Chinese Journal of Stroke

Wind Vane

WANG Yong-Jun

2018, 13(09): 893-895. DOI: 10.3969/j.issn.1673-5765.2018.09.001

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Progress of Vascular Cognitive Impairment Caused by Cerebral Small Vessel Disease

ZHOU Ting-Ting, LI Xiao-Hong, LIANG Zhan-Hua

2018, 13(09): 896-899. DOI: 10.3969/j.issn.1673-5765.2018.09.002

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Analysis of Risk Factors of Non-atherosclerotic Lacunar Infarction

CHI Xiao-Dong, MIAO Shu-Chuan, LI Xiao-Hong

2018, 13(09): 900-902. DOI: 10.3969/j.issn.1673-5765.2018.09.003

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Objective To analyze the possible risk factors of non-atherosclerotic lacunar infarction (NALI). Methods 106 NALI patients were included. The ratio of sex and the percentage of smoking, hypertension, type 2 diabetes, hypercholesterolemia, high level of low density lipoprotein cholesterol in serum of all patients were analyzed. Results The male-to-female ratio of all patients was 1.58:1, and this rate was 1.07:1 in 85 nonsmoking patients. All of 21 smokers were male (32.31% in all male patients). The percentage of hypertension, diabetes, hypercholesterolemia, high level of low density lipoprotein cholesterol in serum were 70.75% (N=75), 48.11% (N=51), 36.79% (N=39) and 39.62% (N=42), respectively. Conclusion Hypertension, Diabetes, hypercholesterolemia, high level of low density lipoprotein cholesterol in serum may play a key role in the development of NALI, and they may be risk factors of NALI.while smoking may play an important role in male NALI patients.

Efficacy and Safety of Intravenous Thrombolysis with Recombinant Tissue Plasminogen Activator in Acute Mild#br# Ischemic Stroke

YU Ruo-Mei, CAO Su-Han, MAO Bao-Yi, YANG Xi, TAO Meng-Xi, SUN Xiao-Pei

2018, 13(09): 903-907. DOI: 10.3969/j.issn.1673-5765.2018.09.004

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Objective To observe the efficacy and safety of intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) in patients with acute mild ischemic stroke. Methods A total of 166 eligible patients from the fist affiliated hospital of Dalian medical university from January 2016 to September 2017 were included in this study. According to whether to receive rt-PA intravenous thrombolysis, these patients were divided into thrombolysis group and control group. The following efficacy and safety outcome between two groups were compared: the National Institutes of Health Stroke Scale (NIHSS) score at 24 hours and 7 days after thrombolysis, 90-day modified Rankin Scale (mRS), 90-day recurrent ischemic stroke, intracranial hemorrhage (ICH) and symptomatic ICH. Results 83 patients in each group. The 24-hour and 7-day NIHSS scores were all lower than the baseline NIHSS score in thrombolysis group, and the 24-hour and 7-day NIHSS scores in thrombolysis group were also lower than that in control group, and all the differences were statistically significant. The proportion of 90-day favorable outcome (mRS≤1) in thrombolysis group was higher than that in control group (88.0% vs 71.1%, P =0.007). The rate of early neurological deterioration (defined as the score of NIHSS increasing ≥2 points comparing the baseline score) in thrombolysis group was far lower than that in control group (3.6% vs 15.6%, P =0.016). The recurrence rate of stroke within 90 days between the two groups had no statistical difference (8.4% vs 10.8%, P =0.599). The incidence of ICH between the two groups also had no statistical difference (6.0% vs 1.2%, P =0.096). There was no symptomatic ICH case in two groups. Conclusion For patients with acute mild ischemic stroke, intravenous thrombolysis with rt-PA within 4.5 h from onset could improve the short-term and long-term neurological function, and reduce the incidence of early neurologic deterioration, while had no effect on recurrent stroke. The safety outcome was that thrombolytic therapy did not increase the risk of ICH and symptomatic ICH in patients with mild stroke.

