Chinese Journal of Stroke

Review of Stroke Studies in 2019

WANG Yong-Jun, LI Zi-Xiao, SUO Yue, ZHOU Hong-Yu, ZHANG Qi-Hui,HAN Chong, LI Shi-Yu, DING Ya-Rong, WANG Yu, DAI Li-Ye, WANG Xue-Chun, CHENG Ai-Chun, FENG Zhi-Yuan,ZHANG Chen, ZHANG Xing

2020, 15(01): 1-17. DOI: 10.3969/j.issn.1673-5765.2020.01.001

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Stroke and Immune

HU Hao-Tian, SHI Fu-Dong

2020, 15(01): 18-21. DOI: 10.3969/j.issn.1673-5765.2020.01.002

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Characteristics of White Matter Lesions and Cerebral Hemodynamics in Patients with H Type Hypertension

HE Qian-Qian, FU Bing, ZHANG Zhao-Ting, LI Min, DONG Wan-Li

2020, 15(01): 22-27. DOI: 10.3969/j.issn.1673-5765.2020.01.003

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Objective To investigate the characteristics of white matter lesions (WML) and cerebral hemodynamics in patients with H type hypertension. Methods WML patients with hypertension in the Second People's Hospital of Lianyungang were retrospectively analyzed. According to the level of Hcy, the selected patients were divided into H type hypertension group and simple hypertension group. The severity of WML was evaluated by MRI and the Fazekas scale. Intracranial arteries were detected by TCD and their hemodynamic characteristics such as pulsatility index (PI) and mean blood flow velocity (Vm) were analyzed. The severity of WML and the characteristics of cerebral hemodynamics were compared between the two groups. Based on the normal PI (0.65-1.10), all the patients were divided into the normal PI group and increased PI group (>1.10). Logistic regression was used to analyze the influencing factors for PI. Results Finally, a total of 217 WML patients with hypertension were enrolled in this study, aged 40-85 years, with an average age of 66.35±8.08 years and 150 males (69.1%). Among them,131 patients (60.4%) were in the H type hypertension group. The total Fazekas score of H type hypertension group was higher than that of simple hypertension group (2.45±0.33 vs 2.16±0.36, P =0.011), and the paraventricular Fazekas score was also higher than that of simple hypertension group (1.48±0.12 vs 1.38±0.15, P =0.009). There was no statistical difference in deep white matter Fazekas score between the two groups. Middle cerebral artery (MCA) PI (1.21±0.20 vs 1.10±0.17, P =0.016) and anterior cerebral artery (ACA) PI (1.16±0.18 vs 1.07±0.18, P =0.023) in H type hypertension group were higher than that in simple hypertension group. Logistic regression analysis showed that H type hypertension was an independent influence factor of ACA PI (OR 2.080, 95%CI 1.073-4.033, P =0.030) and MCA PI (OR 1.951, 95%CI 1.015-3.749, P =0.045). Conclusions H type hypertension is related to the severity of WML, and H type hypertension is an independent influence factor for ACA PI and MCA PI.

Clinical Features, Imaging Characteristics and Prognosis in Patients with Bilateral Cerebral Peduncular Infarction

HUO Xu-Ning, SUN Xiao-Jing, DUAN Yang, CHEN Hui-Sheng, XIA Cheng

2020, 15(01): 28-32. DOI: 10.3969/j.issn.1673-5765.2020.01.004

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Objective To investigate the clinical manifestations, magnetic resonance imaging (MRI) features and prognosis in patients with bilateral cerebral peduncular infarction (BCPI). Methods The clinical data of patients with acute BCPI confirmed by DWI from July 2013 to December 2016 were retrospectively analyzed. Results A total of 18 BCPI patients were included, and 10 (55.6%) patients had quadriplegia, 11 (61.1%) had decreased consciousness. When the illness was most severe, the NIHSS was 12.5 (4.0- 20.5). There were 16 (88.9%) cases with large artery atherosclerosis infarction. Besides the bilateral cerebral peduncle, the other sites involved were the pons (88.9%) and cerebellum (72.2%). 16(88.9%) patients had basilar artery occlusion or severe stenosis, and 2 (11.1%) patients had vertebral artery and posterior cerebral artery occlusion or severe stenosis. At 3 months follow up, 13 patients had poor prognosis (including 10 deaths) and 2 patients were lost to follow-up. Conclusions BCPI was often accompanied by pontine infarction and cerebellar infarction. Its main etiology was large-artery atherosclerosis, and the mechanism was hypoperfusion. BCPI patients usually have a poor prognosis.

