Chinese Journal of Stroke

New Concepts, New Hope

WANG Yong-Jun

2014, 9(05): 365-369.

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Magnetic Resonance Imaging in Cerebral Vascular Wall：Explore New Clinical Path from a Different Perspective

ZHAO Xi-Hai

2014, 9(05): 371-375.

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Chinese Ischemic Stroke Subclassification and Risk Factors in Ischemic Stroke in Young Adults

WANG Yun, HAO Yong-Gang, DONG Qian, LI Shu-Juan, HU Wen-Li.

2014, 9(05): 376-382.

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Objective To explore the characteristics of Chinese ischemic stroke subclassification (CISS) classification and risk factors in ischemic stroke in young adults and to provide the basis for prevention and treatment. Methods There were 52 young adults with ischemic stroke who were hospitalized in our department in 2011. These patients were enrolled in young patient group while 50 middle-aged and old patients with ischemic stroke enrolled in middle-aged and old patient group. Their CISS classification and risk factors were analyzed retrospectively. Results ①88.46% patients in young patient group are male, the percentage is significantly higher than in middle-aged and old patient group (χ 2=5.573, P =0.018). ②The CISS classification in young patient group was as follows: large artery atherosclerosis (LAA) 46.15%, penetrating artery disease (PAD) 36.54%, undetermined etiology (UE) 11.54%, cardiogenic stroke (CS) 5.77%, and no other etiology (OE). Compared with middle-aged and old patient group, there is no significant difference. ③The common risk factors for young patient group are listed in order as follows: smoking, hypertension, hyperlipidaemia, alcoholism, diabetes mellitus and family history. More than half of the patients in young patient group had more than three risk factors, and this number is significantly larger than that of middle-aged and old patient group (χ 2=7.186, P =0.007). The concentration of homocysteine (Hcy) (t =1.250, P =0.038) and the occurrence rate of smoking (χ 2=7.993, P =0.005) and alcoholism (χ 2=17.005, P =0.000) in young patient group are significantly higher than those in middle-aged and old patient group; the concentration of folic acid is significantly lower (t =2.106, P =0.007); and the concentration of Hcy in LAA is significantly higher than that in PAD in young patient group (t =2.046, P =0.004). Conclusion We should pay more attention to the concentration of Hcy in patients with ischemic stroke as it may be related to the age of onset and the CISS classification. The young adults with ischemic stroke have more risk factors than middle-aged and old patients. Improving and reducing the risk factors, especially improving hyperhomocysteinemia, are important to prevent against ischemic stroke in young adults.

Analysis of Clinical Features, Risk Factors and Etiology of Youth Ischemic Infarction in Anyang Region

LI Zhen-Hua*, YANG Qing-Cheng, ZHANG Xiang-Dong.

2014, 9(05): 383-388.

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Objective To explore the clinical characteristics, risk factors and etiology of youth cerebral infarction in Anyang region. Methods One hundred and forty-eight cases of inpatients (aged from 18 to 45 years) with first-ever cerebral infarction were selected in the study. Patients were separated into three groups:youth group I (aged from 18 to 25 years), youth group II (aged from 26 to 35 years), and youth group III (aged from 36 to 45 years). Their basic information and risk factors were recorded, the etiologic patterns were classified using Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification. Results The result showed significantly more men (81.8%) than women (18.2%), more villagers (56.8%) than urbanites (43.2%) suffered from cerebral infarction. The highest exposure ratios of risk factors were hyperhomocysteinemia (58.1%), hypertension (54.7%), hyperlipidemia (45.9%), heavy smoking (30.4%), heavy drinking (17.6%), and diabetes (10.8%). Regarding stroke subtype, largeartery atherosclerosis (LAA) was diagnosed in 41.9% of cases, stroke of undetermined etiology (SUE) in 32.4%, small artery occlusion (SAO) in 13.5%, stroke of other determined etiology (SDE) in 9.5%, and cardioembolism (CE) in 2.7%. Diabetes and hyperlipidemia were found to be common in the group of SAO. SDE was found to be the most frequent etiologic subtype in youth group I, followed by SUE. LAA and SUE were observed to be the most frequent etiologic subgroup in youth group II. LAA was also seen to be the most common etiologic subtype in youth group II, followed by SUE. Conclusion The sex and rural-urban differences are obvious in the distribution of youth cerebral infarction in Anyang region. The most common risk factor is hyperhomocysteinemia, followed by hypertension; hyperlipidemia and heavy smoking, drinking and diabetes are relatively rare. Hypertension and heavy smoking may be related with the increased number of disease after age of 35 years. The LAA and SUE are the most common etiologic subtypes in young adults with cerebral infarction, and etiologies in patients with different risk factors are not the same.

Surgical Treatment of Cerebral Cavernous Malformation Presenting Epileptic Seizures

ZHOU Feng*, WU Jun, PENG Lei, WANG Shuo, SANG Lin, ZHENG Zhong, XIE

2014, 9(05): 389-393.

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Objective To provide effective surgical methods for patients with cavernous malformation complicated with epilepsy. Methods Twenty-seven patients with cavernous malformation complicated with epilepsy in our department were retrospectively analyzed. Simultaneously, we compared different epilepsy prognosis and other relevant factors between patients accepted total resection (including the gliotic and hemosiderin-stained brain tissue adjacent to the lesions) and patients accepted total resection combined with cortex thermocoagulation. Results ① Prognosis of patients treated with total resection combined with cortex thermocoagulation was much better than those who only accepted total resection (P =0.036). ② Prognosis of patients whose course of epilepsy is less than 1 year was much better than those whose course is more than 1 year (P =0.022). ③ There were no statistical significances for epilepsy prognosis in sex, age, the lobe where the cavernous malformation located, different epilepsy seizures, whether preoperative application of antiepileptic drugs (AEDs) and postoperative Karnofsky Performance Status Scale (KPS). Conclusion The analysis of outcome showed that patients with cavernous malformation complicated with epilepsy benefited significantly from early surgery. And at the same time, in order to achieve better effect from the surgery, total resection of cavernous malformation (including the gliotic hemosiderin-stained brain tissue adjacent to the lesions) must be adopted, and cortex thermocoagulation treatment should be applied.

