Correlation between sleep and cognitive functions after hemispheric ischaemic stroke

Background:  The aim of this study was to test the hypothesis of a link between sleep and cognitive functions, particularly memory and attention, after stroke.
Methods:  We studied 11 consecutive patients with first-ever hemispheric ischaemic stroke within eight days after symptoms onset and nine of them at least three months after stroke. Sleep EEG was recorded with a portable system. Cognitive functions were assessed using a standardized battery of tests allowing the estimation of the most relevant domains of cognition. Five age-matched healthy subjects served as controls.
Results:  The patients were aged 43 ± 12 years (18–59). In five patients stroke was right-sided and in six patients left-sided. In the acute stroke phase a correlation between attention and amounts of slow wave sleep (SWS), Rapid eye movement (REM) sleep and sleep efficiency was found. In the recovery phase verbal/figural memory and attention significantly improved in most patients. Furthermore, an association between (i) verbal/figural (non-verbal) memory and amounts of SWS, REM sleep and sleep efficiency, and between (ii) attention and sleep efficiency was observed.
Conclusions:  The results point to a link between sleep and cognitive functions and their recovery after hemispheric stroke. Further studies are needed to determine the specific nature of this link.     

急性缺血性卒中患者超急性期NIHSS评分与CT血管成像脑血管狭窄或闭塞关系研究

目的探讨急性缺血性卒中超早期美国国立卫生研究院脑卒中量表(NIHSS)评分与CT脑血管成像(CTA)对脑血管闭塞病变的预测价值。方法对93例急性缺血性脑卒中患者在发病6h内进行NIHSS评分,根据NIHSS评分分为NIHSS评分≤6分组、NIHSS7～14分组、NIHSS≥15分组。同时进行CTA检查。分析NIHSS评分与CTA显示血管病变的关系。结果 93例急性缺血性脑卒中患者NIHSS评分平均为9.57±5.10分。CTA显示脑动脉正常32例(34.41%),脑动脉狭窄23例(24.73%),脑动脉闭塞38例(40.86%)。CTA显示有脑动脉狭窄或闭塞患者的NIHSS评分(10.53±5.43)高于无脑动脉病变的患者评分(8.13±4.23,P<0.01),其中脑动脉闭塞患者NIHSS评分(12.14±4.99)明显高于无脑动脉病变患者评分(P<0.001)。NIHSS评分≤6分组的16例患者中CTA显示脑动脉狭窄4例(25%),脑动脉闭塞3例(18.75%);NIHSS评分为7～14分组共66例,脑动脉狭窄和动脉闭塞比例分别为24.24%(16/66)和43.94%(29/66);NIHSS评分15分以上组患者脑动脉狭窄和动脉闭塞的比例分别为27.27%(2/11)和54.55%(6/11)。NIHSS评分≥15者在CTA上显示血管狭窄或闭塞的阳性率达95%,根据NIHSS评分预测CTA上显示的血管闭塞的阳性预测值为84.3%。经Logistic回归分析,发病时NIHSS评分与CTA检出血管闭塞相关(r=0.22,P<0.05),超急性期NIHSS评分为预测CTA显示血管闭塞的独立因素(OR=1.1,95%CI=0.6～1.65,P<0.001)。结论急性缺血性脑卒中超早期HIHSS评分与CTA显示脑动脉闭塞相关,急性缺血性卒中的神经功能缺损程度较重往往提示CTA上存在大血管狭窄或闭塞的可能。     

Thalamic stroke: correlation of clinical symptoms, somatosensory evoked potentials, and CT findings

We studied 18 patients with a single ischemic thalamic lesion, who had somatosensory disturbances and/or central pain in the opposite hemibody, by correlating their clinical symptoms, somatosensory evoked potentials (SEPs), and computed tomography (CT) findings. Patients were divided into three groups: (1) those with somatosensory deficits, central pain, and abnormal SEPs, which comprised two thirds of the patients (classic thalamic pain syndrome), (2) those with somatosensory deficits, no central pain, and abnormal SEPs (analgetic thalamic syndrome), and (3) those with almost normal sense perception, central pain, and normal SEPs (pure algetic thalamic syndrome). CT evidence of a paramedian or anterolateral thalamic lesion might be an indicator for the development of central pain, because these types of infarctions occurred only in patients with the classic thalamic syndrome or the pure algetic thalamic syndrome. The differentiation of the thalamic syndrome into three subtypes is of prognostic value, because patients with a loss of cortical SEPs and a posterolateral ischemic thalamic lesion on the CT scan probably will not exhibit central pain.     