Association of CYP2C19 Gene Polymorphisms with Risk of Recurrent Stroke in First-ever Ischemic Stroke Patients with Clopidogrel for Secondary Prevention

ZENG Tao, XIAO Xuan-Hao, XU Bang-Lao, LEI Xiu-Xia, LI Ze, ZHOU Jin, HUANG Hui, PAN Xiao-Ping

2018, 13(09): 908-914. DOI: 10.3969/j.issn.1673-5765.2018.09.005

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Objective To investigate the association of CYP2C19 gene polymorphism with the risk of recurrent stroke in first-ever ischemic stroke (FIS) patients with clopidogrel for secondary prevention. Methods A total of 326 FIS patients who took Clopidogrel regularly were enrolled in this study, and recurrent stroke of all patients were recorded by follow-up. The CYP2C19 gene polymorphism were detected using DNA microarray method. The correlation between CYP2C19 gene polymorphism and stroke recurrence in patients taking Clopidogrel regularly was analyzed. Results After a mean follow-up period of (14.44±5.07) months, there were 139 patients who took Clopidogrel regularly, and 29 ones of which occurred recurrent stroke. Patients of poor metabolizer (PM) and intermediate metabolizer (IM) had higher risk of stroke recurrence comparing with patients of extensive metabolize (EM), and the odds ratio (OR) were 3.05 [95% confidence interval (CI) 1.11- 8.43, P =0.025] and 9.17 (95%CI 2.39-35.16, P <0.001), respectively. The recurrence risk of *2 (G681A ) A allele carriers was 2.63 times that of G allele carriers (P <0.001). The recurrence rate of stroke in patients carrying heterozygous and homozygous *2 allele mutant were 2.82 times (P =0.026) and 9.69 times (P <0.001) that of patients with wild-type genes. The recurrence rate in patients with one loss-of-function (LOF) allele was 3.02 times that of patients without mutant gene (95%CI 1.13-8.05,P =0.030), and this recurrence rate in patients with two LOF alleles was 11.01 times that of patients without mutant gene (95%CI 2.67-45.24, P <0.001). Multifactor logistic regression analysis result indicated carrying LOF allele was an independent risk factor of stroke recurrence. Conclusion For FIS patients taking Clopidogrel regularly for secondary prevention, IM and PM patients had higher risk of recurrent stroke comparing with EM ones. Carrying CYP2C19 LOF allele is an independent risk factor of stroke recurrence in FIS patients.

Clinical and Cognitive Features of Four Patients with Hereditary Cerebral Small Vessel Disease Caused by Notch3 Gene Mutation

CHEN Yuan, ZHOU Yu-Ying, WANG Yan, ZHANG Hui-Hong

2018, 13(09): 915-921. DOI: 10.3969/j.issn.1673-5765.2018.09.006

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Objective To analyze and compare the clinical and cognitive features of four patients with hereditary cerebral small vessel disease (CSVD) caused by Notch3 gene mutation. Methods The clinical data of four hereditary CSVD patients with Notch3 gene mutation were collected. Initial symptom, clinical manifestation, imaging feature, auxiliary examinations, gene detection and neuropsychological assessment were analyzed and compared. Results For reasons of seeing a doctor, two patients were acute stroke, one was cognitive impairment and the other one was dizziness and headache. One acute stroke patient also had familial alopecia and lumbago. Two patients had risk factors of cerebrovascular disease. Magnetic resonance imaging of four patients all showed white matter lesions in different degree and not in the same location. NOTCH3 gene mutation of four patients located at exon 3, 4, 20 and 11, respectively. Neuropsychological assessment suggested they all had cognitive impairment, and the evaluation results showed an obvious decline in executive function, language, abstract thinking and delayed memory, but not obvious change in orientation, calculation, naming, attention and etc. Conclusion Hereditary CSVD patients caused by Notch3 gene mutation have different clinical features, which have heterogeneity among these individuals.

