Validation of hyperintense middle cerebral artery sign in acute ischemic stroke Comparison between magnetic resonance imaging and angiography

We performed a retrospective analysis of non-contrast computed tomography (CT) scans, immediately subsequent magnetic resonance imaging (MRI), and cerebral angiography data from 30 consecutive patients with acute ischemic stroke within 6 hours after symptom onset. Results showed that eleven patients developed subsequent hemorrhagic transformation at follow-up. A hyperintense middle cerebral artery sign on MRI was found in six hemorrhagic patients, all of who had acute thrombosis formation on magnetic resonance angiography and digital subtraction angiography. No patients in the non-hemorrhagic group had hyperintense middle cerebral artery sign on MRI. The sensitivity, specificity, and positive predictive values of the hyperintense middle cerebral artery sign on MRI T1-weighted image for subsequent hemorrhagic transformation were 54.5%, 100%, and 100% respectively. Hyperdense middle cerebral artery sign on non-contrast CT was observed in nine patients, five of who developed hemorrhagic transformation. These data suggest that hyperintense middle cerebral artery sign on MRI T1-weighted image is a highly specific and moderately sensitive indicator of subsequent hemorrhagic transformation in patients after acute ischemic stroke, and its specificity is superior to CT.     

Use of various CT imaging methods for diagnosis of acute ischemic cerebrovascular disease

Thirty-four patients with cerebral infarction and 18 patients with transient ischemic attack were examined by multi-slice spiral CT scan, CT perfusion imaging, and CT angiography within 6 hours after onset. By CT perfusion imaging, 29 cases in the cerebral infarction group and 10 cases in the transient ischemic attack group presented with abnormal blood flow perfusion, which corresponded to the clinical symptoms. By CT angiography, various degrees of vascular stenosis could be detected in 41 patients, including 33 in the cerebral infarction group and eight in the transient ischemic attack group. The incidence of intracranial artery stenosis was higher than that of extracranial artery stenosis. The intracranial artery stenosis was located predominantly in the middle cerebral artery and carotid artery siphon, while the extracranial artery stenosis occurred mainly in the bifurcation of the common carotid artery and the opening of the vertebral artery. There were 34 cases (83%) with convict vascular stenosis and perfusion abnormalities, and five cases (45%) with perfusion abnormalities but without convict vascular stenosis. The incidence of cerebral infarction in patients with National Institutes of Health Stroke Scale scores ≥ 5 points during onset was significantly higher than that in patients with National Institutes of Health Stroke Scale scores < 5 points. These experimental findings indicate that the combined application of various CT imaging methods allows early diagnosis of acute ischemic cerebrovascular disease, which can comprehensively analyze the pathogenesis and severity of acute ischemic cerebrovascular disease at the morphological and functional levels.     

Xueshuantong improves cerebral blood perfusion in elderly patients with lacunar infarction

A total of 64 patients with acute lacunar infarction were enrolled within 24 hours of onset. The patients received conventional therapy (antiplatelet drugs and hypolipidemic drugs) alone or conventional therapy plus 450 mg Xueshuantong once a day. The main ingredient of the Xueshuantong lyophilized powder used for injection was Panax notoginseng saponins. Assessments were made at admission and at discharge using the National Institutes of Health Stroke Scale, the Activity of Daily Living and the Mini-Mental State Examination. Additionally, the relative cerebral blood flow, relative cerebral blood volume and relative mean transit time in the region of interest were calculated within 24 hours after the onset of lacunar infarction, using dynamic susceptibility contrast magnetic resonance perfusion imaging technology. Patients underwent a follow-up MRI scan after 4 weeks of treatment. There was an improvement in the Activity of Daily Living scores and a greater reduction in the scores on the National Institutes of Health Stroke Scale in the treatment group than in the control group. However, the Mini-Mental State Examination scores showed no significant differences after 4 weeks of treatment. Compared with the control group, the relative cerebral blood flow at discharge had increased and showed a greater improvement in the treatment group. Furthermore, there was a reduction in the relative mean transit time at discharge and the value was lower in the treatment group than in the control group. The experimental findings indicate that Xueshuantong treatment improves neurological deficits in elderly patients with lacunar infarction, and the mechanism may be related to increased cerebral perfusion.     