经颅多普勒超声对缺血性脑卒中患者的诊断价值及临床意义

目的探讨在缺血性脑卒中患者诊断中应用经颅多普勒超声的价值和意义。方法运用随机数字表法从2015-06—2016-06来我院就诊的缺血性脑卒中患者中选取196例为实验组,选取同时期来我院健康体检的人员中120例为对照组,所有患者均接受经颅多普勒超声(TCD)检查,对比和分析经颅多普勒超声在缺血性脑卒中诊疗中的应用价值。结果实验组的血管异常率较对照组显著增加,2组血管异常率比较差异具有统计学意义(P0.05);与大面积脑梗死患者相比,小面积脑梗死及腔隙性梗死患者血管异常率显著降低,比较差异具有统计学意义(P0.05),但小面积脑梗死和腔隙性梗死患者血管异常率比较差异无统计学意义(P0.05)。结论缺血性脑卒中患者通过经颅多普勒超声诊疗,有助于早期发现和评估病情,为治疗和评估预后提供参考价值,整个操作过程简单、方便,容易被患者接受,值得推广。     

Dysphagia and hemispheric stroke: A transcranial magnetic study

INTRODUCTION: Dysphagia is a common and distressing consequence of hemispheric stroke. STUDY AIM: To verify the usefulness of transcranial magnetic stimulation (TMS) studies of swallowing in healthy subjects and in stroke patients. MATERIAL AND METHODS: TMS studies of the motor cortical projections to the upper esophageal sphincter were performed in 45 patients with acute mono-hemispheric stroke (26 patients with dysphagia) and 20 healthy adult volunteers. RESULTS: TMS of either hemisphere in normal volunteers evoked motor evoked potentials (MEP) in the esophagus. The average point of optimal excitability was slightly more anterior in the right hemisphere; otherwise, MEP amplitudes and latencies were similar from both hemispheres as were the areas of the cortical map. The cortical map area and amplitude of MEPs were significantly smaller and the latencies longer after stimulation of the affected hemisphere compared with the unaffected hemisphere and pooled control data. Twenty-four dysphagic patients (92.3%) had abnormalities of MEP of the affected hemisphere, while only five non-dysphagic patients (26%) had these abnormalities. Dysphagic patients were older and had more disability compared with non-dysphagic patients. MEPs of the affected hemisphere of patients with dysphagia were later and smaller in amplitude than MEPs of non-dysphagic patients. The cortical map area was also smaller. CONCLUSION: The esophagus is represented bilaterally in motor cortex, but the hot spot lies more anterior to Cz in right hemisphere compared to left hemisphere. Both the severity of stroke and neuroplasticity of the unaffected hemisphere have implications in the development of dysphagia.     

Amaurosis fugax: clinical, Doppler and angiographic findings

Clinical, Doppler and angiographic findings are described in 53 consecutive patients who presented with amaurosis fugax (AF) in a total of 57 eyes; 4 had non-simultaneous attacks in both eyes. Atherosclerotic lesions were detected on Doppler or angiographic (conventional arteriography and/or intravenous digital subtraction angiography) examination in 36 (63%) of the relevant precerebral internal carotid arteries (ICA) in 34 patients. Nineteen (53%) of these lesions caused a diameter reduction of more than 75%. Patient age was the most important factor in predicting the presence of relevant carotid occlusive disease, all 36 lesions being found in patients over 50 years of age. Two unusual cases of AF are described; in one AF was caused by stenosis of the ipsilateral ophthalmic artery, and in another by occlusion of the brachiocephalic artery with a steal syndrome from the right common carotid artery (CCA) to the right subclavian artery.     

