-year case fatality.

Results ICH case fatality was 20.0% and 26.1% at 3-month and 1-year, respectively. Antihypertensive therapy in hospital was associated with decreased 3-month (hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.66~0.95) and 1-year (HR 0.84, 95%CI 0.72~0.98)case fatality. Age (3-month [66~75 years old:HR 1.54, 95%CI 1.08~2.20; ≥76 years old:HR 2.13, 95%CI 1.49~3.04]; 1-year [66~75 years old:HR 1.62, 95%CI 1.19~2.21; ≥76 years old:HR 2.43, 95%CI 1.78~3.31]), Glasgow Coma Score (GCS) at admission (3-month [9~12:HR 2.36, 95%CI 1.66~3.36; 3~8:HR 5.11, 95%CI 3.67~7.11]; 1-year [9~12:HR 2.23, 95%CI 1.67~2.97;3~8:HR 4.41, 95%CI 3.36~5.77]), National Institutes of Health Stroke Scale (NIHSS) at admission≥15 (3-month:HR 1.74, 95%CI 1.28~2.38; 1-year:HR 1.70, 95%CI 1.31~2.22), serum glucose at admission (3-month:HR 1.06, 95%CI 1.01~1.10; 1-year:HR 1.05, 95%CI 1.02~1.09), hematoma volume (3-month [supratentorial 30~60 ml:HR 1.57, 95%CI 1.22~2.02; supratentorial>60 ml:HR 2.42, 95%CI 1.86~3.14; subtentorial ≤10 ml:HR 2.07, 95%CI 1.51~2.85; subtentorial 10~20 ml:HR 2.70, 95%CI 1.64~4.45; subtentorial>20 ml:HR 2.40, 95%CI 1.41~4.09]; 1-year [supratentorial 30~60 ml:HR 1.55, 95%CI 1.24~1.93; supratentorial>60 ml:HR 2.48, 95%CI 1.96~3.14; subtentorial≤10 ml:HR 1.86, 95%CI 1.41~2.46; subtentorial 10~20 ml:HR 2.38, 95%CI 1.53~3.72; subtentorial >20 ml:HR 2.42, 95%CI 1.49~3.92]), intraventricular extension of hematoma (3-month:HR 1.65, 95%CI 1.37~1.99; 1-year:HR 1.47, 95%CI 1.25~1.73), intensive care unit care (3-month:HR 1.53, 95%CI 1.25~1.87; 1-year:HR 1.56, 95%CI 1.30~1.86), complications of recurrent stroke (3-month:HR 2.71, 95%CI 1.99~3.70; 1-year:HR 2.62, 95%CI 1.98~3.47) or seizure (3-month:HR 1.57, 95%CI 1.05~2.35; 1-year:HR 1.57, 95%CI 1.10~2.26) were associated with increased case fatality of 3-month and 1-year. Intravenous hemodiluting agent use in hospital was associated with high case fatality of 3-month (HR 1.86, 95%CI 1.04~3.31) but not that of 1-year. Conclusion Antihypertensive therapy in hospital, glucose control, early identification and treatment of complications of seizure or recurrent stroke and use of hemodiluting agents according to guideline should be emphasized to improve the long-term outcome of ICH in Chinese population.

Predictive Value of Cerebral Microbleeds for Early Hemorrhagic Transformation in Non-lacunar Infarction Patients with Antithrombotic Therapy

DAI Cheng-Bo, WANG Shuo, DUAN Zhen-Peng, CAO Yu-Min, ZHANG Xiong, WANG Li-Juan.

2013, 8(09): 712-717.

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【Abstract】 Objective To assess the predictive value of cerebral microbleeds (CMB) for early hemorrhagic transformation (HT) in non-lacunar infarction patients with antithrombotic therapy. Methods The patients with cardiogenic cerebral embolism or artery atherosclerotic infarction were prospectively enrolled within 24 hours after symptom onset from June 2011 to October 2012 in Department of Neurology of Guangdong General Hospital. All patients took antiplatelet or anticoagulant therapy according to the clinical situation. CMB were detected with magnetic resonance imaging and HT was determined with head CT within one week after onset. The patients were divided into HT group and non-HT group; the differences of the clinical data, etiology, National Institutes of Health Stroke Scale (NIHSS), and CMB between the two groups were compared, and independent risk factors for HT were determined with multivariate stepwise Logistic regression analysis. Results Among 167 patients enrolled, HT occurred in 18 cases (11%), CMB were detected in 57 cases (34%). There was no significant difference of CMB between the patients with and without HT (22% vs 36%, P>0.05). The prevalence of early HT was not significantly different regardless of CMB status in patients with antiplatelet (12% vs 9%, P>0.05), and in patients with anticoagulants (17% vs 12%, P>0.05). Logistic regression analysis showed NIHSS≥8 and cardiogenic embolism associated with the increased risk of HT (odds ratio [OR]3.65, 95% confidence interval [CI]1.47~8.26; OR 5.82, 95%CI 1.89~15.38); There was no relationship between hypertension, large artery atherosclerosis, CMB with HT, their OR and 95%CI values were 1.05 (0.97~1.12), 2.31 (0.91~3.45) and 0.35 (0.09~1.41), respectively. Conclusion CMBs may not be a predictor of early HT in non-lacunar patients with antithrombotic therapy, stroke severity and etiology of type help to estimate HT risk.