Common features in patients with intracerebral hemorrhage following superficial temporal artery-middle cerebral artery bypass in steno-occlusive cerebrovascular disease

Five patients treated for intracranial cerebral hemorrhage after superficial temporal artery-middle cerebral artery bypass in Xuwu Hospital,Capital Medical University,Beijing,China,from 2005-2011 were included in this study.Prior to superficial temporal artery-middle cerebral artery bypass,all patients showed diminished cerebrovascular reactivity and an ipsilateral ischemic lesion.Intracranial cerebral hemorrhage developed within 1-4 days following superficial temporal artery-middle cerebral artery bypass.Transcranial Doppler showed increased middle cerebral artery velocity of 50-100% in the operated hemisphere.These findings suggested that focal hyperperfusion,an ipsilateral ischemic lesion and diminished cerebrovascular reactivity are the important characteristics of intracerebral hemorrhage following superficial temporal artery-middle cerebral artery bypass in patients with steno-occlusive cerebrovascular disease.     

Doppler examination and cerebral arterial stricture in patients with ischemic stroke

With the development of interventional therapy, it is necessary for evaluating cerebral vessels to instruct treatment and determine prognosis of patients with ischemic stroke; however, correlation of distribution of infarction focus and clinical symptoms with degrees of cerebrovasoular stricture is still unclear.OBJECTIVE: To evaluate the characteristics of cerebral arterial stricture of patients with ischemic stroke with transcranial Doppler (TCD) and color duplex flow imaging (CDFI) and compare the correlation between distribution of cerebral infarction focus and clinical types with magnetic resonance imaging (MRI).DESIGN: Contrast observation.SETTING: Department of Neurology, the First Hospital of Jilin University.PARTICIPANTS: A total of 159 patients with ischemic stroke were selected from the Department of Neurology, the First Hospital of Jilin University from January to December 2005, including 106 males and 53 females aged from 27 to 88 years. Bases on diagnostic criteria of cerebrovascular disease established by Rao et al, clinical manifestations of all patients were evaluated with CT or nuclear magnetic resonance. All patients provided the confirmed consent.METHODS: The accepted patients received TCD and CDFI examination at 1 week after onset of ischemic stroke. Among them, 112 patients received cerebrovascular imaging examination simultaneously. MRI was used to check cerebral infarction focus and cerebrovascular stricture ＞ 50% was regarded as the accepted vessels. In addition, DWI-T2 TCD (Germany) was used to check middle cerebral artery, and degrees of middle cerebral artery were classified into mild, moderate and severe stricture based on blood velocity (140 cm/s,180 cm/s). Stroke was classified based on characteristics of infarction focus and clinical symptoms showed with MRI and correlation with degrees of cerebrovascular stricture was analyzed simultaneously.MAIN OUTCOME MEASURES: Correlation between the characteristics of ischemic stroke and clinical symptoms checked with TCD and CDFI.RESULTS: A total of 159 patients with ischemic stroke were involved in the final analysis; in addition, 112 oases received cerebrovascular imaging examination simultaneously. ① MRI results of 159 patients with cerebral artery occlusive disease (CAOD): There were 131 patients (82.3%) with cerebral infarction, 40 (25.2%)with transient ischemic attack and 4 (2.5%) with subclavian steal syndrome (SSS). ② Infarction types with MRI examination: There were 33 patients (20.8%) with solitary cerebral infarction and 98 (61.6%) with multiple-cerebral infarction. ③ Results of TCD, CDFI, MRI angiography, CT angiography and digital subtraction angiography (DSA): Among 112 patients, 181 lesion sites (61 .8%) were located in cranium and 112 lesion sites were located out of cranium; especially, lesion site was mostly observed in stem of middle cerebral artery (31.2%) and watershed of basilar artery (7.2%) in cranium and the beginning site of internal carotid artery (21 .4%) out of cranium. ④ Correlation of vascular stricture checking with TCD, MRI and clinical diagnosis: On one hand, MRI and clinical diagnosis demonstrated that 68 patients had a watershed infarction; meanwhile,TCD examination indicated that there were 3 patients with mild vascular stricture, 24 with moderate vascular stricture and 36 with severe vascular stricture. On the other hand, among 68 patients with non-watershed infarction, there were 27 patient with mild vascular stricture, 26 with moderate vascular stricture and 15 with severe vascular stricture. There were significant differences (x2 =26.854, P =0.001 ). Clinical diagnosis indicated that 40 patients had transient ischemic attack and TCD examination demonstrated that there were 8 patient with mild vascular stricture, 12 with moderate vascular stricture and 20 with severe vascular stricture. There were significant differences as compared with 68 patients with watershed infarction (x2 =21.258, P =0.001). ⑤Correlation of vascular stricture checking with CDFI, MRI and clinical diagnosis: On one hand, among patients who were determined as watershed infarction with MRI and clinical diagnosis, CDFI examination indicated that there were 32 patients with mild vascular stricture at neck, 25 with moderate vascular stricture and 6 with severe vascular stricture. On the other hand, among patients with non-watershed infarction, there were 48 patient with mild vascular stricture, 18 with moderate vascular stricture and 2 with severe vascular stricture.There were significant differences (x2 =6.018, P =0.019). Among patients with transient ischemic attack checking with clinical diagnosis, there were 23 patient with mild vascular stricture, 9 with moderate vascular stricture and 8 with severe vascular stricture. There were no significant differences as compared with patients with non-watershed infarction (x2 =0.597, P=0.440).CONCLUSION: ① TCD and CDFI are effective marks to determine cerebral arterial stricture and hemodynamical changes. ② Infarction and transient ischemic attack at watershed are generally clinical phenotypes of CAOD patients and infarction at watershed is correlated with degrees of cerebrovascular stricture.③ TCD, MRI and clinical analysis of stroke types are significant for instructing treatment and evaluate prognosis.     

