Table of Content

20 November 2019, Volume 14 Issue 11

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Strategic Plan for Priority Development of Clinical Research on Cerebral Small Vessel Disease in China

Alliance of Experts on Cerebral Small Vessel Disease, Chinese Stroke Association (Writer: WANG Yi-Long)

2019, 14(11):  1075-1082.  DOI: 10.3969/j.issn.1673-5765.2019.11.001

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The Prediction Value of High Urinary Albumin Creatinine Ratio for Short-term Functional Outcome in Acute Ischemic Stroke

SHEN Zhi-Yuan, CHEN Yu-Hui, GONG Tao

2019, 14(11):  1083-1088.  DOI: 10.3969/j.issn.1673-5765.2019.11.002

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Objective To investigate the clinical characteristics of acute ischemic stroke (AIS) patients, and the effect of urinary albumin-to-creatinine ratio (ACR), the evaluated glomerular filtration rate (eGFR) at admission on the functional outcome at 90 days in AIS patients. Methods This was a prospective study which enrolled consecutive AIS patients who were hospitalized in Department of Neurology, Beijing Hospital from March 27, 2017 to November 16, 2017. Data of general information, vascular risk factors, ACR, eGFR, and related laboratory tests, NIHSS score on admission were collected. The outcome was evaluated by a mRS score at 3 months. Based on renal function state, all patients were divided into renal dysfunction group and normal renal function group, and the clinical characteristics between the two groups were compared. Based on the mRS at 3 months, all patients were divided into good prognosis group (mRS: 0-2) and poor prognosis group (mRS: 3-6), the clinical characteristics between the two groups were compared and independent risk factors for poor prognosis at 3 months were analyzed. Results A total of 115 patients were included in this study. The prevalence of renal dysfunction in AIS patients was 44.3% (51/115). Compared with normal renal function group, renal dysfunction group had a higher mean age (P =0.009), and higher incidence of diabetes (P =0.001), coronary heart disease (P =0.026) and atrial fibrillation (P =0.003), and a higher NIHSS score (P =0.013) on admission, and higher levels of blood glucose (P =0.001), plasma fibrinogen (P =0.008) and D-dimer (P =0.001) on admission. Compared with good prognosis group, poor prognosis group had a higher mean age (P =0.007), a higher rate of history of stroke (P =0.002), a higher incidence of atrial fibrillation (P =0.040), higher levels of plasma fibrinogen (P =0.004) and D-dimer (P <0.001), higher NIHSS (P <0.001) score on admission. There were no statistical difference in hypertension, diabetes, abnormal lipid metabolism, coronary atherosclerotic heart disease, and smoking history between the good prognosis and poor prognosis groups. Compared with the good prognosis group, the poor prognosis group had higher ACR (P <0.001) and lower eGFR (P =0.030). Multivariate analysis showed that the NIHSS score≥8 on admission (OR 27.05, 95%CI 3.75-178.18, P =0.001), ACR≥3 mg/mmol (OR 35.50, 95%CI 4.79-262.94, P <0.001), history of stroke (OR 20.48, 95%CI 2.35- 178.18, P =0.006) were independent risk factors for poor prognosis at 3 months. Conclusions AIS patients had a higher prevalence of renal dysfunction. The AIS patients with high ACR at admission had a poorer outcome at 3 months.

Clinical Value and Expression Level of Serum miRNA-148a in Patients with Acute Ischemic Stroke

2019, 14(11):  1089-1094.  DOI: 10.3969/j.issn.1673-5765.2019.11.003

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Objective To investigate the level and clinical value of serum miRNA-148a in patients with acute ischemic stroke (AIS). Methods The serum samples of peripheral blood from 42 AIS patients and 42 healthy control participants were collected, and the miRNA-148a levels of all subjects were measured by a realtime fluorogenic quantitative PCR. The receiver operating characteristic (ROC) curve of miRNA- 148a for the diagnosis of AIS was plotted, and the correlation between miRNA-148a expressioin level and clinical data were analyzed. The GSE55937 dataset were downloaded from Gene Expression Omnibus to measure the miRNA-148a expression level in AIS patients, and the target genes and biological functions of miRNA-148a were predicted using bioinformatics analysis. Results The miRNA-148a expression level in AIS patients within 12 h after onset was significantly lower than that in healthy control group (0.76±0.23 vs 1.02±0.21, P <0.001).The area under the ROC curve of miRNA-148a for the diagnosis of AIS was 0.79 (95%CI 0.70-0.89, P <0.001). Spearman correlation test showed that the miRNA-148a expression level in AIS patients were negatively associated with infarction size (r =-0.34, P =0.03) and high sensitivity C-reactive protein (hs-CRP) (r =-0.43, P =0.005). In GSE55937 dataset, the level of miRNA-148a was also remarkably lower in AIS than that in control group (1.93±0.46 vs 2.52±1.00, P =0.011), and the area under the ROC curve of miRNA-148a for the diagnosis of AIS was 0.69 (95%CI 0.54-0.84, P =0.022). A total of 58 target genes were predicted by bioinformatics methods, such as WNT10B and DNMT1. The molecular mechanism of the target genes mainly involve the regulation of cell apoptosis, FoxO signaling pathway and PI3K-Akt pathway and etc. Conclusions The serum miRNA-148a level is significantly decreased in the early phase of AIS patients, and the mechanism of miRNA-148a in stroke may involve cell apoptosis, FoxO signal pathway and PI3K-Akt signal pathway. miRNA-148a may have certain value in the diagnosis and assessment of AIS.