Clinical Analysis of 27 Cases of Dural Arteriovenous Fistula

ZHAO Hui-Qing*, WANG Yang, ZHANG Ya-Qing.

2013, 8(09): 718-722.

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【Abstract】 Objective To discuss the potential risk factors, clinical and neuroimaging characteristics and the treatment of dural arteriovenous fistula (DAVF). Methods The clinical data of 27 cases of DAVF that comes from the continuous hospitalization patients at the Department of Neurology of Beijing Tiantan Hospital from October 2009 to December 2012, including onset styles, risk factors, initial symptoms, neuroimaging characteristics and treatment modalities, were retrospectively analyzed. Results In the 27 cases of DAVF, 13 (48.1%) cases were with acute onset and in which 10 (37%) cases were with the concomitant disease of cerebral hemorrhage or subarachnoid hemorrhage, 3 (11.1%) cases were with the concomitant diseases of thrombosis of intracranial venous sinus and hyperhomocysteinaemia respectively and 11 (40.7%) cases were with the initial symptom of headache. In the 27 cases of DAVF, 3 (11.1%) cases were with subacute onset and in which 1 (3.7%) case was with the concomitant disease of thrombosis of intracranial venous sinus and 1 (3.7%) case was with the initial symptom of limb paralysis or aphasia respectively. In the 27 cases of DAVF, 11 (40.7%) cases were with chronic course and in which 5 (18.5%) cases were with the concomitant disease of cerebral hemorrhage or subarachnoid hemorrhage or thrombosis of intracranial venous sinus respectively, 3 (11.1%) cases were with the concomitant diseases of hyperhomocysteinaemia and 5 (18.5%) cases were with the initial symptom of headache or ocular symptoms respectively. In the 27 cases of DAVF, 19 cases had received brain CT scanner and in which 3 cases had been revealed the possibility of DAVF; 18 cases had received brain MRI scanner and in which 7 cases had been revealed the possibility of DAVF; 26 cases had received the examination of DSA and all of cases had been made a definite diagnosis of DAVF. Transverse-sigmoid sinus and cavernous sinus as the orifices of DAVF were more common in this essay. In the 27 cases of DAVF, 14 (51.9%) cases had adopted endovascular embolization; 7 (25.9%) cases with observation or selective therapy of endovascular embolization; 2 (7.4%) cases had adopted the surgical treatment; 4 (14.8%) cases had given up the treatment. Conclusion DAVF has different concomitant diseases with different onset styles. The clinical characteristics of DAVF are multiplicity. DSA has advantages for the diagnosis of DAVF. Endovascular embolization may be one of the effective therapies for DAVF.

Effects of Sex, Age and Types of Stroke on Post-stroke Aphasia

YAO Jing-Fan, SONG Yan-Li, LI Lei, ZHOU Yun, WANG Chun-Xue, WANG Yong-Jun, ZHANG Yu-Mei.

2013, 8(09): 723-728.

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【Abstract】 Objective To explore the association between the types of aphasia and sex, age and stroke types. Methods Four hundred and twenty-one aphasiacs after stroke who met the inclusion and exclusion criteria and were admitted to Department of Neurology of Beijing Tiantan Hospital, Capital Medical University from July 2005 to July 2012 were restrospectively analyzed. The criteria of handedness instituted by Peking University First Hospital was used to judge patients' handedness. Western battery aphasia was used to assess the aphasiac type and calculate Aphasia Quotient (AQ) score. Patients were divided into youth, middle-aged and elderly groups, and stroke types include cerebral infraction (CI) and intracerebral hemorrhage (ICH). Finally we analyzed the types of aphasia in different ages, sex and stoke types. Results All subjects were dextromanual, in whom males and females accounted for 69.60% and 30.40%, respectively. The types of aphasia included Broca's aphasia (male 85, female 31), Wernicke's aphasia (male 20, female 15), conductive aphasia (male 10, female 5), transcortical motor aphasia (male 50, female 13), transcortical sensory aphasia (male 8, female 3), transcortical combined aphasia (male 13, female 14), anomic aphasia (male 47, female 26) and global aphasia (male 60, female 21). Male patients (69.60%) have a significantly higher level of morbidity of aphasia than females (30.40%) after stroke (χ2=11.57, P=0.003), especially those under 65 years old (73.38%). After 65 years old, the morbidity of female tends to increase with age (42.97%). Sex has no remarkable effect on the types of aphasia (χ2=13.84, P=0.054), Broca's aphasia is the most common types in both males and females (29.01%, 24.22%, respectively). The distribution of aphasic types has no obvious difference among three age groups (χ2=14.94, P=0.382). Aphasia induced by CI (306 cases) is more common than by ICH (115 cases), but the distribution of types of aphasia has no difference (χ2=13.23, P=0.067). Broca's aphasia is the most common aphasic type in both CI and ICH patients (29.82%, 29.55%, 26.67%, respectively), except the females with ICH. Conclusion Age, sex and stroke types have no significant influence on the types of aphasia. Male patients have a significantly higher level of morbidity of aphasia than females after stroke as well as the average age of onset is younger than females. Broca's aphasia is the most common one in both males and females. Broca's aphasia, global and anomic aphasia are the most aphasic types in both CI and ICH patients, except the females with ICH.