Clinical effects of Xingnao Kaiqiao acupuncture on neurological impairment following cerebral infarction*☆

BACKGROUND： Although the curative effects of acupuncture have been confirmed by various treatments of cerebral infarction, few studies have investigated when acupuncture can attain the best clinical effect. OBJECTIVE： Four different time points were selected for acupuncture treatment of cerebral infarction to evaluate the appropriate time course for Xingnao Kaiqiao therapy in terms of improved neurological function. DESIGN： Controlled observation. SETTING： Department of Traditional Chinese Medicine Rehabilitation and Physiotherapy of the Affiliated Hospital of Medical College of Chinese Armed Police Forces. PARTICIPANTS： A total of 120 inpatients with cerebral infarction of different stages, including 75 males and 45 females, aged 41-75 years, were selected from November 2005 to December 2006 at the Department of Traditional Chinese Medicine Rehabilitation and Physiotherapy in Affiliated Hospital of Medical College of Chinese Armed Police Forces. Diagnostic criteria： in accordance with ＂main points of diagnosis on different cerebrovascular disease＂ secondly revised in the Second Cerebrovascular Disease Academic Meeting of Chinese Medicine Association in 1986. All accepted subjects provided confirmed consent, and the experiment received ethical permission from the hospital＇s ethics committee. METHODS： ① Experiment grouping： All inpatients were divided into four groups with non-stochastic concurrent control method according to the disease course： Group Ⅰ （onset within 7 hours）, group Ⅱ （onset from 7 hours to 3 days）, group Ⅲ （onset within 4-7 days）, and group IV （onset within 21-180 days）. On the basis of symptomatic treatment with western medicine, each group received Xingnao Kaiqiao therapy after onset within 7 hours, 7 hours to 3 days, 4 to 7days, and 21 to 180 days. ① The principal acupoints were Neiguan, Renzhong, and Sanyinfiao. ② The auxiliary acupoints were Jiquan, Chize, and Weizhong. ③Acupuncture manipulations： initially, Neiguan （PC6, bilateral）     