踝臂指数、颈部血管彩超、经颅多普勒超声与缺血性脑卒中的相关性研究

目的探讨踝臂指数(ABI)、颈部血管彩超、经颅多普勒超声(TCD)与缺血性卒中的关系。方法对187例患者经过CT/MR检查后分为缺血性卒中及非卒中组,均行颈部血管彩超、ABI、TCD检查,收集相关资料,并进行统计学处理。结果卒中组中ABI及颈部血管彩超异常率显著高于非卒中组(P<0.05);缺血性卒中组颈部血管彩超的ROC曲线下面积大于ABI及TCD(0.60、0.56、0.55,P<0.05)。颈部血管彩超联合ABI的ROC曲线下面积远大于颈部血管彩超联合TCD或TCD联合ABI或三者联合(0.62、0.61、0.56、0.61);结论 ABI、颈动脉彩超、TCD能较好的预测缺血性卒中发生,颈部血管彩超联合ABI能够更有效预测缺血性卒中的发生。     

Doppler ultrasound and clinical findings in patients with acute ischemic stroke treated with intravenous thrombolysis

The aim of this study was to assess cerebral hemodynamics in patients with acute ischemic stroke undergoing thrombolytic therapy and to assess the relationship between cerebral hemodynamics and outcome. Forty-one unselected patients admitted to hospital within 3 h received intravenous thrombolytic therapy and were examined by extracranial and transcranial Doppler ultrasound examinations. Their strokes were clinically graded with the National Institute of Health Stroke Scale. Outcome after 3 months was graded with the modified Rankin Scale. Amongst the 27 patients who had an additional ultrasound examination 24 h after treatment, favorable outcome was significantly more common amongst patients with recanalization than amongst those without (P < 0.004). Thirteen patients with middle cerebral artery occlusions were continuously monitored during thrombolysis and frequently up to 5 h after start of thrombolysis. Early recanalization occurred in nine (69%), at a median delay of 178 min (range 140-287) after stroke onset. All of these nine patients had a favorable outcome. Recanalization within 24 h was associated with favorable outcome. Subgroup analysis suggests that this effect is mostly related to early recanalization within the first 5 h after stroke. Transcranial Doppler may therefore help to identify those patients most probably to benefit from thrombolysis, especially in those patients with a higher potential risk of complications.     

经颅多普勒血管搏动指数与脑血管反应性的关系

目的 研究经颅多普勒(TCD)搏动指数(PI)与脑血管反应性(CVR)的关系.方法 对70例PI增高患者(PI增高组)应用TCD行CO2吸入、过度换气和屏气试验检测CVR,并与PI正常者(正常对照组)进行比较.结果 (1)CO2吸入试验:PI增高组的大脑中动脉(MCA)平均血流速度(Vm)增加率[(21.61±7.39)%]明显低于正常对照组[(44.86±10.18)%] (P<0.01).(2)过度换气试验: PI增高组MCA Vm下降率[(21.89±6.60)%]明显低于正常对照组[(33.63±8.62)%](P<0.01).(3)屏气试验:PI增高组Vm增高率为(22.69±8.37)%、屏气指数为(0.58±0.24),显著低于正常对照组[(46.53±11.83)%、(1.16±0.37)](均P<0.01).结论 TCD PI增高可反映CVR下降.     

Anterior ischemic stroke: Comparison of two clinical outcome prediction scores through the investigation of cerebral collaterals using multiphase CT angiography

PurposeTo compare the evaluation of collaterals on multiphase computed tomography (CT) angiography using the score proposed by the reference study by Menon et al. and the Alberta Stroke Program Early CT (ASPECT) score for the prediction of favorable clinical outcome in patients with anterior ischemic stroke (IS).Materials and methodsRetrospective single center study including 199 patients with anterior ischemic stroke and evaluated using multiphase CT angiography. Collaterals were assessed using the reference score and ASPECT score. The early clinical outcome [National Institute of Health Stroke Score (NIHSS) over day 1] and later clinical outcome [90-day modified Rankin Scale (mRS)] were collected. The primary analysis related to the association between collateral scores and clinical outcome.ResultsCollaterals are an independent predictive factor of favorable clinical outcome with the two scores, ranging from an odds ratio (OR) [95% confidence interval (CI)] = 1.84 [1.23; 2.76], P = 0.003 for the reference score to an OR [95% CI] = 2.63 [1.21; 5.73], p = 0.015 for the phase 3 ASPECT score. The phase 3 ASPECT score offers better sensitivity (Se) for the prediction of a favorable clinical outcome [Se = 95%, specificity (Sp) = 37% for a threshold of 7/7] than the reference score (Se = 83%, Sp = 47% for a threshold of 4/5).ConclusionThis study demonstrates the value of the ASPECT score in analyzing collaterals using multiphase CT angiography for the prediction of clinical outcome.     

