Chinese Journal of Stroke

Review on Stroke Studies in 2018

WANG Yong-Jun, DING Ya-Rong, DAI Li-Ye, SUO Yue

2019, 14(01): 1-14. DOI: 10.3969/j.issn.1673-5765.2019.01.001

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Stroke in Young Adults: A Nonnegligible Population of Stroke Patients

ZHANG Jun-Fang, WU Yun-Cheng

2019, 14(01): 15-17. DOI: 10.3969/j.issn.1673-5765.2019.01.002

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Etiology and Risk Factors of Anterior Versus Posterior Circulation Stroke in Young Adults

ZHANG Jun-Fang,ZHANG Yu-Lei, YUAN Fei, WU Yun-Cheng

2019, 14(01): 18-22. DOI: 10.3969/j.issn.1673-5765.2019.01.003

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Objective To compare the difference of etiology and risk factor between anterior and posterior circulation infarction in young adults. Methods A retrospective analysis of 678 ischemic stroke patients aged 18-55 years old in Shanghai General Hospital from August 2010 to September 2017 were conducted, to analyze the difference of clinical characteristics and TOAST etiological subtype between anterior and posterior circulation stroke in young patients. Results Of total 678 patients, 203 (29.9%) patients in posterior circulation and 475 (70.1%) in anterior circulation. The most common risk factor in the two groups was hypertension, the prevalence of hypertension was 66%in posterior circulation group and 66.8% in anterior circulation group. Multivariable logistic analysis indicated diabetes mellitus as a risk factor contributed greater in posterior circulation stroke than in anterior circulation stroke (OR 1.569, 95%CI 1.082-2.277). Conclusions The etiology and risk factors of posterior circulation and anterior circulation stroke in young adults were similar. Diabetes mellitus as a risk factor contributed greater in posterior circulation stroke than in anterior circulation stroke.

Correlation between Left Ventricular Mass Index and Extra-and Intracranial Artery Stenosis in Ischemic Stroke Patients

ZHAO Min, LI Shun, WANG Meng-Meng, XU Ge-Lin

2019, 14(01): 23-28. DOI: 10.3969/j.issn.1673-5765.2019.01.004

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Objective To evaluate the relationship between left ventricular mass index (LVMI) and cervicocerebral atherosclerotic stenosis. Methods Ischemic stroke patients with echocardiography and digital subtraction angiography (DSA) examination from Jinling hospital from January 2017 to October 2017 were enrolled in this study. The subjects were divided into mild and moderate-severe stenosis groups according to the degree of extra- and intracranial atherosclerotic stenosis. LVMI was calculated by the criteria of American Society of Echocardiography (ASE). The traditional risk factors of cerebral atherosclerosis such as age, gender, hypertension, diabetes, coronary artery disease, lipids, and left ventricular mass (LVM) and LVMI, were compared between the mild and moderate-severe stenosis group. Univariate analysis and bivariate regression analysis were performed to analyze the independent risk factors of cervicocerebral atherosclerotic stenosis and the correlation of LVMI and cervicocerebral stenosis degree. Results Among the 169 enrolled patients, 85 (50.3%) with extracranial atherosclerotic stenosis, and 84 (49.7%) with intracranial atherosclerotic stenosis. For patients with extracranial atherosclerotic stenosis, those with moderate-severe stenosis were older than whom with mild stenosis [(64.3±12.4) vs (56.0±13.2) years old, P =0.001], and the LVMI in moderate-severe stenosis group were higher than that in mild stenosis group[(43.6±10.3) vs (36.6±7.2) g/m2.7, P <0.001]. For patients with intracranial atherosclerotic stenosis, LVMI were lower in patients with mild stenosis than that in patients with moderate-severe stenosis [(36.5±7.2) vs (46.1±13.6), P <0.001]. Spearman correlation analysis showed that there was a positive correlation between LVMI and cervicocerebral stenosis rate (r =0.553, P <0.001). Bivariate logistic regression analysis showed that LVMI (OR 1.13, 95%CI 1.05-1.21), age (OR 1.06, 95%CI 1.01-1.11) were independent risk factors of severe extracranial atherosclerotic stenosis. Conclusions LVMI was positively correlated with cervicocerebral atherosclerotic stenosis in patients with ischemic stroke. LVMI was an independent risk factor of severe extracranial atherosclerotic stenosis.