Physiopathology of ischemic stroke and its modulation using memantine:evidence from preclinical stroke

Ischemic stroke is the most common type of cerebrovascular disease and is caused by an interruption of blood flow in the brain.In this disease,two different damage areas are identifying:the lesion core,in which cells quickly die;and the penumbra(surrounding the lesion core),in which cells are functionally weakened but may recover and restore their functions.The currently approved treatments for ischemic stroke are the recombinant tissue plasminogen activator and endovascular thrombectomy,but they have a short therapeutic window(4.5 and 6 hours after stroke onset,respectively)and a low percentage of stroke patients actually receive these treatments.Memantine is an approved drug for the treatment of Alzheimer's disease.Memantine is a noncompetitive,low affinity and use-dependent antagonist of N-methyl-D-aspartate glutamate receptor.Memantine has several advantages over developing a new drug to treat focal ischemic stroke,but the most important is that it has sufficient safe probes in preclinical models and humans,and if the preclinical studies provide more evidence about pharmacological actions in tissue protection and repair,this could help to increase the number of clinical trials.The present review summarizes the physiopathology of isquemic stroke and the pharmacological actions in neuroprotection and neuroplasticity of memantine in the post stroke stage of preclinical stroke models,to illustrate their potential to improve functional recovery in human patients.     

Reasons for diagnostic delay in patient with out-of-hospital acute ischemic stroke

BACKGROUND:Time window is a common problem in various therapies of acute ischemic stroke,and diagnostic duration plays an important role in prognosis.OBJECTIVE:To analyze the main reasons for out-of-hospital diagnostic delay of patients with acute ischemic stroke.DESIGN:Survey and analysis.SETTING:Department of Neurology,the First Affiliated Hospital of Jinan University.PARTICIPANTS: A total of 116 patients with acute ischemic stroke were selected from the Department of Neurology,the First Affiliated Hospital of Jinan University from December 2002 to December 2005,including 79 males and 37 females aged fnom 35 to 90 years with the mean age of(65 10)years.All patients met the diagnostic criteda of "mainly diagnostic points of various cerebrovascular diseases"established by the 4th National Cerebrovascular Diseases Meeting in 1995.Patients having acute ischemic stroke in hospital were excluded.Moreover,32 nurses received questionnaires of partial items.All patients and nurses provided informed consent.METHODS:①Information,such as social Position,educational level and incomes,was added up based on questionnaires.②Out-of-hospital diagnostic delay was surveyed based on the recorded time of patients treated in emergency department and out-patient clinic or during hospitalization. ③Ability of patients and nurses to identify symptoms of stroke dudng an early period was evaluated:meanwhile,understanding concept of stroke and using emergent system of social medicine by patients were surveyed,Especially.whether Patients understood the emergent number"120" or not and how they used it practically were investigated further.④Attitude and behavior of patients to stroke were surveyed.⑤Whether patients were able to identify the symptoms of stroke or not was investigated;furthermore,identification of stroke by patients and nurses was dealt with semi-quantitative analysis.The scores ranged from-10 to 10.The higher the scores were,the better the identification was.⑥All factors which was possibly related to stroke were dealt with one-way Logistic regression analysis.MAIN OUTCOME MEASURES:①Out-of-hospital diagnostic delay;②evaluating results of general knowledge of stroke;③attitude and behavior to stroke;④identification of symptoms of stroke;⑤results of relative factors with regression analysis.RESULTS:All 116 patients with stroke were involved in the survey of out-of-hospital diagnostic delay.Among them,81 patients and 32 nurses finished the questionnaires of general knowledge of stroke.①Out-of-hospital diagnostic delay:A total of 26 patients directly received the treatment in local hospitals,and the median was 4.00 hours.Another 73 Patients directly received the treatment in emergency department of our hospital.The diagnostic rate was 26%within 3 hours and 7%from 3 hours to 6 hours.②Evaluating results of general knowledge of stroke:About 57%(46/81)patients and 81%(26/32)nurses knew how to use emergent number.In addition,after the onset of stroke.26%(21/81)people knew how to call the first aid;however,only 19%(15/18)cases gave a telephone call of first aid.Among them,about 53%(43/81)patients and 81%(26/32)nurses cleariy understood what stroke was.Only 22%(18/81)patients realized that the best time for treating stroke was within 6 hours after its onset.③Attitude and behavior to stroke:Orice stroke was occuffed,about 47%(38/81)patients directly received the treatment in some famous hospital:meanwhile,25%(20/81) patients waited for observing whether the symptoms disappeared or not;however, 27%(22/81)patients did not know what to do at the phase of onset of stroke;furtherrnore,26%(21,81)patients received regular review in Iocal clinics.④Identification of symptoms of stroke:Patients and nurses in this survey were poorly able to identify symptoms of stroke.The minimal scores of patients were 6,the maximal was 9 and the median was 2;moreover,among 31 nurses.scores ranged from 0 to 8 and the median was 3.⑤Results of relative factors with regression analysis:Educational level was the basic factor for symptom identification and diagnostic delay for patient at the phase of onset of stroke(OR value=0.466.0.225,9.831.P＜0.05).CONCLUSION:Patients and nurses are poorly able to identify the symptoms of stroke.Out-of-hospital diagnostic delay is related to educational level,delay treatment in local hospital or medical community,and poorly common information of stroke.     