56例缺血性脑卒中急性期患者经颅多普勒检测的临床分析

目的 研究急性缺血性脑卒中患者经颅多普勒(TCD)超声检测的动态变化,探讨其变化规律在临床上的意义.方法 选择56例单侧大脑中动脉(MCA)缺血性脑卒中患者于入院即刻、第2、4、7、14、28天进行TCD动态检测分析,记录各血管频谱波形情况及平均血流速度(Vm)、脉动指数(PI).结果 入院即刻TCD检测发现异常率较高,且患侧VmMCA降低,VmACA升高,分别与自身健侧及对照组比较差异有统计学意义(P<0.05).与正常对照组VmMCA{66.51[56.64,71.43]cm/s}比较,主干闭塞组{23.45[7.55,38.72]cm/s}、深穿支闭塞组{52.53[45.56,66.93]cm/s)、皮层支闭塞组{38.44[31.67,52.45]cm/s}VmMCA均明显降低,差异有统计学意义(P<0.05).动态观察发现治疗后患侧VmMCA明显增高,均较入院即刻比较差异有统计学意义(P<0.05);PIMCA值逐渐增高,与入院即刻及对照组比较差异有统计学意义(P<0.05).结论 TCD检测在缺血性脑卒中急性期的早期诊断中具有较高价值.     

脉粥样硬化血栓形成性卒中与幽门螺杆菌感染的相关性

Previous studies have demonstrated that Helicobacter pylori infection is associated with coronary atherosclerotic heart disease, but the correlation between Helicobacter pylori infection and ischemic stroke remains unclear. The present study assessed the effects of Helicobacter pylori infection on atherothrombotic stroke. This study included 115 individuals with atherothrombotic stroke, all of whom were patients receiving treatment at the Department of Neurology, Aerospace Central Hos-pital (Aerospace Clinical Medical College Affiliated to Peking University) in China, from March 2006 to July 2009. In addition, 131 controls without the history of cardiovascular disease, cerebrovascular disease or atherothrombosis were also enrolled in the study. Results show that the Helicobacter pylori-IgG positive rate was greater in the atherothrombotic stroke patients than in the controls, but the difference was not statistically significant (67.8% vs. 61.8%, OR = 1.301, 95%CI: 0.769–2.203, P = 0.327). After correction for potential risk factors for Helicobacter pylori infection and known risk factors for ischemic stroke, no significant difference was detected between them (OR = 1.278, 95%CI: 0.667–2.449, P = 0.459). These results indicate that there is no specific correlation between Helicobacter pylori infection and atherothrombotic stroke. This finding requires further verification in large-sample prospective studies.     

Ventricular fibrillation during off-pump coronary artery bypass grafting: transcranial Doppler and clinical findings

A 73-year-old male developed ventricular fibrillation which lasted for 2 min and 24 s, during off-pump coronary artery bypass grafting. Cerebral hemodynamics were assessed by continuous transcranial Doppler monitoring. Ventricular fibrillation resulted in an immediate fall in cerebral blood flow velocities to almost zero with only slight fluctuations. This was then followed by a pronounced reactive hyperperfusion. Cerebral magnetic resonance imaging examinations and detailed neurological and neuropsychological evaluations were performed before and at 3 and 12 months after surgery. No evidence of cerebral damage was found.     