Construction of Predictive Model of 1-year Stroke Recurrence for Stroke Patients in Xi'an

LIN Xue-Mei, WANG Fang, WANG Jing, CAO Huan, LU Qing-Li, LIU Zhong-Zhong, DUAN Kang-Li, WU Song-Di

2020, 15(01): 33-39. DOI: 10.3969/j.issn.1673-5765.2020.01.005

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Objective To construct a predictive model of 1-year stroke recurrence for stroke patients in Xi'an. Methods Data of acute stroke patients from Xi'an Stroke Database from January 1 to December 31, 2016 were collected. Clinical data included in-hospital data and the follow-up results at 1 year after discharge. After analyzing the risk factors affecting recurrent stroke, a predictive model of 1-year stroke recurrence was constructed using the Cox proportional hazard regression model. Results A total of 2775 patients with acute stroke were enrolled in this study. Recurrent stroke ocurred in 144 patients (accumulated risk 5.34%) within 1 year. A predictive model for the 1-year stroke recurrence as follows: h (t ) = h0 exp (0.02900×age + 0.83649×prior stroke + 0.26683×peripheral vascular disease history + 0.12887×NIHSS score at admission). The area under the ROC curve was 0.82, the best cut-off point was 0.197, the sensitivity and specificity were 0.69 and 0.78, respectively. The total accuracy of the predictive model is 83%. Conclusions The 1-year stroke recurrence predictive model for stroke patients in Xi'an is targeted, simple, practical and easy to operate. The high-risk stroke patients in Xi'an can be identified by the predictive model and are given individualized treatment timely, which will reduce the recurrence rate of stroke and improve the prognosis of stroke patients.

Correlation between Cognitive Impairment and Serum β2 Microglobulin Level in Eldly Patients with Acute Minor Ischemic Stroke

LI Shi-Xin, WANG Ying, MA Qing-Ke, ZHAO Shi-Jiao, MEN Hui, YAN Yu, CHEN Bao-Xin,LIU Xue-Mei, ZHANG Zhi-Chen, ZHU Xiao-Chen, HE Li-Juan, ZHOU Jing, CHENG Miao-Miao, CAO Xin-Hua,JIN Xiang-Lan

2020, 15(01): 40-44. DOI: 10.3969/j.issn.1673-5765.2020.01.006

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Objective To investigate the relationship between cognitive impairment and serum β2 microglobulin level in eldly patients with acute minor ischemic stroke. Methods Clinical data of elderly patients with acute minor ischemic stroke who were admitted to the Department of Encephalopathy, Dongfang Hospital of Beijing University of Chinese Medicine from January 2015 to September 2018 were retrospective analyzed. Serum β2 microglobulin was measured on the next day after admisson. On the 10th-14th day (the condition is stable and delirium is excluded), all patients were assessed using the Beijing version of MoCA and divided into cognitive impairment group (MoCA <26 points) and non-cognitive impairment group (MoCA ≥26 points). The relationship between cognitive impairment and serum β2 microglobulin in eldly patients with acute minor ischemic stroke was analyzed. Results A total of 106 elderly patients with acute minor ischemic stroke were included in this study, with 66 patients in cognitive impairment group and 40 patients in non-cognitive impairment group. Serum β2 microglobulin levels (P =0.040), age (P =0.004) and the percentage of hypertension (P =0.027)in the cognitive impairment group were all higher than that in non-cognitive impairment group. Multivariate logistic regression analysis showed that serum β2 microglobulin level (OR 2.645, 95%CI 1.145-6.110, P =0.023), age (OR 1.112, 95%CI 1.041-1.188, P =0.002) and hypertension (OR 2.806, 95%CI 1.057-7.452, P =0.038) was independent risk factors for cognitive impairment in eldly patients with acute minor ischemic stroke. Conclusions Serum β2 microglobulin is one of the risk factors for cognitive impairment in eldly patients with acute minor ischemic stroke.