Anticoagulation effect of low-dose and low-intensity heparin applied within 24 hours after intravenous thrombolysis for acute cerebral infarction

BACKGROUND: Studies have demonstrated that immediate anticoagulation after thrombolysis can improve the prognosis of patients with acute cerebral infarction. However, the optimal timing and means of anticoagulation therapy remain unclear. OBJECTIVE: To observe the effects and safety of heparin treatment within 24 hours after intravenous thrombolysis for acute cerebral infarction. DESIGN: Observation experiment. SETTING: Department of Neurology, the 306 Hospital of Chinese PLA. PARTICIPANTS: Fifteen acute cerebral infarction patients complicated by moderate and severe neurologic function deficits within 6 hours after attack admitted to Department of Neurology, the 306 Hospital of Chinese PLA between January 2005 and December 2006 were recruited in this study. The involved patients, 11 male and 4 female, were aged 46–79 years. They all met the diagnosis criteria for various cerebrovascular diseases formulated by the 4th National Conference for Cerebrovascular Disease (1995) and confirmed as cerebral infarction by skull CT or MRI imageology. Informed consents were obtained from the patients or their relatives. METHODS: On admission, patients received thrombolysis with urokinase. Immediately after thrombolysis, skull CT was rechecked. Intracranial hemorrhage signs were not found by skull CT. Hemorrhage was also not found in skin, mucous membrane and internal organs. Six hours later, low-dose low-intensity heparin 4–8 IU/kg per hour was intravenously administrated for anticoagulation for 7–10 days successively. MAIN OUTCOME MEASURES: Neurologic function was evaluated before, immediately 6 hours and 14 days after thrombolysis by scoring standard of clinical neurologic function deficit degree for stroke patients (1995). Activities of daily living of patients with stroke were evaluated 90 days after thrombolysis by modified Rankin Scale. RESULTS: Fifteen involved patients participated in the final analysis. ① Comparison of clinical neurologic function deficit degree of patients at different time: Neurologic function deficit score at the end of thrombolysis was significantly lower than that before thrombolysis (t =3.45, P < 0.01). Neurologic function deficit score 6 hours after thrombolysis was higher than that at the end of thrombolysis, and neurologic deficits were increased, but no significant difference was found (P > 0.05). Neurologic function deficit score 14 days after thrombolysis was significantly lower than that before thrombolysis (t =4.769, P < 0.01). ② Therapeutic effect and modified Rankin scale results: 14 days after thrombolysis, 4 patients were basically cured, 7 significantly improved, 2 improved and 2 worsened. The total improvement rate of neurologic function deficit was 86.7%. Ninety days after thrombolysis, according to modified Rankin Scale, score was 0 to 2 in 12 patients (80%), 3 to 4 in 2 patients (13.3%) and 6 in 1 patient (6.7%). Complications of intracranial hemorrhage were not found in patients within 14 days after thrombolysis. CONCLUSION: Low-dose and low-intensity heparin applied within 24 hours after intravenous thrombolysis has good safety and efficacy in the treatment of acute cerebral infarction.     