Correlation between MTHFR C677T Gene Polymorphism and Cognitive Impairment in Patients with Cerebral Small Vessel Disease

WANG Ming-Yu, ZHANG Li-Hui, ZHOU Hao, ZHAO Yong

2019, 14(11):  1095-1100.  DOI: 10.3969/j.issn.1673-5765.2019.11.004

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Objective To investigate the correlation between MTHFR C677T gene polymorphism and cognitive impairment in patients with cerebral small vessel disease (CSVD). Methods This was a retrospective study which included the CSVD outpatients and inpatients in Department of Neurology,Weifang People's Hospital between December 2017 to March 2019. Based on the Montreal cognitive assessment (MoCA) and clinical dementia rating (CDR) score, the patients were divided into three groups: normal cognition group, mild cognitive impairment group and dementia group. The level of homocysteine (Hcy), and MTHFR C677T phenotype were measured. The relationship between cognitive function and Hcy or MTHFR C677T phenotype were analyzed by comparing the above data among three groups. Results A total of 130 CSVD patients were enrolled into this study, including 87 males (66.9%), and with 63 patients in normal cognition group, 35 patients in mild cognitive impairment group and 32 patients in dementia group. The Hcy level in dementia group was significantly higher than that in mild cognitive impairment group (P <0.001) and normal cognition group (P <0.001). The Hcy level in mild cognitive impairment group was significantly higher than that in normal cognition group (P <0.001).The level of Hcy was positively correlated with cognitive decline (r =0.626, P <0.001). The frequency of C677T MTHFR mutation (C→T) genotype was positively correlated with cognitive decline (r =0.359, P =0.001). The frequency of T allele was positively correlated with cognitive decline (r =0.273, P <0.001). Conclusions MTHFR 677 C→T gene mutation was associated with cognitive decline, and it can be used as an early serum predictor for cognitive impairment in CSVD.

Analysis of Aphasia Improvement after Intravenous Thrombolysis in Stroke Patients with Different Severity

FU Sheng-Qi, SHI Bao-Yang, ZHANG Jin, SONG Liang, ZHANG Hong-Tao, ZHANG Shu-Ling

2019, 14(11):  1101-1105.  DOI: 10.3969/j.issn.1673-5765.2019.11.005

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Objective To investigate aphasia improvement after intravenous thrombosis in acute ischemic stroke patients with different severity. Methods Data of 360 acute ischemic stroke patients treated with rt-PA intravenous thrombolysis in Department of Neurology, Zhengzhou People’s Hospital from April 2015 to March 2017 were collected. Based on the NIHSS score on admission, all patients were divided into two groups: NIHSS≤8 group and NIHSS>8 group. The baseline data included age, sex, hypertension, diabetes, heart disease, smoking and drinking, low density lipoprotein cholesterol, onset-to-needle time and etc. Improvement of aphasia and neurological function between the two groups were compared. Results Finally, 158 patients with aphasia were included in this study, with 49 patients with NIHSS ≤8 and 109 patients with NIHSS >8. Baseline data and neurological function improvement at 24 h after thrombolysis between the two groups had no statistical difference. The improvement percentage of aphasia at 24 h after thrombolysis in NIHSS ≤8 group was higher than that in NIHSS >8 group (67.3% vs 45.9%, P =0.021). The complete improvement percentage of aphasia at 24 h after thrombolysis in NIHSS ≤8 group was higher than that in NIHSS >8 group (69.7% vs 44.0%, P =0.021). Conclusions For acute ischemic stroke patients with aphasia, the improvement percentage of aphasia in patients with NIHSS ≤8 was higher than that in patients with NIHSS >8 at 24 h after intravenous thrombolysis.