Analysis of Risk Factors in Symptomatic Cerebral Vasospasm after Subarachnoid
Hemorrhage

ZHANG Ling-Dang, SONG Yi, FENG Qing-Lin, LIU Ming-Dong, FAN Shi-Bing, DU Jiang-Feng, ZHANG Peng, FENG Mei.

2014, 9(05): 394-398.

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Objective To explore the risk factors for cerebral symptomatic vasospasm following subarachnoid hemorrhage (SAH), and provide reference for the prevention and treatment of symptomatic cerebral vasospasm (SCVS). Methods The clinical data of 96 SAH patients were retrospectively analyzed, and the risk factors such as gender, age, history of hypertension, history of diabetes, modified Fisher grades were statistically analyzed. Results Of all 96 patients, 39 were found SCVS. There were statistical differences in age, history of hypertension, cigarette smoking, intraventricular hemorrhage, Hunter-Hess grade, modified Fisher grades, the degree of vasospasm, and the use of nimodipine between the group of SCVS and the group of non-SCVS by univariate analysis. Logistic regression analysis demonstrates that lower age, history of hypertension, modified Fisher grades are the risk factors of SCVS, and the value of their ORs are 0.567, 1.982, 2.713, respectively. The use of nimodipine is the conservancy factor, and the value of its OR is 0.799. Conclusion SCVS after SAH is the result of co-action of multiple factors. The age, history of hypertension, modified Fisher grades, and the use of nimodipine are independent risk factors. Early detection and treatment should be strengthened.

Analysis on the Relationship between Microalbuminuria and the Risk Factors of Acute
Ischemic Stroke

ZHENG Tian-Heng, GAO Jian, ZHU Xin-Pu, HANG Hai-Xia, WANG Shao-Shi.

2014, 9(05): 399-403.

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【Abstract】 Objective To investigate the relationship between microalbuminuria (MAU) and the risk factors of acute ischemic stroke. Methods A prospective observation study was adopted in this study. One hundred and sixty-six consecutive patients with acute ischemic stroke were included and divided into two groups: MAU positive group (n =81) which was defined as MAU level 20~300 mg/L, and negative group (n =85) which was defined as MAU level <20 mg/L. The clinical data and laboratory results in two groups were compared. Results Diabetes (χ 2=8.116, P =0.004), systolic pressure (t =2.735, P =0.007), National Institutes of Health Stroke Scale (NIHSS) (t =2.612, P =0.01), fasting blood glucose (t =2.68, P =0.008), low density lipoprotein cholesterol (t =2.217, P =0.028) and C-reactive protein (t =5.548, P =0.000) in MAU positive group were significantly higher than those in MAU negative group. Logistic regression analysis shows diabetes ([odds ratio, OR] 1.51, 95%[confidence interval, CI] 1.26~2.47, P =0.01), systolic pressure (OR 1.47, 95%CI 1.01~1.17, P =0.004), low density lipoprotein cholesterol (OR 2.43, 95%CI 1.01~5.37, P =0.03) and C-reactive protein (OR 1.79, 95%CI 1.09~1.21, P =0.005) were dependent risk factors of MAU. Conclusion MAU increasing was related to the risk factors of ischemic stroke, including hypertension, diabetes, C-reactive protein and low density lipoprotein cholesterol. MAU increasing might indicate the severity of illness in patients with acute ischemic stroke.

Clinical Value of Susceptibility Weighted Imaging on Hemorrhagic Transformation after
Massive Cerebral Infarction

LIU Yuan-Hong, NIU Zhi-Ling, LIANG Jin-Hua, MA Na, ZHANG Pan-Pan, LIU Le-Xi, NIE Zhi-Yu.

2014, 9(05): 404-408.

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Objective To investigate the early diagnostic value of susceptibility weighted imaging (SWI) on hemorrhagic transformation (HT) after massive cerebral infarction. Methods Thirty nine cases with massive cerebral infarction diagnosed by magnetic resonance were enrolled and head computed tomography (CT) and magnetic resonance imaging (MRI) including SWI were performed within 72 hours after onset. The detection rate and the sensitivity of two methods for diagnosing HT were compared. The HT after cerebral infarction was graded based on European Cooperative Acute Stroke Study (ECASS), the difference in HT grade by two examination methods was compared, HT grading and the National Institutes of Health Stroke Scale (NIHSS) score correlation were analyzed. Results The positive rates of SWI or CT in the diagnosis of HT were 61.54% and 12.82% (P <0.001) respectively. Twenty four cases (61.54%) with HT after massive cerebral infarction were detected by SWI, grade 1 accounted for 12.82%, and grade 2, 3, 4 for 25.64%, 15.48% and 7.69%, respectively. SWI was significantly superior to conventional CT in early detection of hemorrhagic transformation after massive cerebral infarction. HT grading by SWI was positively correlated with NIHSS scores (R =0.94, P <0.01). Conclusion The HT after massive cerebral infarction can be early, sensitively, objectively evaluated by SWI, which provides the basis for the adjusting treatment programs.

Study of Associations between Magnetic Resonance Plaque Imaging and Ischemic Stroke

ZHAO Xi-Hai

2014, 9(05): 409-409.

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