短暂性脑缺血发作对脑缺血耐受的影响

目的 探讨短暂性脑缺血发作（TIA）在脑缺血耐受方面的临床意义。方法 选择30例TIA后72h内发生脑梗死的患者为试验组（TIA组）,并随机选择30例无TIA史的脑梗死患者作对照组。结果 TIA组和脑梗死组在脑梗死体积、治疗前与治疗后15d,30d,90d的欧洲卒中量表（ESS）评分方面存在统计学差异（8.2 ml vs 10.6 ml;62±22 vs 58±24;70±28 vs 66±32;80±20 vs 76±24;82±18 vs 77±23; P均<0.05）。结论 TIA后发生脑梗死对减轻脑细胞损伤有一定临床意义。     

急性脑梗死缺血半暗带演变的磁共振成像研究

目的：探讨应用磁共振弥散／灌注成像技术判断急性脑梗死后缺血半暗带IP存在的范围和时间规律。方法：对72例发病时间在1～24h的急性脑梗死患者行常规MRI、磁共振弥散加权成像（DWI）和磁共振灌注加权成像（PWI）确定IP的范围，计算梗死中心区、IP区及对侧镜像区的ADC值和rADC值并加以比较。结果：26例发病时间〈6h的患者PWI显示存在低灌注区者，其中PWI〉DWI者21例，30例发病时间在6～24h的患者PWI显示存在低灌注区者，其中PWI〉DWI者2例；PWI〉DWI者病灶中心ADC值与IP区及对侧镜像区ADC值差异有统计学意义，其IP区ADC值与其对侧镜像区差异无统计学意义。结论：DWI和PWI结合能灵敏的判断IP的存在，IP存在的时间窗有一定的个体差异。     

阿托伐他汀钙对血脂水平正常的短暂性脑缺血发作患者的影响

目的观察阿托伐他汀钙合用阿司匹林治疗血脂水平正常短暂性脑缺血发作(transient ischemic attack,TIA)患者的疗效和安全性。方法 66例血脂水平正常的TIA患者随机分为治疗组(n=34)和对照组(n=32)组,治疗组口服阿托伐他汀钙20mg/d,阿司匹林100mg/d;对照组口服阿司匹林100mg/d。所有患者分别于入院后第1天及6个月检测血脂水平、谷草转氨酶、血清磷酸肌酸激酶,并行颈动脉超声检测内膜—中膜厚度,并观察2组6个月内TIA复发或进展为脑梗死的病例数。结果治疗6个月时与对照组相比甘油三脂、总胆固醇、低密度脂蛋白胆固醇水平、颈动脉内膜-中层厚度显著降低,高密度脂蛋白胆固醇则明显升高,脑血管疾病发生率明显降低,差异有统计学意义(P<0.05)。结论阿托伐他汀不仅有助于减少血脂水平正常的TIA患者脑血管疾病的发生,而且具有良好的安全性,同时还可以提高动脉粥样硬化斑块稳定性,具有抗粥样硬化作用。     