Analysis on Factors of Progressive Motor Dysfunction and Prognosis in Patients with Cerebral Infarction due to Penetrating Artery Disease

ZHOU Juan, SHI Fu-Ming, CHEN Shu-Ge, ZHANG Li-Wen, DONG Li-Ping, WANG Tie-Jun

2019, 14(11):  1106-1111.  DOI: 10.3969/j.issn.1673-5765.2019.11.006

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Objective To analyze the risk factors of progressive motor dysfunction (PMD) in patients with cerebral infarction due to perforating artery disease (PAD). Methods Patients with PAD cerebral infarction diagnosed by MRI were divided into PMD group and non-PMD Group. The demographic data, vascular risk factors, lesions characteristics, laboratory test result, prognosis and stroke recurrence at 3 and 6 months were compared between the two groups. Multivariate analysis was used to determine the independent risk factors for PMD. Results A total of 287 patients with PAD were enrolled in this study, including 95 patients with PMD and 192 patients with non-PMD. The males (P =0.03), smoking (P =0.04), the glycated hemoglobin (P <0.001), homocysteine (P =0.02), D-dimer (P =0.01) and infarct diameter (P <0.001) were all significantly higher in PMD group than that in non-PMD Group. There was no significant difference in the NIHSS scores at admission between the two groups, but the NIHSS scores at discharge in PMD group was higher than that in non-PMD group (7.69±1.87 vs 2.13±0.49, P <0.001). The rate of good prognosis at 3 months in PMD group was lower than that in non-PMD Group (55.7% vs 70.8%, P =0.01), while the two groups had no statistical difference at 6 months. There were no significant difference in recurrent cerebral infarction at 3 and 6 months between the two groups. Multivariate analysis showed that high glycated hemoglobin level (OR 1.083, 95%CI 1.062-1.105, P =0.03) and large infarct diameter (OR 1.051, 95%CI 1.030-1.073, P =0.01) were independent risk factors for PMD. Conclusions Of patients with cerebral infarction due to PAD, the patients occurring PMD had more severe neurological function deficit and worse prognosis at 3 months. Glycated hemoglobin and infarct diameter can be used as predictors for PMD.

Cerebral Small Vessel Disease

WANG Yi-Long

2019, 14(11):  1112-1112. 

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Advances in Non-traditional Vascular Risk Factors for Cerebral White Matter Hyperintensity

GUO Yu-Zhou, GUAN Ling, WANG Yong-Jun, WANG Yi-Long

2019, 14(11):  1113-1118.  DOI: 10.3969/j.issn.1673-5765.2019.11.007

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Cerebral white matter hyperintensity (WMH) of presumed vascular origin is one of the typical neuroimaging features of cerebral small vessel diseases. A certain number of clinical cases with WMH had no traditional stroke risk factors such as hypertension and diabetes, while had non-traditional symptoms/risk factors including migraine, syncope, obstructive sleep apnea, sleep disorders and orthostatic hypotension. This article reviews the advances in relationship between WMH and non-traditional risk factors (migraine, syncope, obstructive sleep apnea, sleep disorders and orthostatic hypotension). The further study on non-traditional vascular risk factors will help us to understand the potential mechanism of WMH, and interventions for these non-traditional factors may be helpful for prevention and treatment of WMH.

Pathological Basis and Imaging Characteristics of Spectrum of Age-related Cerebral Small Vessel Diseases

LU Zheng-Qi, SONG Kang-Yu

2019, 14(11):  1119-1123.  DOI: 10.3969/j.issn.1673-5765.2019.11.008

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The spectrum of age-related cerebral small vessel diseases (ArCSVDS) is defined as a group of cerebral small vessel disease (CSVD) in which cerebral small arteries, arterioles, capillaries, venules, small veins appear ageing with age, and CSVD include deep perforating arteriopathy (DPA), β-amyloid (Aβ) related cerebral amyloid angiopathy (CAA). In the past, DPA and CAA were considered to be independent disease, while recent studies have found that they both belong to the ArCSVDS from the perspective of not only similar vascular risk factors and potential interactions, but also the mechanism. The blood brain barrier (BBB) damage, endothelial cell injury and perivascular Aβ are the common mechanism of DPA and CAA, and 30%-68% patients had both diseases.