Advances in Anticoagulant Resumption after Intracerebral Hemorrhage

WU Jiong-Xing, WANG De-Ren

2020, 15(01): 46-50. DOI: 10.3969/j.issn.1673-5765.2020.01.007

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Anticoagulation is currently recommended and commonly used in patients with atrial fibrillation and/or mechanical prosthetic heart valves to prevent thromboembolism events, especially stroke. However, the decision-making about whether and when to resume anticoagulant after intracerebral hemorrhage (ICH) is still an unsolved problem due to lacking randomized controlled trials. Several large-scale observational studies and meta analysis showed that anticoagulant resumption after ICH decreased thromboembolic complications without increasing hemorrhagic complications. Given the lack of high-quality evidence, clinicians should carefully balance the risk of thromboembolism and recurrent ICH in individual patients.

Coagulation and Immune in Thrombosis

ZHANG Wei, YAN Tao

2020, 15(01): 51-56. DOI: 10.3969/j.issn.1673-5765.2020.01.008

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Thrombosis is the result of blood coagulation caused by platelet and coagulation factor activation after vascular injury. Studies have shown that there are extensive links between coagulation and inflammation, involving the interaction among the blood cascade system, immune cells and vascular endothelial cells. Platelets, tissue factors, thrombin, contact activation system and complement system jointly promote thrombosis, and activated proinflammatory responses. Plasminogen activation system not only activates fibrinolysis but also promotes the inflammatory process associated with thrombosis. These pathophysiological reactions ultimately lead to thromboinflammation process. This article introduced the relationship between coagulation and immune and the role of immune in thrombosis, to provide reference for the future research on therapeutic targets for inflammatory and thrombotic diseases.

Progress of Immunomodulation Therapy for Ischemic Stroke

ZOU Ming

2020, 15(01): 57-62. DOI: 10.3969/j.issn.1673-5765.2020.01.009

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The immune system plays an important role in the pathological process of ischemic stroke through innate and adaptive immune responses. After ischemic stroke onset, destructive cytokines released by activated immune cells can damage vascular endothelium, blood-brain barrier and neurons. Then adaptive immune response is activated by the combination of lymphocytes and specific antigen and aggravates neuron injury. On the other hand, there are protective responses in the body, neuron injury can be alleviated by removing necrotic tissue, releasing protective cytokines and regulating immunosuppression. Immunomodulation therapy provides a new direction for the treatment of stroke. Immunoregulatory drugs such as fingomod, minocycline and natazumab have shown good efficacy in animal model experiments and clinical studies of ischemic stroke. This article reviews the research progress of immunomodulation therapy for ischemic stroke.

Interpretation for Guidelines for the Early Management of Patients With Acute Ischemic Stroke 2019 (2)

Translator: DONG Yi, GUI Li, ZHENG Hua-Guang, LI Wei, WANG-QIN Run-Qi, CHENG Xin, GAO Yuan, LIU Hui-Hui,DING Hong, DOU Xin, TAN Ze-Feng, LI Shu-Juan, David Wang

2020, 15(01): 63-74. DOI: 10.3969/j.issn.1673-5765.2020.01.010

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JAMA Neurol: Tailoring the Approach to Embolic Stroke of Undetermined Source

YANG Zhong-Hua

2020, 15(01): 75-80. DOI: 10.3969/j.issn.1673-5765.2020.01.011

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Smoking for Stroke: Red and Black