短暂性脑缺血发作发展至脑梗死危险因素的分析

目的探讨短暂性脑缺血发作(TIA)发展至脑梗死的危险因素。方法对144例TIA患者的临床资料进行分析。结果144例患者中50例(34.7%)发生了脑梗死;其中椎基底动脉系统TIA20例中11例(55.0%)发生脑梗死;颈内动脉系统TIA118例中37例(31.4%)发生脑梗死;两个系统脑梗死的发生率差异有显著性(P<0.05)。78%的脑梗死发生在TIA后1个月内,5例死于脑梗死。TIA发作持续>30min、24h内>3次发作以及首次发作后>24h或发作>5次开始治疗的患者发生脑梗死的危险性显著增高(P<0.05～0.01)。发生脑梗死的TIA患者血压、血糖、血胆固醇显著增高(均P<0.05)。结论患者TIA发作持续久、次数多、未及时治疗,尤其伴有高血压、高血糖、高脂血症者短期内发生脑梗死的危险性较高。     

水蛭素合用阿司匹林与单用阿司匹林或氯吡格雷治疗短暂性脑缺血发作的随机对照研究

目的：探讨水蛭素合用阿司匹林治疗短暂性脑缺血发作（TIA）的疗效和安全性。方法：89例TIA患者随机分为3组：（1）氯吡格雷组（n=29），口服氯吡格雷75mg／d：（2）阿司匹林组（n=30），口服阿司匹林100mg／d；（3）水蛭素合用阿司匹林组（n=30），口服水蛭素0．32g，3次／d，阿司匹林100mg／d。观察治疗后90d内TIA复发或进展为脑梗死的病例数，观察出血等不良事件发生率。结果：治疗后90d内总的脑梗死发生率为4．5％，3组之间无显著差异。水蛭素合用阿司匹林组和氯吡格雷组90d内的TIA复发风险分别较单用阿司匹林降低69％（P=0．0078）和65％（P=0．0170）。总的出血发生率为2．25％，均发生在水蛭素合用阿司匹林组。结论：水蛭素合用阿司匹林可降低90d内TIA复发率的效果优于单用阿司匹林，与单用氯吡格雷相似，但出血风险增高。     

TIA与TIA形式的脑梗死的相关因素分析

目的分析TIA及TIA形式的脑梗死的临床特点,探索其临床相关因素。方法回顾性分析83例初步诊断为TIA并在症状首发后24 h内行常规MRI及DWI检查的患者,发病1周内行颈部动脉血管彩超、TCD。记录发病后7 d内的临床转归。根据DWI结果分为DWI+组及DWI-组,确定DWI阳性率。比较DWI+组及DWI-组临床特征差别。分析两组患者动脉粥样硬化斑块的部位、性质、数量及颅内外血管狭窄的部位、程度。结果DWI阳性率为36.1%。DWI阳性与动脉粥样硬化相关(P=0.03),与颈部动脉动脉粥样硬化斑块数目相关(P=0.04),TIA症状首发后7 d内,30.0%DWI+组患者TIA症状反复发作或表现为临床症状持续存在,高于DWI-组(22.6%)。结论临床表现为TIA的病例大于1/3急性期已经形成了脑梗死,动脉粥样硬化斑块数量越多,DWI阳性的可能性越大,DWI+的患者7 d内更易进展。     

Clinical-CT correlations in TIA, RIND, and strokes with minimum residuum

An approach to the controversy of the physiopathology and classification of ischemic stroke is attempted in this study. The computed tomographies (CT) of 88 patients with transient ischemic attacks (TIA), 46 with reversible ischemic neurologic deficits (RIND) and 70 with ischemic strokes with minimum residuum (SMR) are analysed. The incidence of focal ischemic lesions on CT is 25% in TIA and RIND and 35% in SMR, when the study was performed after the first 24 hours. The incidence of cerebral infarction was much lower when the CT was performed within the first 24 hours after the clinical event. No significant differences in size or location of the infarction were found between the different groups. Deep infarctions were smaller than superficial ones. TIA duration correlated neither with the incidence of CT abnormalities nor with the size of the lesions. No correlation was found between doppler or oculoplethysmography abnormalities, clinical groups and CT findings. In reference to the structural lesions that underlie the clinical syndromes, TIA, RIND and SMR should not be considered as different groups.     