Carotid Plaque Vulnerability Evaluation with Multimode Ultrasound

YU Hai-Ge, HE Wen, ZHANG Dong, NING Bin, KAN Yan-Min, WEI Shi-Ji, YU Teng-Fei, LIU Meng-Ze, LI Hai-Xin

2018, 13(09): 922-927. DOI: 10.3969/j.issn.1673-5765.2018.09.007

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Objective To investigate the valuable characteristics of vulnerable carotid plaques in predicting ischemic stroke by multimode ultrasound, and evaluate the diagnostic value of multimode ultrasound. Methods A total of 92 patients who underwent carotid ultrasound examination at department of ultrasound of Beijing Tiantan hospital, capital medical university from August 2016 to October 2017 were included in this study. The multimode ultrasound included routine two-dimensional ultrasound, contrast-enhanced ultrasonography (CEUS) and superb microvascular imaging (SMI). A total of 105 plaques were diagnosed, and all patients were divided into symptomatic group and nonsymptomatic group according to clinical symptoms. The ultrasonographic characteristics of plaques and the patients’ clinical data were included in univariate analysis, and the statistically significant factors were then included in Logistic regression analysis. The receiver operating characteristic (ROC) curve was plotted to test the sensitivity and specificity of predictive diagnosis. Results Univariate analysis showed that smoking index, serum total cholesterol, low density lipoprotein, apolipoprotein B, signal enhancement on CEUS, neovascularization on SMI, plaque surface morphology on CEUS and SMI, calcified nodule location were statistically significant. The Logistic regression analysis showed that high enhancement on CEUS [odds ratio (OR) 9.610, 95% confidence interval (CI) 2.734-33.779, P <0.001], irregular plaque surface on SMI (OR 4.483, 95%CI 1.323-15.189, P =0.016) and calcified nodule on plaque surface (OR 7.206, 95%CI 1.609- 32.265, P =0.010) were independent risk factors of ischemic stroke. The area under the ROC curve, the sensitivity and specificity of predicting ischemic stroke for the three factors were 0.723, 75.8%, 67.4%; 0.657, 50.1%, 76.1%; 0.679, 40.7%, and 82.6%, respectively; and that of multifactorial diagnosis were 0.837, 90.5%, and 62.0%. Conclusion The characteristics of vulnerable plaques, such as high enhancement on CEUS, irregular plaque surface on SMI and calcified nodule on plaque surface are independent risk factors of ischemic stroke. Multimode ultrasound can better detect plaque characteristics, and thus increase the accuracy of predicting ischemic stroke.

Chinese Adaptation and Application Evaluation of Stroke Aphasic Depression Questionnaire-Hospital Version

LIU Yan-Jun, ZHANG Ya-Qing, ZHANG Yi, LIU Xin-Xin, ZHANG Yu-Mei

2018, 13(09): 928-933. DOI: 10.3969/j.issn.1673-5765.2018.09.008

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Objective To adapt stroke aphasic depression questionnaire-hospital version (SADQ-H10) into Chinese version, and test its repeatability, reliability and validity. Methods 120 patients with poststroke aphasia from Beijing Tiantan hospital from January 2016 to February 2018 were included in this study. All the patients were assessed with SADQ-H10, Hamilton depression scale (HAMD), and Beck depression inventory (BDI). A randomly selected sample of 42 patients were re-evaluated with SADQ-H10 within 1-2 week(s) after the first evaluation. Based on the evaluation results, the repeatability, reliability and validity of the Chinese version of SADQ-H10 were tested. Results 110 patients completed SADQ-H10 (91.7%). The time of completing the SADQ-H10 ranged from 3 to 10 minutes. The test-retest reliability was 0.821 (P <0.01). The Cronbach's α coefficient was 0.87 (P <0.01). The content validity ratio (CVR) was 1. With HAMD as the criterion, the validity coefficient was 0.890 (P <0.01), while with BDI as the criterion, the validity coefficient was 0.853 (P <0.01). The paired Chi-square test showed that all P values were greater than 0.05. Conclusion SADQ-H10 has good repeatability, reliability and validity. It may be used as a tool to evaluate the depression in Chinese patients with poststroke aphasia.