Spectrum of anterior cerebral artery territory infarction: clinical and MRI findings

To evaluate and review the clinical spectrum of anterior cerebral artery (ACA) territory infarction, we studied 48 consecutive patients who admitted to our stroke unit over a 6-year period. We performed magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) in all patients, and diffusion magnetic resonance imaging (DWI) in 21. In our stroke registry, patients with ACA infarction represented 1.3% of 3705 patients with ischemic stroke. The main risk factors of ACA infarcts was hypertension in 58% of patients, diabetes mellitus in 29%, hypercholesterolemia in 25%, cigarette smoking in 19%, atrial fibrillation in 19%, and myocardial infarct in 6%. Presumed causes of ACA infarct were large-artery disease and cardioembolism in 13 patients each, small-artery disease (SAD) in the territory of Heubner's artery in two and atherosclerosis of large-arteries (<50% stenosis) in 16. On clinico-radiologic analysis there were three main clinical patterns depending on lesion side; left-side infarction (30 patients) consisting of mutism, transcortical motor aphasia, and hemiparesis with lower limb predominance; right side infarction (16 patients) accompanied by acute confusional state, motor hemineglect and hemiparesis; bilateral infarction (two patients) presented with akinetic mutism, severe sphincter dysfunction, and dependent functional outcome. Our findings suggest that clinical and etiologic spectrum of ACA infarction may present similar features as that of middle cerebral artery infarction, but frontal dysfunctions and callosal syndromes can help to make a clinical differential diagnosis. Moreover, at the early phase of stroke, DWI is useful imaging method to locate and delineate the boundary of lesion in the territory of ACA.     

Ischaemic supratentorial stroke: angiographic findings in patients examined in the very early phase

Summary Eighty patients were studied by angiography within 6 h of an ischaemic stroke. Angiography was carried out with digital equipment and was usually limited to the vascular territory responsible for the neurological deficits. In 12 of 19 patients with internal carotid occlusion, the contralateral side was also studied. The angiographic abnormalities were classified as extracranial, intracranial, and combined extra and intracranial. The data show a high incidence (66%) of occlusive pathology of intracranial arteries, either isolated or associated with a significant presence of a potential embolic source (85%), and a high incidence of carotid occlusions located at the cervical segment (8 of 19). These observations suggest that most strokes are occlusive in origin.Presented at the First European Congress of Neurology, Prague, April 1988 and at the annual meeting of the American Society of Neuroradiology, Chicago, May 1988     

Three-dimensional transcranial Doppler in acute ischemic stroke in the territory of the middle cerebral artery: clinical and CT correlation.

We studied 34 patients with acute ischemic stroke in the territory of the middle cerebral artery (MCA) by three-dimensional transcranial Doppler (TCD-3D). The parameters analyzed were: mean blood flow velocity, systolic and diastolic velocities; indices of pulsatility, hemisphere asymmetry and pulsatility transmission. Of the 34 patients 11 presented marked slowing of flow velocity in the MCA on the infarct side with an asymmetry index (AI) of over 40%, 8 patients with slightly reduced flow velocity in the MCA and an AI of 25-40%, 2 patients in whom there was indirect evidence of collateral circulations in the anterior cerebral artery distribution together with slowing of MCA flow; 5 patients had stenosis of the MCA, 9 patients showed no alterations of the Doppler parameters. The correlation between neurological symptom pattern and AI was significant (r = 0.76). Noninvasive, easy to perform, performable at once and reliable, TCD-3D is a great improvement on traditional transcranial Doppler and is especially useful in assessing the hemodynamics of the cerebral circulation in ischemic stroke.     

64层螺旋CT灌注成像和血管成像在急性缺血性脑卒中的应用

目的：探讨64层螺旋CT 灌注成像（CTP）、CT血管成像（CTA）在急性缺血性脑卒中的应用价值。方法对30例急性缺血性脑卒中患者,于发病12 h内行头CT平扫、CTP、CTA检查,分析平扫及灌注CT表现,计算灌注缺损区CBF、CBV、MTT各参数值,与对侧相应区灌注参数进行比较,重建颈段和脑内动脉CTA图像,并于发病2～7 d复查CT平扫。结果30例急性缺血性脑卒中患者,15例C T平扫未发现异常,14例可见腔隙梗死灶或软化灶,1例可见脑梗死早期低密度改变。10例C T P未见明显异常,20例C T P发现与临床症状相对应的大小不等的灌注减低区,18例可见不同范围缺血半暗带。CTA 显示12例未见明显异常,18例可见血管狭窄或闭塞。结论 CTP、CTA能够快速准确反映缺血部位及范围,显示缺血半暗带,判断闭塞血管,对早期诊断急性脑梗死和指导溶栓治疗具有重要价值。     