Large-Artery Stenosis Predicts Subsequent Vascular Events in Patients with Transient Ischemic Attack

Background and purpose

We investigated subsequent vascular events in patients with transient ischemic attack (TIA) and determined the predictors of such events among vascular risk factors including large-artery disease, TIA-symptom duration, and acute ischemic lesions on diffusion-weighted imaging (DWI).

Methods

We identified 98 consecutive patients with TIA who visited a tertiary university hospital and underwent DWI and brain magnetic resonance angiography within 48 hours of symptom onset. We reviewed the medical records to assess the clinical characteristics of TIA, demographics, and the subsequent vascular events including acute ischemic stroke, TIA, and myocardial infarction.

Results

Large-artery disease was detected in 55 patients (56%). Ten patients (10%) experienced TIA symptoms for longer than 1 hour, and acute infarctions on DWI were identified in 30 patients (31%). During the mean follow-up period of 19 months, seven patients (7%) had an acute ischemic stroke and 20 patients (20%) had TIA. Retinal artery occlusion in two patients, spinal cord infarction in one patient, and peripheral vascular claudication in one patient were also recorded. Cox proportional-hazards multivariate analysis revealed that large-artery disease was an independent predictor of subsequent cerebral ischemia (hazard ratio [HR], 2.8; 95% confidence interval [CI], 1.1-7.1; p=0.02) and subsequent vascular events (HR, 2.9; 95% CI, 1.2-6.7; p=0.01).

Conclusions

In patients with TIA, large-artery disease is an independent predictor of subsequent vascular events. Acute infarction on DWI and a symptom duration of more than 1 hour are not significantly correlated with a higher risk of subsequent vascular events. These findings suggest that the underlying vascular status is more important than symptom duration or acute ischemic lesion on DWI.     

施普善治疗急性脑梗死的磁共振波谱成像评价

目的观察施普善对急性脑梗死患者磁共振氢质子波谱（H magnetic resonance spectroscopy,MRS）及临床症状、体征改善的影响,评价施普善治疗急性脑梗死的疗效。方法选择发病24h内的急性脑梗死患者40例,随机分为施普善治疗组20例及对照组20例。2组治疗前及治疗2周后行美国国立卫生研究院脑卒中量表评分（NIHSS评分）,应用MRS在兴趣区上测量氮-乙酰天冬氨酸（NAA）与肌酸（Cr）比值（NAA/Cr）、胆碱复合物（Cho）与肌酸（Cr）比值（Cho/Cr）及乳酸（Lac）与肌酸（Cr）比值（Lac/Cr）,并对治疗前后结果进行统计学分析。结果治疗2周后2组NIHSS评分较治疗前均有所降低,施普善治疗组较对照组下降明显（P〈0.05）,2组病人NAA/Cr较治疗前升高,但施普善治疗组较对照组升高明显（P〈0.05）,2组病人CHO/Cr及Lac/Cr均较治疗前降低,但施普善治疗组较对照组降低明显（P〈0.05）。结论施普善是一种有效的治疗急性脑梗死的神经保护剂。     

短暂性缺血发作对后续大面积脑梗死预后的影响

目的 观察同侧短暂性缺血发作(TIA)对后继大面积脑梗死的影响.方法 将51例首次发病的大面积脑梗死患者,按照是否预先发生同侧的TIA及发生间隔进行分组,采用欧洲卒中评分方法在治疗前及治疗3周时评价各组患者神经功能缺损程度.结果 发病前4周有TIA发生的脑梗死患者较无TIA发作的脑梗死患者入院时及治疗3周后欧洲脑卒中评分有差异(P<0.05),TIA发生时间小于1周者入院时及3周后评分好于病前2～4周发生TIA者,但仅入院时有统计学意义(P<0.05).结论 脑梗死前发生的同侧TIA可能产生缺血耐受现象,对后继发生的脑梗死起保护作用.