Sleep Disorders and Stroke

YU Feng-Chun

2013, 8(09): 729-729.

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Strategies of Stroke Research Priorities

WANG Qin-Run-Qi, YANG Xiao-Meng, WANG Yong-Jun

2013, 8(09): 751-755.

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【Abstract】 The National Institute of Neurological Disorders and Stroke (NINDS) Stroke Progress Review Group (PRG) provided a comprehensive view of stroke research advances, challenges and scientific opportunities, and made strategies of stroke research priorities in 2012. This article will make a brief introduction to these strategies with the aim to helping the researchers who is engaged in stroke research to know more about the present research directions of stroke.

Progress Study of Thalamic Stroke and Sleep

TIAN Qian-Qian, CUI Lin-Yang, XUE Rong

2013, 8(09): 756-759.

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【Abstract】 Post-stroke sleep disorders has high incidence that not only affects the recovery of the neurological function but also increases the risk of high blood pressure and stroke recurrence. More and more researches suggest that thalamus plays an important role in the regulation of circadian rhythem. Many patterns of sleep-wake rhythm disturbance were found after thalamic stroke, which may be related to inflammatory reaction, the change of the neurotransmitter secretion and the destruction of the neuroanatomical circuit.

Status Quo of Research on Risk Factors of Post-stroke Disorder and Comprehensive Nursing Care Intervention

LI Qiu-Ju*, SHI Yu-Zhi, YIN Xue-Hong, WANG Chun-Xue, ZHANG Ning.

2013, 8(09): 760-763.

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Sleep disorder is a common complication after stroke. Its occurrence is related to many factors. This review puts forward comprehensive nursing care, intervention including environment nursing, diet nursing, mental nursing and rehabilitation nursing based on pharmacotherapy and non-pharmacotherapy in order to provide a reference for the improvement of sleep quality among stroke patients.

Diagnosis and Treatment of Moyamoya Disease Combined with Intracranial Aneurysm

XIAN Peng, DUAN Lian

2013, 8(09): 764-767.

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Moyamoya disease combined with intracranial aneurysm may be caused by the hemodynamic changes. Most of its clinical symptoms are different types of intracranial hemorrhage, also can show cerebral ischemia. It can be diagnosed by digital subtraction angiography (DSA) and computed tomography angiography (CTA). According to the distribution of the aneurysms, different treatments can be applied, including surgery or endovascular embolization, but the long-term effects are unclear. In this paper, the possible causes, clinical features and treatment strategies of moyamoya disease combined with intracranial aneurysm were elaborated in order to increase the understanding of this disease.

Research on Neuroprotective Strategy of Stroke: The Past, Present and Future

LIU Yong, FENG Guo-Dong, ZHANG Guang-Yun, HAN Jun-Liang, ZHAO Gang.

2013, 8(09): 768-772.

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Many ongoing studies of neuroprotective strategy of stroke include albumin, magnesium and cryotherapy therapy. There are also a number of promising neuroprotectants in preclinical development including ginsenoside Rd, NA-1 (Tat-NR2B9c), an inhibitor of postsynaptic density-95 protein etc. Thirty years' study of neuroprotective strategy of stroke experiences the development process from the peak to the trough then to new climax. However, to achieve better development, future research should focus on:conduct a strict design; the object of study should converse from dental caries animal to primate; the evaluation method should converse from behavioral assessment to radiographic evaluation; research paradigm should extend to vascular neural network.

Clinical Application of Indobufen in the Treatment of Antiplatelet

WU Hao, BI Qi.

2013, 8(09): 773-776.

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Thromboembolic disease seriously threatens human's life and health and quality of life, and antiplatelet therapy is an important means of treatment for thromboembolic disease. As one kind of antiplatelet agents, indobufen is remarkable in the treatment and prevention for thromboembolic disease. This article summarizes the secondary prevention effects of indobufen for thromboembolic events in patients with high risk, the treatment for other thromboembolic diseases, and the patency maintenance function for grafts or coronary artery after interventions, with the aim to guide the clinical practice.

How to Carry out Effective File Management in Neurological Clinical and Teaching Scientific
Research Work

LIAO Xiao-Ling, ZHANG Ning, WANG Chun-Xue

2013, 8(09): 777-778.

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How to Improve the Quality of Teaching of Foreign Medical Students for Cerebral Vascular
Diseases in Department of Neurology

LI Ying, BI Qi

2013, 8(09): 779-780.

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