Analysis of Clinical, Imaging Characteristics and Prognosis in Patients with Capsular Warning Syndrome

SUN Xu, LIU Zhen-Yu, FAN Cun-Xiu, LI Jia-Si, BI Xiao-Ying

2019, 14(01): 29-32. DOI: 10.3969/j.issn.1673-5765.2019.01.005

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Objective To investigate the etiology, clinical and imaging characteristics, and prognosis in patients with capsular warning syndrome (CWS). Methods A retrospective analysis of data of 41 patients with CWS from Department of Neurology, Changhai hospital, Navy Medical University from January 1, 2015 to December 31, 2017 was performed. Results Of 41 patients with CWS, 34 (82.9%) with hypertension, 24 (58.5%) with hyperlipemia, 18 (43.9%) having smoking, and 9 (22.0%) with diabetes. 20 (48.8%) cases showed pure motor symptoms, 8 (19.5%) cases showed pure sensory symptoms, and 13 (31.7%) cases showed sensorymotor symptoms. 37 (90.2%) patients had culprit artery (internal carotid artery and middle cerebral artery) stenosis, 11 patients underwent high-resolution magnetic resonance imaging examination, and 10 (90.9%) showed cerebral artery plaques. Of 41 patients, 30 (73.2%) were treated with dual antiplatelet drugs, and 5 patients (12.2%) progressed to cerebral infarction within 3 months. Nine patients (22.0%) had no recurrence after endovascular treatment. Conclusions The main cause of capsule warning syndrome is arteriosclerosis of middle cerebral artery. Patients with clear etiology and surgical indication should be treated as soon as possible. Dual antiplatelet therapy is more effective.

Correlation between Cognitive Impairment and Serum Uric Acid Level in Patients with Transient Ischemic Attack or Minor Stroke

SUN Xu, CHEN Chao, FAN Cun-Xiu, LI Jia-Si, BI Xiao-Ying

2019, 14(01): 33-37. DOI: 10.3969/j.issn.1673-5765.2019.01.006

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Objective To investigate the relationship between serum uric acid level and cognitive impairment in patients with TIA/minor stroke. Methods The clinical and imaging data of 78 patients with TIA/minor stroke who were hospitalized in Shanghai Changhai hospital from June 2015 to June 2016. Patients were divided into cognitive impairment and no cognitive impairment group by using the Montreal cognitive assessment scale. The difference of serum uric acid levels between the two groups was tested by t test, and the relationship between serum uric acid level and cognitive impairment was analyzed by multivariate logistic regression analysis. Results A total of 78 patients with TIA/minor Stroke were enrolled, with 34 in cognitive impairment group and 44 in no cognitive impairment group. The prevalence of hypertension (70.6% vs 45.5%, P =0.026) and diabetes (52.9% vs 29.5%, P =0.036) in cognitive impairment group were higher than that in no cognitive impairment group. The serum uric acid level in cognitive impairment group [(0.31±0.07) mmol/L] was lower than that in no cognitive impairment group [(0.36±0.09) mmol/L], which was statistically significant (P =0.003). Serum uric acid level was an independent protective factor of cognitive impairment (OR 0.990, 95%CI 0.984-0.997, P =0.008). Conclusions Compared with patients with no cognitive impairment, the patients with cognitive impairment had higher prevalence of diabetes and hypertension and lower serum uric acid level. Serum uric acid level was an independent protective factor of cognitive impairment.

X-strain Imaging Characteristics of Carotid Atherosclerostic Plaques in Patients with Cerebral Infarction