Advance in Relationship between Cerebral Hemodynamics and Enlarged Perivascular Space

MA Lin, WANG Yi-Long

2019, 14(11):  1124-1128.  DOI: 10.3969/j.issn.1673-5765.2019.11.009

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The enlarged perivascular space is one of the neuroimaging markers of cerebral small vessel disease. The mechanism of perivascular space enlargement is still unclear. Many studies have shown that abnormal hemodynamics may be correlated with the enlarged perivascular space. This article reviewed the relationship between blood pressure, stiffness of vessel wall and cerebral blood flow with the enlarged perivascular space, to provide reference for studies of pathogenesis and possible treatment methods of enlarged perivascular space.

Research Status and Mechanism of Bowel and Bladder Dysfunction in Cerebral Small Vessel Disease

TIAN Yu, GUAN Ling, WANG Yi-Long

2019, 14(11):  1129-1134.  DOI: 10.3969/j.issn.1673-5765.2019.11.010

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Cerebral small vessel disease (CSVD) is a major chronic whole-brain disease mainly involving small vessels in the brain, with diverse clinical manifestation. CSVD has attracted more and more attention in recent years. As common clinical manifestation of CSVD, bowel and bladder dysfunction (BBD) seriously affect patients’ daily life and social function. Urinary dysfunction may occur in about 70% of CSVD patients, which mainly be manifested as urinary stimulation symptoms including urinary frequency, urgency, incontinence and nocturia, and the clinical symptoms are related with the severity of CSVD and lesions location. Bowel dysfunction is closely related to cerebral vascular diseases, but there is no large-scale epidemiological data on bowel disorders in patients with CSVD. This paper discussed the incidence and clinical manifestation of BBD, the possible pathogenesis of BBD in patients with CSVD, to provide a new direction for the diagnosis and treatment of CSVD.

Advance in Relationship between Cerebral Small Vessel Disease and Intracranial Large Artery Disease

YANG Ying-Ying, WANG Yong-Jun, WANG Yi-Long

2019, 14(11):  1135-1139.  DOI: 10.3969/j.issn.1673-5765.2019.11.011

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Cerebral small vessels and large arteries are closely related in structure and function. There is increasing evidence that cerebral small vessel disease often coexists with intracranial large artery disease, and their severity is consistent. Intracranial large artery atherosclerosis, intracranial arterial dolichoectasia and increased arterial stiffness all reflect structural and functional changes of large artery. This article reviewed the research status on the interaction and coexistence between cerebral small vessel disease and intracranial large artery disease.

Progress of Relationship between Serum Biomarkers and Cerebral Small Vessel Disease

ZHONG Xi, WANG Yi-Long

2019, 14(11):  1140-1145.  DOI: 10.3969/j.issn.1673-5765.2019.11.012

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It is currently believed that the main mechanism of cerebral small vessel disease (CSVD) is vascular endothelial injury, which is closely related to inflammation. Serum endothelial injury and inflammatory biomarkers are the most direct and simple methods to reflect endothelial injury. Studies on biomarkers will help us to further understand the pathogenesis of CSVD. Many studies have shown that inflammatory and endothelial injury biomarkers are closely related to the occurrence and development of CSVD. In addition, the relationship between inflammation and CSVD may be affected by race, genetics, and etc. This article reviewed the progress of relationship between serum vascular endothelial injury markers, inflammatory markers and different imaging markers of CSVD.

Advances in the Relationship between White Matter Hyperintensity and Cognitive Impairment in Cerebral SmallVessel Disease

WANG Xing, SHI Yu-Lu, CHEN Yi-Yi, WANG Yi-Long

2019, 14(11):  1146-1152.  DOI: 10.3969/j.issn.1673-5765.2019.11.013

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Cerebral small vascular disease (CSVD) is one of the most common age-related cerebrovascular diseases. White matter hyperintensity (WMH) of presumed vascular origin is one of the imaging markers of CSVD. The prevalence of WMH is extremely high, and which is closely related to the occurrence and development of cognitive impairment. However, the heterogeneity of imaging manifestations and clinical symptoms of WMH brings some difficulties to early detection and diagnosis. What’s more, the potential mechanism for disease development is not clear, so it leads to a relative lag in prevention and treatment of these diseases. This paper reviewed the current state of research on the mechanisms of cognitive impairment in the development of WMH from pathology, imaging and biology, and summarized the current treatment strategies, and raised some research objectives and directions in the next, for example, to establish the biomarkers and prediction model for assessing prognosis, to explore pathophysiological mechanism of WMH development, and find new potential targets for early intervention.