Correlation of Endothelin-1 and Malondialdehyde with Carotid Plaques in Patients with Ischemic Stroke

WEN Hui-Jun, LYU Min

2018, 13(09): 934-937. DOI: 10.3969/j.issn.1673-5765.2018.09.009

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Objective To investigate the correlation between carotid plaques and endothelin-1 (ET-1) and malondialdehyde (MDA) in patients with acute ischemic stroke. Methods Carotid ultrasonography was performed in 118 patients with acute ischemic stroke. All patients were divided into normal intima group (n =12), intima thickening group (n =28) and plaque group (n =78). The plaque group was divided into plaque I (n =21), plaque II (n =25) and plaque III (n =32). The plasma ET-1 and MDA level were measured in each group. The correlation of ET-1 and MDA with plaque formation was analyzed. Results The level of plasma ET-1 in normal, thickening intima and plaque groups were (2.34±0.27) ng/L, (3.96±0.38) ng/L and (6.23±0.42) ng/L, respectively; and the level of plasma MDA in the three groups were (4.20±0.48) nmol/ml, (6.18±0.52) nmol/ml and (8.37±0.65) nmol/ml, respectively. The level of plasma ET-1 (P =0.036, P =0.031) and MDA (P =0.046, P =0.022) in plaque group and intima thickening group were significantly higher than that in normal intima group; and both ET-1 and MDA in plaque group were higher than that in intima thickening group (P =0.040, P =0.034). With the severity of plaque increasing, the plasma ET-1 and MDA levels gradually increased (P =0.041, P =0.037). Conclusion Plasma ET-1 and MDA levels are associated with carotid atherosclerosis and its severity in patients with acute ischemic stroke.

Effects of Butylphthalide Injection on Cerebral Perfusion and Cognitive Function in Patients with Acute Cerebral Infarction

WU Gang, ZHAN Li-Ping, AN Ming-Shun, LI Yan-Ping, LI Yang, TU Kun, WANG Jin

2018, 13(09): 938-943. DOI: 10.3969/j.issn.1673-5765.2018.09.010

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Objective To investigate the effect of butylphthalide injection on cerebral blood flow perfusion and cognitive function in patients with acute cerebral infarction and cognitive impairment. Methods A total of 80 eligible patients were included in this study, all of whom were randomly divided into two groups: observation group (n =40) and control group (n =40). Conventional therapy was used in control group, while butylphthalide injection was added to conventional therapy in observation group, with a treatment course of 14 days each group. Cerebral blood flow perfusion parameters were achieved by magnetic resonance dynamic susceptibility contrast-enhanced perfusion weighted imaging (DSC-PWI), including ischemia relative cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT) and time to peak (TTP); cognitive function was assessed with Montreal cognitive assessment (MoCA) scale. The changes of cerebral perfusion and cognitive function after treatment were analyzed. Results The relative CBF and CBV had greater increase in observation group than that in control group after 14-day treatment (P <0.05), while the relative MTT and TTP had greater decrease in observation group than in control group (P <0.05). Each item score and total score of MoCA in differences (P <0.05). The CBV and CBF after treatment were positively correlated with the total score of MoCA (r =0.474, P =0.013; r =0.282, P =0.027), and the MTT and TTP were negatively correlated with the total score of MoCA (r =-0.294, P =0.021; r =-0.382, P =0.019) in observation group. Conclusion Butylphthalide injection can improve cerebral blood flow perfusion in ischemic region and MoCA scores in patients with acute cerebral infarction and cognitive impairment.