GUO Li, CHENG Ling-Gang, HE Wen, LI Ming-Qiu

2019, 14(01): 38-42. DOI: 10.3969/j.issn.1673-5765.2019.01.007

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Objective To investigate the value of X-strain imaging (XS) in evaluating carotid plaque motility in patients with cerebral infarction. Methods 26 cerebral infarction patients with carotid atherosclerotic plaques identified by carotid ultrasound from March 2015 to February 2016 were enrolled in cerebral infarction group, and 24 non-stroke patients with carotid atherosclerotic plaques as the control group. Both groups were all examined by X-strain imaging and carotid ultrasound. The strain and movement characteristics of carotid plaques in different positions were compared between the two groups. Results There was no significant difference in carotid plaque size between the two groups by conventional ultrasound. XS results showed that the strain and movement of the plaques between the two groups had significant difference. The movement of plaque in proximal shoulder was more obvious than that in distal shoulder in cerebral infarction group, the transverse movement speed [(0.25±0.07) cm/s vs (0.15±0.05) cm/s] and displacement [(0.28±0.10) mm vs (0.17±0.05) mm] in proximal and distal subgroups also had significant difference. The strain in the top [(2.75±1.01)%] was lower than that in proximal shoulder [(4.43±1.08)%] and distal shoulder [(4.23±1.24)%], the difference was statistically significant. Conclusions The strain and movement of carotid plaques in patients with cerebral infarction are more obvious, and the plaques vulnerability is high.

Association of Sex and Intra-plaque Hemorrhage in Carotid Artery in Community-Based Population

2019, 14(01): 43-48. DOI: 10.3969/j.issn.1673-5765.2019.01.008

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Objective To investigate the association between sex and intra-plaque hemorrhage (IPH) in carotid artery diagnosed by HR-MRI in a community-based population. Methods A cross-sectional study was conducted in Tsinghua community-based population. Data of demographic information, medical history of hypertension, diabetes and hyperlipidemia, smoking and drinking, physical examinations, laboratory test and other information were collected. According to whether there was IPH in carotid artery by HR-MRI, all subjects were classified as IPH group and no IPH group. Multivariate logistic regression analysis was performed to analyze the association of sex and IPH. Results Of all 246 participants, with 105 (42.7%) were males and a mean age of 64.8 years. There were 12 (4.88%) subjects with IPH. Comparing with the no IPH group, the IPH group had more males (83.3% vs 40.6%, P =0.004), a higher proportion of hypertension (91.7% vs 43.2%, P =0.001) and diabetes mellitus (50.0% vs 12.4%, P <0.001), a higher level of fasting blood glucose [(6.30±1.63) mmol/L vs (5.00±0.99) mmol/L, P <0.001]. The multivariate logistic analysis showed that sex was an independent risk factor of IPH in carotid artery (OR 7.68, 95%CI 1.10-53.81, P =0.040).

Conclusions Male may be an independent risk factor of IPH in carotid artery.

Clinical Characteristic of Isolated Vestibular Syndrome of a Vascular Cause

CHEN Liang, LI Jian-Hua, ZHANG Zong-Xin

2019, 14(01): 49-52. DOI: 10.3969/j.issn.1673-5765.2019.01.009

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Objective To better understand the clinical feature of isolated vestibular syndrome of a vascular cause. Methods A retrospective analysis of 158 patients with posterior circulation infarction from the first hospital of Fangshan District of Beijing from January 2013 to December 2015 was performed. Cerebral MRI, vertebral artery color Doppler ultrasound, TCD and intracranial artery MRA were performed in all subjects, with CTA and DSA if necessary. According to clinical manifestation, all patients were divided into vertigo group and common group. Risk factors, clinical charateristic and infarction location were compared between the two groups. Results (1) There were 32 (20.3%) patients in vertigo group and 126 (79.7%) patients in common group. There were no statistical difference in age, hypertension, diabetes mellitus, dyslipidemia, smoking, and atrial fibrillation between the two groups. Posterior circulation artery stenosis rate was higher in vertigo group than that in common group (46.9% vs 32.5%, P =0.034) and the artery stenosis was more found in man (81.2% vs 50.8%, P =0.020). (2) Infarction in vertigo group mostly located in proximal vertebrobasilar artery territory (59.4% vs 34.1%, P =0.003), especially in PICA territory. (3) The false negative rate in initial DWI was higher in vertigo group (18.8% vs 3.0%, P =0.005), while the positive rate of the battery of head impulse test, nystagmus, test of skew (HINTS) was as high as 87.5% in vertigo group. Conclusions Compared common posterior circulation infarction, the patients with isolated vestibular syndrome had a higher rate of artery stenosis and a higher false negative rate in initial DWI, and their culprit lesions mostly located in proximal vertebrobasilar artery territory

Etiology and Pathogenesis of Stroke

WU Yun-Cheng

2019, 14(01): 53-53.

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