Chinese Dysphagia and Nutrition Management Manual for Acute stroke Patients

Experts Group for Chinese Dysphagia and Nutrition Management Manual for Acute Stroke Patients, Chinese Stroke Association, China National Clinical Research Center for Neurological Diseases

2019, 14(11):  1153-1169.  DOI: 10.3969/j.issn.1673-5765.2019.11.014

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Neurology: The Role of Small Diffusion-Weighted Imaging Lesions in Cerebral Small Vessel Disease

YANG Zhong-Hua

2019, 14(11):  1170-1171.  DOI: 10.3969/j.issn.1673-5765.2019.11.015

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Lancet Neurol: When the Risk of Intracranial Hemorrhage Exceeds Ischemic Stroke in Patients with Cerebral Microbleeds, Antithrombotic Therapy or not?

YANG Zhong-Hua

2019, 14(11):  1172-1172.  DOI: 10.3969/j.issn.1673-5765.2019.11.016

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Seizure after Intravenous Thrombolysis in Hyperacute Stroke：a Case Report

CHEN Jing-Juan, LI Guo-De, XU Zuo-Hang, DU Pu, DING Nan, DUAN Zhen-Peng, WANG Yu-Kai, ZHANG Cheng-Guo, ZHANG Guo-Hua

2019, 14(11):  1173-1176.  DOI: 10.3969/j.issn.1673-5765.2019.11.017

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A Case of Idiopathic Eosinophilia Syndrome with Multiple System Involvement and A Prominent Symptom of Epilepsy

SUN Yang, LIU Jia-Qi, BI Xiao-Xia, LIU Fang

2019, 14(11):  1177-1181.  DOI: 10.3969/j.issn.1673-5765.2019.11.018

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Neuroimaging Studies on Cognitive Impairment in Patients with Cerebral Small Vessel Disease

DU Jing, XU Qun

2019, 14(11):  1182-1183.  DOI: 10.3969/j.issn.1673-5765.2019.11.019

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Vascular Cognitive Impairment and Acute Cerebral Microinfarcts

HAN Shang-Rong, WANG Yi-Long

2019, 14(11):  1184-1185.  DOI: 10.3969/j.issn.1673-5765.2019.11.020

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Progress of Dizziness in Cerebral Small Vessel Disease

ZHAO Hong-Yi, LIU Yu, HUANG Yong-Hua

2019, 14(11):  1186-1189.  DOI: 10.3969/j.issn.1673-5765.2019.11.021

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Dizziness is one of the most common complaints and symptoms in outpatients with cerebral small vessel disease (CSVD). The cause of dizziness is very complex. Recent studies showed that a large number of patients with dizziness also had CSVD, and CSVD played a direct or indirect effect on the clinical features, progression and outcome of dizziness in these patients. This article reviewed the clinical symptoms, pathogenesis and mechanisms of dizziness related with CSVD. The method and procedure of CSVD-related dizziness diagnosis and treatment in department of neurology were also discussed.

Advances in the Protective Effects of BMP-7 on Neurons in Cerebral Infarction

KANG Kai, NAO Jian-Fei

2019, 14(11):  1190-1193.  DOI: 10.3969/j.issn.1673-5765.2019.11.022

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Cerebral infarction is one of the common cerebrovascular diseases with high mortality and disability rate. Therefore, it is of great significance to study the development and treatment of cerebral infarction. The intervention measures in acute phase of cerebral infarction can directly affect the patient's prognosis. Studies have showed that the expression of bone morphogenetic protein (BMP)-7 was up-regulated in the case of cerebral ischemia and hypoxia. The role of BMP- 7 in cerebral infarction was very complex. In animal experiment, BMP-7 can not only promote motor neurons recovery and increase neuronal ischemic tolerance, but also inhibit apoptosis and weaken oxidative stress, so it plays an important role in protecting ischemic brain tissue and reducing infarction volume, which can provide a new direction for the treatment of cerebral infarction.

Cultivation of Scientific Research Ability of Cerebrovascular Disease Clinicians

YE Yu-Mei, CHEN Ying, XU Rong, REN Yi

2019, 14(11):  1194-1196.  DOI: 10.3969/j.issn.1673-5765.2019.11.023

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Clinical studies are the base of modern evidence-based medicine (EBM), and clinicians are the main participants in clinical research, so the cultivation of clinician's scientific research literacy and ability is of great significance to the standardization of clinical trials and the progress of medical scientific research. This article mainly discussed the necessity and the goals of scientific research ability cultivation of clinicians, and the related cultivation contents and ways. The enhancement in scientific research ability of clinicians is an important driving force for the sustainable development of cerebrovascular disease cause in China.