Evaluation of Multidisciplinary Treatment of Ruptured Middle Cerebral Artery Aneurysms: A Single-center Retrospective Analysis

ZHENG Shui-Shun, WANG Wei-Wei, GUO Zhang, CHEN Hai-Ping, ZHANG Xiao-Feng

2018, 13(09): 944-949. DOI: 10.3969/j.issn.1673-5765.2018.09.011

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Objective Different treatment strategies for ruptured intracranial aneurysms have been recently developed, and multidisciplinary treatment approaches have been applied in clinical practice. This study aimed to evaluate the outcome of multidisciplinary treatment for ruptured middle cerebral artery (MCA) aneurysms with surgical clipping or endovascular coil embolization. Methods A retrospective analysis of clinical data of patients with ruptured MCA aneurysms treated by clipping or coil embolization determined by consultation were conducted. The outcome measurement included that perioperative ischemic stroke and the complete occlusion rate after the first treatment; the complete occlusion rate, permanent sequelae of ischemic stroke arising from surgical procedures, retreatment, rebleeding and mortality after the whole follow-up. The average period of follow-up was 17.9 months. Results A total of 261 eligible patients were included in this study, with endovascular coil embolization for 107 cases and surgical clipping for 154 cases. Periprocedural ischemic stroke occurred in 28 patients (10.72%), and 24 cases (0.91%) of them had permanent sequelae associated with ischemic stroke. The complete aneurysm occlusion after the first treatment occurred in 80 patients (74.7%) with endovascular coil embolization, and in 150 cases (97.4%) with surgical clipping. After the completion of follow-up, the complete occlusion occurred in 179 cases (82.9%). 9 cases (0.34%) needed retreatment, 5 cases (0.19%) occurred rebleeding, and 5 cases (0.19%) died. The procedure related ischemic stroke incidence (6.5% vs 16.8%, P =0.008) and permanent sequelae of this kind of stroke (5.8% vs 14.0%, P =0.020) were higher in coil embolization group than that in clipping group. The complete occlusion rate of aneurysms immediately after surgery (97.4% vs 74.7%, P <0.001) and after the follow-up (95.1% vs 65.2%, P <0.001) were higher in surgical clipping group than that in coil embolization group. No patient needed retreatment in clipping group, while 9 ones needed retreatment in coil embolization group. There were no significant difference in rebleeding (0.6% vs 3.7%) and mortality (1.3% vs 2.8%) between the two groups. Conclusion The multidisciplinary treatment approaches for ruptured MCA aneurysms can achieve a better outcome. Surgical clipping for ruptured MCA aneurysms showed a lower rate of complications and a higher occlusion rate than endovascular coil embolization.

Advance of Correlation of Cerebral Microbleeds and Cognitive Impairment

LANG Xiao-Lan, MIAO Shu-Chuan, SUN Xiao-Pei

2018, 13(09): 951-955. DOI: 10.3969/j.issn.1673-5765.2018.09.012

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More and more attention is paid to the concept of cerebral microbleeds (CMBs) and the research on correlation between CMBs and cognitive impairment. In recent years, most research focused on the mechanism of cognitive impairment caused by CMBs. This article reviewed the concept and epidemiology of CMBs, the relationship of CMBs and cognitive dysfunction, and the mechanism of cognitive dysfunction caused by CMBs, with the aim to provide reference in treating and delaying cognitive decline of high-risk patients.

Chinese Experts Consensus on Emergency Management of Acute Ischemic Stroke 2018

Emergency Medicine Branch of Chinese Geriatrics Society, Stroke Group of Chinese Society of Emergency Medicine, Chinese Society of

2018, 13(09): 956-967. DOI: 10.3969/j.issn.1673-5765.2018.09.013

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Neurology: Two Cases of Rare Cause of Diffuse Microhemorrhages

YANG Zhong-Hua

2018, 13(09): 968-968. DOI: 10.3969/j.issn.1673-5765.2018.09.014

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