高血压不同中医证型与经颅和颈动脉多普勒超声的相关性分析

目的探讨高血压中医辨证分型与经颅和颈动脉多普勒超声检测值之间的关系。方法选择我院2010-07—2014-02收治的高血压患者134例,应用多普勒超声仪检测不同中医证型患者的大脑前动脉(ACA)、大脑中动脉(MCA)、大脑后动脉(PCA)的平均血流速度(Vm)、脉动指数(PI)和颈动脉狭窄程度。结果经Spearman相关性分析显示,高血压中医分型中肝火亢盛、阴虚阳亢、阴阳两虚和痰湿壅盛型与MCA、ACA、PCA的Vm呈负相关性(r=-0.54、-0.34、-0.30,P0.05),与MCA、ACA、PCA的PI呈正相关(r=0.32、0.29、0.22,P0.05)。本组134例高血压患者中颈动脉超声检测显示72例发生不同程度的颈动脉狭窄。轻、中、重度颈动脉狭窄患者间各中医证型比较差异有统计学意义(P0.05),均以痰湿壅盛型狭窄最为严重。结论不同中医证型高血压反映不同程度的颈动脉血管结构改变,超声检测中Vm、PI有可能作为高血压不同中医辨证分型的重要依据。     

缺血性脑卒中后抑郁与T淋巴细胞分化群的相关性

目的探讨缺血性脑卒中后外周血T淋巴细胞亚群变化与缺血性脑卒中抑郁发病的相关性。方法选择2014-12-2015-06作者医院确诊的缺血性脑卒中患者60例,均完成相应影像学检查,并给予常规内科治疗。根据汉密尔顿抑郁量表评分(HAMD-17项)分为并发抑郁组30例(HAMD评分≥7分)和未并发抑郁组30例(HAMD评分7分),比较两组患者间临床资料(包括性别、年龄、吸烟、饮酒、脑卒中部位、合并慢性疾病)和相关神经系统评分〔包括美国卫生研究院神经功能缺损评分(NIHSS)、日常生活活动能力(Barthel指数)、简易精神状态量表评分(MMSE)〕的差异。另选取健康对照20名,应用流式细胞仪技术检测3组样本外周血T淋巴细胞分化群(CD4~+、CD8~+、CD4~+/CD8~+)变化。结果 (1)并发抑郁组与未并发抑郁组间临床资料和相关神经系统评分比较差异无统计学意义(P0.05)。(2)并发抑郁组血清CD4~+水平为(40.90±7.01)%,低于健康对照组的(49.90±7.62)%和未并发抑郁组的(45.73±8.23)%(均P0.05);并发抑郁组血清CD8~+水平为(27.27±8.29)%,高于健康对照组的(21.50±5.04)%(P0.05);健康对照组、未并发抑郁组、并发抑郁组血清CD4~+/CD8~+水平分别为2.45±0.69、2.01±0.75和1.60±0.42,组间比较差异有统计学意义(F=11.01,P0.05)。结论缺血性脑卒中后存在一定程度的免疫失衡,并发抑郁症患者失衡更明显,这种免疫失衡主要表现在辅助T淋巴细胞CD4~+降低。     

Correlation between electronystagmographic findings and results of transcranial Doppler ultrasonography of vertebrobasilar arterial system in patients with vertigo]

The purpose of the study was the determination of correlations between the results of electronystagmographic (ENG) investigations and the blood flow velocity in the vertebrobasilar arterial system measured by Doppler ultrasonography in patients with vertigo. The studied material comprised 68 patients (39 women and 29 men) aged 34-68 years (mean 52.4 years). ENG findings included unilateral hyporeflexia in 25 cases (37.7%), bilateral hyporeflexia in 15 (22.0%) and unilateral canal failure in 8 (11.9%). Doppler USG with neck rotation test showed normal flow velocity in 15 cases (22.0%) and pathological velocity in the remaining 53 cases (78.0%). These results showed that bilateral hyporeflexia is found usually in bilateral failure of vertebral arteries and unilateral hyporeflexia and unilateral canal failure were found with unilateral vertebral artery failure on the same side.