John H.Zhang

2020, 15(01): 81-88. DOI: 10.3969/j.issn.1673-5765.2020.01.012

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Thrombolysis in Hyperacute Cerebral Embolism Associated with Atrial Myxoma: a Case Report

ZHANG Hong,XIE Zhong-Xiang, CHE Feng-Yuan

2020, 15(01): 89-92. DOI: 10.3969/j.issn.1673-5765.2020.01.013

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Spontaneous High Cervical Spinal Epidural Hematoma Misdiagnosed as Cerebral Infarction Treated by Intravenous Thrombolysis: a Case Report

CHEN Guo-Dong, XIAO Jin, DAI Jian, LIU Bing-Rong, WANG Feng,LI Hai-Yan, ZHOU Rong, WU Zhi-Yong

2020, 15(01): 93-95. DOI: 10.3969/j.issn.1673-5765.2020.01.014

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Role of the Glymphatic System in Ageing and Diabetes Mellitus Impaired Cognitive Function

FAN Yu-Hua

2020, 15(01): 96-97. DOI: 10.3969/j.issn. 1673-5765.2020.01.015

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Progress of Cerebral Hemodynamics in Epilepsy

KONG Zhao-Hong, WANG Qun

2020, 15(01): 98-101. DOI: 10.3969/j.issn.1673-5765.2020.01.016

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There are different changes of cerebral blood flow in different stages of epileptic seizure. During epileptic seizure, cerebral blood flow increased and brain tissue metabolic rate increased in epileptic focus; while during the intermittent period, cerebral blood flow slowed and brain tissue metabolic rate decreased. It is of great significance to study the characteristics of cerebral blood flow changes in epileptic focus in different stages of epileptic seizures, which will help to elucidate the pathogenesis of seizure. This article reviewed the progress in cerebral hemodynamics and possible mechanism of epilepsy.

Review on Gait Analysis

CHEN Hui-Min, WANG Yi-Long

2020, 15(01): 102-107. DOI: 10.3969/j.issn.1673-5765.2020.01.017

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Gait is an important behavioral indicator, and abnormal gait is a common manifestation of a variety of diseases with different physiological systems involved. Gait evaluation includes qualitative, semi-quantitative and quantitative assessment methods. Quantitative gait analysis, which objectively and sensitively measures gait dynamics and kinematics, yields spatial and temporal parameters and describes gait related features such as rhythm and stability. The diverse characteristics of gait under diverse conditions (usual and fast walk, and dual tasks) provide important perspectives of gait in epidemiological research, disease diagnosis, and mechanism exploration. Gait dysfunction may coexist with cognitive impairment, and also may be associated with the declined quality of life and survival rate, and an increased risk of falls and injuries and other accidents in the elderly, which adds a certain burden to the aging society. With the development of biophysics and computer science, and the advanced evolution and standardization of analytical methods, the combination of gait with cognition, neuroimaging and artificial intelligence will bring greater research prospects for gait analysis.

Inflammatory Response and Ischemic Stroke

QIU Xiao-Xue, LI Shi-Wen, Yu Lu, Wu Yi-Ping, Lin Jie

2020, 15(01): 108-114. DOI: 10.3969/j.issn.1673-5765.2020.01.018

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Inflammatory response is one of the important pathophysiology reactions after ischemic stroke, the process of which involves the joint participation of immune and inflammatory cells, activated inflammatory factors from different pathways and sources. Early microglia and neutrophils are activated, and the aggregation and infiltration of lymphocytes can increase the damage to brain tissue. Studies have found that under specific stimuli, neutrophils can change from a pro-inflammatory phenotype to an anti-inflammatory phenotype, which can protect brain cells; some T cell subtypes of lymphocytes can inhibit the expression of pro-inflammatory factors and regulate lymphocytes activity, which plays a protective role in the brain. After ischemic stroke onset, in addition to the local inflammatory response in the brain, the inflammatory response and immunosuppression from the peripheral circulation also participate in the pathophysiological reactions. Immune regulation may become a target for the treatment of ischemic stroke in the future.

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